Drug Shortages

  These drug shortages are seriously affecting patient care for me. It's criminal. There's a good summary of why it's going on here. In 2005 there were 61 drug shortages, in 2011 there were 267 and the list is growing. These aren't obscure drugs that rarely get used. They are common drugs that we use all the time. That we need to use all the time. dilaudid, fentanyl, morphine, midazolam, diazepam, lorazepam, propofol (really?), ondansetron, promethazine, succinylcholine, rocuronium, heparin (!), lidocaine, labetalol, hydralazine, norepinepherine (there are only a few pressors and this is the one we most commonly use!), to name a few. The hospital keeps on telling us to use less of them, but for many, there just isn't a good alternative.

There are a lot of possible reasons why this is happening. With few or, often, one company manufacturing many of these drugs, any production delay, violation of regulations, shipping problems, etc. can lead to a shortage. Being more cynical, I would say a major factor is that these generic medications have no money in them. However, with drug shortages, semi-legal middle-men hoard them, then sell them to hospitals at outrageous costs (up to 800-1000% mark up in price). For example, here's what happened with erythromycin ointment (used in babies!): "All of a sudden, it went short with no notice," Culligan said. "We were able to scramble and secure our supply." Not all hospitals were so lucky; the drug was off the market for a few months. "When it came [back to market], it went from 50 cents to $8 a tube."

 It hurts patient care tremendously and hospitals are forced to buy these drugs from (essentially) the black market. Especially because "manufacturers either routinely don't provide any notice of an impending drug shortage or provide little advance notice and no estimate of the projected duration." (because I'm sure they want it to last forever).

It is inhumane and it is criminal. The FDA is trying to go after them, but they have limited authority and I'm sure they'll get nowhere. They are merely "asking them to increase production, if possible [pretty please], in order to prevent or reduce the impact of a shortage." Our healthcare system is broken in many ways, but this is something that the government needs to take care of quickly. There's are many reasons why we lag behind the rest of the world in health care measures despite having access to the most advanced care in the world and greed from pharmaceutical manufacturers should not be one of them.

Unnecessary medical procedures

There are international laws against unnecessary medical procedures, but the nuts who run this country are trying to push for exactly that in many states to try to punish women who get abortions. The latest is Virginia who is about to pass a law requiring women to get pre-abortion ultrasounds. It's all to provide just another hurdle for women to go through to have a legal medical procedure. It makes it more difficult and more expensive for women. The heartless idiots who propose such bills, like State Sen. Jill Vogel, lie through their teeth and say things like:

"I view this as a serious women's health issue," Vogel said on her website. "At a minimum, ultrasound is necessary to determine gestational age and that there is no anomaly that could affect the health of the mother or outcome of the procedure."

First of all, State Sen. Jill Vogel... you're not a doctor, so you have no qualifications to make such a statement. Can you tell me what possible anomalies you're looking for? Second, you're lying, plain and simple. You want women to go through this unnecessary medical procedure because you want to make it difficult for women to get abortions, or at best you think that seeing their baby on ultrasound will get women to change their minds.

A second bill that will sail through Virginia's mentally challenged legislation is even more heartless. State Del. Mark Cole "would eliminate that financial support even when a doctor believes an unborn child would be born with a gross and totally incapacitating physical deformity or mental deficiency." This goes beyond just pro-life and pro-choice. People supporting this bill, which constitute a majority of Virginia's house and senate, are just plain psychopaths. I just don't see it any other way. The only thing such a bill results in is to force the mother to go through hell and force the baby to live a few miserable hours to weeks in excruciating pain or discomfort.

Just when I don't think the right can stoop any lower, they keep on proving me wrong.

The only thing Virginia has going for it is State Sen. Janel Howell who "tried to amend it so men seeking prescriptions for erectile dysfunction medication such as Viagra would be required to undergo a rectal exam and cardiac stress test."


She said that's "only fair, that if we're going to subject women to unnecessary procedures, and we're going to subject doctors to having to do things that they don't think is medically advisory."
 

 (might I suggest transrectal ultrasounds before prescribing ED drugs?)

Of course, as expected, right-winged psychopaths voted it down.

As someone who will have to read ultrasounds in the near future, I would rather give up my career than be forced to interpret the results of an unnecessary medical procedure that the government forces onto it's citizens.

This is why I don't like religion and everyday business mixing

Jessica Ahlquist is a teenager who fought against blatant display of religion in her public school. She won, with the court finding those displays unconstitutional (it's sad that you even have to take someone to court about something as clear cut as that). Now, her community is treating her like a second class citizen. Freedom From Religion Foundation wanted to send her flowers and not one of the four florists in Cranston, RI wanted to deliver to her. Somehow your religious views make it ok for you to not do your job (and discriminate against others). These 4 florists have been added to the list: Twins Florist, Floral Express, Flowers by Santilli and Greenwood Flower.

Asshole doctors: Less common, but still around

I am on a surgery rotation now and one attending I work with is a complete asshole. Now, surgeons are suppose to have a reputation of being assholes, but after a rather benign surgery experience in medical school (the worst I got was just not being acknowledged), I thought it was a thing of the past. For the most part, it is. However, there are still some physicians around who still perfectly fit the arrogant asshole stereotype.

Despite having gone through medical school, I do not know the intricacies of the types of prostheses or the indications for these types of prostheses. When an attending hears that I am not familiar with those types of equipment, they could respond in one of four ways: 1) Teach me the differences, 2) Direct me to someone who could teach me, 3) just tell me what to order, or 4) Sigh, yell at me for not understanding him, ask where I went to med school and why they didn't teach me that particular fact. Guess which one I got today.

At some point in the past, that type of response was the norm. I suppose it was somewhat of an effective way of teaching. It scarred residents enough to force them to remember it. Today, though, with the hospital working more like a system of individuals, each with their own expertise and responsibilities, rather than a boss that (thinks he) knows everything and his underlings. Today, people don't take to kindly to being treated like an underling. The nurses, physician assistants and administrative people who work with this physician just plain don't work as hard or as effectively because this guy is an asshole to everyone. To me, it doesn't really matter. I ignored most of what he said because I'll be leaving this hospital and won't be seeing him ever again. If I were to see him again though (perhaps as a radiologist), I'm not sure I'd go out of my way to make his life any easier (I just might do the opposite, as long as it doesn't harm patient care). If you're arrogant or an asshole in a hospital, it doesn't matter how experienced, educated or well-qualified you are, your co-workers that you depend on will make your life much, much harder.

Open discrimination

Another one to add to the list. This hotel freely discriminates against those that don't believe the owner's religious beliefs. Richard Dawkins' reservation was canceled once the owner saw him on The O'Reilly Factor. Actually, if I include all companies that have owners that watch The O'Reilly Factor, it would probably be a perfectly accurate list of religion-laced businesses that I would want to keep my money away from.

General medicine is generally frustrating

Not because the medical decision making is difficult or the patients are a mystery. It's more that I spend most of the day doing work that really shouldn't be part of my job description. A typical medical admission is like this:

1. The ER or outside hospital has already diagnosed the patient, my job is to put in the basic orders to get them admitted and write a summary of what brought them in. Then, whether they came in with a diagnosis or not, consult a specialist and wait for their recommendations.

2. Fix their electrolytes, heart rate and maybe start them on some broad antibiotics while waiting for the specialist to see them.

3. Specialist sees them, gives recommendations, and I put in the recommendations into the computer system.

4. Wait for the patient to get better or wait for the specialist to tell me they can be discharged.

5. Figure out where they're being discharged to. Call medical offices to make them appointments. Call nursing homes, long-term care facilities to see if they'll take them.

6. Summarize everything that happened to the patient during their hospitalization.

Every once in a while, I feel somewhat like a doctor when I am answering patient's questions.

All important things, but, as you could see, there is very little actual medical decision making. It's very rare that I am reading up on various medical conditions and thinking about what tests to perform to figure out what's wrong with my patient.

Oh well. Glad I won't be doing that for the rest of my life.

You are what you eat

Blood just drawn from a patient with pretty extreme hypertriglyceridemia with triglycerides of near 10,000. There's more fat than blood in this patient's veins.