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Sing a Song of Sixpence
Pocket full of rye
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Extra Fig points if you know who Jessica Prentice is.
Hat tip to seriouseats

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1 ellucidation or exposition or put your $0.02 here!
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Sometimes I have a good time in the ED, sometimes I don't. This was one of those times.

As usual, all patients and staff are fully anonimized, some are composites. Also per usual, this is behind a cut for length and grossness. My apologies for the ugly formatting. Apparently LJ does not like it when I copy and paste from Word; if anyone has any bright ideas of how to avoid this, please let me know

A bunch of bizarre stuff happens in this post. I promise that while I anonimize, make composites of similar patients, and re-arrange time for better flow I do not make anything up.  Working at Hospital X I don't have to.

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40 ellucidations or expositions or put your $0.02 here!
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A spontaneous food court musical, courtesy of the always fantastic Improv Everywhere

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3 ellucidations or expositions or put your $0.02 here!
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If you haven't read it, you should.
If you have read it, it's probably worth reading again.

And, hey, free book!



Browse Inside this book
Get this for your site


You can read the entire thing for free. Thanks, Neil Gaiman!

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6 ellucidations or expositions or put your $0.02 here!
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My post yesterday was not supposed to mean "statins are bad, people who take them are stupid and doctors who prescribe them are stupider."  It was supposed to be "few physicians use NNT in their prescribing practices and it's important"  and "important outcomes are death/disability, not a arbitrary number" along with a component of "few medicines are good or necessary for every single person, it is a complex decision." 

Let me clarify: Statins are standard of care and will decrease your risk of death for people with multiple risk factors who have had a heart attack. If you haven't had a heart attack and you have few risk factors it is a decision you have to make with your doctor...and your doctor should know about NNT.


So, to everyone I confused, please accept my apologies.

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5 ellucidations or expositions or put your $0.02 here!
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Do you play the lottery? Do you gamble? I've got a great gamble for you.



This article does a really great job of explaining this concept.

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12 ellucidations or expositions or put your $0.02 here!
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I know, I know. You want ED posts. I promise there will be more.

In the meantime, take a look at Chris Jordan's work. I found it beautiful and horrifying.

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10 ellucidations or expositions or put your $0.02 here!
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My phone records are my business. What's on my computer is my business. I'm not going to hand over the keys to my house; I have a similar lack of desire to hand over the passwords to my computer.

There is nothing illegal on my computer, but there are things that I do not want to share with random people. Like financial information. And, equally if not more importantly, confidential patient information. I can cancel bank accounts and credit cards. I can't give another person back their privacy.

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9 ellucidations or expositions or put your $0.02 here!
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Last month the Michigan Secretary of State stopped giving driver's licenses to immigrants. They interpreted an opinion by the state Attorney General to mean that people who are legal visa holders but not permanent residents should not be granted licenses. They can keep their country of origin license until it expires but then they can not get a new one from the state of Michigan.

I think many peoples' reaction will be "Yay! now we don't have to worry about terrorists driving car bombs into Michigan stadium." or "That makes sense, everybody knows that dirty {insert random country here} can't drive." I don't think that most people consider the effect this will have on people from other countries who are:

Medical residents doing their training in Michigan hospitals (statistically likely to stay and continue taking care of either rural or inner city Michigan residents).

Graduate and undergraduate students at the University of Michigan

Post-doctorates and visiting professors here for two or more years.

Engineers working with Michigan auto manufacturers.

I know people in medicine or academia from South Korea, England, Germany, Belarus, Ghana, and Canada who will be affected by this change. Some of them are thinking of giving up their positions and/or returning to their home country due to the difficulties of doing their job with this restriction. They have told me about other professionals who were planning on coming to Michigan and have now changed their plans.

A policy which drives professionals out of a state with a faltering economy seems remarkably poorly thought out.

A policy which is so pointlessly biased just makes me mad.

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11 ellucidations or expositions or put your $0.02 here!
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Cheeseburger in a can.

bleaurgh!

Why? Why? Why?

hat tip (I guess. Although I think I was happier before I knew about this) to Serious Eats.
10 ellucidations or expositions or put your $0.02 here!