Ramblings of an Emergency Physician in Texas
Wow. Short, and sweet, and painful.
…peddling the same tired phenomenon of magical thinking regarding the diagnostic miracle of highly sensitive troponins…
via Emergency Medicine Literature of Note: Yet Another Highly Sensitive Troponin – In JAMA.
Nice! Go and read.
via @nickgenes on that Twitter thing…
This article and its graph (from the NEJM), and its interesting, informative but probably useless graph, was referenced today on twitter, via the Washington Post’s Wonkblog,
Recently, the Centers for Medicaid and Medicare Services announced a scheduled cut in Medicare physician fees of 27.4% for 2012. This cut stems from the sustainable growth rate (SGR) formula used by the physician-payment system. …
To illustrate the level of inequity in this system, we broke down the national spending for Medicare physician services by state and by specialty and determined which states and specialties have contributed most to the SGR deficit between 2002, when the program was last balanced, and 2009. Although SGR spending targets are set on a national level, we computed state targets by applying the SGR’s national target growth rate to each state’s per capita expenditure, using 2002 as the base year. Our analysis is an approximation, because, unlike the SGR, we do not adjust for differential fee changes. …We compared the state targets for the years 2003 to 2009 to actual state expenditures and added the annual difference between these figures to get a cumulative difference between the state’s spending and the SGR target. This cumulative difference was then divided by the 2002 per capita expenditure to determine the percentage growth since 2002.
Here are the graphs, and my attempts at explanation, and the questions I have: [Read more...]
Zdogg and Dr. Harry have the Christmas spirit. Sorta.
There comes a time…when we heed a certain call—when the world must come together as one.
This is NOT one of those times.
But it is the Holidays, so we should probably take a moment to think of those less fortunate than ourselves. People who go hungry while others feast. People without a single shred of hope remaining. I’m talking about healthcare workers taking call during the Holidays.
Follow the link and enjoy their latest video. The chorus is very good. They aren’t Bad Lip Reading quality with their chorus, but not bad…
(Yeah, jealousy, I wish I had this kind of creativity. Or any, really.)
I got a nice email form someone who stumbled across this Humble Blog, and had the following questions; my replies follow. Those who have something constructive to add, please do so in the comments.
1. I’m most interested in EM. Given that I have no prior military service/experience, am I basically going to have to do a GMO tour to get this specialty?
Well, it depends on a lot of factors. Your branch of service is probably the biggest determinant (AF is best, Navy is historically worst at going from Internship straight to residency without a GMO tour), but there are several reasons you might not want to go straight to residency.
Honestly, residency is easy compared with being a GMO, at least the first year of a GMO tour. I finished a Basic Surgery Internship, and went to the fleet as a Battalion Surgeon (honorary doc title). I could spit out the Ddx of hypersplenism but had no idea how to treat musculoskeletal back pain, an ankle sprain, or PFPS. I’ll get into the rest of this later.
2. Did you do a GMO tour? If so, how was it?
Yes, GMO for 4 years. Fortunately for me it was between conflicts. To plagarize some guy, it was the best of times, it was the worst of times. Seriously, if I could have my GMO job 1/2 time and my real job 1/2 time I’d be a very happy person, and a happy doc.
3. What made you ultimately decide to stay in military post-active duty or leave for private practice?
I wasn’t a career type, and I knew I wanted to work in the real world. At the time new EM grads were going to boats, and while they’d be very useful there were there a shooting war, it would be a punishment tour otherwise.
4. What kind of leadership opportunities did you have in military medicine that you feel would have been impossible/unlikely in civilian medicine?
I got to lead, really lead, some excellent Navy Corpsmen, I got to advocate for some Marines and Sailors who needed it, and I got to go places nobody gets to these days. (2 trips to Iwo Jima, try booking that on Kayak).
5. Would you have decided to still do HPSP if the scholarship amount was significantly smaller? (ie, <50% what it is).
It was that then, I did it because I wanted to serve and it served by desires and interests. In general, if you’re considering HPSP just to pay the bills you won’t be a happy camper, and you’re signing on the line for a lot of years.
6. Is it possible to find out how many GMOs the Navy needs? (Currently, there are rumors that the Navy is going to change the GMO program).
No idea. But, don’t consider GMO time punishment, or time lost, it’s just something different, and I still think of (parts of it) fondly. The bonus of being a GMO and re-applying to a military residency? Time in Service is weighted on your app. So, if you want to be a brain surgeon but were bottom of your class, after a few GMO tours you’d most likely be in (YMMV).
Best of luck with your decision, and please let me know how it goes!
Aah, the French:
The idea of putting maggots into open flesh may sound repulsive, but such a therapy might be a quick way to clean wounds, a new study from France suggests.
via Maggots Clean Wounds Faster Than Surgeons | Wound Healing | LiveScience.
I kid. I think this is a good idea, and it’s natures’ way of saying ‘cleanup on aisle three’. Patients not infrequently will be brought to the ED with awful, non-healing wounds infested with maggots.
We typically kill them off, more because a) the staff is completely grossed out and b) if you’re living at home and have maggots in your wounds, let’s just say your personal hygiene is deeply suspect. Rank, in fact. Needs a decon level bad.
However, there is a legitimate role for biological wound cleaning; I have a WWII surgical book with a chapter in it on growing your own sterile maggots. It’s not an ER thing, but it’s yet another tool in the armamentarium of bad wounds.
You. Don’t. Say.
Thanks to a $374,000 taxpayer-funded grant, we now know that inhaling lemon and lavender scents doesn’t do a lot for our ability to heal a wound. With $666,000 in federal research money, scientists examined whether distant prayer could heal AIDS. It could not.
The National Center for Complementary and Alternative Medicine, or NCCAM, also helped pay scientists to study whether squirting brewed coffee into someone’s intestines can help treat pancreatic cancer (a $406,000 grant) and whether massage makes people with advanced cancer feel better ($1.25 million). The coffee enemas did not help. The massage did.
…
“Some of these treatments were just distinctly made up out of people’s imaginations,” said Dr. Wallace Sampson, clinical professor emeritus of medicine at Stanford University. “We don’t take public money and invest it in projects that are just made up out of people’s imaginations.”
via Studying alternative medicine with federal dollars – latimes.com.
For those who are curious about homeopathy:
A multitude of factors on Oct. 16 combined to kill popular IndyCar driver Dan Wheldon, series officials announced Thursday during a news conference at Indianapolis Motor Speedway.
via IndyCar: Dan Wheldon killed by multitude of factors in Las Vegas crash – Autoweek.
Terrible.
I read that headline and said, “Wow!, finally I won’t need to CT all those patients’ heads!”
FDA permits marketing of the first hand-held device to aid in the detection of bleeding in the skull
Helps to determine if immediate CT scan is needed
The U.S. Food and Drug Administration today allowed marketing of the first hand-held device intended to aid in the detection of life-threatening bleeding in the skull called intracranial hematomas, using near-infrared spectroscopy.
But then, wait, said I, is it any good? Apparently Not:
The FDA granted the de novo petition for the Infrascanner Model 1000 based on a review of data comparing results from 383 CT scans of adult subjects with Infrascanner scan results. The Infrascanner was able to detect nearly 75 percent of the hematomas detected by CT scan. When CT scans detected no hematoma, the Infrascanner detected no hematoma 82 percent of the time. The Infrascanner Model 1000, however, is not a substitute for a CT scan.
Anyone considering purchasing one of these based on those numbers? If so, I’ll sell you a random number generator for 1/2 of what they’re asking.
Stated another way, this device will miss more than 25% of intracranial hematomas that are present, and will tell you it’s there when it’s not 18% of the time.
Not ready for prime time. I feel bad for the detailers who are sent out to see this thing, and worse for the patients it’s used on.
Brought to my attention by @EMNews on twitter. (In case you missed it, I’m getting a lot of my bloggable stuff from Twitter. I don’t blog most of what I comment on. Imagine what you’re missing! Get to twitter, and follow me @gruntdoc).
As the original twitterer ( @NickGenes ) said, “…because there wasn’t enough bureaucracy & expense in healthcare yet”.
The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has begun the process of notifying covered entities that they are among the unlucky few who have been selected for the first Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and security audits under the Health Information Technology for Economic and Clinical Health (HITECH) Act. …
While the first twenty covered entities have been selected, approximately another 130 remain in this audit round. HHS has indicated that it hopes to continue with proactive audits in the future and expects to become more aggressive in its enforcement of complaints.
Yes, this is HITECH, the Son of HIPAA, but it all started with HIPAA.
Is it worth pointing out that HIPAA exempted itself from the unfunded mandate and paperwork reduction rules when it was enacted? I pointed out then that their assertion that it wouldn’t cause an increase in paperwork, nor was it an unfunded mandate was really unlikely.
How many Millions of dollars and man-hours are we pouring down these regulatory holes?
Comments on products can be pretty silly, but sometimes they get the Muse going.
For instance, this dainty little Swiss Army Knife:
Has spawned an hours’ reading and chuckling with the top most being:
Found this…stuck into a stone while on vacation. I’m impressed with it, generally. Unfortunately, it turns out that removing it made me the new king of Switzerland, which is a lot of responsibility.
via Amazon.com: Customer Reviews: Wenger 16999 Giant Swiss Army Knife.
Worth the effort to read the comments. Some pretty darn creative people out there…
via Dave in Texas, on Ace.mu.nu
Wow! Many congrats to the MedGadget people!
We’re excited to announce that The Atlantic has launched its brand new health channel and Medgadget is now a partner site of the venerable publication. We’ll be sharing our content that is interesting and informative to the wider audience of The Atlantic.
Well, this is good news. Remember that we were assured the information in the NPDB would be protected? Yeah, me too.
And, I don’t understand this move at all.
Law enforcement can access data bank without doctors’ knowledge
The rule, a response to the expansion of the National Practitioner Data Bank, is intended to help prevent evidence tampering.
By Carolyne Krupa, amednews staff. Posted Dec. 13, 2011.
Physicians and other health professionals no longer will be notified if someone accesses information about them through the National Practitioner Data Bank for an investigation, according to a federal rule that takes effect Dec. 23.
The rule, an exemption to the Privacy Act, is meant to prevent tampering with evidence and is limited to law enforcement agencies, said David Bowman, a spokesman for the Dept. of Health and Human Services’ Health Resources and Services Administration, which administers the data bank.
Umm, prevent tampering with WHAT evidence? by the time something’s being put in the NPDB, it’s know about by a lot of folks, and there isn’t any realy opportunity to ‘tamper with evidence’. This sounds exceptionally fishy to me. I need a better explanation than this. (I know I won’t get it).
Oh, and spot the problem with this logic (which I’ll point out after the quote):
Law enforcement agencies are authorized to see information on adverse actions against physicians such as medical board disciplinary actions and peer review sanctions. Such queries make up less than 1% of NPDB queries, with an average of 20 by law enforcement annually, according to the rule (www.gpo.gov/fdsys/pkg/FR-2011-11-23/pdf/2011-30292.pdf).
When Law Enforcement was required to notify people they’d had a look at their records, their query rate was less than 1%. Now that they can do it secretly, what will that rate be? We’ll never know.
My yearly Christmas favorite, reposted:
Courtesy of the British National Health Service:
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!
FYI: I’m on Twitter, and if you hit ‘Reply” above, it only replies on Twitter, not here on the blog…
