A Few Questions for the AMA | The Redheaded Pharmacist

Sing it!

The American Medical Association AMA just concluded their Annual Meeting of the House of Delegates in Chicago on Wednesday, June 19th. And it seems as if the profession of pharmacy was a topic of conversation. According to the AMAWire, one of the points of discussion for the delegates this year was pharmacist inquiries with practitioners to verify controlled substances. This is the statement they released in response that you will find on the AMA’s website: The AMA delegates “Issued a warning against “inappropriate inquiries” from pharmacies to verify the medical rationale behind prescriptions and diagnoses, calling them unwarranted interference with the practice of medicine.” Forgive me for being a bit confused about the last part of that statement. I’ve always been under the impression that the duty of a pharmacist was to ensure prescriptions were written for a legitimate medical condition in the course of a practitioner’s normal scope of practice. If we are being accused of interference, shall we then be relieved of all responsibilities toward ensuring the best interests of our patients? Are we not the drug expert profession that is the last stop in the chain of treatment from provider to the patient?

via A Few Questions for the AMA | The Redheaded Pharmacist.

NEJM on inflight medical emergencies

Via Doximity, a nice review of inflight medical emergencies:

We conducted a study of in-flight medical emergencies involving large commercial airlines, characterizing on-board assistance provided by flight crews and other passengers and identifying the outcomes of these events, including ambulance transport to a hospital and hospital admission. On the basis of our findings, we suggest a practical approach to the initial management of common in-flight medical emergencies for medical personnel who may be called on to render aid.

NEJM

DoD Buzz | Navy Scuttles All-Cap Messages

Way past time…

WE DON’T HAVE TO SEND MESSAGES THIS WAY ANYMORE, the Navy has decided.Word went out from the Navy’s Fleet Cyber Command on May 8 that the Navy’s internal messaging system now had the ability to transmit in lower case as well as the traditional upper case letters.“Therefore, it is not necessary to limit Navy messages entirely to upper case,” said the directive, first reported by the Navy Times.Of course, the message saying that upper case was no longer needed went out this way: “THEREFORE, IT IS NOT NECESSARY TO LIMIT NAVY MESSAGES ENTIRELY TO UPPER CASE.”

via DoD Buzz | Navy Scuttles All-Cap Messages.

I remember reading Navy messages in the 90′s and wondering why they were always all caps. When I asked I got a very Naval ‘because’.

Mr. Balls, aka Senhor Testicle, goes to bat for cancer research  – NY Daily News

Just go look.

At first blush, the mascot’s name is rather endearing: Mr. Balls.But for those who might find that descriptive title offensive, the scrotum-shaped character also answers to "Senhor Testiculo" in Brazil, where he is a spokes-thing for a group that is seeking to raise awareness of testicular cancer research.

via Mr. Balls, aka Senhor Testicle, goes to bat for cancer research  – NY Daily News.

U.S. intelligence mining data from nine U.S. Internet companies in broad secret program – The Washington Post

Thank goodness my blog’s not on this list!

U.S. intelligence mining data from nine U.S. Internet companies in broad secret program

via U.S. intelligence mining data from nine U.S. Internet companies in broad secret program – The Washington Post.

Forgive the levity. Privacy, schmivacy. It’s not like the Government will ever use any of this for partisan purposes.

I met several CPR survivors today; I was involved with some of them

At the Fort Worth Municipal building, a gathering of AED/CPR survivors. I was told 10 of them; they came with their families, and there were a lot of lay rescuers and EMS, who as usual deserve the credit for a ‘save’, as if they don’t get the heart restarted in the field there’s not a lot we can do in the ER.

I was also told I was involved in the care of 4 of them. Crazy odds.

Two patients knew of me (probably from billing, frankly, none were awake in the ED), and they were 100% neurologically intact. We had nice chats, and I got my photo with both, but as I didn’t ask their permission to post them, I won’t.

Still, wow.

It’s incredibly humbling to have follow-up on a happy ED case, and when it’s neurologically intact CPR survivors, it’s the equivalent of a Moon shot for an ER guy, and today I got four. Four.

(It’s an occupational hazard in the ED that we meet/greet/diagnose/stabilize and disposition, and what that individual patients’ medical future holds we have no idea unless we go out of our way, and we’re busy enough nobody I know goes out of their way to follow up cases).

I am renewed. I’m not a Pollyanna doc (read the blog), but this has my attention: the practice has changed, and it works.

Hallelujah.

Carl McCoy: Dear Grads, Don’t ‘Do What You Love’ – WSJ.com

What he said. Even Docs have to come to terms with this.

Does the doctor love going into the hospital to see a patient in the middle of the night? Does the firefighter love entering a burning building? Does the teacher love trying to control a classroom full of disrespectful children? Not likely. But the work is performed with a sense of purpose that "love" doesn’t capture.We don’t all have to become first responders or social workers. And we can’t all find jobs with such obvious benefits to society. When diplomas are being handed out, though, it might be worthwhile for graduates—and the rest of us—if the popular "do what you love" message were balanced with a more timeless message to find work that, even in some small way, truly matters.

via Carl McCoy: Dear Grads, Don't 'Do What You Love' – WSJ.com.

FatBottomed Girls, mens’ chorus version

I like it.

RAND studies the ED, finds we are good.

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

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

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

It’s been a while since I posted something fun:

 

Is farting in the OR transmitting germs?

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

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

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

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.