Haven’t had much to blog about lately but the events in Boston yesterday have stirred me.
Of course the first thing you think of when you see those horrifying images of people who lost limbs is the overwhelming sadness and disgust with the event itself. However, as an ER doctor, I immediately start thinking about what it would be like to be working at a hospital nearby (Like the Brigham). How many really badly injured patients did they get? How many people were working. How in the Hell would I handle that huge bolus of unstable patients were I there?
But then I remember that when the shit REALLY hits the fan like in this circumstance, everyone goes from a whiny, grumbling, complaining about everything (drug seekers, bogus pts, etc) mode into superhuman mode. The adrenaline surge takes over, your mind becomes razor sharp, and you become a machine. You work harder than ever without a break and you don’t even think about it. You become more efficient than usual and your skills increase. You are at your best when you are needed most. You put that fire out.
Just like after that tragedy in Joplin,MO after that tornado that nearly destroyed a hospital, I look forward to hearing stories from the ER staff and other firsthand accounts from EMS and Police. I’m sure they’ll be impressive. I’ll wonder how I could ever do something like that but then I remember that they would be thinking the same thing were they the ones reading the stories. The worst does indeed tend to bring out our best.

So, we all love to refer chronic backpaineurs to ortho or neuro or pain management or whomever for epidural steroid injections for sciatica.  It offers people something besides pain meds and boring physical therapy but not so radical as surgery.  We’d love to believe that they work and help people – ideally keeping them out of the ER for their chronic problem.  The providers that do them also love to believe that they work – pts would be happy and the money they make from doing a relatively simple and safe procedure (the exception is the risk of fungal meningitis due to contamination of the drug) is awesome!   Of course that financial motivation is going to drive doing the procedure.

Now a pretty big study out of the Annals of Internal Medicine shows that in all likelihood, these injections don’t work.   They may provide short term relief but offer no significant long term benefit.  Now, some providers might like this since it means they can do repeat injections on patients when the first one wears off but I don’t see it that way.   I see the whole thing as a big scam.  And let me tell you, many doctors out there are in on this sort of thing.  All the money in medicine these days is on procedures so everyone wants a piece of this pie.  You make diddly squat using your brain in medicine and all in using your hands.  Human nature cannot avoid this lure so doctors do procedures – often of unclear or unproven benefit to patients who are often desperate for relief from their problem – be it chronic back pain or prostate cancer or whatever.  Insurance companies are pressured to cover these things and when docs all opt to be out of network, the company pays them BIG TIME  – often ridiculous amounts. Payments of near 100K for a routine, non-emergent multilevel back surgery are not uncommon.  Of course an injection pays much less but it’s simple!  It takes three seconds!  Do 20 of them in a day and CHA-CHING!

Until we change the way we reimburse for medical services and start to value the brain as much as the hands, this will never stop. We’ll just move on to the next cash cow.

It was with a sense of dread combined with admiration that I read THIS article about how the ER staff at a hospital in Aurora, CO handled over 20 gunshot victims in the middle of the night.
I love the bit where some of the morning shift staff come in and, not realizing what it happened, say “how was the night?”