Archives for May 2010

How to Make Brownies, Pentagon-Style – Hit & Run : Reason Magazine

The Pentagon’s brownie recipe is 26 pages long.

via How to Make Brownies, Pentagon-Style – Hit & Run : Reason Magazine.

Yes, more government in healthcare is Just the Trick.

London Olympics 2012: Meet Wenlock and Mandeville, drips off the old block | UK news | The Guardian

London Olympics 2012: Meet Wenlock and Mandeville, drips off the old block | UK news | The Guardian.

Yep, when I think Olympics, I think of amorphous one-eyed cartoon-blobs.  Strong work!

Robot Avatar Lets You Go to Meetings without Actually Going There

Robot Avatar Lets You Go to Meetings without Actually Going There.

This will make wearing shorts during meetings a lot more acceptable.

My Medical Museum | Home

Michael Ostrovsky, over at MedGadget, had a terrific idea, and I’m glad to be even a small part of it:

Welcome to My Medical Museum Competition!
We want you to visit your local medical museum, and tell us about it.

Chances are, you live near a medical museum. Maybe it’s an overlooked building downtown, or a hospital library. Inside, you’ll find bizarre specimen, important documents, and yes, medical gadgets.

This contest is an opportunity to showcase your local medical museum’s treasures for the world to see, as well as to describe your local medical history and explain how clinicians and scientists in your area contributed to medicine.

The Grand Prize is a brand-new Wi-Fi 32GB Apple iPad.

via My Medical Museum | Home.

This looks like an excellent opportunity!  So, go visit your local medical library, write it up and sumbit it!  (Over there, though, not here…).

Super Sexy CPR: you won’t think about it the same way again

» Features » Super Sexy CPR..  Go over to Ian’s, and enjoy the hands-down most interesting CPR training video, ever.

Probably NSFW, that’s how interesting.

There’s been a Panda Sighting

I am an Emergency Physician and every day I go down the rabbit hole into the insane world of American Medicine.

via M.D.O.D.: My Favorite Year.

He’s over at MDOD.  Hasn’t lost his touch with the truth.

News Flash: Emergency Physicians frequently interrupted

via CNN, an Australian study on interruptions in the ED:

(CNN) — Interruptions in the emergency room may exact an unhealthy toll on patient care, a group of Australian researchers reported Thursday.

The researchers, from the University of Sydney and the University of New South Wales, found that interruptions led emergency department doctors to spend less time on the tasks they were working on and, in nearly a fifth of cases, to give up on the task altogether.

The researchers carried out a time-and-motion study in the emergency department of a 400-bed teaching hospital, observing 40 doctors for more than 210 hours.

So, an average of 5 hrs observation per doc.  Not bad, but not exactly an average of a full shift for any EM Physician.

They found that each doctor was typically interrupted 6.6 times per hour; 11 percent of all tasks were interrupted, 3.3 percent of them more than once. They calculated time on task and found that physicians spent less time on interrupted tasks than on uninterrupted tasks. In addition, doctors were multitasking 12.8 percent of the time.

That seems low to me, but my thoughts are anecdotal.  Sure, I can spend 30 minutes with no interruptions, then get 3 a minute for what seems like forever.

Other studies have shown that interruptions can result in lapses of attention, memory or perception, they wrote.

“Further, interruptions add significantly to cognitive load, increase stress and anxiety, inhibit decision-making performance and increase task errors,” they said.


The interruptions included a doctor being asked a question while trying to write a prescription.

“Now, most people think it’s very acceptable to interrupt,” but doing so can be dangerous, lead author Westbrook said. She urged hospital emergency department directors to teach hospital personnel when it is acceptable to interrupt and when it may be better to find an alternative strategy.

“We really have to look at ways to try and reduce unnecessary interruptions,” she said.


On average, doctors completed tasks that were interrupted once in about half the time they would have taken if they had not been interrupted. That perplexed the authors, who speculated that the interruptions led clinicians to try to compensate for the “lost” time by working faster and cutting corners. They said there was a strong need to develop processes that minimize unnecessary interruptions and multitasking.”Our results support the hypothesis that the highly interruptive nature of busy clinical environments may have a negative impact on patient safety,” they said.

Or, they stopped dithering and started making decisions.  We need fewer hypotheses and a specific study.

Other industries have recognized interruptions as dangerous, including the airline industry, which has developed strategies to reduce interruptions to the flight crew during takeoff and limited unnecessary communications with the cockpit.

“In our society, we get very used to interrupting each other,” Westbrook said. “Sometimes we need to stop and think about that.”

Yes, and I’ll agree right now that interruptions work both ways. to and from the doc.  The chaotic environment enables some less than wonderful behaviors, and one of those is a lack of respect for the time of others (people seem to like to talk to me while I’m working on the computer, when I need the most concentration, but I’m quiet and still, and therefore I’m chatted up).

All of us in the ED could do a better job on stifling interruptions, we need to focus on those times when we should not have any interruptions, and change behaviors from there (realizing that culture eats strategy every day).

Permian player is impostor | permian, player, bodytext – Breaking News – Odessa American Online

Guerdwich Montimere, a 22-year-old naturalized citizen from Haiti, was arrested Tuesday for posing as a 16-year-old sophomore named Jerry Joseph and attending Permian High School.

After being confronted Tuesday, Montimere, a star basketball player this year at Permian, admitted the deception and was arrested and charged with presenting false identification to a peace officer. Montimere was arrested at Permian and taken to the Ector County Detention Center. At press time he was in a holding cell awaiting booking.

via Permian player is impostor | permian, player, bodytext – Breaking News – Odessa American Online.


Funny, as I start typing this, the Sports Radio I’m listening to is talking about this, and brings up that the gals like the star athelete.  Let’s sincerely hope this doesn’t get worse…

HT: Glen in West Texas

Will Insurance Deny Payment if You Leave AMA? | WhiteCoat’s Call Room

Fifty seven percent of all health care providers (and probably just as many patients) believe that if you leave the hospital or the emergency department against medical advice, insurance companies will not pay for the visit. Half of doctors surveyed have told or would tell patients that insurance would not pay the bill if they left AMA.

via Will Insurance Deny Payment if You Leave AMA? | WhiteCoat’s Call Room.

Go and read for the answer, which surprised me, though not 57% worth…

Kudos to Bob

My son Bob just called to tell me he’s finished with Law School!  He took his final final today, and the academic weight is off him (and he sounds more energized than he has in months).

He had an abortive start at law school, which I mention only to praise him for his perseverance and hard work, and that stubborn, quiet ambition of his.

Now to study for the Bar exam (he’s in Florida, and will take it there), in late July, then off to work.  Setting him apart from most of his new-grad peers, he has an actual job offer, which is terrific!  (I half-jokingly asked once if he was going to need to move back into the basement, and he quipped ‘Then I’d literally be in-house Counsel”, which was clever).

Good for you, Bob, your Mom and I are terrifically proud of you.

Grand Rounds, May 11th Edition

Welcome to Grand Rounds, a weekly collection of excellent writings submitted by medical bloggers. The theme for this week is minimalism – I’m going to restrain myself and let the authors speak for themselves:

via Grand Rounds, May 11th Edition.

Up a little early.  I like the minimalist approach.

Another homeowner friend: Power Washer

The Happy Hospitalist has been doing some home improvement, and good for him!  Motivated to post by him, here’s some of my insight.  (This is the second in a series: go get a wet vac first).

I spent some of today working with one of my favorite homeowner tools, my Karcher power washer, which I bought a few years ago at Costco (at the behest of my brother in law, who assurred me I’d like it)(he was right).  I’ve rented a gas pressure washer, but didn’t want to have to worry about gas in the one I owned.  Also, there may be a better brand, but I’m perfectly happy with this one.

I use it yearly to clean my vinyl and aluminum siding, and to clean tree/bird residue from the porch, dirt from the drive/sidewalks, etc.  It’s satisfying, productive, and keeps me off the internet.  Win win.

Now, I’d like to tell you about your choice of accessories when you get any power washer: a wet suit or a set of extension wands.

Picture this: you’re washing eaves, things are going well, and cold, dirty water is raining down on you (which I did, before the extensions).  Or, you can attach the extension wand, and clean from the relative dryness of several feet away, and not get the dirty rain. The wands also allow you to clean higher without getting on a ladder (which I don’t like, especially with water in use).

Today, the front and dirty side of the house.  In a week or so, out comes the man lift, and the rest of the house.

Don’t forget the wet suit.

MedBlog Grand Rounds 6:32: The Non Narcissist, Non Personally Aggrandizing Edition

I’m pleased to host this roving blog carnival, and thrilled suitably humbled to be the first 7 time host.

Which is a terrible way to start this, the first Non-Narcissist, Non Personally Aggrandizing MedBlog Grand Rounds, and thanks for putting up with my first theme. 31 submissions from 23 submitters makes this theme viable, and well-attended.

Editor’s Pick:

Where romance and medicine collide

by Movin’Meat.  A tale you’ll retell.  Recommended by Musings of a Dinosaur.

Most Recommended Post:

Why We Need Private Primary Care Doctors

from Musings of a Distractible Mind, recommended by both ACP Internist and Musings of a Dinosaur.

The  body of work, in order of receipt*:

On call- tips from the trenches by Dr. Grumpy (self descriptive), and Only in the Country: Sunshine by Dr. Sanity (people with decompensated psych problems are usually interesting), both recommended by Melissa.

Questioning ‘one in four’ from Mind Hacks (a cogent analysis  of whether that’s the right ratio of people who will have mental illness at some point) recommended by Dr. Shock.

significant moments from other things amanzi (peds and surgery mix poorly) recommended by Jill of All Trades, MD.

Boyfriend Doesn’t Have Ebola. Probably. *UPDATED* from Hyperbole and a Half.  The title has nothing to do with the subject: the funniest, most accurate facial pain scale chart, ever.  Recommended by How to Cope with Pain.

Story-telling in the Age of Corporate Medicine (or more on being called an AIDS denier) by Mad in America is his reply to reviews of his book, which is done well.  Recommended by Behaviorism and Mental Health.

This is what you don’t want to think to yourself upon entering a room: by Head Nurse about the thought and action process (just go read it).  Editorial: awesome and prolific nurse blogger, who you should add to your daily reads.  Recommended by Geena of CodeBlog.

Are WHO rankings entirely worthless? from Healthcare Economist points out an astonishing flaw in the WHO’s ranking measurements.  Recommended by InsureBlog.

The Estrogen Dilemma – Hope, Hype or Just One Woman’s Story? from TBTAMLife, Death and Everything In Between by A Day in the Life of an Ambulance Driver,  Numbers by Dr. Wes (who knew a Navy man could rhyme polite words?) and  choice by OncRn were all sumbitted by #1 Dinosaur, who also happens to have a book!

Blood Pressure Control: No Excuses. Just Do It! by is self descriptive, and was recommended by Common Sense Family Doctor.

Primary Care shortage Predicted to Worsen by Everything Health is sobering, and worth the time.  Recommended by ACP Hospitalist (not to be confused with ACP Internist).

Doctors Push to Change “MD” Titles by M.D.O.D. was described, correctly, as gallows humor.  Recommended by Doc D.

The next all-natural blockbuster drug by Common Sense Family Doctor may just be onto something.  Recommended by Dr. Pullen, indicating a mutual-admiration society.

The Golden Smile by StorytellERdoc and Basketball by Methodical Madness are both excellent stories, recommended by Suture for a Living.

Life cycles is from Medical Moments, a nice story in 55 words.  Prose needn’t be wordy to be powerful.  Recommended by Muse, RN.

Gutter, by intueriDr. Charles knows how to pick ’em.

Through my husband’s eyes… by Olivejooice is an homage to her husband for being there (outstanding).  Recommended by Instructions Not Included.

Sugar-Sweetened Beverages by Dr. Paul Auerbach, one of the powers in Emergency Medicine, recommended by Dr. Jolie Bookspan (now blogging on Twitter!).

Coping, and her Wellness Section by Chemobabe were recommended by Doc Gurley (whose posts about her volunteer efforts in Haiti are not to be missed).

Money Matters by MerryCherry, MD shows the Phillipines have trouble with health costs, too.  Recommended by Dr. Emer who submitted his complimentary post.

EHR Certification – A Delicate Balance by On Healthcare Technology shows acronyms aren’t just for medicine, HIT has plenty (and on a serious not argues whether we should be trying to certify EHR’s).  Recommended by Occam Practice Management.

Pre-emptively, the Grand Rounds post you’re reading now was recommended by The Happy Hospitalist, making him very funny!

Last but certainly not least, Paucis Verbis Card: Vasopressors and Inotropes for Shock in Academic Life in Emergency Medicine is a very nice pocket reference card for the pressors.  Nice! It was recommended by Blogborygmi‘s Nick Genes.

(*=except for these) And then, the Old Fashioned submissions:

Do Antidepressants Really Work? from A Better View, and Is That A T. rex Up Your Nose? New Species of Nose-dwelling Leech Discovered From Living the Scientific Life were auto-submitted.


Would you please include a request for submissions to the May 13 Change of Shift rounds at the end of your Grand Rounds post? 
Details for the theme are at my site (, but the reason I’m asking for your mention is that it would be extra special to include and refer blogs/ posts from the doc group on the topic of “The Greatest Nurse I’ve Ever Known….” in honor of National Nurse’s Week.

Submissions no later than 5 pm your time, May 12.

End Notes

All Hail Nick Genes, the creator of MedBlog Grand Rounds! (I know, but it’s a requirement now).

The next installment is at The Examining Room of Doctor Charles.

Thanks to all for participating!

Running a hospital: I was wrong. I am sorry.

I’ve been able to study Paul Levy’s management of BIDMC during several classes (more on that someday), and he’s a smart guy.  Which makes this dumbfounding, if humanizing:

The Board of Directors of BIDMC today issued the following statement, which has been distributed to the media and to the entire hospital community.

The Board of Directors of Beth Israel Deaconess Medical Center, with the assistance of outside counsel, has completed its review of allegations made involving President and CEO Paul Levy. The review focused on a personal relationship with a former employee of the Medical Center. The Board found that over time the situation created an improper appearance and became a distraction within the hospital.

via Running a hospital: I was wrong. I am sorry..

Good for him, and I doubt this is going to be enough.  There’s a scandal worth and immediate $50K penalty and the threat of more in contract negotiations.

Time to call Oprah, or something, and do it All at Once.  Get it all out (and don’t hold back, a la Tiger), etc.  People will forgive bad judgment, they will pillory you for a cover up.

It’s going to come out, so Just Do It.

GruntDoc is Eight today

Eight years ago today, this inauspicious effort began.  I had no idea where it would go, where it would take me, how long it would last, or what I’d do with it.

Time hasn’t answered any of those questions, except ‘at least 8 years’.

Thanks Mom, and my other 9 readers, for checking in now and again.