RAND did us a huge favor here, documenting the shifts in styles of care and validating most of what we’ve said anecdotally.
http://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR280/RAND_RR280.pdf
Enjoy!
I turned 50 today
May 14, 2013 by 4 Comments
Some reflections on the first third of my life.
I’ve been blessed with people in all stages of my life who supported me, and even when situations didn’t warrant it, they kept believing. My parents are alive and healthy, three terrific kids, two grand kids, a most excellent and accomplished son-in-law (and another in the wings).
Professionally I’m on plane, and keep finding new things to be curious about, and sometimes fix, the lifelong learning continues.
My wife deserves the majority of the credit for survival to this point. She kept me from dying of malnutrition in med school, and refrained from killing me when I gave her the opportunity, and she’s The Best.
So, here’s to more 50 year BDay celebrations!
Our unrealistic attitudes about death, through a doctor’s eyes
May 11, 2013 by 5 Comments
We all die. Here’s just a snippet from this doctors’ experience:
…Sometimes an estranged family member is “flying in next week to get all this straightened out.” This is usually the person who knows the least about her struggling parent’s health; she’ll have problems bringing her white horse as carry-on luggage. This person may think she is being driven by compassion, but a good deal of what got her on the plane was the guilt and regret of living far away and having not done any of the heavy lifting in caring for her parent.
via Washington Post.
I’ve seen this many, many times in my ED; the child of the nearly-deceased who has been doing all the caring comes in, says essentially ‘let them die comfortably’, then come in the ones who haven’t been doing the work, haven’t seen the daily decline, and they browbeat the first into a retreat. ‘I think I misunderstood, we need to do everything’ they say to me while watching the floor; my job is nothing compared to the needless suffering they’ve consigned their dying parent to experience.
Shame on us for making dying foreign, and not the end of a life well spent.
Zachary Quinto vs. Leonard Nimoy
May 9, 2013 by Leave a Comment
Is farting in the OR transmitting germs?
May 8, 2013 by 1 Comment
From the BMJ:
“It all started with an enquiry from a nurse,” Dr Karl Kruszelnicki told listeners to his science phone-in show on the Triple J radio station in Brisbane. “She wanted to know whether she was contaminating the operating theatre she worked in by quietly farting in the sterile environment during operations, and I realised that I didn’t know. But I was determined to find out.”
via Hot air?.
Yes, it’s a 2001 article, but I wasn’t blogging then, so missed it.
Brought to my attention by Glen in West Texas, thanks Glen!
All health-care systems have ‘death panels’ of one sort or another | Full Comment | National Post
May 5, 2013 by Leave a Comment
Via @medskep on twitter:
Many scoff at the term “death panel” — Sarah Palin’s morbid, if misleading description of the powers contained in U.S. government health-care legislation back in 2009. Yet there was a grain of truth in that infamous noun phrase. The fact of the matter is that all health-care systems have “death panels” of one sort or another. It’s just a question of who sits on them — bureaucrats, insurers or doctors — and what label we put on their functions.
via All health-care systems have ‘death panels’ of one sort or another | Full Comment | National Post.
There’s the truth, let’s not act like it isn’t.
iPhone: turn off Amber Alerts
May 3, 2013 by 4 Comments
Yes, I’m a terrible human being. I turned off my Amber alerts. (You can too).
Here’s the thing: If I were on the road a whole lot, Amber Alerts would be much more relevant: X is missing in Y vehicle from Z town. As I’m nearly always a) asleep or b) in my very remote near hideaway where nothing scary or even interesting happens, it’s literally alarming when these alerts come screaming through my iPhone. Disturbing, actually, in a literal sense. I feel like I should apologize more for this decision, so, I cannot imagine the heartbreak and fear involved in wondering where your child is, and I mean that. I apologize for opting out.
But, it’s the right thing for me, and it might be for you, too.
Here’s how, and it’s brutally simple:
iPhone: Notifications -> Government alerts
Just so you know, even if you turn all the Government Alerts off, you’ll still get Presidential Level alerts.
So you know.
GruntDoc.com turns 11
May 2, 2013 by 8 Comments
An open letter to central line packaging engineers
April 29, 2013 by 1 Comment
Dear Sirs,
First, thank you for putting all the tools I need into one sterile package, minimizing the amout of running around finding little pieces to start central lines on my patients. (A central line goes into the central venous circulation, allowing the use of hypertonic medications and monitoring of venous pressures to guide fluid resuscitation).
Now, to my gripe: apparently none of you have thought about the order in which these devices are used when starting a line. Yes, everything has a special place, but it tells me you haven’t thought out the actual use of the kit when I have to dig the Seldinger wire out of the bottom of the kit despite its use being necessary very early in the process, and getting it out dislodges many of the other items from their pockets, then making the whole shebang a mess.
Therefore, I offer my assistance in designing a kit that makes more sense when it’s used.
Respectfully,
GruntDoc
FYI, here’s a nicely done animation of how to place a central line:
I do mine a little differently (direct sonographic guidance usually), but this is good for the gist. (The wire is there, but it’s really hard to see…).
What to Say to a Friend Who’s Ill – WSJ.com
April 14, 2013 by Leave a Comment
Well done.
‘A closed mouth gathers no feet.” It’s a charming axiom, but silence isn’t always an option when we’re dealing with a friend who’s sick or in despair. The natural human reaction is to feel awkward and upset in the face of illness, but unless we control those feelings and come up with an appropriate response, there’s a good chance that we’ll blurt out some cringe-worthy cliché, craven remark or blunt question that, in retrospect, we’ll regret.
via What to Say to a Friend Who’s Ill – WSJ.com.
Health-Care Costs: A State-by-State Comparison – WSJ.com
April 14, 2013 by Leave a Comment
Nice graphs of spending by state, then another breakdown of where the money goes per state. Click through and enjoy the graphics.
Health-care spending in the U.S. averaged $6,815 per person in 2009. But that figure varies significantly across the country, for reasons that go beyond the relative healthiness, or unhealthiness, of residents in each state.
via Health-Care Costs: A State-by-State Comparison – WSJ.com.
Physicians: Don’t take UAE jobs
April 12, 2013 by 1 Comment
Via @Skepticscalpel on Twitter:
JOHANNESBURG — For Dr. Cyril Karabus, it was a routine job, albeit in an exotic location. For six weeks in 2002, he filled in for another doctor in Abu Dhabi, lured like many other foreign professionals by the big paychecks that doctors, bankers, lawyers and architects can earn in the United Arab Emirates and other Persian Gulf nations.
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A decade later, while Dr. Karabus was passing through Dubai on his way home to South Africa after attending his son’s wedding in Canada, officials abruptly arrested him, calling him a murderer and hauling him away from his stunned wife.
via United Arab Emirates’ Laws Ensnare a Doctor – NYTimes.com.
Just say no. Australia and NZ are supposed to be nice, civilized places to practice.
An open letter to UnitedHealth Group CEO Stephen Hemsley about my family’s canceled COBRA insurance | Mike Holden’s blog
April 11, 2013 by 1 Comment
It’s stuff like this that makes even trying to support the idea of private insurance untenable.
Mr. Stephen Hemsley:
I made an honest mistake, wasn’t given a fair opportunity to correct it and now my family’s COBRA coverage has been canceled by your company.
UnitedHealth, fix this!
Obamacare Incompetence | TIME.com
April 3, 2013 by 4 Comments
I link to Ezra Klein approvingly about one a decade, so…
Let me try to understand this: the key incentive for small businesses to support Obamacare was that they would be able to shop for the best deals in health care superstores — called exchanges. The Administration has had three years to set up these exchanges. It has failed to do so.
This is a really bad sign.
Bubba Watson’s Hovercraft Golf Cart Will Fill You with Intense Jealousy | Bleacher Report
April 2, 2013 by Leave a Comment
They’ve made a hovercraft golf cart. Very cool.
Bubba Watson, owner of brilliant pink golf clubs and provider of epic shots around trees, has a hovercraft golf cart. Yahoo! Sports spotted this video of Watson hanging out on the course in his very own hovercraft. Apparently, the vehicle is a collaboration between Watson and Oakley in an effort to make something better designed for the intricacies of the golf course.
via Bubba Watson’s Hovercraft Golf Cart Will Fill You with Intense Jealousy | Bleacher Report.
Video at the link.
