July 1st, 2011 by DrWes in Health Tips, Opinion
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He sat in a crisp white coat, staring at a computer screen, note cards in his lap. Occasionally, I noted him jot a note to himself as he compiled his list. A nurse sat next to him, pounding feverishly on the keyboard as she recorded her nurse’s note. He tentatively moved his mouse, then clicked, still staring.
I recall my first day in clinical medicine: no computer, an ER rotation, a white board filled with names and abbreviated medical problems next to them with little magnetic color-coded labels nearby. Room 1: Head trauma. Room 2: Abscess. Room 3: UTI, Room 4: Rash.
I got room 2. It was the biggest, bad-est infected sebaceous cyst on a guy’s back a newly minted doctor had ever seen. Can you say “softball?” “See one, do one,” they told me. And off I went.
Much in medicine has changed since then, but much remains the same. Medicine is miraculous, terrifying, then rewarding all at once. Fortunately, there’s a method within the madness that can serve to preserve and protect those who first start out. Every doctor has had the fortune to learn from those who passed before them as begin their journey to refine their title of “doctor” (literally, “teacher.”)
I thought it would be interesting to put a few of the “Rules of the Road for Medicine” down on paper (with the help of friends on Twitter) for interns and residents as they embark on their own incredible journey ahead. The list is not exhaustive, but hopefully can serve as a resource for our new doctors as they head off to meet their clinical challenges ahead.
Rule #1: Treat every patient like your mother Read more »
*This blog post was originally published at Dr. Wes*
June 26th, 2011 by DrWes in Opinion, Research
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Alright doctors, time to give up the cell phones. (Never mind that there has not been a study linking cell phones and hospital acquired infections).
From the American Journal of Infection Control:
A cross-sectional study was conducted to determine bacterial colonization on the mobile phones (MPs) used by patients, patients’ companions, visitors, and health care workers (HCWs). Significantly higher rates of pathogens (39.6% vs 20.6%, respectively; P = .02) were found in MPs of patients’ (n = 48) versus the HCWs’ (n = 12). There were also more multidrug pathogens in the patents’ MPs including methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Escherichia coli, and Klebsiella spp, high-level aminoglycoside-resistant Enterococcus spp, and carabepenem-resistant Acinetobacter baumanii. Our findings suggest that mobile phones of patients, patients’ companions, and visitors represent higher risk for nosocomial pathogen colonization than those of HCWs. Specific infection control measures may be required for this threat.
What specific measures might they consider?
They better be careful what they wish for or they might also have to take away all those dirty EMR computer keyboards, too.
*This blog post was originally published at Dr. Wes*
June 20th, 2011 by DrWes in True Stories
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Easy case.
Seen it a hundred times.
Old guy (or gal).
Comes into ER.
Found “down.”
“Hey doc, looks like his hearts goin’ slow. I think he (or she) needs a pacer.”
“On any meds that might do this?”
“Nah.”
“How’s his (her) potassium?”
“4.3, normal.”
And like lots of times, you head in. Glad you can help. Call-team’s on their way, thanks to you. Called the device rep to make sure they can be there just in case, too. Cool as a cucumber. Nothin’ to it. Been here, done this.
You arrive to a guy (or gal) that looks pretty good. Maybe has one or two medical problems. Heart rate’s better thanks to the atropine and the fluids they gave him (her) on arrival. The intraosseus line in the tibia is impressive, too. (“At least he (she) wasn’t awake when that happened,” you think.)
So you review, examine, plan your approach. EKG on presentation? Ouch, heart rate agonal. Wide complex rhythm of right bundle branch rhythm. Look at the monitor: “lots more right bundle branch rhythm there, thank goodness, P waves, too.” you secretely notice.
Seems he (or she) is willing (how many times does he (or she) want to pass out at home?), understands what lies ahead, that the crew’s on their way. “We’ll be taking you over in just a few minutes. Any other questions?” There are none.
Perfect.
And after a while the crew arrives, assembles the poor guy (or gal) on the table and ships him (or her) over to the cath lab area. Chest is prepped, equipment assembled, antibiotics given, monitors connected…
… damn we’re good. Smooth operators.
So the local anesthetic is injected and the incisions made. Dissection to the pre-pectoralis fascia just above the breast muscle accomplished, even the wires passed easily into the vein using ultrasound guidance. Even having a nice chat with the guy (or gal).
Poetry in motion.
Sheaths placed in the vein over the guidewire, pacing leads placed through the sheath. Until, from the control room… Read more »
*This blog post was originally published at Dr. Wes*
June 12th, 2011 by DrWes in Humor
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It happens to every doctor at some time in their busy career: the missing pager. Usually, discovering the locale of the digital disrupter is quite simple: you simply page yourself provided, of course, that the contraption is not on “vibrate” mode.
And so it was with me some time ago.
The scene was a familiar one: rushing off to work, heading out the door while contemplating the upcoming caseload of the day with my mind wandering off to great medical thoughts when, suddenly, I reached to my hip to find that I had forgotten my pager.
Dang.
So back to the house I go and scramble for the telephone. My wife, hearing the door opening calls back from upstairs: “Something wrong, dear?”
“No, just forgot my *@#$&#*& pager. No biggie.”
So I called the paging number and waited. (Why it takes so long for electrons to travel to space and back is beyond me.) Some time later I heard in the distance: Read more »
*This blog post was originally published at Dr. Wes*
June 8th, 2011 by DrWes in Health Policy
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We certainly have seen regulations upon regulations appear for health care over the past several years, and this letter to the editor of the Wall Street Journal (1 June 2011) from the Commissioner of the Consumer Product Safety Commission, Nancy A. Nord, should cause us all to pause:
As a commissioner at the U.S. Consumer Product Safety Commission (CPSC), I can attest that no such (regulatory reform) activity is happening at this agency. We certainly have not combed through our regulations to eliminate those that are “out-of-date, unnecessary, [or] excessively burdensome,” as he suggests is being done across the government. Instead, we are regulating at an unprecedented pace and have pretty much abandoned any efforts to weigh societal benefits from regulations with the costs imposed on the public.
In health care, we have seen an unprecedented rise in regulations for in-hospital MRSA screening while little data have been forthcoming about its patient benefits. Doctors are under increased administrative burdens to complete Pay for Performance questionnaires without any evidence of their benefit to patients. Read more »
*This blog post was originally published at Dr. Wes*
