Ramblings of an Emergency Physician in Texas
Polite Dissent » Scott in Hospital: comics, medicine, and medical comics
Scott in Hospital
Hi everyone. This is Scott’s wife and I am posting on his behalf.
For the next few days Polite Dissent will not be updated. Scott is in the hospital after having a minor cardiac infraction (heart attack). He is doing fine now and I’m sure he will give you all the details when he can.
Let’s see if we can’t fill up his comments with good wishes, and get well soon to Scott and Family.
A nice editorial today in the Fort Worth Star Telegram, which I’ll talk about below. This does make me have to reconsider the basic Fort Worth newsreaders’ approach to the Star-Telegram: believe the news reporting as it’s very good, and always go 180 degrees away from the editorials.
Trauma ahead at emergency rooms
By Steve Jacob
Star-Telegram Staff Writer
A hospital’s emergency room is like a swelling river that carries whatever water its tributaries dump into it. As each tributary’s flow increases, the river bears the burden until the riverbanks eventually flood.
…
Texas’ population grew 18.5 percent while ER visits increased more than 30 percent in 1997-2005, according to a Texas Hospital Association survey. Because hospital beds grew just 4.3 percent during that period, ER hallways increasingly serve as bullpens for patients waiting for a vacancy elsewhere in the facility.
…
In 2003, the Texas Legislature started an ingenuous effort to help our trauma centers by creating a new sin tax called the Driver Responsibility Program (DRP). Drivers cited for various violations are required to pay surcharges on their fines, including those for such things as failure to maintain insurance or driving with an invalid license. The biggest hit is $1,000 for the first DWI conviction and $1,500 for the second. The money is intended to be split evenly between trauma centers and the state’s highway funds.The tax makes sense. The No. 1 cause of trauma is traffic accidents, with the cost of care averaging about $50,000 per patient. Texas has consistently led the nation in DWIs and alcohol-related crashes and is among the top three states in traffic deaths.
Unfortunately, the state is having trouble collecting the DRP funds. According to a Department of Public Safety report, less than a third of the $478.4 million generated by the program has been collected. The Senate recently passed legislation authorizing the use of collection agencies and creation of an installment-payment program to boost penalty recovery.
More significantly, the Legislature has not released $82 million in DRP funds for the past two fiscal years, consistent with the state government’s misguided tradition of diverting or withholding designated funds.
The House Appropriations Committee passed an amendment in March fully funding trauma centers to the tune of $98 million annually for the next two years, but it remains to be seen whether the appropriation survives the House-Senate conference committee legislative cement mixer in the session’s final hours.
…
The good news is that there is a growing awakening of the ED crisis, the bad news is that the fixes cost money. A lot of money.
Oh, and I like the river analogy, it’s better than the one we use internally.
At Kevin, M.D. – Medical Weblog: Real Med Students of Genius.
More of the same, here (as Google videos). Medical school hasn’t changed much, apparently.
Over at DB’s MedRants (a misnamed blog if ever there was one) he’s featuring a four paragraph explanation written by a colleague, Dr. Tom Huddle on why health care is not a right.
I think the first three paragraphs are an excellent explanation to disclaim a general ‘right’ to healthcare, and encourage you all to read it, agree or not. Well written and well thought out, a true tour de force.
I’m less impressed with the fourth and last paragraph. Perhaps I’m misreading it, but the author then proceeds to this, which is an unexpected turn, and seems to advocate for just such a right through legislation:
… While advocates for health care as a right press their case for public provision on that basis, their audience listens only because in 21st century America, public provision of some level of health care is thinkable without the consequences that positive rights doctrine would demand in a less wealthy country. That such provision is prudently possible is the real reason why we should now find a way to offer it, given our obligations to the needy. But the decision to do so must be taken in the political arena in which access to health care must compete with other public goods whose advocates scramble for the public purse—it cannot be made by simply appealing to an unjustifiable doctrine of positive rights.
So, I’d take the first three at face value, as they make sense and are internally consistent; the last I’m at a loss to understand in the context of the preceding refutation of a right to healthcare. Is this advocating for a legislative action to require a right to care? Are the “we” those who advocate for a positive right to healthcare, or those of us who would be expected to provide this right?
Count me out on the right to healthcare, count me confused at the end.
I’m considering yet another blog software migration, and am soliciting recommendations / suggestions.
I started with Blogger, then went to Movable Type, to TypePad, and back to MT. I’m currently considering a switch to WordPress (independently hosted) because MT, as currently configured on this blog, is slower than I’d prefer, I’m pretty sure I’m losing comments (because I get emails from frequent commenters), and the Trackbacks haven’t worked in months.
I have worked with a very good WP consulting group for a different blog, and have some experience both with them and WordPress, so I don’t think it’d be bad, and might be a good change. The consultants say they can get everything moved over without losing the basenames Google has already learned, and can get me close with a new template.
Does anyone recommend one blog engine over another, what experience do you have, and why? I want to know before I make the next decision.
How do you tell a doc when it’s time to go?
What do you do when you know a doctor needs to retire: A long drawn-out tale of woe
We have a doctor that, without going into major detail, has a neurological disorder which affects his concentration and ability to stay on task, among other things. He’s the one who will allow charts to be “in the rack” for many hours while he places seemingly useless phone calls at 3 in the morning to on-call physicians on convenience care patients who aren’t sick to let them know he is discharging the patient. He’ll call specialists before doing a workup to ask what work-up he should do on seemingly straightforward patients.
Read the rest, and wonder. And, I don’t know how that conversation would go, and who should be the one to do it. Oh, and it’s not Nurse Kelly.
Non-compete clauses are in a lot of people’s contracts, and doctors are no exception. One side of the argument makes sense: if I’m, say, a cardiologist and have been with a group for a while, have a patient base that considers me ‘their doc’, but then I decide to go my own way and, oh by the way take all those patients with me, that could damage my cardiologist partners.
Emergency Physicians have long been subject to non-compete clauses, but for a different reason: it makes the contract holder worry less about the working docs getting the contract, as if they leave their current contract they’d be unable to practice within a geographic area typically big enough a move would be in order to keep working. Note this has nothing to do with taking patients, it’s strictly about protecting the ED contract holder’s money rights. It’s so important it’s second only to due process in the AAEM’s Contract Guidelines for Emergency Physicians.
From the Nashville Business Journal:
Physician noncompete bill moving through House
Nashville Business Journal – 2:07 PM CDT Wednesday, May 9, 2007
Legislation that would allow non-compete agreements for physicians is getting traction in the state House of Representatives.
The bill, introduced by Rep. Doug Overbey, would let health care providers include contract provisions to restrict certain kinds of doctors from practicing for up to two years after leaving a provider.
…
The bill was amended to exclude emergency medicine specialists and radiologists.Whether to include emergency medicine doctors in the bill was a hotly contested issue. Supporters of having emergency room doctors excluded from the bill maintained ER doctors don’t take patients with them if they move to another facility. They argued noncompetes would only fuel an ER doctor shortage.
Frankly, I’m very surprised the contract groups didn’t win that one, and good for the EP’s and Radiologists in Tennessee.
His title is perfect: SciGuy: My prayers answered — a fire ant virus
My prayers answered — a fire ant virus
The U.S. Department of Agriculture has recently identified a virus that kills red fire ants, and the agency has begun the process of finding a commercial partner to develop the virus into a pesticide.
Read the article. I hope this happens soon enough for the Horney Toads to make a recovery.
The Blog That Ate Manhattan: Grand Rounds, Volume 3, No 33
Welcome to Grand Rounds, a carnival of posts submitted by medical bloggers every week. It’s the best of the medical blogosphere, and I am privileged to host this week.
This week’s grand rounds is dedicated to our favorite surgery registrar, Barbados Butterfly, whose blog was unceremoniously taken down not too long ago. I will not write here of the circumstances of her leaving the blogosphere, or posit the details thereof. I wish only to celebrate her as the quintessential medical blogger that she was.
Another in an excellent series. No theme except logical, easy to read organization.
I’ve written before about an AMA half-price membership flyer, and pointed out it was actually half-price because it was for half a year.
Today comes a pitch email for half price AMA membership. Mildly curious to see if they’re still running the same playbook I followed their link, and when looking into the details, got to this page (click for full-size):
This is an even better deal than before! Now I am offered the chance to pay for six months’ membership and will actually get 4 1/2 months (April 17th through August 31st, 2007)! Yes, that’s right, I’d actually be paying more than full price!
Aah, with leadership like this is it any wonder physicians are voting with their wallets, and sitting on them rather than join the AMA?
Very amusing YouTube video by some Medical Students, Hand in a Box.
If you don’t get it, here’s the original it’s a parody of (warning: NSFW, Language, Adult Situations, Delinquent Behavior, Bad Facial Hair).
via Kevin, MD
CareerJournal | Editor Finds Care, Chaos On the Night Nursing Shift
via Geena at CodeBlog, the outstanding story of a man with a midlife career change. Terrific story, no excerpt, just enjoy it all.
My daughter went to her schools’ awards ceremony (she’s a Sophomore) expecting to get recognition for the AB Honor Roll, and told us not to go. Like a couple of dummies, we didn’t.
She came home with Six awards!
I’m not a person who either lives through their kids or sees them as personal validation, I’m just so proud of her for her own accomplishments! Well mannered and reasonably sharp, a winning combination.
Yahoo!
From Wired comes this introduction:
Intel’s Andy Grove Pitches a Plan for Fixing Health Care
Kristen Philipkoski 05.02.07 | 2:00 AM
Andy Grove, the Intel co-founder and one of the most important technologists of the modern age, wants to fix the broken U.S. health care system with — surprise, surprise — technology. But there’s a twist.
As technology executives get older, they seem to inevitably become interested in health care. The Bill and Melinda Gates Foundation has had a major impact on global health. Steve Case, former CEO of AOL, has just launched Revolution Health, a health management site. They’re joined by Grove, former chairman and CEO of Intel, who is touring the lecture circuit proselytizing his solutions for the troubled health care system.
Well, okay, some fellow who has forgotten more than most know about his field decides his expertise in one field means he’s an expert in others, and medicine is the target. From that standpoint, he’ll have to get in line.
I’m going to skip ahead, but please do follow the link and read the entire article; it’s very well-written, and I’m not trying to deny the good people at Wired any bandwidth / exposure (trying to play nice with the ‘fair use’).
Grove breaks the problem of health care into three manageable chunks. Two have technological solutions — but not complex tech. Grove wants to keep the technology as simple as possible, a surprising idea for a man who put millions of transistors on a chip.
First: Keep elderly people at home as long as possible (an idea he calls “shift left”). Use high-tech gadgets to help them remember to take their medicine and monitor their health. In one year, if a quarter of the people now living in nursing homes went home, it would save more than $12 billion, Grove says.
This is idiotic, and I’ll bet Mr. Groves never once cared for someone from or in a current nursing home. If he had, he’d realize they aren’t there because they need ‘health monitoring’ or scheduled medications, they’re there because they’d die if actual people didn’t come and take care of them, every day. The few I’ve seen from nursing homes who were there just for medications were so exceptionally unable to care for themselves it’d be criminal to send them anywhere other than a strictly supervised environment. Jail is out, so nursing home it is.
Oh, and who’s going to monitor the monitors, and respond when the readings don’t jive? Are they factored into this equation of 12 Billion saved? How much of that 12 BN will be spent making all those homes safe for the disabled, etc. I could go on, but you see the basic error here, no need to belabor it. There are more errors to be dealt with.
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