Archives for 2012

Movin’ Meat: Are low acuity patients congesting the ER?

Big big Kudos to MovinMeat for bringing data to an argument that seemed doomed to opinion-lock.

I have pointed out in the past that my BS-meter starts pinging when people start claiming that the ER is only caring for emergent patients and that non-emergency cases are rare. So this set me off, of course. My perception — and that of many of us in the trenches — is that we are absolutely beset by non-emergencies and that the ER is viewed by many as the "convenience clinic," if not the "vicodin clinic." But is this true? How can we quantify this?

via Movin' Meat: Are low acuity patients congesting the ER?.

It’s a terrific post. It’s worth your time.

Yep. Alive.

Yeah, the world turns, technologies change, and I have this blog that lives on.

So, I’ve been to the Epic User Group Meeting for a love-in on technology we can’t have for years, and then I went to help with a go-live at Wake-Forest Baptist Medical Center for their ED’s Epic go-live. It was refreshingly weird to see a good training program in action and help their academics and residents get into the fight with a new system.

Then, home to work.

Also, I have the admin responsibilities. Some of which I’m decent at, and other I’m charged with that are not under my control, nonetheless which need me to get them done. And yet I cannot move forward. It actually makes me feel a little compassion for the admins who walk among us. A little.

In case you were wondering stale blogs seem to be in big demand, given my email. Daily emails are received, offering me ‘guest posts’, or SEO optimizations, or offers of ads that never work out, or some other goofy idea. Like a blog that’s posting once a month needs any of that.

Still here. Still irascible. Just traveling a lot.

Health Officials: No Need To Call 911 For Mosquito Bites « CBS Dallas / Fort Worth


FORT WORTH CBSDFW.COM – With hundreds of human cases of the West Nile Virus being reported across Texas and more than a dozen related deaths in North Texas it seems some people are overreacting and calling 911 when they’re bitten by a mosquito.In short, health officials say a mosquito is not a health emergency.“We understand peoples concerns regarding the West Nile Virus, but in the absence of any symptoms of West Nile then a simple mosquito bite is really not a reason for someone to call 911,” said Matt Zavadsky, public affairs director for MedStar Emergency Medical Services.One woman called Fort Worth 911 requesting assistance because her young nephew had a bump on his arm.

via Health Officials: No Need To Call 911 For Mosquito Bites « CBS Dallas / Fort Worth.

We’re seeing some of this in the ED, people with bug bites coming straight in ‘to get checked out’.


More ABA Silliness –

Where have we experienced this before?

Christine Hurt reports on an American Bar Association effort to promote breed neutral vicious dog laws.

My question: WTF? Why is this the business of the ABA?

via More ABA Silliness –

Oh, yeah. The AMA. Same political, and therefore membership trajectory.

Colorado Mass Shooting Tested an E.R. Staff –

Wow. Amazing.

AURORA, Colo. — More than three weeks have passed, but Daryl Johnson still begins his emergency room shift at the University of Colorado Hospital here with a sense of foreboding.

via Colorado Mass Shooting Tested an E.R. Staff –

And horribly frightening. I pray I spend my entire career and not have a night like that.

Meacham Hangar storm damage

This is impressive. It took me a bit to figure out what I was seeing, so after you watch the NBC5i video, I’ve annotated one screenshot with my explanation.

View more videos at:



Just in case you thought having your plane in a hangar during a storm guarantees safety…


FYI, I think the far left jet is a Fouga Magister (not shown in this picture, visible in the video).

Chief Complaint of the night

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School Spirits

Henderson St, downtown Fort Worth

iowahawk: Balls and Urns

Statisticians love balls and urns. A typical Stats 101 midterm, for example, usually includes a question along these lines:

via iowahawk: Balls and Urns.

Go and learn why the ‘margin of error’ for political polls is meaningless…

Class Act: Usain Bolt Drops Everything to Honor U.S. National Anthem | Video |

Jamaican sprinter and four-time Olympic gold medalist Usain St. Leo Bolt is one classy guy.

via Class Act: Usain Bolt Drops Everything to Honor U.S. National Anthem | Video |

Go, watch, enjoy. Classy dude.


via Ace.

What did we do before the internet again?

Tonight, another reminder of the wonder of the internet and the connected world.

My beautiful, super-cool iMac locked up tight. Nothing would respond. Nada. Had been its normal super-terrific 1 second before. No warning.

Waited a while, then finally had to do the power-button-off restart. When power restored: black screen, and nice long ‘boooooooop’ sounds, about 3 seconds apart. Pulled the power cord, waited a minute. Rinse/repeat.

Had this been more than a decade ago, I would have been stuck. Literally phone a friend (except I’m back on nights, and it’s 1:45AM, so not tonight), or pack it into the car tomorrow and take it to The Store.

It’s not a decade before it’s now, a time when we can drop big rovers on nearby planets (using the most Rube-Goldberg mechanism imaginable and still make it work), and the internet is available to me.

Unsurprisingly others have had my problem. After reading several posts on the topic, the common theme was ‘the RAM is either bad or needs to be reseated’. So, internet search for iMac RAM work, an easy online go-by, and 15 minutes later I’ve removed and reseated my RAM.

And the sucker started and ran like it was new.

I like our new world.

Pepid: Winning friends and influencing people

Pepid has some really good apps for medical professionals, the ones I’m familiar with are aimed at ER docs. They’re good.

Pepid is so good I gave them an unsolicited endorsement in 2007:

Yeah, that sounds very generic, so let me tell you about when I decided to convert from the free (14 day) trial and spend the bucks.  A patient presents feeling frankly terrible and with a diffuse vasculitic rash.  Very early in the history it’s determined the patient has been taking quite a lot more methotrexate than intended (mixup, not sure why) so I tried out my new Pepid: ‘methotrexate’ brings up not just the drug, but throws me a lifeline: ‘overdose’ is on the front-page drop down menu.  I clicked on that, and it took me to the antidote (Leucovorin AD, liquid folate, which I didn’t remember), and then, tells me it’s dosed based on body surface area, then offers a calculator, all in serial – sequential clicks.  Amazing, and terrific.

That paragraph contains their Achilles heel: The Bucks. It’s never been cheap, and it’s not getting cheaper.

This year I elected to forgo renewing Pepid. It’s not that it’s not good (it is), it’s that the difference between the excellent free medical apps (Epocrates) (Medscape) plus now ubiquitous online resources (UpToDate supplied by my Corporate Overlords) minus their requested yearly rate for my iPhone ($264/year) wasn’t worth it. That’s just for the iPhone app, if you wan their iPad app you’ll have to buy that separately. Really, for only $264 they can’t just throw in the iPad app.

Imagine if you were to accidentally order the 3 year plan: $694. Sticker shock. Wow. So, if you asked them for a downgrade to the one year of the program, they’d do that, right? Sucker…

That’s right. My friend Rick (A terrific Physician Executive, Coach and pioneering blogger) accidentally clicked the 3 year button, immediately asked for a downgrade, and was told no. Pepid was more interested in his money than his loyalty or the customer experience.

Beware: Pepid screwed this doctor. Are you feeling lucky?



L.A. City Council votes 14-0 to ban medical marijuana shops –

In the latest attempt to regulate what many say is an out-of-control proliferation of medical marijuana dispensaries in Los Angeles, the City Counted voted 14-0 Tuesday to ban pot shops.

Under the ban, each of the 762 dispensaries that have registered with the city will be sent a letter ordering them to shut down immediately. Those that don’t comply may face legal action from the city.

via L.A. City Council votes 14-0 to ban medical marijuana shops –

Two somewhat disparate thoughts:

  • where does this leave the ‘legalize it” movement? They did, they were an out of control nuisance to the point LA shut them down, and
  • if Government is in control of your industry, they can kill it.

North Korean weightlifter credits Kim Jong Il for world-record feat of lifting thrice his weight – Yahoo! News India

London, July 30(ANI): North Korean Olympian Om Yun Chol joined an elite list of weightlifters to have lifted three times their weight during the men’s 56-kg, group B, clean and jerk weightlifting competition at the London Olympics, and he has credited his world-record feat to late North Korean leader Kim Jong Il.

“How can any man possibly lift 168kg? I believe the great Kim Jong Il looked over me,” CBS quoted Om, as saying.

via North Korean weightlifter credits Kim Jong Il for world-record feat of lifting thrice his weight – Yahoo! News India.

Smart guy. Were I going back to North Korea, I’d say the same thing. (I wouldn’t I’m not that smart, but I wasn’t raised in his horrific environment).

Clostridium difficile colitis and you, a video tutorial

Learning can be fun!

Just say no to antibiotics you don’t need.

The ultra-awesome