tag:blogger.com,1999:blog-55375042011-07-30T19:38:12.595-05:00A perspective on medical and other issues from a general surgeonBard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comBlogger7961100tag:blogger.com,1999:blog-5537504.post-73429051906404605732010-05-21T10:07:00.002-05:002010-05-21T10:13:58.767-05:00

Time to Go Galt?The below is video of a recent Grand Rounds presented by a Chief Resident at the University of Alabama.Going Galt: When Will Surgeons Say Enough is Enough? from Daniel Cox on Vimeo.Excellent presentation by a young surgeon on the uncertainty of the future. Could have done without the Tebow love....

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-75470200463140519052009-08-09T09:37:00.006-05:002009-08-09T10:26:27.182-05:00

Gone to the Dogs....A frequently heard remark about a poor physician is: "I wouldn't let him operate on my dog!" Well in the UK, sometimes the dogs have it better:As a British dog, you get to choose (through an intermediary, I admit) your veterinarian. If you don’t like him, you can pick up your leash and go elsewhere, that very day if necessary. Any vet will see you straight away, there is no

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-48403230848861512212009-07-07T06:00:00.001-05:002009-07-07T06:00:14.223-05:00

Are we the Greedy Bastards Dr. Gawande Makes us out to be????The criticisms of Dr. Gwande's New Yorker article have ranged from the patients in McAllen are sicker, that the cost issues are multifactoral, and that Gawande makes his point by using the outlier.Honestly, in our own towns we see care driven by financial incentive. We see the billboard ads put up by the cardiovascular and general

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-47282797190243327252009-07-06T06:56:00.007-05:002009-07-07T06:45:04.383-05:00

My Late Take on Gawande... I know I'm late with this.... McAllen, Texas is a city with a population of 101,604 people in the city proper and about 569,00 in the metropolitan area (2000 census numbers). It also has the cost for health care in the U.S. This was a topic of a New Yorker article by Atul Gawande who examines the situation. McAllen has another distinction, too: it is one of the most

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-46137302309879683342009-07-04T10:00:00.001-05:002009-07-04T10:01:18.194-05:00

Happy Birthday America.....IN CONGRESS, July 4, 1776.The unanimous Declaration of the thirteen united States of America,When in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-30337846761575215632009-07-02T09:52:00.000-05:002009-07-04T09:59:23.297-05:00

Happy Blogday....I guess since a post is present for each calendar year I can claim that this is the 6th blogday.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-11167886054942725062009-06-07T17:16:00.001-05:002009-06-07T17:22:10.554-05:00

Kids these Days....If this post sounds like the old "uphill both ways to the hospital barefoot" rant, well it is.At the end of this month the second group of surgery residents (assuming a 5 year term) will graduate that have trained exclusively under the ACGME mandated work hour limits. As few programs extend beyond seven years, after next year there will probably not be a current surgery

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-2149362239994381472009-05-02T10:35:00.002-05:002009-05-02T11:12:19.573-05:00

ATLS again....With warm weather comes misbehavior and an uptick in the trauma service business. I have also been caring for a young lady who has the worse case on pancreatitits I have seen in my career. To top it off I had ATLS yesterday and Thursday.The 8th edition course is far superior to any put forth before. The book is well-done with multiple color photographs. A DVD is included with

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-7394869274016274912009-04-17T20:29:00.000-05:002009-04-17T20:41:07.531-05:00

The Government Big Enough to Give You Healthcare.....Callie Moore Is a 13 year-old young lady who lives in the Athens area and has a multitude of medical conditions: Because of strokes she suffered while in her mother's womb, 13-year-old Callie Moore of Danielsville has a host of complex medical problems. They include spastic quadriplegic cerebral palsy, refractory seizure disorder, mental

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-88936448184666013992009-04-14T12:42:00.002-05:002009-04-14T12:59:39.052-05:00

Grand Rounds Vol. V No. 30....See this week's best of the medical blogosphere, hosted by Pharmamotion.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-28897286904369829212009-04-13T21:00:00.001-05:002009-04-13T21:02:03.403-05:00

Are Medical Staffs Independent or Even Relevant Anymore...I have been dragooned into a leadership position at Big Hospital. Hooray. Another physician (employed by the hospital) pointed out the multiple incestuous relationships contracts The Acme Surgical Group has with the hospital and asked was there some sort conflict associated with that. Upon a moment's reflection I was able to point out the

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-74730153910458494022009-04-11T16:21:00.003-05:002009-04-11T16:37:28.408-05:00

Red 13 Black 3You know college football is big in Georgia when for your spring game: 1)About 40,000 show up, and 2)It's covered live on ESPN and Herbstreit does the play-by-play.Yes, I know that that many or more will show up for the A-day game in Tuscaloosa next week. But it is Easter weekend, and The Masters is underway, so there!

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-57227688412316683782009-04-08T14:57:00.004-05:002009-04-08T18:38:08.281-05:00

Physician Thunderdome..In this post Kevin throws down the gauntlet: Make no mistake, specialist organizations are ready to throw primary care under the bus, with the opening salvo of implying that generalist doctors can be easily replaced by mid-level providers telegraphing their intentions.Let's hope that the ACP is aggressive in countering these tactics. It's becoming clear that a conciliatory

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-73460364558199778442009-04-07T09:53:00.001-05:002009-04-07T09:58:37.931-05:00

Grand Rounds Vol. V No. 29Grand Rounds hosted this week by Leslie.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-52574488424486524522009-04-06T06:00:00.004-05:002009-04-06T06:00:00.168-05:00

Tales from the Trauma Service XIX.....Gentleman working on a landscpe project. The worker above him falls and drops one of these on him:And they strike him in the neck. He arrives alert and oriented, but every time he speaks or coughs air comes out of the wound on his neck. Off to the operating room...][][][][][][][THE FOLLOWING IMAGES MAY BE OFFENSIVE....blah, blah,.....[][][][][]The yellow

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-87356829880591877152009-04-02T19:37:00.001-05:002009-04-02T19:39:04.760-05:00

I Haven't Watched in Years...But I will watch the last episode of "ER" tonight.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-24443987958740615822009-03-31T12:25:00.002-05:002009-03-31T12:35:51.422-05:00

Grand Rounds Vol V, No. 28Grand Rounds hosted by Paul Levy at Running a Hospital.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-35995429653641972242009-03-30T06:56:00.003-05:002009-03-30T07:02:57.104-05:00

The Gang's all Here...Maybe it has to do with spring but thanks to GruntDoc I find that both Panda Bear and my old group-blogging buddy Galen have returned.Now if Grunt Doc will only take me off the dead blog list.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-62236559720931101692009-03-29T16:33:00.002-05:002009-03-29T16:37:43.094-05:00

The Surgical Blog Carnival..Surgexperiences 2:20 hosted this week at Vagus Surgicalis.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-4278951086915643402009-03-26T18:22:00.002-05:002009-03-26T18:48:05.564-05:00

On the Wagon...First off, thanks for all of those who have welcomed me back after my hiatus.Why so long away? After boards some other things came up and I didn't have the time. Then Mrs. Parker got on Facebook and got me hooked too.Then I realized that the time spent on Facebook could also be spent on Blogger.I dislike the new Facebook format, BTW.I'm still spending time on sidebar maintenance, I

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-84270049733825945982009-03-26T07:00:00.000-05:002009-03-26T07:00:00.535-05:00

Tales from the Trauma Service XVIIIPatient comes in after a motor vehicle collision, intubated in the field for combativeness. Undergoes the Full Body Irradiation WorkupTM. Images and unpleasant surprise follows:You can see the contrast within the subclavian vein.Contrast and air within the superior vena cava.Contrast and air within the right ventricle.Contrast and air within the pulmonary

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-13984019974507147312009-03-25T12:27:00.005-05:002009-03-25T16:12:32.372-05:00

Did the Medical School in Athens just Hit a Snag ???Word out today that Medical College of Georgia president Dan Rahn has accepted the position of chancellor of the University of Arkansas for Medical Sciences.Dr. Rahn was one of the driving forces behind MCG expansion to Athens and beyond. How will his departure , along with the tough economic times the state is experiencing, affect the new

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-52767171042236365722009-03-25T11:55:00.003-05:002009-03-25T12:21:34.720-05:00

Epic Admissions Committee Fail....From today's New York Times:A Quandary in Sweden: Criminals in Med School A year ago, Sweden’s most prestigious medical school found itself in an international uproar after it unknowingly admitted a student who was a Nazi sympathizer and a convicted murderer, then scrambled to find a way to expel him.It is hard to imagine how the case could get any more bizarre.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-59673134357631113892009-03-24T11:38:00.002-05:002009-03-24T11:46:48.041-05:00

R-E-S-P-E-C-T..(Part Two)A commenter on this post exposes what could be the dark underbelly of the whole issue of inter-specialist respect: This leads to a another point. Could it be this very sense of superiority, that drives the attitudes of some of our surgical colleagues, and is influencing our medical students as they make their way through their training?Could that be behind their

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-77873885455879693972009-03-24T10:23:00.002-05:002009-03-24T11:41:18.845-05:00

Grand Rounds Vol. V No. 27This week's Grand Rounds hosted at Codeblog.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-12074046600208811502009-03-22T19:33:00.006-05:002009-03-24T10:27:45.236-05:00

R-E-S-P-E-C-T.... (Part One)Dustup over at Dr. Centor's about the age-old question: Do surgeons respect primary care?In this he links to a post from the ACP advocate blog, in which the testimony of Dr. Preskitt, on behalf of the American College of Surgeons, is beaten about.First the testimony:With trauma care and surgical emergencies, there are no good substitutes or physician extenders for a

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-30653295545739890642009-03-21T14:12:00.004-05:002009-03-23T12:18:11.437-05:00

No "I" in Team...Kevin points to a post by Duncan Cross in which he opines that the trial lawyers take care of our patients interests better than we do: Now I don’t think trial lawyers are saints, but here’s the thing: when faced with their own mistakes, doctors can no longer be trusted to act in their patients’ interests. Trial lawyers may be working from craven self-interest, but that

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-67428215228018208462009-03-20T13:30:00.033-05:002009-03-21T16:49:07.291-05:00

Match Stats 2009...After neglecting my usual review of senior medical students voting with their feet last year, here we go again.According to the NRMP a record 29,890 seniors partcipated this year. The breakdown...General surgery:Surgery offered fewer positions this year, with fewer positions filled by US graduates. Six programs did not fill.Internal medicine:While the fill rate for IM remains

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-40258436452617637422009-03-20T13:08:00.002-05:002009-03-20T13:12:26.727-05:00

I, for One Welcome our New Projector Overlord...Barack Obama's Telepromper's Blog

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-5516829023515611932008-08-02T10:33:00.002-05:002008-08-02T10:37:01.481-05:00

Back to Work....While posting will be light until I take boards in September, I hope to start up again on a semi-regular basis.At least blogger still works.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-38334163058829651432007-12-24T11:04:00.000-05:002007-12-24T11:05:07.055-05:00

I received 100 credits on The Sci Fi Sounds QuizHow much of a Sci-Fi geek are you? Take the Sci-Fi Movie Quiz canon s5 is

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-43200317497167761552007-11-20T21:51:00.000-05:002007-11-21T07:35:51.362-05:00

The Future of Surgery XII......From the November 14th edition of The Journal of the American Medical Association comes an article penned by Dr. Josef Fischer titled The Impending Disappearance of the General Surgeon. To begin:In the United States, approximately 1000 general surgeons complete their residency training each year. These surgeons have completed 4 years of medical school and 5 clinical

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-65703121602750363062007-11-19T15:44:00.000-05:002007-11-19T15:50:45.403-05:00

Georgia 24 Kentucky 13For the second straight week the Bulldogs' performance was directly poroprtional to the volume of beer Dr. Parker consumed. Next week:No beer for sale at Grant Field, however...

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-47468723119572343702007-11-11T20:00:00.000-05:002007-11-11T20:02:54.871-05:00

80-Hour Work Week Revisited.....Going "back to school" as it were has placed me squarely in the sights of the 80 hour limitations. My program director maintains a firm line, based largely on a wrist-slapping by the RRC. I am regularly kicked out of the hospital post-call by about 11:00. While I find that enjoyable on some occasions, there is a downside to it. They are, IMHO, and in no particular

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-77001998845699231432007-11-10T19:42:00.000-05:002007-11-10T20:06:03.469-05:00

Georgia 45 Auburn 20As the great thespian Wesley Snipes in puts forth in the cinematic classic Passenger 57:"Always bet on black"Loved the look. A classic from 1996:Real surgical posts coming soon.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-48719803495857728522007-11-01T23:32:00.000-05:002007-11-01T23:39:23.204-05:00

Fellowship...So what's the deal? Well seveal things, the summer was extraordinaly busy with adjusting to the program and the reading that has been involved, so I didn't have much time to post. I am having trouble getting good PACS images for TFTTS and TFTOR. And my "muse" or whatever had left me. I would think, "Wow this story would make a good post!", but I could not muster up the motivation

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-36024713064555060222007-10-30T13:29:00.000-05:002007-10-30T13:40:50.132-05:00

Georgia 42 Florida 30The things that will get one writing again. Great game and I learned that there is at least one other physician blogger who roots for the Dogs. Fellowship has been fun for the most part, more on that later.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-9025762241240438932007-05-18T09:51:00.000-05:002007-05-18T09:51:17.974-05:00

I am Still Alive....But I have been very busy with preparing for talks, taking call, and preparing for my fellowship which starts in July. Blogging will probably be light after that too.Given the recent events surrounding Flea and the Fat Doctor, there has been a alot of discussion about what has come to be known as "Black Wednesday".Readers of my blog know that I post a great deal of pictures

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-48060091516338294932007-03-30T17:06:00.000-05:002007-03-30T17:35:47.670-05:00

Slow Your Ass Down.....The Georgia General Assembly meets for 40 days each year. The 30th day is "crossover day". That is, to be considered for passage into law, a bill must clear one chamber by that day. The remainder will be shelved until next year. The so-called "super-speeder" bill SB 125 passed. The key provision is as follows: (b) In addition to any other fines or penalties imposed by any

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-28095152476387317772007-03-28T12:20:00.000-05:002007-03-28T12:44:57.988-05:00

Buy Him One Too......No actual photographs, but a CT that will leave you astounded. 70-ish with a failed hernia repair about 12 years ago. Comes in after a week of nausea and vomiting. Severly dehydrated. CT obtained:Nothing too unusual so far.....Yellow circle around a fascial defect....What does the yellow line point to?Yes, gentle reader, the patient's hernia defect was so large that it could

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-39544670405198433902007-03-27T19:22:00.000-05:002007-03-27T19:30:35.442-05:00

Grand Rounds Vol III No.27...Hosted this week at Medviews.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-39873317726795465362007-03-25T19:37:00.000-05:002007-03-25T20:19:43.633-05:00

You keep using that word. I do not think it means what you think it means.......A commenter to this post takes issue with my description of EMTALA as an "unfunded mandate". Doctor, Respectfully, you don't know what you're tal(k)ing about. EMTALA is not an unfunded mandate. It only applies to hospitals that accept medicare/medicaid. Don't like the federal rules, don't take federal money.Let's take

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-63159030514018705622007-03-21T14:00:00.000-05:002007-03-21T13:03:57.252-05:00

Unfair and Unbalanced......Be warned, an ill rant follows.While no serious threat to tort reform is forthcoming from the Georgia General Assembly this year, some small efforts are being made. An article in today's Macon Telegraph tells the plight of one who is thought to be a "victim" of tort reform: State senators try to retool immunity to ER docs:Families like the Fretwells seem to be forgotten

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-71161655777302970192007-03-20T09:54:00.000-05:002007-03-20T09:59:07.811-05:00

Grand Rounds Vol III, No. 26Visit Dr. Blackman for this week's best of the medical blogosphere.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-88134694960541374062007-03-15T23:08:00.000-05:002007-03-15T22:09:13.587-05:00

Match Stats 2007........Congratulations and best wishes to fourth year medical students today. The match offers a yearly look at how medical students are "voting with their feet", determining the specialites that have the greatest appeal.According to the NRMP 27944 applicants were vying for 21845 positions, a record number.This years statistics may be found here, on page 4.For surgery:Surgery

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-47184026391406578222007-03-14T21:10:00.000-05:002007-03-14T21:12:57.615-05:00

Leaving Disgusta.......The talk of a branch medical campus in Athens has many in Augusta worried. From the Atlanta Journal-Constitution:Augusta bristles over talk of a UGA-med school linkAugusta —- With its sprawling campus, hundreds of medical students and millions in research dollars, the Medical College of Georgia has long been a jewel for this city east of Atlanta.People in Augusta want to

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-20999109571793751452007-03-13T19:31:00.000-05:002007-03-13T19:41:27.389-05:00

Grand Rounds Vol II, No. 25...............Held this week at ScienceRoll.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-69038530028561935402007-03-11T18:32:00.000-05:002007-03-11T17:33:51.816-05:00

Distributing the Beans.......From The Wall Street Journal, a change in how donor kidneys are allocated: More Kidneys For Transplants May Go to Young The nation's organ-transplant network is preparing a major change in how it rations scarce kidneys that would favor young patients over old in an effort to wring more life out of donated organs.The new policy is being developed by the United Network

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-66367571738147029442007-03-06T14:45:00.000-05:002007-03-06T14:45:01.913-05:00

The Commotidization of Dr. Angell.......Kevin linked to a Boston Globe article about the unintended consequences of increased patient autonomy.Once upon a time, the answer was simple -- doctors made the decisions. They gave you the diagnosis (if they chose to) and they told you what to do about it. Your job was merely to follow "doctor's orders."Fortunately, those days are gone. Starting in the

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-30938268897714371492007-03-06T08:22:00.000-05:002007-03-06T08:25:03.103-05:00

Grand Rounds Vol. 3 #24.........Themeless and seamless this week by GruntDoc.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-62645647091340884392007-02-28T20:25:00.000-05:002007-02-28T20:25:37.149-05:00

Tales from the Operating Room XI........Alas, my blogging muse had left me for a time, but it has returned. With the kind of post everyone likes.......one with gross pictures!!!A 30-ish lady with diabetes and three week history of abdominal pain. She had seen her family doctor and obtained plain films which were unrevealing. She was also treated for a UTI. Her pain worsened to the point where she

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-88110858074843140782007-01-17T13:29:00.000-05:002007-01-17T13:29:51.172-05:00

Castro Colon Conjecture......A great deal in the news the past few days about Cuban dictator Fidel Castro's recent encounter with his country's socialist utopian medical system. One piece of information making the rounds is that El Jefe himself ruled out a colostomy.Fidel Castro himself told surgeons not to perform a colostomy, opting instead for a course of surgery that produced a complication

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-68022196328725146292007-01-16T17:02:00.000-05:002007-01-16T17:29:17.706-05:00

Georgia Trauma System Update.....From Peach Pundit and the Macon Telegraph comes the latest on the funding for the long-overdue state-wide trauma system. Some advice: slow down.The push is on to find new sources of revenue to improve the state's trauma network, and it may lead to big new fines for speeders.Gov. Sonny Perdue has announced a plan to tack on "additional, substantial fines" for

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-4982058679281247882007-01-16T08:40:00.000-05:002007-01-16T08:53:51.389-05:00

Grand Rounds Vol. III No. 17.......Hosted in a poetic format this week by Six Until Me.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-10796758945449970962007-01-15T17:25:00.000-05:002007-01-15T17:28:32.208-05:00

More on the Future of Surgery......Dr. Schwab has a post about his experience as an acute care surgeon (ACS) or a "surgical hospitalist". I have posted about this several times before (just click on the "future of surgery" tag). Dr. Schwab agrees that the acute care surgeon will have a role to play in the future. How and why? Let us count the ways:1. The 80-hour work limits have exposed current

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-87240553077235964042007-01-15T09:55:00.000-05:002007-01-15T09:57:55.923-05:00

Expanding the Empire.....From the Journal-Constitution:Athens medical school just what the doc orderedForty medical school students will begin attending a joint University of Georgia and Medical College of Georgia campus in Athens in 2009, paving the way for a new health science complex at the state's flagship university, UGA president Michael Adams said this week.Adams, who gave a State of the

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-38062390618342006402007-01-09T21:45:00.000-05:002007-01-09T21:43:49.003-05:00

Grand Rounds Vol 3 No. 16.....Hosted this week by Dr. John LaPuma. His theme is "Food as Medicine". I agree with Allen that there are good ways and bad ways to do "themed" Grand Rounds. The "good" way in my opinion is to take the posts that are submitted and work them into the "theme" that you choose. Examples can be found here, here and my own example here. A "bad" example can be found here.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1166626250241292352007-01-08T06:49:00.000-05:002007-01-09T20:48:13.653-05:00

The Upcoming CON Battle.....The Georgia General Assembly kicks off today and tort refrom is not the only health-related subject that is up for debate this year. I saw this post from Peach Pundit about the upcoming battle over Certificate of Need (CON) in Georgia a few weks ago and was moved to comment, given the impact that CON will have this year.For those unfamiliar, a CON is a permit that

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1168034978656084632007-01-06T17:34:00.000-05:002007-01-06T17:39:18.930-05:00

Innovative or Idiotic...Is Dr. Parker ahead of the curve or delusional? Given the results of the match I participated in I myself have questions. Looking at the results from the latest surgery critical care match:72 programs participated, out of 85 ACGME approved programs. Of these only 33 filled. On the other end 77 submitted rank lists for 136 postions, leaving a match rate of 91 percent and

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1167582140856356042006-12-31T11:17:00.000-05:002007-01-15T15:27:28.930-05:00

Georgia 31 Virginia Tech 24Twenty. Eight. Unanswered. Points.Great salvage for the season over the past three games, and a great start for 2007 for the Dogs.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1167063828606041272006-12-25T11:22:00.000-05:002006-12-25T11:27:21.080-05:00

Merry Christmas....The personal, professional, and unfortunately the medico-legal has kept me away. Hopefully thing will slow down after the new year. Best wishes to you and yours on this special day.From the second chapter of the Gospel of Luke:And it came to pass in those days, that there went out a decree from Caesar Augustus, that all the world should be taxed. (And this taxing was first

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1164573784140554382006-11-26T15:23:00.000-05:002007-01-15T15:27:49.713-05:00

Georgia 15 Georgia Tech 12Meetings, getting a new computer up and running, and being very busy has kept me from posting up until now. Great game yesterday. There is talk of UGA retiring Reggie Ball's jersey next year. This nugget lifted from The Georgia Sports Blog:

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1162220216311561352006-10-30T09:53:00.000-05:002006-10-30T09:56:56.343-05:00

Georgia 14 Florida 21It could have been worse.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1161804560112696852006-10-25T13:42:00.000-05:002007-01-15T15:20:57.116-05:00

The Future of Surgery XIII......From this month's Annals of Surgery the march of the specialty of "acute care surgery" moves on. An Acute Care Surgery Model Improves Outcomes in Patients With Appendicitis:Objective: To compare outcomes of appendectomy in an Acute Care Surgery (ACS) model to that of a traditional home-call attending surgeon model.Summary Background Data: Acute care surgery (ACS, a

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1161711768715989342006-10-24T12:41:00.000-05:002006-10-24T12:47:34.493-05:00

Grand Rounds Vol. III No. 5...Held this week at the Health Care Law Blog.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1161629990114213172006-10-23T13:53:00.000-05:002007-01-15T15:22:59.131-05:00

The Future of Surgery XII.....With a hat-tip to Kevin here are my two cents worth on what he calls the "softening" of surgical residency. The article from Forbes:'Flex' Training Can Boost Number of Surgeons:Medical students studying surgery often quit before completing their training. Now, a new study suggests that schools that offer part-time and other flexible training options could boost and

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1161547145502890182006-10-22T14:53:00.000-05:002007-01-15T15:28:10.278-05:00

Georgia 27 Mississippi State 24As the article points out, we are bowl eligible. But next week in Jacksonville won't be pretty sa it stands.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1161196438072945022006-10-19T15:50:00.000-05:002006-10-19T16:03:31.013-05:00

Trauma in the Obese....We already know that obesity can be a hindrance in diagnosis. And in this month's Journal of the American College of Surgeons are two papers which discuss how obesity affects outcomes after trauma. The first: Impact of Obesity in the Critically Ill Trauma Patient: A Prospective StudyBackgroundObesity has risen at an epidemic rate over the past 20 years in the US. To our

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1161181698132360302006-10-18T09:27:00.000-05:002007-01-15T15:26:47.184-05:00

Tales from the Trauma Service XVII.....Patient in a motor-vehicle collision. Rollover with ejection. Flown in and intubated shortly after arrival.Something is here that doesn't belong. From the plates inidcated by the yellow lineswe can see that this patient has been a guest of the trauma service before. More images to follow:Brain windows on the head CT. Whatever it is it appears to pass over

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1161138539048417082006-10-17T21:23:00.000-05:002006-10-17T21:28:59.050-05:00

Grand Rounds Vol. III No. 4Hosted this week by Kim at Emergiblog.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1160597411264945952006-10-16T19:35:00.000-05:002006-10-16T19:43:40.816-05:00

Send the Whirlybird III....Catching up on my reading I found this in the June issue of The Journal of Trauma:Helicopter Scene Transport of Trauma Patients with Nonlife-Threatening Injuries: A Meta-Analysis:Background: Helicopters have become a major part of the modern trauma care system and are frequently used to transport patients from the scene of their injury to a trauma center. While early

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1160917329735367552006-10-15T07:58:00.000-05:002006-10-15T08:02:09.756-05:00

200,000 Served....At around 11:30 last night ACTCIACTC had its' 200,000th visitor. I do think that counts the thousands of times each day my mom loads the page, however. Thanks for all who have paid a visit over the past three years.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1160916492064284672006-10-15T07:26:00.000-05:002006-10-17T00:17:13.880-05:00

Georgia 22 Vanderbilt 24Glad I didn't go to the game yesterday. Complete meltdown as the article indicates. If the Dogs continues as is, the Florida and Auburn games will be bloodbaths.But I'm not as fed up as these guys are.But at least it didn't sink to the level of this (click on video to watch).UPDATE: Here it is with the obnoxious commentary by the (now forner) color commentator for CSS

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1160768289761529702006-10-13T15:44:00.000-05:002006-10-13T15:56:19.133-05:00

Tales from the Trauma Service XVI.....Patient shot in the back at unknown range. Allegedly with a .223 caliber round. Here is the initial x-ray:The yellow line (and paperclip) indicates the entry wound on the patient's back. Now as for the exit, that will be revealed shortly. Here are some additional images:The yellow line represents a lamina fracture of the first thoracic verterbra. No hints on

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1160674715587381702006-10-12T12:33:00.000-05:002006-10-12T13:22:09.956-05:00

Tennessee is Doomed.....Look who made the cover of S.I. this week:That's Georgia punter Gordon Ely-Kelso in the backgound, BTW.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1160581487527840962006-10-12T06:13:00.000-05:002006-10-12T06:20:21.133-05:00

Craft or Trade????? Gotta love Dr. Gawande. Dr. Pho yesterday linked to a New Yorker article about "how childbirth went industrial" :THE SCORE. What follows is a informative look a the history of obstetrics (which I highly encourage you to read) and how things as forceps delivery and the Apgar score have improved outcomes for both mothers and babies: Around the world, virtually every child born

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1160574283738767652006-10-11T09:16:00.000-05:002006-10-11T09:47:44.806-05:00

Grounded.....A few weeks ago the media was abuzz about a paper mill worker from North Carolina who was being sent by his company to India for a rotator cuff repair and a cholecystectomy. He was excited as he had a few days of sightseeing planned before his surgery. There were also significant cost savings involved. From the Christian Science Monitor, Companies explore overseas healthcare Carl

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1160497021329505822006-10-10T22:12:00.000-05:002006-10-11T09:27:43.063-05:00

DNR, Who decides????From today's New York Times: The Last Word on the Last Breath:The patient, only 35, had been in a persistent vegetative state for 15 years. Recently, he had developed septic bedsores and pneumonia. His kidneys were failing, and despite the feeding tube, he was losing weight. Now he was in cardiac arrest. He was dying.But the young staff doctor had no choice. The patient's

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1160495125606200852006-10-10T10:42:00.000-05:002006-10-10T10:45:25.626-05:00

Grand Rounds Vol. 3 No. 3......This week at Unbounded Medicine.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1160328839554370742006-10-08T12:30:00.000-05:002006-10-08T12:33:59.570-05:00

Georgia 33 Tennessee 51It was fun while it lasted. Georgia was exposed this weekend for all to see (as was Auburn). Two winnable conference games coming up before the Worlds Largest Outdoor Cocktail Party.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1159763755267058652006-10-01T23:33:00.000-05:002006-10-01T23:36:15.750-05:00

Georgia 14 Ole Miss 9Gotta get some offense befrore the Vols come to Athens on Saturday. JT3 to start? Maybe.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1159728091526576942006-10-01T13:38:00.000-05:002006-10-01T13:41:31.543-05:00

Operating Room Photography......That won't gross out out. Take a different look at the surroundings On Location With Rick Lee: The O.R.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1159564158216708602006-09-29T20:14:00.000-05:002006-09-29T20:18:37.726-05:00

Overextended......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

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1159321329846506712006-09-26T20:40:00.000-05:002006-09-26T20:42:09.866-05:00

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

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1159150742565973242006-09-24T21:09:00.000-05:002006-09-24T21:19:02.583-05:00

Football can be Dangerous......Bucs' Simms has spleen removed after loss to CarolinaBuccaneers 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

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1159119214358378632006-09-24T12:27:00.000-05:002006-09-24T12:33:34.376-05:00

Georgia 14 Colorado 13My 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.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1157813249063256852006-09-19T09:10:00.000-05:002006-09-19T09:15:41.116-05:00

A Trauma System for Georgia ??????From last week in the Athens Banner Herald:State lacks in trauma treatmentA 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

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1157989799194510802006-09-11T10:35:00.000-05:002006-09-11T12:45:58.123-05:00

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

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1157895793328760102006-09-10T08:36:00.000-05:002006-09-10T08:43:13.346-05:00

Gerogia 18 South Carolina 0In 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.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1157329585411983362006-09-03T19:23:00.000-05:002006-09-03T19:28:15.486-05:00

Georgia 48 Western Kentucky 12Well 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.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1155650545072970592006-08-15T08:59:00.000-05:002006-08-15T09:02:25.103-05:00

Grand Rounds Vol. II No. 47....At Hospital Impact.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1155321397103519792006-08-11T13:16:00.000-05:002006-08-11T14:54:56.916-05:00

Tales of the Trauma Service XV......This guy needs to buy himself a lottery ticket. The injuries you are about to see are from a fight over fifteen dollars worth of crack cocaine. If that is what the street value of life is these days.....This guy also drove himself to the hospital.Start the film:Big big knife. That's gonna leave a mark.....As he was stable my partner who was on call obtained a

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1153004301533211802006-07-15T17:51:00.000-05:002006-07-15T18:53:33.580-05:00

Another Surgeon Joins the Fold.....Thanks to Orac for the heads-up. Sid Schwab, who's book I reviewed here, has started a blog: Surgeonsblog.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1152889374699565042006-07-14T10:02:00.000-05:002006-07-14T15:12:41.426-05:00

Priorities.....A patient struck by a hit-and-run driver. Severe head injury. Being young and otherwise healthy the patient did not carry any health insurance. The patient has been ready for discharge to rehab now for over two weeks, but funding is an issue. The patient was active in the local music "scene" and their friends have put on several fundraisers to assist in costs. This prompted

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1152819155046649242006-07-13T14:35:00.000-05:002006-07-14T08:20:51.610-05:00

Tales From the Operating Room X.....Or when gastric bypass is not your friend. Young patient several years out from laparoscopic gastric bypass presents with severe abdominal pain. Over the past several weeks they have had intermittent attacks of pain which lasted only a few minutes. This episode did not resolve and they were diagnosed with a small bowel obstruction. The patient underwent

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1117939000952427562006-07-07T05:16:00.000-05:002006-07-07T05:23:12.610-05:00

Books for the Young Surgeon....As the 1,046 new surgical interns start their residency locations some of them may be curious about what books they should buy. Many probably have some already, others may not have anything except the book from their third-year clerkship. The factor that will determine the size of your library more than anything is the size of your educational stipend. Some

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1152238415017629062006-07-06T21:10:00.000-05:002006-07-06T21:13:35.026-05:00

Advice for the New Doctor......I first posted this two years ago, but it bears repeating:Sew well, cut well, get well.If in doubt, put in a drain.If in doubt, use retention sutures.It is better to have it and not need it than to need it and not have it.You can't go wrong by getting out of bed.Turn the PEEP down before sticking for a central line.Honesty is the coin of the realm NEVER, EVER

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1152201208058707762006-07-06T09:57:00.000-05:002006-07-06T10:53:28.130-05:00

Belated Birthday Post.....Everyone seemed to be smoking pot, drinking, and wrecking their cars this past weekend, so I was unable to put up my planned post. The medical blogosphere has grown by leaps and bounds over the past three years. One only needs to look at the submissions and hosts for Grand Rounds to see that. There is also now "spawn of Grand Rounds" with Radiology Grand Rounds and

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1152056812213835732006-07-04T18:53:00.000-05:002006-07-04T18:54:43.256-05:00

Two-Hundred-Thirty Years Ago...IN CONGRESS, July 4, 1776.The unanimous Declaration of the thirteen united States of America,When in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.comtag:blogger.com,1999:blog-5537504.post-1152055573059627042006-07-04T18:22:00.000-05:002006-07-04T18:26:13.070-05:00

Now We Are Three.....Too bad I had the On Call Weekend From Hell, or I could have written about ACTCIACTC's third blogbirthday. Maybe tomorrow. Meanwhile check out Grand Rounds Vol. II No.41 at Dr. Rangel's.

Bard-Parkerhttp://www.blogger.com/profile/07529042060117023381noreply@blogger.com