Archives for November 2007

MedBlogs Grand Rounds 4:8

Doctor Anonymous: Grand Rounds – Volume 4 number 8

The near-perfect Grand Rounds.

The thing I missed on my days off

Recently I had several days off. It was terrific, but there was something odd about it, and today I found out what.

While working it struck me how many times I got interrupted while trying to do something / talk / think. Life in the ED is hectic, and when you’re the ‘center of the storm’ it’s not calm, it’s busy as heck. Everyone wants or needs information, and you’re literally at the mercy of the person with the least impulse control.

That’s what was odd during my days off: I got to complete thoughts, have uninterrupted conversations, and go through the whole day without unscheduled demands.

It was weird.

Happy Veterans Day

To all who have served, and the family and loved ones who did what it took to make that service happen, Thank You.


I’ll remind readers that the Soldiers’ Angels Project Valour-IT is still taking donations, here; for project information, here.  My USMC team is in a solid second place, but a) way short of the goal, and b) behind Army?  Any donation is appreciated.


Last year Google took a beating for not having a special graphic for Veteran’s day.  They have fixed that, and have done well:

Veterans Day

Happy Veteran’s Day!

Happy Birthday, Marines!

original poster from:

Thank You for your Service, Captain

Dr. Wes: Another Chapter Closed

A real-life look at insurers rating doctors.

The Blog that Ate Manhattan has actual data about two physician colleagues who were downgraded. You’ll never guess which side of the equation made the mistake:

The Blog that Ate Manhattan: Garbage In, Garbage Out
Two of our finest docs were recently down-graded from premium status by a major insurer for providing sub-par care.

Read the rest for the details.

Garbage, indeed.

Update 11-16-07; it seems to have disappeared.  Interesting.

Epocrates Rx, now on Blackberry; my first take

Free medical BlackBerry software: Epocrates Rx

Follow the link if you

  • have a Blackberry
  • want Epocrates
  • are willing to put up with annoying, potentially serious weirdness.

I’m an early adopter, so as soon as the email hit my inbox I was downloading. First, you have to have an account at Epocrates (It’s ‘free’ software but nothing’s really free). Then, you navigate to, and it warns you that it’s a big download and it takes a while. It is (9MB) and it does.

The first download is a loader program, and you have to input your epocrates username/password, then the really long download begins. Mine hung (I was walking with the phone and passed through a known area of poor signal quality, so that’s on me). A battery-removal restart finished the installation.

Unlike Pepid (decidedly NOT free), there was no protracted index builiding, just a quick ‘agree’ and you’re off to the Epocrates races. Yes, it works, as well as on any of the Palms I’ve had it on. Drugs, etc (I haven’t tried any of the advanced features). So, it does download and it does work.

The serious weirdness? Here’s the support request I submitted this evening:

Dear Sirs,
I’ve downloaded Epocrates to my Blackberry Pearl. It works well, which is a tribute to your team.

However, it has induced a really weird and annoying behavior: every 10 seconds or so the hourglass spins on the BlackBerry, and for a second or so nothing works / can be changed. Then, it’s back to normal, for another 10 seconds. I’ve disabled the timed updating, but that didn’t change anything.

Is there a way to make this stop?


I’ll keep it, for a bit, and see what happens. The once every 10 second spinning a) locks the device for a second, and b) I’m wondering about the battery-life consequences of an every 10 second event. Time will tell, and I’ll update when and if Epocrates gets back to me.

If you’ve tried it, drop a comment (especially tell me if you have the 10 second thing).

Update: Solved! Commenter RIDoc had the answer:

Just read the Doc Alerts, pressed “No” for each request for information, and the hourglass disappeared.

Exactly right, and that worked. Thanks!

Update2: it happened again, and went away after I looked at the (empty) Doc Alerts program. Weird.

Update3: The official word from the Epocrates Tech Support people:

Thanks for contacting Epocrates,

We have discovered that the way to get rid of this is to tap either Yes or No to DocAlerts on the device.

We are troubleshooting to resolve this issue altogether.

Please let us know if we can assist you any further.


So, that’s the answer. My answer has been to delete the thing, as I find it highly annoying to have my phone lock up because Epocrates wants me to perform an action I don’t want to do. I’ll probably try it again in a month or so, but for now I’d say get it only if you have to have it and have no other choices.

Update 11-25-07: It seems they’ve fixed the spinning hourglass.  I have mine reinstalled, and so far it works fine.    haven’t moved to to the memory card, as I don’t know how to do it.  I need to look into it.

Who pays more of their ED bill: the uninsured, or Medicaid?

Here’s one study with an answer that’s surprising, and another finding that’s not:

Govt program a strain on U.S. emergency rooms: study

Thu Nov 8, 2007 3:15pm EST

By Lisa Baertlein

LOS ANGELES (Reuters) – The U.S. government’s Medicaid program for the poor may put more financial burden on overcrowded hospital emergency rooms than the nation’s 47 million uninsured, according to a study published on Thursday.

Researchers at the University of California San Francisco and Stanford University found that the uninsured patients paid 35 percent of their overall emergency room bills in 2004, versus 33 percent for Medicaid.

Wow.  Read the rest for the full story of declining reimbursement from all sources, then ask why ED’s are closing.

ED: Wrong Place for Mental Health Care

A terrific editorial right on point.  The author is Susan Stefan, who is director of the National Emergency Department Project at the Center for Public Representation.

Read it all, but here’s a good slice:

Wrong place for mental-health care

By Susan Stefan  |  November 7, 2007

Boston.comHOSPITAL emergency departments are among the least appropriate and most expensive places in Massachusetts for patients in psychiatric crisis. Yet these departments are where police, families, group homes, nursing homes, and others routinely take people who are agitated, panicked, or threatening to hurt themselves. Emergency departments are also where people go at the end of the month when their medications run out, when their primary physicians can’t see them for two weeks, when they are frightened or desperate and have nowhere to turn after 5 p.m. and their therapist’s answering machine tells them to go to the emergency room.

It’s very well written, and worth the time.

It also helps to explain why a lot of us in Emergency Medicine dislike the idea that we’re the “Safety Net” for all of societies’ problems.  We’re not trained and certainly not equipped to take care of every conceivable problem. 

MedBlogs Grand Rounds 4:7

Counting Sheep » Blog Archive » Grand Rounds, a pain-free experience

More busybodies who should butt-out: Anti-porn Groups Demand Ban on Skin Mags

Anti-porn Groups Demand Ban on Skin Mags
Anti-porn Groups Demand Ban on Skin Mags
UPI | November 06, 2007
WASHINGTON — Dozens of anti-pornography groups asked the U.S. Congress to force the Pentagon to keep sexually related material from being sold in military stores.Pornographic material was banned from being sold in military establishments nearly 10 years ago, but Christian group American Family Association claimed that adult fare, including Penthouse and Playboy material, is still being sold in the stores, USA Today reported Monday.

Umm, we’re not talking about sales to minors here, we’re talking about adults (male and female) who are willing to put on the uniform and put up with the inevitable deprivations. Should they decide to spend their dollars on smut it isn’t anyones’ business but theirs. And, Congress should be ashamed they pandered and caved on this trivial issue.

I’m a personal little “l” libertarian on issues like this, and it’s nobody’s business what legal product is sold on base to adults. Cigarettes are still sold there, by the way, but this faux-moralism is a fun club for the holier-than-thou to wield.

Oh, and they should be able to drink at 18, too. That’s not part of this, but I just wanted to get it out there.

I think Oldfart lives in my town. Or I live in his.

M.D.O.D.: A new one for me!
A new one for me!

After this long you’d think I’ve seen almost everything. Yesterday EMS calls bringing in a trauma victim from a PLANE CRASH! Say what??!!

Our fair city had a V-tail Bonanza (the “Doctor killer”) land very hard and very short of the runway at Meacham.  News reports had the patient surviving, and going to The Other trauma center in town.

Hmm.  If it’s true, there may be a cranky-EM blogger meetup soon.

More on the LA death

Missing a Heart Attack in LA: How Much to Prevent One Death?

So there was this horrendous story out of Olive View-UCLA where a young gentleman died after spending three hours waiting in an ER. His presenting complaint was chest pain and he died of a heart attack. He was 33.

An interesting, and well-written addition to our previous post about a death in (or, outside) an ED.

Blogger stinks, captchas are bad; incidentally, a response to ERNursey


I tried to leave this as a comment, but you have that utterly horrible blogger captcha, and I tried to do it, but it stinks to high heaven.

Here’s my response to her post:


The mentally ill don’t vote. (Insert your funny joke about the party you don’t vote for here).

Their families are a mixture of positions, and I understand, in theory. Psychotropic meds (Thorazine, Haloperidol, etc) were going to revolutionize mental health care (1965 and later); screaming psychotics then became somewhat medicated psychotics. Not droolingly crazy = unfair holding against their will! !Close the horrible institutions! They just hold people who’ll be fine’ (if they take their meds; when they leave very close supervision in a structured environment, they usually don’t). Then they’re on the street, literally.

One of Americas’ few real shames is the number of homeless who need to be institutionalized due to mental illness, but aren’t. Land of the Free, home of the brave, but no home for the decompensated schizophrenic.

Mental health is a life-long problem, and the patient pool we’re talking about here aren’t unhappy about their latest relationship, they’re literally coo-coo for cocoa-puffs, except that makes them sound more cartoonishly pleasant than they really are. They’re miserable, through no fault of their own, and there’s nowhere to go.

There’s plenty of blame to go around here, on both political parties and over a couple of generations. Money is the root of evil here; long term mental health care is horribly expensive just because it’s lifelong. Many states are closing their long-term MH Hospitals due to cost. It’s hard to get re-elected on the tax bill for the mentally ill; inexplicably, toll roads get people re-elected. Go figure.

I want legislation that puts a homeless schizophrenic on the corner next to every legislators’ home (there’s plenty to go around), and then maybe, just maybe, something will happen. Until the mental health advocates and the courts get involved, then they’re all back on the street and in the ED.


Blogger site bloggers: the blogger captchas are bad, they’re stifling, and you need to get rid of them.

Dr. Wes: Strange Bedfellows

Dr. Wes: Strange Bedfellows
I’ve got to rant.

Enjoy the beauty of an on-target, specific Anti-AMA rant.  Well done.