Best, Funniest, Cutest Halloween Pet Costume Ever: Echo the Chia Pet!

This has got to be one of the best, funniest and cutest Halloween pet costumes ever. Meet Echo, the Boston Terrier Chia Pet, winner of an apparent pet costume contest. Echo the Chia Pet, just be glad you're not  the dog in a lobster costume, sitting in a pot. 

Giant Pumpkin Dropped on Car Video: 1,200 Pounds of Halloween Pumpkin vs a Pontiac

In case you missed it, here's that video showing what happens when a nearly 1,200 pound giant pumpkin is dropped on a car, and then filmed for video. According to my inside sources, this is how Cash for Clunkers II will function.

Halloween Light Show Videos 2010: Thriller from Michael Jackson and Others

It looks like the home light show presentations have spread from Christmas to Halloween.  Check out these fun Halloween light show videos for 2010, 2009 or any other year I could find.  Have a safe and happy Halloween.

Halloween light show of Michael Jackson's Thriller

Halloween light show playing to This is Halloween from A Nightmare before Christmas

Halloween light show playing Pump It from the Black Eyed Peas.

Prince Charming (Southern, Balding) Meets Snow White Halloween Costume Picture

If you're looking for some hilarious, funny, clever or dirty 2010 Halloween costumes you've come to the wrong place.  Instead, I present a picture of Happy and Mrs Happy below.  I like to call this the middle aged Southern balding Prince Charming meets Snow White.

I've earned a new appreciation for men (and women) with such thick mustaches that eating becomes a chore.   What's your 2010 Halloween Costume?

Hospitalist vs Night Nurse, RN Xtranormal Medical Video Presentation

My Xtranormal medical video series continues with my Happy original Hospitalist vs Night Nurse, RN, an interaction between a Hospitalist and an  over zealous night nurse in the hospital.  Several years ago, this would not surprise me one bit. 

With that said that, I would like to take this time to thank all the nurses of Happy's hospital, day and night nurses alike for not being that Night Nurse, RN and for providing the best month ever with regards to appropriate interruption of work flow for communication of clinical issues and for a dramatic  improvement in contacting the appropriate physicians caring for the patient, instead of just calling the hospitalist because we are available.  We are not just available out of convenience and for many of you, that is rapidly sinking in.    

I have noticed a decline of 80-90%  in inappropriate and unnecessary pages and work flow interruptions in  the last several months.   Whether that has anything to do with my constant education regarding what issues need to be called or to whom they should be called, my constant hand written DO NOT CALL parameters, written multiple times a day to over ride ridiculous hospital critical notification calling protocols, my discussions regarding my implementation of my five page call parameter order set  or whether there is some sort of covert nursing communication education that is being implemented for the first time in a decade, I don't care.  Whatever the reason is, the results are speaking for themselves.  I've seen a dramatic improvement in nurses who choose to use their nursing education to think instead of acting like robots and that act alone earns my highest degree of respect.

Thank you for being nurses instead of robots.  It has been the best month in seven years.  No patients were harmed. You didn't have to stop what you were doing.  I didn't have to stop what I was doing, and everything worked out just fine.  Let's keep it up.  With that said, I hope you enjoy my Xtranormal medical video depicting an over zealous night nurse (who didn't get the memo) communicating with a hospitalist in my Xtranormal medical video Hospitalist vs Night Nurse, RN.  If you are a Night Nurse, RN  just stop it .  You're not welcome 'round these parts. 

You can also catch up on these other fine Xtranormal Medical Videos.  Some are Happy originals.  Some aren't.

2010 Halloween Costumes (Pictures): Hilarious, Clever, Funny, and Down Right Dirty Stuff.

If you're looking for a few examples of clever, funny, hilarious, or just plain dirty Halloween costumes for 2010, you've came to the right place.    I found these few examples at my local Halloween shop.

Plug and Socket clever and funny 2010  Halloween costume.  

One Night Stand clever and  funny 2010 Halloween costume.

Double Occupancy funny and dirty 2010 Halloween costume.

Banana Flasher funny, dirty and hilarious 2010 Halloween costume.

Breathalyzer funny, dirty and hilarious 2010 Halloween costume. The funny criminals arrest of the year for 2009 was wearing this costume.  You guessed it.  For drunk driving.

Beer Keg funny 2010 Halloween costume.

and last but not least, here's the dirty Blow Me Bubble Gum 2010 Halloween costume

Here's a few classics from years prior

• Funny and dirty Halloween costumes for 2009
• Funny Homemade Halloween costumes from my years past.

You can find a list of all my previous Halloween posts at my Halloween Inflatable Pac-Man Decoration post.   And later tonight, you'll see Mrs Happy and my Halloween costumes for 2010:  Prgenant Snow White and her middle aged, balding porn star looking Prince Charming.  

My 120 Pound Journey Video With Bloody Nipples and a Little Inspiration

Here's a guy that said enough is enough.  He made a heart warming video about his 120 pound journey to happiness.  All it took, in his words, was a little inspiration.  He can now call himself a marathoner and an Ironman.

That's just amazing.  And I'm sure the only medication he took was exercise.  Congratulations.  Ben does life over at his blog.  Here is his inspirational journey to losing 120 pounds all caught on video, bloody nipples and all.

For other great weight related posts visit

• Weight loss options:  The Greatest FAIL ever.  
• Non surgical weight loss options for one pound an hour!
• Try the tongue patch weight loss plan.  
• Losing weight one pound at a time through public display.
• Three Clicks Weight Loss Blog.  Unusual motivation to lose weight. 
• How to lose weight after pregnancy (video).
• One woman's journey to seek out super morbid obesity.

Just Married And Going to the ER? Looking For Funny ER Honeymoon Stories.

Check out this picture sent in by a reader showing a Just Married truck  parked at the entrance of  an ER.  I'm thinking it must have been one heck of a honeymoon.  What do you think?  Just married and showing up in the emergency room?  That's either really good or really bad, depending on who you are.  

I'd love for any ER readers out there to leave some ER honeymoon stories in the comments.   I can't say I've ever taken care of any honeymooners, except for that newlywed 80 year old lady I once admitted for shortness of breath.  But that's boring. 

Cell Phone Lady in 1920's Charlie Chaplin Video A Hoax. I Think It's Obama.

Here's a fascinating video showing a lady (or man in drag)  talking on what looks like a cell phone (iPhone 4) during a 1920's Charlie Chaplin movie clip (The Circus).  The lady talking on the cell phone was spotted by film maker George Clarke.  Watch the incredible video explanation below.

What do you think? Is this the world's first time traveler caught on video? I'd be shocked since I don't think there were cell phone towers built in the 1920's.  

Maybe this is an elaborate hoax. Or maybe it's real.   Maybe it's nothing more than a schizophrenic in drag talking into an ear trumpet.  With all the conspiracy theories running rampant on the Internet, I think I've got the answer.   I think it's Obama.  I think he figured once he loses everything in November, he can go live in the 1920s, when smoking was still cool.

watch the video

Inpatient Rheumatology Consult: It's Never Lupus.

Apparently some hospitalists consult rheumatologists for swollen joints that aren't swollen, at least not swollen according to the inpatient rheumatology consult (CPT 99253, 99254, 99255).  I can't remember the last time I consulted a rheumatologist in the hospital for swollen joints.  Actually,  I've never consulted a rheumatologist in the hospital for swollen joints.

Why?  Because the answer is always 

1. It's not a rheumatological disease.
2. And if it is, give 'em steroids and see what happens.
3. It's never Lupus.  Ever.

A rheumatologist's home is in his/her office.  Get them in a hospital and you just confuse 'em.  Oh yeah, I got asked to see a patient for fibromyalgia pain last week.  I refused the consult as being "outside my scope of practice".

Phew.  Skinned out of that one. Sounds like a job an inpatient rheumatology consult could tackle though. You know.  Job Security.

Why Should I Take My Blood Pressure Medication?

Why should I take my blood pressure medication you ask? The more I do this thing called hospitalist medicine, the more I appreciate the power of life style choices we all make.  Every opportunity I get, I give my patients my smoking lecture  and charge their insurance  a CPT 99406.   Everybody knows that smoking is bad for you and it causes lung cancer.  Nobody knows all the other stuff.  They are always shocked.  

Maybe it's time for me to start a blood pressure lecture.  I often have  patients who say,

 Why should I take my blood pressure medication?

They always answer their own question with the same answer.

I was feeling fine.  I didn't see a reason to take my blood pressure medication.

You see, these are people with insurance.  These are people with the Medicare National Bank.  These are people who don't have to lift a finger or a dime to pay any out of pocket expenses for their health care.  And yet, they still lack the motivation to care for themselves, even with incredible resources out there these days to help them.  Things like great online blood pressure chart sites for home monitoring.  

Whatever the reason, whether it's ignorance, laziness, lack of motivation, lack of remembering, or selfishness, people just don't take care of themselves.  We could cut by 80% the incidence of diabetes, stroke, heart disease and cancer with lifestyle modifications.  That's all it would take to radically change the health of our nation.  And that has nothing to do with whether they have health insurance or not.  It's one reason I keep my own exercise log for almost three years now.  

Look at it like this, more than 85% of this country has more health insurance than they know what to do with.  Eighty-five percent of us have all the health care resources our reduced income can buy through our employers without being given a choice.  Yet, more than 85% of all the people I care for in the hospital are fully insured.

That says to me that people aren't getting sick because they lack insurance.  People are getting sick because they ask themselves

Why should I take my blood pressure medication when I feel fine?

Well, ma'am.  You're not fine.  You ended up in my hospital with a devastating hemiplegic stroke.  But at least you have insurance.  The journey towards death is filled with disease by choice.  Which diseases are you striving for today?

Betty White and Her Dirty Dusty Muffin On SNL ( Hilarious Video about Fiber)

In case you missed this SNL classic video by Betty White, you can catch her talking about her dirty dusty muffin during National Dietary Fiber Day on NPR's Delicious Dish. Hilarious stuff. That's what fiber's all about people. It's Betty White talking about her dusty muffin.  

Chuck Grassley Twitter Disease Ad. A Cute Angle on Social Media, Health and Politics.

Watch this hilarious Chuck Grassley Twitter ad where some little old ladies are concerned he's been stricken with a deadly disease called Twitter.

Funny stuff. While most patients I see are texting in the ER, it's only a matter of time before they control self delete themselves. 

Good stuff from the political front.  Way to play the Twitter disease angle.

Best Respiratory Therapy Slogan Ever. Trust Me. It's Funny.

I heard this respiratory therapy slogan the other day from a respiratory therapy student (not one getting an online respiratory therapy degree).  It's probably the best respiratory therapy slogan ever. Clever and funny. Are you ready for it? If you aren't medical, you may not get it, but trust me, it's hilarious. Are you ready?  Here goes:

PEEP not poop  

Now that's funny, I don't care who you are.    I wonder what the nursing slogan equivalent would.  Probably

Poop not PEEP

This is an example of how doctor humor changes with medical school.

One Million Unique Hits For The Happy Hospitalist. Let's Celebrate in the Caribbean

I'd like to congratulate Happy on achieving his first millionth unique hit milestone on October 25th, 2010 as well as getting more total hits on one day than ever before (3,500).    Let's celebrate by heading to Grand Rounds in the Caribbean.  Thanks for all my loyal readers for making that happen. 

Watermelon to the Face Incredible Trauma Video: ICD Code Anyone? (Amazing Race Clip)

I'd hate to be this lady who got her face traumatized by a watermelon sling shot launcher during the Amazing Race Show.  I can only imagine what that EMT report would be like on the way in to the ER as a trauma.  No matter how many times you watch this watermelon attack her face at full force, in slow motion, you can't help but feel sorry laugh your ass off at this woman.  She's slinging watermelons.  What did she thing was going to happen? 

I wonder what the ICD code would be for facial fruit trauma. We know that watermelon stomach carries the ICD 537.82, but  I couldn't find one for watermelon face. 

Unobtainable ROS: A Benefit of Alzheimer's Dementia in the Hospital

The policy wonks are always talking about the costs of Alzheimer's dementia on society and in hospitalized patients.  As a hospitalist, I take care of many folks in the hospital with Alzheimer's dementia.  Many doctors won't admit it in public, but I'm the Happy Hospitalist and I'm here to help you drink from the fountain of truth and wisdom. The truth is, most doctors would love to have a service of filled to the brim with Alzheimer's patients.

Why is that you ask?  How could a demented Alzheimer's patient actually come with such benefits?  Despite the horrible emotional toll Alzheimer's disease takes on friends and family, it actually comes with one major benefit for the doctors who care for them:  It's called the unobtainable 12 point review of systems (ROS).  If you aren't a doctor, you have no idea what I'm talking about, but it's the truth none the less. 

The unobtainable ROS is a gold mine for maximizing the RVU/time ratio under evaluation and management  (E&M) guidelines.  You see, in the fee for service payment system doctors are forced to operate under time is money.  The more patients you can see in a fixed period of time, the  more revenue and profit your office or hospitalist practice can generate.  That's just a reality of the payment model we practice in, especially a declining payment environment. 

The review of systems is one of the requirements in the documentation game of medical billing and coding.  For patients with dementia, a ROS of systems cannot be reliably obtained. What does that mean clinically?   The E&M coding guidelines as defined by the Medicare National Bank state that an unobtainable ROS is equivalent to a full review of systems.  An unobtainable history is equivalent to a fully documented history. 

What does that mean for doctors?  That means you get credit for the highest level of care for your history component on any hospital or office based E&M code if the patient cannot reliably give you their history.  What does that mean for the hospital follow up billing codes 99231, 99232 and 99233 or the admit codes 99221, 99222, 99223, (here's a secondary look at  99223)?  It means you spend no time talking a history  and can complete your evaluation in 1/10 of the time and you can claim credit for the highest level of care for the history component. 

What did that mean for Happy?  It meant he was able to round on six patients in one hour by writing the following note six times on six patients who presented with the exact same diagnosis.  Here's how a hospitalist can round on six patients in under an hour and bill a level three 99233 hospital follow up on every single one of them:

S) ROS unreliable secondary to dementia.
0) 120/80 80 98.6
PT INR testing 1.1
A) 1) Dementia-stable with no changes planned
     2) pick your chronic disease- stable with no changes planned
     3) pick your chronic disease-stable with no changes planned
     4) pick your chornic disease-stable with no changes planned
     5) anticoagulation management --follow INR
     6) Hip fracture

That's your 12 minute, high risk, $90 level three 99233.  Now that's the type of  service most hospitalists would kill for.  I take that back.  That's the kind of service most doctors would kill  for. If your mother or father has dementia, I guarantee to you that your doctor loves taking care of them.  And that's why you come to The Happy Hospitalist.  To hear truths nobody else is willing to discuss.

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 def view

Funny Medical Stories: I Love The Surgeon and the Lawnmower.

Here's a few funny medical stories to brighten up your day (courtesy of the Internet).  I have no idea if these are true or not.

A man comes into the ER and yells

"My wife's going to have her baby in the cab!"

I grabbed my stuff, rushed out to the cab, lifted the lady's dress and began to take off her underwear. Suddenly I noticed that there were several cabs - - - and I was in the wrong one.

Submitted by Dr. X , San Francisco

At the beginning of my shift I placed a stethoscope on an elderly and slightly deaf female patient's anterior chest wall.

"Big breaths",  I instructed.
"Yes, they used to be", replied the patient.

Submitted by Dr X, Seattle , WA

One day I had to be the bearer of bad news when I told a wife that her husband had died of a massive myocardial infarct. Not more than five minutes later, I heard her reporting to the rest of the family that he had died of a 'massive internal fart.'

Submitted by Dr. X

During a patient's two week follow-up appointment with his cardiologist, he informed me, his doctor, that he was having trouble with one of his medications..

"Which one ?" I asked. "The patch.  The nurse told me to put on a new one every six hours and now I'm running out of places to put it !", I said.

I had him quickly undress and discovered what I hoped I wouldn't see. Yes, the man had over fifty patches on his body! Now, the instructions include removal of the old patch before applying a new one.

Submitted by Dr. X, Norfolk , VA

While acquainting myself with a new elderly patient,

I asked, "How long have you been bedridden?"  After a look of complete confusion she answered, "Why, not for about twenty years,  when my husband was alive."

Submitted by Dr. X- Corvallis , OR

I was performing rounds at the hospital one morning and while checking

up on a man I asked

"So how's your breakfast this morning?".   " It's very good except for the Kentucky Jelly. I can't seem to get used to the taste", Bob replied.

I then asked to see the jelly and Bob produced a foil packet labeled 'KY Jelly.'

Submitted by Dr. X , Detroit

A nurse was on duty in the Emergency Room when a young woman with purple hair styled into a punk rocker Mohawk, sporting a variety of tattoos, and wearing strange clothing, entered . . . It was quickly determined that the patient had acute appendicitis, so she was scheduled for immediate surgery.. When she was completely disrobed on the operating table, the staff noticed that her pubic hair had been dyed green and above it there was a tattoo that read . . .

"Keep off the grass".

The surgeon wrote a short note on the patient's dressing, which said '

"Sorry . . . had to mow the lawn.'

Submitted by RN no name,

As a new, young MD doing his residency in OB. I was quite embarrassed when performing female pelvic exams... To cover my embarrassment I had unconsciously formed a habit of whistling softly. The middle-aged lady upon whom I was performing this exam suddenly burst out laughing and further embarrassing me. I looked up from my work and sheepishly said, 

"I'm sorry. Was I tickling you?"

She replied with tears running down her cheeks from laughing so hard, 

"No doctor but the song you were whistling was  'I wish I was an Oscar Meyer Weiner.'"

Dr. wouldn't submit his name....

Baby's First Doctor Visit:  This made me laugh out loud. hope it will give you a smile! A woman and a baby were in the doctor's examining room, waiting for the doctor to come in for the baby's first exam. The doctor arrived, and examined the baby, checked his weight, and being a little concerned, asked if the baby was breast-fed or bottle-fed.

"Breast-fed," she replied..
"Well, strip down to your waist," the doctor ordered.

She did. He pinched her nipples, pressed, kneaded, and rubbed both breasts for a while in a very professional and detailed examination. Motioning to her to get dressed, the doctor said,

'No wonder this baby is underweight. You don't have any milk.' I know,' she said, 'I'm his Grandma, but I'm glad I came.

Click here for some more humor

• Surgeon Jokes
• How do you hide $100 from a (name your doctor or surgeon)
• Midget jokes (it's a joke people)  
• Lindsey Vonn loses Olympic gold medal.
• Best Obama joke ever. 
• How to be happy in life, by Tiger Woods
• Liquid Viagra
• The Lie Clock 

Online Respiratory Therapy Degree? Perhaps an Online Medical School Too, Someday.

I'm not sure how effective an online respiratory therapy degree could be when you have to see the patient to  believe the patient.    In respiratory therapy, bedside evaluation means everything.  This is one of those situations where critical labs are not critical in folks with advanced lung disease.  A blood gas that looks horrible may not be clinically relevant at all.

Recently, I found myself in the midst of an interesting interaction between two respiratory therapists talking about two different patients.  Both patients were short of breath,  but for very different reasons.   On first glance, the therapists appeared to have vastly different skills sets.  That's not a bad thing.  It's just a fact.  I found myself wondering if one got an online respiratory therapy degree and forgot everything while the other quit medical school to become a respiratory therapist.

In both patients I requested an arterial blood gas to help me interpret the patient's clinical situation.  

Scenario #1
Happy:  The patient said they coughed up blood earlier.  Even though they aren't hypoxemic, could you please get an ABG and calculate the A-a gradient for me?
Respiratory Therapist:  Pause.  Dramatic pause. Pause.  More Pausing.  Smile.  What's an A-a gradient, or what ever you called it?
Happy:  You don't know what an A-a gradient is?
Respiratory Therapist:  No.
Happy:  How long have you been out of training?
Respiratory Therapist:  About twenty years.
Happy:  Smiles.  The A-a gradient helps to determine if the patient is experiencing any type of shunting when you evaluate hypoxemia.
Respiratory Therapist:   How do I calculate it?
Happy:  You can find an online A-a gradient calculator pretty easily these days.  There are even medical  iPhone applications you can download too.

For a moment there I thought to myself surely respiratory therapy schools teach blood gases as part of their respiratory therapy training.  Then I thought to myself maybe he got an online respiratory therapy degree and wasn't expected to learn unimportant things like blood gas interpretation.  Then I realized there probably weren't any online respiratory therapy schools twenty years ago and twenty years is a long time to remember unnecessary blood gas physiology.

Scenario #2
Respiratory Therapist:  Dr Happy.  I'm glad I found you.  I'm worried about Mr Smith.  He's on large amounts of oxygen and doesn't seem to be getting any better since yesterday, even though he's peeing a bunch from the lasix.  What do you think about doing an ABG and calculating the A-a gradient to look for shunting?
Happy:  I think that's a great idea.  Let's get it done.  Give me a call when you have the A-a gradient calculated.
Respiratory Therapist :  Great.   I have special  interest in end tidal CO2 monitoring.  Do you mind if I get one and calculate out his anatomical and structural dead space?
Happy:  Wow.    Them are some physiology terms I haven't heard thrown around since my residency days. 

I found myself wondering, if this respiratory therapist quit medical school to become a respiratory therapist.  It's amazing in this world of medicine, how does one really know the skill set of those taking care of you?  Presumably, both respiratory therapists have gone through their required training, both have passed the necessary testing to get certified and licensed in their field of expertise.  Both have been given hospital credentials to practice within their defined scope of practice.  But their underlying chest of knowledge appears to be incomparable.  What does that mean clinically?

I'm sure if you did a study comparing mortality outcomes in both respiratory therapists, they would be equivalent.  What's important?  Are some respiratory therapists over trained?  Are some under trained?  They are all certified.  We have online respiratory therapy degrees competing with  the structured setting of a University environment complete with the best educators and retirement funds our tax dollars can buy.

Perhaps online respiratory therapy degrees with limited patient experience are enough to get by.  Maybe our world is moving toward an education system based less on a broad foundation of knowledge and more on a limited focus of practice.  It seems like you can get an online health degree in just about everything these days,  including online respiratory therapy degrees and online nursing degrees.

Everything except  for a  medical school education.   And I just find myself wondering over and over again why is that?  It's a question that doesn't need answering.  Because the answer is obvious.  There are no shortcuts to earning a medical education.

Skeleton Carved Pumpkin Design (Cool Halloween Picture)

I was out and about today when I saw this really neat skeleton carved pumpkin displayed with a bunch of other Halloween carved pumpkins. How cool is that?  I can assure you, my carved pumpkins don't look like that. 

Picking a Surgeon In the Hospital.

How do patients pick general surgeons in the hospital?   Good question. Most of the time the doctors in the hospital have never met the patient and the patient has never met the doctor.  As a hospitalist, any patient  who has never been admitted to my hospital will have never met me as their physician.  

Most of the time these days, the same can be said of medical subspecialists and even some surgical groups as well.   You see, in my city, most primary care physicians have abandoned hospital based medicine.  Between the economics of running an office practice and lifestyle issues, many have decided it just doesn't make sense to travel from hospital to hospital seeing in-patients when they could fill their clinic with more insurance paying patients.

As a hospitalist, I have an unlimited patient data base for referral.  It's basically everyone.  If you need a hospital admission, you're probably going to see me by default.  You just don't have a choice.   But not so for medical and surgical subspecialists who require a request to see the patient.  So how does a medical subspecialist or surgeon get called to see a patient?  It's usually at the request of the hospitalist.

When a patient of mine needs a surgeon, I usually ask the patient if they are familiar with any of the doctors in town.  I like to give them first crack at who gets to see them.  Here's how a recent conversation went:

Happy:  You might need a surgeon while you're here.  Do you have a preference on a surgeon?
Patient:  Just one that finished in the top half of their medical school class
Happy:  That's impossible.  There are none.  We're  all internists. 

Just a little good humor to start your morning.  That reminds me, here's a surgeon joke you might appreciate.  Oh yeah, I suppose you're also wondering how to hide $100 from a surgeon. 

On a more serious note, it used to be patients wanted the best.  As you can see, now we're down to the top half.  This is good news for the independently practicing nurse practitioner movement.   When the general surgeon shortage gets bad enough we'll just train nurse surgeons to fill the necessary gap.   At least for the easier cases.

You know, because general surgery isn't that hard, and someone has to do it.  At least the easy cases. 

How Can I Raise My Spirits Today?

If you're wondering how to raise your spirits today, all you gots to do is check out this week's medical Grand Rounds for the uplifting edition.

GE Vscan Phone Sized Bedside Ultrasound Technology For Hospitalists

Does the GE Vscan bedside technology have the opportunity to revolutionize how hospitalists deliver patient care?  A reader asks me what I think:

I read your blog all the time and like it very much. I have a question. Would you consider using a handheld ultrasound machine, like the GE Vscan, at the bedside for a quick look at something that is perhaps suspicious or to just ensure the desired outcome is still within reach? One would not get paid for such a quick scan. For what uses would you consider this technology: heart failure patients? 

Here's a video of the GE Vscan bedside ultrasound technology at work

It's amazing the kind of pocket sized bedside ultrasound technology that's available these days.  Would I use it?  With proper training, it would add an entirely new dimension to the kind of quick, cost effective and efficient care I could offer my hospitalized patients.  

I think the rate limiting steps in implementing wide scale acceptance of this technology are two fold

1. Risk
2. Cost of accepting that risk.

First of all, I'm not trained in providing ultrasound technology support.  I've never done an ultrasound of anything and I have no idea how to interpret ultrasound images with confidence.

Could I learn?  Certainly.  I could see my self using the technology for straight forward questions that need to be answered and therefore bypassing the need to do complete full and formal ultrasound reads.

• Is there pericardial effusion?
• Is there  a large pleural effusion or a large amount of ascites?
• Is there evidence of hydronephrosis?

With experience and training, I'm sure my confidence in obtaining the images and interpreting basic images would rise with every scan.  Perhaps all the expenses that come with in-hospital radiology imaging (transport, tech time, nursing time, waiting time, processing time, IT support time, radiologist time, cardiologist time, and of course the facility fees) would all be avoided if a hospitalist had the training and experience to provide quick bedside ultrasound technology.

So why wouldn't I be excited about bedside technology?  Well, for starters, I would be accepting all the malpractice risk of interpretation and all the malpractice risk of missing a diagnosis  while spending my limited time and resources and not getting paid for it.  In many hospitals only the radiologists can get paid for x ray interpretation or only the cardiologists can get paid for EKG interpretation as a consequence of how the hospital has contracted to have those services provided.  Would I be willing, as a hospitalist, to provide both the technical aspect and interpretation aspect of a bedside ultrasound scan without getting compensated while accepting all the risk?

Absolutely not.

I suppose we as doctors do that every day with uninsured patients. But with bedside Vscan ultrasound technology, I have the opportunity to just say no and let the patient go through a formal full ultrasound scan, even though they may or may not need a complete scan.  That way, someone is getting paid for accepting risk. 

All that could change if bundled care meant this bed side technology had the opportunity to save millions of dollars a year in unnecessary hospital expenses?  Would I consider accepting some of the risk for interpretation in return for compensation on the back end cost savings? 

Absolutely.  

This is but another example of how fee for service and the codified rules of the Medicare National Bank under the CMS Kingdom has destroyed any chance of bringing efficiency to hospital care.  I would train myself to do bedside GE Vscan ultrasound in a heart beat only if it meant I would be compensated for the risk involved in providing that care.  And currently, that just doesn't exist.

Robert De Niro Terrorist Names Watch List Skit on SNL, One of the Funniest Skits Ever.

Check out this hilarious  Robert De Niro funny terrorist names watch list skit he did on  Saturday Night Live a few years back. This video is about as funny as it gets.It's belly aching good humor.  I hope you laugh as hard as I did.

Blogger Posts Not Being Indexed By Google Since October 19th, 2010: Any Others Having Problems?

Nothing medical related, but since I have a Blogger blog, I thought I would seek help from anyone else out there with a Blogger blog having problems.  I have been having problems with all my Blogger posts not being indexed by Google search engine, immediately, since October, 19th, 2010. It sounds like some pretty big sites out there are having problems with Google indexing too. 

After doing some basic research and checking out some of the Google Webmaster forums, I have noticed others are having problems with their Blogger blogs not being archived by Google search engine either.  On one Webmaster forum, a  contributor suggests the problem is with a Blogger indexing bot and not the Google search engine bot (what ever that means).  as well.

Since October 19th, some of my posts have since been archived.  I have had some of my posts archived while others still remain unarchived by the Google search engine.   Just curious, for anyone else that follows this kind of thing, have you been having problems with your Blogger posts not being indexed by Google's search engine?

Hopefully this will get indexed and other will be able to find  this and comment.

Update 1/0/22/10:  On one of the Google webmaster forums, a gentleman who identifies himself as a Google employee left a comment (in the forum on the first link above)

Google Employee
4:30 AM

Hi everyone
Thanks for posting about this issue. We've been tracking and reviewing these reports and have passed your feedback on to the teams to review. I'll check through these specific sites mentioned here and post back as I know more. Feel free to post more examples if you feel they aren't similar to previously mentioned ones.  Thanks again for your feedback, it's really helpful!
Cheers
John

 So maybe a fix is on the way.  

I Can't Afford My Diabetic Supplies, Because I'd Rather Have Cable Television

I can't afford my diabetic supplies, because I don't want to give up my cable television. At least that's what one lady told her pharmacist:

A few weeks ago I had a morbidly obese Type 2 Diabetic patient who was on oral hypoglycemics and insulin for blood sugar management. Her medicaid 3rd party prescription provider no longer covered the syringes or lancets so she told me to put them back because she would rather have her cable tv.

I have stopped being surprised by the lengths Americans will go to protect their amenities and luxuries at the expense of their health.   When you choose not to afford your diabetic supplies because you choose not to give up your cable television, you send a clear message to the world about your priorities.  

The only person she's hurting is herself.  So few doctors accept Medicaid anymore that when she eventually strokes out, there will be no one willing  to take care of her. But she'll know what to do.  Because she'll have the Discovery Health Channel, in hi-definition.   Don't feel sorry for her.  Think of her as the next generation of empowered Medicaid patients. 

It's not FREE=MORE.  It's FREE=Cable TV

Hospitalist Won't Fill Out My FMLA Paperwork. What Should I Do?

I heard a story today about how to get your doctor to fill out your  Family Medial Leave Act (FMLA) paperwork as soon as possible. I think it would apply nicely to hospitalists too.   You might be wondering if doctors can charge you to fill out your FMLA paper work, write emails or take phone calls after normal business hours.  The answer is yes. 

In fact, I recently wrote about the Lakeshore internal medicine group affiliated with Northwestern in Chicago (click on the link above) that's doing just that.  Interestingly enough, I recently called that internal medicine group to discuss internal medicine stuff. 

So I can confirm that yes, the first sentence on their telephone answering message system was none other than, you may be charged for this phone call. 

Here's an alternative solution to paying your doctor to fill out FMLA your paper work.  I over heard office staff at a local clinic discussing the issue of how to get FMLA paperwork filled out quickly.

Clinic Staff:  We had this guy come in last week with a whole pile of cream cheese and bagels  begging us to fill out his FMLA paper work before the end of the day.  I'll tell you what, if you want to get your FMLA paper work done fast, just bring in food.  You want to get anything done around here, just bring in food.

There you have it folks.  Forget about money.  It's about bartering and bribery these days.  Bring in some bagels for the hospitalists and you jump to the front of the line.  I'll even delay clocking out  from my shift and to earn a little overtime just to get a bagel or two.   That's how you get your hospitalist to fill out your FMLA paperwork. 

Funny Baby Names and Their Origins: Funny Example

Ever wonder about the origins of funny baby names?  Here's a story I heard today:

Stranger:  How did you come up with the name Delas

Mother:  Because when I had him I knew he was de las one.

HSA Tips: Deductible Stacking Is The Name of the Game.

Want some HSA tips on how to save money?  HSA stands for health savings accounts.  These are government defined tax shelters used to generate tax free income for spending on qualified health care expenditures.

An HSA is a bank account.   It is, as the name implies, a savings account.  HSAs come with government defined contribution limits.  You contribute tax free dollars in and you get to spend it tax free as well.   Depending on your tax rates, this could mean savings of up to forty percent or more on your actual medical expenses. 

In order to contribute money to an HSA, your health insurance plan must be a qualified high deducitble plan.  So what are the 2010 high deductible minimum and maximum deductible insurance  limits and what are the 2010 HSA contribution limits?

HSA Limits for Deductibles and Contributions

	Minimum Deductible	Maximum out-of-pocket	HSA Contribution Limit	55+ Contribution
SINGLE	$1,200	$5,950	$3,050	$4,050
FAMILY	$2,400	$11,900	$6,150	$7150

There are no changes for the 2011 limits in high deductible qualifying minimums or in the HSA contribution limits.

What you'll notice is that the minimum deductibles for the high deductible plans are far below the maximum contribution limits to the HSA account.  That means, it's possible for a family to have a a total out of pocket (not including the actual health insurance premiums) of only $2,400 in 2010 while contributing $6,150 of income tax free into their savings account in 2010.  The same holds true for 2011.   

That means, assuming they spend their total deductible of $4,800 over two years, they could still contribute $12,300 in tax free income.  Which means after two years, they could have  $7,500 built up in a medical savings acount for future expenses (such as Medicare premiums) or non deductible qualified medical expenses (such as fertility treatments).

What do all these deductibles and limits mean to you?  Well, I learned first hand how some folks use the timing of their deductibles to their advantage.  Most insurance plans reset their deductible limits on a certain date every year.  I had a cancer patient who recently delayed a round of chemotherapy by two weeks so their chemotherapy charges on their $4000 out of pocket deductibles would apply to the following calendar year.   I call this deductible stacking.  It is a natural extension of FREE=MORE.  

I have a high deductible HSA.  If I expected a large medical expense one year and much less the next, you bet I would push forward or delay a therapy to take advantage of deductible stacking.  It should be part of any family's money saving strategy for navigating the crazy world of HSAs and high deductible health insurance plans.

Halloween Flag Pole Decoration Picture (Scary and Cool Stuff)

Earlier, I  showed you a blast from the past with the Pac-Man inflatable blow up decoration.   On the same walk, we saw this scary Halloween flag pole decoration.   Here's the picture:

I don't think I've ever seen such a cool Halloween decoration for a flag pole.  For an archive of all my previous Halloween posts, click on the link above.  

What's the neatest Halloween decoration you've seen?

Funny Halloween Inflatable Blow Up Decoration: Awesome Pac-Man Blast From the Past

Mrs Happy and I were walking Marty and Cooper tonight when I came across this awesome Halloween inflatable Pac-Man blow up decoration.  Nothing like a Pac-Man pumpkin and some Pac-Man monsters to bring back memories of years past. Although, I've got to be honest.  I've never seen the white monsters before.  What is the greatest inflatable Halloween decoration you've seen for 2010 or any years past?

For a little holiday spirit, here are some other Halloween posts of years past.  There's some good humor embedded in them there Halloween posts, including Happy with a mustache.

• Marty and Cooper got scared with some Halloween yard decorations and freaked out. 
• A little Halloween food porn fun with popcorn.
• A few funny homemade Halloween costumes from Happy's past, including disco Happy.
• A little information on Halloween colored cosmetic contact lenses you may need to know.
• A strange case of hospital Halloween decorations and their effect on nursing sanity.
• Funny and dirty Halloween costumes of 2009;  May not be safe for work.
• A little Halloween cartoon humor.
• Our dog ate chocolate Halloween candy.  What do we do now?
• Funny Halloween costume blunder story involving Monica Lewinsky. 
• Funny dog costumes:  You've got to see this one. 
• Incredible Halloween body part bread art (amazing gruesome food pictures).
• Halloween caption contest.  Some good humor here. 
• Healthy fruit snacks and ring pops got good reviews by our Trick-or-Treaters. 
• I grew a mustache as part of  a disco costume.  You won't see that again. 

Unusual Heart Rhythm Discovered: T-Shirt Tachycardia (Picture)

To the untrained eye this doesn't look like an unusual heart rhythm.  It is just your garden variety old man with a sick heart tachycardia. 

But the nurses at Happy's intensive care unit are not untrained. They are highly trained rhythm detectors. So it came as no surprise to me to learn they discovered a new and unusual and until now, undiscovered heart rhythm. 

I present to you the first ever reported case of T-Shirt tachycardia.

It's not every day you get to experience a newly discovered unusual heart rhythm.  I'm going to remember this day forever.  Kind of like remembering where you were and what you were doing on 9-11.

Hospitalists Provide Cafeteria Support Too, Apparently

What is a hospitalist and what kind of care does a hospitalist provide?   It's funny to read what people are writing these days about my professional role in patient care.  It now appears hospitalists don't manage medical issues anymore, but rather go to seven years of medical training to discuss the efficiency of the cafeteria food with their patients.  

I read one article where the reader, obviously not a hospitalist, suggests that a hospitalist is a medical doctor who can do all the things normal doctors can, but instead of seeing patients all day, he makes rounds through the hospital, talking to patients to find out what can make their hospital stay better.  What kind of issues does the hospitalist deal with on their rounds?  Why, the efficiency of the cafeteria food, of course. 

I guess I was sleeping the day I was supposed to learn about the efficiency of hospital food in medical school.  Maybe that means, after reviewing the SHM/MGMA 2010 hospitalist salary compensation report, I should request a pay cut because of my failure to provide cafeteria support.  Or better yet, maybe I could make it up by asking security if I could provide take down support on some code assists. Ok, I feel better about my role as a hospitalist.

Hospitalist vs Neurologist Xtranormal Medical Video Presentation

My Xtranormal medical video specialist battle continues in this  Hospitalist vs Neurologist video presentation.  Enjoy this Happy original  Xtranormal video giving you  a little truth sprinkled with a little hyperbole.

Find other fine  Xtranormal Medical Videos.  Some are Happy originals.  Some aren't.  I think they're all funny.

Status Asthmaticus Findings: Don't Forget the Texting In the ER Sign:

Just when I thought I'd seen it all, along comes another hospitalist experience that gives me a double take. She was a 30 year old black female texting in the ER  right in the middle of her status asthmaticus attack (not  to be confused with status hispanicus).  Status asthmaticus is a severe form of asthma with findings that require continuous monitoring for progression to respiratory demise. This lady was on BiPAP, a form of external breathing support that helps people in respiratory distress to try and overcome their illness without ending up intubated.  She showed all the findings of impending respiratory failure from her status asthmaticus:

• Diffuse wheezing
• Poor expiratory air flow
• Accessory muscle usage
• Hypercapnea
• Tachypnea
• Tachycardia
• Prior history of being on a ventilator

She had all these poor prognostic signs.  All except one.  She couldn't get her eyes off her brand new iPhone 4 long enough to stop texting.  Maybe in her mind, this was her Last Supper.  Here's a lady who appeared to be  minutes away from ending up on a respiratory and she was too busy texing to take her eyes off her phone and answer some questions for me.

In retrospect, I think it may have been the smartest thing she did that night.   With all signs pointing to intubation, her texting rampage in the ER was a sign she just wasn't as sick as she objectively appeared.  

If you're a student or a resident, it's time to learn these other great medical signs:

• Handsome Sign
• Sleeping Husband sign
• O and Q sign
• Twenty sign
• MFer sign
• How to find a lost cell phone in the hospital:  Happy's honesty sign
  
• Band-Aid sign
• Intact Humor Reflex sign
• Fibromyallergia sign
• Denture Stains sign
• Square Root sign
• And while you're at it, check out these funny homeless signs.

 

You can't learn this stuff in a medical school education  You have to come to The Happy Hospitalist to make the leap to great bedside history and physical examination. 

Go here to learn more about texting in the hospital.  

Private Practice Section of the American Physical Therapy Association Impact Magazine, October 2010 Published The Happy Hospitalist

In case you are a physical therapist or a random bystander who happens to pick up the  latest October, 2010 Impact magazine from the Private Practice Section of the American Physical Therapy Association, make sure you turn to page 61.  There, you'll be able to read about my real life experience on How to Find the Real Cost of  Doctor and Hospital Charges Using High Deductible Health Savings Account Rules originally published at The Happy Hospitalist on August 9, 2010

Between this, and an attribution to several more posts in an upcoming health care policy book, I should just about be ready to quit my job as a hospitalist and get an agent.  I'm thinking I could even expand into Marty and Cooper children's books.  Maybe even a movie or two.  

Mystery Meat Picture From A Gas Station: Who Eats This Stuff?

I was getting a bottle of fruit flavored water at the local gas station the other day  when I turned around and I saw this mystery meat staring me in the face.  I found myself wondering in stunned silence, "Who eats this stuff?".  So I asked the clerk behind the desk.

Happy:  What is this mystery meat?
Clerk:  I have no idea.  I just work here. 

It's no wonder America has an epidemic of super morbid obesity.  The farthest distance between two McDonald's is only 107 miles and we've got gas stations from coast to coast selling 50 cent mystery meat by the ton and  state fairs serving 67 types of foods on a stick.  

I'll tell you what, forgot about the mystery meat. Next time you're hungry, fill up your shopping cart full of fruits and vegetables.  One day you'll thank me by not showing up as a patient on my hospitalist service where we don't rarely serve mystery meat, but we do serve a  hospital smoking ban policy.  Which means you can't have a cigarette after your family brings in a sack of mystery meat the night before your heart catheterization. 

What is it going to take for you to kick your mystery meat addiction and show a litte self respect for your body?  You only get one body.  As an American, I'm embarrased to think that any company feels compelled enough to sell this mystery meat garbage, and expect to make a profit from it.

But they do.  Which helps explain a lot about a lot of things.  Not about the companies willing to self this stuff, but about Americans willing to buy it.

Meaningful Use Criteria EHR Interactive Checklist Search Tool: Don't Lose Out On Free Federal Stimulus Dollars.

Meaningful Use requirements? What the heck is that? If you are in the market for an electronic health record (EHR), you need to make sure your EMR qualifies for meaningful use based on the standards established by our federal government. Or, if you don't want to qualify for thousands of dollars in free federal stimulus dollars available through the the American Recovery and Reinvestment Act (ARRA), just don't worry about it.

For your  EHR product to qualify for meaningful use, it must have 15 mandatory qualifying characteristics as well as a handful of optional components. Not every vendor will be honest with you.  You need to educate yourself on what your product must have to qualify for meaningful use. 

That's where I come in.  The Happy Hospitalist has teamed up with the folks at Software Advice  to bring you a nice checklist that allows you to compare and rate up to five EHR products, side-by-side, in interactive spread sheet form, to help you decide which product and vendor best meets the needs of your medical practice.

All the mandatory and optional meaningful use criteria are included to help you in your search for an EHR product.   Once you've had a chance to look it over, the folks at Software Advice, will call you, at your convenience, to help guide you in your search.  They are a valuable resource that can make sense of it all and shave hours off your research process.

Download your free ARRA meaningful use criteria comparison checklist tool and receive your free consultation

Other useful information is available at my EHR Resource Center.

Three Year Blogging Anniversary Hits 3000 Hits For The Happy Hospitalist

I just realized that October 2007 was the month The Happy Hospitalist was born.  I just had my three year blogging anniversary, and wouldn't you know it, I had a record number of page views in one day at just twenty hits shy of 3000 page views in one day.  And it's rapidly approaching 1,000,000 unique visits.

Not bad for a part time operation in a process,  that for most people who do it, survives just a few months.   Here's a graph of my total page views (green) and my unique hits (blue) on a daily basis, since little baby Happy Hospitalist was conceived 2007.  What are you waiting for?  Get blogging today.