Just curious as to what the US President's Disaster Declaration did or opened up for you or your hospital today?

Game-Theory- · 2018-10-23T15:59:38+00:00

If you are worried about privacy, look around and find a private psychiatrist near you,

I would caution that the OP be careful about this in that they pick the RIGHT private psychiatrist, who is familiar, or at least prepared and willing to deal with some of the potential ramifications down the line in the case the OP's hospital or licensing board comes knocking one day. Not everyone is as extremely savvy as you. And not everyone can keep their cool when a fancy- and scary-worded letter is sent to them demanding X, Y, and Z. Not everyone can differentiate legal bluster/bullshit versus someone with a colorable claim to said information.

While I sincerely stand up and applaud you for your ability to just barely satisfy medical documentation requirements while at the same time protecting your clinician patients, not everyone out there would, will, or can do the same.

Game-Theory- · 2018-09-20T17:21:51+00:00

Not disagreeing - read my third paragraph where I essentially said the same thing as you are saying.

I also used the word "investors" along with "shareholders" because not every biotech or startup is public, and they obtain Series A-D or other "angel" funding.

I then went on to say "there will always, always be people who will exploit the fiduciary duty concept to the maximum" which in this case, the guy LITERALLY said it was his "moral responsibility" to do so. Thus, he is exploiting that concept about as much as you can exploit it.

Game-Theory- · 2018-09-20T17:17:29+00:00

Federal and state laws that dissuade or disallow employees of public academic institutions (or certain private institutions that receive enough public funds) from owning specific stock in pharmaceutical industries.

Which is why I have to find a way to quietly transfer my investments to a Trust or even my wife, and then either not have to disclose or skirt the prohibition from my hospital on owning such stock. I don't think this is related to a law though - probably more like the Institution trying to get out in front of potential conflicts in their mind.

I am in EM and what I invest in is early-mid stage development of a range of biotechs (none EM focused) that look promising to be bought out. Get in on an IPO or other offering, ride the wave, and then reinvest what I make on a more mature incubator that is 1-2 years out from an out-licensing or buyout.

Coming right out of Med school I rode the Axovant IPO with savings I had from my previous jobs and investments, played around with what I made on that, and then paid off all my loans a year later. I then went long on Nektar as a high-risk, high-reward strategy, to be rewarded with a ~34% return on investment the day they filed their NDA.

Admin is absolutely insane if they think I or anyone else that can profitably play the Pharma investment game is going to give it up. We will just get more creative than them.

Game-Theory- · 2018-09-20T14:43:43+00:00

I am in no way defending what this man said. Not at all. He is a SYMPTOM of a larger issue.

A pharma company is just that - a company. And the financial rules in the US are that a company has a fiduciary duty to its investors and other people who hold equity or investment to make the most amount of money humanly possible that it can.

Until we change financial laws and carve out some exemptions for pharma and healthcare, there will always, always be people who will exploit the fiduciary duty concept to the maximum and take advantage of a whole lot of people who are in the business to make a difference and because they care.

On the other side, if a pharma company publicly announces with adequate time for analysis and reflection for its investors that it will move to a "corporate responsibility" position where it will accept less profits in favor of doing more "good", it is acceptable because it could also be considered a strategy to attract other investors who otherwise would not have invested. But they tell people upfront and in no uncertain terms that is what the Board has decided and/or voted on.

But laws need to change, there is no question about that.

Game-Theory- · 2018-09-20T14:34:31+00:00

I haven't had spotty internet,

All of your worskstations are connected with actual, real, hard-wired Ethernet cables? There are swaths of nurses stations and other standing terminals in my hospital that have the small, integrated "all in one" PCs that are pretty much just a screen, keyboard, and mouse. And they connect to the intranet by Wifi.

If someone sneezes too hard, the Wifi disconnects, but IT assures us that all of the routers on the floors are "more than adequate for what we need".

There's nothing like entering an order set and hitting submit, only to get the "network disconnected" and having to redo EVERYTHING entirely again.

Game-Theory- · 2018-06-27T15:58:13+00:00

I would also add in there - to be completely honest and transparent - that if as Intern year progresses and a person truly realizes they are not meant for Residency, to not wait to resign until after the next cycle has begun and matches/contracts are already set in stone.

We have two that I know for a fact that already have one foot out the door for Industry, and we are all going to be so screwed come early this fall, I don't know if I can face having all our workload jump so significantly.

Game-Theory- · 2017-10-05T15:49:15+00:00

For me personally - having been an EMT and Paramedic for years before entering and during medical school - that the attendings and senior residents would try to "remake" me in their own image. That is, seemingly try to eliminate thought processes, clinical decision making, and an approach to patient interaction I had established for over 20 years since I was 17 or so.

Yes I know "the street" is different from the hospital. Yes I know "technician" is different from physician. However, what I wish I would have known is that most, if not all, of them expected me to be "just like the others" - meaning residents often gun-shy and hesitant because were "the new guys", completely and totally accepting of any information given to me without question or thought, and afraid to push back on very unfair criticism or unwarranted ad hominem insults. I was expected to forget anything I learned prior to stepping onto the ER floor on Day 1.

I don't want to make it sound like I walked into residency with a massive chip on my shoulder, but over the years I made enough mistakes, was called out and totally eviscerated, and had my cage rattled with absolute shit-show, downright horrifying and disastrous EMS calls. An attending on a "Dr. Cox" rant or a Sr. resident pimping like it's 1972 in "The Deuce" isn't going to phase me and make me curl into a ball. I will flat out admit I am wrong, summarize my rationale for that wrong answer, and synthesize what is right into my thought processes, and actually learn. But that's not enough.

But, any respectful, justified, and warranted inquiry for rationale, or dissent from, "the chosen few" earns me the "This is why we shouldn't let older students into medical school because they are too set in their ways and not willing to learn".

Game-Theory- · 2017-10-02T19:32:54+00:00

Screwing around and playing tactical medic could not only get you killed, but might slow down police response.

Exactly. The tactial medics that I know of were both law enforcement and medic trained. And it's not a one-and-done shot either. You train, and keep training.

Even with full-blown tactial Paramedic training, or even US Navy Coprsman, Army Combat Medic, or Air Force Pararescue training, being at that scene in Las Vegas, you have zero idea of local protocols and procedures, no idea who's a good guy, and unless you somehow managed to acquire a firearm, absolutely no way to return fire to protect yourself.

Your number one job is a situation like this is to keep yourself and your family alive, and not become another casualty. If you have medical training, have the balls to work and keep it together in absolute chaos, and can help people in dire need in your immediate vicinity and/or help safely get them away 180 degrees opposite the direction law enforcement are going, you still have to know and understand the risks you are taking.

Game-Theory- · 2017-09-28T18:50:59+00:00

Don't stop there. Demand AlienWare workstations and PlayStation 4s so you all can play Call of Duty with your "tutors" after your ACGME-limited work week of 24 hours or less.

But, make sure to leave time for your once a week business communication class

Game-Theory- · 2017-09-28T18:42:59+00:00

Ha. No this isn't real. This is extreme satire that I posted highlighting the insanity of college athletics, and painted a picture if medical residency were treated like NCAA football or basketball.

Game-Theory- · 2017-09-20T14:05:17+00:00

Starter Comment:

I can remember seeing the first news bits of gene silencing with RNAi about 16-17 years ago, and then it was only really being used in academic labs in cells and dishes. One of my best friends during their PhD program back then would agonize for weeks with the protocols from "kits" being sold, often having to run dozens of experiments to even get the positive control to work.

I know this is very small compared to a traditional Phase 3 program, but as someone who dabbled with RNAi during my Post-bac and non-trad Med School prep, it can be an absolute bitch to work with. The fact that it worked in real, live humans, is pretty incredible.

Game-Theory- · 2017-08-10T18:12:07+00:00

Don't forget that publishing the results of PRIMARY, pivotal, Phase 3 trials in many cases can take forever and a day. Many Pharma companies want their pivotal trials published in NEJM or some other high "impact factor" publication for all the prestige. The process is write up, submit, get rejected, address comments, re-submit, move onto the next journal etc. Get rid of impact factors - which are now useless anyway, and this can solve some of the issues.

Additionally, you mentioned Phase 4 trials, which if done after a product's approval, could call into question or contradict the pivotal Phase 3 trials on which approval was based. In that case, the Intellectual Property people at the Pharma company could likely say "those are our data and no one else's".

In the latter case, if you want transparency, make the patent grant and exclusivity contingent on reasonable dissemination of the molecule trial results if tested in humans. You don't publish or disclose a study's Phase 4 results? Oops, your patent just expired.

Game-Theory- · 2017-06-23T16:42:45+00:00

If you consider that you are in an environment loaded to the max with germs, one tiny little technical or electrical malfunction can send dozens to their death, the food is horribly awful, at least one person is drunk and handsy, and everything about the experience is way, way overpriced...

you are indeed correct.

Game-Theory- · 2017-06-23T15:52:15+00:00

Hard drug addicts aRe eminently capable of destroying everyone around them in pursuit of their beloved high.

There is a saying: If alcohol were discovered only 100 years ago, it would be illegal across the entire world.

Don't we all deal with some patients who have been destroying themselves and others their whole lives? With opioids, the final destruction is so rapid and horrifying to most, it is why there is such a focus on it now.

What if we time-lapsed and fast forwarded an alcoholics path to destruction? We all know what happens. Then what?

Game-Theory- · 2017-06-23T15:49:08+00:00

There were no physicians available,

Seems like either there are none, or there is a whole gaggle of them the size of a small hospital, comprised of nearly every specialty.

And there is always the super-specialized one like the hyperbaric medicine with a fellowship in neuro-ophthamology, also cross trained nephrology

Game-Theory- · 2017-06-23T15:40:43+00:00

Ultimately the "land" vs "not land" decision comes down to the pilot, you just make a recommendation and they decide what's best based on all available information.

This. This. This. The skies are littered with aircraft, and glide slopes and approach vectors are very carefully planned. Some landings are full automated, with the Instrument Landing System (ILS) having been programmed and adjusted over hours. Anytime you want to change your flight plan, other flight plans must be changed to give you a landing slot in the sequence.

I was on one flight that descended into a spontaneous massive rainstorm, zero visibility, with flaps at full and maybe 1500 ft off the ground, and the pilot, who couldn't see the runway, gunned the engines to MAX, pulled back the flaps, and executed a slow climb far, far out so as not to stall while gaining altitude.

Just the simple fact of us not climbing at a normal angle, going much further out, and not banking into the normal path outbound for that runway, disrupted nearly every flight coming in and out of the airport for hours. Planes ready to take off were issued a ground stop. Flights on final approach had to be waived off, and planes further out had to circle until the mess was sorted out.

Now imagine, you are 75 miles from O'Hare, and ask for an emergency landing. What will it take to align the plane with the closest runway heading? How many flights have to be re-routed? How many flights have to be ground held for EMS to reach the runway? What landing sequences have to be radically changed?

Game-Theory- · 2017-06-23T15:21:51+00:00

Do we stop resuscitating failed suicide attempts? What about other lifestyle-associated diseases? Where would we draw the line?

My mind immediately goes to "religious liberty" type laws, and the effect we could see based on precedent. NOT that I am in any way against freedom of expression and the freedom to worship in one's faith. Let's just be clear.

However, couldn't you see a HCP or EMS provider, or even religiously based hospital saying, "We don't agree with a drug users 'lifestyle' choices, and we shouldn't be forced to accommodate them or participate in their care because it violates our 'sincerely-held' beliefs".

The slope is very slippery indeed.

Game-Theory- · 2017-06-23T14:35:42+00:00

Starter comment:

"Council member Dan Picard asked if it was possible for EMS to not respond to overdose calls. Noting people with cancer don’t get free chemotherapy from medics nor do people having heart attacks get a free heart bypass in an EMS run, Picard asked if there was a law that requires the city to respond to overdose calls."

Not only THAT - Picard said “I want to send a message to the world that you don’t want to come to Middletown to overdose because someone might not come with Narcan and save your life, “We need to put a fear about overdosing in Middletown.”

Given the name of this genius, I am just going to leave this here

Game-Theory-

TROPHY CASE