Placebo Journal - Medical Humor With A Purpose

Placebo Gazette #149

(Keeping Our Finger On The Prostate Of Medicine)

4/21/10

Death and Quality

Hypoactive Sexual Desire Disorder

Fecalatta

Placebo Journal Update

Female Viagra

Let The Frenzy Begin

Dr. Gaga Interview

Get Your Discipline Numbers Up!

The Two Coreys

Don't Sweat The Stall Stuff

AOL Health Recommendations

Patient Complaints by Anonymous

1. Death and Quality

As the debate rages on about how to measure quality, a British Medical Journal analysis argues that hospital "death rates" are a "poor test of quality" and urged inspectors to rely on other measures. It is my opinion that there NEVER will be a true test of quality as quality is indefinable. I highly recommend you read the 70's classic Zen and the Art of Motorcycle Maintenance and see how this term basically drove the main character into a psychotic break. The same will happen to our healthcare system.

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2. Hypoactive Sexual Desire Disorder

This from an anonymous follower of PJ:

I’m hoping you have been invited to this August conference to save the world from this new dreaded malady.

One of the nurses in our department has figured out based on the graphics that this is a treatment for the sexual indifference of the female population faced with the onslaught of old guys with their Viagra Cialis induced erections and no willing partners to be found.

I am truly amazed at the "medicalization" of EVERYTHING which is undoubtedly then followed by a new pharmaceutical or expensive therapy to treat this very serious malady. In this case I suspect the first professionals recognized this problem centuries ago and offered their special services to relieve the symptom. This explains their longitudinal success. I wonder if that’s what this conference is promoting?

“This afternoon’s workshop is being conducted by Bambi in room 2105”.

We need to get in on the ground floor of this . Charter the American College of Hornology. Accredit one year fellowships in Hornology. Offer seminars to prepare “professionals” for certification by the College. Allow about 5 years for “grandfathering” them, but phase that out so only those who have completed our accredited programs and bought our study materials, and attended our seminars can call themselves Hornologists. Require re-certification testing, of course. Set up practice management services with one stop shopping for the accouterments of a Hornology practice. Develop catchy new acronyms and find medical conditions that seem to fit them. Market to “victims” of these dire conditions. Get on Oprah.

Most important, lobby like hell to have Hornology services included in the national health care scheme. What does Bambi think of Senators?

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3. Fecalatta
An employee at a New York Dunkin' Donuts may have spread some Hepatitis A around because he reached into the ice machine while infected. C'mon, people. It's not hard to stop this type of madness. Dude, wash your hands! Now the county is offering free post-exposure treatment to whomever has skin color that matches the filling of their lemon filled donuts.

Anyone want to offer some new ice drink names for the Westchester Dunkin' Donuts? How about Mocha Stoolatta? Got any others?

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4. Placebo Journal Update

We have begun on our 53rd issue of the Placebo Journal. If you have any funny stories that are medically related and happened to YOU, I would love to see them. Send them here.

If you are interested in subscribing to the only print medical journal that will make you laugh (on purpose) then just click below:

5. Female Viagra

Pfizer has found that the electrical stimulation of the pelvic nerve in female lab animals increased blood flow to the genitalia and this effect was magnified when given an experimental drug called UK-414,495. I see where this is going. Either Pfizer is going to make a ton of money off this new female Viagra or they are going to sell that electrical stimulation unit (what I like to call the "husband replacement").

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6. Let The Frenzy Begin

Primary care doctors are in need. There is no debate about that. There really is nothing in the new health care reform bill that was passed to fix this problem. There is no question about that, either. What does this all mean? Well, it means it's time for a competition frenzy.

Here is example number one found on an article at KevinMD. It seems the Retail Clinics, you know the ones that just wanted to treat sore throats and ear pain, want a new "service strategy". Now they want to get into chronic disease management. Hmmm, that's interesting. Remember when their whole premise was just to help out with the quick and easy things and not compete with the local primary care doctors? All lies.

Here is example number two found in an AP article. Read how one nurse practitioner tells patients she's just like a doctor "except for the pay." NPs and PAs (yes, I know you are not mentioned in either article) are very sensitive groups. I have many that are friends and subscribers to the Placebo Journal who I risk losing by saying anything negative about them. I am going to be very careful here.

First, it is not about the word EQUAL. We are all created equal. It is not about intelligence as an NP I am thinking about right now (and I am sure many, many more) is smarter than me. It is about the word DOCTOR. If you want to be a doctor, then by all means, I implore you to become one. We need you. The training is a bitch and; unfortunately, a gauntlet you have to get through. You don't get that in NP school. You will be all the better for it, though. I really comes down to paying your dues. You just can't call yourself one because you, well, just want to.

Nurse practitioners came about to strengthen the healthcare system by making them "physician extenders" not "physician competitors". By going this new route the NP group has made this relationship uncomfortable at best. I will get "hate email" over this but I didn't do anything. The NPs are blatantly changing their strategy, demanding to be called doctors and are in direct competition with us yet I know they will rip me for pointing this out. The bottom line is the you are not a doctor. You are an nurse practitioner. It is a fact and it is not demeaning to say it. It is just a term. Get over it. I call myself the KING of medicine but just because I call myself one doesn't mean I am one. Or does it?

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7. Dr. Gaga Interview

DrGAGAinterview.wmv

Here is our infamous interview of Dr. Gaga. He is a trendsetter. He is a maverick. You need to see it to understand his mission - making family practice sexy again. This is a complementary video to the April edition of the Placebo

8. Get Your Discipline Numbers Up!

Well, the lunacy continues with the group Public Citizen. They are once again unhappy that there are not enough disciplinary actions

against physicians. Some states, like Maryland, are just lagging. This, by the way, has NOTHING to do with real cases or any proof of wrongdoing. All they are looking at is absolute numbers and making a statistical guess. In other words, all they want are headlines and scapegoats. What if the doctors in certain states really didn't deserve any board discipline? Doesn't matter. The idiots at Public Citizens want blood so they need the boards of every state to get their numbers up. Sickening.

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9. The Two Coreys

There were two Coreys. No, not the show. There were two Coreys that internally battled inside Corey Haim. Both are now dead. That is how it is for all people struggling with drug addiction. I am not sure if he committed suicide or just overdosed. The same goes for Heath Ledger. You can even say it was the same for Michael Jackson. Corey Haim obtained 553 prescription pills in the two months before his death. He did this mainly by doctor shopping. Are these doctors guilty of murder? No. Are these doctors guilty of being idiots? Absolutely. There are many mechanisms in place to check on patients who seem suspicious. In Corey's case, one could have just checked the internet. Corey's mom is stating that he died of an enlarged heart and fluid in his lungs. Good try. Corey Haim died by his own hands whether the family admits it or not. So did Heath Ledger. So did Michael Jackson.

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10. Don't Sweat The Stall Stuff

Dr. Paul Nemeth went with his 6 year old kid to a Chicago White Sox game. It was opening day and was to be a great father and son kind of bonding experience; until they had to go the bathroom. That is when things went bad:

As they waited, Nemeth said, he noticed noises coming from the last stall. A man's legs — clad in blue jeans and sneakers — were sticking out from under the stall door.

"The toes were pointing up," said Nemeth. "The legs were shaking and quivering. From a visual standpoint, all you had to see was the legs quivering to know something was going on."

As a trained physician, he had an idea what was happening in there, but he worried it might have been something else.

"It was bizarre. It caught the attention of a lot of people. I tried to turn my boy's attention away from it, then I thought, ‘Is someone having a seizure?'

"So I kicked the door, just to get a reaction. I just wanted to make sure nobody was dying in there. That's when I heard a woman's voice yell, ‘HEY, STOP!' Something was going on and I had interrupted."

Moments later, the stall door opened, and a tall, thin, blond man exited. The tall man held his arms up in triumph.

Then a second person left the stall, someone Nemeth described as apparently female, "scurrying" out of the restroom with a shirt or coat over her head.

Looks like Dr. Nemeth needs to start the "birds and the bees" discussion a little early. He may also want to brush up on some things because sex and seizures are not the same thing. Though I do remember claiming to be post-ictal for weeks at a time before. Ah, to be young again.

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11. Aol Health Recommendations

Under its men's health section, AOL recommends these "5 Tests That Could Save Your Life".

Cardiac CT Angiography - unproven and not universally recommended
Bone Density Scan - no age given by AOL and not universally recommended for men
VO2 Max Test - WTF? This is for athletes in prime condition. I haven't even heard this term since my days getting my master's degree in exercise physiology
Virtual Colonoscopy - again, not universally recommended and if it is positive you need a regular colonoscopy. The worst part about any colonoscopy is the "clean out" which you have to do for both anyway.
Nutritional Evaluation - maybe. How about just losing weight if you are overweight?

This information is the kind of crappy advice given out by the media that drives us doctors crazy. By the way, they call us GPs in the article. Haven't heard that term in years. Nicely done, AOL. Idiots.

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12. Patient Complaints By Anonymous

An anonymous doctor was once called into an authority figure's office for a discussion of patient complaints. A quick glance at the names revealed that the complainants consisted of the following:

(1) Substance abusers claiming that the doctor was "insensitive" to their demands for higher doses of narcotics to be given more often (despite reports from reliable sources indicating that they were in no distress whatever).

(2) A family member who announced that faith alone would render dialysis unnecessary for the patient, and who took offense when the doctor asked why said patient didn't simply walk out of the hospital.

(3) The family members of a clearly terminal patient who demanded "full court press" even after the social worker pointed out that they were financially motivated to keep Daddy alive and his will unread as long as possible.

The doctor pointed out that admitting the patients nobody else wanted (having received them via appointments clerks and ER docs who stated that "Nobody else here wants to ever see this #$%^ again") pretty much guaranteed a high level of dissatisfaction.

The authority figure, however, was not impressed. "You have to work on gaining these patients' trust and respect," was the response. "You know, it's been said that diplomacy is a way of telling people to go to hell and make them enjoy the trip." The A. F. declined to demonstrate how this might be done.

The doctor eventually left the medical organization and has found one that believes in using resources wisely. Problem patients are given their walking papers and directions to other healthcare providers, and the pain-management service refers substance abusers to appropriate treatment facilities.

And you know what? The consultants in this place are excellent. The morale among support staff such as nurses and social workers is first-rate. The doctors are willing to work for less money because they know that their time is not being wasted. Patients even decline referral to tertiary-care institutions because they like the attitude in the second place so much better.

Moral: all authority figures aren't so bad. Some of them are even smart enough to know that you can't please everybody. And the others will have to live with the knowledge that they have made their organizations a magnet for drug abusers, sociopaths and primadonnas. Hoo-ah!!

P.S. Actually what really fries my cookies is the large number of "How to Deal with the Difficult Patient" courses, which make it sound like you can sweeten up ANYBODY if only you follow their advice. This flies in the face of all that is known about personality disorders and substance abuse, but healthcare institutions fall for it every time 'cuz they're so protective of their customer satisfaction ratings.

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Until next time, keep smiling, keep laughing and keep out of the sample closet.

Doug

King of Medicine

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5. Female Viagra

7. Dr. Gaga Interview

DrGAGAinterview.wmv Here is our infamous interview of Dr. Gaga. He is a trendsetter. He is a maverick. You need to see it to understand his mission - making family practice sexy again. This is a complementary video to the April edition of the Placebo

DrGAGAinterview.wmv

Here is our infamous interview of Dr. Gaga. He is a trendsetter. He is a maverick. You need to see it to understand his mission - making family practice sexy again. This is a complementary video to the April edition of the Placebo