April 4th, 2008 by Dr. Val Jones in Humor
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Today I attended a lecture given by an orthopedic surgeon. He was in his early 40’s, tall, and athletic in appearance. He spoke about spinal injuries the way a young boy would talk about crashing his toys together – vertebrae were “smashed, crunched, or wrecked” in various ways. He showed the audience various CT scans and x-rays of the neck, and proudly described the hardware he used to fuse spinal segments. Here are some choice quotes from his lecture:
“I think I’m losing my voice. I don’t talk that much at home because I have all girls. Um… so the cement from a kyphoplasty can get into the veins and travel to the lungs, but it’s not like a big clump gets in them or anything. It’s more like little tiny microscopic pieces of cement. You know, they kind of cause bronchio… bronchiec… broncho… broncholectasis or something. I don’t remember. But if your vertebral body is smushed, what are you going to do? It’s just really awesome to stick that balloon in there and blow up the area. With kyphoplasty you get less… whatever that word is… spill of cement
…So with the thoracic spine I come at it from the back because otherwise the heart gets in the way. Also, I use a posterior approach because then I don’t need another surgeon in there with me, and it’s hard to find them on Saturday mornings.
…If you see lateral translation of the spine then you know you’ve torn everything up. I mean, that thing is going to be a disaster zone so you may as well just go in there with all you’ve got. Hey, if you need surgery, you need surgery. But if a high c-spine injury isn’t unstable then don’t immobilize it or it’ll freeze up like an elbow. You won’t be able to do much more than move your eyes.
…And here’s a case of a guy with Tuberculosis in his spine. We opened that sucker up and it just poured out all over the place. It was awesome. He’s totally fine now.”
I was trying so hard not to giggle throughout this “academic lecture.” It was actually kind of refreshing to get the straight scoop on spinal surgery from an orthopedist who obviously loves what he does. But at the same time, I felt strangely nervous…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 3rd, 2008 by Dr. Val Jones in Medblogger Shout Outs
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Well, I know that blog post title probably got your attention. I’m referring, of course, to the unusual career path of Paul Levy, CEO of Harvard’s Beth Israel Deaconess Medical Center in Boston. Paul has done wonderful things over the past several years as CEO, including using his blog to promote outcomes transparency (by making his hospital’s infection rates public) and being accessible to all his staff via Facebook.
I had the chance to speak with Paul at Dr. Anonymous’ Blog Talk Radio show tonight. You should listen to the podcast to learn more about the world of hospital administration, Paul’s life journey, and what constitutes quality care in medicine. Here are some choice quotes from the call:
“I’m from New York, actually, which is something you don’t say very often when you live in Boston. I have to explain that I really didn’t want to be born in New York but my mother was there and I felt it would be appropriate to be near her during the time of childbirth… And I want to make it absolutely clear that I root for the Red Sox…
Well, personally I have a checkered past. I had no idea I was going to do this [hospital administration.] My background is in the energy field and telecommunications. I used to regulate the utilities in Massachusetts, then the state energy department in Little Rock, Arkansas, and then I ended up running the water and sewer system in the greater Boston area. I guess running a sewer system is good training for running a hospital…
There had been a merger of Beth Israel and Deaconess in the mid 1990s. The merger failed and the place was about to go out of business. I thought it was worth saving, so I persuaded them to hire me. It’s not the usual path. I hope that not too many other hospitals that are failing would want to hire the guy who runs the sewer system.”
So there you have it, folks. Sometimes the best CEOs may be found in unusual places… Kudos to Paul Levy for spearheading a major hospital turn around, and kudos to the Harvard system for recognizing leadership excellence in an unexpected corner of the world. Listen to the podcast to find out more about this fascinating story.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 2nd, 2008 by Dr. Val Jones in Announcements, Medblogger Shout Outs
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For those of you who enjoyed the April Fool’s Grand Rounds (I was participant #2 in an amusing “progressive blog” string of hosts), please join me at the Dr. Anonymous show tomorrow night (9pm EST, April 3) to find out how we pulled it off. In addition to going “behind the scenes” of the April Fool’s edition of Grand Rounds, Paul Levy (CEO of Beth Israel/Deaconess in Boston and author of “Running A Hospital“) will be Dr. Anonymous’ special guest. Paul recently won Medgadget’s coveted “Best Medical Blog of 2007” award.
You can listen to the conversation, join the chat room, call in to the show, or watch Dr. A’s live video feed. This will be a multi-media extravaganza with some of the medical blogosphere’s brightest stars… so don’t miss it! Go to this link a few minutes prior to the show start time.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 2nd, 2008 by Dr. Val Jones in True Stories
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I’m at a medical conference in Houston this week (picking up some CME credits) and between lectures I’ve had some interesting conversations with my peers. Here’s my favorite story:
A patient underwent a total hip replacement surgery, had a normal post-operative course, was transferred for inpatient rehabilitation, progressed well and was discharged home. Several months later the patient decided to sue the hospital, claiming that he was sent home with a dislocated hip. The hospital couldn’t prove that the patient’s hip was not dislocated at the time of discharge because no x-ray was taken on that day. Of course, the only reason an x-ray would have been taken was if there were a strong suspicion of a fracture or dislocation (x-rays are not normally repeated on the day of discharge).
The hospital was found liable and will settle out of court for an undisclosed (but very large) amount.
My guess is that this case will cause:
1. The hospital to take unnecessary x-rays of all total hip patients on the day of discharge from now to eternity.
2. More dishonest patients to file frivolous law suits.
3. The local med/mal attorney population to spread the word about a new source of income.
4. Further cutbacks in the hospital’s charitable care due to funding deficits.
5. Someone with a hip replacement to buy a new Ferrari.
Sigh.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 1st, 2008 by Dr. Val Jones in Medblogger Shout Outs
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Welcome to Grand Rounds Volume 4, Number 28, part 2. This is the most esteemed medblog carnival on the Internet, founded by Nicholas Genes, MD, PhD on September 28, 2004. Grand Rounds is meant to embody the spirit of good science and humanism in medicine, as it is a weekly collection of the very best blog posts from critically acclaimed, international health care professionals.
This noble undertaking has been carefully advanced by high-minded hosts, who happily put aside their life’s work, their families, yes, even the needs of their beloved pets, in order to provide readers with a cogent analysis of the week’s most important medical facts and opinions. I didn’t think I’d see the day when this great public service would fall into the hands of the lackadaisical. But alas, that day has come – and wouldn’t you know that it would be an Emergency Medicine physician who let us all down?
GruntDoc, a pillar of the medical blogosphere establishment, cannot be bothered to fulfill his hosting role this week, and has asked yours truly to finish his work for him. How typical of an EM physician! Get things started and then hand them off to another doctor to complete. (Witness his shameful apathy for yourself at Grand Rounds, Part 1).
Well, it’s one thing to be summarily passed the Grand Rounds baton, and it’s another altogether to be left with the dregs of the submissions. I am agog and aghast at the low-brow nature of this week’s offerings. Here is but a small sample:
The common leech as a celebrity blood-detoxification system (by Dr. Ramona Bates at Suture for a Living).
The surgical value of flatus (by Bongi at Other Things Amanzi).
In search of the perfect gluteal contour (by My Med Jokes).
In search of your lost tampon (by Dr. Jan Gurley of Gurley Doc).
I find this whole exercise utterly deflating – and unworthy of the high calling of Grand Rounds. But because I myself am long-suffering and reliable, I will not shirk my responsibilities, but rather ask a peer with lower standards (whose sensibilities will surely not be offended by flatus) to continue this week’s carnival. Please go to David Williams’ blog for the rest of this collection of health content of questionable value.
-Posted April 1, 2008-This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
