Healthcare Update Satellite – 07-13-2015
Boy bitten by a mouse, mother brings boy and mouse to emergency department, wants rabies testing done. Nurse brings the mouse outside and lets it go. Mom fumes because no one recommended that her son go through rabies shots and that because the animal was released, now she’ll never know if the animal had rabies. She decides to put her son through rabies shots which are paid for by Medicaid. If the shots end up not being covered, she’ll ask the hospital to pay for them. Only problem is that according to the CDC, small rodents “have not been known to transmit rabies to humans”, so the child is going ...
Source: WhiteCoat's Call Room - July 13, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

14 Ways To Know Whether You Are Failing As A Hospital Administrator
I’ve been an administrator. I’ve seen hospitals in which a strong leadership team has improved the hospital’s market share and I’ve seen hospitals that have closed and that are struggling to stay open due to a failed administrative team. Here are some common traits I’ve seen in the failures: 1. You don’t know the names of the people who work in your corporation. You aren’t fooling anyone when you walk the halls without addressing people by their names. All this shows is that you don’t care to take the time to know them. If you don’t take the time to get to know them...
Source: WhiteCoat's Call Room - July 5, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Policy Random Thoughts Source Type: blogs

Healthcare Update Satellite – 06-08-2015
To increase access to medical for our nation’s veterans, the Veteran’s Choice Act authorized the VA to pay for more medical provided to veterans from community health providers. How did the VA save money in that scenario? It either “lost” claims in which providers had proof of submission or it just delayed paying the claims so that veterans would be billed for the treatment. Now providers are refusing to contract with the VA due to all of the hassles. The VA said that it was making interest payments to providers who received delayed payments, but none of the people testifying to a Senate subcommitte...
Source: WhiteCoat's Call Room - June 8, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Survey
Quick request … If you haven’t taken this short survey, it would be much appreciated. Looking to publish the results in a future journal article. Many thanks for your help. http://www.esurveyspro.com/Survey.aspx?id=8ee4bd68-04a7-4b43-b07b-652af4088ddd (Source: WhiteCoat's Call Room)
Source: WhiteCoat's Call Room - June 3, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Uncategorized Source Type: blogs

Rodent Control
A crotchety old fellow from the nursing home gets brought in for trouble breathing. After looking at the swelling in his legs and listening to the crackles in his lungs, it’s pretty obvious that he’s in congestive heart failure. We started an IV, drew labs, and performed a chest x-ray. Then he got some nitroglycerin, some captopril, and he even got Lasix just to spite all of the #FOAMed wonks. About 45 minutes later, the patient needs to go to the bathroom. We didn’t want him walking since he didn’t appear to be the steadiest on his feet, so he got a urinal. He grabbed the urinal and the nurse walked out of the roo...
Source: WhiteCoat's Call Room - May 26, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Memories …
A sweet little lady was brought to the emergency department by her caregiver after having difficulty breathing at home. She got a few breathing treatments and some steroids and was doing much better an hour or so later. When I went back in the room to evaluate her, several family members were present. “Oooh. You got the good doctor. No wonder you’re doing better.” I thanked them because … obviously they were right … but I mentioned that I didn’t recall seeing their mother in the emergency department before. “She hasn’t been here in a long time. You took care of our father.” “Oh. I see. How is he doing?...
Source: WhiteCoat's Call Room - May 20, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Healthcare Update Satellite — 05-14-2015
Morally corrupt and illegal at any other hospital, but the VA system will sweep it under the rug and absolutely nothing will happen about it. Patient in car just a few feet outside the emergency department calls emergency department for help getting out of car so that he could come in for treatment of his broken foot. Seattle VA Hospital tells him ”No, we’re not going to come get you. You’re going to have to call 911 and you’ll have to pay for that.” A fire captain and three firefighters end up coming to help him out of his care and wheel him into the emergency department. Meanwhile, the VA...
Source: WhiteCoat's Call Room - May 15, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 04-26-2015
This article questions whether Obamacare is to blame. Good way to save money. Veterans Affairs just keeps denying claims until the veterans die. Then they mark the files as “no action necessary” so that the surviving family members don’t get benefits, either. Records falsified, employee whistleblowers being retaliated against, management lying to Congress, oh, and a supervisor who required staff members to pay $30 for fortune telling by the supervisor’s wife. If you think things are expensive now, wait to see how much they cost when they’re free. Another example of the Golden Rule. EnglandR...
Source: WhiteCoat's Call Room - April 27, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite – 04-15-2015
You’ve heard of a CAT scan? Get ready for the dog sniff. Dogs can identify bladder and prostate cancer with a 98% accuracy rate when smelling male urine samples. Not into the whole dog sniffing thing as a screen for prostate cancer? A $1 screening test using gold nanoparticles 10,000 times smaller than a freckle is more accurate than PSA screenings and gives results in minutes. When blood is mixed with the nanoparticles, tumor biomarkers cling to the surface and cause clumping. I’m guessing the test will cost consumers several hundred dollars. Doctors are using scorpion venom to create “tumor paint”...
Source: WhiteCoat's Call Room - April 16, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Semantics and the $28 Million Unnecessary Test
There’s been an awful lot of Internet hullabaloo about “unnecessary testing” lately. The Choosing Wisely program keeps trying to assert that we should not perform any “unnecessary” tests. Recently, a paper was published in the Journal Academic Emergency Medicine alleging that “overordering of advanced imaging may be a systemic problem” since many emergency physicians believe that such testing is “medically unnecessary.” The paper was based on surveys that were presented to emergency physicians and the work was at least partially funded by the Veterans Administration and the National Institutes of Health...
Source: WhiteCoat's Call Room - April 10, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Policy Source Type: blogs

Healthcare Update Satellite — 03-04-2015
Homeless North Carolina VA patient comes into the ED to be evaluated for the sores on his feet. His shoes are falling apart. Nurse Chuck Maulden bandages up the patient’s feet and then gives the patient the brand new Nike sneakers off of his own feet. Chuck then works the rest of his shift in a pair of shoe covers and doesn’t say anything about it. Only way that people found out was because the patient’s family called to say thank you. We need more people like Chuck. I’m not aware of too many uses for virtual reality in medicine, but this seems to be a good one: seeing what it’s like to suffer...
Source: WhiteCoat's Call Room - March 4, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 02-10-2015
This article calls testosterone the “drug of the future” and compares its use to estrogen – which isn’t a controlled substance. One person interviewed for the article noted that “almost everything we treat in medicine is age-related. Aging is related to bad eyesight, bad hearing, bad joints, bad hearts, bad blood vessels, and cancer. We treat all of these without trying to minimize or diminish them that they are age related.” Why pick on testosterone use? Damn. Boyfriend secretly records himself having sex with his 17 year old girlfriend. Video “somehow” gets uploaded to inte...
Source: WhiteCoat's Call Room - February 10, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 02-03-2015
Thanks for the patience in putting up with my lack of regular posting. Life has been challenging lately. Still working on it. When government pays for your care, government may try to force its values on you. Learning-disabled mother of six children in England deemed at “grave” risk if she has any more children. Now the government wants to forcibly remove her from her home and sterilize her. A lawyer representing the woman stated that sterilization was “therapeutic.” This process will come to medicine sooner than you think. Just watch. Uber drivers now get to rate their passengers after a ride. When...
Source: WhiteCoat's Call Room - February 4, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 01-19-2015
Penicillin allergy? It’s associated with increased bad outcomes, but not for the reasons you think. The allergies themselves are mostly not allergies. And no, “my mother said I had a rash when I was a baby” isn’t an allergy. However, when compared with patients who don’t have penicillin “allergies”, patients with penicillin allergies have longer hospital stays and are between 14% and 30% more likely to get resistant infections while in the hospitals – possibly because the penicillin “allergic” patients are being treated with much stronger antibiotics that kill of...
Source: WhiteCoat's Call Room - January 19, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

How Can You Be Sure?
“How can you be sure?” That question stopped our discussion for a second. During some down time, several nurses and I were talking about childhood coughs. Her 6 month old child had just started daycare 2 weeks ago and has been coughing ever since. The child was put on amoxicillin and then Zithromax by her pediatrician but … [GASP] … her cough wasn’t getting any better. The nurse thought her child had pneumonia. “What should she be taking now?” I was in a particularly snarky mood, so, with a smirk, I said “probably vancomycin … maybe add gentamycin just for the gram nega...
Source: WhiteCoat's Call Room - January 13, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs

Healthcare Update Satellite — 12-16-2014
Answering the important questions … why does the flu vaccine suck this year? Keep a lookout for next month’s issue of EP Monthly which will tell you everything you need to know about influenza diagnosis and treatment. Of course, if you had read the backboard article in EP Monthly’s November issue, you’d already be doing this … Florida fire department abandons use of backboards for most trauma patients. 4 year old boy develops carotid artery dissection and left sided hemiparesis after riding a roller coaster. Fortunately, he had made significant recovery by six months. How scary is that, though...
Source: WhiteCoat's Call Room - December 17, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 12-01-2014
According to this study recently published in the journal Neurology, etodolac (Lodine) (which may have been discontinued) creates the biggest risk of the medications studied. Think hand dryers are more “sanitary” than using paper towels? Think again. Bacterial counts in the air around jet air dryers were 27 times as high as those around paper towel dispensers and stayed around for up to 15 minutes after the drying ended. Bacterial counts for warm air dryers were about 6 times as high as those around paper towel dispensers. In other words, using a public bathroom with electric hand dryers is likely causing you t...
Source: WhiteCoat's Call Room - December 1, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

An Argument With No Clear Winner
“You’re going to the hospital.” “I’m NOT going to the hospital. There’s nothing they’d do and it would cost us thousands of dollars for nothing. Besides … we have to leave. We’re already late.” A husband was attempting to attach the family’s camper onto the trailer hitch of the family’s truck when the trailer slipped. His middle finger didn’t make it out of the way and got caught between the ball of the trailer and the top of the hitch. When family members helped him pull the camper back off of the hitch, they saw a lot of blood. Then the last portion of his middle finger dropped from inside the t...
Source: WhiteCoat's Call Room - November 23, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Healthcare Update Satellite — 11-04-2014
Back with more of the Ebola Chronicles … Ebola fears causing discrimination problems all over the US. Thomas Duncan died from Ebola. Now his fiancee is having difficulty finding a place to live as landlords are refusing to rent to her. People of African descent are facing discrimination just because they are from Africa. Mothers of some school children told one African cafeteria worker to leave the school because she “might have Ebola.” In Liberia, bleeding patients are often refused medical care due to Ebola fears. The picture at the link shows a picture of a woman who was bleeding heavily from a miscarr...
Source: WhiteCoat's Call Room - November 4, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 10-21-2014
This study makes a good case for requiring orthopedic evaluation in the emergency department for every pediatric patient suffering from any type of bone or joint injury – regardless of the time of day or night. What no one is telling you about Ebola … from a Hazmat Trained Hospital Worker. The gear used to protect providers from Ebola is difficult to put on, difficult to remove, and can usually only be worn for 30 minutes at a time. The medical providers in Dallas who contracted Ebola had no protocols in place and this author believes that the “system failed them.” Patients apparently believe that b...
Source: WhiteCoat's Call Room - October 21, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 10-13-2014
More medical news from around the web on my other blog over at DrWhitecoat.com So what are medical providers supposed to do if they are faced with a potential or actual Ebola victim? Who knows? Here’s a case you don’t see every day … Patient transferred to University of Alabama Medical Center after having what was thought to be a hand grenade embedded in his thigh. He wasn’t allowed in the emergency department, but was instead treated in an ambulance in the parking lot for more than six hours as a military consultant advised medical personnel how to remove it. Eventually was determined to be the 40...
Source: WhiteCoat's Call Room - October 13, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 09-30-2014
This article mocks some of the entries in the government’s new ICD-10 coding scheme. For example, “Bizarre personal appearance” is actually a codeable diagnosis. Estimates are that the costs for a doctor’s practice to change to the new coding system will average from $56,000 to $226,000. And sure, being required to differentiate between Orca bites and piranha bites or between first and subsequent run-ins with a lamp post may seem idiotic to most people, but if the coding isn’t accurate, it gives the government the ability to allege that there was false billing and to levy huge fines or even im...
Source: WhiteCoat's Call Room - September 30, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

How To Discourage A Doctor
This study showed that time lost in dealing with electronic medical records was “large and pervasive”, costing physicians an average of 48 extra minutes a day – during which they could have been performing other tasks such as patient care. I’m sure that hospitals, their administrators, and their attorneys will all deny that they are trying to discourage physicians or to drive a wedge between physicians and their patients. Draw your own conclusions. However, as more physicians move to hospital based practices and exhibit less autonomy, think about who stands to gain and who stands to lose from such t...
Source: WhiteCoat's Call Room - September 26, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Policy Source Type: blogs

Healthcare Update Satellite — 09-22-2014
More updated from around the web at my other blog at DrWhiteCoat.com Study in the journal Pediatrics shows that about 10,000 children are hospitalized each year for accidental medication ingestions. Three quarters of those hospitalizations involved 1 or 2 year olds. Twelve medications were responsible for 45% of all pediatric emergency hospitalizations for accidental drug ingestions. Opioids were not surprisingly the top classification prompting hospitalizations, but buprenorphine and clonidine were the top two medications – responsible for 15% of all hospitalizations. The rate of hospitalization for buprenorphine pr...
Source: WhiteCoat's Call Room - September 22, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Another Example of Defensive Medicine
The ultrasound images above show a circular clot in the superficial femoral vein. The image on the left is without compression and the image on the right is with compression. Normally blood vessels flatten out when compressed. Since the vessel did not flatten with compression it confirmed the presence of a blood clot. While discussing a case with one of the nurses with whom I work, I saw how once again defensive medicine had affected my medical practice. I gave a few examples of defensive medicine in a post several years ago and I also mentioned how sometimes doctors have to prove a negative when dealing with patients. Bot...
Source: WhiteCoat's Call Room - September 18, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Defensive Medicine Patient Encounters Source Type: blogs

Healthcare Update Satellite — 09-15-2014
This study should be required reading in every emergency medicine residency in this country. In fact, the concepts in the studies should be tested on the emergency medicine board exams. Now if the study only compared the type of a patient’s insurance with the likelihood of emergency department recidivism. How else can the media try to tarnish this guy’s reputation? The doctor who oversaw Joan Rivers’ fatal endoscopy was once *sued* 10 years ago. Gasp. The former patient’s attorneys are really trying to create their 15 minutes of fame. They alleged that 10 years ago the patient received no informed ...
Source: WhiteCoat's Call Room - September 15, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 09-08-2014
Think a patient is faking alcohol withdrawal tremors? Yeah. There’s an app for that. Canadian researchers develop app that uses iPod’s built-in accelerometer to determine whether or not tremors are more than seven cycles per second. 75% of true alcohol withdrawal tremors have rates faster than that. Only one in six volunteers could fake tremors that fast. Malpractice fees in British Columbia set to double. Physicians pay anywhere from $2,000 (for family physicians) to $20,000 (for obstetricians) in a defense fund every year in order to offset the costs of malpractice defense. The reserve requirements for the fu...
Source: WhiteCoat's Call Room - September 8, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 08-28-2014
Good news is that the number of medical malpractice cases in Pennsylvania is decreasing. Bad news is that if you practice medicine in the Philadelphia area, you’ve got a big target painted on your back. Philadelphia accounts for only 12 percent of the state’s population yet in 2013, 40 percent of medical malpractice trials resulting in verdicts took place in the city. Philadelphia medical malpractice plaintiffs won 45% of trials, more than any other jurisdiction and significantly higher rate than the national average. Looks like we’ve found another place to avoid when looking for your next place to practi...
Source: WhiteCoat's Call Room - August 28, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Driving With A Foot Out The Window
I saw this while driving down the road recently. A person just tooling down a major road with their foot hanging out the window. What possesses people do drive with their feet out the window? I see it every once in a while from both drivers and passengers. This time my daughter just happened to be in the car with me so she could catch this picture. I did a quick search of the internet and of the medical literature and wasn’t able to find any specific literature on the potential downsides from driving like this. I was, however, able to find other pictures/posts/comments … calling a driver doing this a “j...
Source: WhiteCoat's Call Room - August 21, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Medical Topics Source Type: blogs

Healthcare Update Satellite — 08-12-2014
** CLEAR! ** Not dead yet. Having withdrawal symptoms from lack of blogging and actually violating a cardinal rule of blogging by posting from work. Now that travel is done and life is getting back to normal, will hopefully have more time to write. Sabrina Kropp had damaged the cartilage in her nose from all of her cocaine use. She went to a plastic surgeon who repaired her nose and who then published anonymous before and after pictures of her nose on his web site. Ms. Kropp then sued the doctor for violating her privacy. The pictures pretty much isolate the patient’s nose, so it appears unlikely that anyone would be...
Source: WhiteCoat's Call Room - August 12, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update — 07-24-2014
This study might suggest that mega-hospital care is better, but is immediate care in small volume emergency departments better than delays in care during travel to a mega-hospital … or no care at all because patients can’t get there? This may explain why doctors are so good at practicing defensive medicine. During their careers, doctors spend more time in the courtroom than in the classroom. The headline is misleading since during a lawsuit, doctors aren’t in the courtroom 40 hours per week as they are during medical school. The point is that for 11% of their careers, an average physician has a lawsuit ha...
Source: WhiteCoat's Call Room - July 24, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 07-14-2014
Practicing telemedicine may just get a whole lot easier. Federation of State Medical Boards creating an interstate “compact” that would reduce barriers by providing an “expedited license” to physicians who wish to practice medicine in multiple states. The physician has to establish a state of “principal license” and then may apply to the “Interstate Commission” to receive a license in another state after the “applicable fees” have been paid. The hundreds of dollars per year paid to each state to maintain licensure don’t appear to be one of the barriers that ...
Source: WhiteCoat's Call Room - July 15, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Quick Visit
A mother brought her son to the emergency department with a rather non-emergent complaint … chapped lips. The registration clerk started taking the registration information. “Can I get the patient’s name and date of birth please?” “Yes, it’s Johnny …” The clerk got distracted by the patient who first licked his lips, then smacked his lips, then rubbed his finger back and forth over his lips. “You know, you shouldn’t do that. That’s probably why your lips are so irritated.” Back to the mother. “His name is Johnny Smith. His date of birth …&...
Source: WhiteCoat's Call Room - July 8, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Healthcare Update Satellite — 07-2-2014
Ve have vays of keeping you qviet. Halt den mund! Government-contracted security force who actually call themselves the “Brown Shirts” … threatens to arrest medical providers if they leak any information to media about all of the medical illnesses that are being seen at an illegal alien refugee camp in Lackland Air Force Base. By the way, this story is from FoxNews, so everyone should just ignore it until you or your family members sit next to one of them on a bus or in a movie theater. Combine these kids on playgrounds with anti-vax kids? What could go wrong? Nothing to worry about. Nothing at all. New Y...
Source: WhiteCoat's Call Room - July 2, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

One Way to Cure a Drug Seeker’s Back Pain
A gentleman in his 40s limped into the emergency department for evaluation of severe back pain. He had a chronic history of back pain, but had decided to forgo recommended surgeries because he was told that there was a chance his pain could worsen. He reportedly had multiple MRIs in the past … all of which showed “severely” bulging discs. He also just moved to the area the evening prior to his visit. In all of the excitement and heavy lifting, he strained his back, he couldn’t find his pain medications, AND he lost his wallet. That meant he had no ID and he couldn’t remember his address becaus...
Source: WhiteCoat's Call Room - July 1, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Hemoptysis Pearls
There was a nice article over at Consultant360.com by Drs. Laren Tan and Samuel Louie on hemoptysis pearls. Learned quite a few things. 200 mls of blood (about a cupful) is enough to fill the dead space in the lungs and is therefore generally considered the minimum amount of blood to make the diagnosis of “massive” hemoptysis. Hemoptysis with chest pain – think pneumonia/pleurisy, PE with pleurisy, pulmonary edema from an MI, or lung cancer Hemoptysis with dyspnea – think either exacerbation of patient’s underlying medical problem or a precursor to respiratory failure Hemoptysis with fever ...
Source: WhiteCoat's Call Room - June 26, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Medical Topics Source Type: blogs

Healthcare Update Satellite — 06-23-2014
The right to carry a concealed weapon only exists if your doctor says so. Many states are requiring that physicians certify whether patients are competent to carry a concealed weapon. Some states require mandatory reporting of those deemed not competent to carry a concealed weapon. Of course, the natural extension of such laws is that if the doctors make an inappropriate determination, then the doctors can be held liable if the certifiee does something inappropriate with the weapon. This New England Journal of Medicine article shows that many doctors aren’t comfortable making that determination. Then again, I’v...
Source: WhiteCoat's Call Room - June 24, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Assistant Physicians Coming to Missouri
Missouri is planning to allow medical school graduates who have not completed residency to treat patients in underserved parts of the state. Bills that would allow medical school graduates to provide medical care have passed the General Assembly and are awaiting Governor Jay Nixon’s signature. The newly-minted physicians would receive “assistant physician” licenses and would be able to treat patients in collaboration with a licensed physician – much in the way a physician assistant does. However, the new graduates will be able to call themselves “doctor” while physician assistants will...
Source: WhiteCoat's Call Room - June 22, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Policy Source Type: blogs

Insecticide Poisoning From Aluminum Phosphide and Phosphine
There was a sad story about a woman who died from insecticide poisoning inside her home after family member sprayed agricultural insecticide inside the house earlier in the day. While the story was sad, the back story was quite interesting to me. The poisoning was from aluminum phosphide. When exposed to atmospheric moisture or stomach acid, aluminum phosphate converts to aluminum hydroxide (which is used to treat excess stomach acid) and phosphine gas – which is highly toxic. Phosphine gas typically smells like rotting fish or garlic. Phosphine is explosive and is heavier than air, so it tends to collect in low-lyin...
Source: WhiteCoat's Call Room - June 19, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Medical Topics Source Type: blogs

Healthcare Update Satellite — 06-17-2014
Read more healthcare-related news from around the web on my other blog at DrWhitecoat.com Oklahoma University Medical Center joins the growing ranks of hospitals that are requiring patients to pay a fee of $200 to be treated for non-emergency complaints. That amounts to an estimated 40% of OU’s emergency department visits. If patients do not want to pay for non-emergent care, they will be referred to nearby urgent care clinics. This “triage out” protocol will eventually become a standard throughout US emergency departments. Count on it. Emergency physician writes about how she almost diagnosed Lou Gehrig&...
Source: WhiteCoat's Call Room - June 17, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

14.5 Million Reasons Physicians Practice Defensive Medicine
Cleveland’s MetroHealth Medical Center and a staff physician were recently found liable for a $14.5 million medical malpractice verdict in what is commonly termed a “bad baby” case. The case as described in the article involved 36 year old Stephanie Stewart who was pregnant with her second child. She went to MetroHealth several times for premature labor when the child was 22-23 weeks gestational age (a full term infant is 40 weeks) and was admitted twice, with labor being stopped using medication and bedrest. There were apparently discussions about her requiring a C-section since her first child was de...
Source: WhiteCoat's Call Room - June 16, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Defensive Medicine Medical-Legal Source Type: blogs

BMI Measurements Inaccurate But Still A Government Gold Standard
Everyone needs to read this NY Times article and then think about how inane the concept has become. The Body Mass Index or “BMI” is used as a measure of a person’s body weight. If your BMI is between 18.5 and 25, you’re normal. More than 25 and you’re overweight. More than 30 and you’re obese. The measurement is based on a person’s weight and height, but it was originally created in the 1800s to measure human growth – not as a measure of a person’s ideal body weight or health. More recent studies show that people considered “overweight” using the BMI measur...
Source: WhiteCoat's Call Room - June 14, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: CMS Policy Press Ganey Source Type: blogs

The Effectiveness of Advertising
A cute little 6 year old boy was brought from home. He had autism and didn’t communicate much. His mother stated that he would occasionally just stop eating and drinking. Then he would get dehydrated. Then he’d get constipated. Then it would be a big problem to attempt to get him un-constipated. He had to be hospitalized for dehydration a couple of times and he had to be manually disimpacted once. The mom estimated that he had gotten significantly dehydrated 4-5 times in the past few years. So the patient’s pediatrician sent him to the emergency department to get some IV fluids in order to attempt to avoi...
Source: WhiteCoat's Call Room - June 11, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Press Ganey Source Type: blogs

Healthcare Update Satellite — 06-10-2014
This study found no benefit in doing so. However, note that the study population was limited to patients with a “bending or twisting injury.” Patients were excluded if they had suspected nonmusculoskeletal etiology, direct trauma, motor deficits, or local occupational medicine program visits. I’m still giving steroids for exacerbations of chronic pain and for radiculopathy. Potential patients gone wild … Colorado man shot in emergency department parking lot after “confronting” police with a knife. Lesson #1: Don’t run around in a parking lot wielding a knife Lesson #2: Don’t ...
Source: WhiteCoat's Call Room - June 10, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Michael Kirsch, MD Redux
For the past 30 minutes, my cell phone has buzzed repeatedly, urging me not to climb out of this rabbit hole. “Come back,” it beckons, “we’re not finished yet.” When KevinMD deleted my first comment about Dr. Kirsch, I decided to keep further comments on my own blogs so they don’t mysteriously disappear again. Now I’ve learned that I’ve been demoted: Instead of my comments on KevinMD posting immediately, I must receive prior approval before my comments can be viewed by anyone else on Kevin’s blog. All because I pull aside the curtain so people could see the real “insider.” Next will be th...
Source: WhiteCoat's Call Room - June 9, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs

Michael Kirsch, MD – An Emergency Physician Basher Without A Clue
The nice thing about the internet, about having a blog, and about having a Twitter account is that even us peons have the ability to combat censorship. Here’s a good example. Self-described “insider” and “whistleblower” Michael Kirsch, MD, who blogs at “MD Whistleblower,” has a penchant for bashing emergency physicians even though his commentary shows that his “inside knowledge” is full of misinformation. You can be the judge of Dr. Kirsch’s veracity, but my opinion is that he is unethically spewing his inside misinformation as fact. So I called him out on it. Kev...
Source: WhiteCoat's Call Room - June 7, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Medical Topics Source Type: blogs

Healthcare Update Satellite — 03-25-2014
Patients gone wild. Really wild. 70 year old Brookdale Hospital nurse Evelyn Lynch gets knocked to the ground by patient Kwincii Jones and has her head stomped. She was knocked unconscious and suffered severe facial fractures. Also underwent brain surgery, so it is likely she suffered a brain bleed or has brain swelling as well. Congratulations to the antivaccination movement for increasing the worldwide incidence of pertussis and measles. Measles and mumps are now “crushing” the UK. Patients with “religious exemptions” to receiving vaccinations were reportedly the source of one recent California p...
Source: WhiteCoat's Call Room - March 25, 2014 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

The “Punch” Line
Q: How do you get a room full of little old ladies to all use obscene language at the same time? A: Yell “BINGO!” When elderly patients blurt out obscenities, most of the time it takes everything I can do not to laugh out loud. No offense intended. I just get flashbacks of my mom sitting and putting her fingers in her ears while watching scenes in certain movies or seeing her gasp in shock if an F-bomb catches her off guard. I don’t expect to hear obscenities from someone who just rolled by me with a walker. For example, a while ago I posted a story about one lady from a nursing home who caught me off guard with an M...
Source: WhiteCoat's Call Room - March 19, 2014 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Healthcare Update Satellite — 03-04-2014
Science reporter Miles O’Brien suffers a freak accident while packing equipment after a reporting trip. Case falls onto his arm and causes bruise/injury. The following day, pain and swelling in his arm got worse. The day after that, he was being rushed to the operating room for compartment syndrome. His blood pressure dropped during surgery and the surgeon had to amputate his arm. Best wishes for a speedy recovery, Miles. Patients who have had strokes are 50% more likely to have iron deficiency anemia as are control populations. Authors suggest a couple of possible mechanisms for the correlation including decreased o...
Source: WhiteCoat's Call Room - March 4, 2014 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Unprofessional Act or Political Mudslinging?
US Senate candidate Milton Wolf (@miltonwolfmd), who also happens to be a radiologist, is catching heat because he had previously posted patient x-rays on his Facebook account … and then made what some people would consider as inappropriate comments about the patients who were depicted in the x-rays. Articles in the Topeka Capital Journal are here, here, and here. Note the repeatedly recycled content. The story was also picked up in Talking Points Memo and on Breitbart.com For example, in the comments to the right, he commented that the positioning of a dead patient’s head on CT scan wasn’t going to cause...
Source: WhiteCoat's Call Room - February 26, 2014 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Medical-Legal News Commentary Source Type: blogs