As an MD just completing residency in Family Practice, I agree wholeheartedly with the parent post. I'm trained to deliver babies and plan to do so. However, Washington State (where I am) has insurance premiums that continue to climb. Currently, I couldn't deliver enough babies in Washington to even pay my malpractice premium, let alone my nurse, office staff, etc. And yeah, I'd like to get paid for those services too.
So, I'm leaving the state to go elsewhere. You can argue about the causes of increasing premiums, the evils of lawyers, greedy insurance companies, stupid jurors, clueless politicians, or whoever else you want to blame for the situation. The fact is that if I can't even pay my premiums, then I can't offer that service. Either that, or I go somewhere that I can. And that means that you/your wife don't get good prenatal care and the less-prepared emergency room doctor ends up delivering your baby.
Or, the lawyers will eventually end up delivering all the babies;-)
with no indication on the packaging that this is the case.
This is only done when people actually go to the store to intentionally buy an edited DVD. My brother has a couple of "Cleanflicks" DVDs. The case contains the original DVD with a "clean" DVD-R right next to it. Comparing this to Blockbuster's special edits is apples to oranges.
I'm Mormon and have lived in Utah for all but 4 years of my life. I usually end up voting about 50/50 republican/democrat.
Not all of us vote straight ticket.
The diagnosis problem and inappropriate treatment
on
Working with ADHD?
·
· Score: 1
First, I am a Doctor (IAAD)?
Second, these are just general comments, not medical advice directed towards anyone in particular.
There are several useful algorithms for diagnosing ADHD. The DSM-IV definition is listed in an earlier posting. Our clinic uses the ADHD-RS (Attention Deficit/Hyperactivity Disorder Rating Scale) form. It asks 18 questions about the person's behavior. The questions are rated from NEVER (score=0) to ALWAYS (score=3). The maximum score is 54 (3*18). A common cutoff is a score of 40. Above 40, and you've probably got ADHD. Below 40, probably not. Then, you try treating these kids with one of the medicines. Try Adderall, Concerta, Ritalin LA, or Strattera, or whatever other med floats your boat. Re-score them on the ADHD-RS in a few weeks and see if they're improving. If not, switch them.
If you read the ADHD-RS scale, you'll see that most kids score 10-30. These probably don't have ADHD. But, there's tremendous pressure placed on Doctors by parents and teachers to medicate these kids. If they actually meet criteria, medication CAN be extremely helpful. If not, you're just medicating a normal kid and doing him no favors.
The ADHD-RS is copyrighted, so I couldn't find a link to it that wasn't on a restricted academic site. But, look around and you'll probably find it. You'll find plenty of studies referring to it.
Re:Please be respectful on this topic
on
Working with ADHD?
·
· Score: 2, Informative
There is a new drug released this year who's name escapes me, but it's a non-amphetamine drug that is much easier to deal with. Problems I have read, however, are some rare cases of folks finding they get odd violent tendencies or it can only make their ADHD symptoms worse. Just goes to show how much we truly understand this disease.
I believe you're referring to Strattera, by Eli Lilly. It's not a controlled substance, thereby getting around the triplicate form problem.
I realize that it's probably heresy, but I'm gonna use the $13 to get the new Metallica album. Yeah, I know it's still feeding the RIAA beast.
However, there's a lot of noise made on this forum like:
"Well, I'd buy the CD if it wasn't so much!" "Bands should offer additional stuff when I buy a CD." "The bands don't get any money anyway, so I'm only 'stealing' from the RIAA"
Well, I like Metallica's music. It's only $11-13, depending on where you look, and there's a full-length DVD as well. Also, there's supposed to be some other goodies available to buyers from the Metallica website. This seems like a pretty good value.
I can already hear the knee-jerk reactions coming. I don't care. If you're still too tight to buy it, then all of the ethical cartwheels you're turning to justify your Kazaa habit are just bullshit!
Re:but it's more humane!
on
Chicken Run
·
· Score: 2, Funny
I grew up just north of Beaver, Utah. My hometown's name is "Fillmore". Look it up-it's on the interstate.
When asked where I was from, I could calmly respond:
I realize that this is probably heresy to admit this on this board, but I use Outlook 2000 by choice. I have Norton AV updated weekly. More importantly, I don't open attachments. Finally, I have Windows set to show me the file types. So, what.jpg actually shows up as what.jpg.pif. No problem. A quick delete and it's gone. I also have the auto-preview turned off.
I've had no difficulty with viruses, worms, trojans, or the like.
I've been playing video games since I bought my first Nintendo at age 12 (or so). I played Doom through college and Half-Life through medical school (I studied a little too;-)
As a resident, I'm learning to do endoscopic procedures, such as colonoscopy, upper GI endoscopy, and a few other procedures ending with -oscopy. Manual dexterity and coordination play a significant role in performing these procedures well. You can read the entire endoscope manual about which wheel looks left, right, up or down, and which button takes a picture. But, you've gotta get your hands on the scope and start driving to gain any proficiency.
After my first day of endoscopy, I called my mom to tell her that all those hours spent in front of the Nintendo were now benefitting my career. She scoffed and said it was probably because I could play the piano. But, I remain convinced.
When I order an EKG (I'm a resident), I force myself to cover the computer's interpretation of the data and then read it in a systematic fashion. Afterwards, it's amusing to see what the computer thought.
However, the computer can been pretty good for determining intervals (such as a prolonged QT interval, which can predispose patients to arrhythmias). But, the computer isn't very good at distinguishing between similar-appearing rhythms, such as atrial fibrillation and wandering atrial pacemaker.
I have to chuckle when I open slashdot for the latest news on SCO vs. Linux. When I do, the banner at the top of the page is for "go2unix.com-SCO & more.Unix dealers since 1990 SCO, Linux, Sun, HP, IBM, SGI, etc."
We believe consumers will enjoy the benefits of EZ-D without the inconvenience of making extra trips, returning movies, and paying late fees."
Having dedicated recycling sites, while nice, negates points (1) and (2) in their statement. If the consumer has to run out to recycle the movie, why not have them recycle it at the rental store.
Oh wait? Now this is like the "old" way of renting movies.
Re:Only detects it, doesn't cure it
on
Sniffing Out Cancer
·
· Score: 3, Interesting
I'd have to agree that easier detection would almost certainly increase screening rates. According to the American Gastroenterology Association, only 30% of people who should be screened for colon cancer actually get the screening.
As someone with two second-degree relatives with colon cancer, this is something that's personally very important. I'd rather blow on the cancer detector than get medieval with the colonoscope.
For those in the medical fields, PDAs are a necessity. I'm a medical resident and I consult my PDA a couple dozen times a day. This includes checking reference texts, normal lab values, and most of all, prescribing drugs. Epocrates, a free drug database, is THE killer app for anyone who prescribes meds. The alternative is lugging around a PDR (physician's desk reference), a phone-book sized drug reference.
I also use my PDA to track and record all procedures I perform (babies delivered, lumbar punctures, lacerations sutured, etc). At the end of residency, I hit the button and it spits out all my procedures into a database. When I check out patients when I'm not on call, I simply beam a list of my patients to the on-call person and they've got all the data.
I use several applications at home as well as work that run on Win32 exclusively. Our hospital email and messaging system is all Microsoft and I don't see this changing anytime soon.
Also, Half-Life isn't on Linux (yeah, I know you can use Wine, but it's a no-brainer to play it in Windoze.)
On the upside, I do run a game server from time to time and it's always Linux (usually Red Hat or Mandrake).
Only after medschool, when you are an intern, do you get to work with patients, and only with the supervision of a resident.
As a second year family practice resident, I'd have to disagree. Much of the first two years lend themselves to a lot of computer-based learning. Good examples would be some of the visually-based disciplines, such as Dermatology and Pathology. However, 3rd year and beyond is entirely different. Part of med school is learning the hands-on skills such as listening to heart tones, learning to suture lacerations, basic surgical skills, etc. The other part is the human side. You may be a great surgeon. But if you can't relate to your patients, they won't have confidence in you even though you may know the textbook information by heart. This is only gained by talking to and examining lots and lots of patients.
As for the article itself, 70% patient contact in the clinical years is probably an appropriate amount. Internship/Residency builds on those hands-on and people skills you learned in med school. You do much of the same tasks, just at a much faster pace. I'm definitely in favor of computer-based learning and testing when it's applicable. But eventually you've gotta go see the patient.
(shameless plug)
For an award-winning example of computer-based learning, check out my Alma Mater's Webpath site.
(/shameless plug)
Well, I just stopped by the local Kia dealership. I shot the breeze with the sales man and he said we ought to take a spin. I drove the Kia Sportage for about five minutes and said I'd have to think about it. He was fine with that and said, "Oh yeah. Did you see LOTR? Well, you get a DVD or VHS tape for taking a test drive."
I said that was great, and went on my way with my precious (ha) card. I called the 800 number, entered the ID code and answered a couple of questions (how did you find out about the promo, what did you drive, etc.). I gave my mailing info, and now I'll sit tight for 4-6 weeks.
I'm patient, and I now I figure I can more easily justify purchasing the big, bad set in November.
Slashdot Mirror
So, I'm leaving the state to go elsewhere. You can argue about the causes of increasing premiums, the evils of lawyers, greedy insurance companies, stupid jurors, clueless politicians, or whoever else you want to blame for the situation. The fact is that if I can't even pay my premiums, then I can't offer that service. Either that, or I go somewhere that I can. And that means that you/your wife don't get good prenatal care and the less-prepared emergency room doctor ends up delivering your baby.
Or, the lawyers will eventually end up delivering all the babies ;-)
"We don't need no steenkin' badges!"
So what's Mug Rootbeer? Country
(me shudders)
Seems like more of a Mickey Mouse operation.
with no indication on the packaging that this is the case.
This is only done when people actually go to the store to intentionally buy an edited DVD. My brother has a couple of "Cleanflicks" DVDs. The case contains the original DVD with a "clean" DVD-R right next to it. Comparing this to Blockbuster's special edits is apples to oranges.
I'm a doctor. Take a damn bath!!
Hatch has a personal interest, since I'm sure his music [hatchmusic.com] is pirated on a regular basis. ;)"
Ahhhhhhahahahahaha!!! Do yourself a favor and KaZaa a few Hatch MP3s. You'll be begging for Celine Dion!! Mark my words!
I'm Mormon and have lived in Utah for all but 4 years of my life. I usually end up voting about 50/50 republican/democrat.
Not all of us vote straight ticket.
First, I am a Doctor (IAAD)?
Second, these are just general comments, not medical advice directed towards anyone in particular.
There are several useful algorithms for diagnosing ADHD. The DSM-IV definition is listed in an earlier posting. Our clinic uses the ADHD-RS (Attention Deficit/Hyperactivity Disorder Rating Scale) form. It asks 18 questions about the person's behavior. The questions are rated from NEVER (score=0) to ALWAYS (score=3). The maximum score is 54 (3*18). A common cutoff is a score of 40. Above 40, and you've probably got ADHD. Below 40, probably not. Then, you try treating these kids with one of the medicines. Try Adderall, Concerta, Ritalin LA, or Strattera, or whatever other med floats your boat. Re-score them on the ADHD-RS in a few weeks and see if they're improving. If not, switch them.
If you read the ADHD-RS scale, you'll see that most kids score 10-30. These probably don't have ADHD. But, there's tremendous pressure placed on Doctors by parents and teachers to medicate these kids. If they actually meet criteria, medication CAN be extremely helpful. If not, you're just medicating a normal kid and doing him no favors.
The ADHD-RS is copyrighted, so I couldn't find a link to it that wasn't on a restricted academic site. But, look around and you'll probably find it. You'll find plenty of studies referring to it.
There is a new drug released this year who's name escapes me, but it's a non-amphetamine drug that is much easier to deal with. Problems I have read, however, are some rare cases of folks finding they get odd violent tendencies or it can only make their ADHD symptoms worse. Just goes to show how much we truly understand this disease.
I believe you're referring to Strattera, by Eli Lilly. It's not a controlled substance, thereby getting around the triplicate form problem.
I realize that it's probably heresy, but I'm gonna use the $13 to get the new Metallica album. Yeah, I know it's still feeding the RIAA beast.
However, there's a lot of noise made on this forum like:
"Well, I'd buy the CD if it wasn't so much!"
"Bands should offer additional stuff when I buy a CD."
"The bands don't get any money anyway, so I'm only 'stealing' from the RIAA"
Well, I like Metallica's music. It's only $11-13, depending on where you look, and there's a full-length DVD as well. Also, there's supposed to be some other goodies available to buyers from the Metallica website. This seems like a pretty good value.
I can already hear the knee-jerk reactions coming. I don't care. If you're still too tight to buy it, then all of the ethical cartwheels you're turning to justify your Kazaa habit are just bullshit!
I grew up just north of Beaver, Utah. My hometown's name is "Fillmore". Look it up-it's on the interstate.
When asked where I was from, I could calmly respond:
"I'm from the Fillmore-Beaver area!"
I realize that this is probably heresy to admit this on this board, but I use Outlook 2000 by choice. I have Norton AV updated weekly. More importantly, I don't open attachments. Finally, I have Windows set to show me the file types. So, what.jpg actually shows up as what.jpg.pif. No problem. A quick delete and it's gone. I also have the auto-preview turned off.
I've had no difficulty with viruses, worms, trojans, or the like.
I've been playing video games since I bought my first Nintendo at age 12 (or so). I played Doom through college and Half-Life through medical school (I studied a little too ;-)
As a resident, I'm learning to do endoscopic procedures, such as colonoscopy, upper GI endoscopy, and a few other procedures ending with -oscopy. Manual dexterity and coordination play a significant role in performing these procedures well. You can read the entire endoscope manual about which wheel looks left, right, up or down, and which button takes a picture. But, you've gotta get your hands on the scope and start driving to gain any proficiency.
After my first day of endoscopy, I called my mom to tell her that all those hours spent in front of the Nintendo were now benefitting my career. She scoffed and said it was probably because I could play the piano. But, I remain convinced.
Just my $0.02!
When I order an EKG (I'm a resident), I force myself to cover the computer's interpretation of the data and then read it in a systematic fashion. Afterwards, it's amusing to see what the computer thought.
However, the computer can been pretty good for determining intervals (such as a prolonged QT interval, which can predispose patients to arrhythmias). But, the computer isn't very good at distinguishing between similar-appearing rhythms, such as atrial fibrillation and wandering atrial pacemaker.
I have to chuckle when I open slashdot for the latest news on SCO vs. Linux. When I do, the banner at the top of the page is for "go2unix.com-SCO & more.Unix dealers since 1990 SCO, Linux, Sun, HP, IBM, SGI, etc."
So, what LAN games do you suppose they play when there's a lull in the war?
America's Army? uh, um, never mind.
Read on for more of Matt's review of this guide to tricking private members to do your bidding.
In related news, Washington State has banned the sale of this book because of gratuitous discussion of "private members".
It seems that their point is:
We believe consumers will enjoy the benefits of EZ-D without the inconvenience of making extra trips, returning movies, and paying late fees."
Having dedicated recycling sites, while nice, negates points (1) and (2) in their statement. If the consumer has to run out to recycle the movie, why not have them recycle it at the rental store.
Oh wait? Now this is like the "old" way of renting movies.
I'd have to agree that easier detection would almost certainly increase screening rates. According to the American Gastroenterology Association, only 30% of people who should be screened for colon cancer actually get the screening.
As someone with two second-degree relatives with colon cancer, this is something that's personally very important. I'd rather blow on the cancer detector than get medieval with the colonoscope.
I just love a good pun!
For those in the medical fields, PDAs are a necessity. I'm a medical resident and I consult my PDA a couple dozen times a day. This includes checking reference texts, normal lab values, and most of all, prescribing drugs. Epocrates, a free drug database, is THE killer app for anyone who prescribes meds. The alternative is lugging around a PDR (physician's desk reference), a phone-book sized drug reference.
I also use my PDA to track and record all procedures I perform (babies delivered, lumbar punctures, lacerations sutured, etc). At the end of residency, I hit the button and it spits out all my procedures into a database. When I check out patients when I'm not on call, I simply beam a list of my patients to the on-call person and they've got all the data.
For me, it's essential.
I use several applications at home as well as work that run on Win32 exclusively. Our hospital email and messaging system is all Microsoft and I don't see this changing anytime soon.
Also, Half-Life isn't on Linux (yeah, I know you can use Wine, but it's a no-brainer to play it in Windoze.)
On the upside, I do run a game server from time to time and it's always Linux (usually Red Hat or Mandrake).
As a second year family practice resident, I'd have to disagree. Much of the first two years lend themselves to a lot of computer-based learning. Good examples would be some of the visually-based disciplines, such as Dermatology and Pathology. However, 3rd year and beyond is entirely different. Part of med school is learning the hands-on skills such as listening to heart tones, learning to suture lacerations, basic surgical skills, etc. The other part is the human side. You may be a great surgeon. But if you can't relate to your patients, they won't have confidence in you even though you may know the textbook information by heart. This is only gained by talking to and examining lots and lots of patients.
As for the article itself, 70% patient contact in the clinical years is probably an appropriate amount. Internship/Residency builds on those hands-on and people skills you learned in med school. You do much of the same tasks, just at a much faster pace. I'm definitely in favor of computer-based learning and testing when it's applicable. But eventually you've gotta go see the patient.
(shameless plug)
For an award-winning example of computer-based learning, check out my Alma Mater's Webpath site. (/shameless plug)
Well, I just stopped by the local Kia dealership. I shot the breeze with the sales man and he said we ought to take a spin. I drove the Kia Sportage for about five minutes and said I'd have to think about it. He was fine with that and said, "Oh yeah. Did you see LOTR? Well, you get a DVD or VHS tape for taking a test drive."
I said that was great, and went on my way with my precious (ha) card. I called the 800 number, entered the ID code and answered a couple of questions (how did you find out about the promo, what did you drive, etc.). I gave my mailing info, and now I'll sit tight for 4-6 weeks.
I'm patient, and I now I figure I can more easily justify purchasing the big, bad set in November.