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Can You Electrocute Yourself From Peeing?

Why yes, you can.

From a German collection of 30 illustrations showing how you can die from electrocution. Uplifting.


*This post was originally published at KevinMD.*

It’s not what you say – or even how you say it

Yesterday I was sure that I wasn’t going to talk “swine.”  Twelve hours ago I had almost, definitely decided on my topic.  And it wasn’t swine flu.  But sometime between then an hour ago, I changed my mind.  I’m allowed to do that.  It’s my blog.  And, guess what.  I changed it again.
I actually began to write about the swine flu but then took a break – for a very important reason.  My sister, daughter and I had to start decorating hats for friends and family members who will join us this weekend to participate in the brain tumor walk in Washington D.C.  Each year we form a team in memory of my husband, who died 4 years ago.  As I was about to start writing my “swine” blog again, a friend and fellow team member emailed me to make sure that I pick up a “yellow” shirt for her tomorrow instead of a white one (when I pick up team members’ shirts for them), indicating that she is a brain tumor survivor.
This weekend always marks the beginning of two weeks of intense emotions.  It begins with the brain tumor walk, moves onto the anniversary of my husband’s death in the Jewish calendar, then his birthday and, the day after that, the anniversary of his death in the common calendar.
This weekend also serves as a reminder of how important friends and family are. Each year I am amazed by the number of people who join me to celebrate my late-husband’s life and to support our family.  While my children have to carry the burden of their father’s death, they also have learned how important life is and how lucky they are that so many people care about them.
It is difficult to know what to say when somebody becomes terminally ill or when a family member dies.  What are the proper words?  For the most part, it is not the exact words that matter.   What does matter is that friends and family are there to show support.  Immediately – and a week later.  And 6 months later.  And 2 and even 4 years later.
Some of my friends began to check on my weekly after my husband died and, to this day, still check on me the same day of every week.  Others called me recently after a religious leader in my synagogue was diagnosed with the same type of tumor my husband had – because they wanted  to make sure I was doing OK.  Likewise, my daughters’ friends, who are now 5th graders, watch out for her.  When a classmate’s father recently died, it upset my daughter greatly.  That evening  I received several phone calls from her friends’ parents, who had heard she was very sad.  I also received a phone call from her guidance counselor, letting me know about the death and making sure my daughter was OK.
We have over 65 people walking with us this Sunday.  Our team is comprised of aunts, uncles, in-laws, and cousins.  It also include teachers, a principal, and an old patient of mine.  Plus, there are friends of my husband’s, good friends of mine who barely or never knew him and, of course, old and new friends of both of my daughters.  Some didn’t even know my daughters when their dad was alive.
I will keep my fingers crossed that most of the people walking this Sunday are accompanied by someone wearing a yellow shirt, rather than just a sea of white.

Alcohol At The Beach

In continuing with the theme of getting ready for the beach and water sports this summer, let’s consider what to do about substance abuse. There is no controversy whatsoever about the fact that persons under the influence of alcohol or any other mind-altering substance have a higher incidence of accidents. In fact, ingestion of alcohol figures prominently as a statistic in falls, drownings, motor vehicle accidents and virtually every variety of activity that has ever been studied. The issue, then, is not whether or not alcohol contributes to illness and injury, but to what extent we are able to control its use by reason and, when necessary, prohibition.

Im June of 2008, Solana Beach, California banned alcohol consumption on its beaches for at least a year. This ban continues. Here is what appears on the city’s website:

Alcoholic Beverages – Alcohol is banned at all beach areas in Solana Beach. Alcohol is also prohibited in the parking lot, community center, viewpoint or any other public place adjacent to the beach. Glass is prohibited as well.

There are similar rules at, among others, Torrey Pines State Beach, Cardiff, San Elijo, South Carlsbad and Carlsbad state beaches.

City officials made this move proactively, to avoid the sorts of tragedies and social problems that have intermittently plagued “wet” beaches. Recognizing that judgment is often an irrelevant factor when it comes to drinking alcohol, they made a strong and, in my opinion, laudable move. Like it or not, judgment is impaired by drinking alcohol, so the concept of “responsible drinking” is an oxymoron when water sports and potentially hazardous surf conditions coexist with beer, wine, and liquor. Of course, the same is true for certain prescription drugs and illicit drugs.

Needless to say, civil libertarians and numerous other individuals are opposed to mandated prohibitions. They cite lack of observation of problems, principles of freedom and personal rights, and even the loss of romanticism. The issue obviously has two sides.

From a safety perspective, it’s a no-brainer. There’s no benefit to drinking alcohol and entering the ocean. It can never make you safer, and can only make you less safe. Even if you are able to drink alcohol at the beach and safely dispose of your metal cans and glass bottles, not litter, not be rowdy or obnoxious, and keep your drinking to yourself, the moment you dip a toe, you are a greater risk to yourself and to the lifeguards and other rescuers entrusted to protect you. You may not believe that to be the case, but the stories and statistics don’t support you. Having pulled intoxicated victims from the water, treated them at the scene, stitched their heads and set their broken bones in the emergency department, and having had to tell their families and friends that they are dead (while knowing that none of this would have ever happened had the victims been sober), I am offering well-intentioned advice. Not every city will mandate that you leave your beer cooler at home when you head to the beach. When you need to be the one to decide, choose wisely.

Preview the Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 24-29, 2009.

Join me from January 24 to February 2, 2010 for an exciting dive and wilderness medicine CME adventure aboard the Nautilus Explorer to Socorro Island, Mexico to benefit the Wilderness Medical Society.

photo courtesy of

*This post, Alcohol At The Beach, was originally published on by Paul S. Auerbach, MD, MS.*

Telemedicine Care: A malpractice risk? Au Contraire …

In early 2006, four years into running my current medical practice, doctokr Family Medicine, I got a call from my medical malpractice carrier.  Just weeks before I’d received a notice that my malpractice rates could go up by more than 25%.  The added news of a pending investigatory audit was chilling. In 25 years of practicing medicine I’d never been audited.

“Is there a complaint, or a law suit against me that I don’t know about?”

“No,” the auditor told me over the phone, “We’ve never seen a medical practice like yours and feel obligated to investigate your process from a medical-legal perspective.”

“Great,” I thought, with a weary sigh. “I’m already battling the insurance model, the status quo of the medical business model, and slow adoption by consumers who are addicted to their $20 co-pay. All I’m trying to do is to breathe life into primary care and get the consumer a much higher quality service for less money than currently subsidized through the insurance model. And now this.”

The time had arrived to add the concerns of the malpractice companies to the list of hurdles to clear if a new vision of a medical care model was ever to catch flight.

I frequently am asked the question “Aren’t you afraid of the malpractice risk?” when I explain my medical practice model, which is based on the doctor answering the phone 24/7, resulting in the patient’s medical problem being solved by the phone more 50% of the time. The simplest counter to this question is to analyze the risk patients incur when the doctor won’t answer the phone. What happens when the doctor is the LAST person to know what’s going on with patients?   The answer is obvious.  But malpractice companies could have concerns beyond patient safety. Buy-in from the malpractice companies would be critical to the future viability of all telemedicine.

I prepared a summary paper, which included 12 bullet points, explaining how a doctor- patient relationship based on trust , transparency, continuous communications and high quality information systems significantly reduce risk to the person you’re trying to help.

Bullet 1: The industry standard is that 70% of malpractice cases in primary care center on communication barriers. My medical team deploys continuous phone and email communications and 7 days a week- same day office visits when needed between doctor and patient thus significantly reducing these barriers.
The remaining bullets could be summarized by the conclusions from the Institute of Medicine’s visionary book Crossing the Quality Chasm: A New Health System for the 21st Century using a table developed by The American Medical News when they reviewed the book. I carefully plotted our practice standards compared to the traditional business model as it stands today based on this table:

The auditor showed up, spent 4 hours reviewing our practice, electronic medical records, compliance to HIPPA, our intakes, on-line connectivity, procedures, and practice standards. While the auditor reviewed, I sat as unobtrusively as I could, feeling my brow grow damp with perspiration, as I carefully answered her questions. During the auditor’s time, I never moved to sway her to “my way.” I just let the data that I had accumulated from four years of practice do the talking.

Once the auditor left, I waited for two weeks for the results. By the time their letter arrived, I was scared to open it.  The news arriving made me jubilant. The medical practice company announced a DECREASE in my premiums because we used telemedicine and EMR to treat patients so fast (often within 10 minutes of someone calling us we have their issue solved without the patient ever having to come in).

I will admit that I felt, and actually still do feel, vindicated by having my malpractice insurer understand fully the value that the type of telemedicine my practice offers to our patients: round-the-clock access to the doctor, speed of diagnosis, and convenience, which all led to healthier patients and lower risk.

Doctors answering the phone all day for their patients, it’s not just lower risk, it’s better health care at a better price. It’s a win-win-win strategy whose day is arriving.

Until next week, I remain yours in primary care,

Alan Dappen, MD

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