OK, this is ridiculous

This blog is taking over my life, BORG like. I google my own name because I needed to quote some research I have published and I needed the info from karger publishers. So I google, and for “Raul Benavides” my first citation is on the 2nd pages of the search, with the first actual link to my work on the 3 or 4th page. “That’s OK, since raul benavides is not uncommon a name, being on the 2nd page means I get hits on my work.”

but, guess what Is the #2 overall hit on page #1:

The “ass clinic” post on this blog.

Yes, much more significant than my 2-3 published research articles is the blog entry here on my days dealing with anal warts..

damn you, “The Internet”

I wish Al Gore had never invented you, you mock me so.

Ass Clinic

In the spirit of the previous post, I have a “drive premeds away” story, too. Well, one of many. MUCH less in the patient embarrassment end as in the previous post than the MED student discomfort end , I had GI surgery for my ’subspeciality’ month for surgery. so that means you do ALL ends of the digestive systems. and guess what, HPV causes just as big warts down in the ass as on the other end. So, to tend to that, we had what all the surg residents referred to as:

“Ass Clinic”

check out butts all day, rating them on a 1-10 scale on surgery or not (oK, not on 1-10 scale, but in retrospect, well, we might as well have) I have seen way more butts than I care to see in my lifetime.

THEN

in the surgeries themselves, they are in trendelenburg –correction: JACKKNIFE — position. Remember how school cafeteria table folded in an upside down v? imagine being put on top of those with yer ass sticking up to the sky. that’s how I saw a GREAT number of my surgeries for 3-4 weeks, working on their ass. removing warts, hemorrhoids.

no wonder I didn’t go into surgery.

arrgh!!! Damned 24 hour news media

I need sleep but I must vent!!!
I am a cowboys fans. I am the type that will tape the games and turn off TV’s to keep the score a “surprise” for later..
mock me if you must.
I tivo’ed todays MNF phil vs dallas. a

I was traveling back from work at the hospital tonight at 11:30pm mon. got in the car, turned it on

I had left it on espn radio that morning, so the radio turns back on when the car cranks.
I turned to changed the station, as my finger moved I hear the radio come to life, then the FIRST THING out of the speakers….:

“…. and so what do you think about that donovan mcnabb interception that won the come from behind game for the cowboys?….”

CRAP. too late

dammit, this medical stuff is a sacrifice!!!!!

patient empowerment and the media, and MD respect.

So I earlier made an entry that touched upon patient respest for m.d., which indirectlly touches upon informed patients. I knew that that deserved follow up but several night calls defeated that intention.

Let me start this message with the extreme opposite of how the “new media, etc” had merely perpetuated the snake oil problem and possiblly made it worse.
I had a patient, L lung FULL of lung ca, metastatsis everywhere, had a spinal met that basically pararlysed him. Was so out of it, couldn’t even comprehend his med situation. So I tried to make the family make him Do not intubate/do not resuscitatate in the event of catastophic event. For days I tried, I will not go into the many details of those conversations. Then, one day, the family member showed me a book by Kevin trudeau http://www.cures-they-dont-want-you-to-know-about.com/. I had glanced at this book before while at barnes and noble, the biggest example of internet snake oil shiester dom you’ve ever seen. (HOnestly I encourage every MD to at least glance this book, as it is a BIG seller and will impact, statistically, every practice at least once and you HAVE to be prepared for it.) She says “you know, you should read this book, it says things that doctors don’t know and should be educated on”. IT WILL happen to you to. I politelly stated, i’ve read it, but declined to comment more.
I think sometimes we think that the proliferation of cheap misleading infor on the internet is harmless/ won’t really effect anyone besides their pocketbook, but believe me, this family was letting him wallow in pain BECAUSE this book/sister internet site states, and I am not exaggerating, you need to read this book, don’t trust doctors, they are undereducated on natural cures cause they get money from drug sales. he literally says, and I QUOTE: “I am qualified to comment on medicine because I am **NOT*** a doctor” There is REAL harm.
By the way, as a consequence, the patient almost died twice, is in the ICU now practically comatose when he is not in pain, and on life support. He is NOW DNR/DNI, but honestly it is too late for that. He will wallow for months/years now.
As you can tell I am still quite livid.
I have no problem with mdconsult type sites that know to edcuate patients to a certain degree but entrust the medical decisions to MD’s. Even then, we all get slightly annoyed when you do your best to meld thousand of review articles/research protocol into a decision for a patient, and when you are walking out they are whipping out their palm pilot/powerbook and when you walk back in they probe your knowledge to see why you didn’t use so and so antibiotic becase a NEJM articel suggested it was better for this bug in this state for this indication.It’s hard to explain that only AFTER four to five years in the field do you understand that there will always be a new article, so it is not a matter of blindly following this month’s jama, or you’d change every month.

Rule number one:
You learn everything you REALLY need to know, that’s striaightforward enough to just follow a book/article, in your first two years-three years in med school
The rest is GRAY (dark black sometimes), and really needs thinking because no one has addressed the unique need of THAT patient ever in ANY research.

Rule number two:
Different MD’s will do different things, and each will be uniquely correct, and each will be uniquely wrong. REmember this when each of your attending gives different advise on how to address so and so disease.

Therefore, you now have the unique problem of people having unlimited access to research articles that, yes they can read and understand, but don’t have any context to place it in. Not cause they are unintelligent, but because it’s not their professsion. In fact, the intelligence factor plays in a different way usually. usually it is high powered, well educated successful people that are the worst candidates. Why? Because they are so successful in one thing, so they figure they can figure out the rest of the world given time. hey, I’m the same way too. the same way that i used to think, when I met a mechanic/accoutant/lawyer/etc, that “hey, give me those books and some time, I could figure it out and save myself some cash. I’m smart and successful, aren’t I”

thus we have patient walking in, having read jama and saying “hey I can somewhat understand this!’
probe the doctor, see he doesn’t use the latest protocol they read about, and have this underlying doubt the whole time.

now don’t get me wrong, the mass education of patients is great, and the majority of self informed patient I met at baylor clinic (our private/self pay/rich folk clinic) is definatly for the betterment, and the mostly defer to their doc for real decisions. But there are negatives, and you too will feel them. Not in the community clinic/hospitals, but in your outpatient clinics for the well off, you have to be prepared.

Get a subscription to time/newsweek.

this has gotten too long….

the good, bad and ugly

I have a few moments, so lets chat:
I will admit that I am one of those MD’s that bears his fangs whenever the word “lawyer” is stated. Of course, the human side of me knows that only a few percentage actually adhere to the common slick willie stereotype, I still writhe in hate whenever I read the latest vioxx story.
However, picking up the the latest businessweek bears the low standards that sometimes we adhere to when conferring MD as well as JD’s. It outlined the process by which some MD basically would sign BLANK diagnosis forms for diangosis of silicosis for mass claims. This fraud is now facing countersuit and the degree to which the physicians would slip the needed diagnosis based on no (not even weak) evidence is of course disheartening.
Of couse, I can’t let the lawyers off that easily. they, in order to back up their claim, hired an unassuming radiologist to reread the thousands of xrays. AS this radiologist was not informed of the gravity of his reads (he was told they were to be quick, 5-10 minute, $45 dollar each reads), he did a cursory read and popped out impressions. The lawyers then turned around and sumitted them as DIAGNOSIS of silicosis in a court of law. As soon as he found this out he filed that he NEVER submitted a diagnosis of silicosis or anything else in any of the xrays. This happening is still being hashed out in court I believe.
That and the best is the literal roving echocardiogram machines the lawyers would move from business lobbies to malls, looking for fen-phen users and taking quick echos on the spot in business lobbies, etc. “echo mills” they were called. For those unaware, phenphlramine in particular in fen-phen causes heart valve abnormalities, and echos are commonly used to diagnose these abnormalites . So they were “trolling” for valve leaks, so to speak. Of course, it has already been discovered that some of these echo reports were “doctored” (sorry) .
Sorry to see that corruption bears it’s head is so many places. It used to be that the money and prestige associated with being an MD maybe kept things better in the past. But with palty reimbursement rates, HMO’s now negotiating lump sums for seeing patients, (YES, these days managed care will negotiate a flat payment for seeing their patients with many doctors, regardless of specialty. See more patients and order lots of expensive tests/workups or god forbid a long hosptial stay for more patients than anticipated, and you could be in the negative. OR, order less agreesive testing and cheaper/less treatment and make a profit. Conflict of interest, HUH? But a reality now. Salaried MDs are not just for hospitalists, residents, and academic MDs anymore), and patient respect for MDs decliining, I can honestly see where making a quick buck would happen more often.

medical cocktail party humor

from www.pushfluids.com:

“In entirely unrelated news, today in plastic surgery clinic, while looking up the ICD-9 code for “mass,” I discovered that the diagnostic code for masturbation is 307.9. You know, just in case you want to bill your insurance company or something.”

’nuff said…..

another old joke

One many have heard before

…. sure to offend

How do you hide $100.00 from a surgeon?
Put it in a book.

How do you hide $100.00 from an internist?
Put it under a bandage.

How do you hide $100.00 from a radiologist?
Put it on the patient.

How do you hide $100.00 from a cardiologist?
.. you can’t!

In my busier days now, my contributions will be smaller…but I will try to keep them going.

New evac plan for Houston annouced today

Due to analysis of the Houston evacuation, those of us at the medical center have been given initial word of a new, tiered evac plan to be put in place for the next metroplex emergency. This is to be annouced by Gov. Rick Perry at an upcoming conference.

It will be tiered by higher learning status.

Those from UT Dallas, SMU, and UH will evac up 45 north to dallas
Those from UT-austin will evac up 71 to austin
Those from Texas A & M will evac via 45 south towards the gulf coast
And those from Oklahoma will take the 610 loop and drive around and around until further notice..

apologies, but that was the funniest joke I had heard in a long time, those from OU, A&M feel free to adapt that the other way, of course…
yes, I’m from UT austin…..

-=dedicated to bobby=-

Banning together in h-town

As I hunker down in houston for the storm, I am actually in a small way actually having a decent time. This is this nicest I have EVER seen houstonians act toward each other. I chatted with a complete stranger for easily 20 minutes in one of the few restaurants open over a very good dinner. We talked to the person standing in line standing behind us for the past 20 minutes at Tom thumb. We met and talked to at least 3 of our neighbors in our complex, and sat in the pool with one of them for about an hour.There is an incredible sense of community and togetherness formed between all of us staying through the storm. Some because they too turned around after spending hours on the highway. Others because they identified with me because they too were in a profession that required them to stay through a disaster at times. (such as one IT manager from MD anderson, she was on call the entire weekend).This is easily the first time I felt a sense of belonging in this city, and the most sense of community since I lived in austin during the early ’90s (before it became tres’ chic) . Not that h-town is UNfriendly, but natives seem to feel that they are much open and lovey lovey than all the other big cities in TX. I hate to say it, but normally I have not found this city to be any more welcoming or friendly than the next big burg, despite the PR blitz they give about this being a ‘friendly’ big city, especially in comparison to their big city Texas neighbors (Austin, San Antonio, and especially Dallas). Not that Dallas was welcoming at all when I lived there for 4 years , but there is certainly no appreciably big change in ‘neighborliness’ on a day to day basis from there to here. If dallas is a 7/10 on the ‘don’t bother me I’m busy” scale, and austin was a 4.5/10, then houston has been a 6/10 normally.But now, I definately feel a sense of community, and feel of “hey you, how’s it going?” from an entire neighborhood.Here’s to hoping it lasts.

Guess who is back in Houston?

Several HOURS after dehydrating in my car on I-10, I made a U-turn while I had enough gas to make it back and am now IN MY APT waiting out the storm. I know people always say, “how can you take a chance, just drive?”, you cannot understand until you are in it:

1) We took 3 hours to travel 5- 10 miles in stop and go traffic, using over 1/4 of a tank of gas for JUST that, with the AC OFF.
2) People were starting to cuss and become hostile in the heat.
3) We KNEW, through the news, that no gas was available for about one hundred miles, and following trends, we would run out of gas in under 50 miles EASILY.
4) I was feeling initial signs of heat exposure, and we forgot to pack a cooler
5) Our cat looked like she was about to start shaking (remember animals pant, not sweat, to cool, so they burn alot of energy and lose h20 in exhalation much faster than us) This normally indoor kitty was going to last max 7-8 hours in 106 degree weather with no water.
6) In stand still traffic you have no breeze because it is blocked by all the other cars, and with the pavement and engines, the temp was way above normal ambient temps.
6) Brand new, well maintaned cars were stranded on the side of the road, either out of gas or broken down. In that traffic and environment, even “good” cars were overworked.

We thus decided that the risk of being stranded on I-10 with no gas was MUCH higher than the risk of being harmed in our relatively newly built and well designed 3rd story apartment. I turned around, and took about 20 minutes to traverse the roads back home. WE stocked up, and will ride out the storm here.

We are not alone, though. I already secured clearance to ride out the storm in the VA hospital here.(yes, our wonderful homeland defense dept required that I send in a formal request for pre-authorization to enter VA in the event of the storm. This is the same place that required I have my request for a parking sticker NOTARIZED. No joke). In addition, if I agree to volunteer to staff St. Lukes over the weekend, I can use it as shelter, also. So if it gets nasty, we leave the cars in the covered parking garage, and walk to the shelters before the storm hits.

We shall see. they don’t have WiFI.