Its All About That Bass featuring Kate Davis

Greetings:

You gotta hear this......

Its All About the Bass featuring Kate Davis....

Amazing stuff...


http://youtu.be/iyTTX6Wlf1Y


Enjoy


Marc

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Iatrogenic polyuria

Dr. William Reichert commented on a recent post of mine. I thought he told an interesting story and with his permission, I am featuring it here so more of you might see it.

He wrote

Some time ago, I was consulted on a patient because of excessive urination. The patent was putting out 4 or 5 five liters a day and nobody knew why. I checked out all the usual suspects, diabetic ketoacidosis, hyperglycemia, diabetes insipidus, etc. and all the medications listed on his chart. No diuretics. Finally, at my wit’s end, I entered the ICU room and noticed a number of med bags, some full, some empty hanging there on the IV pole. I checked each and discovered a bag labeled "dopamine” slowly dripping in.

I went to the nurse and asked how long the patient had been on dopamine. She said "Hes not on dopamine." I said, "Come with me" and showed her that he was in fact getting low dose dopamine, a drug that behaves like a diuretic.

Unbeknownst to those "taking care" of him, he had been on dopamine for no one knows how long. The next day I got a call from the head of nursing informing me that it was not nursings fault. Perhaps the IV team or the pharmacy was responsible. I agreed with her. I did not want to be accused of being mean to the nurses. Anyway, according to the computer printout and the nursing notes, he was NOT on dopamine. Maybe a relative sneaked in and hung the drug. No one was faulted. The problem resolved. No "root cause analysis” was undertaken. Why bother?

This reminded me of a polyuria story of my own. One weekend, I was covering for another surgeon and rounded on a postop patient whose urine output had been increasing over the last several days. The labs were OK, and he had no obvious reason for his 3500-4000 mL/day outputs. I looked at the intake and output records [this occurred back in the day when such things could easily be found at the bedside] and saw that he was getting more and more IV fluid every day. I called a resident and asked him what was going on. He told me they had been increasing the IV fluid rate every day to keep up with the losses in the urine.

Facepalm!

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Medicine like air travel once was fun

A Wall Street Journal blog about a reunion of employees of American Airlines lamented the good old days of air travel. Heres an excerpt:

"They came together to celebrate the days when flight attendants in white gloves hustled to serve you, gate agents doled out upgrades and arranged seating so families could be together, and managers worked flights with the single mission of ensuring excellent customer service."

The employees told tales of the fun they had and the camaraderie they shared. The passengers had fun too.

One retiree said of todays airline employees, "They dont look like they are having any fun at all."

Certainly the same can be said of todays passengers.

Im usually not a fan of the airline-medicine analogy, but Im going to make an exception here.

Back in the day, those of us in medicine had fun too. Dont get me wrong. It wasnt at the expense of the patients.

We always approached our patients with a proper attitude of respect. But it was OK to enjoy those encounters and also the fellowship of colleagues. We helped each other out, and we did it with spirit and camaraderie.

Not anymore.

All we read about now is how doctors are burned out, stressed, depressed. We battle with electronic records, hospital administrators, clipboard carriers, third-party payers, the government and just about everyone else.

What happened to the fun? Its all about the money.

David Shaywitz in Forbes: "The view from the front lines suggests that hospitals and care delivery systems are obsessing like never before on doing whatever they possibly can to maximize their revenue. They are consumed, utterly consumed, by this objective."

He added: "Many (I’d say most) providers and provider groups feel that they are locked in a deadly battle with payors (and increasingly, other providers) for their livelihoods; many feel they are having to work harder and harder to bring in the same (or less) money then doctors a generation ago. Many feel that the profession has lost the autonomy and respect it used to enjoy, and that providers are now viewed as mechanized assembly line workers, held to strict quantitative “quality” metrics that rarely capture the complexity, or essence, of the patient experience."

I believe what Shaywitz said is true. Can anything be done or is it hopeless?

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Problem with my blog I need your help

I have a big problem.

For the last 10 days, Twitter has been blocking me from tweeting any links to my blog.

This is the message I get whenever I try to send a tweet with "skepticalscalpel.blogspot.com" in it.

I have tried to contact Twitter through @twitter and @support four times and have received no reply, nor have they replied to numerous ticket requests through the Twitter Help Center.

I discovered a site called virustotal.com which compiles reports from 63 different programs that detect viruses, worms, trojans, and malware.

Originally a site called BitDefender claimed my site was malicious. The next day, BitDefender declared my site was clean, but AutoShun, which previously had no problem with my site, said it was malicious. The following day, AutoShun said my site was unrated and Clean MX said "malicious." But the day after, AutoShun went back to calling it malicious and Clean MX said my blog was clean. At no time, did more than one of the 63 detection programs identify my blogsite is being malicious.

You would think that if my blog contained any suspicious programs, more than one of the 63 virus detection organizations would have come up with a positive result on the same day.

None of the programs saying my blog was malicious gave me any clue as to what part of my site was supposedly creating the problem.

I attempted to get some help from Blogger, which hosts my blog. Although one person on a forum responded with some advice, it wasnt enough for me to solve the problem.

My blog is averaging 1600 page views per day. Not one person has contacted me to complain that I am harboring viruses or any other malicious software. That is because, to the best of my knowledge, no such malicious software exists on my blog.

Maybe it would help if you would go to the results section of the virustotal website and cast your vote in favor of my site as not being malicious. In the upper right-hand corner of the site you will see this cartoon.



 Please click on the green face to support my blog.

Meanwhile, I have discovered an interesting workaround which enables me to tweet links to my blog, but visitors to the site will still be blocked by Twitter from tweeting links.

If you consider yourself computer-savvy, maybe you can figure out how I did it. If you think you know the answer, please submit a comment.

I also would welcome any comments or suggestions that could help to resolve my problem. If anyone knows a way to contact a human at Twitter, please let me know.

Thanks.

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A Fun and Lucrative Business by Marc Charles

7:44 AM

Greetings:

Ive enclosed an article I wrote for International Living.

Enjoy :)

Marc


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A Fun and Lucrative Business Almost Anyone Can Do

By Marc Charles

I discovered a fun and lucrative business almost anyone can do…from anywhere.

I say “almost anyone” because this is not for everybody. There’s some work involved, a knowledge curve and details that might overwhelm some people.

But, this business is fun, and you can do it “on the road”, in your spare time or work from your kitchen table if you want to.

The idea is to acquire products at deep discounts from more than a hundred countries around the world, and sell the products online at amazing markups.

The greatest obstacle when it comes to selling products online is traffic. You need tons of targeted traffic and qualified buyers (versus tire kickers). The problem is this kind of traffic costs money, unless you can piggyback sites like Amazon, ebay, CraigsList and other shopping sites.

Last week while moderating a forum I set up around this business, I was amazed how people were leveraging this business and making money.

One gentleman from Germany was importing colored computer cables at deep discounts and reselling them on technology shopping sites at huge mark ups.

A young woman, Jenny, is importing Christmas supplies and reselling them to other online retail stores. She’s doing this from her “pantry office” next to the kitchen in Calgary Alberta Canada.

The point is this is a fun and lucrative business almost anyone can do, even if you don’t have a lot of money to get started.

I also discovered a trading exchange that enables entrepreneurs to locate reputable suppliers in other countries and order from them directly instead of going through a middleman. 

I know dozens of entrepreneurs who are leveraging this neat business. You can meet them in this program I’ve developed to help get youstarted. URL

Today, starting a business on a shoestring is much easier than it was 30 years ago—or even five years ago.

Theres nothing wrong with building a big business. I’ve helped dozens of entrepreneurs and start-up ventures do it.

But when you run a business from your kitchen table, a back bedroom, or even “on the road” as your travel you can greatly reduce the downside risk and expense.

Almost anyone can do this business. Plus, the weak economy makes this business even more viable.

Editors note: Remember you only have one more day to get Marc’s program with a $100 discount. Try it out. This might be just the right opportunity for you. Sign up to receive it now. URL

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Meaningful Use Stage 3 Is Coming Should Be Fun

An alert reader tipped me off to something many of you may not be aware of. Stage 3 of Meaningful Use is close at hand.

The "proposed" rules will be officially published on March 30. The good news is that comments will be received for a couple of months.

The bad news is that if the Office of the National Coordinator for Health Information Technology is anything like every other regulatory body Ive ever dealt with [e,g., the ACGMEs Residency Review Committee for Surgery], the "proposed" rules will be the real rules and the comments will be simply a way for disgruntled physicians to vent.

If you dont believe me about the venting, take a look at the 185 mostly negative comments posted on Medscape’s story about Stage 3.

Here are a few of the new rules that will be in effect by 2017 or sooner.

More than 25% of patients seen by an eligible professional (EP) or discharged from a hospital or emergency department (ED) must "actively engage" with their electronic health records (EHRs).

When I was practicing, I had trouble getting some patients to take their medicine or even get out of bed. I don’t know where the people making these rules live, but most of my former patients were highly unlikely to actively engage with their electronic records. I suppose as is the case with unplanned readmissions of noncompliant patients, penalties will be handed out if only 24% of one’s patients engage their records.

Patient-generated data from a nonclinical setting must be incorporated into the EHR for more than 15% of patients seen by the EP or discharged from a hospital or ED.

A “nonclinical setting” is something such as home health care or physical therapy. How anyone is going to be able to track this? Did they mandate only 15% because they know this will be nearly impossible to comply with?

EPs and hospitals must use their EHR to create a summary of care and electronically exchange it with other providers for more than 50% of transitions of care and referrals. In more than 40% of these transitions of care, the provider has to incorporate in its EHR a summary of care from an EHR used by a different provider. In more than 80% of transitions of care, the provider has to perform a "clinical information reconciliation" that includes not only medications and allergies, but also problem lists.

EHRs from different vendors lack "interoperability." They dont communicate very well with each other. “Copy and paste” is out of control now. Wait until you see what happens when people try to comply with these transition of care rules—assuming that EHRs from other doctors can even be opened. This is going to be a monumental amount of work, all of which of course will be uncompensated.

I retired more than two years ago. In social situations, I’m often asked, “Do you miss being a doctor?” I miss the satisfaction that came from helping patients and most of the people I worked with, but I don’t miss the ever-expanding bureaucracy, regulations, and busywork associated with practicing and teaching surgery.

Old age has its rewards. One of them is not having to deal with Stage 3 or even Stages 1 and 2 of Meaningful Use.

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