June 9th, 2009 by KevinMD in Better Health Network
Tags: Army, CT Scan, Military, Radiology, Walter Reed, War
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The military is learning from the dead.
In the past five years, every soldier who was killed in Iraq and Afghanistan has been given a CT scan. Why? In the hopes of creating a database of war injuries, which can be used to better equip and treat future soldiers.
The effort has already paid dividends. While examining the data, it was noticed that chest tubes used to treat pneumothoraces in the field were too short. The standard tubing would have been appropriate for 50 percent of soldiers, versus longer tubing that would fit 99 percent.
Also, it was because of these “autopsy scans” where it was noticed that many of the troops died from wounds in the upper torso, which could have been prevented with the appropriate body armor. On the basis of these findings, the military rushed more armor plates to Iraq.
It’s an interesting piece, and goes on to discuss the sensitive implications of the findings to family members:
The possibility that a relative burned to death is a particular source of anguish for families, and one area in which CT can outperform an autopsy. In a body damaged by flames, CT can help pathologists figure out whether the burns occurred before or after death. The scans can also tell whether a person found in water died from drowning.
It’s truly remarkable to see how much that can be learned after death.
*This blog post was originally published at KevinMD.com*
June 9th, 2009 by RamonaBatesMD in Better Health Network, News
Tags: Fat Sculpting, NPR, Plastic Surgery, Silicone
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I want to say these two stories were well done (both aired on June 1, 2009). I was actually interviewed, but not quoted, for the story on fat-grafting. I pointed Allison Aubry to Dr Scott Spear as her expert. He is involved in one of the U.S. studies on breast augmentation using fat grafting.
Sculpting the Body with Recycled Fat by Allison Aubry.
Doctors Still Unsure Of Long-Term Risks
Surgeons like Dr. Scott Spear of Georgetown University Hospital want to know more about the techniques used to transfer fat for breast augmentation.
“We’re at the beginning of the learning curve,” he says. He has initiated a clinical trial to answer some questions about the best way to perform the procedure and whether there are any measurable risks. To date, there are no published studies in the United States, so doctors are relying on their own clinical experience.
Silicone Injections May Harm Some Patients by Patti Neighmond
When people get injected with silicone at pumping parties, Gorton says “there is no way to verify if they’re using medical-grade silicone. You can go to hardware stores and buy a big tub of it,” he says. “The element is the same, but it’s just not the same safety or purity or quality.”
*This blog post was originally published at Suture for a Living*
June 9th, 2009 by Bryan Vartabedian, M.D. in Better Health Network
Tags: Gastroenterology, Pediatrics, Physician, Social Media, Tips, Twitter
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Let’s face it, Twitter isn’t that hard to figure out. The interface is intuitive and a little time on the application makes its basic function pretty obvious. But there are a couple of things that medical newbie’s might keep in mind before taking the leap on to Twitter. While I didn’t find myself in any kind of trouble, I had to figure a few things out on my own.
1. Follow and listen. Twitter is as much about listening as it is about talking. The best thing you can do to see how doctors are using microblogging to advance their platforms, practices and passions is look and listen. Pick a group of doctors (look at my follow list for some ideas) and follow them for a couple of weeks to see exactly what they do and how they interact with others. Don’t reinvent the wheel.
2. Goof around now, but ultimately think how you want to use it. You likely won’t have any idea about how to use Twitter when you first jump in. And that’s okay. You can’t understand it’s power until you reach a sweet spot of followers and cultivate relationships that have some history and meaning (in Twitter terms, of course). Ultimately you do want to think about connecting with those who will put you where you want to be – whether it’s just raising your profile as an author or specifically drawing patients for lapband surgery, or whatever. But also keep in mind that you may start by goofing off and never stop … like me.
3. You can follow whoever you darn well please. The world is full of self-ordained social media experts who spend their days working to make you feel like you don’t follow enough people. If you’re a physician with a real job you’re too busy to follow 30,000 people. Keep your eye on the ball and think about the network you want to develop. Whatever you do, don’t believe the nonsense that it’s ‘bad etiquette’ to not follow someone who follows you.
4. Your patients and your hospital are listening. Social media is interesting. While we type in the privacy of our boxer shorts, the world reads what we write. And that includes your patients. While my grandmother used to tell me before going out, ‘don’t do anything you wouldn’t do in front of the Virgin Mary, I’m telling you, don’t Tweet anything you wouldn’t want your patients to see. You represent your personal brand, practice, and profession with that very first tweet. Keep in mind that some hospitals have social media/blogging policies. You might look into this before taking the plunge. If you keep your hospital/institution off your bio, commit to never discuss anything relating to patients and always vow to be a really nice guy you should be good.
5. What happens on Twitter stays on Twitter. Remember that everything you type will remain etched in the infosphere for eternity. This can be retrieved by future employers, partners, soon-to-be-ex-spouses or anyone else interested in seeing or exploiting what you’re really about. Exercise intelligent transparency. Be smart and use your frontal lobe before hitting ‘update’.
I was interviewed by the AMA News last week on doctors and Twitter and that’s what got me thinkin’ about this post. I get a charge out of helping doctors recognize the power of connecting beyond their immediate environment. I hope this helps.
*This blog post was originally published at 33 Charts*
June 8th, 2009 by Emergiblog in Better Health Network
Tags: Burn Out, Emergency Medicine, Nursing, Tired
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You walk into the unit, put down your backpack, fill your pocket with pen, scissors, and tape, sling the stethoscope over your neck, swipe your namebadge into the infernal timeclock and enter stage right.
It’s showtime!
Get the triage, hook up the monitor, grab the EKG, slam in the saline lock – grab the bloods in the process, hang a liter of normal saline, put up the side rails, hook the call bell to the side rail, throw on a warm blanket, medicate for fever and slam the chart in the “to-be-seen” rack.
Repeat x 30 over the next eight hours.
Feel like burnt toast, look like burnt toast, act like burnt toast.
*****
Where’s the patient?
You know, the person you just triaged, hooked, slammed, hydrated, side-railed, blanketed, medicated and lined up for evaluation?
Oh.
Did it ever occur to you that the reason you feel like burnt toast is because you are so focused on what you are doing you have lost sight of the “who” you are doing it to?
*****
Well, it occurred to me.
Because that is exactly what had happened.
Oh, my physical care was fine.
But I had stopped looking patients in the eye. I was spitting out standard responses instead of listening to what my patients were saying. I was expending the bare minimum of energy required to complete tasks.
I was doing; I wasn’t caring.
And I was burnt.
*****
But I discovered something.
And this is huge.
I was not focusing on tasks because I had burned out, I burned out because I had started focusing on tasks.
Let’s face it. The ER, while seemingly exciting to those outside the ambulance doors, can actually feel redundant to those of us who deal with the same issues every day. The same complaints. The same symptoms. Over and over and over.
So, what makes each case interesting? What makes each case unique?
The patient behind the story. The person under the symptoms.
Lose sight of the person and you lose sight of the profession. Lose sight of their humanity and you lose sight of your own. Lose sight of your own and you become a burnt shell.
*****
You would think that after three decades of this, I’d have figured this out by now.
I guess you never stop learning.
This time, my teachers were an elderly man with a DVT who talked to me about his time on the LAPD, back in the day.
And the young woman who described, quite vividly, how it felt to go from the pinnacle of health to the devastation of a cancer diagnosis, overnight.
Or the 18-month old who tucked their head under my chin and fell asleep as Mom described the terror of witnessing a first-time febrile seizure.
*****
Who would have guessed that sometimes patients are the cure for burn out and not the cause of burn out.
The patients didn’t change, they were always willing to talk.
All I had to do was stop and listen.
That simple.
Go figure.
*This blog post was originally published at Emergiblog*
June 8th, 2009 by KerriSparling in Better Health Network, Patient Interviews
Tags: Diabetes, Endocrinology, Insulin Pump, Internal Medicine, Patient Advocacy
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Even though I do not like the disease, there are some diabetes-related simple pleasures that make me smile:
- I like when I change the battery and the insulin reservoir at the same time. Having my Medtronic 522 “full” on both sides makes me happy.
- I like when the carb count on something is exactly 10 grams of carbs because it matches my insulin to carb ration precisely. One snack, one unit, one oddly happy Kerri.
- I like the sound of the pump counting up a bolus. Boop boop beep!
- I like when the sound of the bolus is caught by Chris and he ends up whistling it back to me, almost without thinking. It’s a little soundtrack snippet of our life.
- I like when the cats wait patiently for me to remove the pump tubing from my body before they lunge for it.
- I like when new boxes of diabetes supplies show up and I can organize them in my little OCD supply closet.
- I like when the number on my meter is two digits, but higher than 89 mg/dl. It’s a tight range, I’m not usually in it, but it brings me weird joy.
- I like when the Dexcom beeps and my coworker (who works a wall away from me) IMs me quietly to check, “Low?” because she’s ready to get juice if necessary.
- I like not having to wear a watch.
- I like when I get to dump all the used test strips that have piled up throughout the day. Knowing I’ve tested a bunch makes me feel like I really stayed tuned in.
- I like the smell of white glucose tabs.
- I like when the new infusion set doesn’t sting at all.
- I like having someone in my life who is willing to get their hands covered in SkinTac in an attempt to stick a Dexcom sensor to random places on my body.
- I like that the hope of the parents of kids with diabetes rubs off on me, and makes me feel good for even just a few minutes.
- I like that diabetes gives two people, who wouldn’t otherwise have a thing to say to one another, a whole dinner’s worth of conversation.
- I like having coworkers who understand but don’t push.
- I like when my best friend clinks her beer to mine and says, “Bolus, baby.”
- I like when the cat licks my hand after I test.
- I like “free shower:” a shower without a pump site or a CGM sensor attached.
- I like having a whole network of people who understand – and do not judge – my diabetes life.
I like when I can focus on the silly, simple things when I feel a little overwhelmed by the tough stuff.
*This blog post was originally published at Six Until Me.*
