Wednesday, May 29, 2013

Can Oral Sex Be Considered Sound Medical Advice?

J. Peter Zegarra, M.D.
This story has been making the rounds for a couple of weeks. However, to me it is so amusing and ludicrous that I can't help writing about it. A Sacramento surgeon has been reprimanded by the California Medical Board for giving bad medical advice. Dr. J. Peter Zegarra had advised a patient to get an EGD. The patient said she was hesitant to get the procedure done. She complained that she has a very strong gag reflex and would have difficulty getting through it. In response, Dr. Zegarra, in front of the patient's husband, told the patient to perform oral sex twice a week to suppress her reflex. Let's just say the patient was not amused.

She brought the matter to the Medical Board. They too failed to see the humor in all this. Says Cassandra Hockenson of the Board, "This constituted unprofessional conduct, and so this is a message that probably wasn't appropriate."

This incident raises a few questions. It makes me wonder about the doctor's relationship with the patient and her family. Had they known each other for a long time and that's why he felt he could openly suggest oral sex to her and her husband? I can't imagine giving a patient advice like this after meeting with them for fifteen minutes. But if she had been his patient for years, maybe he felt less inhibited about saying something as politically incorrect as this. What was the husband's reaction? Did he laugh out loud when the suggestion was made knowing that it was just a joke? Or did he jump with glee thinking about how he would help his wife follow her doctor's orders? What was the patient's reaction when he first suggested fellatio as a medical aid? Did she run out of the office in tears at the horribly inappropriate words she got from her doctor? Did she attempt it at home and didn't like it so she referred the matter to the Medical Board as revenge? Or did she also initially saw this as a bad attempt at humor then later on decided it was wrong enough to bring the doctor's name to the attention of the Board?

I guess we'll never know the answer to all these questions. However, I do have one suggestion for Dr. Zegarra next time a patient complains about a strong gag reflex. Viscous lidocaine. Simple. Just ask an anesthesiologist and he would have saved your hide and good name and prevented this whole shameful episode.

Monday, May 27, 2013

The Dirty Secret Of Biometric ID's

Our hospital recently installed new Pyxis drug dispensing machines. These babies did away with the usual password for accessing the medications and instead required a biometric ID, aka fingerprint scan, to get in. It seemed like a much safer and more secure method than a password that could be easily stolen by someone looking over your shoulder while you log in.

Unfortunately the device has proved trickier than anticipated to use. The first time I tried to enter the system, it asked to scan my fingertip four times in a row to get a record. Try as I might, I just could not get it to scan properly four times. No matter how hard I pushed down on the glowing red window, it just wouldn't accept my print. It took me several days and a few different machines to finally get all four prints scanned properly.

The problems were just beginning. The Pyxis seemed to accept my fingerprint erratically. Sometimes I could get in on the first try. Other times I would pound the red window in frustration as it kept blinking and asked me to try again. This was especially bad in the mornings when I'm trying to get my drugs to get the first case of the day going. No matter how I positioned my finger or how hard I pushed down, the darned thing just wouldn't cooperate.

Then one day, one of the nurses noticed my frustrations with the Pyxis. She kindly suggested that what worked for her was to place a small dab of Purell on her finger to get it wet. Sure enough, there was a small bottle of Purell sitting right on top of the machine. I put a small drop on my fingertip and, voila, the machine picked up my print right away. I was elated. I was no longer subject to the tyranny of the blinking red light.

But the Purell wasn't entirely a panacea. Some machines didn't have a little bottle of Purell sitting on it. That meant I had to walk over to a nearby wall that had a bottle attached and put a drop on my finger then walk back to the Pyxis, usually losing my place in line, and start all over again. The machines that did have Purell on it became very messy. There would be dribs and drabs of Purell all over the top and the keyboard. It was very unsightly.

Then I had an eureka moment. I noticed that if I washed my hands immediately before I tried to use the Pyxis, the red light of pain would not register. Apparently, the computer requires a certain amount of sheen or reflection off the skin to record a fingerprint. So where could I conveniently get some liquid to wet my finger without hunting down a Purell bottle or walk to a sink to moisten it and bring it dripping back? Hmm. Can you guess? That's right, I stuck my finger into my mouth and gave it a quick lick. Desperate times call for desperate measures.

Furtively, while watching to make sure nobody was looking, I did just that and smashed my finger onto the pad. Bam. It worked right away. I got my drugs then quickly found an alcohol pad to wipe down the machine. So now I know the reason for the difficulty in accessing the Pyxis. But I didn't want to lick my finger every time I needed to check out drugs. That was just too gross to contemplate.

Then I tried a different tactic. I just need something to make my fingerprint shiny for the red light to bounce off so the machine can analyze it. Instead of using saliva, how about a bit of grease? I just washed my hair so I couldn't use that. But I figured if I rubbed my forehead with my finger, I can get just enough skin oil to allow the Pyxis to work. Plus it's not as unsanitary as using my saliva. It can't be any worse than shaking somebody's sweaty palms now, can it? Sure enough, the greasy forehead trick worked just as well.

So next time you confront a biometric ID, you'll know the secret to logging in quickly and accurately. Just make sure you wash your hands afterwards unless you want somebody's DNA stuck on your finger.

Tuesday, May 21, 2013

Anesthesiologists Prefer The Natural Look

Why do women think they need to come for surgery looking like this?
One thing I've never understood is why women feel the need to get all made up before coming for surgery. They come to preop with heavy powder plastered all over their faces. Overly abundant mascara and eyelash extenders obscure their eyes. Fingernails are painted with black or dark red polish, looking like they're ready for a night out on the town. Who do they think they are going to impress?

When I see a girl come for surgery with a ton of makeup on, all I can think of is what a mess this will become by the time I'm finished. First of all, that dark fingernail polish? It is a total pain in the ass. Half the time my pulse ox monitor can't pick up the patient's arterial flow and I'm left with readings that normally would suggest incompatibility with life. I then have to scrounge for fingernail polish remover and wipe away the polish to properly monitor my patient.

That ruby red lipstick that looks so cute when you go out clubbing? That stuff gets smeared all over my equipment. It spreads onto my gloves, my face mask, my laryngoscope, and inevitably onto those teeth that their dentist just charged a bundle for whitening. By the end of the operation, that lipstick looks like it was applied by a five year old in a moving car.

And those eyes. Why must women put on false eyelashes and mascara before surgery? When I tape the eyes during surgery to prevent corneal abrasions, the makeup and eyelashes become adherent to the tape. It's not a pretty sight when I pull the tape off afterwards.

So for all the women who are about to undergo anesthesia, please don't put on any makeup the morning of the operation. You're not going to find Mr. Right while you're being prepped for surgery. Plus we promise we will provide great care even if you don't look like Kim Kardashian.
What makeup looks like after surgery.

Friday, May 17, 2013

Suspended From School And Hoping To Become A Doctor

The Los Angeles Unified School District made national headlines this week when it banned the practice of suspending kids from school for "willful defiance." The district felt that sending children home from school for acting out was detrimental to their education and discriminatory to minorities.

The use of willful defiance was criticized by students such as one Damien Valentine, a sophomore in high school and profiled in a recent LA Times article. Mr. Valentine, 16 years old, has been suspended from school multiple times since he was in 7th grade. He said he was suspended for talking in class and not switching chairs when the teacher asked him to do so. Says Mr. Valentine, "Getting suspended doesn't solve anything. It just ruins the rest of your day and keeps you behind." The young man says he likes chemistry and hopes to be a doctor one day.

He says he wished his teachers had spent more time talking with him and helped him control his ill temper. Now he is joining a program in the school district that attempts to mediate the difficult relationships of teachers and students. When students misbehave, instead of kicking them out of class, the teacher and students write letters to each other explaining their actions and how the animosity should be resolved. Says one of the proponents of this new compassionate teaching, "Instead of punishing students, we're going to engage them."

Excuse me if I don't buy into this new touchy feely form of discipline, if you can even call it discipline. When I was little and I acted out in school, the teacher did engage us, with a forced march to the principal's office where the big wooden paddle was just waiting to be taken down from behind his desk. If he didn't do it, I was sure that the note that was sent to my parents would lead to the same actions at home. There was none of this "but the teacher was unfair and doesn't understand me" business.

So Damien Valentine thinks he can get into medical school despite multiple suspensions on his academic record? His denial of his own culpability is beyond belief. He hasn't yet realized that his own actions lead to his suspensions, which most surely ruins his day and all future days. And responsible adults who should know better are abetting his delusions by letting him think it is the teacher's fault that he is getting kicked out of school. If this is the pool of students from which future physicians will be selected, the malpractice lawyers are going to have a field day.

Tuesday, May 14, 2013

Anesthesia Illustrated

Okay this is pretty cool stuff. Anesthesia Illustrated is a project of the Stanford University Anesthesia Informatics and Media Lab. The website broadcasts all the lectures that were recorded over the course of the three year anesthesia residency at the university. This is amazing work and it's all free, for now.

The videos cover a broad spectrum of topics. While many of them seem to be about obstetrics anesthesia, they range from the very basic, like how to properly induce anesthesia, to the complicated, like pediatric cardiac anesthesia.

This is almost like getting a Stanford anesthesia residency education for free. Between these webcasts and simulations as learning tools, young doctors in training may never have to talk to or touch a real live human being before they start their practices. 

Saturday, May 11, 2013

Porsche-Physician Social Mixer. For Shame LACMA.

I recently received this flyer from the L.A. County Medical Association. It is an invitation for an upcoming networking mixer sponsored by LACMA to be held at the Beverly Hills Porsche dealer. My readers know that I am a huge fan of Porsche cars. However I felt that this event is a bit inappropriate and broadcasts the wrong statement about the real purpose of LACMA and its members.

To me, it seemed to imply that the regular educational conferences held by LACMA was not interesting enough for more members to attend. Isn't that where doctors should be doing their networking? Is this an indictment on the quality of the speakers they invite to their usual meetings? What does Porsche think they will get out of this? Don't tell me that the dealer will rent out space to a bunch of doctors out of their appreciation for medical education. They are hoping to snag a few sales from some of the assembled MD's. Is this any different from drug companies sponsoring "educational dinners" at a fancy restaurant?

Holding a gathering at a Porsche dealer also sends a bad message. When we are fighting tooth and nail to keep our reimbursements stable, much less keeping pace with medical inflation, what kind of image does that send to Congress, insurance companies, and the public about physician incomes? LACMA should know that image, especially with Hollywood in its backyard, is everything. While doctors complain about how Obamacare will devastate physician salaries, they are holding a car and wine party in Beverly Hills.

Now I'm not saying that LACMA should have a mixer at the local Kia dealer. But perhaps it would have been more suitable to hold a meeting in a less conspicuous and blatantly consumerist location. And doctors shouldn't be lured into attending just so they can be surrounded by cars that cost as much as houses in much of the country. LACMA should continue their business of physician advocacy and educational fare without creating a potential publicity boondoggle.

Wednesday, May 8, 2013

Why I Make A Lot Of Money

There is an interesting study that has been published by the online recruiting site TheLadders. After analyzing the names of their six million members, they have found that people with shorter names make more money. They don't give an explanation for this finding. Maybe it is all just a publicity stunt. But it is still worth a look.

According to the firm, the highest paid male names all have five letters or less: Tom, Rob, Dale, Doug, and Wayne. The top five female names also tend to be shorter though there is less of a correlation: Lynn, Melissa, Cathy, Dana, and Christine. In fact, when they analyzed the numbers, they found that for each letter that a name is lengthened, the person makes $3,600 less per year.

TheLadders also found that people who use shorter nicknames make more money than the corresponding longer names. Bills make more money than Williams. Debbies make more money than Deborahs. Philips earn more than Phillips. Again no reasons are given for this.

This must be the reason why I make a lot of money. Other than the fact that I am an anesthesiologist, I have an extremely short first name. Are you ready to find out what it is? My first name is spelled--D-r. But you can call me Z, which is even shorter and more portentous of future fortune. A website that I had never heard of before wouldn't lead me wrong, would it?