Your eyes do not deceive you, it’s different

The first new theme for this blog in years.

It was well overdue, but as usual only a crisis can make things happen.

Something changed on the blog, I know not what, but suddenly I couldn’t get into the dash through a web browser (but could through the WordPress app, odd). After several emails with the webmaster, a trial of reinstalling the software, etc, it was determined that the theme, very custom and lovingly assembled by my great web guy, was the problem. Time for an updated theme.

Thus, this. It’ll get tweaked going forward, but for now this is the starting point. (It looks good on my iPhone, too).

It’s also a chance to clean out some dead/dying stuff from the sidebars. Remember blogrolling? Blog link lists? I noticed the number of dead blogs on Instapundit last night, and realized my blog was certainly no better on that front, so those are gone (for now; were there a great hue and cry I’d look at restoring them with updated versions, but I’m betting they’re not missed).

Thanks for coming. And thanks to Brian, the web guy!


Theme change coming

Will elaborate later. In the mean time
Keep Strong and Carry On.

The Aerospace Genius succeeds

My brother the Aerospace Genius is celebrating the sale of the 1,000th copy of his book!

If you have time, congratulate him, and if you have a racer in the family, consider a nice book on racing for Christmas!

Congrats, brother!

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.

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?



Karen -The bus monitor-Final donation tally

Lets Give Karen -The bus monitor- H Klein A Vacation! — Indiegogo.

In case you don’t recall, this is the nice elderly lady who was working as a bus monitor when she was verbally abused by some feral children who thought it would be a good idea to video the attack and post it to YouTube.

One good guy started this donation page to raise $5K ‘to send her on the vacation of a lifetime’. They raised $703,833. That’ll make for a very nice retirement fund, and she can vacation when she wants.

Good for Max Sidorov for doing this (and for indiegogo for having a platform to make it happen).


BLS Jobs By Industry Treemap

BLS Jobs By Industry Treemap.

Follow the link to a very neat, interactive map of where the jobs are (and aren’t) according to the Bureau of Labor Statistics. Then play with the time scale on the left.

Very fun and educational tool! Interestingly, Healthcare has been pretty resilient throughout the last 10 years.

via @AceofSpadesHQ

Ten Years

Today marks my Ten Year Anniversary at my current ED, in Giant Community Hospital.

It’s been remarkably good. Initially I was a fish out of water, only a year out of training in a system where the ED is noted to Know their Stuff to this system where the ED is the Scapegoat for the Staff. It resulted in several uncomfortable moments with the consulting staff (Consults and Pain) written just 17 days into my tenure.

As time has elapsed (as it is wont to do), the ED  has decreased as the Scapegoat of Record, and I’m happy as a clam in the practice of Emergency Medicine here. Though, times have changed.

When I was brought aboard a decade aboard our ED was seeing about 72k a year, and I was one of two docs hired to go from 7 to 8 Doc shifts a day. This year we’re going to exceed 100K visits easily, and are trying to go to 12 shifts a day. The facility has not changed much over time (a facelift about 5 years ago and the addition of about 7 beds 5 years ago), so we’re in hall beds daily, and sometimes all day every day. This will change within 18 months, as today we held our ED Groundbreaking for an 87 room  ED, each room of which will hold two patients, so no hall patients for at least a week. At the end of 2013.

Professionally, I’m good. It takes a lot to get my pulse up, and our nursing staff remains top flight despite a fairly high turnover rate. The medical staff is good to interact with, and the ED call list is as good as it’s ever been, and way better than the dark ages of a few years ago.

Personally, I and mine are in the same home for a decade, which is a record. The Kids are off on their own (One a mom of 2, one a budding lawyer, and one who walked for Graduation this May and will graduate at the end of June, aged 20). So, we’ve been lucky as parents.

Good news for me: professionally I have new avenues (Medical Informatics) but still get to work shifts, my wife still suffers me with class and style, and I have the best EM job on earth.

I hope the next Ten are as good.

Thanks for playing.

It’s my Tenth Blogging Anniversary

Every year marks an Anniversary of blogging, mostly to remind others I’m still here.

I started this inauspicious blog in 2002, not knowing really why. I still don’t know why. In people years that’s Ten Years, in the Social Media world it’s a lifetime.

Friends are the biggest thing I’ve gotten out of it, and I thank all of you who’ve taking the time to comment and occasionally critique. I’ve been to BlogWorld and met some terrific med bloggers, and have had fun conversations with others who are only internet buddies. This has continued in the SoMe world, and I continue to enjoy the blog but also Twitter, where rapid-action snark is appreciated/derided in equal measure.

It’s always odd to me that anyone even mentions I’m a blogger and that I have a blog; it’s like people pointing out you have good penmanship or have perfect attendance: it’s just something I do. I enjoy this, I’ve enjoyed the time spent here, and plan to continue.

I’d be lying if I told you I’m the blogger I used to be: clearly not. Re-reading some of my posts makes me realize I used to be a lot angrier, and that’s a big motivator for a blogger. I’m older, more established and frankly happier, which is a nice realization but is kryptonite for the rant blogger.

Professionally I’m doing well, plenty of patients and challenges, and yet: there could be more. I’ve recently been named (surprising mostly me) Director of Medical Informatics (chief tech geek and data dude) for the consulting company to which 130+ of us Independently Contract for the ED’s of the Gigantic Hospital Corporation, which we all like and respect. It’s a terrific opportunity, and a challenge I’m not sure I’m up to. Here’s hoping.

At any rate, as I’ve said before I’m too lazy to quit, so I’ll keep blogging.

Thanks for coming!

I was in a Texas kind of mood

when I designed my MacBook Air decorations:




Yeah, my name and email are on the bottom, but they’re a touch hard to make out... A little too easy to see, it turns out. Was a field of bluebonnets (my own photo). Cropped that bit out.

Upside: I will NOT have yet another clone of an Apple computer at the next meeting.

FYI, I got these (quickly and well made) from

Epic Spring Council

I’m off to Epic’s Spring Council in Madison, WI. It’s my first trip to Madison, and my first trip to an Epic meeting.

Looking forward to both.

If there’s anything worth mentioning, I’ll be tweeting those tidbits (over on Twitter, @gruntdoc ).

Just so you know I’m not dead. Merely resting. Pining for the Fjords.

It’s Time For Double Daylight Saving Time – Raw Fisher

Do the Double, then leave it there.

It’s Time For Double Daylight Saving Time

Tonight, the clock shifts forward. Tomorrow, sunset moves from 6:07 p.m. to 7:08 p.m. But our work here is not done. If we really wanted to fill our lives with joy and save energy and money, if we really wanted to move beyond the fiction of our agrarian conception of time and into the modern world, we’d shift to year-round Daylight Saving Time–or, if we really wanted to embrace reality and maximize life, go to Double DST, a big, two-hour push forward of the clocks that would turn our summers into a marathon of gorgeous, endless evenings.

Here, adapted from my piece from this moment two years ago, is the argument for Double DST:

President Warren G. Harding didn’t like daylight saving time. If people want more daylight, he said, they should just wake up earlier.

via It’s Time For Double Daylight Saving Time – Raw Fisher.

Just think about the weirdness twice a year in payroll departments trying to keep track of this oddness. (Also, my EMR locks up on the fall-back, and that’s a problem).

Five Leadership Mistakes Of The Galactic Empire – Forbes

Amusing, and true:

But mistakes are learning opportunities. And in thinking about Star Wars, let’s leave the prequels behind and focus on the original trilogy. It occurs to me that the Star Wars films have a lot to teach us about leadership styles.

In particular, the Galactic Empire strikes me as a quintessential example of how not to effectively run an organization. Let’s take a look at five of the Empire’s biggest mistakes and see how you can avoid them in your own organization.

Mistake #1: Building an organization around particular people, rather than institutions.

via Five Leadership Mistakes Of The Galactic Empire – Forbes.

Really good point about tolerance for failure.

Last Known WWI Veteran Florence Green Dies at 110 – ABC News

Florence Green never saw the front line. Her war was spent serving food, not dodging bullets.

But Green, who has died at age 110, was the last known surviving veteran of World War I. She was serving with the Women’s Royal Air Force as a waitress at an air base in eastern England when the guns fell silent on Nov. 11, 1918.

via Last Known WWI Veteran Florence Green Dies at 110 – ABC News.

I had no idea there were any WWI vets left.

110 years old. Terrific run.

FBI warns of threat from anti-government extremists | Reuters

A fisking of a grossly awful article.

(Reuters) – Anti-government extremists opposed to taxes and regulations pose a growing threat to local law enforcement officers in the United States, the FBI warned on Monday.

These extremists, sometimes known as “sovereign citizens,” believe they can live outside any type of government authority, FBI agents said at a news conference.

Well, no! Nobody’s above the law (unless they’re elected).

The extremists may refuse to pay taxes, defy government environmental regulations and believe the United States went bankrupt by going off the gold standard.

Wait, defy environmental regs? Like not exactly calculating the amount of fertilizer per hectare to put on their lawn? I can see how that’s an FBI concern.

Routine encounters with police can turn violent “at the drop of a hat,” said Stuart McArthur, deputy assistant director in the FBI’s counterterrorism division.

“We thought it was important to increase the visibility of the threat with state and local law enforcement,” he said.

In May 2010, two West Memphis, Arkansas, police officers were shot and killed in an argument that developed after they pulled over a “sovereign citizen” in traffic.

That’s awful. Dangerous nutjobs are everywhere. Were Police not aware of that already? This needs FBI intervention?

Last year, an extremist in Texas opened fire on a police officer during a traffic stop. The officer was not hit.

An officer shot at but not hit. Terrifically bad for that officer, but this isn’t evidence of a tsunami of lawlessness. It’s one dirtbag who (fortunately) can’t shoot. I hope the Officer ended him (there’s no information in the article about that).

Legal convictions of such extremists, mostly for white-collar crimes such as fraud, have increased from 10 in 2009 to 18 each in 2010 and 2011, FBI agents said.

Wha? These are White Collar goofballs? So these (scarequotes) ‘sovereign citizens’ are lawyers and accountants and doctors and such? That would explain their not being good shots, but none of the rest of the story.

And, an INCREASE from TEN to (hold your breath) EIGHTEEN in twelve months? It’s a tsunami of lawlessness! Now I see why the FBI is in on this.

“We are being inundated right now with requests for training from state and local law enforcement on sovereign-related matters,” said Casey Carty, an FBI supervisory special agent.

FBI agents said they do not have a tally of people who consider themselves “sovereign citizens.”

So far you’ve described two dangerous morons and 28 non dangerous idiots. One killed two cops, and here’s for his dying in prison, dunno about the other ones. So, 30. 30 of these ‘sovereign citizens’ in a citizenry of about 300 Million. It should be easy to make a tally of them. Just sayin’.

J.J. MacNab, a former tax and insurance expert who is an analyst covering the sovereign movement, has estimated that it has about 100,000 members.

Sovereign members often express particular outrage at tax collection, putting Internal Revenue Service employees at risk.

Let’s give then that 30 of 100,000 are bad people. 3/100k= .0003 which means a 0.03% risk from these people.

via FBI warns of threat from anti-government extremists | Reuters.

Okay, I have family in Law Enforcement. I’m not Anti Law.

This doesn’t mean this alleged group (which they cannot even describe in a way to identify anyone in it) is a danger more than the general population.

Reuters fail. Weird there’s time spent putting this out.