MedBlogs Grand Rounds 4:32 Smack Down | Doc Gurley

Grand Rounds Smack Down | Doc Gurley
“Are you ready to ruum-ble? This week here at Doc Gurley is the Grand Rounds Smack Down edition, where the best contenders of the health care blogosphere wrestle down and dirty with tough, scary topics.

Aah, themes.

amed news woke up

When amednews.comdid this happen? amednews.com closed to nonmembers in 2005, and I stopped looking for medical news there because I’m not an AMA member.

Today I followed a link, and it’s now open to nonmembers (for the first 90 days after publication). This is a good thing, and I’m glad they did it.

My HS Band & Orchestra director elected to the Texas Bandmasters’ Hall of Fame

I’m sure it was my bass trombone and string bass playing in the early 80’s that put him over the top.

WHAT’S HE DONE?

>> During Charles Nail’s 17-year tenure as band and orchestra director at Permian High, the bands and orchestras won the Texas State Marching Band contest in 1982 and finished second three other times. It was selected five times for the finals competition.

>> The Permian band was also selected as the Texas State Honor Band and was never awarded less than a superior rating in every contest and festival it entered during his time there, the biography says.

>> The Permian Orchestra was twice chosen as the Texas State Honor Orchestra and also was invited to perform at the prestigious Mid-West Band and Orchestra Clinic/Convention in 1985.

This leaves out the Marine helo pilot role in Vietnam.  True, that’s not musical, but it will give you some insight into how he ran his bands.  It was a formative chunk of my life, and I owe him a debt of gratitude.

Fort Worth Star Telegram eviscerates JPS Hospital System

IStar-Telegram.comt is a SIX part series, and the first two installments are so bad it’s worse than a car wreck: you know a car wreck eventually ends.

At a certain point it’s just piling on. There are deficiencies highlighted herein that any hospital would be guilty of, and it’s painful to read. Yet it has to be read.

Isn’t this the press King-Drew got before the curtain fell?

For the record, it’s not my hospital system (but I feel a little, just a little, of their pain).

Dang it, I just caused a problem…

I’m right now having some fogged windows replaced at the house.  Being a naturally curious sort, I asked about the sealant being used to secure the new windows to the frames.

It’s this stuff, which the friendly window guy didn’t know a lot about, except that it’s what they use, and “it’s strong”.

I’m exactly the kind of dork who, after reading about it, tells him a little about it (apparently is strong enough to bind the universe, can be applied in sub-freezing temps, etc).

10 minutes later I overhear him telling his co-worker: ‘hey, remember that job the other guys wouldn’t do because it was too cold?  Well, the homeowner looked up this caulk and it can be applied in sub freezing temperatures“.  Oy.  I’ve caused a problem for others, and didn’t even mean to.

The good news?  These windows have a 20 year warranty, so it’ll be a while before I cause this particular company more problems…

A fun project: Hardwood chair mat

I’ve had one of those really serviceable plastic mats for my office desk chair for years, and was never really happy with it. It looks like a plastic mat, it grows dents after a few minutes with the chair in the same place, etc (the same reasons you don’t like yours).

Fortuitously, my sister in law is in the flooring biz, had some discontinued engineered hardwood samples to get rid of, and the light came on in my head: make my own chair mat!

Procrastination followed, but here’s how I did it:

  • measured the size it needs to be
  • got Home Depot to cut down my 3/4 inch 4×8 plywood to my needed 4×5 (they have a nice rip saw)
  • bought trim to finish the outer edges (doesn’t match perfectly but is close)
  • got some PL premium decking and flooring glue, and some Elmer’s Wood glue

I took all this home, put the bare plywood on sawhorses, laid out the flooring to make sure it’d fit (and wouldn’t have a noticeable pattern). I probably did this wrong (but it worked out) and attached the edging first, then started putting on the flooring, gluing the planks to the plywood with the PL, gluing the tongue and groove with the Elmers’ (and stapling every row down with an air-nailer and 3/4 inch brads on an angle, hidden). Yes, it’s probably over-secured, but I’ve never built a floor before.

When all was done, I flipped it over (the eye-rolling teen helped here) and the hanging-over bits were trimmed off with a circular saw.

Result:

a nice hardwood chair mat

It’s sturdy, not bad looking, and much better than the plastic.

The thing I didn’t think would matter (it does) is that the floor is now 1 1/4 inches higher relative to the desk, so now I need to raise the rest of the desk about that much (probably really only an inch would be fine) so my legs fit under the keyboard tray better.

I figure I’ll get around to raising the desk in another 5 years; sooner if I get tired of taking off my shoes when I sit down.

Dr. Val interviews the Surgeon General

Revolution Health LogoDr. Val is showing the power of blogs (well, the power of professionally done blogs) by getting a one on one interview with the Surgeon General.  Read her post for the interview, but here’s the part that I enjoyed the most:

(Dr. Carmona):….The American public wants the best of everything, they want it yesterday, and they don’t want to pay for it. That pretty much characterizes the problem that we have. We see health as a right, we want somebody to give us a card, and if we want to smoke, that’s our right too. There’s this attitude that if we want to drink excessively, that’s our right, and if we want to ride a motorcycle without a helmet, that’s our right (“you can’t tell us what to do”). However, when I crash my motorcycle and I have a head injury and I’m disabled for life, I also expect society to pay for that.

Heh.  I believe I’ve said something like that myself.

Pallimed: A Hospice & Palliative Medicine Blog: "I Wanna Be A DNR" and other Goodness from the Web

A little humor for your day, via Pallimed (via Dr. Wes. it’s a tangled WWW):

The description, per Pallimed:

A ICU Nurse and some colleagues rewrote the lyrics to the popular Nickelback song “Rockstar” to emphasize how some patients may feel in the ICU. The video itself is just the lyrics. Here is hoping she puts together more song parodies and maybe a video or two.

Gallows humor, but it’s well done and humorous.

Farming community moving on after arsenic poisoning – Boston.com

I blogged about this when it happened in 2003 (and the suicide of a man who posthumously took the blame), and wondered idly if anything more came of it. Here’s the answer (complete with a what happened in a small ED that night description).

Farming community moving on after arsenic poisoning

By David Sharp, Associated Press Writer | April 26, 2008

NEW SWEDEN, Maine –It has been five years since this tiny farming community was turned upside down by a crime that still baffles: Someone used arsenic to spike the coffee at Gustaf Adolph Lutheran Church, killing one parishioner and making 15 others violently ill.

Soon those who drank the coffee were throwing up, suffering diarrhea, or both.

The first patient arrived in the Cary Medical Center emergency room in nearby Caribou at 3:30 p.m., and sick parishioners kept pouring in over the next six hours. Dr. Dan Harrigan, an emergency room physician, arrived at work at 6:30 p.m. to find one of the parishioners outside on his knees.

Not knowing what they were dealing with, doctors and nurses at the 65-bed hospital struggled to keep patients’ blood pressure from dropping too low.

It wasn’t a pretty sight. Nurses described countertops and the floors covered with vomit-filled basins, buckets and garbage cans. "Out of 26 years in emergency medicine, I doubt I’ll have another night like that," Harrigan said.

By dawn, one of the parishioners had died, several had been transferred to Eastern Maine Medical Center in Bangor, and doctors had figured out they were dealing with a heavy metal poisoning. Laboratory tests later confirmed it was arsenic.

Read the article: several were left with lifelong disabilities, but their community moves on.

Best Procedure of the Day

The patient’s CC: bug in ear.

Physical exam: Pt in mild distress, holding one ear.  Otoscope exam shows the back end of a bug.

I started by filling the ear with 1% lidocaine, to drown the bug so they quit moving (which is apparently painful and freaky in an attached-to-your-brainstem weirdness kind of way).

Then it happened, something that hasn’t happened in years of doing this: the bug came out to keep from drowning!  There’s a little bug running on the bed, which met its maker quickly.  Re-exam showed the inside of the ear none the worse for wear, and the relief of everyone was terrific.

First time I’ve been charged by a bug, though.

Wall Street Journal Health Blog : Rage for Doctor Ratings Fraught With Uncertainty

Wall Street Journal Health Blog : Rage for Doctor Ratings Fraught With Uncertainty

Dmitriy Kruglyak at Trusted.MD and Val Jones from Revolution Health are quoted.

Good for you two!

Jay Reding.com — Why Universal Health Care Keeps Failing

Jay Reding.com — Why Universal Health Care Keeps Failing

In the midst of analyzing the failure of California to drink the Universal Coverage koolaid comes the following money quote:

Universal health care has a basic and fatal flaw, you can’t simultaneously reduce the cost of a service and increase access to it. If you have universal access, you have to find a way of paying for people to get that access, which raises costs. If you want to keep costs down you can only economize so far before you have to restrict access. Universal health care is a bit like a perpetual motion machine—it would be wonderful in theory, but it can’t actually exist in reality.

Not without astonishing taxes, anyway.

Is it bad…

… that my WinXP box wouldn’t load the profile, today, that three system restores wouldn’t fix it, and now that the chkdsk /r has been running for three hours? It’ll get up to 75%, then backslide to 50%, rinse/repeat.

I really don’t want to have to do a Windows reinstall. Yes, it’s all backed up (twice, in different places), but, man…

Update: after 3 hours (not hperbole) it finished, reporting that it had found and fixed errors.  And it fixed my little problem, so I’m back in business.  The business of not providing updated, thoughtful comment to the blog, that is.

Backboards and Band-Aids…: It’s been real, and it’s been fun…

Backboards and Band-Aids…: It’s been real, and it’s been fun…
And for once, it’s been real fun.

I’ve had to blog for almost 9 months now…heck, if it was a fetus it’d be about ready to pop out. Unfortunately, the blog will no longer be updated after today. Im hanging up my blogging hat. Future PA and SWAT Medic are going to do the same, they never really got into the whole blogging thing anyway.

I’m going to miss this blog…

Us too.

I think she’ll be back, there’s too much fire in her writing to think she’ll walk away at this stage of her game. I hope she’ll be back, anyway.

Update: Shortest retirement in blogging history?  You decide.

Wasted medical dollars – Opinion – USATODAY.com

Wasted medical dollars – Opinion – USATODAY.com
Wasted medical dollars

By Kevin Pho

A recent analysis by PricewaterhouseCoopers concluded that more than half the dollars in our $2.2 trillion health care system are wasted.

Kevin, MD’s roll toward worldwide medblog domination rolls on.  Good work, Dr. Pho!