12 STI’s of Christmas, 2010

My yearly Christmas favorite, reposted:

Courtesy of the British National Health Service:

Hmmm.

NSFW. Funny, but Unsafe for work, unless your work involves STD’s in which case it’s required.

It’s my seasonal favorite post, and I hope it’s one of yours.

Not the STD’s, the funny song with equally amusing illustrations. The backstory, from a previous blog post:

I have seen several searches of this blog for the British National Health Services’ “12 STI’s of Christmas“, and wondered why. The answer: the NHS site no longer carries the wonderful show, for reasons unknown to me. As for the searches, I guess the Christmas season has people thinking about sexually transmitted infections (diseases on this side of the Pond) set to Christmas tunes.

Merry Christmas!

Want To Avoid Unnecessary Tests? Stick To One ER, Researchers Say – Kaiser Health News

On a recent Friday night at the Boston Children’s Hospital ER, Dr. Fabienne Bourgeois was having difficulty treating a 17-year-old boy with a heart problem. The teen had transferred in  from another hospital, where he had already had an initial work-up – including a chest X-ray and an EKG to check the heart’s electrical activity. But by the time he reached pediatrician Bourgeois, she had no access to those records so she gave him another EKG and chest X-ray. He was on multiple medications, and gave her a list of them. But his list differed from the one his mother gave doctors, neither of which matched the list his previous hospital had sent along.

via Want To Avoid Unnecessary Tests? Stick To One ER, Researchers Say – Kaiser Health News.

This is excellent advice.

Every ED has seen a patient, probably today, with “they saw me at the ER across town, but they didn’t do anything and I’m still sick”.  While it makes some sense not to return to a restaurant that gave you a meal that wasn’t to your tastes, medicine is quite different.

If a patient gives me this history, I now have a blank slate, and need to essentially start at zero with them.  So, I will do the correct workup to exclude the life threats based on the history and physical exam, which may be exactly the tests they had yesterday.  I’m not going to assume they did the same tests, or that they were normal.  It’s the standard of care at this time, and I have very very few alternatives.

Let’s flip this around: it’s a patient we saw a day or three ago who comes back to us and says “I’m not better”, that’s so much better for the patient, and us!  We have immediate access to their records and tests, and will not have to repeat studies we already know the result of.  Therefore, the patient avoids unnecessary testing, and gets better care.

Yes, you say, you could get the records from the other hospital, and the answer is, maybe, someday, better during M-F business hours (when hospitals are set up to work, still), less on Sunday AM on a 4 day weekend.  Someday EMR’s will be inter-operational, but frankly that’s going to require legislation as hospital systems want to own ‘covered lives’ and they see contro of medical records as proprietary information as theirs and theirs alone.  (Also, who’s going to spend money to give away their information)?

So, stick to one ED.  Yeah, sometimes you have to go back a couple of times.  That’s okay.  It’s the right thing for you.

The Milwaukee Rabies Protocol

In case you wondered what was required to diagnose, and how to treat potentially successfully, rabies.  This is from the place that had a neurologically intact survivor (some damage but functional, which beats the norm).

The Milwaukee Rabies Protocol (.pdf)

via Notes from Dr. RW