Disqus - Latest Comments for nuclearfire

Re: VA Nurse Pay: Any Amount Is Too Much For What You Get

Zenfire — Sun, 03 Apr 2011 13:11:16 -0000

The rest of the joke is a gun is better than a VA nurse because a gun can draw blood, only kills one patient at a time and can be fired.

Re: Transferring a Patient To a VA Is An Exercise In Futility and An Embarrassment To Our Country.

Zenfire — Wed, 02 Mar 2011 19:37:32 -0000

Wait, you'd rather go without insurance than be cared for by the VA? Then why are you trying to force your patient to go to the VA?

Actually, I think the transfer policies at the VA are awesome. The specific thing you're talking about is f-ed up though and is not something that we do at my VA.

Disclaimer: I'm a VA patient and a VA ER doc.

Re: Charlie Sheen Addiction Videos Show A Man On a Rampage. God Help Him.

Zenfire — Tue, 01 Mar 2011 09:11:00 -0000

If he's been pretending to not be special, I hate to see him when he's not pretending.

Re: Efficiency of Hospital Rounds Rapidly Improved with my iPad

Zenfire — Fri, 28 Jan 2011 17:31:49 -0000

It's only $40 mil with 10% interest. Not that hard to do.

And mom says you truly are an anesthesiologist: didn't feel a thing.

Re: http://blog.jayparkinsonmd.com/post/2927995422

Zenfire — Fri, 28 Jan 2011 16:55:24 -0000

Finally found it, in The Atlantic:
"Sucides amongst military reservists have become a concern; a Pentagon study earlier this year showed that "reservists lack the support structure that active-duty troops have," says Donnelly. For its part, the US Army supplies us with this information about its forces: "Suicide is the fourth-leading cause of death among 25- to 44-year old people in the United States. Historically, the suicide rate has been lower in the military than among civilians. In 2008 that pattern was reversed, with the suicide rate in the Army exceeding the age-adjusted rate in the civilian population (20.2 out of 100,000 vs. 19.2)."

Key points:
among reservists
typically military lower than civilian
"high" rate is 1/100,000 more than civilian population

Re: http://venomousporridge.com/post/1443199503

Zenfire — Thu, 27 Jan 2011 12:01:27 -0000

I'm pretty sure he's just mocking Fred Phelps.

Re: WSJ: Electronic Medical Records Don’t Improve Outpatient Care Quality

Zenfire — Tue, 25 Jan 2011 21:26:33 -0000

EMRs don't do that. None of them talk to each other. Even the Federal VA system is broken up in to VISN (pronounced visions) that are not compatible, so when a doctor buddy at a VA in KS calls to ask me to review his patient's records, I can't from a VA in Colorado.

What Jay is saying is that we are being given the bait and switch.

Re: http://blog.jayparkinsonmd.com/post/2927995422

Zenfire — Tue, 25 Jan 2011 21:21:58 -0000

So what does this mean? The military so safe that it's more likely you'll die of suicide than in battle? The suicide rate is so high compared to the regular population that you're even more likely to die by your own hand than the enemy?

Unfortunately, we can't know since the linked article only has raw numbers without incidence and prevalence rates and doesn't compare this to a matched general population.

Re: http://blog.jayparkinsonmd.com/post/2909878070

Zenfire — Mon, 24 Jan 2011 13:19:50 -0000

Great advice. My physician father told me the same thing. Glad I took his advice. Still, if I could do it again, I'd have done computer science.

Re: George Clooney contracts malaria following Sudan trip

Zenfire — Thu, 20 Jan 2011 22:53:03 -0000

Or we could start using DDT again and save millions of lives.

Re: Efficiency of Hospital Rounds Rapidly Improved with my iPad

Zenfire — Tue, 11 Jan 2011 10:02:13 -0000

Good points. Thanks.

Re: Efficiency of Hospital Rounds Rapidly Improved with my iPad

Zenfire — Tue, 11 Jan 2011 10:01:34 -0000

Hi Frank. I was offered NSG and cards. Turned them down cause I didn't need the money. Born with a trust fund that pays more in interest than you make in a decade. Do they still have doctor anesthesiologists? The nursing ones are so much easier on the eyes, better at their job and you can pay them a lot less. They probably know the difference between "your" and "you're" too. Sure is an honor to be talking to a living fossil.

Re: Efficiency of Hospital Rounds Rapidly Improved with my iPad

Zenfire — Tue, 11 Jan 2011 07:56:35 -0000

I'm sorry. I really don't understand what you mean. Literally, I don't get it: "And if you write everyone odd as too confused, uninterested, or uneducated to bother talking to much, I do believe that will impact both the physician/patient relationship, and at times, the quality of care."

When I read Happy's post I hear: "wow, using this new technology, I can do my job more efficiently, which could lead to all sorts of improvements like being able to see more patients, make more money, cut out waste in the system." How can you be upset about improved efficiency in anything? Nothing wrong with that, but I'm sensing you hear something different. A bad experience with a physician before?

You're right. I am a younger doctor. I don't care as much about how people perceive me. If they don't like me, they can go elsewhere. In fact, I feel this worry among doctors is a large problem in medicine. We're so damn worried about the perceptions of others it keeps us from doing a good job. I'll give you two examples.

Older doctors are all afraid about having patients read our notes "because they won't understand." Younger doctors like myself want patients to be able to access their entire medical record electronically. WIll they see that I wrote that they're an "obese white female"? Yep. They may get upset, but it starts the conversation about what obese is and why it's documented.

Two, physicians consistently don't tell patients the difficult stuff like you're fat, you're a sedentary lump, you're smoking is killing you. Study after study shows this, but in my practice and training, the few who tried, nicely, politely, professionally, time after time got yelled at or nasty complaints written about them...so they stop. We aren't here to be your friend. Sometimes, we do have to say things that are hard to hear. That's the job.

Personally, as a patient, I can't stand the politely professional but hiddenly distant older physician. I want the brutally honest guy who comes in a says Nuclear, you're a lazy fat lump who needs to get off his butt and exercise.

As I re-read his post over and over, I just don't hear the attitude you're referring too.

Re: Two Americas.

Zenfire — Mon, 10 Jan 2011 21:02:58 -0000

First, I'm not "writing it off" as tragic. It is a tough issue and I felt Jay was writing it off by demonizing those on the opposite side of the issue as him. As a father of a young son and having watched the interviews with the father of the slain child, I could hardly flippantly disregard thoughtful commentary on this.

When it comes to guns there are philosophical/political issues and practical issues.

Personally, philosophical issues trump for me. I'm an admittedly hardline guy who believes that the founders wanted citizens to have weapons for the purpose of self-protection and for overthrowing totalitarian governments (I in no way think our government is even close to that, as bad as it may be). I think that this is a very important freedom (the first protects the second and the second the first) and worth some risk. Guns are specifically designed to kill. Evil and violence is a part of this world. Some like myself believe that violence and the threat of violence are necessary tools to use against those who are evil including the government (with all due respect to the NRA, the second amendment was not about hunting).
I strongly disagree with the sentiment that something is bad and can result in death, therefore we need to make it illegal. Many things are dangerous and can be used to kill (hammers, screwdrivers, fertilizer and gasoline) or accidentally result in death (cars, planes, bungee jumping). Just because something is dangerous does not mean it should be outlawed. The balance between risk and reward must be considered.

There are also practical issues. Many on both sides will get into arguments over statistics about if gun control laws decrease violence or increase it. If laws that reduce legal guns do anything to reduce illegal ownership or if reducing guns does reduce overall deaths or just switches the etiology of death to a different instrument.
On my side of the issue:
Kenya has extremely strict gun control laws, has seen massive influx of illegal weapons in the last decade and has a high murder rate from guns.
Mexico also has strict gun control and yet very high murder rate from guns.
Countries like Switzerland, Norway and New Zealand had lax gun laws but do not have high murder rates with guns.
Many cities in the US with the strictest gun control or bans (pre-Keller) have the highest homicide rates with guns while others with high gun ownership have low rates.
Blah blah blah.

I'm sure there are many statistics and examples on the other side of the issue too.

I'm not sure we'll ever really know the right answer. Many books have been written on both sides of the issue and we could prostitute statistics all day long to "prove" our points and get nowhere.

Will either of us change the others mind, nope. Do I think those who want to ban guns are unintelligent or immoral? Only when they demonize those they've never met who disagree about the issue.

From the father of the 9yo victim: “This shouldn’t happen in this country or anywhere else, but in a free society, we’re going to be subject to people like this, so I prefer this to the alternative.”

A gun didn't kill that girl. An evil (or mentally insane) person did. He could have just as easily done it by driving a car into the crowd or using a homemade bomb.

Re: Efficiency of Hospital Rounds Rapidly Improved with my iPad

Zenfire — Mon, 10 Jan 2011 11:41:01 -0000

Happy is speaking to physicians who realize that most of our work occurs away from the patient. Checking labs or vitals, reviewing other doctors notes or outside records, discussing radiology or pathology findings with the radiologist and pathologist, and worst of all documenting and finding the documentation.

He's not talking about spending less time with the patient or on their case, just less time doing stuff that wastes time. If you looked at his prior post on this issue where he talks about waiting in line to use a computer you might have realized that.

Re: Efficiency of Hospital Rounds Rapidly Improved with my iPad

Zenfire — Mon, 10 Jan 2011 11:35:38 -0000

I'm not sure doctors are against EMR in general, just the specific EMRs we get stuck with that don't work. You really shouldn't have to sell the physicians on a specific EMR; it should sell itself IF it is good. Unfortunately, I still haven't found one that its but am desperately looking for one.

Re: Efficiency of Hospital Rounds Rapidly Improved with my iPad

Zenfire — Sun, 09 Jan 2011 19:38:57 -0000

Is your hospital and IT department supporting you (i.e. supportive of you doing) with this?

Re: Two Americas.

Zenfire — Sun, 09 Jan 2011 17:42:51 -0000

No icon and no website, dash. Do you really want an answer or just trolling? Let me know before I spend the time on a reply.

Re: Two Americas.

Zenfire — Sun, 09 Jan 2011 11:16:38 -0000

How many more die in car crashes, from obesity, from smoking, etc.? Life is dangerous and these deaths are tragic but the issue deserves more intelligent discourse than scare quotes (") and insulting either the intelligence or morality of those who disagree with you.

Re: Average Hourly Earnings of Primary Care Relative To Other Specialists (Graph)

Zenfire — Thu, 06 Jan 2011 08:17:05 -0000

But this isn't primary care vs. specialty. It's procedures versus non-procedures. The missing category in the graph is non-surgical, non-procedure oriented specialties. Rheumatology, endocrinology, physiatry, neuro-ophthalmology etc. are specialties where there aren't procedures and have significantly lower pay than those with comparable education.

I don't begrudge my brothers for getting paid better. The prevailing zero sum gain, anti-speciality mentality is not good for anyone. Most of the students I teach are aware of the money difference, but it is the lack of respect, mountains of paperwork and being compared to equals with mid-levels that is far more influential in their future job choice.

I do agree that the RVU system is F'd up.

Re: iPhonECG case monitors your heart rate to make sure you're appropriately excited about CES

Zenfire — Tue, 04 Jan 2011 12:44:59 -0000

When are you going to start selling them?

Re: iPhonECG case monitors your heart rate to make sure you're appropriately excited about CES

Zenfire — Tue, 04 Jan 2011 12:44:47 -0000

Me too.

Re: iPhonECG case monitors your heart rate to make sure you're appropriately excited about CES

Zenfire — Tue, 04 Jan 2011 12:43:15 -0000

Actually, that's exactly what you need. A "standard 12 lead ECG" is just 12 different strips with the leads placed in different locations to capture different axis.

Re: iPhonECG case monitors your heart rate to make sure you're appropriately excited about CES

Zenfire — Tue, 04 Jan 2011 12:39:52 -0000

You're completely clueless. This is an electrocardiograph not a heart rate monitor. You need to be able to measure electrical impulses so you'd need two leads.

Re: Hospitalist Rounding Experience with the iPhone and iPad: Wow!

Zenfire — Mon, 03 Jan 2011 23:39:01 -0000

I use Epic also. The iPad and iPhone functionality are great, unfortunately the EMR itself is crap and yeah, I've seen the same problem with the daily identical notes. Our hospital is one CMS audit away from bankruptcy.