Parachute Paper

About once a year I give the medical students and residents a talk on how to read and analyse research papers. I do my best to explain that just because there is a paper that says something, it might and most likely is just BS. We go through whether the study has a proper design, statistical analysis and if its conclusions are supported by the reaseach. At the end of the talk, I always finish by saying, when push comes to shove, trust your experience and your own observations as this is the best BS test of any paper and them I give them the Parachute Paper!

Parachute use to prevent death and major trauma related to gravitation challenge: systematic review of randomized controlled trials.
BMJ 2003;327 number 7429


As an aside, I was called to give a deposition when there was a lawsuit against one of our docs. The plaintiffs attorney kept showing me papers that he got off the internet. I gave him a condensed version of my talk and gave him a copy of the paper. They dropped the case.

Environmental Crisis of non-epic proportions

Warning, this may contain some actual scientific postulates.

I'm stranded in the airport. We have a plane but no crew. This leaves me with more time and very little to do to settle my ADD. So here is some of my rambling.

Somehow I got to thinking about the gulf oil spill and remembering how all the environmentalists were screaming about how bad it was and how many microbiologists were saying it was no big deal and that there were microbes in the ocean that were going to eat that stuff right up. In fact, it was adding to the microbial food chain. As it turns out the microbiologists were right. I then started to think, well perhaps oil is part of the food chain. I mean, we have bacteria that have evolved to eat oil so it is part of their food chain, that means perhaps something else eats something and excretes oil. I know that there is a bunch of research trying to use recombinant technology to get algae to excrete oil, but I got to think that there is already microbes that do it. All microbes need a metabolic fuel. Well, plant and animal tissues contain amino acids as their building blocks with some carbohydrates thrown in. Amino acids have by definition amino groups. These amino groups contain a large amount of energy which could be used to power microbes. This would allow the decomposition of bio-organic materials, producing free nitrogen and splitting off hydrogen to allow it to combine with methane moieties to create hydrocarbons. This would also explain why we have so much nitrogen in the atmosphere as it would be in circulation just as the CO2 and O2. How long do you think it will be before someone discovers a ammonia loving microbe that lives deep in the soil that eats coal and secretes oil and natural gas with free nitrogen as a byproduct? What will the anti-oil environmentalists do when they find out that oil is a natural part of the world food chain?

Non-union

I was just sitting at home listening to all the talk about the Wisconsin teachers union and how many democrat politicians are all about the rights of unions and collective bargaining. I was wondering then, why is it not legal for physicians to form a union? For that matter, if we as physicians form too large of a group, the Feds force us to break up. Here is something. I am a teacher ( in a medical school). Does that mean I can join a union?

Attorney PSA

As a general rule, it is not wise to stop your medication because you saw an add for an lawsuit clearing house on TV. I know its hard to believe but it probably was the plavix that was keeping your coronary arteries from clogging despite it being on 1-800-BAD-DRUG. I hope that you recover from your massive MI and have a chance to watch some of the other lawsuit seeking commercials.

I'm sorry to vent but it is getting ridiculous. We really did have a patient today who stopped their plavix because they thought it was banned after seeing a commercial on TV.

The Anti baffle with BS EMR Tab

It took many meetings and a ton of phone calls but we finally have our medical centers EMR equipped with a feature that lets you actually see on the same screen what you need to take care of the patient. Better yet, it can be printed out and placed at the patients room so you can see the patient and then check everything without having to find a computer, log in and wade your way through all the sections of pure computer generated BS.

Originally, the patients chart was a way to keep track of important lab values and information that let you take care of the patient. This was its whole purpose and its most important purpose. It is now a billing, government compliance checking monster in its own right. More time is spent on the paperwork than the care. The actual stuff that you need to take care of the patient is lost in the sea of BS.

I was so happy that we were able to get it so the nurses could print off the single page review of the recent vitals, I/Os, meds and labs. Unfortunately, the medical centers attorneys are afraid that if this is left at the bedside where we used to keep the patients charts it would be both a JACHO and potential HIPPA issue so they made it so you can not print it! So here we go again, Ms. Jones is coding, someone please find a computer and log in and make their way through all the HIPPA screens and all the other BS to find out what meds she is on and what has been going on!

Obama-innovation

I listened to the President talk about how he wanted to promote innovation. The problem is that he and his team have so alienated the pharmaceutical industry that many of our drugs are in short supply or no longer can be found, and here is the latest. Phizer announced that it is laying off thousands of its research and development personnel and moving its whole antibiotic research facility to China. Maybe we can use Obama-innovation and move our whole health care system to China?

(Dumbing Down)(Dumbing Down)

One of the concerns that we have had in the surgeons lounge is whether the new resident work hour limits have "dumbed down" the residents education. It is hard not to think that by decreasing the work 50% that you wont decrease the experience by 50%. On top of this, is that concern that we are further dumbing down our care by replacing residents with NPs. In one of the most ironic episodes, I was in the lounge last night waiting for the patient to have an artline discussing this very thing with another doc waiting for his post op film when I got a stat consult. The patient had come in through the ED where they were seen by an ARNP who consulted pulmonology. It was another ANRP from pulmonology who came and saw the patient and then arranged for admission who then called for the stat consult. The consult was for acute shortness of breath, decreased breath sounds on left! When I got to the room, the patient was pulling a chair over to see if he could stand on it to adjust the picture on the TV. He had a slight wheeze. I asked if he was short of breathe, he answered," Oh, yeah". I asked how long had he been short of breathe, to which he answered, "ever since they removed my left lung". I thought either I am being set up or this is candid camera. I asked what brought him to the hospital this evening to which he replied that he was having some abdominal pain from his old ventral hernia. Being paranoid, I checked him over and then went to the chart. There in all the best EMR was a six page history and physical of computer generated mumbo/jumbo. No where could I find anything that mentioned his hernia or the fact that he was missing a lung. I went to call the resident who had approved the admission but he had already left and signed out to another. This resident stated that the patient was having severe SOB and pneumothorax and that surgery had been called to place a chest tube! I then tried to call the pulmonology ANRP, but they had also finished their shift and left!

Welcome to the world of "not accountable" "Shift" "Dumbed Down" medicine.

Those who cant, teach!

In medical education, the apprentice principle is in high regard. That is to say, you want to get your residents out working with those in the field who are actually working. It is one thing to have lectures by researchers, but it is much better to be out in the field working with those in the trenches. This has led to the attitude that the ones who are good at the actual job are the ones doing the job. Those that suck, sit in auditoriums and teach. That little bit of Dogma got me thinking. Our President taught Constitutional law, but the law that he proposed, pushed and signed was declared unconstitutional. I guess, the principle that "those who cant, teach!" is true for attorneys as well