There Are Days… : PANDA BEAR, MD
My Good Friends and Patient Readers,

I’ve decide to stop blogging.

Phooey.  He’s been one of the best writers in the medical blogosphere.  I did wonder how he could keep up the vouminous and well-done output, and now we know.

Panda, you’ll be missed.  Please visit when you feel like it.

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I find that to be an incredible number, as I really don’t think I’m any different than I was at 30. Oh, some of the cosmetics have changed (Grey is the new Brown, heh), but mentally I have the same outlook I did when I was a touch younger.

This doesn’t mean I haven’t grown or matured, but I have always had a mental picture of what aging is, and it doesn’t seem to be happening to me. I find that odd. I’m one of those people that really never wanted to be young when I was; I wanted to be a grown-up, an adult. I detested being a kid: this doesn’t mean I acted grown up, but didn’t enjoy my station in life.

I do enjoy my now. I love my family, my life seems on track (note the seems: nothing ever goes quite to plan in my existence), and I see myself here for the next two dozen years. That thought makes me happy. Stability was something I took for granted growing up, all the more odd because I lived in an oilfield town where my classmates changed yearly, which you’d think would make me appreciate my good fortune.  Enjoying my current circumstances has never been one of my strengths, mores the pity.  Enter med school, the service, a residency, an EM job prior to this, and stability is something to pursue.

Life is good, I feel younger than the calendar suggests, and thanks for coming. Have some cake today, for me. Candles optional.

If I live through today (nice family celebration scheduled, the odds are on my side), I intend to tell the story of how I nearly killed myself, accidentally, and how that convinced me I was not taken for some Reason.

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Health Business Blog
Welcome to the latest edition of Grand Rounds at the Health Business Blog. This is my fourth time hosting (fifth if you include the April Fool’s edition).

Good one!

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The humor behind health care reform - This doctor’s tongue-in-cheek rallying cry is steeped in undeniable truth. - Medical Economics

I was buried in a sea of charts when a colleague joined me in the physicians’ lounge. We joked about our frustrations with paperwork and patients, while somberly agreeing that medicine’s in a bad way and physicians are more and more dissatisfied.

At the same time, we recognized that many of our problems are self-induced, stemming from doctors’ tendency to ignore fundamental truths. So I set out to compile a list of what we need to remember—truths that often go unnoticed while physicians utter empty words about professionalism, duty, and healing.

The Protestant Reformation began with Martin Luther’s theses. I’m not Luther, and my “undeniable truths” may not be nailed to a church door. But they could be the stirrings of a healthcare reformation.

Go, read, and comprehend!

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We’ll get a call from an ER doc with a patient who’s stuck in the middle of a situation: their ED patient has an emergency requiring specialty treatment, they have a specialist in said speciality, but said specialist ‘doesn’t feel comfortable / hasn’t done in years’ the procedure the patient needs, so we’re called to get the patient to a specialist that’ll take care of them.

As a description I’ll tell one bowdlerized tale to give the flavor: patient with an open femur fracture.  Sending hospital does have an orthopedist on call, but “s/he only does spines, and they doesn’t feel comfortable doing this”.  (This happens with virtually all specialties, I’m not singling out ortho, just using them as an illustration of a general problem).

So, yes, medically we can take care of this patient, and medically we accept the transfer; when I talk to admin, I make sure they know all the facts, and then I make sure we do the right thing for that patient, and that’s to bring them to us.

Here’s my question: besides an EMTALA complaint (which the hospital reportedly files a lot of, and reportedly come to nothing), is it time to start reporting this level of professed incompetence to certifying boards?  I would presume a Boarded Orthopedist would be able to take care of an open femur fracture as part of both routine training and certification (and I’d bet they’re credentialed for that procedure at their hospital); if they then profess incompetence in caring for that injury, wouldn’t their certifying board like to know?

What say you, physicians?  Report, yea or nay, and if not, why not?

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TBTAM has a really well-written piece today about an interview with Paul Levy (and a nice part with some good introspection that most doctors would identify with about why they got into medicine), but she’s very troubled with his response to typical physician negotiating tactics. Read her post for the particulars, then come back here and read after the break.

I have to say that I was listening to the show live, and while I heard the same words, I heard the subtext differently (I’m not speaking for Mr. Levy here, he can do that very well). I heard his responding to the typically horrible way doctors negotiate: it’s all or nothing, him or me, take it or leave it. Frankly, an approach that would make a second grader blush.

The specific example he gave was a physician who says essentially ‘do it my way or I quit’, to which Mr. Levy’s response was that he’d then say ‘Great, when are you leaving, we could use the office space’. I don’t think that’s the position he wants to take with any doc, I think he was trying to demonstrate horrible negotiating tactics and their only true counterpoint, to negotiate in the same style. Mr. Levy no more wants docs to quit than most actually mean they’ll quit, but since most docs learned their negotiating skills from Lord of the Flies, when confronted with horrible tactics he’s left without much else.

As I had heard the conversation that way, I came away very impressed with him, his insight into doctors and their want/need continuum, and their deficits in basic negotiating skills (which has to be very foreign to someone who’s business trained, as negotiation is a big part of their world, at least among equals).

Count me a Paul Levy fan. And a TBTAM fan, for that matter.

Update: Animal Farm was the first novel I used to describe how Physicians learned to negotiate, but that wasn’t quite right.  Lord of the Flies is a much more satisfactory comparison.

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Dr. Val continues to set the bar, this time with Governor Mike Huckabee.  The power of a blogger.

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The wreck of the good ship, EMTALA at edwinleap.com
EMTALA, the Emergency Medical Treatment and Active Labor Act, was passed in 1986. For those who aren’t familiar with yet another acronym, EMTALA is a federal law that was enacted to keep poor, uninsured patients from being ‘dumped’ on indigent-care hospitals, or any other facility, for financial reasons. Although it was a good idea, it soon grew fangs, tentacles, claws, rose up to several hundred stories in height and developed a surly attitude and bad breath. It is, in fact, one of the largest unfunded mandates the US legislative branch has ever gifted on its subjects.

Dr. Leap, speaking the Truth.  Read it.

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Slowdown’s Side Effect: More Nurses

Economy’s Woes Prod Many
Who Left Field to Return;
Brushing Up on Anatomy

By CONOR DOUGHERTY
May 7, 2008

The ailing economy is helping to ease the nursing shortage.

With house prices falling and the cost of gasoline and food rising, many nurses are going back to work, in some cases to make up for the income of a spouse who has lost a job. Hospitals say part-time nurses are taking on extra shifts. And nursing schools are seeing an increase in people applying for refresher courses on the ins and outs of modern hospitals. Some older nurses are putting off a planned retirement.

“We are seeing a temporary lessening of the nursing shortage,” says Jane Llewellyn, vice president of clinical nursing affairs at Rush University Medical Center in Chicago. But, she says, “as soon as the economy turns up we’ll see them staying home again.”

So, it’s a WAGE shortage, not a nursing shortage.  There are nurses out there, but for the current wage structure they’d rather stay home.

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Japan Steadily Becoming a Land Of Few Children - washingtonpost.com
…
The number of children has declined for 27 consecutive years, a government report said over the weekend. Japan now has fewer children who are 14 or younger than at any time since 1908.

The proportion of children in the population fell to an all-time low of 13.5 percent. That number has been falling for 34 straight years and is the lowest among 31 major countries, according to the report. In the United States, children account for about 20 percent of the population.

European and Japanese non-immigrant populations have fallen well below replacement, and that means they’ll be substantially different in 20-30 years.

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