Friday, September 29, 2006

I'm probably going to make some of my readers angry by posting this, but what the hell...
First off let me say this is not an attack on physician extenders (NP's, PA's) whatsoever. I have a NP working with the trauma service and they are more helpful than the residents are. Some of the extenders are more capable than the physicians who supervise them. They also work in underserved areas delivering care to those who otherwise might not receive it.

This is a beef I have with some physicians who utilize them, IMHO, in an unprofessional manner. The basis of this is the growing (some may say epidemic) communication problem among physicians today. We don't talk to each other. It is a rarity that I receive a call from a physician asking me to consult on a patient. More often a clerk calls me or my answering service. In fact some physicians act irritated when I ask for them to call me to discuss the patient. But that is the subject of another post entirely. My problem lies with those who think the great unwashed among us are not good enough to speak with them, but have to appeal to their extender.

For example, a gynecological subspecialist has an very capable NP who works for him. She takes his calls at night and runs his service when he is out of town. If a patient is known to have a general surgical problem prior to their gynecological surgery (gallstones, for example) and a cholecystectomy is required, the physician himself does not call, the NP does. If an intraoperative consult is needed, the same applies. If I attempt to call this physician, I am not given the opportunity to choose to speak to the NP or the physician, I must speak to the NP who will pass my message along. I may or may not get a callback.

With others, sometimes days go by without an attending presence on the chart. Are my treatment plans and recommendations reaching the appropriate person? With "backsigning" of the notes, I can't tell.

Am I being petty? Maybe. But when I extend the courtesy of a phone call about a patient to a physician (rather than going through the unit clerk as described above) I expect to speak directly to the decision-maker.

Ok, diatribe over.

Tuesday, September 26, 2006

Grand Rounds Turns Two.....
Volume III Number 1 this week at Tech Medicine.

Sunday, September 24, 2006

Football can be Dangerous......
Bucs' Simms has spleen removed after loss to Carolina
Buccaneers quarterback Chris Simms had his spleen removed in an emergency procedure at a Tampa, Fla., hospital after rupturing it in Sunday's 26-24 loss to Carolina.

Former NFL quarterback Phil Simms confirmed to ESPN's Chris Mortensen that his son's condition was stabilized after surgery, during which he received blood transfusions.

It is thought the injury occurred in the second quarter. Chris Simms took several hard hits and left the game for two plays in the second half but returned to help the Bucs take the lead in the fourth quarter.

One case I found details an elective laparoscopic splenectomy to avoid the convalesce associated with non-operative managment:
The safety and efficacy of laparoscopic splenectomy in the management of benign hematologic diseases is well established. Laparoscopic splenectomy for splenic trauma has been reported infrequently, and most consider a minimally invasive approach to be contraindicated. A heralded, standout college football player who sustained a grade III splenic laceration while playing football was referred for laparoscopic splenectomy so that he could convalesce rapidly, complete his final year of athletic eligibility, and prepare for the National Football League draft. The ethical issues regarding this patient's care were discussed extensively with the patient, his parents, and the hospital administration. After informed consent, the patient underwent a laparoscopic splenectomy with no intraoperative complications. He was discharged 20 hours after surgery. The patient played in a collegiate football game 12 days after surgery, was drafted into the National Football League 9 months later, and was on the opening day roster 12 months after his surgery. We do not advocate laparoscopic splenectomy for injuries to the spleen as the standard of care. This case, however, illustrates the potential for laparoscopic surgery to provide a safe and feasible alternative to traditional surgical approaches.
GO DOGS!!!Georgia 14 Colorado 13
My goodness. The Dogs acted like they stayed at home for about 50 minutes of the game as they were dominated by the winless Buffs. With Joe Cox's performance the quarterback controversy will continue.

Tuesday, September 19, 2006

A Trauma System for Georgia ??????
From last week in the Athens Banner Herald:
State lacks in trauma treatment
A top state official says Georgia needs twice as many certified "trauma centers" equipped and staffed to treat people with almost any kind of severe injuries, and a legislative study committee could recommend spending $70 million to $80 million a year to shore up the expensive, money-losing system.

The death rate from trauma - injuries such as those people can sustain in house fires and car wrecks - is 20 percent higher in Georgia than the national average.

"There is a direct cause and effect with the relatively small number of trauma centers we have and a bad outcome," said state Rep. Mickey Channell, R-Greensboro, a member of a joint state House-Senate study committee that has planned a series of five public hearings to study trauma care issues before the next session of the legislature convenes in January.

At the first hearing, Dr. Patrick O'Neal, head of the state Office of Emergency Medical Services and Trauma, told the committee the state has too few trauma centers, and the ones that exist are not well distributed geographically.

The majority are in the metro Atlanta area with only four south of I-20. Why the problem?
There's one big reason for the low number: Money, Channell said.

"In order to be approved (as a trauma center), there are all sorts of things you have to have, like having doctors on call 24 hours in all sorts of different specialties. That's very, very expensive, and at the end of the day, that's the root cause of it," he said. "Money is what it's going to take to change it."

Doctors have told the committee that the state's trauma care system operated at a loss of about $215 million last year, Channell said.
One option that is being discussed at these meetings is to attach surcharges to traffic tickets, an approach that has worked in other states.
While the article does an excellent job of raising awareness of the problem, (especially the lack of a trauma center in rapidly growing northeast Georgia) it is somewhat misguided. Not all trauma patients require care in a level 1 trauma center. Having worked at Athens Regional, and familiar with the capabilities of that hospital as well as St. Mary's. They have the physical plant and medical staff capability to perform as a level 2 trauma center, if they (and their medical staff) had the desire to do so.

Monday, September 11, 2006

Five Years Ago......
There are times in history where you never forget where you were when events happened. For my parents it was where they were when President Kennedy was assassinated. For my cohort, it was when the Challenger exploded.
Then there was Tuesday, September 11, 2001.
There will be untold volumes of bandwidth today with 9/11 remembrances, and I am hesitant to pile on especially when others do it so much better.
But nevertheless...
I was about six weeks into my current job, still trying to get to know people. My wife and young son were with her mother who was having surgery that day. I walked into the surgeon's lounge in between cases. The TV was on CNN and the view was smoke coming from the north tower. There was discussion about a pane that had flown into the tower. Some sort of accident, maybe. The live footage of Flight 175 crashing into the south tower took that off the table at once.
I tried to call my wife but with both of us being in the depths of a hospital, the call could not go through.
Still cases to do though. I was in the middle of one when Flight 77 struck the Pentagon. That was my last for the day and I, as millions of others, spent the rest of the day transfixed in front of the television.
I eventually was able to reach my wife, parents, and siblings. Of course everyone down here was OK, and after several hours we heard from our family living in Manhattan.
And the world changed forever.

Sunday, September 10, 2006

Gerogia 18 South Carolina 0
In probably the best three interception performance put on by a quarterback Matthew Stafford led the Dogs to a shutout over the Evil Genius and his Gamecocks. JT3 is due to have a MRI today to determine the extent of his ankle injury.
Real medical posts upcoming.

Sunday, September 03, 2006


Georgia 48 Western Kentucky 12
Well so much for redshirting Matthew Stafford. The freshman phenom probably placed himself as the second-string QB for the visit to the house of the Evil Genius next week.
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