Archives for February 2007

ACEP has an official Blogger

via Emergency Medicine doc, in her first blog post an introduction:

Welcome to Gardner’s Gate. I am the first ever official American College of Emergency Physicians (ACEP) blogger. I am a practicing emergency physician and I currently serve as the Secretary/Treasurer of the Board of Directors of ACEP. I plan to use this space to talk about the business of the college, the state of medical care in America, interesting events in the news, the ethics of healthcare, my family, my friends, and my fellow colleagues on the Board of Directors.

She is Angela Gardner, MD, FACEP, the current Sec/Treas of the organization.  I expect it to be short on rants but long on information.

Dilbert and Google medicine

Catbert strikes again, on medicine and Google:

Catbert and Google

Medpundit and Kaiser’s EMR


Birth Pangs: There aren’t too many hosannas being sung to electronic medical records at Kaiser these days:

Kaiser Permanente’s $4-billion effort to computerize the medical records of its 8.6 million members has encountered repeated technical problems, leading to potentially dangerous incidents such as patients listed in the wrong beds, according to Kaiser documents and current and former employees.

At times, doctors and medical staff at the nation’s largest nonprofit health maintenance organization haven’t had access to crucial patient information, and system outages have led to delays in emergency room care, the documents show.

There’re a lot of ‘ifs’ in the upside to the EMR.

Don’t Steal My Charts

A note by a nurse on a pile of charts in the ED tonight:

BritMeds Up

NHS Blog Doctor: The BritMeds 2007 (7) are up now.

Panda Bear and 10 things to like about Emergency Medicine

A former Marine and an EM Resident:has written a pretty good list:

Panda Bear, MD: Ten Things I Like About My Job
4. My colleagues are as profane and irreverent as I am making for a really fun work environment even when things are ostensibly blowing hard. While we are circumspect around the patients and in areas where the usual compassion fascists prowl, I have only heard Marines and sailors swear as much or tell more off-color jokes. This may bother some of you but (and I say this with respect) you can pound sand. If you don’t like it, go into a specialty at a program where they wouldn’t say shit if they had a mouthful, gather up your skirts, and waggle your fingers while making tsk-tsk noises to your heart’s content.

That was my favorite, but you should read the whole list.

Doing Nothing is Hard

Especially when you’re trained and conditioned to Do Something.  Hallway Four tells the story.

John Stossel on Universal Healthcare

A good article on Universal Healthcare, and his problems with Gov. Schwarzenegger’s plan:

The root of the problem is that few people face the true cost of medical care. Medicare and Medicaid beneficiaries don’t because taxpayers pay their bills. People with employer-based medical insurance don’t because insurance policies shield them from it. Since they pay only small co-pays when they see a doctor, they don’t ask, “Do I really need that test?” but rather, “Does my insurance cover it?”

People who don’t face the full cost of their choices don’t act like cost-conscious consumers. Higher prices result.

With a rational government policy, people would save money for routine medical care and buy insurance for solvency-threatening illness. After all, we don’t buy auto insurance to pay for oil changes and worn-out windshield-wiper blades. But today, people expect medical insurance to cover routine physical exams because someone else seems to pay the premiums.

All this hurts people who buy their own insurance or don’t have it.  …

More government isn’t the answer.


via On The Fence Films

Corporate Suicide Alert

Fast on the heels of my endorsment of PEPID over Epocrates comes this stunner, from Epocrates (in my email):

We think it’s important to let you know that many Palm® OS and Windows Mobile® (Pocket PC) OS software applications, including all Epocrates products, cannot at this time be installed or synced via computers with the new Windows Vista operating system. 

We strongly recommend that if at all possible, you postpone installing Vista or upgrading to a new PC with Vista installed. 

Since resolution of this problem depends upon software changes by both Palm and Microsoft, we regret that we cannot give you a firm date for a fix.

If you are already using Windows Vista, please review our FAQ for the latest recommendations from our customer support and engineering teams. Read FAQ »

Thank you for your patience and understanding.


The Epocrates Team

Huh?  Did they not know the biggest maker and most aggressive distributor of operating systems was coming out with Vista?

I’m not using Vista (I’ll wait for SP1 before I even look at it), but this seems particularly clueless for a medical software company.

Texas Medical Association Does Not Support HPV Mandate

Well, this is an interesting turn of events, from the TMA website:

TMA supports “strongly supports” physicians’ ability to immunize young girls with the Human Papilloma Virus (HPV) vaccine but does not at this point endorse Gov. Rick Perry’s mandate that the vaccine be administered for all girls entering sixth grade in 2008, says TMA President Ladon Homer, MD. TMA’s position was developed by the association’s Council on Public Health.

“Organized medicine has and will continue to promote prevention as a best practice for the health and wellness of all Texans,” Dr. Homer said. “This includes supporting a recommendation to administer the HPV vaccine and acknowledging its potential to prevent cervical cancer among Texas women. However, mandating a vaccine for a disease not spread by casual and/or occupational contact – and currently only available to one gender – represents a considerable departure from past practice concerning school immunization requirements. School immunization requirements came into existence to protect school children from outbreaks of contagious disease in the school setting, not to compel vaccination.”

“TMA has played a proactive and involved role in Texas’ previous vaccine debates and would prefer that any vaccine mandate for school entry be vetted through the legislative and regulatory process to ensure stakeholder input from all interested parties,” Dr. Homer said.

(emphasis mine).

This legislative session may be more interesting than usual.

Happy Valentine’s Day!

Please note I’ve spared no expense in bringing you a new, decorative header graphic, just for today.

Now, quit reading blogs and figure out how to express your feelings to your sweetheart!

MedBlogs Grand Rounds 3:21

Grand Rounds: Give me some sugar! It’s up.

Movin’ Meat thinks about EMTALA

Movin’ Meat: In which I shall make an unpopular argument. Actually, he argues against his own unpopular argument, but it’s an interesting discussion.

I have a different idea, in his comments. Read the article, and comment there.

Treat Everyone the Same

Two decades ago I read a terrific autobiography of a man who had specialized in Infectious disease, and had treated kings, monarchs, the rich and powerful, and just regular people.  Over and over in his book he’d point out that the Rich and Famous (R&F) get worse medical care than the general public because the system got changed to accommodate the demands of the R&F.

In fact he realized it, and when consulted to help with the case of a European Monarch (?50’s?) with pneumonia, his deal was that the monarch would check into a public hospital under an assumed name, stay on a regular floor, and get the same care everyone else got.  He recovered.

Everyone in medicine has seen it, and it stinks: they’re rich/powerful/connected, and so the normal patterns and flow don’t apply, usually to the detriment of the one who thinks they’re getting special treatment.  Yes, it’s special, all right.

Dr. Tim (from Left Brain) had his original post picked up at BlogCritics, and it’s a told-to-be-true tale of exactly the same behavior, gone nuts:

VIP Syndrome

If he gets worse, we will take him immediately to the operating room.  JVIP agrees to this plan, but soon becomes agitated in the ER. “When am I going to get my room,” he complains to the ER nurse, followed by, “It smells in here. Did someone crap their pants?” followed by “There are drunks in here, get me out of here right now!” The ER nurse, then the ER physician, as well as the residents, explain that the hospital is very full, but they are working as fast as they can to obtain an available bed as soon as possible. JVIP tells them to hurry, and make sure it’s a private room. But after one more hour of being in the ER, JVIP decides he can’t stand it any more, and checks out Against Medical Advice.

Being a (Junior) VIP, he is incensed by his “shabby” treatment, and uses his connections to contact the local newspaper outlet, the local television news outlet, the mayor’s office, and several prominent friends who are tight with the hospital board members….

Read it, as it’s a modern immorality tale, and a cautionary one as well.

BritMeds 6 is up

NHS Blog Doctor: the BritMeds 2007 (6)