Archives for June 2010

MGH launches ER finder for iPhone – White Coat Notes –

Researchers from the Emergency Medicine Network at Massachusetts General Hospital today launched a free application for the iPhone that will tell you where the nearest hospital emergency rooms are in the United States, along with directions and other information designed to help people away from home.
via MGH launches ER finder for iPhone – White Coat Notes –

I tried it, and it worked very well for me (not needing it, just testing it out).

Oddly, the blog article tells all about it, except its name (true, it’s in the headline but that looks like a generic description, not the app name) which I had to watch the video to find. It’s EMNet findER, free in the iTunes app store.

I cannot think of a reason not to have this on your iPhone, especially if you ever travel.

Update: from Richard Winters (twitter) (blog):

@gruntdoc do they have an app that finds a consultant who doesn’t call back? or one that finds my stethoscope?


Other needed apps:

ER FindMyNurse – patient
ER FindMyDoc – patient
ER Find the Nurse I need – doc
ER BoxLunchMenu
ER INeedAMiracle – everyone…

Got an ER app you need?  That’s what the comments are for…

Captain Atopic : Degranulated: Inspiring Rider

Captain Atopic : Degranulated: Inspiring Rider.


Teaching advanced combat first responder care in Iraq

Story by Sgt. Ben Hutto, 3rd HBCT, 3rd Inf Div PAO
Photos courtesy of Sgt. Deshon Bell, 203rd BSB

CONTINGENCY OPERATING SITE KALSU, Iraq – Ten policemen from Babil and Karbala provinces graduated from the 3rd Heavy Brigade Combat Team, 3rd Infantry Division’s tactical combat medical care course at Contingency Operating Site Kalsu June 15.

The five-day course was designed to teach students practical ways to treat combat injuries.

“It is an advanced first-responder course,” said Staff Sgt. Timothy Mollett, a medic assigned to Headquarters Company, 2nd Battalion, 69th Armor Regiment. “Most of them know the basic things like clearing an airway or stopping bleeding. What we do is break everything down to the basics and build from there.”

Both medics said the course was more about demonstrations and exercises than formal classroom instruction.

“They are just like [U.S.] Soldiers,” said Mollett, a native of Columbus, Ohio. “They don’t like slide shows but love hands-on training. They learn better that way, too.”

via Digital Video & Imagery Distribution System.

I’m glad ‘normalizing’ operations are still going on, and that it’s their 8th 5 day class there’s a good amount of support for this mission from both sides.

(I was contacted by someone and alerted to this story.  Thanks!)

Why I’m not ranting about the 21% SGR cut

It surprises me more than you.

This (the 21% SGR cut (backgrounder)) is typically just the match to get my fuse lit.  And now that I’m facing a 21% pay gut from my single biggest payor, I’m not really angry about it.

Wary of the change to my income, which will be some but not a huge amount (I hope); weary of the political machinations of a few smart, well intentioned elected representatives on both sides of the aisle and the legion of mouth breathers that fill the rest of the chamber.

It’s been SGR pong for about 10 months now, with patches, band-aids, clever financing and a lot of we’ll kick that can a bit more.  I was energized against the cuts back when they were happening several band-aids ago (and this game of congressional chicken has been going on for a decade at least), and I think I’ve finally reached an emotional exhaustion point.  Frankly, I’m glad it’s happened.  (That girlfriend who kept threatening to leave finally did, and you feel sad but actually liberated, as the BS finally stops).

I sincerely hope this cut stays in place for several more months, maybe a year.  It’ll be instructive to a lot of us, one way or another, on whether a massive and massively underfunded entitlement program can be effectively overhauled, or whether we’re doomed financially.  Greece without a bailout, unless it’s in Yuan.

I hope every provider out there who doesn’t have to take Medicare drops it. Yes, they’ll see Grandma, but bring your checkbook.  (If enough dropped their Medicare, congress would have to include a re-sign-up amnesty rather than enforce the 2 year restriction on re-signing, lest the fix have no one to practice it).  And if Medicare isn’t fixed, well, they lost nothing.

(Some medical economist out there has to know this: at what point would shedding the myriad rules (and attendant paperwork, and administration, i.e. overhead) pay for itself in just opting out, as a hospital or system?  If nothing else that would make pricing for hospital-based care very price transparent, and competitive.  I wonder how many people in the carpeted zone exist only to serve the unfunded governmental mandates?  I’d be willing to be nobody knows, as it’s such a crazy idea, and it’s an industry that’s just beaten down with so many rules, and mandates.

So, I have no real fight on this topic left.  It’s abundantly clear neither party wants to fix this, which is more than depressing.

Also, a full apology to MovinMeat over at allbleedingstops.  I took him to task in the comments to this post for being a Single Payor advocate, forgetting that he’s not been one, ever so far as I can recall.  I got that part wrong.  (The rest stands).

However, those who’ve been advocating a Single Payor system, imagine the fun of doing this kick the can routine, brinkmanship, etc, for all the health-care in the US.  Continually, like we’re doing now with a small part they cannot either fix or control, SGR.

So, see?  Not ranting.

Update: While I was writing this:

June 24, 2010 — After another week of tough political wrangling and more twists and turns than a roller coaster, a 6-month “doc fix” that rescinds a 21.3% cut in Medicare reimbursement to physicians passed the House of Representatives tonight, 417-1.

The bill, which is retroactive to June 1 and also provides a 2.2% rate increase, was passed by the Senate on June 18 and will now be sent to President Barack Obama for his signature.

Emergency Medicine Excellence Award™

Emergency Medicine Excellence Award™

HealthGrades Identifies Hospitals Among the Top 5% for Emergency Medicine

HealthGrades is proud to announce that the first annual analysis of hospital emergency medicine programs found that the best-performing hospitals consistently outperformed all other hospitals for all eleven cohorts studied.

via Emergency Medicine Excellence Award™.

Neat, especially as Giant Community Hospital, where I humbly serve in the ED, is on the list.  As we got the award, I will not question, or even investigate, the methodology…

Nice to be noticed. | Relief from EMTALA at last! Call the Dept. of Labor!

But today, dear colleagues, it’s all better.

via | Relief from EMTALA at last! Call the Dept. of Labor!.

I’m thinking some calls to the toll-free number are in order.

NEJM This Week iPhone App

The New England Journal of Medicine (NEJM) has released an iPhone app called “NEJM This Week”

via NEJM This Week iPhone App at MedGadget.

Very nice!

Man Survives Bullet in Head, Being Hit by Truck – CBS News

(AP) A spokesman for a South African emergency service says a man has survived after shooting himself in the head and then being hit by a truck.

via Man Survives Bullet in Head, Being Hit by Truck – CBS News.

If South Africa has a lottery, this guy should buy himself a ticket.

Sky Talk: American 777 loses door at D/FW

American 777 loses door at D/FW

Deplaning didn't go smoothly Tuesday morning for an American 777.

Apparently, an American Airlines flight arriving at Dallas/Fort Worth Airport lost its door in a Terminal D jetbridge.

via Sky Talk: American 777 loses door at D/FW.

Heh.  And, ow.  Nobody injured, fortunately.  A career or two may have gotten dinged, though…

» the funnybone. » Get fit using medical equipment.

» the funnybone. » Get fit using medical equipment..

Umm, I’d break the pole if I tried it, but not interfere with this health care provider.

…and that’s when I shot wine from my nose…

I was having my occasional glass of red wine with dinner (it’s AMA approved, and possibly cardioprotective, plus, I like it), having a conversation with my grandson, who’s 10ish.  (I don’t now his exact age; I’m not one of Those grandparents, and to be fair, I wasn’t one of those parents, either).

Just to have some fun with him, because I figured he’d think it was silly, I decided to start spelling some words when chatting with my wife at the table.  As in “I think if I s p e l l some words h e won’t be a b l e to understand what w e are saying”.

“I can’t keep up, you spell too fast” was not the response I thought I’d get and …see title.

Fun having family visit.  I need to help him with his spelling, though.

A Cartoon Guide to Becoming a Doctor: The med student gunner: profile

A Cartoon Guide to Becoming a Doctor: The med student gunner: profile.

Nice one…

via Doc_Rob on twitter…

Cheaters Never Win (and sometimes they have their Board Certification stripped and get sued)!

From Wachter’s World, which he prefaces with:

As a member of the executive committee of the American Board of Internal Medicine, I can’t provide too much of the inside scoop, so I’ll mainly point you to the published descriptions of a remarkable case: that of one Dr. Arora, who ran an ABIM board review course with a difference.

Good for the ABIM.  If you need to cheat to pass the Boards, you don’t need to be Board Certified.

Philadelphia, PA, June 9, 2010 – The American Board of Internal Medicine (ABIM) took formal action today to sanction 139 physicians for soliciting or sharing confidential examination questions used to certify doctors in internal medicine and its subspecialties. ABIM has also initiated legal action in the U.S. District Court for the Eastern District of Pennsylvania last week against five physicians who were among the most egregious offenders.

Through an extensive investigation, ABIM established that the physicians being sanctioned shared or solicited actual ABIM examination questions – a significant breach in the professional standards ABIM requires of all of its board-certified physicians and any physician taking the exam for certification. Hundreds of questions were compromised and immediately removed from the ABIM exam question pool.

via ABIM News | News | American Board of Internal Medicine.

(emphasis added)

For the test to mean something, it has to be, you know, a test.  Not a test where you remember the question and know that answer, but a test wherein, when faced with a question, you know the substance of the material, are able to apply reasoning skills and arrive at the correct result.

I’d think the hospitals these docs practice at (and the states that license them) would be very interested in the circumstances surrounding their loss of board certification.  They could very conceivably lose more than their boards…

intueri: to contemplate

Zippy Goes to Times Square.

via intueri: to contemplate.

Yep.  The Zippy I took to the Bahamas in now in the concrete jungles of NYC.  Fortunately, with a guide / author fully up to the task.

(Zippy has certainly become more, how can I put this, sophisticated, since he was with me…).

Hospital uses armed man in unannounced drill – Saturday, May 29, 2010 | 2:01 a.m. – Las Vegas Sun


Hospital uses armed man in unannounced drill

Test of security procedures results in frightening moments

By Marshall Allen

Saturday, May 29, 2010 | 2:01 a.m.

How’s this for an ill-conceived emergency preparedness drill? An off-duty cop pretending to be a terrorist stormed into a hospital intensive care unit brandishing a handgun, which he pointed at nurses while herding them down a corridor and into a room.

There, after harrowing moments, he explained that the whole caper was a training exercise.

via Hospital uses armed man in unannounced drill – Saturday, May 29, 2010 | 2:01 a.m. – Las Vegas Sun.

Wow.  Terrorizing the nurses in the name of preparedness.  Wong on so many levels it’s mind-boggling.

Hat Tip: reader Eric B