tag:blogger.com,1999:blog-24021163.post6693000322651496854..comments2024-02-18T01:56:38.508-06:00Comments on M.D.O.D.: Libby Zion case in the rear view mirror..911DOChttp://www.blogger.com/profile/06466669111561150174noreply@blogger.comBlogger55125tag:blogger.com,1999:blog-24021163.post-32046628354787169152012-10-03T18:31:07.748-05:002012-10-03T18:31:07.748-05:00Sorry, I have no medical background and am unable ...Sorry, I have no medical background and am unable to give an opinion. Nevertheless, what strikes me, is the passage: "The reason for our previous long hours ... was continuity of care SO THAT a young physician would see a case... and see..." That is all very well, but, then, the first concern of care would be to teach. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-14706803591697904012009-06-29T20:01:14.889-05:002009-06-29T20:01:14.889-05:00ha, you people think patient are being taken care ...ha, you people think patient are being taken care of only in the US? Everywhere else in the Western world they have HUMANE way to train residents and nobodu suffers.<br />The reason everybody is brainwashed about the necessity of this horror ( yes, 80 hour per week and 30 consecutive hours straight without sleep IS horror) in order to better train the physician is not better training, because you can't train half dead bodies to make life and death decisions, but pure old money - residents are cheap slaves - highly trained physicians duing the job for a wage which is the same as a babysitter's one - per hour.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-80918229634802060442009-01-20T01:02:00.000-06:002009-01-20T01:02:00.000-06:00anon, sorry so long in responding. short answer. p...anon, <BR/>sorry so long in responding. <BR/><BR/>short answer. people would die. <BR/>reason, medical emergencies happen 24/7 and just because they are inconvenient is no reason to impose regs from above. the only reason VA hospitals run at all is because of residents and medical students who have no work hour restrictions. after hourse, at most VA hospitals you can not get a 'stat' anything unless you, the medical student or resident, do it yourself. this is true from drawing blood, to getting an EKG, to getting a special study or emergency surgery done. <BR/><BR/>also, as is true generally, a centralized entity can not possibly make rules that apply to chaotic situations. <BR/><BR/>what's the answer? i don't know because the residency and training programs are based on a hugely outdated model in which it was possible to know most of what was available to know in medicine by the time you got to your internship. <BR/><BR/>academic institutions survive on the backs of medical students (who pay for the privelege) and residents who make less tha minimum wage based on hours worked.<BR/><BR/>academic physicians are thereby liberated to do academic things and that's okay, but my solution would be to make medicine attractive as a career because if the pipeline of the ponzi scheme trickels down then regulations and rules will not matter at all, there won't be anyone there.911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-63522089482813849882009-01-12T14:57:00.000-06:002009-01-12T14:57:00.000-06:00I am just now learing about all this duty hour stu...I am just now learing about all this duty hour stuff. I'm not a resident but curious.... <BR/><BR/>Would you rather have the duty hours regulated by other physicians or by the government? <BR/><BR/>and<BR/><BR/>What do you anticipate would happen if the government started regulating resident duty hours?<BR/><BR/>(this is in reference to the IOM Report from December 2008)<BR/><BR/>Thank you for this post, it was most insightful to read all your comments!<BR/><BR/>curious outsiderAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-19223874204166310302008-06-29T18:07:00.000-05:002008-06-29T18:07:00.000-05:00dear anonymous, good question. the way this is typ...dear anonymous, <BR/>good question. the way this is typically handled where i have worked is to get a disposition for the patient. in other words, get everything you can get done, done. do not leave procedures, like lumbar punctures or pelvic exams, for the follow-on doc. contact everyone that might be involved in the definitive care, and then wrap the patient up in a bow for your colleague. then they can simply make a call when the rest of the labs and CT scans etc... are done.<BR/><BR/>if you have to check out patients who are mid workup then i typically just tell the new doc to take the patient and get full credit for their workup.911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-83991280652194161952008-06-28T17:33:00.000-05:002008-06-28T17:33:00.000-05:00I see your point about handing off a patient to th...I see your point about handing off a patient to the next shift, but where does that end, exactly? If a patient comes in after the doc's been there 36 hours, does he have to stay another 36? I am asking honestly, because I don't know how you'd handle it, but at SOME point, you do have to hand off patients to the next person, right?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-38503213155217121892008-06-24T09:01:00.000-05:002008-06-24T09:01:00.000-05:00There were no work restrictions when I was a med s...There were no work restrictions when I was a med student, 80 hr work week when I was a resident.<BR/><BR/>More hours = smarter, better trained doctor. Now that I'm done with training I wish I'd done it the old way. While I was in the middle of it though I was glad it was the new way.<BR/><BR/>Obviously there's no going back. I think 12on/12off + 48hr weekend 2x/month is best system under current rules for typical med/surg rotations.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-29799923154308230942008-06-23T13:17:00.000-05:002008-06-23T13:17:00.000-05:00I have not much original to add here except to rec...I have not much original to add here except to reconfirm that training when I did, many years ago, produced, in the main, surgeons who had had a broad and deep experience while in training, and who, by virtue of sticking with the system then in place, declared themselves the type willing to place high quality and continuous care of patients above pretty much everything else. My friends in academic surgery have been saying for the past decade that the times are a-changin', and for the worse: surgical residents have a shift-worker mentality, are finishing training with less experience and commitment. I'm sure there are exceptions and if I were to need surgery, I'd hope my surgeon would be one. But I'd rather have me.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-33726528834744365262008-06-23T07:08:00.000-05:002008-06-23T07:08:00.000-05:00Oldfart: Not sure how much I pay for insurance. I ...Oldfart: Not sure how much I pay for insurance. I do know the OB fresh out of school pays 80 grand. YEs the OB's are the big pockets. But it is very stressful to be deposed and I am hoping to avoid that if possible. One of the ways we do this is by knowing the law better than most of the patients. At this point I am happier having a Lawyer as a patient than a lay person because then they know when they have a case.<BR/><BR/>I will check on the nurse being sued and found liable. I believe I have been to seminars that have indicated this. But I will check and get back to you.pinkyhttps://www.blogger.com/profile/00198277802918823591noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-52271509783745513092008-06-23T03:09:00.000-05:002008-06-23T03:09:00.000-05:00It's really the only humane thing to do. Seriousl...It's really the only humane thing to do. <BR/><BR/>Seriously, internet/forum/comment section skirmishes are fairly frustrating with very low payoff. I'm all over the "gun control"/gun enthusiast forums (don't want to start anything here), and it seems like that shit never ends. There's never an endgame; your enemies either disappear or just keep commenting with small permutations on a theme, ad nauseum. It's like the damn labor of Sisyphus, and frankly I don't see how you guys have the patience (especially 911). Guess you're right, pull the trigger before they can click "Publish Your Comment!"21https://www.blogger.com/profile/09560786230715552515noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-25249366841972813892008-06-22T19:28:00.000-05:002008-06-22T19:28:00.000-05:00Dear Anon..My dick is bigger than yours!!Perhaps y...Dear Anon..My dick is bigger than yours!!<BR/>Perhaps you practice somewhere where pts actually go upstairs..I don't. I routinely manage 10-15 admitted pts for 24 hrs plus while seeing another 30-40 pts at the same time. And we don't admit DVTs either. I routinely manage DKA until they don't need to go to the unit. Post stent MI's, and more.<BR/>You, however, have managed admitted pts after I have stabilized them and managed them for you so you don't have to do shit, dickwad. You won't touch them until they are no longer critically ill. I do it, you pompous POS!<BR/>And where did you train? Hobokkin? I guess so since your pts are "more" sick now. How fuckin funny. You came into the real world!! <BR/>And I would love to lie in a bed a few hours while "on call" but no, I'm seeing new pts the entire time I'm working. You only get to see the ones I think are ill enuff to put in the hospital and after I've got them packaged for you.<BR/>Yep, I only work 8 hrs at a time, but I and my compadres are THERE 24/7/365, seeing everyone who presents. Go back home and wait for a phone call Shithead!<BR/><BR/>Amy, you are right on..No answer for you..<BR/><BR/>Pinky what do you pay for malpractice insurance?? Me, 25K+/yr. I don't even keep track of it anymore..<BR/>You are correct in that nurses should not have to police drs actions, that's why you have NO LIABILITY unless I order IV strychnine(sp) and you give it..<BR/><BR/>And our OB buddy's are the only ones to see shift duty as the way cover their responsibilities 24/7. <BR/>My apologies and appreciation to all of them..<BR/><BR/>RR, you are right. I am too old for the reparte' I think I'll just shoot them all from now on..<BR/><BR/>HTFU, OFOldfarthttps://www.blogger.com/profile/14333534023484494721noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-27203757812099399782008-06-22T18:43:00.000-05:002008-06-22T18:43:00.000-05:00named in a suit is far from being liable. i have b...named in a suit is far from being liable. i have been named in many suits though i have never been found liable. in most suits i've been named i was named because my name was somewhere on the three hundred page chart. i would be very surprised if this were not the case with nurses. so, if there are any nurses out there who have had to pay any money in a malpractice suit, speak up. i think oldfart is right, nurse liability is nearly non existent apart from criminal behavior. <BR/><BR/>dev?911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-31652265334653865352008-06-22T15:52:00.000-05:002008-06-22T15:52:00.000-05:00"The problem with today(sorry I don't know how old..."The problem with today(sorry I don't know how old you are) is nurses are getting taught to do paperwork and to actually believe they might be sued for malpractice for a poor pt outcome (that was the drs fault, not theirs)"<BR/><BR/>At my hospital I know of 4 nurses on my unit who have been named in lawsuits. Many of the OB's have been sued. Many have been settled out of court even when they did nothing wrong. We even started a group called Mal-anon to chat about what to do when we get sued. <BR/><BR/>Theoretically, if the nurse does not access the chain of command when a Doctor does something that is not appropriate. She can be liable. I have a girlfriend right now who is in that situation. It is unfair to expect nurses to police the Doctors behavior. But that is the climate I work in. I also work in L&D in a State that has more Lawyers than need be.pinkyhttps://www.blogger.com/profile/00198277802918823591noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-72971811848923114422008-06-22T12:34:00.000-05:002008-06-22T12:34:00.000-05:00This is an interesting discussion to hear from bot...This is an interesting discussion to hear from both sides. I don't have much to add to the discussion. But I do have a question for the previous poster. <BR/><BR/>You state several times that more staffing is part of the solution. I dont' see hospital admins doing more staffing of anything. Hasn't their trend been to staff less and less trying to plug the holes with protocols, paperwork, and computer programs? How will they be convinced to employ more actual humans who cut into their bottom line?Amelia Ameshttps://www.blogger.com/profile/17296224743117560163noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-19511734409920563662008-06-22T08:40:00.000-05:002008-06-22T08:40:00.000-05:00The 'oldfarts' of the world (and I'm one of them) ...The 'oldfarts' of the world (and I'm one of them) are missing the argument. The whole continuum of care nonsense that was inflicted on us way back when, was BS then, and is even more BS now.<BR/><BR/>The issue isn't 'do you want to re-explain your problem to doctors on every shift' because of rational work limits (we don't let airline pilots fly for 30 hours at a stretch, do we?), it's do you want a resident (by definition, a physician with less than full training) who has been working for 29+ hours (meaning without sleep for 30+ hours?) attempting to manage a NEWLY PRESENTING, critically ill patient? A patient who frankly wouldn't have been alive 25 or 30 years ago, at all?<BR/><BR/>Handoffs are a problem. The answer isn't in fewer handoffs, it's better systems to do them...protected time for the hand-over to occur, increased, staggered staffing, more supervision (which is more staffing), perhaps longer residencies (especially for skills-based specialties like surg - more staffing, again), better documentation (not more TJC or nursing manger bullshit), better documentation systems like a decent EMR, less boarding of patients in the ED, less CYA medicine, faster diagnostic studies, and all the other problems we suffer?<BR/><BR/>Frankly, while I may be an old fart (I'm 52, if thats an indication) I am appalled at the "I did it, so you have to, too" attitudes of some of my colleagues. Our mentors, way back when, used techniques and drugs that frankly killed people - why is one example of "doing it the old way" better, and another, with equal results, not?<BR/><BR/>BTW, I work at a rather large academic medical center/Trauma Center in a very major city, in the ED...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-71303523682611850712008-06-22T07:55:00.000-05:002008-06-22T07:55:00.000-05:00Sorry oldfart I have to laughre:"WE are the ONLY t...Sorry oldfart I have to laugh<BR/><BR/>re:"WE are the ONLY teaching physicians who are there 24/7/365"<BR/><BR/>Really who are you kidding? You work an 8-12 hour shift then go home. I trained in the "old days" too and simply the patients in hospital were not sick as they are now (by the way when is the last time you managed an admitted patient?). The days of a patient with a DVT sitting inhouse for 5-7 days on a heparin gtt waiting to become therapeutic on coumadin are long over. But hey, don't believe me, I've just managed inpatients for over 20 years, I am sure you know better than I. You also gave NO DATA to support your statements about errors with work hours. Your opinion is fine, but opinions are like assholes, everybody has one. From the data I have read, the results area at best conflicting. Personally, I think work hours are not a bad idea as long as the residents are reading off the clock. I am saying that as someone who has taken real 36 hour call for the better part of two decades, not an ER doc who did it for has internship year off-service, and since then has worked 8-12 hour shifts. Your hypocrisy is hilarious.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-51720559875225617752008-06-22T06:10:00.000-05:002008-06-22T06:10:00.000-05:00Heres my real point..If continuity of care is so f...Heres my real point..If continuity of care is so f-in important WHY DON'T the NURSES STICK AROUND 24 HRS!?!? Hmm? Hmm? I know they'll work double shifts occasionally but only for significantly more Cash. And if you're gonna try to get one to teach you something, better not do it around shift change. The only thing I ever asked Nurses for was their phone numbers. Latest Vitals, Physical Exam? They'd tell you to look at the chart stupid, they're busy.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-20323792885175709402008-06-22T06:03:00.000-05:002008-06-22T06:03:00.000-05:00Not to slam on the Nurses, I married one, and I al...Not to slam on the Nurses, I married one, and I always win those doctor popularity contests they have (Advise to residents, buy a big box of Krispy Kreme Donuts for the Nurses/Unit Secretaries/etal of the floors you work on) might cost $100 or so, so what its Tax deductible. I did it once as an Intern and became known as the doctor who bought donuts for all the Nurses.)but take what they teach you with a grain of salt.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-24842825007870508532008-06-21T16:53:00.000-05:002008-06-21T16:53:00.000-05:00I would say as much learning comes from good nurse...I would say as much learning comes from good nurses as teaching docs. The problem with today(sorry I don't know how old you are) is nurses are getting taught to do paperwork and to actually believe they might be sued for malpractice for a poor pt outcome (that was the drs fault, not theirs)<BR/>In fact I have never heard of nurse being sued, by themselves, in my entire career. I'm sure it has happened, but there's 30+ yrs of experience here having never seen it.There's a reason nursing malpractice only costs, like $25/yr<BR/><BR/>Good Nurses Rock!!!Especially ED Nurses!!(Plus they're the best looking, usually have great tits, and are fun, I married one!)Oldfarthttps://www.blogger.com/profile/14333534023484494721noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-27257303155307537772008-06-21T16:18:00.000-05:002008-06-21T16:18:00.000-05:00I am suprised no one has mentioned the nursing sta...I am suprised no one has mentioned the nursing staff at the teaching hospitals. Years ago when I worked as a nurse on Medical Stepdown, none of the Interns really made a lot of decisions alone. Most diagnosises has a recipe of what to do. So much of the stuff was ingrained in them. And if they wrote an order like give Magnesium to this patient on dialysis, we would discuss why we could not do that. IF they disagreed, they had to speak to their resident. So it was not like a whole bunch of new guys were set loose on the public. The nurses were watching their every step.pinkyhttps://www.blogger.com/profile/00198277802918823591noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-314666519125194222008-06-21T16:12:00.000-05:002008-06-21T16:12:00.000-05:00Scut, I am BACK in Academics after spending 10 yrs...Scut, I am BACK in Academics after spending 10 yrs in in private practice EM(an oxymoron) in 1 of the busiest ED's in the nation with ZERO residents or students, waay over 120K/yr. And got tired of seeing less than satisfactory training from more than a few young colleagues(911 exempted)<BR/>I somehow doubt that provides with me a, what was that, "plantation mentality".<BR/>I somehow doubt your are an EM resident or you would know that WE are the ONLY teaching physicians who are there 24/7/365, you Pansy Assed Faggot! Supervising, teaching, and seeing patients and in general handling everything no one can, wants to, or has the balls to take care of and hopefully teaching a few good young doctors along the way.<BR/> <BR/>You would not be one of those..Please stay off my blog <BR/>until you HTFU!!<BR/><BR/>Ruby, I already do all the above, just not often enuff. And U may be right about being too old. I'd just as soon strangle the little PAFMF, wouldn't take near the strength of typing a response...Kind of like last week, got tired of a certain gen surg and told him he was acting like a chicken shit, fucking highschool bully, do you want to walk outside?Didn't take me up on that either..Toodles..Oldfarthttps://www.blogger.com/profile/14333534023484494721noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-27133991566158307632008-06-21T16:06:00.000-05:002008-06-21T16:06:00.000-05:00YOu know what scares me the most? Etohtheipi is st...YOu know what scares me the most? Etohtheipi is starting to make sense! Could a general surgeron slide over into pathology or would they need another long school thing?<BR/><BR/>Also I would perfer working with old Doctors out of residence who can do the surgery while they are sleeping. <BR/><BR/>One of my Doctors has argued that "What are these new Doctors going to do when the sh!t hits the fan?" Out Doctors almost never call in their second and they can be up for 24 hours working.pinkyhttps://www.blogger.com/profile/00198277802918823591noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-75737588752759154022008-06-21T09:42:00.000-05:002008-06-21T09:42:00.000-05:00At my intstitution the residents are based at the ...At my intstitution the residents are based at the nearby tertiary care facility. They take no ownership for the patients.<BR/>There is a day float person who doesn't know jack about the patient. They initially hired two newbie NPs to do the off going team's scut work, but there was little sign out, only a scut list passed down including who to d/c etc. The NPs were clueless. They soon departed. Now we have 2 older seasoned NPs who attend rounds daily, know what is going on and they pretty much tell the PGY1 floats what to do. Seems to work better and improve continuity of care.<BR/>Our facility has short rotations - one week on ICU/CCU then a week on medicine. So if it is the 6th day of your rotation on ICU and the pt is sick as he!! the MO tends to be, who cares, it is not worth thinking about his issues, do the basics because you'll be gone the next day, let the next guy deal with it.<BR/><BR/>I'd much rather have a resident trained in the old school than the current method (as long as he had a competent fellow and or staff MD overseeing care). <BR/><BR/>I don't have a solution, but reducing hours to 56 will only make it worse in my opinion. <BR/><BR/>CardioNPAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-3991883459746185692008-06-21T06:06:00.000-05:002008-06-21T06:06:00.000-05:00I have always said that robot doctors kill. Workin...I have always said that robot doctors kill. Working hours tirelessly can only cause problems for the healer and the patientAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-29812164330526053192008-06-21T02:24:00.000-05:002008-06-21T02:24:00.000-05:00Oldfart, I often get the feeling that you're too o...Oldfart, I often get the feeling that you're too old for this comment battle bullshit. Not too old as in "just can't do it anymore," as that's clearly not the case, too old as in "Dammit, I'm too old for this bullshit!" Something like John McClain would say after killing 12 krauts in an elevator. Let 911 and the kids fight it out; in the meantime, try fly fishing or shoot some animals or go dunk on someone shorter than you. Love your posts though, makes me smile to know that some people are still kickin' it Old School.<BR/><BR/>Etotheipi: now that I think about it, you remind me of some kind of a Sith lord, like the Emperor. All the other docs here seem to be jedi fighting the good fight against all odds, while you always sneak in a comment or two with a wry smile tempting the righteous to the dark side. The dark side of course being pathology.....its powers.....limitless. <BR/><BR/>I'm listening.21https://www.blogger.com/profile/09560786230715552515noreply@blogger.com