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Archive for January, 2008

Friday, January 25th 2008

England To Pay People To Lose Weight

I guess as long as the government is going to be making health care expenditures, that this is as good a use of tax money as anything else.

Obese and overweight adults in England could be paid to lose weight under plans being considered by the Government. The new strategy to tackle poor eating habits and sedentary lifestyles includes the suggestion that people should receive financial rewards or shopping vouchers for achieving and maintaining a healthy weight.

The report points to evidence from the US that showed that small financial payments, as part of a broader programme, were effective in encouraging individuals to achieve and maintain weight loss.

I failed to find that study or report from the United States. If there is evidence incentives work, then that is really sad. In fact, depending on what that study from the US (or other evidence) says, it makes me appalled that tax dollars fund care for any health conditions even remotely linked to obesity.

Getting Your Jeans On Not Incentive Enough

There is a huge marketing campaign towards losing weight and fitness. Everyone knows the health risks of being obese. And if providing incentives for people to lose weight is independently more efficacious than virtually any other public health measure then that is terribly sad. Everyone Britain who only loses weight to get the carrot at the end of the stick should be ashamed of themselves.

Oh well, if it’s going to happen at least I’ll hope the British program works.

Monday, January 21st 2008

The Ends Justify The Means…

The old arguments for government guaranteed access to health care. Here’s my favorite point:

Also, the people who are so adamantly against throwing a couple bucks of their tax money into the pot to help out their fellow countrymen are really sad excuses for human beings. Really. Subhuman at best.

Certainly, but it ignores the entire point – being an asshole with one’s ‘property’ is a right while no such ‘right’ to health care can be defended with any sincerity.

I don’t agree with the choice not to aid your fellow human being, and it isn’t the choice I have/will make with my life, but it should remains that. A choice.

Sunday, January 20th 2008

Opt Out = Opt In

This is alarming. Everyone should be an organ donor, but to force such is shameful. And the ability to opt out is an inadequate solution to protect people’s right to themselves which I would argue extends past their death.

Gordon Brown has thrown his weight behind a move to allow hospitals to take organs from dead patients without explicit consent.

The proposals would mean consent for organ donation after death would be automatically presumed, unless individuals had opted out of the national register or family members objected.

While polls show 90 per cent of Britons are in favour of organ donation, 40 per cent of relatives refuse consent for the organs of their relatives to be donated, a figure which rises to 75 per cent among black and ethnic minorities. To solve this, the organ taskforce plans measures to boost donation, including putting pressure on doctors to identify patients as potential donors before they have died.

Saturday, January 19th 2008

What's Up With The Work Hours Claimed?

I’m surprised about all the hardcore numbers that fly around concerning hours worked. For some people there’s a lot of pride in being hardcore and claiming a lot of hours on the clock in sheet. This is, of course, especially true on surgical rotations.

But how accurate are some of these figures you see?

Now granted, I’m on the ‘slow’ general surgery service but there are friends on the other county hospital team who are claiming 100+ hours/week for consecutive weeks. I’m sure it’s possible but…damn, I just don’t know what they’re doing.

I wanted to see if I could “stretch” my numbers. I haven’t taken any days off in the rotation so far and I’m using a liberal interpretation (e.g. on Wednesday I had some ‘free’ time between didactic sessions, which since I was using it to study up at the hospital I’ll count):

Sunday: 6am – 12am (Total Hours for Week: 18)
Monday: 12am – 10am (Total Hours for Week: 28)
Tuesday: 6am – 7pm (Total Hours for Week: 41)
Wednesday: 5am – 6pm (Total Hours for Week: 54)
Thursday: 5am – 4pm (Total Hours for Week: 65)
Friday: 5am – 12am (Total Hours for Week: 84)
Saturday: 12am – 8am (Total Hours for Week: 92)

Okay, that is as far as I can actually stretch it. I guess I am legitimately, conservatively above 80 hours but I also had some time off Friday afternoon but then had trauma call o/n.

Is this just a chump rotation I’m on? This week I didn’t stay past 7pm when I wasn’t on call, I had that ‘free’ time in the afternoon on Wednesday and Friday, and I got out by ~10am both my post call days.

All that said, I still can’t reconcile how my friends at other schools, and my own school, are putting in so many more hours consistently. Is that legitimate?

Saturday, January 19th 2008

Randomness Is The Civil War

The Civil War In Four Minutes

I’m a huge Civil War buff. In high school, offered the option of traveling anywhere in the continental United States, I made my family spend spring break taking a driving tour of the eastern theater.

So just because: here in four minutes is the history of the Civil War (h/t The Irish Trojan).

Friday, January 18th 2008

Be A Little Greatful

Yeah, every year the government wants to slash reimbursement, the disparity between primary care and the specialists is appalling, medical students (*ahem*) are coming out on average with six figures in debt. But I hope it doesn’t take a not exactly prestigious ‘study’ on AskMen.com to remind us how lucky the physician community is.

Even by the hour and more importantly even beyond the earning potential.

Bureaucracy and the increasing intrusion of non-medical men into the decision making process are further challenges but practicing medicine is incredible work. Without hyperbole: a gift. What we are able to do for patients is sometimes as remarkable a thing as anyone will ever see.

I hope I don’t lose sight of all of it when I’m out there.

Friday, January 18th 2008

Hypothermia In Spinal Cord Injury

I’ve discussed the case of Kevin Everett some on this blog. The question being posed now, is all the hype surrounding the hypothermia’s treatment he received really worth it?

“There’s a chance he could actually walk again, thanks to an innovative treatment,” Katie Couric said on CBS News. Sports Illustrated put the case on its cover, and newspapers carried headlines like “Big Chill May Save Football Player From Paralysis.”

Some doctors, including Everett’s supervising physician, say such accounts misrepresent the role of hypothermia in a way that could be dangerous to future patients.

Here’s the best potential consequence – when lawyers start crying it as the ‘standard,’

Lawyers have already cited Everett’s treatment as relevant to other people’s potential litigation. A blog entry published in September by Allen, Flatt, Ballidis & Leslie, a law firm in Newport Beach, Calif., put it this way: “The immediate choices that these doctors make can determine whether a patient dies, lives or ever walks again. Clients with spinal injuries look to their attorneys to stay on top of the latest and best innovation for recovery.”

Dr. Benzel, of the Cleveland Clinic, bristles at such assertions.

“It now appears criminal to not employ, urgently, hypothermia for the care of spinal-cord injuries,” he said. “But in reality, it is not substantiated by truth. We should demand, and the public should demand we demand, research that substantiates safe and effective treatment before we embark on it.”

Via Kevin, MD

Tuesday, January 15th 2008

Quote of the Rotation

We might have already stumbled upon the quote of the rotation. A 36 year old obese patient comes in for a new patient visit to gen surgery clinic.

The surgeon looks down at the age on the chart, back up to the very large patient and says:

“How…did you put on four hundred and forty-one pounds in thirty-six years?”

Only with a little more color than I care to convey in print.

Monday, January 14th 2008

I'm Gonna Be A Surgeon

I’m a week into my surgery rotation and I want to be a surgeon.

My Fashion Statement On My First Day

I’m on a pretty tame service but it isn’t a walk in the park. I worked 78 hours my first week and loved every minute of it (well almost).

I’ve looked stupid, impressed, been chided, been shouted at, even been complimented. Haven’t had anything thrown at me yet.

I’ve been pimped much less than I thought I would, I’ve done a terrible job trying to laprascopically ‘retract’ a liver, I’ve made remarkable progress with my ‘one handed’ ties, I’ve gotten pretty good anticipating with the camera, and I’ve slowly figured out that my chief doesn’t really want to hear anything but objective info that would change his plan on a patient and my assessment. Our rounding is more than I ever could’ve expected from the myth of surgical rounds:

“She’s passing gas. She looks great.”
“Okay, advance her diet.”

And away we go.

I’ve seen my handful of lap choles, I’ve seen a thoracotomy in the resuscitation bay, I’ve seen a lap Nissen, I’ve seen my share of total and subtotal colectomies, I’ve seen a decompressive craniectomy and a ventriculostomy (while on trauma call), I’ve seen an ileostomy takedown which made my patient happier than I’ve ever seen a patient.

I’ve noticed many of the same things which Mark over at Denialism articulates,

1. Surgeons always tuck in their scrubs.
2. Surgeons must never have their stethoscope around their neck, it must be in their pocket (their least valuable tool – haha).
3. Carrying anything other than a stethoscope, some gauze and supplies, and a pen light will lead to ferocious mockery. Pity the fool who would dare to bring a reflex hammer onto the surgical wards.
4. Surgery is almost always about the “most likely” or “most common”. They don’t spend a lot of time worrying about about diagnosing things to death, and the consequences are often too severe for delaying interventions.


6. It’s amazing watching some of these open procedures than anyone can survive such rough treatment of their insides. Seeing the force put on things like retractors, you wonder how people ever recover.

And I want to do surgery or a surgical subspecialty. That isn’t really a surprise seeing as I thought I wanted to do surgery coming into school. But once here, so much was interesting. So consider this a reaffirmation. I may not know specifically what I’ll try to match into yet, but it will be something surgical.

Friday, January 11th 2008

The Reality of American Fiscal Solvency

Hey Look, Ron Paul Is Right

Ron Paul may be a racist (or more likely he’s not and Orac is just ‘ill informed’ or worse) but Dr. Paul is certainly right about the financial future of this country. Indeed, the only candidate who is right about the single largest challenge to this nation; a challenge larger than the war on terror, than the war in Iraq.

We better get our finances in order.