Happy Birthday to the USMC!

SemperFi

I post this every year, and I still enjoy it…
original poster from: stores.ebay.com/WONDERFULART

15 Years in.

ABEM and their new POS TOS

A guest post! (Finally, a use for my blog)!

So there I was, just cruising the Internet, when I thought to myself, “Jeepers! It’s about time I checked on my ABEM Maintenance of Certification status! Golly, I might be late for the latest LLSA!”

Well, not really. But anyway, there I was on the ABEM website, when I ran into this rather odious new “click here to consent” barrier (see below).

Most of it was pretty standard – I certify everything is true, I won’t cheat on the exam, I won’t share test questions – OK, fine. Then we get to the particularly unsavory bits:

1. a mandatory arbitration clause.

This is a big deal, especially with the whole hubbub with ABIM and their MOC controversy. Essentially you are waiving the right to sue ABEM and must turn things over to an arbitrator, who is almost always going to find in favor of the big company and not you, the individual. And oh by the way, if there’s a dispute, you have to schlep out to Ingham County, Michigan to do this arbitration – not in your home court system.

No me gusta.

Here’s some information on why mandatory arbitration doesn’t benefit you:
http://www.hotcoffeethemovie.com/default.asp?pg=mandatory_arbitration

TL;DR: pre-dispute mandatory arbitration is biased towards the larger organization and should be avoided at all costs. Given that ABEM is made up of us, the emergency physicians, we should be able to tell our specialty board to take their arbitration clause and shove it.

2. mandatory personal information sharing with Elsevier’s for-profit “Official ABMS Directory”.

The other part that I find undesirable is the mandated information sharing. I hate getting 15,000 tons of locums spam, advertising, and a bunch of other garbage in either my home or my work mail box, to say nothing of the ‘helpful’ phone calls and emails from headhunters trying to fill an EM job in BFE.

And yet, ABEM is mandating that we share our personal information with Elsevier – to then publish in in a for-profit “doctor’s directory”?

To put it bluntly – EFF NO.

I’m an emergency physician. I don’t need to advertise. I don’t need to have people “looking me up” to see if I’m board certified. And oh by the way, I don’t have an “office” – so I use my home address for most of my certification stuff. I definitely don’t want that info out in public, especially given the casual disregard to privacy that is all too prevalent today. In my opinion, the less personal information shared, the better.

But there’s NO WAY to opt out of this information sharing. Emailing or contacting Elsevier goes nowhere. We’ll see what happens with ABEM.

Quite honestly, I find that overall, there’s little regard to doctors’ privacy, because people think “oh, you want people to find you so you get more business”. No, I don’t – not in our specialty. People find me just fine – they look for the big blue H sign on the highway, or the brightly lit sign that says “EMERGENCY – Physician on Duty”. I don’t need ‘helpful’ directories to publish all of my information.

I’ve sent out an email to ABEM, at abem@abem.org and moc@abem.org. You should too.

Let’s fix this before it gets out of control.

Sameer Bakhda, M.D.
Monterey, California
Twitter: @sameerucla

2016-09-01_15-53-49

(Many thanks to Dr. Bakhda for the post! FYI, the title is mine, so blame me for that.)

ZDoggMD

Seriously, make sure you’re following him! Because of beautes like this:

Memorial Day, 2016

Happy Memorial Day, which, per US Memorial Day.org, is defined as

Memorial Day, originally called Decoration Day, is a day of remembrance for those who have died in our nation’s service.

You can’t thank them but you can thank their families, and remember their sacrifice.

Blog Birthday? Nearly missed it!

So, I still have the blog, though those of you in the know are following me over on Twitter where my writing and attention span really shine in 140 characters.

Still in a weird place professionally, in that ‘things are happening’ and yet writing about it is Verboten.

So, 14 years of a blog. Yeah, i have shoes older, but I’m enjoying having it even if I’m not busy here.

Thanks to the seven of you.

Ammunition and the Firefighter

It’s about 4 years old, but I think most haven’t seen this by SAAMI, the sporting arms and ammunition manufacturer’s institute:

It’s 25 minutes but it’s informative and entertaining (though it’s a little hard to watch all that ammo being destroyed).

Yes, the VA is without doubt the model for American healthcare

Well, let’s consider their actual track record:

Shot:
The Pentagon reported Friday that 265 active-duty service members killed themselves last year, continuing a trend of unusually high suicide rates that have plagued the U.S. military for at least seven years.
http://www.usatoday.com/story/news/nation/2016/04/01/us-military-suicides-remain-stubbornly-high/82518278/

 

Chaser:

A VA suicide hotline designed to help distressed vets, at times instead sent their calls to a voicemail message, provided no immediate assistance, and did not even return some calls, according to a new report. … The crisis center was recently the focus of a HBO documentary praising the workers’ tireless efforts to help vets. The film, “Crisis Hotline: Veterans Press 1,” even won an Oscar last year.
http://www.cnn.com/2016/02/18/us/va-crisis-line-report/

A former Marine intelligence officer told the Senate Veterans’ Affairs Committee on Wednesday he waited more than a year for care, and when he finally saw a VA psychiatrist, he was prescribed a medication for depression. When he reacted poorly to the prescription, however, he was not able to make a follow-up appointment for another two months.
http://www.militarytimes.com/story/military/benefits/veterans/2015/10/28/report-vets-still-face-long-waits-mental-health-treatment/74734474/
Two former Minneapolis VA employees … say they were instructed to falsify records to make it look as if veterans were canceling or delaying appointments, a practice they allege allowed VA managers to hide long appointment delays. … Investigators have said efforts to cover up or hide delays were systemic throughout the agency’s network of nearly 1,000 hospitals and clinics.
When Anthony McCann opened a thick manila envelope from the Department of Veterans Affairs last year, he expected to find his own medical records inside. Instead, he found over 250 pages of deeply revealing personal information on another veteran’s mental health.
http://www.npr.org/sections/health-shots/2015/12/30/461400692/patient-privacy-isn-t-safeguarded-at-veterans-medical-facilities
One complaint against an employee found they accessed a veteran’s medical records—in violation of the Health Insurance Portability and Accountability Act—61 times. The employee even posted the private medical information on her Facebook page and “discussed it with her friends.” … The only punishment this employee received was a two-week suspension.
http://observer.com/2016/01/this-couldnt-have-been-a-more-scandalous-week-for-the-veterans-affairs-department/

Katherine Mitchell, a VA doctor in Phoenix, said that shortly after she complained to the Veterans Affairs inspector general about safety concerns, the department punished her, citing patient privacy.https://www.washingtonpost.com/politics/federal_government/va-uses-patient-privacy-to-go-after-whistleblowers-critics-say/2014/07/17/bafa7a02-0dcb-11e4-b8e5-d0de80767fc2_story.html

The Department of Veterans Affairs has not listened to whistleblowers or protected them, and it also has not punished employees who tried to stop or interfere with whistleblowers, according to a letter the U.S. Office of Special Counsel sent to the White House and Congress on Thursday.
http://www.cnn.com/2015/09/17/us/veterans-affairs-whistleblower-osc-findings/

Last May, a three-judge panel of the United States Court of Appeals for the Ninth Circuit accused the department of “unchecked incompetence” and ordered it to overhaul the way it provides mental health care and disability benefits.
http://www.nytimes.com/2012/03/25/us/recent-california-suicides-highlight-failures-of-veterans-support-system.html?_r=1

A study by a VA researcher found that veterans with PTSD were nearly twice as likely to be prescribed opioids as those without mental-health problems. They were more likely to get multiple opioid painkillers and to get the highest doses.
http://www.wsj.com/articles/SB10001424052702304672404579181840055583388

We gathered data from five of the states with the most veterans. We found they are dying of accidental narcotic overdoses at a 33 percent higher rate than non-veterans.
http://www.cbsnews.com/news/veterans-dying-from-overmedication/

“Veterans are now required to see a prescriber every 30 days, but at the El Paso VA, they are unable to get an appointment, so they go without, or they do something they shouldn’t — they buy them on the street.”

“The VA let them get wound up on all these drugs and now they cut them off completely. … These guys are coming into my office and they are a goddamn mess and the VA is just blowing them off.”
http://www.startribune.com/cut-off-veterans-struggle-to-live-with-va-s-new-painkiller-policy/311225761/

HT: Tig (thanks, brother).

How long do condiments last?

Some good info here:

Honey, salt, sugar: Indefinite

Tabasco sauce, pepper, vinegar: 3-4 years

Jelly in plastic tubs: 2-3 years

Olive oil, parmesan cheese, taco sauce, mustard, soy sauce: 1-2 years

Mayonnaise, relish, barbecue sauce, tartar sauce, horseradish sauce, maple syrup, nut butters, salad dressing, ketchup: 1 year

ZDogg sings about stroke

It’s good!

Follow him on twitter, @ZDoggMD or at this blog ZDoggMD.com

Pearl Harbor Day

December 7, 1941. 74 years ago.

If you meet a Pearl Harbor vet, thank ’em. They’re pretty rare (an 18 year old then would be 92 now…).

Thanks to our Pearl Harbor vets.

Happy Birthday, Marines!

SemperFi

I post this every year, and I still enjoy it…
original poster from: stores.ebay.com/WONDERFULART

Happy Birthday to our youngest, latest in a series (and an Aunt!)

Happy Birthday, sweetheart! We wish you all the best.

Here’s a nice throwback birthday post:

We love you a lot! Your life has progressed in the last seven years (see the following post), we’ve been happy to have raised you (so far), and we wish you the best. First year out of the teens. Congrats. Still can’t drink.

Looking at the blog I found this trip down memory lane turned up this ‘gem’ from several years ago:

Today’s the first day of teendom for my littlest girl. She still talks to me, and that’s encouraging, but usually only about horses, or how much she loves horses, or how I should get her a horse.

Tonight we were eating TCBY, and I commented how tall something was. “It’s about 13 hands” was her reply. Horse crazy.

However, no horse this year, and she’s OK with it (though secretly resentful, in the way I still am that I didn’t get either an airplane or a motorcycle for my 13th birthday).

Happy Birthday, sweetheart

Happy Birthday, honey, from all of us. You are loved more than you can know.
[Read more…]

How ER docs actually process what we do

A remarkably good blog post from Seth Treuger ( @MDaware on twitter).

The classic model of history, physical, testing, diagnosis & treatment does not apply to us. I think we do 3 things in emergency medicine:

  1. Resuscitation
  2. Risk stratification
  3. Care coordination

Resus is the fun sexy stuff that we stay up late at night having twitter arguments about. As much as I love ketamine, I can go a number of shifts without using it, and very little of what we do is resus. Most of what we do is risk stratification and care coordination.

Read it. It’s good.

 

When healthcare is literally legislated

Hint: it’s not good. A terrific article from Weingart and Faust.


If the drafted CMS measure goes into effect, we are hosed. Because data will be collected retrospectively, hundreds of patients will be deemed severe sepsis who were never actually sick.

Government organizations do not invent this stuff. Behind every measure there is, somewhere, a group of physicians that made it happen. Just as medical malpractice would not exist without plaintiff witnesses, these measures would not exist without us. Let’s fight back before it is too late.

Hint: it’s too late. Enjoy the people who wrote the tax code legislating your care.