Posts Tagged ‘healthcare’

ER Trip

Written by Brian on June 6, 2009 – 9:13 am -

So I stopped off in SLO on my way up to graduation, and had Grandma watch the kids while we went out with friends.  They were walking to the park, and Grandma hopped on my nephew’s Razr scooter.  She ate shit.  She fell from standing on the sidewalk and stopped herself with her face.  Lara got a frantic call from Grandpa for us to come home because someone was bleeding, and of course we were there in seconds. 

My mom was pretty banged up.  I superglued a little scratch on her head and had her put some ice on her face.  There was a little crepitus when I moved her nose, and of course I was concerned about TBI even though she had no LOC, no HA, etc.

She proceeded to drink a margarita and got ready for bed.

I convinced her to go get her head scanned.  I told her that it would help me sleep better. 

ED Physician starts doing his H&P, my mom is being difficult because it’s 10:00PM and she just wants to go to bed.  I decide to speed it up and give him a quick synopsis: “Mom fell from standing, landed on her face, did not break the fall with her arms, no LOC, complains of some neck pain…”

ED Physician: “Do you have neck pain?”

Mom: “Yeah”

ED Physician: “Don’t move your neck.”

Mom: [moves neck] “I just want to see if my nose is broken.”

ED Physician: [yelling] “DON’T MOVE YOUR NECK!”

Mom: [moves neck] “There’s nothing wrong with my neck.”

ED Physician: “I’m glad you have x-ray vision in your armamentarium.” [leaves room to get C-Collar and says under breath] “WOMEN!”

Her scans were negative, and we got out of there before midnight.

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Scramble Update and Advice

Written by Brian on March 24, 2009 – 9:26 am -

I discussed some of this in previous posts, but here’s an update:

I was operating under the advice of many when planning the match.  I was told several times that there are always EM spots available in the scramble, as long as you are willing to go to some podunk town in BFE for residency.  My desire to stay on the west coast was strong, both for myself and my wife’s career.  I decided to apply to and rank only west coast programs, and if I didn’t match – I didn’t care where I went. 

After the Osteopathic match – programs were calling and emailing me for days to get me to interview.  I told them all that I was waiting for the allopathic match.  Most responded that they would not wait to fill their spots.  I decided to take my chances.

Despite good grades, scores, and audition rotations – I didn’t match.

On Tuesday, I scrambled from home because I live in SoCal.  I scanned my CAF, board scores, and LORs in PDF format so that I could email them to program directors.  At 9 AM, I emailed everyone.  I made phone calls from my cell phone and used my land line to fax my app.  I submitted ERAS apps to everyone that had an open spot.  I GOT NOTHING BUT BUSY SIGNALS from 9AM to noon.  I tried, but even the Osteopathic programs that had been courting me earlier had filled.

When I re-checked the NRMP site, every program had filled except Puerto Rico.  I quickly switched gears and started applying to IM and Traditional Internships.  I got one interview, and although they loved me, they questioned my dedication to IM because my personal statement and LORs all said EM. 

Luckily, a program director heard that I was scrambling and saved me a spot at a Traditional Internship.  I have a job for next year.  My current plan is to work my ass off and pray that I can fall into a PGY-II spot somewhere.  If not, I have no qualms about repeating my intern year.  The difference between an intern salary and an emergency physician salary is roughly $150,000.  That means that my match strategy was a $150,000 mistake.  Please don’t make the same mistake.

Some advice:

  • Schedule audition rotations toward the end of the interview season at your top picks so that you will be fresh in their minds when making their rank list.  Schedule a “Practice” rotation before then, so that you can learn the ropes.  I did an audition rotation first thing fourth year.  By the time they made the rank list, I was a distant memory.  I was also very green early in my fourth year, so I didn’t have the knowledge and experience that showed in later auditions.
  • Don’t count on the scramble.  I heard from many people that even traditionally non-competitive programs like OB-GYN and PEDS filled quickly.  Apply to a lot of programs, interview at a lot of places, and rank at least 10.
  • Don’t count on the NRMP match.  If you do the allopathic match – set up a contingency plan.  Rank a few spots in another specialty or at Transitional/Internship years at the end of your rank list just in case. 
  • Plan to scramble early.  Even some people at the top of our class had to scramble.  When you get letters of recommendation, ask the writers if they can write two copies – one geared toward your specialty, and a generic one.  Write a generic personal statement and upload it to ERAS just in case you need to scramble into another specialty.  Continue collecting letters of recommendation even after interview season – you might get a great letter in ERAS that can be used in the scramble.
  • TAKE BOARDS EARLY.  The COMLEX-II is much easier than step I.  If you did poorly or even mediocre, you can easily look good by scoring better on step II.  If you do have to scramble, many programs will ask if you have passed your boards and are on track for graduation.  If you fail an exam and have to re-take it, that may look bad at the last minute.

Good luck everyone!

Bri

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The Solution

Written by Brian on July 17, 2007 – 6:11 pm -

Since the release of ‘Sicko’, people have been whining and complaining about the broken healthcare system.  One thing I haven’t heard a lot of is solutions.  Everyone needs to quit bitching and start looking for some solutions.  Here’s my simple plan.  Of course, no one would ever implement it because you would never see tangible results before the next election.  Too bad.

Problem: Medical school is expensive.  Nowadays, doctors are graduating with more than $200,000 in student loans.  Do you really think docs are just going to give away their services after spending that much on education?

Solution: Money for states to fund medical education would be nice.  Lower tuition rates and more state schools would allow docs to get out with less of a debt burden.

Problem: An attitude of entitlement.  Everyone thinks that they are entitled to the BEST medical care available, and that they shouldn’t have to pay for it. 

Solution: Kill Michael Moore.

Problem: Lawyers.  Every doctor lives in fear of being sued.  Every time you talk to a patient or write in a chart you have to do things to cover your own ass.  Lawyers can convince a patient that had a bad outcome that they just hit the lottery. 

Solution: Kill all lawyers.

Problem: Insurance companies.  They just keep making money!

Solution: This one is simple and elegant.  Just require that a certain percentage of premiums (say 70%) be used to pay claims.  If they don’t reach 70%, customers receive premium refunds.  This forces them to cut overhead and operating expenses to control costs and maximize profit, rather than compromising patient care to make a buck. 

Problem: Insurance is hard to get if your employer doesn’t offer it, and it’s expensive no matter what you do!

Solution: The more people buy insurance, the cheaper it gets.  The whole idea behind it is that you are spreading the risk out over a large group.  The trick is getting healthy people to buy something they think they won’t need.  If you call it Universal Health Care and just increase taxes, people are going to be pissed about high taxes.  If you require people to buy insurance they don’t think they need, people are going to be pissed.  I’m still working on this one.

Problem: No personal responsibility.  People can just declare bankruptcy if their medical bills get out of control.  As long as they don’t have a house or other assets, they get off scott free.

Solution: DEBTOR’S PRISON – A great idea that has become lost in time.

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The ‘Ashley Treatment’

Written by Brian on January 5, 2007 – 2:54 pm -

Biomedical Ethics has always intrigued me.  This groundbreaking case has shocked and amazed me.  When I mentioned it to one of my professors, he exclaimed: “THIS HAPPENED IN AMERICA?” 

Ashley is a 9 year old girl with static encephalopathy, an idiopathic condition that renders her permananently disabled.  Her doctors removed her breasts, uterus, and ovaries at the request of her parents.  They also used high-dose estrogen to force her growth plates to fuse and stop the growth of long bones.

Many people are outraged, accusing the parents of orchestrating the treatment to maintain a more “portable and manageable” child. 

Her parents claim that the treatment was done to decrease Ashley’s discomfort by eliminating menstrual cramps and bedsores.  They also claim that there is a family history of breast cancer, but there is no mention of BRCA testing.

Here’s a link to the story on CNN.

Here’s a link to the family’s blog.

What do you think?  Please comment below…

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Health Insurance – Arms Are Good

Written by Brian on December 13, 2006 – 3:51 pm -

So a couple things set off this opinion piece.  First, I was in class and we happened to be talking about stem cell research.  Someone pointed out that the 6 billion dollars California is putting into stem cell research would pay for health care for the 6 million uninsured Californians for at least a year.  That led to a heated debate about health care and insurance, and I just had to chime in.  The truth is, probably half those people can afford a health plan.  Instead, they have decided to spend that money on a new car payment, or a big-screen TV or something.  Like I said in my previous rant, those people have the freedom to make that choice.  Read more »

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