Archives for July 2007

Texas Medical Board to Require Physicians’ Fingerprints

TMB to Require Physicians’ FingerprintsThe Texas Medical Board (TMB) will resume using fingerprints of physicians for criminal background checks as part of the licensing process on Sept. 1. The fingerprinting will begin with the 4,000 physicians now applying for licenses in the state. After that, existing physicians will have to be fingerprinted when they apply to renew their licenses.

Joke’s on us: Texas Licenses renew yearly, so this esentially means this year.

…The price of fingerprinting is expected to be $48.95 through Oct. 1. After Oct. 1, the price is expected to drop to $44.20.The medical board previously required fingerprinting but eliminated the ink-based system in the late 1990s due to technical problems that delayed the licensure process. Electronic fingerprinting systems are more thorough and accurate and give the TMB instantaneous results, Dr. Patrick says. The DPS runs a national background check against FBI records to alert the medical board to any felonies or misdemeanors.

TMB has been using applicants’ names for background checks and running them against Texas criminal records. But that system doesn’t alert the medical board to past convictions in other states, he says.

“I suspect everyone would consider fingerprinting an imposition, but it’s something we’ve done before, and we now have the capability of doing it again in a less invasive way,” Dr. Patrick said. “If nurses are required to do it, then certainly doctors should be.”

It’s not the money, I have $44. It’s just that a) I had to submit fingerprints to the TMB when I originally applied for licensure in 1993, and b) I have another Texas State issued license that requires fingerprints. Is there some reason, other than the convenience of the TMB I should be re-fingerprinted?

Prescription-pad rule decried : proposed benefits really add up

Prescription-pad rule decried
The Associated Press

WASHINGTON — Pharmacist groups are mobilizing in an effort to delay implementation of a new law that requires Medicaid patients be issued prescriptions on tamper-resistant pads.

The law takes effect Oct. 1.

Most doctors, including those in Texas, don’t use such pads regularly.

…The law is designed to make it harder for patients to obtain controlled drugs illegally and easier for the government to save money. But the quick start date leaves little time to educate doctors and pharmacists.

I don’t think we’re that dense. The education required would be “here’s your new prescription pads”.


“Our members are absolutely flabbergasted that they’re going to be put on the hook for denying prescriptions if something is not on a tamperproof pad,” said Paul Kelly, vice president of government affairs for the National Association of Chain Drug Stores. “Our biggest fear is the negative impact this could have on patient care and access to prescriptions.”

Pharmacists’ groups have asked lawmakers and the Centers for Medicare and Medicaid Services to delay putting the law in place.

I wouldn’t want to be a pharmacist who has to say “yes, it’s the right medication, but it’s on the wrong kind of paper”. That’s precisely the kind of bureaucratic crap that makes my blood pressure spike. It helped me leave the Navy.

And now, the part I don’t get:

Medicaid is the federal-state partnership that provides health coverage to about 55 million poor people. President Bush had recommended the requirement for tamperproof prescription pads in his 2008 budget. The Congressional Budget Office projected that the requirement would save taxpayers $355 million over the coming decade, mainly through preventing fraudulent prescriptions,…

Hmm, say that again? This is proposed to save 35 Million a year just in fraud (355 million over a decade), and it covers 55 Million people. Let’s do that math:

35 Million/year / 55 Million covered = 63 cents per covered person per year? How much are these new tamper-proof prescription pads going to cost? What’s the ratio of good to fraudulent scripts? I’m guessing they’re guessing.

Kevin, M.D. hires a lawyer

Kevin, M.D. – Medical Weblog: Terms of Use Agreement
Terms of Use Agreement
This Terms of Use Agreement (this “Agreement”) is entered into by and between Kevin Pho, M.D. (the “Author”) and “you,” the user of this web blog, also known as the “Kevin, M.D.—Medical Weblog” (the “Site”). Access to, use of and/or browsing of the Site is provided subject to the terms and conditions set forth herein. By accessing, using and/or browsing the Site, you hereby agree to these terms and conditions.

It goes on and on, and does not appear to be parody.

If blogging requires this, I want nothing to to with it. I suspect this disclaimer has nothing to do with his blogging, and everything to do with his plan to take over the world commercial ventures.

Oh, and talk about timely: Dr. Wes on a very similar disclaimer, and how it doesn’t make him warm and fuzzy.

MacBook Pro Firmware Update: Word to the Wise

Last night my Intel-based MacBook Pro told me I needed to do a firmware upgrade, something having to do with the monitor. I cicked the yeah/sure/whatever button, and it downloaded the upgrade.

Then a rather persistent window kept popping up explaining how to install the firmware upgrade, having to do with a shutdown/restart and holding the power button until some flashes happened, so that’s what I did. I think. I’m pretty sure I did as instructed. Probably.

Here’s what I was left with: a MacBook with a completely bank screen. Oh, it sounded about right (the CD drive whirred a bit), but a completely dark, blank screen. Multiple, multiple retries to boot, sometimes holding the power button for a minute, etc. Dead screen. Wouldn’t boot from the install disk (or, if it did, I couldn’t see it).

It’s times like these I can justify all the different computers I have, and after some panic-IMing with my mac-based friend, and I tried resetting the PRAM or somesuch, without luck. Then he sent me The Link, and this is where the Word to the Wise comes in. The Link is to the Mac Firmware 1.3 restore disk download and procedure, and I’d encourage anyone contemplating this firmware upgrade to print it out, download and burn it to a disk prior to starting. I was lucky enough to have a mac-mini, so I had another Mac to burn the right kind of image, but I can see having just one mac in the house and being stuck if yours went like mine.

Anyway, the firmware restore disk fixed my nice mac, and now you’ve been warned.

Askimet and Skitch

First, the switch to WordPress seems to be a success, in that the built-in anti-spam plugin Askimet has missed exactly two spam messages, but caught the other 1,866. Niiiiice.


And, the above picture is via Skitch, a terrifically flexible screen capture / doodle-with-it program, currently free, but only for Mac (I knew the PowerBook would come in handy).

Since I’m self-censoring (and have had some weird cases, but have decided not to blog them) I’m trying hard not to do cat-blogging, or somesuch.

Update: I have one Skitch invitation left, send me an email (not a comment, click the ‘contact’ form).

Addicted to Medblogs: July’s Calendar Doc is Dr. Schwab

Addicted to Medblogs: July’s Calendar Doc is Dr. Schwab

His interview is almost as good as his picture!

Add Radiology to the Unhappy List

Unhappy with the Google Advisory Group on Medicine:

Via MedicExchange, and thanks to Stuart Hall (the author) for the link:

Google’s decision to set up an advisory group has sparked controversy as well as congratulation. While the lack of nursing professionals or health librarians has caused a storm of protest on health blogs, it also appears it’s also a ‘no show’ from the radiology community too.
Product Marketing Manager Missy Krasner announced the formation of the ‘Google Health Advisory Council’ on 27 June with the following laudable aim:
“We want to help users make more empowered and informed healthcare decisions, and have been steadily developing our ability to make our search results more medically relevant and more helpful to users.” More generally the mission is to “better understand the problems consumers and providers face every day and offer feedback on product ideas and development”.
The stated composition includes healthcare experts from “provider organizations, consumer and disease-based groups, physician organizations, research institutions, policy foundations, and other fields”.
While the list of participants is impressive there’s no obvious representation from medical imaging professionals. In response the head of the American College for Radiology (ACR) Arl Van Moore wrote to Google to say it was pleased to hear that the advisory group was being established: “However, it is unfortunate, and frankly quite puzzling, that Google has apparently chosen not include a representative from radiology, a vital, and increasingly far reaching area of medicine.

A swing and a miss for Google on this one, it seems.

GruntDoc: Burge Bandwagon!

I have given this at least a full week of intermittent thought, and having looked at the major declared candidates I am pleased to announce my early and unreserved endorsement for President: David Burge, of Iowahawk fame.

burge08First, I spent literally minutes enjoying his announcement of an exploratory committee, and the proposed Campaign Platform is not any dumber than a lot already out there. Additionally, since it ignores healthcare, I figure Future President Burge is either laissez-faire or negotiable, and either way I can help to make a difference. But, I can only make a difference I am able to get into the cabinet early, and I’m thinking HHS Secretary, thus my early endorsement.

Plus, he’s a astonishing writer and a gearhead to boot. His Coupe of Justice is an impressive piece of work, and his support of the troops goes beyond endorsing magnets for humvees, so he’s there for the troops, which matters to me.

I urge you to consider my new pal David Burge (the Burge Urge, catchy!), and it’s either me or Doc Lee for HHS Secretary, and I’d gladly be Surgeon General if HHS Secretary is out.

So, vote Burge!

Update: Surgeon General!  Better.  Fewer meetings, nice Uniform.

MedBlogs Grand Rounds 3:43

Featuring the best graphic yet for Grand Rounds:

Welcome to Grand Rounds, Volume 3.43, hosted for the first time ever at
Having used Grand Rounds as a springboard into the world of medical blogging when I first started reading medblogs, it is truly an honour to be hosting Grand Rounds.

And, another opportunity to read the best of the Medical Blogosphere!

Professional Scolds of Medicine

There are those in medicine who hold themselves out as so terrifically thoughtful and sensitive and a) since they’re so terrifically sensitive and thoughtful everyone should do what they believe, and b) if you don’t, you’re wrong, and unprofessional to boot. They’ll look down on you, and want you to look down on yourself, too. They’re fun to annoy by not playing their game.

I have thought about this before, but Ad Libitum’s latest made me remember why I avoided a few of my peers in med school, and why I like the refreshing groups of realists I work with in Emergency Medicine.

The point of the post is that, essentially, docs cannot ethically blog about their patients, and I take exception to that. Per Ad Libitum

The key underlying principle about physicians writing or blogging about their patients is that, as pointed about by Charon (2), patients own their stories. In fact, Charon recommends that physician-writers must have patients read and approve any narrative about them for publication.

I don’t know a thing about Dr. Charon, but I don’t buy this underlying assumption, so the rest is built on nothing. To accept this idea makes the Physician some sort of detached bystander, which isn’t how medicine works as I practice it: both I and the patient are part of their story; yes, it begins as the patient’s story, but once they communicate it to me, as their doctor, it’s OUR story. (Personal stories are like secrets: the only way to have one is to never tell it to anyone else).

IMHO there is nothing unethical in blogging about patient interactions provided they’re suitably anonymized, and not illegal (which is different) providing you follow the HIPAA guidelines. Although I won’t hold myself out to be a paragon of blogging perfection, when I blog about patients they’re so anonymized that frankly I’m more at risk of a non-patient of mine thinking I’m writing about them than my actual patient (or patients) that spurred the post. As a practical aside, it’s unlikely any of my patients will ever find this blog, let alone scour it to find a case that might be them (hint: it’s not you).

More Ad Libitum:

…It can alter the blogger-physician’s view of patients – each patient encountered can now be seen as a subject about which the physician can write or blog, and the physician may change his or her interaction with the patient in order to extract more writing/blogging material.

Anyone who does this is an idiot, and I wonder about people who worry about such things (more Scolds). Medicine is hard enough without trying to view every interaction through some ‘is this bloggable filter’, and I bring this up here to squash it like a bug. I and every other medical blogger don’t write about 99% of our interactions, and it’s because they’re either not noteworthy, or too noteworthy (not able to anonymize) or we just forget. Frankly, most of what we do isn’t that interesting, or notable, like our patients.

I don’t think Ad Libitum’ a scold, by the way, but I do think the premise of his post is off: it’s not unethical to blog about patients, providing common-sense precautions (and good judgment) are used.

Dilbert and Meeting Attendees

via Aggravated Doc Surg:

Today's Dilbert Comic


Emergency Physicians Monthly has re-done their site

EPMonthly is one of the monthly news magazines for Emergency Medicine, and it’s quite enjoyable.  They’ve had a web site for a while, but it was a bit hard to read (black text on a gray background, etc).

No more.  They’ve revamped the place, and now it’s easy to navigate and easy to read.  They intend to have a more-involved comment section, and I hope they get what they want.  (Their “Standard of Care” section could be a big beneficiary of direct comments).

Kudos to them, and here’s hoping for the best for EPMonthly!


I had a patient today who personified misunderstanding. I tell this not to embarrass my patient, but to give a glimpse into the life we lead in the ED, and the confusing cues that can occur:

After a history and physical examination, I began my new spiel, explaining what we would do, and the expected time:

Me: “We’re going to draw some blood, test your urine, and get a cat scan…”
Pt: “I don’t have a cat”.
Me: “…..Umm…., it’s an x-ray test”
Pt: “Oh, okay”.

Same patient, later:

Pt: “I’ve been pushing the TV button on my call button, but no TV has shown up yet”.
Me: “Your room doesn’t have a TV. It’s a generic nurse call button, and if your room had a TV that button would turn it on and off. Your room doesn’t have a TV.”
Pt: “Oh”.

I’m not completely sure I wasn’t on some Candid Camera thing, but nobody asked me to sign a release, so maybe I don’t understand.

Change of Shift is up

Welcome to Change of Shift!

Old host, new venue this week as Change of Shift makes its debut here at Nursing!

Nurses: Help Requested

I got a call from the friend of a friend, a young male, and he has a question I’m not terribly qualified to answer: what should he do to get into the Nursing field, de novo?

I am asking, on his behalf, for constructive input.  Keep the snark to yourself, this is for those interested in entering the worthy profession of nursing.