Daily Archives: September 1, 2021

EM history, EM jobs, CMGs:

The original cover of the book by James Keaney, MD.

I had drinks with a legend of emergency medicine in Honolulu in 1994. I met him the evening before when he addressed the Hawaii chapter of the American College of Emergency Physicians. Everyone in the room was blown away by his talk, and I was fortunate to be included at a small dinner with him the following evening.

He regaled us with stories about the old days of emergency medicine in his thick Boston accent. I doubt he remembers that evening, but I will never forget it.

Two years earlier, I was a nave second-year resident. I was trying to grasp the nature of how to do my job, and it was difficult for me to consider what was going on in the post-residency world of emergency medicine. Our specialty was still young. The majority of EPs were salty veterans of emergency rooms.

This group included a lot of physicians who had drifted into the specialty for less than glamorous reasons. Some had been kicked out of residency or had too many malpractice claims. Others had substance abuse issues. Many had little to no formal training in emergency medicine, which had only been recognized as a specialty 12 years earlier. Residency-trained, board-certified emergency physicians were in the minority.

There was a lot of buzz around that time about a book that satirized the business practices of emergency medicine. It was so scandalous the author published under an alias: the Phoenix. That book was The Rape of Emergency Medicine, and the author was James Keaney, MD. Despite the politically incorrect title, it remains essential reading for understanding how emergency medicine became the first medical specialty to be commoditized in the 1980s.

I recently reread the book that made Dr. Keaney famous. It is a hilarious story with a cast of fantastic characters, including scrubs, suits, kitchen schedulers, Crips, Bloods, big cats, mosquitoes, pledge drivers, Weasel, Monk, and Cro-Magnon. The text drips with sarcasm and details the evolution of the emergency medicine business model, an endless turf battle to acquire management contracts for hospital emergency departments while filling shifts with any available clinician. All the while, the contract managers (AKA the suits) developed marketing campaigns that emphasized the quality of their services with slick, glossy handouts and receptions for hospital administrators supplying ample amounts of food, beverages, and gifts.

Shortly after the book's publication, Dr. Keaney was featured in Emergency Medicine News and then part of a feature story on 60 Minutes. The legendarily tough Mike Wallace interviewed him in a piece that brought to light the staffing models for emergency departments of that era.

The great irony is that 30 years later emergency physicians face a new challenge influenced in part by corporate medicine. Residency-trained, board-certified emergency physicians in the 1980s and 1990s were in short supply, and every business-savvy person knows that scarcity creates value. Entrepreneurs set up corporations that moved around a collection of physicians with varying levels of competence to staff the nation's emergency departments.

These corporations merged and changed into new companies many times over, but a version of that business model continues to be utilized today at many hospitals. The big difference, of course, is now we have more than enough residency-trained, board-certified emergency physicians. The scarcity that created the market in the first place no longer exists.

With this in mind, how does a company staffing emergency departments continue to prosper when the value of its service goes down? It drops the price to increase sales volume or finds a cheaper way to supply the service. Enter the nonphysician provider.

Of course, the trick now (as it was then) is to convince the consumer (hospital administrators) that your service continues to offer the same (or at least acceptable) level of quality with cheaper labor. You bring in the marketing department to produce more slick advertising that features the quality of your nurse practitioners and physician assistants at a fraction of the cost. (Read The Corporatization of EM Education for an example of this strategy: EMN. 2021;43[7]:1; https://bit.ly/3jzTUae.)

The net result now (as it was then) is the loss of some of our professional independence. Corporations create standardized processes that can improve quality in the emergency department, but these processes need to balance quality of care with fiscal responsibility. This goal can be extremely tough when other physician specialists providing care at a hospital have the negotiating power to dictate the terms of their compensation because of their professional independence. This dilemma can push hospital administrations to look elsewhere for savings, and that search might end up in the emergency department.

After the publication of his book, Dr. Keaney became a founding member and the first president of the American Academy of Emergency Medicine. This organization has been at the forefront of calling attention to questionable business practices in emergency medicine for nearly three decades. You can download a free copy of Dr. Keaney's book on the AAEM website: https://bit.ly/2UssEQq.

Reading this book provides residents and attendings alike with an essential historical reference for our specialty. It is a call to action for us to advocate for safe clinical environments and fair business practices. I encourage all residents to read his work and think about its impact on their future careers.

Dr. Cookis the program director of the emergency medicine residency at Prisma Health in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him atwww.facebook.com/3rdRockUltrasound, follow him on Twitter@3rdRockUS, and read his past columns athttp://bit.ly/EMN-Match.

See the original post here:
After the Match: Emergency Medicine's Past Plagues Its... : Emergency Medicine News - LWW Journals

Vaccines and masks will help end this pandemic

Recently I was in a local supermarket and was absolutely appalled at the number of people without masks. On Aug. 17, I was at a different market waiting to get my booster shot and decided to note the number of people I saw without masks. I have estimated the age group best I could but feel I am fairly accurate.

Three young couples with small children. Three obese women over 50 years old. Four women under 30 years. Six women between 40 to 60 years old. Fifteen men between 30 to 50 years old. Four men over age 60 - two of whom had obvious health issues.

Thats 38 people I noted in 30 minutes and only in a small area of the store. I would really like to be politically incorrect when describing these stupid people but this is a family paper. I cannot remember if there was an uproar when I was a child and got all my immunizations and then as a young mother when my children got the polio vaccine, diphtheria-tetanus-pertussis and the measles-mumps-rubella shots.

Please get the vaccine and wear your masks to help us end this pandemic.

Sandi Simpson, Lakeland

More: Voice of the People: 'My body, my choice' except for masks

More: Voice of the People: Moral leadership and dedication to truth lacking on Polk Commission

More: Voice of the People: Zoning change on Crystal Beach Road doesn't fit rural community

Mandatory COVID-19 vaccination would likely be unnecessary if mandatory masking were allowed. Stop whining about infringement on personal rights. Do your part to protect yourself, your family and your community.

Stop making unfounded statements questioning COVID-19 vaccine safety. The vaccine was appropriately studied and tested before widespread distribution. It is as safe as any other vaccine. It is certainly safer than the adverse health effects of COVID-19 infection.

A new report indicates that COVID-19 can be eradicated, just like smallpox and polio. The only way to achieve eradication is through public acceptance of infection control measures. That means vaccination and, for now, face mask and social distancing. This is not political; it is public health.

Mavra Kear, Ph.D., APRN, Lakeland

Don't blame President Joe Biden. He is president in name only. He does what they tell him to do, and who they are I dont know for sure. I would guess its the people that would want to bring America to its knees and it looks they might succeed this time.

If only we had any military people that knew what was going on and had the guts to step in and right a wrong and worry what would happen later. But we dont.

I feel like I served for nothing. I also feel like at my age I may never see the country return to normal.

Afghanistan run by Taliban, America run by Democrats - same thing.

Claud Lynn, Lakeland

The Ledger encourages its readers to share their opinions through letters to the editor. Submit your letter byclicking here, or send it tovoice@theledger.com. Include your name, street address, a phone number and an email address. Only your name and city of residence will be printed. Letters are limited to 200 words or less and are subject to editing.

Here is the original post:
Voice of the People: Vaccines and masks will help end this pandemic - The Ledger

Festival season was in full swing in August 2000, with crowds expected in Castletownroche, Ballylanders, Coolagown and Lismore. Castletownroche looked forward to the Welcome Home Weekend, while over in Ballylanders locals were anticipating Pattern Day. In Lismore, eight days of craic was culminating in a family fun day in St Carthages, and Coolagown was celebrating its first ever Old Time Threshing and Vintage Display. Here, attendees were warned about the politically incorrect and incorrigible Bachelors in Trouble opening act.

Fermoy was all set for File Fhearmui 2000, the traditional music festival. The weeks schedule included set dancing cilis, pub trailsand a concert in the park. Contingency plans included the gigs taking place in the Rowing Club, in case of inclement weather.

In Fermoy, the new pay parking was finally in place, with empty parking spaces in the town indicating it was working well or keeping shoppers at bay. Time would tell of the success of the scheme. Also in the town, the IDA announced a plan to build a 1 million business park at the site of the old Army camp.

Mitchelstown, though celebrating the biggest ever music festival, expected losses of 5,000. Overhead costs were increasingand it was now a big-time event with small-time sponsorship. Jack L was touted as the highlight act of the weekend. Meanwhile, in the Castle Gardens in the town, plans were afoot by owner Michael White to construct three self-catering chalets to meet the accommodation needs of tourists to the town.

The village of Araglin was in demand by the County Councils of both South Tipperary and Cork, as Cllr Mattie McGrath called for the Vehicles Office to desist from forcing Araglin residents to register their cars in Cork as Araglin is, of course, in another county altogether. The council had confirmed by letter that Araglin was definitely in Tipperary!

Rumours abounded in Tallow that George Best, legendary footballer, was looking to buy an English-style thatched cottage in the town. However, in Lismore, hopes were dashed when it was revealed that newly weds Jennifer Aniston and Brad Pitt would not be honeymooning in the castle quarters, contrary to popular rumour.

However, celebrities were to be found closer to home as Ballylanders John Gallahue and Glanworths Darren Dennigan were set to star in an RT documentary, Hearts on their Sleeves. The boys were members of the Irish Skills Team, who had competed in the 35th Skills Olympics.

Elsewhere, at a function in Maryborough House Hotel, Ballyduff man Kevin Condonwas celebratingafter winning the first prize in Joinery in the National Apprentice Competitions 2000.

In Fermoy, chef Denise Dingivan was awarded a bronze medal at the Sodexho Irish Chef of the Year competition, for her Innovative Salad entry.

31 years ago this month in 1990, Lazarus Mick Meaney rose from his coffin, having been buried alive for two hours in Kilworth something recalled in anAugust 1999 edition of The Avondhu.

In other stories of triumphant rising, the Kildorrery Juvenile GAA boys qualified for the North Cork final against Mallow following a replay against Sean Clarachs. They won the match 5-18 to 2-1.

Over in Fermoy GAA, the junior A footballers defeated Rathluirc Rovers after a tough, dour encounter in front of a handful of spectators. However, the article highlighted the achievements of Adrian OFarrell and Brian OCallaghan, playing his first championship game since a serious leg injury three years previous.

Castletownroche recounted a subdued victory over Killavullen for the junior A hurlers. Although the team won the match, and tributes were paid to players including Donal Relihanand Jonathan OConnor, the writer noted that the performances left a lot to be desired, with an unsubtle reminder that training would recommence that Friday!

The Kilworth U14 footballers were crowned North Cork champions in August 2000, beating Clyda Rovers to take the Rev Burns Cup home.

Fanahan McSweeney AC were continuing their unstoppable success, as Karen Considine brought home gold as a member of the Irish team that won in the Celtic Games in Scotland. Meanwhile, for Grange/Fermoy AC, Tullamore was the site of victory as the U10 girls team of Roisin Howard, Kate Sheehan, Tracey Clancy, Aisling Hutchings, and sub Karen Geary, brought home silver.

Fermoy Cycling Club were looking forward to the Crotty Cup races and the Comeragh 100 Cycle Challenge. In the Junior Tour of Ireland, the team would be represented by Frank Doyle for six days of tough racing.

On the water, Fermoy Rowing Club were looking forward to their first At Home regatta since the 1960s.

See the article here:
Memories from the Archives - August 2000 - The Avondhu Press

Theres a dark joke about this years extreme temperatures that has been haunting me for weeks: This is the coldest summer of the rest of our lives.

The prospect is nothing short of terrifying given what this year has wrought.

In June, sky-high temperatures in the Pacific Northwest killed as many as 600 people. Several hikers have been found dead in California in recent weeks, most likely because of temperatures that were above 100 degrees Fahrenheit. Globally, July ranked as the hottest month in recorded human history.

So, from my Los Angeles apartment that regularly crosses 85 degrees indoors, I called some climate scientists and asked them, Is every upcoming summer going to be even hotter than this one?

The short answer was: Yes, generally.

Vijay Limaye, a climate and health scientist with the Natural Resources Defense Council, told me that each recent decade had been unmistakably warmer than the one before it, so its highly probable that future years will continue to break heat records.

We should act like thats going to be the case: that this will be the coldest summer when we look forward, he said.

A United Nations report this month found that the Earth is locked into intensifying global warming for the next 30 years because countries have delayed curbing their fossil-fuel emissions for so long. Preventing further warming is within reach, but would require a coordinated and immediate worldwide effort, the report found.

The effects of climate change can be seen locally. The average high temperature in July in L.A. has risen by more than two degrees since the 1960s, as it has in Boston, Washington, D.C., Atlanta and several other cities.

And it will probably keep climbing. In Los Angeles County in 1990, the average annual maximum temperature an average of the high each day was 74 degrees. In 2090, the average maximum temperature will be somewhere between 80 and 82 degrees, according to state projections.

The climate that your children are going to experience is different than any climate that you have experienced, Paul Ullrich, a U.C. Davis professor of regional and global climate modeling. There was no possibility in your life span for the types of temperature that your children are going to be experiencing on average.

But still, that doesnt mean that 2022 in your city will definitely be warmer than 2021 has been. There are year-to-year fluctuations within this overall warming, especially at the local level. In California, for example, the climate phenomenon El Nio could make for an unusually chilly year.

Its really important not to set up these falsely simplistic expectations for the public, said Julien Emile-Geay, climate scientist at the University of Southern California. If we do put out the expectation that everything is gradually getting warmer, and then next year if its cooler, people will say, Ha ha, climate change doesnt exist.

Heres another way of thinking about this: The hottest year on record worldwide was 2016, followed by 2020, so its not as if each consecutive year is warmer than the one that came before it.

But the larger trend is clear. The top seven warmest years on Earth were in the past seven years.

For more:

A guide from The Times on how to reduce your carbon footprint.

Between wildfires, drought and a resurgent virus, this summer has been rough. Is this the beginning of the end of summer as weve known it? My colleague Shawn Hubler reports.

The Times created this tool a few years ago that allows you to track warming in your hometown. (I learned that Thousand Oaks, where I grew up, experienced around 20 days of 90-plus degree weather annually in the early 1990s, but now sees closer to 30.)

Thirteen American military personnel were killed in the Kabul airport attack last week some of the last casualties of Americas longest war. President Biden flew to Delaware to witness the transfer of remains on Sunday.

Of the 13 killed, 10 were based at Camp Pendleton in San Diego County and several were originally from California. Read more about them.

California

Caldor fire: Smoke is overwhelming Lake Tahoe and confounding the thousands of newcomers who fled there in recent months to escape the coronavirus, The Times reports. Plus, theres new research on the effects that wildfire smoke and ash have on your skin. (Its not pretty.)

As of Sunday evening, fire crews were fighting to beat back the Caldor fire to prevent it from spreading to the Tahoe Basin, The San Francisco Chronicle reports. The blaze was 19 percent contained.

Covid-19 in schools: An unvaccinated, unmasked teacher in Marin County infected 12 of the 24 students in her elementary school classroom with the coronavirus, revealing how easily the virus can spread inside schools when people dont wear masks.

Doctors spreading misinformation: Theres a growing call to discipline physicians disseminating incorrect information about the coronavirus and the vaccines. Earlier this year, a San Francisco doctor who falsely claimed that 5G technology caused the pandemic surrendered his license.

Those California commutes: The number of so-called supercommuters, people who travel 90 minutes or more in each direction to work, has increased by 45 percent over the past decade. Five of the 10 metropolitan areas with the highest percentage of supercommuters nationwide were in California, with Stockton at the top of the list.

If California goes red: With Democrats holding supermajorities in both houses of the State Legislature, any Republican who may beat Gov. Gavin Newsom in the recall election would be parachuting into politically hostile territory. Newsoms successor could find that winning the race proves easier than governing a state thats become the cornerstone of Americas liberal agenda, Politico reports.

Drug overdoses: California wants to become the first state to pay people with addictions to stay sober, a program that the federal government has already shown to be effective for military veterans, reports NPR.

Water rights: A lucky few California farmers are immune to emergency water cuts under the states complicated water rights system, which some experts say is ripe for reform as extreme drought magnifies the inequities within it, reports The Los Angeles Times.

SOUTHERN CALIFORNIA

Mountain lion: A 65-pound mountain lion seriously injured a boy in his front yard in Calabasas last week. The lion was shot and killed by a wildlife officer on Saturday, NBC Los Angeles reports.

Vaccine protest: Several hundred people gathered near Santa Monicas pier on Sunday to push back against proposed Covid-19 vaccination mandates, reports The Los Angeles Times.

CENTRAL CALIFORNIA

Heat and poor air quality: Fresno residents are urged to avoid or limit their time outdoors over the next few days because of triple-digit temperatures and poor air quality from wildfires burning nearby, reports The Fresno Bee.

Cantaloupe country: Mendota is a small town in the Central Valley that advertises itself as the Cantaloupe Center of the World. But the melons are disappearing as farmers let portions of their melon fields lie fallow amid the drought or abandon fields where theyve already been planted because theres not enough water for the fruit to survive, The Washington Post reports.

NORTHERN CALIFORNIA

A hometown under attack: A Times reporter returned to the place she grew up, a valley in Plumas County that has been hit hard by the Dixie fire. The rodeo campgrounds have been covered with the tents of National Guard troops, and the fairgrounds have become the base camp for hundreds of firefighters, she writes.

Rural California battered by virus: Mortuaries and hospitals are filled beyond capacity in rural, northern parts of the state, where inoculation rates are low, The Los Angeles Times reports.

In her latest newsletter, The Timess California restaurant critic, Tejal Rao, offers three zucchini recipes that celebrate the summer vegetables versatility.

Todays California travel tip comes from Joe Vela, who recommends Ao Nuevo State Park, one of the nations largest breeding grounds for northern elephant seals.

The park in San Mateo County is allowing visitors to take self-guided walks to view the seals between Friday and Monday. A free permit is required to visit the preserve.

How do I check to see if Im registered to vote?

You can check whether youre registered to vote here. If youre not registered within 14 days of an election, in California, you can also register the day of the vote. (So, in this case, on Sept. 14.) You can learn more about same-day voter registration here.

Read answers to more of your frequently asked questions about the California recall election here.

Tell us what else you want to know about the recall. Email your questions to CAtoday@nytimes.com.

For years, the Dumbarton Quarry in Fremont was a giant hole in the ground that had once supplied the rocks used to build Bay Area roads and bridges in the 1950s.

But on Friday, the site along the San Francisco Bay reopened as a campground, one of the largest new campsites in California in decades.

Visit the East Bay Regional Park District site for more details.

Thanks for reading. Ill be back tomorrow. Soumya

P.S. Heres todays Mini Crossword, and a clue: Ending with black, blue or straw (5 letters).

Briana Scalia and Miles McKinley contributed to California Today. You can reach the team at CAtoday@nytimes.com.

Sign up here to get this newsletter in your inbox.

Go here to read the rest:
Is This the Coldest Summer of the Rest of Our Lives? - The New York Times

The publics relationship with health and authority has changed substantially over the previous decades, with people now demanding greater individual control and decision-making in healthcare.

The fancy words, epistemologies and sociological frameworks that underpin all this are all incredibly interesting, but it ultimately boils down to one word. Respect.

As we enter into whatever-week-this-is-actually-who-can-even-remember-what-time-as-a-concept-is-any-more of lockdown, pandemic fatigue is gripping us all and respect is becoming increasingly important.

Ongoing compliance with and support of public health directives cannot be taken for granted, but is dependent on mutually respectful relationships that foster goodwill. This requires authorities and the public to view each other as working constructively in partnership and is something we see across public health interventions.

Ive noticed clear parallels to my work on reaching out to vaccine hesitant parents to increase uptake, and there are a few lessons to learn from it.

While the odd charlatan or grifter is lurking around most people are actually trying in their own way to do the right thing by public health. However, misinformation, confusion or inability to access necessary resources often results in well-intentioned people having significantly different sometimes factually incorrect views of what this right thing is.

The problem comes when politicising such differences becomes more of a focus than addressing them.

Most Australians support public health interventions. In fact, politicians have learned during the pandemic they can receive significant political dividends from them. Its true in vaccination too, as support for vaccines in Australia is high and opposition low.

This has meant targeting non-compliant persons is a vote winner.

Populist approaches to public health are smart politics but they make for stupid policy. The political threshold for success in infectious disease management is a simple majority, but public health thresholds are much higher youll need to win over 90% of the population to achieve herd immunity in vaccine campaigns, for example.

This means to put it bluntly only a small percentage needs to be put offside to stuff it up for everyone. Only a very small minority are intransigently opposed to initiatives like lockdowns or vaccination, which means there is capacity to bring those genuinely sitting on the fence on board.

Unfortunately alienating the small percentage required to reach these thresholds remains a politically popular strategy.

Those not immediately taking up the intervention or wanting to ask questions about vaccines, for example, are often immediately pejoratively labelled as anti-vaxxers or selfish dummy mummies (an actual headline!).

Similar politicisation is occurring in Covid, where the infected and those in hotspots are increasingly viewed as possessing some form of moral failure.

Rather than bringing people on board, such responses can lead people to oppositional sources, as they are often the only ones offering empathy, understanding and respect.

People are more likely to be the victims of misinformation than they are the proponents or supporters of it.

Despite this, some politicians have now decided bringing the public along with them is too hard. Rather than trusting, communicating and working with the public to achieve goals, a one-way conversation has been imposed with threats for non-compliance.

Cutting off the two-way conversation is likely to erode trust, and being involved matters.

Weve heard multiple stories of parents who had no questions about vaccinating their children until they had negative experiences of provider-imposed loss of autonomy, decision-making and control during birthing in institutional settings, eroding their trust in medicine and making them question the very value of the institutions themselves.

We are likely to see a similar erosion of trust if public health interventions become something the government does to us rather than with us, which threatens compliance and sustainability of public health responses in the longer term.

Militarisation and policification of the governments response are certainly not helping, particularly in those communities who already have trust issues with those institutions.

Some of the harsher interventions are more pandemic security theatre than evidence-based public health. Rather than being told why initiatives are important, were told they just are, and that well be fined if we dont. Avoiding such discussions is counterproductive and breaks down trust.

Vaccine hesitancy studies highlight frustrations when doctors refuse to acknowledge any risks of vaccines, even when such risks are presented on product material (note: driving to the appointment is still the most dangerous part of vaccination).

Refusal to discuss particular issues and avoiding conversations erodes trust once you dont trust someone to be honest about one issue, it is likely you will wonder about other issues too. Governments need to be careful not to waste the publics trust and goodwill on harsh public health interventions that look like action, with little evidence, and even less explanation.

We shouldnt forget access issues and social determinants in this response. The back story of the person with an unvaccinated child was more likely to be related to access issues than opposition for example a single parent in precarious casual employment who cancelled the appointment because they were offered an additional shift, and couldnt make another one.

Access issues are key in the pandemic response too. Vaccinations and testing remain harder to access than they should be, one million people have been told to register with a non-existent platform or they cant enter or leave certain areas, and were seeing social supports for the most disadvantaged ramp down while the pandemic ramps up.

Compliance is not just about getting individuals to do the right thing, Its also about breaking down barriers to being able to do the right thing. We have a long way to go in this pandemic, but its going to be a lot longer if the government doesnt bring the public back as an active partner in managing its response.

We keep hearing that were all in this together, we need to see it as well.

Jon Wardle is a professor of public health at Southern Cross University

See original here:
Heavy-handed interventions from governments arent the answer to hesitancy, building trust is - The Guardian