My point was, it's just not remotely kosher that I get a bill, and illegal and some legal immigrants don't. And if it were the case that ER's send bills out based on skin color, you might be right. However it is the implication of what you said that is racist. That is, why is it that you assume Hispanic immigrants don't get a bill while you do? Because they are all smarter and harder working than you educated and employed in jobs where they have excellent private health insurance?
Hmmm, maybe not.
Maybe its because you think that Hispanic undocumented immigrants are more likely to be on the public dole and get medicaid? Hmm, because they are lazy and don't contribute as much to the tax base as hardworking white dudes like you? Ah, yes, there we go. So yes, you are still a racist assmunch.
Just because you refrain from saying "I hate those god-damned illegal Mexicans," it doesn't mean you aren't racist, just clueless about your own beliefs.
I think the article and you are both right. Smaller places that are close to the 'Superstar Cities' in TFA are the ideal. I live in Davis, CA, which has the small town feel (though its actually a small city.) It is 70 miles from the closest 'Superstar City', San Francisco - which I visit just enough for it to be pleasant (several times a month.)
So I get the high speed access, university atmosphere, and small town feel while still having access to SFO. Now if it weren't for all the drunk college kids it would be perfect.
Thanks, I just made $10 on a bet with a friend of mine. Though as an added benefit you also proved my point to the other poster regarding idiots like you who think they know what they are doing when in fact they haven't got the medical knowledge to adequately pick their own nose.
One of the things we have to do in our training is apply a tourniquet to another person and then have one applied to ourselves, so I know exactly how it feels. Wow, Torodung wasn't joking about you putting that tourniquet around your neck.
And for a good example of what I was talking about see the below comments from the AnotherUsername idiot. A little bit of knowledge can cause a lot of damage.
Well, I've never been in combat, but I have trained special forces medic's in trauma resuscitation. My residency is one of the places they trained, because apparently Flatbush Brooklyn is one of the closest things to combat that you get in the US. In fact, they gave me an award as their favorite instructor one rotation since I was the chief resident in the ER and really made sure they got their hands in it.
And so I am reasonably familiar with both ATLS and the deviations from it in which SF Medics are instructed. To be specific the reason that you may need to use a tourniquet in combat in because its hard to maintain direct pressure under combat situations rather than what you seem to be suggesting, that direct pressure won't actually stop the bleeding. Direct pressure to the wound and if necessary to the artery supplying the area is in fact in every way clinically superior to a tourniquet. The only reason you would not use the superior method would be if it is not feasible to maintain good direct pressure.
So getting back to your original statement:
The thing about tourniquets is this: If there is bleeding that is more than a mere scratch, apply a tourniquet. As in, the bleeding isn't likely to stop anytime soon by itself, and could be life threatening. No. Direct pressure is superior. I have controlled a great deal of bleeding in my decade as an ER physician and the years I worked EMS. I have never once applied a tourniquet nor seen one applied except by some asshat like yourself who thinks that they know more than they do. (See my above posts about the dangers of a little bit of knowledge.)
People seem to have a fear of tourniquets, but they can be left on for several hours without any damage. Put them about 2 inches above the wound, but not on a joint. Write the time on the casualty's head. Better to just put it on right away rather than using up the casualty's dressing on something that won't work anyway. People... like the American College of Surgeons (ya know the ones who write ATLS?) have a very well founded fear of tourniquets because douchetards like yourself cause all sorts of damage with them. In fact, their use is actively discouraged in ATLS, and are only recommended as a last resort. You can cause ischemic injury to the muscle in as little as thirty minutes in addition to all of the other complications (permanent nerve damage because of incorrect application, compartment syndrome, arterial damage and thrombosis in older patients who may have pre-existing vascular disease, post-tourniquet syndrome, etc.) Not to mention the intolerable pain that most people get unless they are sedated or have a regional block done... which you'd probably know about if you had ever actually used one.
So why not run along and watch some more of your DVD collection of 'real life' trauma-dramas or work on your MySpace before your mom makes you go out and mow the grass. And if I am ever in a car wreck and you find me. Just call 911 for me, ok?
I disagree. Training can make someone more knowledgeable, but you can't teach common sense, and at the level we are talking about common sense is more important.
There are actually very few things beyond CPR (which is a community level intervention that everyone should know) in the EMT-Basic level of teaching that are more than a concrete presentation of common sense ideas. If something is broken, make sure it doesn't move that much. If something is cut and bleeding, put a clean gauze dressing over it and apply pressure to stop the bleeding. If someone is having trouble breathing if you have oxygen, give it to them. If a baby comes out, tie off the cord wrap it in something warm, and put it on mom's chest. If someone is not breathing or in cardiac arrest, call for extra help and do CPR.
This ain't exactly rocket science. (Hell, FWIW, I took my EMT-Basic written and practical exam drunk and passed with flying colors.) And someone with half a brain who thinks about it for half a second can come up with most of it if they keep a cool head.
In my experience people with 'training' can make some huge errors, often because of a blasé attitude that comes from a false sense of confidence in your abilities. Someone who does not think of themselves as 'trained' is often more cautious and less likely to make those overconfidence type mistakes. So when you are talking about basic level skills, I would rather have a bystander with common sense who remains calm and pays attention than an overconfident EMT-B with an ego the size of Wisconsin, a belt that would put batman to shame, and a blasé attitude. Unfortunately, in my experience EMS tends to attract people who tend to become overconfident when they get a smidgen of knowledge.
Of course that is again, only at the Basic level of training... a bystander (no matter how much common sense) can't start an IV, cardiovert SVT, or give me morphine for a femur fracture. This also doesn't mean that having EMT-B training is a bad thing. But it does mean at that basic level of care, common sense is much more important than you give credit to.
I saw your second comment below, but there is one important thing to remember: training isn't everything, and common sense is often more valuable than training. An untrained bystander who is calm and thinks about what's going on can be more valuable then a hyper-excited volly firefighter who doesn't take two seconds to step back and think.
There is a reason that Brady Emergency Care actually states that you should not transport a live venomous snake with you in the ambulance. Anyone with common sense would think.... hmmmm... take an animal that can kill me and put it in a 10'x8' metal box, then jump inside and close the door.... maybe not such a good idea. But you know some hick firefighter/EMT-B did exactly that, hence the reason that its in the book.
So don't assume that an untrained bystander is going to render poor care, or that a trained bystander will provide good care.
This is why you should not take first aid device from a video game or/.
Never apply a tourniquet unless the bleeding is 1) immediately life threatening and 2) cannot be controlled in any other way. The best way to control bleeding is direct pressure - which can stop 99% of significant external bleeding. Tourniquets not only cause nerve damage, but if there is an amputation, they can cause ischemic damage to healthy tissue which may decrease the chance of a successful reattachment or make the ultimate amputation worse.
And don't worry, there is a law in emergency medicine: All bleeding stops eventually.
That is not a bad debt. I don't owe that debt at all. If my name was rodriguez and I didn't speak english, I wouldn't have been charged at all. You know, its assholes like you who almost make me turn me into a Libertarian. My partner's last name is Gonsalves. His dad is an immigrant who speaks English with a very heavy accent.
I am also an ER doctor like the one who probably paid about $80 in malpractice insurance and practice costs (not to mention the time it took to see you) to see your racist ass for free. I worked last night with two nurses who were immigrants too, and one with a Latino name. Like many nurses in the US are. They also paid for the privilege of starting your IV, giving you medicine and fluids, and probably cleaning up your puke or shit off the floor. All while you secretly tell yourself that spicks like them don't deserve the same quality of care that your malignantly entitled white male self does.
And remarkably, I still agree that you should not be charged for that care. Health care is no more a commodity than police protection and the fire service. Health care is a right, just like food, education, and freedom of speech. So even racist pieces of shit such as yourself deserve compassionate and competent care.
I am hopeful like you about the democrats, but you are wrong about the Hippocratic Oath. The original doesn't include anything about seeing anyone without regard for ability to pay. It does proscribe having sex with your patient's male and female slaves when you go for a house call (look it up, shit you not.) But it says jack squat about treating without regard for compensation.
Though many modern oaths do.... the one I took when I graduated from medical school included: "that in the treatment of the sick, I will consider their well-being to be of a greater importance than their ability to compensate my services." You might also be thinking about the code of ethics for emergency physicians, which does say something similar. http://www.acep.org/practres.aspx?id=29144
But there aren't a whole lot of specialties that are as explicit about it as Emergency Medicine... but then we don't have a choice anyway courtesy of EMTALA. If you have the be the safety net for providing care (and accepting the cost for it) to all of the uninsured in America because the rest of society won't accept that responsibility, you may as well get some ethical yayas out of it.
All Americans have health care, even those that cannot afford it, and the idea that there are people without access to health care is a myth that inflames the clueless and serves the purposes of political propaganda. The quality is mediocre, but what do you expect with socialized medicine. It is not hypothetical, I was one of those invisible souls raised on government health care for the destitute. Ah, yes. As President Bush said - if you need health care, just go to the ER.
Sorry, nope. As an ER doctor, I can tell you there are many things you will never get that way. Need a pap smear? Nope, we don't do them in the ER? Need surgery and chemotherapy for your advanced cervical cancer? Again, sorry - we don't do that in the ER. Maybe when you come in bleeding out from your vagina, we'll admit you, but you won't be getting definitive care. Need surgery for your broken arm? Nope - that's not an emergency, so the only care you will get in the ER is stabilization. No orthopedist has to admit you under EMTALA to do it either, since the standard of care is splint and then follow-up for outpatient surgery. Of course when you try to make that appointment, they will tell you $20,000 up front or no follow-up appointment.
And don't play that 'I grew up on welfare' card. So did I dipshit - when it was a more decent system in the 70's and 80's. We've been going downhill since then with regard to public assistance - including health care assistance. Thank you republican controlled congress and private health insurance industry!
Looking at health care as a business is not only fundamentally morally corrupt, but its also not realistic. For example, people have suggested rating physician quality like the asshats who suggest rating a patient's creditworthiness. Fortunately or unfortunately its actually quite hard to measure quality of care that physicians provide. Say for example you decide that you look at a heart surgeon and determine what percent of his patients survive for at least a year after surgery. Sounds pretty simple, except that the best surgeons often are the only ones willing to take the sickest cases, and so the most technically skilled surgeon who takes the cases that no one else will touch looks worse than the technically marginal guy who only cherry picks the easiest cases. Of course measuring things in complex ways like that are harder to do, so you will only get simple (and meaningless) measures on scoring systems (which already exist.) Moreover, there is no easy way you can measure the important things that make a technically competent clinician into a great doctor: sympathy, listening, and actually giving a shit about your patients.
Which brings me to a pet peeve of mine.... I hate few things worse than referring to my patients as 'customers'. I haven't had customers since I waited tables in med school. In my ER practice (which pays the bills) or in the clinic where I volunteer my time two days a week, I only have patients - not a single customer. And trust me, you don't want to be a customer. Because if that were the case, when I am sworn at, pissed on, or threatened with bodily harm, I would happily to let that piece of business walk right out the door. If all I had was customers, when my 'customer' with alcohol intoxication and a head injury who had already vomited on me and took a swing at me after calling me a fucking faggot decides to bolt out of the ER, I wouldn't wrestle him to the ground to keep him in the ER till we get his head CT.
So no, I won't check your credit score. But I also sit at the back and play with my cell phone when they make me attend 'customer service' talks. I don't care about customer satisfaction. In fact, I am of the belief that if every patient I see is fully satisfied with the care they got, I am probably not setting enough limits. (I'm not House, but I am also not the vicodin and antibiotic fairy.) And while I don't give a rats ass about customer service, I do give a rats ass about practicing medicine well, and about the people who are my patients - even if they do puke on me.
So trust me, don't yearn to be a customer. You wouldn't like it.
Not to dispute your choice of profession, but you're just plain wrong here. The problem is that you are assuming that doctor is a generic profession, which is incorrect. Your orthopedic surgeon who only does back surgeries makes about $400,000/year and works 40 hours a week. Your general practitioner works 60 hours a week and makes $160,000. Your orthopod gets paid essentially 90% of what he charges, your GP however is lucky if he gets 70%.
But that is also the reason that we have a relative shortage of primary care docs and a surplus of specialists.
I am speaking as an ER doc who, unlike your primary care or your surgeon does not get to pick and choose which insurances to accept (and in fact has to see everyone regardless of insurance status or ability to pay - which I would do anyway... that's one of the reasons I picked EM.) But the OP is right in that Medicare and Medicaid don't pay shit. I lose about $30 on every Medicaid patient I see in the ER when you add up the costs of practice and the payment received. Of course that is better than losing more on a patient who has no insurance and does not pay out of pocket, but its still a net loss.
Though I agree with you in the remainder of your assessment of the US Healthcare system. We need single payer. Yesterday. And it needs to be a Canadian style system - everyone in, no one out. If we have a two (or more) tiered system, those who rely on the purely public system will get the same thing you experience. Unless the public system is the same one that members of Congress and the President and their families get, it will be no different than Medicare and Medicaid is now. Of course that's a lot better than being uninsured in the US, but its a lot worse than simply being a citizen in more developed countries like Canada.
Given that a child's immune system is at best only partially developed before the age of six months, it's somewhat irritating to me that doctors regularly inject 7 vaccines at a time into children as young as 1 month of age. Um, there's your answer. Your 5 year old does not need as much protection as your 5 month old, because the 5 year old is more capable of fighting infection. The only reason we don't give newborns a full round of shots as soon as they come out of mom is that they have to reach a certain age to respond well to most shots (not so to hep B.)
Most countries wait until at least 6 months of age before beginning the injections of MMR and DtAP vaccines. First off, its DTaP, not DtAP (which becomes important below.)
If you search for DTaP, you will indeed find that many countries list the first time they give this as a much older age than we do in the US. However, this is not because they leave their kids vulnerable, but because the first diphtheria, tetanus, and pertussis vaccinations are often given with DTwP which is cheaper. In older kids, if you use the whole cell pertussis component they have worse side effects (which are rare in infants and younger children). So you use the cheap DTwP first, then the DTaP later in childhood. So stating that 'most countries' give DTaP at a much later age is misleading at best.
Anecdotally, The plural of anecdote is 'not data'.
Say the patient has been diagnosed with schizophrenia, but doesn't believe that diagnosis is valid because he knows the real problem is that its really that the video game industry in an unholy alliance with the DoD and is out to get him?
Or many other diagnoses or bits of information that patients do not want providers to access but which are important to their care. Like drug abuse, blood born or sexually transmitted disease, or other mental health problems. A pregnant woman with pelvic pain with a history of chlamydia PID is at much greater risk for having an ectopic pregnancy that will kill her, however that may not be divulged by the individual if she's able to manage her medical records.
There are other rights as well to consider. If I am suturing your laceration and you move suddenly and cause me to stick myself with the bloody needle I was suturing you with, do you think its unreasonable for me to want to know whether you are HIV or Hep B or C positive?
In addition, what if you arrive to the ER after a motor vehicle crash and cannot give the critical information that you are on a strong blood thinner.
OK, lets assume that the couple were incredibly lucky and bulls-eyed the pilot's eye. Both the blink reflex and the fact that the helicopter must have been moving at least some would have limited the exposure to less than a quarter of a second. If this couple was indeed using one of the cheap green laser pointers, there is no way that the cop had eye pain for hours afterward. He certainly probably had a startle effect, and a momentary decrease in vision, but unless he was taking off or landing or doing some other critical action this would have been of minimal concern. If it disoriented him, this guy obviously needs to not be flying low above homes if that's all it takes to make him incapable of safely operating a helicopter. Though I think the most likely thing is that he got all butt-hurt and wants to extract revenge by claiming injury that was not realistically possible.
Actually, he is an idiot. If you head a country and stand by while the government under your control under the pretext of religion executes teenagers for the crime of having consensual gay sex, you are not just an idiot, you are an evil psychopathic deviant and a fucking moron. Ahmadinejade's idiocy is no different from the fucknuts with a PhD who support intelligent design. Just because you have letters after your name that doesn't protect you from having your head firmly planted up your ass as he most assuredly does. When you let religious superstition dictate your actions and beliefs despite the fact that all logical and scientific sense (and in the case of Ahmadinejade, all sense of human decency) calls for you to reject these superstitious tenets, you define the term idiot.
Maybe he meant as in with their own parades and being in everybody's face... You mean like straight people do? You know, I really don't mind homophobic shits like you, if you would just act queer in public.
It conflicts with other laws or causes harm to other truly unrelated individuals? For example, a physician keeps electronic medical records on a computer which the police believe may have been used to violate copyright. Every one of his patient's medical records are then auctioned off to the highest bidder in violation of HIPPA? (Not to mention their medical care is compromised and their health threatened because of lack of access to their health history?)
Wait dude, its not just the faggots and the Jews, you forgot the rag-heads, dot-heads, and the darkies. And the chicks too... everyone knows a chick can't keep a secret. And like they'd ever be able to land a job at JPL other than as a secretary.
Oh, and you almost forgot racist homophobic fucktards like yourself!
There is no "right to privacy" Yes there is. It is a universal human right.
Simply because the laws of a society do not recognize basic human rights, that does not make those rights non-existent. It makes the society unjust. For example, in 1950 in Alabama, people of color were denied many civil rights. However that does not mean that Rosa Parks did not have a human right to keep her seat on the damn bus when a white man demanded it.
You are confusing civil rights granted by law and universal rights, granted by one's humanity.
http://www.un.org/Overview/rights.html
Article 12. No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.
Uh, your point seems to be that it requires a knowledge of evolution to study the evolution of some biological system. Is anybody actually disputing this here? No, actually my original point is that an understanding of biology requires an understanding of evolutionary theory. Just like an understanding of chemistry requires knowledge of atoms, bonding, molecules, ions and salts, etc.
Evolution is certainly an important subject for any biologist/biochemist to understand. Is it the single most important concept in all of biology? No its not. But I didn't say that either. I said: "biology - in all its manifestations - cannot be understood without an understanding of evolutionary theory." That is, you have to have evolutionary theory to understand biology, not that it is the only important concept. Its is necessary but not sufficient.
In fact I think you'd be hard pressed to decide on a 'single most important concept' in biology (or in chemistry or physics, etc.) However you can come up with a list of the basic fundamental concepts of any field. Those are the unifying principles that form the basis of the field. For biology, these are generally accepted as being cell theory, evolution, homeostasis, and genetics. There are some who would add others (e.g. biochemistry,) however you would be hard pressed to find a legitimate list (i.e. not from DI, the Kansas Board of Ed, etc.) of the fundamental concepts that did not include evolution.
So while you are correct that evolution isn't the single grand unifying theory, it is one of the fundamental concepts without which any real understanding of biology cannot happen. You can do rote memorization, you can catalog insects, you can work in a lab and do biological experiments (that people who understand the basic principles design), hell you can even practice clinical medicine without that. But the understanding necessary to design research or be an academic in the field only comes with these unifying principles.
So you can be Beaker without it, but you can't be Dr Bunsen Honeydew. Had Llywelyn said: "Meep-meep-meep-meep! Evilution bad!" that would have been fine. However when you make an argumentum ad verecundiam using yourself as the authority and claim (by implication) credentials you obviously don't posses, you should get smacked down very hard.
Most of vaccine research seems to have very little to do with how pathogens evolve You are making an argumentum ad nauseum. Just because you keep saying this doesn't happen, that doesn't make it so. However, as an object lesson for you, try google-scholar with the search terms "HIV+evolution+vaccine". Only 19,600 hits. You are right, that isn't much of a connection at all!
It does have to do with how they enter the host and invade the immune system, but one can observe *that* and *how* that happens without talking about how it came to be. You are referring to research from a while back there, sparky. When biochemistry was divided into two camps: feed-n-weigh and divide-and-conquer. (FNW = feed rats a diet deficient in something and see what falls off, DAC = homogenize an entire rat in your waring blender and then do HPLC on the resulting liquid.) What year were you washing glassware in your summer job again?
nor do you need to understand how influenza's hosts evolved relative to it in order to model the traveling waves of its propagation. Are you really that retarded? OK, lets say people in one part of the world have due to selective pressure from pathogens evolved some form of unique resistance. And because of that, a given infection spreads through them less quickly. Ya think that might effect your model? Like say the MX gene system for influenza? Or the CCR5-delta32 allele and HIV resistance (though that evolved under pressure from Y. pestis, HIV resistance is a byproduct.)
And if you don't like the insults, get back to work. Dr Honeydew needs his coffee.
The idea that the understanding of molecular biology requires the belief in neodarwinism is absurd beyond my ability to express. The original narration described the structures, their actions, and purposes. If anything, the narration supports ID more than neodarwinism, as it very clearly implies that the structures being described have purpose. Nothing is mentioned implying that those systems, mechanisms, or structures came into being randomly. Straw man x 2. If it were the case that evolutionary theory suggested that 1) evolved structures cannot have a purpose and 2) evolution is a purely random process your argument would not be a straw man. However, evolutionary theory does not say that, thus you are a tard.
Evolution is descent with modification due to natural selection. That is, random events occur - mutations in germ lines. Then deleterious mutations (the lion's share) are selected against by natural selection. The few mutations that offer a survival benefit are selected for. Random mutation is the fuel on which the engine of natural selection acts. So its neither a process that is wholly random nor a process that does not deliver useful, purposeful results.
But please, try another logical fallacy. You creationist whack jobs are just so adorably cute when you do that!
I used to work in a microbiology lab which worked on vaccine research. I can't think of anything I did there on a day-to-day basis there, or really anything anyone did there, required anything that vaguely resembled an understanding of modern evolutionary theory. Does it require evolutionary biology to do grunt lab work, run gels, grow cultures per recipe, etc? Not at all. Does it require evolutionary biology to understand how pathogens evolve to better invade hosts and evade their immune systems. Does it require evolutionary biology to understand how organisms evolve to better protect themselves from those? Yes. In fact, TFA was written by someone who studies that very thing. But if you were someone who actually did research in immunology, virology, and vaccine research you would know that.
However if your contribution in the lab was as a tech running the experiments that people like the author of TFA designed, I could easily see why you wouldn't catch that link. So your bad there... but hey, awesome job showing yourself to be an ignorant tool who thinks he can argue vaccine science because he once had a summer job washing glassware and running the autoclave in a lab near folks who understand it. Just because the lab where you worked did research that doesn't mean you did.
Excitation delerium is a very commonly used term that refers to anyone in such a state of excitement, usually due to stimulatns like cocaine or methamphetamine It is used commonly? I'm an ER physician and I have been in EMS or an ER for over a decade and I've not heard that before. I know what 'delerium' is, and what 'agitation' is, and what 'tweaking on meth' is, however 'excited delerium' sounds like something that non medical folks throw around when they want to sound medical-y.
This is equally as bad as medical people trying to sound like they are lawyers... for example, I never write 'alleged assault' on a medical record. I write 'Patient states: I was just standing there and these three dudes came up to me and started whaling on me!' I don't have anything more than a layman's understanding of 'alleged' so I don't use it - with good reason. It would be nice if lawers and cops stopped doing the same with medical terms.
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Hmmm, maybe not.
Maybe its because you think that Hispanic undocumented immigrants are more likely to be on the public dole and get medicaid? Hmm, because they are lazy and don't contribute as much to the tax base as hardworking white dudes like you? Ah, yes, there we go. So yes, you are still a racist assmunch.
Just because you refrain from saying "I hate those god-damned illegal Mexicans," it doesn't mean you aren't racist, just clueless about your own beliefs.
I think the article and you are both right. Smaller places that are close to the 'Superstar Cities' in TFA are the ideal. I live in Davis, CA, which has the small town feel (though its actually a small city.) It is 70 miles from the closest 'Superstar City', San Francisco - which I visit just enough for it to be pleasant (several times a month.)
So I get the high speed access, university atmosphere, and small town feel while still having access to SFO. Now if it weren't for all the drunk college kids it would be perfect.
And for a good example of what I was talking about see the below comments from the AnotherUsername idiot. A little bit of knowledge can cause a lot of damage.
And so I am reasonably familiar with both ATLS and the deviations from it in which SF Medics are instructed. To be specific the reason that you may need to use a tourniquet in combat in because its hard to maintain direct pressure under combat situations rather than what you seem to be suggesting, that direct pressure won't actually stop the bleeding. Direct pressure to the wound and if necessary to the artery supplying the area is in fact in every way clinically superior to a tourniquet. The only reason you would not use the superior method would be if it is not feasible to maintain good direct pressure.
So getting back to your original statement: The thing about tourniquets is this: If there is bleeding that is more than a mere scratch, apply a tourniquet. As in, the bleeding isn't likely to stop anytime soon by itself, and could be life threatening. No. Direct pressure is superior. I have controlled a great deal of bleeding in my decade as an ER physician and the years I worked EMS. I have never once applied a tourniquet nor seen one applied except by some asshat like yourself who thinks that they know more than they do. (See my above posts about the dangers of a little bit of knowledge.)
People seem to have a fear of tourniquets, but they can be left on for several hours without any damage. Put them about 2 inches above the wound, but not on a joint. Write the time on the casualty's head. Better to just put it on right away rather than using up the casualty's dressing on something that won't work anyway. People... like the American College of Surgeons (ya know the ones who write ATLS?) have a very well founded fear of tourniquets because douchetards like yourself cause all sorts of damage with them. In fact, their use is actively discouraged in ATLS, and are only recommended as a last resort. You can cause ischemic injury to the muscle in as little as thirty minutes in addition to all of the other complications (permanent nerve damage because of incorrect application, compartment syndrome, arterial damage and thrombosis in older patients who may have pre-existing vascular disease, post-tourniquet syndrome, etc.) Not to mention the intolerable pain that most people get unless they are sedated or have a regional block done... which you'd probably know about if you had ever actually used one.
So why not run along and watch some more of your DVD collection of 'real life' trauma-dramas or work on your MySpace before your mom makes you go out and mow the grass. And if I am ever in a car wreck and you find me. Just call 911 for me, ok?
I disagree. Training can make someone more knowledgeable, but you can't teach common sense, and at the level we are talking about common sense is more important.
There are actually very few things beyond CPR (which is a community level intervention that everyone should know) in the EMT-Basic level of teaching that are more than a concrete presentation of common sense ideas. If something is broken, make sure it doesn't move that much. If something is cut and bleeding, put a clean gauze dressing over it and apply pressure to stop the bleeding. If someone is having trouble breathing if you have oxygen, give it to them. If a baby comes out, tie off the cord wrap it in something warm, and put it on mom's chest. If someone is not breathing or in cardiac arrest, call for extra help and do CPR.
This ain't exactly rocket science. (Hell, FWIW, I took my EMT-Basic written and practical exam drunk and passed with flying colors.) And someone with half a brain who thinks about it for half a second can come up with most of it if they keep a cool head.
In my experience people with 'training' can make some huge errors, often because of a blasé attitude that comes from a false sense of confidence in your abilities. Someone who does not think of themselves as 'trained' is often more cautious and less likely to make those overconfidence type mistakes. So when you are talking about basic level skills, I would rather have a bystander with common sense who remains calm and pays attention than an overconfident EMT-B with an ego the size of Wisconsin, a belt that would put batman to shame, and a blasé attitude. Unfortunately, in my experience EMS tends to attract people who tend to become overconfident when they get a smidgen of knowledge.
Of course that is again, only at the Basic level of training... a bystander (no matter how much common sense) can't start an IV, cardiovert SVT, or give me morphine for a femur fracture. This also doesn't mean that having EMT-B training is a bad thing. But it does mean at that basic level of care, common sense is much more important than you give credit to.
I saw your second comment below, but there is one important thing to remember: training isn't everything, and common sense is often more valuable than training. An untrained bystander who is calm and thinks about what's going on can be more valuable then a hyper-excited volly firefighter who doesn't take two seconds to step back and think.
There is a reason that Brady Emergency Care actually states that you should not transport a live venomous snake with you in the ambulance. Anyone with common sense would think.... hmmmm... take an animal that can kill me and put it in a 10'x8' metal box, then jump inside and close the door.... maybe not such a good idea. But you know some hick firefighter/EMT-B did exactly that, hence the reason that its in the book.
So don't assume that an untrained bystander is going to render poor care, or that a trained bystander will provide good care.
This is why you should not take first aid device from a video game or /.
Never apply a tourniquet unless the bleeding is 1) immediately life threatening and 2) cannot be controlled in any other way. The best way to control bleeding is direct pressure - which can stop 99% of significant external bleeding. Tourniquets not only cause nerve damage, but if there is an amputation, they can cause ischemic damage to healthy tissue which may decrease the chance of a successful reattachment or make the ultimate amputation worse.
And don't worry, there is a law in emergency medicine: All bleeding stops eventually.
I am also an ER doctor like the one who probably paid about $80 in malpractice insurance and practice costs (not to mention the time it took to see you) to see your racist ass for free. I worked last night with two nurses who were immigrants too, and one with a Latino name. Like many nurses in the US are. They also paid for the privilege of starting your IV, giving you medicine and fluids, and probably cleaning up your puke or shit off the floor. All while you secretly tell yourself that spicks like them don't deserve the same quality of care that your malignantly entitled white male self does.
And remarkably, I still agree that you should not be charged for that care. Health care is no more a commodity than police protection and the fire service. Health care is a right, just like food, education, and freedom of speech. So even racist pieces of shit such as yourself deserve compassionate and competent care.
I am hopeful like you about the democrats, but you are wrong about the Hippocratic Oath. The original doesn't include anything about seeing anyone without regard for ability to pay. It does proscribe having sex with your patient's male and female slaves when you go for a house call (look it up, shit you not.) But it says jack squat about treating without regard for compensation.
Though many modern oaths do.... the one I took when I graduated from medical school included: "that in the treatment of the sick, I will consider their well-being to be of a greater importance than their ability to compensate my services." You might also be thinking about the code of ethics for emergency physicians, which does say something similar. http://www.acep.org/practres.aspx?id=29144
But there aren't a whole lot of specialties that are as explicit about it as Emergency Medicine... but then we don't have a choice anyway courtesy of EMTALA. If you have the be the safety net for providing care (and accepting the cost for it) to all of the uninsured in America because the rest of society won't accept that responsibility, you may as well get some ethical yayas out of it.
Sorry, nope. As an ER doctor, I can tell you there are many things you will never get that way. Need a pap smear? Nope, we don't do them in the ER? Need surgery and chemotherapy for your advanced cervical cancer? Again, sorry - we don't do that in the ER. Maybe when you come in bleeding out from your vagina, we'll admit you, but you won't be getting definitive care. Need surgery for your broken arm? Nope - that's not an emergency, so the only care you will get in the ER is stabilization. No orthopedist has to admit you under EMTALA to do it either, since the standard of care is splint and then follow-up for outpatient surgery. Of course when you try to make that appointment, they will tell you $20,000 up front or no follow-up appointment.
And don't play that 'I grew up on welfare' card. So did I dipshit - when it was a more decent system in the 70's and 80's. We've been going downhill since then with regard to public assistance - including health care assistance. Thank you republican controlled congress and private health insurance industry!
Looking at health care as a business is not only fundamentally morally corrupt, but its also not realistic. For example, people have suggested rating physician quality like the asshats who suggest rating a patient's creditworthiness. Fortunately or unfortunately its actually quite hard to measure quality of care that physicians provide. Say for example you decide that you look at a heart surgeon and determine what percent of his patients survive for at least a year after surgery. Sounds pretty simple, except that the best surgeons often are the only ones willing to take the sickest cases, and so the most technically skilled surgeon who takes the cases that no one else will touch looks worse than the technically marginal guy who only cherry picks the easiest cases. Of course measuring things in complex ways like that are harder to do, so you will only get simple (and meaningless) measures on scoring systems (which already exist.) Moreover, there is no easy way you can measure the important things that make a technically competent clinician into a great doctor: sympathy, listening, and actually giving a shit about your patients.
Which brings me to a pet peeve of mine.... I hate few things worse than referring to my patients as 'customers'. I haven't had customers since I waited tables in med school. In my ER practice (which pays the bills) or in the clinic where I volunteer my time two days a week, I only have patients - not a single customer. And trust me, you don't want to be a customer. Because if that were the case, when I am sworn at, pissed on, or threatened with bodily harm, I would happily to let that piece of business walk right out the door. If all I had was customers, when my 'customer' with alcohol intoxication and a head injury who had already vomited on me and took a swing at me after calling me a fucking faggot decides to bolt out of the ER, I wouldn't wrestle him to the ground to keep him in the ER till we get his head CT.
So no, I won't check your credit score. But I also sit at the back and play with my cell phone when they make me attend 'customer service' talks. I don't care about customer satisfaction. In fact, I am of the belief that if every patient I see is fully satisfied with the care they got, I am probably not setting enough limits. (I'm not House, but I am also not the vicodin and antibiotic fairy.) And while I don't give a rats ass about customer service, I do give a rats ass about practicing medicine well, and about the people who are my patients - even if they do puke on me.
So trust me, don't yearn to be a customer. You wouldn't like it.
But that is also the reason that we have a relative shortage of primary care docs and a surplus of specialists.
I am speaking as an ER doc who, unlike your primary care or your surgeon does not get to pick and choose which insurances to accept (and in fact has to see everyone regardless of insurance status or ability to pay - which I would do anyway... that's one of the reasons I picked EM.) But the OP is right in that Medicare and Medicaid don't pay shit. I lose about $30 on every Medicaid patient I see in the ER when you add up the costs of practice and the payment received. Of course that is better than losing more on a patient who has no insurance and does not pay out of pocket, but its still a net loss.
Though I agree with you in the remainder of your assessment of the US Healthcare system. We need single payer. Yesterday. And it needs to be a Canadian style system - everyone in, no one out. If we have a two (or more) tiered system, those who rely on the purely public system will get the same thing you experience. Unless the public system is the same one that members of Congress and the President and their families get, it will be no different than Medicare and Medicaid is now. Of course that's a lot better than being uninsured in the US, but its a lot worse than simply being a citizen in more developed countries like Canada.
Most countries wait until at least 6 months of age before beginning the injections of MMR and DtAP vaccines. First off, its DTaP, not DtAP (which becomes important below.)
Second your statement is quite untrue. If you look at the WHO's vaccine information, you can see the vaccine schedules for various countries. http://www.who.int/vaccines/globalsummary/immunization/scheduleselect.cfm
If you search for DTaP, you will indeed find that many countries list the first time they give this as a much older age than we do in the US. However, this is not because they leave their kids vulnerable, but because the first diphtheria, tetanus, and pertussis vaccinations are often given with DTwP which is cheaper. In older kids, if you use the whole cell pertussis component they have worse side effects (which are rare in infants and younger children). So you use the cheap DTwP first, then the DTaP later in childhood. So stating that 'most countries' give DTaP at a much later age is misleading at best.
Anecdotally, The plural of anecdote is 'not data'.
Say the patient has been diagnosed with schizophrenia, but doesn't believe that diagnosis is valid because he knows the real problem is that its really that the video game industry in an unholy alliance with the DoD and is out to get him?
Or many other diagnoses or bits of information that patients do not want providers to access but which are important to their care. Like drug abuse, blood born or sexually transmitted disease, or other mental health problems. A pregnant woman with pelvic pain with a history of chlamydia PID is at much greater risk for having an ectopic pregnancy that will kill her, however that may not be divulged by the individual if she's able to manage her medical records.
There are other rights as well to consider. If I am suturing your laceration and you move suddenly and cause me to stick myself with the bloody needle I was suturing you with, do you think its unreasonable for me to want to know whether you are HIV or Hep B or C positive?
In addition, what if you arrive to the ER after a motor vehicle crash and cannot give the critical information that you are on a strong blood thinner.
So its not that simple.
Nick
OK, lets assume that the couple were incredibly lucky and bulls-eyed the pilot's eye. Both the blink reflex and the fact that the helicopter must have been moving at least some would have limited the exposure to less than a quarter of a second. If this couple was indeed using one of the cheap green laser pointers, there is no way that the cop had eye pain for hours afterward. He certainly probably had a startle effect, and a momentary decrease in vision, but unless he was taking off or landing or doing some other critical action this would have been of minimal concern. If it disoriented him, this guy obviously needs to not be flying low above homes if that's all it takes to make him incapable of safely operating a helicopter. Though I think the most likely thing is that he got all butt-hurt and wants to extract revenge by claiming injury that was not realistically possible.
It conflicts with other laws or causes harm to other truly unrelated individuals? For example, a physician keeps electronic medical records on a computer which the police believe may have been used to violate copyright. Every one of his patient's medical records are then auctioned off to the highest bidder in violation of HIPPA? (Not to mention their medical care is compromised and their health threatened because of lack of access to their health history?)
Wait dude, its not just the faggots and the Jews, you forgot the rag-heads, dot-heads, and the darkies. And the chicks too... everyone knows a chick can't keep a secret. And like they'd ever be able to land a job at JPL other than as a secretary.
Oh, and you almost forgot racist homophobic fucktards like yourself!
Simply because the laws of a society do not recognize basic human rights, that does not make those rights non-existent. It makes the society unjust. For example, in 1950 in Alabama, people of color were denied many civil rights. However that does not mean that Rosa Parks did not have a human right to keep her seat on the damn bus when a white man demanded it.
You are confusing civil rights granted by law and universal rights, granted by one's humanity.
http://www.un.org/Overview/rights.html
Article 12. No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.
In fact I think you'd be hard pressed to decide on a 'single most important concept' in biology (or in chemistry or physics, etc.) However you can come up with a list of the basic fundamental concepts of any field. Those are the unifying principles that form the basis of the field. For biology, these are generally accepted as being cell theory, evolution, homeostasis, and genetics. There are some who would add others (e.g. biochemistry,) however you would be hard pressed to find a legitimate list (i.e. not from DI, the Kansas Board of Ed, etc.) of the fundamental concepts that did not include evolution.
So while you are correct that evolution isn't the single grand unifying theory, it is one of the fundamental concepts without which any real understanding of biology cannot happen. You can do rote memorization, you can catalog insects, you can work in a lab and do biological experiments (that people who understand the basic principles design), hell you can even practice clinical medicine without that. But the understanding necessary to design research or be an academic in the field only comes with these unifying principles.
So you can be Beaker without it, but you can't be Dr Bunsen Honeydew. Had Llywelyn said: "Meep-meep-meep-meep! Evilution bad!" that would have been fine. However when you make an argumentum ad verecundiam using yourself as the authority and claim (by implication) credentials you obviously don't posses, you should get smacked down very hard.
No need to thank me.
And if you don't like the insults, get back to work. Dr Honeydew needs his coffee.
Evolution is descent with modification due to natural selection. That is, random events occur - mutations in germ lines. Then deleterious mutations (the lion's share) are selected against by natural selection. The few mutations that offer a survival benefit are selected for. Random mutation is the fuel on which the engine of natural selection acts. So its neither a process that is wholly random nor a process that does not deliver useful, purposeful results.
But please, try another logical fallacy. You creationist whack jobs are just so adorably cute when you do that!
However if your contribution in the lab was as a tech running the experiments that people like the author of TFA designed, I could easily see why you wouldn't catch that link. So your bad there... but hey, awesome job showing yourself to be an ignorant tool who thinks he can argue vaccine science because he once had a summer job washing glassware and running the autoclave in a lab near folks who understand it. Just because the lab where you worked did research that doesn't mean you did.
And it shows.
This is equally as bad as medical people trying to sound like they are lawyers... for example, I never write 'alleged assault' on a medical record. I write 'Patient states: I was just standing there and these three dudes came up to me and started whaling on me!' I don't have anything more than a layman's understanding of 'alleged' so I don't use it - with good reason. It would be nice if lawers and cops stopped doing the same with medical terms.