Saturday, January 31, 2009

What Happens in Vegas...Only Happens in Vegas

For some reason, I have been intrigued by the public demonstration of psychopathology called Ex-Illinois Governor Rod Blagojevich. This guy is the poster child for the DSM IV Axis II diagnosis of narcissistic personality disorder.From the pompadour hair to the old western movie image he has of himself, it has been interesting--like watching a train wreck interesting.

Now, comes the humor...and it comes from Las Vegas. The Las Vegas Wranglers, an ECHL farm team for the Calgary Flames, has designated the January 30, 2009 hockey game against the Bakersfield Condors as "Rod Blagojevich Prison Uniform Night." The Wranglers and the Condors will wear prison garb as shown in the photo above. Also, the ECHL referees will dress like prison guards. I find this funny as hell. In these days of economic turmoil and human strife, we have to have something to laugh at. And there is nothing better to laugh at than the "ILLGOV" (the name on the Las Vegas Wranglers sweaters) who is soon set to stand trial for attempting to sell Obama's former senate seat to the highest bidder. This is funnier than Monica Lewinsky doing one of those "Got Milk?" ads with the white mustache above her upper lip.

Monday, January 26, 2009

Travolta Extortion Is a New Low

While it is OK to sit from afar and question the impact of Scientology practices and dogma on the death of John Travolta's son Jett, trying to profit from it is wrong and unethical. It appears that Bahamian "ambulance driver" Tarino Lightbourne and Bahamian Tourism Minister Obie Wilchcombe (not to be confused with Obi Wankanobe) tried to extort $20 million to keep a cell phone image of the dead teen (taken by Lightbourne) from being released to the public. Also, the co-conspirators were threatening to leak "circumstances surrounding Jett's death" to the media. What scum these two are! As an EMT (or medical professional) patient confidentiality is a prime directive. First, using the cell phone was wrong (who was doing CPR)? Second, trying to profit from it was wrong. In terms of the Tourism Minister, he was reportedly a friend of the Travolta family. It is amazing and a shame how greed ruins people. I hope the bastards get what they deserve.

Along the same lines, it may be time to ban cell phones with cameras from ambulances and hospital patient care areas. Just try and use a cell phone camera in a Las Vegas casino and you will be quickly contacted by security. We cling to our cell phones, but, like anything, they are misused.

Thursday, January 22, 2009

Clinically-Depressed Poodle Mauls Former French President Chirac

I don't care who you are, this is funny as hell!

Former French President Jacques Chirac was rushed to a hospital after being mauled by his pet dog who is being treated for depression, in a dramatic incident that rattled the ex-president's wife.

The couple's white Maltese poodle, called Sumo, has a history of frenzied fits and became increasingly prone to making "vicious, unprovoked attacks" despite receiving treatment with anti-depressants, Chirac's wife Bernadette said.

"If you only knew! I had a dramatic day yesterday," she told VSD magazine. "Sumo bit my husband!"

Mrs. Chirac, 74, did not reveal where the former president was bitten, but said, "the dog went for him for no apparent reason."

"We were aware the animal was unpredictable and is being treated with pills for depression. My husband was bitten quite badly but he is certain to make a full recovery in weeks."

Chirac was taken to a hospital in Paris where he was treated as an outpatient and later sent home.

The 76-year-old was president of France for 12 years until 2007.

Quel grand chien !

Wednesday, January 21, 2009

Microsoft Hell

I was excited. My new version of Photoshop CS4 was delivered by the UPS dude. I opened the package and popped the DVD into my desktop computer. Immediately an error code came up saying that I needed to upgrade Windows Vista with Service Pack 1. So, I ran Windows Update and, as you might think, the Service Pack 1 wouldn't load. I got a plethora of 10 digit error codes that made as much sense to me as the IRS Tax Codes. I was starting to get frustrated.

So, I Googled the error codes on the net and read several geek posts about how to fix the problem. None seemed to agree and I followed their advice to no avail. So, I checked the Microsoft web site. Much to my surprise they had a free Windows Vista Service Pack 1 upgrade assist center. I logged on and eventually somebody with the name "Sirinivasin" came on line and said his name was "Mike." OK. I answered his questions and he remained perplexed. I allowed him to log on to my computer with Microsoft Easy Assist. He checked numerous things on my computer. Finally, he downloaded a Freeware product and did something. Then, he rebooted the computer and the connection was lost. When my computer came back up, everything was in turmoil. I was now officially angry.

The phone rang and it was some fellow named "Bob" with an Indian accent so thick I couldn't understand a word he was saying. Ultimately, he spoke slowly and I caught what he was saying. We tried a few things and he finally said somebody would call back tomorrow. I hear the chatter of an Indian (dot, not feather) call center in the back ground. He suggested I reinstall Windows Vista. Thus, I did that all night long.

At 8:00 AM a fellow named "Mike" called back. He made some suggestions. Download this, try that, reboot this, uninstall that. Nothing worked. He would give me a task (which would take an hour or so) and then call back. Once I completed all the requested tasks, he quit calling. I was now entering a degree of "pissed off" heretofore unseen. I went for a walk.

Next, I logged back in to the Microsoft Vista Service Pack 1 help center. This time a helpful fellow named Poovasin answered. He said his name was "Jay." He had me run through the same procedures I did before--all to no avail. Then, as I do, I became a smart ass. I told him I was frustrated and he said, "I am extremely sorry you feel that way." I answered, "It is not your fault. It's Bill Gate's fault." He answered that he would have their best tech call tomorrow. I asked, "Should I buy a Mac?" He answered, "Wait until our best tech calls. He can fix the problem." These guys are actually nice and put up with as much shit as a female Asian blackjack dealer in Las Vegas.

I actually have a Mac Book Pro laptop. I use it some. But, I have alot of money invested in high-end Windows programs (e.g., Photoshop CS, Adobe Illustrator, Quark Express). I have VM Fusion on the Mac (which allows yu to also run Windows Vista and Windows programs). I just have not made the decision to go exclusively with Mac. I won't by a damn Dell. Then, it hit me. I am in Microsoft hell! It is like the roach hotel--you can check in, but you will never check out. This sucks and so does Microsoft.

P.S. This post was written flawlessly on a Mac Book Pro. My Sony Windows desktop is repeatedly processing an endless loop of attempting to install Window's Vista Service Pack 1.

Monday, January 19, 2009

What's With the Chiropractors?

I have never had any strong feelings about chiropractors either way. Live and let live I have always said. I have a friend who is a chiropractor. He is a nice guy and fairly conservative. I know another chiropractor that got a mail-order MD from a Caribbean medical school and puts MD on his building although the state will only license him as a DC. He has sent some patients to the ED in the past. The most recent case in memory was a supposed cervical fracture. The patient arrived by ambulance with a backboard applied. The x-rays from the chiropractic clinic were very weird views. I could not tell squat from them. So, I scanned the patients neck with the spiral CT. I found nothing other than degenerative joint disease. The patient was most relieved. She had no history of trauma and was perplexed as to how shoe has "broken her neck" as the DC stated. But, in all professions there are good and bad practitioners. Live and let live.

Interestingly, not long ago I was talking with a physician friend. His son could not get into the medical school or osteopathic school. Thus, he went to chiropractic school. Upon graduation, his father gave him office space in his medical building and he started a practice. Supposedly, the chiropractic son was also trained in chiropractic neurology (whatever that is). Later I met the son. He was a great guy--but disappointed with his choice of chiropractic as a profession. I spoke with him at length. He lamented that all he could do was crack backs (called "adjustments"). He stated that the chiropractic concept of "subluxation" is pure baloney (this differs from real subluxation--which is a serious condition). His residency training in chiropractic neurology was some weekend courses. He said that his chiropractic education was almost evangelical in nature--heavy on faith and light in science. That surprised me as some states call chiropractors "physicians".

He went on to say that more than half his class (they evidently graduate 3 classes a year) did not enter practice after graduation. Furthermore, he said the average debt of a chiropractic graduate is in excess of $100,000. Also, almost half of the defaults for the federal Health Education Assistance Loans (HEAL) are chiropractors. What gives? Why spend all your time in school and incur the debt and not practice?

My friend's son recently learned that he had been finally accepted to an osteopathic school. He is closing his practice and becoming a physician. The osteopathic school would not give him credit for any of his chiropractic training so he has four more years of school to finance. But, he appears to be fulfilling his dreams.

I truly believe there is some role for physical therapies in musculoskeletal conditions (especially low back pain). But, does it take 3 years to learn to do nothing but pop backs? At least in osteopathic school, my chiropractor friend will master medicine and manipulation (he will soon learn the significant acadmic difference between medical school and chiropractic school). Interestingly, in Australia and New Zealand, physiotherapists (physical therapists) with 3-year bachelor's degrees do manipulations. But, live and let live. If chiropractic works for you and doesn't harm you, go for it. But, I am not sure that government programs should pay for it as the scientific evidence for the practice does not exist as best I can tell.

Sunday, January 18, 2009

Just In Case You Were Wondering

Best places to see a platypus:

1. Hidden Valley Cabins (Queensland)

2. Nymboida River (New South Wales)

3. Bombala (New South Wales)

4. Lake Elizabeth (Victoria)

5. Mountain Valley Private Nature Preserve (Tasmania)

6. Latrobe (Tasmania)

Friday, January 16, 2009

Emergency Department Abuse

Overuse of the emergency department (ED) is primarily an American phenomenon. While many hospitals EDs are busy worldwide, we Americans simply use the ED for convenience. While we physicians are justifiably wary of socialized health care (a health care system run by the US government would have the efficiency of the US Postal Service and the compassion of the IRS), the current system is not working. There are several things that must change before ED overcrowding will get better:

1. There has to be a network of primary care physicians who truly act as primary care physicians. The current payment scheme in the United States favors doctors who do procedures. So, you see this slow migration of family practitioners away for standard care to procedure-based care. You get paid more to remove moles than see a sick baby. The Advanced Practice Nurses are moving into primary care and doing a good job.

2. There is no true indigent care system in the United States. Here in the land of plenty, the poor still receive inadequate health care. Sure, a few organizations like Catholic Charities and the Salvation Army help, but the only source of health care for some poor people is the ED. The government, through unfunded mandates such as EMTALA and OBRA, require hospital EDs to treat all patients. Even public hospitals are covertly shunning the indigent and trying to recruit paying patients. This is nothing but cost-shifting and it costs hospitals billions of dollars. The most expensive place in the United States to receive health care is the ED. So, why do we send primary care patients there? Even community physicians routinely dump their non-paying and complicated patients on the ED. The ED physician is usually not a great primary care physician. I am the doctor you want to see when you are seriously ill or injured. I am not the doctor you want to see to manage your chronic hypertension or diabetes—I haven’t kept up with that science.

3. Community physicians routinely send patients to the ED who can be managed in their offices or by phone. You see a trend with primary care physicians. First, when out of residency, they are hungry and eager and do a good job of covering their patients. As they get older and their practices grow, they become less interested in seeing patients outside of office hours. Also, some community physicians will dump their patients on the ED when the work-up is complicated or they are not up on the science.

4. Interestingly, several studies have shown that people with insurance are just as apt to abuse the ED as the indigent. They see insurance as something to be used. They can get care immediately and fairly quickly in the ED with a modest co-pay instead of making an appointment with their family doctor. I see both indigent patients and the insured as equal culprits in EM abuse.

5. We can’t talk about ED crowding without blaming the lawyers. Once a patient enters the magic world of the ED, the ground rules change. Because of liability concerns, we have to assume that every patient who comes to the ED has some catastrophic condition. Once we exclude that with costly diagnostic tests, we can then give them a diagnosis and provide treatment. In a family practice clinic, a physician can examine a headache patient and carefully plan treatment. In the ED, we have to scan the patients head, do a battery of tests, and sometimes a lumbar puncture to assure they don’t have a subarachnoid hemorrhage or brain tumor before we can treat their migraine headache. The State of Texas recently received the sole “A” grade from ACEP for tort reform. Tort reform has evidently made Texas a better place to practice medicine. Lawsuits are down there and malpractice premiums are down according to a recent article—and applications for medical licenses are at record numbers according to Emergency Physicians Monthly.

There are no easy solutions to complex programs. The United States emergency care system cannot be stressed anymore--for it is already breaking. Everybody needs to do their part to remedy the situation. If we wait for the government to step in, I’ll walk away and sell manure or raise shrimp.