Aprosody

Boy have I got to stop watching CSPAN! I cant help it though it is so rich in pathology. I was watching Rep. Barney Frank when he was discussing the A.I.G. issue. At first it was hard to get through his aphrasia and his velopharyngeal incompetence but when I closed my eyes it was the aprosody that was so striking! It is just like the responses I get when I catch a prescription drug abusers trying to convince us that they need pain medications in the ER for something that they dont have. Then in between questions he had classic Biot's breathing which makes me think that there may be hydrocephalus or at least something worthy of a mri and tap for opening pressure.

I know that I mentioned this before and I am sure that it is probably why the whole HIPPA law was enacted, but cant we make sure that every elected official has a complete physical and mental health exam before running for or taking office? I mean we can comply with HIPPA and keep all information private except to the election commission who could simply state, "you cant run because you have a brain defect on MRI". Oh, wait a minute, that would be discrimination and they passed laws agaist that as well. How then do you get rid of an elected official who has a major health issue that prevents his or her ability to fill their post? Are there guidelines and then who enforces them? I'll bet money that the amount of Senators with Lewey bodies on MRI would scare the pants off of us. What about the meds that they are on? Would you trust your representative if you found out that they take 1 mg of Xanax tid for anxiety, adderal for ADD and then Effexor for depression and that they have bipolar characteristics? We have already had a president with Addisons disease and associated steroid psychosis and he managed to put nuclear missles in Turkey and take us to DEFCON 4. How do we even know what the blood alcholol level is of our Congressman when they vote on bills? Is there routine drug testing? Do you even notice that Sen. Feinstein has conjunctival irritation and mydriasis? I hope that it is allergies and the result of her medications!

Back to CSPAN, Sen. Dodd is talking, does he have ocular hypertelorism?

Fratricide

(Blue on Blue) It was an amazing meeting for the AMA and rumors were rampant. One was confirmed today by the Amercian Legion. The Obama Administration is planning on changing Veterans Benefits in a significant way. Injuries that are acquired by military service will not be covered and treated through the VA. Instead, it will be out of your own pocket by your own health insurance! That is to say if you can get it! Part of a RPG in your back tends to be a pre-exisisting condition. I can just see it now. IED strike, mulitrauma make it to Balad oh wait, lets see, you are BlueCross PPO, let me see if I can get that pre-certed for you. Oh, this is out of network so it will cost you more unless you want to go to Ramadi! I wonder if the politicians who are thinking of doing this have ever looked at dog-tags. They have your blood type on them, you know, the blood that you are spilling for your country. Oh, wait a minute, they have never served in the military.

Is Healthcare a Right? Or a Left?

I was stuck in an airport and managed to catch a local radio show. I think it was the "Valentine Show". Anyway, I was struck by his statements about "the right to healthcare". It goes something like this. I am paraphrasing as I can not remember it exactly. "If healthcare is a right, and we are going to make the government provide our "rights" then lets look at some other things that also then should be "rights". Lets say, food. You need to eat. Clothing, you need to be warm. For that matter, heat then should be a right. Of course, a place to live should be a right as well. So, if healthcare is a right and we decide that the government is to provide it, then they should also provide food, clothes, and places to live on the taxpayers dime. But then, by forcing one group to pay for anothers healthcare, isn't that violating their rights? I guess for the "Left" a "right" means that it is something that you get for free or at least someone else pays for the bulk of it while a "Right" "Right" is something that you can go out and get on your own and the government should not get in the way.

Teleprompter case

One of the hardest parts of the job is having to give bad news. This is especially true after exploratory surgery when you find out that the tumor is far worse than imagined and that it has spread extensively. (I think that the pathologists should have to talk with the families and patients, after all they are the one who really decided that the cancer was there). As soon as you walk in to talk with the family they sense what is going on. They know if it is good or bad. Sometimes it is hard to find the right words that convey the information and at the same time comfort. I would love to have on of those presidential teleprompters to take with me where others can sit back and give me the words to say and answers to the questions that I am asked. Change that, I would rather have those people that are sending the stuff to the teleprompter just talk to the family.

Little lost Remoras

A group of our collegues has just merged to form a larger medical group. In the process they need to expand both their front and back office staff and placed several ads for help. They had a flood of applicants and were supprised by the number who applied that had recently been paralegals. Apparently there has been a huge number of lawoffs in our local legal community. I checked with a patient who is a realtor who always seems to have the pulse of the town and she said that "quite a few local attorneys have their houses on the market and are trying to unload them". I asked her why this was and she said that she only has some ideas but thought that in a bad economy everyone would be trying to sue each other and was supprised that the lawyer clients are looking to go to smaller cheaper houses. I guess like in any business, when money is tight, the first to go is the help, and that must be why the attorneys are letting their paralegals go. I wonder how much some of our states tort reform measures have contributed to this as well as our states recent increase in "legal malpractice suits"?

HIPPA'ed Intraoperative radiology

In a stroke of high tech brilliance our hospital now has all digital xrays. All you have to do is pull them up on the computers in the operating rooms. In the old days, you put all the films on the viewing boxes so that in the surgical case you could look over and see all the films. Now, you have to pull them up on the computer. Of course on the computer to look at the different films you have to just scroll through them. Oh, wait a minute. If you are operating you are sterile so you have to have someone scroll through the films for you! To add to the confustion, HIPPA is concerned that someone might accidentally see the films so the computer goes to sleep and you must re-enter the passwords to see the films every few minutes. This ties up the circulating nurse up as she now is the "mess with the computer nurse" in addition to other duties of constantly filling out the JACHO paperwork. Then of course, the computer decides to not talk to the server and crashes when it tries to autoupdate in the middle of the case. I never had the old xrays and ct films "crash" in the middle of the case. I did have one fall on the floor once. The nurse just picked it up and rehung it. When the computer crashes she has to reboot it, call tech support (in India) and spend an hour trying to fix the problem. The last case, I had to unscrub and go to radiology to look at the films on the main system because the whole thing had crashed. Of course it was an emergency case in the middle of the night. Aint technology wonderful, especially when the government gets involved!

Flaming Zombie

In order to comply with JACHO and to decrease infections our hospital has those gelled alcohol santizers everywhere with signs to encourage everyone to use them when they walk by. There are also signs everywhere that say "No Smoking". Of course no smoking is allowed in the hospital and you can imagine that the patients who smoke will drag their IV poles and pumps, scds and drains out the door and around the corner to the smoking area. You can gues what happened next. One of our regulars who was in the hospital drying out from a blood alcohol level of 0.37 had used the sanitizer on the way out and still had a lot of the gelled alcohol on his hands and had dripped some on his gown. When he lit up, he lit up! He tried to put the fire out on his gown and this lit. Luckily he was not badly hurt. (He had disconnected his oxyegen back in the room) I wonder if he had MRSA and if the fire killed it? Later we found out that the same patient had some of the sanitizer in his room and had been drinking it.