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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. 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.

Healthcare Update 02-18-2013

Some hospital CEOs just don’t like being questioned. When one hospital chief of staff led some other physicians in questioning the manner in which a hospital was being run, hospital CEO Bruce Mogel allegedly had black gloves and a gun planted in the doctor’s car. Then someone called 911 and reported that someone was driving down the street waving a firearm. The doctor was arrested in the hospital parking lot and was strip searched at the jail. The doctor sued. During depositions, a witness alleged that the CEO claimed “People do not know how powerful I am.” Now a jury has found the hospital liable for $5.2 million. It appears that former CEO Bruce Mogel got away scot-free … and is now a “consultant” at the Nelson Financial Group in Arizona. As a follow up to the article about wait times in upstate New York emergency departments, the CEO of one hospital provides a great response … and reiterates that health care insurance doesn’t equal health care access. “With a severe primary care shortage and some practices without after hours and/or weekend care, people are forced to seek care that is available … [j]ust around the corner, millions of Americans are about to have health coverage. Where will they seek care if we have not expanded access to primary care?  In the emergency room.” Government regulations never seem to get less onerous, do they? HIPAA regulations change again. Now doctors can be held liable if their business associates cause patient privacy breaches, penalties increase, and privacy notices have to be modified. For some reason, I seem to read about events like this on a regular basis. Another car crashes into hospital emergency department. This schmoe wasn’t seeking medical care, he was intoxicated and trying to get away from police. What would happen if Press Ganey ratings were superimposed on the Wong-Baker pain scale (i.e. the “smiley faces”)? GruntDoc shows you. There are 313 million people in this country. In 2008, there were 110 million cases of sexually transmitted diseases. According to census data from 2010 (.pdf file), about 60 million people are under age 14 and about 40 million people are over age 65 – both groups being lower risk for contracting an STD. That leaves 213 million people to harbor 110 million cases of STDs. To be fair, the 110 million number doesn’t separate out people who have more than one STD, so it doesn’t necessarily mean that about half the country has STDs. Even more scary, the article states that people 15-24 accounted for half of all sexually transmitted infections. That’s 55 million STDs when census data for 2010 shows that there are only 44 million people in that age demographic. Those aren’t very good odds. Ummm. You know those little spinning blades that chop things up in the blender? Yeah. They’re … sharp. When Consumer Reports’ camera man cuts his finger on a blender blade, the magazine does a little research and discovers that blender injuries have tripled in the past decade and are responsible for more than 7000 ED visits per year. More than 30 states have decided not to create Obamacare health insurance exchanges, instead opting to let the federal government do it for them. The Heritage Foundation has a brief discussion on some of the issues involved in the decision. Wacky court verdicts Aussie style. Court awards liver cancer patient $350,000 because doctor failed to refer patient to a weight loss clinic. The patient was 300 pounds and 5 feet tall. The court ruled that the patient’s terminal liver cancer was caused by the ...

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The Last Patient of a Long Night Shift

By Birdstrike M.D.   My first night shift in a stretch of 7 was almost over.  It was 6:15 a.m. and I had to keep moving otherwise the minute I would stop, my eyelids would drop like two ton shades and I’d fall asleep.  That never makes for a good drive home after a night shift. “Got time to see one more?” asked Jenny the nurse. “Do I have choice?  The door-to-doctor time storm-troopers would have it no other way,” I grunted back, eye lids drifting closed. “Febrile seizure,” it said. Good, this should be quick and easy, I think to myself.  We’ll give some Tylenol, reassess in 30 minutes and this baby will be happy, smiling and bouncing off the walls.  That way I can get out of here at 7 a.m. and be home in bed with my eye blinders on drifting towards sweet REM sleep at 7:20 a.m.  My sanity depends on it.  15 feet away, I head towards the room.  Looking into room 4, I expect to see the usual post-febrile seizure toddler, sitting up in bed, recovered, awake and well appearing.  First I see the child’s mother, well put together, attractive, smiling and relaxed.  I cross the threshold to the room, look down on the hospital stretcher and I see a child, about 1-year-old, still seizing.  Still seizing?  I think to myself.  This isn’t right. “Jenny, get in here!  We’ve got a seizing baby,” I say.  I look down at the child, who is pale, head turned to the right, with the left arm twitching violently.  “Call respiratory!  Jenny, you get the IV, I’m going to start bagging.  Someone get the Broselow tape and some Ativan.  Let’s stop this seizure.  Get some diastat, too.  We may need it.  As I bag the child, Jenny quickly gets an IV in.  We give a dose of Ativan and the baby stops seizing quickly.  The O2 sat is 97%, the baby is breathing spontaneously and I stop bagging.  I put an O2 mask on the baby.  I feel the brachial and femoral pulses.  They are bounding. Considering the baby has normal vitals, I turn to Mom hoping to get some history while hoping the baby will quickly awaken from the post-ictal slumber.  “Mom, hi, I’m Doctor Bird, tell me what happened please.” She looks at me and smiles.  Her lips spread apart and reveal a soul-sucking brown smile.  Why is she smiling?  Her baby just got done seizing?  Why isn’t she panicked?  I look towards Jenny the nurse whose face is beet red and stressed like mine, after a 12 hour night.  I shoot a glance at the clock and it’s well after shift change now.  I’m fried.  I haven’t slept in over 24 hours.  I look back at Mom and I realize she’s the calmest one in the room.  There’s something really, really wrong here.  In the corner of the room is a man sitting on a chair that I hadn’t noticed before.  He’s smiling.  I look at him.  “Hey doc!  How’s it goin’?  Havin’ a good night?” he asks with a smile and a laugh as he slaps his knee.  Having a good night?  I’m having a horrible night, I think to myself, and I’ve got a seizing baby on the stretcher in front of me.  It doesn’t seem to be cramping his style too much, however.  I feel the energy drain right out of my chest.  At that moment I know exactly what the diagnosis is, and I feel like I might puke my guts out. “Charge nurse?  Please escort them to the family consult room.  Thank you.   Suzy, call the chopper, now.  Jenny, let’s get ...

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It Didn’t Feel Like A “Win”

By Birdstrike M.D.   My kid and I are outside in the front yard blowing bubbles, enjoying the blue skies and 70 degree weather when she says, “Cool Daddy! Look, there’s a police car coming down the street. Oh, cool! I think he’s coming to see us!” Uh, oh, I think to myself. Despite my kid’s excitement, I know that rarely does anything good come delivered by a policeman. My wife is inside, my one kid is with me and my other is inside, so they’re not coming to give me some tragic news. Or are they? My parents….my siblings….is everyone okay? Why is a sheriff pulling into my driveway? I exhale for a minute. Maybe it’s Jim, the officer that lives in the neighborhood, I think to myself. He’s probably just stopping by to chat or say, “Hi.” As the car rolls closer, squinting to look beyond the window glare I see that it’s not Jim. It’s an officer I’ve never seen before. Clearly none of us has done anything to get arrested…. “Daddy! I wanna go see inside the police car! Daddy, will he give us a ride? Ooh, ooh, can I see his gun? Cool!” says my kid, jumping up and down with excitement. “Let’s see what he wants,” I answer. The driver door opens. A huge officer gets out, in grey uniform, bulletproof vest bulging underneath, with black wrap-around sunglasses, and a toothpick in his mouth. “Are you Dr. Bird?” he asks, as serious as a heart attack. “Yes, sir,” I answer. “I got a present for ya,” he says, as he pulls a thick rolled up stack of paper from under his arm and hands it to me.  “Here’s your subpoena,” he says. “My what?” I stammer. “What’s this all about?” “You’re getting….” he starts before, “Daddy! Daddy! I wanna ride in the police car. I wanna see the lights go on! Yay!” says my little one. “…sued,” I finish the sentence for him. “Yes, sir. You and every other doctor in this county it seems like. I’ve got about a dozen more to go serve. These lawyers are unbelievable. (laugh) I happen to know this one will sue you for breathin’ and win, too. You know, the one on the back of the yellow pages? You ever run into any trouble, though, you call him. Trust me, he got me out of a jam one time,” he says with another grunt-laugh. “Wow. Thanks for that wonderful advice. You’ve really brightened my day,” I snark back at this guy, who apparently thinks it’s hilarious to be part-time process server and part-time comedian. “Oh, don’t take it personally. It’s just business,” he says chuckling, as he spits out the same old lie and cliché I’ve heard a thousand times from doctors who’ve been sued. “That’s great. Thanks. Anything else I can do for you today, officer?” I ask, dejected. “Oh, yeah, I’m gonna have to give you a ticket for parking your car on the street overnight….Just kidding!” he says, and give’s a snort-laugh. This guy’s unbelievable, I think to myself as I turn to walk away. “Don’t worry, Doc. You’ll win that case. That lawyer will sue a dead dog if he could get it to settle for a bone and a biscuit,” he says. “Uh, thanks for your…uh, support,” I say, shaking my head in disbelief. Yep, it happened. After about 30,000 lawsuit-free patient encounters I finally got hit with a lawsuit. I guess 29,999 out of 30,000 isn’t bad, I think to myself. What’s that, 99.99% accurate? Well, it’s still not perfect; still not ...

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Healthcare Update — 02-11-2013

Patients gone wild. Also, a perfect example of why doctors shouldn’t play security guard. Iowa man attempts to leave emergency department, doctor doesn’t allow him to do so. Patient then slams doctor against wall and puts doctor into a choke hold before being pulled off and restrained. Who gets paid to study this stuff? “Researchers” find that number of ED visits for pubic hair grooming injuries is on the rise. I had a couple of snarky comments, but I’ll have to leave those to you all. Possible hope in battling drug-resistant superbugs? Scientists discover how to manipulate genes in bacteria to prevent bacteria from effectively eliminating waste. Waste then builds up and makes the bacteria more susceptible to antibiotics. Cook County, IL pays $20 million settlement to family of child who was “overly sedated” at county hospital then suffered heart attack and stopped breathing when left alone in recovery room after outpatient testicle surgery. Can you imagine working for more than 10% of your career with a lawsuit hanging over your head? If not, don’t become a doctor. Study in Health Affairs shows that the average physician spends more than 50 months of his or her career with an open malpractice claim. Neurosurgeons spend 27% of their careers fighting malpractice suits. Emergency physicians spend 12.8% of their careers with a malpractice claim. Dr. Ben Carson comes up with some good ideas for changing health care. A health savings account that can be passed on to future generations? Not bad. Not bad at all. Purdue University typhoid fever scare after cafeteria worker travels internationally then returns home and goes back to work. Symptoms of typhoid fever, caused by salmonella typhi, include a high fever (obviously), rash, and profuse diarrhea. Remember Typhoid Mary? Now it’s the Typhoid Boilermaker. 17 year old girl left blind, brain damaged, and paralyzed after smoking synthetic marijuana and suffering several strokes. All about the RUC and how its secretive meetings determine how much you pay for health care … and indirectly determine whether health care will be available to you in the future. Changes to the UN-Affordable Care Act make it more likely that your employer won’t provide you with health insurance. But remember … “If you’re one of the more than 250 million Americans who already have health insurance, you will keep your health insurance. This law will only make it more secure and more affordable.” More fallout from the UN-Affordable Care Act. New food labeling rules imposed in the law expected to cost grocery stores more than $1 billion per year. Grocery stores will have to provide labels on unpackaged goods such as items in salad bars. If grocers get the labeling wrong, their counsel notes that it is a federal crime subjecting the grocers to … jail time. Put down that assault crouton and step away from the salad bar, sir. Maybe they should just throw everyone in jail and get it over with. How the UN-Affordable Care Act may affect corporations – lots of outsourcing and less employment. All they need to do is create a billion dollar health care law and things like this wouldn’t happen. British hospitals serving lasagna to patients, DNA testing showed that the meat was mostly from horses, not cows. School kids got the same meals. And if that wasn’t bad enough, now some of the horse meat may actually be donkey meat. UK encourages citizens to purchase additional insurance to help pay for health care as they get older. Even though it takes a large proportion of your earnings in taxes throughout your life, your government can’t ...

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Spaghetti and Impaction

Stool impactions probably aren’t what most people would consider an “emergency” … until they actually have a stool impaction. Personally, I wouldn’t wish a stool impaction on someone. In chronic constipation, more and more stool collects in the colon until size of the ball of stool is too big to pass through the opening to the outside world. The major function of the colon is to absorb water from the stool, so the longer the stool sits in the colon, the larger the amount of water that gets absorbed, and the harder the blob of stool gets. By the way – the whole water absorbing function of the colon is why it is important to keep well hydrated to maintain good bowel habits. There are a lot of ways that you can try to get rid of a stool impaction, but when the stool gets hard enough, pretty much the only way to remove the impaction is by having someone use their fingers to perform a “disimpaction.” There’s just no good way to get a big hunk of stool the consistency of clay soft enough for it to pass through the rectum. It has to be dug out. Disimpactions aren’t fun for the doctor or the patient. They’re painful and obviously messy. I’m probably more willing than most docs to perform disimpactions because I can see how much the patients are suffering. Although unpleasant, disimpactions are an easy fix to the patients’ problem. Like I said, you probably can’t appreciate how bad impactions are until you’ve been on the other side of the gloved finger. As I donned my mask, gown, and multiple layers of gloves to commence the procedure on one patient,  one of the nurses sent a nursing student in the room with me to observe. The student said that she had seen “many” disimpactions in the past, but the nurse wanted her to observe this one, so she reluctantly came in the room with me. I introduced the student to the patient, then had the patient lay on his side and pull his knees to his chest. The nursing student stood against the wall behind me. “OK, Mr. Smith, you’re going to feel some pressure. I’ll try to be as gentle as I can.” The patient muffled his moans as I began removing stool. Although the large impaction appeared relatively solid on the x-ray, the initial pieces of stool that came out were in little round globs. Then the nursing student tells the patient “Oh, you just have little balls. This shouldn’t be too bad.” I stopped for a second and cocked my head to the side. In the awkward silence that followed, the student realized what she had said and tried to correct herself. “I mean little balls in your rectum.” I looked back at her and started to chuckle. “I mean little balls of stool.” At that point, she was beet red and she excused herself from the room. “Sorry about that, Mr. Smith, she’s still learning.” “She had me worried there for a second. I thought you were going to go grabbing my nuts next.” The nursing student had taken an afternoon lunch break by the time I had removed all the “little balls.” I was hoping they were serving spaghetti with meatballs so I could ask the student if she gloved up before lunch, but no such luck. ———————– 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 ...

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Dear Diary

Well, I thought we escaped it, but we didn’t. The past week has been full of emesis, diarrhea, and disinfectant spray. Just when we think that things are on the mend, someone else in the family starts having a stomach ache. The vomiting is the worst. When it starts out, it sounds like a loud belch … until you hear the progression of the sounds. Yeah. Too much information. But on a good note, I have seen that my kids are immune to boredom. They were able to watch the same episodes of Disney sit-coms a half dozen times and still got mad when I turned off the television. I’ve cut back on my work hours a little which gives me some extra time to hang out with Mrs. WhiteCoat and the kids. Kind of fun taking a morning to walk through the mall or going to lunch and catching a matinee before the kids get home from school. In fact, I took about a 30% pay cut from previous years, but we’re happier than we were before, I get to see a lot of the kids’ events that I used to miss, and we pay a lot less in taxes. Last weekend at one of my son’s wrestling matches, I had some mom from another team call me an asshole. Probably won’t be the last time. And I wasn’t even the one instigating. Wrestling matches last 1:30 each round. There are three rounds per match. It was a team meet and my son’s team was just barely beating another team — whose parents were sitting in the bleachers right next to us. During one of the matches, their wrestler was getting beat and, while on the mat, he signaled the referee that he was hurt. The referee stops the match and the wrestler jumps off the mat and goes to get some water. Several of our parents started yelling. Wrestlers aren’t allowed to take water breaks in the middle of matches. The opposing team’s parents started yelling at us. I kept my mouth shut. Mom from their team: “You all can just shut up!” Mom from our team: “You BETTER not be talking like that to my family.” One of our team dads yells “Your kids get water breaks? Our kids don’t get water breaks. Is that in the rules somewhere?” A loudmouth mom from the other team yells “Hey SHUT UP. He has ASTHMA.” Then I just let out a spontaneous laugh. I wasn’t laughing at the kid’s medical problem. I just thought to myself that I’ve been doing it wrong all these years. I should just be giving patients drinks of water instead of steroids and albuterol for their asthma attacks.  What a dunce I am. Loudmouth mom looks at me and yells “What are you laughing at, ASS-HOLE?” Them’s fighting words, of course. But I kept my mouth shut. I just smirked at her, held my water bottle high in the air, and took a long swig. Mmmmm. Breathing better already. The water didn’t help as their wrestler got pinned shortly after his water break ended. I had about a half dozen snarky comments that I wanted to blurt out at the mom, but I didn’t want to start a brawl in the stands. So I opted to have another long swig of water. Mmmmmm. Next week I’m having another surgery … on Valentine’s Day no less. Hopefully not a big deal. Just getting a hernia repaired. I’ve been dealing with it for a while, but now it has gotten big enough that it hurts, so ...

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Healthcare Update — 02-04-2013

Chinese man runs out of money to pay for dialysis. Government “insurance” only pays half the costs of treatment (keep that in mind, Affordable Care Act supporters). Then human ingenuity kicks in. The man builds himself a dialysis machine out of used and discarded medical equipment, mixes his own dialysis fluid, and has been dialyzing himself … and it has been keeping him alive for 13 years. Doctors hearing about his unorthodox methods warned him about the risk of serious infection and “long-term complications” because he wasn’t using sterile water to make his dialysis fluid. Something tells me that if the complications were that likely, they probably would have happened in the past 13 years. After getting outed in the media, the Chinese government then offered to provide him with assistance to pay for his treatment. He’s reluctant to take the government up on its offer. I wonder what would happen to this patient if he was in the US. Hat tip to @MedicalQuack Just call them “assault” bacteria when you describe how they kill people – our legislators and the media will jump all over that. We can’t let ourselves become complacent over drug-resistant bacteria. Interesting point … once doctors become employees, does their incentive to fill their schedule with patients decrease? Will they want to stay late in the office to see an urgent patient? Will they go on strikes and leave patients without health care? See how access to care decreases as the paradigm unfolds. With increasing numbers of antibiotic resistant organisms in hospitals, do we need to start asking whether it is safe to go to the hospital? By the way, your ZeePack is becoming less and less effective against all types of infections because bacteria see so much of it prescribed, but for lunch these resistant organisms drink ZeePack cocktails and then have Levaquin hors d’ourves … and then they laugh at the people spending money on ineffective medications. Medical device company Stryker cuts 1,170 jobs, citing the Affordable Care Act as the reason. Medical device company smith&nephew cuts 100 jobs in the US due to the Affordable Care Act. Then the IRS states that the least expensive health insurance plan available in 2016 under the Affordable Care Act will cost a family $20,000 per year. If you don’t pay up, you are forced to pay an extra tax/penalty. Maybe we need to start calling it the UNaffordable Care Act. The good news is that they won’t develop intestinal worms any time soon. The bad news is that the medication some drug dealers mix with cocaine and heroin may cause dangerously low blood counts and skin necrosis. California patient becomes upset about incontinence which occurred after prostate surgery, goes to doctor’s office and shoots him dead. Busting 5 malpractice myths? Some of the claims seem spurious to me. HT to @epmonthly 101 year old Chinese woman declared dead and then wakes up at her funeral – just as she was being put in her coffin. Now all I can think of when I hear stories like this is a YouTube video one of my co-workers once showed me. New Surviving Sepsis guidelines have been released (.pdf file). Nice summary here. Norepinephrine is the pressor of choice. Initial fluid bolus of 30ml/kg recommended. Hat tip to @kane_guthrie If you want to kill your husband, putting poison in your hoo hah and asking hubby to have a whiff probably isn’t the safest way to go about doing so. There are just too many comments that can be made to this story. More than 7,000 residents of Great ...

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One of our registration clerks thinks she’s pretty slick. We play little practical jokes on each other every once in a while. One day she’ll unplug the keyboard to my computer when I’m in a room with a patient. I’ll come out to try to enter orders and start pounding the keyboard. Another day I’ll squirt a syringe of saline onto her chair so her butt gets wet when she sits down. And on and on and on. Recently, she tried to scare me. My desk sits across the station from hers and my back is to her. She thinks I can’t see her, but I can see everything that goes on behind me by the reflection off of the x-ray computer screen. While I was looking at an old chart on the screen, I saw her get up out of her desk, put her finger up to her lips to tell everyone to be quiet, and try to sneak up behind me. She was trying to tip-toe, but I could hear her little clown sneakers squeak as she walked. When she got close enough to me, she dug her fingers into my sides and yelled. I saw it all coming. I acted like I was sleeping and I stretched my arms up in the air, yawning. [Yawwwwwwn] “Is it time for me to go home already?” “You think you’re funny, don’t you WhiteCoat? Just wait. I’ll get you yet.” When my shift was over, I decided to make a pre-emptive strike. The registration clerk sits in a little cubby hole of sorts. There’s a line of several windows – one for each registration clerk – with a ledge and two chairs in front of each one. There’s a wall right next to the window where she was sitting. The clerks can’t see around the wall from that seat, so there is a mirror across the hall that the clerks use to see if patients are coming. Due to several slow nights at work, we discovered that shadows in the waiting room created a few blind spots in the mirror. I said goodnight to everyone, got my coat on, and acted like I was leaving for the night. I waited a few minutes and watched the clerk in the mirror. Soon she settled into reading a book on her Kindle which she rests on the computer keyboard. I then pulled my hood over my face, ran up to her window, slammed one of my hands on the desk and in the best Jacob Marley voice I could muster, I yelled “Hellllp!” Then I fell over onto one of the chairs and fell on the floor. The clerk jumped out of her skin, then screamed. “Aaaaaah! Where the hell did you come from?!?! Aaaaaaahhhh Get a nurrrrrrse Get a dooooctorrrrrr!” There were a couple seconds of silence, then her little head poked through the open window over the ledge to look at me on the floor. I was laughing so hard I had trouble catching my breath. “Damn you, WhiteCoat! You just made me wet myself.” And I didn’t even need a syringe of saline to do it.

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