Good Morning
Sunday, October 31, 2004
Walter Bin Laden
So Walter Cronkite, the man once held to be the most trusted man in America ,is quoted as saying he thinks that he is "inclined to think that Karl Rove, the political manager at the White House, who is a very clever man, he probably set up bin Laden to this thing." See the story here
And Mr Cronkite used to work for CBS.
hum...He probably also thinks that UBL is hidden away in VP Cheney's secret bunker and will be "miraculously" captured on Nov 1. And that Bush personally contaminated those vials of flu vaccines over in England just so we would have a "crisis".
And Mr Cronkite used to work for CBS.
hum...He probably also thinks that UBL is hidden away in VP Cheney's secret bunker and will be "miraculously" captured on Nov 1. And that Bush personally contaminated those vials of flu vaccines over in England just so we would have a "crisis".
Thursday, October 28, 2004
Limiting Physician-in-training hours
As someone who has been thru this very process, I'd like to make a few comments. My residency program had 8 interns, 7 second year residents, and 8 senior residents.
People get sick 24 hours a day. So someone needs to be there, fresh and awake to treat them. In my program, the 2nd year residents worked in the ER, and the interns and senior residents worked the rest of the hospital. The hospital was a 650+ bed facility. As an intern, I was responsible for ALL after-hours codes (in case you don't know what that means, it's when someone stops breathing or their heart stops and CPR, IV medications, intubations, etc., are done). There were probably 3 or 4 a night, since our hospital has close to 150 ICU beds. These people were sick. The interns also were responsible for obstetrical care after hours; we also had to answer calls from any other part of the hospital.
Our "call" period was from 5pm to 8 am. With 8 of us, that means every 8th night. Plus, when it was a weekend, we were in the hospital from 8a-8a Sat or Sunday.
In addition to our hospital work, we staffed our clinic from 8am-5pm during the week. Each resident would be in clinic 3-4 days from 8-5. On days we weren't in clinic, we were rotating with different specialists in their offices, following them to the hospital, etc. We would spend approx. 6 weeks each with cardiologists, pulmonologist, rheumatologist, orthopedic surgeons, general surgeons, pediatricians, and psychiatrist.
Also, from 8-5pm, there was one resident in the ER (2nd year); one to cover obstetrics (intern); one to cover pediatrics (2nd year), one for the ICU (intern) and one for the regular, adult patients (intern).
Now, we had to be in clinic, so we could treat our patients when they needed us. We had to rotate with the specialists to learn more expertise. We had to staff the hospital at nights.
How do you expect all this to be done, if residents are limited to only a limited numbers of hours "on the clock?" Remember, I was in clinic all day (8-5), and then worked at night (5p-8a). If I then have to go home to sleep (which believe me, I really wanted to do), who would cover my clinic time, or time with the specialist?
Remember, just to staff the hospital, we need 5 physicians available every M-F from 8a-5p. We need 3 physicians every night from 5p-8a. On Sat and Sun, we were lucky-only needed 3 docs for a full 24 hours. The second year doctor is all tied up in our very busy ER (45,000 patients last year). The intern is running back and forth from the ICU to the OB delivery suite. The senior resident is working everywhere.
Then we need 5-8 docs to be in clinic every day from 8a-5p.
Is the answer to double the number of residents? Some problems with that. 1. Training residents is extremely expensive. Their salaries, malpractice insurance, training time in ACLS, CPR, etc. 2. There aren't enough people wanting to be physicians to double the slots. They'd never fill.
Is the answer to make them work shorter hours? Sounds good, until you realize that there are still 24 hours in a day. If Dr X. can only work 12 hours a day, we need 2 people for that day instead of one. That also means that Dr X. will have to work 7 days a week, with no days off (I guess we could just go home after our shift, pass out in bed, wake up 12 hours later and go back to work- who needs time off, anyway). If we let Dr X. work for 24 hrs at a time, at least it can go home, sleep for 8 hours, and then have a productive day with their family, shopping, mowing the lawn, etc.
Is the answer to just close the program down to new patients after a certain time of day? Don't think that'll fly.
A final thing to think about. When the docs-in-training graduate from their residency program, what are they going to do in their private practices if they were in clinic all day, had to spend all night in the hospital treating their patients, and then have to have clinic the next day? Do you think their patients will mind if they get a Call at 8am stating "Dr X was up all night at the hospital, so he's decided that he's too tired to see you. We need to reschedule. And since Dr X is in solo practice in a small town, she now is responsible to her patients 24 hours a day, 7 days a week. Won't matter to the law firm of Dewie, Cheetim and Howe that Dr X was sleepy, she should have responded faster to Mrs. Johnson's phone call.
People get sick 24 hours a day. So someone needs to be there, fresh and awake to treat them. In my program, the 2nd year residents worked in the ER, and the interns and senior residents worked the rest of the hospital. The hospital was a 650+ bed facility. As an intern, I was responsible for ALL after-hours codes (in case you don't know what that means, it's when someone stops breathing or their heart stops and CPR, IV medications, intubations, etc., are done). There were probably 3 or 4 a night, since our hospital has close to 150 ICU beds. These people were sick. The interns also were responsible for obstetrical care after hours; we also had to answer calls from any other part of the hospital.
Our "call" period was from 5pm to 8 am. With 8 of us, that means every 8th night. Plus, when it was a weekend, we were in the hospital from 8a-8a Sat or Sunday.
In addition to our hospital work, we staffed our clinic from 8am-5pm during the week. Each resident would be in clinic 3-4 days from 8-5. On days we weren't in clinic, we were rotating with different specialists in their offices, following them to the hospital, etc. We would spend approx. 6 weeks each with cardiologists, pulmonologist, rheumatologist, orthopedic surgeons, general surgeons, pediatricians, and psychiatrist.
Also, from 8-5pm, there was one resident in the ER (2nd year); one to cover obstetrics (intern); one to cover pediatrics (2nd year), one for the ICU (intern) and one for the regular, adult patients (intern).
Now, we had to be in clinic, so we could treat our patients when they needed us. We had to rotate with the specialists to learn more expertise. We had to staff the hospital at nights.
How do you expect all this to be done, if residents are limited to only a limited numbers of hours "on the clock?" Remember, I was in clinic all day (8-5), and then worked at night (5p-8a). If I then have to go home to sleep (which believe me, I really wanted to do), who would cover my clinic time, or time with the specialist?
Remember, just to staff the hospital, we need 5 physicians available every M-F from 8a-5p. We need 3 physicians every night from 5p-8a. On Sat and Sun, we were lucky-only needed 3 docs for a full 24 hours. The second year doctor is all tied up in our very busy ER (45,000 patients last year). The intern is running back and forth from the ICU to the OB delivery suite. The senior resident is working everywhere.
Then we need 5-8 docs to be in clinic every day from 8a-5p.
Is the answer to double the number of residents? Some problems with that. 1. Training residents is extremely expensive. Their salaries, malpractice insurance, training time in ACLS, CPR, etc. 2. There aren't enough people wanting to be physicians to double the slots. They'd never fill.
Is the answer to make them work shorter hours? Sounds good, until you realize that there are still 24 hours in a day. If Dr X. can only work 12 hours a day, we need 2 people for that day instead of one. That also means that Dr X. will have to work 7 days a week, with no days off (I guess we could just go home after our shift, pass out in bed, wake up 12 hours later and go back to work- who needs time off, anyway). If we let Dr X. work for 24 hrs at a time, at least it can go home, sleep for 8 hours, and then have a productive day with their family, shopping, mowing the lawn, etc.
Is the answer to just close the program down to new patients after a certain time of day? Don't think that'll fly.
A final thing to think about. When the docs-in-training graduate from their residency program, what are they going to do in their private practices if they were in clinic all day, had to spend all night in the hospital treating their patients, and then have to have clinic the next day? Do you think their patients will mind if they get a Call at 8am stating "Dr X was up all night at the hospital, so he's decided that he's too tired to see you. We need to reschedule. And since Dr X is in solo practice in a small town, she now is responsible to her patients 24 hours a day, 7 days a week. Won't matter to the law firm of Dewie, Cheetim and Howe that Dr X was sleepy, she should have responded faster to Mrs. Johnson's phone call.
Didja ever notice...
Why is it that when a poll comes out showing Kerry ahead of Bush by 2 points (with a +/- 4), the news media trumpets that as a resounding lead for Kerry, but when a study shows the president ahead by 6 ( with a +/- 4) the race is tied???
Typical day in the office
Today, I had a patient come in with a cold. After examining her by looking in her ears, down her throat, listening to her lungs, and finding nothing significantly wrong with her, I made the mistake of telling her that she had a "cold"
Her spine bristled at that, stating that she "wouldn't come to no doctor for no cold", and she demanded a shot for her condition. When I then told her that we don't have a shot for the common cold, she looked at me and said "son, there ain't nothin' common about me" and stormed out of my exam room. Another happy customer.
Moral of the story: "Mam, you suffer from a viral infection of your respiratory tract" and "here, take this phenylephrin/quafenisin combination pill to ease your condition."
Her spine bristled at that, stating that she "wouldn't come to no doctor for no cold", and she demanded a shot for her condition. When I then told her that we don't have a shot for the common cold, she looked at me and said "son, there ain't nothin' common about me" and stormed out of my exam room. Another happy customer.
Moral of the story: "Mam, you suffer from a viral infection of your respiratory tract" and "here, take this phenylephrin/quafenisin combination pill to ease your condition."
Friday, October 22, 2004
If you can't beat 'em, beat em!
The left in this country is getting desperate. Instead of actually articulating thoughts and debating ideas, they have resorted to violence and intimidation. Check out this story for evidence. Pathetic.
Thursday, October 21, 2004
The new Boston Tea Party
A 21 year old college student died after sustaining a head injury during the "celebration" of the Boston Red Sox's victory over the Yankees last night.
As tragic as this death is, why is it that when the home town team wins, people go on an anarchistic rampage, turning over cars and starting fires? Thank God the Red Sox didn't lose the game, or the entire city of Boston might be in flames still.
As tragic as this death is, why is it that when the home town team wins, people go on an anarchistic rampage, turning over cars and starting fires? Thank God the Red Sox didn't lose the game, or the entire city of Boston might be in flames still.
Flu shots only Bad for Republicans
The Kerry campaign is on a rampage about Vice-president Cheney getting a flu shot, but apparently under all the din of the campaign hair-spraying they didn't hear that President Clinton got one as well. I guess only heart patients on the Left side of the aisle qualify under the government recommended guidelines.
I'll try to remember that for my patients.
I'll try to remember that for my patients.
Wednesday, October 20, 2004
Not a real job
Ter-AY-za Kerry was quoted as saying the following about Laura Bush: “But I don't know that she's ever had a real job — I mean, since she's been grown up.” She then followed up with “And it's not a criticism of her. It's just, you know, what life is about.”
Original Here
I’m sure that Mrs. Kerry really and truly doesn’t think that was an insult. But coming from a woman who is worth more than the GDP of Nairobi, I think it’s a quite shallow. I wonder if the wannabe-first lady could handle a library full of 2nd graders, all running around, jumping, yelling, etc.
I guess, though, that a public school librarian isn’t a real job. I wonder if the heiress would still say that if Mrs. Bush were working for the Heinz Foundation Memorial Library? She'd probably just call her a "servant."
Speaking of real jobs, I wonder if Mrs. Kerry has ever had one????
Original Here
I’m sure that Mrs. Kerry really and truly doesn’t think that was an insult. But coming from a woman who is worth more than the GDP of Nairobi, I think it’s a quite shallow. I wonder if the wannabe-first lady could handle a library full of 2nd graders, all running around, jumping, yelling, etc.
I guess, though, that a public school librarian isn’t a real job. I wonder if the heiress would still say that if Mrs. Bush were working for the Heinz Foundation Memorial Library? She'd probably just call her a "servant."
Speaking of real jobs, I wonder if Mrs. Kerry has ever had one????
Monday, October 18, 2004
What the...
What’s wrong with people these days? A judge in Colorado has just ruled that it’s ok for people who have requested an absentee ballot for the November election to also show up at their polling place and vote- as long as they swear they didn’t send in their ballot. He also said that people there who show up at the wrong precinct to vote may still cast their ballot for president, but NOT for any other office, such as Senate. On the other hand, I’m surprised the judge was smart enough to rule that voters must show some type of ID to prove their identity before punching the chad.
So, let’s start with the first issue. Someone who’s received an absentee ballot can still vote at the poll, as long as they promise they haven’t already voted. Hmm. “Gee Mrs. Cleaver, you look lovely today. I haven’t voted yet.” I don’t see any potential for fraud there.
Second. Why, for Pete’s sake, should someone who doesn’t have the initiative to find out where their correct place to vote is still be able to cast a ballot for President; yet they cannot vote for senator, mayor, congress, etc. Is this judge saying that they are too ignorant to vote for these other offices, but not for President? The presidency ain’t important, I guess.
Third. Why would the judge who made the first two rulings, all of a sudden have a dramatic attack of common sense and decide that if you do vote absentee, but then show up at the wrong precinct on election day, all you need to do is flash a little identification and, WAMMO, you get to vote again.
And as you can imagine, this third ruling is causing a conniption from those on the left. The socialists are steaming mad. How dare they require someone who CANNOT LEGALLY VOTE IN THE FIRST PLACE show ID.? That will disenfranchise all the felons, illegal aliens, non-US-but-here-legally-citizens and dead people.
So, let’s start with the first issue. Someone who’s received an absentee ballot can still vote at the poll, as long as they promise they haven’t already voted. Hmm. “Gee Mrs. Cleaver, you look lovely today. I haven’t voted yet.” I don’t see any potential for fraud there.
Second. Why, for Pete’s sake, should someone who doesn’t have the initiative to find out where their correct place to vote is still be able to cast a ballot for President; yet they cannot vote for senator, mayor, congress, etc. Is this judge saying that they are too ignorant to vote for these other offices, but not for President? The presidency ain’t important, I guess.
Third. Why would the judge who made the first two rulings, all of a sudden have a dramatic attack of common sense and decide that if you do vote absentee, but then show up at the wrong precinct on election day, all you need to do is flash a little identification and, WAMMO, you get to vote again.
And as you can imagine, this third ruling is causing a conniption from those on the left. The socialists are steaming mad. How dare they require someone who CANNOT LEGALLY VOTE IN THE FIRST PLACE show ID.? That will disenfranchise all the felons, illegal aliens, non-US-but-here-legally-citizens and dead people.
Thursday, October 14, 2004
Adult Stem Cell
With the presidential election bearing down on us, John Kerry is continually denigrating President Bush over the topic of stem cell research. I feel it necessary to point out a few facts about this subject; facts about which John Kerry is greatly misinformed.
Putting aside the ethical arguments behind obtaining embryonic stem cells, there are several problems with embryonic stems cells lines. First, they are difficult to maintain and develop. The South Korean scientists that created the first human cloned embryo started out with 242 eggs, but ended up with just one line of stem cells. Next, genetic mutations are common; they cell lines often grow rapidly and form cancerous tumors when transplanted into their subjects. Also, when the scientists are able to get the cell lines to differentiate into the desired tissue type, they often act abnormally; an example is the diabetes study from the University of Calgary. The stem cells were grown into insulin-producing cells that functioned well in the lab, but when transplanted into diabetic mice, the cells failed to produce insulin and the mice died.
Adult stem cells are a viable alternative to embryonic stem cells. These stem cells are found in umbilical cord blood, placenta, bone marrow and tooth pulp. In fact, according to a report published on CBSNews.com on 10/2/04, “fat derived stem cells, researchers say, might someday provide replacement tissue for treating such conditions as Parkinson’s disease, heart attacks, heart failure and bone defects.” In the same report, according to J. Peter Rubin, MD, of the University of the Pittsburgh School of Medicine, there is “evidence that fat-derived cells can morph into bone, cartilage, skeletal muscle, blood vessel tissue, heart muscle and nerve cells.” Imagine that- turning your liposuction waste into a cure for Parkinson’s.
More advantages: adult stem cells found in one type of tissue can repair damaged tissue of a completely different type. They can be harvested from each patient, grown in culture, and then transplanted back into the same patient-thus no transplant rejection. And importantly, there are no ethical concerns in harvesting these cells.
In fact, on Sept 4, 2004, Reuters news service reported the results of a groundbreaking study where bone marrow stem cells obtained from adults were injected into patients who needed heart transplants, and their hearts began to grow healthy muscle and blood vessels!!! Four out of the five patients treated thusly no longer needed transplants!!
And some final words of advice to John Kerry- remember the tragedy of unrestrained scientific experimentation on humans in the name of some nebulous “greater good.”
Remember the horrifying experiments of the Nazis at Dachau. The deliberate infliction of gun shot wounds to see how they’d heal. The traumatic amputations of limbs without anesthesia, and then transplanting these different limbs on to other prisoners to see if they’d adapt.
Remember the Tuskegee Syphilis study. Taking black men known to be infected with syphilis and deliberately withholding treatment just to observe the natural history of the disease.
Remember the studies done at the Jewish Chronic Disease Hospital in New York (1963)-where chronically ill but cancer free elderly patients were injected with live cancer cells to see how the body would respond.
Remember the Willowbrook State School incident (1963-1966) where mentally retarded children were purposely injected with live hepatitis vaccine to test the efficacy of an experimental hepatitis vaccine.
Why destroy an embryo to collect stem cells when there is another viable option?
John White, MD
Putting aside the ethical arguments behind obtaining embryonic stem cells, there are several problems with embryonic stems cells lines. First, they are difficult to maintain and develop. The South Korean scientists that created the first human cloned embryo started out with 242 eggs, but ended up with just one line of stem cells. Next, genetic mutations are common; they cell lines often grow rapidly and form cancerous tumors when transplanted into their subjects. Also, when the scientists are able to get the cell lines to differentiate into the desired tissue type, they often act abnormally; an example is the diabetes study from the University of Calgary. The stem cells were grown into insulin-producing cells that functioned well in the lab, but when transplanted into diabetic mice, the cells failed to produce insulin and the mice died.
Adult stem cells are a viable alternative to embryonic stem cells. These stem cells are found in umbilical cord blood, placenta, bone marrow and tooth pulp. In fact, according to a report published on CBSNews.com on 10/2/04, “fat derived stem cells, researchers say, might someday provide replacement tissue for treating such conditions as Parkinson’s disease, heart attacks, heart failure and bone defects.” In the same report, according to J. Peter Rubin, MD, of the University of the Pittsburgh School of Medicine, there is “evidence that fat-derived cells can morph into bone, cartilage, skeletal muscle, blood vessel tissue, heart muscle and nerve cells.” Imagine that- turning your liposuction waste into a cure for Parkinson’s.
More advantages: adult stem cells found in one type of tissue can repair damaged tissue of a completely different type. They can be harvested from each patient, grown in culture, and then transplanted back into the same patient-thus no transplant rejection. And importantly, there are no ethical concerns in harvesting these cells.
In fact, on Sept 4, 2004, Reuters news service reported the results of a groundbreaking study where bone marrow stem cells obtained from adults were injected into patients who needed heart transplants, and their hearts began to grow healthy muscle and blood vessels!!! Four out of the five patients treated thusly no longer needed transplants!!
And some final words of advice to John Kerry- remember the tragedy of unrestrained scientific experimentation on humans in the name of some nebulous “greater good.”
Remember the horrifying experiments of the Nazis at Dachau. The deliberate infliction of gun shot wounds to see how they’d heal. The traumatic amputations of limbs without anesthesia, and then transplanting these different limbs on to other prisoners to see if they’d adapt.
Remember the Tuskegee Syphilis study. Taking black men known to be infected with syphilis and deliberately withholding treatment just to observe the natural history of the disease.
Remember the studies done at the Jewish Chronic Disease Hospital in New York (1963)-where chronically ill but cancer free elderly patients were injected with live cancer cells to see how the body would respond.
Remember the Willowbrook State School incident (1963-1966) where mentally retarded children were purposely injected with live hepatitis vaccine to test the efficacy of an experimental hepatitis vaccine.
Why destroy an embryo to collect stem cells when there is another viable option?
John White, MD
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