A prayer for the troops

Let's all remember today the soldiers at Fort Hood killed and wounded in the shooting. These young men chose to serve their country only to be cut down at home in a "random" act of violence by a "moderate" Muslim reportedly yelling "Allah Akbar", while calmly shooting his fellow soldiers. A let's also remember the virgins in heaven anxiously awaiting this ass hole, who couldn't even martyr himself correctly. Let's hope the military will do it for him, and that our soldiers won't have to aim their weapons inward as well as outward.

Over 2000 pages of shit

The socialist liberal jackholes have had this "plan" for health care (read: sticking their big noses into another aspect of our lives and appealing to the non-contributing class) on the back burner for years, full well knowing that if is wasn't shoved through just at the right time (read: perfect storm) it would never fly. Well, thanks for electing that perfect storm. There is no way they could have come up that quickly with over 2800 pages, including amendments, in a couple of months, complete with the wherefores, shalls, and other dumb crap. Good God. Just allow competition for insurance companies (whose "immoral" profits are at a gross margin of 2-6 percent) across state lines and few other tweaks and we could "fix" the "crisis", in 30 pages or less. There will be those that fall through the cracks, but unless those cracks are covered with an Iron Curtain (pun intended) a free society will always have them. I'm not talking here about those who make enough but choose not to purchase insurance and instead the new 3G iphone and a 52 inch Sony LCD.

I didn't spend 8 years post graduate study and 3 years residency training to be treated like a pawn in a game of who can pander the most. If you want my services, good sir, you will pay what I am worth.

Use the Force... I'm Serious

Most docs find something in their areas of expertise that they just have a knack for, and for me that thing is reducing dislocated shoulders without sedation. Now this sounds barbaric, especially if you remember Mel Gibson in Lethal Weapon very dramatically dislocating and relocating his own shoulder to either kill the bad guy or screw the hot chick... can't remember, but it ain't like that bro'. The quicker the shoulder is reduced the less pain experienced, period.

Now I am not the only doc who can do this and most ortho guys can do it but most docs see a dislocated shoulder and just order up the meds and figure they will end up giving them anyway so they don't bother with a gentle tug.

Here's where 'the force' comes in... My little trick is to get complete focus from the patient and complete agreement that getting their shoulder in place now is much better for all involved than waiting thirty minutes to get that first Xray and set up for conscious sedation. Most folks will let me try and here's what I do.

I talk the patient through the procedure... I watch their eyes... and slowly, ever so slowly, I extend their dislocated extremity up into a sort of Roman salute... Usually, near the apex, a 'clunk' lets me and the patient know that all is well. Start to finish, about three minutes.

Of course, there are those people, usually those that tell me that they have a 'really high pain threshold', who can not relax their muscles enough for me to perform this maneuver and propofol here we come.

But the trick, the real trick, is getting that patient to trust you and listen. There, I may retire in peace now.

Press Ganey Redux

An oldie but goodie here with two new comments which just may be from inside the belly of the beast. Gotta check out the neato sharp-edged sign too.

I Can Say "No" Now

If your specialist physician has refused to sign your family medical leave act paperwork for your terrible seasonal allergic rhinitis, do not bring it to me. I'm not going to sign it either. Besides that, when you leave, I am going to talk about what a douchebag you are with everyone in the office (though in complete compliance with HIPAA).

RSS and Feed Problems Fixed

Our feed is no longer hijacked to another site. Give it a try.

Fab-ulous

Out for a day hike on some boulder fields. Great weather, a little Indian-summerish, not a care in the world and then WHAM! Something stings you in the back of your calf.

Rattlesnakes usually don't kill people and this one didn't either, but it did force an admission to the ICU and a consultation with the Vascular Surgeon just in case. The venom from a 'wet strike' here is mostly proteolytic and hemolytic (severe local swelling and coagulation abnormalities), but can also be centrally acting on the heart. Compartment syndrome can result from these bites and if not diagnosed can, well, it can rot your leg, or hand, or arm off.

Used to be we gave anti-venin made from horse serum for severe envenomations, and, while it worked to stop the progression of the snake-bite (crotalid bite if you are on the pedantic side of academics), it also gave the patient a terrible case of serum sickness and hospital stays for severe envenomations were quite long because of this. Enter big-pharma.

Big-Pharma, we all know, roasts babies on spits for fun and is in league with big-Tobacco in the shamefully capitalistic pursuit of profit-making. If Satan existed they would be in league with him too, but for now just picture Dick Cheney with his shotgun. Somehow, in spite of all this however, they managed to produce crofab, which has revolutionized the treatment of crotalid envenomation.

I think, though, now that we know it works, that further profit from this drug should be confiscated and given to, uh, mmm, a non-profit organization. Power to the people in power! Huzzah!

Malingering

Malingering used to be called 'gold-bricking', or 'lying' and it used to get you fired.

I am here calling on all of you who may work in the military medical system or the VA system. Can you tell me what happens to malingerers in the military now or in the VA system. I think I know the answer, but I want you to tell me. Malingering, you do it and you get what?

Along these lines for you in the military, what does going A.W.O.L. get you now? Educate me.

Can't wait for the same kind of thinking and rules to be applied across the board to all Americans under Obamacare.

I've got it!

Sometimes I amaze myself.

I had an epiphany this morning. Here is my solution to the health care "crisis": whenever doctors refer to anything about health care, include DENTAL CARE as part of the discussion.

"We need to strongly support complete medical / dental coverage for all!" Why is this so brilliant? Because every dentist across America will have a fucking meltdown when they are asked to put up with the crap we do. These guys typically run good businesses; they may or may not accept insurance; they are well paid. They are perfect examples of true entrepreneurs. I admire this.

Now. Ask for a government mandate a la EMTALA, call it DentalTALA. Ask for a single payor for all dental procedures. Ask for a public option, with no balance billing allowed.

Watch the dentists revolt. These guys are smart and their national organizations, I assume, are, unlike ours, not ready to take it in the ass.

MEDICAL / DENTAL CARE FOR ALL! Give me your voice and I will give you a mob of angry DMDs marching on the Capitol.

The World of Medical Administration

Paychecks available in medical administration if you can write something like this for an interoffice memo at the clinic. Warning, remove all sharp objects from your computer area before reading.

Good morning all,
Bill and I frequently put out magazines in front of Triage and Physical Therapy for our patients to read. These magazines are from our personal subscriptions, which we decided to share with our patients and the clinic. The past few weeks there have been one or two magazines for our patients to read; magazines that are very outdated. Thursday I brought in 13 new magazines and placed them on our magazine table at 0800. By 1000 there were 6 left. Now today, there are 2 left. We expected a few would walk off, or a patient would take one home, or some could get tossed because they are old, or that some would be taken into the "reading room." But to have 10 magazines disappear in 2 working days is a bit excessive. I'm unsure if staff is taking them to their areas, or putting them in their waiting rooms, or if patients are taking them. But we will be putting a sign up asking patients not to take our magazines. If you decide you would like a few of the magazines we brought, please make sure you leave us with a good amount of magazines. We don't mind sharing our magazines, and we don't mind bringing them in... just please, if you take them, don't take them all. ;)

God Has a Sense of Humor

After cursing the world of medicine from a doctor's perspective it turned around and cursed me.

On my way to a nice resort, yes, partly to celebrate my divorce from the ER , I find myself typing this blog entry from a hospital bed, in full contact precaution lock-down, wondering what the hell I breathed-in, ingested, or got voodoo cursed into my body that would lay me out so severely that I... Shit this is hard for me... I called 911.

If I hadn't been reeking of vomit and it's green cousin from the south I would have kissed the male paramedic with halitosis (and poor IV skills) full on the mouth for finally getting the stick and beginning to un-prune me.

I also decided I could write a thirty minute comedy bit about being sick in an airliner bathroom and getting a leg cramp... I'm kinda tall you see.

S. aureus enteritis! Spawn of Satan! My doctors cast you out! What's that? You wish to enter a herd of pigs? How about Michael Moore? (gleeful demonic laughter).