Archives for October 2010

Online doctor ratings aren’t very helpful –

By Kevin Pho

When I ask new patients how they found me, frequently they say on the Internet through search engines such as Google.Out of curiosity, I recently Googled myself. Numerous ads appeared, promising readers a “detailed background report” or a “profile” of me. Among the search results was information about my practice, whether I was board certified, had any lawsuits against me, and reviews from online doctor rating sites. Thankfully, most were favorable, but some were not.

via Online doctor ratings aren’t very helpful –

Kevin, MD, who else?

Great work Kevin!  (I shook his hand once, might have been my brush with fame).

Dr. Wes: Accountable Care Organizations: It’s So Sad, It’s Funny

Dr. Wes: Accountable Care Organizations: It’s So Sad, It’s Funny.

Go and watch the video.

If you’re in medicine, you’ll get it.

If you’re not, you’ll still appreciate the clueless humor.

President Lyndon Johnson nearly shot dead by Secret Service agent… hours after JFK assassination | Mail Online

President Lyndon Johnson was milliseconds away from being shot dead by a Secret Service agent – only 14 hours after John F. Kennedy’s assassination, a new book has revealed.

via President Lyndon Johnson nearly shot dead by Secret Service agent… hours after JFK assassination | Mail Online.

Interesting.  Here’s the funny part.

Oh, dear.

You know that patient you saw yesterday…

…another in a series.

“You know that patient you saw yesterday?” was how the conversation started.

I did remember, it’s not often I Find the Pony, diagnostically.  A good case, which from my aspect means I had to think, act, and make things happen. Yesterday I was quite pleased with myself.

Now the ‘do you remember’ intro. Never good. Never.

A colleague tells me how the patient I saw yesterday (and made a couple of good, if odd-to-present-at-the-same-time diagnoses) died while getting an x-ray study, in the ED, when one set of their symptoms returned. (Sorry for the vagueness, thank a room full of lawyers who are afraid of their shadows and have rubber sheets).

Darn. The day before, the patient was doing well, thanks to a good diagnosis and getting the right people to buy in and act. And now my patient is dead, from one of the same diagnoses.

Lifetime death rate: 100%. I do what I can, we all do.

But 100% is an absolute. Sorry.

» Features » how NOT to pee in your scrubs…

» Features » how NOT to pee in your scrubs….

Genius.  Go, watch, and learn.  (Hint, it’s not just for scrubs…)

Joe Gibson Memorial Foundation – Home

Joe Gibson Memorial Foundation – Home.

I hadn’t heard about this, and while it’s probably a little late to start training for a 10K race being held tomorrow in Arizona, this looks to be a worthy foundation and a regular event.

What got my attention:

Joe Gibson, MD was a Phoenix Emergency Medicine Physician who had dedicated his life to saving and helping people in need. He was known to have a happy, infectious personality and a zest for life. A lifetime athlete, Joe spent time training and participating in triathlons and running races to balance his life and to stay healthy.

On December 29th, while on a training run in Phoenix, Joe was hit by a car. He sustained massive head injury and brain death. Even after this tragedy, Joe continued to give back as he became an organ donor and was able to save 4 lives with this last parting gift.

He was obviously loved, and he lives on through this foundation.  Inspiring.

Army finds simple blood test to identify mild brain trauma –

FREDERICK, Md. — The Army says it has discovered a simple blood test that can diagnose mild traumatic brain damage [TBI] or concussion, a hard-to-detect injury that can affect young athletes, infants with “shaken baby syndrome” and combat troops.

“This is huge,” said Gen. Peter Chiarelli, the Army vice chief of staff.

via Army finds simple blood test to identify mild brain trauma –

Yes, it is, if it pans out.  There’s so little actual information in this it’s hard to get excited about it, but let’s say they’ve isolated a ‘brain injury’ protein.

First, it would have uses outside TBI, though that in and of itself might be useful.  I don’t want to poo-pooh this test for TBI, but there are already rules for returning to contact sports (and combat has to be the ultimate in contact activities), so what’s the purpose here?  (I forsee more Purple Hearts, which is fine…).

Stroke?  TIA? Seizure?  Pseudotumor cerebri, as a strain indicator? What if this is the test that allows us to diagnose meningitis without doing lumbar punctures?  I’m all in on that front…

Let’s hope this pans out, for all our sakes.

Knowing when it’s That Time

Knowing when to stop trying to save people is hard, especially when that’s how you’re trained, and innately wired.  It’s been a frequent theme on this blog.

Movin Meat has a good post on the subject today (weeks ago, just found this in my drafts folder), and it’s remarkable for two reasons.  First, it’s a well written account of doing the right thing, even though that’s much harder than the easy thing, and secondly, the power of convincing medical writing to influence the actions of physicians.

Movin Meat specifically cites thinking about the recent Atul Gawande piece in the New Yorker, which helped him make sure the option of how to die was presented to the patient and family.  That’s good writing, and it’s something the world could use more of (as long as it’s not preachy, or gratuitously political).

The World Death Rate is steady at 100%.  There’s nothing at all comforting, comfortable or holy about dying on the vent in the ICU.  Talk with your family about what you do, and don’t want.

Google Earth on Port Au Prince Haiti Airport

I hope this is a combination of satellite photos of the airport that just happens to have a very busy runway…

Y'all be careful out to embiggen


This is a pretty neat tool for docs.  I’ve signed up (free), have it on my iPhone, and will see if it’s super-useful.  Maybe not for an EM doc, but time will tell.  It’s at

The biggest plus I see right off is the HIPAA compliant SMS texting, which would make some communications available we just cannot now.

At any rate, check it out and see if you like it.  I find the web interface easier for adding colleagues, but maybe that’s just me.

YouTube – Doximity.

One happy thing I got from this is a list of all my medschool classmates, and where they are now.  A surprising number are in my area, and more than a few are in EM!

It’s 10:10:10

I don’t know what it means either.

I suspect it means numbers as we know them increment in a series, and that we’re just superstitious enough to wonder at the result.

Tumortown | Culture | Vanity Fair

Still and all, this is both an exhilarating and a melancholy time to have a cancer like mine. Exhilarating, because my calm and scholarly oncologist, Dr. Frederick Smith, can design a chemo-cocktail that has already shrunk some of my secondary tumors, and can “tweak” said cocktail to minimize certain nasty side effects. That wouldn’t have been possible when Updike was writing his book or when Nixon was proclaiming his “war.” But melancholy too, because new peaks of medicine are rising and new treatments beginning to be glimpsed, and they have probably come too late for me.

via Tumortown | Culture | Vanity Fair.

An excellent writer describing his cancer experience.  Not to be missed.

Destitute Companies Get Health Insurance Pass From Feds | WhiteCoat’s Call Room

Why repeal the new health care law? Just get a waiver so you don’t have to comply.

via Destitute Companies Get Health Insurance Pass From Feds | WhiteCoat’s Call Room.

Terrific post.

It’s also a disgrace.  It’s disgraceful that big companies continue to get anything they want from our increasingly dysfunctional government.

I am not an Obamacare fan, and would like it repealed, with smaller, more focused Bipartisan fixes, but if the government is going to pass something then roll over this easily to special interests… it’s already worse than useless.

CAF Airshow this weekend

The Commemorative Air Force airshow is this weekend, in Midland-Odessa. It’s been years since I went and want to go again someday (the only flying B-29 flew today in preparation).

If you’re in driving distance, it’s an amazing event.

HT: Sleepless in Midland

Standard of Care Project at EP Monthly

The Power of Agreement

We can stop baseless malpractice suits before they get started. How? By having a majority of practicing emergency physicians go on record as to the baseline “standard of care,” beneath which is negligence.

via Standard of Care Project at EPMonthly.

This has been rolling for a while, and I’ve been late to blog it.  That does not, in any way mean I’m not 100% FOR it.

The idea is beautifully simple: the Standard of Care in Emergency Medicine should be set by practicing EM physicians, not case-by case in courts before lay juries with battling experts.  (AAEM had the ‘remarkable testimony’ series as a retrospective attempt to shame ‘experts’ who gave, well, remarkable statements under oath, which to date has two cases in it).

This has the very real advantage of being a clear, concise peer statement that this is / is not the Standard of Care.

I voted (while at ACEP).  If you’re an Emergency Physician (and you have to cough up some information to determine your bona-fides before you can vote) go to the Standard of Care Project, and cast your vote.  They have set the bar at 30,000 votes, which is ambitious.  It’s also worth it.