Walking Piano Keyboard Musical Debut Video. Please Hold Your Applause 'Til The End

While up in Sioux Falls, SD last week checking out Check-Up,  I had a chance to stop by their Washington Pavilion of Arts and Science.   They had some fun stuff there including this giant walking piano keyboard.  I've seen them on TV before but it was fun to try it myself.  Watch the video below

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Is This A HIPAA Violation From Texting?

I love texting.  It's quick and it allows me to answer my questions on my own schedule.  I don't have to stop what I'm doing to answer my phone or go find a land line to respond to a page. If I get a text  I  can determine the urgency of the communication  and I can return the call when I get a chance.

I also like texting  doctors with requests for consults or questions or to let them know things that are important, I think, to them.  Bronch cultures came back positive?  Nothing wrong with texting the pulmonologist so we don't waste 24 hours of hospital time waiting to address the findings. 

I just send them a text.  Communication expedites everything inside a hospital's walls.  But sometimes it fails.  Take for example my own partner who changed cell phone numbers on me.  If I was told, I forgot.  Oops. 

I'm covering for her patients when I get a call from the nurse that Mr COPDer has passed away.  I send my partner a text

Mr COPDer from room 621 died at 16:27 on 5/27/10.  FYI.

Two minutes later I get a call back from some soft spoken dude (who sounded stoned) on the other end asking me who I am.  I told him I was a physician. He said he didn't know what COPDer meant.  I said never mind.  I have the wrong number.

Now stoner dude knows that Mr COPD died.  Who has access to my medical information?  

Stoner dude does.  That's what happens when text numbers aren't updated. But I'm thinking this text can't be a HIPAA violation since Mr COPDer is already dead.  What would I be violating?    I guess no form of communication is fail safe, no matter how much you try to protect the information. 

Clostridium Difficile and Pseudomembranous Colitis Outbreaks Linked To Illegal Immigrants From Mexico.

Illegal immigrants from Mexico are responsible for Clostridium difficile related pseudomembranous colitis outbreaks.  At least that's what people commenting on one article about an outbreak in one Arizona community are saying.  

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Patriotic Pancakes Picture. Cool Food Porn For Memorial Day Remembrance

Fellow physician and  Suture For A Living blogger Tweeted this neat patriotic pancake picture.  That looks like a delicious way to go through our  four pound bags of blueberries (our favorite Sam's Club food ).

Have a great Memorial Day weekend. Go for a Memorial Day ride.  I might be out fishin' tomorrow.

Happy Nurses Day. Here's Your Present. Love Management

I have a wild imagination, but I found this happy Nurse's Day present kind of odd.  I'm rounding in the hospital the other day when I saw one of the nurses wearing this t-shirt.  If you are a nurse and you want to celebrate your profession, what better way for nursing management to say thank you for everything you do than to buy you a t-shirt....

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Sack Tapping Game Causes Testicle Trauma. Another Boy Loses His Jewels and Jimmy Kimmel Taps In

Just when I think teenagers couldn't get any dumber, along comes a story about a boy who lost his testicle after a classmate punched him in the balls playing a game of "sack tapping". There is apparently an epidemic of testicular sack tap trauma in Minnesota from the sack tapping game.

Read what  the UrbanDictionary.com say about sack tapping

 

Here's a must do checklist for parents and teenagers to discuss

• Use a condom.  Check
• Wear your seat belt.  Check
• Don't let other boys punch you in the balls on purpose.  Check

OK. Now your job as parents is over.  Here's what Jimmy Kimmel (video) has to say about it.  Good stuff.

The Propofol Shortage, Why It's In Short Supply And Why Did Teva Stop Manufacturing It? Should The Government Force Them The Make It Again?

Yahoo is reporting that Teva Pharmaceuticals will stop manufacturing propofol, the infamous medication connected with Dr Conrad Murray and the death of Michael Jackson.

Propofol is by far the most commonly used anesthetic in this country according to the American Anesthesia Society, used for both general anesthesia and sedation.   What's up with the propofol shortage?  Why is it in short supply?  Why did Teva stop manufacturing propofol?

• The drug is hard to manufacture
• The drug is being bombarded by civil lawsuits
• The drug has difficult storage requirements
• The drug lacks of significant profit margin

No US compannies are currently manufacturing the drug, resulting in an FDA approval of a propofol version made in Europe.  

Perhaps it's only a matter of time before Obama determines that access to propofol is a right and forces Teva to initiate production of this life saving anesthetic used in most surgical or procedural interventions.  If health care is a right, shouldn't access to  propofol be part of that equation?

Cigarette Chain Smoking Two Year Old Boy Smokes Two Packs A Day. Shocking Video!

Watch this shocking video of a chain smoking two year old toddler from Indonesia. Unbelievable. This kid's parents should be thrown in jail for this unbelievable display of child abuse.  Perhaps if she could teach him to blow smoke rings, that would be another story.

Apparently in Indonesia, anyone at any age can buy cigarettes. This poor child is doomed. How does the mother respond?  She says he's totally addicted. 

Um.  I'm pretty sure the kid doesn't have a job.  It's your fault lady.  Who the Hell gives their two year old a cigarette?  The pain you're causing your kid for the rest of his life pales in comparison to the screams and anger you don't want to deal with today.

If you were in America, the solution would be simple.  Just take him to the ER. Here's the video of the kid smoking. 

Exercise Is Medicine Billboard and The Tale Of Two Women

While in Sioux Falls, SD last week checking out the cool bronze sculpture Check-Up, I came across this Exercise is Medicine billboard outside the local health club.

What a perfect representation of the truth.  Exercise IS medicine.  In fact, it's one of the best medicines out there.  In addition to quitting smoking for good, exercise is right up there with the best medicines we have to offer.

• Heart disease
• Stroke
• Cancer
• Diabetes
• Metabolic syndrome

They are all part of the leading causes of economic suicide in this country leading  to chronic debilitating multiorgan failure.  In addition to the prevention of vascular related disease, exercise does what no medication can do, it keeps your body moving.  This old man running marathons is a tribute to the power of  exercise as medicine.  

Now take the example two forty year old 400 pound women who presented to the hospital six months prior for essentially the same problem.  "I'm short of breath doctor".  Both women had tens of thousands of dollars worth of testing.  Both had stable hearts.  Both had evidence of restrictive lung disease, obstructive sleep apnea, chronic fatigue and diabetes.   Both had a poor quality of life.  Both were told they had to lose weight  as a matter of life or death using a regimen of diet and exercise.  Both were referred to the appropriate services.  Both were fully insured.

Six months later, the results were as expected.  One woman took the advice to heart.  She lost 75 pounds.  She wrote me a letter:

Dear Dr Happy.

I want to thank you for setting me straight last year.  I took your talk to heart.  My husband and I have started a new journey together.  We have joined a gym and are watching carefully what we eat.  I've lost 75pounds and have never felt so good in my life.  I have more energy now than I've had in years.  You are my inspiration.  Thank you for giving me back  my life.  It hasn't been easy and the battle is constant, but I know it's up to me.  Again, thanks for speaking truthfully.

And then there is the other lady who got readmitted six months later with lymphedema, cellulitis and sepsis like syndrome.  She was 40 pounds heavier than before.  We talked about her weight loss and what she was doing about it.  She said she wasn't doing anything.    She had an excuse for everything.  Everything.  The response to every question was denial.  The response to every recommendation was refusal.  What did she want?  She wanted a handicap sticker and an electric motorized scooter. 

Exercise is medicine.  Electric scooters are not medicine.  Exercise is the best medicine out there. From prevention and treatment of chronic disease to improving and delaying the onset of progressive functional decline, exercise as a medicine is better than most  everything we pay for (and will now be forced to pay for) in our 2.5 trillion dollar health care system.

To those of you who say you can't exercise, you are missing out on the best medicine available.  Are you going to be the woman who has lost  75 pounds and feels great or are you going to be the woman confined to the scooter on your way to an early demise.  

It's your choice.  Mrs Happy and I have made the choice. We choose running as our exercise of choice.  You can follow me on my daily running log as I walk the talk of healthy lifestyles.  Exercise is the best medicine out there. 

See my other Sioux Falls posts

New BP Logo and Slogan Revealed: Broken Promises

Here's the new BP logo and slogan:

 Broken Promises

Mini Spinners (Spinning Rims) On A Minivan Video

It's not every day you get to see spinners (spinning rims) on a minivan.  Some things were just meant to be laughed at.  I call them mini spinners.  Watch the video below

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Do You Need Help With Hospital Bills? Outrageous Charges Are Never Meant To Be Paid.

So I'm filling out paperwork for a patient when they show me a list of their hospital charges.  They had a  previous five day hospital admission with a diagnosis of pneumonia and COPD dyspnea. 

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"Check-Up" Sculpture By Artist Carol Cunningham. A Kid, a Dog and a Stethoscope.

I was in the great city and state of Sioux Falls, SD last week when I discovered this bronze sculpture titled "Check-Up" by Carol Cunningham of Estes Park, Colorado. It was a commissioned work by the Colorado State University School of Veterinary Medicine.  Notice the bandage on the child's leg.  He just got back from his pediatrician and now he's giving his pet dog a check-up with his stethoscope.  

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Terrorists Blow Up A Donkey. Democrats Mortified.

The Jerusalem Post is reporting that terrorists blew up a donkey on the Gaza border.  Democrats are planning a full scale retaliation.

What Is The Difference Between An Optometrist and an Ophthalmologist? Linguistic Creep Means "The Eye Doctor Is In"

I snapped this picture of "The Eye Doctor Is In!" sign at my local Sam's club.   Who is this "eye doctor"?  Are they a Dr Nurse?  Are they an optometrist?  Are they a medical doctor?  What is the difference between an optometrist and an ophthalmologist?  The sign just says "eye doctor".  Who is it?  Who knows.  Did they get picked apart by physician credentialing software?  Who knows.

To practice optometry, an optometrist must graduate from an accredited four year post graduate institution after completing at least three years of undergraduate preoptometry course requirements and then get licensed in their state of practice. To practice ophthalmology, an ophthalmologist must graduate from an accredited four year medical school after completing the 90+ undergraduate premedical couurse requirements, then  complete a residency in ophthalmology which consists of an internship year in internal medicine or general surgery and three years or more of additional training in ophthalmology.  Then they must get licsensed by state authorities. 

The lay public, the really lay public, has no idea what the state and federal licensing standards are for the different professional clinical training tracks.  

There was  a time where I  had no idea what the different  requirements were for an RN, NP, PA, MD, JD, DDS, Pharm  D, PhD or any other professional degree.   Most of the public has no idea how the whole higher education system works.

They have no idea  that most physicians complete  a four year undergraduate degree, a four year medical school degree and a  three year residency  with upwards of two to four  more years of additional subspecialized fellowship training.

Most of the general public has no idea of the time committment necessary to earn a doctorate degree in medicine.  They don't know how the educational committment of a Dr Nurse is different from an optometrist is different from a veterinarian is different from a Pharm D.    Why would they know?   It's not something that has been well publicized.

For the Sam's Club Walmart public, they probably have no idea who the  eye doctor is.   But I suspect they wouldn't care.  They just want to be fixed.

The word "doctor" has no restricted meaning anymore. Through the decades, linguistic doctor creep has devalued the public's perception and interpretation of what it means to be a clinical doctor.   I have many patients every day who call their NP or PA doctor.  To much of the public, all training is the same.  They don't care.  They just want to be fixed.

While many clinical tracks offer a doctorate degree in their field, only physicians are clinical doctors, per say.  I'm sorry to say Dr Optometrist,  you have doctorate degree in optometry.  Linguistic creep has made you a doctor.

Perhaps it's time for medical doctors to abandon the word doctor for good in favor of the word physician to publicize the difference between  being a doctor and being the doctor.  From here on out I shalt be known as Physician Happy M.D. You can call me Fiz.

And one word of advice to impress your friends., the word ophthalmology is pronounced off-thal-mol-ogy, not op-thal-mol-ogy, as is often mistakenly done.  Take the poll below and let the world know what you think.

LOST. Is Dead. What Now?

LOST. is dead.  Six years of on your seat entertainment is over.  It's the only show that has captivated the attention of Mrs Happy and I for six long years.

Now what? What I am going to do with that extra hour a week?   Please, everyone take a moment of silence to honor the death of LOST.

March of Dimes 2010 Walk. Pictures of Trains and Dogs

Mrs Happy and I, along with Marty and Cooper walked in the March of Dimes Walk-a-thon this year. It was an excellent experience. We walked with one of Mrs Happy's friends and her family. Two miles. There were hundreds of people there, all out to support a great cause.

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Forklift Carrying Heavy Cargo Pictures

UPDATE:  The reveal!  Home remodel before and after 2010-2011 picture video tour.

I snapped these pictures at the local granite supply yard  We had the granite vs quartz debate for our first floor remodel and in the end chose granite. I'm not sure what's in these giant cargo containers. But I was standing by some granite slabs and all of the sudden this giant heavy container started to move on me.  I jumped out from behind the container and noticed the forklifet was picking it up.

What the.... I  can't eat and drink at the nurses station because OSHA is concerned an employed nurse might swallow some bacteria or other biological fluid. But it's OK for a forklift operator to pierce these giant cargo containers without looking behind them to see if someone is standing there.

Maybe OSHA cares more about nurses than they do about people buying granite. 

Edible Arrangements Take Fruit Baskets To A Whole New Level

Edible Arrangements (ediblearrangementsDOTcom) have taken fruit baskets to a whole new level of sophistication.  What better way to say I Love You or Happy Birthday or Happy Anniversary with a bowl of fruit in the shape of flowers.  It's the gift that keeps on giving, diarrhea.   Happy  64th Birthday, Richard.  Nothing says Happy Birthday like a regular bowel movement.

If you've never seen a fruit basket arrangement by Edible Arrangements, they are a site to be seen.  They aren't cheap, but they sure do look fancy.  And the fruit is oh so good.  Maybe next time we'll save some money and just get some some homemade fruit flavored water.

If you decide to get one for your family, you can go online and find discount codes from a variety of websites that will give you 10% off.  We found one by Googling for it.  And it worked.  

What kind of gift do you usually give people who have everything and need nothing?  You give them fruit like we got for the fruits of our labors.  

200 Day Moving Average Graphs For the S&P, Nasdaq and Dow Have Been Pierced. Technical Analysis Says Major Support Levels Broken

For those of you who follow market indices and technical analysis, the 200 day moving average (DMA)  is an important technical and psychological barrier.  May 20th, 2010 marks an important technical break in market analysis as the S&P 500, Nasdaq and Dow Jones indices have all fallen below and closed below their 200 DMA.

Breaking above or below the 200 DMA  usually indicates a major market moving swing to come.  With much of the market now dominated by computerized trading and stop losses set at  important moving averages, one should tread this market with caution. Instead of support, the 200 day moving average now becomes a resistance level.

• Graph of the 200 day moving average  for the Dow (orange line)
• Graph of the 200 day moving average for the S&P 500 (orange line)
• Graph of the 200 day moving average for the Nasdaq (orange line)

That's why I put all my 401K into cash earlier this year.  With so much uncertainty surrounding the current global political and economic climate,  my motto is when in doubt, stay out.  Everyone has their own threshold for risk.  For me, my risk tolerance is at an all time low, especially since I see nothing that suggests a sustained global economic recovery is in place.  Under normal circumstances, I would say stay long and strong.  I don't think we are living in normal circumstances. 

The velocity of money has plummeted, the vast majority of exotic interest only and ARM mortgages are going to be reset in the later half of 2010 and all of 2011, new mortgage applications at 13 year lows, mortgage delinquencies are expected to double from 5% to 10% in the next two years and 5 million more  homes are expected to be thrown onto the market that is already down 30% or more.  Oh yeah,  and unemployment applications rising.   I see nothing to suggest a sustained economic recovery is in order.

The only thing that will generate growth is reducing taxes.  And we know that aint gonna happen until we throw them all out of office, Democrats and Republicans alike.  This isn't about donkeys or elephants.  It's about taking the pigs to market.  The pigs that will always give you what you want, not what you earned.

We live in uncertain times of a magnitude never before experienced by multiple generations. 

Grand Rounds Comes Home

Grand Rounds makes a pit stop at home base.  Go check out this weeks best offerings. It's a nice selection.

The Day I Told A Surgeon He Was Acting Like An Ass

We all know that some people can be jerks.  Every day I try my best to treat people how I would want to be treated.  But some people need to know, in no  particular words that they are acting like an ass.  And five months ago, on Christmas Eve none the less, I told a surgeon he was acting like an ass.

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Woman's 42 Million Dollar Jack Pot Turns Into $20.18

A woman was paying the penny slots at Fortune Valley Casino in Colorado when her machine said she'd won 42 million dollars, due to a computer glitch. In the end she got her jackpot of  twenty dollars and change.

 She says she's OWED the whole thing.  Why does that not surprise me?

How Not To Implement An EMR And How To Implement an EMR The Right Way

I've been a hospitalist now for seven years and I can categorically state with certainty there is a good way and a bad way to implement an electronic medical record (EMR) and other patient data tracking technology at your hospital.  And Happy's hospital has gone off the deep end.  We should be the poster child for how not to implement EMR and other patient tracking technology.

What does Happy's hospital have thus far?

• We have an EMR that is photocopied page by page into a permanent electronic record.  This requires me to log in with an independent user ID and password
• We also have a daily electronic patient record from which to manage some, but not all, lab and x ray reports.  This requires me to log in daily with an independent user ID and password
• We also have a portal website that contains access to hundreds of protocols and other important web based information sites.  This requires me to log in daily with an independent user ID and password
• We have an ER physician order entry system and patient data base that talks with none of the other hospital data systems, leading to highly inefficient duplication of work effort.  

Now comes word, starting this week that Happy's hospital patient medication administration system is going entirely digital as a safety initiative (bar coding of every medication and patient wrist band etc).  There will no longer be paper access to the daily updated medication list in the chart.  And the print function has been disabled, so I have no way to print the accurate list.

I contend this will actually increase patient errors and complications.  While the system is an excellent idea, making it user unfriendly negates all the benefits.  There is no way I am ever going to log on to a fourth daily system to view something that is not easily accessible at my fingertips. 

But I have found a way around the system.  You see, apparently, post operative re initiation of medications and discharge medications are still on a paper system.   Now that the daily paper  medication administration record has been replaced by one that is only digital, I have now been forced to write a daily order for my patients.

Please print a copy of the patient's daily discharge medications and place in the chart

This solves the problem by generating an up to date list of the current medications being administered, even if I have no intention of discharging the patient.  Because nobody asked the physicians what effect this horrible work flow interruption will have on the safety of their ability to accurately manage the medications of their patient.  Any benefit (although extremely small) that a patient won't get someone else's medication with the bar coding system is negated 10X over by all the physicians, including me, who will never take the time to log into, yet again, another computer technology program that is not integrated with the others.  Instead of adding another program every year, the whole thing needs to be gutted and built from the ground up, using a modular approach.

I have requested to be a member of my IT committee before any other major multi million dollar computer systems are implemented in the future that become a workflow disaster.  This is a waste of resources and I'm shocked this system got implemented with such poor implications for physician work flow.  In the end, it's the physician that writes the order.  The system must, above all, make sense for the work flow of the physician.  Everything else is secondary.  Without the physician order, there is no system.  Period.

Soon, the Medicare National Bank will require hospitals and physician offices to implement an EMR or face declining payment.  For hospitals and doctors out there looking for an electronic medical record I have joined forces with an expert in the field of making EMR decisions.  They have an in depth checklist that gives you a clear understanding of what you need to look for when you're getting an EMR for your office or hospital.   If you just want the checklist email me at happyhospitalistATgmailDOTcom and I'll send it to you.  I don't want you wasting  their time calling you back if you don't have any interest in discussing your options.

But, if you want the real benefit of having someone call you to discuss, for free, the options that will dramatically improve your work place efficiency, sign up with your contact information below so the experts can call you to help you understand your needs and put you on the path to finding  the right product for your needs.

It's all free to you.  You have nothing to lose. If enough folks sign up, I'll even hand out a gift card worth $100 to a random client.  But the $100 is nothing compared to what you can gain in hospitalist efficiency with a well run EMR and the money you WILL lose from the Medicare National Bank if you don't implement your own system soon.

I wish Happy's Hospital had taken the advice from these guys and actually found something that makes sense, for the long term, instead of spending millions of dollars on products that will never have good workflow functionality.  Sign up below to get your free EHR comparison checklist and get started today.  It's that easy.

Other useful information is available at my EHR Resource Center.

Mean Things Husbands Say To Their Girlfriend or Wife

So I'm in the  ER one day when the nurse comes out with her jaw dropped

Nurse:  You'll never believe what I just heard.
Happy:  What.
Nurse:  This woman is like 500 pounds and I'm helping to roll her when all of the sudden her husband blurts out "Damn woman, you're fat".
ER Doctor:  He just now noticed? 

What's the meanest thing your loved one has ever said to you?

Medication Disposal After Death: What Happens To Your Medications When You Die?

I had an interesting conversation the other day with a home health care and hospice nurse at Happy's hospital regarding medication disposal after death.    I asked her, "What happens to all the medications when the patient dies?"  

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Velocity Of Money Chart 2010 Shows The Economy Is In Deep Trouble

Our government is printing trillions of dollars to bail out everyone from Main Street to Wall Street to the one trillion dollar Euro Street bailout this month.  You would think all that money being printed would lead to out of control inflation.  But it isn't.  Why?  When you print trillions of dollars, the value of every existing dollar must decline.  But it isn't doing so in dramatic fashion.  Why?

Because the velocity of money has plummeted (updated graph).

What does the velocity of money mean? Read what  businessdictionary.com says about the velocity of money

Basically, here's how I understand it. Our government is printing trillions of dollars to bail out big banking institutions. The banks are taking the money being gifted to them at a Fed Funds borrowing cost of 0% and then buying US Treasury Bonds earning 4% interest.   This has creating a massive profit spread for banks without generating any velocity of money.  Now the bank is leveraging this guaranteed profit 10:1 or higher for this guaranteed profit at tax payer expense. There is no risk for these banks, only reward.  And all this newly printed money is adding nothing of value to our economy.

These banks are stealing the tax payers money right out in the open with the blessing of our government while you earn less than 0.5% interest on your hard earned dollars.  It's blatant white collar Wall Street crime that Obama and Co are perpetrating while claiming to clamp down on fraud.  What they are doing is a massive multi trillion dollar fraud against us, the consumer and saver.

 And we are supposed to take it lying down.  These trillions of dollars going right into the pockets of big banking institutions is doing nothing to invigorate the economy.  These trillions of dollars are creating no velocity of money.  In fact, it's probably making the problem worse since now the banks have zero appetite for risk to loan to the general public.  I suspect the velocity is falling even quicker with no appetite for loaning to the public.  Instead, all they have to do is borrow free money from the government and loan it back to the government at a profit.

If you are a bank, would you loan your money to  a poor black man from Mississippi trying to buy his first home with 5% down?  Would you even loan it to IBM at 6% when you can leverage 10:1  against a  sure bet of 4% with the govenrment.   Of course, I would pick the sure thing with a massive leveraging of my capital every time.

Your government is recapitalizing our banks that made massive profits on the way up but lost 10X as much on the way down.  And your government is making matters worse by creating a sure thing for banks that pretty much guarantees they won't loan to the public.  And the public and businesses lose by not having access to capital.

Perhaps we have to look at this plan and state it for what it is.   Maybe the government doesn't want banks loaning to the public.  Maybe they want to recapitalize the banks with massive profits while every other sector of this country struggles.  But why?  Why would your government want banks not to lend?  Why would they want to prolong the recession?   

Maybe it's because they know once banks start lending, all those trillions of printed dollars will cause the velocity of money to skyrocket  and hyperinflation will destroy the dollar and the government will fall and the riots will begin.

Perhaps the goal of our government IS to keep banks from lending as long as they can so the incredible debt destruction and asset deflation going on all around us is propped up by the trillions of newly minted dollars being printed to recapitalize the banks to prevent deflation.

Perhaps our government is printing trillions of dollars with the explicit goal of inflating the massive deflationary wave hitting our assets while also trying to time the whole thing to prevent hyperinflation.  Perhaps the government's goal is to make the recession longer, prevent jobs from returning while waiting for the trillions of printed dollars to get absorbed in the greatest deflationary period of all times.

We live in interesting times.

Digital Copiers and Your Medical Records (Video). A Shocking Security Breach Of Confidentiality

Watch this incredible video about the breach of security regarding your medical records from none other than your standard garden variety digital copier.

The video shows how a simple secondary transaction of used digital copiers can lead to access of records not intended for public view, including access to sex offender records, new building plans for a ground zero building in New York City and of course hundreds of pages of medical records, all stored nicely on the digital copier's hard drive.

Did you know digital copiers have a hard drive that saves every page ever copied. I didn't. I wonder what Happy's hospital does with all the copiers they get rid of in the secondary market. I wonder how secure my medical records are. I showed you previously who has access to my medical records. Now, apparently, the whole world does in the secondary digital copier market. How easy it is these days to gather the personal information of others.   

Watch this video and be shocked.  Watch the video at the 3 minute mark discussing medical records breach of confidentiality.

Men and Women Are Born This Way. Hilarious Video With the Truth Revealed!

Here you have it folks.  Watch this hilarious video about how men and women are born this way.    And there isn't anything we can do about it.  When do men stop thinking about sex?  The answer is never.  And this video is proof.

S-Corps and Physicians And New Taxes Proposed By Congress

Now comes word that Congress is looking to change the way S-Corporations pay their tax bills.

An S-Corporation, or S-Corp for short, is a legal and accounting method used by many entrepreneurs and other professionals (doctors, lawyers, engineers, accountants) to set up their business.  I don't claim in the least to understand all the differences between an S-Corp, sole proprietorship, LLC, etc.  Read the  explanation from Financial Advisor explaining the basics.

Congress is looking to change that, by having profit distributions subject to employment taxes as well,  claiming that businesses are skirting their obligation to pay payroll taxes (Medicare/Social Security) by accounting for income as profit distributions instead of as wages and salary.

The bill under Congressional review has 50 popular tax breaks and other associated tax increases, including a 5 year delay on the planned May 31st, 2010 21% Medicare cut to physician revenue under the annual sustainable growth rate formula.  In five years, the formula  states at least a 40-50% cut will be mandated under federal law.

Let's imagine for a moment that a physician makes $1,000,000 a year in revenue with a 50% overhead.  What would a 50% cut in revenue look like in five years?  Well, 50% of 1,000,000 in $500,000.   Assuming physician overhead rises 0% in five years  (which won't happen) and assuming physician payment doesn't rise in five years (which will happen), a mandated 50% cut in five years would mean the physician works for free or pays money for the right to work 80 hours a week.   

That will never happen.  And that's why a five year delay will in effect take the SGR mandate permanently off the books.  The AMA will claim victory and physicians will continue to be abused by 0%-0.5% yearly increases by the Medicare National Bank.  Physicians have already experienced a 25% decline in Medicare payments over the last decade, despite the annual reversal of SGR economics. 

There is nothing to cheer about a five year repeal of SGR when the formula embeds 0% increases in practice expenses.  The only solution is for physicians to either accept the falling payment of the MNB with graceful jubilation or get out of Medicare all together and let the government find people willing to take care of the populace on the cheap.

With rising taxes and declining payment, it's only a matter of time before we are left with a nation of insured and no physicians available to care for them with out cash in hand.  Because everyone knows that increased taxes are passed on to the consumer, in one way or another.  They always are.

How To Keep Your Tomato Plants From Leaning or Tipping Over As They Grow Bigger

I just finished planting my garden in my raised vegetable garden bed.  Everything went in by seed except for my tomato plants.  There were probably a hundred varieties of tomato plants to choose from at the garden store. Check out this picture  of all the different tomato plants to choose from.

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Debt Destruction And Bailouts Move Up The Food Chain. Who's left?

We live in a leveraged debt driven world empire that is collapsing all around us. First it was the consumer bailout.  Free money to try and stimulate the economy with cash for clunkers, $500 rebates, $8000 home buying credits and $700 billion dollars stimulus packages.  That didn't work.  Then it was the bank bailouts to help them recapitalize and prevent bankruptcy. $700 billion dollar TARP funds.   GM.  AIG.  0% fed funds guarantees.  That didn't work.  The banks aren't stupid enough to lend money to the consumer when the government is a guarantee to massive profits.

Who's last?

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Alcohol Abuse Rehabilitation Potential For Painters Limited By Their Need To Stay High

I learned something new the other day.  That alcohol abuse rehabilitation potential for painters can often be limited until they leave their trade.  And most will never do that.  Why you ask?

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Why Is Outpatient Primary Care Dying?

I received a letter the other day for a reader. Why is outpatient primary care dying?  Here's why:

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Preauthorization Real Life Audio Experience

Preauthorization from a hospitalists point of view. The only medication that got the patient out of the hospital was denied by a checklist operator at the other end of the phone. This is the current and future reality of health care.

VRSA (Vancomycin Resistant Staphylococcus Aureus) and My First Twitter Experiment For Patient Safety and Using Open Source Facebook and Twitter To Revolutionize Hospital Safety.

Scary stuff.  We all know about MRSA (methicillin resistant staph aureus).  Now we have to worry about VRSA (vancomycin resistant Staphylococcus aureus.  According to Today's Hospitalist, the CDC is reporting an 11th confirmed case of VRSA since 2002. This is an absolute shame.

It's time for hospitals and doctors and nurses to take a stand and do the right thing for patients everywhere.  Vancomycin has long been considered the standard treatment of choice for any suspected MRSA infection.  When I was a resident, MRSA outbreaks were to be feared.  Ten years later, it seems as if we treat just about everyone who walks in the hospital's front door with cellulitis and every pneumonia patient from the  nursing home  with vancomycin.  

The legal landmines out there are powerful.  Physicians want to do the right thing, but they also want to prevent themselves from get sued for a bad outcome.  It's easier to defend yourself in court from a failure to rescue lawsuit in an MRSA death if you gave vancomycin from the get go.  Any drug resistant strain now seems to be grounds for a lawsuit against hospitals and doctors. The Medicare National Bank has turned hospital acquired drug resistant infections into never events ripe for class action lawsuits.

Bacteria are amazing creatures.  They have been around for billions of years because of their ability to mutate and reproduce against all odds. Humans are the perfect vector for bacteria looking for world domination.

Our failure to act must end now.  But how should we act?  We need systemic nationwide policies  and we need them now.  Much like universal precautions policies, it's now time for our hospitals to implement a nationwide  voluntary  system of prevention for drug resistant bacteria and all other patient safety issues.   Ultimately, patients, hospitals, doctors and nurses need to take responsibility for their actions and implement policies and procedures that are known to work.  

We are a country full of independently operating pods of local hospitals.  We need an immediate national push independent of  the slow acting government mandates.  It's time to stop waiting for the government to tell hospitals how to do  doing things their way and  start doing the right thing for our patients now.   How do we do that?

Social media.  The power of social media lies in its ability to disseminate information quickly.  I propose that Facebook and Twitter should immediately establish platforms for the sharing of hospital information on systems processes that work.  We know of the incredible power  checklists have in reducing complications.  It's time for hospitals to share their secrets.  Facebook and Twitter are the perfect platforms to introduce such national efforts.

Instead of catching a hospital acquired infection, hospitals could brag to their patients about catching the patient safety virus by participating in open source  safety protocol initiatives  on Facebook and Twitter.  The advertising possibilities are unlimited.  

We need to  start a viral media push to implement hospital safety standards nationwide on a voluntary basis and make hospitals, doctors and nurses publically accountable for their participation, or lack their of.  Instead of reinventing the wheel 4000 different times in hospitals all across our country, we need one wheel that works well in 4000 hospitals.  The transformation could be immediate and lasting.  The benefits could be dramatic.  It's time we turned the Twitter and Facebook platforms into one giant real time conference call for the sake of our patient's safety.

I am a hospitalist.  I want to provide the highest quality care with the least amount of complications  at the most affordable price.  I walk the walk as a member of my hospital's VTE prevention committe.  But I'm tired of trying to reinvent the wheel.  I spent over a year in committee work playing devil's advocate in a process that seemed so silly.  We have hospital employees making $50 an hour and more sitting in two hour committee meetings trying to reinvent the wheel.  That's unacceptable when I'm paying $12,000 a year in health insurance premiums, mostly a result of out of control health care costs to pay for a bloated and complicated administrative hospital structure.

The inefficiency of this safety process is unacceptable.  I should be able to go onto the Internet to a dedicated open source Facebook or Twitter platform, search for a VTE prevention platform and checklist protocol to implement, and I should be able to download it immediately.  And I should be able to get the community of experts to rate the validity of that systems process and to point out the strengths and weaknesses.

I think having access to the policies and procedures of other hospitals willing to publish their systems process  would  do more for patient safety than any mandate the Joint Commission could ever hand down.  In fact, I think the socialization of hospital safety through Twitter and Facebook, has the opportunity to make the Joint Commission irrelevant.  It's time hospitals and doctors and nurses stop waiting for government to mandate safety and do the right thing.  It's time we implement quality care protocols by learning what works and what doesn't through the experiences of all 4000 hospitals in this country.  I do not want to have VRSA as the expected infection in ten years, much as MRSA has become today.

This is the future of health care. I'm going to start off my little experiment be leaving a Tweet for my current patient safety project at Happy's hospital.  I believe having a daily  reminder checklist for all my medical patients will reduce complications and cost and dramatically improve my patient experience in the hospital.   I want a daily checklist for hospitalized nonsurgical patients.

Tweet me your ideas now on what to include and how to create the checklist.   I have already started the process at Happy's Hospital.  I do not want it to take a year to complete.

My Quickest Admission and Discharge Ever: 15 minutes

What's your quickest admission and discharge ever?  I had mine the other day.  Fifteen minutes.  Nobody is going to pay for it.  The Medicare National Bank requires at least eight hours in the hospital before they will pay an observation stay. I presume most insurances are the same.

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The Epitome Of Bad Government

Your democratic Congress is recapitalizing our banks by raping the tax payers.  Unbelievable.  When do I get to borrow money at 0% and loan it back to the government at 3%?  Why would a bank  loan loan free money  to the consumer who may not pay it back  when they can loan it back to the government for a guaranteed  3% spread earned with printed money.

I suspect this was exactly the government's plan to recapitalize the banking sector after it lost  huge leveraged bets with the housing market.  And I suspect the government is doing this to keep the public from understanding the massive theft going on with their money.  What the public doesn't know doesn't hurt them.  Well, consider yourself informed.  This tax payer theft is many times larger than all the bailouts that started the tea party movement (and teabagging for Jesus).  This is why the banks are making massive profits while the economy is in a tailspin.  And it's unbelievable. 

The reason the fed funds rate is at zero has nothing to do with improving the consumer's ability to borrow and spend.  In fact, all the fixed income savers are getting killed.   The fed funds rate is zero because the banks are so screwed that they will probably need years of borrowing money from the government at 0% and loaning it back to the government at 3% to recapitalize their balance sheets at the expense of the US tax payer.   And you want the federal government being the regulators?

Cool Sunshine Rainbow Picture Without A Cloud In The Sky

Mrs Happy took this picture earlier this winter of a sunshine rainbow without a cloud in the sky.  Talk about a cool rainbow.  I've never seen anything like this before.  Perhaps this sunshine rainbow was caused by ice crystals in the air.   Maybe these were H.A.A.R.P. lights.  Although, I don't recall any earthquakes that day.  

Anyone know what causes this sunshine rainbow phenomenon and what the technical name for it is?

Also check out these other pictures of rainbows on both sides of the sun and a full rainbow panorama view using the Photosynth iPhone app.

Grand Rounds Goes Minimal This Week

At a bare minimum, check out Grand Rounds for the week.

How Our Government Is Like a Picture of a Chest X Ray With a Bad Heart And Bad Lungs

This patient presented to the emergency room with complaints of shortness of breath.  He is always on three liters of oxygen.  He is living with emphysema / end stage chronic obstructive pulmonary disease (COPD).  He has a bad heart as witnessed by his shock box / defibrillator.  He used to smoke 4 packs  a day. 

This is all smoking related disease. Compare his chest x ray with a bad heart and bad lungs to that of the normal chest x ray below.  Notice the barrel chested appearance and the flattened diaphragms.  He's lost a lot of weight.  This is the COPD metabolic syndrome.  Folks with advanced stages of COPD require a lot of energy and calories to maintain their weight.  He will never be able to eat enough calories to maintain his weight. In fact, he gets short of breath chewing his food.  

He has chronic air hunger / COPD dyspnea for which narcotics may be the only answer.  There is nothing acute going on here.  There is nothing fixable.  This is all chronic disease in the end stages of life.  This is all self inflicted harm.  This is all avoidable.  This is not finishing strong.

I admitted a young man in his 30's who had been on prednisone since he was four years old for "refractory asthma".  He is a two pack per day smoker.  Here's a guy who can't get his asthma under control so he takes dangerous medications with a severe long term side effect profile and he has no desire to quit smoking.  

Yesterday, I took care of an open heart bypass patient two months out of surgery who is smoking one pack of cigarettes a day.  The day before that, I took care of a patient recovering from a stroke three months ago, who smokes two packs of cigarettes a day.  And the day before that I took care of a 450  pound  woman with life threatening super morbid obesity who presented with  short of breath.  She was too big for evaluation of any kind, including physical exam.  

Our country has run out of money.  We simply don't have the resources to care for people who care for themselves, let alone those people who don't.  We have a Federal government pushing poor people into a government insurance program that's broke and that few doctors accept.  Medicaid is going bankrupt and it isn't because it pays doctors well.  In fact, many doctors don't accept Medicaid because they refuse to work for $4 an hour.  Good for them. 

Today I read that ObamaCare, if additional spending options  are implemented,  will negate all $120 billion dollars in expected savings.  The fact that Congress rammed a health care finance reform  bill down the throats of Americans is bad enough.  To have it full of deceitful  economics and blatant lies makes it all the much worse.  

The fact is, there is no way to pay for the bill as proposed.    Nor will there be any way to pay for the ultimate cost, which I suspect will be three trillion dollars or more.  We can't pay for patients with a bad heart and bad lungs like this anymore.  Not in the way we pay for it now, at least. 

And many folks just want the government just to take care of them.  They want FREE=MORE.  They feel entitled to a living standard they did not earn.  And they want someone else to pay for it.  We are Greece, only trillions of dollars beyond them.  We have storms on the horizon, one hundred trillion dollars worth ($100,000,000,000,000).

Just the other day I had a post heart bypass patient upset that his cardiologist said he didn't qualify for disability because his heart was doing just fine after surgery.  In his mind, the patient couldn't understand how having bypass surgery wouldn't qualify him for life long disability.  I helped explain it:

Happy:  Sir, you aren't disabled.  If anything, your heart is stronger now than ever before.  Heart disease is the number one disease in this country and the leading cause of death.  It does not earn you a disability badge nor a handicap sticker.  I agree with your cardiologist.  You should have a long life of fruitful employment to look forward to. 

And with that, the patient left the emergency room against medical advice.  That's one way to improve emergency department throughput.  

This smoker's chest x-ray represents our government's economic security.  Short on cash and living on borrowed time.  And every now and then a jolt ripples through the economy  reminding us just how close to death we are.

How To Have Sex With A Fat Woman: One Husband's Experience With His Dying Wife

How do you have sex with a fat woman?  This post comes from the files of the crazy and unbelievable.  Some men will go to incredible lengths to have sex with their loved one.  But what if their loved one has a very large middle section that hangs over their sexual region?

I'm talking to a medical school friend of mine the other day when he tells me a story about a guy who showed up in his emergency room with a two by four piece of wood.  The nurse asked him what he was doing with the wood and why he brought it to the hospital.

Husband:  My wife is on hospice.  She's probably going to die soon.  I brought this 2 x 4 piece of wood to the hospital so I could lift up Sandy (he named her Pannus) so I could f**k her one more time before she dies.

Nurse:  Jaw dropped and speechless

I guess I have never in my life thought about that scenario.

How do women with super morbid obesity have intercourse?  I didn't think they did.  But, apparently some women let their husbands push their incredible mass of flesh out of the way with a 2 x 4. I guess I just assumed (and wrongly so) that having intercourse was physically and anatomically impossible for women with a very large pannus.  

Perhaps someone should market the piece of wood as the 2 x Fourplay.  I bet they'd come out way ahead.

Ba Da Bump.

Wow. Just when I think I've heard it all.  This story  beats the heck out of the fat woman who bit off a man's ear after being called fat.  

Dr Gott's Hospitalist Column

A reader of Dr Gott's column  is upset because her family medicine doctor no longer goes to the hospital and she asks Dr Gott, the notable newspaper doctor, for his opinion.   In a nutshell, here's what Dr Gott says about hospitalists

• We are  here to stay
• We are extremely qualified

Here's Dr Gott's hospitalist column.   A reader sent me this article because a friend of  hers who's mother (probably in her 80's or 90s) died at the hospital and she is suing the hospital for a bad outcome and is upset because her primary care physician was not allowed to come to the hospital.  The reader wants her friend to know that hospitalists are an asset to the patient care experience.

Most hospitals do not exclude physicians from admitting privileges. You can read here about the hospital admission process.   If you have a medical license and clear the hospital  physician credentialing software process without any red flags, you can admit patients to a hospital.  I just applied for credentials to a smaller hospital in Happy's state for possible moonlighting opportunities.  The packet of papers was 36 pages long and required my signature in 14 different places.  

You don't simply get to show up and admit patients to the hospital and start billing the Medicare National Bank.    You have to earn admitting privileges and those privileges do not come easy.  More than likely, the primary care doctor chose not to come to the hospital and instead chose to use hospitalists.  We have our fair share of primary care physicians who cherry pick  which patients they let the hospitalist see and which patients they admit on their own.  Often, the high maintenance, highly complicated, highly time consuming patients with angry and emotional families get cared for by the hospitalist service and the quick and easy dehydration and orthopedic post operative consultation patients get followed by the primary care physician, if they still come to to the hospital at all.

All studies have shown that hospitalists provide the same, or better care with reduced length of stay and no increase in readmission rates.  In fact, hospitalist programs are a driving force behind many  hospital quality improvement initiatives.  

More than likely the bad outcome in this lady was because the patient had advanced age with  multiple medical problems,  bad protoplasm and ten chronic medical conditions.  More than likely, the bad outcome was a matter of biological predetermination rather than medical negligence.

Sue the hospital. Sue the hospitalist.    Let your lawyers scour the records.  Let them look for negligence.  More likely than not, they won't find any.    It will cost hundreds of thousands of dollars to litigate, if it ever gets to that point.    And in the end, short of cutting off the wrong leg, you will discover that 90 year old ladies die in the hospital because 90 year old ladies  die in the hospital.   

Your pain is real.  Your search for closure is probably misguided. 

The Moral Hazard Through A Nice Neighborly Conversation

The essence of the moral hazard experience through a nice neighborly conversation.

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The Medicaid Contagion Has Spread. Medicaid Is Not Insurance. It's An Insult.

The world debt crises is rapidly spreading across western civilization.  So is the Medicaid contagion.  Once  a program mostly abandoned by primary care, Medicaid has found a dead end with subspecialty groups as well.  Medicaid is the backbone inisurance program of choice for ObamaCare's poor and humbled masses.  But, Medicaid is rapidly becoming an insurance program on paper only.

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Hostile Takeover Of Your Physician Office Practice? By Your Partners?

I have never seen anything like this before.  A hostile corporate takeover of a doctor's office practice.  Not by a hospital.  Not by a competing group of doctors.  Nope.  By your own medical partners.  I got a letter in the mail the other day explaining why a doctor in Happy's town was going out on his own to form their own solo practice.

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Hay Bales On a Flat Bed Truck (Cool Picture); America in Action

I was driving home on Mother's Day when I passed this flat bed truck carrying a bunch of hay bales. Now that's just cool.

I wonder how much each of those hay bales weigh and what kind of wind gust it would take to knock them off.  This is America in action. 

New Symbol of Health Care Reform

Here is the  symbol of America's new health care reform.

Welcome to ObamaCare, whever everything is promised and nothing is paid for.  The Europeans and IMF (for which the US contributes 20% or so) just printed one trillion dollars worth of shock and awe to try and contain their massive debt crises.

That's only one trillion dollars ($1,000,000,000,000) for the bankers who took all the risk on the way up and now get crony government bail outs on the way down.  Between Social Security and Medicare, the unfunded liability is 100 trillion dollars ($100,000,000,000,000).  Our politicians say the ten year cost of health care reform is only one trillion dollars.  That will never happen.  We are heading down the road of unsustainable economic destruction.

The Greeks got themselves into trouble by spending too much for too many years.  And what is government's solution?  More debt.  Good luck.  The debt death spiral is in full force. 

Should Hospitals Pay Doctors To Be On Call?

I've heard many doctors want to be paid to be on call in the emergency department.    With payment declining for many procedural codes, looking to hospitals for an extra  source of income is a natural extension of trying to maintain cash flow of a practice.

I say go for it.  The treatment of medicine as a field where you honorably took care of the freebies because those with insurance paid well is long gone.  Now, everyone is paying poorly and nobody wants to get stuck spending their time on patients who aren't going to pay.  And with Medicaid the default insurance for the poor, it's the same as being uninsured as far as physician payment is concerned.  

That's the reality that our third party insurance system has created.  It took the honor out of medicine.  Now physicians are treated like criminals every time they submit a bill that doesn't meet documentation standards. They are questioned and requestioned in all their medical decisions with Medicaid preauthorization and radiology management requirements. 

Physicians have become pawns in the middle of a medical-hospital-industrial complex who's main goal is to extract as much money as possible  from the Medicare National Bank.

Getting paid to be on call is the new reality.  Hospitalists, by nature of their relationship with hospitals, are basically being cross subsidized to be on call.  Without hospitalist salary subsidies that average around $100,000 per physician, per year, hospitalists would not be the fastest growing medical subspecialty around.  Hospitals are climbing over each other for the right to pay physicians $100,000 a year to be available at all times.  How telling is that?

The beauty of free market enterprise is that everyone has a choice to make.  In order to have hospital privileges, doctors must take ER call.  That means they risk exposure to uninsured patients whom they have no relationship with.  These patients often show up at 3 am with highly complicated and time consuming conditions.  And they're freebies.  And they are a higher medical legal risk for a number of reasons.

The doctors asking to be paid for call  have every right to ask the hospital to pay them.  They also have every right  to walk away and withdraw their hospital privileges if the hospital declines their request to pay for call.  The hospital has every right to look at their books and decide if the price of paying the subspecialists to be on call is worth it.   Would the DRG and facility fee payments they get allow them to come out ahead or not?  Hospitals also have every right to hire their own subspecialist hospitalists who would be available to take all the hospital call they needed.

It's a different world we live in.  No longer do physicians accept freebies as a price of doing business when all insurances are freebies in one way or another and ObamaCare promises a race to the bottom.   I don't fault any physician for trying to get the hospital to pay them to be on call.  In fact, I commend it.  If the hospital says yes, they have proven their worth.  If the hospital says no, the physicians have every right to walk away and abandon their community need for their services and let the hospital deal with the lack of subspecialty services.

Eventually, this mode of thinking is going to change.  Once bundled care arrives, doctors (who stuck around) and hospitals will work very closely together to make hospital care as cost effective and efficient as possible.  The winners will be the doctors who have been practicing great medicine.  The losers will be the doctors that have been making money off of highly lucrative but  unnecessary care.  I think given all the pros and cons of bundled care, in the end, the bundling of services will reward physicians who are already doing the right thing for patients.  And patients will win.

For more information on hospitalist salary, visit

• Hospitalist compensation salary survey 2010 (SHM/MGMA) based on 2009 data
• Hospitalist subsidy and support payments update for 2011, based on 2010 data.

LINK TO E/M POCKET REFERENCE CARD POST EM Pocket Reference Cards Using Marshfield Clinic Point Audit One Hospital: (Admit/Consult) One Side, Follow-Up On Other Side $10.00 One Clinic: (New/Consult) One Side, Established On Other Side $10.00 Two Hospital Cards $16.00 Two Clinic Cards $16.00 One Hospital Card + One Clinic Card $16.00 Two Hospital Cards + Two Clinic Cards $29.00 Click image for high definition view

Why The Federal Reserve Needs To Be Audited: The Red Roof Inn, That's Why

Watch Representative Alan Grayson talk about why we need to audit the Federal Reserve. Because we, the American taxpayer, own the Red Roof Inn.  That's why.  Unbelievable.  Where is the accountability?

Pella Full View Storm Door Installation Review: Two Big Thumbs Up

UPDATE:  The Reveal!  Home remodel before and after 2010-2011 picture video tour.

Seven years ago when Mrs Happy and I moved into our humble home, I bought a full view storm door.  It wasn't a Pella.  It wasn't an Anderson.  But it wasn't cheap either.  I remember spending probably $250 at the time.  It was a nice one with black  edges and a  nice etched glass full view center piece.  But it also had ugly gold hardware.  I'm not sure what we were thinking.

Unfortunately, after I got it home, I realized I couldn't put it together.  I opened the box, laid out all the pieces and realized that the kit required me to do things I had never done before.  It required taking exact measurements and chiseling out the wood for the locking mechanism.  I was just exiting my medical school and residency for the previous seven years.  I had absolutely no construction experience, even for installing a full view storm door.  

So with that, I abandoned my self installation of the storm door and hired some guy to come out and do it for us.  I think he charged us $100 or so to install the door.

Over the last several years, it stopped closing tightly and we could never get the storm door to lock without heavily maneuvering the door.   And this year the glass started falling out of its casing.   Every time we opened the storm door, the glass risked falling out.  Mrs Happy's father in law thought we should screw in supporting screws around the edges.  We decided it was time to buy another storm door.

We went down to Lowe's to check out their offerings.  We found a liking to the Pella Select brand 3 in 1 full view storm door.  You get to pick your frame color, your handle hardware color  and your glass design separately as three individual purchases.  The guy at the store said he had the full view storm door set himself and they were really easy to put together.

We settled on the Pella Select 36 inch white frame (#147635) with the antique brass hardware (#109513) and the clear unetched glass (#251220).

 We got it home and I went to town.  The advertising material showed a picture of a woman putting it together in  less than 60 minutes.  I can assure you while it didn't take me less than 60 minutes to put together, it was much easier than I thought it would be.

This model basically came with its own door frame.  There is no chiseling of the  wood required.    The directions were fantastically simple.  The parts were very well marked and easy to find.  The only thing I had to do was buy a 1/4 inch piece of wood to shim the side of my door hinge, an unexpected finding that added about an hour to my project.

Otherwise this Pella full view storm door installation was a piece of cake.  Mrs Happy had her doubts about my abilities to complete the project.  But fear not wise women.   Your shining  Happy came to the rescue.

We now have a fully functional full view storm door that closes tightly and latches shut with no effort at all.  The door  hinge technology on this model  is a major upgrade from my last storm door.  The hydrolic mechanism also appears to be much more visually appealing.  There are no chains hanging down.  You just push a button to keep the door open and release the button to let the door close.

All this for about the same price of my last full view storm door.  The frame cost me  about $170.  The glass cost me about $50 and the handle hardware set me  back about $50 as well.  With tax, the total came to just under $290.  Hopefully, it lasts another seven years.  

I would say the storm door took me closer to four hours to fully install, but  that's because I had to shim the door and remove some hinge hardware from the previous storm door that had stripped screws. That was a nightmare.  If anyone knows how to  easily remove stripped screws, I'm all ears.     Short of that, I probably could have finished the job in under two hours.  I saved us $97 (which is what Lowe's charges to install full view storm doors) and got our door up so Mrs Happy, Marty and Cooper can once again sit and enjoy the sunshine.

For now, we decided to leave the screen on and keep the glass off.  This Pella full view storm door review and ease of installation gets my two big thumbs up.  Congratulations Pella on building a quality door that is easy to install especially for those foks with limited experience in putting things together.  

We are in the midst of a full first floor home remodel and the drywall, paint and dust can unbearable at times.  I'll be posting some remodel pictures in the near future to show the transformation of a construction grade home built at the height of the housing boom into one with some personal designer elements and class.

I might add that higher taxes take money away from big remodel jobs which pay for many construction jobs (plumber, electrician, contractor, designer, cabinet maker, granite supply, granite cutting, handle hardware, painter, trim carpenter...)  The list goes on and one.  If you raise taxes, these people won't have jobs, because it's not poor people living on social security and welfare that support the millions of American jobs.

It's people like me who have money to spend on major home renovation projects who would not spend the money if it went to the government for redistribution.  Now, would you rather have the trim carpenter collecting an unemployment and welfare check or would you rather have them out working and being productive members of society.  I can assure you, the higher you tax people who have money to spend, and the fewer jobs you generate and the less growth you get in your economy.  Any time tax something, anything, you get less of it.