March 6th, 2011 by Edwin Leap, M.D. in Opinion, True Stories
Tags: A Doctor's Mind, Being Smarter Than Your Brain, Controlling Your Thoughts, Doctors and Decision Making, Doctors and Mental Focus, Doctors and Mental Strength, Doctors and Thought Processes, Doctors' Perspective, Doctors' Thoughts, Emergency Medicine, Emotional Health, General Medicine, Good Medical Decision Making, Good Thoughts, Healthy Mind, Heuristics, Hostage To Your Thoughts, Mental Health, Optimism, Physicians and Thought Control, Positive Thinking, Processing Thoughts, Psychology of Medicine, The Impact Of Thought
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Here’s my column in the March issue of Emergency Medicine News.
Second Opinion: Be Smarter Than Your Brain
“Everyone is a drug seeker. Why does everyone want to be on disability? I’m so tired of lies. Great, another lousy shift. I wonder who will die tonight? I’m so sick of suffering. I’m so weary of misery and loss. I hope this never happens to my family. I’ll probably get sued. Being sued nearly drove me crazy. This job never gets easier, only harder. I have to find something else to do; I can’t go on this way. I think I’m going crazy. I don’t have any more compassion. People hate me now.”
These are only a few of the wonderful thoughts that float through the minds of emergency physicians these days. Sure, not every physician has them. But I know our specialty, I know our colleagues, I hear from doctors around the country and I see that fear, frustration and anxiety are common themes.
Older physicians fantasize about career changes, and younger ones are often blind-sided by the hard realities of practice outside of their training programs (where their work-hours and staffing do not necessarily reflect the world beyond).
We are crushed by regulations and overwhelmed by holding patients, often put in situations where we are set squarely between the devil and the deep blue sea. “Spend more time with your patients; see them faster. Don’t let the ‘psychiatric hold’ patient escape; why are you using so much staff on psychiatric patients? See chest pain immediately; why didn’t you see the board member’s ankle injury as fast as the chest pain?”
In all of this mess of emergency medicine, we often find ourselves frustrated and bitter. But is it only because of our situations? They are admittedly daunting. But is our unhappiness merely the result of the things imposed on us? Or could it be more complex than that? Lately, I have come to wonder if our thoughts are perhaps worse enemies than even lawsuits, regulations, or satisfaction scores. Read more »
*This blog post was originally published at edwinleap.com*
March 6th, 2011 by Glenn Laffel, M.D., Ph.D. in Opinion, Research
Tags: Alcohol Abuse, Alcohol-Impaired Driving, Blood Alcohol Level, Dr. Glenn Laffel, Drunk Sports Fans, LA Times, Legal Alcohol Limit While Driving, Legally Drunk, Pizaazz, Sporting Events and Alcohol Consumption, Sports and Your Health, Too Much Alcohol
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Among fans who attend live sporting events, drinking alcohol is nearly as commonplace as root-root-rooting for the home team. And while virtually no one has a problem with a fan who pushes back a beer or two during the game, flat-out drunk fans can ruin the experience for those sitting nearby. Worse yet, these people frequently get behind the wheel of a car after the game is over.
Recently, Darin Erickson and colleagues at the University of Minnesota decided to find out just how many fans go overboard at games, and their findings are worrisome, indeed. Using standard blood alcohol testing on 362 adult volunteers who were leaving 13 professional baseball and three professional football games, the scientists found that 40 percent had measurable levels of alcohol in their blood and a stunning eight percent were legally drunk (as defined by a blood alcohol level of .08 or greater). The highest alcohol level recorded by the scientists was .22.
Erickson’s group also observed that Monday Night Football attendees were more likely than other fans to have been drinking. In addition, fans who were 35 years old or younger were eight times more likely to leave the game drunk, and those who attended tailgating parties before the game were 14 times more likely to leave the game drunk.
The latter finding is consistent with a study from the University of Toledo, in which scientists gave breathalyzer tests to tailgaters at a college football game. The scientists found that an astounding 90 percent of the participants consumed alcohol during tailgate festivities, and among them, the average blood alcohol concentration was 0.06, well on the way to being legally drunk.
Maybe these people should save the money they spent on tickets and go to a bar. Erickson’s study was published in Alcoholism: Clinical & Experimental Research.
*This blog post was originally published at Pizaazz*
March 5th, 2011 by GruntDoc in Health Policy, Opinion
Tags: Cignet, Dr. Allen Roberts, First Monetary HIPAA Fine, GruntDoc, Health Insurance Portability and Accountability Act, Healthcare Policy, HHS, HIPAA Non-Compliance, HIPAA Privacy Rule, HIPAA Violation, Maryland, U.S. Department of Health and Human Services
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Via the Threatpost article “HIPAA Bares Its Teeth: $4.3m Fine For Privacy Violation“:
The health care industry’s toothless tiger finally bared its teeth, as the U.S. Department of Health and Human Services (HHS) issued a $4.3 m fine to a Maryland health care provider for violations of the HIPAA Privacy Rule. The action is the first monetary fine issued since the Act was passed in 1996.
…
A copy of a penalty notice against Cignet depicts a two-year effort in which HHS struggled with what appears to be a dysfunctional Maryland provider unaware of the potential impact of HIPAA non-compliance, and unwilling or unable to cooperate with HHS in any way.
When first reading the title I was willing to rail against HIPAA, as I’m tired of it. Then I read the post. Wow. It’s like a test case designed to see just how far you could push HHS, and frankly how incompetent you can be while pushing. Seems HHS was having trouble getting Cignet’s attention. I bet they have it now.
*This blog post was originally published at GruntDoc*
March 5th, 2011 by John Mandrola, M.D. in Opinion, Research
Tags: AF, Atrial Fibrillation, C-Reactive Protein, Cardiology, CRP, Dr. John Mandrola, Heart Disease, Heart Health, Heart Rate Turbulence, Heart Rhythm, HRT, Inflammation and the Heart, Journal of Cardiovascular Electrophysiology, Predicting Heart Attacks, Predictions In Medicine, Premature Heartbeat, Premature Ventricular Contraction, Preventive Health, Preventive Medicine, PVC, St. Louis, Washington University School of Medicine
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It’s hard to believe that turbulence could be a good thing for the heart. Consider how the word turbulent is defined: “Characterized by conflict, disorder, or confusion; not controlled or calm.” Those traits don’t sound very heart-healthy. But when it comes to heart rhythm, it turns out that a turbulent response — to a premature beat — is better than a blunted one. The more turbulent the better.
No, you haven’t missed anything, and turbulence isn’t another of my typos. Until [recently], heart rate turbulence was an obscure phenomenon buried in the bowels of heart rhythm journals.
What Is Heart Rate Turbulence (HRT)?
When you listen to the heart of a young physically-fit patient, you are struck not just by the slowness of the heartbeat, but also by the variability of the rhythm. It isn’t perfectly regular, nor is it chaotic like atrial fibrillation (AF). Doctors describe this — in typical medical speak — as regularly irregular: The heart rate increases as the patient inhales and slows as he or she exhales. This variability occurs as a result of the heart’s responsiveness to its environment. The more robustly and quickly the heart responds, the healthier it is.
HRT seeks to measure how quickly and vigorously the heart rate reacts in response to a single premature beat from the ventricle — a premature ventricular contraction (PVC). Normally after a PVC, the heart rate speeds for a few beats, and then slows back to baseline over the next 10 beats. The healthy heart responds with a more intense rise in heart rate and a quicker return to baseline. Using simple measurements of heart rate from a standard 24-hour electrocardiogram (ECG) monitor, a propriety software program averages many of these responses and comes up with a measurement of turbulence onset and turbulence slope. Read more »
*This blog post was originally published at Dr John M*
March 4th, 2011 by Bryan Vartabedian, M.D. in Opinion, True Stories
Tags: 33 Charts, Charlene Li, Doctor Patient Relationship, Doctors and Social Media, Doctors on the Internet, Dr. Bryan Vartabedian, Facebook, General Medicine, Healthcare Professionals Online, Healthcare Social Media, Medicine and Social Media, Online Physician Conduct, Professional Behavior On The Internet, Professionalism In Healthcare, Social Health Media, Twitter
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This week a reporter cornered me on the issue of professional behavior in the social space. How is it defined? I didn’t have an answer. But it’s something that I think about.
Perhaps there isn’t much to think about. As a “representative” of my hospital and a physician to the children in my community, how I behave in public isn’t any different than a decade ago. Social media is just another public space. Sometimes it’s easy to forget that we’re in public. When I’m wrapped up in a Twitter thread it’s easy to forget that the world is watching. But the solution is simple: Always remember that the world is watching.
On Twitter I think and behave as I do in public: Very much myself but considerate of those around me. I always think about how I might be perceived.
Here’s a better question, online or off: What is professional behavior? I have a pediatrician friend who, along with the rest of his staff, wears polo shirts and khaki shorts in the summer. The kids love it. One of my buttoned-down colleagues suggested that this type of dress is “unprofessional.” Or take a handful of physicians and ask them to review a year of my blog posts and my Twitter feed. I can assure you that some will identify elements that they find “unprofessional.” I believe I keep things above board.
This is all so subjective.
The reporter was also interested in how I separate my professional and personal identities in the online space. I’m not sure the two can be properly divided. The line is increasingly smudged. I try to keep Facebook as something of a personal space. I think it was Charlene Li who suggested that she only “friends” people she knows well enough to have over for dinner. That’s evolving as my rule as well. But independent of how I define “well enough,” Facebook is still a public space. My comments and photos can be copied to just about anywhere.
Social media has not forced the need for new standards of physician conduct. We just need to be smarter than we were before. Everyone’s watching.
*This blog post was originally published at 33 Charts*
