April 9th, 2011 by Happy Hospitalist in Health Tips, Opinion
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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*
March 31st, 2011 by Happy Hospitalist in Humor
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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*
March 24th, 2011 by Happy Hospitalist in Health Tips, Humor, Medblogger Shout Outs
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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*
March 19th, 2011 by Happy Hospitalist in Humor, True Stories
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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*
January 7th, 2011 by Happy Hospitalist in Better Health Network, Opinion
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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*