Archives for January 2011

Yeah, I’m alive

I’m in one of those phases where feeding the blog is a) not a priority and b) a potential liability, so it’s one of those things.

It’s not that I don’t like all 9 of you readers, I do.  It’s just that with the repeal of the 24 hour day I have less time to get work/family/TV/CME/all that other stuff in.  2/3 of my kids have been home for a while, it’s been terrific, and tomorrow I go down to 1/3, keeping the lawyer.  Go ahead, tick me off, and find out what having a temporarily unemployed lawyer at the other end of a complaint feels like.  He’d like me to tell you that’s a joke, so it is, because he says it is.  That’s what a decent legal education gets you.

My medical practice is smooth, and I’ve given a couple of talks to groups recently, so that’s fun. I talked for medical CME about whether non-contrast of the abdomen is ready for ED use (short version, no), and it was decently well received; yesterday I spoke to a nursing CME conference, ditto.

If you’re an ED doc and you haven’t at least looked at how to manage patients who come to your ED with a ventricular assist device, catch up.  They are no longer locked up in the CCU, they’re now being sent home with them.  This wouldn’t be a problem except they break a lot of rules… like no CPR if pulseless, etc, and some of these are designed to be pulseless.  You can see the problem.

As for the liability, I’m getting more leadership/responsibility roles, but middle management types can’t blog those.  Paul Levy can, as a CEO, but nobody in the middle can, and it makes sense to me.  Lacking amazing stories of management (and I wonder if there are any), nada to blog about.  Hold your breath for the reports from my addition to the hospital Bylaws Committee.  Yeah, crazy stuff.

On a professional note, I’d like to alert all me ED colleagues that apparently a) jeans are no longer pre-washed before sale b) adolescent females don’t wash them before wear, and c) you’ll see patients in the ED with inexplicably warm yet blue extremities.  Connect the dots, win a prize.  I’ve picked up 3 of these recently (that have seen other docs who haven’t connected the dots), and have added alcohol-preps to my skin exam in select cases.  Awkward diagnosis, and rewarding.  (The key is warm, blue extremities but the skin discoloration skips the ‘between the digits’ areas).

I’ll be here. Thanks for checking in. | The Practice Test; my latest book!

practice test

Well, here it is at long last!   My third book.  It’s called The Practice Test, and it’s about how we can face the struggles of medical practice with more balance and perspective.  How many docs knew every scientific and clinical question necessary to pass board, but were never prepared for life as a doctor?  Most, I’d say.

My book is set up like a parody of board exam questions, and it’s suitable for aspiring physicians, retiring physicians, practicing physicians, medical students, residents, medical spouses, educators, policy-makers and even patients who want to understand their doctors a little better.  And if they want to buy one for their physicians, I won’t mind a bit!

Here’s a link to read about it, look inside and  order it if you desire. | The Practice Test; my latest book!.

Hope he doesn’t mind me swiping nearly all of that post!  He’s a terrific writer, and I’m willing to bet his book will be excellent.  Follow the link, and order away!

Proposed Law would Ban Docs from Asking if Patient Owns Gun | | Local News

TALLAHASSEE, Fla. — A state lawmaker has filed a bill that would ban doctors from asking their patients if they have a gun in the home.

Rep. Jason Brodeur, R-Sanford, said he has heard of a number of cases in which doctors asked their patients that question, which he thinks should be off limits.

“What we don’t want to do is have law-abiding firearm owners worried that the information is going to be recorded and then sent to their insurance company,” he said. “If they’re on Medicaid maybe it’s sent to the government. If the overreaching federal government actually takes over health care, they’re worried that Washington, D.C. is going to know whether or not they own a gun and so this is really just a privacy protection.”

Under the legislation, a doctor could face a fine of up to $5 million or be sent to prison for up to five years for asking about guns in the home.

via Proposed Law would Ban Docs from Asking if Patient Owns Gun | | Local News.

Oh, geez.  I understand the stated intent as recorded in this news item: gun ownership is being recorded, lots of things are reported to insurance companies and the government, and this bill is an attempt to keep this information out of those circles, at least as obtained in a doctors’ office where people still believe what they say is between them and their doc.  It should be, but lots of things should be absolute aren’t.

Also, as a gun owner, I’m aware there are individuals and groups who want to do away with private firearms ownership.  I don’t believe in black helos or vast conspiracies. I do believe that given the right crisis guns have been grabbed on flimsy pretense (New Orleans after Katrina, for instance).  I do not believe making more lists of gun owners is a terrific idea. (Standard ‘no violent felons’, etc disclaimer here: if you’re not allowed by law to have them, then don’t, and I won’t cry when yours are taken legally).

Guns are able to be kept safely in homes provided the gun owners (and parents of children) exercise diligence. I think pediatricians asking about guns in the home (providing it’s not “Do you have an Eeeevil Gun! Gun! in your home?!) can be useful to prevent tragedy. Before you start typing, shot kids are a tragedy.  A preventable one, when precautions are taken; from a public health standpoint asking about guns in the home is on par with car seats from a ‘used right’ standpoint.  One dead kid from an unsecured weapon is too many.  Shot adults are a similar tragedy, but they’re not the group impacted by the usual docs (pediatricians) asking about guns in the home.

And now: this law is wrong.  I have no doubt it’d be overturned in court as a restriction on speech (which it certainly is), and it’s, well, kinda dumb. Want to keep lists like this out of the hands of insurance companies and Medicaid? Use you legislative authority and prevent them from keeping such lists.  Problem solved, nobody’s free speech rights are infringed, and docs can get back to public health interventions.

(As an adult ER doc I never ask this: I live in Texas and presume everyone has a gun in the home. Also, ER doc…).

Oh, and my personal way to prevent firearms accidents in kids: lock them up (the metal things) until they’re old enough to get right from wrong, then demystify the guns.  They’re no longer forbidden objects to be sought out, they’re tools they know about, know (generally) how they work, and to leave a house where their friends find a mysterious gun.

Update: The Volokh Conspiracy weighs in.  I’m in good company, though it’s troublesome the author feels there’s legal authority to restrict doc-pt speech.  via Snowflakes in Hell (a terrific, frequently updated gun blog).

The 2010 Medical Weblog Awards Sponsored by Epocrates and Lenovo

The 2010 Medical Weblog Awards Sponsored by Epocrates and Lenovo

Welcome to the 2010 Medical Weblog Awards! It is time to celebrate and showcase the original reporting, engaging writing and discussion, breathtaking multimedia, and the spirit of community in the medical blogosphere. This is the seventh year of the competition and these awards are designed to highlight the exciting and useful role that the medical blogosphere plays in medicine and society. This year’s competition is sponsored by Epocrates® and Lenovo®.

via The 2010 Medical Weblog Awards Sponsored by Epocrates and Lenovo.

Yes, I’ll be helping judge even though they got my name wrong (fixed). Bad pub better than none?  You decide.  (Why do I get to help judge? Because I won the first one, that’s why.  I think.)

BTW, go THERE to leave submissions, not here.  And may the Best Blogs win!

Top Winkler officials indicted | indicted, winkler, officials – Government – Odessa American Online

KERMIT Two Winkler County officials and the former hospital board administrator were indicted Thursday on charges related to the 2009-’10 case of the two whistle-blowing Winkler County nurses, according to  court documents obtained by CBS 7.

County Attorney Scott Tidwell and Sheriff Robert Roberts were indicted by a grand jury on two counts each of third-degree felony misuse of official information and retaliation, and two counts of official oppression, a class A misdemeanor.

Stan Wiley, who resigned from Winkler County Hospital in October, was indicted on two counts of retaliation.

The indictments, which come from the Texas attorney general’s office, result from the criminal investigation of nurses Anne Mitchell and Vicki Galle. They were fired from Winkler County Memorial Hospital and were indicted and arrested by local authorities in 2009 in connection with misuse of official information after sending a letter to state medical regulators. The letter outlined concerns including Dr. Rolando G. Arafiles’ supposed attempt to use hospital supplies for at-home procedures.

via Top Winkler officials indicted | indicted, winkler, officials – Government – Odessa American Online.

There’s some quote about ‘you can get a Grand Jury to indict a sandwich’ or somesuch, so while this isn’t a conviction it does bode well for some actual justice…

Anti-Vaccine Doctor Planned to Profit from Scare : Discovery News

Just when it seems the scandal cant get any worse, it does.According to new research published in todays BMJ, Wakefields motive for the fraud was money — and lots of it. Wakefield "planned secret businesses intended to make huge sums of money, in Britain and America, from his now-discredited allegations," according to a BMJ press release.

via Anti-Vaccine Doctor Planned to Profit from Scare : Discovery News.

I have a friend whose answer to things that dont make sense is “follow the money”. He’s usually right.

I cannot tell you the thrill I have knowing this contemptible scum has picked my State to work from.

The Happy Hospitalist is really happy with his iPad

Last week, I gave my glowing opinion of doing my hospital rounding using my iPhone application. It was quite an efficiency booster. I was able to round on 16 people and discharge 13 of them in less than four and a half hours. These patients were all known to me, so I wasn’t sure how much time I saved by using my iPhone.

Yesterday, I picked up a new service entirely. But I also had my iPad up and running for the first time for my daily rounds. How did I do rounding on a new service of 14 patients I had never met before? I was able to complete my Saturday rounds on 14 patients in four hours and twenty minutes flat and I got out in time to see my grandmother’s problems with facial hair after menopause before the clock struck noon.

via Efficiency of Hospital Rounds Rapidly Improved with my iPad.


Retracted autism study an ‘elaborate fraud,’ British journal finds –

(CNN) — A now-retracted British study that linked autism to childhood vaccines was an “elaborate fraud” that has done long-lasting damage to public health, a leading medical publication reported Wednesday.

An investigation published by the British medical journal BMJ concludes the study’s author, Dr. Andrew Wakefield, misrepresented or altered the medical histories of all 12 of the patients whose cases formed the basis of the 1998 study — and that there was “no doubt” Wakefield was responsible.

“It’s one thing to have a bad study, a study full of error, and for the authors then to admit that they made errors,” Fiona Godlee, BMJ’s editor-in-chief, told CNN. “But in this case, we have a very different picture of what seems to be a deliberate attempt to create an impression that there was a link by falsifying the data.”

via Retracted autism study an ‘elaborate fraud,’ British journal finds –

I’m guessing First Do No Harm isn’t in his lexicon…

The Pestilence League Versus The Evil Vaccinations | ZDoggMD

The Pestilence League Versus The Evil Vaccinations | ZDoggMD.

Good one.

via @precordialthump on twitter.

Doc Rob: Unplugging

I have made a very big decision: I am going to unplug myself from the internet world for a while.  That means that I am hanging up my blogging for now.

via Unplugging.

I’m not going to swipe any more of his post, go have a read.

He’s been a good, prolific blogger with smart thoughts expounded in an entertaining way.

I speak for many that I hope he returns with his humor and voice intact, but even if he doesn’t we’re the better for having had him for this long.

Thanks, Dr. Rob, and enjoy the Llamas.

Joint Commission – Anti-Safety in Action | WhiteCoat’s Call Room

“Severe pain can trigger suicide in hospital ERs” the headline reads. If they’re still calling it an “ER” you already know they’re clueless.

Since 1995, there have been 827 reports of patient suicides in the United States. Of those, about 14% are in non-behavioral health units, making a total of about 116 non-psychiatric inpatient suicides in 15 years.  That’s about 8 inpatient suicides per year out of 198 million inpatient days per year (644 inpatient days per 1000 population in US x 307 million US population) for a total chance of an inpatient committing suicide on any given day of … 1 in 24.75 million.  Now I admit that the numbers may be off by one in a couple million or so because reporting suicides is voluntary for hospitals, so not all suicides get reported.

via Joint Commission – Anti-Safety in Action | WhiteCoat’s Call Room.

Again, I went into medicine as I understood there would be little math.  Others are good at it, and thanks to White Coat for doing the heavy lifting.

Read his post, and enjoy the probably well-intentioned silliness.

And, marvel at what happens to every organization that outlasts its original mandate: it eventually has to keep ‘doing something’ to make all its parts relevant.  Unfortunately, what it does makes it more irrelevant than had they done nothing.

It must take a lot of fortitude to do nothing when that’s what is the right thing to do in these realms…which is why it seldom happens, if ever.