Home / Blog

Blog

1209717_19610439The focus of this web site is medicine. In this blog, you’ll read about patient stories. The situations have been changed to be HIPAA compliant. You’ll also read a lot about health care policy. I may throw in posts about life lessons, computers, and will even throw in family stories once in a while. If you’re looking for articles about politics, sports, or celebrities, you’re in the wrong place – unless the topics have some relationship to medicine.
If you want to add a guest post or to cross-post something from your blog, or if you have a patient story you want me to write about, e-mail me. See more information in the “About Me” page.

Battling diarrhea with … yeast

Recently-published meta-analysis shows that the yeast Saccharomyces boulardii has “clear beneficial effects” on children with acute diarrhea. Pooling of 22 studies showed that duration and amount of diarrhea was significantly reduced in children who took the supplement. Interesting back story to the discovery of Saccharomyces boulardii: The yeast is found on the skin of lychee fruits. French scientist Henri Boulard discovered Saccharomyces boulardii in the 1920s after noticing that natives of Southeast Asia were chewing on the skin of lychee fruits in an attempt to control the symptoms or cholera. You can purchase Saccharomyces boulardii from Amazon without a prescription. Saccharomyces boulardii is related to another yeast – Saccharomyces cerevisiae – which is found on the skin of grapes and plums and is used in brewing beer and baking. Antibodies to Saccharomyces cerevisiae are often seen in patients who have inflammatory bowel disease such as Crohn’s disease and ulcerative colitis, suggesting that Saccharomyces cerevisiae may play a role in bowel inflammation. Then I begin wondering whether the link between beer and “beer belly” may be related to more than just the alcohol and the extra calories in the beer.

Read More »

Healthcare Update — 09-12-2014

Need certification or recertification in BLS, ACLS or PALS? Don’t wait for the next course to be offered at your hospital. You can get same-day certification with an entirely ONLINE course NOW at Pacific Medical Training. If you sign up for training through this link, you’ll get a 15% discount on the cost of the course at checkout and you’ll be able to download your certificate of completion as soon as you pass the online test. ———————— 40 year old father/husband went to emergency department two days after feeling nauseous when he ate breakfast. Reportedly had cardiac symptoms, including chest pain. Was in the emergency department 4-5 hours, during which time no cardiac enzymes were ever ordered, and then released. Two days later, clutches his chest and dies from heart attack. Jury awards family $4 million. Good news: Chinese researchers discover new way to kill cancer cells by injecting the metal gallium into the arteries supplying the tumors. Bad news: In rabbit studies, the metal somehow finds its way into the heart and lungs and forms deposits there. $62 million medical malpractice award to patient who goes to Winthrop University Hospital for endoscopic removal of an ectopic pregnancy, developed complications from an unnoticed bowel perforation, then developed sepsis that eventually required amputation of both legs. In addition, the high doses of antibiotics she was receiving caused her to lose her hearing. When a front page story about the patient ran in the newspapers during trial, the hospital’s attorneys requested a mistrial, stating that the plaintiff “should be thankful the doctors were able to save her life.” Not really a good argument to use. In the end, the plaintiff and her attorney were happy that “justice was served” and someone in the comment section to the article suggests that everyone “remember this case the next time you find yourself asking why a Tylenol in the ER costs you 30 bucks.” Ohio jury awards patient and husband $1.2 million when patient had persistent pain after undergoing partial hysterectomy and physician didn’t order CT scan to diagnose perforated bowel until the patient was “critically ill.” By the time the complication had been diagnosed, she had developed respiratory distress syndrome and now requires a walker to help her walk. Remember how the government is making elderly patients pay for more care when they’re admitted as “observation” versus fully admitted? Then they came up with the “two midnight” rule, where providers had to predict whether a patient would need to stay in the hospital for two midnights – and then sign an attestation to that effect. The government won’t give “prior authorizations” for admissions, so providers are left to guess whether the government will retrospectively consider an admission appropriate, and anything deemed as “unnecessary” care is considered fraudulent when the government is billed for it. End result? Community Hospital Systems pays $98 million to settle false claims allegations. “The United States alleged that from 2005 through 2010, CHS engaged in a deliberate corporate-driven scheme to increase inpatient admissions of Medicare, Medicaid and the Department of Defense’s (DOD) TRICARE program beneficiaries over the age of 65 who originally presented to the emergency departments at 119 CHS hospitals. The government further alleged that the inpatient admission of these beneficiaries was not medically necessary, and that the care needed by, and provided to, these beneficiaries should have been provided in a less costly outpatient or observation setting.” Several emergency physicians and emergency nurses were “whistleblowers” in the case. When a hospital wants to admit you as an “observation” status, keep criminal investigations and settlements like this in mind. One ...

Read More »

Assault With A Semi-Deadly Weapon

Ramen Noodle Bowl

A man comes to the registration window clutching both sides of his head. “Help me … please. My head … it’s killing me.” He is brought straight back to a room and the doctor is called right in to see him. Between moans, the doctor gets the history. “I was fine before the fight. Then my baby’s momma came to my house with her boyfriend. She was nice at first, then she started arguing with me. Then he got all tough and tried to get all in my face. Then out of the blue, she grabs a bowl off the counter and hits me over the head with it.” “Wow. Did you pass out?” “No. But I was damn close.” “Did the bowl break?” “No, it wasn’t open.” “What do you mean it wasn’t open? What kind of bowl was it?” “One of those Ramen Noodle bowls.” “Wait. You mean one of those little plastic bowls with the peel off paper on the top?” “Yeah. But that sh*t HURTS!” “Did you get hit with anything else?” “No. She just slammed me in the head with the Ramen Noodle bowl then they took off running. I think I may have a concussion.” “Pardon me a minute.” The doc walks out into the nurse’s station shaking his head. He regains his composure and walks back into the room. “Well, after examining you, there are no signs of bleeding inside your brain and no concussion. We’ll give you some Tylenol … number three … here and then give you a prescription for a couple of days of Dolobid (pronounced “Da-LAW-bid”). You can follow up with your family physician if you’re not feeling better.” With that, the patient was given three Tylenol tablets, given a prescription for Dolobid, and discharged in stable condition. A couple of hours later, the patient calls the emergency department. “Man, that wasn’t no Dilaudid. That was crap. Can’t y’all just call me in some Oxycontins to last me through the night?” “No. We can’t call Oxycontin into a pharmacy. Try some ice and the Dolobid. You should feel better tomorrow.” So the nurse who took care of the patient overheard the conversation and made a suggestion. “I know something you can call in that would probably help more than pain medications.” “What’s that?” “Testosterone patches?” “Harrr harrr. That’s scheduled, too, you know.” “A football helmet?” “Nonprescription. Not carried in drug stores. Don’t you have patients to see?” “Some plastic bags to store the Ramen Noodles in?” “Stop. I’m getting a concussion.” ———————– This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on Dr.WhiteCoat.com, please e-mail me.

Read More »

How To Get Rid of Fruit Flies

Fruit Fly Vinegar Trap

They’re back. And now I’m an expert at exterminating them. A couple of years ago, I wrote a post about how we had a fruit fly problem and how we got rid of the problem. The fruit flies always seem to appear in late summer and hang around until late fall. And they love to dive bomb at people’s faces. Before learning about the solution, I would grab them out of the air. But fruit flies are pretty adept at dodging giant hands. So I started clapping them to death. That worked most of the time, but they would win by sheer numbers. It was like some freaky insect zombie movie. Kill one and it attracts even more. I’d even keep a couple of cans of Raid about the house and spray them, but that got Mrs. WhiteCoat upset. A couple of years ago, a neighbor suggesting putting out a glass of apple cider vinegar. Apparently, fruit flies are drawn to the aroma since it smells like fermenting fruit … which happens to be a fruit fly delicacy. They dive bomb the glass then can’t get out and drown. He also suggested putting a few drops of soap in the vinegar to break the surface tension so that the fruit flies couldn’t float on the top of the water like these water strider insects. So we set up a vinegar trap. Put a half inch of vinegar into a glass, add a couple drops of soap, and put it near the garbage can or the sink. Putting the glass in the microwave for 15 seconds will get more aroma out of the vinegar and attract more flies. Your home will be noticeably less fruit fly laden in no time. We’ve seen some of the fruit flies coming out of the garbage disposal, so one of the things we did to help prevent the fruit flies from coming around was to first throw some baking soda down the drain then run hot water and the disposal, then throw a bowl of ice cubes down the drain and run the disposal again. If this post has helped you out or if you have any other suggestions, please leave a comment in the comment section to let me know.

Read More »

What’s The Diagnosis 22

Child Skin Lesion

A six year old child is brought to the emergency department by an aunt and a Child Protective Services worker. He was sent home from school by the teacher who said that the child appeared to have marks from being hit over the shoulder by a whip. The school principal called Child Protective Services. The child says he wasn’t hit by a whip but can’t say what, if anything, did happen. The lesion is dry, rough, and non-tender. It does not appear to be a bruise. No drainage. No fever. No URI symptoms. No other lesions anywhere else on the body. The child is up to date on immunizations. What’s the diagnosis and what’s the treatment? Answer posted below in a few days. . . . . . . . . .    Answer: Lighter Burn to the Neck The mark wasn’t caused by a whip, but rather was caused by a worse form of abuse. A lighter burn is caused by keeping the flame of the lighter lit until the metal head of the lighter gets hot, then using the hot metal head to burn the skin. See the picture for a comparison – probably not the same lighter, but the characteristic “U” -shaped outline of the lighter burn becomes more apparent. While the burn may initially appear too narrow to match the outline of the lighter head, by holding down on the patient’s shoulder and stretching the skin, a near-perfect match to the head of the lighter was obtained. The patient and his sibling were removed from the household until further investigations could be completed.

Read More »

Healthcare Update — 07-28-2014

Patients with “insurance” wonder why they can’t find access to medical care? Here’s a good example of why: Wisconsin pays a pittance to those who care for its Medicaid patients. As in 71% lower for office visits than private insurance payment rates, 76% to 78% lower for hospital care than private insurance rates, and 91% lower for emergency care than private insurance rates. According to the article: One result of Medicaid’s low payment rates for physicians is a shortage of primary care clinics in low-income neighborhoods in Milwaukee. That contributes to many people seeking care in high-cost hospital emergency departments. Wheaton Franciscan-St. Joseph estimates that roughly half of the patients in its emergency department — the busiest in the state — could be treated elsewhere. Letter to the editor about the article from an emergency physician notes that the abysmal payment rates make it difficult to recruit and maintain emergency physicians in Wisconsin. Oregon hospital notes “record breaking” increases in emergency department visits after Obamacare implemented. Average daily patient volumes in the 60s increased to the mid-70s with some spikes up to 100 patients per day. Wait times also increasing. BMJ investigation shows that drug manufacturer Boehringer Ingelheim reportedly hid data from regulators regarding safety of Pradaxa [dabigatran]. Some Life Pro Tips from Reddit contributors on how to speak to people who have hearing impairment. Not scientific, but I’ve found that I tend to speak slower and enunciate each word when a patient initially says that he or she cannot hear me. After going back and forth once or twice, I’m usually able to speak in a normal or near-normal voice. Any ENT experts care to chime in? Slowly, of course. And for all you young whippersnappers out there, here are two related sitcom videos related to auditory issues from Monty Python and Taxi. More on the $190 million Johns Hopkins settlement after gynecologist found to have taken secret pictures of up to 8000 patients. Hopkins joined an insurance collective with other universities such as Yale, Cornell, Columbia, and the University of Rochester. Now money will be coming out of the pockets of several institutions that had nothing to do with the Hopkins incidents. Recently-published CDC study based on 2012 data shows that children covered by Medicaid use the emergency departments at a rate nearly double that of patients with private insurance. Pregnant California woman in labor is unable to cross street to get into hospital for 30 minutes because President Obama’s motorcade was passing through at the time. Pakistani town organizes protest of 100 people calling for a doctor to be arrested when patient under doctor’s care dies of stroke. Protestors laid patient’s body in road in front of the clinic and initially refuse to leave. Philadelphia psychiatrist pulls out gun and shoots armed patient who had just shot his case worker. Police admit that the doctor’s actions stopped the patient from going on a rampage and killing others, but police are also “investigating” why the doctor had a gun at work since “bringing guns to work is against the rules at the hospital.” Those “no gun” zones work so well. Obviously the patient in the incident was playing close attention to the rules. And Chicago is a shining example of how properly implemented gun-free zones save lives. You know all those fitness wristbands and fitness apps for your phone? They’re a gold mine for advertisers and identity thieves. Almost 75% of the apps studied sent data to third parties; nearly half shared personal information with advertisers — all without the user’s knowledge. Another analysis found that the top ...

Read More »

A Medical Malpractice Attorney Tells It Like It Is

Gavel Pic

By Birdstrike MD Below is conversation between an Emergency Physician and a medical malpractice attorney. It was originally posted on Student Doctor Network by an anonymous poster that goes by the handle “TrumpetDoc.” It has been reprinted and edited with permission of the original author. If you have any thoughts or experience regarding medical malpractice, from either the plaintiff or defendant side, I’m sure you’ll find it quite interesting. ……………………………………………… Recently I [TrumpetDoc] had a discussion with a local medical malpractice plaintiffs’ attorney at a social gathering. Since I have been hearing often from my former group’s lead MD/JD and influential leaders in Emergency Medicine, that increased medical testing never protected anybody, I asked his thoughts on the subject. His comment was, “That’s Bull—t! When there is a bad case or outcome, and I see an upstream doc that had the chance to make the diagnosis with a test or procedure, I smile every time. I can get an expert from any specialty to debunk a doc’s thought that his/her exam and thoughts are good enough these days. And if we go to trial, I have a pretty set script here. To the effect of ‘so Doctor, you just didn’t care enough about my client to order this test?’ Or ‘so my client was just a statistic, just a percentage to you?’… [Juries] love that stuff!” He went on to explain that the medical malpractice environment will be getting worse for us doctors and he was extremely bullish on the med-mal business in the coming years. He continued on, “You guys are being hung out to dry. So are hospitals. There is already starting to be a contraction on spending and ‘costs.’ This is just awesome for me. There will be a lot of bad discharges, refused admits, procedure delays, diagnoses delays, all in the name of ‘costs.’ Your societies and hospitals are masking this as evidence based practice, etc. But I can get a jury to see that very differently. A lot of physicians will be paying out before long, as will hospitals…Testing is what makes diagnoses, saves people.” I rebutted by explaining that malpractice cases are best prevented and defended not by practicing “defensive medicine” but by documenting in the chart our thought process, differential diagnosis and rationale, using the concepts of clinical acumen, experience, and evidence and that our own experts could and would defend our actions. He responded with, “But that is in your world; people live in mine… juries live in mine,” with a smug smile and chest tapping. I had to restrain myself. He continued on, “If a patient is in the ER and wants to be admitted…you better just pray nothing happens in a reasonable time frame after if you discharge them against their wishes.” I asked about defensive medicine protecting from us suits and he said, “To a point, it does. Will you get sued? Sure. Will I be less inclined to take a case that had a complete workup? Yup. If you appear to me like you cared and did everything you could, you certainly more protected.” To him that equals ordering tests such as labs, CTs, and MRIs in the ED and admitting patients to avoid risk. He went on to say, “Nurses will hang you. EHRs [Electronic Health Records] are awesome! And nurses chart everything they freaking think of while in the ER with a patient. They are there to cover their butt, and often it is very helpful to me. It is so common that there are discrepancies in the medical record, and now they are so easy to find.” Regarding Choosing Wisely, he said, “This will ...

Read More »

Medical School in the Big City, Vol. II: A Month in the Morgue

Skull pic

  By Birdstrike M.D.   “So, I grabbed up my suitcase, and took off down the road When I got there she was layin’ on a coolin’ board” – Son House, Death Letter Blues   Fourth year of medical school is great.  Finally, I get some elective time.  Last month was great: Dermatology, ahh…….Sleep, rest, low stress and drug rep lunches: Yum.  I can still smell the delicious smoked ribs the rep brought for lunch, just last week.  I’m already hungry as I drive to start my second elective month in a row.  This month is going to be even more relaxed.  The patients might have >gasp!< pimples and rashes like last month, but this time they probably won’t even move!  After getting worked to death on 6 straight months with hospital call, this is the break I need. I walk into the building and as I get close to the bottom of the stairs, I smell something.  Is that ribs, again?  Wow, drug rep food already?  It’s only 9 in the morning.  That’s weird?  Oh, well.  I guess life really is good on these elective months, when you’re not getting called at 2 a.m. for a patient who might be dying.  I look at the clock.  Shoot, I’m a few minutes late.  I open the door. A group of students and residents are standing around a table that is covered by a sheet.  The smell of barbequed ribs hits my nose stronger.  A bearded man on the other side of the table, waves to me to come over.  That must be Dr. Black.  I creep toward the others around the table as Dr. Black pulls the sheet off of the table.  The overwhelming smell of smoke chokes my nose and as I see what is lurking under the sheet, I feel my stomach drop and my head get dizzy.  There laying on the table is a charcoal-black human body, burned to a crisp, arms drawn up to the face in a fetal position.  A few of the others turn away.  I hear a gasp, and a few deep breaths as we look at each other.  Oh my god, that smell!  I feel like vomiting.  It’s the smell of barbequed ribs, alright.  Human ribs.  Welcome to Forensic Pathology, I think to myself. “One thing we always do with burn victims is to x-ray them.  Does anyone know why?” asks Dr. Black. “To identify them by dental records,” chirps Gunner Boy with the bow tie. “No, although we do that occasionally,” says Dr. Black.  “It’s to see if there is any lead in them.” “Huh,” Gunner Boy seems puzzled.  “This person died in a fire.” “Are so sure?  Why might such person have lead in them?” asks Dr. Black. Now it’s my turn.  “It’s because they’ll shoot them full of lead, then light the house on fire to try to cover up the evidence,” I blurt out. “Yes sir,” nods Doctor Black. Betsy, the mousy-haired girl that was in my Anatomy group looks at me disturbed, as if to ask, “How’d you know that?” “Welcome to Big City Morgue, Betsy,” I shoot back. I look down at the burnt corpse and despite the whole body being as black as a charcoal briquette, for some reason there’s a patch of skin on the right arm that’s completely unburned.  It’s a tattoo that says, “Mom, I love you forever.  R.I.P.”  Below that is another tattoo that says, “Straight to Hell.”  How unbelievably ironic, I think to myself. We move to the next table.  Dr.  Black pulls back the sheet.  It’s an 18 year ...

Read More »