Plugging in-looking for recommendations

For any of you healthcare folks out there that may read this, I have a request:

What electronic device can you not function without at work?

PDA
Blackberry
iPhone

What software/apps do you recommend? The only one I am familiar with is ePocrates. Any others? Is there anything along the lines of an electronic scutbook?

Thanks for your time!

R/

DocV

Job Hunting

Wow...I haven't had to actually find a job for 25+ years. Putting together a CV, phone interviews, in-person interviews, salary and benefit negotiations, cost of living and quality of life decisions, new state licensure. It's

been interesting.

I purposely decided not to hang up my own shingle and have been looking at group practices or staff positions. They have run the gamut from Medicaid mills on up.

I have had 2 serious offers so far. One is from a private group of physicians who own their own hospital and have a small in-house dental practice. I am strongly considering that one. The other position at a state hospital just had it's funding pulled as a cost saving measure. So much for that.

Off to a third interview on Monday. We'll see how that goes.

The bait shop is still a consideration. Maybe I'll add a marina... ;-)

On the R.O.A.D

Retired On Active Duty. I used to make fun of those guys, now I am one! My official retirement orders have been approved. Now I need to spend my last few months on active duty looking for a new job. 3 interviews so far. One at a hospital in Pennsylvania, one in North Carolina, and a group practice in North Carolina.

Or maybe I'll buy a bait shop.

Don't Be Dragging Us Down!

M.D.O.D.: I've got it!

ETOTHEPI,

Do you really want to unleash the fury that is a bunch of angry people armed with small, sharp instruments?

Just the Facts...Joe Friday schools Obama

Dentistry Succumbing to the Mid-Level Craze

You are going to get what you pay for. We're headed back to the Barber-Surgeon days....

A while back I wrote about the emergence of mid level practitioners in my field (dentistry).

http://docv-downinthemouth.blogspot.com/2008/12/more-mid-level-practitioners-emerge.html

Alaska and Minnesota have begun to license such practitioners. In my opinion, the argument for and against is very similar to the controversy that goes on about PAs and NPs. Once again, I see the the problem not being their breadth of knowledge, but their depth.

While very little in my world is life threatening, there are those occasional "Oh @#$%!!!" moments especially with medically compromised patients. The very population that most of these mid level providers will treat is also the population that has problems with uncontrolled diabetes, hypertension, heart disease, and so forth. I can teach just about anyone to pull a tooth or plug a filling but you have to remember that tooth is attached to a human being. You have to be ready to deal with the complications. Not all of dentistry is a mechanical art and that difference is what you pay me for.

Another blog on the subject:

http://www.boingboing.net/2009/10/08/armed-to-the-teeth-t.html

And a really great blog, "The American Way of Dentistry:

http://www.slate.com/id/2229633

A Little Slice of Life

Only in America....

http://peopleofwalmart.com/

Access Problems

On the Buckeye Surgeon's blog, https://www.blogger.com/comment.g?blogID=2760353953251845523&postID=6887089455401358985 is a discussion about a prisoner that was given a reprieve from his death sentance (lethal injection)because they were unable to get venous access. If that is a problem, why not go the IO route?

My understanding is:

• IO access is a safe and effective route
for accessing the central vascular system

• IO access is similar to central line access and carries
less risk of complications. (At least in theory)

• IO is the first alternative to IV
in adult cardiac arrest patients

Just a thought....

Blogger's Block

Wow. I didn't realize how challenging it would be to maintain a blog. Is there such a thing a blogger's block? I am in awe of the the folks who write the blogs that I frequent and their ability to come up with interesting stories and observations. I should have stayed in EMS...there's better stories there. Now that I am on shore duty, dentistry is just the same old grind. I had hoped to make a better impression....

Okay, enough of the puns. My retirement papers are in, 9 months to go on active duty. I have to find a real job now. Maybe I ought to renew my EMT-P certs!

Anyway, I'll try to keep plugging away at the blog sphere.

Another "Back in the Day" story...American Iron

I was waxing nostalgic with friend about the good ol’ days when Cadillac made ambulances and Plymouth had the corner on police cars. Specifically the Fury III with the 440....darn thing was like being on rails, you couldn't make the rear end slide out from under you. The deputies used to turn the air cleaner cover upside down....just to hear that WHOOOOOOMMMMM when the secondaries opened......Shazam!!!!

Sigh! Those were the days! There was a time when the sweetest sound I ever heard was those secondaries opening up as the SO units crested a hill coming to bail my a** out. Hearing those WHHHHHOOOOOOOOHOOOOOOOMs followed by the sound of the sirens...it was like a cavalry charge!

The call? A Domestic with injuries...we didn't know what on the initial call... On our arrival there were lots of people (Sumdood’s Cousins I think) and lots of emotion. Some of the "Cousins" didn't want us to leave with the patient because they thought he would be arrested at the hospital. Some of the others wanted a piece of the patient. Patient wanted to get the hell out of there before he got whupped up on more.

We got him loaded up quick, but the Cousins wouldn't move from around the rig. I tried to move forward slowly …no effect. I gunned it a little and moved forward again. People started banging on the unit and smacking the windows. A bigger crowd was gathering and the mood was rapidly getting ugly. The rig started rocking…then somebody bounced a beer bottle off the windshield.

That was it!!

I picked up the mike and said "Ambulance 3, requesting a 10-33 our location".

Dead silence on the radio. I thought somebody ripped the antenna off.

Then dispatch came back and said "Ambulance 3. Repeat!"

"Ambulance 3, 10-33 our location!!!" Sheesh! Was anyone awake?

"10-4 Ambulance 3. 10-33 your location!"

Then the hotshot tones started on the countywide. "Attention all units and State Patrol. Ambulance 3 has declared a 10-33 at..." and gave our location.

About 10 seconds later, all the SO units on patrol marked on, the area trooper marked on from home! , a city unit marked on, then the deputies the next county over. Even the Fire Company marked on responding. About a minute (a very loooong minute!) later, you could hear the first units cresting the hill and screaming down into the hollow.

Some of the crowd scattered when they heard the cavalry coming. The first few of those big Plymouths screeched to a stop…there was a moment of dead silence…then the smell of overheated asbestos and the clicking of cast iron cooling…the remaining crowd looked like a heard of dear in the headlights. They scattered when that peculiar sound, known to strike fear in the hearts of all Sumdoods, floated through the air… the sound of the Supervising Deputy racking the slide of his Ithaca and asking....

"These boys givin' ya trouble Doc?"

A Quiet Passing

Michael Jackson, Farrah, Ed McMahon, Billy Mays...their deaths were splashed across the media. My Dad's wasn't. On June 22, at 4:50 pm, the finest man I have ever known quietly passed away. The man I admired and respected the most, whose opinion meant every thing to me was gone. There was no news media present, just my sister and I. There were no late breaking announcements on CNN, just tearful phone calls as I contacted the rest of the family.

I guess I sound jealous or spiteful, but the world lost a wonderful man without knowing it. A man who worked hard, paid his bills on time, had a loving wife, three kids, and eight grand children. If more of the world followed his example, this would be a much better place to live.

Good-by Dad. I hope I made the right decisions. I miss you.

Medics, Nurses, ER Docs, Hospitalists, Anesthesiologists, and Surgeons; A Big Thanks to You All

My Dad has multiple medical problems and, this past weekend, compounded them (no pun) by falling and sustaining an intertrochanteric fracture with a varus deformity.

I have already thanked the actual individuals involved in his care, but wanted to post a big warm fuzzy to the all the professions as a whole because I know you guys don't get to hear "thank you" enough.

From the moment the 911 call was made to when Dad was taken off the vent and transferred from the ICU his care was phenomenal. His pre-op problems made him a poor surgical risk and he had some not unexpected post anesthesia problems so I know that his care had to be managed carefully.

I like to think karma or whatever actually endowed the medics with all the positive attributes of Amubulance Driver, Medic March, TOTWTYTR, Izzy, and EE, the nurses with the caring and compassion of Nurse K and Guitar Girl, the ER Docs, Surgeons, and Hospitalists with the wisdom of Scalpel, Grunt Doc, 911, and Happy, and the Anesthesia folks with the abilities of Anesthesoboist and Michelle.

I never said a word to anybody or identified myself as a healthcare professional. For all anyone knew, I was just Mr. V's concerned son. (It wasn't until he was in the ICU post-op that one of the attendings recognized our last name. He had trained with my brother).

So to all of you out there on the frontlines; THANK YOU from Mr. V and his son!

The last time I took the kids to the range my daughter shot a newish Sig 239, single stack, 8 round, 9mm, at the range and really liked it. She spotted it at the rental rack and wanted to shoot it "because it looks like Ziva's (NCIS) gun!" (Despite the fact Daddy brought a .45, a Hi-Power 9mm, and a S&W 422 .22 cal)

For a 10 year old, she handled it well and kept her rounds in center of mass. I tried it and really liked it too.I got to talking to the range master and he said I ought to look at the Sig P6 (225) since I already have a 220 in .45 acp. The P6 is a West German police trade in gun. It is an older, 8 round single stack, 9mm that is basically a cut down 220. Sorta like what the Colt Commander is to the 1911. I found one at J&G sales for $411 total for a "hand select". There are other places that might have it for less but J&G had them in stock ready to ship, so I ordered it and it arrived today.

I am very pleased with my purchase. It is a typical cop gun. Carried a lot and shot little. The innards are pristine. There is a little holster wear around the muzzle but that is it. For about half the price of a new 239 I've got what is shaping up to be a great carry piece. It digested everything put through it including some Wolff 9mm. It exhibits typical Sig workmanship and accuracy. The one I have was made around 1971. It has an alloy frame and steel slide.The only down sides so far are the cost of factory mags (~40.00) and the fact it is a single stack in a world of high capacity pistols. However, the plus is, because of the slim magazine, it conceals like a dream. It is very lightweight. My Blackhawk Serpa paddle holster and a leather IWB holster for the 220 both work with it. All in all, if you are looking for a good deal in high quality pistol I can recommend this. It's also kind of cool to have the "little brother" to my 220.

Thoughts on Pirates...

I was off the coast of Somalia last year involved in some anti-piracy operations... if they can be called that.

My thoughts on the current situation?

When seconds count, the Navy is only hours away. Maybe it's time to start arming our merchants.

Presley O'Bannon, Stephen Decatur, and William Bainbridge must be spinning in their graves. Does anyone remember what "...to the shores of Tripoli" meant?

Sam's Club Practice?

Well maybe not Sam's Club exactly...

I saw an ad in the Sunday paper by a local internist. For the "price of a daily cup of gourmet coffee" you could become an exclusive member of his practice and receive exceptional access and good, old fashioned personalized care. He announced that he was currently interviewing patients.

It's an interesting idea. I wonder how many people are going to take him up on it. What exactly he is offering. And, what his criteria for acceptance into his practice are. I'll keep an eye on it. Any thoughts?

On Behalf of a Grateful Nation...

Why aren't more people talking about this!!!!

The Obama Administration announced Thursday a plan to start billing private insurance companies for war and service related injuries of their subscribers who are veterans.

http://www.bio-medicine.org/medicine-news-1/VFW-Against-VA-Collection-Increase-Proposal-38578-1/

That's great. The economy is bad enough as it is. Veterans have a high enough unemployment rate. Who is going to want to hire them if their insurance premiums are going to be more expensive for employers? Are they going to be in a higher risk pool? If they have to pay for their premiums how are they going to afford it? This is totally unacceptable!

These men and woman sacrificed for their country, the mission of the VA as envisioned by Abraham Lincoln was to provide for those that "bore the brunt of battle"

The Other Guy Started It......

In The Happy Hospitalists blog is an entry about a dentist who is less than thrilled about paying more in taxes if she breaks a certain income threshhold.

http://thehappyhospitalist.blogspot.com/2009/03/when-you-tax-something-anything-you-get.html

To her it appears to be a "tipping point" ,as described by Nurse K, where the effort is no longer worth it. Anyway, what really torqued my lugnuts was a remark by David MD: "Any dentist earning more than $250,000 per year is not doing enough to see the poor that can't afford dental care. "

Weeeeeeeeellllll David , me bucko! Since when did good works and morality get tied to income? Dentists have been smart enough not to get sucked into the managed care mess that afflicts most health care today. A Wall Street Journal article several years ago showed that the average general dentist made about 170K per year. And ya know what Davy? We give a lot of it back to the community. We don't need the government or a bunch of Birkenstock wearing, latte sipping, 10 year old Volvo driving, knee jerk, boo-hoo liberals telling us how to provide for the poor. I have spent the past two decades providing health care in some of the worst hell holes on this planet . I can't wait to retire and start making as much money as I can so I can go back to some of those places and do some more. The less the government takes from me the more I will be able to do good works with!

Lettin' the Fox Guard the Chicken House

Kansas Governor Kathleen Sebelius has accepted President’s Obama’s offer to be his HHS nominee according to news sources including The New York Times.

Mmmmmmmm... She was also once the president of the American Trial Lawyers Association. And guess what? She has never treated a patient in her life. Sounds like a win/win to me!

My Alter Ego

My Superhero Self!

Thanks to AD at a Day in the Life of an Ambulance Driver...

PA's and NP's in my world

This has been on my mind and Happy Hospitalist's post http://thehappyhospitalist.blogspot.com/2009/02/dr-nurse-pa-perspective-and-your.html got me thinking about the whole thing.

I am board certified in my field and I completed a 2 year hospital based residency, but nothing that compares to physician residencies. Because of my training and my interests I see a fair number of medically compromised patients. There are times I need to consult with my patient's primary care physician before embarking on a proposed treatment plan. When I consult with a physician it is not to ask permission to treat the patient, but to see if there are any potential landmines with my choice of meds or procedures. There have been a few times as of late that I have gotten a reply from a PA. I'm sorry, but I will not accept those consult replies.

My treatment plan will be based on my judgement and the input of the patient's physician not a mid level provider. When the patient is in my office, I am wholly responsible for their care and the outcome of any treatment. I could not defend any decision made by one of my colleagues based on input by anyone other than an MD or DO and I don't think it would be defensible in court.

Tattoo:Tooth ratio

Why is it the tattoo to tooth ratio directly proportional to ETOH intake and inversely proportional to good sense?

Like I really believe that your mandibular condyle fracture and through&through lip lac was cause by a slip and fall. Especially when your shipmate is two cubicles down with a boxer's fracture.

Arrrrrrrgh!

Back in the day...

As you know I was once a Medic. In fact, my start in EMS was in the days of Ambulance drivers, attendants, and funeral home rigs. When I started all you needed was a Red Cross Advanced First Aid and CPR card.

The events I talked about yesterday and a post in Too Old to Work, Too Young to Retire's "Tales from the 'Blance http://tooldtowork.blogspot.com/2009/01/tales-from-blance.htmlcaused me to take a trip down memory lane to one of my favorite "rookie" stories.

It was a nice summer Saturday afternoon. The kind of day to be sitting on a blanket at the lake watching the volleyball games, seeing and being seen. At the time I was a young "attendant" with Eternal Rest Mortuary and Ambulance Service. We were dispatched to a possible OD in one of the nicer parts of town. On arrival at a pleasant suburban ranch house, we were met by an angry father and a distraught mother. It seems the eldest daughter was made to babysit her siblings whilst Mom and Dad went to the club for a game of tennis.

Little Miss was apparently in a snit because she missed out on her day at the lake and decided to punish M & D by downing whatever she could find in the medicine chest and washing it down with some of Dad's 18 year old single malt. We followed them into the living room where a very beautiful, but obviously angst ridden 16 year old girl was sprawled on the coach with a large glass of water. She was alert and oriented, but very sullen and non communicative. I introduced myself and told her we were going to take her to St. Joe's (Hospital) so the doctor's could check her out and make sure everything was okay. With out a word, she finished the glass of water, got up and sat her self on the cot.

As we rolled her out the front door, her mother, who was going with us in the rig, mentioned that she had called their pediatrician who had advised her to give Little Miss ipecac syrup and a big glass of water...the water she had just finished...but nothing had happened yet. "No problem", I said, "I'll give her a basin if she needs it. She'll be just fine". We put her in the back of the Caddy and I climbed in with her while Mike A. got Mom situated up front.

I raised the head of the cot as much as I could, draped a big bath towel over her like a bib and gave Little Miss a surgical basin as Mike pulled away from the curb."Okay Honey. Do you feel like you need to throw up?" She just shook her head, no. Since her head was up I was sitting on the attendant chair that faced her with my back to the rear door (The old low top Cadillacs had two chairs that faced each other and folded into the floor).

In a few minutes she started that peculiar half hiccup/ half spasm that signals imminent evacuation of the stomach contents. I put a damp washcloth on her forehead and said "It's okay sweetheart. It's just the Ipecac. Go ahead and throw up in the bowl. You'll feel better." She just looked at me. The spasms increased in frequency and she was obviously about to spew.

I leaned forward to help her with the bowl when she turned, leaned over, and puked right in my lap!As soon as her stomach was empty she wiped her lips with the back of her hand, looked me right in the eyes, and with the sweetest smile you can imagine said, "F*&k you, a#$hole!"

Be prepared...

I am extremely proud of my oldest son (10 y/o) today. We went to the grocery store to pick up a few things for the ribs we're fixing tonight. As we were leaving the store a little old lady with a cane missed the curb and face planted without being able to break her fall. I saw it coming but couldn't move fast enough to catch her.

She hit the ground with that awful wet melon sound and lay still . She was perfectly prostrate with her face straight down, nose squashed, and her arms at her side, dorsum down. A puddle of blood was quickly forming around her face, bubbling every time she breathed.

Once a Medic always a Medic....I started my primary survey. Okay, I have A and B, but her airway wasn't going to stay patent in that position much longer. She was other wise non-responsive. A small crowd was starting to gather. One guy hollered he was dialing 911. An off duty cop and a nurse came up and asked what they could do. I decided we needed to log roll her because her breathing was becoming more labored. Before we did, my son tugged on my sleeve and said "Dad, give me your keys. I'll go get your bag". I gave him my keys and he took off across the parking lot.

With the cop holding c-spine, the nurse, myself, and a Sailor in the crowd log rolled her. My son arrived back, out of breath ,with my trauma bag (like I said, once a Medic...) opened it up and asked "what do you need Daddy?" Gloves, Penlight, gauze, OP airway, he handed me everything I asked for with little need for direction. The bleeding was mostly from the nose and forehead lac. Surprisingly her anterior teeth were intact. The Fire Dept arrived within a few more minutes and we turned her care over to them.

The cop came up and shook my son's hand and told him what a great job he did and that his Daddy should be very proud of him. Well, let me tell you. My heart was nearly busting with pride. In the middle of a crisis, my son came through without hesitation. Heck, he knew stuff I didn't even think he knew or remembered.

Nate the Great, you are a great Scout and your Daddy is very proud of you.

Heard today...

...at the facility I am temporarily assigned to; "My President is in now. I won't be having to do this sh@# much longer."

Sigh! I am hearing that sentiment more and more. Wake up folks! He did not promise 40 acres and a mule for everyone. The "stimulus" check is not in the mail. There is a long bumpy road ahead of us. Turn your attention more toward what Congress is doing rather than what President Obama is saying.

Hello....Is anybody out there?

I am so needy and desperate for affirmation! I can see by my site meter that people are looking at this blog. Would you mind leaving a comment on how you got here and what you think so far? What would you like to hear about?

Thanks!

Where's Mah Teef?

MDOD has a post with a CT demonstrating a removable partial denture lodged in the pharynx.
http://docsontheweb.blogspot.com/2009/01/grandpa-wont-eat.html


Based on personal experience, and a quick surf of the literature, there are numerous reported cases of this with sequalae ranging from dysphagia and difficulty breathing to esophageal or colon perforation, some of which have resulted in death.
http://www.ncbi.nlm.nih.gov/pubmed/18278709?dopt=Abstracthttp://www.ajnr.org/cgi/reprint/28/9/1734.pdf

Inadvertently swallowing dentures is a big deal. Dentures are one of those items that should be accounted for regularly by the nursing home staff.

Dentures should also be labeled. I have also seen several cases where dentures were collected by staff for a "mass" cleaning and disinfection. It was a crap shoot as to whether the patients got correct ones back. Ownership was determined by best fit.

Snope-ed

Tha's what I get for posting about something and not verifying it my self. Apparently the comments below that I attributed to SOTH Nancy Pelosi are untrue per http://www.snopes.com/politics/soapbox/pelosi.asp

Just when I was getting good and worked up...

Hey did you know that the order of succession is the Vice President, the Speaker of the House, then the Secretary of State? Wonder if Hill and Bill know that? Hmmmmmmmm.....

The New Year Begins

Just got back from a great weekend with Mrs.V and the baby Docs. We went to Wintergreen Resort in the Blue Ridge. Went snow tubing, made s'mores, went to Monticello, UVA, and Crabtree Falls. The kids want to move to the mountains. The wifely woman was less than thrilled with the windy roads and switchbacks. Next week it's back to work on the ship. Back to the same old grind (dental pun).

I read recently that the Speaker of the House is seeking a windfall profit tax on retirement accounts. Madam Speaker(or maybe Comrade Chairman) Nancy Pelosi wants to put a Windfall Tax on all stockmarket profits (including Retirement fund, 401K and Mutual Funds! Alas ,it is true - all to help the 12 Million Illegal Immigrants and other unemployed Minorities!

This woman is frightening. She quotes..." We need to work toward the goal of equalizing income,(didn't Marx say something like this?), in our country and at the same time limiting the amount the rich can invest." (I am not rich, are you?)

When asked how these new tax dollars would be spent, she replied: "We need to raise the standard of living of our poor, unemployed and minorities. For example, we have an estimated 12 million illegal immigrants in our country who need our help along with millions of unemployed minorities. Stock market windfall profits taxes could go along way to guarantee these people the standard of living they would like to have as 'Americans".

Read that quote again and again and let it sink in. 'Lower your retirement, give it to others who have not worked as you have for it'.

I would really be outraged if my retirement fund hadn't of tanked along with the kid's education funds. Sure, I'll have a 20 year retirment from the military, but so much for having the funding to start a private practice. Arrrrgh!