Manch Medic’s post reminds me to ask: Any tips from EMers on transitioning to a week of night shifts? I’m incredibly excited to dive back into clinics with another ER month next week, beginning with a week of 10pm-6am shifts. Sleeping suggestions, napping suggestions, caffeine suggestions? Thanks in advance.

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The disease-ifying of normal just took one leap forward today with this question from Ask Metafilter :

I get very moody if I don’t eat in the morning. If I don’t eat until 3-4pm I get headaches, drowsiness and feel nauseous.. I think I’ve always had this. Since I usually eat enough it doesn’t really bother me. I’m 21, male, and a vegetarian. What do I have?

I love the answers:

You have a condition known as hunger.

The good news: it is easily treatable

The bad news: there is no permanant cure

This condition can be treated at a specialized clinic, the one you want is known as a restaurant. This condition can also be treated at home, but you will need specialized supplies from a grocery store. Most sufferers find that several treatments per day are necessary.

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This week’s Grey’s Anatomy featured the Candirú fish , native to the Amazon. It generally parasitizes other fish, drinking their blood, but has been known to swim up human urethras, attracted by urine, and lodge themselves in the urethra with its sharp backwards-pointing spines.

I know, I know, I’m supposed to enjoy the show for its drama, but the “penis fish” man somehow had grapefruit-sized testicles as a result of the urethral obstruction. This ain’t how it works. The testicles are not magically connected to the bladder or something. The guy would end up with postrenal renal failure , not scrotal edema (maybe anasarca or something, but not just in the scrotum, come on).

Oh, and these interns are pimping each other on what an actinic keratosis is? Okay, done ranting.

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Clutch quote from an OB resident 3 weeks ago that’s still been bothering me, in reference to a patient with metastatic cancer who was in pain and needed a CT scan but was refusing contrast:

“I am so sick of these patients. Just suck it up already and deal with it. God.”

If you’re ever working with me, and I ever say anything as remotely cruel and disgusting as that about a patient, especially one with metastatic cancer all over the place, please, please, sock me in the gut, or slap me, or something. There’s ranting, and there’s bitching, and then there’s just plain inability to have any sort of compassion or caring for your patients.

I feel guilty that I didn’t speak up and put the resident in her place. Granted it was 3 residents versus one med student, but I wish I would take the right path rather than the easy one a little more often. Sigh.

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May’s Annals of Emergency Medicine features an article, Emergency Medicine in the Blogosphere: The Irreverent Wit of the Specialty’s Unofficial Voice , which surprisingly reveals several ER bloggers’ full names and whereabouts.

Welcome to the world of non-anonymous blogging, gentlemen!

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(In which we mostly correct the Panda Bear .)

Major points to Panda Bear for his passion, but his health policy leaves something to be desired, I must admit. His latest rant is good–and I agree some of it in theory, but he doesn’t seem to be well-versed in the single-payer “woo,” so here we go:

The key thing to keep in mind is that the various plans proposed to insure the entire nation will do nothing to lower the cost of medical care because they are just another scheme to shift the costs from one set of consumers to the other.

Actually, that’s not correct, Panda. Single-payer plans have consistently been evaluated and shown to cover everyone while saving money. They do this by cashing in on the massive savings associated with administrative waste (probably at least $100 BILLION), allowing drug price negotiating, and setting global budgets for health spending. (See the California Health Care Options Project , The Vermont Single-Payer Study , The Maryland Single-Payer Study , Massachusetts Health Care Studies , and Maine’s Single-Payer Microsimulation .) Just to be clear, these analyses were done by The Lewin Group and Mathematica Consulting , not single-payer supporters.

The only difference will be that instead of half, every single health care dollar will take a trip through the federal sausage mill.

60% of health care dollars already take a trip thru the federal sausage mill–yes, 60%–and when they go to the Medicare mill, you actually get more sausage (health care) for your buck. There’s lower overhead costs compared with most private insurers–no advertising, no huge executive salaries, no profit demanded by investors.

The money is going to come out of somebody’s pocket and it’s not going to be the government which has no pockets, just hands to grab from one to give to another

This is how insurance works–not just health insurance, but car insurance, home owner’s insurance–all of it. It’s risk pooling. And the bigger your risk pool, the better to keep the system going. Money for our health care system comes from the citizens, whether it’s from Medicare taxes or loss of income from businesses providing health insurance (the businesses get to write off the health insurance bucks).

This is why the concept of Health Savings Accounts (not to mention privatizing Social Security) invokes such howls of rage from our ruling elites. Not only do they hold the people in contempt thinking them incapable of planning for their own future but the money tied up in these accounts and owned by citizens is just another chunk of money that cannot be stuffed into the voracious maw of the political influence machine.

I’m against HSAs because they won’t do squat for our problems. 80% of health costs are from 20% of patients –those are obviously our sickest patients–and they’re going to spend thru their HSAs within the first 2 days. HSAs are a great tax-free way for the rich to protect their money from taxes, but like I said before, they’re focusing on a leaking faucet when there’s a Niagara Falls right next door. Also, sure, an HSA might make someone think, “Should I really go to the doctor for this cold? Maybe it’s a virus.” Okay, so you’ve saved the system 50 bucks. But what consumer patient, when truly sick, is in any state of mind to decide if he needs the CT scan the doctor is recommending? Or if she should be admitted? Come on. (It’s a myth that more consumer information improves health care decisions , anyway.)

It would be demoralizing to our nation to have the disparities of medical access so wide that the poor and ignorant suffer or die from conditions that those who can think and plan ahead easily eacape. We will, unfortunately, always need to give medical care as charity.

Awkward! 18,000 people die each year from lack of access to proper health care. You’ve never seen an uninsured diabetic come into your ER with a nasty foot ulcer or infection that eventually leads to amputation, Panda? Come on. And survival rates after amputation suck.

I don’t think we will, fortunately, always need to give medical care as charity. There are tons of other nations able to provide for health care for their citizens, because it’s a priority for their countries. We can make it one too, if we want to.

There are many conflicting forces in medical care, each one trying to stiff the other with the bill. The insurance companies want to pay as little in claims as possible which is understandable given the nature of their business. The medical industry, from physicians to the lady mopping the hospital floors, would like to get paid fairly for their services. The government wrings its hands at the cost but at the same time would like as many people dependent on government as possible. The people want all the medical care they can eat but they want somebody else to pay for it.

You’ve really gotta read Money-Driven Medicine, Panda. You’ll love it.

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I’m getting really sick and tired of the media’s portrayl of Cho as a mentally-ill individual and all the following of “leads” from his psychiatric hold and the fact that two girls complained about him to police.

People with mental illness– and that’s 1 in 4 of Americans –are NOT dangerous. Even schizophrenics, those with the classic disorder that comes up when someone says “crazy person”–are NOT dangerous. They are suffering, sick patients. Did you know that the prevalence of schizophrenia in the population is about 1%? That’s 2.2 million Americans. If schizophrenics are so dangerous, we should be expecting to have about 2.2 million more school or workplace shootings sometime soon. (t’s absolutely important that if people need treatment, they get it, and there’s follow-up to make sure they’re getting it.)

Are there exceptions to the rule? Of course . Was Cho a very sick individual? Absolutely. But if we take aggressive, radical steps against every student or person who gets evaluated or placed on a psychiatric hold, we’re going to be hurting a huge number of people based out of fear and ignorance–and wasting a lot of time, money, and energy in the process. Terrible things happen in the world, and I’m sorry World, but there’s not always someone to blame.

Mental illness often reveals itself in the late teens and early 20s, and it’s often genetic. It takes a terrible toll on patients–they go from functioning in the primes of their lives to becoming isolated, lost, and removed from the world that they know. Imagine for one minute that you’re schizophrenic. Voices from inside your own brain tell you things–they’re so real that your brain’s auditory centers actually light up as if they’re hearing things. They tell you terrible, horrible things, 24 hours a day. That you’re a terrible person, that the police are coming for you, that you’ve done something terribly wrong. Want to know why schizophrenics so often are wearing headphones or earplugs, or are singing to themselves? They’re trying to find some way to drown out the voices that speak to them all day long.

These people don’t need our judgment and punishment, they need our compassion and help.

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I just suffered through a stupid Zetia ad featuring this lady:

who goes on to say something to the effect of, “My doctor tested my cholesterol, and it was a little higher than we wanted, so he prescribed Zetia!” And now my life is perfect! (Okay, the last line is my cynicism talking.)

Now, I guess I don’t know all her risk factors, but for an otherwise healthy woman, with a cholesterol level “a little higher” than “we wanted,” I’m pretty sure her doctor should have tried 12 weeks of diet and exercise changes first. Or maybe the guidelines have changed, and the Zetia advertisers are more up to date and know more than me. It’s happened before, I’m sure.

This is exactly the reason every other country has banned direct to consumer snake-oiling advertising (besides New Zealand)–it doesn’t present information fairly or in accordance with national guidelines, doesn’t show patients that your doctor actually has to do some quick thinking and calculating to determine if drugs are the right answer for you, and that drugs aren’t always the right answer for you to begin with. (Drugs have SIDE EFFECTS and can do BAD THINGS to people.)

Let’s either jump on the Evidence-Based Medicine bus–and make our advertisers and patients do so, too–or else it’s going to just be another thing we have to explain to our patients and educate them about. Or, I guess, the other option is to just prescribe drugs, admit patients, and do procedures when we feel like it or think it might be a good idea.

On that note, I think I’ll go ahead and get my appendix out, while I’ve got a few free weeks before I’m back in clinics.

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