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Miscellaneous thoughts and ramblings
Wednesday, April 13, 2005
 
I Left My Blog in San Francisco
I am currently sitting in the beautiful atrium of the San Francisco Marriott.

Why? Because for the next few days I'm attending the American College of Physicians Annual Session in an attempt to stay smart and learn some of the new developments I've missed.

I'm posting from my Treo which has a tiny screen (and a keyboard to match) and a browser that only has one open window at a time, so if you're expecting links, or cool pictures, you're out of luck. I'll be luky if half the words are spelled right.

All of this is just beating arond the bush so I can tell you that until Sunday my blogging will be slim to none. I fully expect Godby to pick up the slack with at least one link to an interesting news story with h
Comments:
How "luky" you are -- or we are?

Someone took the words right out of your mother. Oh my gawd...I just noticed the perfectly good Freudian slip. I meant to say "mouth" -- what kind of error was that? I think I ought to get some slee...ee...ee..pppppppp
 
Great. Looks like it has a text field character limit, too.

What I was saying is that I expect Godby to at least post a link to an intersting news story and add some of his own witty analysis, and then another tear-jerker about the challenges and joys of family life.

I swear, if I post more from my Treo than Godby does from his "job" we're going to have to renegotiate how we divide up Irina's donations. ;-)
 
: D Can I take part in the negotiations?
 
Irina: I guess that would only be fair.

And now, live blogging from the ACP national seesion!

7 am (ouch) to 8:30 - Update in hypertension and nephrology

Take-home points:
1) hypertension is bad
2) chronic kidney disease is bad
3) sitting with hundreds of poor souls for 90 minutes through a lecture with almost no actual treatment recommendations is bad
 
How do you like that treo? Is it a good substitute for a PDA? I want to get one just to consolidate a phone/pda.
 
Psychotoddler: love my Treo. only had it for a few months. It's not a substitute for a PDA. It is a PDA with Palm OS. I used to carry my Palm, my phone and my pager everywhere I went. Now I only have one box. Best of all, I can read your blog during borring lectures, and read the news on the potty without a newspaper.
 
9 am - 10: The Welcome Address. Keynote Speaker: a big mucky-muck from the Robert Wood Johnson Foundation, a lefty healthcare policy foundation. Take home message: we need major change in how we deliver healthcare. Dilbert would like her. I'm regretting I had such a big breakfast.

Oh, good. She just mentioned covering the uninsured and reducing racial discrimination. A smattering of applause. She then used the phrase that should have flooded the room with tear gas: social justice. Note to self: must stop oppressing minorities.

Stay tuned. I may learn some medicine in the next few days.
 
Since you started reading the Treo in the bathroom, have you noticed a rise in infections among your patients? Could be an interesting presentation for next year's conference.
 
Fun reading, I like the way you summarize.
 
10 am - 10:45 morning break. I walked over to Union Square. Weather is gorgeous but a little cool. There was an art show that I walked through. Some beautiful photographs caught my eye and would be great on all the empty walls in my office, but I've already empoverished myself just by going to this conference. I took the photographer's card, in the hopes of buying from his website when I can. Perhaps we can persuade Irina to buy the office a small 8 x 10. ;-)
 
10:45 - 12:15 Hyperlipidemia.
Great lecture and discussion! (Finally.) Take-home points:
1. Obesity is a scourge.
2. Push statin doses aggressively to get the LDL down.
3. The emerging risk factors (homocysteine, C reactive protein, etc.) are likely just distractions from the traditional risk factors and there's no evidence that modyfying them has any benefit in preventin heart attacks.
4. I should probably be evaluating and treating triglycerides more aggressively than I am.

12:15 - 1:45 lunch. I ate in the park over the Moscone North Convention Center listening to a fountain and watching kids running on the grass. Then off to buy little bags of Jelly Beans for my partner and office staff for holding down the fort while I'm gone. Then back to the hotel to recharge the Treo and blog!
 
I already miss b&c and the kids. :-(

Has Godby even looked at the blog today? This week?

Ralphie: You have a very good but scary thought. I wash my hands, but not my Treo. Maybe I'll wipe it with an alcohol swab. I'm not sure I could bear to go back to analog bathroom reading, though b&c always reminds me that I have a bunch of medical journals to catch up on.

Wickwire: Thanks. I may do the whole conference, except for Saturday's sessions (or maybe I'll post about them after I get home). Remember, reading Kerckhoff Coffeehouse doas NOT count for Continuing Medical Education credits!
 
1:45 - 3:15 Practice Finance.
This is a topic in which I am much more interested than I used to be, since I have 4 heirs to the Bean dominion to feed. Nevertheless the lecture was fiendishly dull. I was in the front row and still couldn't pay attention. My heavily baised interpretation of take-home points:
1. Doctors have completely relinquished their right to set the prices for their services to insurance companies. Both doctors and patients are worse for it.
 
I don't do small, only larger than life! ; )
 
2. Most doctors pay too little attention to the bussiness of their practice, thereby doing a lot of unintentional charity work (i.e. care for which we expected to be payed, for which we are not payed, for patients who are not poor). Doctors should remember that for no pay, they could read a book or play with their kids. Unintentionally caring for a (non-charity) patient for free simply steals time and money from the doctor's family and allows insurance companies to keep fees low and collections difficult. Intentional charity work for patients who can't afford care is important, but that's a different story.
3. B&C is the greatest office manager of all time.
4. I sincerely and deeply long for the day I can disenroll from Medicare.

Irina: he has some huge photo's too, and we have a hallway with nothing on the walls!
 
Here's something my father learned about medical office management:

When you give an envelope of cash to your office manager to deposit at the bank, and she does so, but into her account, it's called embezzlement.
 
What is it called when your wife is your office manager?
 
Regarding Bean's point #2. That is why I will waste 20 minutes of my time to extract $11.54 from a medicare supplement plan. It is not their money, it is ours.
 
Also, if you can't take the time to evaluate the financial side of your practice, you shouldn't be in private practice. Why not just take a salary while others lose money for you?
 
4:00 - 5:30 Update in Oncology.
Interesting lecture on the latest in chemotherapy advances, but useless to the internist, since we'd have to be crazy to be prescribing chemo ourselves rather than get patients to a specialist. Reviewing the latest evidence in cancer screening would have been much more useful.Take-home points:
1. It's better not to have cancer.
2. I should continue to send cancer patients to oncologists (as opposed to librarians or tailors).

Ralphie: Practice consultants hear these stories all the time. That's why B&C does the deposits.

B&C: What is it called when your wife is your office manager? True love! Or poverty. Or both.

There was actually one doctor at the lecture who was an employee in a large group who was frustrated that he couldn't get a straight answer from the partners about collections and expenses. Newsflash: look for another job. They won't take you seriously until you can realisticaly threaten to bolt.
 
I'm so afraid to read your posts in my open-office concept...or anywhere. The originals (non-political ones, mind you) and the follow-up comments always get me laughing out loud.
Doctor Bean, why spend hundreds of dollars on a medical conference when all you need to know is LAUGHTER IS SO VERY THERAPEUTIC!
You people are like an early SNL gang, Seinfeld & Co., Spanky and his Gang (aka The Little Rascals) -- keep up the good work.
When can we expect to see the Kerckhoff gang doing mud wrestling? I'll get ringside seats for that!
 
Pearl, I believe I mentioned our college days before. I don't remember any actual mud-wrestling but there was the time that Nomad pushed Godby's head into the wall. Does that count?
 
Whoa! We gotta hear more about that one!
 
I'm sleepy from a late night of anonymous sex in the local bathhouses, but I figured when in Rome...

torontopearl: flattery will get you everywhere.

Friday 7 am - 8:30. Pre and peri operative management.
Great lecture, chock-full of stuff I need to know and mixed with a little humor to keep me awake. Take-home points:
1. For non-orthopedic surgeries with high risk of thrombosis, heparin 5000 units every 8 hours (not 12) with inflatable compression stockings should be used.
2. Plavix should be stopped 5 days before surgery, but patients with co€
 
2. Plavix should be stopped 5 days before surgery, but patients with coronary stents need aspirin & Plavix for a duration that depends on the stent type to prevent stent thrombosis.
3. I'm generally evaluating and managing coronary disease peri-operatively just fine, but I should look at the ACC algorithms again to refresh my memory.
 
B & C----Mommy's little precious engaged in a horrible act of gratuitous violence??? Horrors!
Mama Nomad
 
Mama Nomad: nobody said gratuitous. Godby may have deserved it. I don't remember the details.

8:45 - 10:15 Cardiology Update.
Style: Humorless monotone droning. Thank gawd the coffee is kicking in. Content: pretty good; actually relevant to primary care.

1. Push the statin doses to get the LDL down. (Same point made in yesterday's hyperlipidemia talk.)
2. All diabetics should probably be on a statin, maybe regardless of LDL, certainly if their LDL is over 70.
3. In severe heart failure, resynchronization with implantation of a pacemaker and defibrillator saves lives.
4. In atrial fibrillation, rate control with anticoagulation is as effective, as safe or safer, and cheaper than rhythm control.
5. Drug-eluting coronary stents are better than the bare metal ones. I just love saying the word "eluting". I don't know why.
 
1.) Use inflatable compression lederhosen instead of stockings whenever possible.

2.) In really, really severe heart failure, pounding on the patient's chest with your fist while yelling, "Live, dammit, live!" increases ratings durings sweeps.
 
Doctor Bean, will I automatically get my M.D. designation if I know -- and can repeat --all this technical information you've shared with us? I'll have saved myself several thousands of dollars and a few years at a med school in that case. If I want to major in...say, dermatology, will there be a bonus question to get that specialized designation?
Ralphie, you're very funny...but you already knew that, right?
 
Torontopearl: Kerckhoff Coffehouse is currently applying for acreditation as a medical school. We hope to offer degrees in pastries, espresso, and muffins.

11 - 12:30 Geriatrics Update.
Unimaginably hideously dull. Malignantly sopporific. Really not interesting in any way. If there was a live monkey on the stage spilling kerosene and playing with matches, that would just elevate this talk to dreary.

It's also clinically irrelevant, and given how little attention I'm paying, I don't know if that's good or bad. I think I'll read the article that Ralphie linked to in his new post. I think I might be a geriatric patient before this is over.

Take-home point:
1. I have to pick which lectures to attend more carefully.

By the way, I'm sorry for the many typos. That's the best I can do on my Treo without a spell checker.
 
Sorry, Dr. Bean, don't hate me for doing my job, but this is what I do: I think you meant to say, "I have to be more careful in picking which lectures to attend."

Or maybe you really DO want to attend some lectures more carefully than others...?

In any case, have a good San Francisco kind of weekend! (hopefully that means it's all uphill from here!)
 
Woops, forgot Nomad's mom was lurking around here. Better be more careful what I say.

Compression Lederhosen! LOL

Live monkey with matches! LOL again.

Tears in my eyes.

Hey Doc, why not offer to give the practice management lecture next year.
 
You can't appreciate how much money you just saved me! Thanks!

BAC, how are you holding up?
 
Lurking? I thought I was brazenly present. By the way, precious, take your vitamins....and Dr. Bean, mind your geriatrics comments....senior discounts are my life. Mama Nomad
 
Torontopearl: I don't mind. Edit away. It's hard for me to review what I've written on this tiny screen. A bad carpenter blames his tools...

b&c: I'm glad we're entertaining you. Give the kids a big *smooch* from me.

Psychotoddler: Happy to help. To be fair to the geriatric lecture, there actually was one interesting fact: vitamin D (in a meta review of randomized controlled studies) helps to prevent falls. Not fractures, falls! Who woulda thunk?

Nomad's Mom: I didn't say anything bad about my geriatric patients. I love my older patients. They actually follow my advice and aren't delude that thy're immortal.

This ends live blogging from the ACP Annual Session. Have a wonderful weekend, a peaceful Sabbath, and inflatable lederhosen.
 
From the articles in the local press, I believe the medical information given at this blog is far better then that given at Drew Medical School and that anyone in LA would be better off treated by TorontoPearl, Ralphie and me than risk a visit to Drew Medical Center. Need a name for our facility - "WithDrew Center", "Mom and Pop Wellness Center" Dr. Bean -have a quiet and relaxing Shabbat-madness awaits your return! Svenmom
 
Shabbat shalom! : )
 
The ACP Annual Sessions -- expensive
Round drip airfare to San Francisco -- a lot of money
3 nights at the San Francisco Marriot -- a gazillion dollars

Coming home to wife and kids -- priceless
 
beautifully said -- hope ball-and-chain reads your words!
 
so to sum up:

Sick: Bad

Not Sick: Good

Medicine: Some good

Medicine: Some not good

Getting old: Bad

Not getting old: worse

Not getting paid: worser

Got it.
 
Psychotoddler: That's it. You're a great doctor.
 
No, you're a great teacher.
 
Can you feel the love in the blog right now?
 
I don't think I've ever seen such a continuum of comments based on lots of nothing... Oh ya, now I remember; I did -- it was called SEINFELD. May you continue to walk in Jerry's big footsteps, Doctor Bean...
 
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