Think About the Plants!

One of my very favorite professors often gives us notable quotes to breakup his lectures (most of them revolve around Chuck Norris...yes, you read that right). He threw this one on the board recently:

"Never trust a doctor whose office plants are dead."

As someone who loves plants and yet seems to have a black thumb instead of a green one (I killed a cactus in college, y'all), this doesn't bode well for me. I mean, I'm pretty good at keeping animals alive; as long as it can tell me it's hungry (whining, jumping on my face, rattling the food bowl, pawing at my bedroom door at 6am), it will survive my care. But if it doesn't let me know? It might get forgotten for long periods of time. I go through several plants a year, which all seem to invariably die off when I bring them in for the winter because the lady who shares a porch with me is no longer able to take pity on them when watering her own plants.

So only patients who can actually vocalize their problems to me.

NC Giving a "License to Kill" to ED Docs?...Not Quite, Guys

White Coat's Satellite Healthcare Update over at ER Stories earlier this week included a story about a bill proposed in NC that would extend some malpractice immunity to ED providers. If you read the story linked, you won't see any actual info about the bill. But you WILL read a good bit about the  North Carolina Coalition for Patient Safety director and chair member and their medical malpractice woes. Also, you will read a few fearful statements about the ethical ramifications of this act; NC-CPS director Laurie Sanders warns that enacting such a bill " gives every doctor and nurse a green light to commit malpractice in the ER." Damn, how'd she know?! I thought we medical providers did such a great job of concealing our eagerness to commit malpractice.

Don't get me wrong, malpractice DOES happen. And the idea of completely absolving ED workers from all malpractice, no matter what, seems pretty crazy to me. So I actually went and read the bill (guys, always do this, there's usually a spin - negative or positive - in the news article!) Yeah, the article was blowing it all out of proportion, or at least blowing the wrong things out of proportion.

My final conclusions? Damn, I'm glad I didn't go to law school. Also, this bill is shockingly not a giant "Get Out of Malpractice Free" card for ED workers! What it does is:

1. Say that any ED provider can't be held liable until it has been proven that they acted negligently
2. Require a bifurcated trial (first a trial for medical liability and compensation, then a trial for punitive damages) for any malpractice case where the plaintiff is requesting more then $75k in damages.
3. Impose a $250k cap on noneconomic damages - this actually seems like the one that should be making headlines
4. Allow for payment of damages in the form of structured settlements as opposed to only a lump sum
5. Require that it be specified how much of an "award" is for economic and how much is for noneconomic losses
6. Require the jury be instructed on the meaning of economic vs noneconomic ("pain and suffering") damages
7. Limit the amount a defendant who is appealing a ruling in favor the plaintiff must pay to either the amount specified by the jury OR the maximum limit their malpractice insurance covers, whichever is lower; this means that the provider doesn't pay an damages out of pocket until an appeal has been completed (at which point, if still found guilty, they will have to pay the rest of the damages)

Yep, nowhere in there do I see a promotion from "MD" to "007" in there for NC practitioners. Sorry guys, maybe next time!

Med School Is...

...coughing through a viral URI lecture and threatening to cough Rhinovirus all over your classmates who laugh at you.

I'm Training to be an INS Agent?

Arizona lawmaker's have proposed a bill (SB 1405) requiring hospitals to check whether patients they treat are legally in the US or are illegal immigrants. Hospitals would not deny these illegals emergent treatment, but would be responsible for promptly reporting them to the authorities. If the hospital doesn't report, they are "subject to civil liability". AZ Senate President Pearce says that "It's a felony to (aid and) abet. We're going to enforce the law without apology."


So here's the deal. I graduated from college as a biologist. I am currently a medical student, and I will soon be a physician. No where in there do you see anything about INS training, right? Yeah, that's because I don't have any. And while I still have a significant amount of training to go through, that particular area of expertise is not in the cards.


Do I support deportation of illegal immigrants? Yep, sure do. But you know who I think should be doing that? People who are trained and paid to do that. INS agents. Not medical professionals. By treating that potential illegal alien in the ED, the medical staff is not aiding and abetting, they're doing what they have trained to do. Are they also committing a crime by treating prostitutes, drug addicts, drunk drivers...? 


I can understand the desperation here. AZ is overrun. Our health system is sagging, sagging, verging on collapse. We can't afford the legal citizens and their [frequently self-inflicted] problems, let alone illegals by the millions. But making it MY job to profile and screen them? Nuh-uh, guys, not gonna work. Let's not even get into the moral issues here; what about the damned paperwork? A recent study published in the Annals of Emergency Medicine estimates community ED physicians spend about 55 minutes for every two hour shift working on "indirect patient care" such as paperwork, phone calls, and reviewing labs. It's not like nurses have it any better. Who is supposed to be taking on this extra workload?


I do have to say, at the end of the day, I could do the job of an INS agent while working as an ED physician for a price: give me an increase in pay for the extra work and a comfy pension. And then, give me handcuffs and a taser to use on people at my discretion. Drunk dude trying to get frisky? That'll be a taserin'! JCAHO inspector getting all up in my business about coffee at the nurses' station? That'll be a taserin'! Maybe a double for the JCAHO guy.

They Made Me Come Back

At the fine Medical School I attend, students are given a roughly three month break after completing MS1, likely in order to lull us into feeling "happy", "fullfilled", and "rested" before springing MS2 and boards upon us. Many students do things that are useful to their future residency applications, like research, anatomy TAing, working in doctor's offices, etc, etc. I, on the other hand, called them a bunch of gunners and went backpacking in Europe for 37 days. Because if I can hemorrhage over 200 grand on a medical education, I can damn well spend 3 grand on a month of hopping trains, ooohing over buildings and paintings, and day drinking like it's my job. It was an amazing experience and I know I made the right choice (my liver may disagree).

After a few weeks back, in which time I recovered from my 3rd HAC (hostel-associated cold) and worried my family with my strangely nocturnal ways, I left for another trip. This one, however, was a medical trip located further south...as in, South America. I spent two weeks mastering the ability to perform Pap smears, feel breast lumps, and tell people to take off their underwear in Spanish. I am now really, really good at all of these things. I'm pretty sure my sterile technique suffered, though. The clinic was nice, but still definitely not up to American standards.

Now I'm back and already studying for test 1 AKA trial by pyrogens (because we're studying immune response...get it, get it? Still not funny?). So I'll try to keep this thing interesting..

Finals

End-of-year finals are quite the adventure. I never knew I could learn so much information in just nine months, and I'm even more shocked to realize that I can recall a fair share of that knowledge. Still, I've been doing a lot of rereading, cramming, and note-taking (in the most cramped, unibomber-esque handwriting I can manage).

Perusing through one of my textbooks last night, I found this gem:

"Pain is an unpleasant sensation."

Goodness, I really needed my full medical education to wrap my head around that one!

An Apple A Day...

Who doesn't know the old saying:

"An apple a day, keeps the doctor away"

Well, since I've gotten to know my classmates pretty well over the past year, I have to say that I ate two apples this morning. Just to be safe.