Don't tempt the medicine gods.

First night on call

Graham's first night on call during his medicine sub-i: "Man it sucked."

Don't worry, it gets better. An attending once told me to always look at the orders first, then the note. When it comes to things getting done, the note means nothing. This is especially true out of academic medical settings when you have several consultants and cross-covering physicians writing orders on your patient.

This anesthesiologist thinks so:

How do you protect yourself? An opiate contract! These things, for which there is no evidence of any effect whatsoever, are proliferating at a terrific rate (9). To sum it up: you compel the patient to sign a contract which states: Honestly, I'm not lying, I'm in pain. It's like asking a used car salesman if he's telling you the truth; it's not ...

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A hand surgeon comments on this vignette in the movie:

As a hand surgeon who treats many traumatic injuries, Moore's portrayal of a patient who amputated his middle fingertip captured my interest. He depicted this uninsured man as required to pay $23,000 to have his finger "saved." Moore lost considerable credibility here. Most hand surgeons would never consider micro-surgically replanting this table saw injury at the finger nail base. ...

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It's not only here that there's a critical shortage of physicians:

Japan's health minister promised to try to resolve a shortage of doctors after a pregnant woman miscarried in an ambulance during a frantic three-hour search for a hospital that would accept her.

Eight hospitals turned down the 38-year-old woman, who was six months pregnant, and the ambulance carrying her collided with a minivan on its way to ...

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Apparently, it was argued that the replacement was better:

Doctors removed the top of the man's head and put it in cold storage while they operated on his brain, the court in the western city of Koblenz said Tuesday.

Because the refrigerator was defective, the section of skull was not kept cool enough and could not be reattached. Doctors replaced the bone with a plastic prosthesis.
(via
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The punching bag of new medications takes another hit:

Analysts were forecasting blockbuster annual sales of $2bn (£1.01bn, E1.49bn) for the insulin spray. It delivered just $4m in the second quarter of 2007 "“ the first time Pfizer disclosed sales of the product.

Mickey Mouse sign



(via Radiology Picture of the Day)

More on the no-brainer study suggesting it's easier to see a dermatologist for Botox:

This can be spun in two ways. #1. Dermatologists are greedy and make patients with a potentially cancerous skin lesion wait weeks while cosmetic patients get through to the front of the line. #2. Health Insurance is willing to pay a professional with 12 or more years of advanced training as little as $20 to evaluate ...

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Exception to the rule

Sometimes urgent care visits do go right:

He listened, and expressed understanding. Then he said "doctor, I don't care how it looks when you're done...and I don't care if I have to deal with complications; as long as you do your best, I will be happy. Please try, I don't want to go to the ER...especially if you can fix it." (hmmm...can I get that in writing? Does that ...

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Health care reform

Despite the attention the issue is getting, don't expect too much to change.

Nonphysician providers are reporting healthier pay increases:

Doctors are increasingly squeezed by soaring costs and declining payments from insurers and Medicare. The slipping salaries came as primary-care physicians reported a 3.7 percent increase in gross charges, while specialists charged 2.3 percent more.

"Patients can expect to feel the pinch right along with practices as physicians in some specialties see more patients each day for incongruous pay," said William Jessee, ...

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It's US Open time, and The Independent Urologist compares income potential, threats, lifestyle and overhead for these two professions.

A link between removing the ovaries and dementia?

Researchers at the Mayo Clinic compared a group of women who had their ovaries out before menopause for reasons other than cancer with a group of similar women who didn't have their ovaries out. The women who'd had their ovaries out had a higher risk of developing several neurological problems "” including dementia, cognitive impairment and parkinsonism, which is related to ...

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Code Blog wonders aloud:

Why don't we call doctors by their first names? Is it a sign of respect to say "Dr. Jones" instead of "Fred?" Or is it a throwback to the era when nurses used to scramble to give up our seats when a physician walked onto the unit? These days, nurses work more closely with physicians than ever. We call ourselves the "healthcare team." Do teammates ...

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What's the point of enjoying the scenic living if you're on call all the time?

Typical was what one primary care doctor who recently left for an out-of-state job and a 50 percent salary hike told Mundy: "I came here knowing I'd make less money, but I did it for the rural lifestyle. I never had time to enjoy the mountains. I'll leave, make a lot more more money and ...

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A profile of "one of the most famous plastic surgeons in history", and the trail of lawsuits against him:

Few doctors can boast a résumé quite as impressive as Jacobs's. After growing up in Queens and Long Island, Jacobs attended SUNY Albany and got his medical degree from McGill University. He did his residency at St. Luke's Roosevelt Hospital Center, where he says he'd already amassed a large patient following ...

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There can be various degrees of editing involved:

Physician dictates: No tenderness present over chest
Transcribed: No tenderness is present over the chest.

Physician dictates: Came in with chest pain
Transcribed: The patient came in with chest pain.

. . . I was instructed to type exactly what the physician dictated. I only changed or edited sentences such as when doctor dictates throughout the report he or she ...

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The patient was a schizophrenic who was supposed to be restrained during the incident.

Doctors in executions

Great lengths go to shielding physician identities:

At all Florida lethal injections, a man in a purple moon suit leans over the dying inmate to listen for a heartbeat and feel for a pulse. After a few seconds, he nods, and the witnesses are informed that the death sentence has been duly carried out.

The man is a doctor and the gear shields his identity "” not just ...

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