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Tag Archives: Random Thoughts

Dear Diary

Dear Diary Some things just don’t make sense to me. Why do dogs just like to eat random objects? Lately, it’s been a case of “guess what the dog ate today” around our house. Eraser. Hairbrush. Tube of toothpaste (she loves toothpaste). Martial arts training knife. Our other dog just walks around with his tail between his legs when he sees something chewed up on the floor because he thinks the other dog will blame him for it. Then we get the great idea to lock spazzy boxer pup in the bathroom so she won’t have to sit in her cage for 12 hours while the family drives to a football game and back this past weekend. No, that was Ms. WhiteCoat’s idea. I had nothing to do with it. We returned to find the door broken, the stripping ripped up from the door jamb, and a bathroom that looked like it was being renovated. Our vet calls it separation anxiety. I call it something else. Then the dog gives us the big googly eyes when we get home as if to say if only we had provided her with a doggie counsellor to help control her impulses, none of this would have happened. Where do all the damn headphones in the world go? I have this pet peeve. I hate it when people take my things and don’t put them back. With six people in the house, no one will own up to losing whatever it is that’s missing. So if things go missing more than a couple of times, I buy 10 of them. Kids kept stealing my combs out of the bathroom, I bought a 20-pack and threw a few in each kid’s room. Kids were taking all of my pens, I got a 100 pack of the pens I like from Staples for like $20 and bring up handfuls from the storage room when they go missing. Tennis balls to play with the dog go missing – I bought 50 used ones off of eBay. Of course, half the missing balls were in the gutter, but now we have extras. Also have a half dozen nail clippers laying all over the house. But mine are left alone. One thing that just doesn’t reach the saturation point of missingness is headphones. I had a couple of good pairs of ear buds that went missing. So I went online and bought 10 pairs of them for $4 apiece. Within a week, they had all vanished. Not a trace. I bought 10 more. Gone within another couple of weeks. WTF? So I said to hell with it and I jog listening to music from the speaker on my phone now. I checked on eBay and no one from this house is selling them. And I looked through the doggie doo and didn’t see any wires, so it isn’t spazzy boxer pup, either. Maybe we got ourselves a gremlin. What is it with our family and insects? First, it’s the ants. Then I leave for work last week for an overnight shift. I get an urgent call from home telling the secretary to pull me out of a room with a patient. Mrs. WhiteCoat is on the other end of the line and is freaking out because our basement has turned into the set for some horror flick. She says there are like 200 flies on the ceiling of the basement buzzing all around. I made the mistake of telling her that maybe there was a mouse dead in the ceiling or something. She calls around to every exterminator in ...

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Happy Thanksgiving

Just finished dinner and going to play a few games of Pictionary with the family, then have a few glasses of wine while watching a movie. To get you in the Thanksgiving spirit, here’s a special Thanksgiving video from the great WKRP in Cincinnati: http://www.kewego.com/video/iLyROoafYtDe.html And, for some discussion around the dinner table, did you ever wonder why they don’t sell turkey eggs in supermarket? Here’s one plausible explanation: http://www.straightdope.com/columns/read/1262/why-cant-you-buy-turkey-eggs-in-stores Hat tip to Instapundit for both ideas. Special thanks and prayers to all our troops overseas. We all appreciate the sacrifices you are making for us and hope that you are home with your families soon. Your bravery and dedication means a lot to every one of us. Hope everyone has a Happy Thanksgiving.        

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Greedy or Necessary?

Mrs. WhiteCoat had a patient issue and doesn’t know how to proceed, so she asked me to post the case for other people to comment upon. A patient came to her practice 2 years ago with thyroid problems. She had been seeing an endocrinologist for several years before seeing Mrs. WhiteCoat and even the endocrinologist was having problems controlling the patient’s thyroid using medications. On the first appointment, Mrs. WhiteCoat performed an exam and found a thyroid mass which ultimately turned out to be cancerous. She referred the patient to an ENT surgeon for thyroid removal. The patient never followed up with Mrs. WhiteCoat after that. A few days ago, the patient sends Mrs. WhiteCoat an e-mail saying that she is doing well and asking Mrs. WhiteCoat to call in a refill of the patient’s thyroid medications. Mrs. WhiteCoat wrote her back and said that she had not evaluated the patient since having her thyroid out almost 2 years ago, that she has no idea what the patient’s latest thyroid labs showed, and she doesn’t even know the patient’s medication dose. She stated that she wouldn’t call in a refill without seeing the patient in the office, examining her, and going over the patient’s labs with her. The patient wrote back that she had “normal” thyroid labs in February and has been on the same dose of thyroid medications for the past year. She couldn’t afford to miss work any further, doesn’t want her thyroid to get out of control again, and appreciated Mrs. WhiteCoat’s understanding in calling in the prescription. There are two ways of looking at this. One one hand, the patient is probably stable after having her thyroidectomy and most likely will be continued on the same dose of medication if she does come in for evaluation, so an office visit would likely be low yield. That being said, when things go wrong, nobody thanks you for cutting corners to save them money. If the thyroid cancer returns, or if there are signs of metastasis somewhere and they are missed, then what happens? On the other hand, some people may think that requiring patients to come to the office under circumstances like this is just being “greedy.” Mrs. WhiteCoat has student loans, office workers, office lease, malpractice insurance, and a dozen other expenses that she has to pay in order to keep the office running. If she provides free telephone services to all patients, then soon there may no longer be an office for patients to call for their refills. I suggested that if another doctor is ordering lab tests on her, that doctor should be refilling her medications. We kind of touched on this issue in a previous Open Mic Weekend, but now it’s a real situation. What should she do?

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Dear Diary

The Hurricane Sandy coverage has me absolutely captivated. Hard to believe how much destruction occurred. Reading about all the hardships that people on the East Coast are going through right now makes me wish I could help somehow. My brother lives in Hoboken and we weren’t able to get in touch with him until today. You always assume the worst when that happens. He still has 8 feet of water in his basement and wasn’t able to get out of the house until today. Still only spotty power in his area. He reports that much of lower Manhattan is still dark, tunnels are still flooded, and he spoke to police who said that lines of people trying to get into the city are “the worst they’ve ever seen.” Seeing what they’re going through makes all of our problems seem so minor. Prayers to everyone going through this disaster. Keep strong and keep the faith. Halloween is officially over. Son dressed up as a ghoul all in black and sat up in a tree scaring the kids who came to the house for candy. Said that he was taking after me, whatever that means. Little kids would come up and take candy from the bowl and he would shake a tree limb and stare at them. Some ran away without candy. While he was doing that, some guy in a clown suit with a chain saw (no chain) was walking up and down the street stopping and looking at people and freaking out all the parents. Funny, yet creepy. Only went through 12 bags of candy this year, but we got smart and bought those giant bags of Dum Dums to mix in with the candy, so giving a few lollipops and a candy bar to kids at least made it look like they were getting more. It was difficult getting our kids down to sleep. They all had a sugar buzz and a half eating all the candy they weren’t supposed to be eating. Son was up playing AC/DC at 10:30 on a school night. Oldest daughter didn’t have school today and she slept until noon. The day after Halloween has also permitted me to discover that candy wrappers and lollipop sticks do not mix well with canine digestive systems. When sitting in the living room this morning wondering “what’s that smell?”, we eventually found two piles of doggie puke consisting of a mixture of Science Diet, candy bars, Laffy Taffy, candy wrappers, and lollipop sticks. Cleaning that up was enough to get me to skip breakfast. Mmmmmmm mmmmmm good. Middle daughter just got word that her pictures were up for American Girl. She’s so excited and we’re so excited for her. I’d link to the page at American Girl web site, but don’t want them getting ticked at me. If you want to see her, go to AmericanGirl.com and go to the “Gift Guide”. She’s opening a present at the top of the page. Oldest daughter just got her first IMDB movie credit, hopefully the first of many. She also found out that she made the basketball cheerleading squad. Good work, kiddo. Now that means I’m going to have to go to the basketball home games when I’m just not a basketball kinda guy, but that’s OK. I’ll be cheering loud for everyone. Every year, our house becomes infested with fruit flies. I can’t figure it out. We keep fresh fruit in a fruit bowl and we give Master Oogway fruit in a dish a couple of times a week. Side note: I never did tell everyone that the ...

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Criminalizing Society

The criminalization of society continues. Regular readers know that I strongly disagree with state efforts to criminalize the practice of medicine. See previous posts here, here, and here for a few. Two days ago I posted an article about a doctor who was criminally charged with providing excessive pain medications to patients who died (as I expressed concern about back in 2009). Now federal agents are arresting physicians for providing fraudulent or “unnecessary” care. This isn’t concerning to anyone? I have no problem with taking professional action against any medical practitioner who is a danger to the public. Well, I have a little problem. Some of the assertions of “dangerous” activities I have seen made by state licensing boards make me wonder whether the board members should be charged with a crime for incompetency. In one instance, a board was prepared to file a letter of reprimand against a physician because he didn’t order a CT scan on a patient with a headache. The reason? “This patient came to the hospital by AMBULANCE and you didn’t do enough.”  Action taken against license because a patient dialed 911. I also don’t have a problem filing criminal charges against medical practitioners that break laws. Intentionally engage in fraud? You deserve what’s coming to you. Steal from patients? Go to jail. However, throwing someone in jail for doing their job – even if they do their jobs poorly – just sends the wrong message and will lead to unintended consequences. I’m not going to go on a long rant about this, but I wanted to illustrate how more and more professions are coming under a government attack because they allegedly don’t do their jobs appropriately. Tarl commented about the case of the Italian scientists who were charged with manslaughter and sentenced to six years in jail because they failed to predict an earthquake that killed more than 300 Italian citizens. Prosecutors argued that the scientists offered “incomplete, imprecise and contradictory information” to the Italian citizens. As Tarl noted, scientists from around the world denounced the trial, noting that predicting earthquakes is impossible. Think about the implications for Italian scientists in the future. Doing everything in their power to avoid a six year prison term in the future, the seismologists will now be encouraged to report to the media that an earthquake may occur and that things may not be safe every time that a truck without a muffler drives past the seismologists’ offices and shakes their equipment. Chicken Little, baby. If someone drops a cup of coffee, the sky must be falling. Run for the hills. In a few years, the population will be so sick of the false alarms that when the real earthquake does hit, they will have ignored the warning anyway. But by criminalizing an inexact science, the buffoon Italian prosecutors have made Italy a safer place, right? Then consider the case of attorneys for GlaxoSmithKline who were indicted for making false statements to the FDA when Glaxo was being investigated for promoting Wellbutrin for an off-label use. The in-house counsel hired a national law firm to help Glaxo respond to the FDA’s allegations. A year later, the government came after the attorney for obstruction of justice … for representing her client … alleging that the attorney had assisted Glaxo in furthering a cover-up or a crime. Even documents that are protected from discovery by the attorney-client privilege were forced to be turned over to the government. How will the threat of criminal charges affect an attorney’s practice of criminal law? Go to jail if you defend your client too ...

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Dear Diary

Did you ever have one of those months where you had about a hundred things to write about, but you had no time to write about them? Yeah, that’s been me lately. So where do I begin? Just got back from the ACEP Scientific Assembly in Denver. Have another post about that later. So I’ll begin with the kids. Lots of birthdays in the house this time of year. My middle daughter happened to be born on the same day as I was. By far my best birthday gift ever. One of the things that was at the top of her birthday wish list was an Orbeez Soothing Spa. The web site says that Orbeez are “wet and wacky, soft and squishy, fun and funky, bouncy and beautiful.” In reality, it’s more like some marketing genius has convinced 10-12 year old little girls that they need to come home and relax in a spa-like foot bath after a hard day at school. Us? We walked uphill both ways to school in bare feet over shards of broken glass and nobody batted an eye. Now, every kid who watches afternoon cartoons needs a foot bath. So, despite my better judgment, we got her Orbeez for her birthday. To activate these things, they must be soaked in water first. Then they go from a little pebble the size of a BB to a large squishy ball the size of a marble. once activated, then kids can put their feet into a foot spa so that they can have soothing relief or from a hard day at school. The problem is first of all that once the kids find out that these things can be squished, then you find squished Orbeez all over the house. Stepping in one unexpectedly in one’s bare feet is not pleasant. Apparently, the dogs don’t think that they taste very pleasant, either. After a few days, an odor began to waft through the house. Did Mrs. WhiteCoat just express the dogs’ anal glands? No. Did someone pour anchovy juice on a used sweatsock? Nope. It was the Orbeez foot bath. These superabsorbent polymers apparently absorb more than water. Next year, I’m putting a loofah sponge and some moisturizer in an Orbeez box for her birthday present. Mrs. WhiteCoat also had a birthday at the end of last month. I was going to get her more perfume, but I was scared off by all of these women in lab coats chasing me through the store. Then I noticed … the stores already have Christmas decorations. That’s just un-American. I am not buying anything from a store that has Christmas decorations up before November 1. It’s just the principle of the matter. And if I see one Santa Claus looking all smiley at my kids before Thanksgiving, I am going to knee him in his jingle bells.

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