Monday, March 14, 2011

Not So Evil Anymore

Many of you read have read my rants against my evil iPhone. In my mind, the iPhone was a method by which the messiah Steve Jobs ensnared his victims into the world of Appleology. All the technology geeks out there who bemoaned the monopolistic practices of Microsoft suddenly couldn't get enough of the tightly controlled ecosystem that is the iPhone and iTunes. The Jesus Phone appeared to be a device by which the weak minded go trapped into its cult. I shuddered at what I was getting myself into. Would I soon be brainwashed by this technologic orthodoxy and start knocking on strangers' doors to convert the heathens to this new religion?

But now I've changed my mind. The iPhone isn't merely a really bad cell phone with a great ability to waste away your day playing Angry Birds. (Full disclosure. I did download that game, but only the free versions. I'm not about to give more money to the high priest.) But I've discovered apps that can actually save me money. I found an app that can download books for free. Now these books are only in the public domain, ie/ before 1923. But that covers a lot of territory. So if you ever wanted to revisit your Western Literature class in high school, this is the perfect program. I've read books by Lewis Carroll, Arthur Conan Doyle, and Edgar Allen Poe since I've downloaded this program. I never have to buy another paperback anymore if I want to catch up on my literary classics. At about $10 per paperback, my savings are really adding up. Anna Karenina or Romeo and Juliet anyone?

I've also found the iPhone to be the best babysitter. You see it everywhere you go. At restaurants, children no longer take part in conversations at the table. They're all staring down at their iPhone/iPods playing games or texting each other. I've converted my DVD's into the iPhone format. Now the kids can watch Cars, Toy Story 3, and any other of their favorite DVD's at home and watch it outside when I need some peace and quiet. I normally wouldn't condone this sort of activity but sometimes we all need just a few minutes of respite from the whining and complaints that accompany small children when they go out..

So here's another paean to the Almighty Mr. Jobs. My iPhone still gets awful reception at my home. But its other uses makes it completely indispensible. Goodness I hate you for that.

Happy National Pi Day

For all you geeks out there, today is National Pi Day. You know, 3.14. I think every doctor, who after all are really health scientists, find math and science fascinating to a degree, with the exception probably of orthopedic surgeons. If you can't get enough of pi, you can find all sorts of facts and trivia here and here. Have fun. And go out there and make it a really good pi day.

Saturday, March 12, 2011

How Running A Hospital Is Different From Any Other Business

You know those ubiquitous signs in restaurants, shops, and virtually every business you've ever walked into that read "We reserve the right to refuse service to anyone"? Have you ever seen a similar sign in any hospital? Wouldn't life be grand if doctors could post such a sign right smack in the middle of the hospital front entrance?

A legal website I happened upon discussed the ramifications when restaurants hang up these signs. It makes several points about the rights of restaurants to refuse service to patrons. I had to chuckle when I read the conditions. I'll list them here and contrast how hospitals are operated differently from food purveyors.

Patrons who are unreasonably rowdy or causing trouble. Have you ever been to the Emergency Room on a Saturday night?

Patrons that may overfill capacity if let in. Patients are lined up in the hallways in gurneys and wheelchairs and yet we still admit more into the hospital. Isn't amazing how the fire department will conduct strict capacity inspections of establishments like restaurants, movie theaters, and Cowboy Stadium, yet turn a blind eye to fire safety when hundreds of people are packed into ER's?

Patrons who come in just before closing time or when the kitchen is closed. Well, we never close. Even when every hospital bed is full and nurses are walking off their jobs from sheer exhaustion. Unlike waitors and busboys, we are expected to keep working no matter how many patients we can care for safely.

Patrons accompanied by large groups of non-customers looking to sit in. If we did this every extended family member and gangbanger bro who tries to come in with their "innocent bystander" gun shot wound victim would get locked out, leaving a terrible situation for our overwhelmed and underpowered security officers to keep peace. So let them all in.

Patrons lacking adequate hygiene (e.g. excess dirt, extreme body odor, etc.) Ha ha! You haven't lived until you've smelled pus and stool and who knows what other body fluid on a homeless man who hasn't bathed for weeks and comes in with wet gangrene of his crotch.

Now which business would you rather be running, a restaurant or a hospital? I think opening a Burger King franchise may not be such a bad idea.

Friday, March 11, 2011


Our sympathies go out to the people of Japan who just suffered an 8.9 earthquake and devastating tsunami destruction in the aftermath. The videos are terrifying, even when filmed from hundreds of feet in the air by helicopter. No Hollywood special effect can match the horror victims must have felt when the giant walls of water came crashing down on them.

Living in SoCal we are acutely aware of the perils of living in earthquake territory. School children undergo regular earthquake drills. There are annual mock earthquake readiness practices conducted by the safety officers and hospitals. Yet when the real thing happens, I wonder how prepared we will really be. Can anyone really be ready for destruction on such a large scale as we're witnessing in northern Japan? Here's a page from the Huffington Post on how to donate for earthquake relief.

Yes You Can Abuse Me. I Am Your Doctor.

Doctors, why do we do this? We let our patients abuse us to a degree we wouldn't tolerate from acquaintances, friends, or even family members. You all know what I'm talking about. The verbal abuse we receive from our patients would make their mothers cry in shame and their fathers break out the hickory switch for a quick swat to the behind. Yet we just smile and continue with our jobs as if nothing happened instead of correcting this misbehavior.

I've been kicked, grabbed, spat on, and swung at with a closed fist. And I'm just the freaking anesthesiologist. If our patients attempted any of these aggressions on a police officer, they'd be hauled off to jail faster than they can scream "Don't Taze me bro'!" Why don't they understand I'm here to help? I'm supposed to be their friend and ally. I'm here to protect them from the dastardly deeds being concocted by the surgeons to rid their body of bad humors.

Sure you can say the patient's bad attitudes are a consequence of their ill health. But that is not always the case. Some of the most humiliating verbal abuse I've received have come from perfectly oriented patients, or their family. The complaints. The whining. The threats, both physical and legal. They'll think they can influence my medical judgement by declaring they have a family member who is a lawyer. Or they have a good friend who is on the hospital's board of directors.

Yet through it all we doctors continue to perform our duties. We bite our tongues and laugh about our abusers after we've treated and saved their lives. We don't need to be canonized for the work we do. But we should expect a little respect. Otherwise we just might take out our revenge by writing about it in a medical blog.

Thursday, March 10, 2011

Wacky Doctor's Note

Doctors are notorious for writing illegible notes in the charts. Sometimes you have to wonder if they even bother proofreading their chicken scratches. Take this note I saw. While clearly legible, it raises the question whether the doctor or patient is the one that is altered. Under the subjective examination, the physician described the patient as being both "alert" and "confused". Hmmm. Now I'm confused. Or maybe I'm alert and the doctor is confused. Or maybe the patient is alert to the fact that he is confused. A conundrum indeed.

Another Insurance Scam

I hate insurance companies. But this one is personal. It's not because of the negligible reimbursements they try to deny doctors while paying their company officers millions of dollars a year. No, this time it's about how they treat me as a health insurance member.

As some of you readers may know, I recently moved into a new house. It is a very nice house. It is a very lovely house. It also moves my family into a new zip code. A "better" zip code with better schools, better streets, better crime statistics, and just all around better. As part of the process of moving, I notified my insurance carrier about my change of address. "No problem," said the customer service rep who helped me over the phone. "Oh, by the way," he said at the end of the conversation, "your insurance rates will go up with the move." "Why?" I asked dumbfounded. "It's because of your new zip code." Huh? "What does my zip code have anything to do with my health insurance premiums? I have never used my insurance for anything. I've never been hospitalized a single day in my life. I don't take any prescription medications or have any chronic illnesses. Why are the premiums being raised?" "I don't know," was his reply. "I'm just letting you know about the increase. Will that be alright?"

Naturally he wouldn't know the reason for the rate increase. He's just a customer service rep, not the actuary who crunches the numbers to come up with the real reason for the rate hike. My personal suspicion is that my new neighborhood has an older population than the previous one. Therefore people probably use their insurance more often here than in the old neighborhood. But I'm still miffed. California has a law prohibiting insurance companies from using zip codes to determine car insurance rates but somehow the lawmakers didn't make the same rules for health insurance. Then I got a letter from the insurance carrier last week that my health insurance rates are going to go up 17% in a couple of months on top of my already increased rates. They cite the usual blah blah about rising medical costs, higher utilization rates, sicker patients...

What happens when ObamaCare kicks in and everybody is forced to purchase insurance from these rascals? What will happen to the country when insurance companies continue to raise rates every year on a product people are legally obligated to purchase? Either you pay the insurance companies a ransom to stay within the law or you're fined by the government and have to pay a penalty because you can't afford their rising premiums. Will there be a debtor's prison for people who can't afford rising health insurance premiums and can't or won't pay the government penalty? Where will this madness end?

Wednesday, March 9, 2011

Colonoscopy With Friends

Did you know March is Colorectal Cancer Awareness Month? I didn't either. Then I got this email in my inbox. The company that sent the spam is in the business of helping the elderly with living assistance in their own home. I guess as part of their public service, they are promoting the concept of colorectal cancer screening as a bonding experience amongst friends. (I am not endorsing this company. I just thought their email is amusing.)

The idea certainly has merits. Imagine sitting around with your buddies the night before your colonoscopy in front of the giant screen TV watching Ultimate Fighting Championship. Instead of chugging beer, everybody is downing ice cold drafts of Golytely. Yum. Then you can chase that down with shots of green jello. You could even make some kind of drinking game out of it. Every time somebody gets body slammed into the cage everybody has to drink another pint of the bowel prep.

The next day, have a bet who has the cleanest colon. The loser has to buy an In N Out triple-triple animal style for everybody in the group after the procedure. I think with with a game like this there would be greater compliance with screening for colon cancer, the second leading cause of cancer deaths in the United States. So be creative. Have fun. Anything you can do to make this milestone in life more amusing is worthwhile.

How You Know You Are Paying Your Nurses Well

How do you know if you are paying your nurses in the hospital well? When the nurses' break room resembles a Louis Vuitton showroom. These large LV bags on the table easily cost over $1000 each. I'm glad our nurses can enjoy a nice reward for all the hard work they put in around here.

Wednesday, March 2, 2011

Dr. Emery Neal Brown

It's not often anesthesiologists get a write up in the press. It's even rarer that we are mentioned in an article that's not about impaired physicians or enablers of prescription drug abusers. So it is quite refreshing to read a New York Times article about Dr. Emery Neal Brown, a professor of anesthesiology at Harvard Medical School.

Dr. Brown is very frank about why he chose anesthesiology. He states he likes the fast pace of the profession. Unlike most other medical fields, anesthesiologists also have relatively more predictable work hours with which he can indulge in his other love, research. That line should be used for every medical student aspiring to get into an anesthesiology residency.

He talks about his work into the neurophysiology of anesthesia. He frowns on telling the patient they are being put to sleep. Instead he prefers the euphemism reversible drug-induced coma. Being put to sleep is for the veterinary hospital, not the Veterans Hospital. He also discusses the difficulty of conducting anesthesia research on live human beings. I never really thought about the ethical dilemma of conducting research in anesthesia--is it proper to give a patient anesthesia only for research purposes if the patient is not undergoing surgery? He has a very interesting, and ingenious, solution to that problem.

So go ahead and surf over to the NYT. Feel good about all the great men and women who keep our field at the forefront of medical research. Perhaps you too may feel a little inspiration in becoming a better anesthesiologist.