Internal Medicine. Great guess. I guess the whole "talking to the patient" stuff gave it away.
Yes, the neverending battle between the ED and the admitting physician...
Thank god we recently got a cardiac observation unit...
What still gets me is when our ED guys want to admit something, they just quit thinking and say, "r/o AMI." I've seen two GI chest pains (obvious by history) receive anticoagulation... and then bleed like crazy from their PUD.
We are different creatures indeed.
Of course, now when I am down in the ED, I am going to be looking around to see if there are any geeky ED physicians tr0lling slashdot.:)
Wonderful points. I was speaking from my point of view.
Even when I'm taking care of the sickest of the sick in the ICU and CCU, I usually have the time to develop a relationship with a family. ER docs (for good and for bad) do not have time to build relationships with patients. Well, you do develop some relationship... the repeat offenders! Yuck.
The ERs/EDs of this world are a whole seperate breed. At least in our hospital, it's one place that I have really seen become bogged down with the additional coveryourass work-ups. Business is way, way up in our ED as well as community doctors are having to pull away from financially-challenged patients due to the higher malpractice rates.
He is expected to serve his time in a minimum security facility where he will be able to receive drug counseling.
U.S. Attorney Robert W. Merkle, who prosecuted the case, told Castagna that no crimes ''are more violent than the use of child pornography and the distribution of narcotics.'' He said Dubin's attempt to minimize his activities as just a ''lifestyle'' was a ''new low in euphemisms.''
Merkle said it was particularly aggravating that Dubin used his medical knowledge to satisfy his own appetite and risk the lives and mental health of his victims.
The author of a popular text, "Rapid Interpretation of EKG's," wrote in the 50th printing an insert among the copyright legalese boilerplate. In this insert, he offers a free car shown on page 46 to the people who send their name and address to the publisher, and who's name is pulled out of a hat.
Only 5 people responded out of the 60,000 copies sold, and Jeffrey Seiden won the prize- a shiny red 1965 Ford Thunderbird, with only 16,000 miles on it, worth $20,000.00.
However, it turned out that this was not a Yale University matter although reported in the New Haven Register. Author Dale Dubin had lost his medical license and served five years in federal prison for selling drugs and possession of child pornography. He had been released in 1989.
Maybe if you frame it like that, EKG machine reads don't really need to be perfect... they are, after all, just an adjunct... A human still makes the decisions.
/me just returned from the ER to admit somebody with chest pain.
Anyway, even when physicians completely agree regarding the read of the EKG, often that read is wrong... machine or human... because an EKG is just not a great test. Sure it's awesome for ST-elevation-take-the-guy-to-the-lab stuff... but that's maybe 1 out of a hundred. We all see AMIs with fairly normal EKGs.
It's just not a great test... so if the machines read it wrong, whooopie-do...
Poor little article on build-your-own-ECG has turned into why-medicine-is-expensive...
Being a physician and having a friend who received a multi-million dollar settlement, I think I have a unique view of this.
The problem started when MD's somehow got placed on a pedestal many years ago. People feel that doctors should know all the answers... well, we don't. There is still a lot of art in medicine... experience, knowledge, skill--all of these things are important.
Doctors that practice _wrong_ medicine should be punished. Doctors that make genuine mistakes should not.
It gets complicated by the Save Your A$$ situation that many have referenced here. If I can tell you that you have a 90% of having something routine, but a 10% chance of having something rare and dangerous... would you want me to spend the money to find out? What about 95% and 5%? What about 99.5% and 0.5%?
I believe that this is not a horrible problem. I just tell my patients that I am not perfect... and then tell them what I think and what the options are. Together we formulate a plan... and decide if we are going to do the million dollar work-up. It even gets more complicated because many work-ups can "cost" more in complications than actual dollars.
Happy patients don't sue... I try to keep my patients informed.
Davak
Re:My wife the nurse said ...
on
Build Your Own ECG
·
· Score: 4, Informative
First thing we were taught in medical school regarding ECG is to ignore the computer interpretation. The sensitivity is way too high; therefore, the specificity is greatly reduced. Thus, the interpretation is seldom useful.
Where computer-automated reading of ECG is much more effective is in the automated defib units that you might find in airplanes, malls, ambulances, etc. The computer is good enough to know if a jolt of electricity would be helpful in correcting the problem.
Of course, the expense and the value of ECG is in the physician interpretation. Likewise, an aspirin in the hospital will cost you dollars instead of cents due to administration costs, nursing costs, insurance, etc.
What has really helped ECGs is fax machines and now the internet. If a health care professional has a question regarding a waveform, they can get it to someone who can give an accurate reading. Soon, if not already, physicians will be able to see the ECG live (and in living color) of patients on planes...
And quit dogging the editors for posting this... We need more tech-related medicine news. It warms this geek MD's heart.
The real question is whether the submitter knew the origin and full meaning of the word "hysterical".
1. Hysteric \Hys*ter"ic\, Hysterical \Hys*ter"ic*al\, a. [L. hystericus, Gr. ?, fr. "yste`ra the womb; perh. akin to ? latter, later, and E. utter, out.] Of or pertaining to hysteria; affected, or troubled, with hysterics; convulsive, fitful.
2. adj 1: characterized by or arising from psychoneurotic hysteria; "during hysterical conditions various functions of the human body are disordered"- Morris Fishbein; "hysterical amnesia" [syn: hysteric] 2: marked by excessive or uncontrollable emotion; "hysterical laughter"; "a mob of hysterical vigilantes"
Although this isn't the apparent cause in this case, this is the exact reason that I worry about using distributed attacks against spam... such as vipul's razor.
In this type of case, one overpowering rule makes the program more harmful than helpful. Being too sensitive greatly decreases specificity as well... thus the system spirals into uselessness.
Sorry, I don't have any mod points... but I'll blast away my Karma bonus... I agree.
Thinking, exploration, calculation, research, experimentation--all of these take a great deal of time. Relationships with friends, your SO, and eventually kids require a great deal of this time to keep healthy and strong.
If you want smart kids/pets, that takes time as well.
No, I am not saying that one can't be productive or creative once older; however, it just becomes more difficult. Those that do it successfully usually do it though their profession. That is... you can do it though your job if they give you the freedom to do so.
I don't think all of this is so bad... most of us would rather have healthy relationships than awards/accomplishments as we get older.
Alas, I recently ran over either you or one of your biker friends. I am very sorry.
I was just on my cell phone trying to find a house further from my work... and calling the lawn people because my neighbor's grass is two shades greener than mine (i hate that bob.)
Please, somebody explain to me how open source on a closed, specific system helps...
If I am crunching shuttle code at home, how do I test it? Wouldn't be a security problem to publically report the hooks and calls to write such code?
Of course, NASA does office stuff, networking, etc... I guess "some projects" would have to be highly specific. But if you are gonna help NASA, who wants to help the secretary? I wanna help the shuttle fliers get in on the P2P action... (heck, pinging the shuttle would probably be faster than pinging some of the servers I've been using lately.)
Davak
Re:Possible legal problems?
on
Gentoo Games
·
· Score: 4, Informative
20 or so posts in a forum plus a logo doesn't form the foundations of a great company. Especially when half the posts are discussing installation and politics of America's Army.
Yeah, we have America's Army... but surely the fledging company was helped by the Army's obvious goal of getting the game out to as many people as possible...
That being said, I don't know how many of us geeks they want to recruit onto the front lines... (pizza boxes under the bunk beds, wars would have to be scheduled between 3pm and 2am, Simpson's battle crys, etc.)
I want a portal gaming system that is similiar to the current mp3 player setup... except for games.
Yes, iPod for games!
Just USB or firewire the freaking games onto your gaming system. Sure I won't be able to get a GIG of information now... but come on! Size and jedi ninji graphics isn't the most important thing. Downloading is so more efficent than these little CDs or cartridges. You could even exchange games by connecting the gaming systems to each other.
What would even rock more would be if they would release the SDK for free. Then you could have fresh shareware/freeware stuff to try all the time.
Plus, you could have it play mp3, ogg, divx, whatever...
I would drool to have this setup... I would equally drool to program such a device.
Given an infinite number of shotgun-carrying hicks and an infinite number of road signs -- evidentually you will find a passage of Shakespeare in braille on some back road in Mississippi.
Yes. MIR was infected with mold. This mold came from the us, the good ole earth. The interesting thing is that it mutated while in space... evolution in action.
Slashdot Mirror
Yes, the neverending battle between the ED and the admitting physician...
Thank god we recently got a cardiac observation unit...
What still gets me is when our ED guys want to admit something, they just quit thinking and say, "r/o AMI." I've seen two GI chest pains (obvious by history) receive anticoagulation... and then bleed like crazy from their PUD.
We are different creatures indeed.
Of course, now when I am down in the ED, I am going to be looking around to see if there are any geeky ED physicians tr0lling slashdot. :)
Davak
Even when I'm taking care of the sickest of the sick in the ICU and CCU, I usually have the time to develop a relationship with a family. ER docs (for good and for bad) do not have time to build relationships with patients. Well, you do develop some relationship... the repeat offenders! Yuck.
The ERs/EDs of this world are a whole seperate breed. At least in our hospital, it's one place that I have really seen become bogged down with the additional coveryourass work-ups. Business is way, way up in our ED as well as community doctors are having to pull away from financially-challenged patients due to the higher malpractice rates.
How can we fix it?
Davak
Davak
Anyway, even when physicians completely agree regarding the read of the EKG, often that read is wrong... machine or human... because an EKG is just not a great test. Sure it's awesome for ST-elevation-take-the-guy-to-the-lab stuff... but that's maybe 1 out of a hundred. We all see AMIs with fairly normal EKGs.
It's just not a great test... so if the machines read it wrong, whooopie-do...
Davak
Being a physician and having a friend who received a multi-million dollar settlement, I think I have a unique view of this.
The problem started when MD's somehow got placed on a pedestal many years ago. People feel that doctors should know all the answers... well, we don't. There is still a lot of art in medicine... experience, knowledge, skill--all of these things are important.
Doctors that practice _wrong_ medicine should be punished. Doctors that make genuine mistakes should not.
It gets complicated by the Save Your A$$ situation that many have referenced here. If I can tell you that you have a 90% of having something routine, but a 10% chance of having something rare and dangerous... would you want me to spend the money to find out? What about 95% and 5%? What about 99.5% and 0.5%?
I believe that this is not a horrible problem. I just tell my patients that I am not perfect... and then tell them what I think and what the options are. Together we formulate a plan... and decide if we are going to do the million dollar work-up. It even gets more complicated because many work-ups can "cost" more in complications than actual dollars.
Happy patients don't sue... I try to keep my patients informed.
Davak
Where computer-automated reading of ECG is much more effective is in the automated defib units that you might find in airplanes, malls, ambulances, etc. The computer is good enough to know if a jolt of electricity would be helpful in correcting the problem.
Of course, the expense and the value of ECG is in the physician interpretation. Likewise, an aspirin in the hospital will cost you dollars instead of cents due to administration costs, nursing costs, insurance, etc.
What has really helped ECGs is fax machines and now the internet. If a health care professional has a question regarding a waveform, they can get it to someone who can give an accurate reading. Soon, if not already, physicians will be able to see the ECG live (and in living color) of patients on planes...
And quit dogging the editors for posting this... We need more tech-related medicine news. It warms this geek MD's heart.
Davak
Davak
The real question is whether the submitter knew the origin and full meaning of the word "hysterical".
Ripped from dictionary.com My best bet is number 2.What I want to know is... can you jump-start a car with this? :)
Davak
In this type of case, one overpowering rule makes the program more harmful than helpful. Being too sensitive greatly decreases specificity as well... thus the system spirals into uselessness.
Anyway, Cloudmark is a commerical product based on vipul's razor. Sadly, vipul's razor will not compile in the window's environment yet.
God, I hate spam
Davak
Yuck!
Davak
I liked it better when the trolls didn't have actual good points.
Davak
Thinking, exploration, calculation, research, experimentation--all of these take a great deal of time. Relationships with friends, your SO, and eventually kids require a great deal of this time to keep healthy and strong.
If you want smart kids/pets, that takes time as well.
No, I am not saying that one can't be productive or creative once older; however, it just becomes more difficult. Those that do it successfully usually do it though their profession. That is... you can do it though your job if they give you the freedom to do so.
I don't think all of this is so bad... most of us would rather have healthy relationships than awards/accomplishments as we get older.
Davak
I guess signing "AC" doesn't automatically make me post anonymously.
Too tired post-call... damn pager.
Davak
I was just on my cell phone trying to find a house further from my work... and calling the lawn people because my neighbor's grass is two shades greener than mine (i hate that bob.)
Sincerely,
AC
If I am crunching shuttle code at home, how do I test it? Wouldn't be a security problem to publically report the hooks and calls to write such code?
Of course, NASA does office stuff, networking, etc... I guess "some projects" would have to be highly specific. But if you are gonna help NASA, who wants to help the secretary? I wanna help the shuttle fliers get in on the P2P action... (heck, pinging the shuttle would probably be faster than pinging some of the servers I've been using lately.)
Davak
Gamecube or Gamecube
vs
Gentoogames
Davak
cries...
Prophylaxis against spelling-nazi trolls.
Davak
I really hope this is better than it looks.
20 or so posts in a forum plus a logo doesn't form the foundations of a great company. Especially when half the posts are discussing installation and politics of America's Army.
Yeah, we have America's Army... but surely the fledging company was helped by the Army's obvious goal of getting the game out to as many people as possible...
That being said, I don't know how many of us geeks they want to recruit onto the front lines... (pizza boxes under the bunk beds, wars would have to be scheduled between 3pm and 2am, Simpson's battle crys, etc.)
Anyway, I hope this is more than it now appears.
Davak
What angers me is that everybody assumes that these people do not actually Worship jedi!
Articles and films already exist regarding this spiritual movement.
Plus, we already admit that other such religions exist:
- Star Trek - Leonard Nimoy Should Eat More Salsa Foundation
- Hicks - Love thy Mullet
- Plastic surgery - Cosmetics for the holy
Anyway...
Davak
I want a portal gaming system that is similiar to the current mp3 player setup... except for games.
Yes, iPod for games!
Just USB or firewire the freaking games onto your gaming system. Sure I won't be able to get a GIG of information now... but come on! Size and jedi ninji graphics isn't the most important thing. Downloading is so more efficent than these little CDs or cartridges. You could even exchange games by connecting the gaming systems to each other.
What would even rock more would be if they would release the SDK for free. Then you could have fresh shareware/freeware stuff to try all the time.
Plus, you could have it play mp3, ogg, divx, whatever...
I would drool to have this setup... I would equally drool to program such a device.
Davak
This is an opinion, not a troll. If you disagree, supply proof that he's wrong. If you believe he's just stirring up trouble, then mark it "flamebait"
There is a core group of coders that believe this...
Davak
Given an infinite number of shotgun-carrying hicks and an infinite number of road signs -- evidentually you will find a passage of Shakespeare in braille on some back road in Mississippi.
Davak
This technology has existed for quite a while...
Pubmed search will show that already several applications for this exists.
As a physician I am stunned that the pubmed database (text-only version here) is not used more by the public. Very stimulating!
Davak
How about a BBC article
The fungi that did the damage, Novikova said, included members of the genera Aspergillus, Penicillium, and Cladesporium - all very common on Earth.
Davak
It ain't what it used to be...