Wednesday, March 31, 2004

No, despite the previous post placed by Heather, I do not, repeat do not, definitely do not have mono. This is definitely the worst URI that I have had in many years, definitely not mono. I found myself today raiding the medicine cabinet and taking two of everything.

On another note, rheumatology is cool. Ask the patient how they're doing, what meds they're taking, and look at all their joints. Pretty simple. Seven more clinic days until the end of med school. Sweet.

Tuesday, March 30, 2004

Brian has finally come down with my mono. Though he insists that he doesn't. I cannot believe the timing our bodies have. I was sick for the whole, long evil interview process and he will be sick for our move, graduation and house buying trip. Stupid immune system

Now for my rant of the day: Those people with kids or those people who want to have kids, PLEASE FOR THE LOVE OF PETE CHILD PROOF YOUR HOME!!!

I am on peds radiology and saw a film yesterday of a kid who had a history of possibly swallowing a penny. The film not only showed a coin in the kid's stomach it also showed a sharp, pointy screw bright as day in his colon. So this kid could have had the screw poke a hole in his gut on its trip to his diaper, thus causing him a painful surgery and a long course of antibiotics at the very least. All because his mom or whoever didn't bother to pick up the floor.

So the take home point is toddlers put bright shiny things in their mouths and have very little judgment about swallowing things. They need parents to watch out for them. It could be worse a suppose, like maybe an electric cord that the kid chewed through.

Monday, March 29, 2004

Well I think that this is cool.
Today was a simple but good day. There's nothing quite like getting up early and getting your day started and on top of that to find out that clinic for the day has been cancelled. As well as for tomorrow.

So, we started packing in earnest today. Actually putting things into boxes that will not be unpacked until they arrive in Lexington, which date is still probably 6 weeks away. At the rate we're going, today is definitely not too early to start though.

Problem: Heather and I have a ton of books some of which are either duplicates since we've had pretty much the same academic coursework or just plain old useless to us and taking up space and we don't want to move them. Bookstores won't buy them back and selling them on eBay is not worth the effort. I doubt people shopping at Goodwill want to read about Immunology and Physiology.

Solution: Donate them to our high school library. For it to be only across town, this was only the third time since graduation that I've been back on campus. Looks remarkably unchanged. As a bonus reward for our tax-deductible donation we got a tour of the newly finished auditorium. Looks great. For additional donations of $100-$1000 we could get our names engraved on chairs in the auditorium. Thanks, but no thanks.

Friday, March 26, 2004

I just want to add that I'm incredibly humored that my banner ad is now for constipation relief and has a related search for green stool. That's what I get for certain stories, huh?

And without going as inanely on and on as I just did, that if you really want to feel screwed as a consumer, talk to a few mortgage agents. I have talked to some very sketcky people in the last two days. One guy wanted to connect a mortgage to a life insurance policy and take out a second loan and use that to invest in some off-shore scheme and that would make more than enough to pay off the first loan. No f***ing way I getting involved in that level of crap. The icing on the cake was when he mentioned that his "twin brother" is a realtor who has incredible negotiating skills and can talk homesellers into anything. After talking to this guy for 10 minutes I had to get some towel to wipe the snake oil and bullshit off of the phone.
Interestingly enough, in connection to posts by Taylor and Chad, the other day I saw an ad for a vending machine-like service for a wireless LAN. It was actually an offer to be a franchisee in this service. You buy the right to place a wireless access point in a high-traffic area. If people swipe their debit card through the vending machine, they get the password that allows them access to the wireless network for whatever amount of time they purchase. If I could remember the name of it I'd link to it.

Another point: Though this doesn't truly reflect on the market-responsive variable pricing for M&M's in a vending machine that Taylor suggests, there was once a system in place in which consumers paid only for the minutes that they used. Almost all internet providers have given up on that, though you can still find some cell-phone plans that have that as an option. Of course, Virgin has brought it back with a vengeance. The companies figured out that they can charge more than you would have spent on minutes anyway and the average consumer out there thinks that he's getting a bunch of free minutes which most consumers never utilize. I admit to my own idiocy in this scheme.

Back to the point, most people who have broadband never use enough bandwidth to justify the cable company charging $45 a month. Nor do most people watch enough cable TV to justify the other $40 a month. Although a really interesting concept would be paying per channel per time based on market demand. Can you imagine how cheap it would be to watch AMC at 3am? Or how expensive to watch a certain tournament on CBS tonight? So obviously with cable TV it doesn't work because the system is set up to provide balance. Most cable providers are actually losing money providing ESPN right now, but they're making money off of OLN.

Broadband is another issue. For every person like myself who uses a considerable bandwidth at certain times of day, there are those who practically never utilize the bandwidth. In a perfect world, the cable company should charge them half price and charge me twice as much.

So, I'm getting tired of this post and I'm not sure I've made a single point at all, but in wrap, I guess my point is that current business models just aren't geared up yet for highly individualized pricing or pricing by instantaneous market demand. However, I'm in complete agreement that that would be the ideal of consumer-driven free-market capitalism. The flip side is that the current way of doing business is near the ideal of business-driven free-market capitalism. The difference being, like Chad has said, people are too lazy to shop around and are goaded into the "best fit" offered by businesses, which is how we get to the point that those of us who know we should be getting a better deal feel like we're getting screwed when talking to these companies on the phone because there is no deal that they offer which fits our needs within the close margin of efficiency that we are accustomed to in our various professions.

Posts like this are the crap that happens on my day off.

Thursday, March 25, 2004

MisManaged Care

Saw a couple of real assholes yesterday (not literally). One guy was totally working the system to allow the taxpayers of the State of ___ and the County of ___ to pay for his care. This guy came to the emergency room because he had had a cold for a week and wanted some thing for the cough. So of course I ask, "What have you tried?". He then rattles off two or three items, none of which even have cough on the label. Great. "Why didn't you go to your regular doctor?". Doesn't have one. No big surprise. Neither do I. Whatever. 9 days out of 10 in our ER this guy gets a rx for an antibiotic (No, he doesn't really need it) and a rx for some damn good cough medicine. Most patients are incredibly thrilled by this combination, particularly the magic antibiotics for their viral infection. This guy wants to know if there's a shot he can get right then. Anybody want to know why? Keep in mind this guy is otherwise perfectly healthy, reportedly has a job with decent income (just no health insurance), and is dressed decently. If he gets a shot in the ER the hospital sucks up the cost because this guy will never pay the bill (98-99% of our ER patients never pay the bill)(that statistic excludes those who never make it out of the ER). If he gets a prescription on the way home he has to pay about $25 to fill it.

More math: had he gone to a regular doctor his visit would have cost about $30 or so and about $25 or so to fill the prescription. An ER visit is well over $1000 and a shot of antiobiotic would have been 2-3x more than the pill form. So, this guy cost the system over $1000 and paid for none of it, when he could have gone to a regular doctor and paid around $50, even with no insurance.

After seeing this gem I was walking down the hall and the triage nurse was leading another dude down the hall. His mouth was running the entire time about how his wait was so long and we should get our act together. Then it came, "Y'all need to take some of that money y'all've got and build a bigger unit." If it had not been quittin' time, I would have gladfully seen this guy just to get the rest of his opinion on our financial situation. Then I could have asked him just how often he comes to our ER for "belly pain" and how often he pays his bill, because it's sure as hell not from him that we get any money.

Now for irony. Obviously I'm opposed to most forms of state-controlled healthcare. It's bad. Evil. It's bad healthcare and on top of that would seriously impede my financial statements. Those are my reasons. They're obvious. The ironic part is that these two rednecks I saw in the ER yesterday, I'm sure, would vote down any plan or even political candidate that suggested such a system, even though they abuse the current system and treat it like state healthcare, since it's the taxpayers paying for them as is.

Enough, I have to try some more mortgage lenders.

Tuesday, March 23, 2004

I had a mundanely productive day today. Haircut. Washed car. Got oil changed. I guess those are examples of things that are extremely boring for blog readers to read.

On the other hand some of my classmates and I got a lot of video editing done for the annual skit night production. We are absolutely on track to have a larger and intensely more funny presentation than last year's class managed to muster.

We are now moving right along on the path to buying a new home in Lexington. It's amazing how complicated it can be to secure a loan when you're going to have plenty of income in less than 4 months, but the fact that you have zero income when applying for the loan automatically puts you into what might as well be the loser group of home mortgage options. I'm very disappointed with the whole process right now.

On a brighter note, our internet browsing of home listings has produced numerous homes that we would be very happy in, so at least once we get up there in a few weeks we'll have plenty to choose from.

So, I haven't picked up any good stories lately, but I thought of an old one. There was once an ER attending who never trusted anything that a medical student told him and rechecked things for which there was no need to recheck them. So one day there was this lady with constipation and occasional blood in the feces. Obviously time for a rectal exam, which was normal, which means heme negative and normal tone (the sphincter is tight to a normal degree). Keep in mind that a large proportion of our patients have stories that don't make medical sense with their physical exam. Anyway, I expected normal tone in this lady and that's what I found.

So, the attending wanted to repeat this part of the exam. So he donned a glove and inserted a finger. He begins to scowl, which is usually followed by some explicit explanation to the student that he is a dumbass. He inserts another finger and the scowl hardens. Uh oh. In a loud voice, in that way that tries to let the entire ER know that the student doesn't know even basic exam skills he announces, "You call that normal tone, this sphincter is very flaccid". Then, as if you readers didn't see this one coming when I started the second paragraph, the patient, in her best ghetto-like accent and probably offended by the word flaccid, belts out "That ain't my butt". Yes, I can't believe I just shared that story.

The worst part, it is absolutely true and occurred in a university medical center. Terrifying. It was definitely worth it to see the guy that discusses which type of ammo has the best stopping power turn every shade of red on the color wheel.

Saturday, March 20, 2004

So, myself, my wife, and her family just back from the Fairhope Arts Festival. Saw a few interesting items, the most interesting of which was an artist who had a method of doing emulsion printing onto stoneware. Unfortunately, no web site to link to.

Of course, Thursday was "Match Day". Congratulations to everyone in our class, as we already knew our results. Everyone seems to have survived the annual trip to New Orleans without incident. Things just seem better when no one spends the night in Central Lockup.

On a more mundane note, we received our replacement Roomba. It's working great. To whom I was discussing the temporary failings of the Roomba last week, I hate to admit that I discovered that it was probably user error that was causing our problem.

Wednesday, March 17, 2004

Excellent, at this point this blog has passed the one-day wonder phase.

A very random thing happened while we were in Austin over the weekend. When we got home, someone had paved the middle third of our driveway. Not the part by the street, not the part in front of the house, the middle part. Granted, that's the part that needed repaving, but it's still random. There are actually a lot of our neighbors who have new driveways now. I'm thinking some paving company had some extra asphalt mixed up and took pity on our driveway.

Monday, March 15, 2004

So, I got that first post out of the way. This won't technically be a one-hit wonder, although tomorrow will decide if it is a one-day wonder or not. That out of the way, I also figured out how to make the time-stamp realize that this is the Central Time Zone. Outstanding.

Congratulations to Taylor on the wedding. Beautiful event. However, I am curious how long it takes to get that much saran wrap off of a car. :) Austin was an interesting city. Texas big.

Congratulations also to my wonderful wife Heather who matched to her residency program today. It's nice that we can actually be in the same place next year and are greatly looking forward to moving, knowing with all certainty embedded in a legal contract that we will both be in Lexington. Not to mention that UK is a number one seed in the tournament. Also, we can now move full speed ahead with homebuying maneuvers. This is very exciting for us. Match day on Thursday will now be very anticlimactic, which considering the unusual situation that we had, is exactly what we wanted.

Ah, yes, I almost forgot to mention a story from the hospital today, as has been requested by some readers. Any identifying factors are changed in any of my stories, for anyone paranoid about the security of private information. These stories will be about as specific as saying "that blonde-headed lady from Mississippi". HIPAA.
I met Jesus today. Or at least a guy responding to that name. I didn't actually have anything to do with this gentleman's care, just observed that there was a guy on a gurney in the hallway (our hospital is broke) chatting with the nice nurse about how he is Jesus and his people are wandering in the desert. I realize that that's not much of a story, but hey, I worked a short shift today. And somehow, if one steps back and thinks about that scenario for a moment, that story seems more meaningful without knowing the beginning or the ending of it. It's open to metaphysical interpretation. Maybe he, as a poor man with a message, really was Jesus laying on that gurney. Or maybe he was just high on something, schizophrenic, or delirious from any number of other causes. Holy cow, that was way deeper than I meant to think.
So, this is my blog. I, too, have joined the bandwagon of "blogging". Seriously, I hope no one is expecting great works of blogtistic thought to appear here. In fact, I recently read in the best newspaper in the world (insert laughter), USA Today, which I only read when hotels that I'm staying at leave it in front of my room door, that almost a third of the 10,000,000 blogs currently available are so-called one-day wonders. Also, that another third have not been updated in over three months at the time of the survey. I think my goal for the moment is just not to fall into either of those categories.

So, thank you Taylor and Richard for convincing me that this is something interesting and worthwhile to do.