Archives for March 2011

Doctors, Gun Groups Compromise on Gun Ownership Questions | Sunshine State News

Rant follows the pull quote here:

The National Rifle Association and other gun rights groups had pushed for a much stronger bill that would have precluded doctors, in many cases, from asking patients about whether they own guns. Backers of the measure, sponsored by Sen. Greg Evers, R-Baker, had said patients were being harassed over gun ownership.

But citing the confidentiality of what is said between doctors and patients, and a broader desire to protect other members of patients’ families, doctors had pushed back hard against the bill (SB 432). The issue had promised a fight between two of the most powerful lobbies at the Florida Capitol.

But an amendment adopted before the committee’s vote on Monday would now generally allow doctors to ask questions about gun ownership, as long as the physician doesn’t “harass” the patient, and doesn’t enter the information into the patient’s record without a good reason. That leaves enough room that doctors now support the measure, as does the NRA.

via Doctors, Gun Groups Compromise on Gun Ownership Questions | Sunshine State News.

Nobody should support this bill. I’ve said so before. And to remind everyone, I’m a doctor who owns a gun.

Your doctor harasses you about guns? Stand up, walk out, get another doctor. Tell your shooting friends to avoid that doc. That’s fine. Look, if you own a gun, ostensibly for self defense, but cannot say ‘no’ to a question you think is out of bounds you need to sell your gun. Use the money to buy a sign that says “Please don’t hurt me, I’m unarmed (and don’t ask me questions in an offensive manner either)”.

What kind of sissies live in Florida that if their doctor ‘harasses’ them about guns they need a law affecting all doctors in their state so they don’t have to say ‘none of ya beezwax’? Really, this rose to the level of insult to the patient population that legislation was required? This is where our Republic is, we need to regulate speech so nobody gets offended?

Nothing good will come of this special interest encroachment into what can be discussed in a physician patient relationship. This sets a terrible precedent going forward. ‘Well, it was okay to ban conversations about guns, so now the (insert special interest group) manufacturers have this bill, see, and…’.

Shame on the Florida docs for agreeing to this travesty. Opposing this, and taking it to court had it passed, would have been the right thing to do. For your profession, your patients, and your country.

MLB, Players Association adopt new protocols regarding concussions | News

Major League Baseball and the Major League Baseball Players Association adopted a new series of protocols under the new joint policy regarding concussions, including the creation of a seven-day disabled list.

A committee of experts created the policy, which will oversee the manner in which concussions are diagnosed initially and will be used to determine when players and umpires can return to the field following a concussion. The new policy goes into effect on Opening Day.

via MLB, Players Association adopt new protocols regarding concussions | News.

That’s a really good idea. I’m impressed.

Family Medicine Rocks – Family Medicine Rocks Blog – Mike Sevilla, MD – Grand Rounds Volume 7 Number 27

I’m honored to be hosting Grand Rounds for the fourth time. This is not the GR theme today, but I did want to mention that it’s Doctor’s Day tomorrow in the United States. Doctor’s Day was first observed on March 30, 1933. Eudora Brown Almond, wife of Dr. Charles Almond, decided to set aside a day to honor physicians.

The red carnation is commonly used as the symbolic flower for National Doctors Day. In 1990, law was passed designating March 30 as “National Doctors Day.” Big shout out to all my physician colleagues out there!

via Family Medicine Rocks – Family Medicine Rocks Blog – Mike Sevilla, MD – Grand Rounds Volume 7 Number 27.

From the formerly anonymous Dr. Anonymous, it’s the well-known Dr. Mike Sevilla at his new blog, Family Medicine Rocks.

Yahoo! News: US News breaks out the best hospitals by 1 Mil Metro areas

To take a bite out of their guesswork, U.S. News tapped its latest annual evaluation of the nation’s nearly 5,000 hospitals and, for the first time ever, ranked the best ones in the 52 U.S. metropolitan areas with 1 million or more residents. Today’s release of those rankings represents the largest expansion of U.S. News Best Hospitals since the annual rankings began more than two decades ago.

via Yahoo!.


Update: Hmm, that article over-spoke. Here’s more what’s happening, from the WSJ: they’re just getting less support, not running away.


Google Drops Health Project – GLG News

Google Health being dropped is a setback for Electronic Medical Records EMRS in three ways: 1 Widespread adoption through cloud access; 2 Time-to-market and payback; and 3 Cross-industry collaboration.

via Google Drops Health Project – GLG News.

My summary: Google couldn’t find any way to make money doing this, so they bowed out.

I think that’s a completely rational decision for them to make. Unfortunate for the world, but that’s business.

The plate I’d make


Texas, ah luv u


Aggravated DocSurg: Waiting & watching for Jon

We were invincible. Packed into Jon’s pale yellow Olds Cutlass, the car I’d always wanted, careening down the road between our high school and its “sister” all-girls school, we’d sing along with whatever was playing on the oversized speakers garishly mounted in the back. More exactly, we’d usually be screaming along with the music, which was loud enough to rouse more than a few nearby drivers from their afternoon daydreams.

We were on our way to……take a typing class.

via Aggravated DocSurg: Waiting & watching for Jon..

It goes sideways after that.

Excellent post.

A guest post from a friend who knows a thing or two about nuclear power

From a High School friend who went the Navy path, and keeps in touch: RadGuy in West Texas…

My background in nuclear power. I completed 6 years in the US Navy’s nuclear program. I qualified at the Nautilus (S1W) prototype in Idaho, and was assigned for several years to a nuclear power guided missile cruiser. My last year in the Navy was spent planning and performing repair work on submarine, cruiser and carrier nuclear plants. As a civilian, I spent 5 years doing inspection and testing in the engineering department at one of the largest (1250+ megawatts per unit) nuclear plants in the United States. I ended up with a reasonable amount of knowledge enlightened by a great deal of practical experience.

Why is this on a medical blog dealing the Emergency Medicine? The EM system has evolved in a way that the nuclear power industry has not. In EM, many trained technicians have been added over the years; ranging from EMS first responders in the field, to the various techs in-house in most EDs. Having a group of people trained to perform specific tasks not only speeds care, but it allows those dealing with the most serious problems to act with greater focus.

The nuclear power industry has not evolved in a similar manner. An irrational fear of nuclear energy has left power plant operations to be a great mystery, and made outcasts of those who run the plants. This has left us with a very small number of operators run massive plants. Typical coverage might be 4 or 5 operators in the control room, and a similar number out in the plant. In my civilian career, that would be perhaps a dozen per unit, on a two unit site approaching 10,000 acres. Yes, there are more than a thousand other employees, but only around slightly more than 20 on site that are trained and allowed to operate equipment. The high level of engineering and verbatim compliance with written procedures allows this to work. Highly trained people do certain things in a pre-planned certain order.

In Japan we have seen a large, multi unit plant hammered by a huge earthquake and a tsunami. The earthquake was of a severity far beyond what the plant was designed for. All power was lost, and bad things started to happen that could not be coped with by the onsite staff.

The immediate need was for power, and circulating water. A group of trained responders should be available to provide these things from self contained equipment they bring with them. A modern nuclear plant is built on a truly vast scale. Careful modification will be needed so that these crews may begin to provide the needed services without help from the plant operators. The task is to arrive, hook up the needed services, and let the trained plant operator operate the needed equipment inside the plant.

All the equipment should be of a size to be carried in or behind standard size vehicle, say a large pickup or van. The equipment must be self contained, and be simple to operate. These units should be sized to be contained in a large pickup, or towed in a reasonable sized trailer. When needed, they should be suitable for air transport.

A fair standard would be 300 hp class diesel engines, attached respectively to generators, pumps, and air compressors. These should be of a robust but ordinary commercial design. Fuel tanks sized for around 24 hours of operation.

On the plant side, design must allow vital systems to be accessed from outside, with ordinary hand tools. I propose color coded and number steel access plates on the outer walls of various plant buildings. Crews can unbolt the cover plate, expose connections, and hook up the appropriate service.

In Japan, the first need was a power connection for each unit. Assume that first responders begin to arrive around three hours after the initial event. Whether they arrive by road, air, barge or train does not matter. The first units to arrive connect to the first power panel for the assigned unit. This power is not to run plant equipment, but rather to provide power for instrumentation, control and communications. For each unit, this is well within the capacity of a single portable diesel.

Once there is power for communications, and more direct intervention can begin. As additional power units arrive, they can be attached to single plant loads, those deemed most vital at the time. Examples might be a small number of pumps, or even a single large pump. It could be power for a single set of motor operated valves. The power units would be attached under the direction of the operators for each plant. These could be emergency feed pumps, fire pumps, isolated HVAC systems.

Besides power, there may be a need for cooling water. From photographs, it appears the circulating water intake structure in Japan was badly damaged. If the systems are intact, portable power can run some of the pumps. With damage such as occurred in Japan, connections similar to standard dry standpipe fire systems should be provided for in an individual basis for vital loads. This could be heat exchangers for cooling anything from the plant emergency generators, to decay heat removal systems. Single fire engines, or trailer mounted pumps can then provide water for individual loads.

These small interventions will provide time for other needed repairs, and for more trained plant operators, engineers and technicians to arrive. From the available information from Japan, perhaps a dozen such portable units would have allowed things to progress much more slowly. Indeed, with timely intervention and a bit of luck fission products would not have been released.

It is time to accept nuclear power as a part of daily life. The communities that use the power from these plants can also provide support in emergencies. Truly, we are all in this together.

A cuationary tale: Greetings from Mexico « Musings of a Dinosaur

What happens after an appletini, a margarita, and a couple of tequila shots?

via Greetings from Mexico « Musings of a Dinosaur.

MedBlog Grand Rounds 7:26 – Better Health

Welcome to this week’s edition of Grand Rounds, the Cliff’s Notes of the medical blogosphere. Each week a different medblogger reads through peer submissions and summarizes/organizes them all into one blog post (using their own unique structure or theme). Instructions for participation (and hosting) are here.

When I host Grand Rounds I like to organize the posts into emotion categories – kind of the way that movies are categorized into “drama, action, comedy, etc.” This achieves two goals: first, readers have the option of starting with their favorite emotion – maybe you need a “pick me up” or maybe you’re looking for something to get your blood pumping? Second, I get a general feeling for how my fellow bloggers are feeling these days. Judging from the volume of posts in each category, it seems that the majority of you are either surprised or outraged!

via Better Health.

Nicely done!

Interesting plates

Over the last few weeks I’ve seen some interesting vanity plates, and got pics of 3:

so over you...

so over you

beat the heck out of OU

Beat the Heck out of OU

aggies don't like TU

Aggie plate: beat the heck out of Texas

These made me chuckle.

Former Winkler County Hospital Administrator Pleads Guilty, Must Serve Jail Time

From Texas Attorney General Greg Abbott

ODESSA – Former Winkler County Memorial Hospital administrator Stan Wiley pleaded guilty today to abuse of official capacity. The defendant’s guilty plea stems from his decision to fire two nurses after they filed an anonymous complaint with the Texas Medical Board against one of the hospital’s physicians.
Visiting Judge Robert H. Moore III sentenced Wiley to 30 days in the Winkler County Jail for his improper conduct.

Today’s plea deal was reached after the defendant agreed to cooperate with the State’s prosecution of three remaining defendants in this case. The Texas Attorney General’s Office is handling the case as district attorney pro tem, as the Winkler County District Attorney recused himself from these proceedings.

Today’s guilty plea stems from the Office of the Attorney General’s investigation of official oppression, retaliatory conduct, and misuse of official information by four Winkler County officials: Wiley, Sheriff Robert Roberts, County Attorney Scott Tidwell, and former Winkler County Memorial Hospital physician Dr. Rolando Arafiles.

If the guy who made a deal gets 30 days, what is the Attorney General going to be looking for in those that go to trial?

I’ve written about the Winkler County nurses before, and I wonder if this gives them some solace. I doubt it.

I take my job for granted

until a student of medicine shows me it’s unusual…

We have (mostly) non-EM studs rotate through our ED on their sometimes mandatory, sometimes killing a month elective ED tour. There is little reason for EM destined students to rotate in our place, as we don’t have a residency and we’re not part of the club of EM residency directors ( i.e. letter of rec writers). So, usually not EM hard chargers. Nothing wrong with that, but they’re not my cuppa tea.

Today’s lesson: shoulder reduction for the non-EM Stud, and for me in What We Do Isn’t Usual.

As is our norm, after a thorough Hx, PE, Xrays and Time Out, was in on a 2 doc reduction; One does the sedation, one the reduction. I don’t typically have students follow me: I don’t dislike the students, but I don’t have them. Personal preference.

Today, a shoulder reduction. My colleagues’ student. Not destined for a life in the ED (already matched, not in a remotely EM specialty). My colleague is on the sedation, and I’m on the reduction. I, after discussing the technique, in my presence and under my direction, allowed the stud the first attempt at reduction after sedation. No go. Good effort, not enough muscle.

Second attempt was mine, and when we got the happy “clunk” (with the accompanying interesting sound), I was happy but the Stud wasn’t. While not actively vomiting, the Stud wasn’t uber-happy. At all. Wide eyed, in fact. Unpleasantly surprised, in reality.

After a period both the patient and the Stud recovered. One with a shoulder that’ll work, and one with an appreciation for what it takes to reduce a dislocated shoulder.

And I got the indirect lesson, that what I do isn’t common, and is actually a skill.

Students teach, too.

Thank you for the lesson.



I Love this time of year

All the trees turn green, and the grass makes its move from hibernation to hassle.

Yea, spring!

Dr. Wes: The Wren

Dr. Wes: The Wren.

A beautifully done blog post. Recommended.