EM Physicians Dominate Romance Novels

From Yahoo News

If romantic fiction is any guide, any doctor looking for love would be advised to be an emergency room surgeon or deliver babies rather than practise colon resection or remove in-grown toenails.

Hospital novels are one of the fastest-growing areas of romantic fiction which, according to the Romance Writers of America, generates 1.2 billion dollars in annual sales and accounts for 39.3 percent of all fiction sold in the United States.

In an offbeat letter published in Saturday’s Lancet, Kelly describes the typical plot structure and characterisation in 20 randomly-selected medical romance novels.

Of the male protagonists, six worked in emergency medicine, five in surgery and three in obstetrics, neonatology and paediatrics, he found.

“There was a marked preponderance of brilliant, tall, muscular, male doctors with chiselled features, working in emergency medicine,” says Kelly, a University College Dublin psychiatrist.

Pain Scale Absurdity

From Scalpel or Sword:

Two patients came into the ER by ambulance complaining of pain.

One was a young woman with another migraine, who “usually gets” Dilaudid 4-6 mg IV in addition to IV Reglan and Ativan. She was allergic to many other medications, but she had a full bottle of dilaudid 8 mg pills and some Actiq lollipops in her purse from two different pain specialists. Her usual medications also included Ambien 20 mg at bedtime and Xanax 2 mg every 6 hours. Although she complained of vomiting constantly for 3 days, her vital signs, physical exam, bloodwork, urinalysis, and imaging tests were all negative, and she never vomited in the ER. She spoke calmly and was in no apparent distress.

The other patient was an elderly lady who had fallen at home, fracturing her hip. She was taking a blood thinner, so her grotesquely angulated and deformed thigh was also markedly swollen. The fact that she had crawled down the stairs after her injury in order to call the ambulance probably contributed to the swelling and deformity somewhat. She trembled a bit as she asked for something to relieve her pain.

Guess whose pain was a 5/10 and whose was a 10/10?

Visble Body Website


The Argosy Visible Body, which promises to be a free virtual anatomy website, is looking like a rather impressive product already. Videos of the development, provided by the company, show a simple interface and an easy method to get to individual anatomic parts of the body. Here are the features the website will provide:

Search for and locate anatomical structures by name.
Hide, rotate, see through, and explore parts of human anatomy.
Move the model in three-dimensional space.
Zoom in and out.
Click on systems or structures to make them transparent or hide them.
Click on anatomical structures to reveal names.

In beta / demo now, “Coming in mid-November”

"25 Skills Every Doctor Should Possess"

From the Cheerful Oncologist, excerpted below:

Skills all doctors should possess:

1. Recognize when a patient needs to be transferred to the ICU.

2. Deliver bad news compassionately, yet honestly.

3. Identify a pneumothorax on a chest radiograph.

4. Diagnose iron deficiency anemia.

5. Help a patient stop smoking cigarettes.

6. Diagnose thrombotic thrombocytopenic purpura, which has a mortality rate of 90% if not treated and 10-20% if treated.

ACEP on CA-MRSA

From the American College of Emergency Physicians

Washington, D.C. — The spread of a potentially life-threatening antibiotic-resistant staph germ that is responsible for more deaths in the United States each year than the AIDS virus has prompted the American College of Emergency Physicians (ACEP) to launch an education initiative aimed at protecting the public against the further spread of infection.

“This emerging ‘super bug,’ as it’s known, is causing ACEP to mobilize for two reasons,” said Linda Lawrence, MD, FACEP, president of the American College of Emergency Physicians (ACEP). “First, we are concerned about the possible spread of this potentially dangerous bacterium – especially in schools, nursing homes and health-care settings – so we are asking people to practice good hygiene, such as frequent hand-washing, to help prevent public outbreaks. Second, ACEP is cautioning against the continued widespread overuse of antibiotics, a practice that has in part caused drug-resistant germ strains like this one to emerge.”

At the same time, emergency physicians across the country are on the lookout for cases of antibiotic-resistant infections so these patients can be isolated and treated with the few types of antibiotics that remain effective, before developing potentially life-threatening complications or spreading their infection to others.

Air Medical Controversy in Texas

From JEMS

EMS Units Bypassed Nearest Helicopters: Physician Says Ties to a Firm Don’t Influence Agencies’ Decisions

What happened to Bridges that night was part of a pattern repeated more than two dozen times in the last two years in the area: EMS crews did not call the closest helicopter ambulance service.

In each incident, the EMS unit on the ground and PHI shared the same medical director, Roy Yamada.

Yamada, a Fort Worth physician, works as director of emergency medicine for Midlothian and in a similar role for nine other area EMS departments, most in Tarrant County. He is also PHI’s North Texas medical director, a position for which he has apparently been paid almost $200,000 in 2 1/2 years.

Such ties are becoming increasingly common in the competitive air ambulance industry, in which people who oversee local EMS agencies also work for air medical providers.

But these alliances, critics say, can lead to delays in hospital care for critically injured patients as well as unnecessary helicopter flights that can cost patients as much as $10,000 when ground transport would be sufficient.

Defensive Medicine (ED Example) on CBS

From CBS.com

CBS) It started as a simple stomach ache, but Alexandra Varipapa, a sophomore at the University of Richmond, decided to go to the emergency room.

There, doctors ordered a full CT scan, a radiation imaging test, which found a harmless ovarian cyst. She never questioned the CT scan, CBS News correspondent Wyatt Andrews reports.

But her father did – when he got the $8,500 bill, $6,500 of which was that CT scan.

“I was pretty flabbergasted,” said Robert Varipapa, himself a physician.

Varipapa says his daughter’s pain could have been diagnosed far more easily and cheaply with a $1,400 ultrasound.

“A history, a pelvic examination and probably an ultrasound,” he said. And he would have started with the ultrasound.

But the hospital defends the CT scan, saying an ultrasound might have missed something more serious.

CMS Sets Requirement for Hospitals Without 24/7 Physician Coverage

From the Iowa Hospital Association

IHA has received several questions from hospitals regarding a new Centers for Medicare & Medicaid Services (CMS) requirement aimed at patient safety and emergency services. The requirement, effective October 1, mandates that all hospitals, including inpatient acute (whether Prospective Payment System or exempt), Critical Access Hospitals, long-term care, psychiatric, rehabilitation, children’s and cancer hospitals, that do not have physicians available on the premises 24 hours per day, seven days per week (24/7) inform patients of that limitation prior to patients receiving an inpatient or outpatient service.

CMS does not plan to prescribe specific language for the notice, but its discussion of the requirement indicates the notice must specifically state the hospital does not have physicians on the premises 24/7. The notice also must describe how the hospital will meet any emergency service needs when a doctor is not on the premises. The disclosure would be required at the point of registration or preadmission testing.

CMS does not intend to provide standard language for the new disclosure notice, but the notice still requires federal Office of Management and Budget (OMB) review and clearance under the Paperwork Reduction Act. Hospitals subject to the requirement (those that do not have 24/7 physician coverage on site) will need to create a disclosure notice and a plan for distributing the notice at all inpatient admissions and outpatient encounters.

Available information suggests hospitals simply need to provide the notice to each patient, without obtaining patient signatures documenting individual receipt. Hospital policies and procedures must be documented. However, the American Hospital Association cautions against finalizing the notice and procedures until CMS receives OMB clearance and issues provider manual instructions.

CMS has already completed the first part of the clearance process by soliciting public comment on the proposed disclosure requirement. CMS has yet to publish another notice with a 30- day comment period directly to OMB. It is expected that instructions will not be circulated to hospitals until the instructions receive OMB clearance, which is still pending.

California ED data

This week’s San Diego Union Tribune features a story of one doctor’s attempt to encourage hospitals to come clean with ED wait-time figures as a step toward improving traffic flow. Dr. Roneet Lev, an emergency physician at Scripps Mercy in Hillcrest, leads the Emergency Medicine Oversight Commission of the San Diego County Medical Society. She recently persuaded 19 hospitals to share emergency room procedures and statistics.

Also in California, the site of the Office of Statewide Health Planning and Development posts numbers from hospitals on the annual number of patients who enter the ED without being seen. It also asks facilities to disclose the number of hours per month they were on diversion. All you have to do is type in the city or name of the hospital you’re researching. 

Firefighters, police push for city’s help treating drug-resistant infection.

From the Fresno Bee

The Fresno City Council agreed Tuesday that a drug-resistant staph infection afflicting some city firefighters should be considered a work-related injury for firefighters and police officers.

Some firefighters are upset they’re forced to pay health insurance co-payments and use their sick time to recover from the infections they believe they contracted at work.

If treated as work-related illness, the city’s workers’ compensation insurance would cover those bills and pay the firefighters for lost work time.

The council voted 6-1 to direct city staff to write a policy making all cases of methicillin-resistant Staphylococcus aureaus a work-related illness for firefighters and police officers. The council must approve the policy in a separate vote.