Archives for June 2008

Medical helicopters collide, killing at least 6 –

Medical helicopters collide, killing at least 6 –

Medical helicopters collide, killing at least 6

  • Story Highlights
  • NEW: Six killed includes one patient; one critically injured
  • Collision sets fire to 10-acre area near Arizona’s Flagstaff Medical Center
  • “We’ve got lots of heaps of metal to go through,” fire captain says

(CNN) — At least six people were dead and one critically injured Sunday after a midair crash between two medical helicopters near a hospital in Arizona, authorities said.

The collision, at Flagstaff Medical Center in Flagstaff, Arizona, set fire to a 10-acre area, according to fire officials, and another two rescue workers were injured by a secondary explosion after the crash.

The helicopters collided at roughly 3:45 p.m. local time, according to the Federal Aviation Administration.


HPSP now a LOT more lucrative

That’s a much better deal than I got…

Military sweetens the deal to entice medical students

A beefed-up scholarship program now offers a $20,000 signing bonus as well as full tuition and an increased monthly stipend.

By Myrle Croasdale, AMNews staff. July 7,

Katie Doyle could have borrowed $200,000 to get through medical school. Instead, when she enters Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Fla., this fall, she won’t borrow a dime.

Doyle accepted a military scholarship that will pay her tuition, books and other school fees. A monthly stipend will cover living expenses. The scholarship, called the Health Professions Scholarship Program, or HPSP, also comes with a new $20,000 signing bonus.

…, Congress authorized the three branches to bolster their recruitment packages, resulting in the $20,000 bonus, along with a $300 hike in the scholarship’s monthly stipend, which is now $1,900. The money comes from military appropriations earmarked for medical corps recruitment. In 2007, the Air Force recruited 211 medical school students; the Army, 242; and the Navy, which also recruits for the Marines, 181.

That’s got to be a BIG shortfall for the Navy.  My Intern class in San Diego had over 100, and that was only one of two big NAVHOPS’s, with several smaller facilities.  Thus, the enticements.

A reminder: the Navy HPSP Wki

Surgeonsblog: Milestone or Finish Line?

Surgeonsblog: Milestone or Finish Line?
My original intent — to inform and to entertain, focusing on what it’s like to be a surgeon, and to enlighten about some surgical diseases and situations — seems generally to have been fulfilled and to have run its course.

Dr. Schwab wrote an excellent book (I have a siigned copy) and has always had an excellent medical blog.  I predict he’ll blog again, but only time will tell.

Texas Senators both choose to screw docs

Update: I appear to have been drawn in by polemics from a group not prone to them.  See Health Care BS for details.

Both Texas Senators (both Republicans).  I’m reproducing the email I got today from TMA after the break.

Thanks for nothing, Senators.

[Read more…]

New Grad Advice 2008

Shadowfax started a nice thread, and the impressive 10/10 added to it today, a list of advice for new EM grads. Read their advice, but here’s mine:

  1. Lease, don’t buy. Way more than half of new grads change jobs within two years. I know, it’ll never happen to you, but here’s the thing: I was you. I got my ‘dream job’, bought a beautiful home in a perfect neighborhood. I sold and moved in 10 months. It’s a really nice way to lose a lot of money. It can happen to you.
  2. Be humble. True, you’re at the absolute top of your game, you know the best literature on every subject, and can intubate with your off hand in the dark, blindfolded. Your new colleagues have been practicing EM for a very long time, and while they’d be interested in your incremental knowledge of the state-of-the-art, they’re not itching for you to enlighten them. Open your ears, listen, and learn. (Use your filter: there’s a pony in there somewhere). [Read more…]

Canadian Healthcare Author Writes a new Ending

Investors Business Daily:

Canadian Health Care We So Envy Lies In Ruins, Its Architect Admits

By DAVID GRATZER | Posted Wednesday, June 25, 2008 4:30 PM PT

As this presidential campaign continues, the candidates’ comments about health care will continue to include stories of their own experiences and anecdotes of people across the country: the uninsured woman in Ohio, the diabetic in Detroit, the overworked doctor in Orlando, to name a few.

But no one will mention Claude Castonguay — perhaps not surprising because this statesman isn’t an American and hasn’t held office in over three decades.

Castonguay’s evolving view of Canadian health care, however, should weigh heavily on how the candidates think about the issue in this country.

Back in the 1960s, Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec — then the largest and most affluent in the country — adopt government-administered health care, covering all citizens through tax levies.

The government followed his advice, leading to his modern-day moniker: “the father of Quebec medicare.” Even this title seems modest; Castonguay’s work triggered a domino effect across the country, until eventually his ideas were implemented from coast to coast.

Four decades later, as the chairman of a government committee reviewing Quebec health care this year, Castonguay concluded that the system is in “crisis.”

“We thought we could resolve the system’s problems by rationing services or injecting massive amounts of new money into it,” says Castonguay. But now he prescribes a radical overhaul: “We are proposing to give a greater role to the private sector so that people can exercise freedom of choice.”

Castonguay advocates contracting out services to the private sector, going so far as suggesting that public hospitals rent space during off-hours to entrepreneurial doctors. He supports co-pays for patients who want to see physicians. Castonguay, the man who championed public health insurance in Canada, now urges for the legalization of private health insurance.

In America, these ideas may not sound shocking. But in Canada, where the private sector has been shunned for decades, these are extraordinary views, especially coming from Castonguay. It’s as if John Maynard Keynes, resting on his British death bed in 1946, had declared that his faith in government interventionism was misplaced.

What would drive a man like Castonguay to reconsider his long-held beliefs? Try a health care system so overburdened that hundreds of thousands in need of medical attention wait for care, any care; a system where people in towns like Norwalk, Ontario, participate in lotteries to win appointments with the local family doctor.

Years ago, Canadians touted their health care system as the best in the world; today, Canadian health care stands in ruinous shape.

This had to be hard for him, and I respect any man who can see his life’s’ work not working as intended, and trying to change it, though this seems a weak start.

It reminds me of the 80’s Soviet Union farms.  5 year plans and Communist Agriculture consistently resulted in inadequate crops and food shortages.  In desperation farmers were allowed a small plot of land to grow food, the sale of which they got to keep the proceeds from.  Guess what sector of their farm economy was most productive?  This is now proposed for medicine in Canada.

I’m sorry for Canadians, and at the same time unsurprised.  Now, can we learn from others?

Los Angeles Times: UCLA Medical Center preps for its biggest operation: moving day

Los Angeles Times: UCLA Medical Center preps for its biggest operation: moving day

June 25, 2008

On Sunday, 2,100 doctors, nurses, technicians and managers at UCLA Medical Center will participate in a task of epic proportions: moving to the gleaming new hospital across the street.

Although the distance is short, the details are daunting. The shift to the new Ronald Reagan UCLA Medical Center will require military-style precision. Using 30 ambulances and 80 gurneys, three teams of professionals will transfer 350 patients — many of them hooked up to monitors and respirators — at the rate of one every two minutes.

How cool; that’s a story they’ll all remember for their entire lives.  It’s not often a hospital just picks up and moves.

MedBlog Grand Rounds 4:40; ShrinkRap and the iPhone Grand Rounds

Shrink Rap

Welcome to Grand Rounds, Volume 4, #40 (see future GR schedule). If you missed our first Grand Rounds last year, with our amazing Clicky Brain, then feel free to pause and enjoy.

This year, since the anticipated release of the Apple iPhone 3G is just around the corner (July 11), we asked for submissions to have some connection to the iPhone, no matter how twisted the logic is to make the connection. The medical blogosphere obliged. So we are including, free of charge, our Clicky iPhone, which will let you visually navigate this week’s Grand Rounds submissions (yes, the buttons on the phone really work).

I am in awe. Wow.

Dr. Schwab, ER Bloggers, and Conservatism

Alerted by Kevin, MD today, I find that Dr. Schwab (Surgeonsblog) has decided to label ER Blogs, and bloggers as mindlessly conservative, and apparently unenlightened.  (Oh, plenty of disclaimers are sprinkled throughout, so you know he’s not actually talking about anyone, just everyone).

First thoughts: somewhwere Shadwofax has his lower lip stuck out just a bit, and this might be what made Graham pack it in.


So.  Fisking is what I seem to do best in these situations, so I shall.

… And yet. Reading some ER blogs — not all, and by no means all the time — I find the vitriol off-putting. The derision. And the take-no-prisoners attitude — the downright hatred, so it often seems — toward “liberals,” suffused throughout. (Not to mention a similar attitude, quite often, toward their own clientele). I love political give-and-take; most of my work-colleagues politicked far to my right, yet we had enlightening and stimulating, good-hearted arguments. But reading some ER blogs, unlike any other category in the healthosphere, is like listening to Rush Limbaugh or Ann Coulter. It’s a polemicist’s playground.

Well, that’s rich.  I so tired of the lockstep leftist blather on Dr. Schwabs’ blog I eventually just stopped reading it.  A polemicists’ playground?  Read the sentence preceding that one, and see if you can find the disconnect.


In case you’re ever wondering if a blog writer is a fevered leftist, just wait for the following to appear in a blog post:

I’ve had my moments of moral muttering, liberally laced with haughty holiness. I consider George Bush the worst president we’ve ever had (and no, Mr. Bush, history will not vindicate you). But I’ve never called him “a bucket of spit.”

It’ll show up, appropos of nothing whatsoever.  They think it’s normal to interject their BDS into everyday life and any blog post.  Really.  It’s astonishing.

Nor do I kiss off all conservatives as some sort of existential threat. (Some, of course. But not the whole group.) Physicians are, in general, a conservative bunch. But they’re also educated; enough, you’d think, to have left their minds at least slightly ajar.

I have an open mind, but to paraphrase, not so open that my brains fell out.  I am reasonably well educated, I take my time making decisions when I have the time, and have come to the conclusion that the government isn’t the answer to every problem.  My personal politics skew more libertarian, but here’s the thing: NOBODY CARES what I think politically.  That’s why, excepting politics about medicine, I leave it out.

His ending:

Maybe it’s an inevitable corollary: working in an ER turns people. Another possibility: people who lean loudest to the right are the ones who choose the job in the first place. Or perhaps (with a couple of exceptions) it’s just that the rightward ER docs blog, and the leftward ones go home and tie-dye.

Get it?  If you’re conservative, you’re “turned”.  Perhaps some introspection and insight are needed on the part of the blogger.

My wife got a dental implant t…

My wife got a dental implant today. Frankly, I always thought if I were to spend a lot of money on implants, they wouldn’t be dental.

I have a dilemma

Good news: my neighbors now have one fewer skunk.
Bad news: his demise came under my new car (he zigged, I zagged to miss: didn’t work out well).

The dilemma: will my car get salmonella with tomato juice?

Update: no chemicals necessary; the heat under the car dissipated the odor after about 3 days.

Another thing I find amusing

CNN has used this graphic before, and though it bugged me, I let it go.  Since I have a blog and nothing to say, I’ll point it out so it’ll bug you, too.

This graphc:
reverse Lead II

The EKG tracing in the photo is backward (meaning it reads incorrectly from left to right, which is the convention).  There’s nothing particularly interesting about it, but it’s backward, and it gets my (unpleasant) attention every time.

So, CNN, I’ll be glad to review your medical graphics, for an entirely reasonable fee. Or get someone else to do it, but please do so.

18 admitted patients sitting i…

18 admitted patients sitting in the ED, waiting on a bed. 18 beds that cannot be used by ED patients to be seen.

Brand new federal requirement: NPI needs to match IRS data

Really, it’s like they don’t want docs to use the Government system…

Brand new federal requirement: NPI needs to match IRS data
Brand new federal requirement: NPI needs to match IRS data
Healthcare IT News
By Diana Manos, Senior Editor

WASHINGTON – Just when doctors thought things couldn’t get much worse, experts say, the Centers for Medicare & Medicaid Services has thrown another wrench into the already difficult transition to using National Provider Identifiers.

According to a June 11 CMS announcement, doctors will have to reconcile their NPI data with their IRS legal name data in order to get paid.

I read to there, and thought, ‘well, that’s not entirely unreasonable’.  What an idiot I am.

According to billing experts, this is a disaster waiting to happen. Every aspect of the data must match, including the exact spelling of names, the use of initials and even blank spaces in the data. The slightest discrepancy could send Medicare claims back to the drawing board.

Aah.  So, Medicare issues a NPI, which isn’t checked against the IRS name, then retroactively and apparently without notice announces they’re not going to pay for work already done in good faith, over yet another clerical gotcha, in which they were complicit.  Breathtaking, the hubris.

After a year-long contingency period, the use of NPIs was required by CMS as of May 23. Both before and since that deadline, doctors have had difficulty getting paid due to a host of complications with CMS and clearinghouse systems, experts say.

Cyndee Weston, executive director of the American Medical Billing Association, said the IRS matching requirement “has blindsided the whole industry.”

I might actually join the AMA if they said ‘no more’ to this crap.  Unfortunately, I suspect they’ll hold their hat in their hands, appoint a commission, and say pretty please.

Bait & Switch.  They’d never dare pull this crap on lawyers.

Nurses to be Evaluated for Compassion

…just not individually…

From BBC, which focuses an unflinching eye on the reality of socialized medicine, and the astonishing weirdness within and without (though I should say that the eye sees without seeing…)


Nurses to be rated on compassion

Nurses are to be rated according to the levels of care and empathy they give to patients under government plans.

Health Secretary Alan Johnson told the Guardian newspaper that he wants the performance of every nursing team in England to be scored.

He said he believes compassionate care was as crucial to the recovery of patients as the skills of surgeons.

Nurse leaders welcomed the move and said they would work with ministers on developing the system.

But he ruled out rating individual nurses and also said it would not affect pay.

Group compassion? What the heck are they even pretending to measure?