tag:blogger.com,1999:blog-65556025264342246012024-02-19T05:52:28.937-05:00Human Factor in Medicine and Life.This blog portrays my observations. My experiences and interpretations, as a physician and also on a more personal level.
A picture already exist through your eyes in your mind, you just need a camera to capture it.Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.comBlogger113125tag:blogger.com,1999:blog-6555602526434224601.post-14559650359255412872013-03-21T22:32:00.000-04:002013-03-21T22:32:20.550-04:00CAUTION<div style="text-align: justify;">
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I sat in my car kind of exhausted after admitting 16 new admits. As I turned the engine on I saw the warning on the GPS screen, so it came to me that there should be a warning at the start of a Hospitalist shift.</div>
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I changed few things here so if there ever is a warning, it should look like this.</div>
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"Admit patients safely and obey hospital rules. Watching your life pass by while spending insane amount of time in hospitals can lead to serious health problems. Place all night orders when completely awake. Some patient data provided by ER doc maybe incorrect. Talk with patients rather than navigating the computer". Agreed?<br />
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PS: About the picture.<br />
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Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-15387082182555895392013-03-14T21:45:00.000-04:002013-03-14T21:45:35.097-04:00What About Bob!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguJng_HapvHVCvulSN-xrWJFAbMTqn_vLP6sEDQ2Le5NSGufdPWkeAiYv0gpn804wXkZRl70xwVBOdgKvudTAZzy8a0zcMotybdpfeqJ9HNccqF3l9DNKE1ta_qWbxEYbVw5ar94E9Ipfp/s1600/ALI_0504.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguJng_HapvHVCvulSN-xrWJFAbMTqn_vLP6sEDQ2Le5NSGufdPWkeAiYv0gpn804wXkZRl70xwVBOdgKvudTAZzy8a0zcMotybdpfeqJ9HNccqF3l9DNKE1ta_qWbxEYbVw5ar94E9Ipfp/s320/ALI_0504.jpg" width="213" /></a></div>
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I had a meeting with one of the administrators this week. He told me this interesting story. </div>
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During his rounds in the hospital, he went to see an elderly sweet lady. She was lying in bed, lost in her own thoughts. He introduced himself and inquired if there is any thing he can do?</div>
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Our lady was very grateful that a hospital administrator came to her room and he cares enough to ask her if there is any thning she needs. That pleasant conversation went on for few minutes.</div>
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Our administrator by then was quite confident that he has created a good rapport with this lady. On his way out he asked "is there anything else I can do for you?"</div>
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She looked up at him and said "let me ask Bob" she turned her head towards an emty chair asked "so Bob is there any thing else he can do for us?" </div>
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For the next five minutes she continued to have a very creative discussion with the empty chair and invisible Bob. </div>
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During this time our administrator stood there, very confused and not wanting to interrupt, after she was done she dismissed him.</div>
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There are so many lessons to learn from this story but mostly, never sit on an empty chair, you may hurt Bob! ............</div>
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PS: About the picture.</div>
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Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-59584527980168269352013-03-12T22:55:00.003-04:002013-03-12T22:57:10.493-04:00Disease Management System.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQjbdxrHwAT-sYikeI4hChwMvjx4UwjW_pvhzeZWuziC21U3ASgs4DVjWLQNvnKxh-cJecdJrVXMtcIpkB3ZNdu2DE8qppTm-OAk_lQAke1AA3jPNgT84AF4kqg0Tloj08jX0ca6hG220c/s1600/Sunrise+Kauai-549.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQjbdxrHwAT-sYikeI4hChwMvjx4UwjW_pvhzeZWuziC21U3ASgs4DVjWLQNvnKxh-cJecdJrVXMtcIpkB3ZNdu2DE8qppTm-OAk_lQAke1AA3jPNgT84AF4kqg0Tloj08jX0ca6hG220c/s400/Sunrise+Kauai-549.jpg" width="400" /></a></div>
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Andrew Weil is an internationally renowned writer on holistic health and wellness, I recently came across an article about him. </div>
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Mr. Weil says "we do not have a health care system in America. We have a disease management system-- one that depends on ruinously expensive drugs and surgeries that treat health conditions after they manifest"</div>
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For details you can read <a href="http://www.cnn.com/2013/03/08/opinion/weil-health-care/index.html?hpt=hp_c1" target="_blank">this</a> article. I agree with the idea that our main emphasis is biased more towards the health industry rather than the patient and primary care.</div>
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We do not emphasize as much about balanced diet, exercise and prevention as we do about emerging medications coming out soon or the latest and the greatest CT scan on the block. Health industry these days is targeted towards maximising profits.</div>
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Recently I overheard one radiologist bragging to the other "I have a 128 slice CT, what do you have?". </div>
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Few months ago I had a pleasure of visiting <a href="http://www.livingwellnessuniversity.com/Saxena/Home" target="_blank">Dr Shilpa P. Saxena's office</a> during a meet and greet campaign for a new hospital my organization built in the area. </div>
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She was indeed a breath of fresh air. She believes that patient makes better choices when they understand all the factors which lead to a diseased state. She is the only physician I know who has a fitness centre in her own office. </div>
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In her practice if a patient comes in with high cholesterol, he is not automatically prescribes Statins, but he is prescribed a regimen of work out and exercise. I wrote about obesity some time ago <a href="http://humanfactorinmedicineandlife.blogspot.com/2010/08/i-was-walking-in-chinatown-new-york.html" target="_blank">here</a>, I think we need to work on these issues a little more.</div>
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I think we need more PCPs to fashion their practices along the same way.</div>
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About the picture: A new day.</div>
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Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-25992489246011072352013-03-10T22:40:00.000-04:002013-03-10T22:41:08.554-04:00Bring your own measuring cup.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUDQMS4D2oQ9uyl8vwu391XuWbhunVnN_ilyO2wkUOeUH-0HtOMeFikluSeDlU-YLKhpdstMz1ZJOMsfy0nbghJJMSHIlphftadDfRA2Z4C7az-H9AN-QbYVrNygbIHJ2uvx4GULo20_AE/s1600/ALI_20110722_Europe_01055.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUDQMS4D2oQ9uyl8vwu391XuWbhunVnN_ilyO2wkUOeUH-0HtOMeFikluSeDlU-YLKhpdstMz1ZJOMsfy0nbghJJMSHIlphftadDfRA2Z4C7az-H9AN-QbYVrNygbIHJ2uvx4GULo20_AE/s400/ALI_20110722_Europe_01055.jpg" width="400" /></a></div>
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I recently met a sweet old lady, I think she was in her early eighties. She had abnormal liver functions.<br />
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I was suspecting either statins, hepatitis or alcohol.<br />
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Considering she may be a a closet drinker. So I asked her "ma'am do you drink alcohol everyday". She looked at me and said "just 1 glass a day".<br />
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I got a little curious and asked her how big of a glass do you use and she said "16 Oz".<br />
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I smiled and advised her to shrink the size of her glass from now on.<br />
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PS: About the picture: Alcoholic bird versus chips heist.Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-7105187433839578762013-03-08T17:56:00.000-05:002013-03-08T17:59:13.344-05:00God give me a "sweet-dream" bacteria, not a nightmare bacteria.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUOuc4wux-dp9aimWIw-x7Fobw-JTQ5AfG4T45i3Vzfu4YXmCslIhWe5tpmXHnC9B_HGICwwHLuEYEyj6us7NmAd2nQ-MnaPNVDR1s5bqQT2NdI8spFps6FVUScJuJPOhN2YRn06YpAZyh/s1600/ALI_0560.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUOuc4wux-dp9aimWIw-x7Fobw-JTQ5AfG4T45i3Vzfu4YXmCslIhWe5tpmXHnC9B_HGICwwHLuEYEyj6us7NmAd2nQ-MnaPNVDR1s5bqQT2NdI8spFps6FVUScJuJPOhN2YRn06YpAZyh/s400/ALI_0560.JPG" width="400" /></a></div>
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<span style="font-family: inherit;">Once there was a bug, it was called Enterbacteriaceae, it was a run of the mill bug (if there are any).</span><br />
<span style="font-family: inherit;">It started to misbehave occasionally, later is became anti social and now it is all out psychopath. </span><br />
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<span style="font-family: inherit;">We have a monster of a bug now<span style="background-color: white; line-height: 19px; text-align: left;"> called carbapenem-resistant Enterobacteriaceae or CRE. Even s</span></span><span style="font-family: inherit;">ome of our most potent antibiotics have no affect on this bug.</span><span style="font-family: inherit; line-height: 19px;"> Unfortunately... it is spreading.</span></div>
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<span style="line-height: 19px;"><span style="font-family: inherit;">Most of us who are healthy would not be affected with this bug but our hospitalized patients or who have weak resistant may succumb to this bacteria.</span></span></div>
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<span style="font-family: inherit;">I am not surprised that Dr Fieded from CDC calls it a "Nightmare Bacteria"</span><br />
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<span style="font-family: inherit;">And the reason is;</span><br />
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<span style="font-family: inherit;">1- It is highly resistant.</span><br />
<span style="font-family: inherit;">2- It carries a mortality rate of 50% or more.</span><br />
<span style="font-family: inherit;">3- The way it becomes resistant, it can spread this mechanism to other bacterias.</span><br />
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<span style="font-family: inherit;">Our other bad boys like, MRSA (Methicillin-resistant Staphylococcus aureus) or ESBL (Extended -Spectrum Beta Lactamase) bacterias, seems like angels here.</span><br />
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<span style="font-family: inherit;">Please remember you can decrease your risk by properly washing hands, follow precautions and always judicious use of antibiotics.</span><br />
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<span style="font-family: inherit;">PS: About the photo: <a href="http://en.wikipedia.org/wiki/Dreamcatcher" target="_blank">Dream catchers</a>. </span><br />
<span style="font-family: inherit;">Disclaimer: Dream Catcher not recomedend for use as an alternate to antibiotics or doctor visit.</span><br />
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<br />Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-46224266706539464732013-03-06T20:02:00.001-05:002013-03-06T20:02:24.563-05:00Tele-Intensivist. <br />
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We are so used to Doctor in a box AKA Tele-Neurologist (<a href="http://humanfactorinmedicineandlife.blogspot.com/2010/10/tele-neurologist-specialist-on-call.html" target="_blank">prior blog here</a>) these days that it is just a routine to request a Tele Neurology consultation without giving it a second though.<br />
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Some of you may be naive to this concept!. So in cases where we need a stat neurology consult and as there is a shortage of neurologist in town, we ask for a tele neurologist consult. A nurse brings a computer to the room and turns the camera on. A neurologist remotely reviews everything and then gives his recommendations.<br />
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So I thought that was it, but then came in Tele-Psychiatrist. We went with the flow and started to request them for our suicidal patients.<br />
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And again I thought that we were done.<br />
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Today I was reviewing some documents and I saw that one of our hospitals have been approached by Tele-Intensivist/Critical care services. <br />
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I am at a little loss here, how can they intubate or place lines from hundred of miles away. May be I am still living in the time where if I am a patient I would rather see a doctor in person.<br />
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What is that Chinese curse "May you live in interesting times" I think we are.<br />
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PS: About the picture. Room full of consultants.<br />
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<br />Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-17859263109254945952013-03-03T22:33:00.000-05:002013-03-03T22:35:05.806-05:00Healthcare Being Sequestered!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoP4CPdQNbntaM7dhJ_oKUoN-hR0DDWdbvcTRnQ-2mm7TtApjWmpNDCgZRFH4GYanDT6hbod_zcOrvlZEYFSUvXwBb1moWzacOAasVwmxCxB_Cp9g0MfTRpkg6CGKR9IvZxXvhaiV4bv7H/s1600/ALI_0199.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoP4CPdQNbntaM7dhJ_oKUoN-hR0DDWdbvcTRnQ-2mm7TtApjWmpNDCgZRFH4GYanDT6hbod_zcOrvlZEYFSUvXwBb1moWzacOAasVwmxCxB_Cp9g0MfTRpkg6CGKR9IvZxXvhaiV4bv7H/s320/ALI_0199.jpg" width="320" /></a></div>
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<br /></div>
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<span style="color: #262626; font-family: inherit; font-size: 14pt;">President Obama signed forced spending cuts of $85 billion
dollars last Friday. There has been a public outrage but it is already too late.</span><br />
<span style="color: #262626; font-family: inherit; font-size: 14pt;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: 15.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; font-family: inherit; font-size: 14.0pt;">What does this mean for us? just $11 billion dollars spending
cut for Medicare.</span></div>
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<span style="color: #262626; font-family: inherit; font-size: 14.0pt;"><br /></span>
<span style="color: #262626; font-family: inherit; font-size: 14.0pt;">Yes Sir, Medicare is going to slash away $11 billion in payments
to healthcare providers, this amounts to a 2% cut.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 15.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; font-family: inherit; font-size: 14.0pt;"><br /></span>
<span style="color: #262626; font-family: inherit; font-size: 14.0pt;">All Medicare providers including hospitals, doctors and other
allied health services will get the brunt of this order.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 15.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; font-family: inherit; font-size: 14.0pt;"><br /></span>
<span style="color: #262626; font-family: inherit; font-size: 14.0pt;">It will also effect CDC, American Public health, FDA,
Vaccination programs, education programs (HRSA) , substance abuse and Mental
health services administration (SAMHSA) and community healthcare center
patients.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 15.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; font-family: inherit; font-size: 14.0pt;">Imagine this is only one sector, please go and search what is
happening to your sector. <o:p></o:p></span></div>
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<span style="color: #262626; font-family: inherit; font-size: 14.0pt;"><br /></span></div>
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<span style="font-family: inherit;"><span style="color: #262626; font-size: 14.0pt;">PS: About the picture: Bend a slinky too many times and it will stop springing back to its </span><span style="color: #262626;"><span style="font-size: 19px;">original shape.</span></span></span></div>
<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-20830222651337725752013-02-26T23:12:00.001-05:002013-02-27T09:03:43.242-05:00Please change Diet orders. Mediterranean diet<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFzfHY9FNfZeouYjAxl08Wu0NpwcFMDpr445Q2aeIaT5aAIA8RntmdwfwYGFQgh1HWw8rx3IYm6PRld5yUXsiTVzPOWpecmexxAsFOm2q2U_ioKk1zVM7g4SF5f6yxSRrhw12uSTZoS4_B/s1600/mediterranean+diet.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFzfHY9FNfZeouYjAxl08Wu0NpwcFMDpr445Q2aeIaT5aAIA8RntmdwfwYGFQgh1HWw8rx3IYm6PRld5yUXsiTVzPOWpecmexxAsFOm2q2U_ioKk1zVM7g4SF5f6yxSRrhw12uSTZoS4_B/s400/mediterranean+diet.jpg" width="400" /></a></div>
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<br />
Each day I admit cardiac patients who end up with a "heart healthy diet".<br />
It may change now!.<br />
<br />
The definition of heart healthy diet is evolving as we speak. For a diet to be heart healthy I may have to order some nuts, fish, virgin oil with some red wine.<br />
<br />
I hope I won't get into trouble.<br />
<br />
A new <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1200303?query=featured_home&&" target="_blank">study published in New England Journal of Medicine</a> defies our conventional beliefs regarding low fat diet to be heart healthy. This new study suggest that Mediterranean diet is more "heart healthy" almost by 30% as compared to a regular diet.<br />
<br />
In this humongous study out of Spain, where 7447 individuals were enlisted were shown to improve their heart attack risk by 30%.<br />
<br />
<br />
Participants were asked to eat white meat like fish, lentils, almonds, walnut and virgin oil. Results are so phenomenal that some of the primary researchers even changed their own diet.<br />
<br />
By the way today I bought some nuts on my way back!<br />
<br />
PS: About the picture, very visual menu somewhere in Europe.<br />
<br />
<br />
<br />Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-72061614440084557022013-02-22T20:43:00.001-05:002013-02-22T20:43:06.314-05:00Buddhist temple, Kyoto, Japan<div style="float: left; width: 100px; margin: 0 20px 10px 0; padding: 0; font-size: 0.8em; line-height: 1.6em;"><a href="http://www.flickr.com/photos/15882714@N03/8472178500/" title="Buddhist temple, Kyoto, Japan"><img src="http://farm9.staticflickr.com/8521/8472178500_54ca3678e5_t.jpg" alt="Buddhist temple, Kyoto, Japan by At_a_tangent" /></a><br/><span style="margin: 0;"><a href="http://www.flickr.com/photos/15882714@N03/8472178500/">Buddhist temple, Kyoto, Japan</a>, a photo by <a href="http://www.flickr.com/photos/15882714@N03/">At_a_tangent</a> on Flickr.</span></div><br clear="all" />Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-55325930442455295652013-02-22T20:41:00.003-05:002013-02-22T20:41:40.697-05:00Keeping an eye on me.<div style="float: left; width: 100px; margin: 0 20px 10px 0; padding: 0; font-size: 0.8em; line-height: 1.6em;"><a href="http://www.flickr.com/photos/15882714@N03/8475964487/" title="Keeping an eye on me."><img src="http://farm9.staticflickr.com/8376/8475964487_f08751e40e_t.jpg" alt="Keeping an eye on me. by At_a_tangent" /></a><br/><span style="margin: 0;"><a href="http://www.flickr.com/photos/15882714@N03/8475964487/">Keeping an eye on me.</a>, a photo by <a href="http://www.flickr.com/photos/15882714@N03/">At_a_tangent</a> on Flickr.</span></div><br clear="all" />Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-82895111590463581302013-02-22T20:41:00.001-05:002013-02-22T20:41:28.382-05:00Bird One<div style="float: left; width: 100px; margin: 0 20px 10px 0; padding: 0; font-size: 0.8em; line-height: 1.6em;"><a href="http://www.flickr.com/photos/15882714@N03/8475964321/" title="_DSC0419"><img src="http://farm9.staticflickr.com/8517/8475964321_31461f5bc4_t.jpg" alt="_DSC0419 by At_a_tangent" /></a><br/><span style="margin: 0;"><a href="http://www.flickr.com/photos/15882714@N03/8475964321/">_DSC0419</a>, a photo by <a href="http://www.flickr.com/photos/15882714@N03/">At_a_tangent</a> on Flickr.</span></div><br clear="all" />Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-79619646529626103692013-02-22T20:22:00.001-05:002013-02-22T20:22:22.292-05:00Yahoo Dome, Kyoto. HDR version<div style="float: left; width: 100px; margin: 0 20px 10px 0; padding: 0; font-size: 0.8em; line-height: 1.6em;"><a href="http://www.flickr.com/photos/15882714@N03/8482501967/" title="Yahoo Dome, Kyoto. HDR version"><img src="http://farm9.staticflickr.com/8370/8482501967_38c489373d_t.jpg" alt="Yahoo Dome, Kyoto. HDR version by At a tangent" /></a><br/><span style="margin: 0;"><a href="http://www.flickr.com/photos/15882714@N03/8482501967/">Yahoo Dome, Kyoto. HDR version</a>, a photo by <a href="http://www.flickr.com/photos/15882714@N03/">At a tangent</a> on Flickr.</span></div><br clear="all" />Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-10448535142258684732013-02-22T20:06:00.000-05:002013-02-26T22:42:54.526-05:00Huddle, Multidisciplinary Rounds.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7IXS4z5pw0Hs4cjsEjF1CvuqUvwAAMC9cMEb3W8muRuIJBojlMnqv8C0qYujWvkQcHCl7CE2ZBaj0LslPozFNRWLSv4JgKx3jkDKk6w-5DijxzCqjEqtEQcaJpmIf4LobbSOdDZPn4Ox6/s1600/ALI_20110721_Europe_00806.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7IXS4z5pw0Hs4cjsEjF1CvuqUvwAAMC9cMEb3W8muRuIJBojlMnqv8C0qYujWvkQcHCl7CE2ZBaj0LslPozFNRWLSv4JgKx3jkDKk6w-5DijxzCqjEqtEQcaJpmIf4LobbSOdDZPn4Ox6/s320/ALI_20110721_Europe_00806.jpg" width="320" /></a></div>
<br />
<br />
<div>
Finally I was able to successfully roll out Huddle or multidisciplinary rounds at all three hospitals.</div>
<div>
<br /></div>
<div>
So far I have heard great things the way we are conducting these rounds. </div>
<div>
<br /></div>
<div>
We have a huddle for 20 minutes every day, less than a minute per patient at a specific location in each hospital.</div>
<div>
<br /></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">Out team members include everyone who are stakeholders in patient care.</span></div>
<div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);"><br /></span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">1- Dedicated case manager. (I would appreciate if you can assign a dedicated case manager for all our patients</span><span style="background-color: rgba(255, 255, 255, 0);">)</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">2- House nursing supervisor.</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">3- Floor supervisors (optional).</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">4- Physical therapy and occupational therapy.</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">5- Dietary.</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">6. Core measure/ quality measure person for real time corrective measures for CHF, Pneumonia, AMI etc.</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">7- Hospital DRG coder. (Again this would take care of any def. in documentation).</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">8- Mr. Computer, so we can take care of orders during rounds.</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">9. Pharmacist (if they can).</span></div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">Our team has so far improved,</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">1- Potential early discharges and transfers. </span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">2- Plan of care for the day.</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">3- Identify needs for patients.</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">4. Improve work flow and delegation of tasks.</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">5. Improve core measure compliance and power plans. </span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">6. Improve documentation. </span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">7- Contain cost per case.</span></div>
<div>
<br /></div>
<div>
And the best part is.... it is a lot of fun.</div>
</div>
Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-32113308302293444672012-05-24T12:29:00.000-04:002012-05-24T13:19:48.435-04:00Hiroshima, A Hard Stop.<br />
<br />
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<div class="separator" style="clear: both; text-align: center;">
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLVfJwmvPKGiIeITZ0NncvjULcR_zSMdfxqLMOcVxK55pAGcOcPJcehnOg-Vyar99dJ0L0LP8iLzMqkAKm6B0ArhrDtZHLud2gOIaNpJTQOqdqz-wnVMbMI-FNo9Po1dEIEMDnJIPh3RV0/s1600/photo-4.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLVfJwmvPKGiIeITZ0NncvjULcR_zSMdfxqLMOcVxK55pAGcOcPJcehnOg-Vyar99dJ0L0LP8iLzMqkAKm6B0ArhrDtZHLud2gOIaNpJTQOqdqz-wnVMbMI-FNo9Po1dEIEMDnJIPh3RV0/s200/photo-4.JPG" width="149" /></a></div>
<br />
<br />
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
A
hard stop is something you can absolutely not do after a certain point. I believe as far as nuclear arsenal is
concerned we should have had a hard stop on August 6<sup>th</sup>, 1945.</div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
We
were in Koyoto for few days; we were debriefed regarding our Kaizen project in
Fukoaka. Dr Rippe, Dr Nunez and I
decided to make a quite round trip to Hiroshima. We took a bullet train and
ended up in Hiroshima. <o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
I
wanted to visit this site since I wrote a blog <u><a href="http://humanfactorinmedicineandlife.blogspot.jp/2010/08/i-am-not-one-of-shadow-people.html">here</a></u> almost two years ago
regarding a patient of mine who was in Hiroshima. <o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
As
soon we entered the Hiroshima Peace Park, it felt like the bomb was still hovering over you rather then something which has happened almost 70
years ago. <o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Sometimes
you can almost feel the sounds of tortured spirits screaming and begging you to
stop their anguish, your mind starts to play tricks on you, you can smell
bodies burning and seeing charred skin. As you continue to walk you finally
come across ground zero, the prefectural Hall that now lies in ruins. <o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
My
friend Ramone was in so much anguish, he could not even finish the museum. <o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
In
the end you wonder what has changed since then? Our course remain
unaltered. Auschwitz, Bosnia, Rawanda and 9/11…. <o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
About
the picture: The picture shows a
shadow left behind by radiation heat rays. The shadow is of a person who was sitting
250 meters from the hypocenter, waiting for the bank to open. It never did!<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
</div>Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-7422765575006856912012-05-22T11:31:00.001-04:002012-05-22T11:33:30.658-04:00Toyota Production System. Part 3.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3bJQAB-DppY7CU5GXJ7Q2AL2R4091j-q6c2n8zN5yCa4xMcxTPELHe-UMGSZ828XSEwB-3l9jzQY46XKgDLIsCD5jEC6ysGN4yScrxnaVUF20JqfA0Cw3anVtqV8lnA0q9ag1JZesHB1m/s1600/photo-3.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3bJQAB-DppY7CU5GXJ7Q2AL2R4091j-q6c2n8zN5yCa4xMcxTPELHe-UMGSZ828XSEwB-3l9jzQY46XKgDLIsCD5jEC6ysGN4yScrxnaVUF20JqfA0Cw3anVtqV8lnA0q9ag1JZesHB1m/s200/photo-3.JPG" width="149" /></a></div>
<br />
<br />
Kaizen
project at Showa Industry.<br />
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Our
2 teams spent 5 grueling days at the Showa Tekko plant in Fukuoka. This
particular plant produces all kind of equipment, from air conditions to vacuum
boilers. Some of their cooling equipment is as large as a small building.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Our
project was to Kaizen (Improve) their production line. They produce a certain
model of air conditioner. Our task was to reduce overtime of their workers
without any change in their production capacity.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
We
utilized Toyota Production principles as I have mentioned before. We divided
our team into 2 sub teams. <o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
We
observed three different operators.
First operator was involved in the assembly, second was
the inspector and third operator was involved with packaging.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Our
goal was to reduce the total TakTime. We started with standard flow chart and
measured their timings. Caroline White was our team leader and she did a
remarkable job leading our team. <o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
We
came up with some great ideas. Dr. Nunez and Ruth Hemphill suggested a U shaped
module for the inspector work station which reduced his walking time
significantly, my team suggested to eliminate waste (Muda) from packaging and
add value to the operator’s time by assisting other colleagues. <o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Our
patients are not cars, but on the other hand we do have a line, a line in the
ER. Different patients presenting with different problems like a production line,
where you may have a Camry and the next could be a Highlander.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Our
goal is to have a standard work for these problems so that all operations run
free of defects/medical errors and our quality remains top notch/improved survival.<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-34338509296342455852012-05-18T10:39:00.001-04:002012-05-18T10:39:43.532-04:00Toyota Production System. Part 2.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxkNxig19pawVsoEa3Svnjtpaw0Zd_PGo9SYdiueUXEWyM0LXIgLR31-tpNyfkCWDBvmqoFDwtv4rPYJSbhMr1iz_KGTXK-nFJYe91xbKUR5ooE8aHDZuBbagJyTz3HYbAIYiWG8cqiIWB/s1600/photo.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxkNxig19pawVsoEa3Svnjtpaw0Zd_PGo9SYdiueUXEWyM0LXIgLR31-tpNyfkCWDBvmqoFDwtv4rPYJSbhMr1iz_KGTXK-nFJYe91xbKUR5ooE8aHDZuBbagJyTz3HYbAIYiWG8cqiIWB/s320/photo.JPG" width="239" /></a></div>
<br />
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Toyota Production System Training. <span style="mso-spacerun: yes;"> </span>Part 2.<o:p></o:p></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Kaizen,
it is all about improving a system, any system. This
course,<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">Gemba Kaizen</i>, is about learning skills to improve efficiency
as you decrease <i style="mso-bidi-font-style: normal;">Muda </i>(waste) associated
with work. <o:p></o:p></div>
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<br /></div>
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There
are few key concept one need to comprehend as you learn more about Toyota Production systems.<o:p></o:p></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Cambria; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria; mso-hansi-font-family: Cambria;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Jidoka: it roughly translates to “Automation with
a human touch”. So whenever there is an equipment malfunction, the machine stops
immediately that prevents it from producing defective products.<o:p></o:p></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Cambria; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria; mso-hansi-font-family: Cambria;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->“Just in time” approach: Any process produces
only what is needed by the next process in a continuous flow. It helps with
producing only what is needed, when it is needed and in the right amount.<o:p></o:p></div>
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<br /></div>
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Using
these principles Toyota mass-produces automobiles utilizing the philosophy of
Jidoka and “just in time”. These vehicles are of exemplary quality, long
lasting and up to the par for the customer.<o:p></o:p></div>
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<br /></div>
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Few days ago we spent our day at the Toyota museum. It was a very interesting
experience. Museum has tow major pavilions. One is about textiles/Looms and the
seconds part is about Automobiles.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
Toyota
name is so synonymous with cars that few people know that their initial
business was manufacturing automatic looms.<o:p></o:p></div>
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<br /></div>
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This
was the first time I observed a museum as a student rather than a spectator. Our
goal was to observe Toyota Lean manufacturing and Toyota production system and later describe that process to the group with a brief sketch.</div>
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<o:p></o:p></div>
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<br /></div>
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About
the picture: <o:p></o:p></div>
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<br /></div>
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Picture 1- First circular looms designed by Sakichi Toyoda.</div>
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<br /></div>
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Picture 2- This<span style="mso-spacerun: yes;"> </span>is my sketch. I was impressed by
the automotive pavilion where they tested different metals, improved their
design, they went to the source to get better materials and design and at the
same time kept safety in their mind. </div>
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<br /></div>
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I was never good at sketching!<o:p></o:p></div>
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<br /></div>
<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-39299035463676628542012-05-13T03:44:00.001-04:002012-05-24T12:31:09.959-04:00Kaizen. Toyota Production System.Very interesting day at the Toyota museum. I was amazed by the way this organisation has integrated lean principles in every process. <br />
<br />
Their humble beginnings from a loom machine production company to the largest automotive sale company in the world. <br />
<br />
More to come later. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwdz-Lv3Jv07ZrdfhiE8IvwpaUpkJzBp45r_MZhJiq1cc-Tq7fEtoETMyLROHVc7GaJfbG6Tw9If1ko7h0gsLKJpC2Hk4XLh9d1yp_DsznYvFbIMJcONq7nfdlKXmx1m0R-ShnuaB5SB0j/s640/blogger-image-1070014821.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="238" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwdz-Lv3Jv07ZrdfhiE8IvwpaUpkJzBp45r_MZhJiq1cc-Tq7fEtoETMyLROHVc7GaJfbG6Tw9If1ko7h0gsLKJpC2Hk4XLh9d1yp_DsznYvFbIMJcONq7nfdlKXmx1m0R-ShnuaB5SB0j/s320/blogger-image-1070014821.jpg" width="320" /></a></div>Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-48442140976282632182012-05-12T04:31:00.002-04:002012-05-12T15:11:47.411-04:00Toyota Production System.<div class="separator" style="clear: both; text-align: center;"><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-5bFWijnUDTjjQht2GDmM1sJYZ_YG3wCFhC3xtX48Shh6Yhb8L6YxoOy6MdAIwpmyLgjqpQX1KvwFFVxb7r1N77uPGEsCcPSNWdaEdiQy7_VUnRCyQuJ6lCcIFxuow0cAeRkORDZciLPS/s1600/photo+2.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-5bFWijnUDTjjQht2GDmM1sJYZ_YG3wCFhC3xtX48Shh6Yhb8L6YxoOy6MdAIwpmyLgjqpQX1KvwFFVxb7r1N77uPGEsCcPSNWdaEdiQy7_VUnRCyQuJ6lCcIFxuow0cAeRkORDZciLPS/s1600/photo+2.JPG" /></a></div><br />
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<div style="text-align: justify;">I am attending a course, <i><a href="http://en.wikipedia.org/wiki/Toyota_Production_System">Toyota Production System</a></i> in Nagoya, Japan. I am very excited to learn some new skills in regard to this system. For the next 2 weeks I am here in the land of the rising sun, hopping from one city to another. We have our Value stream map ready to present and as some of you may have guessed, our project in Sepsis-error proofing. Details later.</div><div <br />
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</div><div style="text-align: justify;">About the picture: I saw this gigantic spherical structure today as I was walking along with my group around the museum of Science, looks alien.</div>Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-39930880202092619032012-05-09T23:18:00.001-04:002012-05-09T23:18:29.609-04:00Top Ten Things.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiHQY581wY_V8asB2SZeo7h4aDEIDOhBdEgsu4i9-0Mxp70gRwHk7WKGjA9mNtSWN8KsNVIsWbwPQrdZt3xSJcVFrezYSoExjLQX03k9au8zryzi9Cr0Xh1eUeQmSLBykFJ8mYyAeHDLwC/s1600/ALI_20120415_Macro_00014-2.NEF" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiHQY581wY_V8asB2SZeo7h4aDEIDOhBdEgsu4i9-0Mxp70gRwHk7WKGjA9mNtSWN8KsNVIsWbwPQrdZt3xSJcVFrezYSoExjLQX03k9au8zryzi9Cr0Xh1eUeQmSLBykFJ8mYyAeHDLwC/s320/ALI_20120415_Macro_00014-2.NEF" width="320" /></a></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; font-family: Arial;">I was recently invited as a keynote speaker at our hospital for our staff and nurses dedication day.</span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; font-family: Arial;"><br /></span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;"><span style="font-family: Arial;">This is part of my speech.</span></span></span></div>
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<span class="apple-converted-space"><b><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;"><br /></span></b></span></div>
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<span class="apple-converted-space"><b><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;">Top ten list of things I appreciate the most of the staff and nurses.<o:p></o:p></span></b></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .25in;">
<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;">1- Thank you for loaning me their pens.<o:p></o:p></span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;"><br /></span></span></div>
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<span class="apple-converted-space"><span style="font-family: Arial;">2-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span></span><!--[endif]--><span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;">Being redundant, you
save more medical errors than I can count.<o:p></o:p></span></span></div>
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<span class="apple-converted-space"><span style="font-family: Arial;"><br /></span></span></div>
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<span class="apple-converted-space"><span style="font-family: Arial;">3-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span></span><!--[endif]--><span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;">Making it a great place
to work everyday.<o:p></o:p></span></span></div>
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<span class="apple-converted-space"><span style="font-family: Arial;"><br /></span></span></div>
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<span class="apple-converted-space"><span style="font-family: Arial;">4-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span></span><!--[endif]--><span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;">Thank you for being
passionate about your work. Some people mistake that their eventual goal is
to make lots of money, the focus whould be directed towards your goal.</span></span></div>
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<span style="font-family: Arial;"><br /></span></div>
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<span class="apple-converted-space"><span style="font-family: Arial;">5-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span></span><!--[endif]--><span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;">Thank you for not
hanging up on us in the middle of the night even If you hear us snoring on the other end.</span></span></div>
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<span style="font-family: Arial;"><br /></span></div>
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<span class="apple-converted-space"><span style="font-family: Arial;">6-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span></span><!--[endif]--><span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;">Thank you for smiling
even on your worst day.<o:p></o:p></span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;"><br /></span></span></div>
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<span class="apple-converted-space"><span style="font-family: Arial;">7-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span></span><!--[endif]--><span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;"> Thank you for your compassion and sensitivity.</span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;"><br /></span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;">8- Thank you for using
two point restraints.<o:p></o:p></span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;"><br /></span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;">9-Thank you for charting
and bearing with administators, directors and doctors. <o:p></o:p></span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;"><br /></span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;">10- Thank you for deimpacing and giving fleet enema and kayexalte.<o:p></o:p></span></span></div>
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<br /></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;">In the end I would like
to thank God for letting me prescribe Haldol and thank you from the bottom of my heart for
everything you do."<o:p></o:p></span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;"><br /></span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;">About the picture: Nothing to say today.</span></span></div>
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<span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: Arial;"><br /></span></span></div>Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-80598175461484272572011-10-03T21:04:00.000-04:002011-10-03T21:04:30.405-04:00Despair.<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnkW5kY1DoA2olE7TJkscthvlC6gjh0fpyP9t_0YehrK0ghCAfal5Afe4Wr1U54ORknsPo7cpJENitKmlFC0_F5wwwuDAi7E_jVaBRS_Av7vu_mesr1s_klx8WUzByJu4Ic2vp_X86KvB3/s1600/20110721-CSC_2243.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnkW5kY1DoA2olE7TJkscthvlC6gjh0fpyP9t_0YehrK0ghCAfal5Afe4Wr1U54ORknsPo7cpJENitKmlFC0_F5wwwuDAi7E_jVaBRS_Av7vu_mesr1s_klx8WUzByJu4Ic2vp_X86KvB3/s320/20110721-CSC_2243.jpg" width="320" /></a></div><br />
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<div style="text-align: justify;">She was middle age, sitting up on a hospital bed. She was still like a statue and very disheveled. She was trying to appear strong but the flow of tears were a dead give away. Maybe her inability to control her emotions was compounding her despair and frustration. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">She was again admitted with another suicidal attempt. When we started to talk she opened up and said "I always felt the desire to end it all" she paused for a second like she was trying to find the right words then she said very softly,</div><div style="text-align: justify;">"when I was 8, I used to take cold baths in winter and stand outside the house, hoping I may catch pneumonia!. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Just imagine, 8 years old and so much pain to bear! </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">"I love walking in the rain, 'cause no one knows I'm crying" </div><div style="text-align: justify;">Unknown.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Blog you later.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">About the picture: I shot this inside Doge's Palace. To me it depicts despair.</div><div style="text-align: justify;"><br />
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</div>Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-52455771150580407302011-09-22T21:11:00.001-04:002011-09-22T21:25:09.257-04:00She cried, good Luck with needle stick!<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnWPTHDhhI8Ce3AK0tASzwBENaTbL18OvnalrMUc2KrCpg_k8wR9r80fIVRJY9T_K1b7R2DPJpyC0ay4p2NuwVXXihTlevi5p8cQoc1YPL1MW3noz1yXtw7cmGaEEB1rPuHi4YXboGqoBW/s1600/hope.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnWPTHDhhI8Ce3AK0tASzwBENaTbL18OvnalrMUc2KrCpg_k8wR9r80fIVRJY9T_K1b7R2DPJpyC0ay4p2NuwVXXihTlevi5p8cQoc1YPL1MW3noz1yXtw7cmGaEEB1rPuHi4YXboGqoBW/s320/hope.jpg" width="271" /></a></div><span class="Apple-style-span" style="font-size: 15px;"><br />
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<span class="Apple-style-span" style="font-size: 15px;">She cried not that she was stuck, she cried because I was stuck with her needle.</span><br />
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</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">Sometime back I saw her initially in the ER, around 4:30 in the morning; she was a young girl, a high risk IV drug user who was septic. She was in shock, confused and burning. Her anxious father was pacing nearby; I was afraid that he was going to pass out any time.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">I provided not much comfort to him when I told him that she was in septic shock and that she has a guarded prognosis. <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">She initially refused a central line placement but after much debate she consented but only if my other colleague in the ER would do it. Maybe she found my ER attending to be more comforting. I spoke with the ER physician and she obliged and placed the line.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">The next 24 hours were tough for her, but utilizing the 6 hour and 12 hour <a href="http://humanfactorinmedicineandlife.blogspot.com/2011/03/sepsis-protocol.html">sepsis</a> bundles we were able to stabilize her. I was questioning a vegetation on her heart valve. During a transesophageal echocardiogram, cardiologist saw an artifact in the atrium. Assuming that this could be the central line, we pulled back the line and the artifact on the echo disappeared. Viola… no vegetations. <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">As I was almost done with securing the line I stuck myself. For a second my mind went blank, thinking about the significance of this needle stick from a very high risk patient. Naturally I started to think about my wife, my daughters and our baby who is on the way. All the statistics about needle stick started to resonate ….. risk of transmission after HIV infected blood 0.3%, risk of Hep B 30% and Hep C 10%....<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">Initially I was very angry at myself, I didn’t know what her status was, I should have been more careful, I should have double gloved or ….. done something else. For a moment I felt anger towards her too, though I knew it was not her doing. <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">As I was desperately washing my hands, squeezing as much blood as I could, she found out and started to cry. She tried to reassure me by saying “I do share needles but I always clean them”…. not much of a comforting thought. <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">In the middle of this suddenly a sense of calm came over me, I found peace with myself and with her, and I thought for a second and said “it is not your fault that I stuck my self, though it shows that how our actions can affect other people lives.”<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">I started the HIV prophylaxis, I need testing in 6 weeks, 12 weeks and 6 months. These medications were not easy to take and there were lots of them.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">She walked out of the hospital, determined not to use again and plans to go to rehab, she was doing wonderful. On her way out she winked at me and said “good luck”. <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">So what is the lesson from this?........Sepsis Bundles work!….<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">Blog you later.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">PS: About the picture, I saw this in field's museum in Chicago. Myth is that some diamonds bring bad luck. So it is a good thing that I do not own this rock.</span></div>Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-68431204416042986442011-09-19T10:43:00.002-04:002011-09-19T23:23:04.426-04:00Conundrum of Consultation.<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix3t14aQKhmzLYzoOnBNi6b9qDcrkf_PJ9Y-Ba8SamM3t0hNkOzD0ND7CjdTQA3T1fxcjv2qhPx1_q4gjMFl9nontL45kmTBd5cLpSx1KWGPTuL7uutMU93QRXoUbz5dYO8qi2d9X9_Dyb/s1600/20110728-CSC_2577.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix3t14aQKhmzLYzoOnBNi6b9qDcrkf_PJ9Y-Ba8SamM3t0hNkOzD0ND7CjdTQA3T1fxcjv2qhPx1_q4gjMFl9nontL45kmTBd5cLpSx1KWGPTuL7uutMU93QRXoUbz5dYO8qi2d9X9_Dyb/s320/20110728-CSC_2577.jpg" width="320" /></a></div><br />
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<div class="MsoNormal" style="text-align: justify;"><span style="color: #444444; font-size: 11pt;">Few years ago a fellow physician asked me to see a patient. When I asked him why he said “STP”, he chuckled and said “for STP, share the pain”. <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 11pt;">As a hospitalist, medical consultation is one of the essential components of our work. Various specialists require assistance in areas which are beyond the scope of their expertise. So, an orthopedist may want a hospitalist to manage infections or diabetes or a cardiologist wants us to evaluate a patient for abdominal pain. </span><span class="Apple-style-span" style="font-size: 15px;">The reasons could vary. Some are from orthopedist, some from cardiologist etc….. </span></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444;"><span class="Apple-style-span" style="font-size: 15px;">They vary from atypical chest pain to coagulopathy. Most of them are very appropriate and we love to tackle medical problems of all sorts. </span><span class="Apple-style-span" style="font-size: 15px;">But then there are some consults which are called for all the wrong reasons.</span></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: #444444; font-size: 11pt;">Interestingly when you look at the reason for consult, mostly it is a very vague reason like “medical co- management”. However, at times when you ask the nurse the reason is entirely different.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444;"><span class="Apple-style-span" style="font-size: 11pt;">Don’t take me wrong, most of the times physicians need assistance like if someone is septic, they want a hospitalist or intensivist to take over the case. If someone has brittle diabetes, they want an opinion for better glycemic control. But some times the consult could be just STP (share the pain) or just in</span><span class="Apple-style-span" style="font-size: 15px;">difference</span><span class="Apple-style-span" style="font-size: 11pt;">. At times referring physician just want someone else to do their scud work. </span></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444; font-size: 11pt;">However, regardless of nature of the consult you would almost always find this statement at the end of dictation “Thank you for allowing me to assist you in this very "interesting patient”"<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: #444444; font-size: 11pt;">I will give you some very “interesting” consults I have received in the past few years.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444;"><br />
</span></div><div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;"><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 11pt;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-size: 11pt;">A nurse called me for a consult for “medical co management”. I asked her what the story is? Apparently patient was very belligerent towards the attending physician. After the attending physician left patient wanted to leave against medical advice. Nurse called the attending physician; he did not want to be bothered. When she asked for further direction, he said lets call for a hospitalist consult. That left me very perplexed. What am I suppose to do, get a couch, asks the patient to lie down and provide behavioral counseling?<o:p></o:p></span></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444;"><br />
</span></div><div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;"><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 11pt;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-size: 11pt;">I was called for diabetes management on a chest pain patient. When I came down to evaluate the patient I found out she was a 91 year old lady with <a href="http://humanfactorinmedicineandlife.blogspot.com/search/label/hospice">hospice</a> for terminal lung cancer. Apparently <st1:place w:st="on">EMS</st1:place> brought her to the hospital while they were on their way to hospice house from nursing home. In the ambulance she started to moan. <st1:place w:st="on">EMS</st1:place> thought it was a good idea to stop at the hospital. ER physician decided to admit this hospice patient. On the whole scheme of things diabetes was the least of her problem. I spoke with the family and transferred her back to hospice. <o:p></o:p></span></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444;"><br />
</span></div><div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-align: justify; text-indent: -.25in;"><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 11pt;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-size: 11pt;">Sometimes the consult is called because the surgeon or a refereeing physician does not want to perform medication reconciliation or discharge paperwork; we are consulted for “hypertension”, when patient is on a hint of diuretics for hypertension. They just don’t feel like doing it I guess.<o:p></o:p></span></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444; font-size: 15px;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444; font-size: 15px;">Now on the other hand I would rather be a consultant on some cases than being the primary attending. Few years ago I was called to admit a 42 year old man with chest pain due to a thoracic aortic dissection. After ER physician finished presenting the case I asked him “do you think I have some divine connections, if you want I can come down and pray for this patient at bedside, as I am surely not a cardiothoracic surgeon and you want someone who can crack open his chest”.</span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444; font-size: 15px;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444; font-size: 15px;">Sometimes when I am being consulted I feel transiently important, it is good for my ego that they want my opinion. On the other hand I think we need to have very clear and defined reason for consult, not just “co- management”. This would not only improve care but also clearly focus on the specific issues which need to be addressed. Like the other day I saw a patient for “co-management”. Later found out that the physician was concerned about the side effects of a certain medication. I missed it completely as this was not mentioned nor conveyed to me at any time.</span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="color: #444444;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: #444444; font-size: 11pt;">I can see how we need to improve communication from our side. This is an ongoing project at this time.<o:p></o:p></span></div><span class="Apple-style-span" style="color: #444444;"><br />
</span><br />
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</span><br />
<span class="Apple-style-span" style="color: #444444; font-size: x-small;">PS: About the picture: This is not a magic ball. Inside Vatican Museum.</span>Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com1tag:blogger.com,1999:blog-6555602526434224601.post-90592522758150264592011-09-13T00:24:00.002-04:002011-09-13T08:19:19.712-04:00Dante’s Inferno.<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXQBGkrSRa_XI0Nw-q1Yym8mRvtaPXLanw2xh_5kZHuf0Dj2E_WcNdUVnfZbmwoJgz0jhsiVPF7VTDGhaBsZRQ1xcVwCZ2RP6gxf3FMr2yP0AQN4fXV_If4HMstcBRekKkcaOkyDcEcl5L/s1600/faces+9-11.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXQBGkrSRa_XI0Nw-q1Yym8mRvtaPXLanw2xh_5kZHuf0Dj2E_WcNdUVnfZbmwoJgz0jhsiVPF7VTDGhaBsZRQ1xcVwCZ2RP6gxf3FMr2yP0AQN4fXV_If4HMstcBRekKkcaOkyDcEcl5L/s320/faces+9-11.jpg" width="320" /></a></div><br />
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</span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-size: 11pt;">Nine Eleven.... </span><span class="Apple-style-span" style="font-size: 15px;">always</span><span class="Apple-style-span" style="font-size: 11pt;"> brings a feeling of dread, though it has been a decade now. </span><br />
<span class="Apple-style-span" style="font-size: 11pt;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black;"><span class="Apple-style-span" style="font-size: 11pt;">In Dante’s Inferno, when Dante along with Virgil started to descend deeper into hell (Inferno), they observed </span><i style="font-size: 11pt;">Contrapasso</i><span class="Apple-style-span" style="font-size: 11pt;">, best explained as symbolic punishments,</span><span class="Apple-style-span" style="font-size: 11pt;"> best suited for one's sin. A kind of a poetic justice. </span></span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">For example a con man in hell would be reassured that he will be served a full meal, when he would become hungry, he would be served with putrid and rotten food. A murderer will be kept alive for eternity, where he would only wish every second for death to relieve him from his agony.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black;"><span class="Apple-style-span" style="font-size: 11pt;">If there is hell, what would be the punishment for our deeds? Let’s assume if we are not …..</span><i style="font-size: 11pt;">Umm…..</i><span class="Apple-style-span" style="font-size: 11pt;"> not adequate. Not just adequate but negligent, if I may say so ... pernicious</span><span class="Apple-style-span" style="font-size: 11pt;"> to others! So those guys who crashed the planes, what should they get in Dante's Inferno?<o:p></o:p></span></span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-size: 15px;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black;"><span class="Apple-style-span" style="font-size: 11pt;">I have been in a hiatus, working on my book, busy with work etc and ...</span><span class="Apple-style-span" style="font-size: 15px;"> OK</span><span class="Apple-style-span" style="font-size: 11pt;">, have you ever come across a situation when someone calls you after a long time and you try to provide some lame excuse of being really busy? And when they ask you what you have been up to? You reply sheepishly “nothing much”. </span></span><span style="color: black; font-size: 11pt;"> </span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">Well, I will not give any excuses, I will stop while I am ahead.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"></div><div class="MsoNormal" style="text-align: justify;"></div><div class="MsoNormal" style="text-align: justify;"></div><div class="MsoNormal" style="text-align: justify;"></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;">Just some random thoughts...</div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">PS: I wrote few words last year on <a href="http://humanfactorinmedicineandlife.blogspot.com/2010/09/911-nine-eleven-845-am-minute-before.html">Nine eleven here</a>. Took this picture around the same time.<o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com0tag:blogger.com,1999:blog-6555602526434224601.post-60620248491817078332011-04-11T17:45:00.007-04:002011-04-11T18:37:29.957-04:00Three Things You Want In Future.<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsgtPkrtg88DK-oaHPD73KVZBMQ2G3SURxbbDyNkJAbE0g4uFZphbj8B0ylVYIKBEdNcP6CmGX4hfO4y4yseofdR0YRgD-ufYor65gplYcpKRiJmtG_IjA4DYW9JVJ69xSp10KShu54Brd/s1600/Future.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsgtPkrtg88DK-oaHPD73KVZBMQ2G3SURxbbDyNkJAbE0g4uFZphbj8B0ylVYIKBEdNcP6CmGX4hfO4y4yseofdR0YRgD-ufYor65gplYcpKRiJmtG_IjA4DYW9JVJ69xSp10KShu54Brd/s320/Future.JPG" width="320" /></a></div><div style="text-align: justify;"><br />
</div><br />
<div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;"><o:p> </o:p></span><span class="Apple-style-span" style="font-size: 11pt;">Today was a very special day. I have been invited for talks before but this was </span><span class="Apple-style-span" style="font-size: 15px;">the</span><span class="Apple-style-span" style="font-size: 11pt;"> best.</span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">I went to my daughter’s class to talk about what I do. </span><span class="Apple-style-span" style="font-size: 15px;">The teacher has invited parents to come to the class and talk about what they do for a living.</span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">When I arrived at the school there were 17 children eagerly waiting. I talked about what Hospitalist are and what hospital medicine is about? </span><span class="Apple-style-span" style="font-size: 15px;">I also informed them about wound care and hyperbaric medicine. I asked for any volunteers with any “boo-boo” for demonstration. One 7 year old volunteer with an ant bite came forward, who I readily discharged from my service after prompt therapy.</span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">All in all it was a lovely experience.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">In the end I asked them if there were any questions or comments, here are some fine examples;<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="color: black; text-align: justify;"><span style="font-size: 11pt;">“My sister kicks me at night, can you do something about it”.<o:p></o:p></span></li>
<li class="MsoNormal" style="color: black; text-align: justify;"><span style="font-size: 11pt;">“My granny has a metal in her hip. Does she need any thing?”<o:p></o:p></span></li>
<li class="MsoNormal" style="color: black; text-align: justify;"><span style="font-size: 11pt;">“Do you also treat cats and dogs?”<o:p></o:p></span></li>
<li class="MsoNormal" style="color: black; text-align: justify;"><span style="font-size: 11pt;">“I know how you become a doctor, you go to med school”.<o:p></o:p></span></li>
</ul><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;"><o:p> </o:p></span><span class="Apple-style-span" style="font-size: 15px;">The best thing is my daughter thought I was awesome! You</span><span class="Apple-style-span" style="font-size: 15px;"> </span><span class="Apple-style-span" style="font-size: 15px;">can’t beat that.</span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;"><o:p> </o:p></span><span class="Apple-style-span" style="font-size: 15px;"> </span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">Blog You Later.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-size: 15px;">About the picture: My 6 year old daughter was asked what three things you want to do in future.</span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">So if you look at the picture, she scratched 1- Fly 2- Talk to cars. Before what she wrote above. <o:p></o:p></span></div>Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com2tag:blogger.com,1999:blog-6555602526434224601.post-11143616732251588162011-04-04T23:18:00.001-04:002011-04-05T07:04:46.031-04:00Chinese Curse<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEMlpfzaF1qrbqcTRVwvP8nYORgohUU0GtBVYqqQ3dTWSvso1H7S0zDWuJXjVEfTt92l_wWKZ5IFn6NEn1zTEpq8b3HtkDuG4JjAZ6TSCBDxmSswXsZcYYCBaQ4Lybj-ZdI5IqjVEcZ-Zz/s1600/Presedential+Rabbit-157.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEMlpfzaF1qrbqcTRVwvP8nYORgohUU0GtBVYqqQ3dTWSvso1H7S0zDWuJXjVEfTt92l_wWKZ5IFn6NEn1zTEpq8b3HtkDuG4JjAZ6TSCBDxmSswXsZcYYCBaQ4Lybj-ZdI5IqjVEcZ-Zz/s320/Presedential+Rabbit-157.jpg" width="320" /></a></div><br />
<span class="Apple-style-span" style="font-size: 15px;">I took care of an elderly lady once. She was brought to the hospital by police after someone reported elder abuse. She was found in her room in diapers only. There were only crackers in the room. Apparently she was locked in the room by her family member; she was kept in diapers, as it would be “easy” to care for this way. She was fed mostly crackers and water. There were no sheets on the bed as it makes it easy, no sheets…. No cleaning.</span><br />
<br />
<div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">When I saw her in the room she was eating grapes…… her bed side table was full of food. She was voraciously devouring her food. It was embarrassing to see her eat like that but on the other hand I was also glad that she could eat. She would not talk to me as every time I would ask her a question, she would give me an evil eye and continue to gobble something else…… grapes, lots of them I remember the most from that moment. <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">The sad part was that even after all that she did not complaint about her family member who did this…. only a mother can protect her child like that. <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">This event reminded me of a story from my childhood. There was this little kid, he was asked by her mother to go to the <i style="mso-bidi-font-style: normal;">bazaar </i>and buy the cheapest plate from a thrift store. He asked why mother? She said “this is for your grandmother as she breaks all the new stuff; I don’t want to waste money on a new plate”. This child went to the bazaar and came back with two old dirty plates. She was surprised and asked him “why two plates my dear?” and he said “one for granny and …. one for you when you are that age”.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">In <st1:place w:st="on"><st1:country-region w:st="on">South Korea</st1:country-region></st1:place>, a couple is being charged for <a href="http://news.bbc.co.uk/2/hi/asia-pacific/8600517.stm">murder</a> after their baby daughter starved to death while they went out to play an online computer game. Sadly the game was about nurturing a virtual girl as she grows in a virtual world. What an irony.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">It has been a famous Chinese curse, may you live in interesting times. I hope not too interesting.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;">Blog You Later.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span style="color: black; font-size: 11pt;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-size: 11pt;">About the picture:I spotted this p</span><span class="Apple-style-span" style="font-size: 15px;">residential</span><span class="Apple-style-span" style="font-size: 11pt;"> rabbit outside White House, hoarding something.</span><br />
<span class="Apple-style-span" style="font-size: 11pt;"><br />
</span><br />
<span class="Apple-style-span" style="font-size: 11pt;">PS: Correction, obviously that is not a rabbit, I am not sure what I was thinking. LOL.... thank you Ann.</span></div>Anonymoushttp://www.blogger.com/profile/05949093500053138276noreply@blogger.com2