Thursday, August 24, 2006


Plan B, the emergency contraception, medication has gone over the counter for women 18 years of age and older. Those under 18 can still get it, but need to get a prescription from a doctor. You can find my comments on the matter in one of my prior posts entitled "Emergency Contreption". Any thoughts?

Tuesday, August 22, 2006


I am looking at different educational savings plans and would like advice from any of you finance-savvy people out there.

Mutual fund vs. 529e vs. Custodial account? Hmm…

I’m a bit torn. I like the tax advantage of a 529e; however, don’t like the idea that the money can only be used for one purpose (education). What if the college-bound student doesn’t need the money due to scholarships or attends a school with lesser tuition? I just like being in control of my own money and not having rules placed on it. With an income above the average American, I am in need of tax advantages, so I suppose I could learn to deal with the loss of control.

Any comments?

Monday, August 21, 2006


Here is a story that I just love. It involves so many wonderful learning issues, including human stupidity, natural selection, repeated unplanned pregnancy / irresponsibility, distrust with Western medicine, alternative medicine, and my personal favorite - the immediate lawsuit filing after a loved one's death. This story is so good, I just wanted to share it with everyone.

(In doing some research in toxicology, I found this article about a herbal substance known as pennyroyal. It is found in most herbal stores and used in pennyroyal tea. Funny, since it causes abortions and severe liver and renal failure with death.)

Tuesday, August 08, 2006


This malpractice site ran by a New Orleans law firm actually listed an article in a blog entitled "Doctors Have the Upper Hand At Trial". Yes, we do have an upper hand at trial mainly because if we actually take the time and effort to go to trial, most cases that go that far are bullshit in the first place and pressured there by you social vultures.

What they so delicately forgot to mention was that most malpractice lawsuits don't even go to trial in the first place. Insurance companies would much rather settle out of court for a lesser amount than it would take to go to trial and support the doctor - hence potentially lose more. So, if a doctor wants to actually prove he/she did nothing wrong, that doctor has to pay for it all themselves.

Trial attourneys love to encourage paitients to file suit simply becasue the suit will likely be settled out of court by the insurance companies and lawyers. So, the patients are happy, the lawyers really happy, and the doctor is pissed off because most of the time he/she never did anything wrong in the first place. Really makes you wonder - if most suits that actually go to trial are ruled in favor of the physician, who do you think is right in all those settlements that don't go to trial?

Doctors are so sick of lawsuits, and why wouldn't we be? We do our jobs, usually extremely well, and when some patient has a bad outcome, they immediately think it was the doctor's fault. (Ignorance is bliss.) Wake up! Medicine is not perfect (and never will be), doctors are not perfect, and patients have a good tendency of making a hard job even harder. Now the patient is upset and what happens, they see some advertisement on the TV for some random personal injury lawyer (aka social vulture). The patient calls and the lawyer proceeds to have a great day because usually, if there is any sort of sad outcome, they know that the case will never go to trial and instead be settled out of court for some "undisclosed amount". Well, a good percentage of that amount goes to the lawyers - those nice folks out to serve in the best interest of their clients.

Give me a break. Any personal injury lawyer who says they went into practice to truly help people is so full of it, they reek of it. I'm trying to help people when the need it most, while the vultures fly in and try to feed off the dead. Feed away boys, at least my children can be proud of what I do.


Monday, August 07, 2006


A middle-aged female patient comes into the ED with chest pain, a very common chief complaint. She was extremely concerned that it may be her heart and was sure it was a heart attack. I obtained a good history, which sounded like a possible heart attack (acute coronary syndrome vs. infarction). I always ask about alcohol, smoking, and drug use - especially cocaine, meth, etc. She strongly denies all the above. I tell her we will work her up for cardiac chest pain and get the labs cooking. As I'm walking out of the room, she asks, "Doctor, could this be caused by injecting Ritalin, because I do that." Boy, did I feel stupid for not remembering to ask that very important Ritalin injection question they teach you in med school.


There is a debate out there as to whether medical care is a right or a privilege. Immediately, most people would say it is a right, but the argument is much deeper than that. Currently, there is a health care crisis mainly because of this argument. Patients and the general public believe health care is a right, while many of those in the medical profession, from nurses to doctors to pharmacists, think the contrary. Here's the dilemma...

Right or Privilege:
If health care was a right of every person, every patient, US citizen or not, would have access to medical care - whether they could pay or not. Actually, this system is already in place at every state-funded university or teaching hospital in the nation. Due to EMTALA (Emergency Medical Treatment and Active Labor Act), emergency physicians and hospitals are FORCED to see and treat people who can't pay. EMTALA defined- any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition". If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives. So, we as ED physicians and the hospitals that house us, are forced by law to see and treat patients who can't pay for services, and then are still liable for litigation by those patients when there is a bad outcome. I'm sorry, but if I am to be forced by the government to see and treat you, than the government should be liable, not me. Better yet, don't sue, be thankful your even getting care, and stop being a drain on society.

What is supposed to happen in this system is that people get their medical care and the government picks up the bill; however, in our current system, this doesn't happen. So, people get their free care and who pays? Nobody. The physicians and hospitals supply all their services (nursing time, equipment, supplies) free of charge. Basically, the hospital and physicians are giving charity care, which should not happen. The end result, hospitals have to overcharge patients who CAN pay for medications and supplies in order to partially offset the enormous costs of giving away care to the millions that can't afford it.

In the last decade, over 400 emergency departments have closed while the number of patients seeking emergency care has jumped over 10 million - leading to problems with waits for beds and boarding of patients in EDs. Now, in a monitary economy such as ours, you would think that with such a demand for emergency care, emergency departments would be springing up like weeds. Simply put, medical care, in selected areas throughout the country is socialized and free. It is the non-paying American public (citizen or not) who is driving American health care into the ground.

Health care is a privilege, not a right. Every person deserves care for actual medical problems, but with so many people actively abusing the system (getting free care for non-life-threatening problems and wasting our time) my sympathy on the matter is gone.

Sunday, August 06, 2006


Patients who need to walk outside in a hospital gown trailing IV poles to smoke cigarettes are extremely frustrating. They waste everybody's time. The nurses sometimes have to wheel them outside, plus, I stop by in the 2-3 minutes I have to see them during the day, and they aren't even there.
I understand that smoking is quite possibly the hardest addiction to kick, but it is just bizarre to see a patient outside with IV pole in hand, gown on, no shoes, sick as hell, and smoking. Kind of defeats the purpose of a what we're trying to do at the hospital, don't you think?
On a different note, smoking should be absolutely banned from any public building, including the outdoors part of a restaurant. Sorry, just because you made the extremely bad decision to start smoking doesn't mean that I shouldn't be able to enjoy a meal outside. First of all, you smokers stink (how can you not tell?), and secondly, your smoke always seems to blow right in my face. But, when you come into the emergency room for your chest pain, shortness of breath, and massive heart attack, you won't be smoking then...there's no smoking in the hospital.

Saturday, August 05, 2006


I think the whole concept of natural selection is completely wrong. People who become highly educated, acquire good careers, and actually have something to contribute to society usually have to wait to have children. By the time they do have children they have an increased risk of birth defects or problems with pregnancy. On the other hand, it seems like any teen with half a brain, but able to screw, is able to get pregnant on the first try and have a completely normal baby. Unfortunately, these teens will have their babies, never go far in school, will take the scut jobs in the world and be total drains on society, while all the highly educated people who can't have kids end up paying high taxes to cover the medical care, food, etc. of these young societal black-holes. Natural selection is failing miserably.

Friday, August 04, 2006


FYI, "doctors" of chiropractic medicine are not doctors, at least not the kind of doctor that works in a hospital or medical clinic. Chiropractors are not like your family physician, orthopaedic surgeon, neurosurgeon, or emergency doctor. These are all MDs (medical doctors). Chiropractors are simply "doctors of chiropractic medicine", just like some physical therapists are "doctors of physical therapy". Basically, these days anyone can label themselves a "doctor" if they go to some sort of school after college. So in actuality, the term doctor now references many professionals, from doctor of philosophy (PhD) to doctor of junk (JD).

To become a chiropractor one must attend 4 years of school from 1 of 16 chiropractic colleges accredited by the Council of Chiropractic Education (CCE). When finished, they must pass a board exam and aquire state licensure in order to practice legally. Chiropractic's original focus seemed to be on back pain, neck pain, and a thing called malallignment. These days, there are actually chiropractors out there who believe that chiropractic care is the only care and that people should obtain all their medical care from chiropractors. I won't waste time in saying that these people are complete idiots.

To become a medical doctor one must attend 4 years of medical school and pass a series of 3 national board exams. After medical school, they are technically MDs; however, are unable to go practice medicine right away. Instead, MDs who just graduated medical shool must now attend residency. Residency is where a physician learns thier selected specialty. Residencies, such as Family Medicine, Pediatrics, and Emergency Medicine are 3 years long, while surgical specialties last from 5-7 years after medical shool. Plus, after residency, they now have to pass another board exam, sometimes a written and oral exam. So, by the time a medical doctor enters the community and starts practicing medicine, that person has gone through at least 7 years of medical training.

Here's the real difference between the two. In 4 long years of medical school, students learn a lot, but not nearly enough to practice medicine on their own. It is their time in residency that truly makes them a doctor. It is the daily act of seeing patients, learning how to elicit a good history from those patients, think about a differential diagnosis for what may be the problem, and formulate a plan to diagnose the problem. All this is done under the direct supervision of an attending physician, or mentor MD.

A few thoughts:
- In no way can a chiropractor come out of 4 years of school, start working in the community, and be prepared for what may walk through their doors. So many things can cause back pain (some deadly), which I highly doubt they know anything about, i.e. kidney stones, urinary infections, ectopic pregnancy (deadly), ovarian cysts, pancreatitis, numerous forms of cancer (deadly), aortic aneurysms (deadly), ischemic bowel (deadly), aortic dissections (deadly), autoimmune disorders, fractures, trauma, spinal stenosis, ruptured spinal disc, and the list goes on and on. And I didn't even go into things causing neck pain! All of these potentially dangerous conditions can present with simple back pain. A bit scary huh? In no way should anyone with any of these problems go to a chiropractor for help. If a chiropractor says they can treat and fix any of these problems, walk away, because that chiropractor is now more deadly than any disorder I just mentioned.

- I support chiropractic medicine...for those patients with chronic back or neck pain that have not found any relief by medical means. Truthfully, if you have pain and no specific medical diagnosis was found to be causing such pain, chiropractics is for you. Many patients, from fibromyalgia to cancer, have chronic pain. I support any means to help these people, whether it's a chiropractor, masseuse, or accupunturist. But, the big bad medical causes of such pain should be sought FIRST. Once the bad is ruled out, you can then relax and try finding better means to deal with it.

- I think that any MD who says there is no place for chiropractic care in our society is wrong. The reverse of this is also true and potentially deadly.

- Many people seek medical care and are diagnosed, treated, and do not have to deal with that particular problem again secondary to medication, therapy, or surgery. Yes, the medical bills are expensive (a whole other topic of frustration), but the problem is solved. Now, who knows anyone that has visited a chiropractor and never had to go back for continuing care? It doesn't happen. That's the trick, the visit doesn't cost that much, so you keep coming back for more because they really never fix the problem in the first place. What a nice system for them. Patients just keep returning for more and never realize that the problem isn't solved. Hey, whatever works right?

- Concerning X-rays? MDs barely get enough training in 4 years of medical shool to diagnose problems on imaging studies. They'd probably be lucky to put the X-ray up in the correct orientation. MDs even require overreads from trained radiologists (other MDs trained in imaging modalities). How can chiropractors be able to diagnose all problems seen on X-rays, which may show extra problems that they aren't even looking for? Their not. This is a very dangerous game they are playing.

- IMPORTANT NOTE OF INTEREST: Medical practice is scutinized closely and held to a "standard of care" for any patient problem. This means that if a medical doctor deviates from that "standard of care" and there is a bad outcome, you are liable for litigation (will get sued). Chiropractic medicine does not have this kind of scrutiny and there is no standard of care. So, they are fairly protected from litigation since there is no standard to hold them to. Plus, who then corrects their mistakes or holds them accountable when mistakes are made?


J. Edward Hill, president of the American Medical Assn. (AMA)gave this speech in February, 2006. It is self-explanatory.


In 2007, Medicare wants to cut physician payments by 5%. Here is the response by physicians everywhere...


Informing a family that a loved one is very sick or died used to be the toughest part of the job. The absolute worst is informing of a child's death. Obviously those times are terrible and nothing can prepare one for dealing with the emotions, which is probably why doctors have a high rate of alcohol and drug abuse. Thankfully, I have neither.

My saddest moment thus far...

An elderly woman was brought into the ER from home due to dehydration. She had a long-standing history of Alzheimer's dementia and received care from her elderly husband. They lived alone and it became quickly apparent that the woman was not dehydrated, but perfectly normal (in a demented way). The husband had a look on his face of fatigue. He had spent the last 5-7 years watching his wife deteriorate into an abusive shell of a woman. Apparently, the years had finally taken their tole and his call to 911 for dehydration was actually a cry for help. He had been trying to arrange for both of them to go to some assisted care facility in Penn. or South Carolina, where their daughters lived. Basically, he was trying to do this on his own, with no money, no family close by, and with a wife that needed constant care. I was amazed at how strong his love for her was. He was keeping his vow to take care of her in sickness and in health, and was being destroyed for it. Truly tragic.


This is for those who dream of socialized medicine where all people have access to medical care. Wake up! It already exists in the U.S. Any poor, homeless, or uninsured person is able to walk into any university or teaching hospital and receive FREE care. They can't be turned away, it's the law. They will walk though those big expensive doors of a state-of-the-art facility, see world-class physicians, receive the same top-quality meds that any CEO would get, and are placed into hospitals where the most cutting-edge research is taking place. When these patients leave the hospital, they still have no money, and they will never pay their bill. So, what happens. The hospital and I eat the costs.

Now, if you are complaining about the system, you are probably a well-educated and working individual with enough income that you actually do pay your medical bills. Unfortunately, the real people being screwed in this whole ordeal are the working middle-class. American medical care is expensive (due to litigation, the price of malpractice insurance, expensive medications, research, etc.), and those working enough to pay their bills bear the brunt of the problem; however, you are still terribly naive to think socialized medicine is the answer. Before you cry any longer about the system do this. Travel down to Latin America or another country with socialized medicine and try it out. Acquiring health care and treatment is quite different with such a system. You may soon change you mind and come to appreciate what you already have a bit more. Stop thinking you're politically informed and start thinking more realistic.

If you really want to make a change in the system, here is my advice. Advocate for caps on malpractice claims and consequences for inappropriate lawsuits. The price of physicians' malpractice insurance will decrease, the price of physician costs will decrease, and hospitals and doctors wouldn't have to charge so much for care. As for the extremely high cost for medications, we're all screwed.

Lastly, if you still want socialized health care that bad, leave.


Here's the problem:
Physicians that work at free clinics or urgent care centers, where patients can come in for emergent free care, are at no risk of being sued. They are protected under the law from litigation. Emergency physicians anywhere else are under legal force to see any patient that walks through the door, insured or not. Hence, uninsured patients who come into the ER, 1) end up receiving free care (usually the hospital eats the cost) and 2) can still sue the doctors forced to take care of them. Basically, we are forced to treat patients for free and then have no protection from litigation. If you think about it, some patients get free care and then get a large settlement because insurance companies would rather settle out of court than defend the doctor, even when that doctor didn't screw up in the first place.

And you wonder why your medical bills suck. Read this article below about new legislation in place to help fix this problem.

For you social slugs and drains out there, be glad you live in this country.


Read this article to understand one of many reasons why lawyers are destroying American health care.

Tuesday, August 01, 2006


In regards to personal injury and/or malpractice lawyers, I think that anyone who makes a living in such a way must find it difficult to look at themselves in the mirror. I'm sure at some point during thier path to "greatness", they felt a flicker of humanity; however, it seems that such a flicker is momentary. Yes, I make a living off sick people...some may say that I am exploiting the sick just like those lawyers I speak of. If this is what helps you sleep at night, so be it. But I take comfort in the concept that, while mistakes will be made, I am trying to actually help the patient. These blood-suckers swoop in after mistakes are made and exploit not only the patient, but the physicians, hospitals, and insurance companies - all the while filling their pockets with no risk of being sued themselves.

For all you patients out there complaining about the rise in health care costs, look no further. I have your answer right here. As long as there are naive patients, with imperfect doctors and heartless lawyers, the amount I have to spend on malpractice insurance will increase, the amount of your insurance will increase, the cost of health care and medical bills will increase, and you will find yourself screwed. You, the patients, will ultimately be left behind in the end because lawyers will earn more, doctors will still earn a decent living, insurance companies will do just fine, and drug companies will run rampant over us all.


I freely give emergency contraception to those who it applies to. That much should be said right now. Those of you out there that don't support medical contraception in general, let alone emergency contraception, are complete idiots. I suppose you are the same people with 11 kids you can't support and use my tax money to pay for your medical care. However, you boys and girls out there screwing without caution and getting pregnanct are even bigger idiots for obvious reasons.

I recently took care of a middle-aged woman who was raising two children on her own. Probably not that uncommon these days. From what I gathered, she hadn't had sex in quite some time. Well, single moms definitely deserve some relaxation, but her relaxation ended with one too many drinks at the bar and unprotected intercourse with a one-night stand. She sees me the next day asking/crying for help. Aside from the typical concerns about STDs, she was particularly afraid that if she took emergency contraception, she may be killing her unborn fetus. After I confirmed she was indeed not currently pregnant, I informed her of her options, and she left with a Rx for Plan B.

What you need to know...
- It is not RU-486 "The Abortion Pill"
- It will not work if you are already pregnant
- Works best if taken within 3 days of sex, may still work after, but not as well
- Usually take one pill right away and wait 12 hours to take a second dose, that's it

Two last notes. Of course abstinence works best, but let's face it, abstinence sucks. I do support emergency contraception; however, I don't think it should be given an "over the counter" label.