Ramblings of an Emergency Physician in Texas
I stumbled across Klout.com recently, thanks to an tweet by the well-respected web strategist and industry analyst at the Altimeter Group, Jeremiah Owyang. Needless to say, it’s not a place doctors venture much.
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So I looked into the scores and characteristics of a few physician bloggers. The results were interesting.
via Dr. Wes.
Indeed they were. Go, read.
Thought Leader. I’ve never been accused of that before.
I have made a very big decision: I am going to unplug myself from the internet world for a while. That means that I am hanging up my blogging for now.
via Unplugging.
I’m not going to swipe any more of his post, go have a read.
He’s been a good, prolific blogger with smart thoughts expounded in an entertaining way.
I speak for many that I hope he returns with his humor and voice intact, but even if he doesn’t we’re the better for having had him for this long.
Thanks, Dr. Rob, and enjoy the Llamas.
“Severe pain can trigger suicide in hospital ERs” the headline reads. If they’re still calling it an “ER” you already know they’re clueless.
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Since 1995, there have been 827 reports of patient suicides in the United States. Of those, about 14% are in non-behavioral health units, making a total of about 116 non-psychiatric inpatient suicides in 15 years. That’s about 8 inpatient suicides per year out of 198 million inpatient days per year (644 inpatient days per 1000 population in US x 307 million US population) for a total chance of an inpatient committing suicide on any given day of … 1 in 24.75 million. Now I admit that the numbers may be off by one in a couple million or so because reporting suicides is voluntary for hospitals, so not all suicides get reported.
via Joint Commission – Anti-Safety in Action | WhiteCoat’s Call Room.
Again, I went into medicine as I understood there would be little math. Others are good at it, and thanks to White Coat for doing the heavy lifting.
Read his post, and enjoy the probably well-intentioned silliness.
And, marvel at what happens to every organization that outlasts its original mandate: it eventually has to keep ‘doing something’ to make all its parts relevant. Unfortunately, what it does makes it more irrelevant than had they done nothing.
It must take a lot of fortitude to do nothing when that’s what is the right thing to do in these realms…which is why it seldom happens, if ever.
Jailed and bailed as the person who sent he the link says…
KERMIT The ongoing saga of the whistle-blowing Winkler County nurses took a turn for the karmic Tuesday with the arrest of Dr. Rolando G. Arafiles on charges of retaliation and misuse of official information. Both are third-degree felonies.
Arafiles left the Winkler County Jail on a personal recognizance bond and had his passport revoked, CBS 7 reported. (Arafiles is a native of the Philippines).
Arafiles arrest results from the criminal investigation of nurses Anne Mitchell and Vicki Galle.
They were fired from Winkler County Memorial Hospital and were indicted and arrested by local authorities in 2009 in connection with misuse of official information after they sent an anonymous letter to the Texas Medical Board with examples of 10 patients they believed Arafiles had not properly treated.
Arafiles’ criminal charges come from the Texas Attorney General’s Office. In the arrest warrant affidavit, Arafiles is accused of giving patient information to Winkler County Sheriff Robert Roberts, Arafiles’ friend and also a patient, so that Roberts could investigate the source of the anonymous accusations against him. After determining the patients themselves hadn’t made the complaints, Roberts identified Galle and Mitchell as the whistleblowers, setting into motion all future events that brought national attention to the small community.
via Winkler doctor arrested | arafiles, winkler, county – Local News – Odessa American Online.
I had hoped this wasn’t over.
Sunday, December 19, 2010 by Captain Atopic
So this is it; During the course of this wee blog, I had several ideas about how to wrap it up- the range from just disappearing to a protracted series of farewell posts.
Like a long list of medstudent bloggers, I’m pulling the pin now that I’m finished. My aim with Degranulated was to blog weekly until graduation, and, well, that’s where I am.
It was a good ride. I predict Captain Atopic will return, though in the Residency form. And if not, we still got the free entertainment.
Thanks, Captain Atopic!
We tried, Mom. We tried so hard.
A Beautiful, Loving Tribute. I mourn your loss.
… All of a sudden, we started seeing large numbers of herion users, many of them “novice” injectors, still using their veins. Most of them were pretty frank that they had only recently started using heroin, and few of them had any record of ER visits for drugs in the past. So, amateur economist that I am, I started systematically asking the heroin users how long they had been using, whether and what they had used before, and why they changed. …
Excellent post about economics in action, as seen by an Emergency Medicine physician.
Nice one.
FWIW, Fort Worth is mostly a cocaine town, with a smattering of meth and black tar heroin only once or twice a year. AFAIK, our Rx drug problem is hydrocodone (sorry about that word, spam filter, you’re about to get a pounding). I think Oxycodone and its ilk being Schedule II in Texas, requiring different State prescription pads, has kept that class abuse down (some).
Interview with Dr. Flea « ScienceRoll.
Interesting interview with Flea, an early medblogger and the definition of beware what you blog. Read the interview for the lowdown on that…
He’s wrong about not blogging anonymously. I think he means not to blog like you’re anonymous, which is a different thing…
Anyway, good for Berci for getting the interview!
New AMA Policy Helps Guide Physicians’ Use of Social Media
For immediate release:
Nov. 8, 2010SAN DIEGO – Millions of Americans use social networks and blogs to communicate, but when those users are physicians, challenges to the patient-physician relationship can arise. New policy adopted today by the American Medical Association (AMA) aims at helping physicians to maintain a positive online presence and preserve the integrity of the patient-physician relationship.
It’s not surprising there is some guidance on social media from the AMA. I suppose the only surprise is that it took this long.
Follow the link above to read the policy, which I find remarkably reasonable. I have some litle heartburn about this one:
(e) When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.
Plenty of thoughtful people disagree with things I’ve written (and a few unthoughtful folks disagree with everything), but I’m not a fan of giving AMA blessing to harass.
Yes, there’s some things written out there I’m not a big fan of. I take it as a sign of strength that we can disagree but not make a federal case of it.
And, for you aspiring to get into a professional school, f) is not just for practicing physicians:
(f) Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students), and can undermine public trust in the medical profession.
You’d have to go a long way to damage the medical profession, but it takes one facebook post to damage yours. “Dude, I was so wasted when I…” doesn’t instill confidence in you or your judgement. Just putting that out there.
So, rare kudos from me for the ever-shrinking AMA.
I get emails after bemoaning the inefficient / laughable requirements being imposed by ABEM for continuous certification, and while I thank them for writing I’m not interested in being the Lonely Critic who Wails at ABEM.
So, allow me to publish (with their permission) someone elses’ lament at the current state of ABEM:
Thank you so much about your column about ABEM! It is making me feel like I am not the only one going thru this. We have 150 hours of CME required now, 4 through my state, 8 through my insurance, and now I find we can’t count the LLSA’s as continuous ed! Plus the articles in LLSA are horrible.
I took my CONCERT this year and the scores still aren’t out 8 weeks later for a computerized test. Someone needs to rise up against ABEM, they are not our advocates. I felt like maybe ACEP can help but I don’t think they can. ABEM I think is run by a lot of ivory tower guys who work 4 shifts a month in a University Hospital with the residents doing all the work. Thanks again for your columns!
One of my colleagues recently took the recertification test, which is now computer-based, and his description was less than flattering. “It’s like they scanned a photograph of a slide, and then uploaded that for the test”. He’s also about 8 weeks out from the test, and awaiting his scores…
I don’t want to be the anti-ABEM forum (is EMED-L still around?) but when I get emails like this it tells me I’m not alone in wanting ABEM to perform better. Significantly better.
The NNT | Quick Summaries of Evidence-Based Medicine.
I think I blogged this before, but didn’t describe it much. Allow me to rectify that mistake.
theNNT.com is an ever expanding site which boils down high quality reviews of medications and interventions, and presents its recommendations in a very much more approachable grren/yellow/red/Warning triangle format rather than some ratio.
While I won’t use this as a single source to change my practice I’m going to have to do some more research on some ofht eh shibboleths of our age ( Octreotide for variceal bleeding, PPI infusions for Upper GI bleeding, etc) are just two of the studies that fly in the face of current practice.
An aside: while inhaled corticosteroids for asthma aren’t beneficial in the review, what it doesn’ tell you is that the Feds think it does, and will grade your asthma care on how many of your asthma patients get a prescription for them. So, be aware.
Graham is behind this, and good for him.
STEM cell researchers have found a way to turn a person’s skin into blood, a process that could be used to treat cancer and other ailments, according to a Canadian study published today.
The method uses cells from a patch of a person’s skin and transforms it into blood that is a genetic match, without using human embryonic stem cells, said the study in the journal Nature.
Wow. Very cool.
I wonder if, hopefully, someday, this could be a replacement for random blood donation?
Doc Gurley (who’s been going to Haiti since at least the first earthquake relief started) wrote a post today about cholera (currently hitting Haiti hard).
She found there were very few YouTube videos about how to make Oral Rehydration Therapy (ORT) fluid, which is the mainstay of cholera treatment. Simply put, if you can replace orally what you’re losing from the far end, you get to live. It’s cheap, it’s easy, but you have to know what to do for it to work.
ORT is super cheap and amazingly easy to make. Thanks to Doc Gurley, there is now an illiterate (as in language independent) how to video: Recipe for Life!
While it seems graphic, I think it makes perfect sense. Here’s hoping it helps!
Per Doc Gurley, swipe the video! Repost it everywhere! She says Haitians have cell phones, and the more universal this knowledge is the more likely it is to help.
By Kevin Pho
When I ask new patients how they found me, frequently they say on the Internet through search engines such as Google.Out of curiosity, I recently Googled myself. Numerous ads appeared, promising readers a “detailed background report” or a “profile” of me. Among the search results was information about my practice, whether I was board certified, had any lawsuits against me, and reviews from online doctor rating sites. Thankfully, most were favorable, but some were not.
via Online doctor ratings aren’t very helpful – USATODAY.com.
Kevin, MD, who else?
Great work Kevin! (I shook his hand once, might have been my brush with fame).
