WhiteCoat

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Cracking the Top 100

Friday, April 29th, 2011

I hate Top 100 rankings.

In my e-mail box there was another Top 100 solicitation. This one was for the Top 100 most influential people in healthcare.

I deleted it. Then I thought a moment and pulled it out of the trash bin.

What if *I*, humble and pure WhiteCoat the blogger, could be voted as one of the Top 100 most influential people in healthcare?

How would Modern Healthcare handle the fact that an anonymous blogger could be held in such high esteem? What if I could be voted more influential than … Kathleen Sebelius … or … President Obama ?!?

Mwuaaaahahahahaha.

I’ve been blogging for almost 5 years and I’ve never done something like this before … until now.

So here’s my plan:

I’m asking that someone go to Modern HealthCare’s site and nominate me for the Top 100. I’m also asking that you nominate some other people in the medical blogosphere as well.

If any of us are officially nominated, I’ll post an update with a site where everyone can go to get out the vote. Then we can see exactly how influential all of us health care bloggers can be.

Thanks!

1) Nominee’s last name — Coat
2) Nominee’s first name — White
3) Nominee’s title — Health Care Blogger
4) Name of organization — Emergency Physician’s Monthly Magazine
5) Location of organization — Annapolis, MD

Kevin Klauer – Editor-In-Chief – Emergency Physician’s Monthly Magazine – Annapolis, MD
Mark Plaster – Publisher – Emergency Physician’s Monthly Magazine – Annapolis, MD
Rick Bukata – Professor Emergency Medicine – University Southern California, Los Angeles, CA
Greg Henry – Columnist – Emergency Physician’s Monthly Magazine – Annapolis, MD
Kevin Pho – Medical blogger - KevinMD.com - Nashua, NH
Ibee Grumpy - Medical blogger – DrGrumpyInTheHouse.blogspot.com - Grumpyville, USA
Nurse K – Medical blogger – crasspollination.blogspot.com – Montana, USA
T K – Medical blogger – ERstories.net –  Suburban Northeast, USA

Under The Knife – Part 2

Thursday, April 7th, 2011

By the time we reached the hospital, the parking garage was nearly full. How damn many surgeries do they do at 6:00 in the morning? We ended up getting to the registration desk 15 minutes late.

The presurgical waiting room was dark and kind of musty. There were many antique chairs situated in a maze throughout the room. A large plasma screen TV showed a grid with patient numbers, status, and comments. As we walked up to the desk, we were given a number and told to reference that number in all communications about the patient — me. That number would also be used to track my progress through surgery and into the recovery room.

As we sat down to fill out more paperwork, we walked past a young woman who was sitting in a chair, rocking back and forth, crying, and rubbing the beads on a rosary. That upset my wife and I could see her begin to fidget.

One by one, patient numbers were called, random people and family members stood up, walked to the desk, and then walked out the door into pre-op.

“7126″
“That’s us,” I said to my wife. She just gave me this long sorrowful look that kind of made me feel sad. We took all of our belongings and followed everyone else down the hall to pre-op.

Once inside, there was another maze of hospital gurneys separated by curtains. We were led to one of the “rooms” in the middle of the maze. Hospital staff scurried about with portable computers, entering data as they walked from room to room. On the bed in my room was a garment bag and a gown. I knew the routine. Everything off. Gown with the opening in the back. Hair net to catch all of my flowing locks.
I took off my sneakers, folded up my sweatsuit, and put everything into the bag. I had to wear a sweatsuit to the surgery, because it made me feel as if I was more “healthy” compared all the other people who needed surgery. Also, I figured that if I wore jeans when I left the hospital, they would press upon the surgical site. See? I was thinking ahead.

I sat myself in the bed and pulled the sheet up over my legs. My wife pulled the chair next to me and held my hand. Then we just sat and waited.

A nurse came in and took a history. She confirmed everything that was in the records from my preoperative physical the week prior. Nope. Nothing changed.
Then a surgical resident came in, performed a brief physical exam, and took another history. Same questions the nurse asked. I knew I would have to repeat the same history at least 2-3 more times. That’s just the way things go.

Then the anesthesiologist came by and sized up my jaw. Held my chin in his hand and turned my head from side to side like he was getting ready to sock me. Had me open my mouth. Made sure that I showed him all of my intact teeth. He just wanted to make sure that there wouldn’t be any problem getting the tube down my throat.

Another nurse came in and started my IV. By then, word had gotten around the pre-op area that I was a doctor. One of the other nurses chickened out on sticking me for the IV. The new nurse’s hand was shaking when she came at me with the needle. I felt bad. What’s the big deal? It’s not like I’m going to yell at you. She aced it on the first stick and taped it into place.

For some reason, about 5 minutes later I got very nauseous. Just came up at me out of the blue.

“You better get me a bucket quick – I’m going to hurl,” I told my wife. I was getting that tight feeling in my jaw and my salivary glands were doing double time.
“Did they put something in the IV?” I asked.
“I don’t think so.”

I looked across the hall. There was another guy sitting in a bed staring at me. For some reason, I got irritated.
“Honey, can you close the drape?”
“Why?”
“Because otherwise I’m going to jump out of this fricking bed and go puke in the lap of that dude eyeballing me across the hall.”
“Just relax. He doesn’t have anything else to do. Look at his wife.”
He was just sitting in the bed. His wife was hunched over her CrackBerry texting away and completely ignoring him. Not sure what was so important at 6:30 AM on the day of her husband’s surgery, but my wife was right. Then I felt bad for getting annoyed.
OK, buddy, enjoy the show.

Another nurse came by, ripped open several alcohol swabs and held them up to my nose. “Sniff these, they’ll help.”
I looked at her as if to say “are you kidding me?”
“Trust me.”
So at that instant, I became a “huffer” of isopropyl alcohol. If the odor didn’t help, I could always suck the alcohol out like I’ve seen some patients do in the past.
Damned if it didn’t work.  The nausea didn’t go away, but it did get better.

Then an anesthesia resident came by and gave me some Zofran. Cool. Nausea pretty much gone. He began to give me a second medication when Mrs. WhiteCoat asked what it was. He held the syringe so she could see it but so that my line of sight was blocked by his hand.

Mrs. WhiteCoat’s eyes began to tear up.

I thought to myself “Why the heck is she get….”

Whoa.

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Here are links to the other parts in case you get lost:
Part 1Part 2Part 3Part 4Part 5Part 6

 

Under the Knife – Part 1

Wednesday, April 6th, 2011

“You can’t keep popping antibiotics to cure your diverticulitis,” Mrs. WhiteCoat told me.

Yeah, yeah. I know. That’s why I grudgingly went to see a surgeon.

Then I started wondering to myself. Aside from those neurologic complications and the increased incidence of tendon ruptures, why can’t I just take Cipro and Flagyl every few months?
Actually, I was more worried about long-term complications from repeated episodes of diverticulitis. Inflammation from diverticulitis can cause strictures, adhesions, fistulas, obstructions, and other badness that I didn’t want to have to deal with later in life.
So … I may as well get this diseased colon of mine removed while I’m still “healthy.”

We decided to stick with a surgeon that we’ve known for a long time. I had seen him a couple of years prior when I had to stay in the hospital for another episode of diverticulitis. He has lots of experience doing colon surgery, plus he’s a good guy. I requested a month off of work, figuring that I would hopefully be back to normal a few weeks after the surgery.

A week before surgery, I got an e-mail with preoperative instructions from the nurse. Had to make sure that I was “cleaned out” before the surgery, so the day before surgery involved drinking lots of laxatives. I decided I wanted to go even one step further. I pretty much only drank liquids for the two days prior to surgery. I didn’t want there being any chance of extra stool in my colon that could contaminate the surgical site.

We had to be at the hospital at 6:00 AM on the day of surgery. That meant getting up about 4:30 in the morning. No problem, I figured, I’ll be sleeping most of the day. I just felt bad for my wife.

While we were getting dressed, she looked at me and said “I could hardly sleep last night. Aren’t you worried?”
I really wasn’t, except for one thing that kept running through the back of my head. It was almost like a bad omen.
One of the last patients that I had seen in my last emergency department shift was a gentleman who was 50-ish and who had been in a nursing home for the prior 4 months. He suffered a relatively straightforward injury. He was shoveling snow when he slipped and fell, breaking his hip. He had a standard hip replacement performed, but that’s when his troubles began. First, his surgical wound got infected. They had to open up and debride some of the infected tissue. Then, the hip prosthesis became infected. He was on intravenous antibiotics for a month. The organisms were unfortunately resistant to most antibiotics, and the infection persisted, so the surgeons had to remove his entire hip prosthesis. Then he was on more antibiotics to try to cure the remaining infections in the tissues. Since he did not have a hip joint, he was unable to walk and was relegated to a bed. Then he began to develop bed sores. He came to the emergency department because his hip was getting more red and was draining pus … again.
When I looked at him, I felt such pity because you could tell that he was a strong, proud man who was beaten down by a bunch of superbugs and wouldn’t even have existed if it weren’t for all these patients thinking that their runny noses and coughs need antibiotics.
Yep, fate being what it is, I could just see myself getting infected by one of these multiply drug-resistant organisms that I complain about on my blog so much. If I had had a temporary colostomy bag, I could deal with it. Postoperative pain, no problem. Infections… now those worried me. And there wasn’t a damn thing I could do about it.

I packed up a couple sets of scrubs and a couple packs of gum, since I knew that I wouldn’t be able to eat for a while after surgery. I put a computer and an MP3 player in the backpack. I also took my phone and an extra battery just in case. Anything else, I figured someone could bring me later if I needed it.

With that, I gave each of the kids a kiss on the forehead while they were sleeping, then my wife and I walked out of the house hand-in-hand.
I’M driving,” she said.
“Fine, I’m sure they’ll have some nausea medicine there for me when we arrive,” I joked.

On the way to the hospital, my wife kept looking over at me with tears in her eyes while she was driving. “Cripes, it’s colon surgery,” I thought to myself, “it’s not like they’re doing a heart transplant or something.”
I just smiled back at her.

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Here are links to the other parts in case you get lost:
Part 1Part 2Part 3Part 4Part 5Part 6

 

Update

Wednesday, March 30th, 2011

Just so that everyone doesn’t think I’ve bitten the dust …

Surgery went fairly well. First couple of days post-op were a blur. Developed a post op ileus which resolved by Day 4.

At home now and trying to get my body to heal. Had a little setback when part of the surgical wound popped open and began draining clear fluid. Guess I’ll have to hold off on doing those upside-down crunches for a while.

Jotted down a few notes while in the hospital and will try to put them to a post in a few days.

Thanks to everyone for their e-mails and text messages. All the positive energy gets directed right to the surgical site. And as an added benefit, they make me smile.

Will try to get back to regular posting soon.

Break

Tuesday, March 22nd, 2011

By the time you read this, I’ll be having a gas … literally. As in Sandman, Great Z’s, and Anesthesioboist kind of gas.

I’m having surgery done to fix some issues that have been giving me trouble for quite some time. According to the surgeons, I’m expected to be in the hospital for about a week and then another 2-3 weeks recuperation at home. That means I’ll be out of the hospital in a few days and back at work in about a week.

Just kidding. I promised that I would be a good patient.

A couple of people are hopefully going to guest post in my absence, so looking forward to reading their stuff when I return.

I also scheduled a few “blast from the past” posts from my old blog for the rest of the week so you don’t get bored.

If you’re thinking good thoughts, thanks.

Hopefully I’ll be back next week. May even try to post a couple of short posts while in the hospital once the anesthesia wears off.

Healthcare Update – 02-21-2011

Monday, February 21st, 2011

See more health news from around the web on the Satellite Edition of this week’s update over at ER Stories.net.

The “Valentine’s Day Massacre” – healthcare budget style. Cook County Hospital system in Chicago slashes nursing staff in its hospitals. Oak Forest hospital will fire more than 100 nurses, leaving it with only 27 nurses. Provident Hospital will cut 37 nurses, leaving it with 67 nurses. In addition, Provident Hospital begins refusing patients by ambulance. The hospital had planned to divert all ambulances last month, but postponed its plans to give other area hospitals time to prepare for the almost 5,000 extra patients each year.
One Chicago alderman asks “How far are we going to reduce the value of people’s lives?”

57 year old man walks into South Carolina emergency department … and shoots himself in the head.

“Doctor drain” from New York (with many physicians heading to Texas) attributed to high insurance premiums and high litigation costs. New York City Mayor Michael Bloomberg gave a keynote speech at the New York State Bar Association’s Presidential Summit and noted how states with lower malpractice premiums are attracting more doctors from states with higher medical malpractice premiums such as New York. He even interviewed several physicians who left New York for Texas and who stated that their reason for leaving was because of high insurance premiums.
The president of the New York State Trial Lawyers Association called Mayor Bloomberg’s speech a “surprise attack rooted in bad data.” After all, who knows more about how how the system should be working than a group who has a vested interest in keeping the status quo?

Trial lawyers looking to “protect [their] gravy train” by releasing “primer” on medical malpractice lawsuits.

More patients gone wild. Montana man brings gun to hospital emergency department looking to “shoot people from child protective services.” Taken into custody in the waiting room and gets a room at the Greybar Motel until he can come up with $100,000 bond.

California man requests that police officers come to the emergency department so that he can “confess something.” After they arrive, the patient tries to grab one of the officers’ guns. Get him a room with the guy from Montana.

You had your chance to get vaccinated. Influenza cases packing emergency departments. At one North Carolina hospital, patients with influenza symptoms are waiting 15 hours to be seen because of the increase in number of patients.

Estate of New Mexico patient wins $10.3 million at trial after patient developed bedsores on his heels after being admitted to hospital for several weeksl. He later died of unrelated causes. The award included $9.75 million in punitive damages.

Child awarded $19.2 million after being given 100 times the dose of nutrients after she was born which allegedly led to a cardiac arrest and other “severe complications.”

13 year old patient wins $1.4 million settlement after developing anaphylactic reaction to allergy shots and ending up brain damaged.

Canadian hospital shuts down emergency services for the weekend because of nursing and radiology tech shortage. The next closest hospitals are more than 100 kilometers away.

Canadian emergency physicians take video footage of conditions in the emergency department and post it to YouTube when they can’t get administration to respond to problems such as mold growth, overcrowding, and outdated equipment. Doctors began complaining about the conditions in 2004. Suddenly, the Canadian health minister reported that fixing the problems is now a “priority.” Hat tip to Grunt Doc.

Open Mic Weekend

Saturday, February 12th, 2011

Time for more input from you … the readers.

Comment, rant, or ask about anything medically-related that interests you in the comments section. Other readers feel free to chime in and answer, comment more or rant more.

Just remember – be nice and no personal attacks.

Safety of Medical Care in US

Wednesday, February 9th, 2011

Remember that statistic from the 1999 Institute of Medicine report that trial lawyers like to throw in everyone’s face about how “up to 98,000 people in the US die each year due to medical mistakes”? It’s like TWO 737 jetliners crashing every day … and we’re doing nothing about it.

So today a news story was sent to my inbox that included Saudi Arabian Ministry of Health statistics on medical malpractice. The report shows that there were 1,356 cases of malpractice in Saudi Arabia in 2009 and that “129 people died from medical mistakes in 2009.” Of course, the 129 number seemed quite low to me given the 98,000 number that is constantly cited in the press. Maybe Saudi Arabia’s population is just smaller than I thought.

Nope. Saudi Arabia has a population of roughly 26 million – about 1/12 of the 310 million people in the United States.  Multiply those 129 Saudi Arabian deaths by 12 and the population adjusted death rate from medical mistakes in Saudi Arabia is 1,548 — versus 98,000 for the United States.

Look at it another way. Divide 98,000 deaths from medical mistakes in the United States by a population of 310 million and you get about 316 deaths per million population in the United States due to medical mistakes.
Divide 129 deaths from medical mistakes in Saudi Arabia by 26 million population and you get about 5 deaths per million population in Saudia Arabia from medical mistakes.
316 deaths per million in the US versus 5 deaths per million in Saudi Arabia.

Is medical care in the United States that much worse than in Saudi Arabia — even without the benefit of safety agencies such as the Joint Commission and HospitalCompare.gov?
Or do unrealistic requirements from “safety” organizations such as the Joint Commission and “quality measures” from our government actually cause more deaths from medical mistakes?
Or are the Institute of Medicine’s numbers so far off that they shouldn’t be believed?

I did a little more searching.

This parliamentary paper from the United Kingdom pegs deaths due to medical “incidents” at about 3,500 per year in England. In a country of 52 million people, that averages out to about 67 deaths per million population – still about one fifth of the alleged United States numbers.

Then I found a Canadian study showing that the range of deaths from “medical misadventures” in various industrialized countries ranges from 1 per million population to 10 per million population. The US is in the middle of the pack at about 6 deaths per million population per year – which equates to about 1,860 deaths per year from “medical misadventures” in the United States.

1,860 deaths versus 98,000 deaths

Why are the numbers in that IOM paper such outliers?

And why do the trial attorneys keep citing it as gospel?

Cross Post

Friday, January 28th, 2011

For those interested, I also just posted a story on ER Stories about a patient encounter that frustrated me a little bit.

Open Mic Weekend 01-15-2011

Saturday, January 15th, 2011

I’m leaving on a trip with the family for the weekend.

Feel free to ask questions, vent, rant, or otherwise post in the comments section.

Remember the only rules: Be nice, no personal attacks, and try to keep things medically-related.

I’ll be back to try to answer questions on Monday.

Everyone enjoy your weekend!

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