Baby Eats Solid Food For the First Time (Cute Video and Pictures of Zachary)

Life is fun for six month old baby Zachary as he actively explores the world around himself.  Unfortunately, his curiosity wasn't expecting sweet potatoes. It turned his life upside down.  Watch the video of cute expressions I shot last week as our six month old baby eats solid food for the first time last week.  Adorable.  Cute.  Funny.  Precious.   All of the above.  He has got a whole face full of opinions on the experience.

Funny thing is, I get the same looks when I admit people with a diagnosis of TWTGH (Too weak to to home)

How do I know if my baby is still hungry?  Find out how!

For much more of Zachary, you can visit all his blog posts and videos  or catch his Faces of Zachary slideshow presentation that is updated almost daily.

Teaching Healthy Food Choices To Children Should Start at a Young Age (Picture Proof!)

Teaching healthy food choices to children should start at a young age.  It turns out Mrs Happy has been sneaking in some Zachary education behind my back.  When she isn't learning about Halloween sign language she's teaching him about choosing healthy food choices.  We have an obesity epidemic in this country.  The solution to our problems begin with our children.

How smart is my baby?  Thanks to Mrs Happy,  six month old baby Zachary is smart enough to read about the ingredients of his food choices.  Now there's a kid that's talkin' the talk and walkin' the walk.

Well, not yet.  But soon.

He's figured out breast milk is just perfect.  Even when he's doin' the redneck bottle feeding thing.

For much more of Zachary, you can visit all his blog posts and videos  or catch his Faces of Zachary slideshow presentation that is updated almost daily.

Doula Home Birth Pumpkin Carving Picture! Hilarious Ob/Gyn Halloween Fun!

Yes folks, it's official.  Pumpkin carving has gone to the births.  Home births that is.   Here's a home birth pumpkin carving brought to you by the Facebook page of  Blessed Birth Doula Services in Savannah, GA (permission to use picture granted on her FB site so feel free to share).  Now that there might be some of the best  OB/Gyn medical Halloween humor ever made.  She's got a few other funny medical pumpkin carvings too.  You should go go out her site.

Something tells me there might be quite a few of these baby pumpkins being born in the redneck pumpkin patch I found the other day.   I wonder if these baby pumpkins do redneck bottle feeding too.

By the way, we had a Doula bedside when Mrs Happy delivered Zachary.  She was wonderful, as was the midwife.  And, in fact, Zachary was almost the same color as this home birth pumpkin carving picture because of his jaundice.  Maybe this poor little baby pumpkin needs a BiliBlanket too. 

 You can view all my other Halloween posts too. 

The Most Important Characteristic of EMR/EHR. Be More Like Apple

The American College of Physicians President Dr Virginia Hood has a great essay and a great paragraph about what is wrong with electronic medical records (EMR/EHR).  Fellow hospitalist Dr R.W. Donnell picked out the best paragraph of the essay.  Go check them both out.  

I just recently discovered the unintended consequences of EMR when an outpatient physician declined to admit their patient to the hospital because their new EMR made admitting their patient too complicated.  

If vendors continue to sell EHR products to hospitals instead of physicians, the EHR will fail.  Hospitals don't see patients, physicians do.   Hospitals care about compliance.  Physicians care about safety and efficiency. 

What's the solution for hospitals out there?  How can they find an EHR product their physicians will accept with excited and wide open arms?  They need to treat their physicians on staff like a bunch of children.  Literally.  That's right.   Put them in a room, shut the door and just let them play like kids.  Give them multiple EHR vendor products to sample and let them figure it out on their own.   Physician needs must be met first or the whole process will implode.

How do you know when you've found the perfect product?  The perfect product will need no explanation.  If none of the products satisfy this single criteria, say no until that product declares itself.  You'll know.  It's that easy.

This is the beauty of Apple Computer and all their products.  They just work.  No explanation needed.

If you're looking for help finding your EHR product, visit my EHR resource center filled to the brim with free interactive guides.

Medical Software Buyer's Toolkit
Ten Step Guide to Selecting the Right Medical Software
EHR Comparison Interactive Checklist
How to Qualify for EHR Stimulus Funds Under ARRA
ARRA Meaningful Use Criteria Checklist
EHR Cost of Ownership Price Comparison Tool
Assess Vendors' Financial and Strategic Viability
Understanding the Ambulatory EHR Market

 Also, try this E/M pocket reference card for all your bedside medical billing and coding needs.

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

Walmart Makes Smokers Pay More For Health Insurance: Occupy Walmart Protesters Heard Chanting "We Are The 19%"

It turns out, when you run a business, you have to make smart business decisions or your competition will help you go bankrupt.  In a world where where health care inflation has been running more than double,  for decades, the base  rate of consumer inflation, Walmart is making the smartest business decision ever to protect its bottom line.

That's right folks.  Walmart is going to make smokers pay more for their health insurance.  In fact, smokers who choose to work at Walmart are  will now be free  to pay 40% more in  health insurance premiums than their nonsmoking colleagues.  They also have the right not to accept health insurance from their employer.  

In fact, I even heard one state had a bunch of  smoking Occupy Walmart protesters chanting "We are the 19%"

Congratulations WalMart.  You are doing what should have been done years ago.  In fact, it's time to take this kind of employee empowerment even further and offer a whole range of lifestyle discounts to folks who choose to engage in activities that reduce their cost to their employer.  

Smoking is just the beginning.  Perhaps, this is the beginning of the end for health insurance and the start of a new era of lifestyle protection plans (LiPPs).

2011 Hospitalist Salary Survey (By Today's Hospitalist Magazine)

Want to know if your hospitalist compensation package  is on par with other hospitalist groups around you?  I have previously written about the results of the  hospitalist salary compensation survey for 2010,1011 (SHM and MGMA).  The parabolic rise appears to have no end in site.  Hospitalist demand continues to grow as witnessed by the rapid expansion of hospitalist subsidy/support payment for 2011,  despite poor economic conditions.

Here's another look at an exceptional 2011 Hospitalist Salary Survey done by the folks at Today's Hospitalist.  If you are a hospitalist, you owe it to yourself to stay well informed about what you are worth in the market place.  As shown in the SHM/MGMA survey, hospitalist compensation continues to grow, with the mean total compensation of hospitalists coming in at just under $230,000, and  almost 1/3 of hospitalist compensation packages worth over $250,000 a year.

They've got a wealth of information with over 100 graphs in an interactive, easy to read format.  I wish EHR could be this easy.  Go check them out for the full scoop on your compensation.

For other hospitalist resources visit

• Hospitalist RVU Benchmarks and Standards
• List of 2011 wRVU and tRVU values for E&M codes
• Medical Billing and Coding Lectures
• E&M Pocket Refence Cards
• Hospitalist Compensation per wRVU
• How do doctors get paid?

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

EMR Comparison

Successful software implementation starts with choosing the right system. This  checklist contains over 50 of the most important features to look for when evaluating:

• electronic medical records
• medical billing software 
• scheduling software
• technology, security and certifications

Download now and get started today Other useful information is available at my EHR Resource Center.

The Future of EHR/EMR: Make Anything a Touchscreen (Awesome Video!)

Is this the future of EHR/EMR? .  Making anything a touchscreen on the go? If so, physician order entry just became the easiest process ever.  Perhaps this technology has the possibility of making the best unintended consequence of EHR/EMR ever:  physician satisfaction. 

No more E&M refernce cards on the go. No more EHR help needed.  These touchscreen anywhere EHRs will  do everything for you.

Gosh.  Now there's an idea who's time can't come soon enough.

EMR Comparison

Successful software implementation starts with choosing the right system. This  checklist contains over 50 of the most important features to look for when evaluating:

• electronic medical records
• medical billing software 
• scheduling software
• technology, security and certifications

Download now and get started today Other useful information is available at my EHR Resource Center.

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

Are Multitasking Hospitalists Dangerous To Your Care?

Are multitasking hospitalists dangerous to your care?  I don't think so.  When I'm not at home doing my father son workout for my L5-S1 radicular back pain, I'm at the hospital  doing my physical therapy hamstring stretching exercises while I manage severe sepsis  with shock and multiorgan failure by phone.  If you want to be a great hospitalist, you have to learn to multitask or you're never going to make it in this field.

I hope the Joint Commission doesn't see this.  They may create a new policy that all hospitalists need to take a shower, in the nude, before rounding,  so we aren't contaminating our patients with nastiness when we sit on their beds to provide AIDET driven customer service.

Ok.  Maybe we are dangerous.  At least we'll get good satisfaction scores.  And that's what matters most.

Hospitalist multitasking protocols:  Trading great patient satisfaction scores for life threatening infectious disease outbreaks one patient at a time.

By the way, those are the best hospital socks ever made. 

Nursing Homes Gone Wild.

Two elderly men  at a nursing home in Lincoln, NE got into a fist fight earlier this month.   You'll never guess what they were fighting over.  A Hawaiian shirt.  Sounds like a story for the nursing homes gone wild file.

Nice.Perhaps the one guy could sue the other for cane and suffering.

Spider Carved Pumpkin Designs (Cool Halloween Pictures)

I took these two pictures of cool Halloween spider carved pumpkins. They go nicely with the cool skeleton carved pumpkin picture I took previously. You can view all my Halloween posts here, including the redneck pumpkin patch.

Xigris Pulled From The Market Today October 25th, 2011. No Survival Benefit Cited

Xigris has officially been pulled (voluntarily) from the market.  Here is the FDA statement

FDA Drug Safety Communication: Voluntary market withdrawal of Xigris [drotrecogin alfa (activated)] due to failure to show a survival benefit

Safety Announcement

[10-25-2011] The U.S. Food and Drug Administration (FDA) is informing healthcare professionals and the public that on October 25, 2011, Eli Lilly and Company announced a worldwide voluntary market withdrawal of Xigris [drotrecogin alfa (activated)]. In a recent study, Xigris failed to show a survival benefit for patients with severe sepsis and septic shock.

Xigris treatment should not be started in new patients. Xigris treatment should be stopped in patients being treated with Xigris.

All remaining Xigris product should be returned to the supplier from whom it was purchased.

In a recently completed clinical trial (PROWESS-SHOCK trial), Xigris failed to show a survival benefit. In this trial of 1696 patients, 851 patients were enrolled in the Xigris arm and 845 patients were enrolled in the placebo arm. Results based on preliminary analyses done by Eli Lilly and Company, that were submitted to the FDA, showed a 28-day all cause mortality rate of 26.4% (223/846) in Xigris-treated patients compared to 24.2% (202/834) in placebo-treated patients, for a relative risk of 1.09; 95% CI (0.92, 1.28), and P-value = 0.31 (not statistically significant).

FDA previously issued an early communication about the ongoing safety review of Xigris in February 20091. 

Xigris has been scrutinized for years due to its arrival on protocols and national sepsis guidelines, with glaring conflicts of interest.  I would personally like to take this opportunity to request the FDA and Eli Lilly remit payment for all hospital expenses previously incurred by using this apparently worthless $10,000 per 72 hour infusion drug.

RIP Xigris.  RIP Xigris drug reps.

EMR Comparison

Successful software implementation starts with choosing the right system. This  checklist contains over 50 of the most important features to look for when evaluating:

• electronic medical records
• medical billing software 
• scheduling software
• technology, security and certifications

Download now and get started today Other useful information is available at my EHR Resource Center.

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

C Diff Prevention In the Hospital Explained (Simple Picture)

Clostridium difficile can be a nasty infection to get, when it is allowed to generate toxicity.  Many community bound folks have c diff colonized in their gut flora.  Only after this bacteria is allowed to "take over" does it make the toxin responsible for the deleterious side effects.

The spectrum of consequences for a c diff infection are large, ranging from mild annoying diarrhea to toxic megacolon and death.  We are taught early in our training that c diff is classically associated with the antibiotic clindamycin.  Clinically, however, clostridium difficile toxicity is seen far more commonly in patients on many other antibiotics, which makes clindamycin lawsuits all the more irrational. 

Should clindamycin be banned? Yes, it should, but only if we are going to ban every single antibiotic ever made. 

C diff is transmitted in a fecal-oral route.  That means prevention  of c diff  cross contamination outbreaks can be contained with good hand washing techniques.  But don't use all those Purell hand sanitizers in the hospital.  You may not kill the c diff spores that make the diarrhea causing toxin.  Use soap and water.  That's your best bet.

EMR Comparison

Successful software implementation starts with choosing the right system. This  checklist contains over 50 of the most important features to look for when evaluating:

• electronic medical records
• medical billing software 
• scheduling software
• technology, security and certifications

Download now and get started today Other useful information is available at my EHR Resource Center.

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

How Smart Is My Baby? Smarter Than You Think! Fascinating TED Video.

So you think your baby isn't paying attention? Think again. Do you find yourself wondering how smart is my baby?  It turns out babies are much smarter than you think. Watch this fascinating TED video by Alsion Gopnik, professor of psychology and philosophy, about the incredible scientific mind of babies and young children.  It turns out playing is just one giant scientific experiment for babies and infants.

"What's it like being a baby?  It's like being in love, in Paris, for the first time, after you've had three double espressos"

I always knew baby Zachary was doing highly complicated statistical analysis behind those beautiful blue eyes.

Redneck Pumpkin Patch (Picture Humor)

It's pumpkin season.  Who knew this is what a redneck pumpkin patch looked like?  I wonder if all those little pumpkins arrive by way of a doula home birth pumpkin expert.  And I wonder if they all do  redneck bottle feeding too.

Funny Burned Out Store Sign (Picture): Lights, Camera, Hilarious Dirty Action!

Nothing like a good partially burned out neon Hancock Fabrics store sign to get your funny giggles for the day! I heard it was intentional though.  The owners realized there was no money to be made in curtains and table cloths anymore. However, they are concerned about their operating margins after the AARP demanded 1/2 price for all senior citizens.  During tough negotiations, they believed, after giving up several inches, they should be able to take a yard.

For other great sign humor, visit

• Funny church signs and slogans
• Street signs warning of drunks in the area
• Funny homeless signs:  The best one ever!
• Funny door sign:  Do not knock!

Car Covered In Bumper Stickers (Pictures): Anti Bush, Pro Obama, War, Environment, etc...

Saw this car the other day.  It's a riding billboard bumper sticker haven  for an  anti war, pro environment,   anti-Bush, pro-Obama platform.

I love these pictures.  The best part about this proud display of American freedom is.....the Prius.  Made by Toyota.  The greedy profits of which go to Japan.  Maybe there's a little room left for an Occupy Japan bumper sticker on there.  Something to consider once the preOccupied America rallies fizzle in the drizzle.

Click any image to enlarge.  These pictures brought to you by Happy, Big Oil, Google, Apple, Dell, HP, Time Warner, Canon and a thousand other greedy companies providing jobs, health care benefits and retirement contributions to tens of millions of Americans every day.

I looked every where on that car and I couldn't find the best Obama bumper sticker ever or this funny health care bumper sticker  or the honk if you're paying my mortgage bumper sticker.  Better hurry though as there's not much room left. 

Funny Halloween Onesie: I Want My Mummy! (Picture)

Here's some good Halloween onesie humor for you.  That's six month old Zachary showing off his "I want my MUMMY" Halloween onesie.  It looks to me like he really does want  his mommy.

For other great onesie ideas visit

• Laughing my diaper off (LMDO) onesie
• Camouflage onesie
• Future Potbelly! onesie
• Tax deduction onesie
• My favorite custom made onesie.  
• Young buck onesie
• Handsome like daddy onesie
• Still living at home funny onesie
• Onesie tie business attire.
• Moose onesie with a hoodie

For much more of Zachary, you can visit all his blog posts and videos  or catch his Faces of Zachary slideshow presentation that is updated almost daily.

Click here for all my Halloween posts.  

The Daddy Puppy (Cute Baby Video of Zachary)

Zachary loves Marty and Cooper, our little puppy angels.   Well, we broke down and got another puppy. The Daddy Puppy that is.  And he thinks The Daddy Puppy is the best thing since breast milk. Watch him laugh and smile and giggle at crazy Happy Daddy Puppy being silly.  

For much more of Zachary, you can visit all his blog posts and videos  or catch his Faces of Zachary slideshow presentation that is updated almost daily.

Finding the Right EMR/EHR (Five Step Video Help)

The Happy Hospitalist has given you  quite a few EHR resources over the years to help you find the right EMR/EHR for your practice.  Now, The Happy Hospitalist has teamed up with the folks at Software Advice to provide you with a great collection of video resources to help you find the right product for your EHR needs.   Below is the trailer for the  first in a series of videos to come.  If you're in the market for an EMR/EHR and you don't know where to start, watch the trailer, then click on the bubble speech below for more information on finding the right EHR.  The folks at Software Advice have guided thousands of clients through the maze of vendors.  And all their help is free to you.

Grand Rounds Heads to India.

In celebration of the up and coming  Indian festival called Diwali, known as the festival of lights, here's a little fireworks picture I took earlier this year.  India also happens to be the site of the weekly Grand Rounds  presentation.   Enjoy this week's best offerings from a land far, far away.  

Custom Puzzle Photography Picture Art of Baby Zachary

Here's a neat three piece puzzle photography picture of Zachary I made yesterday.  Fun for the baby, I'm sure.  Make a puzzle out of these pictures and you'll have baby fun for hours.  We've noticed he really enjoys looking at himself in the mirror.  I suspect he'd really enjoy putting Humpty Dumpty Zachary back together again in a real custom picture puzzle.  He'd learn the motto:

If at first you don't succeed









Try, try again:

That there is some fun custom puzzle photography art. You can buy your own Jigsaw Puzzle Kit for great family fun on Amazon, or check out any of the online photo print/book/novelty stores for great ideas.

For much more of Zachary, you can visit all his blog posts and videos  or catch his Faces of Zachary slideshow presentation that is updated almost daily.

Halloween Sign Language Video Fun! Learn the Basics!

Mrs Happy and I are taking a baby sign language class.   Who knew babies could understand signing so young?  And what did we learn about today at our baby sign language class?   Why, all about Halloween sign language, of course. In this video, I show you how to do basic signs for several Halloween words, including Halloween, black, witch, haunted house, ghost, pumpkin, and bat.  Happy Halloween!

If you're really into that baby sign language thing, here's a little sign language crossword puzzle to master between your free moments.

Rainbows On Both Sides of the Sun? I Saw a Sun Dog (Pictures)

Have you ever seen rainbows on both sides of the sun on a bright sunny day with no rain clouds anywhere to be found? This cool phenomenon is called a sun dog.   The scientfic name is parhelion and they are caused by ice crystals in the air.

According to Wikipedia, sun dogs are also called a mock sun or a phantom sun.  Sun dogs are a pretty cool weather phenomenon.    We snapped a couple pictures of our sun dog the other day while walking our dogs, Marty and Cooper.  The second picture below  I took through the lens of my polarized sunglasses to give a  little different view of nature. 

Mrs Happy took another picture of these cool sunshine rainbows last year.  

Click either image for a full size view.

Also, check out this picture of a full rainbow panorama view using the Photosynth iPhone app.