Archives for May 2008 and their Leader E… and their Leader Executive chairs. Veerrry nice.

I just got my new chair, which…

I just got my new chair, which I waited 6 weeks for. It was definitely worth the wait.

.PARALLEL UNIVERSES.: Grand Rounds, 4.36

.PARALLEL UNIVERSES.: Grand Rounds, 4.36

His 5th time hosting!

We Need Free Trade in Health Care –

I have said this privately for a while, and now it’s being said openly: one way to drive down costs is to open the US to non-US trained physicians.  I have no doubt that will work and is being advocated in a WSJ Editorial today: We Need Free Trade in Health Care –


Yes, I read it, and all those non-US trained docs will be restricted to ‘underserved and rural areas’.  Riiight.  My legs’ wet, is it raining?

We Need Free Trade in Health Care

May 27, 2008; Page A19

Health-care reform is a major election issue. Yet while Democrats Hillary Clinton and Barack Obama offer comprehensive plans, important gaps remain. Neither plan addresses the need for more doctors, a problem that Gov. Mitt Romney ran into when he introduced comprehensive medical coverage in Massachusetts in 2006.

Comprehensive coverage of the over 45 million uninsured today will require that they can access doctors and related medical personnel. An IOU that cannot be cashed in is worthless.

Massachusetts ran into this problem: Few doctors wanted (or were able, given widespread shortages in many specialties) to treat many of the patients qualifying under the program. The solution lies in allowing imports of medical personnel tied into tending to the newly insured.

This is what the Great Society program did in the 1960s, with imports of doctors whose visas tied them, for specific periods, to serving remote, rural areas. U.S.-trained physicians practicing for a specified period in an “underserved” area were not required to return home.

It is time to expand such programs – for instance, by making physicians trained at accredited foreign institutions eligible for such entry into the U.S. But in order to do this, both Democratic candidates will first need to abandon their party’s antipathy to foreign trade.

It could easily happen.

These are the people Memorial Day is for.


In Memory of SPC David Lee Leimbach

Read it and just try not to weep.

BMC Trauma Chief Drowns in Boating Accident | BU Today

BMC Trauma Chief Drowns in Boating Accident | BU Today
Erwin F. Hirsch, a much-respected and well-loved physician who served as chief of trauma surgery at the Boston Medical Center for 25 years, died yesterday afternoon after his dinghy capsized in the harbor off Rockport, Maine. The 72-year-old surgeon was legendary for his efforts to provide the highest quality care to all patients, regardless of their finances or personal histories, and for his seemingly inexhaustible energy and good will.

I didn’t know him, but it sounds like I would have enjoyed working with him.

Inside the Scandal That Rocked the Formula One Racing World

Inside the Scandal That Rocked the Formula One Racing World is a very well told story of last years’ spy scandal involving McLaren and Ferrari. It makes for good reading whether or not you follow Formula 1.WIRED

And, this is a very good weekend for open wheel motor racing: the first combined Indy 500 in years (following the ‘merger of CART and IRL’ and the Monte Carlo Grand Prix.

How I Nearly Killed Myself

I teased this recently, and said I’d tell the tale. I have told it several times in my life, and still feel stupid while doing so, but maybe if I tell it here I’ll keep someone from doing themselves in. It can be a cautionary tale for others, and it’s a mystery to me why I wasn’t taken to meet my maker that night.

It’s 1988 or so, I’m getting a Masters’ degree (because getting a real job is too stultifying, and school I’m good at). My degree is in Life Science (biology) but my meager student income flows from being a paid lab rat for the Organic Chem department. (Those with significant O-chem experience are already cringing: keep reading, it’s worse than you think). The Professor I worked for was developing a new synthesis of a known structure, and my job was to make it happen. I was not the brains of this operation.

I was, however, the guy who was reasonably good with bench chemistry (in the day, I’d be lost now) and could be trusted to follow instructions and get to get a multi-step process right, over and over. As I’d been doing this for about a year, I was both trusted in the lab and overconfident in my abilities. (For fun, keep track of the safety lapses that follow).

Friday night, alone in the lab; I’ve gotten comfortable using ether as my solvent for this operation and it’s about 8:30 PM in a completely abandoned lab on the 4th (top) floor of a very empty building. The research lab is a room in the back: 8 feet wide, 12 feet long, with a door on one end, a hood on the other end, and a sink on the counter that runs from one end to the other on one side. The hood never turns off (and it’s good to have it on for ventilation in the little room anyway), the sink is important because it’s the source of suction for my major colleague in chemistry, above it being 2.5 gallon carboys of deionized water and acetone (both used to clean glassware). The shelves over the bench are covered with the typical assortment of obscure reagents, there’s paper stacked neatly on the bench. Oh, and there’s a Farrah poster on the back wall held up with black string from the drop-ceiling metal. It’s not mine, but it makes for something more fun to look at than brown gooey chemicals.

The sink suction was necessary to help my Rotovap work (have a look; it’s astonishingly ingenious) and is light-years better than the standard O-chem distillers. It can do in minutes what would take an hour in a regular, non-suction distilled evaporator, which is why I used it. Running water across a venturi makes a nice vacuum, the whole reagent end of the business spins, the diluent comes off like a shot, what’s not to like?

I’d discovered ether came off very quickly, unless it came off so quickly the reagent vessel started to frost over, then it finished very slowly. Being a problem solver the answer was easy: heat it (gently) with a shallow vessel of water on a hot plate.

That was what I was doing, standing rather dumbly in front of a rotovap doing its thing, wishing it would hurry up, when the ground glass joint holding my experiment to the machine popped off. Reagent and ether diluent bubbling into the hot water, I started to curse, seeing 8 hours of work being hydrolyzed.

That’s when the hot plate clicked on and the room instantly burst into flame. The entire countertop from door to hood was a fireball, to the ceiling, and over the top. I sensed more than recognized the fire was rolling over my head; the heat flash was impressive, and not really appreciated until later. Heat, light, and a flight reflex I’ve never had before or since: this is hard-wired, required no input from me, and maybe saved my life.

I ran. I ran faster than I have before or since. Carl Lewis could not have caught me for the next 200 feet, running through the hall to the stairs at the end. Some rationality returned at the doors, and I thought, then said aloud to no one, “I just set the lab on fire”, my legs carrying me back to the scene of my crime against chemistry and safety.

Fire extinguishers are ubiquitous in chem labs, so I got one reflexively on my way to the little room where I’d nearly bought it, but was much more worried about burning the building down at the time. There was a fire in the water under the rotovap, and one short shot of the extinguisher put it out nicely. The paper on the end of the counter was aflame, and the fire extinguisher shot made them into a thousand burning embers flying through the air independently. Phoo.

I’d started to tremble a bit, and realized I should get help, just in case. I walked out to our dedicated hotline to the security department, picked it up and declared the following: “I’m GruntDoc, I’ve just had an explosion and fire in the chemistry lab. The fire is out but I think I need some help”, and hung up. (I found out later I scared years off the dispatcher, who called the University Policeman on duty).

The University Officer I’d been a Boy Scout with, and he said when he got up the stairs my hair was still smoldering. That’s when I took stock, and found that, indeed, the hair on the top of my head had been pretty well singed, but no other injuries. We looked around a bit, decided the building wouldn’t burn down tonight, and he left me to clean up.

While rectifying my mistake I found the following: little burned pieces of filter paper are harder to clean up than you’d think, the rotovap knob was fused to the machine body, the plumbing insulation overhead was burned, and Farrah’s strings had burned through, dumping her unceremoniously onto the floor. Then I looked at the 2.5 gallons of Acetone, and wondered why it hadn’t ignited. If it had, in that confined space, I would have been horribly burned at best, most likely I’d have been killed.

I really think there was a divine intervention for me that night. I wonder why: is there a Big Moment for me someday, or was it just pity for being so stupid all at once? I’ll never know for sure. I hope.

That many safety errors are a firing offense, so I expected at least that, and maybe to expelled on Monday when the Prof got back. I went in prepared for the worst, and got the following: ‘Did you learn something?’ Yes. ‘Still want to work?’. Yes. ‘Okay.’ I finished the project, the degree, and went on to bigger and better things.

I hope I wasn’t spared just to blog. That’d be silly.


What GruntDoc forgot to include, is my involvement in this escapade, one of our BIG encounters.

I was a Lab tech at said University, and had been somewhere, dressed up and anyway, I was wearing a skirt and blouse that fateful day.  Very unusual for me to be dressed up.

Had a call from University police that there had been a fire in the lab.  I went up to the school and set out our big fans, to vent out the place.

I had a few comments from the staff, mostly the cop’s but including the stressed out dispatcher, that I looked like a girl.   I usually wore jeans and a tee shirt to work.

GruntDoc had been in my office many a time to reorder centrifuge tubes, to this day, I don’t know how he broke so many tubes or if he claimed them broken so he could come to my desk to reorder…anyway…

At any rate, that was my first real lasting impression of the GruntDoc.   Fire,.. Farrah burnt to a crisp and how mad would Dr. Rob… on Monday?    GD was right, Dr Rob..wasn’t that mad.

I didn’t get a raise for going above and beyond the call of duty, but I did finally marry the hero of the story.

Musings of a Dinosaur: Grand Rounds Volume 4, No. 35

Musings of a Dinosaur: Grand Rounds Volume 4, No. 35
IN THE BEGINNING, Nick Genes created Grand Rounds. And the Rounds were unformed and void; and Nick Genes said, “Let there be Hosts!” And there were Hosts; and Nick Genes saw that it was good, so he did pre-Grand Rounds interviews with the Hosts on Medscape. And it came to pass that on May 20, 2008 Grand Rounds did come to be hosted by #1 Dinosaur, who was pleased as punch to be hosting for the second time.

A themed Grand Rounds even I like.  Good work!

There Are Days… : PANDA BEAR, MD

There Are Days… : PANDA BEAR, MD
My Good Friends and Patient Readers,

I’ve decide to stop blogging.

Phooey.  He’s been one of the best writers in the medical blogosphere.  I did wonder how he could keep up the vouminous and well-done output, and now we know.

Panda, you’ll be missed.  Please visit when you feel like it.

It’s My Birthday

I’m 45 today.

I find that to be an incredible number, as I really don’t think I’m any different than I was at 30. Oh, some of the cosmetics have changed (Grey is the new Brown, heh), but mentally I have the same outlook I did when I was a touch younger.

This doesn’t mean I haven’t grown or matured, but I have always had a mental picture of what aging is, and it doesn’t seem to be happening to me. I find that odd. I’m one of those people that really never wanted to be young when I was; I wanted to be a grown-up, an adult. I detested being a kid: this doesn’t mean I acted grown up, but didn’t enjoy my station in life.

I do enjoy my now. I love my family, my life seems on track (note the seems: nothing ever goes quite to plan in my existence), and I see myself here for the next two dozen years. That thought makes me happy. Stability was something I took for granted growing up, all the more odd because I lived in an oilfield town where my classmates changed yearly, which you’d think would make me appreciate my good fortune.  Enjoying my current circumstances has never been one of my strengths, mores the pity.  Enter med school, the service, a residency, an EM job prior to this, and stability is something to pursue.

Life is good, I feel younger than the calendar suggests, and thanks for coming. Have some cake today, for me. Candles optional.

If I live through today (nice family celebration scheduled, the odds are on my side), I intend to tell the story of how I nearly killed myself, accidentally, and how that convinced me I was not taken for some Reason.

MedBlogs Grand Rounds 4:34 – Health Business Blog

Health Business Blog
Welcome to the latest edition of Grand Rounds at the Health Business Blog. This is my fourth time hosting (fifth if you include the April Fool’s edition).

Good one!

The humor behind health care reform – Medical Economics

Dr. Leap is getting even more famous!

The humor behind health care reform – This doctor’s tongue-in-cheek rallying cry is steeped in undeniable truth. – Medical Economics

I was buried in a sea of charts when a colleague joined me in the physicians’ lounge. We joked about our frustrations with paperwork and patients, while somberly agreeing that medicine’s in a bad way and physicians are more and more dissatisfied.

At the same time, we recognized that many of our problems are self-induced, stemming from doctors’ tendency to ignore fundamental truths. So I set out to compile a list of what we need to remember—truths that often go unnoticed while physicians utter empty words about professionalism, duty, and healing.

The Protestant Reformation began with Martin Luther’s theses. I’m not Luther, and my “undeniable truths” may not be nailed to a church door. But they could be the stirrings of a healthcare reformation.


Go, read, and comprehend!

Transfers due to Incompetence

Recently, I and my colleagues have taken a lot of transfer calls that have, as their basis, professional incompetence.  Allow me to explain, and then to ask a question.

We’ll get a call from an ER doc with a patient who’s stuck in the middle of a situation: their ED patient has an emergency requiring specialty treatment, they have a specialist in said speciality, but said specialist ‘doesn’t feel comfortable / hasn’t done in years’ the procedure the patient needs, so we’re called to get the patient to a specialist that’ll take care of them.

As a description I’ll tell one bowdlerized tale to give the flavor: patient with an open femur fracture.  Sending hospital does have an orthopedist on call, but “s/he only does spines, and they doesn’t feel comfortable doing this”.  (This happens with virtually all specialties, I’m not singling out ortho, just using them as an illustration of a general problem).

So, yes, medically we can take care of this patient, and medically we accept the transfer; when I talk to admin, I make sure they know all the facts, and then I make sure we do the right thing for that patient, and that’s to bring them to us.

Here’s my question: besides an EMTALA complaint (which the hospital reportedly files a lot of, and reportedly come to nothing), is it time to start reporting this level of professed incompetence to certifying boards?  I would presume a Boarded Orthopedist would be able to take care of an open femur fracture as part of both routine training and certification (and I’d bet they’re credentialed for that procedure at their hospital); if they then profess incompetence in caring for that injury, wouldn’t their certifying board like to know?

What say you, physicians?  Report, yea or nay, and if not, why not?

The Blog that Ate Manhattan: Paul Levy – You Are Not the Boss of Me. Well, Okay, Maybe You Are.

The Blog that Ate Manhattan: Paul Levy – You Are Not the Boss of Me. Well, Okay, Maybe You Are.

TBTAM has a really well-written piece today about an interview with Paul Levy (and a nice part with some good introspection that most doctors would identify with about why they got into medicine), but she’s very troubled with his response to typical physician negotiating tactics. Read her post for the particulars, then come back here and read after the break.

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