Archives for April 2009

Emergency Physicians Monthly – Swine Flu Update: April 28

I know you’re already tired of hearing about it, but:

Emergency Physicians Monthly – Swine Flu Update: April 28

They’re have a nice Informational about ‘Swine Flu’ and a good Q&A in the comments.

View From The Porch: Some more ruminations on the ammo shortage…

View From The Porch: Some more ruminations on the ammo shortage…

A nice rational look at the current ammo shortage.

via Snowflakes in Hell.

Pandemics and Politeness

I have learned the Western Way of politeness: when meeting a stranger look them in the eye and give a firm handshake.  I do this quite a lot in this ‘patient satisfaction’ world, shaking the hands of not just the patients but also their families.  (And sometimes you’d think I’d learn).

I’m wondering if we need some sort of socially acceptable way to say ‘I’d shake your hand but given that this is a hospital where illness concentrates, let’s not’.   Seems like a good tradeoff from a risk-benefit standpoint.

Yes, I use the alcohol-based foam gels between patients, and when I pass a dispenser, and when I think about it.  I’m pretty obsessive about it.  I’m not advocating not touching patients appropriately, just seems like something we should be able to change.

Merck made a US Doctor hit list

This came out in the Australian version of the Vioxx suits:

Article from:  The Australian

AN international drug company made a hit list of doctors who had to be "neutralised" or discredited because they criticised the anti-arthritis drug the pharmaceutical giant produced.

Staff at US company Merck &Co emailed each other about the list of doctors – mainly researchers and academics – who had been negative about the drug Vioxx or Merck and a recommended course of action.

The email, which came out in the Federal Court in Melbourne yesterday as part of a class action against the drug company, included the words "neutralise", "neutralised" or "discredit" against some of the doctors’ names.

Don’t be evil.  It’s not just a Google slogan.

via Slashdot

Incoherent Support for “The Public Plan”

Shadowfax is reveling in the first 100 days of a new administration with glee, and as such would usually be allowed the customary adult ‘just ignore it’ pass, but at a certain point … an intervention is in order.

After an okay lead in we find this bit of Hope:

The other possibility is that the public plan will have some advantages due to lower overhead, executive compensation, provider networking, lack of profit motive, etc, which will lead to the public plan being cheaper, and thus patients would prefer the public plan and shun the private insurers.

The premise of this opposition is, however, based on some self-contradictory logic, and on an assumption that the public plan will have Medicare reimbursement rates.   If the goverment-run [sic] plan turns out to be an NHS-style nightmare of byzantine rules, rationing care, and bureaucratic interference in the doctor-patient relationship, wy [sic] would patients choose it?   Seems to me that the marvels of competition would ensure that patients would shun such a system and flock to the consumer-oriented private insurance plans.

This assumes a premise of a level playing field, wherein one side doesn’t a) have the ability to impose its will on the other through legislation and b) the same side that can skew the playing field can put its hand into the public wallet and extract as much money as it takes from the citizenry to outspend or bankrupt the private system, then it’s all gravy, from the progressive side of the world.  No more fat-cats, no more private payment schemes (they are schemes: I dislike Insurance Companies only a little less than Socialists) and everyone in a nice Government Hospitalization Facility, where we’re All Equal.

Attention Progressives: FREE equals MORE. Medicaid is exactly the horrible system he describes, a low paying, byzantine disaster that providers shun in droves, and for good reason.  Has this bad system driven those patients to paid insurance?  No.  It has driven them to ED’s by the family, but has not been in any way a social or medical panacea.  (Why? Because it has to be paid for, and States understand very well how Free=More and they’ve been paying for it.  For years.  States Are Aware.  They’re also very willing to shift this burden onto the US Govt. to get this spending off their balance sheets).  Expect States to be all for Universal Care, it’s self interest in action.

I’d welcome universal coverage for every American.  I would.  I also would welcome Space Aliens (with some reservations) and World Peace (with conditions).  Okay, I’m kidding, Aliens would bug me.  Socialism of 14% of the total US Economy (not the budget, the Entire Economy) bugs me, too.

GruntDoc’s Perquisites for Universal Care:

  1. Make MediCare work transparently, with understandable rules and payments on billing (and on time).
  2. Make Medicaid a fully-funded non-joke.  (It’s not funny.  It’s a tragic fraud, promising care to patients they cannot get, because the program is so awfully administered and governed).  (By the government we’re going to trust our healthcare to under this plan).
  3. Start an education program, today, with the focus on making everyone aware that We’re All Going to Die.  Spending on astonishing end of life and futile care is dragging all of us under now; imagine a future where our kids are paying for Everything for Everyone (remember: Free=More).  I won’t be surprised when our kids decide enough is enough and decide we’ve had all they’ll pay for, or worse, they’re not going to work to support this insane spending.

When people are no longer craven and Government is Efficient and Works, we’ll talk.  Until then, beware those who promise you the world.  Free=More.

» Features » putting the fun back into defibrillation.

ImpactedNurse » putting the fun back into defibrillation.

Heh.  I’d like one.  I doubt BioMed would let us plug it in, though.

Off label drug use and medmal suits: should there be “Truth” in labeling?

Pardon my silliness with “truth”, it’s an actual cause for concern.  The question is: should the FDA’s package insert be admissible in court as The Word in a trial involving off-label use?

Frankly, I’d never thought about it.  Fortunately, two legal scholars at the Northwestern University Law Review (one of whom happens to be a law blogger) have though it through, and answer nay:


The FDA approves prescription drugs and medical devices for only the specific uses indicated in the product labeling that the manufacturer submits in the approval process. A physician may determine, however, that a use not indicated in the FDA-approved labeling—an “off-label” use—would benefit a patient. This Article argues that in medical malpractice cases involving an off-label use, the product’s label should not be admitted as evidence of either the standard of care or the physician’s alleged breach of that standard.

I can think of two meds I use ‘off-label’, IV phenergan and haldol, neither of which are FDA approved for that route but which have proven themselves safe and very effective (for a long long time before I became a physician). (DWL: I know there’s no 100% safe drug).

Thanks to Mark Hermann, JD of Drug and Device Law for co-authoring this, and for giving me a heads-up.

What to do when you get a leech on your eye

Per our Australasian colleagues:

The Australasian College for Emergency Medicine has reported the first case of a leech being safely removed from a human eye.

A 66-year-old woman from Sydney’s north was gardening in March last year when she flicked soil into her left eye.

Doctors at the Hospital removed the leech from beneath her upper eyelid using a 3 per cent saline solution.

Read the very short article to get the story.  Try not to think about a leech being stuck to your own eye.

Now you know.  Also, try not to think about having a leech stuck to your own eye.

How scarce is ammo?


It’s so scarce it’s essentially a futures commodity now…These are prices for delivery in October.  It’s April.

This is from Sportsmans’  If you don’t have ammo by now you have some decisions to make.

Vid Chuckle

This is for the bio majors, and those to be…

Via Musings of a Dinosaur

4.19.1995 | Homeland Security Watch

4.19.1995 | Homeland Security Watch

14 years since Oklahoma City.  The above link brings it back home for me.

Quote too good to check


“A reporter interviewed one of the SEAL snipers that took out the pirates
and breathlessly asked, “what did you feel when you had to fire your rifle
and take another human being’s life?

The SEAL thought about it for a few seconds and replied, “Recoil….”

Hat Tip: reader Jim

A day I was happy to be an Emergency Physician

Even in a profession, most days are just days at work.  EM is no different: I’ve had a longer than normal string of Just Days.  I was due from a karmic EM point of view.

Karma apparently has a sense of humor, giving me one of the best/busiest days in years.  I won’t go into the individual patients, but they were desperately ill, a lot of them.  Our consultants were terrific, doing their part selflessly, happily.

The Nurses, techs and sundry other professionals were on their games (nurses especially), and it was a pleasure working next to them.

I knew these days were there, still.


The Family I didn’t think existed

I take care of a of of patients with dialysis.  Certainly not all of them, and not even a big percentage of the ones in my county a year, but I do see one to several per shift.  I see dialysis patients, I mean.

I see their families, too.  They’re people, in that they run the gamut from normal to abby, from pleasant to un, from selfless to ish.

The other day I had diagnosed a patient with xxx, and offered an MRI of the same problem, mostly to facilitate the patients’ and consultants’ interaction.

“Oh, we have to get to our evening dialysis appointment” says family member, quickly echoed by the patient.

What?  You’d rather o to dialysis than get the MRI (which is amazingly insightful and probably borne of experience, but I’m not certain.  At any rate I’m not going to argue against it).

“Okay!” says a stunned me.

People who want to get to dialysis.  Sometimes in the ED we wonder if they exist.  They do.

Prologue « Ten out of Ten

Prologue « Ten out of Ten
…So I’ve come a long way, surviving this adolescent growth spurt, with most of my teen angst now behind me. But it’s funny how life works, just as you find one career obstacle safely in your rearview mirror, another one pops up unexpectedly in front of you. And once again I found myself in unfamiliar territory, flying by the seat of my pants, trying to make the right decisions. It’s a long story that I’ll break up over a series of upcoming posts.

Start here, and read the follow-ons.  It’s The Nightmare for independent EM groups.