WhiteCoat

Healthcare Update Satellite — 03-04-2015

March 4th, 2015

Homeless North Carolina VA patient comes into the ED to be evaluated for the sores on his feet. His shoes are falling apart. Nurse Chuck Maulden bandages up the patient’s feet and then gives the patient the brand new Nike sneakers off of his own feet. Chuck then works the rest of his shift in a pair of shoe covers and doesn’t say anything about it. Only way that people found out was because the patient’s family called to say thank you. We need more people like Chuck.

I’m not aware of too many uses for virtual reality in medicine, but this seems to be a good one: seeing what it’s like to suffer from schizophrenia. Imagine being cooped up in an elevator with strangers staring at you and voices telling you “you will fail”. The author of the article wore the VR headset only briefly, but noted that after he removed the headset, “the feeling of discomfort lingered.”

Long Island woman fights to keep database about NY physicians online. It is scheduled to go offline due to lack of funding. “Choosing someone because they were nice just didn’t work anymore.” Just think, you can always rely upon the accurate and reliable data from Press Ganey and Healthgrades.com. /sarcasm.

Long Island town demanding that nearby hospital construct an emergency department in its town. Hurricane Sandy destroyed the prior hospital in 2012. Commenter to the article notes “Everyone wants the luxury and availability of a hospital but fails to support it financially. Don’t be like Long Beach or your hospital will also be Long Gone.”
Spot on, ma’am. Spot on.

I suppose this explains why I never see any parents of newborn children coming to the emergency department with strokes. Sleeping more than 8 hours per night associated with almost a 50% increase in stroke risk.

Woman complains to TV station because Florida’s Gulf Coast Medical Center emergency department is close to maximum capacity, and her 87 year old father had to sleep in the hallway. News flash, lady: Emergency departments are crowded all over the country. However, Florida doesn’t have enough doctors because of the miserable environment Florida has created for its medical providers. Remember the amendment to Florida’s Constitution revoking the licenses of doctors who had three malpractice cases against them? You reap what you sow.

California hospital’s emergency department volume up 7% after Obamacare implementation. Our hospital’s ED volume is up 15%. According the article, Obamacare advocates say that ED numbers would decrease once people received insurance. Now they’re walking it back, citing studies that the decrease in emergency department use only begins to show up at 1 year after insurance enrollment. They’ll be sure to measure and report on the new numbers … just after the next election.

Patients gone wild. Louisiana’s own Patricia Munzey arrested and charged with assault and battery of emergency personnel after she threatened to “slap and kill” ED staff and then kicked a nurse in the face when she was trying to bandage the patient’s injury.

More patients gone wild. Pennsylvania patient William Whitmoyer gets brought to emergency department and threatens to come back to hospital with gun and “make hamburger meat” out of everyone in Geisinger Medical Center. Upset over administrator making $5.6 million. Because the threat of violence caused alarm and was an inconvenience to staff, he was arrested and charged with disorderly conduct and with making terroristic threats.

Quite an interesting idea circulating on Reddit: People waiting in the emergency department for a someone else to be treated should be encouraged to donate blood.

Interesting infographic on the shelf life of multiple foods. According to the comments, though, it seems to create more questions than it answers. Some people are claiming that eggs can be left out on a shelf for a year without spoiling if they aren’t washed. Not sure I’d be the first to try a year old omelette.

Healthcare Update Satellite — 02-10-2015

February 10th, 2015

Home remedy for lice kills a 1 year old child. Headline is a little misleading, though. Family members put mayonnaise all over the child’s scalp to suffocate the lice. No the child didn’t die from mayonnaise poisoning. The child died because the family members put a plastic bag over the child’s head and the bag slipped down over her face and suffocated her. Sad story.
The article links to another story about how 84% of lice in the US have a gene mutation making them resistant to OTC medications such as permethrin. I didn’t know that little factoid.

Another new one on me … Tightie Whities could be lowering your sperm count. The article links to this study on French men whose sperm was found to be of worse quality and whose sperm counts decreased significantly after wearing tight underwear for 15 hours a day. I thought it was just because they were French. OK OK I’m kidding. Also, riding a bike for 12-16 hours a week and growing older than 40 also cause deterioration in sperm and lower sperm counts according other studies cited in the article.

Need an investment? Buy as many Nicorette lozenges as you can find. Glaxo has apparently stopped producing the lozenges due to “quality control issues” and now buyers can’t find them anywhere. They’re currently selling for three or more times their retail price online. Even if the Nicorette gum tastes terrible, just chew a piece of gum and mix it with a piece of different gum.

This explains a lot. Al Qaeda Claims Responsibility For Patient Satisfaction Surveys.

“The doctors and nurses had no backbone to stand up to our sham company, the government and insurance companies forced our meaningless data down their throats, and the patients became captains of the ship. It became, quite literally, inmates running an asylum. Patients got more tests, more cancers, more drugs, more prescriptions, more addictions, and higher mortality. Here is the best part – the US Government, American taxpayers, and insurance companies are funding it all!”

Woman treated with fecal transplant for persistent clostridium difficile infection. Prior to the transplant, she weighed 136 pounds. Sixteen months later, the patient had gained 35 pounds and was unable to lose the weight even with a supervised protein diet and exercise regimen. The fecal donor, the patient’s daughter, was “healthy but obese.” Another instance raising the question whether the food that we eat makes us gain weight or whether the bacteria in our systems are primarily responsible for weight gain. Or perhaps the food that we eat alters the bacterial flora in the intestinal microbiome and affects our weight.

$17.5 million settlement after Kentucky’s TJ Samson Community Hospital ordered to pay $18.27 million in a jury verdict for a child who suffered brain injury at birth. Obstetrician who delivered baby was cleared of liability.

Regulating ourselves to better health care. National Practitioner Data Bank now requires state health profession regulatory boards to swear that they have submitted all reportable actions in a timely manner and expands audits of board actions to make sure that no physicians slip through the cracks.

Michigan man arrested for dialing 911 more than 100 times in one month. Initially says nothing and hangs up. Then when deputies stopped responding to the location, he began pretending that he had labored breathing. Finally made a call stating that he was hurt and needed help. When police triangulated the cell phone signal and knocked on doors throughout the trailer park, they found the suspect with 6 or 7 cell phones and a police scanner. He admitted to making the calls out of “drunken boredom” and was arrested.
Just think … if he just called 911 and went to the emergency department 100 times in a year, nothing would happen and he would get thousands of dollars in medical care.

England experiments with using private pharmacists providing medical treatment to patients with minor injuries and ailments. Emergency department patients are offered the option of waiting to see the physician or of seeing the pharmacist instead. So far, patients have given “extremely positive feedback” on the process.
Next up: Colonoscopies by college biology majors.
I’ve said before that I think we should deregulate the practice of medicine so that anyone can treat anyone for any medical ailment.

Amazing. And amazingly priced. Cell phone attachment allows patients to be screened for HIV and syphilis using a drop of blood. The devices cost $34 and are 96% accurate. Hat tip to Instapundit for the link

Should testosterone be as tightly regulated as it is? This article calls testosterone the “drug of the future” and compares its use to estrogen – which isn’t a controlled substance. One person interviewed for the article noted that “almost everything we treat in medicine is age-related. Aging is related to bad eyesight, bad hearing, bad joints, bad hearts, bad blood vessels, and cancer. We treat all of these without trying to minimize or diminish them that they are age related.” Why pick on testosterone use?

Damn. Boyfriend secretly records himself having sex with his 17 year old girlfriend. Video “somehow” gets uploaded to internet. Girlfriend finds out about it and becomes furious. She followed him into a bar, called him a “dog” in front of his friends, then dumped battery acid all over his lap. Boyfriends penis “will never work again” and he’ll have to urinate through a tube for the rest of his life.

Healthcare Update Satellite — 02-03-2015

February 3rd, 2015

Thanks for the patience in putting up with my lack of regular posting. Life has been challenging lately. Still working on it.

When government pays for your care, government may try to force its values on you. Learning-disabled mother of six children in England deemed at “grave” risk if she has any more children. Now the government wants to forcibly remove her from her home and sterilize her. A lawyer representing the woman stated that sterilization was “therapeutic.”

This process will come to medicine sooner than you think. Just watch. Uber drivers now get to rate their passengers after a ride. When passengers get lower scores, some drivers no longer want to deal with them and they have to wait longer for a ride. “1 star for passengers does not do them any harm. Sensible drivers won’t pick them up, but so what?” One expert interviewed for the article stated that “It’s inevitable that these review systems are coming. What I’m worried about is whether they’re accurate enough. Otherwise, we’re going to get a disinformation economy.” The disinformation economy is already happening with doctors via Press Ganey and its ilk. Wait until it happens with patients and they can’t find a physician willing to care for them. Then watch it happen to hospital administrators as the ratings follow them around after they destroy the morale at one hospital and try to bring their destructive ways to another facility.

What’s the sex position most likely to cause a man to have a penile fracture? Cowgirl, baby. Cowgirls are twice as likely to cause penis fractures than the boring missionary position.

Think you’re doing yourself a favor by purchasing those herbal supplements at health food stores? About 80% of the time you’ll be wrong. When the NY Attorney General investigated supplements such as ginkgo biloba from retailers GNC, Target, Walgreens, and Wal-Mart, only 5 of 24 contained the actual ingredients by DNA testing. The others contained either unrecognizable DNA or DNA from a different plant. Even more worrisome was that 5 of 24 impostors contained either wheat or beans, putting people with allergies to those products at risk.

Because we don’t have enough clipboards walking around hospital hallways … Studer Group being acquired by Huron Consulting Group in $325 million deal to create a consulting operation with more than 1500 employees.

Fascinating article on a topic that isn’t really discussed. What should people do when they hear voices? Some experts recommend talking back to them. Reading the stories about people suffering from this problem really opened my eyes. It’s one thing to have a patient tell you they’re hearing voices. It’s another thing to read about patients who go into detail about what the voices are saying and how the voices affect every aspect of their lives.

Woman develops toxic shock syndrome, develops liver and kidney failure, falls into a coma and deteriorates to point that family planned to meet with doctors to take her off of ventilator. Four hours before the family had their meeting, the patient woke up. Kidney and liver function improved. Now she’s eating and undergoing rehab. I’m happy for the patient and her family, but I’m worried about the precedent that the story sets. Will families of all terminally ill patients in comas now expect the same to happen to their family members?

Back in December, Dr. Wes Fisher did an investigation into the ABIM Foundation, Choosing Wisely, and the ABIM Foundation’s $2.3 million condiminium with regard to Maintenance of Certification requriements. He ripped the ABIM Foundation for waste, hypocrisy, and corruption.
Today, the ABIM Foundation admits “we got it wrong” and announced fundamental changes to its MOC Program.
The power of the well-written word should never be underestimated.
Great job, Wes!

Swarms of nanobots being used in clinical trials to target 12 types of cancer cells and to repair spinal cords.
I used to laugh at people who worried about government controlling our thoughts by injecting nanobots into our systems. Now I’m stocking up on tin foil to make hats for all my family.

Latest proposed budget includes a $50 million cut to program to help vaccinate un-insured and underinsured patients. However, the budget increases funding by $128 million to provide vaccines free of charge to children under 19 years old.
Of course the free children’s vaccinations will come to a screeching halt when people finally listen to ophthalmologist and Senator Rand Paul who reportedly has personal knowledge of children getting “profound mental disorders” after receiving vaccines.

Great quote from Glenn Reynolds at Instapundit: “ObamaCare — the policy that’s so popular, it never takes effect until after the next election!

Healthcare Update Satellite — 01-19-2015

January 19th, 2015

Penicillin allergy? It’s associated with increased bad outcomes, but not for the reasons you think. The allergies themselves are mostly not allergies. And no, “my mother said I had a rash when I was a baby” isn’t an allergy. However, when compared with patients who don’t have penicillin “allergies”, patients with penicillin allergies have longer hospital stays and are between 14% and 30% more likely to get resistant infections while in the hospitals – possibly because the penicillin “allergic” patients are being treated with much stronger antibiotics that kill off the “good” bacteria in their systems.

Ever wonder why it seems that whenever you call a doctor for a medical problem they tell you to go to the emergency department? Here’s a good reason why: 26 week pregnant patient calls on-call obstetrician with severe abdominal pain and severe headache. On call physician attributes symptoms to a “gastric condition” and that she did not need to come to the hospital. The following day, the patient suffered a stroke. Patient and family sued and were awarded $10.9 million.

Georgia malpractice attorney Wilson Randolph Smith settles case on behalf of his clients, then forges client’s name on settlement check and keeps the money. Tells clients that the case would likely be set for trial later this year. Eventually gets caught and is now cooling his heels in the county jail.

Florida prosecuting pain clinic physician whose prescriptions were associated with three patient deaths. One patient was prescribed 3360 oxycodone pills in the year before his death.

I’m not a big fan of the AMA, but Steve Stack, an emergency physician and president-elect of the AMA is doing a good job at keeping medical issues in the media. I’ve seen multiple interviews pop up in my news feed quoting him on pertinent issues. The latest is about EMRs and “meaningful use.”

Patient writes local newspaper to thank caregivers in emergency department and hospital for providing great care to him. At first I thought this was a great thing and trust me when I say that his letter made an impact on the providers. Then I thought how sad it was that patient gestures like this are so uncommon given the 160+ million emergency department visits each year.

“Glassholes” go into mourning. Google pulling Glass version 2.0 from the market and this Forbes writer Steven Rosenbaum wonders whether Glass will be this decade’s Apple Newton. I sure hope so.

Sad story. Beautiful Ecuadorian beauty queen wins coupon for $1000 worth of liposuction as part of pageant prize. Initially refuses and tries to donate the prize to someone else, but finally talked into procedure after doctor “insists” she have the surgery. She then dies of cerebral edema during surgery. Under Ecuadorian law, doctors may be imprisoned for up to 3 years for medical malpractice.

What happens to patients when one emergency department stops taking ambulance runs? The patients don’t just disappear and the emergencies don’t just vanish. Ultimately they will seek care at other hospitals and ambulances will have to spend more time taking patients to facilities that are farther away. This is just what is occurring in California after Doctors Medical Center stopped taking ambulance runs. Ambulance runs and patient volumes at other facilities increased dramatically. Doctors Medical Center is trying to avoid closing, but is running “deficits because it serves mostly patients of MediCal and Medicare, which provide low reimbursement rates.” Now ambulances and surrounding hospitals will receive the trickle down effect of low reimbursements as the ripple effect spreads throughout the medical system.

Innovation pays off. When researchers were having difficulty culturing any new organisms in labs to try to create new antibiotics, they went au natural. Digging up dirt cultures from one researcher’s backyard, they were able to find 10,000 additional compounds to test against human pathogens. One bacteria from a grassy field in Maine was found to be more effective than vancomycin at killing MRSA and was able to do so at much lower concentrations. In addition, the bacteria so far haven’t developed a resistance to the medication. Just give it some time. Zithromax was a blockbuster antibiotic, too – until most docs started giving it out like M&Ms at a holiday party. Now bacterial resistance to Zithromax is so high in some areas that it is marginally better than a sugar pill.

Voodoo priests on the frontline of Haiti’s mental health care where there are currently about 10 psychiatrists for a population of 10 million. Yup. Pretty soon this will be about all that most patients will be able to get from their Aetna and United Health Care “Affordable Care Act” plans.

How Can You Be Sure?

January 12th, 2015

“How can you be sure?”

That question stopped our discussion for a second.

During some down time, several nurses and I were talking about childhood coughs. Her 6 month old child had just started daycare 2 weeks ago and has been coughing ever since. The child was put on amoxicillin and then Zithromax by her pediatrician but … [GASP] … her cough wasn’t getting any better. The nurse thought her child had pneumonia.
“What should she be taking now?”
I was in a particularly snarky mood, so, with a smirk, I said “probably vancomycin … maybe add gentamycin just for the gram negative coverage, too.”
“I’m being serious. She’s not getting better with antibiotics.”
“BINGO! That’s because she has a virus infection and antibiotics don’t kill viruses any more than RAID kills dandelions.”
“But a virus infection isn’t going to last for two weeks.”
“Neither is bacterial pneumonia. The fact that she isn’t getting better with antibiotics should tell you that she has a chest cold. It’s a virus.”
“How can you be sure?”

Ugh.

There’s just no good response to that question. The truth is that we can’t be “sure” that there isn’t a bacterial infection present. We can’t be “sure” she didn’t aspirate a foreign body. We can’t be “sure” that she doesn’t have tracheomalacia. There is just no way that we can ever give a Flo’s Progressive Insurance 100% guarantee that a given set of symptoms is being caused by a given disease process and nothing else. The problem is that often patients expect this kind of diagnostic accuracy and get upset when there’s a misdiagnosis. Unfortunately, medicine is an inexact science at best. One of the things that I always found ironic is that many patients and even some medical experts expect doctors to “prove” their diagnoses do exist or to “rule out” other diagnoses by showing that those diagnoses couldn’t possibly exist. However, in court, when a doctor is accused of wrongdoing, an expert is required to testify to “a reasonable degree of medical certainty” which in most cases means that something is “more likely than not.” In other words, court testimony demands only 50.001% certainty while clinical practice often demands a much higher level of certainty.

Our discussion transitioned from snark to reality.
“Most of the time you can’t be ‘sure’ of a medical diagnosis – especially a diagnosis with a symptom as vague as a cough.”
“Well patients want certainty. If I bring my child to the doctor, I want to KNOW what’s wrong, not get some wastebasket diagnosis like a viral infection when my baby could have pneumonia.”

I nodded my head. Then I went to the cafeteria to get some lunch and I mulled that last statement while walking down the hall. How could I explain the concepts of pre-test probability and futility without getting too far into the weeds? The runny cottage cheese at the salad bar gave me an idea.

I got back to the ED and asked the nurse
“Have you ever given your child poisoned food?”
“Of course not.”
“But how can you be sure? How do you know that the formula doesn’t have contaminants in it – like that Chinese infant formula contamination back in 2008?”
“That’s completely different from diagnosing pneumonia.”
“True, but it’s the same concept. We assume that a healthy-appearing child with a runny nose and cough in the middle of winter has a head cold the same way we assume that the food we eat is not contaminated. If there are signs of complications with a coughing child, we may do further testing to see if there are other problems. If there are signs of food spoilage, we may choose not to eat the food.”
“Not the same thing.”
“Hear me out. We naturally eat food without examining it much because the likelihood of it being poisoned is quite small. However, if we wanted to be “sure” that the food wasn’t contaminated or poisoned, then we could do a bunch of microbiological testing before we eat every bite to make “sure” that the food wasn’t poisoned. But because the likelihood of poisoning is so small, all of the expenses of the extra testing probably would be a waste of money.”
“Not the same.”
“Even worse, if we do a bunch of testing on a well-appearing child with a runny nose and cough, there may be some complications from the testing or complications/side effects from the treatment for a disease that may not be present. People can get resistant infections or bad diarrhea from antibiotics for a “pneumonia” that was over-read on a chest x-ray.”
“I’ll say. My daughter has had diarrhea for a week.”
“Exactly my point. She’d probably be doing better with nasal saline, suction, and perhaps some … OTC cough medications” – a cringeworthy concept for most pediatricians.

I was convinced I had prevailed in our little discussion until she asked “Can children take Levaquin?”
“Only for bacterial infections.”
“But …”
“No. Just no.”

Healthcare Update Satellite — 12-16-2014

December 16th, 2014

Answering the important questions … why does the flu vaccine suck this year? Keep a lookout for next month’s issue of EP Monthly which will tell you everything you need to know about influenza diagnosis and treatment.

Of course, if you had read the backboard article in EP Monthly’s November issue, you’d already be doing this … Florida fire department abandons use of backboards for most trauma patients.

4 year old boy develops carotid artery dissection and left sided hemiparesis after riding a roller coaster. Fortunately, he had made significant recovery by six months. How scary is that, though? Can you imagine calling the neurologist and vascular surgeon telling them that you have a four year old child with an acute stroke?

A patient suffering from a rare condition called ossifying fibromas had lost the structural integrity of two bones in her back. Normally, the vertebrae are removed and replaced with artificial bones, but the process is difficult because the artificial bones must be filed down during surgery to make sure that they fit. Surgeons in Zhejiang University used CT scans and a 3D printer to create a titanium implant that exactly matched the patient’s spine.

A lot of insight about emergency medicine wrapped up into a few paragraphs from a Florida Times-Union columnist who went to the emergency department with his wife.
“Most [patients] probably shouldn’t have been there, but the poor and uninsured use emergency rooms for all their illnesses, from a head cold to a sprained ankle …”
“Nearly everyone at the ER was surly because of the wait, and they took it out on the staff.”
“Emergency room patients get outrageous bills even for simple ills. Many just toss them in the trash and the rest of us pay through higher bills. American health care is a mess. I’ll be really grateful when someone finds a cure.”

Using ground coffee to stop bleeding from wounds? I never heard of this one before. After reading this letter to the editor, I did a little internet searching and found other recommendations including powdered sugar, corn starch, and cayenne pepper. Don’t know if any of these work, so don’t try them without contacting your personal physician first. Direct pressure for at least 5 minutes always worked best for me.

After miserably failing to pass Proposition 46 in California, a medical malpractice plaintiff, supported by an amicus brief from a consumer watchdog group, have now successfully petitioned the California Supreme Court to review the state’s medical malpractice caps.

Emergency department visits on the rise … again. Latest estimates from ACEP are that there will be about 140 million emergency department visits in 2014. Thirty percent of those visits were for injuries – many in patients 75 and older. Nearly 75% of hospitals continued to board patients in the emergency department, showing how hospitals are operating at or above capacity.

In medical malpractice cases, expert witnesses are usually required to practice in the same specialty as the defendant physician. A malpractice case against a prison physician in Indiana was thrown out because a plaintiff’s medical expert was not a prison physician and was therefore deemed unqualified to testify about “correctional medicine.” The Appellate Court stated otherwise, holding that the standard of care for doctors practicing in prisons is no different from the standard of care for doctors practicing in the general population. Allowing this distinction would “empower prison physicians to determine for themselves what standard of care should apply for each individual case.” The 19-page opinion is here (.pdf file) and incidentally presents a fairly in-depth discussion on management of patients who have undergone a sex change operations.

Innovative new research shows how chronic neuropathic pain can be relieved by activating a receptor in the brain by using either adenosine or a drug invented at the National Institutes of Health. Bonuses are that no tolerance develops, there is no potential for addiction, and the “protective” actions of acute physiological pain (such as pulling your hand away from a hot stove) are not affected. How long until patients develop allergies to this medication?

Healthcare Update Satellite — 12-01-2014

December 1st, 2014

More health related news from around the web on my other blog at DrWhitecoat.com.

This edition begins with another installment of the Ebola Chronicles … perhaps the last in the short-lived series now that the media has stopped whipping the public into a panic.

New York City actively monitoring 357 people for symptoms of Ebola – most of whom came to the US from the three Ebola-affected countries.

Arizona man returns from Sierra Leone after being involved in “Ebola response” then decides he doesn’t feel well the following day and calls 911. Brought to Maricopa Integrated Health Systems by firefighter in hazmat gear and part of the emergency department was shut down to accommodate the patient.

Number of Ebola cases in West Africa doubling every 2-3 weeks. Among factors contributing to the increase are 60% of Ebola patients remaining undiagnosed, terrorist groups such as ISIS attempting to weaponize Ebola, and Ebola’s nonspecific symptoms. The article’s author calls Ebola a “slow-motion atomic bomb.”

Interesting insight into why half of the doctors in Liberia have died. Liberia had two civil wars between 1989 and 2003 and still has no centralized h
ealthcare system leadership.
This quote really puts things in perspective:“People are giving up their sick dying and dead family members to people wearing anonymous white space suits, in most cases never to see them again,” Moran said. “Give them the benefit of the doubt that, just like Americans, if people in your family are sick, you want to take care of them.”

Clipboards visit UC San Fransisco on their national tour to tell medical providers how to prepare for patients with Ebola.

Oh, and the Ebola nurse from Maine wants everyone to stop calling her the Ebola nurse. Did I mention that she was the Ebola nurse?

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Can EKGs predict risk of death in patients with syncope? The GESINUR study shows that 65% of syncopal patients had abnormal EKGs but that only a few findings were predictive of all-cause mortality at one year. Of 524 patients, 6.3% died within 1 year, but only one patient died from a sudden cardiovascular cause. Presence of atrial fibrillation, intraventricular conduction delays, LVH and paced rhythm were all associated with increased all-cause mortality at one year.

Woman and her husband go to emergency department after woman begins having “serious internal or abdominal pains,” thinking she may need surgery or something. Twelve hours later, doctors found the source of the patient’s problems: a 7 lb 14 oz baby boy. The patient and her husband had no idea she was pregnant.
Every time I hear about a case like this, it reminds me of this story from many years ago.

Study in the American Journal of Public Health shows that drinking sugar soda affects length of telomeres and can shorten your life. Drinking one 20 ounce bottle of sugared soda per day is estimated to shorten one’s life by 4.6 years – which approximates the effects of cigarette smoking.

Started taking NSAIDs recently for aches and pains? Your risk of dying if you have a stroke just went up an average of 42% – depending on what type of NSAID you’re using. According to this study recently published in the journal Neurology, etodolac (Lodine) (which may have been discontinued) creates the biggest risk of the medications studied.

Think hand dryers are more “sanitary” than using paper towels? Think again. Bacterial counts in the air around jet air dryers were 27 times as high as those around paper towel dispensers and stayed around for up to 15 minutes after the drying ended. Bacterial counts for warm air dryers were about 6 times as high as those around paper towel dispensers. In other words, using a public bathroom with electric hand dryers is likely causing you to inhale the bacteria on other peoples’ hands … after they have used the toilet.

Then again, if you live near this defecating dwarf, you probably don’t have to worry about airborne germs – just those on the steps.

Finally, the video of the week takes one final look at the media coverage of Ebola in the US versus that in the UK. There is some profanity, so probably NSFW. Also note that the one person being filmed discussing “Ebola ass-ness” is a comedian doing a comedy spoof. Still pretty funny, though.

An Argument With No Clear Winner

November 23rd, 2014

Fingertip Amputation“You’re going to the hospital.”
“I’m NOT going to the hospital. There’s nothing they’d do and it would cost us thousands of dollars for nothing. Besides … we have to leave. We’re already late.”
A husband was attempting to attach the family’s camper onto the trailer hitch of the family’s truck when the trailer slipped. His middle finger didn’t make it out of the way and got caught between the ball of the trailer and the top of the hitch. When family members helped him pull the camper back off of the hitch, they saw a lot of blood. Then the last portion of his middle finger dropped from inside the trailer hitch onto the leaves.
“Dammit.”
The wife raised her voice. “Get in the truck. We’re going to the hospital.”
The husband wrapped his bleeding finger in a Brawny paper towel he had retrieved from inside the camper. He raised his voice louder. “YOU get in the truck. We’re going to the CABIN.”
“Paul, don’t be silly. You’re bleeding. The tip of your finger is sitting on the ground. If we get to the hospital quickly, maybe they can reattach it.”
“They’re not going to do anything except sew this up and charge us thousands of dollars to do it. I’m NOT going to the hospital. I’ll have Doc Welby call me in a prescription for antibiotics. We can pick it up on the way out of town.”

So the patient shows up in triage with a blood soaked paper towel wrapped around his finger. It was obvious that he’d rather be about anywhere else than sitting in the emergency department at that point.
The finger was amputated just past the distal interphalangeal joint – meaning that the tip of the finger, the nail, and the end of the bone were missing. Clean wound. There were some extra flaps of skin to the sides of the finger which would make it easier to repair the wound. I did a digital block to numb the finger so that we could clean it and we used a commercial tourniquet to stop the bleeding.
The wife softly asked “Is there any chance that the end of the finger could be reattached?”
I started to respond “I don’t think so …” when the patient let out a loud “HEH” and smirked at his wife.
“You were saying, doctor?” She continued.
“I was saying that I didn’t think so, but I can ask the hand surgeon. Do you have the end of the finger with you?”
“Tell him what happened to the end of your finger, Paul.”
“We couldn’t find it.”
“Tell him what really happened to the end of your finger, Paul.”
“It’s gone.”
“Paul didn’t want to come to the hospital. I told him that you may be able to reattach the end of his finger. Paul had a temper tantrum, picked up the end of his finger, and threw it into a field. Isn’t that right, honey?”
Paul folded his arms and looked at the opposite wall, maneuvering his tongue to pick an imaginary piece of food from a tooth. He pretended he didn’t hear what she had said.

OK, then.
So I called the hand surgeon. He came down, looked at the patient’s finger, and arranged to send the patient to outpatient surgery to repair the injury.
Just as the patient had predicted, he was probably charged thousands of dollars to sew up his finger. He was discharged later that day.

For the rest of the day, I kept thinking how that husband and wife dispute ended up in a draw. They were both right. The wife was right that he needed to come to the hospital for evaluation, but he was right in that the surgeon probably wasn’t going to do much except sew up the injury.

OK, I also wondered how many times during their vacation that the husband held up his hand and waved the dressing on his injured finger in front of his wife’s face … as in “see which finger I injured, honey?” … but the irony of their argument was still pretty compelling.

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This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room please e-mail me.

Healthcare Update Satellite — 11-04-2014

November 4th, 2014

Ebola PictureBack with more of the Ebola Chronicles …

Ebola fears causing discrimination problems all over the US. Thomas Duncan died from Ebola. Now his fiancee is having difficulty finding a place to live as landlords are refusing to rent to her. People of African descent are facing discrimination just because they are from Africa. Mothers of some school children told one African cafeteria worker to leave the school because she “might have Ebola.”

In Liberia, bleeding patients are often refused medical care due to Ebola fears. The picture at the link shows a picture of a woman who was bleeding heavily from a miscarriage and who was unable to find treatment at multiple clinics.

Hospitals developing policies on what care may not be provided to Ebola patients. Invasive procedures, hemodialysis, endotracheal intubation, and CPR are all being reviewed to determine whether the risk to health care workers is worth the benefit to patients. For example, if an Ebola patient suffers a cardiac arrest and it takes a half hour to don protective gear, will doing so benefit the patient?

The CDC says it is unlikely (.pdf file), but other infectious disease experts assert that Ebola can already spread by aerosols and droplets. Even vomiting creates an aerosol which can transmit gastrointestinal viruses.

Tori Spelling's Ebola Nervous Breakdown Picture Of The Week

But at least Tori Spelling is OK. She was hospitalized with “symptoms of Ebola” which ended up being a nervous breakdown caused by her husband cheating on her. Took selfies of herself in her hospital bed with Twitter hashtags written on a facemask she was wearing. We need to have a 21 day media blackout on any celebrities that pull this crap. Make that a 21 week media blackout.

And some other select news …

Support for California’s Proposition 46 drops almost in half once voters actually learn about the ballot language.

Patients gone wild. Former police officer gets drunk, gets brought to emergency department, assaults nurse, then tries to take Taser from the police who responded to the scene. He got a smackdown by police officers before being arrested for disorderly conduct and attempting to disarm a police officer.

Alabama jury awards family of patient $4 million for missed MI resulting in patient’s death. 40-year-old man went to the emergency department complaining of abdominal and chest pain after eating breakfast two days prior. He was diagnosed with gastrointestinal problem, was sent home, and died of an MI two days later. Plaintiff attorney argued that full cardiac workup should have been performed and hopes that the large verdict “sends a message to doctors, particularly emergency room physicians.”

Remember, marijuana is a harmless drug. Adolescents who use cannabis were 63% less likely to complete high school, 62% less likely to earn a college degree, eighteen times more likely to develop cannabis dependence, eight times more likely to use other illicit drugs, and seven times more likely to attempt suicide.

Science journalist describes how she suffered a broken heart … literally. She was diagnosed with Takotsubo cardiomyopathy

British woman has cosmetic procedure performed during medical tourism trip to Thailand. She was unhappy with the results, so she returned to the clinic for corrective surgery and died under anesthesia.

Healthcare Update Satellite — 10-21-2014

October 21st, 2014

More medical news from around the web on my other blog over at DrWhitecoat.com

Study from University of Maryland proves that emergency physicians are idiots … at least when treating pediatric extremity injuries. Splints were placed improperly in 93% of suspected pediatric fractures treated in emergency departments. “The researchers found that the most common reason for improper placement of a splint was putting an elastic bandage directly on the skin, which occurred in 77% of the cases. In 59% of the cases, the joints were not immobilized correctly, and in 52%, the splint was not the appropriate length. Skin and soft-tissue complications were observed in 40% of the patients.”
Of course, I’m sure that the orthopedists evaluated the patients immediately after the splints were placed to make sure that the patients had not readjusted the splints prior to their orthopedic follow up. That almost never happens.
This study makes a good case for requiring orthopedic evaluation in the emergency department for every pediatric patient suffering from any type of bone or joint injury – regardless of the time of day or night.

What no one is telling you about Ebola … from a Hazmat Trained Hospital Worker. The gear used to protect providers from Ebola is difficult to put on, difficult to remove, and can usually only be worn for 30 minutes at a time. The medical providers in Dallas who contracted Ebola had no protocols in place and this author believes that the “system failed them.”

Patients apparently believe that being in the same hospital as an Ebola patient is bad for their health. Patients at Texas Health Presbyterian Hospital are canceling outpatient procedures, no one is walking in the hallways, and the ED wait times have dropped from an average of 52 minutes to … zero.
“It feels like a ghost town,” said one vendor who recently visited the hospital.

Ketamine has almost immediate positive effect on anhedonia and depression associated with bipolar patients who are resistant to other treatments. The more remarkable thing is that the effects can also be seen on PET scans and effects from a single dose of medication last for over two weeks.

Another example of why doctors should be wary of treating VIP patients. Former NFL running back sues orthopedic surgeon after alleging that his Achilles tendon tore during Baltimore Ravens tryout. Alleges that the surgeon misrepresented the fact that the Achilles tendon had fully healed after his prior Achilles surgery.

Ambulances line up outside North Wales hospital waiting to drop off emergency patients. At one point the line was 13 ambulances long and the wait was hours just to get into the emergency department. One of the government administrators recommended that patients go to NHS Direct or pharmacies for speedy health advice.
At least the patients are covered by insurance, though — just like many of the patients in the US now.

Australian nurses want penalties to be imposed on hospitals if patients aren’t seen within four hours in emergency departments.
If this penalty materializes, a few things will happen. First, nurses will be penalized by hospitals for not effectively moving patients through the emergency department. Second, there will be massive fudging of statistics during busy times. Third, patients who have exceeded the four hour threshold wait will be passed over so that patients who have been waiting less than four hours can be evaluated within the threshold.
When you pay for a statistic, you get the statistic … not necessarily the intended benefits behind the statistic.

From comments at Overlawyered.com
Employee of a surgicenter goes to facility for a colonoscopy. When he wakes up, he was wearing pink underwear. As a result, he suffered extreme emotional distress, humiliation, loss of wages and loss of earning capacity. He is now suing.
While I probably would have laughed off a prank like this, I can understand why some people would have been upset. But suffering a loss of earning capacity from being dressed in pink panties as a prank? I’d like to see how that happened.

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