Wednesday, July 13, 2016

Cage Fight At The VA

There is a cage fight going on at the Veterans Affairs hospital near you. It involves the VA's recent proposal to allow advanced practice nurses (APRN's) to practice to the "full extent of their education, training, and certification without the clinical supervision of physicians, regardless of individual state regulations." The ASA is having none of this.

This is the number one battle right now for the ASA. It's importance to the society and specialty is bigger than Obamacare, bigger than MACRA. Though NP's could potentially supplant physicians in other specialties like internal medicine, anesthesiology is uniquely susceptible to being replaced by nurses in clinical practice.

Medscape has lined up the president of the ASA, Daniel J. Cole, M.D. and the president of the AANA, Juan Quintana, DNP, MHS, CRNA, to go mano a mano to breakdown this controversy. Reading the interviews tells me that the two sides will never come to terms with each other. It's war. It's a fight to the death. Both sides are talking past each other, reciting their respective journal statistics without acknowledging the merits of the other. This will not end until one combatant is down on the mat, bleeding profusely out of every orifice, barely conscious. Then victory will be declared until the next president of the U.S. is elected, fresh lobbyists are hired, and new members of Congress are bribed. Then the fight will be renewed once again.

While the entire article is worth reading, I could barely get past the terrible picture of Dr. Cole in the article. Here's a screenshot.

Why is the man purple? He looks like he got some terrible spray tan going on where they loaded the nozzles with blueberry juice instead of tanning pigment. Or maybe he just came back from a blueberry pie eating contest where the contestants aren't allowed to use their hands. Regardless this horrible picture is very distracting and unfortunately lowers the quality of Dr. Cole's arguments. Looks count.

By comparison, Mr. Quintana's skin tone is more appropriate in his picture.

Not to sound too paranoid, but I think there is some conspiracy going on in the graphic design studio at Medscape to make the anesthesiologists' side less credible. Step it up Medscape. There is no place in your supposedly nonpartisan news coverage for this kind of blatant favoritism.

Tuesday, July 12, 2016

The Hypocrisy Of Natural Childbirth

I love this editorial in the New York Times. Titled "Get the Epidural," the author Jessi Klein explores why some women think it is better and more natural for deliveries to be performed without the comfort of an epidural anesthetic.

Says Ms. Klein, "But how often do people really want women to be or do anything 'natural'? It seems to me the answer is almost never. In fact, almost everything natural about women is considered pretty horrific. Hairy legs and armpits? Please shave, you furry beast. Do you have hips and cellulite? Please go hide in the very back of your shoe closet and turn the lights off and stay there until someone tells you to come out. (No one will tell you to come out.) It's interesting that no one cares very much about women doing anything 'naturally' until it involves their being in excruciating pain. No one ever asks a man if he's having a 'natural root canal.' No one ever asks if a man is having a 'natural vasectomy.'"

There it is. Not only do women have to undergo unnecessary pain during labor for the questionable benefits of "natural" delivery, it is also a highly sexist attitude to condescend women who do choose to have an epidural. So get the epidural. You and your newborn baby will enjoy their birth day more.

Monday, July 11, 2016

Pokemon Go For Doctors

The worldwide craze of the new game app Pokemon Go has people wandering all over the streets looking for Pokemon characters. Some are getting into trouble by running into signs or even getting robbed. Wouldn't it be wonderful if we could harness that kind of intensity from medical students so they devote their energy into improving their medical skills? How about planting Pokemon characters into different body surfaces and orifices to motivate students to examine their patients more thoroughly? Here are a few suggestions.

Yes sir. With a treasure hunt like this for students to explore, they will all become expert clinicians in no time.