Friday, October 26, 2007

EM Physicians Dominate Romance Novels

From Yahoo News

If romantic fiction is any guide, any doctor looking for love would be advised to be an emergency room surgeon or deliver babies rather than practise colon resection or remove in-grown toenails.

Hospital novels are one of the fastest-growing areas of romantic fiction which, according to the Romance Writers of America, generates 1.2 billion dollars in annual sales and accounts for 39.3 percent of all fiction sold in the United States.

In an offbeat letter published in Saturday's Lancet, Kelly describes the typical plot structure and characterisation in 20 randomly-selected medical romance novels.

Of the male protagonists, six worked in emergency medicine, five in surgery and three in obstetrics, neonatology and paediatrics, he found.

"There was a marked preponderance of brilliant, tall, muscular, male doctors with chiselled features, working in emergency medicine," says Kelly, a University College Dublin psychiatrist.

Pain Scale Absurdity

From Scalpel or Sword:

Two patients came into the ER by ambulance complaining of pain.

One was a young woman with another migraine, who "usually gets" Dilaudid 4-6 mg IV in addition to IV Reglan and Ativan. She was allergic to many other medications, but she had a full bottle of dilaudid 8 mg pills and some Actiq lollipops in her purse from two different pain specialists. Her usual medications also included Ambien 20 mg at bedtime and Xanax 2 mg every 6 hours. Although she complained of vomiting constantly for 3 days, her vital signs, physical exam, bloodwork, urinalysis, and imaging tests were all negative, and she never vomited in the ER. She spoke calmly and was in no apparent distress.

The other patient was an elderly lady who had fallen at home, fracturing her hip. She was taking a blood thinner, so her grotesquely angulated and deformed thigh was also markedly swollen. The fact that she had crawled down the stairs after her injury in order to call the ambulance probably contributed to the swelling and deformity somewhat. She trembled a bit as she asked for something to relieve her pain.

Guess whose pain was a 5/10 and whose was a 10/10?

Wednesday, October 24, 2007

Visble Body Website

The Argosy Visible Body, which promises to be a free virtual anatomy website, is looking like a rather impressive product already. Videos of the development, provided by the company, show a simple interface and an easy method to get to individual anatomic parts of the body. Here are the features the website will provide:

Search for and locate anatomical structures by name.
Hide, rotate, see through, and explore parts of human anatomy.
Move the model in three-dimensional space.
Zoom in and out.
Click on systems or structures to make them transparent or hide them.
Click on anatomical structures to reveal names.

In beta / demo now, "Coming in mid-November"

"25 Skills Every Doctor Should Possess"

From the Cheerful Oncologist, excerpted below:

Skills all doctors should possess:

1. Recognize when a patient needs to be transferred to the ICU.

2. Deliver bad news compassionately, yet honestly.

3. Identify a pneumothorax on a chest radiograph.

4. Diagnose iron deficiency anemia.

5. Help a patient stop smoking cigarettes.

6. Diagnose thrombotic thrombocytopenic purpura, which has a mortality rate of 90% if not treated and 10-20% if treated.

Tuesday, October 23, 2007


From the American College of Emergency Physicians

Washington, D.C. — The spread of a potentially life-threatening antibiotic-resistant staph germ that is responsible for more deaths in the United States each year than the AIDS virus has prompted the American College of Emergency Physicians (ACEP) to launch an education initiative aimed at protecting the public against the further spread of infection.

"This emerging 'super bug,' as it's known, is causing ACEP to mobilize for two reasons," said Linda Lawrence, MD, FACEP, president of the American College of Emergency Physicians (ACEP). "First, we are concerned about the possible spread of this potentially dangerous bacterium – especially in schools, nursing homes and health-care settings – so we are asking people to practice good hygiene, such as frequent hand-washing, to help prevent public outbreaks. Second, ACEP is cautioning against the continued widespread overuse of antibiotics, a practice that has in part caused drug-resistant germ strains like this one to emerge."

At the same time, emergency physicians across the country are on the lookout for cases of antibiotic-resistant infections so these patients can be isolated and treated with the few types of antibiotics that remain effective, before developing potentially life-threatening complications or spreading their infection to others.

Air Medical Controversy in Texas


EMS Units Bypassed Nearest Helicopters: Physician Says Ties to a Firm Don't Influence Agencies' Decisions

What happened to Bridges that night was part of a pattern repeated more than two dozen times in the last two years in the area: EMS crews did not call the closest helicopter ambulance service.

In each incident, the EMS unit on the ground and PHI shared the same medical director, Roy Yamada.

Yamada, a Fort Worth physician, works as director of emergency medicine for Midlothian and in a similar role for nine other area EMS departments, most in Tarrant County. He is also PHI’s North Texas medical director, a position for which he has apparently been paid almost $200,000 in 2 1/2 years.

Such ties are becoming increasingly common in the competitive air ambulance industry, in which people who oversee local EMS agencies also work for air medical providers.

But these alliances, critics say, can lead to delays in hospital care for critically injured patients as well as unnecessary helicopter flights that can cost patients as much as $10,000 when ground transport would be sufficient.

Defensive Medicine (ED Example) on CBS


CBS) It started as a simple stomach ache, but Alexandra Varipapa, a sophomore at the University of Richmond, decided to go to the emergency room.

There, doctors ordered a full CT scan, a radiation imaging test, which found a harmless ovarian cyst. She never questioned the CT scan, CBS News correspondent Wyatt Andrews reports.

But her father did - when he got the $8,500 bill, $6,500 of which was that CT scan.

“I was pretty flabbergasted,” said Robert Varipapa, himself a physician.

Varipapa says his daughter's pain could have been diagnosed far more easily and cheaply with a $1,400 ultrasound.

“A history, a pelvic examination and probably an ultrasound,” he said. And he would have started with the ultrasound.

But the hospital defends the CT scan, saying an ultrasound might have missed something more serious.

Friday, October 12, 2007

CMS Sets Requirement for Hospitals Without 24/7 Physician Coverage

From the Iowa Hospital Association

IHA has received several questions from hospitals regarding a new Centers for Medicare & Medicaid Services (CMS) requirement aimed at patient safety and emergency services. The requirement, effective October 1, mandates that all hospitals, including inpatient acute (whether Prospective Payment System or exempt), Critical Access Hospitals, long-term care, psychiatric, rehabilitation, children’s and cancer hospitals, that do not have physicians available on the premises 24 hours per day, seven days per week (24/7) inform patients of that limitation prior to patients receiving an inpatient or outpatient service.

CMS does not plan to prescribe specific language for the notice, but its discussion of the requirement indicates the notice must specifically state the hospital does not have physicians on the premises 24/7. The notice also must describe how the hospital will meet any emergency service needs when a doctor is not on the premises. The disclosure would be required at the point of registration or preadmission testing.

CMS does not intend to provide standard language for the new disclosure notice, but the notice still requires federal Office of Management and Budget (OMB) review and clearance under the Paperwork Reduction Act. Hospitals subject to the requirement (those that do not have 24/7 physician coverage on site) will need to create a disclosure notice and a plan for distributing the notice at all inpatient admissions and outpatient encounters.

Available information suggests hospitals simply need to provide the notice to each patient, without obtaining patient signatures documenting individual receipt. Hospital policies and procedures must be documented. However, the American Hospital Association cautions against finalizing the notice and procedures until CMS receives OMB clearance and issues provider manual instructions.

CMS has already completed the first part of the clearance process by soliciting public comment on the proposed disclosure requirement. CMS has yet to publish another notice with a 30- day comment period directly to OMB. It is expected that instructions will not be circulated to hospitals until the instructions receive OMB clearance, which is still pending.

California ED data

This week's San Diego Union Tribune features a story of one doctor's attempt to encourage hospitals to come clean with ED wait-time figures as a step toward improving traffic flow. Dr. Roneet Lev, an emergency physician at Scripps Mercy in Hillcrest, leads the Emergency Medicine Oversight Commission of the San Diego County Medical Society. She recently persuaded 19 hospitals to share emergency room procedures and statistics.

Also in California, the site of the Office of Statewide Health Planning and Development posts numbers from hospitals on the annual number of patients who enter the ED without being seen. It also asks facilities to disclose the number of hours per month they were on diversion. All you have to do is type in the city or name of the hospital you're researching. 

Firefighters, police push for city's help treating drug-resistant infection.

From the Fresno Bee

The Fresno City Council agreed Tuesday that a drug-resistant staph infection afflicting some city firefighters should be considered a work-related injury for firefighters and police officers.

Some firefighters are upset they're forced to pay health insurance co-payments and use their sick time to recover from the infections they believe they contracted at work.

If treated as work-related illness, the city's workers' compensation insurance would cover those bills and pay the firefighters for lost work time.

The council voted 6-1 to direct city staff to write a policy making all cases of methicillin-resistant Staphylococcus aureaus a work-related illness for firefighters and police officers. The council must approve the policy in a separate vote.

CPAP for CHF instead of ETT?

From USA Today

For more than 30 years, paramedics have been saving the lives of these patients by inserting, through the vocal cords, a breathing tube about the width of a small garden hose and then pushing air into the lungs with an inflatable bag. Called intubating, it's the street version of a hospital's mechanical ventilator.

But the aggressive treatment is very uncomfortable for those on the receiving end, and it carries the risk of dangerous infection. So a device more commonly found in the hospital is making its way into the nation's ambulances, including Harper's rig in Houston.

Harper asks firefighters to bring him the breathing device known as CPAP, for continuous positive airway pressure. The football-size device with long plastic tubing and a plastic mask is being used now by emergency crews in seven other big cities, including Miami and Boston. Another 16, including Atlanta and Philadelphia, plan to put the device in ambulances soon, this month's Journal of Emergency Medical Services (JEMS) reports.

Thursday, October 11, 2007

Negligent Credentialing?

From the American Medical Association

Hospital can be sued for credentialing doctor with questionable qualifications, Minnesota high court rules

Physicians fear that a recent Minnesota Supreme Court decision could compromise statutory peer review protections and taint physicians in medical liability cases that are tied to negligent credentialing claims.

For the first time, the high court recognized that patients can sue hospitals for allegedly granting privileges to doctors with questionable credentials. The unanimous decision adds Minnesota to a list of at least 25 other states that recognize negligent credentialing claims.

House Bill Aims to Modernize 911 Systems

From Washington Technology:

Proposed legislation in Congress that would promote implementation of IP-based 911 services is picking up support from public safety groups and disability organizations.

The 911 Modernization and Public Safety Act of 2007 (H.R. 3403), sponsored by Rep. Barton Gordon (D-Tenn.), seeks to facilitate rapid deployment of IP-enabled 911 services and IP-enabled enhanced wireless 911. It would extend enhanced 911 services to IP-based telephone services. The goal is to migrate today’s 911 systems to new technologies.

Depletion of Nitric Oxide in Bank Blood Spells Trouble

Great summary of this important finding at Medgadget

It has been long known that people who receive blood transfusions have a higher chance of having all kinds of medical problems following the transfusion. Research coming out of Duke now shows that stored blood loses a great deal of its nitric oxide content which is critical in oxygen transfer from blood to tissues.

HIPPA In Action

From the WSJ Health Blog

Hospital Suspends Workers for Peeking at Clooney’s File

Patient Refuses to be Seen by a Muslim Doctor

From the NY Times "The Ethicist" Column

A patient came to the E.R. where I work, and a nurse gave him a preliminary evaluation. When the patient saw my name, he refused to be examined by a Muslim doctor. I couldn’t reach his primary physician, and the other physician on call was also Muslim. A physician assistant offered to complete the evaluation, but as the patient was in no immediate danger, I did not allow this. Instead I discharged the patient without a full evaluation. Was I right? — Ali Mohamed Osman, M.D., Houston

Interesting Teaching Model

From Unbounded Medicine

This surgical model is made of glass fiber and has abdominal and thoracic compartments separated. A selective bronchial intubation can be done in this model. It also has a structure that simulates a diaphragm. You can perform both laparoscopy and thoracoscopy.

The organs of a pig are placed within the model.

Tuesday, October 09, 2007

Study Presented at ACEP Symposium: EM Physicians Risk Takers?

From the WSJ Health Blog:

....she wanted to find out whether the ER really did draw thrill seekers or it was just a medical myth. So they gave a test called “Are You a Risk Taker?” (it’s something like this) to 87 emergency medicine residents and 77 family medicine residents to find out. (They chose family medicine because both family practitioners and ER docs are generalists, Bascom said.) They’re presenting the results today at the annual scientific meeting of the American College of Emergency Physicians in Seattle.

The test breaks personality types down into several categories: Impulsive Sensation Seeking, Neuroticism-Anxiety, Aggression-Hostility, Sociability, and Activity. Emergency medicine residents scored in the high range more frequently in every category than family medicine residents. The difference was only statistically significant in one category, but it’s a notable one: “Impulsive Sensation Seeking.” A tad more than 19% of emergency medicine residents scored high in that category, compared with just over 5% of family medicine residents. (FYI: Bascom took the test for fun, and she, too, scored high on Impulsive Sensation Seeking.)

The difference in Neuroticism-Anxiety is also striking, even if it’s not statistically significant: 11.4% for the ER, versus 3.8% for family practice. Bascom wasn’t surprised.of the result. ER docs “are a little more tightly wound,” she told us.

LUCAS™ Chest Compression System

From Medgadget:

Physio-Control, Inc., a subsidiary of Medtronic, Inc., has announced that the LUCAS Chest Compression System is now available in the United States through an exclusive distribution partnership with JOLIFE AB, a Lund, Sweden company. The device is designed to deliver consistent CPR chest compressions without the off intervals, and to deliver direct current cardioversion during chest compressions. The device's protocol is fully compliant with the official ACLS guidelines.

Saturday, October 06, 2007

Blogger Takes HealthVault for a Test Drive

The Medical Quack leads us through registration and initial use of the site.

Microsoft Health Records - Special Review and Basic Information

I have included what I hope to provide is some extensive information on the new Health Vault. If you read this blog regularly, you know I am a big advocate of privacy, and for many good reasons. I hand it to Microsoft for taking a jump into the records business, and thus this morning I set up my account to go through the motions and see first hand how it works.

More Doctors in Texas After Malpractice Caps

From the NY Times

Four years after Texas voters approved a constitutional amendment limiting awards in medical malpractice lawsuits, doctors are responding as supporters predicted, arriving from all parts of the country to swell the ranks of specialists at Texas hospitals and bring professional health care to some long-underserved rural areas.

The influx, raising the state’s abysmally low ranking in physicians per capita, has flooded the medical board’s offices in Austin with applications for licenses, close to 2,500 at last count.

“It was hard to believe at first; we thought it was a spike,” said Dr. Donald W. Patrick, executive director of the medical board and a neurosurgeon and lawyer. But Dr. Patrick said the trend — licenses up 18 percent since 2003, when the damage caps were enacted — has held, with an even sharper jump of 30 percent in the last fiscal year, compared with the year before.

“Doctors are coming to Texas because they sense a friendlier malpractice climate,” he said.

Thursday, October 04, 2007

Microsoft's HealthVault

Microsoft introduced the beta of a Electroinc Heath Record called HealthVault today.
Here's the Wall Street Journal's Health Blog's take on the event.
Here's GruntDoc's comments.

Wednesday, October 03, 2007

"A Dangerous Gap in Trauma Care"

From the Wall Street Journal

Trauma from injuries including accidents, falls and violence is the leading cause of death for Americans under the age of 44, claiming more than 140,000 lives and permanently disabling 80,000 people annually. But only one in four lives in an area served by a coordinated system to transfer patients to designated trauma centers from less-equipped hospitals, according to the American College of Surgeons, which sets standards for trauma care. And only eight state trauma systems met nationally recommended preparedness levels in a study by the federal government after the Sept. 11, 2001, terrorist attacks. While some progress has been made, many states remain woefully unprepared, trauma experts say.

Monday, October 01, 2007

Heart Attacks in Kids

From CNN

A report from Ohio doctors documenting nine cases over 11 years in kids as young as 12 says heart attacks in children are a rare but under-recognized problem.

The conditions of the patients in the Pediatrics report were diagnosed through blood tests that showed abnormal levels of an enzyme made by injured or dying heart tissue. Many also had abnormal heart-imaging tests. Both methods are used to diagnose heart attacks in adults.