Can any of you ER docs out there explain this ad?

Who are they marketing to? I mean I know Drackman is going to buy a sono-site machine because of the hot blond and will make a joke involving the word 'probe', but serisouly. WTF? This is the worst commercial I think I have ever seen. Better than an MRI? For what?

"So when's the MRI"

"Don't need one... she's got something better."

"Why yes she does, and if I could just get her to drop that shitty machine I'd be all up in it too."

And later...

"See anything doc?"

"Yes, it's like a penis, only smaller."

And don't expect the snappy Frank comment tonight... probably stuck in traffic coming out of Athens. Man, that's going to be a crappy drive for Frank.

JCAHO the Pusher

Yeah JCAHO, that's you he's singing about. Dumbass bunch of paper pushing clowns. Here is a JAMA bit that is so vague I can't tell if it is tongue in cheek or not, but let's see if we can draw any conclusions from the JCAHO mandate to 'adequately treat pain'.

What has been the impact of this policy from the very awesomely smart, still clinically practicing, doctor-geniuses at the JC (which has been de rigeur for over a decade now)?

Well, there's the idea that by asking someone if they are in pain and by putting their answer on a graph that we have done science and/ or medicine. This idea has been soundly debunked, but it does not keep ER doctors from getting called on the carpet by dirtball narcotic seekers who don't get their oxys when they hit their third ER of the day. I should know, I've been called on the very carpet I speak of, and a collegue lost his job because of too many of these complaints. So go have carnal knowledge of yourself, JCAHO.

Besides that, well, there's this, and this, and this  I'm no detective, but I think, in that last link, that what they are discussing is illegal, and I can't believe there would be many who would do that, can you?

And I understand correlation does not prove causation, but I do know that if I tell a patient, 'no, I am not refilling or supplying you with narcotics', that, depending on how "JCAHO" the administration is, that my job is at risk.

So, once again, screw off JCAHO, you are pushers and hacks and you have blood all over your hands. You should consult your handy 'guidelines for blood-spills' laminated card. It will probably keep you out of hell. I mean, I would like to see you present it in an effort to stay out of hell.... would pay a lot of money to see that.

War News off the Template

So taking care of active military continues to reward in so many ways. Most don't want to be sick.... Almost no one demands a refill of oxycontin or percocet, and many thank me. Some bring me presents... a unit T shirt.... a campaign coin. It has been SO worth the cut in pay and increase in hours over the freak show of the ER. I'm not going back.

Many of these fine young men and women are wearing black steel bracelets in remembrance of fallen comrades though the Marines, if you can believe it, are not allowed to wear them anymore. Marines? WTF?

So there is a growing field across the services, the field of the surveillance aircraft operator (UAV or now the "UAS".... unmanned aerial system), and these men and women have stories. Try this one for example.

A young woman was flying her remotely piloted aircraft over a town over in the war zone and saw a crowd of people running. This usually means, she explained, a group of insurgents massing for an attack, but she noticed no weapons on these people so she panned-back and out and saw that they were RUNNING FROM insurgents who were, she could plainly see, going door-to-door and executing people unlucky enough to have remained in their homes.

The murderers were run down to a man as it's hard to hide from an invisible camera in the sky directing aircraft and infantry right to where your sorry ass is running, but this is only part of the story.

The town in question was then garrisoned by infantry who occupied one of the homes where a family had been murdered.

A few days later a Vehicle Borne IED drove up to this house and killed most of the American infantry. They ID'ed the driver, and this particular UAV operator was amazed over the next few days to see an endless parade of townsfolk to the home of the 'martyred' bomber bringing flowers, gifts, and food. It, evidently, was quite a
wonderful event in this little town.

And this is the war the left wants. The one we SHOULD have been fighting from the beginning. You know, the one where our troops are at a disadvantage due to terrain, caves, towering mountains and such.

How WESTERN to want to WIN a war. How "Bush-y" to force them to fight in the open with little cover in Iraq.

Afghanistan... Not on my "must see" list, and, evidently, a place where life will remain cheap and squalid. It's Bush's fault.

Happy Halloween (scary rogue cop post)

A modern classic. What's scarier than a rogue cop? DFAS? Maybe.

D.F.A.S. and the Nine Cirlces of Hell

A tribute to DFAS. One of the most efficient and excellent government agencies to ever come down the pike. Some say they have passed even the DMV in their excellence.

This is a love letter to you DFAS. I love the process. I love how you have managed to have computers make decisions for you! Skynet is definitely aware (to hear you tell it). Wow, I didn't know we could do that yet!

And I love it, absolutely LOVE IT that the pay mistake was my fault. I can't figure it out yet, but I'm working on it... I don't pretend to operate on your level of superhuman logic.... but one must try. Hell, I can't do Calculus, but at one point I could do a little of it....

I am also pleased that you have decided to dock my pay in accordance with the money I stole from the government. Every paycheck a different number. What are you trying to tell me? I can't figure it out, but when I do I expect a moment of clarity, an epiphany even, that will, no doubt, change my life.

As a result of this process which is, evidently, still ongoing, and has taken ten months to this point, I have become a more dedicated worker for you. I am going to start paying lots more attention to process and to systems for they never fail. And human reason, well, we all know what happens when that is let out of it's cage. My charts are going to reflect my newfound love of process... just you watch DFAS!! I SWEAR!

And, since this wonderful learning opportunity started for me, I have become much more interested in organizational charts, and, I do believe, I have found the master chart created by Dear Leader which shows exactly you fit into the wonderfully wonderfully wonderful government. I would come personally to your underground bunker (wherever it is) and hug you all for this lesson that I have received. It is definitely worth every bit of the fifteen thousand dollars. How could I put a price on the kind of wisdom YOU have granted me??

So I must ask you D.F.A.S., did I pull the correct organizational chart? The one under my signature? I think I see you guys squarely in circle eight. Keep up with what you are doing and I have no doubt you can move down quickly.

Forever loyal, forever yours, forever grateful. And if you are looking for new employees might I suggest looking up a certain 'CannedAm', she, no offense intended, could run your entire agency right now.

Your Humble Servant,
Drone

The Tyranny of Residency

Great choice nurses... Great choice PAs. Honestly. If you guys want to explore new areas of medicine you can. Tired of working in the ER? Go to the OR. Tired of the OR, go to derm, or psyche. Nice options.

But what for us? What if you do your ER residency and practice for twelve years and then can't stand the sight of it anymore? What if you, in that time, have become a pretty damn good primary care physician? Well, you won't have to do a whole residency and fellowship to get boarded in Family Practice will you? I mean if you want to change you don't have to go back to square one do you? Three years of training? Credit for time served right?

No, nor can you, if you are a Family Practice doc, with lots of small town ER experience or big town ER experience, can you get credit for time served.

We are so jealously guarding our fences that we haven't seen that our house is on fire. It's a huge freaking fire too.

Confederacy of Losers

This isn't medical but had to post about it. As a physician and small business owner that EMPLOYS many people, I had to post about these"Occupy Wall Street" losers getting so much attention. That is because they almost made me late for Carrot Top in Las Vegas, what with their marching up and down Las Vegas boulevard. What a hodgepodge of jerk offs, slackers, weirdos, and losers. Got to admit though, it was entertaining. Almost like a pre-show show. Signs advocating economic justice?, education reform, repealing the patriot act, District of Columbia home rule, end of the two party system, make love not war.

"It's all related," said Dennis Dodson, an artist from Aspen, CO. "Everyone has one voice". One sign said " Tax the rich until they are poor-let them see what it's like". Let's just take that asinine statement to its conclusion. 308 million dread-locked fruitcakes foraging for food since no one works and no one is hiring.

This gem from USA Today- Debra Sweet, 60, a VETERAN PROTESTER (what is this?) who traveled from New York to push Obama to fulfill his campaign promise to end the Afghanistan War, acknowledged that the protests lack specific focus, but called it an " incredible phenomenon" that people across the nation are embracing the movement.

Translation- We really don't know what we are protesting, but we don't have anything better to do, and I remember tripping out on acid at the 1968 Democratic convention-boy what a time we had. Thought I'd come down and yell for a while.

Go home guys. Most of you are lazy, or live in your mom's basement. Money for nuthin' and your chicks for free. Your liberal arts women's studies or sociology degree can at least get you a fast food job. Contribute. Work your way to the top, then you can look back and make fun of yourself and your stupid protest friends when you were younger. Just don't hold up traffic and make me late for dinner and a show. Carrot Top doesn't like you being late.

"Buck" and Modern Medicine

Buck Branaman  is a genius. And the movie "Buck" is worth watching over and over. It's a movie in which you will meet a man like many who chose medicine WANTED to become. Mr. Branaman is one of the worldwide experts in horse-training and he's much more than that, he's probably the best human psychologist I've seen in a long time.

Now the thought struck me while watching one particular part of the film that Mr. Branaman would have quit his profession long ago were it not for the fact that people who seek his services do not compose a huge voting block and, as far as I can tell, pay him for what he does. Some actually save money for years to go to his clinics. Wow.

I can picture the moment when the government decides that all horses have a right to Buck Branaman's time and expertise, pass laws about how he may go about delivering his service,s and how he may be reimbursed. It's going to be the same day that he retires. I mean the way he treats the owner of the renegade Stud-Colt at toward the end of the film is not only a HIPAA violation, it is very POOR customer service, will generate a complaint, and the poor woman's money will have to be refunded.

EXCEPT... EXCEPT!!! The woman herself was grateful for the upbraiding she received and said, after, and through some tears, "He's right.... he's right.... I do have problems I need to fix and the horse is only one of them."

So I'm picturing myself saying something similar in the ER, "No sir, I am not refilling your pain medicines, you have problems which you are covering up by taking them and you are lying to me in order to try to get them from me, now, I can either call the cops on you right now, or I can help you find the help you need, but I am NOT refilling your narcotics."

For me, another job lost. But, thankfully, not for Buck Branaman.... not yet at least. Sometime after EHTALA is passed by congress.

I am Shocked... Shocked to Find Gambling in this Establishment.

I have a fabulous idea. Let's let the government take over ALL of health care and let's take decision-making in medicine away from individuals and give it to people following protocols designed by committees. That should do really well.

Haji Beware (my favorite tattoo ever)

My DiCaprio Turn

"Catch me if You Can", right, the one with DiCarprio passing bad checks and faking being a pilot, doctor etc??

So it has been long enough since the actual incident to tell this story now, but being a doctor with a lot of in hospital experience DOES occasionally have it's unexpected benefits.

A patient of mine came in one day with pain.... Doesn't matter where.... suffice it to say that it concerned me very much because there was no injury and the pain was in a vascular distribution and I was very concerned about an aneurysm; but no one else was.... not a soul at the Military Treatment Facility could be bothered to see him in clinic and the ER, well, let's just not talk about them.

Fast forward one month. My patient, after some skillful maneuvering by moi, was transferred, based on MRI findings (which took three weeks to get), to one of the 'mini-meccas' down the road. It was a Friday. There was some concern that he needed an immediate neurosurgical procedure, but the neurosurgeon at the mini-mecca ran crying from the room after examining the patient (and the MRI and CT). And it was Friday, and Dr. Burned Hospitalist was in charge.

Scared neurosurgeon had requested transfer of the patient to the large mecca a mile and a half away... the one with residency programs in everything from pet psychiatry to psychic-gamma-knife-surgery. I call Burned Hospitalist on Saturday and explain that I am his patient's primary care physician and he tells me he is going to discharge him to follow up at the Mecca NS clinic on Monday because he 'can't transfer him on a weekend'. Fucking liar.

Well, he thought he had a weak sister on the phone but I asked Burned Hospitalist if my patient was,

1. Controlled on his pain medicine?
2. Set up with follow up with a particular physician?
3. Off all IV meds?

And the stuttering and stammering followed at which point he said he would just keep him there over the weekend until he could arrange a transfer on Monday (i.e. get someone else to do it).

Well, I don't live too far from the mini-mecca and I was in the area that night in pursuit of pleasure in the form of skillfully played live music, and after that bit of enjoyment I decided to drop by and see my patient. It was ten thirty in the PM.

The place was locked-down, but I called up to the floor and spoke with my patient's nurse and asked if they could bend the rules for me and she practically had me teleported up.

She was VERY happy to see me. "We have to get him transferred," she said, "He needs to be at the Mecca...." I agreed.

"Do you mind if I use your phone and do you mind if I, as his primary care physician (and with his consent and all) look at his chart?"

This I was allowed to do. And then I did this, I went to see my patient, I told him he was going to be transferred and I told him that when it happened he was not to answer too many questions. I extracted the same promise from the nursing staff. And I picked up the phone...

"Transfer center? Yes, hello, this is 911doc here and I am calling you from the mini-mecca... I have a patient that we would like to transfer to your Neurosurgical service.... No, tomorrow is fine... I just need to set it up.... yes, i will hold.... Oh hello Dr Superman, 911doc here.... yes.... yes... tomorrow is fine.... can I put you down as accepting? Thank you sir."

And it only took one more phone call the next day for me to affect the transfer of the patient on the weekend. Burned Hospitalist signed the papers and was none the smarter, but I'm still pissed he got paid for my skillful impersonation, but if you really think about it I didn't lie, I just Bill-Clinton'ed it... It's all in the parsing.

And by the way, the nurses high-fived me on the way out as they were not fond of Burned Hospitalist and could never get him to do jack shit. Imagine that...