UpToDate® Forced To Admit Google Used as Their Main Source of Information.

Waltham, MA -  On the heals of an imminent 60 Minutes documentary exposing the inner workings of UpToDate®, the popular subscription-only, physician-authored clinical decision support resource,  officials were forced to admit  most of their authors use Google as their goto resource.

In a prepared statement to reporters, Wolters Kluwer Health, which owns UpToDate, confirmed  that Google is hands down the most popular resource used by their 6,000 physician authors to regurgitate medical information into neatly repackaged articles for the $500 per year professional service.

It turns out Google and UpToDate are pretty much the same thing.
"I don't even know why this is news.  Everyone knows doctors have been using Google for years to get their trusted medical information like the rest of us, said CEO Nancy McKinstry.

"As little as 20 years ago, our physicians would have had to go to a library and ask a librarian to find peer reviewed articles, but nobody has time for that anymore.   The use of Google is just a natural extension of the internet revolution."

UpToDate says they actually encourage their authors to use lay people resources to fine tine their articles for the current patient-satisfaction-centered model of care.  "We know patients are using Google to find their trusted information.  It just makes sense for our authors to use Google too so our users don't find themselves in the uncomfortable situation of questioning the accuracy of Google with their patients," said Nancy.

In fact, just last week UpToDate stopped hosting all images on their servers and instead link directly to Google images to help physicians see hundreds, sometimes thousands of examples for any given condition.

"Our goal is to have Google and UpToDate coexist in a perfect symbiotic relationship where doctors feel good about using our service instead of Google and patients feel comfortable their physicians aren't dumber than Google," said Nancy.

Dr. Franklin Bennington, a surgeon at Johns Hopkins University School of Medicine and prolific UpToDate author of more than 500 articles says he has no problem using Google to keep physicians abreast on best practices.

"In my article on performing lap appys, I linked to a 2007 YouTube video with over 2 million views I found by typing lap appy videos into the Google search engine.  And I even included recommendations on post-operative care from an online forum by a guy who calls himself Knot-A-Surgeon."

The revelations have left many physicians angry at paying $500 a year for information they can get free from Google.  But those emotions quickly subsided after realizing they can earn hundreds of hours of continuing medical education credits everyday just by looking things up.  "I used UpToDate the other day to try and find some information on routine hypertension management and earned 60 hours  of qualifying CME in just 30 minutes," said Dr Elaine
Fenwick, a Kentucky Hospitalist who's state license totally coincidentally requires 60 CME to be renewed next week.

Recent research confirms the lack of patient mortality difference between physicians preferentially using Google over UpToDate as their research choice.  However, one subset of patients did suggest physicians with prolific Wikipedia experience may actually have a slight survival benefit.

"The data is intriguing and we may have to gently nudge our authors to lean more heavily on Wikipedia than we have in the past," said Nancy, who also notes a 78% increase in patients printing Wikipedia articles to show their doctors.

The close relationship between Google and UpToDate has some financial speculators suggesting Google my purchase UpToDate and change its name to GoogleCME®. 



Nurse Admitted to Hospital After Literally Working Her Ass Off.

Houston, TX -  After years of mandatory overtime, 16-hour days without a restroom break and a revolving door of understaffed and overworked conditions as a hospital nurse, it finally happened.  Jan Stevens, R.N. was admitted to the hospital last week shortly after her ass literally fell off during a busy day in which two nurses called in sick at the last minute, without explanation, on a sunny Friday afternoon.

Surgeons working their asses off to fix Jan's ass.
"I tell my husband and kids all the time that I'm exhausted after working my ass off at work , but I never thought it would actually happen," said Jan.

The strange event occurred while Jan was giving Ativan to an old and naked demented guy trying to ask her out on a date while two young Facebookers demanded more Dilaudid for their abdominal pain of no possible cause, one patient's out-of-town physician daughter was on hold waiting to reverse an end-of-life DNR and two smokers descended on the nurses station, in their street clothes, asking when the doctor would be there to discharge them.

"I was just standing there, overwhelmed with nonsense, when I felt a sudden weight lifted off my pelvis.   I turned around and  there was my ass laying on the floor in a pool of c diff.," said Jan.

Rapid response team members transported the hard working nurse to the  ER where Emergency physicians worked for hours to try and find an admitting physician.

"The ER doctor told me he was working his ass off to find a surgeon to admit me and I just looked at him and shook my head.  I told him 'You don't get to say that to me today.'"

Hospital officials were stunned by the work related injury, but they admit it was only a matter of time before something like this was bound to happen.

"We've got some pretty hard workers here at the hospital but Jan is one of our best.  We'll have to take this incident back to our 12 committees to start a root cause analysis,"   said Wendy Stenson, Vice President of Meetings.

"But regardless of what we find, we just don't have the money to increase staffing ratios.  Maybe we'll think about  implementing mandatory prophylactic ass taping for all our staff."

Since Jan's remarkable event went viral, she has received hundreds of job offers, but Jan is thinking about taking advantage of the workers' compensation lifestyle for awhile instead.

"I think I've earned it."



Joint Commission Implements Mandatory Universal Patient Helmet Regulations.

Baltimore, MD - In an effort to reduce injuries and deaths related to in-hospital falls,  the Joint Commission notified hospitals last week of strict new universal  helmet regulations for all hospitalized patients, without exception.

Hospitals prepare for mandatory patient helmet use.
Patient death or serious injury associated with a fall while being cared for in a health care setting has been a recognized since 2002 as one of 27 original never events as defined by the National Quality Forum (NQF).  The complete list was revised in 2011 to include 29 never events, but falls by confused old naked men have continued to result in serious injuries despite endless attempts to counteract natural traumatic hospital acquired deaths.

"We've heard from hospitals loud and clear.  They've tried everything from 4 point leather restraints and  putting on fall-risk arm bands to Ativan drips with soothing country music and we have concluded that patients are just gonna fall.  So we figure it  makes sense for us to force all patients to wear a helmet," said Mark R. Chassin, M.D. FACP, M.P.P, M.P.H, president and chief executive officer of The Joint Commission (TJC).

"In a few years, universal helmet use will be as normal as universal hand washing is today."

Hospitalists were thrilled to learn about mandatory helmet regulations in the hospital.  "I get at least two calls a night from the night nurse letting me know they found a patient laying unresponsive on the floor in a pool of blood at 2 a.m. with a large pulsating scalp bleeder and do I want to do anything about it," said Hospitalist James Fleming.

"But now with mandatory helmet regulations, I think we'll be more comfortable not ordering the stat CT head.  It's just going to take some time getting used to."

While hospitalists were thrilled with their new found nocturnal freedom, not all specialities were equally excited.  Stan Bedlow, a prominent local Neurosurgeon was concerned the new policy would interfere with his ability to operate effectively and efficiently.

"We asked The Joint Commission to waive their tough new standards for neurosurgical patients, but they said no.  "I'm not really sure how I'm going to access the brain through a helmet, but we believe The Joint Commission is the gold standard in safety, so we'll probably just consult the  hospitalist to manage it.

Some surgical nurses were happy to hear the hospital was finally going to counteract unsafe operating practices. "We've had a few patients roll off the table and die while the anesthesiologist was doing advanced sudoku puzzles and trading stocks and the orthopedic surgeon was blasting Guns N' Roses and singing Sweet Child o' Mine, " said one surgical nurse who wished to remain anonymous for fear of telling the truth and losing her job.

Even the Obstetricians were left scratching their heads on the new mandatory helmet policy.  "We've been told by our hospital quality officials that all expectant mothers and their newborns will be required to have a helmet secured prior to the baby exiting the birth canal or C-section.  We figured this was a perfect job for the third year medical student so we've decided to base their whole clerkship grade on how well they perform retraction-helmet duty," said Academic Obstetrician Dr. Michelle Johnson.

The Joint Commission expressed confidence their strict new safety measures would be accepted kindly by physicians who understand the importance of universal safety precautions in the hospital.  "We anticipate physician experience with our helmet regulations will help them fully embrace our anticipated full body Charmin wrap requirement planned for next year's accreditation process," said Dr. Chassin.


Walmart Rounds Helping Train Nation's Young Doctors.

Little Rock, AK - Doctors at the University of Arkansas Medical Center celebrated the three year anniversary of Walmart Rounds on Friday, a one-of-a-kind initiative exposing student doctors to a wide variety of conditions rarely seen anywhere else in the world.

Attending physicians, residents, interns and medical students  from most specialities have donned their white coats and headed to their favorite local Walmart isle for the last three years to observe the stunning pathology of Walmartians in their natural environment.

Walmart helping train young doctors.
"During Walmart rounds, we try and tell our students to be as discrete as possible whenever they discover a horse or a zebra, but sometimes their excitement overcomes them," said attending Neurologist Dr. Krzesimir Bednarczyk.

"Just last week one of my gunners in isle three started yelling back to the team 'Here comes a hemochromatosis with a lupus rash, even though it was clearly just an old lady with a bad tan.'"

When the Rheumatologists heard about a possible case of lupus heading their way,  they laughed and chuckled arrogantly.  "I teach all my fellows that nobody has lupus unless we say they do," said Dr. George Bostinza, the Rheumatologist known best for his shirt 'Why the Hell did you order a sed rate anyway?'

"We also had to put up a sign that says 'If  you're here for fibromyalgia, STOP!  Turn around and go back.  Fibromyalgia is a primary care disease.'"

But FP would have no part of it.  By punting every shopper to another service, attending physicians used Walmart rounds to educate student doctors on the financial aspects of medicine.   "We always thought our young Medicaid clinic patients rolling up in their fancy rims and newest iPhone were a bit on the entitled side, but we were shocked to learn how belligerent they became when the cashier wouldn't accept their Medicaid card as payment in full," said Dr. Alan Fenwick.

ER doctors hanging out in deli hated Walmart rounds because of the never ending stream of shoppers sent over by other teams telling them to go see ER without even a courtesy call overhead.  "Just last week some old guy showed up with Dizziness of No Possible Cause to get a stat MRI and wondered why the neurosurgeon wasn't waiting for his immediate arrival," said Dr. Brenda Dresser, an Emergency Medicine doctor who has since authored a case series in the NEJM titled  Turkey Sandwich Request as a Sign of Homeless Dilaudopenia.

"We're also thankful that I.D. chose to hang out in produce so we could them all our toxic sock syndromes."

After just one week of Walmart rounds, the Infectious Disease teams started handing out gloves and yellow gowns after seeing dozens of their C. difficile and MRSA patients man-handling the grapes.  "Less than six months after starting our infection control program in produce, we noticed a statistically significant 76% reduction in mold on Walmart strawberries," said Dr Daniel Messer, the ID doctor who routinely refuses consults for bilateral cellulitis on principle.

Over the last three years, the Pulmonologists working cigarette checkout discovered  87% of their patients did not quit smoking last week, 92% forgot to bring their oxygen with them and 98% did in fact have $30 lying around for their copays. "They're basically just a bunch of liars," said Pulmonologist Dr. Stan Spencer, himself a two pack-per-day smoker.

While hanging out in baking, ortho  routinely spilled olive oil and waited for a fracture in unsuspecting lol's.  Appalled by the caveman like approach to medicine, many ortho students tried to escape to Dermatology hanging out in skin care, but realized they didn't usually show up until 11:00 am and were usually gone by noon for a long F.A.C.

Not so for the trauma doctors. They found Walmart to be fertile training ground for excited young surglings.  "The Walmart Scooter Club  has been a  gold mine for our young trauma doctors.   We see at least at least one high impact scooter-scooter collision every Friday.  Anything can happen when you've got two 500 pound objects colliding at break-neck speed," said trauma surgeon Dr Stan Harlow.

Even the Hospitalists used Walmart rounds as a quality improvement project after they discovered none of their patients ever showed up to their PCP follow-up appointment
within a week of discharge.  "We started scheduling follow-up at our Walmart rounds and discovered a 72% reduction in 30-day readmission rates over the last three years," said Dr John Fender, Director of Outpatient Hospitalist Medicine.

Two specialties in particular, Psychiatry and Pediatrics, have both abandoned their hospital training programs all together for a full time Walmart residency experience.  "We just couldn't replicate the level of pathology seen at Walmart in our hospital," said the hospital CEO.



New Granny Dumping Law Excites Doctors and Nurses.

Minneapolis, MN - Hospitalists and ER doctors clapped loudly Monday after Minnesota Governor Mark Dayton signed legislation SF 18342, making it illegal for families to drop elderly relatives off in the ER and then leave.  The offense is a misdemeanor with a fine of up to $2,500.

Granny Dumping Law hopes to reduce Vacation Observation admissions.
Dubbed the Granny Dumping Law, officials hope this puts an end to the practice of using expensive emergency rooms and hospitals as a holding tank for the state's at-risk elderly community while their children take family vacations to warmer climates or simply want a weekend alone without their parents or in-laws.

Doctors and nurses say they can see a granny dumping case from a mile away and are tired of being used as daycare staff by uncaring children who use the state's hospital system as their vacation kennel.

"At least once or twice a day every winter, we see families decked out in Tommy Bahamas, driving slowly through the ER parking lot in a minivan pilled high with suitcases before calmly wheeling granny up to triage to say something is wrong with nana and then driving off, " said ER triage nurse Adrian Bremer.

The legislation allows doctors and nurses to hand out fines on the spot, after being deputized by the state, when they suspect cases of granny littering in the ER.   The minimum fine is $1,000 but quickly rises to $2,500 for cases involving poocanos or toxic foot syndrome.

In today's age of entitlement, some families don't even try to hide their desire to rid grandma for the weekend. "I had a guy last Friday drop off his mother-in-law with a box of Kellogg's Raisin Bran ® saying he was having a big poker game this weekend and he'd be back Monday to pick her up," said Adrian. "When I told him that wasn't appropriate, he said 'EMTALA bitch' then asked where his satisfaction survey was."

Instead of working up these patients, ER doctors have started to call the hospitalist to directly admit them from triage for Vacation Observation (ICD-10 code 33.10.9).

"We used to call the families after everything came back normal except the gratuitous contaminated UA, but they never answered their phone and we aren't allowed to send an old person home from the ER," said emergency doctor James Johnson, who claims that's a hospital policy and he's just doing his job.

But hospitalists say the already busy winter months have become increasingly more intolerable with the rising number of vacation related admissions.

"I'm averaging three vacation observation patients a day on my list and they are the hardest to please.  I think the families are telling them we are a 5-star hospitel." said hospitalist Dr. Jenny Howell.

Even some community doctors have starting using Vacation Observation as a reason to clear their census for their own family vacation.

"It was awesome.  I had my Physician Assistant Assistant's nurse call the hospitalist last Friday evening and make up a story about how all seven of my patients needed a higher level of care so I could clear my census for vacation," said one Family Medicine doctor who wished to remain anonymous because he knew what he was doing was just plain shitty.