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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. Factual statements may or may not be true. I may change ages, gender or presenting complaints about patients. I may even entirely make up complete patient encounters from my fertile imagination. Trust me, if you think I’m writing about you, I’m not. There are billions of people in this world and readers send me stories about patients all the time. It isn’t you.
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.

What’s The Diagnosis # 19

Had another patient arrive by ambulance with hip pain after falling on the ice. We seem to be getting a lot of hip pain patients lately. Pain prevented him from walking. We got x-rays that the radiologist read as normal. But the patient still couldn’t walk. Look at the x-rays and see if you can find the problem. Scroll down for the answer. I just realized that the program I use to display the pictures won’t separate pictures within a post – they all get lumped into one gallery. So when you view the pictures in the gallery, only look at the first three pictures if you don’t want to spoil the answer.   . . . . . The angle of the femur seemed odd on one of the hip x-rays and there appeared to be a linear lucency through the base of the femoral neck. The radiologist thought that the lucency was just shadows, but we had the advantage of being able to examine the patient. Since he couldn’t bear weight on that leg and since he had pain when his leg was log-rolled, we had a suspicion that there was something more than a bruise or a strain going on. So we got a CT scan. The results are below. Femoral neck fracture. The radiologist called back and profusely thanked us for being diligent. It wasn’t like we could send the patient home unable to walk, so a CT scan wasn’t that much of a leap in testing. The point of the post is NOT to bust on radiologists. This is a team sport, so we help each other out. They catch as many of our misses as we catch of theirs. But a good physical exam can make you a lot more suspicious about equivocal x-ray findings. Now here’s a good review article by Dr. Thomas Byrd about physical examination of the hip. Know this stuff and you’ll be ahead of the game.

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Healthcare Update — 12-30-2013

Also see more updates on my other blog at EP Monthly.com In Australia, a paramedic who was fed up with waiting for beds in the ED got in trouble for publishing a picture of a crowded emergency department hallway – showing just how crowded it was. Seven elderly patients piled up in the hallway with no place for anyone to move. Fire hazard, health hazard and public relations hazard. Lucky he wasn’t in the US or it would be a HIPAA violation as well. The biggest thing that the government was worried about was whether or not the photo was staged. In the “your unborn baby doesn’t belong to you if we say so” department … a court in the United Kingdom ordered a pregnant woman to be forcibly sedated so that the state could remove her unborn child by Cesarean section. Pregnant Italian woman in England on business trip calls police when she has panic attack. Police talk to woman’s mother on phone who stated that she had “bipolar” condition and hadn’t been taking her medications. Police take patient to “hospital” to “make sure that baby is OK” and instead bring patient to psychiatric hospital where she is restrained and admitted against her will. Five weeks later, she is strapped down, forcibly sedated, and she woke up with a surgical wound on her abdomen … and no baby inside. She then gets sent back to Italy without her child. The UK is now preparing to put her child up for adoption. The government that has the power to provide everything to you has the power to take everything away from you. What are the 8 germiest items in your home? I guessed three of them before clicking the link. To tie in one of the dirtiest places in the home to a way to fight allergies, consider this study from the National Academy of Sciences showing that exposure to dog-associated household dust is protective against reaction to multiple airway pathogens. In addition, exposure to dogs had a significant effect on the microbiome in the GI tracts, increasing one type of Lactobacillus which is protective against RSV. Wild stuff. Illinois hasn’t even legalized marijuana yet and the state is already threatening to revoke a medical marijuana physician’s license for “unprofessional” behavior. Turns out that the physician charges $99 registration fee to see patients and confirm that those patients really do have a medicinal need for marijuana. In four months, he has had 25,000 requests for appointments. What unscrupulous researchers can do with “studies.” Researcher puts human antibodies into blood of rabbits treated with an experimental HIV vaccine to make it appear that the vaccine was working. It wasn’t. No one could replicate the results and the researcher eventually fessed up. The fraudulent results were one reason that the university where the researcher was working received millions of dollars in federal grants. Now, instead of going to jail for fraud, Dr. Dong-Pyou Han has agreed not to contract with the US Government or to serve in an advisory capacity to the Public Health Service for three years. A slap on the wrist for tainting research to get millions of extra dollars in government funding, potentially become known all over the world if you aren’t caught, and putting the lives of millions of people at risk when they trust a vaccine that you know doesn’t work … yeah, that’s about right. Evidence that we have the most expensive urine on the planet. Taking multivitamins is a waste of money. Or is it? The studies cited in the comments note that vitamins are ...

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What I Can Tell You Is, “Thanks”

By Birdstrike MD I can’t tell you that the “patient satisfaction obsession” is suddenly going to focus on patient health over profits and start being applied fairly to doctors and nurses. I can’t tell you that someday politicians, administrators and insurance companies will wake up and see things the way you and I do. I can’t tell you that someday, all the demands for inappropriate medications, tests and treatments will end. I can’t tell you that all of a sudden the government will stop making cumbersome and nonsensical rules and regulations, stop crushing private practice and start increasing instead of decreasing doctor pay. I can’t tell you that all of a sudden you are going to stop taking hits in the line of duty for doing the right thing for your patients. But what I can and will tell you is that I appreciate every time you or any other doctor, nurse, physician’s assistant, paramedic or tech laces it up for a shift to take care of the sick and injured. I can tell you, “thanks” for everyone too sick, too short of breath, dizzy, psychotic, weak, unconscious or too intoxicated to say it or realize it themselves. I can tell you that I appreciate all the blood, sweat, tears and REM sleep you leave on the floor during your days and nights on the front lines treating the sick, bleeding, broken, bruised, and destitute. For what it’s worth, you are a hero to many, whether they say it, know it, or not. I’ve been there, done it and still face the same battles.  What you do is not easy. It’s incredibly difficult. Don’t ever let anyone tell you otherwise, including yourself. You make a damn big difference to this world. For anyone who steps up to the plate in an Emergency Department, hospital, OR, or doctor’s office to be there when no one else can or will, to wait for me, my family members, your own friends, enemies or complete strangers to pass out, get run over, to arrest or stop breathing, keep your chin up. For what it’s worth, you’re a hero to me. Happy Holidays, Birdstrike MD . . .

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Healthcare Update — 12-13-2013

See more healthcare stories from around the web over at my other blog at EPMonthly.com Interesting analysis by David Neumann about the effectiveness of Roche’s influenza treatment Tamiflu. Roche had hidden several studies regarding the effectiveness of Tamiflu until last year. Now that those studies have been reviewed, researchers have concluded that Tamiflu essentially amounts to a bunch of overpriced sugar pills. Tamiflu had no impact on patient symptoms or on development of serious illness in several study populations. We’ll see how long it takes for Roche to be prosecuted for consumer fraud. Hat tip to Nick Genes. Meanwhile, a 13 year old with a computer is schooling everyone on how to fight the flu. Eric Chen’s computer model on how to develop influenza medications beat out more than 1500 other competitors to win the Siemens Competition in Math, Science and Technology.  He took home a $100,000 grand prize. Meanwhile, I can’t get my 13 year old to stop playing Modern Warfare. Autisim symptoms improve with … hot tubs and intestinal parasites? In many households, there could soon be a battle for the Viagra pills. Researchers found that women who had significant menstrual cramps had good relief from Viagra pills administered intravaginally. Don’t go there. Just don’t. Florida surgeon arrested for practicing medicine without a license. Interesting story, though. He would allegedly consult with potential clients in his Florida office, describe a surgical technique he had pioneered, state that he wasn’t licensed in Florida, then tell the potential clients that the surgery would have to be performed in Mexico. He was charged with practicing medicine or with offering to practice medicine without a license. Legitimate bust? Hat tip to Skeptical Scalpel for the story. USDOJ puts emergency physician in jail for a year for failing to file income tax returns. When faced with the opportunity to choose between employee and independent contractor, it is becoming more advantageous to be an employee. Too many issues can arise with independent contractor status. Another article on my little fascination with the gut microbiome. Gut bacteria and the gene activity of those bacteria change rapidly with changes in diet. Even a vegetarian who suddenly ate meat had sudden changes in bacteria adapted to digesting meat. Now that we know that the microbiome can be rapidly changed, we have to determine what bacteria are good and bad for each individual. Excited to see to what extent (if any) that diet can affect disease. My prediction is that there will be a few subsets of bacteria that are beneficial for most humans, but that there will be a large variance in which other bacteria are most beneficial for each individual. One step further down the path to complete government control. Doctors who order more tests than the government deems appropriate will be forced to get “prior authorization” from the government (i.e. jump through additional hoops) to order the tests for their patients. Of course, spending all of that extra time with the patients will increase the level of billing on every single patient in which doctors have to spend that extra time, so I suppose payments will all even out in the end. Note that since the criteria apply to Medicare claims, the effects will disproportionately affect our nation’s elderly population. Speaking about Obamacare’s adverse effects on seniors, Effective January 1, 2014, the funding to care for homebound senior citizens will be cut by 3.5% every year for the next 4 years. The feds estimate that 40% of the existing home health companies will go out of business due to the cuts. Other organizations estimate that the loss of home health ...

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Happiness Is …

You know what really makes an emergency physician feel good? You’re working a shift and the secretary says “someone is here to see you.” You cautiously go up to the front desk and peek around the corner. It’s not a sheriff trying to serve you with a lawsuit and it’s not an administrator with his or her arms folded across his or her chest. That’s a good feeling. Then you come out from behind the desk, the person says “remember me?” and you don’t see a shotgun or a kukri. That’s a good feeling. Then you have no idea who the person is, but you say “suuuuure” and the patient doesn’t call “bullshit” on you. That’s a good feeling. Then the patient hands you a plate of home baked cookies and a card and says “I’m the one who the paramedics brought in with a cardiac arrest last month. You’re the one who saved my life.” That’s a really good feeling. Then you look around and notice that it isn’t just the patient who came to give you cookies. There’s a whole group of people there. His whole family shakes your hand, hugs you, and adds their thanks. That’s an even better feeling. Then you go back into the department to get the rest of the staff and everyone makes fun of you for having tears in your eyes. Hey – screw them. They aren’t ruining the moment. Little moments like this make me look back and think how I’d never choose any other specialty than emergency medicine. ———————- I’m making full blog posts available to the RSS readers and newsfeeds to make them easier for subscribers to read … without having to visit the blog. Want to help support this blog? Here are a couple of ideas for end of the year shopping: Get Great Savings on Toys at Amazon.com Also, if you have a “use it or lose it” FSA account through work, you’re running out of time to make your purchases. Check out FSAstore.com for all the FSA Eligible products and services. There’s even a guide showing you what does and does not require a prescription. This Holiday Season get Free Shipping on All Orders Over $50 at FSAstore.com This blog gets a small percentage of every purchase you make from these sites when you visit the sites through the links above — and it doesn’t cost you anything extra. Thanks for your support!

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RSS and Newsfeed Readers – Why NOT to Use Feedly

I haven’t really integrated feed readers into my daily routine for several reasons. I like going to my favorite sites and blogs and not only reading the content, but also reading the comments to the content. In the online world, there is a saying that “content is king.” Content is king for several reasons. 1. Content draws readers. When readers like content and forward the content to their friends, good content draws even more readers. 2. With more readers, content brings more advertising dollars. Advertisers like eyeballs. Advertisers are more interested in sites that have larger readership simply because the higher traffic allows the advertisers to introduce their product to more people. 3. Probably most important to bloggers is that content brings together a community of people with similar interests to engage in discussions. Bloggers create content to engage their readers and the engagement is reflected not only in site visits, but also in the comments to posts. Good or bad, we like reading what you think about what we say. RSS and newsfeed readers are therefore good and bad. RSS and newsfeed readers are helpful to the people reading the content because they organize all of the content in one central location. When time is at a premium, it is a lot easier to skim a feed in the morning than it is to read through a couple of dozen web sites. On the other hand, feed readers can be harmful to a blogger’s morale. If everyone reads posts through feeds, then traffic to web sites drops off. When traffic suffers, there’s less feedback to the bloggers, and when there’s less feedback, there is less motivation to sit down and try to create content during your free time. I get the whole feedback/convenience concept which is why I throw affiliate links into my posts. If people want to support the blog and don’t want to visit, the opportunity is there. If not, I can just imagine the tens or hundreds of thousands of anonymous readers subscribed to my posts and how much I am changing the opinions of medical professionals all over the world. Hey – a guy can dream, right? When Google closed down its reader, there were a lot of questions about which feed reader to use as a replacement. Feedly.com kind of surfaced as the leader. As Feedly became more popular, it began to implement changes that were not so user friendly. Last month, Feedly tried to require all of its users to have Google+ accounts. An expression of outrage by its current users got Feedly to remove the requirement. Now Feedly has apparently attempted to lay claim to the content created by independent bloggers. I read a story on a site called the Digital Reader about how Feedly had secretly changed the way in which it links to content in its reader. Usually, if a reader sees something he or she likes in a post on an RSS reader or a newsfeed, the reader can click on a link to the post within the newsfeed which takes the reader to the publisher’s website. Feedly apparently began hijacking all of the links to the blogger’s content. When readers clicked on the links to articles within their Feedly feeds, they were directed to other links on the Feedly site instead of the links to the site of the publisher who actually created the content. If Feedly readers wanted to e-mail their friends a link to the content, again, the links would direct those friends to Feedly, not to the original publisher’s site. In the comments section to ...

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