The Forum on Science Ethics and Policy (FOSEP) is going national. The Seattle fixture of the public science scene is now in Boulder, Colorado and poised to make a national impact within the year. Keep in touch with the progress at FOSEP's newly designed website.
For background, visit this thread at Medscape's Med Student Connect board and the imaging posted earlier.
Want to know what this shows? Join the discussion! (I won't be posting here much, so you can take this url off of your blogroll.)
May 17: As I tried to pack for my cross-country move, I categorized my stuff left over from umpteen years of education. If only I'd figured that out earlier!
May 23: You may have already read my musings on the significance of graduation - the day that is.
June 2: While teaching some second year students during their transition to the wards, I learned that an expert medical student is only a mediocre intern and a horrible attending.
June 14: I jotted down dome of my thoughts and emotions on the eve of my first responsibilities of internship.
June 27: It took a little while until I actually had my first shift. But soon after, I wrote just a bit about that.
July 4: I think hand washing is one of the easiest ways to reduce complications in medicine. Yet it remains the hardest for us health workers to actually do...
I've a few more entries in me until I put blogging on hold in favor of learning to be a doctor. But at least this will give you something to chew on. And maybe you'll see me back at Medscape in another capacity someday!
Dear (Insert CT lawmaker name here),
I am a resident physician in the Yale-New Haven Hospital emergency department. I'm writing to tell you a little bit about ER conditions so that you will have a sense of how emergency care is an important issue that should be included in the currently debated health plan. A health care plan in our country cannot be comprehensive if it does not address emergency care.
When I show up for my 12 hour shift at Yale's level one trauma center, I am immediately inundated with an atmosphere that to an outsider could be perceived as chaos. The scene is far from the clean depictions on your television set, and believe me, there is not time for the intrigue that home viewers expect from “Grey's Anatomy.” Every night at many of the top hospitals in this country, patients sit in emergency room hallways for lack of private rooms. It is not unusual for these folks to receive all of their care in the hallway. I will personally wheel patients in and out of rooms so that they may have the dignity of a private exam. It breaks my heart to tell these folks, “We'll only be in here for 10 minutes before I take you back out into the hallway.” Can you imagine your doctor saying, “You have appendicitis and will need surgery, but until then try to make yourself comfortable on this hallway stretcher,” like I have? When you are having the worst pain of your life, you can't understand there is someone sicker than you.
This brings me to the health plan. There are always really sick patients. President Obama has been championing primary care as the centerpiece of his plan; and rightly so: prevention and a steady relationship with one doctor will go far to reduce health care costs. But increasing resources to primary care will not alleviate the overcrowding problems we face in delivering emergency care. For example, with 97% of the population in nearby Massachusetts insured, ER use has increased by nearly 10%. A refrain we physicians wish to emphasize is: coverage does not equal access. Where do people go when they get sick after hours?
I am familiar with and applaud sections 214 and 215 of the current Senate bill (“Systems for Emergency Care...” and “Trauma Centers...” in “Quality, Affordable Health Care for all Americans” submitted by Sen. Reid), and hope you will support these provisions. The grants and mandates are based on recommendations a 2006 Institute of Medicine report and will go far to improve care through one of the most frequent access points for people in need. In the interim, I'll do my part to see as many patients as I can safely handle so that our ER's hallways are used for walking, not patient care.
Thomas Robey, M.D., Ph.D.
If you are wondering why I don't post more here in the next year, it's because I'll be using my time to write other things. Such as letters like this...
My posting frequency will be much less this year. I'm afraid I just won't have the time to polish my writing in a way I'd be comfortable presenting to the blogosphere. But I am still writing. And I'll be back. There's still plenty of 'Hope' around. Hopefully I won't lose it through internship!
Today's looking like another beautiful day.
The black bear that seen earlier this week in Seattle was found yesterday in Everett, WA, just 30 miles north of where is was first sited. The bear turned up in another urban area, so wildlife officials tranquilized him and transported him out of the urban area. Hopefully for him, the adolescent male was dropped off along Highway 2 in an area that is not already claimed by an older, stronger bear. In the end, I'm happy the animal did not meet the same demise that the poor creature found in the University District three years ago.
According to wildlife officials, at no point were humans at risk from the bear; they claim that the bear was more at risk from cars or from dumpster diving. Evidently, human food doesn't do much good for bears. It probably doesn't do best for humans either!
Anyway, I am so happy to be finished with one more task that I could yip with joy. Fortunately, I can save myself the embarrassment because the neighborhood coyotes are at this moment doing just that. Well, at least they are yipping for some reason.
If you would like to read more of my reflections, consider following this link to my column at The Differential.
I hope this bear is not destroyed. I wonder how much cash has been spent on the bear thus far. Multiple squad car chases and a helicopter have been involved... Read the article. You're not going to believe it.
The bear, now named "Urban Phantom" has made his way back north and east of the city. Hopefully, we will find a spot more to his liking in the Cascades. Here's a map detailing many of the animal's sightings.
Need a hint? My wife is an awesome packer. I am not.
So what will I do with my time? I'll try gardening, home improvement, internet ideas and reading... These things I already do and actually enjoy more than commercial programming. For example, I liked this piece in the New York Times by its editorial observer Verlyn Klinkenborg about reading aloud. Reading aloud is fun. I just need to find some people who agree with me. I bet there are a few in New Haven!
And what about other screen entertainment? Movies? Internet? We will still be able to do that, but on my desktop computer. I think the screen is bigger than our TV's anyway. And shows I really want to see? I guess I'll have to try out BitTorrent for size. In the mean time, I've got some packing to do!
6/21 - 7/20 Yale ED & Orientation
7/21 - 8/17 Bridgeport Hospital ED
8/18 - 9/14 Bridgeport Hospital ED & EMS
9/15 - 10/12 Bridgeport Hospital ED
10/13 - 11/9 Pediatrics at Bridgeport Hospital
11/10 - 12/7 Medical ICU at Yale
12/8 - 1/4 Ultrasound & Anesthesia
1/5 - 2/1 Ob-Gyn at Bridgeport Hospital
2/2 - 3/1 Yale ED
3/2 - 3/29 Cardiac Care Unit at Yale
3/30 - 4/26 Orthopedics
4/27 - 5/24 Medicine at Yale
5/25 - 6/21 Yale ED
This is just one more step in my transition to residency!
There comes a time when all that's left to be said is, "Goodbye old friend." This week I used that phrase twice. Once to the Harborview emergency department and later in the same day to my clinic shoes. Over the past 2 years I've used a dedicated pair of shoes during ED shifts and overnight call. The day I stepped out of the Harborview ED was the same day I said goodbye to these old friends. The left toe bears the badge of ortho (plaster). The right foot has a spatter from irrigating my last wound in Seattle. Both bear marks from my away rotation at San Francisco General, as the heels and laces retained a tinge of the scrubs' cranberry pink dye. The real reason for discarding this pair was the torn apart left heel and loss of sole traction. Otherwise, with a splash of bleach they'd be ready for another shift!
The entries each indicate transport to the hospital where I was on call. My willing compliance with HIPAA and patient confidentiality rules prevents me from saying any more about the specifics of the cases, but I will comment briefly on a facet of patient care that could use improvement. Information is often lost in the transition from witnesses to emergency response personel to emergency physicians to their hospital consultants. (I was a student on the orthopedics team at the time.) We hope that the important information is maintained, but invariably, there is something that we wish we had known at the time.
Even with excellent sign-offs between providers, patients come in to the hospital with limited histories. Patients could be 'out of it' due to shock, pain or pain medicine. There could be a language barrier. Patients are sometimes intubated. Important features may have been observed but not documented on the scene, in transit or during an initial physical exam.
One of the important questions in the patient's history for emergency docs are: How did this occur? Among providers, this question becomes: What was the mechanism? Discovering or confirming this info with the patient is one way emergency providers evaluate patient alertness and orientation while they do their injury surveys, so patients sometimes get annoyed at having to tell the same story over and over again. But that's if the patient can tell the story. Sometimes they cannot.
It turns out that the Seattle 911 blog had information that may have been helpful for providers to understand these patients' injuries. In two of the cases from Friday, the entry was made while (or soon after) the patient was in the emergency department, further underscoring the potential utility of electronic documentation of pictures. One of the patients described the accident in a way that when I saw the image, I thought, "I saw the person involved in that accident." The other image generated a, "So that's how that happened" response in me. The importance of pictures (yes, worth a thousand words) is well known in emergency care; the soon to be history Polaroids of automobile accidents are often taped to critically injured patients' charts. The photo below is more a reminder of how beautiful it was on Friday that how the accident occured.
It wouldn't have changed how we treated these patients to know the specifics documented in the blog entries; the primary determinants of treatment are derived from the physical exam and what the x-rays and CT scans reveal. But one wonders if speedy documentation of accidents and injuries in the field could ever be incorporated into the electronic medical record. iPhone medicine is already being practiced in many emergency departments. The fellow on our service used his Blackberry to photograph one of our patients' wounds. He only partially joked with the radiology tech that he needed it to plan for a surgery. The image was later used to communicate with the attending surgeon and was reshown the next morning during a sign-out conference.
Reforming and universalizing the electronic medical record is central to the Obama plan to reduce health care costs. I hope the software programmers include a mechanism for documenting accident photos. In the mean time, maybe I should keep the local injury blogs open on one of the ER's computers.
Photos are from the Seattle 911 blog and were taken by Ben Otteson and Dana Vander Houwen.
Yes, this is the obligate link to another page post. Sorry about that.
There's another kicker in the feature (that seems a little off): the carbon costs of marketing and storing a steel bottle on the shelf of an REI or equivalent store may be as much as producing it in the first place!
The bottom line seems to me to be: Use old stuff. Reusing anything is better than buying a new 'green' object. The worst steel bottles are the red colored ones - every time I see someone drink from one, I think, "Noooo! Don't drink that kerosene!" But that's just the Boy Scout in me...
Perhaps it was this cartoon by Milt Priggee...
Not that I'm not a sports fan. I root for the Cubs and try to find places to watch my beloved Pitt Panthers. But it's the other stuff I'd rather do. And the study has particularly suspect scoring methods for 'misery.' Namely not including pro soccer, for which many Seattlites go bonkers for and for giving more misery points to teams that reach the finals but lose... Maybe Seattle residents just find ways to celebrat that they actually got to the finals...
Lest you think this cartoon inaccurate, I live in Seattle, and routinely see eagles, owls, red tailed hawks, Cooper's hawks and ferocious hummingbirds from my window. Salmon spawn within city limits. Seals hang out near the Ballard locks to harvest said fish. And we see snow-capped mountains on any day with clouds above a 7,000 foot ceiling. You can rent a kayak two blocks from my apartment.
I've not embedded the clip because YouTube has restricted it and because if you are visiting my front page, you still get to hear the "Imperial March" in the background. Wondering why? Read this. Then watch Susan Boyle live a dream.