palmd | October 30, 2009This is the penultimate day of our Donors Choose challenge to fund needy Michigan classrooms. We have fully funded 13 separate projects and scooped up matching funds from the Gates Foundation and Hewlett-Packard.
You have all been terribly generous, but I have to ask one final favor. A generous reader just gave $100 to a project to create an outdoor science classroom focusing on gardening. It's a terrific project and that single donation has brought the project within $300 of being fully funded. If you, dear readers, could kick in even a few small donations (in the 1-5 dollar range) I…
palmd | October 28, 2009A hat-tip to my buddy Abel over at TerraSig for keeping this story alive and inspiring me to chime in. --PalMD
It's no secret that I find the anti-vaccination crowd to be abhorrent. The public's health is the first victim, followed closely by individual patients and parents struggling with individual health decisions. I cannot fault patients for making bad decisions---the anti-vaccination movement has a very effective propaganda arm. Folks like Jenny McCarthy have a large audience and make no secret of their desire to see infectious diseases increase in others:
I do believe sadly it's…
palmd | October 27, 2009The young resident presented the patient in the usual dry terms we use for such things.
"The patient is a 42 year old woman recently hospitalized for cirrhosis due to alcohol use. Her cirrhosis has been complicated by esophageal varices, encephalopathy, and refractory ascites."
In other words, the woman has drunk herself nearly to death.
"Is she still drinking?" I asked.
"She says not. She says she stopped about six months ago when she first got sick."
"What did GI say? Did they refer her for transplant evaluation?"
"No," she said, a bit disappointedly, "they said she wasn't a candidate…
palmd | October 27, 2009You guys are great. Large donations continue to trickle in, but really, we can live quite well off of small donations. It would be really cool if we finished off the drive with a bunch of micro-donations, in the 1-10 dollar range. These small donations add up really quickly.
A Story to Tell is $97 away from being fully funded, allowing the teacher to buy a laptop and printer.
Inner City Soccer Team is a bit more of a challenge with $376 to go. There is no reason we can't get this done before the end of the week.
So let's do it---a buck here, a buck there, and soon enough...
palmd | October 26, 2009When I see a patient at the office, I spend time developing trust, forming a therapeutic alliance, thinking through their physical complaints, examining them, and applying the best evidence to formulating a plan for maintaining their health. It's a lot of fun.
Less fun is the part where I try to get paid. To bill an insurance company, I must use numeric diagnostic codes that best fit what I'm seeing, and I must pick a code representing a level of service, that is, how hard I worked.
The diagnostic codes are referred to as ICD-9 codes, and the service codes are called E/M codes. Not all ICD-…
palmd | October 26, 2009We have some very generous readers. We've managed to fully fund 12 out of 14 proposals from needy Michigan classrooms. We can probably pull off funding the final two projects this week, and although our readers have been quite generous in the size of individual gifts, I'd love to see a bunch of micro-gifts, in the 1-10 dollar range.
Remaining Projects
A Story to Tell: The teacher is trying to get a lap top and printer for her kids. That's it. She's $148 $123 away from getting it.
Inner City Soccer Team: Aside from the benefit of athletics, these kids are isolated in an economically and…
palmd | October 25, 2009My daughter handed my wife a hand-written Channukah wish-list which I will reproduce for you in its entirety:
Barbie remote corvette
Barbie camper
Ken doll
For real elephant
I'm not sure which one we will get her, but I have my biases.
palmd | October 25, 2009I try not to overbook at my office. I have about 16 slots every morning for returning patients (fewer if I have new patients booked, which I usually do). I usually schedule, counting new and old patients, 12 patients every morning. If I were to cut my appointment slots down to 10 minutes instead of 15, I could really pack 'em in, and I may have to do that some day, but with the 15 minute slots, I can usually squeeze in people who want to walk in because they're sick. There's only so much that can be done to control the flow; if someone has chest pain, I'm going to be running late from…
palmd | October 25, 2009My county health department released 10K doses of H1N1 vaccine yesterday and opened up two distribution centers for them. With all the anti-vaccination craziness out there, I was worried no one would show.
Turns out, no need to worry.
My friend went yesterday and waited for four hours with thousands of other people. From a public health perspective, perhaps it would have been better to have multiple smaller centers to avoid exposure, but people did not wait inside in crowded rooms, but outside in the wind. That's probably better, but who knows. At a time when mass vaccination is needed,…
palmd | October 24, 2009For some reason, me and the PalKid were watching Apollo 13 this morning. She was fascinated by the story, especially because it's a true story. During the lift off, the camera panned around the control room, and she said, "Daddy, how come there's only mens? Are girls not allowed in space?"
Those of us who advocate diversity in science are often asked, "how could it matter what faces are in the crowd?"
Here's your answer.
palmd | October 23, 2009Technically, the Donors Choose challenge to help out needy kids doesn't end until the end of the month. But donations given by Sunday are going to be matched by Hewlett-Packard. There are two great projects I'd love to get funded by Sunday, and I can't see any reason why we can't do it. If enough of us give a couple of bucks, we can get there in no time. Some donors have been freakishly generous, but a whole lot of 2 dollar donations can add up quickly.
A Story to Tell will purchase a computer and printer to help kids print up memoirs, helping them learn to construct stories and write.…
palmd | October 23, 2009I got home pretty late last night. The last week or two has seen a huge rise in influenza-like illness (ILI). Late in the evening, I began to get a scratchy throat and chills, but sometimes fatigue can feel like flu. I went home and had a nice dinner and a shower and felt a bit better.
At about 3 a.m., a little knock on the bedroom door woke me from a deep sleep. My daughter walked in crying, "my throat hurts!" She never gets up in the middle of the night. My wife sent me to the other room to sleep, gave her some motrin, and lay back down. Within a half an hour, the kiddo broke into a…
palmd | October 22, 2009As many of my readers are aware, most of us are going to need two flu shots this year: one for the seasonal flu, and one for the pandemic (swine) flu. I got my seasonal flu shot two weeks ago, and I'm taking the family to the community college up the street this weekend for our pandemic shots. It's not going to be a lot of fun holding my daughter down, but she's been hospitalized in the past with breathing problems so we're not taking any chances.
There's yet a third flu shot out this year. It's called the "Emergen-C Shot". I saw it on TV advertised homonymically as "emergency shot",…
palmd | October 22, 2009I've let you guys alone for a couple of days, but now it's crunch time. Hewlitt-Packard is going to match donation based on how much we are able to raise in the next few days. They have 200K to distribute, and who gets it will be based on how much we raise before Sunday. There are a couple of projects that look interesting, and all of them help kids in poor Michigan schools.
A story to tell: teaching kids how to write is pretty important. $219.00 left to fully fund.
Tools of the trade: kids making comic books to help learn English. How cool is that? All they need is a printer, and they'll…
palmd | October 21, 2009I get a lot of comments hostile to doctors, and I'm OK with that. Going to a doctor can be comforting, painful, humiliating, frightening, or all of the above. Doctors can be saints, assholes, and everything in between. But there are two phenomena I find puzzling. One is the act of "punishing" the doctor by not taking care of yourself, the other the idea that the doctor should take care of you for free.
We pay doctors for their professional expertise. We hope that they will behave as compassionate professionals, but as human beings, we often fail. I strive to be compassionate, and teach…
palmd | October 21, 2009How may topics are there on which Glenn Beck, Rush Limbaugh, Arianna Huffington, Bill Maher, and now Louis Farrakhan can agree?
One, and one only: flu vaccination.
Let's give a run down of the "reasoning":
Glenn Beck: the safest option is doing the exact opposite of what the government recommends.
Limbaugh won't get one because HHS Secretary Sibelius recommends it
HuffPo: need i say more?
Maher: too bat-shit insane to think properly about it
Farrakahn thinks it's a plot to reduce the Malthusian crush of minorities
Anything that unites these folks just has to be wrong.
palmd | October 20, 2009Michigan has suffered enough. We've been devastated by economic and manufacturing changes, leading to mass unemployment, poverty, and poor education. That last one is really killing us.
According to news reports, more than half of Michiganders plan to forgo vaccination, mostly for reasons that betray a lack of education. This is at a time when schools across the state are closing their doors because of the flu. They aren't closing their doors out of irrational fears, or for quarantine or isolation purposes, but because so many people are sick that it's not worth it to keep the doors open…
palmd | October 20, 2009Hewlett-Packard, the folks who made the computer I'm using at this very moment, are going to kick in more money to our project, and they're doing it on some sort of pro rated matching system that I don't understand. What I do understand is that as of today, HP is tracking how much we give, and based on how much we raise by Sunday, they will kick in some serious dough.
Also, as a special bonus to those who have given, HP is going to send out giving cards which will let you decide where more of HP's money goes.
The details are not clear, but it boils down to this: the more we give by Sunday…