My friend and fellow blogger Kerri Morrone Sparling has created a photo montage (one photo taken each day for 365 consecutive days) of her life with diabetes. It is a fascinating pictorial experience that somehow captures the reality of the disease – and living life to the fullest despite daily blood sugar monitoring.
Please take the time to experience it here.
Here’s my weekly round up of quotable quotes from my peers:
NHS Blog Doctor: Antibiotics do not cure snot. [Please go to the site for a fabulous illustrative photo.]
KevinMD: Since work-hours were restricted in 2003, there are no studies that have shown any marked improvements in patient safety or outcomes. Worse, errors have arisen from the so-called “patient hand-off,” the period of communication where rested doctors replaces those who are fatigued. Does increasing the frequency of patient hand-offs outweigh the benefit of better rested doctors?
Richard Reece, MD: The moral for doctors: Don’t expect as much leverage as in the past when negotiating with hospitals, even though you represent their main revenue stream.
Paul Levy: The medical community in Boston likes to boast about the medical care here, but we don’t do a very good job holding ourselves accountable.
Dr. Wes: Thanks to exorbitant costs of implementing EMRs in physician practices, the Medicare requirements for billing and prescribing electronically, and the prohibitive documentation requirements mandated by CMS in the name of “quality,” independent physician practices of all types will have no choice but capitulate to larger entities that have a fully integrated electronic medical record paired with collection software.
Heart found in a car wash (h/t Dr. Wes)
Ramona Bates, MD: I don’t think I would ever want to be part of doing a posthumous face lift or blepharoplasty or other cosmetic procedure, but I would be willing to debulk tumors if it would help families or individuals say “goodbye” more easily.
WhiteCoat Rants: For $79 you can blow into your iPod and it will play you a song if your blood alcohol is more than 0.08. You know this device wasn’t made for parents.
Just what we need. A bunch of drunk teenagers farting around with their iPods and getting into a “who can get the highest blood alcohol” contest.
The Happy Hospitalist: It frightens me to hear people say they want to work in medicine and work in a similar capacity as physicians, evaluating, diagnosing and managing disease, but not want to put in the time and sacrifice to be residency trained in depth and scope…
Science-Based Medicine: Our soldiers, grievously wounded in combat, deserve only the best science-based therapy available… If I were to propose treating our injured soldiers with bloodletting and toxic metals (both common methods in the 1700s and early 1800s) based on the concept that it would put the “imbalance of the four humors” back into balance, the Pentagon and the military medical establishment would toss me out on my ear as a dangerous quack–and rightly so. But introduce a method that claims “ancient Chinese wisdom” based on somehow magically redirecting the flow of a mysterious “life energy” by sticking small needles into parts of the body that correspond to no known anatomic structures through which “qi” flows, and suddenly the Air Force is funding a program to train medics and physicians treating our wounded soldiers how to do this method based on the same amount of convincing scientific evidence that qi exists as for the four humors (none) and in the face of no strong clinical evidence that it’s any better than a placebo.
Rural Doctoring: Hospitalists, take note: this is an example of why people go ape-sh*t crazy in the hospital:
• Her right arm is completely immobilized to protect the graft site.
• Her left arm has a heplocked IV in it.
• Half her head is shaved because the surgeon took the donor skin from the scalp.
• She’s vegetarian and the cafeteria sent her chicken for lunch.
• Dinner was vegetarian but she can’t really cut up a baked potato with only one hand.
• The hospital has double rooms and is running at capacity, so the staff is harried.
• Her roommate is an elderly, demented woman who keeps trying to get out of bed by herself and objects to the TV being on. So far, all she’s said to us is “Mind your own business!”
I hope you enjoy this week’s round up of quotable quotes from the medical blogosphere…
Scalpel or Sword quotes Taiwanese hospital administrator who chose “Hello Kitty” as a new design theme for their maternity ward: “I wish that everyone who comes here, mothers who suffer while giving birth and children who suffer from an illness, can get medical care while seeing these kitties and bring a smile to their faces, helping forget about discomfort and recover faster.”
Charlie Baker on hospital financing: Calculating hospital operating margins actually draws a starker picture. Hospitals collectively lose $30 billion on Medicare and Medicaid and earn $66 billion on commercial business, thereby generating a $36 billion gain overall on their insured patients. They lose another $13 billion on their uninsured patients, netting out to a $24 billion – or 3.6% – operating margin.
This means private sector employers and their employees and families are paying as much as 10-11% more than they would otherwise pay for health insurance – to fund the provider operating deficit created by Medicare and Medicaid.
Paul Levy: There are two types of hospitals, the kind that have had a wrong-side surgery and the kind that will have one.
Edwin Leap: Over the past few years, I’ve observed some curious phenomena. For instance, the raging debate over pharmaceutical companies. Sure, bad data is bad data. And of course, we shouldn’t have our prescribing practices ‘purchased’ by gifts, trips or cute reps.
But, what I find fascinating is the collective anger against those companies for trying to ‘profit.’ Ghastly! Companies, publicly traded ones, in America,trying to make a profit? What are they thinking? I mean, considering doctors and nurses work for free, with no thought to financial benefit…right?
Let’s face it, like it or not, those huge companies make life better. They create and market substances that keep us healthier; and of course, in some instances they offer very vanity driven products that keep us having sex longer or getting fewer wrinkles. But on the balance, we wouldn’t want them to go away, any more than we really want oil companies to disappear.
Respectful Insolence: given the utter lack of scientific support for the vast majority of CAM modalities and the weak support for the remainder, what’s left if you’re a CAM advocate trying to prosletyize about how great CAM is?
Argumentum ad populum, of course. Otherwise known as the bandwagon fallacy or appeal to popularity, it is one of the most favorite logical fallacies of all.
Terra Sigilata: Readers often ask me and other sci/med bloggers why revered academic medical centers are increasingly offering these questionable approaches. The truth is that there is a market for them. A good market. And one that will gladly pay out-of-pocket for such things.
Never mind if the approaches are effective. Or safe. Or can delay treatment with science-based approaches known to be effective.
Smoking, abusing alcohol, using CAM: Just because a lot of kids do it, does that mean it is right for yours to do so as well?
DB’s Medical Rants: Because prices are increasing, Medicare has tried classic bureaucratic techniques to minimize expenses. Our billing system requires extensive documentation. If we do not document well, then we are not paid appropriately.
In an effort to pay physicians more appropriately, Medicare adopted RBRVS. But then they made a huge mistake. They let the AMA develop the RUC – The primary care reimbursement mess. The members of that secret society include very few primary care physicians and many proceduralists.
Movin’ Meat: Wondering why it is that my placing a stethoscope on a patient’s chest is universally interpreted as a signal for the patient (or a family member) to begin talking.
PixelRN: The other day I was talking to a veteran CCU nurse. She told me that she worked at the hospital where the first defibrillations were studied and performed. Like many health care studies, the testing was done on animals – dogs in this case.
She then went on to tell me that one of the requirements for working in her CCU (back in the 1970’s) was that you actually had to defibrillate a dog to show that you were competent in that skill! Yes, the dogs were sedated before hand, but still.
Nurses see (and do) the craziest things.
Forgive me for not keeping up with my own weekly feature: “heard around the blogosphere.” I’ve been very selfish lately, reading and chuckling to myself without sharing. Let me try to remedy that… Here are my top 10 amusing/noteworthy quotes from around the blogosphere:
1. Dr. Rob: “Santa: I suppose if a guy like me can deliver presents to all of the children of the world without developing a significant budget shortfall, perhaps Obama can deliver quality care for all Americans and save money. I would suggest he talk to me before he tries, however, because it isn’t as easy as it looks.”
2. Terra Sigillata: “My hiking boots are old enough to go to college.”
3. Edwin Leap: “Disability is not a career choice.”
4. Ten Out of Ten: “At the interdepartmental meeting the surgeon was irritated at all the hospital cafeteria food being fried and suggested offering some healthy entrees. Turns out they tried that once before but could never sell the healthy stuff.”
5. Respectful Insolence: And then Carol Alt had to come along. Move over, Jenny and Suzanne, there’s a new model woo-meister in town, and she’s looking to out do you both with her vegan raw food woo after having been totally convinced by–you guessed it!–an anecdote.
6. Scalpel or Sword: “Sometimes, [in the ER] what looks like a quickie really isn’t, so one has to be careful.
PATIENT 1
Chief Complaint: sprained ankle (Great, send them
back!)
Nurses note: pt c/o twisted ankle and vaginal discharge for one week. (Never mind.)
7. Scanman: “Soon, specialists will uniformly be comprised of American medical graduates, while the majority of generalists will be composed of mid-levels and foreign-trained physicians. It’s an interesting demographic glimpse of the future American medical workforce… A new kind of caste/class system where the financially less desirable, menial jobs are relegated to second class citizens.”
8. KevinMD: “Primary care is associated with negative connotations such as bureaucracy, paperwork, and being perceived as the lowest physician on the totem pole. Or as this doctor puts it, “‘PCP’ now seems to be synonymous with overworked, underpaid ‘loser’ who at least by some people’s opinions aren’t carrying their weight.” Taking a tip from marketers, how about re-branding the profession?… “
9. GruntDoc: “C=M.D. C=75% and that means I know 3 out of 4 diseases, and that ain’t bad.”
10. PearSoup: To pregnant mommy: “Mommy, If there was a fat person contest you would win! Yay!”
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Dr. Ramona Bates is a plastic surgeon who quilts. Dr. Rob Lamberts is a primary care physician who loves animals that begin with the letter “l” (such as lobsters and llamas). The two have put their creative minds together to benefit brain cancer – in honor of a fellow blogger whose young son is losing his battle with the disease.
This holiday season, you might consider bidding on Dr. Bates’ “lobster quilt” to support brain cancer research. There is a silent auction in progress here. Owning the quilt would make a good story, and the return on investment could be priceless. You can search for updates on the auction on Twitter: #lobsterquilt
P.S. Note that Dr. Rob has also started a traveling lobster initiative – where Zippy the plastic lobster is photographed by medical bloggers around the world to enhance awareness of brain cancer. I had the honor of hosting this little crustacean last summer, and took him to the White House. To learn more about Zippy’s travels, check out this website: http://funwithzippy.com/
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