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Permanent Emergency Job in 30 Minutes from Madison, WI Wisconsin with Enterprise Medical Service

Be a part of starting the first true Rural Emergency Medicine Residency program in the country! Medical Director sought to lead the Emergency and Urgent Care Departments in the hospital. Progressive,

Permanent Emergency Job in Elk County Pennsylvania Pennsylvania with Enterprise Medical Service

18K volume, non-designated facility seeks ER physician who is BC in Emergency Medicine or Family/Internal Medicine plus experience. Employee status offering $120.00 hour plus benefits. 12 hour shifts

Permanent Emergency Job in Southwest Missouri Missouri with Enterprise Medical Service

Level II, 56K volume Emergency Department seeks Board Certified Emergency Medicine physician. Nine hour shifts with physician double coverage. Residents rotate through the Emergency Department daily.

Permanent Emergency Job in Western Wisconsin Location Wisconsin with Enterprise Medical Service

Level III, 15K facility seeks Emergency Medicine physician. Employee position offering hourly rate plus benefits and paid time off. Physician should be BC/BE in Emergency Medicine or BC in primary care

Permanent Emergency Job in Philadelphia Metro Area Pennsylvania with Enterprise Medical Service

Three hospital system seeks BC/BE Emergency Medicine physicians. Volumes include 50K volume, Level II trauma center, a 45K volume facility and an 18K volume Emergency Department. Depending on the facility,

Permanent Emergency Job in Beautiful Eastern Kentucky Kentucky with Enterprise Medical Service

14K volume facility seeks additional Emergency Medicine physician. Hourly rate of $110.00/Hur plus benefits offered. Overtime (48+ hours) offers an hourly rate of $125.00/Hour. BE/BC Emergency Medicine

Permanent Emergency Job in Near the Coast North Carolina with Enterprise Medical Service

75K volume facility seeks Board Certified Residency trained Emergency Medicine physicians. This facility is not designated, but if it were, it would be a Level I Trauma Center. Trauma includes MVA,

Permanent Emergency Job in Central Illinois Area Illinois with Enterprise Medical Service

Level II Trauma Center with a combined ER/Urgent Care volume of 30K seeks BC/BE IM/FP/ER Physician. 12-hour shifts with physician double coverage during the day. Respond to codes on the floors, but

Permanent Emergency Job in Central Mississippi Mississippi with Enterprise Medical Service

36K volume facility in Central Mississippi seeks physician due to growth. Independent Contractor status with large group. 12 hour shifts with physician double coverage for 12 hours of the day. 13 shifts

Permanent Emergency Job in Less than 1 Hour from New Bedford Massachusetts with Enterprise Medical Service

Private Emergency Medicine group seeks BC/BE Emergency Medicine physician. Candidate MUST be residency trained. 52K volume facility with 41 hours of physician coverage per day. Level II Trauma Center.

Permanent Emergency Job in One Hour from Nashville, TN Kentucky with Enterprise Medical Service

36K volume, non-designated department seeks Emergency Medicine physician for IC status. Primary Care Boards plus experience or Emergency Medicine Boards. Competitive hourly rate plus liability insurance

Permanent Emergency Job in Practice Located in Jackson County, AL Alabama with Enterprise Medical Service

8K volume department seeking an Emergency Medicine physician. BCFP or IM plus EM experience, or EM trained physician. Employee status, hourly rate competitive for the volume plus full benefits. 12

Permanent Emergency Job in Northwestern Pennsylvania Pennsylvania with Enterprise Medical Service

18K volume facility seeks Board Certified physician in Emergency Medicine or Primary Care. Single physician coverage with 12 hour shifts, experience is a plus. Salary of $192K 205K depending on credentials

Permanent Emergency Job in Southeast Kentucky Kentucky with Enterprise Medical Service

15K volume, non-designated facility seeks two physicians to add to the group of 3 they currently on staff. Candidate can be an independent contractor or employee status that would offer full hospital

Permanent Emergency Job in Northeast South Carolina South Carolina with Enterprise Medical Service

Emergency Medicine physician needed to join a solid department of 4 current physicians. Negotiable hourly compensation, plus full benefits and malpractice. 12,000 volume facility. Single coverage,

Permanent Emergency Job in Just north of Greensboro, NC North Carolina with Enterprise Medical Service

If you have the desire to work in a brand new emergency department, this opportunity is for you. Looking for residency trained physician to join Residency Trained, BC EM Group. 36K Volume and growing,

Permanent Emergency Job in Jonesboro, AR Location Arkansas with Enterprise Medical Service

Low trauma, 19K emergency department seeks additional physician who is board eligible/board certified with ER experience. 12 hour shifts with single coverage. Choose from independent contractor or employee

Permanent Emergency Job in Southeast Wisconsin Need Wisconsin with Enterprise Medical Service

Join a 35K volume facility that is seeking a Board Certified/Board Eligible Emergency Medicine physician in order to provide full time, double physician coverage. Currently they have six EM providers

Permanent Emergency Job in St. Louis Suburb Missouri with Enterprise Medical Service

St. Louis area hospital has a need for a Director for the Emergency Department. Candidate must have five years of experience in subject and a Master Degree. This is a Hospital employed position with

Permanent Emergency Job in North Central West Virginia West Virginia with Enterprise Medical Service

Hospitals 14K volume Emergency Room department seeks an additional physicians due to community growth and demand. 12 and 24 shifts are offered. Primary Care Boards plus experience or ER Boards is a

[Primary survey] Primary survey

[Editorial] Mid Staffordshire: where to from here?

[Miscellanea] See page 545 for answers

[Review] Improving post-hypoglycaemic patient safety in the prehospital environment: a systematic review

To determine the extent to which post-hypoglycaemic patients with diabetes, who are prescribed oral hypoglycaemic agents (OHA) are at risk of repeat hypoglycaemic events (RHE) after being treated in the prehospital environment and whether they should be transported to hospital regardless of their post-treatment response, a systematic literature review was carried out using an overlapping retrieval strategy that included both published and unpublished literature. Retrieved papers were reviewed by each author for inclusion. Disagreements regarding inclusion were resolved through discussion. Ninety-eight papers and other relevant material were retrieved using the developed search strategy. Twenty-three papers and other relevant material were included in the final review. A narrative synthesis of the findings is presented. Although several case reports demonstrate the risks associated with repeat or prolonged hypoglycaemia, the review was unable to locate any specific high quality research in this area. Consequently, caution is required in interpreting the findings of the studies. Post-hypoglycaemic patients treated in the prehospital environment have a 2–7% risk of experiencing a RHE within 48 h. The literature retrieved in this study recognises the potential for OHA to cause RHE. However, the extent to which this occurs in practice remains unknown. This lack of evidence has led to the recommendation that conservative management, through admission to hospital, is appropriate. The review concludes with recommendations for both practice and research.

[Original articles] Effect of a pathway bundle on length of stay

Background: Pathways to guide clinical care are well accepted and used in many emergency departments. We wanted to introduce a number ("bundle") over a short space of time and involve the whole patient stay in the pathway. It was hypothesised that a more efficient process would result with an overall reduction in length of stay (LoS). Methods: A "bundle" of 14 evidence-based pathways of care was introduced into a medium-sized district general hospital (DGH) in late 2006/early 2007. These pathways covered emergency department care and acute medical care for a period of up to 48 h. A total of 8184 acute emergency admission episodes were audited, 3852 in the 8 months before introduction of the new pathways and 4332 in the 8 months after their introduction. Results: The overall effect of introducting the pathway bundle had a trend towards reduction in LoS by 0.2 days (95% CI –0.2 to 0.5), but this was not statistically significant (p>0.1). However, in those patients with <=2 diagnoses, the introduction of the pathway bundle had an independent effect in reducing LoS by 0.4 days (95% CI 0.04 to 0.7, p<0.01). In patients with <=2 diagnoses (63.0% of all pre-pathway cases and 63.4% of all post-pathway cases), the reduction in LoS equates to a saving of 2154 (CI 215 to 3769) bed days per annum or 5.9 (CI 0.6 to 10.3) beds saved each day. This reduced LoS represents an improvement of 2.5% (CI 0.25% to 4.38%) in medical bed usage. As this benefit occurs in the uncomplicated group of patients without multiple co-morbidities, such pathways would have the most effect in the type of patients who may be looked after by an emergency or acute physician. They are much less likely to be effective in those who require specialist intervention due to a more complicated presentation and possibly those with multiple co-morbidities. Conclusion: The introduction of a bundle of evidence-based care pathways can modestly reduce LoS for certain types of acute medical patients in a DGH setting.

[Original articles] The Manchester Triage System provides good reliability in an Australian emergency department

Background: The Australasian Triage Scale is a simple five-point system of triage that forms the basis of triage in most emergency departments in Australia. The Manchester Triage System (MTS) is an algorithmic aid to the process of triage. It utilises a series of flow charts that lead the triage nurse to a logical choice of triage category also using a five-point scale. Objective: To evaluate the inter-rater reliability of the MTS in an Australian emergency department. Methods: 50 triage scenarios were derived from the notes of 50 consecutive patients who had presented to the emergency department. All available nurses who had been trained to use the MTS were invited to participate in the study. The nurses were asked to assign a triage category to each scenario using the MTS. Weighted kappas were calculated for all pairs of raters. Results: 20 nurses participated in the study. The range of kappas was 0.4007 to 0.8018, with a median of 0.6304. Conclusion: The MTS is a reliable system of triage in the emergency department.

[Original articles] Amethocaine versus EMLA for successful intravenous cannulation in a children's emergency department: a randomised controlled study

Background: Topical anaesthetics reduce the pain of venous cannulation. The emergency department at the Starship Children’s Hospital in Auckland uses EMLA (an eutectic mixture of 25 mg/g lidocaine and 25 mg/g prilocaine) for topical anaesthesia. Amethocaine has recently been shown to be a more effective topical anaesthetic. It is suggested that, because amethocaine does not vasoconstrict veins, it may increase the success of cannulation. Aim: The primary aim was to determine if amethocaine improves the success of cannulation compared with EMLA. The secondary aim was to determine if amethocaine is a more effective topical anaesthetic in a children’s emergency department. Methods: A parallel, randomised, double-blind controlled study was performed in children aged 3 months to 15 years who were offered topical anaesthesia for venous cannulation. Caregivers gave verbal consent at triage, followed by written consent. Children were randomised into amethocaine or EMLA groups. Those who went on to have an intravenous cannula were analysed on an intention-to-treat basis. The primary outcome was a successful first attempt at cannulation. A convenience cohort was also observed for distress using a visual analogue scale and the Faces, Legs, Activity, Cry and Consolability Score. Results: From November 2006 to June 2007, 2837 children were enrolled and 809 were known to have had intravenous cannulation. 679 complete data and consent forms were returned. There was no significant difference between the first attempt success rates (75.8% amethocaine vs 73.9% EMLA) or between pain scores for the 65 observed cannulations. Conclusion: Amethocaine is not more successful than EMLA for first attempt intravenous cannulation in a children’s emergency department. Trial registration number: Australian New Zealand Clinical Trials Register ACTRN12606000409572.

[Original articles] Comparison of neurological outcomes following witnessed out-of-hospital ventricular fibrillation defibrillated with either biphasic or monophasic automated external defibrillators

Background: Biphasic waveform defibrillation results in higher rates of termination of fibrillation than monophasic waveform defibrillation but has not been shown to improve survival outcomes. Objective: To compare the effectiveness of a biphasic automated external defibrillator (AED) with a monophasic AED for witnessed out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF). Methods: In a prospective population-based cohort study, adults with witnessed VF OHCA were treated with either monophasic or biphasic waveform AED shocks. The primary outcome measure was neurologically favourable 1-month survival, defined as a Cerebral Performance Categories score of 1 or 2. Results: Of 366 adults with witnessed OHCA of presumed cardiac aetiology, 74 (20%) had VF. Termination of VF with the first shock tended to occur more frequently after biphasic AED shocks (36/44 (82%) vs 20/30 (67%), p = 0.14). Return of spontaneous circulation (ROSC) occurred more frequently after biphasic AED shocks (29/44 (66%) vs 8/30 (27%), p = 0.001). Neurologically favourable 1-month survival was also more frequent in the biphasic group (10/44 (23%) vs 1/30 (3%), p = 0.04). The median time interval from the first shock to the second shock was 67 s in the monophasic group and 24 s in the biphasic group (p = 0.001). Conclusions: Treatment with biphasic AED shocks improved the likelihood of ROSC and neurologically favourable 1-month survival after witnessed VF compared with monophasic AED shocks. In addition to waveform differences, a shorter time interval from the first shock to the second shock could account for the better outcomes with biphasic AED.

[Original articles] Ten things your emergency department should consider to prepare for pandemic influenza

Pandemic influenza remains a potential major threat to global public health. It is essential for emergency departments to be involved in planning for the management of such a major event. It is also important for emergency departments to be clear on their internal arrangements for staff and for patient care. This paper outlines 10 suggestions for UK emergency departments based on the recent experience of emergency departments in Hong Kong and elsewhere.

[Original articles] Comparison of powered and conventional air-purifying respirators during simulated resuscitation of casualties contaminated with hazardous substances

Background: Advanced life support of patients contaminated with chemical, biological, radiological or nuclear (CBRN) substances requires adequate respiratory protection for medical first responders. Conventional and powered air-purifying respirators may exert a different impact during resuscitation and therefore require evaluation. This will help to improve major incident planning and measures for protecting medical staff. Methods: A randomised crossover study was undertaken to investigate the influence of conventional negative pressure and powered air-purifying respirators on the simulated resuscitation of casualties contaminated with hazardous substances. Fourteen UK paramedics carried out a standardised resuscitation algorithm inside an ambulance vehicle, either unprotected or wearing a conventional or a powered respirator. Treatment times, wearer mobility, ease of communication and ease of breathing were determined and compared. Results: In the questionnaire, volunteers stated that communication and mobility were similar in both respirator groups while breathing resistance was significantly lower in the powered respirator group. There was no difference in mean (SD) treatment times between the groups wearing respiratory protection and the controls (245 (19) s for controls, 247 (17) s for conventional respirators and 250 (12) s for powered respirators). Conclusions: Powered air-purifying respirators improve the ease of breathing and do not appear to reduce mobility or delay treatment during a simulated resuscitation scenario inside an ambulance vehicle with a single CBRN casualty.

[Original articles] Predicting admission and mortality with the Emergency Severity Index and the Manchester Triage System: a retrospective observational study

Objective: To compare the degree to which the Emergency Severity Index (ESI) and the Manchester Triage System (MTS) predict admission and mortality. Methods: A retrospective observational study of four emergency department (ED) databases was conducted. Patients who presented to the ED between 1 January and 18 July 2006 and were triaged with the ESI or MTS were included in the study. Results: 37 974 patients triaged with the ESI and 34 258 patients triaged with the MTS were included. The likelihood of admission decreased significantly with urgency categories in both populations, and was greater for patients triaged with the ESI than with the MTS. Mortality rates were low in both populations. Most patients who died were triaged in the most urgent triage categories of both systems. Conclusion: Both the ESI and MTS predicted admission well. The ESI was a better predictor of admission than the MTS. Mortality is associated with urgency categories of both triage systems.

[Short report] Predictors of the need for rapid sequence intubation in the poisoned patient with reduced Glasgow coma score

Aim: In patients presenting to the emergency department (ED) with significant poisoning and reduced Glasgow coma score (GCS), the decision to proceed with rapid sequence intubation can be a difficult one. Traditionally, patients with a GCS of 8 or less are thought to require airway protection. It has been found that a number of these patients can be managed safely without advanced airway support in a well-monitored ward environment. The objective of this study was to define the key physiological indicators of intubation requirement in this complex group of patients. Method: Prospective parallel group comparison. The study was conducted in the ED of a Scottish teaching hospital over a 12-month period. Group 1 included all poisoned patients admitted to the ED with a GCS of 8 or less who were not intubated and managed conservatively in the short-stay ward. Group 2 included all poisoned patients with a reduced GCS who were intubated. Demographics and physiological parameters were analysed in both groups (intubated vs non-intubated). Results: 12 patients were identified in the intubated group and 14 in the non-intubated group. Demographics were similar in both groups. Analyses of means and medians of physiological parameters indicated minimal predominance of oxygenation/ventilatory failure in the group requiring intubation. This correlated with the physician’s perception of inadequate airway protection or ventilatory failure. Conclusion: Clinical assessment by experienced medical staff rather than physiological variables are the key to determining intubation requirements in the poisoned patient with reduced GCS. GCS alone is not a good predictor of intubation.

[Critical care series] Critical care in the emergency department: traumatic brain injury

Head injury outcome is influenced by the initial insult and the various pathophysiological changes that take place in the posttraumatic phase, some of which may be amenable to intervention. Appropriate measures taken during initial emergency department management and subsequently in the intensive therapy unit can significantly improve outcome. The primary goal is to limit secondary brain injury. Early imaging, rather than admission and observation for neurological deterioration, reduces the time to the detection of life-threatening complications. This paper discusses the current management of severe head injury, some prognostic indicators and methods used to rule out an associated spinal injury.

[Best Evidence Topic reports] Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary

[Best Evidence Topic reports] BET 1. NEBULISED HYPERTONIC SALINE SIGNIFICANTLY DECREASES LENGTH OF HOSPITAL STAY AND REDUCES SYMPTOMS IN CHILDREN WITH BRONCHIOLITIS

[Best Evidence Topic reports] BET 2. HEART FATTY ACID BINDING PROTEIN FOR RAPID DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION IN THE EMERGENCY DEPARTMENT

[Best Evidence Topic reports] BET 3. HONEY FOR THE SYMPTOMATIC RELIEF OF COUGH IN CHILDREN WITH UPPER RESPIRATORY TRACT INFECTIONS

[Prehospital care] Emergency ambulance transport induces stress in patients with acute coronary syndrome

Background: Trials with healthy volunteers have shown that emergency ambulance transportation induces stress, which becomes evident by an increase in heart rate, blood pressure and plasma levels of stress hormones such as adrenaline, noradrenaline, cortisol and prolactin. A study was undertaken to test the hypothesis that emergency ambulance transportation may also lead to stress in patients with acute coronary syndrome. Methods: Venous plasma levels of epinephrine, norepinephrine and lactate as well as visual analogue scale (VAS) scores for pain and anxiety were measured in 32 patients with defined clinical signs of acute coronary syndrome before and after transportation. Heart rate, blood pressure and transcutaneous oxygen saturation levels were recorded every 3 min. Results: Mean (SD) plasma levels of epinephrine and norepinephrine increased significantly (p<0.01) during transportation (159.29 (55.34) ng/l and 632.53 (156.32) ng/l before transportation vs 211.03 (70.12) ng/l and 782.93 (173.95) ng/l after transportation), while lactate levels, heart rate and mean blood pressure remained almost stable. There was no significant change in mean (SD) VAS scores for pain and anxiety (3.79 (3.70) and 2.89 (3.01) vs 2.13 (3.30) and 1.57 (2.78)). Conclusion: Emergency ambulance transportation induces a rise in plasma catecholamine levels and therefore stress in patients with acute coronary syndrome, but does not result in cardiac shock as lactate levels and haemodynamic parameters remain normal.

[Prehospital care] Construction of an adaptable and specific severity score for prehospital emergencies

The aim of this study was to design a severity score specific to mobile emergency and resuscitation services (MERS). A prospective, multicentre cohort study including 17 868 patients was performed. The severity reference criterion was determined by multiple correspondence analysis. A multiple linear regression was used for the construction of the severity score. The score performances were analysed in terms of area under the receiver operating characteristics curves (AUC). Twelve variables were identified for the construction of the severity score. The multiple regression (r2 = 0.947; p<0.001) provided a severity score that took on values from 8 to 68. The score performs well in distinguishing the various patient outcomes in terms of AUC. This study develops the first adaptable and specific severity score of MERS activities.

[Prehospital care] Use of prehospital dressings in soft tissue trauma: is there any conformity or plan?

Background: Acute soft tissue wounds are commonly seen in the prehospital setting. It was hypothesised that there is a lack of consistency in early management of trauma wounds, particularly in the dressings used. Methods: In January 2007 a questionnaire-based study was undertaken to evaluate the early management of such injuries. All 13 UK ambulance services were contacted, as well as 2 voluntary ambulance services. The questionnaire considered the implementation of a wound treatment policy and staff training, immediate wound management including haemostasis, cleansing, analgesia, dressings and the use of antibiotics. Results: The response rate was 100%. Only 27% of services had a wound treatment policy in place, but all services implemented staff training. All services regularly achieved haemostasis of wounds using a combination of pressure and elevation. Regular cleansing was performed by 47% of services and those that did so used normal saline or water. All ambulance services administered analgesics. The most commonly used analgesics were Entonox and intravenous morphine. Other analgesics administered were paracetamol and ibuprofen. No local anaesthesia was used. Dressings were applied regularly by all services; 13 different types of dressings were in regular use. Conclusions: This study confirmed that there is currently no national standard protocol for early acute wound management in the prehospital care setting. The key areas for improvement are cleansing, simplification of dressings and the introduction of standardised protocols and teaching.

[Prehospital care] Sepsis: a need for prehospital intervention?

Prehospital staff have made a significant contribution in recent years to improving care for patients with acute coronary syndrome, multiple trauma and stroke. There is, however, another group of patients that is not currently being targeted, with a similar time-critical condition. This group of patients is those with severe sepsis and septic shock and they could also benefit greatly from timely prehospital care. This article will consider how prehospital staff can improve the outcome of patients with severe sepsis, and in particular how they can aid emergency departments in identifying and initiating treatment in patients with severe sepsis.

[Emergency casebooks] Importance of the log roll

Immobilisation is a crucial part of the management of a trauma patient. This case describes the importance of stabilisation and early imaging in preventing long-term disability. The patient presented with no history or symptoms suggestive of spinal instability, but was under the influence of alcohol and had signs which were difficult to explain. After deterioration in his vital signs, he was found to have a rare and spectacular assembly of injuries which could have proved devastating had immobilisation been compromised. A comprehensive literature search was undertaken to establish the current consensus on the timing of mobilisation and imaging.

[Emergency casebooks] Early administration of thrombolysis can prevent myocardial necrosis: time is myocardium

A case is presented in which a 66-year-old man received thrombolysis for an acute ST elevation myocardial infarction (STEMI) within 6 minutes of developing chest pain. An ECG performed 10 minutes after thrombolysis showed complete resolution of the ST segment elevation and showed no other abnormality. An echocardiogram showed normal left ventricular function and there was no detectable myocardial necrosis, as evidenced by two negative troponin assays. The case clearly reinforces the benefits of the rapid delivery of thrombolysis when appropriate for patients with STEMI. Clinicians need to be aware of the benefits of early thrombolysis as laid out in the national service framework. Evidence for the early administration of thrombolysis, data from the Myocardial Infarction National Audit Project and the future with regard to improving thrombolysis times are discussed.

[Emergency casebooks] Calcific tendonitis of the medial collateral ligament

The case is presented of a woman with a gradual onset of knee pain due to calcific tendonitis of the medial collateral ligament (MCL). The diagnosis was made based on clinical findings, plain radiography and magnetic resonance imaging. Her symptoms improved with non-operative measures. Calcific tendonitis is a common pathology of the shoulder, but has not previously been described to involve the MCL of the knee. Different treatment options are considered in the paper.

[PostScript] Dissociation of mortality at high levels of overcrowding (the death plateau)

[PostScript] The Livingston paediatric calculator, revision needed

[PostScript] Training for acute care common stem trainees

[PostScript] The utility of nitrous oxide

[PostScript] CORRECTION

[Miscellanea] For questions on page 471

[Miscellanea] Sophia

Happy 223rd Independence Day

First used years ago, still applies…

Better Health » The Friday Funny: The Homeopath’s ER

Better Health » The Friday Funny: The Homeopath’s ER Go watch the video. It’s funny, and explains the goofyness of homeopathy very succinctly.

The Michael Jackson autopsy | The Sun |News

Update 6/29/09 @ 12:36 This may all be a hoax. NOPE. APPARENTLY THIS IS REAL. British Media and News Reporting may actually not be related. The shock findings of the Michael Jackson autopsy | The Sun |News 8st 1oz, no food just pills in his stomach, bald, bruised, his ribs broken by CPR, 4 needle wounds near [...]

Treatment difference between Bird and Swine Flu

Via Dr. Val on Twitter: RT @Doctor_V RT @bobfinn: CDC’s Cox: “What’s the diff btwn bird & swine flu? 4 bird flu U need tweetment, 4 swineflu U need oinkment.” [Ugh] Hahaha. Here’s hoping I can deliver both!

Michael Jackson, King of Pop dies

My first thought: I’m willing to bet drugs (legal, clean, prescribed by a doctor) were involved, and that a review of the records will show some questionable prescribing. First Do No Harm, unless it’s a celebrity? Why are docs willing to engage in this kind of horrible, destructive prescribing? It’s reprehensible. If it is doc-assisted, please [...]

Better Health » Some of My Best Friends Are Doctors

Better Health » Some of My Best Friends Are Doctors Dr. Val does a nice Fisk! Yes, docs make a decently good living. No, it’s not why the health care system is in trouble.

Dead Blogs, Medical Edition.

Yes, it’s that time. As a general rule either no posting for 3 months or an intentional abandonment will get you added to the heap of Dead Blogs (right sidebar, near the bottom). Adventures in Medicine Blogborygmi (this one hurts, and I suspect he’ll be back soon, but dead is dead) decided he wants to live! Canadianmedicine, now [...]

A Happy Hospitalist: You Are Living In The Medicare Tomato

A Happy Hospitalist: You Are Living In The Medicare Tomato You want to know what the process is like for a physician to make a living as a physician. Look only toward the Medicare Tomato. Imagine for the moment that you have been taken out of reality and into the alternate bizarro world of the Medicare [...]

Running a hospital: What a public plan is really for

Running a hospital: What a public plan is really for by Paul Levy of BIDMC. Surprise: it’s not about access for patients. Where have I heard that before….?

Day by Day: Don’t Mess with Texas

Mr. Muir at Day by Day… Don't Mess with Texas