Code Black is still on TV Did it get any better

Despite some recent ratings problems, the TV show "Code Black" somehow remains on the air. It has lost viewers after five of the last seven episodes including a whopping 23.8% drop in the all-important 18-49 year-old demographic after the 2/17/16 installment.

Its still viable because of fans like Sharon who said on the ratings website: "The best medical show on. I have been in the medical profession 30 years and it depicts the most true to life situations of any of the medical shows I have watched. Love the show." Sharon must work on the psych floor.

I decided to take another look at it. Having seen the 2/17/16 episode, my opinion hasnt changed. Heres why.

A van full of people dressed as zombies with full makeup was in a crash. You may recall from my last review of this program that I had predicted something similar when I wrote, "Stay tuned for the next episode featuring a bus that tumbles off a narrow mountain road while carrying non-compliant hemophiliacs."

For a while, the docs couldnt tell the real injuries from the ones created by moulage. Very clever.

Two victims from the zombie van crash underwent major surgery—a man who had his ruptured diaphragm repaired and his son who failed conservative management of his injured spleen and required a splenectomy. Father and son spent their entire hospitalizations in the emergency department, and they looked remarkably well postoperatively.

Thanks to some timely counseling by the ED head nurse who got the child to overcome his dislike of the fathers fiancée, the man married her in his spacious ED room. Both were in full zombie regalia. The wedding was attended by the son and a number of ED staff including one of the attending physicians who performed the ceremony.

A woman had abdominal pain a few weeks after in-vitro fertilization. She was the wife of a VIP who donated a floor to the hospital. Of course, higher-ups in the organization became involved, and the patient was treated differently than the average patient [at least that was realistic]. She crashed while waiting to have a CT scan and needed emergency surgery for an ectopic pregnancy.

But the piece de resistance for this episode occurred when the surgeon performing the splenectomy on the child asked for a suture [type unspecified]. The camera took a close shot of his hand while the scrub nurse handed him … a scalpel. My research staff captured that moment.

When I was a resident, we had some great scrub nurses. We used to say to them, "Give me what I need, not what I ask for." Maybe thats the case at Angels Memorial too.

Thanks to a sharp-eyed anonymous commenter on a previous post for letting me know about the scalpel incident.

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Cautionary tales about the matching process

Within the next two weeks, anxious fourth-year medical students will submit their residency choices to the National Residency Matching Program. I have written many posts about how to investigate residency programs and the workings of the match.

Here are a couple of stories about deception and disappointment. The first appeared as an anonymous comment on a post I wrote about how to rank surgical residency programs.

I am the spouse of a surgical resident halfway through their residency. When I hear of the idea of "vetting" the residency program as med school graduate, it makes me laugh and cringe. Its not really possible.

We were extremely concerned about not getting stuck in a malignant or toxic program. But these people must have been aware of how bad the program was, we thought the place had the happiest, friendliest people. What a facade.


So now what? We struggle. If it gets too bad I suppose we will try to switch to a new surgical program. Maybe the switch is to a different discipline altogether. Time will tell.

The take-away is perhaps make sure you are lucky, because if you are not, life is hard, and options to fix it are even harder. [I wish I could tell you how to make sure you are lucky.]

In the mean time we will show up at each and every required recruitment dinner. We will smile, we will follow the script and lie our asses off. Why? Because if we dont we will be labeled a "problem" resident and never get a recommendation from the PD to another program. So the cycle continues. Does the program kick out good surgeons, perhaps, but how many do they lose or worse ruin?

Vetting...no. Luck of the draw.

The second, also by an anonymous writer, appeared on the KevinMD website. At over 1700 words, it is too long to reproduce here. But it echoes the theme. Here are a few excerpts.

Within only a few days of starting my residency, I was called “retarded” and referred to with homophobic slurs. Women were commonly referred to with misogynistic labels.

After one semester of training, I was told that I had not been studying enough because I didn’t do well on the national in-service examination, a test given nationally used to measure your performance versus residents at other programs. I was threatened with academic probation and warned that I needed to read more. [Do you think the writer might be a surgical resident?]

He describes his increasing despair at the lack of teaching and respect. He failed to obtain a fellowship and speculates about possible reasons.

Today I remain discouraged, jobless, and deeply regretful of the decision I made as a medical student to choose the residency program that I did. I try to remain hopeful that someone will give me a chance and renew my interest in practicing medicine the right way, but it is hard to remain optimistic.

My goal in writing is that as this year’s match day approaches, I plead with the newly graduating doctors out there to please do your homework. Do ask about board passage trends, do try to find out why questionable programs don’t always fill with applicants in the NRMP, and do not assume that an appropriate educational plan is being offered at a program simply because it is accredited. The ACGME and the NRMP publish listings of programs that are on notice, so avail yourself of these listings. Your residency program is a place where you will work very closely with what may amount to be only a small number of supervising doctors, and you only really get one chance to make the right decision.

In my case, there were red flags that I did not pay close enough attention to. During my interview, the residents gave very short and incomplete answers to my questions, and several of them seemed downright unhappy. I had just assumed that the faculty were part of a medical school which was never the case, and I failed to do any research with respect to the effect that program size might have on education. Don’t make the same mistakes that I did, and best of luck to all of the new docs out there. 

I don’t think the match depends on luck, nor do I think that the size of a program makes a difference.

There are two sides to every story, and we will never hear the other sides of these.

However, do not completely discount these anecdotes just because the writers are anonymous. You can understand why the writers did not reveal their names.

I hope all of you did your due diligence, but as these stories show, sometimes it is not enough.

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How To Make Money With Adfly And Forums 2014 Trick

How To Make Money With Adfly And Forums 2014 Trick

I do not know if you knew this but having an Adf.ly or a Shorte.st account on forum will give you TONS of traffic and remember that Traffic means Money.

Well you know i found out about this awesome way to make traffic online and also money online because i always mess around to found ways to make my life easier lol does that makes sense? 

How to make money with adfly and forum is the best trick ever and i know for sure you are going to love this trick because i havent seen anyone else saying this trick , so i think i am the first one i do not know?

First you need to register to this FAMOUS forum called WarriorForum click there to signup now 

Now you probably saying what in the world is WarriorFoum , well it is a forum that is all about money making online you will find ALOT of ways to make money online and i am always there you probably will see me around asking questions or buying other ways people offer to make money online.!

I am telling you this forum is THE BEST right now on the internet , you can even search for it just go to google and put WarriorForum or just click HERE and just signup right away.!

Now , how can i make money with this website? Well you are going to put your affiliate link of adfly with shorten url , that means you will get your link affiliate link referral link and short it on adfly also and then put it on you SIGNATURE on WARRIORFORUM , now why on your signature? Because you can , and because that is not SPAMMING you can put your links there.!

Also if you see someone needs help , please if you know the answer you can always help them and put the adfly link there and they will clik your link or even GUESTS who are not member of WarriorForum ,

Now check it out and please do not spam and be gentle.!

GodBless

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Duke Docs Who Attached Intestine to Vagina Must Stand Trial

Catchy headline, isnt it?

That headline appeared two years ago on the Outpatient Surgery website. Too bad it wasnt accurate.

This case has been a topic on the Internet off and on for a few years. Although the patients surgery took place in 2008, the malpractice trial did not occur until earlier this month.

Like nearly every news media article about malpractice incidents, details were sketchy and sensationalism was featured.

Also common in cases like this that although many stories appeared about the case before the trial, but few reported the verdict. That is because after deliberations lasting less than one day, the doctors were not found guilty of negligence.

According to a story on the only media outlet reporting the verdict—Courtroom View Network, heres what happened.

The patient underwent surgery for debilitating chronic constipation at Duke University Medical Center in 2008. Postoperatively, she developed a recto-vaginal fistula [a tract or tunnel from the rectum to the vagina] due to a portion of vaginal wall being caught in the surgical staple line when the intestine was reconnected. The problem was corrected by a second operative procedure.

Prior to the first case, the patient had been informed that secondary procedures might be necessary if complications arose.

The malpractice suit was originally denied by a lower court because the plaintiff could not find an expert witness to testify that negligence had occurred, but an appeals court ruled that an expert was not necessary because "even a layperson would be able to determine whether or not negligence occurred," and "It is common knowledge and experience that intestines are meant to connect with the anus, not the vagina, even following a surgical procedure to correct a bowel problem."

Although the second operation solved the patients problem, she claimed that she had suffered a conversion disorder causing slurred speech, tremors, and weakness. However, subsequent treating physicians felt that her symptoms were inconsistent and that she was "trying to appear disabled."

This case illustrates several important principles about medical malpractice cases.

They often take a long time—an average of 4 to 5 years—to be resolved.

Every less-than-perfect outcome is not necessarily due to negligence. Recto-vaginal fistula is a known complication of this type of surgery.

Stories from 2013, when the appeals court said the case could go to trial and from this year just before the trial started, implied that the surgeons had mistakenly attached the intestine to the vagina which many of us found hard to believe. But without knowing the details, we could only speculate.

The jury did not believe the alleged damage—a conversion reaction—was real.

This lawsuit, which cost both the plaintiffs attorney and the defendants insurance company a lot of money and dragged two highly competent and respected surgeons through the mud for 7 years, should never have gotten off the ground.

There was a reason that plaintiff couldnt find an expert to testify that negligence occurred. The intestine was never mistakenly "attached to the vagina."

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Pain is not the 5th vital sign

No, contrary to what you may  have heard, pain is not the 5th vital sign. Its not a sign at all.

Vital signs are the following: heart rate; blood pressure; respiratory rate; temperature.

What do those four signs have in common?

They can be measured.

A sign is defined as something that can be measured. On the other hand, pain is subjective. It can be felt by a patient. Despite efforts to quantify it with numbers and scales using smiley and frown faces, it is highly subjective. Pain is a symptom. Pain is not a vital sign, nor is it a disease.

How did pain come to be known as the 5th vital sign?

The concept originated in the VA hospital system in the late 1990s and became a Joint Commission standard in 2001 because pain was allegedly being undertreated. Hospitals were forced to emphasize the assessment of pain for all patients on every shift with the (mistaken) idea that all pain must be closely monitored and treated .

This is based on the (mistaken) idea that pain medication is capable of rendering patients completely pain free. This has now become an expectation of many patients who are incredulous and disappointed when that expectation is not met.

Talk about unintended consequences. The emphasis on pain, pain, pain has resulted in the following.

Diseases have been discovered that have no signs with pain as the only symptom.

Pain management clinics have sprung up all over the place.

People are dying. In 2010, 16,665 people died from opioid-related overdoses, a four-fold increase from 1999 when only 4,030 such deaths occurred. And the number of opioid prescriptions written has doubled from 109 million in 1998 to 219 million in 2011.

Meanwhile in the 10 years from 2000 to 2010, the population of the US increased by less than 10% from 281 million to 308 million.

Doctors are caught in the middle. If we dont alleviate pain, we are criticized. If we believe what patients tell us—that they are having uncontrolled severe pain—and we prescribe opioids, we can be sanctioned by a state medical board or even arrested and tried.

Some states now have websites where a doctor can search to see if a patient has been "doctor shopping." I once saw a patient with abdominal pain in an emergency room. After looking up her history on the prescription drug website, I noted that she had received 240 Vicodin tablets from various doctors in the four weeks preceding her visit.

Thats a lot of Vicodin, not to mention a toxic amount of acetaminophen if she had taken them all herself during that month.

What is the solution to this problem?

I dont know, but as long as pain is touted as the fifth vital sign, I do not see it getting any better.

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Medicine like air travel once was fun

A Wall Street Journal blog about a reunion of employees of American Airlines lamented the good old days of air travel. Heres an excerpt:

"They came together to celebrate the days when flight attendants in white gloves hustled to serve you, gate agents doled out upgrades and arranged seating so families could be together, and managers worked flights with the single mission of ensuring excellent customer service."

The employees told tales of the fun they had and the camaraderie they shared. The passengers had fun too.

One retiree said of todays airline employees, "They dont look like they are having any fun at all."

Certainly the same can be said of todays passengers.

Im usually not a fan of the airline-medicine analogy, but Im going to make an exception here.

Back in the day, those of us in medicine had fun too. Dont get me wrong. It wasnt at the expense of the patients.

We always approached our patients with a proper attitude of respect. But it was OK to enjoy those encounters and also the fellowship of colleagues. We helped each other out, and we did it with spirit and camaraderie.

Not anymore.

All we read about now is how doctors are burned out, stressed, depressed. We battle with electronic records, hospital administrators, clipboard carriers, third-party payers, the government and just about everyone else.

What happened to the fun? Its all about the money.

David Shaywitz in Forbes: "The view from the front lines suggests that hospitals and care delivery systems are obsessing like never before on doing whatever they possibly can to maximize their revenue. They are consumed, utterly consumed, by this objective."

He added: "Many (I’d say most) providers and provider groups feel that they are locked in a deadly battle with payors (and increasingly, other providers) for their livelihoods; many feel they are having to work harder and harder to bring in the same (or less) money then doctors a generation ago. Many feel that the profession has lost the autonomy and respect it used to enjoy, and that providers are now viewed as mechanized assembly line workers, held to strict quantitative “quality” metrics that rarely capture the complexity, or essence, of the patient experience."

I believe what Shaywitz said is true. Can anything be done or is it hopeless?

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