My professional college beclowns itself

A fisking of a paranoid, ill-considered and frankly stupid idea a 9th grader would be ashamed to put forth. From the American College of Emergency Physicians ‘leadership’.

ACEP Clarifies Campaign Rules

By James M. Cusick, MD, FACEP

Chair, Candidate Forum Subcommittee of the ACEP Council

ACEP is a member-driven organization with a representative body of our peers – the ACEP Council – chosen through component bodies, including our chapters (1 representative per 100 members), our Sections of Membership, and other aligned organizations.

There follows some boilerplate language designed to get you to tune out.

None of this is aimed at the author, BTW, I have no doubt he was asked to write this and didn’t make this decision. This is about the College and a terrible decision that reflects poorly on it.

In addition, protections were incorporated into the rules to keep candidate interviews in ACEP publications. Our goal is to avoid candidates being put in the position of commenting on College policy without adequate preparation and to ensure that the campaign process is fair and equal for all candidates.

Wait, what? Candidate interviews for ACEP positions can only be in ACEP house organs? Is Stalin in charge? And for the rationale of “…being put in the position of commenting on College policy without adequate preparation and to ensure that the campaign process is fair and equal for all candidates” means ‘we intend to cover up for the candidates we really want to win, and the gaffes from the unworthy will be published in bold print, but rest assured if you’re our selection it’ll totally be glossed or even left out’.

Count on that. And that’s bollocks.

It’s the biggest horse shit this college has dumped in quite a while, and that isn’t how I want my college to represent itself because that’s how it represents me. Really, if you’re running for President of ACEP, you should be able to handle a non-coddled interview. Seriously, you’re going to say they’re too fragile to be interviewed ‘without adequate preparation…’ and then expect them to deal with legislators and their staffs who are dealing with skilled negotiators and people who know what they are there for? No thanks, I’d rather know the warts and all right up front, not filtered through the ACEP info-seive.

Certain candidates may unfairly benefit from coverage in non-ACEP publications, while some may be disadvantaged. In order to ensure a fair election, campaign questions and the vetting of candidates is the responsibility of ACEP, its Council and its Council Committees.

Umm, no, it’s the right of all of ACEP to know who’s running for office, what their unfiltered views are, and how they handle themselves with tough questions from tough questioners. It’s called campaigning, it’s not the pinewood derby. The very idea that ACEP can make an election totes fair by limiting the questions and answers to their own publications is laughable, were it not so tragically and pathetically sad. If you’re worried someone has an unfair advantage, Editorialize in ACEP Now, and their 150 avid readers can spread the word. But this entire approach is insulting to the intelligence and spirit of ER docs in our great nation.

(Any of you ER docs want to make sure your patients are only presented one at a time, with discreet illnesses and injuries, with a pre-selected choice card of correct diagnoses? No? It’s because we live and work in the real world, and that’s an absurd proposition, like this).

Also, and some may not be aware, but this is most likely a reaction to the excellent challenge by Dr. Greg Henry, ACEP Past-President and fixture asking for a robust questioning in his April 28, 2014 article ACEP, let’s set a real agenda. Read that article, and the kind of questions he wanted to ask, then you’ll see this in-house gag order for what it is: cover for their chosen.

If you’re a candidate for president and you buy into these rules, I know you’re not ready for the job.

If there are specific questions you would like asked of the candidates prior to the election, please send them to communications@acep.org. The Candidate Forum Subcommittee will consider them, the selected questions will be posed to candidates and their responses will be made public.

Really. You’re not only going to vet the answers and decide what goes out you’re going to control the questions, too? Here are a couple for you: a) boxers or briefs, and b) puppies or kittens?

I for one would like to have someone bathed in the knowledge of fights won and lost ask our presidential candidates hard questions about the tough choices facing ACEP, but we will absolutely not get it with this format. On purpose.

Hell, we’ll be lucky to find out if they like puppies.

 

via ACEP Clarifies Campaign Rules « The Central Line.

Your Government at Work, Army Corps of Engineers Division

Our Government is out of money. That’s given. Related but unrelated, our Government=Things we do together.

The Army Corps of Engineers recently decided that plowing Govt. Park access fees back into the parks through non-profits is verboten, because, get this, the money isn’t going into the US Treasury.

No thought to what makes the parks work. No thought to what the NonProfits (that’s Washington for sucker-bait) put into the parks, or what the Federal version of park running and maintenance will cost (that’ll be way way more than non-profits did it for). Or the park non-profit employees who are now out of a job.

This smacks of bureaucracy run amok, remote pencil pushers running roughshod over local policies that actually serve the constituents, i.e., normal people who like parks.

I’ll call my Congressperson tomorrow. Perhaps sense will prevail, but I have doubts.

Now, about that Government takeover of healthcare, still think that’s a terrific idea?

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.

Dumb American Speedometers: Ford Mustang

The other day my lovely wife bought a Ford. It’s nice. (They sold her a car that’d already been sold; then made up for it by giving her a car with more options than the one she originally tried to buy and eating the difference. Thanks Ford!).

While she was beating the dealer until they cried negotiating I looked at the other show-room vehicles. And I found the Ford Mustang (genes and all).

I was thinking Steve McQueen, and Bullitt. Really.

The drivers’ door wouldn’t close (on the showroom floor) and then I saw the dash:

2013-Ford-Mustang-Shelby-GT500-speedometer
Seriously, nobody in the US (or Canada, eh), needs 1/2 of this speedo. Yes, there’s a stretch or two of Texas highway that are 85, but 220? Drop this car out of a C-130 and it wouldn’t do 220.

I get marketing. You want to sell this car as a True Sports Car with a lot of Speed!!! Here’s the thing: as my eyes slowly age I don’t want to have to squint at the 1/2 inch to discern the difference between 35 and 45 while knowing this bad boy won’t go over 160, and never near 220. I don’t need a big HUD to tell me, but this display is just dumb.

Thanks,

a guy who’d buy a Mustang but not one with this silly detail in it.

BS Study*: Doctors Feel Patients’ Pain | Empathy | LiveScience

Been a while since I pulled out the BS flag, and this seems entirely appropriate:

Good doctors really do feel their patients’ pain.

Hmm. ‘Good’ doctors?

A study, published today (Jan. 29) in the journal Molecular Psychiatry, shows that when doctors see their patients experiencing pain, the pain centers in the physicians’ own brains light up. And when the doctors give treatment to relieve pain, it activates the physicians’ reward centers.

The doctors were then instructed either to use an electronic device that they believed would relieve the patients’ pain, or to withhold the pain relief. In response, the patient-actors either grimaced in pain or maintained a neutral expression to suggest their pain had subsided.

via Doctors Feel Patients’ Pain | Empathy | LiveScience.

Umm, what? These ‘good’ doctors were told that an electronic device would either relieve or not relieve pain, and then they reacted to their patients’ acting with activity in their own pain or reward centers by fMRI.

My first question: did these docs really buy into this magical electronic pain-relieving device, and if so, why? I have to wonder if it was their amusement areas lighting up and not their pleasure centers…

Second, at no time is ‘good’ established in this article. Were there a subset of docs whose fMRI’s didn’t change, and thus they’re ‘bad’?

Not buying it (would buy one of those magical electronic pain relievers, though).

 

*I say this is a BS study based on this writeup. If it’s something else entirely, okay, but this is just awful.

Ohio Congressman Has Cops Confiscate Cameras At Town Hall Meeting | Pixiq

This is kinda political, and as you shouldn’t give a fig about what I think of politics, please skip it. I’m doing it a) to vent my spleen about a stupid Congressional stunt and to show that I’d rather call out conservatives who behave badly than fill my blog with finger pointing that “they’re the problem” while remaining deathly quiet when their side screws up.

(I’m sorta little L libertarian, mostly, and will never be electable as I’m ‘a little for a, a little from b’ in my political leanings).

So a REPUBLICAN Congressman (Ohio) is afraid of bad publicity at a Town Hall meeting, so he gets the Cops to do his official suppression and intimidation, and they then did it!?

Talk about someone you shouldn’t buy a used car from, let alone vote for. Imperious behavior tells you everything you need to know about what he thinks of his constituents.

(I don’t live in OH, and won’t get the chance to vote against this idiot, but if you’re in his district it’d be worth the effort to have him thrown out).

 

August 23, 2011 @ 9:39PM

Ohio Congressman Has Cops Confiscate Cameras At Town Hall Meeting

Steve Chabot had two cameras confiscated in public meeting

By Carlos Miller -…

Hoping to prevent an embarrassing Youtube video from making the rounds, Republican Congressman Steve Chabot of Ohio ordered police to confiscate cameras from people attending a town hall meeting Monday night.

The result was two embarrassing Youtube videos that are sure to make the rounds.

The first video shows a police officer confiscating a video camera from a woman in the audience as television news videographers record the interaction.

The second video shows a police officer confiscating a man’s iPhone as it recorded, capturing the dialogue between the two.

The cop tells the man that he is not allowed to record the event “to protect the constituents.”

Meanwhile, televisions news crews were videotaping openly.

via Ohio Congressman Has Cops Confiscate Cameras At Town Hall Meeting | Pixiq.

Also note, now this idiot has videos that show the cops grabbing cameras, which is way, way worse than anything a Think Progress noodlehead could come up with in a YouTube rant. We fully expect nonsensical behavior from them, not official suppression and intimidation from an elected official. Thanks for proving the noodleheads’ point.

 

Doctors, Gun Groups Compromise on Gun Ownership Questions | Sunshine State News

Rant follows the pull quote here:

The National Rifle Association and other gun rights groups had pushed for a much stronger bill that would have precluded doctors, in many cases, from asking patients about whether they own guns. Backers of the measure, sponsored by Sen. Greg Evers, R-Baker, had said patients were being harassed over gun ownership.

But citing the confidentiality of what is said between doctors and patients, and a broader desire to protect other members of patients’ families, doctors had pushed back hard against the bill (SB 432). The issue had promised a fight between two of the most powerful lobbies at the Florida Capitol.

But an amendment adopted before the committee’s vote on Monday would now generally allow doctors to ask questions about gun ownership, as long as the physician doesn’t “harass” the patient, and doesn’t enter the information into the patient’s record without a good reason. That leaves enough room that doctors now support the measure, as does the NRA.

via Doctors, Gun Groups Compromise on Gun Ownership Questions | Sunshine State News.

Nobody should support this bill. I’ve said so before. And to remind everyone, I’m a doctor who owns a gun.

Your doctor harasses you about guns? Stand up, walk out, get another doctor. Tell your shooting friends to avoid that doc. That’s fine. Look, if you own a gun, ostensibly for self defense, but cannot say ‘no’ to a question you think is out of bounds you need to sell your gun. Use the money to buy a sign that says “Please don’t hurt me, I’m unarmed (and don’t ask me questions in an offensive manner either)”.

What kind of sissies live in Florida that if their doctor ‘harasses’ them about guns they need a law affecting all doctors in their state so they don’t have to say ‘none of ya beezwax’? Really, this rose to the level of insult to the patient population that legislation was required? This is where our Republic is, we need to regulate speech so nobody gets offended?

Nothing good will come of this special interest encroachment into what can be discussed in a physician patient relationship. This sets a terrible precedent going forward. ‘Well, it was okay to ban conversations about guns, so now the (insert special interest group) manufacturers have this bill, see, and…’.

Shame on the Florida docs for agreeing to this travesty. Opposing this, and taking it to court had it passed, would have been the right thing to do. For your profession, your patients, and your country.

Briefs: Bullet from suicide attempt ends up in Starbucks | Northeast Tarrant | News from…

This is going to sound awful, but… if you kill yourself you’re obligated not to take others with you.  I know that people who kill themselves aren’t thinking about others, but, here’s a cautionary tale:

Bullet from suicide try ends up in Starbucks

GRAPEVINE — A Starbucks customer stirring his drink Thursday afternoon heard a bullet whiz by his ear after a man shot himself across the street from the coffee shop, police said. The man was on the front porch of his house in the 900 block of East Wall Street, said Lt. Todd Dearing, a Grapevine police spokesman. The bullet went through the man’s head and the drive-through window at Starbucks and past the customer and finally lodged in a restroom wall at the back of the business, Dearing said. The man who shot himself was taken to …a hospital…

Bold by me.

via Briefs: Bullet from suicide attempt ends up in Starbucks | Northeast Tarrant | News from….

Rifle?  Crazy high powered pistol firing a very solid bullet?  I doubt we’ll ever know, but it’s a cautionary tale.  Extremely fortunate that round didn’t collect an innocent soul.

How to kill the space program: Satellites to issue speeding tickets from space – SciTechBlog – CNN.com Blogs

UK drivers had better stay under that speed limit, because the traffic authorities are watching… from outer space. According to The Telegraph, an American company called PIPS Technology has developed a system that uses two cameras on the ground and one mounted on a satellite in orbit to catch speeders.

via Satellites to issue speeding tickets from space – SciTechBlog – CNN.com Blogs.

This is entirely feasible now, with toll tags and the like.  Wisely, I think they’d rather have the tolls than a few fines and empty roads.

Putting big heavy snoopers into space is very very expensive, and totally optional.  Use an optional program against a populace (even one that’s guilty) is a really good way to get that one, and its more useful cousins, unfunded.

So, why am I not blogging more personally and regularly?

Sloth.

That, and a very gradual change in how I currently see this blog, and myself.

I’m enjoying my new shooting hobby, but haven’t inflicted the horrific paper-target carnage on you, gentle readers.  The tales of tiny holes in paper would cause most to blanch, and I’m not callous enough to inflict those stories on you.  (I have had an influence on a colleague or two, and now there are more shooters in my ED than many, I’d wager…)  (At least one can repeatedly hit a target 1K yds away.  Whee!).

Professionally, I’m on-plane: the learning curve is mostly behind me, and now I’m in ‘practice mode’: do the best I can for each patient, get enjoyment from it whenever it happens.  No, my profession isn’t about being entertained, but the job is sometimes more task than enjoyment.  (Just like your job).

I’ve been Officially Instructed to stop being cranky at work, so Happy! (or not unhappy!) is the Rule of the Day.  I get it, and hope nobody has taken my taciturn manner personally.  (If you have, it’s not personal: tell me face to face if I’ve crossed you and I’ll tell you we’re fine, and that it’s me, not you, and mean it).

Current macro medical politics makes me so crazily unhappy I dare not commit my thoughts to blog, so I’m waiting for the right vehicle to which to add my thought(s).  So, silence there.

Interestingly, the Readers Digest article (March, 2010) has resulted in more unhinged hate-mail than I’ve gotten in a good while, and I’m intrigued by the black/white should/shouldn’t a few people have about docs and health care professionals in general.  The idea that those employed in health care aren’t robots without experience or opinion (let alone judgment) seems too shocking for these naifs.  (Those who are shocked! Shocked! are also pretty profane, making the average Borderline Personality look like a piker…).  Ahh, well.  Such is fame.

And, to the Sloth.  I’m not an original writing blogger (a few posts to the contrary); my limited strength typically falls in commenting on others’ ideas, and pointing out strengths and weaknesses.  This makes me an unoriginal blogger, which I get.  Yet I persevere, or at least don’t quit.

Not ready to quit yet, by a long shot.  Blog maturation, or senility?  We shall see.

In-Dentured servitude

Yeah, dumb pun: the article was sent to me by a dentist…

It’s a short post, so I grabbed it all (go read his, though, for the links to the source material, and to read a good blog by a Navy Dentist).

New Jersey Assembly Bill , A.B. 4175, introduced on 23 November 2009 will require physicians, dentists, and nurses to complete 30 hours of volunteer service in their respective fields as a condition for biennial registration.

Well…..Guess what New Jersey? This is the final straw. You just lost another provider. Happy? Whose going to treat all those folks with insurance now?

via Down in the Mouth: Involuntary Servitude.

So, this is one of those weird times where those potentially affected say ?wha?  Is there some pressing reason to command volunteerism in order to be licensed?

I’d be willing to bet you could find a few people in every medical profession who think they must never treat anyone for free, and barring some scheme like that proposed in NJ, they’d be legally right.  Morally, I don’t know.

This is one of the reasons EMTALA is widely derided in the emergency department world: the difference between generosity, giving your time and talent without expectation of reimbursement when it’s needed and you’re able , and State coercion, the taking of your time and talents whether you consent or not.

(“You can stop taking Medicare or quit your job” you say, and while the second is correct the first is not, as I’m hospital based and required to accept Medicare, and the strings attached).  Also, it’s quite a thing to be expected to quit ones’ job to avoid having my work literally taken from me by governmental fiat (thanks, Pete Stark).

I wonder what the NJ medical, nursing and dental societies thought of this?  I’d bet if they made a public statement it was at least mildly supportive (imagine saying “no”, and being pursued by some idiot with a camera and a mic yelling “don’t you care about the children?”).

For some reason if your job is thought of as one of compassion many people, governments included, expect you to be willing to do it for free.  I don’t get that.

(An aside for those of you with business outside medicine: you can write off bad / uncollectable debt; we can’t).  (No, I don’t know why, either).

Someday medicine is going to figure out how to explain that it’s not the bad guy, that we’re giving way more than we take.  And make it understandable to everyone.

ABEM is over-reaching their role

The American Board of Emergency Medicine (ABEM) describes itself as:

Welcome to the American Board of Emergency Medicine (ABEM) public website.  ABEM certifies qualifying physicians who specialize in Emergency Medicine and is a member board of the American Board of Medical Specialties (ABMS).  ABMS certification is sought and earned by physicians on a voluntary basis. ABEM and other ABMS member boards certify only those physicians who meet high educational, professional standing, and examination standards.  ABEM and other ABMS member boards are not membership associations.

The thing I’d like to bring your attention to is that it’s a Voluntary organization.  For a voluntary organization they’re adding lots of requirements without asking members…

Since most of you don’t know about Board Certification, it’s a way for doctors to demonstrate (mostly to their peers and employers/hospitals but also to patients) that they not only finished their residency, but paid attention and learned enough to pass the Board Certifying exam.  Yes, it’s possible to be a doctor, finish a residency, but not pass the board exam and have a nice lifelong practice anyway.

I’m Board Certified by ABEM, which required completing an accredited residency, passing first a written then an oral examination.  Okay, I’m done, right?
Emmm, no. I’m BC for 10 years.  In order to re-test to be BC for another 10 years, I have to take (and pass) yearly tests over medical literature, tests payable to the ABEM.  Which ABEM didn’t bother to figure out how to give us CME credit for.  Genius.

Imagine my surprise at ABEMs’ latest addition to hoops to jump through to maintain my Board Certification: the Assessment of Practice Performance.  In a nutshell: show ABEM that 10 patients didn’t hate my medical performance, prove that on 10 hand-picked charts I’m keeping up with published treatment benchmarks (like aspirin for ACS, antibiotics in 6 hours for pneumonia, etc), and self-certify the same to ABEM.

While that’s easily doable for me at Giant Community Hospital where I work (we already keep track of this, and a lot more), it’ll no doubt be harder for very small ED’s.  I agree this sort of performance thing needs to be tracked, and practice outliers nudged back toward the middle, but what on earth does this have to do with being Board Certified?  Where in ABEMs’ mission statement does it say they’re going to certify we’re practicing on par?  Nowhere.

This would be an entirely different argument if Board Certification were required for employment in EM (it’s not), at my hospital (it’s not), in my group (not), exempted me from any state CME requirements (doesn’t), increased my pay (doesn’t), you get the idea.  That’s a lot of work to keep a voluntary certification that gives me back… nothing tangible.  Oh, I’m a Diplomate of the American Board of Emergency Medicine, and with that and $6 I can get coffee almost anywhere.

I find it interesting there’s not much push-back on this new requirement.  ACEP’s President-Elect ‘interviewed’ ABEM President Debra Perina about this latest addition, uncritically and without any challenge: EM Leaders Discuss ABEM’s Maintenance of Certification Program.

To paraphrase the question, why? The answer:

SS: Is it correct to say that the public is asking for more accountability regarding continuing medical education, even between board examinations?

DP: That’s correct. I know that ACEP and the emergency medicine community have been following testimony in House and Senate hearings from consumer advocates requesting assurances that physicians remain competent throughout the course of their practice. The public is questioning boards that test sporadically or in some cases offer lifetime certification.

Hmm.  I genuinely understand the desire of the public to make sure docs are keeping up, and practicing inside norms (and this is not asking for a flaming: I’m aware there are docs who give amoxicillin for everything imaginable, who don’t keep up, etc) but this is a) window dressing on that front and b) if meant to serve as some reassurance to the public, it’s inadequate, at best.

But that’s really beside my point, which is that it’s not ABEM’s role to make certain my practice is up to par, that’s the role of, ultimately, my State (which licenses me) and my peers, who have a lot more impact on my practice than the ABEM.  ABEM should document that the provable (I’m keeping up with my certification, meaning the every 10 year tests, grudgingly the yearly tests*), and that’s it.

In an upcoming rant: competition is good, is it way past time ABEM had some legitimate competition from another Board Certifying organization?

*In either the first or second year of these yearly tests, the article being tested was about Neseritide, which in the article was the best thing for CHF since phlebotomy.  Of course, by the time we were being taught/tested on it, Neseritide was out of vogue as it hadn’t worked out in practice as it had in studies.  But, you had to give the currently wrong answer to the test.  Pitfalls of keeping up through testing.

Dying man robbed in ER waiting room – More health news- msnbc.com

Dying man robbed in ER waiting room – More health news- msnbc.com
PHILADELPHIA – Police say three people who noticed a man unconscious and dying in an emergency waiting room robbed him instead of going for help.

The City of Brotherly Love.  I don’t think it means what they think it means…

Holman Jenkins: Why Obama Bombed on Health Care – WSJ.com

Holman Jenkins: Why Obama Bombed on Health Care – WSJ.com
Someday this country will have a health-care debate that’s not abject in its idiocy.

It will involve a term used by Congressional Budge Office chief Doug Elmendorf, who has become a notoriety for harping on the word “incentives.” The same word was used the other day by Warren Buffett, about what’s missing from the health-care plan on Capitol Hill.

We actually prefer the formulation of Duke University’s Clark Havighurst, who speaks of restoring the “price tags” to health care.

Now that’s a concept that the public could actually make sense of

Amen.  The lack of pricetags, and ‘skin in the game’ is directly responsible for a lot of the healthcare spending explosion.  Market, please.

It’s All Excessive Medical Care In Hindsight « The Central Line

It’s All Excessive Medical Care In Hindsight « The Central Line

Wow.  Very nice rant from Graham.  Another ED basher gets is head handed to him.