I too remember the Old Days (TM). Slashdotting was an actual thing. We fearlessly rode the waves of the ether, and many a site trembled at the sound of our clicks.
I rarely post any more... but the passing of Rob is sobering reminder than none of us are getting any younger... RIP Roblimo:(
I work with mentally ill patients, and I was an active SWAT officer when Columbine happened. It changed how we did everything.
After Columbine, we got our floor-plans on ALL of our local schools, and spent hours and hours during the nights assaulting those locations, and gaming-out active shooter scenarios. We had other officers play the OPFOR, and hunted them through the hallways. What we discovered was that as fast as we were, we weren't fast enough. By the time a police response arrives at a school, the gunman can have already killed several dozen (as happened at Virginia Tech).
The answer to a "man with a gun" is another man with a gun, and the School Resource Officer is critical against a homicidal maniac. The faster you can get that man on-scene and putting rounds on-target, the better.
And our mental health system is badly broken. Look into the eyes of Lanza, Holmes, Loughner... it doesn't take a board-certified psychiatrist to tell you they've lost touch with reality. Unfortunately, there are very few resources out there to address people like that. Until that changes, people like that (though they throw up red flags to every person who knows them) are going to continue to fall through the cracks.
The uber-green and anti-nuke activists likely don't live there, and probably consider these folks collateral damage in their larger fight. Ideally, such activists would be up-front about the economic costs of some of their stands. Even beyond this now-impoverished small town, growing economies need affordable energy; that's just an economic fact. High energy costs reverberate through the entire supply chain, and raise the costs of virtually every good-and-service that normal people use.
Everybody wants clean air and water, but some green initiatives come with a serious price-tag.
I recommend the blank-keyed "stealth" model. It not only keeps those without any computer skills away from your terminal (some people look at a blank keyboard, and literally don't know what to do), but they're also ideal for home. Mine keeps my non-touch-typist kids away from my computer.
Dead-on right. It's not the back-end, it's not what brand of software, it's not the brand of tablet... it's the interface.
I'll say it again... most physicians are NOT geeks, with the occasional exception (confession: I actually have a server rack in my house). People may not realize this, but plenty of physicians can't even type, particularly the older ones.
I have a colleague... I'll call him Dr. Smith. He's a GP, and he's literally been practicing for nearly 50 years. That's not a typo... he started in 1960. He's old-school, and anybody (including me) would be happy to have him take care of them... because he takes all his own calls... comes into the ER to see his patients, even in the middle of the night and on weekends. He's also a hell of a nice guy, and a good doc... a real dying breed.
He's computer-illiterate. Completely. You threaten him with "learn this crappy new system or else," and he's going to balk. He'll retire, or drop his privileges and move to the hospital across town like a bunch of his younger colleagues given the same ultimatum.
You think you can force physicians to simply eat sh*t? Who do you think you are... Medicare? You MUST have physician buy-in, and physicians balk at being told "use this crap or else" by some suit who doesn't take care of patients, ESPECIALLY when the UI slows them down, cuts into their productivity, and interferes with their care of patients. I've worked in environments where that was done as a top-down forced implementation (I'm an ex-military doc), and it sucks out loud (it was also reverted to paper in less than 24 hours after the entire facility literally ground to a halt).
How do you like it when some admin weenie comes down to your server room and says "we're implementing this brand-new system. It sucks, it's slow, it crashes, it's full of security holes... but you're going to use it or else." Somehow, I think a similar industry-wide fiat like that directed against IT, posted on Slashdot, would easily generate a 1000-comment thread... in the first 15 mintues.
Doctor Dugan, is it? I have to ask what specialty you practice, and what sort of practice environment you inhabit.
You sound like you're one of those who wants to throw open the health care licensing gates to anybody who wants to take care of a patient. Having seen some of the stunts pulled by my fully-educated colleagues over the years, I'm a bit leery of turning over those keys to just anybody, particularly those with even LESS training and knowledge.
What, exactly, are you proposing as an alternative to the current system?
And spare me the thinly-veiled "profit-driven whores" implication in why physicians didn't adopt EMRs 30 years ago. That isn't why, and you know it. The truth is that the technology sucked even more then than it does now.
It's not protectionism or any of that other trite conspiratorial nonsense that keeps physicians from using EMR (you can't get ten physicians to agree on damned-near ANYTHING, from what PACS software to use, to what size coffee cups to keep in the surgery waiting area... how do you expect them to engage in any kind of organized conspiracy to keep using paper?) You want to know why physicians dread EMRs?
Well... being one (and a tech geek to boot), I'll tell you:
It's the UI.... that and the cost. If you can make it fast, user-friendly, intuitive, lightweight, and inexpensive, the world will beat a path to your door.
For example, when I was an intern, we were evaulating a hospital-based order-entry system from TDS. It was the old light-pen system, and the damned thing took 14 screens to order an Xray.
I'm now a practicing ER physician... nobody is under greater time pressure than I am, and the EMRs that I've seen so far will slow me down. My colleagues at a nearby hospital who use one of the tablet-based systems complain bitterly about how slow it is.
Make it faster and easier to use than paper. Make it... you know... an actual upgrade? Not some ugly, unwieldy kludge forced by some data-mining, numbers-obsessed bureaucrat. Doctors generally aren't geeks... they care about ease of use. A system that doesn't make it easier to take care of patients will be universally despised, and resisted by everyone on the medical staff.
Physicians have enough to do, and enough to worry about. Want to have medical staff buy-in? Make the EMR an asset instead of a liability.
They really should try to build in some life-like behavior for the deer, aimed at the idiots who like to spotlight them at night. Those fools are particularly dangerous, because in low-light they can't be sure of what's beyond their target, yet they blast away at it; pity the poor sod whose house is downrange.
Put in a photocell that makes the robotic deer raise its head, and turn toward the light... that'd be pure gold.
I have one question: Why have a hard drive in a small, easily-knocked-about video camera? What's better about a delicate, shock-sensitive moving part in an electronic good that's going to be abused? There's a lot to be said for more storage, but how about buying more tapes?
Call me a Luddite, but I just bought one of these for Christmas, and I went with the tape version. Talk all the smack you want about tape, but it's durable, shock-resistant, and stands the test of time.
Besides... what's with this site? Did I miss it, or did they not even attempt the mod they're talking about?
One of my physician colleagues just got an extremely unpleasant visit from Childrens's Services and a bunch of Police Officers for a bogus child abuse complaint... all phoned in nice-and-anonymously to a hotline. No consequences, no recrimination, and no worries for the little scumbag that made that bogus report. It certainly opens the door to plenty of harassment and abuse, particularly for people with a serious beef against you (ex-spouses, ex-gf/bfs, ex-business associates, angry neighbors, disgruntled customers or patients, the list goes on and on).
And there's not a damned thing you can do about it.
I take care of abused children in my ER, and I've seen some truly horrific cases. Some were heinous enough that they had me thinking the parents needed to be under the jail rather than in it... but there has to be a process to clear your name from this kind of thing if it's bogus. The "sexual offender" label is damaging and libelous enough that it could literally ruin your business, or your life.
Working in Emergency Services, I use the internet pretty much every shift.
I'm expected to know/do something about virtually anything that walks in the door, including industrial toxin exposures, any/all medication overdoses, even "my child ate this weird plant" complaints. I can access pill databases, get radiology reports and images, look up MSDS, and even have a few botany sites bookmarked for exactly that kind of weird stuff.
Standard ER stuff I can do with my eyes closed, but reference materials online are absolutely essential for the bizarre ones, and it's why I have redundant internet connections (one of which I set up and maintain myself).
Agreed... there is nothing like working on a dual-processor box. I'm using a dual-core 4200, and it's as responsive as my old dual-athlon workstation.
Many claim that there is no real difference between dual and single processor machines for most common applications... but subjectively (and I'll allow that it could be psychological), dual-processor machines simply feel snappier.
Programs seem to open more quickly, and there is none of that barely-perceptible "lag" that seems to happen when you have a bunch of windows open, and a full system tray.
You keep saying that... I don't think it means what you think it means. I'm beginning to think you're a bot programmed to say the same thing over and over.
Fortunately, most troops don't have themselves in knots over the trivially false assertions of the left-wing anti-war crowd. Remember "BUSH LIED!!" and "NO WAR FOR OIL!!" and "WE SUPPORT OUR TROOPS... WHEN THEY KILL THEIR OFFICERS!" Remember all that tripe? Most aren't buying it, to their credit.
It's absolutely hilarious to me that you're so very concerned about the psychological health of those troops, yet you continue to promulgate the falsehoods that they're murderers, and defend the left-wing talking points that minimize the good things that have been done in this conflict. Those falsehoods psychologically harm the few troops that believe one iota of that nonsense. Is that what you want? Are you vile and small enough a person to take out your anger with the administration on the returning troops?
I've personally counseled both troops and police officers who have used lethal force in the line of duty... the perceived rightness of their cause is important in minimizing the psychological costs involved in doing their duty. Do you think all those worthless fools who screamed "babykiller!!!" at returning vietnam vets helped their psychological recovery?
I'll repeat it again: as a matter of policy, routine, or military culture, we. do. not. deliberately. slaughter. civlians.
I'm glad you know you have GERD. Curiously, sometimes even your doctors can't say that the burning in your epigastrum and chest is definitely GERD, instead of angina, or esophageal spasm, or barretts esophagus, or a pulmonary embolus... Risk stratification for some of those other conditions is quite important. Your doctor can assist you in that effort, or not... your body, your choice. It sounds to me like you've made a conscious, economically-based decision to chart your own treatment course, and that's perfectly fine.
It's pretty clear that you disapprove of my profession's work... but if you have a problem with our drug laws, take it up with the DEA, or congress. I prescribe at their pleasure, and I can lose that privilege VERY easily. In fact, the DEA has recently dragged several physicians in my area right out of their offices in the middle of the day for inappropriate prescribing (among other charges). Some of them are facing life (yes, that's life in prison). You don't like the law, too bad... get it changed, or move somewhere where you'll have unfettered access to your drugs of choice.
Yes, if drugs were legalized, I wouldn't have people pestering me for drugs all the time (actually I'd just have fewer... I'd still have the homeless guys and drifters who want me to feed, clothe, and buy their prescriptions for them, since "you can afford it") In place of drug seekers, I'd have even more mulitply-drug-resistant infections, partially-treated meningitis, side effects, allergic reactions, medication interactions, overdoses (intentional and unintentional), and withdrawl.
I'm against the legalization of drugs because of the harm they can do in untrained hands, not because I'm a toadying little servant of "The Man" (TM).
I wish you'd clarified that earlier on (or maybe you did and I misunderstood). I don't have any problem with you taking pain medication after your surgery. Tonsillectomy is a heinous surgery to undergo as an adult, and the pain is extreme. You had every reason to want pain medication, and I'm actually glad to hear that you coordinated it with your doctor.
The issue about the spammer is different... here's how.
I have NO problem prescribing powerful pain medications to people that really need it. In fact, among my colleagues, I'm one of the more liberal about this issue. Even so, I absolutely draw the line at people abusing medications, or using them inappropriately.
Part of my oath is to give no deadly medicine. It's actually far easier for me to just dash off a prescription and get the patient out of my ER. They take up less of my time, fewer of my beds, they write fewer complaint letters to my administrator, and they don't scream/berate/physicially assault me and my nursing staff. However, sometimes the path of least resistance does actual harm to the patient, and that includes perpetuating someone's addiction.
What kind of claim could I make towards looking out for the best interests of patients (and that's ALL patients) if I behaved that way?
I realize people are going to get high whether I want them to or not... but I absolutely will not assist them in their efforts.
What you did was illegal. Taking scheduled narcotics not prescribed to you (ie. your friend's vicodin) is illegal. Your buddy could even be busted for dispensing or trafficking.
My point about Lortab and Vicodin was this: if you got no relief from the Lortab, but DID get relief with the Vicodin, and the doses were not appreciably different, then the difference was likely in your head. Those two drugs have the same ingredients, the same generic, and are pharmacologically equivalent; your body doesn't know the difference.
No, you don't need to go to medical school to know that you're in pain. You DO need to go to medical school to learn clinical pharmacology, and how to use prescribing privileges safely and effectively. So you didn't triple the dose, you only doubled it? Same thing, different degree... rationalize as you will.
And then there's this:
WTF do you care?
Why the f*ck do I care? Because it pains me to see people needlessly get themselves in trouble. Believe it or not, I actually have compassion, and want all my patients to get well. Much of the mess that people get themselves into is easily preventable with some common sense and following instructions. Adjusting your own medications is not something I generally recommend to the layman.
I'm actually concerned about your self-medicating, and instant "hook-up" buddies with their ready vicodin supply. Take note; I'll always be ready in my ER to clean up the mess if you do something really dumb, and I'll never dance, gloat, and say "I told you so." That said, you can expect a serious, no-bullsh*t, no-punches-pulled discussion about your actions when you finally wake up enough to get off the ventilator. Most take it well, while others curse and spit on me... but some conversations are, by their very nature, difficult to sugar-coat.
My goal is not to be an arrogant jerk, my goal is to help you learn. Don't shoot the messenger... I'm actually trying to help you.
The studies on combination opiods/analgesics have been around for over 20 years, and suggest that combination agents (combining more than one mechanism of action) are more effective than single agents alone, even when those single agents are used in higher doses.
JCAHO is the Joint Committee on the Accreditation of Healthcare Organizations. They're the guys who determine if your hospital gets "certified" to actually take care of patients. You can check out their website Here.
They do some valuable things... but they also can ding your hospital on some truly maddening minutiae. Also, as I noted in my initial post, not all of their "input" is necessarily helpful.
Yes, I am a doc, and your behavior was foolish and illegal. You want to accuse me of childish anger and "dumb sh*t?" Allow me...
When your pain medicine doesn't take care of the pain, the answer is to call your doctor and make some alternative arrangements. The answer is most definitely NOT to make your own executive decision to increase the dose... that's how people overdose and get hurt. You had 12 ounces of Lortab elixer? That's 360ccs, or roughly 24 standard doses, generally prescribed every 4-6 hours. You went to medical school where again? Never mind... forget medical school... just do the basic math.
Even more foolish is your decision to go get some street drugs from a "friend." You went ahead and took a mystery pill given to you by some "friend?" You're certainly a trusting soul... Was he a pharmacist? Did you look up the imprint code on the pill?
You also realize, do you not, that Lortab is the same thing as Vicodin? Look it up if you dont believe me. Of course, you could have been taking a large amount of the vicodin (even more foolish), but otherwise, you've been the victim of the placebo effect.
Tylenol is one of the nastier common overdoses... Asprin is equally bad.
Fortunately, tylenol has an antidote, provided you get it on board in an appropriate time frame. The problem is adolescents who take a bunch of tylenol as an attention-getter (they assume it's non-toxic), then have second thoughts, and don't tell anyone for a few days. Those kids tend not to do well.
BTW, there are hydrocodone preparations that don't contain tylenol, they're just not used as commonly.
We used to... until JCAHO decided that it was a violation of confidentiality. Most ERs kept a "frequent flier" list of their drug seekers: a recipe box with index cards was the usual method, complete with name (including aliases), preferred drug, and typical cover stories used. Those boxes were absolutely invaluable for keeping patients from doctor-shopping by surfing from ER to ER, stocking up.
Thanks JCAHO... thanks a lot for leaning forward to help us in our fight against prescription drug diversion.
Prescription drug abuse/diversion is a major problem... I get hit with drug seekers in my ER every single day. Some of these people have legitimate chronic pain conditions and need to be under the care of a pain specialist, while others are simply using narcotics to treat their psychological pain (or just gathering "party supplies" for the weekend). Some of these people self-medicate and push their vicodin/lortab dose until they get acetaminophen toxic... bad way to end up on the liver transplant list.
And before somebody says it, no, I don't think drug legalization is the answer.
Slashdot Mirror
Hallelujah, brother... preach it.
I too remember the Old Days (TM). Slashdotting was an actual thing. We fearlessly rode the waves of the ether, and many a site trembled at the sound of our clicks.
I rarely post any more... but the passing of Rob is sobering reminder than none of us are getting any younger... RIP Roblimo :(
I work with mentally ill patients, and I was an active SWAT officer when Columbine happened. It changed how we did everything.
After Columbine, we got our floor-plans on ALL of our local schools, and spent hours and hours during the nights assaulting those locations, and gaming-out active shooter scenarios. We had other officers play the OPFOR, and hunted them through the hallways. What we discovered was that as fast as we were, we weren't fast enough. By the time a police response arrives at a school, the gunman can have already killed several dozen (as happened at Virginia Tech).
The answer to a "man with a gun" is another man with a gun, and the School Resource Officer is critical against a homicidal maniac. The faster you can get that man on-scene and putting rounds on-target, the better.
And our mental health system is badly broken. Look into the eyes of Lanza, Holmes, Loughner... it doesn't take a board-certified psychiatrist to tell you they've lost touch with reality. Unfortunately, there are very few resources out there to address people like that. Until that changes, people like that (though they throw up red flags to every person who knows them) are going to continue to fall through the cracks.
They killed the goose that layed the golden eggs.
The uber-green and anti-nuke activists likely don't live there, and probably consider these folks collateral damage in their larger fight. Ideally, such activists would be up-front about the economic costs of some of their stands. Even beyond this now-impoverished small town, growing economies need affordable energy; that's just an economic fact. High energy costs reverberate through the entire supply chain, and raise the costs of virtually every good-and-service that normal people use.
Everybody wants clean air and water, but some green initiatives come with a serious price-tag.
Thank God for the UN's beneficence and adherence-to-principle.
Good thing none of those votes were bought through corruption... or through funds skimmed from the Oil-for-Food program.
I own two Das's... they rock.
I recommend the blank-keyed "stealth" model. It not only keeps those without any computer skills away from your terminal (some people look at a blank keyboard, and literally don't know what to do), but they're also ideal for home. Mine keeps my non-touch-typist kids away from my computer.
Dead-on right. It's not the back-end, it's not what brand of software, it's not the brand of tablet... it's the interface.
I'll say it again... most physicians are NOT geeks, with the occasional exception (confession: I actually have a server rack in my house). People may not realize this, but plenty of physicians can't even type, particularly the older ones.
I have a colleague... I'll call him Dr. Smith. He's a GP, and he's literally been practicing for nearly 50 years. That's not a typo... he started in 1960. He's old-school, and anybody (including me) would be happy to have him take care of them... because he takes all his own calls... comes into the ER to see his patients, even in the middle of the night and on weekends. He's also a hell of a nice guy, and a good doc... a real dying breed.
He's computer-illiterate. Completely. You threaten him with "learn this crappy new system or else," and he's going to balk. He'll retire, or drop his privileges and move to the hospital across town like a bunch of his younger colleagues given the same ultimatum.
You think you can force physicians to simply eat sh*t? Who do you think you are... Medicare? You MUST have physician buy-in, and physicians balk at being told "use this crap or else" by some suit who doesn't take care of patients, ESPECIALLY when the UI slows them down, cuts into their productivity, and interferes with their care of patients. I've worked in environments where that was done as a top-down forced implementation (I'm an ex-military doc), and it sucks out loud (it was also reverted to paper in less than 24 hours after the entire facility literally ground to a halt).
How do you like it when some admin weenie comes down to your server room and says "we're implementing this brand-new system. It sucks, it's slow, it crashes, it's full of security holes... but you're going to use it or else." Somehow, I think a similar industry-wide fiat like that directed against IT, posted on Slashdot, would easily generate a 1000-comment thread... in the first 15 mintues.
Doctor Dugan, is it? I have to ask what specialty you practice, and what sort of practice environment you inhabit.
You sound like you're one of those who wants to throw open the health care licensing gates to anybody who wants to take care of a patient. Having seen some of the stunts pulled by my fully-educated colleagues over the years, I'm a bit leery of turning over those keys to just anybody, particularly those with even LESS training and knowledge.
What, exactly, are you proposing as an alternative to the current system?
And spare me the thinly-veiled "profit-driven whores" implication in why physicians didn't adopt EMRs 30 years ago. That isn't why, and you know it. The truth is that the technology sucked even more then than it does now.
It's not protectionism or any of that other trite conspiratorial nonsense that keeps physicians from using EMR (you can't get ten physicians to agree on damned-near ANYTHING, from what PACS software to use, to what size coffee cups to keep in the surgery waiting area... how do you expect them to engage in any kind of organized conspiracy to keep using paper?) You want to know why physicians dread EMRs?
Well... being one (and a tech geek to boot), I'll tell you:
It's the UI.... that and the cost. If you can make it fast, user-friendly, intuitive, lightweight, and inexpensive, the world will beat a path to your door.
For example, when I was an intern, we were evaulating a hospital-based order-entry system from TDS. It was the old light-pen system, and the damned thing took 14 screens to order an Xray.
I'm now a practicing ER physician... nobody is under greater time pressure than I am, and the EMRs that I've seen so far will slow me down. My colleagues at a nearby hospital who use one of the tablet-based systems complain bitterly about how slow it is.
Make it faster and easier to use than paper. Make it... you know... an actual upgrade? Not some ugly, unwieldy kludge forced by some data-mining, numbers-obsessed bureaucrat. Doctors generally aren't geeks... they care about ease of use. A system that doesn't make it easier to take care of patients will be universally despised, and resisted by everyone on the medical staff.
Physicians have enough to do, and enough to worry about. Want to have medical staff buy-in? Make the EMR an asset instead of a liability.
They really should try to build in some life-like behavior for the deer, aimed at the idiots who like to spotlight them at night. Those fools are particularly dangerous, because in low-light they can't be sure of what's beyond their target, yet they blast away at it; pity the poor sod whose house is downrange.
Put in a photocell that makes the robotic deer raise its head, and turn toward the light... that'd be pure gold.
I have one question: Why have a hard drive in a small, easily-knocked-about video camera? What's better about a delicate, shock-sensitive moving part in an electronic good that's going to be abused? There's a lot to be said for more storage, but how about buying more tapes?
Call me a Luddite, but I just bought one of these for Christmas, and I went with the tape version. Talk all the smack you want about tape, but it's durable, shock-resistant, and stands the test of time.
Besides... what's with this site? Did I miss it, or did they not even attempt the mod they're talking about?
It's anonymous in a lot of states.
One of my physician colleagues just got an extremely unpleasant visit from Childrens's Services and a bunch of Police Officers for a bogus child abuse complaint... all phoned in nice-and-anonymously to a hotline. No consequences, no recrimination, and no worries for the little scumbag that made that bogus report. It certainly opens the door to plenty of harassment and abuse, particularly for people with a serious beef against you (ex-spouses, ex-gf/bfs, ex-business associates, angry neighbors, disgruntled customers or patients, the list goes on and on).
And there's not a damned thing you can do about it.
I take care of abused children in my ER, and I've seen some truly horrific cases. Some were heinous enough that they had me thinking the parents needed to be under the jail rather than in it... but there has to be a process to clear your name from this kind of thing if it's bogus. The "sexual offender" label is damaging and libelous enough that it could literally ruin your business, or your life.
Working in Emergency Services, I use the internet pretty much every shift.
I'm expected to know/do something about virtually anything that walks in the door, including industrial toxin exposures, any/all medication overdoses, even "my child ate this weird plant" complaints. I can access pill databases, get radiology reports and images, look up MSDS, and even have a few botany sites bookmarked for exactly that kind of weird stuff.
Standard ER stuff I can do with my eyes closed, but reference materials online are absolutely essential for the bizarre ones, and it's why I have redundant internet connections (one of which I set up and maintain myself).
I'd be far less effective without it.
Agreed... there is nothing like working on a dual-processor box. I'm using a dual-core 4200, and it's as responsive as my old dual-athlon workstation.
Many claim that there is no real difference between dual and single processor machines for most common applications... but subjectively (and I'll allow that it could be psychological), dual-processor machines simply feel snappier.
Programs seem to open more quickly, and there is none of that barely-perceptible "lag" that seems to happen when you have a bunch of windows open, and a full system tray.
Please try to pay attention.
You keep saying that... I don't think it means what you think it means. I'm beginning to think you're a bot programmed to say the same thing over and over.
Fortunately, most troops don't have themselves in knots over the trivially false assertions of the left-wing anti-war crowd. Remember "BUSH LIED!!" and "NO WAR FOR OIL!!" and "WE SUPPORT OUR TROOPS... WHEN THEY KILL THEIR OFFICERS!" Remember all that tripe? Most aren't buying it, to their credit.
It's absolutely hilarious to me that you're so very concerned about the psychological health of those troops, yet you continue to promulgate the falsehoods that they're murderers, and defend the left-wing talking points that minimize the good things that have been done in this conflict. Those falsehoods psychologically harm the few troops that believe one iota of that nonsense. Is that what you want? Are you vile and small enough a person to take out your anger with the administration on the returning troops?
I've personally counseled both troops and police officers who have used lethal force in the line of duty... the perceived rightness of their cause is important in minimizing the psychological costs involved in doing their duty. Do you think all those worthless fools who screamed "babykiller!!!" at returning vietnam vets helped their psychological recovery?
I'll repeat it again: as a matter of policy, routine, or military culture, we. do. not. deliberately. slaughter. civlians.
You presume a great deal, my friend.
I'm glad you know you have GERD. Curiously, sometimes even your doctors can't say that the burning in your epigastrum and chest is definitely GERD, instead of angina, or esophageal spasm, or barretts esophagus, or a pulmonary embolus... Risk stratification for some of those other conditions is quite important. Your doctor can assist you in that effort, or not... your body, your choice. It sounds to me like you've made a conscious, economically-based decision to chart your own treatment course, and that's perfectly fine.
It's pretty clear that you disapprove of my profession's work... but if you have a problem with our drug laws, take it up with the DEA, or congress. I prescribe at their pleasure, and I can lose that privilege VERY easily. In fact, the DEA has recently dragged several physicians in my area right out of their offices in the middle of the day for inappropriate prescribing (among other charges). Some of them are facing life (yes, that's life in prison). You don't like the law, too bad... get it changed, or move somewhere where you'll have unfettered access to your drugs of choice.
Yes, if drugs were legalized, I wouldn't have people pestering me for drugs all the time (actually I'd just have fewer... I'd still have the homeless guys and drifters who want me to feed, clothe, and buy their prescriptions for them, since "you can afford it") In place of drug seekers, I'd have even more mulitply-drug-resistant infections, partially-treated meningitis, side effects, allergic reactions, medication interactions, overdoses (intentional and unintentional), and withdrawl.
I'm against the legalization of drugs because of the harm they can do in untrained hands, not because I'm a toadying little servant of "The Man" (TM).
I wish you'd clarified that earlier on (or maybe you did and I misunderstood). I don't have any problem with you taking pain medication after your surgery. Tonsillectomy is a heinous surgery to undergo as an adult, and the pain is extreme. You had every reason to want pain medication, and I'm actually glad to hear that you coordinated it with your doctor.
The issue about the spammer is different... here's how.
I have NO problem prescribing powerful pain medications to people that really need it. In fact, among my colleagues, I'm one of the more liberal about this issue. Even so, I absolutely draw the line at people abusing medications, or using them inappropriately.
Part of my oath is to give no deadly medicine. It's actually far easier for me to just dash off a prescription and get the patient out of my ER. They take up less of my time, fewer of my beds, they write fewer complaint letters to my administrator, and they don't scream/berate/physicially assault me and my nursing staff. However, sometimes the path of least resistance does actual harm to the patient, and that includes perpetuating someone's addiction.
What kind of claim could I make towards looking out for the best interests of patients (and that's ALL patients) if I behaved that way?
I realize people are going to get high whether I want them to or not... but I absolutely will not assist them in their efforts.
Foolish and illegal? Hardly
You might want to rethink that assertion.
What you did was illegal. Taking scheduled narcotics not prescribed to you (ie. your friend's vicodin) is illegal. Your buddy could even be busted for dispensing or trafficking.
My point about Lortab and Vicodin was this: if you got no relief from the Lortab, but DID get relief with the Vicodin, and the doses were not appreciably different, then the difference was likely in your head. Those two drugs have the same ingredients, the same generic, and are pharmacologically equivalent; your body doesn't know the difference.
No, you don't need to go to medical school to know that you're in pain. You DO need to go to medical school to learn clinical pharmacology, and how to use prescribing privileges safely and effectively. So you didn't triple the dose, you only doubled it? Same thing, different degree... rationalize as you will.
And then there's this:
WTF do you care?
Why the f*ck do I care? Because it pains me to see people needlessly get themselves in trouble. Believe it or not, I actually have compassion, and want all my patients to get well. Much of the mess that people get themselves into is easily preventable with some common sense and following instructions. Adjusting your own medications is not something I generally recommend to the layman.
I'm actually concerned about your self-medicating, and instant "hook-up" buddies with their ready vicodin supply. Take note; I'll always be ready in my ER to clean up the mess if you do something really dumb, and I'll never dance, gloat, and say "I told you so." That said, you can expect a serious, no-bullsh*t, no-punches-pulled discussion about your actions when you finally wake up enough to get off the ventilator. Most take it well, while others curse and spit on me... but some conversations are, by their very nature, difficult to sugar-coat.
My goal is not to be an arrogant jerk, my goal is to help you learn. Don't shoot the messenger... I'm actually trying to help you.
The studies on combination opiods/analgesics have been around for over 20 years, and suggest that combination agents (combining more than one mechanism of action) are more effective than single agents alone, even when those single agents are used in higher doses.
Pubmed, courtesy of the NIH, is your friend.
Good afternoon, Wowbagger, long time no see.
JCAHO is the Joint Committee on the Accreditation of Healthcare Organizations. They're the guys who determine if your hospital gets "certified" to actually take care of patients. You can check out their website Here.
They do some valuable things... but they also can ding your hospital on some truly maddening minutiae. Also, as I noted in my initial post, not all of their "input" is necessarily helpful.
Yes, I am a doc, and your behavior was foolish and illegal. You want to accuse me of childish anger and "dumb sh*t?" Allow me...
When your pain medicine doesn't take care of the pain, the answer is to call your doctor and make some alternative arrangements. The answer is most definitely NOT to make your own executive decision to increase the dose... that's how people overdose and get hurt. You had 12 ounces of Lortab elixer? That's 360ccs, or roughly 24 standard doses, generally prescribed every 4-6 hours. You went to medical school where again? Never mind... forget medical school... just do the basic math.
Even more foolish is your decision to go get some street drugs from a "friend." You went ahead and took a mystery pill given to you by some "friend?" You're certainly a trusting soul... Was he a pharmacist? Did you look up the imprint code on the pill?
You also realize, do you not, that Lortab is the same thing as Vicodin? Look it up if you dont believe me. Of course, you could have been taking a large amount of the vicodin (even more foolish), but otherwise, you've been the victim of the placebo effect.
Dumb sh*t indeed.
You're correct, but you have it backwards... Schedule II is MORE tightly controlled than schedule III. You were otherwise correct.
Tylenol is one of the nastier common overdoses... Asprin is equally bad.
Fortunately, tylenol has an antidote, provided you get it on board in an appropriate time frame. The problem is adolescents who take a bunch of tylenol as an attention-getter (they assume it's non-toxic), then have second thoughts, and don't tell anyone for a few days. Those kids tend not to do well.
BTW, there are hydrocodone preparations that don't contain tylenol, they're just not used as commonly.
Do ERs have some sort of checklist / questions
We used to... until JCAHO decided that it was a violation of confidentiality. Most ERs kept a "frequent flier" list of their drug seekers: a recipe box with index cards was the usual method, complete with name (including aliases), preferred drug, and typical cover stories used. Those boxes were absolutely invaluable for keeping patients from doctor-shopping by surfing from ER to ER, stocking up.
Thanks JCAHO... thanks a lot for leaning forward to help us in our fight against prescription drug diversion.
Burn, you son-of-a-b*tch.
Prescription drug abuse/diversion is a major problem... I get hit with drug seekers in my ER every single day. Some of these people have legitimate chronic pain conditions and need to be under the care of a pain specialist, while others are simply using narcotics to treat their psychological pain (or just gathering "party supplies" for the weekend). Some of these people self-medicate and push their vicodin/lortab dose until they get acetaminophen toxic... bad way to end up on the liver transplant list.
And before somebody says it, no, I don't think drug legalization is the answer.