…again, over at the indefatiguable Kim’s.
Archives for October 2006
More from ACEP in NOLA:
McKenna’s team gave surveys to 423 emergency department patients.
Most of the 285 patients with cell phones didn’t know about ICE. Only 76 said they had heard of ICE and 26 said they had already put ICE in their cell phones.
That’s actually pretty good! Show me a third of people who hear about a good idea but then act on it, and that’s remarkable.
Most of the patients who had their cell phones with them agreed to learn about ICE while in the emergency department.
Afterwards, 129 patients agreed to have ICE programmed into their cell phones while they were in the emergency department.
Why not, there’s not much else to do.
Okay, it’s in mine, and my parents’ (I put it there); how about yours?
Oh, if this sounds familiar: July, 2005
Looks like I missed it by skipping the ACEP Fall meeting:
Many ER doctors say inpatient overcrowding – patients admitted after emergency treatment but parked in their department until rooms open up – is the major cause, and a national priority.
But Leavitt, who spoke at the American College of Emergency Physicians meeting Monday, said he believes the overcrowding is, rather, a matter of local hospital capacity and patients using the ER instead of a doctor’s office. “Emergency rooms ought to be kept for emergencies,” he said.
Inpatient overcrowding, he said, is a problem to be dealt with at the local level.
But doctors say the problem is that ER patients can’t be sent elsewhere in hospitals, causing an ER stackup that leads to inefficiencies and delays in treatment.
But Leavitt said the problem appeared spotty. “There are areas of the country with insufficient capacity. But in some areas they’re overbuilt,” Leavitt said.
This position met with disagreement:
Dr. Ramon W. Johnson, a ACEP board member from Mission Viejo, Calif., said Leavitt “dodged the question. He tried to make it seem a local issue. It clearly is a national problem.”
Dr. Todd B. Taylor, ACEP’s equivalent of speaker of the House, added, “Anybody who believes that inpatient crowding is not the problem with emergency departments just is not looking at the information.”
All emphasis added.
Yes, ER’s should be kept for emergencies. This has been flogged to death here, but: as long as the individual patient decides what’s an emergency and what isn’t (until the end of an apparently undefinable Medical Screening Examination), the ED’s will be crammed to capacity. More primary care offices (9-4:15 M-F, 1/2 day W or Th) aren’t going to do a heck of a lot to empty the ED.
Oh, and I want the data on those ‘overbuilt’ areas.
My wife came to work recently, and observed me ‘at work’. We had a nice, brief conversation, and I went back to medicine in the ER.
That night, we had the following enlightening exchange:
Wife: “When I saw you first, you were on the telephone; I listened, and you were pissed. Then, when we talked you were your normal self, and then when you turned around you were pissed again.”
Wife: “Yes, it was remarkable.”
Persona, per the Encyclopedia Britannica:
in psychology, the personality that an individual projects to others, as differentiated from the authentic self. The term, coined by Swiss psychiatrist Carl Jung, is derived from the Latin persona, referring to the masks worn by Etruscan mimes.
For the record, so far as I know this is the first time Carl Jung has entered my life.
And, one of my private concerns seems to have come true. I’ve often heard of docs who were ‘different at work, but not in real life’, and hoped it wouldn’t be me. Alas, I have a public and private personality, and they’re different. (For the record, my wife’s definition of pissed (I asked) is me using my stern voice: no shouting, just the ‘I’m not tolerating any crap right now’ voice).
Since then I’ve been more aware of my ‘at-work’ persona, and I have to admit it’s not the real me. The real me would laugh and joke with most of the people I meet, be they patients, staff or housekeepers. Having paid more critical attention since the enlightenment, I actually only laugh and joke with the housekeepers and the secretaries. The patients get the friendly but all-business me, not quite Joe Friday (just the facts, ma’am), but not a long way off either; the nurses get the mildly pleasant but mostly-business me.
There wasn’t a conscious ‘I”ll be a different guy’ moment, and I think this began in residency, but it’s real. Now whether, and what, to do about it. I’m not sure it’s bad for me or my patients, but it’s not a happy realization, either.
…over at Emergiblog:
I’m your host this week!
Let’s get together at the local Starbucks and really indulge ourselves!
First, it’s always nice to be included, thanks!
Second, it’s through this Grand Rounds I found this blog post that will keep my BP high for the rest of the week. Conscience is often invoked when convenience is at issue.
Lastly, I’m a little concerned about next weeks’ host. Hopefully both Kim and Nick have the wrong URL, as the referenced blog has been inactive since 2004. Enquiring minds, and all that.
One of our techs approached me with this query, asked of her by one of my patients.
The tech, having worked in the ED for a while, did a little questioning of her own.
“How much do you eat”?
Well, not much.
“Do you take any drugs”?
only crystal meth.
“I wouldn’t ask him for any prescription for medicine to gain weight. I wouldn’t bring it up”.
A good tech is worth their, er, you know. In gold, most nights.
I only recently started watching reruns of the TV show Scrubs, and I’m sorry I only just found it. Funny stuff.
One little rant got my attention today, in an episode called “My bosses’ free haircut”, where two docs are lamenting the loss of stature and respect given to physicians:
“Today, people think of us as drug-dispensing walking lawsuits who are in fact less informed than their Internet phones”.
I think that just about covers it.
I have a school-age child, and I worry. I also think this is a good idea.
BURLESON, Texas (AP) — Youngsters in a suburban Fort Worth, Texas, school district are being taught not to sit there like good boys and girls with their hands folded if a gunman invades the classroom, but to rush him and hit him with everything they’ve got — books, pencils, legs and arms.
“Getting under desks and praying for rescue from professionals is not a recipe for success,” said Robin Browne, a major in the British Army reserve and an instructor for Response Options, the company providing the training to the Burleson schools.
That kind of fight-back advice is all but unheard of among schools, and some fear it will get children killed.
And I pray it never comes up.
In the past week or so I attended a seminar organized by my medmal carrier, with the purpose of educating us on how to deal with frustrated and angry patients, and avoiding suits from them. The course was given by two attorneys who have significant experience in medmal defense, and give this as a traveling road show. Why did I go? I’m against being sued, and attending knocked some off my bill this year. The bad news? Most docs have an office and this was aimed at the longitudinal-care doc.
Things I enjoyed: good speakers who know their topic, and can present some useful information without being terribly patronizing. Also, they had a wireless voting gadget, with every attendee having an (anonymous) keypad, and live surveys were taken during the talk and the results incorporated into the talk. And, it finished a few minutes early.
Things I learned that were potentially useful: say “Uh, huh…” more, to encourage a history to be given spontaneously; don’t say the word ‘no’ in a confrontational situation (which will be hard for me); and, as an ER doc I cannot fire a patient.
Things I relearned: at any doc gathering there are a few who were ACE’s (Admission Committee Errors), and they like the microphone during comment times (and sometimes when it’s not time). These are the docs who think they’re the only ones with unjust suits and want to gripe at every lawyer they see; they’re the ones who want to argue with lawyers temporarily on their side about whether the ADA applies to their office (it does); and they’re the ones who never learned how to turn off the ringers of their cell phones. Look, fellas: we all have a phone, we all have them on, and they’re not all that hard to squelch. Show how smart you are and don’t let us know when yours goes off.
SO, I tried the ‘uh, huh’ today, and got what I deserved: two minutes of unhelpful dreck about the patient’s cousins’ uncle’s hernia, and blank stares from those to whom ‘go on’ is unintelligible. I really think emergency medicine is a world all its own. I’ll probably tell someone “no” really soon.
I’ve been reading about nano this-and-that, and now there’s some progress in my field: bleeding that Needs to Stop.
Swab a clear liquid onto a gaping wound and watch the bleeding stop in seconds. An international team of researchers has accomplished just that in animals, using a solution of protein molecules that self-organise on the nanoscale into a biodegradable gel that stops bleeding.
If the material works as well in humans, it could save thousands of lives and make surgery far easier in many cases, surgeons say.
Molecular biologist Shuguang Zhang, at the Massachusetts Institute of Technology in the US, began experimenting with peptides in 1991. Zhang and colleagues at MIT and the University of Hong Kong in China went on to design several materials that self-assemble into novel nano-structures, including a molecular scaffold that helps the regrowth of severed nerve cells in hamsters (see Nano-scaffolds could help rebuild sight).
Their work exploits the way certain peptide sequences can be made to self-assemble into mesh-like sheets of “nanofibres” when immersed in salt solutions.
In the course of that research they discovered one material’s dramatic ability to stop bleeding in the brain and began testing it on a variety of other organs and tissues. When applied to a wound, the peptides form a gel that seals over the wound, without causing harm to any nearby cells.
Ed Buchel, who teaches general and plastic surgery at the University of Manitoba, in Winnipeg, Canada, sees equal potential for treating trauma and burns. “If this works as well on humans as it does on rats, it’s phenomenal,” he says.
Still, they caution that extensive clinical trials are needed to make sure the materials work properly and are safe. The MIT researchers hope to see those crucial human trials within three to five years.
Their research will appear in the 10 October 2006 edition of online journal Nanomedicine.
This is a far-horizon thing, but if it works as described it’d help, for a zillion or so patients and their doctors.
Columbus day in the US, celebrating the Old World’s discovery of a new world.
And, another new world dawns: North Korea announces their first nuclear weapons test.
The USGS page, confirming a seismic event of 4.2 magnitude, has maps.
I’d be willing to bet a lot of people on the Pacific rim didn’t get much sleep last night.
Update: in the chance this was a fizzle and not fissile, maybe someone was trying to dismantle it.