Shout Outs

Updated 3/2017--all links removed as many no longer active. 

Gina (@geeners), Code Blog: Tales of a Nurse, is this week’s host of Grand Rounds. You can read this week’s twitter edition here.

How’d we get to Volume 8 already?! I think hosting this Grand Rounds finally ties me up with GruntDoc, who has hosted 7 times. Grand Rounds is the weekly round-up of blog posts by medical bloggers.

Whereas in the past the host would post nearly every link they received, it appears that we are now moving towards more curated content. I said in my previous post that I wasn’t going to institute a theme, but I was definitely more drawn to the personal-story type posts. Thanks to everyone that submitted! ……..

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Dr Rob is finally back blogging! His recent Musings Post explains: Plugging Back In.

This post is to announce two things:

1. I am back blogging again.


2. I am not blogging on this blog. I have a new blog called More Musings (of a Distractible Kind).

I also have a new project, Llamaricks, which is a blog that will hopefully draw audience participation. It’s a place for poetry; poetry by me and poetry submitted by my readers (assuming I have any). Hopefully there are people talented and/or shameless enough to submit their prose to me on that site.

OK, so I am already being untruthful. I really had three announcements. ……..

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There’s a nice discussion going on over at doc2doc: Poll: Should doctors self prescribe? Various opinions. Here are a few:

Probably antibiotics for infections would be ok, and something like Voltaren for artritis, or celebrex, but no controlled substances, this is where the water gets muddied.

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Doctors should not self prescribe nor under any obligation prescribe any medication for a family member or friend without their own "clinical consent" in regard to the medical condition in question.

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Generally doctors should not prescribe for themselves and any narcotic prescribing for self or family is a definite No. There is a saying that 'the doctor who treats himself has a fool for a patient' ….

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Then there’s this via @skepticscalpel: “Why internists shouldn’t operate MT @hhask @writeo After-hours surgery resulted in woman's death http://bit.ly/AA2DHL”

The link is to an article in The Oregonian by Nick Budnick: Oregon Medical Board sheds light on cosmetic surgery by Northeast Portland doctor that led to woman's death

For botching an after-hours cosmetic surgery that caused her friend's death, a Northeast Portland physician faces administrative charges and could lose her license.
Soraya Abbassian committed "gross or repeated" negligence while performing the Dec. 15, 2010 surgery, including administering what an autopsy found to be a fatal overdose of local anesthesia, according to a disciplinary complaint issued by the Oregon Medical Board on Thursday. ……….

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H/T to @scanman for the link to this letter written by John Steinbeck to his eldest son, Thom: Nothing good gets away

In November of 1958, John Steinbeck — the renowned author of, most notably, The Grapes of Wrath, East of Eden, and Of Mice and Men — received a letter from his eldest son, Thom, who was attending boarding school. In it, the teenager spoke of Susan, a young girl with whom he believed he had fallen in love.

Steinbeck replied the same day. His beautiful letter of advice can be enjoyed below. …..

Dear Thom:
We had your letter this morning. I will answer it from my point of view and of course Elaine will from hers.

First—if you are in love—that’s a good thing—that’s about the best thing that can happen to anyone. Don’t let anyone make it small or light to you.…………..

And don’t worry about losing. If it is right, it happens—The main thing is not to hurry. Nothing good gets away.

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Jordan Grumet Interviews Himself on his blog In My Humble Opinion (twitter handle @jordangrumet)

…….

Q: Taken as a whole, what is your blog about? What are the major themes?
A: If you asked me this question a few years ago, I would have said that my blog is a love letter to my patients. As I grow wiser, I realize that it is more accurately a love letter to my father.

When my father (a prominent oncologist) died, I was seven years old. As silly as it sounds, I spent a great deal of my childhood and young adult years trying to forgive myself for his death. Even though I knew I wasn't responsible for his aneurysm, I struggled with issues of being worthy of love.

As I read my own writing, I'm struck by the parallels. I fight to be protect my patients and lead them through the dying process, much in the way I wish I could have done for my father. …………

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Via Jackie-ES blog post: Join Patternfish and HeartStrings in Supporting WomenHeart (photo credit). I purchased the pattern, now to finish the projects I have started so I can knit this beautiful scarf.

Patternfish also launched a monthly charitable support initiative starting this month where the Designer of the Month picks a favorite charity and to which Patternfish will make a contribution. And I am the first to help kick off this initiative by choosing WomenHeart, the lifeblood organization devoted to improving the quality of life and the healthcare of women living with heart disease.

Patternfish will be donating $1.00 for each Thinking of You Scarf pattern sold during January to WomenHeart and I will match that dollar for dollar.

Changes

Due to many things, I will be closing my practice over the next few months and going to work for the Arkansas Disability Determination Services (DDS).  I only recently made the final interview and signed the contract.  My first day there will be October 3rd.  I don’t want to discuss the reasons, but I want you to know how difficult a decision this has been for me.

I have not hinted to patients that I might leave until recently.  I didn’t want them to leave me prematurely, so I now worry that I may not have given them enough heads up.  Such a blurry line between taking care of yourself/family and abandoning patients. 

I don’t think I have abandoned any of them, but I wonder if they might feel that way.  I have managed to “leave the door open” to see current patients on Fridays and Saturdays (if need be) over the next few months. 

Yesterday, I got the letters to patients, organizations (ie AMA, Arkansas State Medical Board, AMS, PCMS, etc), and hospitals in the mail. 

There are many things left to do, but I am fortunate to have a young colleague who is willing to allow me to transfer the charts to him.

I have begun making the phone calls regarding cancelling malpractice insurance, office overhead insurance, etc.   I will have to figure out a new voicemail message and when to change it.

I have been caught mid-contract with several leases (ie Pitney Bowes, credit card processor, and the actual office), but so it goes.  I have yet to talk with the building management.  I am hoping they will be able to sublease it for me.

I hope to continue to blog.  I have to maintain my medical license and do CMEs and blogging has become a way of learning for me.  Not sure what to do with the title as I will no longer be “suturing” for a living, but for now it will stay the same.  I will update the header at some point.

Guidelines for Injector in Aesthetic Medicine

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. 

There is a great article in the “throw-away” MedEsthetics magazine (July/August 2011 issue) written by Padriac B. Deighan, MBA, JD, PhD.  You can read the entire article here (pp 16-20; online issue).   If you employ any practice extenders in your office or run a medical day spa, you will find the article useful.

Deighan categorizes injectables in three ways:  botulinum toxins, dermal fillers, and sclerotherapy.

Botulinum toxins are prescription only drugs which are available to physician offices and via pharmacies, but not directly to non-physicians.  In other words, a registered nurse can inject neurotoxins under physician supervision, but cannot acquire them.

Botulinum toxin injection is considered a medical procedure which should only be provided in a medical setting by a trained and licensed provider (ie physician, registered nurse, nurse practitioner or physician assistant). 

Deighan notes that a medical spa is a medical setting ONLY if it is owned by a physician.  He recommends against Botox parties in patient’s homes, even though a physician can legally provide this service in that setting.

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Injectable dermal fillers are not prescription drugs, but are medical devices

As such, they are delivered pursuant to the practice of medicine and all state and federal guidelines.  This is a distinction without difference because, although they are not prescriptive, medical devices – as categorized by the United States Food and Drug Administration (FDA) – can only be utilized in a medical facility and delivered to patients by an appropriate medical provider.

Non-medical day spas or even medical day spas without physician supervision should not be injecting dermal fillers.

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Moving on to sclerotherapy used most commonly to treat leg veins but also other areas.  Sclerotherapy is the introduction of a foreign substance into the lumen of the vein to cause thrombosis and subsequent fibrosis.  The injected solution falls into three types:  Chemical Irritants (glycerin, polyiodinated Iodine), Hypertonic solutions (Hypertonic-saline 11.7%, Hypertonic-glucose), and Detergent sclerosants (Sodium morrhuate, Sodium tetradecyl sulfate, 0.25% -3%, Ethanolamine oleate, and Polidocanol foam, 0.5-5% ).

Deighan states that saline is not considered a medical device or product, but the others are and therefore are subject to medical practice guidelines for the particular state and must be delivered in a medical setting.

…….

Please go read the article for his take  on CMAs (certified medical assistants) and cosmetic medical procedures.  Here’s part of it:

Recently, many CMAs have wrongfully asserted that they are allowed to inject and, therefore, have been injecting botulinum toxins, dermal fillers and sclerosants.  CMAs are marginally trained, non-medical personnel………

It will also be a huge problem in any professional negligence claim, because there will be no coverage for such a loss.  An insurance carrier will not provide a defense or indemnity for any claim related to these procedures. …….

He extends this same stand to “certified” technicians. 

For example, some “certified laser technicians” and their employers incorrectly believe that the designation “certified” elevated their stature and allows them to perform medical services.  Certified Laser Technician, Certified Medical Esthetician, and Medical Esthetician are not categories of medical providers. ……..

Related posts:

Medical Spa Regulations (March 26, 2009)

Medical Lasers and the Law (March 25, 2009)

Shout Outs

Updated 3/2017:  all links removed as many no longer active and it was easier than going through all of them.

Colorado Health Insurance Insider is the host for this week’s Grand Rounds.  You can read this week’s edition here.

Welcome to Grand Rounds!  It’s the third time we’ve hosted Grand Rounds at the Colorado Health Insurance Insider and we’re honored to be hosting again. It was a pleasure to read so many great articles for this edition.  Since our blog tends to focus on health care policy and reform, I’m starting things off with the posts that pertain to that topic.  Enjoy!  . ……..

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TBTAM responds to the Supreme Court ruling on the Vermont Law:  Supreme Court to Docs – You Have No Privacy

……Apparently, Big Pharma’s right to “free speech” trumps my right to privacy. How getting access to my prescribing information has anything to do with free speech is beyond me.  In the twisted logic of the pro-business, anti-citizen Supreme Court -

Speech in aid of pharmaceutical marketing ….… is a form of expression protected by the Free Speech Clause of the First Amendment.

And so has Doctor Wes:  When Speech Trumps Privacy

…….What interests me from this ruling is that the act of collecting this information -- the prescribing physician's name and address; the name, dosage, and quantity of the medication; the date and place where the prescription was filled; and the patient's age and gender -- was considered "speech" with the justices ruling that "the creation and dissemination of information are speech for First Amendment purposes."

Think about that: writing a prescription and disseminating that information is now "speech."…….

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Doctor Wes writes about  Appointment Phishing along with the NY Times:  U.S. Using ‘Mystery Shoppers’ to Check on Access to Doctors - NYTimes.com.

From NY Times:

Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it.

The administration says the survey will address a “critical public policy problem”: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice.

From Doctor Wes

…….When information gathering trumps patient care - particularly fictitious care - we've got a problem. Is this a new quality standard we can expect from our new government health care initiative?

Just like scam-artists that phish for unsuspecting people's financial information online, governmental appointment phishing should not be tolerated in any way, shape, or form. It is fraud - plain and simple. ….

Dr. Kent Bottles view:  Are Mystery Shoppers Such a Bad Idea for Health Care Quality Improvement?

…….I disagree with my colleagues that a properly planned and implemented mystery shopper program is a bad idea for trying to improve health care. For far too long, we in medicine have been too arrogant to learn lessons from other industries that improve quality. I think we need all the help we can get to take better care of patients.

From White Coat Underground:  Is Medicare spying on doctors?

The short answer is "yes"; of course they are.  Normally, if Medicare wants to check up on a doctor (rather than doctors) they simply order an audit…….

It's the wrong question.  A better question might be, "My blood pressure has been running high, in the 160's, but I feel OK, how soon can I see the doctor?" …

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Thomas Fiala, MD, PSB - the Orlando plastic surgery blog , reports  France bans mesotherapy

Here's an interesting development in the mesotherapy (melting fat by injection) story: as of early April 2011, the French Ministry of Health has outlawed all mesotherapy for the purpose of dissolving subcutaneous fat. Whether you call it "Lipodissolve", "mesotherapy", or "injection lipolysis"...it's no longer permitted there. The Ministry of Health views it to be a serious health risk.  ………

Lipodissolve methods have had a checkered past here in the USA, …..,which we've discussed in an earlier blog (link here).

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Dr Val, Better Health, is now hosting a radio show called, "Healthy Vision with Dr. Val Jones."  It is currently available here on iTunes.  The show has three segments (one about the importance of regular eye exams, one about contact lens care, and one about UV protection for eyes). It's available as a full show (20 minutes) and as individual segments.

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H/T @gastromom: Human Trafficking: The Shameful Face of Migration

This month PLoS Medicine publishes a series of articles focused on migration and health. The series provides new insights into the ways by which global movement of people influences the health of individuals and populations, and sets out policy approaches for protecting the health of those most vulnerable during the five phases of migration….. One category, that of trafficked persons, stands out as a uniquely vulnerable group that is largely ignored.

Trafficked persons are defined as “individuals who are coerced, tricked or forced into situations in which their bodies or labor are exploited, which may occur across international borders or within their own country”   …….

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Another nice NY Times article from Dr. Pauline Chen:  Epilepsy From the Patient’s Point of View

……..For the last 20 years, Dr. Brien J. Smith has tried to change how doctors and patients view epilepsy. Earlier this year, Dr. Smith, chief of neurology at Spectrum Health in Michigan, became chairman of the Epilepsy Foundation. Being elected head of a national organization does not seem unusual for a doctor who is a well-recognized authority and advocate in his or her field.  What is extraordinary is that Dr. Smith knows firsthand about the disease and what his patients experience: He learned he had epilepsy when he was in high school.

“Every day I see how off-base health care workers are with seizures and epilepsy,” Dr. Smith said recently. “There’s a lot of stigma attached, a lot of stereotypes regarding cognitive abilities and how seizures should look.”   ……..

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Sarah McFarland, Threads Magazine, has a piece announcing:  “Show Your Support" and Embellish a Bra (photo credit)

The 2011 American Sewing Expo is coming right up - September 23-25 at the Suburban Collection Showplace in Novi, Michigan…..

A staple exhibit at ASE is the annual entries in the "Show Your Support Bra Challenge." Sponsored by Coats &Clark and BurdaStyle, the contest showcases some amazing lingerie decorated by the skills of sewers across the country…..

You can find the Show Your Support Bra Challenge full rules and the entry form online at the ASE site. Good luck, and good for you if you enter!

Reminders to Self

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. 

My husband had a screening colonoscopy last Friday.  His nurse in the recovery is the only one I had issues with.  I, not my husband. 

All went well, but let me tell you he is not an ePatient Dave.  He did not read his instructions about when to quit eating and the prep.  I did.  I then reminded him along the way:  “Only clear liquids today.”  “You must take the Ducolax at 3 pm.  Do you want me to text you a reminder?”

Sometimes the instructions we give patients are clear, but not always read.

The staff at the front desk were very kind and organized.  Calls had been made the day before and I had insured the insurance information they had was correct.   I did not tell anyone I was a doctor.  I’m not sure if my husband did later or not.

…..

When I was called back by the nurse, she mispronounced my name calling me Rhonda (which I forgave easily).  She did not introduce herself to me.

As we entered the recovery area, she did not take me to my husband and assure me he was okay.  She took me to the desk and abruptly said, “You need to sign this.”

No explanation of what “this” was, so I replied, “What is it I am signing?  I don’t sign anything until I have read it.”

She then said, “It’s the discharge instructions.  He’s already been given them.”

Note she had not reviewed them with me.  I would be the caregiver.  Note also that I had no way of knowing if she had reviewed them with my husband (who is not an engaged ePatient Dave) prior to sedation or in his current state of post-sedation fogginess.

She said, “Sign it when you’ve read them then” and quickly moved on to some other task.  I felt like a box that was simply being checked off.

I reviewed them, signed it, and moved over to my husband’s bedside.

The nurse with no name came by soon after and told him it was time to get up and go to the bathroom.  She led him over and said to me, “You can go to the bathroom with him.” 

Me, “Why would I want to go to the bathroom with him?”

Her, “Well, you don’t have to.”  [I think she found me difficult and perhaps uncaring.]

She left him alone in the bathroom with his clothes.  After standing there for about five minutes, I knocked on the door and entered.  “Are you okay?”  He was dressed, but swayed as he bent over to try to put his boot on.

Me to my husband, “You can sit in this other area where we are to wait on your doctor and put your boots on.  Here let me help you.”

In hindsight, I think she meant for me to help him get dressed in the bathroom, not to watch him actually use the bathroom. 

………

Reminders to myself

1.  Check names.

2.  Always introduce myself.

3.  Slow down and tell patients/family what is going on and why. 

4.  Patients and caregivers need to be given the instructions.

The Economics of Limb Salvage in Diabetes

Updated 3/2017-- all links removed as many are no longer active and it was easier than checking each one.

The January issue of the Plastic & Reconstructive Surgery included a supplement:  Current Concepts in Wound Healing: Update 2011.  One of the articles (first reference below) discusses the economics of limb salvage in diabetes.  An important topic.

Consensus panels have recommended that optimal preventive foot care should include education of the patient and health care workers, therapeutic shoes and insoles, and regular foot care as part of a multispecialty program.

After their initial introduction, the authors broke down their article into the following sections (bold emphasis is mine):

Cost and Impact of Prevention

…..In contrast, Ortegon et al. did not report results based on risk groups. These authors reported an improvement in quality-adjusted life-years and costs for all groups combined. The incremental cost-effectiveness ratio (1999 U.S. dollars) was $12,169 to $220,100 per quality-adjusted life-year gained, depending on the estimated effectiveness of ulcer prevention. The cost-effectiveness increased as the effectiveness of prevention increased. In the model of Ortegon et al., optimal foot care was only cost-effective if greater than 40 percent of foot ulcerations were prevented.

Cost of Diabetic Foot Ulcers

The average cost of diabetic foot ulcer treatment ranges from $3609 to $27,721.  …….

A small percentage of foot ulcers account for the majority of health care costs. For example, 9 to 20 percent of diabetic foot ulcers require hospitalization.  The major cost in treating diabetic foot ulcers is inpatient care, accounting for 74 to 84 percent of total costs.

Cost of Wound Technology

Many of the studies that compare the cost of new technologies for diabetic foot ulcers are sponsored by industry …..

There are two bioengineered tissue products that are U.S. Food and Drug Administration approved. Dermagraft (Advanced BioHealing, Westport, Conn.) is tissue-engineered human dermis, and Apligraf (Organogenesis, Inc., Canton, Mass.) is a bilayered product of dermis and epidermis. Both products are designed for multiple applications. Therefore, the expense of therapy is increased because of repeat treatments, but the cost-effectiveness is enhanced by reductions in costly complications such as infections and amputations. …..

The projected average yearly costs for Dermagraft were 15 percent higher than treatment of patients with good wound care; however, the cost per healed diabetic foot ulcer was less than with good wound care ($77,703 versus $73,380 converted from euros using historical exchange rates for 2007). …..

Negative-pressure wound therapy ……….The average direct costs of patients who were treated for at least 8 weeks was $27,270 for patients treated with negative-pressure wound therapy and $36,096 for patients treated with good wound care. The biggest differences in the cost of care were attributable to hospitalization ($7823) and treating infections ($15,749).  ……….

Cost of Peripheral Vascular Disease

…….It has been debated for years whether a primary amputation or revascularization procedure is more cost-effective. The rationale for early amputation assumes that the patients will be able to rehabilitate with a prosthetic and walk independently. For many patients, this is not true. Among unilateral amputees with vascular disease, successful rehabilitation is achieved in 47 to 66 percent of patients.   Several studies suggest that the cost of revascularization is less than or similar to amputations when the costs of rehabilitation and prosthetic limbs are included. For instance, Raviola et al. and Mackey et al. reported that the cost of amputations was $24,700 and $26,142 and the cost of revascularization was $23,500 and $27,081 in 1985 and 1984 U.S. dollar values, respectively.

Postoperative complications, revisions, and length of hospitalization are the primary expenses in revascularization. Raviola et al. reported that the average cost of uncomplicated revascularization was $20,300. The cost of graft revision was 41 percent higher ($28,700), and when bypass failed, the cost of amputation was $42,200. ……….

Interventions for Peripheral Vascular Disease

Revascularization of the lower extremity entails two areas of treatment: endovascular interventions and open surgical revascularization. The cost effectiveness of these procedures involves the cost of the initial procedure, the need for revisions, and the long-term success of the procedures. Lombardi et al. found endovascular procedures to be safe and cost-effective when performed in an outpatient setting. This creates immediate cost savings over open procedures. The length of stay for open procedures ranges from 3.9 to 7.4 days. ……..

Revascularization of the foot through a pedal artery may not always be possible with endovascular techniques; thus, the cost comparison is not appropriate for many limb salvage patients with diabetes.

Their conclusion:

More research is needed in this area, for several reasons. There are very few prospective data that evaluate the cost of limb preservation in patients with diabetes and lower extremity complications. Also, most of the data are based on models sponsored by the wound care industry, and much of this information is 10 years old or more. Finally, technological advances have changed what treatment costs and what we consider appropriate therapy. To understand the cost-effectiveness of limb salvage, the actual costs need to be evaluated as part of randomized clinical trials or prospective longitudinal studies that eliminate narrow inclusion criteria often seen in phase III clinical trials.

 

REFERENCES

The Economics of Limb Salvage in Diabetes; Hunt, N. A.; Liu, G. T.; Lavery, L. A.; Plastic & Reconstructive Surgery. 127():289S-295S, January 2011; doi: 10.1097/PRS.0b013e3181fbe2a6

Discussion: The Economics of Limb Salvage in Diabetes; Driver, Vickie R.; Yao, Min; Plastic & Reconstructive Surgery. 127():296S-297S, January 2011; doi: 10.1097/PRS.0b013e318203a47c

Doctors and Civics

Updated 3/2017-- all links removed as many are no longer active and it was easier than checking each one.

Monday Diane Rehm had “A Conversation with Richard Dreyfuss” during which he discussed his initiative to encourage a civics curriculum in public schools.  It struck a cord with me as I faced my first meeting as a first-time trustee of the Arkansas Medical Society Board***.

I feel out of place.  There is language and protocol I don’t know.  I was asked (strong-armed) and said yes.  After listening to Dreyfuss, I am (almost) ashamed that I had to be strong-armed or even asked to be involved.  As a citizen of the United States, as a citizen of Arkansas, as a doctor and member of the society, perhaps it is as Dreyfuss believes – it is my duty to be involved.

The Dreyfuss Initiative is to teach our younger generation to be why civics is so important.

“To teach our kids how to run our country, before they are called upon to run our country….if we don’t, someone else will run the country.”  Richard Dreyfuss

Even though I wasn’t taught the importance of “civics” in the medical profession, it isn’t too late to learn.  So later today I will be attending the Arkansas Medical Society Day at the Capitol, the lunch and afternoon events.  I am forgoing the evening reception.

Is being involved only on the level of your local hospital enough?  Probably not, but it is a start.  Policy set in our local hospital or even in our offices are influenced by national and state policy.  It is important (as I am learning and admitting) to be involved on a state and national level.

I am not fond of politics, so this is not a natural fit for me.

Currently, I serve on the LRSC Medical Executive Committee (local surgery center) and the Pulaski County Medical Society Board of Directors.   In addition to being a member of my county and state medical societies, I am a member of the American Medical Association though I often don’t feel represented well by them.  Perhaps that is my fault.

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How involved are you?  How involved do you think we should be?

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***There is a question of whether I will be needed after all.  As with the US Congress, the number of trustees each county society gets is related to their membership/population.  It seems Pulaski County may have lost a trustee, so I may not be needed.

By the way, if any of my fellow Arkansas colleagues are reading this, the Arkansas Medical Society is having a membership drive.  Consider joining if you aren’t a member.

Shout Outs

Updated 3/2017-- photos and all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

Highlight Health is the host for this week’s Grand Rounds! You can read this week’s edition here.

Welcome to Grand Rounds: the Impact of Healthcare Reform.   For this edition of Grand Rounds, Vol. 7 No. 11, we’re focusing on the impact of healthcare reform: what are the changes to healthcare delivery, utilization, quality, costs (either as a provider or a patient) and outcomes. After all, these changes affect everyone, whether you’re a patient, a healthcare provider or a biomedical researcher.……..

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A beautiful love poem via twitter by  @otorhinolarydoc: An Otorhinolaryngological Love Poem - http://tl.gd/7a67bf

My ossicles shiver at the sound of your name
My cochlea swirls at the sound of your voice
I get symptomatic labyrynthitis when I see your beauty
And my world becomes vertiginous when you enter it

That’s the first verse, go read the rest.

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Wall Street Journal has an interesting article by Sue Shellenbarger:  Women Doctors Flock to Surprising Specialty.

People often assume women gravitate to certain professional fields because they have an innate liking for the work. Women become pediatricians because they love babies, for example, or they become veterinarians because they love animals.

So why are women flocking to colon and rectal surgery as an occupation of choice?  ………….

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From Shrink Rap comes a nice post by Dinah:  News Flash: Preauthorization Impacts Care

The American Medical Association had a press release on November 22nd and announced findings from their survey on the impact of insurance company preauthorization policies. Surprisingly, they discovered that these policies use physician time and delay treatment. It's funny, because preauthorization policies were designed to save money. And I imagine they do, for the insurer, but they cost money for everyone else. ………..

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Check out this nice video designed to teach basic suturing techniques to medical students:

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Wow, these are lovely but I don’t think my relatives would like to have their food served on them.  H/T Street Anatomy.  (photo credit). 

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A.Word.A.Day is having a contest.  Deadline for submissions is this Friday, December 10th. 

Have you come across a pleonasm somewhere? How about making up your own examples of pleonasm? Send us your pleonasms, whether homegrown or captured in the wild (include a picture, if possible). The best entry will receive a copy of the word game WildWords (courtesy WildWords Game Company) and a runner-up will receive a copy of the word game One Up! (courtesy Uppityshirts).

Would love to hear your examples of pleonasm with a medical twist or link.

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Isn’t this bag wonderful!  The pattern for this Noriko Handbag  is free from Lazy Girl  as her  “year-end gift to you.”   (photo credit)

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I’m hoping to attend with a couple of friends -- Arkansas Women Bloggers Meetup Scheduled! (photo credit)

When: December 11, 2010 11am-1pm

Where: Museum of Discovery @ 500 President Clinton Avenue

Why: Meet other bloggers and help decide future activities/goals for AWB

We will keep you updated with event details as we pull them together.

To RSVP, you can leave a comment on this post. If you're on Facebook, you can RSVP and invite friends at the event page. You can also RSVP by emailing us at arkansasbloggers@gmail.com.

I Need to Reschedule You

Over the past 20 years, there have been very few times I have asked patients to reschedule.  Even though I tell patients they have nothing to apologize for when they then to cancel, I always apologize.   This is especially true when it comes to asking them to reschedule surgery.

Yes, I know you have asked for time of work.  Yes, I know you have arranged for someone to help care for you, for your children, etc.  Yes, I realize you may have airline tickets to come into town to stay with family here while recovering.

Yes, I keep all that in mind, so if I ask you to reschedule it truly will be a handful of good reasons:

I am sick or need surgery myself.  I had to ask a patient to reschedule her breast reduction early in my solo career.  I had an acute herniated disc (C6-C7) which left me with numbness in my left  index and long fingers and loss of triceps function, not to mention the pain.  I had to explain to her that it was not safe for me to do her surgery until after my own.  [She did reschedule.]

A family member is sick or dying.   I had to ask a patient last May to reschedule after my mother had her stroke during her CABA.  After we made the decision to AND (allow natural death), we did not know how long it would be.  I did not want to be in surgery when it happened.  I thought it was reasonable.  [She never rescheduled.]

I have a funeral to attend.  I have not canceled or rescheduled a surgery for this (yet), but have rescheduled a few office visits.  As I and my friends get older, I can see this happening more frequently in the future.  I will try to be considerate of both my friend/family and my patients.

Usually, when I ask a patient to reschedule it will be a last minute thing.  I regret this, but as you can see from the reasons I allow myself to make this request it will always be last minute.  Some things are tough to plan.

Believe me when I say I am sorry to have to ask you to reschedule.  I truly mean it.