Friday, July 02, 2010

TOFKAJCAHO and the Department of Redundancy Department

I don't know if I can fit this all into a coherent post but let me try. First, all of us who made it through medical school were forced to delve deep into the methods of clinical research and make sense, at least for a little while, of the statistics and science involved in double blind placebo controlled trials and the like. In short, we are schooled in Western thought and Western science and whether things work or not. Here's an example of a fairly typical bit of what I'm talking about written in science-speak. Pretty dry, eh?

Now, for folks like me that believe in the scientific method and in actions having consequences (and that clinical research is way too complicated and intricate for ME to do), having the absolute SHITE that comes out of TOFKAJCAHO crammed down our throats is like having me give basketball lessons to Michael Jordan. Witness the following 'research' from the nitwits...

So it is with no small amount of exasperation that I must beat the dead horse again. What did we think was going to happen when EMTALA was passed? What did we think would happen when Obama got hold of what was left of the best health care system in the world? What were our national organizations thinking in not protecting us? Well, I may be one of the first rats of the ship, but I'm off. Good luck to you all, especially since this linked article fails to mention that the number of ER docs is tanking.

And then there's this.


  1. That ER visits chart is great!

    I've been a medic since 1997 and know how many trips I make has risen. However, I will forward this idea that is indicative of the problem of EMTLA yet not directly attributable (maybe, depending on how you approach the problem).

    Ambo companies do not get paid for the call if a patient isn't transported. As such, we are directed to take as many as we can to the ER in order to improve our revenue collections knowing full well that many will never pay for the service. Like the hospitals that charge $20/pill for Tylenol, we too are forced to do the same, just through transports.

    For a long time I have supported a "treat and release" or transport to the nearest appropriate facility knowing that appropriate may be Urgent Care or their PCP. This way we can decide on scene that the nose bleed or tooth ache patients are diverted to an ideal treatment facility.

    Of course our lawyer brethren are ensuring this will never happen.

  2. I might be one of the few MDs who's never read a journal article, except for that "How to look like you read an article on rounds when you really didn't" one.
    I mean, anyone can look good when they've read the article. And I can't sit through a Powerpoint Presentation, its the whole slide thing, reminds me of my Aunt Betty who'd torture us with 180 blurry pics of Graceland...
    And the Human Brain's got a finite capacity for information storeage, every worthless p value is just one less important sports statistic, like how Bobby Cox hit .225 with 9 homers and 58 RBIs for the 68-69 New York Yankees, that you can use to win bar bets...

    Frank "I got your Double Blind Study right Here" Drackman

  3. “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.”

    William Osler quotes

  4. That Osler's full of Crap Man.......

  5. Future News,

    "Handwashing and Patient Treatment as Tradeoff Factors in Mortality and Morbidity Within the Modern Emergency Department"

    This study brings intellectual rigor to the subject of handwashing by ED medical staff. Given ED waiting times averaging 2 hours, but with average clinical interactions of only 7 minutes, some medical professionals in the trenches have commented "I don't have time to wash my hands. Can't you see what it is like around here? I'm the only doctor here at the moment. Leave me alone."

    This two year study has shown that, in this case, the view from the ground is the correct one. The newest clinical trials, some requiring handwashing and some prohibiting it, have yielded determinative statistics. The current system efficiency is 8 patient interactions per physician hour. Handwashing between each patient interaction uses up so much time that this efficiency is impossible. Yet, some handwashing is needed, it seems, to lower mortality and morbidity. The optimum washing interval is know known to be 2.38 patients.

    TOFKAJCAHO is working on the guidelines, measurement systems, and appropriate software updates to EMR systems to nudge staff towards this optimal hand washing behavior. Significant theoretical analysis is directed at how to interpret and achieve the fractional .38 patient optimum.

  6. Dear Mr. Garland,
    We would like to extend to you an offer to be our director of research. It pays a million dollars a year and has a retirement program and health insurance that is *wink* not of the Obama variety. Please respond by smoke signal from nearest vantage point should you accept. Should you go public with this, we will, of course, deny it.
    The JC

  7. Dear Dr. Garland,

    I would like to take issue with the following statements. “The current system efficiency is 8 patient interactions per physician hour. Hand washing between each patient interaction uses up so much time that this efficiency is impossible. Yet, some hand washing is needed; it seems, to lower mortality and morbidity. The optimum washing interval is known to be 2.38 patients.”

    These data are clearly wrong and on my esteemed review I have hypothesized that you have an insufficient sample size to make your conclusions.

    Please consider the following:

    The H0 is that there is no difference in infection rate between groups. You should consider an effect size ɸ of 0.3 of the total ED time sample to be significant. Using α of 0.05 and a β of 0.20 with an allocation ratio of 1:5 this will require 105 interactions and a total sample size of 630. Please review your data and add more patients to your sample.

    Your study shows promise and is at least somewhat interesting. I sincerely hope that you consider my advice however please do NOT resubmit to our ‘Journal of Theoretical Flatulation’ as you have now been banned.

  8. To Anonymous 7:13,

    That was future news about a future paper, and I probably won't be an author. But, in agreement, if I am an author of that paper in the future, then I would deserve to be banned. We'll have to wait to see. (smile)

  9. What is medically numb the mind is that you have no idea what Ben knows Rall, and go and bash Assuming you already know only by their connection with the medical part, so the first year.

    Ben has more knowledge about adequate health care and natural medicine and real than most doctors physiological ever have or will have in the life of scscripting only pharmaceutical drugs. You should go to their seminars and learn the truth.

    Besides the vaccine did not end with the disease, all that you are a sheeple who bought the lies. That year, along with the rest of them in the full picture of modern pharmaceuticals, now the 4th leading cause of death in the U.S. by its own Journal of the AMA, and was known ago, medical errors is the third. Why do you think that it is not headline news. The huge amounts of advertising money and the powers that bee control every bit of information. That regardless of whether people would never admit it or not.

  10. dear kashif ali,
    please purchase or make a new tin-foil hat. the one you are working has holes in it .