Skin in the Game and Other Things : PANDA BEAR, MD

Skin in the Game and Other Things : PANDA BEAR, MD

Panda Bear is Back.  To say he’s been missed would be an understatement.

To say his writing is as sharp as ever would be faint praise.  Raised from the dead.

Hat tip to the Happy Hospitalist for finding him.

Galen’s Log is back

Galen’s Log
It’s been four years since I left blogging. Time and energy were limited, and as part of a larger medical group I felt constrained in my ability to write candidly, despite my anonymity.

My situation has changed, and there is certainly no paucity of blogging topics.

He used to be terrific, then left us.  Looks like he’s writing better than ever.  Will revive from the Dead Blogs.

Is there a doctor in the house?: And I was doing so well

Is there a doctor in the house?: And I was doing so well
Just so you know, I had a really great post planned. It was about how I was doing so well lately….

This is the best written doctor blog on the internet, because it’s raw and real.  (I think).  It’s also like watching an accident happen, except it’s not an accident.  It’s painful, and moving.

Safe for work, but maybe not your psyche.

Tundra Medicine Dreams: Coming to an End

Tundra Medicine Dreams: Coming to an End
And so, for now, so long. May you each and every one go well.

Thanks, TMD, for the excellent blog.  I hope you find something that lights your creative writing fire soon.

Compassion in MedBlogging

Explained more eloquently in the full post, but:

Head Nurse: Let’s talk about compassion.
This is an important point for those of us who blog, and those of us who nurse: People will criticize you for not being the constant comforting angel that they think you ought to be. To hell with them. The important thing is that you do what you are meant to do for those people who find themselves in your care.

I’m occasionally accused of not blogging in a warm-and-fuzzy fashion suitable to whatever aggrieved person comments, and I don’t generally respond; they don’t know me, they are’t my patients, heck with them.

Life in the Fast Lane » Blog Archive » Is Twitter the essential Blogging nutrient?

Life in the Fast Lane » Blog Archive » Is Twitter the essential Blogging nutrient?

Fun illustration, and good post.

Medicare’s mistake – Opinion – USATODAY.com

Medicare’s mistake – Opinion – USATODAY.com

Kevin, MD (Dr. Pho) has yet another excellent op-ed in USA Today.  Why not Kevin, MD for Surgeon General over Dr. Gupta!

DB’s Med Rants slurs EP’s

A doctor I used to think had it together shows himself to be yet another ED basher, and a rather arrogant one to boot.

In a blog post today Dr. Centor unloads egregious tripe on me and my colleagues:

The second major concern is over use of technology in the emergency department.  Ask any practicing physician about testing in the ED.  Patients have too many imaging studies.  I think we all understand why those studies are done, but a significant percentage are clearly unnecessary.

Now clearly, ER physicians have a high exposure to malpractice claims.  When in doubt, they image.  The emergency department is often overwhelmed with patients, so technology trumps the history and physical examination.  We need a multispecialty panel to develop reasonable standards for technology use in the ED.

In case you missed it I’ll rephrase: there are too many imaging tests in the ED because EP’s are too lazy or stupid to do a history and a physical exam, so we just CT everybody.  Additionally, EM isn’t an actual specialty, so other specialties need to meet and tell them what to do.

The contempt he (and apparently his friends) hold the ED in is inexplicable though sadly common.  I’d like to have him explain the patronizing ‘I think we all know why these studies are done’ that’s not doublespeak for ‘they aren’t as smart as we internists are’.

First the monetary rebuttal to this load: as of 2006, ED care was 3.5% of the total healthcare budget.  Squeeze out all the negative imaging studies and it’d be less, but getting a margin out of 3.5% to make a dent in total healthcare expenditures would be difficult to say the least.

EP’s image patients after a history, a physical examination, and in order to rule out life threats while still focusing on the most likely diagnosis.  The statement “when in doubt, they image” is both dismissively arrogant and ill informed.  Are there a large number of scans done in EDs?  Yes.  I’ve called Dr. Centor on this bias hobby horse of his before, but he doesn’t want to hear it.

 

As for needing ‘multispecialty panels to develop reasonable standards for imaging in the ED’, he’s ignoring two very important things.  First, EM is an actual specialty with its own standards and unique fund of knowledge, since 1979.  From ACEP:

In 1979 emergency medicine was recognized as the 23rd medical specialty, a major milestone for ACEP and its members. The American Board of Emergency Medicine, the independent certifying body for the specialty, was also established and the first certification exam was given in 1980.

Second, EP’s do the studies they do because they have a higher diagnostic yield in the shortest amount of time.  A urologist would prefer an IVP for that hematuria and flank pain, but the CT will pick up the renal artery dissection a lot better than the IVP ever will.  EM is past needing specialists telling us their worms’-eye-view imaging recommendations, thanks just the same. 

 

Dr. Centor’s proposals about the ED are unwarranted from an economic perspective and unfounded from the medical.  Let’s hope nobody offers him that Health Czar post, and that if there is such a person they focus on actual problems and not peeves. 

White Coat Rants joins EPMonthly

One of my favorite EM bloggers joins my favorite EP Newspaper:

To those of you who have followed me from my old blog … welcome back.

To everyone who has followed a link to this blog from EP Monthly … welcome.

I go by the pseudonym of WhiteCoat. I’m a practicing ED physician who has a blogging addiction. I started writing a blog called WhiteCoat Rants about a year and a half ago…WhiteCoat

Emergency Physicians Monthly and I decided to combine forces to bring our readers the best of EP Monthly’s written publication and a good look at the medical blogosphere. My old readers can check out all the great articles that EP Monthly has to offer and EP Monthly’s readers can put up with my ranting. Great deal, huh?

I certainly should be, and best of luck to both!  Now to update my links…

Kevin, MD interviewed in Forbes

Continuing his takeover of Medical Blogging:

Q&A

Primary Care’s Primary Advocate

David Whelan, 12.12.08, 12:31 PM EST

Forbes talks with Dr. Kevin Pho of KevinMD.com about health policy matters as President Obama takes office.

Kevin Pho, an internal medicine doctor in Nashua, N.H., has a busy medical practice. But he’s also become an influential voice as the country embarks on another round of health reform under President Obama and “health czar” Thomas Daschle. Pho runs KevinMD.com, the most popular doctor blog.

It’s a good interview.  I see a future HHS Chairman…