What WikiLeaks Means for Health Care Privacy

"By releasing stolen and classified documents, Wikileaks has put at risk not only the cause of human rights, but also the lives and work of the individuals. We condemn in strongest terms, the unauthorized disclosure of classified documents and sensitive national security information."

Official White House statement yesterday regarding Wikileaks disclosure of diplomatic cables

No matter what people think of Wikileaks disclosure of approximately 250,000 classified diplomatic cables to the Internet yesterday with the help of the New York Times, The Guardian, Der Spiegel, and Le Monde, the implications to electronic health care information security are significant.

Day in and day out, I type huge volumes of information on my patients on a computer and my fellow physicians do the same. As a result, vast health care information warehouses are at the disposal of the government, insurers, and major health care institutions eager to become more efficient, strategic, or competitive. We are promised the information is private, confidential, and even stripped of its identifiers for group analysis. It is even protected to remain so by law.

And now we find that even the government's most sensitive and classified diplomatic data is subject to disclosure, some how, some way.

Worse, once the leak occurs, the government is powerless to correct the breech.

While a single individual's private health care information may not carry the gravitas of wartime communiqués, each of us deals with famous patients who might not want their diagnosis, HIV status, or drinking history spread far and wide. For them, this private information might be just as personally damaging as anything disclosed by WikiLeaks.

Yet in our new era of the Electronic Medical Record and government funding of health care in America, we now find that this potential loss of our health care privacy is the price (and risk) for care we'll have to accept.

-Wes

A Free iPhone 4 Heart Rate Monitor

Hey, it's fun AND free!

Use your iPhone 4's camera to measure your heart rate. The application detects how the color of your finger changes when blood flows into it, much like the way a pulse oximeter works.

-Wes

Addendum 29 Nov 2010 06:50 am CST: Seems there's an app for Android phones too.

A Photo Documentary: Apple Turkeys

From our house to yours, a tradition for the kids' plates on Thanksgiving: apple turkeys!









Happy Thanksgiving!

-Wes

For Travelers This Holiday Season

Courtesy of Saturday Night Live.

-Wes

For Thanksgiving: Fat Wars

It seems the Washington Post, cloaked under an anonymous author, wants to use scare tactics to keep most of us from enjoying Thanksgiving with their ominously-titled article, "And for Dessert, A Heart Attack?" They spew all kinds of garbage about how eating a high fat diet might give you a heart attack with very little data.

If you want to know more, consider this reference from some pretty smart folks at Harvard.

Then eat, drink, and be merry without guilt (courtesy of Dr. Wes).

Happy Thanksgiving!

-Wes

Reference: Renata M and Mozaffarian D. "Saturated Fat and Cardiometabolic Risk Factors, Coronary Heart Disease, Stroke, and Diabetes: a Fresh Look at the Evidence," Lipids 31 Mar 2010.

Plenty to Be Thankful For

It's from an old post, but it's worth repeating:

I am thankful for the teenagers who are complaining about doing chores -- that means they are home and safe.

... for homework. It means we live in a country where education is valued and encouraged for all.

... for the taxes I pay; it means I have income.

... for the mess that I have to clean up after parties, because it means I am surrounded by friends.

... for the clothes that fit a little 'too snug' because it means I have enough to eat.

... for the lawn to mow, windows to wash and gutters to clean; it means I have a home.

... for the parking spot I found at the far end of the parking lot, because it means I am capable of walking and am blessed with transportation.

... for my huge heating bill, because it means I am warm.

... for the person behind me in church that sings off key, because it means I can hear.

... for the pile of laundry and ironing, because it means I have clothes to wear.

... for all the complaining I hear about the government; it means we have freedom of speech.

... for the alarm that goes off early in the morning because it means that I am alive!- Author unknown

And for those who can access Facebook at work (we can't), this week's Grand Rounds full of thanks is being held at Amanda Brown, DVM's Facebook page.

Happy Thanksgiving!

-Wes

TSA Security and Health Care

John Pistole, TSA administrator, acknowledged travelers' concerns about body-scanning machines that can see through clothing. He agreed that, to some, the pat-downs, which involve groin and breast checks, are "demeaning." But he said the policy is "not going to change."

Wall Street Journal, 22 Nov 2010

I read this article this morning and could not help but think: as it has been with TSA policy, so will it be with health care policy.

• The new policy for body scanners and pat-downs did not occur overnight - the new TSA policies were likely in the works for months behind closed doors - just like our health care policies eventually were.



• The public outcry over the new security measures didn't occur until the people were actually affected. Once that occurred, then came the recordings, the stories of exposed breast prostheses and ureterostomy bag disruptions in the main stream media. Even a rebellious movement to avoid the scanners and overwhelm the security personnel Thanksgiving weekend was mobilized. (Scores of news organizations are now trying feverishly to quell the uprising.)
  
  We have not yet seen the impact of 32 million or so new people entering our current health care system. Will stories of states closing their doors to Medicaid patients arise? What patient-related horror stores will we hear then? (My jaded eye suspects that, like the so-called "doctor (pay) fix," government will swoop in to provide states with funding and reassurance at the eleventh hour to avoid the impression that health care reform law would be perceived as causing fewer people to be covered, not more.)



• Whether change will happen to the security procedures as a result is anybody's guess. (My guess: the TSA administrator will fall back to public safety to justify the motive and no one argues that the skies are vulnerable, so (as he predicts) little will change.) If people are unhappy when the new health care law takes full effect, what uprising might occur then when the realities of the limitations to care provided kick in?



• At least the security policy as it pertains to pilots was retracted - probably because of union pressures. Will doctors need a similar negotiating voice in the future once they're all employees?



• The matters of security and health care are likely to remain divisive and the force needed to change the existing policies will grow more difficult. Like airplanes, people will have to accept waiting in line for health care soon - at least for the complicated, expensive and highly specialized things.

Oh, the times, they are a changin'. It's going to be interesting to see what transpires this Thanksgiving season in the airports and to ponder what it might mean in the years ahead for health care.

Once thing is for certain though: like flying, most of us will be paying much more for the pleasure.

-Wes

Get $10 Off MedTees

Five years ago, my wife and I started MedTees.com, a medical t-shirt web site that helps support a number of worthwhile charities and non-profits (the list of groups is found on the right-hand sidebar of the site's home page). The philosophy of the site is simple:

At MedTees.com, we pick up where diagnosis and treatment leave off. That is, what happens AFTER the dust settles and you go home and they CAN'T fix what's wrong or the fix is tough to live with.

Lots of folks have used these Medtees in creative ways. As a result, we have contributed nearly $10,000 to our charities and non-profits since we started. The holiday season is particularly important for that effort.

Beginning at midnight tonight (0001 am 20 Nov 2010) and continuing though midnight 23 November 2010, you can get $10 off any purchase of $50 or more by entering the code FRIENDS10 at checkout. The site is powered by Cafepress.com (we don't collect credit card information, they do) and they ship just about anywhere in the world.

So end this notice to friends and family, and if you have any new ideas for shirts, we're still accepting those, too.

-Wes

Ablating Hypertension

Refractory hypertension might be approached with radiofrequency catheter ablation techniques in the future, provided it's found the cure is not worse than the disease.

This week, the first non-blinded, prospective, randomized industry-sponsored Symplicity HTN-2 Trial of drug-refractory hypertension using endovascular low-power radiofrequency ablation within the renal arteries in 52 patients was reported. It is thought that this form of catheter ablation denervates the perivascular sympathetic innervation of the kidneys decreasing renin production and, therefore, blood pressure. (The guys over at Medgadget have some cool industry-sponsored pictures and videos about this technology). The ablation therapy in this trial appeared to carry promise at better blood pressure lowering compared to conventional medical therapy:

106 (56%) of 190 patients screened for eligibility were randomly allocated to renal denervation (n=52) or control (n=54) groups between June 9, 2009, and Jan 15, 2010. 49 (94%) of 52 patients who underwent renal denervation and 51 (94%) of 54 controls were assessed for the primary endpoint at 6 months. Office-based blood pressure measurements in the renal denervation group reduced by 32/12 mm Hg (SD 23/11, baseline of 178/96 mm Hg, p < 0.0001), whereas they did not differ from baseline in the control group (change of 1/0 mm Hg [21/10], baseline of 178/97 mm Hg, p=0·77 systolic and p=0·83 diastolic). Between-group differences in blood pressure at 6 months were 33/11 mm Hg (p < 0.0001). At 6 months, 41 (84%) of 49 patients who underwent renal denervation had a reduction in systolic blood pressure of 10 mm Hg or more, compared with 18 (35%) of 51 controls (p < 0.0001). We noted no serious procedure-related or device-related complications and occurrence of adverse events did not differ between groups; one patient who had renal denervation had possible progression of an underlying atherosclerotic lesion, but required no treatment.

This is an interesting study, but the long-term effects of this therapy to the renal arteries remains to be seen. The effects of low energy (6-8 watts of energy)applied over 2 min for each lesion will likely have variable effects at the tissue level.

Electrophysiologists have had a long history of experience with radiofrequency energy to ablate things. We have learned over the years that catheter tip temperature bears little resemblance to the tissue temperatures achieved. We know that low, long power applications make for larger lesions, provided tip catheter contact is stable. The low power applications used in this technology may have significant effects on surrounding tissues.

But we've also learned about the challenges with this technology inside vascular structures. We have learned (the hard way) about the development on intimal hyperplasia and later stenosis of vessels with radiofrequency ablation (in our case - pulmonary vein stenosis). If bilateral renal artery stenosis were to occur, how might the patient's blood pressure behave? Similarly, we have learned that stents placed in arteries cause inflamation and restenosis as well. Are we to think, naively, that inflamation inside renal arteries that have burn lesions applied inside them are more resistant to inflamation and later stenosis?

Hard to know.

Some protective effect against burns probably exists within the lumen of arteries thanks to the cooling effect of the brisk blood flow there. This convective cooling effect of the blood flow might be why these patients fared as well as they did while sufficient effects of heating occured in the outer adventitial layers of the renal arteries.

But there's also the question: what if it works too well? There are very effective treatments for patients with orthostatic hypotension (blood pressure that falls excessively with standing). It is interesting that one such patient was described in the USA Today article that covered this trial, but no mention of this complication occured in the peer-reviewed journal article published in Lancet which said:

Minor periprocedural events requiring treatment and possibly related to the procedure consisted of one femoral artery pseudoaneurysm that was treated with manual compression, one post-procedural drop in blood pressure resulting in a reduction in antihypertensive drugs, one urinary tract infection, one extended hospital admission for assessment of paraesthesias, and one case of back pain that was treated with analgesics and resolved after 1 month. Seven (13%) of 52 patients who underwent renal denervation had transient intraprocedural bradycardia requiring atropine; none had any sequelae.

No doubt a much larger trial will be forthcoming to evaluate these concerns. Still, this innovation might offer an interesting option for drug-refractory hypertension in the future but the jury's still out on it's long-term safety profile.

-Wes

Grand Rounds is Up

Kim over at Emergiblog hosts this week's edition of the best of the medical blog-o-sphere:

We’ll travel through the medical blogosphere of 21st century...

Enjoy!

-Wes

How It's Spun

I read this morning's New York Times article entitled "Mistakes Chronicled on Medicare Patients" and wondered what would this article be like if it was spun toward the positive, rather than the negative?

So I decided to write a different story based on the positive aspects of the government's data, rather than the former article's negative spin, just so we might consider our quality overlords' agenda:

US Hospitals Remarkable Achievements

Six out of every seven hospitalized patients over the age of sixty five receive remarkable care, according to a new study from the Office of Inspector General for the Department of Health and Human Services. The study said that despite the aging of the general population, their multiple medical problems, the increased oversight and regulatory burdens on today’s physicians, the overwhelming majority of patients who enter today’s hospitals receive exceptional care and can be expected to recover fully.

While there remains areas that we can improve clinically, we should not underestimate the remarkable achievements in outcomes of our patients with cancer, heart failure, pneumonia, and acute myocardial infarctions. “These common conditions occur is patients who are the sickest of the sick,” said Dr. Mortimer T Schnerd, study coordinator. “To achieve such progress in the fight against these diseases is remarkable despite the limitations of the imposed governmental quality measures. Patients today are living longer than ever before and typically present with co-morbidities during their hospital stay. All too often it seems the government quality oversight bodies are not happy with our successes. The seem to feel it's better to continue to expend innumerable resources to assure the unrealistic goal of immortality,” said Dr. Schnerd. “But then again, how else will they rationalize reduced payments for our excellent care to more and more people?”

Funny how we never hear how much money we expend on new hires and the total cost to hospitals for implementing quality measures as a counterpoint to the cost of errors that occur in today's hospitals (ie, the "value" to our health system that these measures represent). Recall that Mr. Berwick, our current head of the Center for Medicare and Medicaid Services, managed to skim $1,404,776 in retirement benefits in just seven short years above and beyond his annual salary from his Institute for Healthcare Improvement in 2008 - a quality managment organization. I dare say that's a sizeable amount for most mortal humans.

No, dear doctor, please don't mention this. That's too unseemly and isn't said in the name of quality care!

But to not mention the cost of implementing and maintaining quality measures dodges an important issue. Where should we draw the line in paying for quality measurement rather than spending that money on the frontline caregivers themselves?

-Wes

What Insurance Will Cost You in the New Era of Health Reform

Now that health care reform has passed, ever wonder how much you'll have to pay for health insurance if you carry no employer-based insurance in 2014?

I have spent some time entering sample scenarios to a helpful Health Reform Subsidy Calculator from the Henry J Kaiser Faimily Foundation. The calculator helps you understand the government subsidy you might acquire for insurance based on your income now vs. 2014, age, employment status, difference between a single person insured vs. a family of four, all adjusted with a regional 'cost factor' based on where you live.

Some interesting cut-offs were noted and I have highlighted a few examples using their calculator:

If a 30 year old man without employer-based insurance enters a government insurance "pool" and makes $15,302, then he will have his insurance paid my Medicaid and pay a "modest" out-of-pocket amount for coverage, depending on his state. If he makes one dollar more ($15,303), his premium will become $3,404 annually, for which the government will provide a tax credit of $2,981 and will require an unsubsidized payment from the patient of $459. This does not include an additional $2,083 of out-of-pocket expenses for health care used, resulting in a possible total cost to the individual of $2,542. (16.6% of his income).

If the same person is 49 years old instead and and makes the same $15,303, the premium rises to $6,717, but the government picks up a larger share so the unsubsidized payment for insurance remains $459 and the out-of-pocket expenses remain $2,083.

Now, if the 49 year old has to cover a family of four and makes $31,155 without employer-based insurance, he and his family will be covered by Medicaid. But if this individual makes one dollar more ($31,156), his premium for insurance will be $16,360 with the government crediting the individual for $15,425 for a total unsubsidized annual premium of $935. Out-of-pocket expenses for health care services for this individual and his family rises to $4,167 for a total cost of $5,102 annually ($16.4 percent of their total annual income).

Finally, if we take a person making $200,000 annually at age 49 who is has no employer-based insurance, their premium jumps to $16,300 annually with no government subsidy available and an additional $12500 in out of pocket expenses to be paid ($28,800 annually or 14% of their income).

What is clear is that health care is about to get MUCH more expensive for the majority of Americans, even those from the government's definition of "middle class."

Take some time and enter your information to see where you'll be under the new law when it takes effect. The results are eye-opening.

-Wes

Salamanca Soccer Player Miguel Garcia's Sudden Cardiac Arrest

How fast does sudden cardiac arrest cause unconsciousness?

Just seconds.

Here's video of Salamanca soccer player Miguel Garcia's episode. At the start of the video, Mr. Garcia can be seen in the background of the image kneeling behind the players in the foreground. Watch carefully as he stands after tying his shoes.



Although it is difficult to see, it appears an automatic external defibrillator arrives in about 2 minutes, though given the fact his shirt is still on as he's taken from the field, we note the device is on his gurney as he's hurried to a nearby ambulance. Reportedly, he survived this sudden cardiac arrest event.

This was NOT a heart attack, but rather an loss of cardiac function caused by a rapid, often disorganized heart rhythm disorder. Compare the relatively long time to resuscitation using an external automatic defibrillator verses the very rapid response afforded to Belgian soccer player Anthony Van Loo whose internal defibrillator was already installed before he played as primary prevention of sudden death from right ventricular dysplasia.

-Wes

h/t: Electrophysiology Fellow blog

Down. Set. Hut. Clear!

Sudden cardiac death survivor stories are never boring. From the NY Post:

A veteran Brooklyn high school athletic director suffered a near-deadly heart attack while announcing a football game yesterday but was brought back to life by the team doctor as stunned spectators listened to the dramatic rescue over the PA system. "Clear!" Dr. Ed Golembe shouted as he applied the pads of a defibrillator on Marshall Tames, the athletic director at Erasmus Hall HS, around 1 p.m. at Midwood High's field. The rescue was inadvertently broadcast over the PA system at the 2,000-seat stadium where Erasmus was in a playoff game with the Bronx's Dewitt Clinton HS.

"As I was calling a play, I turned around and heard all this happen," said Erasmus coach Danny Landberg. "I got flustered."

It seems a defibrillator might have been responsible for the coach losing the game, but it sure helped one man live to see another one.

Hearing the commotion, I wonder if the crowd started singing' "Ah, Ah, Ah, Ah, Stayin' Alive, Stayin' Alive..."

-Wes

Back Up and Runnin'

Seems the server's back up, photos and all.

Thanks for your patience.

-Wes

Technical Difficulties

It seems the server where all my really juicy image content is stored has seen better days. Consequently, images are failing to appear on this blog. Hopefully the problem will be rectified sometime before Christmas Season 2011.

I regret the inconvenience.

-Wes

Addendum

13 Nov 2010 09:50 - More info: Register.com, from whom I purchase server space, was hit by a malicious distributed denial of service attack (ddos). Eeeewwww. Might take a while to recover....

Lab Improvements

I'm loving our new big-screen x-ray monitor recently installed in our newly-renovated EP lab:



The easy video-switching capabilities of this monitor offers vast improvements over earlier models and greatly streamlines productivity:

Click image to enlarge

-Wes

FDA Proposes New Cigarette Labels

The FDA will soon require new cigarette package labeling to deter smoking. So in politically-correct governmental fashion, they are asking which labels you'd like to see. (You can pick your favorites here.) My personal favorite (so far) is the one shown to the left, but its impact factor pales in comparison to this example found in England. (That, my friends, is cancer!)


Ironically, it appears the FDA isn't too sure how forceful it should be in these warnings about the dangers of smoking. They offer a cornucopia of milquetoast labeling options - many of which contain cartoons. Might such unrealistic portrayals defy they hard-hitting message they want to project? Worse, at least one cartoon (seen here) even seems to promote cigarettes AND drug use together!

In an even more astonishing example, some images almost make me what to take up smoking so I can blow big bubbles. Since I could never do this well before, maybe I should take up smoking! Seriously, is an empowerment message what the government wants to portray?

Make these labels big, ugly, and real.

Anything else is a waste of taxpayer's money.

-Wes

Schooling Doctors

If you haven't been introduced to 33 Charts, a blog by pediatric gastroenterologist Bryan Vartabedian, MD, ("Dr. V") take a minute to do so. I was struck by his honest post entitled "Is It the End of Private Practice?" in which he laments:

I was driven out of private practice in 2004 by rising malpractice premiums and plummeting reimbursement. In Texas at the time the trial attorneys ran the place and medmal insurance carriers simply couldn’t keep up with the greed.

Medical practices are just too expensive to run and the services that physicians provide are dangerously undervalued. You do the math. Sure it’s a complicated issue. But the end result is institutionally employed doctors with institutional pay and the risk of institutional service.

Of course we need to contain costs. And I know, it’s about the patient and nothing else. And all doctors are filthy rich. Of course they are.

Self-annointed experts blather about doctors, medical economics, and solutions. Government bean counters and consultants think they’ve got it figured out. They have no idea what we do, where we’ve been, or the staggering self-sacrifice necessary to manage a panel of chronically ill patients.

I spent the best years of my life working 15-hour days as a scut monkey training to get where I am. But the next generation will be more judicious. As society sees what doctors do as a commodity, society will see commodity doctors.

The plight of the physician in America is now considered dead last. But don’t cry for me. Cry for your self.

Almost immediately, as if to quell Dr. V's concerns, came this comment:

Hard to challenge your conclusion as well as the likely direction of the key trends. But ‘interesting energy’ Bryan…perhaps a calling to leadership?

There is way too much fatalism, and ‘poor me’ victimization in dis-organized medicine today; which I also sense in your piece.

Where is the ‘what’s my (our) part’ reflection? Where’s the ‘ownership’ of the dysfunction?

Bryan was "schooled."

Please, good doctor, don't mention these things, it is unpleasant. Don't you want to be a leader, good doctor? It's not nice to buck the establishment. You must conform now. Don't you want to achieve a senior leadership position in our organization?

For doctors, the subtle undertones of such a challenge are tough to ignore. We aren't stupid. There is a disproportionate salary reward for doctors who chose the leadership route in large health care organizations. Since doctors are exceedingly gifted at working systems to their personal advantage (can you say "medical school gauntlet?"), and with large corporate structures with large corporate management teams with large corporate human services departments eager to earn their employee-doctors' trust, they need "key opinion leaders" that can influence their younger peers. The temptation to abandon patient care in favor of "leadership" is seductive. Worse, when clinical doctors and administrative doctors butt heads in sticky situations regarding patient care, the trump card for administrators looms large now lest you be labeled a "difficult doctor."

"You must allow the EMR to order tests automatically, doctor, it's in the guidelines."

"But my patient will have to pay for those tests!"

"Dear doctor, you do not understand, this is in the best interest of quality care."

"But my patient can't afford all these tests!"

"But, dear doctor, our hospital report cards will suffer if we don't have these tests documented every six months on their chart and if our report card isn't as good as our competitor's report card, you won't make as much money either."

"But..."

"Shall we move on?"

-Wes

De-funder Dog

It's one thing to de-fund portions of the PPACA that are particularly egregious, but the Republicans must address and offer solutions to the the many challenges that face patients today: cost of insurance, lack of competition between insurers, lack of health care cost transparency, insurance portability, and pre-existing condition exclusions.

-Wes

The Townhall

They can from far and wide, this evening after. Cordial pleasantries were eagerly extended, like soldiers in a foxhole, I knew I was with friends. These were faces I'd seen a thousand times before over the years, but in very different circumstances. No young faces, mind you - they never bothered to check their e-mail: too busy, they'd say.

"Wes, damn good to see you! Thank for your help with Ms. Smith. Don't you love it when medicine comes together to save a life like that? I mean, damn, that's why we all do this right?" he said jovially.

"Wes, have you met Dr. Fatchamata Cheesedip?"

The young face approached bearing a platter of some sort: "What can I get you?"

Beautiful venue. People on their best behavior.

Or not.

Herding cattle, in the nicest of ways, came to mind.

For there they were, a sea of faces sitting at the table facing down shadowed by the faint glow of a cellphone sending texts or Twittering or emailing: "Take out dog. Get to ur homework, k?" "Oh, sure, 24.9% pay cut 1 January, WTF?" "After elections! Time to f-in' quit."

The gavel descending to bring the meeting to order.

"Aye," the back table mumbled, anticipating the first order of business as people chuckled. With a collective average MCAT score of 13, they knew the protocol: review the minutes, vote on bylaws, give some awards, appoint the head Puh-bah. Thank the organizers. Take one or two ideas from the floor. Thanks for coming.

Of course the room grew quiet when health care reform was mentioned. "We're uniquely positioned." "New era." "With our innovative EMR..."

Nothing new.

Like eerily awaiting the thinning of the herd.

"Think they'll have those yummy sandwiches next year?"

-Wes

A New Leadless Pacemaker-Pill?

The weak link in any pacemaker system are the leads that attach to the heart. Now a new innovation under development by Medtronic is on the horizon that might combine the pacemaker and lead together on a pill-sized device installed in the heart percutaneously:

The company has been developing the pacemaker for about a year now. It looks a cross between a battery and a beetle, with bug-like antenna sweeping back from one end.

The technology has yet to be tested in animals -- never mind humans. It's about five years away from being ready for market, if it's approved by the Food and Drug Administration.

While this first device will offer only backup VVI pacing, using several such devices controlled wirelessly might offer even more potential for sequential or simultaeous multi-sight pacing some day.

Very cool.

-Wes

How to Vote When You Have a Heart Attack on Election Day

... it can be done, but is harder than you might think:

Someone who knew Kopplin and who lived in the same municipality had to print a form from the Internet, take it to the City of Milwaukee Election Commission and testify that he knew Kopplin. Then he had to bring the form to the hospital where Kopplin filled it out and signed it in front of two witnesses. The absentee ballot had to be returned to the commission by 5 p.m. Tuesday. His neighbor couldn't make it and Kopplin's kids don't live in Milwaukee. Kopplin eventually found a friend who is a Milwaukee resident to do the grunt work.

"What I had to go through to get a ballot and get it signed and get it turned in by 5, leave it to politicians to come up with this," Kopplin said.

Kopplin received a stent in his heart and is hoping to go home from the hospital on Wednesday.

This man is a Great American indeed.

-Wes

How E-Prescribing is Just Like Twitter

I'm surprised I didn't notice this sooner, but e-prescriptions will only accept 140 characters in their instructions, just like Twitter. If you still must have longer instructions, you must print the prescription and hand it to the patient for it to be manually filled at their pharmacy.

Then again, maybe doctors will start to use some "twitter-like" abbreviations in their instruction fields now, like:

"Chk ur BP b4 taking b/c itz K 2 hold if nl. TIA."

Dude. That'd b fab.

-Wes

Grand Rounds Vol 7, No.6: The 2010 Politically (in)Correct Mid-Term Election Edition

Welcome to this week's mid-term edition of the medical blog-o-sphere's Grand Rounds! Before we begin, be SURE to get to the polls to VOTE!

This week submissions were classified by state or country of origin. Politically incorrect posts by state were colored RED whereas politically correct posts by state were colored BLUE. (States with both extremes are represented in PURPLE.)

Now what would any political post be without a POLITICAL MAP of the states represented in this week's Grand Rounds?

(Scroll down or click on a desired state)

TENNESSEE


It is rare to find such a wonderful example of our great democracy in action, where even the little guy can run for governor. But along came this must-see video, by far the most politically-incorrect submission to this week's Grand Rounds. This post should serve as a reminder to all of us why we MUST get out and vote today. (Submitted by the Happy Hospitalist). Go Basil! (Return to map)

GEORGIA

The Peach State has both extremes,

• From the very politically correct: Kimberly Manning, MD takes one heck-of-a-big-breath as she offers a refreshingly realistic view of the tenacity required to manage medicine, kids, home and a bit of social life. Doctor-moms never get enough credit. (Via: the ACP Hospitalist blog)


• To the very politically incorrect: Insurance executive Bob Vineyard isn't too happy with the Department of Health and Human Services granting "Obamacare waivers" to large, influential companies and wants to make sure you know about it. Tell us how you feel! (Return to map)

PENNSYLVANIA

Dr. Rich, ever politically incorrect yet astute over at the Covert Rationing blog, shares with us why he feels this midterm election cycle is a yawner: the fat lady, er, man, has already sung. (Return to map)

KENTUCKY

Dr. John Mandrola of the Dr. John M blog, always a bastion of political correctness, explains who should be on death expert panels if he were in charge and why. (Return to map)

ARKANSAS

Doctors who blog add depth to medical stories found on the internet. A fantastic example is Dr. Ramona Bates's coverage of California Republican U.S. Senate Candidate Carly Fiorina’s recent hospitalization due to an infection related to her post-mastectomy breast reconstruction. We need more like this. I wonder if she's thought about a run for Congress... (Return to map)

ILLINOIS

File these under politically correct:

Ever have something break (like an exploding ICD) and want to find out if others have seen the same thing? Check out Tony Chen's FDAZilla search engine that makes it easy to search the FDA's MAUDE database.

John H. Schumann, FACP uses President Obama's handling of the career USDA employee Shirley Sherrod's contextual kerfuffle as an example for "making nice" after we screw up. And while errors are inevitable and this is probably the best way to handle them once they've occurred, the story also reinforces principles to which all blog readers should ascribe: checking sources before drawing conclusions. (Return to map)

NEW YORK

(Political Action Committee) Chris Langston, Program Director of the John Hartford Foundation, happily reintroduces us to the must-see satirical video that lampoons a clueless “health care executive” who has read in Modern Healthcare how to create an Accountable Care Organization (ACO) and “have lots of meetings” to make his board happy. While Langston acknowledges "...everyone interested in health care reform is hoping that ACOs will provide a miracle cure for our ailing health system, no one is really sure how they will work." But like the true executive that he is, he then explains (with the help of Modern Healthcare, of course), how they will work. It's hard to find a better example of executive political correctness.

Elaine Schattner, M.D. shares her review of a new Broadway play Bloody Bloody Andrew Jackson and shares these tag lines:

Some times you have to take the initiative.
Some times your whole family dies of cholera.
Some times you have to make your own story.
Some times you have to shoot the story teller in the neck.
Some times you have to take back the country….

Hmmm. A metaphor? (Return to map)

NEBRASKA

Regarding sentiment for health care reform, the Happy Hospitalist reminds us that some former supporters are throwing in the towel. In a word: change. (Return to map)

MASSACHUSETTS

(Political Action Committee) Julie Rosen of the Bedside Manner blog explains why health literacy matters and brings our attention to the need for good public education and its benefits of such later health care. (Return to map)

INDIANA

(Political Action Committee) Walter Jessen of Highlight HEALTH reports on how the National Breast Cancer Coalition (NBCC) has thrown down the glove to push for a breast cancer vaccine by 2020. This is a great example how special interests confront our legislators every day. (Note: they listen more if you bring lunch!) (Return to map)

CANADA

In "From Plain Film to 3D: Radiologists as Superstars," Notwithstanding Blog argues that radiologists are the economic superstars of American Medicine. Funny to hear this from Canada. Still, it's acknowledged "... the challenge facing American radiologists in my lifetime may not be justifying their value in patient care so much as justifying their value over and above their American-boarded Indian-based counterparts." Exactly. (Return to map)

UNDISCLOSED

Dr. Fizzy over at A Cartoon Guide to Becoming a Doctor explains, as only a cartoon can, why Health Insurance Sucks. Too bad Dr. Fizzy may soon be mandated by law to buy it. (Return to map)

* * *

Before closing, I'd like to point you to a few more salient election day thoughts by Paul Levy, CEO and President of Beth Israel Deaconess Medical Center:

I hope the very good people who lose in tomorrow's balloting will keep up their fights, whether they are incumbents or challengers. They, especially, deserve our thanks for participating in our election process.

Amen.

Next week's Grand Rounds will be hosted by Mother Jones, RN at Nurse Ratched's Place.

-Wes