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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.

Best and Worst States to Practice Medicine

Medscape did a survey and some research and came up with a list of the best and worst states in which to practice medicine. You can find the entire presentation at this link, but if you don’t want to create an account at Medscape to view the information, a summary of what they came up with was below. Doctors by far most valued a comfortable living environment in making their decisions where to practice. Other important factors in the decision included proximity of family and friends, climate, job opportunities, and malpractice climate, insurance mix, physician density, medical board activity, and tax burden. Best States to Practice Medicine In the Southwest and South Central regions, Texas was recommended as having low physician density, low cost of living, and few malpractice claims per capita, but these positives were offset by the increased health system burden of the uninsured patients and by the hot weather in Texas. In the West and Northwest regions, Idaho was recommended for its low cost of living, nonlitigious climate and good housing market. Downsides to Idaho included the dominance of two main health systems in the state and the lower than average number of registered nurses. In the Southeast, Tennessee got the nod for higher than average compensation, no state income tax and a mild climate. However, there was a high density of physicians in Tennessee and its school systems are ranked 42 out of 59 in the country. In the Mid-Atlantic, Virginia came out on top for its moderate cost of living, moderate physician density, favorable malpractice climate, low tax burden, and good quality of life. However, the compensation was the second lowest in any region. In the Midwest, Indiana was rated tops for its excellent compensation, low cost of living, low malpractice payouts and balanced lifestyles. On the down side, there isn’t as much nearby access to urban centers if that is important to you. In the Northeast, New Hampshire has great schools, comparably low cost of living for the region, a relatively low tax burden, and good nursing/PA support. However, the compensation in the Northeast is lowest in the country and the climate is cold. Worst States to Practice Medicine Worst states to practice medicine included Nevada, Hawaii, Maryland, Illinois, Connecticut, and … FLORIDA. Big surprise there.

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ACEP – Giving Effective Powerpoint Presentations

Registered for the conference and was going to do a Twitter flurry about the lectures, but then though people might appreciate an outline of notes taken instead. The first lecture was from David Greenberg about how to deliver winning presentations. He’s written a couple of books about the topic and is a dynamic speaker. Withoug giving away all of his secrets, here is a summary of his lecture. *Need to involve audience in lecture to improve retention* After 24 hours, audience remembers 25% of what they hear, 55% of what they hear and see, 85% of what they hear, see, and do. To improve presentation … 1. Identify topic and audience. Structure presentation around audience 2. Write down key points of presentation – an outline 3. Prepare your opening – Get audience’s attention. Open with a question or an interesting fact. Present a problem or an opportunity – Give audience the goal of the lecture. What benefit will they get if they listen to you? – Provide them with an overarching message. “If there is one thing I want you to take away from this lecture, it is this: …” – Provide audience with a brief outline of your talk. Tell them what you’re going to tell them … then tell them … then tell them what you told them. 4. Prepare the body of your presentation. Variety is important. Add stories, pictures, and charts to make lecture more interesting. “Best presenters use practice, visuals, and stories.” For each point you make, provide a story or example illustrating the point and then emphasize the take away for that point 5. Summarize lecture for closing 6. Leave with a few parting thoughts – anecdote, prediction, etc. Prepare your lecture to be completed in 75% of your allotted time. That way if things run over, you have time to work with. See more information at David’s site at www.simplyspeakinginc.com

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An Amazing Little Girl

By Birdstrike M.D.   Off I go to work a few shifts at a desperately understaffed rural hospital in a state far away.  The rental car GPS leads me to the ED address and it’s not there.  All that is there is what looks like a small supermarket with a funeral home next door.  I see a security guard in the parking lot.  He has a lump in his cheek and a badge that says “Sam.”  I pull into the supermarket parking lot to ask for directions.  “Sir, do you know how I get to Bumtruck Valley Hospital?” In a slow, deep, and nearly indecipherable drawl he answers, “You found it, Cowboy.  Welcome to Bumtruck Valley Hospital.” “That’s not a supermarket?” I ask. “It’s not a market, and there’s nothin’ super about it, Shooter.  Funny how they put it right next to a funeral home, ain’t it?  Smart businessmen they are.  Kind of a conflict of interest though, I’d say. Ha, ha,” he gurgles.  “You workin’ here tonight?” “Yes, sir.  I am,” I answer. “How much they gonna pay ya?” he asks. “Apparently not enough,” I conclude. “I know that’s right,” laughs “Security” Sam.  “You won’t be back.”  I park in the dirt lot and go in for my shift. There’s only one patient waiting: “5-year-old, headache, fever.”  I walk in the room to find a 5-year-old girl laying on the stretcher in a fetal position.  She is fantastically dressed with a beautiful, silk smocked dress, shiny gold-plated curls with a green bow to match her emerald eyes. A stark contrast is her mother who looks like she’s from a different gene pool altogether, sitting in the chair, dressed in pajamas. I introduce myself and raise my hand to shake the mother’s hand and she does the “pant-leg hand-wipe” maneuver.  If you’ve never been a victim of this, it is when you go to shake someone’s hand, and rather than raising their hand to shake yours, they quickly send the hand down to their own pant-leg and proceed to very quickly wipe it on their leg, then quickly raise it up to shake yours.  All in a split-second you find yourself shaking the hand of someone who felt it necessary to wipe something off of their hand before shaking yours.  What it is that they attempted to wipe off, or whether they successfully did so or not, is yours to ponder for eternity.  It’s an etiquette faux pas of epic proportions. “What brings you in here today, Suzie?” I ask, directing my question at the little girl herself, seeing what information she’ll give me before invoking Mom’s help. “My head hurts,” she answers, laying there in a heap, looking sick.  “It hurts right here,” she says, pointing to the back of her head and neck.  “And I feel real hot,” she says, sinking back onto the hospital gurney.  Amazed at how well she’s answering my questions directly and to the point, I continue.  She proceeds to tell me that the symptoms started a few hours ago, her mom has not checked her temperature, and she’s had no other symptoms except for feeling a little achy. Then, slowly rolling out of her mother’s mouth, in a deep drawl come the words, “Yuh, her neck is stiff, real stiff. She’s been actin’ like she’s dyin’.  You know, LETHARGIC. Dyin’!”  With that, she sticks her fingernail between her two front teeth, picks a piece of food out, holds her finger up to look at it, smells it, then puts it back in her mouth to perhaps…..eat it?  Gross! Suzy proceeds to tell me that she lives with her mom, takes no medications, has no significant medical problems, has never had surgery, and has no allergies. Her vital signs are normal, except for a borderline temperature of 100.1o F.  I proceed ...

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Healthcare Update — 05-15-2013

Also see more Healthcare Updates on my other blog at EP Monthly.com Pain pills make you impotent. Well, the study doesn’t quite say that but the headline sure catches your attention, doesn’t it? The study did note a 45% increased likelihood of using testosterone replacement or medications for erectile dysfunction when patients were taking long-term opioids. You think YOU’ve got it bad? In Pakistan, four children share the same ICU bed and machines such as MRIs have been out of order for more than 3 years – forcing patients to go to private hospitals and pay out of pocket to have the tests done. The Medical Marijuana Associates would have a conniption just thinking about this happening in the US, but the government that provides everything to you has the power to take everything away from you. Don’t worry. Nothing like this would ever happen in this country. On the other hand, according to the article, the tests cost about 20,000 Rupees – about $200 US Dollars – which is a fraction of the cost for the same tests in the US. Another bamblance stolen – this time the driver was still inside. Tennessee’s John Shanks jumped in the driver’s seat of an ambulance in Erlanger Hospital’s parking lot and drove away while the driver was in the back of the ambulance cleaning it. Driver tried to subdue thief who when jumped out of the ambulance and ran away in a serpentine pattern. He was later caught and charged with multiple crimes. Patients gone wild episode of the week. Intoxicated male “causing trouble” in Newfoundland ED. Police called to scene and patient now faces charges of causing a disturbance and assaulting a police officer. Remember the story about the brawl in the Georgia ED waiting room a few weeks ago? Now police have released pictures from surveillance video that shows the alleged perps and are looking for information identifying them. Identified so far include Quantavious Cortez Thomas, Altravious Antwan Thomas, Montravious Monque Gibson, and Cedrick Octavious Marshall. Tragic story. Twelve year old girl dies after taking grandmother’s used Fentanyl patch out of the garbage and putting it on her leg – possibly to help with a stomach ache. Richard Epstein eloquently explains how the Affordable Care Act is unraveling before our eyes. Insurance isn’t worth much if no one can afford it. How much will individual health insurance premiums increase under Obamacare? Estimates from 17 of the country’s largest health insurance providers expect 100-400% increases. In other words, 90% of individuals will be dropping their health insurance policies. Businesses will see a 50-100% increase in their premiums. Instead of calling it the UnAffordable Care Act, maybe I’ll start calling it the UnAffordable Insurance Act. Indiana man goes to hospital and shoots himself in hospital emergency department after shooting his former boyfriend at boyfriend’s place of employment. More “unnecessary” spending in medicine. Urologists at Henry Ford Hospital allege that emergency department treatment for UTIs alone cost $4 billion per year in “unnecessary” health care costs. I need to start publishing retrospective studies about wasteful procedures in other specialties. Irish emergency department so crowded and busy that it has to pull an ambulance up to the front door to act as an extra resuscitation room for a patient. To be fair, there were five patients all needing resuscitation at the same time. I actually think that the doctors were pretty resourceful in coming up with the idea. South Carolina parents sue hospital for performing corrective surgery on young child with ambiguous genitalia, stating that the doctors picked the wrong sex. Doctors created ...

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Why I Hate Squirrels

The squirrels aren’t gone … yet. But they will be. I tried to be nice. I bought a live trap. Hav-A-Hart. It doesn’t work. The damn squirrels keep knocking it over. So then I got smart and put a five pound weight on top of the trap so they couldn’t knock it over. That didn’t work. All that happened is that I thought something in the house had fallen when I heard the five pound weight hit the floor. I ran back upstairs and the trap was knocked over and all the bait was gone again. Then I got a 10 pound weight and put that on top of the trap. There is no way that a two pound squirrel is going to knock over 10 pound weight. Little did I know that Arnold Schwarzensquirrel was living in my attic. They still managed to knock the damn trap over. Okay. No more Mr. Nice Guy. So during my next day off when I was woken up at six o’clock by the sound of squirrels gnawing holes in my rafters, I went back to Home Depot. I looked around and asked the salesman what you would use for a squirrel problem. He showed me some nasty smelling animal repellent that he said would do the trick. Active ingredients include “putrescent whole egg solids,” “dried blood” (even though the bottle contained a liquid) and garlic. I sprayed a little bit of it outside. It smelled rancid. That will do the trick. So I went back home, pulled off the piece of sheetrock separating our closet from the attic, and sprayed the repellent around the attic. It stunk like hell. Then I sealed backup the hole in the wall and hoped for the best. When my wife gets home, she walked upstairs and screamed. I ran upstairs. “What is that smell?” Oh no. “Did you kill one of the squirrels? You better not have killed one of the squirrels. It smells like something died.” I went into the closet and the smell from the attic had wafted into our closet. Now our whole closet stunk like a massacre scene at an Italian restaurant. I opened up the hole in the wall and went back into the attic. The smell was overwhelming. Then I noticed something: A beam of light shining against the insulation. The little bastards had chewed a hole in the roof. I went outside and climbed up on the roof using a ladder. The squirrels had bent back a piece of the flashing and had chewed a little hole through one of the shingles. Then they had chewed a hole through the roof and into our attic. So back to Home Depot I go to get more building supplies. I got some chicken wire so they couldn’t chew another hole through the patch I was going to make. I also got some new flashing, new shingle that kind of matched our old shingles, and some “great stuff” to seal up the whole. An end to the problem was in sight. I patched up the hole in the roof with the “great stuff,” put some chicken wire down over the hole so they could not chew another hole there, and replaced the flashing and the shingles. Not perfect, but it worked. And it will keep the damn squirrels out. Finally. But oh no, these are resourceful squirrels. I wake up the next morning planning on finishing up an article for the blog before I went to work. More gnawing on the walls. I threw on a T-shirt and ran outside to look ...

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Healthcare Update – 05-07-2013

Also see more Healthcare Updates on my other blog at EP Monthly.com Here’s a headline bound to catch your attention. Psychiatrists spend a million hours a year attempting to get approval from insurance companies to admit suicidal or mentally ill patients. Link to the study in Annals of Emergency Medicine is here. Study on Medicaid use in Oregon shows that patients who have Medicaid have no better health outcomes than people who don’t, but they do utilize “a lot more health care.” In addition, Medicaid “nearly eliminated catastrophic out-of-pocket medical expenditures.” Is Obama just dangerously misinformed about ObamaCare? Or is he willfully misleading the country? Article picks apart statements that the president is making about the UnAffordable Care Act. The rules about the UnAffordable Care Act keep evolving. Wellness programs that require workers to meet certain health standards to get lower insurance premiums cannot be included as part of minimum coverage requirements that employers must meet. Unions lobbied against wellness programs alleging that they would discriminate against unhealthy workers. South Carolina legislature flips ObamaCare the bird. State House passed a bill that makes it a criminal act to enforce or attempt to enforce the law in South Carolina. Governor Nikki Haley calls the health care exchanges “nothing more than a way to make the state do the federal government’s bidding in spending massive amounts of taxpayer dollars on insurance subsidies that we can’t afford.” Ouch. More allegations of “false advertising” relating to advertised emergency department wait times. This case is at St. Elizabeth’s Hospital in Brighton, Massachusetts. The hospital spokesperson says that the advertised time is a “door to room” time which is a “standard measure” for hospital emergency departments. Not true. False advertising and consumer fraud claims aren’t subject to the medical malpractice caps that are present in many states. Will be interesting to see where this is headed. Man’s runny nose that lasted for several years wasn’t an allergy — it was a CSF leak. And don’t go running to the ED asking for MRIs of your brain because your nose is running. This was an exceptional case. Senator Chuck Schumer wants to increase federal restrictions on hydrocodone prescriptions because they are “gateway drugs” and because “our doctors are prescribing too much of this.” Hey Chucky … how about we put federal restrictions on how many dumb laws you can try to pass? After all, those laws are a gateway to … oh I don’t know … even dumber laws? Patients gone wild. Florida patient attacks doctor after being told to stop cursing and to stop calling the staff names. Arrested and faces felony charges. More patients gone wild. New Jersey man arrested for disorderly conduct and criminal mischief in St. Luke’s Hospital emergency department. No mention of what he did to deserve such charges. JAMA study shows that children with migraine headaches were six times more likely to have experienced colic as an infant. Meanwhile, a study published earlier this year in Pediatrics showed that colicky infants often had significantly different intestinal flora than their non-colicky counterparts. Proteobacteria was increased in colicky babies while bifidobacteria and lactobacilli were decreased. More articles on doctor shopping and drug seeking patients. This Ohio article provides a couple of chilling statistics from a study done Toledo’s St. Lukes Hospital: Ohio overdose deaths totaled more than traffic fatalities by almost a third. And of the 1,544 Ohio citizens who died of drug overdoses in 2010, prescription opioids were listed on 45% of the death certificates. Defense attorney praises doctor for refusing to settle a medical malpractice case when sued for a patient ...

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