Reasons I'm Leaving Emergency Medicine (number 9)

Dr. Deborah Peel was not the name of the female attending I'm fixin' to tell you about, but I like the name so I'll use it. This story goes back, again, to my residency training.

I believe my Deb has a lot in common with the real Dr. Peel... an overblown sense of her own importance, a barely buried contempt for masculinity, and a boatload of guilt and remorse from sources unknown (but which, probably, have to do with the ever-dawning realization that the career she chose over family will not be all it was supposed to be).

Deb got drunk one night at a conference all us senior residents attended. It was 3 in the morning and my wife was with me at a little pizza joint. We were all drinking beer and having a blast. We had just come from one of the last drug-company boondoggles I will ever see, with open bar and super food and music at a very posh venue. We had a blast (ever since that drug company function I have only prescribed their medicine... for everything).

There were about six of us around that table when Dr. Deb said to me, one drunk to another, "You know 911, you need to treat your wife better" (my wife was sitting right there and heard the whole thing).

"Huh?" with quizzical look and waiting for the punch line.

"You walk around like you're some kinda big-shot and you don't deserve to have your wife and you are not a bigshot and everyone thinks you're an asshole," said Dr. Deb.

This was not a punchline. I was stunned. I left with my wife and we went to the hotel where she tried, unsuccessfully, to convince me that I was a good husband and a good doctor and that Dr. Deb had been drunk and crazy to say what she had said. For the record I only beat my wife when she deserves it and only with my non-bowling hand... I usually remove the all my rings too. I later learned that Dr. Deb spent the rest of the night trying to seduce a fellow resident who was 12 years her junior. Classy.

I was so upset by this that I went to the program director and asked if the rest of the attendings felt about me as Dr. Deb did. "No", he assured me. He then wrote her statement off for reasons having to do with her life outside medicine (pending divorce, screwing one of the nurses etc...), and they did, in fact, graduate me on time and with honors.

No matter, I couldn't get over it and avoided most contact with the bosses after that. 8 months to go in residency and I shut my mouth and tried to let it die.

Dr. Deb offered an apology of sorts at the graduation party she had at her house. The apology was in the form of a joint... I declined.

Another Air Ambulance Crash

Flying patients by helicopter is a subject of much controversy in the EM literature. There sometimes is no other way to get a sick patient to definitive care, but the statistics are shaky on whether the helicopter is, in the end, worth it. We posted on this just a month ago, and, tragically there has been another crash. With specialists fleeing for the relative safety of large multi-specialty hospitals and ERs closing they are used more and more. EMTALA strikes again.

Can I get an AMEN!!!

At least Justice Thomas and the Supremes believe the 2nd Amendment is a CERTIFIED RIGHT!!!(I love Justice Thomas!)
However, friends, it was 5-4 decision. When Hussien Obama is president there will be 3(I think) Justices over 75 years old on the Court. OMG!! I've come to believe over my years that the appointment of federal judges thru out our nation is the most critical job a Pres has. And if that liberal, communist, radical islamist becomes our president, we are in for so much trouble..
Comments

She Keeps Calling them "Illegals", How Gauche!

The above video has not been vetted by MDOD, but this happens every single day in nearly every hospital in America. I have posted on this at least twice... see here, and here.

Our system is being crushed by giving away free care to EVERYONE. Solution? Don't change a thing EXCEPT this, everyone pays for their care. If they can't pay then they get community service to be determined by a court. Even though community service could not possibly pay the tremendous bills generated by those who can not get insurance or CHOOSE not to get it, it would get the message out loud and clear that the ER and American hospitals are not endless reservoirs of taxpayer largesse.

Immediately the bogus ambulance calls and 3am visits for narcotic refills and pregnancy tests would cease. Immediately, our physicians would be seen in as high regard as our dentists, who do get paid for what they do.

I am perfectly prepared for your hate mail on this, but I am the one, as is Oldfart, 'Cat, ERDoc85, Lofty, DRX, and even my friend etotheipi who currently see and treat all comers regardless.

The problem we have is not doing this, it is our inability to get the government to get the message out that riding the ambulance and going to the ER is not "free", you and I pay for it with our taxes, rising insurance premiums, and skyrocketing medical bills. Hospitals are making up the shortfall on your backs. End the 'free care' and most of our problems are fixed.

And for you haters our there, here's some hate, and guess where it comes from? That's right, the left, who perpetually act like fourth graders smoking a joint. Contrarily, I have absolutely no problem with this. Go figure.

Mystery CT Scan

This a CT scan of a really cool problem we've probably all heard of but never seen. For the sake of argument let's call our patient "Carl Peel"- Dr. Peel's illegitimate son by Bill Clinton. He came in just a few days ago. I'll give everybody some time to guess the diagnosis before giving the whole story. What is wrong with Carl?

Reasons I'm Leaving Emergency Medicine (number 10)

As I approach my exit from the circus of the Emergency Department I thought I would do a 'top ten' list of reasons I am leaving.

Number 10:

Dr. "Spanz" was an attending at my residency program. He was widely feared by all in the hospital for his temper and his commanding presence.

Prior to residency I had been a Medical Officer in the service. There I worked for and took care of warriors. Leaders. They treated me well... probably better than I deserved, but I was their 'doc', and they at least acted like they were happy to have me.

There I learned that a General worth his salt treats his 18 year old enlisted folks like they are adults and then punishes them when they aren't. Dr. Spanz treated us like children and punished us when we acted like adults. Of course, across the spectrum of medical training this is the sad norm.

When I started my residency other residents said of "Dr. Spanz", "You will hate him while you are here but when you leave you will remember him fondly as his lessons will not fade and his teaching will save your ass."

The first part of this bit of wisdom proved true, but the latter... not so much. This guy was very fond of reaming you a new one at every opportunity, and was a staunch defender of all manner of dirtbag patients who frequented our club. Kick, spit, cuss, and hit, as a patient you could get away with it when Dr. Spanz was on. He would go up to the most abusive patients and smile and pat their hands and talk to them like they were the Queen of England.

We, as residents, were, for some reason, deserving of his wrath, but patients were always right and wonderful and fluffy. I have never in my life met as self-important an asshole as Dr. Spanz- a big fish in a smallish pond. He WAS the smart kid who was always picked last for kickball. He's still taking it out on his indentured servants, and he still has a hole in his heart that he can't fill.

Fifteen years out and I still can't let it go. Do I have issues? Yes, but Dr. Spanz, you suck. It was hard enough as it was. Your pomposity and barely concealed neuroses would have not been tolerated in any other setting than academic medicine. And by the way, you are ugly too.

Libby Zion case in the rear view mirror..

Most of you must know of the Libby Zion case some 15 or so yrs ago. If not, briefly, young lady dies of infection after being in a NY teaching hospital ED waiting for care.

This episode changed medical education in a huge way, as residents(drs in training) are now forbidden to work more than 80 hrs/wk and more than 36 hrs in a row. Obstensibly, to prevent fatigue and reduce errors in medical care leading to this sort of "outcome" (and now the hrs are soon to be reduced to 57 hrs/week!)

My personal record as a resident BP (before penicillin) of continual service was, without stop or sleep, Friday 6AM until 3PM the following Monday..(neurosurgery rotation)

Despite the good intentions, the objective data, show that this reduction of hours has INCREASED poor outcomes, mistakes, etc. Probably due to the increased number of "turnovers" which is what we call signing the patient over to a new doctor before diagnosis, definitive treatment, etc is established by the initial treating physician.

The reason for our previous long hours of work during residency, was continuity of care, so that a young physician would see a case thru the initial stabilization and treatment of a patient and see the progression and effect of said treatment.

Doesn't seem to have worked as intended. So would your rather have a tired doctor directing your care who knows exactly what has gone on in the initial stages of your treatment or a fresh doctor who takes over but doesn't know what or how ill you were 36 hours ago??

Comments??

Suggestions from the cheap seats??

OK, you MDOD readers, I'm soliciting suggestions for the place, timing, theme of the first meeting of the minds. We, the contributors to this mindless drivel of a blog, should meet, for the first time, and just see who is KRAZY..
Give me/us your suggestions! Maybe we'll do it!

Canoe

Have you ever been in a canoe? Just wondering, because this body I just cut open and then removed all of the internal organs from tongue to anus, looks exactly like a canoe. The body, with its empty ribcage and abdominal cavity flayed open, would probably float if I tossed it in the local pond. All I need is a wooden paddle, an orange life vest, a boy-scout uniform and a six-pack of beer. I could even fish with bits of tissue as bait.

Why did my wife look at me funny when I told her this? Must be a girl thing.

'Interventions' Aren't Always Well Received

A funny story about my great friend 911DOC. He was visiting friends a few years ago...friends he hadn't seen for several years. They threw a few beers back and the next day the friend - who had somehow become a grubby little liberal shithead - asked 911DOC if he thought he had a problem. I am pretty sure this is how it went. I love you, man. Happy Father's Day.

MDOD Worldwide Breaking NEWS

As far as I can tell right now MDOD is breaking this story worldwide. Based on the same depth of analysis and hard evidence that you will soon read in any number of "reputable" news sources, I am hereby blaming the flooding in Iowa, and specifically at the University of Iowa, on George W. Bush and Republicans and Global Warming, Climate Change, or Global Cooling, or mouse farts.

After a record breaking winter with snowfall in excess of anything seen in decades, I now hate myself for driving a truck. I am now purchasing carbon credits and a prius. I can't quite get how this is a result of global warming, so I am retreating to 'climate change', but I do know, deep in my heart, that it is GWB's fault. I hope and meditate that Al Gore can get up there soon.

Gaia, please forgive us. Off to repair the ozone hole and throw urine on people with fur coats.

And dear readers, please do forward any links to sources that claim this scoop. We started it HERE! Interviews with major media outlets will be granted on a first come, first served basis. I'm hoping for NPR.

Thanks Taxpayers (part one million)

Dr. Peel came in by ambulance the other night on a cocaine and crystal meth bender. She sure has put on a lot of weight. She was distressed that her 'significant other' was cashing her disability checks to pay rent, after all, she said, her significant other is supposed to love her. So, she called a 'good friend' who supplied her with cocaine and crystal and some fine kind. She had no insurance and no money since she had just spent it on 'partying' and when old Doc Peel gets to partying the only thing that stops her is runnin' out of stuff or wanting to stick a knife in her lover. The sticking a knife in her lover part was the reason she was placed on a mental health hold... I believed she would do it.

After she finished chowing down the sandwich and soda we gave her (and damn if she didn't gum that thing to death!) she demanded something to counteract the cocaine and stood in the hallway begging to go smoke. Such a shame, a promising career like that caught in the web of substance abuse and broken hearts. Thanks, by the way, for paying for her care all you taxpayers out there. It was very expensive, especially because, since psychiatrists are rare as hen's teeth on hospital staffs these days (it doesn't pay) we had to transfer her hours down the road for admission and treatment. Good luck doc.

Light At The End Of The Tunnel?

Looks like heading to the ER because of chapped lips won't fly any longer in the great state of Utah.

Utah's Medicaid program has received federal funding to help develop a program to divert Medicaid patients from the ER for non-emergent problems to primary care providers. This novel concept seems to make some sense, eh?

Created by the Deficit Reduction Act of 2005, about $50 million in grants will help Medicaid programs in 20 states fund local and rural initiatives to provide alternative health care settings for individuals with non-emergency medical needs. About friggin' time.

Hang in there 911 Doc and Shrodinger's Cat. The cavalry may be coming after all!

Update from Washington

Couldn't get an audience here

Nobody home here.

Dumbocratic National Committee meeting at the Marriott

Beautiful Mt. Vernon

Well I'm back from DC (that's District of Communism). A man once said if I ever go crazy I hope its in DC..that way I won't stand out from the crowd. Truer words were never spoken. Tried to get an audience for my USSA proposal and also stopped by the IRS to discuss postponing my quarterly taxes for a few years. Got nowhere. Did some sight seeing on the mall, went to the zoo, and saw a large group of liberals protesting outside the Marriott(see above) to get their voices heard and state's votes counted by the DNC. Nearly vomited after hearing this at the subway stop next to the Marriott ... "Like, I, like think Obama should allow Hillary to run and, like, let the votes count, because, he's, like, younger and stuff and can run later, and, like, Hillary deserves a chance." (No shit, these people vote and affect my taxes, the amount I pay on capital gains, defense spending, diplomatic relations, etc, etc, ) I started to cramp up with an immediate visceral reaction, realizing I failed to wear my Friends Don't Let Friends Vote Democrat t-shirt. I must say, I did enjoy the pandas at the National Zoo, but I much more enjoyed watching the 20 somethings bang into each other on the Mall protesting things they new nothing about, but felt cool doing it (Darfur, war, the man, global warming). But it is good to be home.

911- Full time ends for me in 10 weeks, then will do some fill in until the new gig is up and running. Lofty, the wheels are in motion and rolling downhill. Paying patients, no nights, no ambulance diversions. Ahhhh A great weight lifted off the shoulders. Atlas can shrug all he wants now, I'm about to get off.

CAT

21st Century Alchemy... Still a Failure.

The only thing surprising about this article is that it is, evidently, surprising to the author.

* Just found this... Orthopedic surgeons may be leading the charge. Will the government listen to the experts who actually fix people, or will it tie them to the rack?

** And meet my hero.

HIPAA Logic

HIPAA, a law designed to protect patient privacy in the realm of medical information, is a huge stinking turd.

At my facility we just spent many hundreds of thousands of dollars to implement an electronic patient tracking system in the ER.

Besides taking pen and paper away from us and generating 8 pages of 'nursing notes' on every patient (to maximize billing), it took away our chalkboard which we used for years, with good effect, to show everyone where patients are, which doctor is seeing them, and which nurse is responsible for them.

Now we have a giant flat-screen plasma monitor (it's really quite beautiful with a crisp picture) which displays patient's room numbers, patient's initials, and coded symbols for doctors and nurses assigned to the patients. We are going out today to buy a chalk-board. Thanks to Dr. Deborah Peel, you freaking genius of bureaucratic masturbatory ignorance. Gotta go, "TH" is coding... Where are they? Who's their nurse? Shit.

The "O", "Q", and "Dotted Q" Signs

Gallows humor is one method many of us use to handle horribly sad or tragic situations. Guilty.

I recalled today, as I drove past a hospital I spent much of my third-year of medical school in, about the "O", "Q", and "dotted Q" signs.

A crusty old attending who has now passed (bless him) was waxing poetic about hospital work before heroic measures, 'code blues', and death prolonged by machines. The following physical findings ("signs") were, evidently, quite common then, and quite diagnostic.


The "O Sign": Patient with agonal respirations, mouth agape, near death. The mouth is in the shape of an "O" hence the "O sign"... very bad.

The "Q Sign": Patient dead. Tongue now lagging out of mouth (thereby changing the "O" to a "Q").

The "Dotted-Q Sign": Patient long-dead. Fly on end of tongue (thereby dotting the "Q").


Now you know and you wish you didn't.

Wipe-O-Mania!

By Michael Kahn

LONDON (Reuters) - Disinfectant wipes routinely used in hospitals may actually spread drug-resistant bacteria rather than kill the dangerous infections, British researchers said on Tuesday...

The "superbug" epidemic is not new. I remember many a medical school lecture, many an article, and many an attending waxing poetic (whilst on rounds) about the problem of growing bacterial resistance.

This was usually used as a caution against throwing antibiotics at non-critical illnesses that were likely viral in nature. This is hard in the ER, especially since the advent of the rule of "customer satisfaction", as most folks want antibiotics whether they need them or not. But that's a topic for another post...

So, if you read this Reuter's article what do you conclude? Are you even more scared than before? Here's my conclusion. Buy stock in disinfectant wipe manufacturers, or options, but do not buy a long position.

Another possiblity? We are the victim of the technological imperative. These bugs have always been there but we couldn't find them as well until now (or we never looked as hard). Personally, I think that infection transmission by these routes is very patient specific, and more related to the patient's immune status than to meticulous aseptic technique OR lack of using enough antibacterial wipes. One more thing. Using as many wipes as they seem to want us to use will fill up the landfills, clog incinerators, put poisonous chemicals in the air, and increase global warming (or cooling).

Natural Cures They Don't Want You To Know About

I was just sitting in my office dictating charts when I heard yet ANOTHER commercial for Kevin Trudeau's Natural Cures "They" Don't Want You To Know About. Mr. Trudeau claims that the powers that be don't want you to know exactly which herbs and foods may help you to feel better. He encourages you to read about the 'conspiracy' to keep you sick and overweight. He says, "The medical establishment exists only because people are sick."

Shit! They're onto us.

As a diabetes specialist, OF COURSE I want to keep Americans fat and diabetic. It's my industry. We call it job security in the diabetes world.

Anyhow, I want to congratulate Mr. Trudeau for exposing our disgusting and inappropriate relationship with the pharmaceutical industry. Since he has exposed us, I feel a bit guilty and want to provide FULL DISCLOSURE with respect to the gifts and kickbacks I have received from pharmaceutical companies over the past few years:

Merck Schering-Plough: Yet another Porsche Cayenne Turbo was delivered to my home on Saturday. The 2007 they gave me last year for writing so many Vytorin prescriptions only has 8000 miles. I'll keep this one in storage until my son is ready for it. With the way Vytorin is going, may be the last Cayenne from Merck for awhile.

Novo Nordisk Inc.: 7-day junket to Vegas with a $10,000 'head start' on chips and a weeklong orgy with their 10 hottest drug reps. Priceless. We're going again the end of June. Hell, they do this for me every year, I'll write insulin for people who don't even have diabetes.

Sanofi-Aventis: A week with Megan Fox in The Beverly Hills Hotel with a closet full of edible underwear. Let's just say I have been 'Transformed'. Have this week on the docket again for early August.

So, there you have it. You win Mr. Trudeau. By the way, your line that "The medical establishment only exists because people are sick" is genius. In fact, I don't get it. Anybody? Help?

From SSAEM

Hi Folks. Been in the Nation's Capitol with a 1000 or so of my closest friend's from the Socialist Society of Academic EM, you know, good old SAEM.
Rest assured that I'll have a few comments on the proceedings.
But first, the Keynote address was a "town hall" with the 3 candidates' Medical Big Thinkers. Surprising what floated over the crowd, but I digress.

Just 1 observation today. The dude representing CLITon was actually probably the best of the worst for ONE reason..Now before you start yelling that Oldfart forgot his asprin again..

He actually mentioned(not too stridently)that the time has come for the USSA to stop spendng 75% of our health care $$ in the last 3 months of life! You all know it will be cold day in Hell before I vote for a woman, if you can really call her that, I want DNA proof, but, let's face it. Rationing the $ that we spend flogging 85 year old hearts with LevemDead for days in the ICU and rescusitating nursing Gulag's 90 year olds, needs to end. And, I submit, it will be a Dem who will have to force it down our throats before it happen, if it ever will..Just think what we could do with THAT money back in our CURRENT HC System!!

Let's have a group hug and then get on with bidness..HTFU!!!