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.

Another First Year Medschool Perspective

An excerpt from “Dickens and the Phoenix” at Medscape (registration required):

I came to medical school at the age of 33. I knew that the first 2 years meant books, and by books, I mean misery. When I give tours to applicants, I tell them that I want to be a doctor, not a medical student. Nobody wants to go to medical school. It ought to be like in The Matrix, when Neo says, “I know jujitsu,” and he instantly knows it. Except in this case, it would be, “I know anatomy.”

Medical school is a full frontal challenge to your mind, body, and spirit. You can’t prepare for it. I thought that age would give me some perspective, and it has, but it hasn’t made things much easier.

It’s a short article, but for 1st year students, a good read about an MSII in Houston who had things turn around for him helping Katrina victims as a volunteer.

Biochemistry of Burger King and Cinnamon Rolls

Earlier this year, I wrote a negative nutritional opinion about Burger King’s Enormous Omelete Sandwich. Well, Burger King listened, and they decided that two eggs, two slices of cheese, a sausage patty and two slices of bacon on a bun was just not enough breakfast without adding a couple of slices of ham. At almost 800 calories and two days worth of saturated fat in one meal, I don’t see why they just didn’t throw in a nice galette of hashbrowns and gravy (you know, to help make it go down nice and smooth) to make it an even 1000. Silly me, I forgot…you don’t have to get this by itself, you can have a combo with a large breakfast tater tots and a 44oz Coke to wash this manly meal down with, all on your way to work/school/back to your house because you didn’t feel like cooking.

Now anyone who knows me knows for sure that 1) I am no health nut, 2) I have more than just baby fat on me, and 3) I don’t discriminate against hardly any kind of food, fast or slow. However, as I said in my post from earlier in the year, if I’m going to consume that many calories in a meal (which is a bad idea to begin with, but we all indulge ourselves in different ways…at least it’s not a crack pipe), I’m going to be 1) sitting down, 2) have a paid professional attend to my meal (or be the handiwork of a loved one or my own damn self), and 3) take the time to enjoy it. I sure as hell won’t waste it at Burger King.

Having said that (and proving the first sentence in the 2nd paragraph above), I love cinnamon rolls. I really don’t care for the outside part, though; it’s usually hard or too high a bread:flavor ratio. I bite the outside just enough to hollow out the middle where the flavor is packed in, leaving a moon-shaped carcass of a roll, shamelessly eviscerated. Chik-Fil-A released an item that was made just for me (and probably thousands of others, but I prefer to think of me first): a package of just cinnamon-roll middles. This is the cinnamon roll equivalent of muffin tops, only muffin tops are dumb and these are cool.

All this at 1:30 in the morning, as I study for a biochemistry exam tomorrow on (and I kid you not): dietary lipid metabolism (chylomicrons, [VL,L,H]DLs; cholesterol, fatty acid and triglyceride synthesis), gluconeogenesis, glycogenolysis/glycogenesis, hormonal regulation/effects in the fed/starved state, etc. I think, just writing about all this, “Just how much bile salts, CCK, lipases, and insulin would have to be mobilized to take care of all the above if I were to eat it?” Ha!