Life in Texas

Yes, it really is better.  At least for me.

Today, we had the AC on all day, due to a temp of 80 and 68% humidity.  Now it’s 30, the heat’s on, and there are thunderstorms outside.  I’ve never been in a thunderstorm when it’s freezing, so that’s a first.



High today?  80.  Projected high tomorrow?  35, with a low of 22.  It’s not the absolute numbers, it’s the quick change.

Please ignore all the weird comments here; I’m trying to debug the ‘Preview” and SpamKeywords in the upgrade.

Aussie Mass Casualty Drill: "A Royal Disaster"

And lest you think I’m being judgemental, I don’t think our joint would do any better:

If the calamity sounds unfamiliar, that is because it was fiction: a massive and intricate role-play designed to reveal any cracks in the preparations of the nearby Royal Adelaide Hospital for a disaster – specifically one in which people were contaminated by chemical, biological or radiological fallout.

Pretty normal, except that the test designers did more with their victims than have them sit on the ground and wait for the school bus:

But as the actors in the so-called Exercise Supreme Truth ran around wildly, demanding medical attention patiently or aggressively in line with instructions on their individual scenario cards, it was not chinks in the hospital’s emergency armour that were exposed so much as gaping chasms…..

“Some were instructed to refuse decontamination. Another had to drive onto the footpath with a dead contaminated friend in the back. We told seven people, ‘without breaking anything, we want you to see if you can get into the hospital’. Within 15 minutes they all got in … All the focus seems to be on police and security but if there is a mass casualty incident where do [authorities] think all the people are going to end up?”

The hospital’s plan demands immediate lockdown, with entry via a single point which is strictly policed. Amid the chaos of Supreme Truth, that proved unenforceable and contaminated patients repeatedly entered “clean” areas…..

And that’s without a real disaster.  We’ve been luck so far, as regards a big intentional BW or radiological mass casualty, and I pray our luck holds out.

Beer Goggle Formula

Yes, there is now one.  In the BBC, via the Houston Chronicles’ SciGuy.

"Do you know who I work for?"

In the ED we treat all kinds of people, all walks of life, without prejudice (we strive, but we’re people, too).  And, interestingly, people like to tell me what they do when I’m chatting with them.  This is different than the medical history, and usually while performing whatever procedures we need to do.

The most reticent to tell me what they do are lawyers (and I’m just guessing here, but if I was a lawyer in an ED I’d worry a little that I’d get over-tested and overdiagnosed due to medmal paranoia; so far as I know not one of my colleagues has ever gotten as much as a phone complaint from a lawyer they took care of, and that’s the sort of thing doctors would talk about).  That kind of reticence is not the same in people who work for lawyers. 

I was reminded of this by a post from Overlawyered about the couple on a Southwest flight who (allegedly) were attempting to join the Mile High club, in coach.  One of the coitus interrupti (allegedly) said, when denied further alcohol service, “I work for a lawyer,” joining a not terribly select club of people who think their bosses’ importance in one field confers special powers to them in the ED.  Usually while drunk.

“Do you know who my boss is?” is slurred, at highly indignant volume just often enough for the staff to say, in unison “No, and we don’t care”.  It’d be terribly funny were it not for the now emasculated and indignant drunk we still have to take care of.


So far, nobody has tried to join the mile high club in any of my ED’s, but I practice pretty close to sea level.  And nobody cares who I work for.

Update: at least one lawyer says I’m right!

MedBlogs Grand Rounds 3:10

Notes from Dr. RW

It’s trendy nowadays at traditional academic Grand Rounds for the speaker to disclose any potential conflicts of interest. Here are mine. I have no financial ties with drug or device companies. A Zithromax clock, a hand me down from National Nurses Day, graces one wall of my office. I have attended about four drug company lunches in the past year. That’s about the extent of any blandishments from Evil Pharma.

Although under appreciated, non-financial conflicts, perceived or real, are just as important as the financial kind. We all have them. I, for example, am a) a Christian, b) a member of the vast right wing conspiracy and c) a staunch adherent to the principles of science. (Note that a is not inexorably linked to b or in opposition to c). I’ve become opinionated and crotchety in middle age and have many biases. But not to worry, dear readers! I’ve done my darndest to keep those biases out of this edition of Grand Rounds. To that lofty end there will be no editor’s choice, best of the best, or best of the rest! Everything included here gets equal billing in hopes that this carnival will be a good time for all….

An all-inclusive Grand Rounds (which is why mine got it). This should keep you busy for an afternoon!

Things not to do in the ED #27

Profess that as “a good Christian man” you want to change hallway chairs to get away from the patient who got drunk and high and broke his hand a day ago.

Especially since this if the third ED you’ve been to today to try to get a vicodin prescription for your undiagnosable chronic neck pain.


(Insert your own pain in the neck joke here).

Slow at work, slow at the blog

…is there a symmetry?

Seriously, in the past week I’ve had entire shifts wherein I saw 10 – 15 patients (normal 25+).  The Thanksgiving Day shift was slowest, and it was very nice; despite being an ED that sees more than 80K a year, there’s still a very tight feel to the nursing staff (excellent nursing leadership, the best I’ve ever seen, or heard of).

The slowness allowed several ‘how is your life’ conversations we haven’t had in a while, and that was very pleasant.

Yes, this is the lull before the storm, we know, it happens every year for now the last three years; we’ve decided to enjoy it.  The patients will come soon, in droves, and the ED will get crazy busy.

The blog will get busier, too.

Bothersome Patient Behaviors

I think every physician at some point laments the subsegment of their specialty that frankly they enjoy the least, and do a little ‘grass is greener’ daydreaming about how in a different specialty they’d see none of their current bane.


That’s why I enjoyed reading a Medscape abstract about

A Survey of Neurologists on Bothersome Patient Behaviors

Results: The response rate was 42.3% (78 respondents). Almost all of the patient behaviors were found to be bothersome or very bothersome. The top 5 most bothersome patient behaviors from most to least were the following: no show for appointment, verbally abusive with your staff, poor compliance with medications or treatment, late for appointment, and do not know the medications that they are taking. Of the 30 items, those behaviors as well as answering cell phones during office visits and unnecessary phone calls after hours were among the most highly rated as bothersome.

Every specialty has its problems.  I’m (mostly) grateful for the problems I have.

MedBlogs Grand Rounds 3:9

Doctor Anonymous

Welcome to the most anticipated Grand Rounds in a long time! These are the 27 best posts that the medical blogosphere has to offer this week. In my editors picks, I wanted to highlight well-written stories. There’s also a short excerpt to check out from the best of the week. I’ve tried to make this a potpourri of posts for your enjoyment. Let’s go!

I think this is the future of Grand Rounds, actual picks as opposed to all of them (with a link dump at the end).

Second Opinion

I had the best history last night:

“I felt a little odd, so I went to Walgreen’s and checked my blood pressure, and it was high.  I wanted a second opinion, so I went to Minyard’s.  It was high there, too”.


I like patients who get their own second opinions from competing drug store BP machines before coming to the ED.

Excellent Alcohol PSA

Here: Now Available Over the Counter, from Protein Wisdom

Dead Blogs

I finally took a little look at the blogs in my right sidebar; we all know that most blogs come, and go; bright lights that burn out quickly.

So, there’s now a group of blogs at the bottom of the right sidebar, the dearly departed of the medblogging world.  If I’ve pronounced your blog dead too quickly, please drop me a line.

To save you some scrolling:

Dead Blogs

Ad libitum-EBM
Chronicles of a Medical Mad House
Doc Around the Clock
Doctor Disgruntled
Dr. Andy
Feces Flinging Monkey
Journal Club
Lingual Nerve
nature erratum
Professor MD
Red State Moron
The Modo Blog
Treat Me With Respect
Waking Up Costs

The nature of blogging, the circle of digital life, whatever.  Like real life, enjoy them for what they were.


Bill Frist’s blog, appears to be stalled / abandoned; no posts since Sept. 7th.


Anyone know why?

Lawsuits and Medbloggers

Dr. Flea recently gave a deposition.

Charity Doc was served this week, and he runs down some of his prior suits, with a promise of more to come.  (Nine!?)

Now, Dr. Charles readies for a deposition, and his post describes (in a non-profane way) at least some of how I felt during my trips through our marvelous tort system.

Just reading those posts explains why I tell pre-meds to go into real estate.  Really.

Medgadget’s Sci-Fi Writing Contest

While we’re blogging about all these great medical advances, we’re getting kind of anxious for the future to just show up, already. We can’t quite imagine what that future will be like… but maybe you can! Or, at the very least, you can tell an entertaining tale involving medicine, from the perspective of a few years from now… or decades, or centuries. Or, write about healthcare in a world just slightly different from today’s.

You can write about a medgadget, an ethical dilemma, a dangerous new experiment, or some overbearing pharmaceutical firm or government institution. Or anything else you can conceive of that’s medically sci-fi. We’re just laying down a few ground rules:


Read the rules at MedGadget, and best of luck to any and all contestants!