Orange Prank Calling Tanning Salon Video. Consult Your Doctor.

This is funny. It's the orange prank calling tanning salon video. Good humor in a strange kind of way.If your skin is orange, don't go to a tanning salon.  Consult your doctor.

Orange you glad it's 2011?

New Year's Eve Celebration 2010 In The Hospital? It's Crazy Fun I Tell Ya.

By now you've heard of the hospital whiteboard.  It carries with it a wealth of important information. Such as, if you're a nurse working at a hospital on New Year's Eve, how do you celebrate the arrival of the new year?  Why, doing midnight vitals of course.  Happy New Year.    I hope everyone's celebration is safe. If you happen to get admitted to the hospital this evening and your hospitalist doesn't show up for a couple hours, it's probably because they're having a party in their call room.  Just be patient.  They'll get there eventually. In the mean time, you can celebrate with midnight vitals.

Coffin Calendar 2011 by CofaniFunebri Proves Sex Sells, Even When You're Dead

Sex sells, even when you're dead.  This Italian 2011 coffin calendar by  CofaniFunebri proves you can sell anything with a woman dressed in almost nothing. (WARNING: SOME PAGE CONTENTS  NOT SAFE FOR WORK, BUT ONLY IF YOU LIVE IN AMERICA).

I've got an idea.  For patients upset that their primary care doctor isn't going to be there for them, perhaps it's time that hospitalists implement their own physician marketing strategy using sexy calendars.  I'd stay away from the coffins and sexy TSA skeleton calendar motifs though. Perhaps we could show scantily dressed hospitalists holding their cheap stethoscopes in provocative poses while washing their hands and not drinking coffee at the nurses station.  

Just write all the patient's appointments on the calendar and hand it to them on discharge.   It might even be the best way to prevent patients from bouncing back for another hospital admission, considering the Medicare National Bank will  start slashing hospital revenue in less than two fiscal years for patients who bounce back within 30 days for heart failure, pneumonia or acute myocardial infarction.  

The only unintended consequence I can imagine for such a plan is a dramatic rise in December admissions as dirty old man try to squeeze in one last chance to get next year's calendar.  On second thought,  it might be better to give them the 2011 sexy coffin calendar instead.

The Happy Hospitalist Is Now Mobile On Your Cell.

If you want to catch up on all my posts on the go from The Happy Hospitalist, the Blogger mobile platform is now operational.  You don't have to enter any special URL.  It just works.   Enjoy Happy on the go.   Just don't Happy and drive.

Nurse Practitioner Business Model At Its Finest.

I just got done blogging about a hospital that is mandating the use of nurse practitioner hospitalists when I have a patient give me their APRN experience.

Happy:  Who's your doctor outside of the hospital?

Patient:  I don't have a doctor.  I have an A-P-R-N.

Happy:  Wow.   I'm surprised.  Not a lot of people can distinguish the difference.

Patient:  Well, Hell.  I haven't seen my doctor since 1985.  The only people he sees now are healthy pregnant women and well baby checks.

I got to thinking, this doctor is a genius.  He pawns off all his elderly, highly complicated, chronically ill, super morbidly obese, four pack per day smokers with chronic multiorgan failure to his APRNs  who then admit them to Happy and his hospitalists while the doctor keeps the healthy pregnant women and healthy baby checks for himself.

When you think about it, this doctor has turned himself into an APRN being paid like a doctor  and he's created doctors out of his APRNs  being paid like APRNs.

What a genius. 

Nurse Practitioner Hospitalists Mandated By Hospitals? Run Forest, Run!

A reader sent me an intriguing scenario in which physician hospitalists (whom I can only assume are employees of a hospital system) are being forced to sign off on the daily rounds of nurse practitioner hospitalists.

Dear Happy,
Recently we are being required to "use"  nurse practitioners  to  round on patients. Then we are "required" to sign their progress note. In your opinion what is the significance of signing?

That's just nuts.  The only situation I could ever find myself agreeing to be the physician of record for any provider whom I haven't first given my consent to practice under my guidance is if that hospital gave me 100% financial protection  from any and all malpractice actions brought on by  any patient which I was being forced to sign off on for care provided by the nurse practitioner.

The only reason a hospital would hire a nurse practitioner to do daily rounds is because it's cheaper than hiring a physician.   By having an NP round on patients, they reduce their labor expenses  and increase their operating margins.

That's great for the hospital and great for the folks who's bonus structure is tied to the economic benefits of hiring nurse practitioners.  But why would the hospital then turn around and require a physician to sign all NP notes?  That's easy. The Medicare National Bank requires that all patients have a  collaborating physician for all inpatient charges.

That means, even if you had an independently practicing nurse practitioner with no physician over site practicing medicine in the middle of Idaho, Medicare  would require a collaborating physician to be the attending of record if that patient ever got admitted to the hospital. That's the rule and that's why your hospital is mandating you to sign every record of care provided by a NP as if it was your own.

Your hospital is trying to have its cake and eat it too.  I suppose they figure they can get patients evaluated by a nurse practitioner with 1/10 the training  and a fraction of the scope of a fully certified internal medicine physician, and a fraction of the cost, and then use you, the physician to comply with the CMS rules and regulations. 

It's about money and your hospital is putting you in the middle of their money making machine.  The only question now is are you going to allow yourself to be used for the financial gain of others and are you willing to accept the legal and medical liablity for the actions of someone with just a fraction of your training?  What exactly does signing a nurse practitioner's note mean?

• Does it mean you've seen the patient?
• Does it mean you've only read the note?
• Does it mean you agree with everything the nurse practitioner hospitalist wrote?

It doesn't matter what it means.  The fact of the matter is, if the dung ever hit the fan, the one the lawyers are coming  after is you, the physician of record, not the NP who has everything signed off on by you.  You will be held 100% responsible to the letter of the law.  Unless your hospital is willing to pay 100% of all legal expenses AND 100% of any and all  judgments against you in a patient you signed off on, I would tell your hospital to take their NPs and shove it where the sun don't shine.   And even then, you are left with the lawsuit ready to haunt you for years whenever you apply for hospital credentials.

If you aren't willing to force your hospital to make this happen,  I would hope you have the self respect to demand compensation for every patient you place your signature on as if it was your own.  That means your hospital should  pay 100% of your effort.  That means, your hospital would also be paying for an additional NP which is not a business model they would consider investigating.

Many private practices employ NPs in order to increase volumes at a reduced cost, then pocket the difference as a profit distribution.  In this case, the physicians accept responsibility for the care provided by the NP, but also profit from the increased volume of reimbursement at a reduced cost. In your situation, instead of you earning this profit for using NPs, the hospital is using you to skim this profit from you and depositing it in their accounts. They are using you and there is no way around that fact. 

When physicians hire NPs, they are are hopefully mentored and trained by the physician of record.  They do it on their terms and the physicians work closely with their non physician providers to ensure a high quality of care at a comfort level acceptable to the medical physician.  That's the only way I would ever work closely with an NP on my patients.  It would be on my terms.  Why?  Because NP education is so woefully inadequate to practice an independent scope of hospital internal medicine.  

If your hospital is forcing you to sign nurse practitioner hospitalist notes without protection or compensation, they are using you and you have no one to blame but yourself. 

Italian Greyhound Tongue Sticking Out (Picture)

Cooper, our seven year old Italian greyhound, was caught in this adorable picture pose  sleeping with his tongue sticking out.   He loves to sleep with his head and ears resting on Mrs Happy's pregnant belly.   He's our version of a fully organic combination of  part  home Doppler fetal heart tone monitoring system and part incubator for the little fella inside. I don't think life could get any cuter than that.

To find more of Cooper and his brother Marty, visit

• Their YouTube channel with dozens of Iggys in action
• Their beautiful slideshow with hundreds of pictures
• All their blog posts

Having The Santa Conversation With Your Child (Audio File)

Looking for a cute and funny example of the Is Santa Claus Real? conversation with a young child? Look no further.  Of course Santa is real.  But here's how this mom and daughter hashed out the details. This is from our niece. Now this is what you call good ol' fashioned home grown humor. Play the audio file below. 

If you have problems following along, here's a transcript of mother and daughter discussing the details  in the   one and only Santa conversation they'll ever have. It's a dandy.

Mom:  Ok, what do you want to know?

Girl:  Is Santa real or not or is it you putting Christmas presents under the tree?

Mom: Laughing  And what do you say is weird about it?

Girl:  That it's a magical fat guy flying in a sleigh.

Mom: Laughing. Pause.  And what else?  Laughing.

Girl: That little midgets are working around in the shop making presents for us.  Laughing

Mom and Girl:  Both Laughing.

Girl:  It doesn't seem real! Laughing

Mom:  Laughing

Girl:  What the heck?  I hate it when you answer my questions.

Mom:  Laughing.  I told you all fat men are magic.

Girl:  No.  Seriously mom.

Mom:  What do you think?

Girl:  Laughing.  I already told you.  I think he's real because everybody says he's real.  But then if you think about it, magical fat guy riding in a sleigh dropping presents down your chimney doesn't seem real.  Like an Easter Bunny.  An overgrown bunny that lays eggs.  Bunnies don't lay eggs.

Mom:  Laughing a lot.  Giant bunnies are magical too.  Laughing.

Girl:  Frustrated.  That's not my question though. 

Mom and Girl:  Both laughing.  

A little while later Mrs Happy and I got a text from our neice

Santa's Not Real!.  My mom's been giving me all my presents!

So we texted her back.

WHAT!!! You mean your mother has been buying us all our Christmas presents too?  No way!.

She texted us back.

No.  That was probably grandma.

I hope everyone had a great Christmas.

For more fun visit the best nursery rhyme ever and the greatest tooth fairy letter ever and a funny letter to Santa.

Birthday Brownie Dessert For The Pregnant Woman Please. (Picture)

Happy birthday Mrs Happy.  I hope you enjoyed your birthday brownie dessert as much as I enjoyed sharing it with you.  I got her a GPS Garmin watch of her own to help her and our baby exercise.   It's a good thing, since I signed her up for a half marathon the week before her due date.

We got a little scare though.  After reading through the Garmin's important safety and product information section it said that the product, its packaging, and components contain chemicals known to the State of California to cause cancer, birth defects, or reproductive harm. 

It's a good thing we don't live in California.  I always knew it was a dangerous place to live.

My Blackberry Doesn't Work BBC Video. Great Stuff.

Check out this hilarious take on technology at the fruit stand.   It's called My Blackberry Doesn't work.  Funny stuff from the BBC. Watch the video. 

Funny Onesie: Still Living At Home

Mrs Happy and I bought our first baby item the other day.  It's a onesie that says Still Living At Home.

Kids these days. They don't do nothin' but mooch off their parents.

For other great onesie humor, visit

• Funny Halloween onesie:  I want my MUMMY!
• Camouflage onesie
• Future Potbelly! onesie
• Tax deduction onesie
• Onesie tie business attire
• My favorite custom made onesie
• Young buck onesie
• Still living at home onesie
• Laughing my diaper off onesie
• Moose onesie with a hoodie

Letter to Santa: Funny How Straight and To The Point This Young Child Is.

Some kids know exactly what they want Santa to bring them.  Like my 4 1/2 year old nephew.  He wrote a letter to Santa Claus and he ain't beatin' around the bush.  It's funny how straight and to the point he is. 

Grandma gets a gun. Little Evan gets his pillow pet and a planter.  He even spelled everything right.  I'm impressed.   Mrs Happy got herself a Brest Friend pillow.

For some other great childhood humor, check out the greatest tooth fairy letter ever courtesy of  my niece, the best nursery rhyme ever and a cute conversation about Santa.  

Guns and Grandmas: Grannys Packing Heat at Christmas

So you think most grandmas are sitting around playing cards and drinking coffee during Christmas?  Not Grandma Happy.  When this grandma isn't celebrating her birthday, she's bringing  new meaning to the term guns and grandmas.  This picture is enough to bring most hard core card carryin' NRA fanatics to their knees with excitement and joy.

Merry Christmas granny. Don't shoot your eye out.  In case anyone is wondering, that's a real Tec-9 semi-automatic.  Known 'round these parts as the street sweeper.  And it can shoot your eye out.

Merry Christmas to all and have a great day!

Show Santa Claus In My House On Christmas Eve

If you're trying to prove Santa Claus is real for your young kids, and they are starting to lose that Christmas spirit, your solution has arrived.  All you need to do is give them a picture showing Santa Claus in your home and your problem is solved.

But how do you get a picture showing Santa Clause in your house?  That's easy.  That's where Happy comes to the rescue.  I've teamed up with these darn special folks that have trained hundreds of thousands, if not millions of  little elves that will stake out your home and wait for the big man to arrive.  

They'll snap your picture of Santa Clause posing in your home and, if you have Wi-Fi, they'll even email it directly to your computer in an instant.  

So make your picture of Santa in your home as easy as 1-2-3.  Put the elves back to work.  The elves are dirt cheap, so the picture is cheap.  And 100% of all my proceeds generated by getting your picture through The Happy Hospitalist will be donated to the Make a Wish Foundation.

What are you waiting for?  Get your Santa was here in my house picture today and bring Christmas smiles and cheers to your kids. Just click on Santa and you're almost done.

Italian Greyhounds Dressed For Christmas: Santa's Little Helpers.

If you're wondering Is Santa Claus Real?,  stop wondering.   I've got proof.  I've discovered our Italian greyhounds,  Marty and Cooper, are a couple of the lead helpers in the army of Santa's little helpers going to work tonight to capture a picture of Santa Claus in my house and houses all across my neighborhood.

Santa has the world divided into local neighborhood grids and he has commandeered  local neighborhood elves  to help spread Christmas cheer.  And Santa's elves are little.  They have to be if they are going to squeeze through the windows and doors to get that bonus shot of Santa Claus posing in your home.   And who says greyhounds can't be elves?  Our Santa's little helpers make some of the finest elves around.  

Here's our Italian greyhounds dressed in their best Christmas outfits.  They really are little Christmas elves spreading Christmas cheer.  And just because they're elves, doesn't mean they don't like getting presents themselves.  Here's Cooper looking for his own Christmas squeaker and snackies.  Looks like the giant rawhide candy cane peaked his interest. 

I almost bought him one of these Snuggies for dogs, but didn't. Because Christmas elves are what they are.  For all Marty and Cooper content, you can check out their YouTube Channel filled with dozens of fun filled moments, their slide show filled with hundreds of beautiful pictures and all their blog posts to catch up on all their quirky moments in life. 

Snuggie For Dogs. Yes Folks, Snuggies Have Gone to the Dogs

First we had the Santa Snuggie.  Then came the Camo Snuggie for hunters.  Now, I've discovered the Snuggie for dogs.  For $7.99 you can get your very own dog Snuggie and keep your pet warm in style.

I almost got our Italian greyhounds, Marty and Cooper, Snuggies for Christmas, but I didn't.  Instead, I got our Italian greyhounds dressed for Christmas as Santa's little helpers.  Because that's what they really are.   

For all of Marty and Cooper's content, you can check out their YouTube Channel filled with dozens of fun filled moments, their slide show filled with hundreds of beautiful pictures and all their blog posts to catch up on all their quirky moments in life.  

If you think your dog is Snuggie worthy, you  can pick up your own dog Snuggie today.   And don't forget your camouflage dog collar, complete with pretty orange bow (arrow not included!)

Submit Your Hidden Happys Content Contest Answer Now

The Hidden Happy's content contest has now ended. As instructed, the first person to accurately submit, in the comments of this post, an accurate list detailing all the URLs, in order, from Hidden Happy #1 through Hidden happy #12, will win.  For the first six Hidden Happys, you also have to to include the URL of the in between linking site.  There may be more than one right answer, as there may be more than one linking site.

I'll start you off with the answer for the first two Hidden Happys.  Submit your answer along the lines of something like this:

#1: http://thehappyhospitalist.blogspot.com/2009/11/cheap-christmas-tree-idea-shes-beaut.html

Linking site: http://thehappyhospitalist.blogspot.com/2009/11/how-to-save-money-on-your-christmas.html

#2: http://thehappyhospitalist.blogspot.com/2009/12/christmas-pranks-taken-to-unbelievable.html

Also realize there were several possibilities for the linking site.  All correct answers will be accepted.  Just give me one.  If you got to a Hidden Happy through a search bar search as instructed, you don't need to include that.

Good luck.  You only need to submit the answer once.  None of your answers will show up immediately, in the comments section but they are all time stamped.  So keep submitting until the winner is revealed.  $300 could be yours for a very Merry Christmas.

Hidden Happy #12. Win $25 Instantly or $300 Tomorrow. Or Both.

Here's your last and final Hidden Happy.  Hidden Happy #12 has arrived.

             

12 Hidden   Happy

It's also your last and final flag prize before the Hidden Happy contest contest winner is announced tomorrow and the winner takes home a $150 gift card for themselves and a $150 donation to the nonprofit charity of their choice.  

If you want to win an instant $25 gift card right now to Amazon, be the first person to leave a link on this post to the post where Hidden Happy #11 is.  It's that easy.  If you want to win the whole thing you'll have to follow the directions on the original Hidden Happys post. If nobody is smart enough to win the contest, all money will be donated to charity.

The game sounds complicated, but if you can get to Hidden Happy #6 with a little effort, I changed the rules and finding the other six becomes a piece of cake.

Do You Like My New Menu Bar? Take the Poll

I've generated a new menu bar to help find what you are looking for at the site.    Tell me what you think.  Please leave comments below and let me know if you have problems viewing it on your browser.  Thanks

20 Week Ultrasound Pictures: It's A Boy!

It's official. Mrs Happy and I are having a boy.  And here are the 20 week ultrasounds fresh off the press to prove it.  Ten fingers.  Ten toes.  Four heart chambers and boy parts to prove it.    In fact, I think he's already circumcised. 

Italian Greyhounds Wearing Hats, Reindeer Ears I Think (Pictures)

Marty and Cooper, our seven year old Italian greyhounds, stayed with their cousin Archie while we went to Disney a few weeks back for our family Christmas.   It was an educational experience.  We learned about Disney's gum ban, looked at an x-ray of a snake that swallowed a golf ball discovered the future of health care in America at Epcot's Spaceship Earth exhibit, learned how extended unemployment benefits are a scam, watched the Disney people make a No Way Jose ice cream sundae at the Beaches and Cream restaurant, watched the amazing Hollywood Studios Light Show 2010 and discovered Disney's gingerbread carousel at the Beach Club resort. 

Cousin Archie is this  miniature schnauzer caught crying on video.  He kept our babes entertained and annoyed at the same time.   When we left town, we told Archie that since we paid him and his family for the suite package to take care of our babes, we expected a daily picture text and commentary on how they were doing.  We got these pictures sent to us as a reminder of how precious our little ones always are.   Here are Marty and Cooper during their fashion day event.

As you can tell, they're both having a blast.  Way to go guys!  For the full Marty and Cooper experience, you can always read all their blog posts, see all their beautiful slideshow pictures or  watch all their videos on their very own YouTube Channel. 

Blood Pressure Monitors Are Not Just For Walmart or Walgreens Anymore (Picture)

Are you stressed out at the thought of not getting help with your hospital bills?  Are you worried you might have a stroke or heart attack trying to figure out how to pay for it all?  Have no fear.  Happy's hospital has the solution for you.  Self check blood pressure monitors are not just for Walmart or Walgreens anymore. 

Right at the entrance of Happy's hospital, on the way to patient accounts, you can find this conveniently placed ATM stuffed full of taxpayers' money.  It's just waiting to make its way into the hospital's coffers.  And thanks to Happy's hospital, you can also check your blood pressure with this conveniently placed blood pressure monitor.  Unfortunately, since you've cleaned out your account to pay your hospital bill,  (at least until the next stimulus plan comes),  you don't have any money left  to keep your Internet service so you you'll have to stop keeping track of your blood pressures at your online blood pressure chart site.  

If your systolic blood pressure is over 170, the  patient initiated rapid response team policy will be implemented against your will and the hospitalist will be automatically paged for blood pressure medication.    Then they'll gather up your things for a direct  hospital admission.  

After you get that hospital bill, you can be discharged knowing you'll always have the convenience of a hospital ATM blood pressure monitor combo close by when you get your next hospital bill.

Now I get it.  This is an example of stealth marketing at its finest.  I think placing these blood pressure monitor cuffs right next to the hospital ATM is just part of the master business plan in the new realities of how hospitals get paid.  Perhaps this is the start of something big.  Perhaps all ATMs city wide will have a built in blood pressure monitor cuff and a direct line to Happy's hospitalists. It's a growth opportunity for hospitalist programs everywhere.  Think  of it as another hospitalist advantage to justify the current SHM/MGMA hospitalist salary compensation. 

 Now that's how to run a hospital. 

Answering Your Cell Phone During Class Video (Runner-up Best Fail Blog Video For 2010)

Here's a video of a guy who answered his cell phone during class (no longer available).  I love the response by the teacher.  We need more teachers like this in America.  This was runner up for the best Fail Blog video of 2010.  The watermelon in the face video was the top Fail Blog video of 2010. 

You're my hero lady. I think it's time doctors and nurses followed this lady's lead too.  Have status asthmaticus findings?  No more texting in the ER on my watch.     The only problem is, in America, this teacher would get fired and sued and the kid would probably hit the jackpot lottery for having his civil rights violated.  It's nice to know that some places in this world still have consequences for one's actions.  If you're going to answer your cell phone during class, be prepared for the consequences.  

Can I Take Thyroid Medication (Levothyroxine, Synthroid) At Night Instead Of Morning?

How should I take my thyroid medication?  I helped answer that reader's question last year.  Well, new research backs up my response.  As someone who takes levothyroxine, I found this new research comforting. You can take thyroid medication in the evening instead of the morning.   Most folks are taught to take their thyroid medication in the morning on an empty stomach and to wait at least one hour to eat after taking their thyroid medication.  That means breakfast has to wait. 

A new prospective randomized crossover trial in the Archives of Internal Medicine (Arch Intern Med 2010;170:1996-2003 ) suggests taking levothyroxine or Synthroid on an empty stomach at night is just fine and free thyroxine  levels  actually increase with this practice.  And patients don't have to wait for breakfast.

While thyroid levels improved, hypothyroid symptoms didn't.  But at least hypothyroid patients can enjoy an uninterpreted life at the breakfast bar once again.  Between eating breakfast and not eating late at night, it might even be a great weight loss option  as well. 

As someone who has taken levothyroxine every morning now  for 2 1/2 years, I'm thinking about switching to the night time dosing, so I too can return to enjoying the free doctor's lounge granola and blueberrries and milk  I used to devour every morning during my morning checkout rounds years ago.  

Perhaps night time levothyroxine dosing might even improve patient expectations and satisfaction surveys if I'm not stopping to have a 10:30 lunch instead of doing my  hospital discharge summary.  

On second thought, I don't think it would make any difference.   

Wait Times In Canada for Medical Care 2010 Report: The Fraser Institutes 20th Annual Waiting List Survey.

Ever wonder what waiting times in Canada are like when you need to get health care?  The Fraser Institute has released its 20th  annual Wait Times For Health Care In Canada report  that helps define how long you're going to wait for health care in Canada. 

Americans in search of government run single payer health care like to look to Canada as the gold standard for what Americans should strive to get.  Well, here's how things are rationed in Canada.  You're going to wait.  And you're going to wait a very long time to get your health care.

In America, I don't think 85% of the population is willing to wait nine months of pain and suffering  to get their elective orthopaedic surgery, just so the other 15% of the population can get theirs too.  We are a selfish nation that demands everything yesterday.  Although, I would suspect the vast majority of  these elective surgeries do get done in the United States.

 

You see, in addition to charity donations by doctors and nurses for patients, you  can find these same doctors and nurses providing free care at volunteer clinics all over this country of ours.  And they do it without making others wait nine months to get their knee fixed.   

That's how we do things in America.

How Do Grandmothers Celebrate Their Birthday?

Every wonder how grandmothers celebrate their birthday?  Do they sit at home waiting for their kids to call?  Not this 76 year old fireball.  You go to a Mexican restaurant, put on a giant sombrero and have Happy Birthday sung to you in Spanish.   That's how this Happy Grandmother celebrates her 76th Birthday.  You look good grandma.  You don't look a day over 75. 

Charity Donations For Patients by Doctors and Nurses (Picture)

This is great stuff.  As doctors and nurses we often focus on the medical aspects of getting patients well enough to be discharged from the hospital.  We have gifts for nurses and gifts for doctors.  We even have hospital gifts for patients.  But we never think about the poor people doing their best to stay out of the ER and get managed by the local charities fully funded without the help of government intervention. 

For these folks, those with no resources at all, we often  forget about the little things that can make all the difference in the world.  Imagine trying to live your life day in and day out with out the basic items of dignity.  Even averbal, demented old nursing home patients get a monthly stipend for their personal items.  

Happy's ER doctors and staff are collecting personal items to give to a local no questions asked free charity  clinic fully funded by private donations and fully staffed by the goodwill of people just trying to make a difference.  Here's a picture of all the charity donations being collected by the ER doctors and nurses to give the their  less fortune patient population. 

While the ER may get stuck day in and day out taking care of patients faking a seizure in the ER, they still have the heart to give these same folks free Maxi Pads and Sensodyne toothpaste.  Come on people.  Let's fill these containers to the brim with compassion and caring. 

On second thought.  Maybe they're just trying to prevent bad smells from coming back to the ER after the holidays.   You never know. 

Why My Twitter Account Was Suspended Indefinitely. No More Tweets From Happy.

My Twitter account was suspended last week.  I figured it was a mistake because of all the WikiLeaks stuff going on.  It wasn't that at all.  My Twitter account, like so many blogs, had been used as another form of social media for receiving my blog posts.  The Twitter people must think they are better than that. 

That is apparently why my Twitter account was abruptly suspended without warning.   As Stephen Colbert says, I have been control self delete (d) from the Twitter Universe.  Why you ask?  Well, if you run a website of any kind and have been using Twitter as a way of disseminating your information without including your own typed conversation, you are breaking the rules and risk being banned.  Artie, the random Twitter support tech,  helps explain where I became the master of Twitter rule breaking.   The following is the email conversation I had with the folks at Twitter.  I suppose if Google is willing to buy you for over 4 billion dollars, you can do what ever you want.

My first Email to Twitter:

happyhospitalis, Dec-12 06:29 am (PST):

I logged into my twitter account at twitter.com/happyhospitalis to find that my account has been suspended. I'm not sure why. I don't do anything but repost posts of mine from my The Happy Hospitalist Blog at http://thehappyhospitalist.blogspot.com, a medical related blog with other random content about travel, gardening, and dogs. I think my suspension is a mistake.

I received an email shortly after I sent that conversation that said I had to respond to a couple of their questions. So I did.

happyhospitalis, Dec-12 06:36 am (PST):

I have read your Best Practices page and understand. None of it would explain my suspension, but I agree to follow those rules.  I have read your rules page as well. I have no reason to believe I have broken any of these rules. Again, I use Twitter as a platform to help send out my blog posts at The Happy Hospitalist ( http://thehappyhospitalist.blogspot.com), a medical related site. Thanks for helping out! I can't think of any reason other than mistake for the suspension. Merry Christmas and Happy Holidays to ya!

A few days went by without a word and I finally got a response

artie, Dec-16 01:06 pm (PST):

Hello,

Your account was suspended for violations of the Twitter Rules, such as:

• Posting multiple and/or unrelated updates to a trending topic
• Updates consisting mainly of links, and not personal updates

As such, your account will not be re-enabled.

Here are the Twitter Rules: http://twitter.com/rules

Thanks,

artie

I responded in short order

happyhospitalis, Dec-16 01:15 pm (PST):

Thanks for responding Artie. I'm confused. What I offer isn't spam. I have a healthy following of folks that use my site to keep updated on my informative posts that have a very personal touch embeded within my titles It's a medical site because I'm a physician that informs and entertains about medical stuff and about my life in general. My Tweets aren't spam My titles of my posts are my personal updates. It's what I do on a daily basis and it's a way for folks to keep up to date on my thoughts and life, including a strong following of other physicians and family and friends. I have been listed on Twitter by many Twitterers.

I would hope you would reconsider suspending my site Artie.

No luck.  Artie's sticking to his or her guns.  I'm banned.

artie, Dec-16 02:10 pm (PST):


Hello,
Your account was permanently suspended for multiple violations of the Twitter Rules: http://twitter.com/rules

I'm sorry, but this account will not be restored.
Thanks,
artie 

The Twitter folks have decided they don't want their platform to be used as a way of disseminating information.  If you have a blog and all you do is post links to other content, Twitter doesn't want you.    I don't even know what they mean as far as "posting multiple or unrelated updates to a trending topic.  I've never done that, but Artie has the sense that I did.  So I can only assume they're lying or making it up. 

Regardles, I've never really found Twitter all that helpful for my site. In the last 365 days, less than 2% of my visits have come from the Twitter platform.   That's OK though.  I feel bad for the 1,300 of  you that followed my blog from the Twitter platform and the multiple lists that were following me as well.  For those nearly 1,300 of you following my site from Twitter, you can still find all my updates on my Facebook page.  Become a fan of The Happy Hospitalist today.

For the rest of you.  Tweet till your hearts desire.

Gifts For Nurses During the Christmas Holiday

So I'm minding my own business when I see a guy bring in four giant trays of bagels.  This is the vascular surgery group's idea of gifts for nurses during the Christmas holidays.  I'm sure they don't do a lot of bloodless surgery.  Here's the picture of the bagels with massive tubs of cream cheese.

 I think these nursing gifts are a secret ploy to increase business.  Not that my hospitalist group is any better. This year, like last, we gave chocolate covered potato chips as our gift to the nurses.   I think we knocked off a few nurses in the process.  We might take out a few more this year.

What did you get or give this year to your nursing crew?

My Kid Won't Take His Medicine. What Should I Do? Sippy Sure. Of Course.

So your toddler won't take his medicine?  Wondering what you should do  Look no further.  A physician has invented a solution to the age old problem of kids not taking their medication.  It's called Sippy Sure.  It was invented by Dr James Loging and his wife Ashley after their never ending battles with their kids about taking their medication.

No more hassles with getting your toddler to take their medication.  Just use the same cup every day and your child won't know the difference.  You just put the liquid medication into the separate medication container, fill their Sippy Sure with juice and when your child is ready to drink, their medicine is dispensed at the same time. It might be the best $8.95 you ever spend.  Here's a pretty video of the Sippy Sure in action.
 

I'm thinking about maybe convincing Happy's hospital to get a few dozen of these for our patients.  You don't have to be a toddler to drink out of a Sippy cup.  Just put the Miralax in a Sippy Sure and grandma will be pooping in no time.  No more battles with demented old patients not willing to take their medication.  

You can pick up your Sippy Sure from my patient resource store today.  Mrs Happy is 19 weeks pregnant this week.  We might have to hunt one of these down to administer the benadryl.  That way we can get the duct tape safely secured without a fight.

It's Not Too Late To Win $400 on The Happy Hospitalist

If you're looking for a $400 payday for doing nothing more than surfing the Internet, join others in playing my first ever Hidden Happys content contest right here at The Happy Hospitalist.   The contest runs through December 23rd.  It's not too late to play.   You can start playing anytime between now and December 23rd.  You might even win  my next flag prize as well.  Just find the Hidden Happys and the linking sites and be the first to publish the list on December 23rd.    It's that easy.

           

Hidden Happy

Grand Rounds is Electrifying This Week

Want an electrifying edition of Grand Rounds?  Head to Dr John Mandrola's EP cardiology blog to get the scoop on this week's best offering.  Dr John.  I wish you'd change your blog name to something a bit more exciting.  How about Pumping to the Oldies?  Or One Pump Chump.  Or My Catheter Is Bigger Than Yours.    You can ask Dr Wes about the last one. 

Hospital Whiteboard Exposes Holiday Traditions

Ever wonder what the purpose of those dry erase hospital whiteboards are?  Often times they are utilized to facilitate communication between doctors, nurses, respiratory therapists or other hospital staff.  At Happy's hospital, these whiteboards are often placed in the staff restrooms to facilitate private communication among staff.

For example, you can learn about hospital gossip and hospital rumors in the private hospital whiteboards. Or, during the holiday Christmas season, you can learn about the favorite holiday traditions of your coworkers.  

Can you tell which holiday tradition is Dr Happy's  on this hospital whiteboard?

How Not To Run a Hospital or Hospitalist Program

I gave you a game the other day called patient shuffle which gives you the experience on  how to run a hospital.  This game won't show you how hospitals get paid, but it will give you a sense of the chaos that goes on in hospital care. 

If you're looking for how not to run a hospital or a hospitalist programs, look no further than St Peter's Hospital in Helena, MT.  How do they think a hospital program should be paid for?  By charging community primary care doctors for the right to use hospitalists at their hospital.

Helena Physicians’ Clinic 

Helena Physicians' Clinic responded by removing their hospital privileges and not going through the physician credentialing process at St Peter's anymore.  In other words, they are taking their business elsewhere. 

If you want to know how not to run a hospital, simply call the administrative geniuses at St Peter's hospital in Helena, MT and ask them how they possibly got into a position of leadership in their community.   Hospitalists are worth their weight in gold.  Hospitals should be crawling over backward to establish a hospitalist program who's SHM/MGMA physician compensation survey suggests is worth over $100,000 in subsidy per hospitalist, per year, but who's hospitalist advantage can bring in 57 million dollars a year in additional hospital revenue. 

If you're looking for great hospital leadership, don't go to Helena, MT.  It seems to me these people lack the vision to see past the tip of their nose.  Making a primary care doctor pay for the right not to see their patients?  How ridiculous.  I think this hospital is doomed.  They should be paying primary care doctors NOT to come to the hospital anymore, considering all the advantages a hospitalist brings to the table. 

Accurate E/ M Coding: The Proof Is In The Letter.

I think my coding people finally got annoyed with me. Everytime my audit came back less than 100%, I would argue my case. And every time my score  would jump back to 100% accurate.  I'd say that's pretty accurate E/M coding. 

Instead of going through the back and forth communication where I eventually show them why I'm right, they just agreed with me this time.   It took them seven long years, but I think I've finally broken their spirit. 

If you're looking for the self taught coding advice of Dr Happy, check out all my medical billing and coding lectures. If you're a hospitalist, most of your billing and coding will be with the evaluation and management (E/M) hospital follow up CPT® codes  Make sure you don't miss my explanations of these CPT® codes 99231, 99232 and 99233. They're worth a lot of money to your bottom line. 

I got 100% on my billing company audit.  What more could a hospitalist ask for?

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

Saying Nice Things To Your Doctor

Do you ever say nice things to your doctor?  This lady did.  I'm just minding my own business when a strange lady came up to me at the nurses station.

Woman:  Dr Happy.  I know you don't remember me, but I remember you.  You took care of my father five years ago this month when he died in the emergency room.  I can't thank you enough for what you did.  I will always remember you.  Thank you so much for everything you did.  You will always be remembered.

Happy:  I appreciate that.  Thank you very much

Nurse:  That's going to make me cry.

Happy to nurse.  How 'bout that.  I'm usually getting yelled at instead.

In a job that often deals with entitled and  and thankless patients, it's always nice to know some people out there can still give thanks for a job well done.    Whomever you are lady, thank you for your kind words. 

My iPhone Stopped Charging. How Do I Fix It?

So I showed up at work yesterday with my iPhone in hand ready to tackle another busy day as a hospitalist.  I look down to discover that my 3G iPhone has 70% of its charge missing.  It's hard to make it through an eight hour day as a hosptialist without a cell phone.  I know I plugged it in the night before.  I figured the iPhone charger wasn't plugged in all the way.

So I called Mrs Happy and asked her to bring my charger to work.  She did.  I plugged it in at work and nothing.  No charge at all.  I tried three different outlets.  I even plugged the iPhone charger into the USB port of the computer I spilled coffee all over. 

Nothing.  No charge at all.  I thought this was the end.  It's two years old, at least.  I know I can get the new iPhone 4 at a discount.  I figured it didn't make sense to take my phone in to see the iHospitalist.  After taking a moment of silence for my dying 3G iPhone, I called Mrs Happy and told her I thought it was time to upgrade our phones to the new iPhone 4. 

Happy:  Good morning.  Thanks for bringing my iPhone charger, but I plugged my phone in and it still doesn't work

Mrs Happy:  It's probably just the outlet.  Did you try a different outlet?

Happy:  Yes.  I tried three different outlets.  I even plugged it into the computer.  I get nothing.  The thing is almost out of battery and I can't get it to charge.  I think it's time to get new phones.

Mrs Happy:  Did you try blowing on the connection?  My dad blows on stuff to fix it. 

Happy:  Laughing.  OK then. Blowing huh?  I'll give it a shot.

So I grabbed my phone and gave it a few quick blows at the power connector (stop it Frank).  Then I plugged it in.  And wouldn't you know it.  The darn thing started charging.  So I called Mrs Happy back

Happy:  You're never going to believe this.  I blew on the connectors and it worked.  The thing started charging.  You'll have to tell your Dad it actually works.

Mrs Happy:  Laughing.  

If you ever find that your iPhone stops charging, just blow on the connectors and that'll fix it. 

Redbox Groupon Coupon: 3 Movies For $1. Merry Christmas From Happy

I love Groupons.  They are revolutionizing retail marketing.  Here's just one example of an incredible Groupon deal.  Groupon is completely free to join and you're never obligated to buy anything, ever.  You pick and chose which deals you want to take advantage of.  Like this  Redbox Groupon coupon that will get you three one night rentals for only a dollar.  This great  Redbox Groupon coupon deal excludes Blue Ray movies  and video games.  You have until the end of the day on December 14th, 2010 to make your purchase, (click on the Redbox logo below)   and well into March 2011 to use  your Groupon codes.    In case you haven't heard of Redbox now is your chance to take advantage of what they have to offer.

Redbox boasts almost 25,000 video vending machines nationwide, each carrying approximately 630 DVDs, including up to 200 new releases. These shiny red beacons of home entertainment can be found in and around grocery stores, pharmacies, convenience stores, and other common places that citizens frequent on a day-to-day basis. To redeem this Groupon, customers will simply input their Groupon rental code using the redbox touch screen, and then take home the hottest blockbusters and tearjerkers. Nearly all Redbox titles have been released within the past six months and new releases are made available every Tuesday. Current small-screen offerings include The Twilight Saga: Eclipse, Shrek Forever After, and Scott Pilgrim vs. the World.

Throw some pancake and sausage on a stick in the oven, rent a $0.33 new release and have the cheapest date night ever on Happy.  Click on the Redbox image to get your Redbox Groupon coupon today.


Offer no longer available.

Camo Snuggie: Camouflage Gear Gift For Hunters With an Itch For Luxury.

You've seen the Santa Snuggie (or might I say knock off of a Snuggie).  Now we've get the Camo Snuggie.  Look no further folks.  You've found the perfect gear gift for your hunting relatives.  Make sure you even dress up your hairy and smelly hunting buddies in this  nice soft blanket with sleeves before they head out for the wild , wild wilderness and shoot Bambi in the heart.

Nothin' like drinkin' beer and shootin' stuff up while wrapped in the nice comforts of home in your very own Camo Snuggie. They're so popular, even Best Buy is sellin' them these days for only $15.99.  If you can't find one at Best Buy, you can pick up your own Camo Snuggie on Amazon.  What better way to make a hunter smile than to dress them up in camo style. 

Just don't bring your camouflage Snuggie to the hospital when your friend accidentally shoots you in your cankles.    We don't need to start a hospital gown fashion gown entitlement revolution.  I'd never be able to listen to your heart and lungs through that thing.  Not that it makes any difference.

Most of the time, at least. 

For the hunting pet, I offer you the camouflage dog collar, complete with a pretty orange hunting bow (arrow not included)

Funniest Christmas Card Photo Ever: Awkward Pregnancy Holiday Moments in Time.

Ok, I just want to warn you.  You're going to laugh your ass off.  I present to you the funniest Christmas card photo and caption ever.  I gave you a  $100 Christmas caption contest last year.  This year I'm giving you a $400 Hidden Happys content contest.

But life isn't about money.  It's about laughing.  So here you are.    This is freakin' funny.  Are you ready? Are you ready?   Here goes.  The funniest Christmas card photo and caption ever. 

I can appreciate what they were trying to do here but if your Christmas photo looks like it should have a porn soundtrack playing in the background, then you may want to reconsider the card.

Now that's funny, I don't care who you are.  You can find a bunch of other gut busting, laughing out loud funniest pregnancy poses of all times over at the Pregnant Chicken that the author helped aggregate. 

The photos are courtesy of another gut busting website titled Awkward Family Photos such as this gem of an awkward holiday photo.  They are  running a contest for the next week.  Go submit your most awkward holiday photo ever and get laughed at by millions.

Now, if they would just offer an awkward patient photo section, the site would be complete.  

             

11 Hidden   Happy

Only one more Hidden Happy. The winner will be determined December 23rd, 2010. It's not to late to play. The game gets much easier after Hidden Happy #6. Just give it a shot and you could take home a nice $400 prize. Just click on the Hidden Happy face for more information.

To find the last Hidden Happy, simply search for Hidden Happy #12 in my search bar and your done.  Make sure you follow the rules to win the prize.

Disney Bans Gum Sales and Pepsi But Not Cigarettes or Alcohol

If you need to get gasoline on the massive and expansive  Disney property, about the only place you'll find it is at a Hess oil gas station.  Mrs Happy and I recently returned from Happy's family Christmas vacation on the Disney property.

Like so much else with Disney, I'm sure Hess oil has an exclusive agreement to provide convenience store operations on the Disney property.  Mrs Happy and I stopped at one such Hess station to pick up some Mountain Dew for our sister-in-law.  It turns out you can't buy Mountain Dew on Disney property.  Disney has an exclusive relationship with Coke to sell only coke products at the exclusion of Pepsi products.

Oh yeah, you can't buy gum either at the Hess convenience stores on Disney property.    Disney banned gum sales on their property.  But if you'd like a carton of camel crush cigarettes, a heart attack burger and a two liter bottle of coke, no problem.  Just thank Disney and send the bill to magical fairies running Obamcare economics. Saturated fats (heart disease), cigarettes (emphysema) and empty sugar calories  (diabetes) haven't risen to the level of Disney contraband like gum has.

So, if you're at Disney and need to find a massive obesity inducing sugar load, a carton of Marlboros to kill your lungs and an artery inducing heart attack burger, just head down to your local Disney property Hess convenience store gas station.  You can even get drunk and dance at a Disney night club if you want.  They'll sell you all the conveniences of modern American life.  Disney even has their own EMS providers to send you to the hospital (more on that soon). 

However, if gum is what you seek,  you'll have to travel five miles down the road and off the Disney expressway.  Gum is too dangerous for Disney guests, even the sugarless variety. 

I suppose it's only a matter of time before Disney signs an exclusive contract with the Marlboro Man to be the exclusive provider of Mickey Smokes.    It all started with a mouse. 

Twitter Account Suspended for Reasons Unknown

For any of you Happy Hospitalist fans reading from Twitter, I tried to log into my account only to discover it has been suspended.  It must be a mistake.  I'm not sure why, but I have gone through the process they say is required to reinstate it.  So it might be a while before the account works again.

I don't know if my posts will continue to be pushed to the Twitter platform or not.  If you're following me on Twitter in hopes of winning my $400 Hidden Happys content contest, you might want to try an alternative route for receiving my content, for the time being.  

I'll give an update when I get word from Twitter.