Music Is In The Silence Between The Notes.

Music is in the silence between the notes.  Just imagine even the most renowned symphonies would be just noise if there was no pause between the notes. Life is just like that. If there is no sorrow, joy would not mean any thing. If there is no tragedy, happiness would be meaningless. 

If some one would remain euphoric all the time you would call him insane, if someone is always sad, you would think that he is "depressed". Life requires balance, that could only be achieved if you experience both spectrum. Sometimes it requires a touch of the other side to cherish what you have. Some people only realize what a blessing good health is, until they come out of an illness.

There is a short Urdu story by Azad. There was this man who found out that there is a place where you can go and trade ones worst problems. He went there and traded his chronic colic pain for bad arthritis. On his way back he realized how difficult it was for him to walk with this new ailment. .He had no choice  in the end but to return and get his old ailment back. They say that no one gets more than their share of bad luck, not an ounce more than they could tolerate, I guess it is true, maybe it is adaptation or I just hope that it is not  Karma! 

I write this because in the past one week I admitted two patients, both with foot pain. One person got an amputation the other had a simple infection. Surprisingly both were stoic. I made it  a point to ask both of them today how come they never had a complaint. They both said it could have been worst! 

Blog you later.

About the picture: Curves and different shades caught my eye in this frame as I was walking towards this building in DC. 

Irony!

Few years back I received a call from a lawyer in North Carolina. He was calling to find out if I wrote a letter in favor of an inmate. I knew the patient but I never wrote a letter on his behalf.

I asked him to fax the letter to me. It was a most interesting letter. The letter basically stated that this former patient of mine should be released from jail due to health reasons. I wish if this was as simple to get a "get out of jail" card from a doctor. My letterhead was forged using my business card and interposing the image on a copy paper. The terminologies and language in the letter were flawed and the context was way too simple.

I called the lawyer back and told him that I am not the author of this letter. He laughed and said he thought so. Out of curiosity I asked him what is he convicted of. 

He replied "forgery". 

Blog you Later,


About The Picture: I took this picture of a picture at Hirshhorn Smithsonian art museum by Tomas Struth of Pergamon Museum, Berlin.

Enough with Made Up Statistics.

46% of all statistics are made up.

I come across various times in a day when I am quoted statistics of some sort like "26.5% of patient develop heart failure after a single meal containing excessive salt" or "12.45% of medical errors are due to physicians".

I remember during my fellowship I was doing a breast biopsy. That was was my second biopsy procedure, my first biopsy was a success. The patient asked me how many have you done. I replied "lets put it this way I have been successful 100% of the times". She was pleased for a short time until I told her that this is my second time!

Sometimes I am amazed at the recall people have with these numbers. Now I am not so bad with recalling the numbers but some of my colleagues are just too amazing. So naturally I decided to make a note of these numbers and started to check these figures. I was amazed that 46% of the times these were wrong.  

So remember for next time, 46% of statistics are made up................ including this one :)

Blog you later.

Statistics are human beings with the tears wiped off.  ~Paul Brodeur, Outrageous Misconduct

About the picture: 100% Downtown.

Need Money For Weed?

Hardly a day passes by when I don't have to admit patients with drug related problems. I have seen almost all kind of complications ranging from anoxic brain injuries after Ecstasy use to brain abscesses after IV drug use. Acute myocardial infartions from cocaine to aortic aneurysms after meth. Addicts of all ages from 18 to 79 years olds, people from all socioeconimical backgrounds.There are already enough problems, why create some more. I wrote about this issue here  in the past.

On my last call I admitted 9 patients, six of those were drug related issues. These admissions are more complicated  as some of them are suicide attempts and some psych issues. Few of them are brought in by police and they are admitted for medical clearance, they later require transfers to psych facilities which are not easy to find.

Anyways just another day in paradise.

About the picture: This gentleman was at Times Square, I had to give him a dollar for this picture.

Illusions Of Healthcare, Uninsured.

I have two young patients, both with cancers. They need surgery, chemotherapy and radiation, and they need it now. We have a diagnosis and plan, unfortunately we can not implement it. The kind of surgery they need,  we are unable to perform those at our hospital. I can not transfer them anywhere because they are UNINSURED.  So they are stuck in limbo.

In this day and age where we are the most powerful nation in the world but some of our own do not posses some basic needs. I spent a lot of time talking to different hospitals but I am still waiting for an answer. So naturally I am frustrated.... this is quite an illusion of care. Maybe tomorrow is going to be another day.

About the picture: Luray Caverns, Virginia. There is water at the bottom of this particular shot which reflects the roof and gives you an illusion.

Super Doctor.

I was talking to a fellow physician and he inquired “how many patients do you see in a day” I said “maybe around 20”.  He smirked and replied “20 ONLY! I can see around 40 in a day and still have time to hit some balls”. Hmmmmm....... there is something fishy here at Smallville.

Few years ago I used to work for this company; I had no option but to see a huge number of patients. Sometimes my census would be around 40 or so. I remember one day that I got 26 new admissions. I took care of them all along with the patients who were already on my list. By the end of the day I was a tad confused. When nurses would call it would take me a moment to recall a patient. I would have to think twice so that I don’t confuse a chest painer with a GI bleeder.

You can see a lot of patients but I think it is not fair to the patient. As I always say it is just not about billing. You can not provide adequate care when you are breezing through your list. The goal is not just to see them but to make the right decisions. One way to see them would be to call 20 thousand consults and let other doctors make decisions for you or you can try to see them like you should and spend your whole day ……. and night seeing them all.

Devil is in the details…. If you are detail oriented and if you have a good system in place, then you decrease your chance of error. Believe me it is going to happen… you will make an error (Murphy’s Law) but the difference is the gravity of error.

So what is the magic number, various factors play a role when you consider the right number of patients to see. If you have midlevel support or you have residents, than you can probably see more but that is not the case for most of us. I think 15-20 patients per day is a fair number in a 12 hours shift in a hospital setting. I read  this article sometime ago at Today’s Hospitalist, it nicely breaks down various situations vs census of patient accordingly.

I call these doctors Super Doctors. It is like "look! It's a bird. . . . It's a plane. . . . No....It is a SUPERDOCTOR!” No patient can really identify what breezed through them. But just remember it takes only one kryptonite to bring down the mighty. 


About the pic: Not Krytonite, it is a Topaz at Smithsonian Museum at DC.

Birthday Party and "I Have A Sick One"

Birthday is supposed to be your day, you enjoy, relax and have fun with your friends and family. Statistically and according to my personal observation, people who have the most birthdays usually live the most.

Few days ago I had mine, somehow it doesn't look kosher if you try to take a day off. My birthday started a little early with a page from ER around 2 in the morning. They gave me routine greetings and put me on hold for some major announcement. Soon I was talking to a fellow physician who said those dreaded 5 words "I have a sick one". When you hear something like this you know you better get up and get ready. Someone is heading to ICU. 

I drove to the ER, dodging few deers (Yes real deer!) and reached there around 3 in the morning. This lady was really sick, she literally decided to throw the book at me. She saved all known critical medical problems for me specially for this day. That took few hours to stabilize. At the same time I was informed that a turkey gulper is waiting for me. Around thanksgiving I usually see one or two who decide to gulp a turkey without utilizing the mastication process which results in a turkey stuck in limbo in the esophagus.  Anyways patients kept on pouring in for the rest of the day without showing any sensitivity that it was my birthday. 

Later I went to the wound care center where my office manager Debbie was kind enough to bring this cake, 

due to lack of resources I had to use a scalpel to cut this cake. The rest of the day passed by pretty fast. I came home around 6 pm, pretty fatigued for the day but it was lovely to see my family and have a great dinner.

PS: No wounds were harmed while utilizing this particular scalpel.

Flu Shot, Did You Get One?

According to CDC (Center for disease control), flu 2010-2011 season started in October and it will peak in January. Current recommendations are that everyone above 6  months of age should get the vaccine. This year you don't have to get a separate vaccine, this year vaccine includes protection against 2009 H1N1, H3N2 and influenza  B  virus.

I got my Flu shot early last month at the hospital cafeteria, I was ambushed as I was on my way to get some food. Unfortunately my wife and our two daughters were not so lucky. So as we got out of the plane at Washington Dulles Airport, we saw a kiosk right near the baggage claim, personals over there were offering free Flu vaccine. My wife got a shot and the little ones got nasal sprays. Children were overjoyed when they figured out that they will get a "mist" rather than a shot.

Anyway I like this campaign, it is very effective and convenient. Don't forget to get your shot.

21% Medicare Cuts and Air Tran.

Some of my blogs get published at other online websites like here at KevinMD.com; I saw a number of comments at one of my recent post which I originally published it here. Some of these comments were thoughtful, some very critical and some very amusing. I would like to mention few here.

“I had a plumber come to my house to snake out a blocked sewer line. Two guys showed, and it took them an hour to do the job. The bill? $100.00 plus the cost of a new wax seal for the toilet bowl. You can’t say hello to a doctor for that kind of money. 

“Which is why they make about 500% more than plumbers on average. And they make that regardless of whether the job they do is phenomenal or not.”

“I don’t know about finances but patients are much more likely to say thank you after I teach them to SCUBA dive than after I save their kid’s life. They are also much more likely to pay their fees to the scuba shop for certification than they are to my office for vaccination of their infant.”

Well I can answer some of their concerns but I will leave it for everyone else to make their own inference.  

I recently traveled through Air Tran, I took a picture of this pretzel packet, I found the text very amusing and very practical on the other hand.

It is a possibility that with recent fear of 21% cuts to Medicare payments, we may just not have problems with finding treatment for our elderly, just like it takes forever for Medicaid patients to get an appointment. But we may also find little brochures in hospitals and doctors offices with similar language.