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Urine Testing: If It’s Not Captured Via Catheter, It’s Not Accurate

After eight years of hospitalist medicine and seeing inaccurate urinalysis results day after day, year after year, I’ve come to the conclusion that the straight cath vs clean catch debate is not a debate.  If the urine didn’t come from a straight cath, I have zero faith in the accuracy of the results.

I know, I know.  It takes time and effort for a nurse to perform the straight cath.  It’s not comfortable for the patient to have a catheter inserted into their urethra.  Plus, with bad nursing technique, one could introduce bacteria into the bladder when performing a straight cath urinalysis.

All that aside, if I’m a physician trying to make medical decisions based on accurate data, then having bad urine results that don’t represent the true picture is worse than not having any data at all.  For example, here’s a classic case of what I have to deal with day in and day out when trying to make medical decisions on my patients.  Below is a snap shot of three UA results obtained from Happy’s ER over two visits.  I’m sure it’s the same no matter where you get your care in this country.  The first two urinalysis results came from a clean catch sample of a horribly weak 89 year old female who presented with family complaints of “fever and weakness”, both days. Read more »

*This blog post was originally published at The Happy Hospitalist*

How To Live Forever: Have A Dermatologist As Your Primary Care Physician?

Everyone has their own perspectives about life and death, often based on life experiences and their worldly views. Doctors are no different, except to say that doctors deal with life and death every day of their lives. For medical doctors, death perspectives are more likely to be defined by their disease specialty.
Here are a few examples of  death perspectives from the different medical specialties

If you’re a pulmonologist, nobody dies without first getting a bronchoscopy.If you’re a cardiologist, nobody dies without first getting a heart catheterization.If you’re a nephrologist, nobody dies without first getting a run of dialysis.If you’re an oncologist, nobody dies without first getting a course of chemotherapy.If you’re a neurologist, nobody dies without first getting an EEG and an MRI. If you’re a gastroenterologist, nobody dies without first getting a colonoscopy.If you’re a rheumatologist, nobody dies from lupus, because the answer is never lupus.  If you’re an infectious disease doctor, nobody dies without first getting a course of doxycycline.If you’re a family practice physician, nobody dies without getting a consult.If you’re an internist, nobody dies without first admitting the patient to the hospitalist.If you’re a dermatologist, nobody dies. Period.

What’s the moral of the story?  If you want to live forever,  get a dermatologist as your primary care physician.

*This blog post was originally published at The Happy Hospitalist*

Healthy Thought For The Day

A new blog has entered the medical world.  She’s only a couple months old, but she has an awesome name: happy internist.   happy internist shows us all   how to die healthy:

my patient saw her gynecologist.  he told her to eat right, get lots of exercise, and lose weight.  that way, he said, you can die healthy.

What a great quote.  It’s called finishing strong.  Given what I know about the incredible pain and suffering I witness everyday from self induced disease, dying healthy is a goal worth living for. Death is inevitable.  Dying healthy takes hard work and personal sacrifice.

She was discovered at this week’s Grand Rounds, where Dr Val has done an excellent job of organizing the best of this week’s Internet medical offerings.

*This blog post was originally published at The Happy Hospitalist*

Dogs, Hospitals, And Unintended Consequences

Every day I go to the emergency room to admit my adults, I can hear the screaming babies and toddlers. Sometimes, the screams are actually from their parents after realizing  how much their visit is going to  cost.  But most of the time it’s really frightened kids in an unfamiliar environment.

Happy’s hospital used to hand out hospital stickers so kids would associate emergency rooms with a fun place to hang out.  It turns out, after  intense behind the scenes discussions with administration, that this policy was a covert attempt to increase the volume of our pediatric emergency room volumes.

After looking at the numbers, and understanding how hospitals get paid,I have now come on board and am part of a committee think tank that does nothing more than think of ways to get more people through the doors.   We invited the intelligence behind the 50% rise in pediatric ICU volumes after implementing the pediatric ICU art project. Read more »

*This blog post was originally published at The Happy Hospitalist*

Family Physicians: Are They Paid Well Compared To Other Docs?

Here’s an interesting article, talking about stuff that’s not new to anyone who has read my blog for the last three years. The current relative value unit (RVU) system is a scam, perpetuated by a super-secretive group of subspecialists each  inflating their own worth for the benefit of themselves, at the expense of primary care.

If you don’t understand what I’m talking about, first read about RVUs explained. Then come back and read this article put out by the National Institute for Health Care Management. It’s titled “Out of Whack: Pricing Distortions in the Medicare Physician Fee Schedule.” In his essay, Dr. Robert Berenson shows how distorted primary care specialties are paid, relative to other specialties, in an all Medicare practice with the equivalent input of hours worked. Read more »

*This blog post was originally published at The Happy Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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