RAND did us a huge favor here, documenting the shifts in styles of care and validating most of what we’ve said anecdotally.
http://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR280/RAND_RR280.pdf
Enjoy!
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Some reflections on the first third of my life.
I’ve been blessed with people in all stages of my life who supported me, and even when situations didn’t warrant it, they kept believing. My parents are alive and healthy, three terrific kids, two grand kids, a most excellent and accomplished son-in-law (and another in the wings).
Professionally I’m on plane, and keep finding new things to be curious about, and sometimes fix, the lifelong learning continues.
My wife deserves the majority of the credit for survival to this point. She kept me from dying of malnutrition in med school, and refrained from killing me when I gave her the opportunity, and she’s The Best.
So, here’s to more 50 year BDay celebrations!
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We all die. Here’s just a snippet from this doctors’ experience:
…Sometimes an estranged family member is “flying in next week to get all this straightened out.” This is usually the person who knows the least about her struggling parent’s health; she’ll have problems bringing her white horse as carry-on luggage. This person may think she is being driven by compassion, but a good deal of what got her on the plane was the guilt and regret of living far away and having not done any of the heavy lifting in caring for her parent.
via Washington Post.
I’ve seen this many, many times in my ED; the child of the nearly-deceased who has been doing all the caring comes in, says essentially ‘let them die comfortably’, then come in the ones who haven’t been doing the work, haven’t seen the daily decline, and they browbeat the first into a retreat. ‘I think I misunderstood, we need to do everything’ they say to me while watching the floor; my job is nothing compared to the needless suffering they’ve consigned their dying parent to experience.
Shame on us for making dying foreign, and not the end of a life well spent.
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From the BMJ:
“It all started with an enquiry from a nurse,” Dr Karl Kruszelnicki told listeners to his science phone-in show on the Triple J radio station in Brisbane. “She wanted to know whether she was contaminating the operating theatre she worked in by quietly farting in the sterile environment during operations, and I realised that I didn’t know. But I was determined to find out.”
via Hot air?.
Yes, it’s a 2001 article, but I wasn’t blogging then, so missed it.
Brought to my attention by Glen in West Texas, thanks Glen!
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Via @medskep on twitter:
Many scoff at the term “death panel” — Sarah Palin’s morbid, if misleading description of the powers contained in U.S. government health-care legislation back in 2009. Yet there was a grain of truth in that infamous noun phrase. The fact of the matter is that all health-care systems have “death panels” of one sort or another. It’s just a question of who sits on them — bureaucrats, insurers or doctors — and what label we put on their functions.
via All health-care systems have ‘death panels’ of one sort or another | Full Comment | National Post.
There’s the truth, let’s not act like it isn’t.
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Yes, I’m a terrible human being. I turned off my Amber alerts. (You can too).
Here’s the thing: If I were on the road a whole lot, Amber Alerts would be much more relevant: X is missing in Y vehicle from Z town. As I’m nearly always a) asleep or b) in my very remote near hideaway where nothing scary or even interesting happens, it’s literally alarming when these alerts come screaming through my iPhone. Disturbing, actually, in a literal sense. I feel like I should apologize more for this decision, so, I cannot imagine the heartbreak and fear involved in wondering where your child is, and I mean that. I apologize for opting out.
But, it’s the right thing for me, and it might be for you, too.
Here’s how, and it’s brutally simple:
iPhone: Notifications -> Government alerts
Just so you know, even if you turn all the Government Alerts off, you’ll still get Presidential Level alerts.
So you know.
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11 years of nothingness, punctuated by inanity.
Thanks to my 11 readers. I appreciate nearly all of you.
Here’s to twice the fun for the next 11 years!
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Dear Sirs,
First, thank you for putting all the tools I need into one sterile package, minimizing the amout of running around finding little pieces to start central lines on my patients. (A central line goes into the central venous circulation, allowing the use of hypertonic medications and monitoring of venous pressures to guide fluid resuscitation).
Now, to my gripe: apparently none of you have thought about the order in which these devices are used when starting a line. Yes, everything has a special place, but it tells me you haven’t thought out the actual use of the kit when I have to dig the Seldinger wire out of the bottom of the kit despite its use being necessary very early in the process, and getting it our dislodges many of the other items from their pockets, then making the whole shebang a mess.
Therefore, I offer my assistance in designing a kit that makes more sense when it’s used.
Respectfully,
GruntDoc
FYI, here’s a nicely done animation of how to place a central line:
I do mine a little differently (direct sonographic guidance usually), but this is good for the gist. (The wire is there, but it’s really hard to see…).
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Well done.
‘A closed mouth gathers no feet.” It’s a charming axiom, but silence isn’t always an option when we’re dealing with a friend who’s sick or in despair. The natural human reaction is to feel awkward and upset in the face of illness, but unless we control those feelings and come up with an appropriate response, there’s a good chance that we’ll blurt out some cringe-worthy cliché, craven remark or blunt question that, in retrospect, we’ll regret.
via What to Say to a Friend Who’s Ill – WSJ.com.
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Nice graphs of spending by state, then another breakdown of where the money goes per state. Click through and enjoy the graphics.
Health-care spending in the U.S. averaged $6,815 per person in 2009. But that figure varies significantly across the country, for reasons that go beyond the relative healthiness, or unhealthiness, of residents in each state.
via Health-Care Costs: A State-by-State Comparison – WSJ.com.
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Via @Skepticscalpel on Twitter:
JOHANNESBURG — For Dr. Cyril Karabus, it was a routine job, albeit in an exotic location. For six weeks in 2002, he filled in for another doctor in Abu Dhabi, lured like many other foreign professionals by the big paychecks that doctors, bankers, lawyers and architects can earn in the United Arab Emirates and other Persian Gulf nations.
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A decade later, while Dr. Karabus was passing through Dubai on his way home to South Africa after attending his son’s wedding in Canada, officials abruptly arrested him, calling him a murderer and hauling him away from his stunned wife.
via United Arab Emirates’ Laws Ensnare a Doctor – NYTimes.com.
Just say no. Australia and NZ are supposed to be nice, civilized places to practice.
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It’s stuff like this that makes even trying to support the idea of private insurance untenable.
Mr. Stephen Hemsley:
I made an honest mistake, wasn’t given a fair opportunity to correct it and now my family’s COBRA coverage has been canceled by your company.
UnitedHealth, fix this!
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I link to Ezra Klein approvingly about one a decade, so…
Let me try to understand this: the key incentive for small businesses to support Obamacare was that they would be able to shop for the best deals in health care superstores — called exchanges. The Administration has had three years to set up these exchanges. It has failed to do so.
This is a really bad sign.
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They’ve made a hovercraft golf cart. Very cool.
Bubba Watson, owner of brilliant pink golf clubs and provider of epic shots around trees, has a hovercraft golf cart. Yahoo! Sports spotted this video of Watson hanging out on the course in his very own hovercraft. Apparently, the vehicle is a collaboration between Watson and Oakley in an effort to make something better designed for the intricacies of the golf course.
via Bubba Watson’s Hovercraft Golf Cart Will Fill You with Intense Jealousy | Bleacher Report.
Video at the link.
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Yours Truly shows up on this list, for the first time.
Fort Worth, Texas magazine sent more than 4,500 local physicians a survey, asking them to voluntarily rate their peers and name the best doctors in Tarrant County. Medical professionals willing to participate went online to cast their votes.
While Fort Worth, Texas magazine provided the fields of specialty, the physicians identified the professionals they regard as being leaders in those fields.
The final results were submitted to a select panel of physicians for review.
Things are going to start happening to me now, my name in print!
3 of these fellow EM practioners I don’t know, and I am glad to count as working colleagues three of the others.
Humbling enough to blog about.
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Appalling decision.
The document (from the DOD) reads in part:
“Passage of this legislation could directly and indirectly influence potential court-martial panel members, witnesses, or the chain of command, all of whom exercise a critical role under the Uniform Code of Military Justice (UCMJ). Defense counsel will argue that Major Hasan cannot receive a fair trial because a branch of government has indirectly declared that Major Hasan is a terrorist — that he is criminally culpable.”
via Defense Department says giving Purple Heart to Fort Hood survivors would hurt Hasan trial | Fox News.
But saying it’s not a terrorist attack doesn’t influence those same people? This is sophomoric at best, but bizarrely this is the Line from DoD officials.
Also, there’s a systematic robbing of the Fort Hood victims of benefits and now military awards, which is unconscionable.
For Shame.
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Well written, and I think correct.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
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More TPa for stroke…
Delusions of Benefit in the International Stroke TrialResults of the largest and arguably most important trial ever of thrombolytics clot-busting drugs for acute stroke were published last week in The Lancet, and the study’s conclusions are breathtaking. Not because of the study results, which are unsurprising, but because the authors’ conclusions suggest that they have gone stark, raving mad.
via Delusions of Benefit in the International Stroke Trial | Closer to the Truth.
Well, that’s not good.
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As a medical student in the GYN clinic in El Paso, one occasionally needed both language and female standby assistance, at the same time.
Occasionally like 80% of the time*.
I asked one of the clinic technicians to assist me with an exam; after we were done, trying to be med student charming I said “Thank you, senorita!”
She said, laughing, with the clinic staff chuckling at my discomfort, “It’s Senora, it’s only senorita until someone does you The Favor”.
Education takes many forms. Sometimes when you don’t expect it or even want it.
(This is however a family point of amusement, which we sincerely enjoy).
*Medical statistics are made up on the spot: 75% are BS and the other 33% don’t add up.
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From NPR:
Doctors who follow the advice will consider alternatives to opioids and prescribe only a few days’ worth of the drugs, if they decide that’s the best course for short-term pain relief. They’ll also avoid starting patients on long-acting opioids, like Oxycontin, and will refrain from replacing lost, or allegedly lost, opioid prescriptions without lots of due diligence first.
I like it.
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The found a dead link on the blog, alerted me to it, and asked for a little recognition if I changed it.
http://networking.answers.com/
So, there ya go.
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So, I was trying to sign up for the Rapid Rewards for Southwest on my iPhone.
I got nearly to the end before the design fail happened. I wonder what I should answer when I’m not sure of the question.
Heh
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This post has to do with Formula 1 racing coverage. Skip it should this not be your thing.
At the end of last years’ season, Speed Network lost the contract for US coverage for the 2013 season to the unknown (to F1 coverage) NBC Sports network. As I (and many others) had come to appreciate and respect the Speed coverage of F1, this change was met with trepidation. It was actually a point of conversation and bonding at the F1 race I attended in Austin last year (‘I hope they keep the Speed TV team’ was the predominate theme).
NBCSports kept 3/4 of the team, and the one not carried forward was Bob Varsha, their play by play guy with an encyclopedic memory of F1 races and politics. He ‘retired’, and I hope his life goes forward in a good fashion. Bob was terrific, and his replacement (Leigh Diffey, who covered a race or two every season) is quite good. Carried forward were the excellent David Hobbs, Steve Matchett and track-side reporter Will Buxton (who has no wikipedia article yet). I see that as a huge nod to the fans, as there have to be a lot of people who could do the broadcast job, but there was concern at NBC about the audience who liked and respected these TV personalities. Good for NBCSports for keeping them on.
The new NBCSports coverage for the first F1 race this season was quite good, and that that despite challenges! NBCSports not only covered the usual practices, but, when qualifying was delayed by rain, showed all of qualifying off-schedule before the Australian GP! It was a good race, and the Twitter coverage was, IMHO, better than the Speed effort
A good race, covered well. Thanks.
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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:
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.
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Wow! Very nice.
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My good friend Dr. Richard Winters has skills: doctoring, parenting, professional coaching, and computer coding. Add his dislike for mumbo-jumbo and his skills with javascript, and you get:
Talk Like A Healthcare Management Robot
Instructions: Click the button. Learn to talk like a Healthcare Management Robot.
This is the most recent one I got: “Our clinical organization needs to transform physician-centered healing missions around value-added architectures.” Everyone in medicine can imagine someone saying that unironically.
I do like how he gets the point of the exercise across:
Be careful though. If you talk like a robot, physicians won’t listen.
Amen!
Now, go there, click, and laugh. This has already surpassed the Dilbert mission statement generator in my book.
Thanks, Rick!
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First, thank goodness no-one was killed outright, though I did read someone had a spine injury. Recovery hopes for all.
Second, the whole town could have been immolated from the force of the explosion, but the detonation happened just high enough only some came to the surface.
Lastly, had that happened, and we didn’t have dash-cam video to explain it, would Islamists have been the first blamed? Russia has had a bad time with them (though the US led war has seemed to concentrate their attention on us), but there’s no love lost. Nobody predicted this asteroid, so there wouldn’t have been an extraterrestrial source to blame. A million dead (Russians, sorry I’m not good at current old-USSR nomenclature) would be motivation for reprisal…
The curse about living in interesting times has landed on us, and we dodged a bullet this time.
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From my lovely wife the other day…
I posted this to Twitter earlier, but realized I wanted it on the blog, too.
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For those not actively engaged in the practice of medicine, this will mean nothing to you. For those of us in the trenches:
I cannot wait for the day the government realizes this misguided effort is costing them Billions (and harming patients and providers).
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