…so please don’t tow it.

It is http://pandabearmd.com/blog/

I just got an email notifying all of us that the 2004 LLSA closes March 31st.  So, if you haven’t taken it, time to get on the stick.

(If this post appears to be written in Greek, just ignore it).

Calling it like he sees it: Panda Bear, MD: Blackwhite, an explication of residency call hours.

My last call shift was roughly 6 years ago, and I wouldn’t do it again. I do remember thinking that my patient care wasn’t impaired but my sense of humor was. It was the first thing I lost as fatigue set in.

I may have said this before, but the happiest day of my life, bar none, was when I handed my pager to the department secretary and vowed never to have another.

And, I think residency call could still be fixed. With a lot more residents.

Take a minute and read this post: M.D.O.D.: Butterfly Effect, especially of you’re considering getting a tattoo.

Because, one thing leads to another.

Grand Rounds 3.25 ? ScienceRoll

A day early, and with a Monty Python theme. Be still my heart.

Sometimes it’s a bit bothersome to work in the ED, especially when working a late night shift.  I’m referring, of course, to the ‘clinic visits’.  “Vagnial discharge for 5 months”, ”rash for a year”, “back pain for 5 years”, “cough for 9 months” are hard enough to see when the sun’s up*, but when they present after 1AM they’re utterly toxic to the soul of the Emergency Physician. 

Look, we’re all circadian creatures of a sort, and it’s utterly crazy to think that at some point that morning your patient decided ‘you know, that problem I’ve had for months?  I think I’ll take it to the the ED, because it’s an emergency now’.  When these patients introduce their complaint to an ER doc who’s up not because they want to be but because they have to be, the doc might be forgiven for thinking “I’d be in bed were I you”, or occasionally worse.  These same patients who present at 2PM are mildly bothersome, but not really an issue; the same complaint at 2AM will get the doc’s attention, but in entirely the wrong way.

I’m of the opinion there’s not enough of a night-time charge for ED visits, but that’s back to the $5 to be seen, but we’ll give you $5, and by the way, there’s a $5 ice cream machine by the lobby door conversation.

I’m just tired of being an emergency physician who works an expensive after-hours clinic.  The case that set this off was “I have a toothache for three weeks, and I want to be checked for a discharge I’ve had since my miscarriage”.  How long ago was your miscarriage?  “5 months”.

Bye.

* Like in any ED you can tell if the sun is up.  Every one I’ve been to is like a submarine, it’s the same inside day in and day out.

I am a very deadline-oriented person.  This isn’t a terribly mature way to go through life, and occasionally it works to my disadvantage.  The absolute worst thing that can happen is when I’m asked to do something, and am then told ‘oh, it’s not due for a long time’.  That task will then be left on the desk.

This doesn’t mean I forget about it.  I consider all my procrastinating and procrastinatable tasks every day.  I track their non-completion in my To Do list.  I spend more mental energy planning when to get around to doing these tasks than I would spend if I actually did them.  Goofy.

This morning I cannot sleep (night shift to day shift flip hasn’t worked sleep-wise yet, and the time change didn’t help), so, the two letters of recommendation I have been putting off got done.  One I’ve been putting off for about two weeks, the other actually has a close-in deadline.  I enjoyed writing these letters, and always agree to write letters of rec for my scribes when they ask.  My only request is that they give me a copy of their CV.  One I got was six pages, well written, and made me glad I don’t have to compete against this guy to get into med school today.

Aah, well.  I’ll have to get more things to not do, to fill the time.

Here: Blog, MD ? Blog Archive ? Pediatric Grand Rounds: Volume 1, Issue 24

NHS Blog Doctor: The BritMeds 2007 (10)

Another in the series. The tenth, if I’m not mistaken.

…but at different locations. Read hers, I’m too ticked to type it out: You will be angry and bitter and hostile today « Hallway Four

Scientists say nerves use sound, not electricity

The common view that nerves transmit impulses through electricity is wrong and they really transmit sound, according to a team of Danish scientists.

The Copenhagen University researchers argue that biology and medical textbooks that say nerves relay electrical impulses from the brain to the rest of the body are incorrect.

“For us as physicists, this cannot be the explanation,” said Thomas Heimburg, an associate professor at the university’s Niels Bohr Institute. “The physical laws of thermodynamics tell us that electrical impulses must produce heat as they travel along the nerve, but experiments find that no such heat is produced.”

Hmm. I’m not buying it. Too many lectures involving micro-electrodes measuring electrical nerve impulses, and all that.

And, what about local anesthetics? Are they just sound-deadening?

The scientists, whose work is in the Biophysical Society’s Biophysical Journal, suggested that anesthetics change the melting point of the membrane and make it impossible for their theorized sound pulses to propagate.

So, anyone have a vacuum chamber and a nerve? Me, I’m sticking with the whole saltatory-conduction thing.

Many thanks to Aggravated Doc Surg for bringing this to my attention.  I thought I was the only one with this idea, but clearly I’m not:

To my surprise, Congresswoman Mary Bono (the late Sonny’s wife) recently introduced a bill that would alter IRS rules to allow physicians to at least partially offset the cost of providing uncompensated emergency care mandated by EMTALA.

And goes on to quote parts of the bill (.pdf). 

There are things to quibble about in this first draft; none are deal-breakers, but they should be modified to some degree.  First is the “Board Certification” requirement: unless this is required by HCFA, it should be ‘credentialled provider in the Emergency Department’, and we can all avoid a food fight about Board Certification that serves only divisiveness.

Second, while basing any tax allowance on the Medicare fee schedule is a good place to start, I’m not sure we should aim that low.  Every ED has a payor mix that’s at least somewhat above the medicare allowable; I’d prefer a calculation that takes that into account, so we’re not taking a tax allowance at 50 cents on the dollar, rather than a higher number that’s usual in most ED’s.  (I know it’s not dollar for dollar, but it’s higher than the medicare allowable rate).

Congresswoman Bono is to be congratulated for at least introducing this legislation.  I hope our EM professional societies see fit to support it as possible: the American College of Surgeons is already onboard.

Up, now.