Sunday, February 25, 2007

The IN's and OUT's of Hospital Style

While your choice of hospital shoes still says a lot about who you are, trends are moving up the body and now scrubs and accessories have started to become more fashionable. In this version of In’s & Out’s, we declare what is hot and what is not on the floors, in the OR, and beyond.


racingstripesscrubs.JPG1. Racing Stripe Scrubs –
The old days of shapeless, burlap-like, draw-string scrubs are done. Taking a cue from Dr. 90210’s freakish Robert Rey who tailors his OR apparel to show off his biceps, more and more hospital staffers are customizing their scrubs. While we have not seen the Rey-esque tank-top scrubs yet, we have seen quite a bit of the snazzy scrubs with bold racing stripes down the legs. They come in all sorts of non-hospital-like colors, e.g. navy blue, dark green and even brown. They also come in male and female varieties and unlike their predecessors, are able to highlight those hospital workers with nice features.

2, Low-rise Scrubs (a.k.a. Hipsters) – Following the trends from the denim world, now you can see your favorite nurse or doc’s coin slot with the evolution of low-rise scrub pants. Points to the RN’s and MD’s who can find low-rise scrub pants with racing stripes.

mules.jpg3. Schlogs –
They’re part shoe, part clog. When you see them from the front, you might think that they’re standard leather shoes of the Ecco variety but pull up that scrub leg and they are backless with a cushiony insole. Oooh la la, comfort and style. More impressively, these shoes have actually done the rare cross-over as both surgeons and medicinites are donning the schlogs.


1. Crocs – Here’s a tip: when it crosses over into the general public, it is no longer cool (see: red leathercrocs.jpg Dansko clogs circa ’01). Hence, as soon as 7-year-old boys were skipping around in crocs, they no longer were considered cool hospital footwear. They’re done.

2. iPod –
This is one of those rare fads that was out as soon as it was in - sorta like neck tattoos. It seems to be most popular amongst the interns, particularly the prelims and transitionals who may be using it as a subtle ‘F--- You’ to their seniors. We love gadgets as much as the next guy but do you really need to listen to music while you change that wound dressing or write orders? If you want to demonstrate your bitterness about being low man on the totem pole, do what every other intern does - ignore pages. Huh?

3. Fanny Packs – Just a reminder: fanny packs have never been and never will be an acceptable accessory! Ever.

4. BlueTooth headset – This trend lasted all of 5 minutes and belonged exclusively to the attendings. Now that they sell the ear-gadgets at gas stations, it is definitely over. However, it has now become a simple way to identify those doctors who you would never want treating your family.

Monday, February 19, 2007

Top 5 Differential Diagnoses for Britney's Break

baldbrit.jpgDespite the appearance of physical health - at least, until she shaved her head - Britney is not well. To enlighten our writers and readers we decided to enlist the help of an Ivy League-trained clincal psychologist for this special edition of Celebrity Illness. Enjoy.

1. Substance Abuse Disorder - Addiction. That’s right, you guessed it. Like we said about so many young celebs in this article: if it smells like drugs, and looks like drugs.... it’s drugs! Coke, Meth, Crack, X, Alcohol…whatever. That’s my call.

2. Borderline Personality with Psychotic Features -
Altogether likely. Given the labile mood, strange and extreme behavior and chronic emptiness coupled and with pre-morbid narcissism, pattern of unstable relationships and shallow affect, BPD with psychotic features is definitely a contender for the diagnosis. It is almost a requirement for to be a Hollywood/performer type.

3. Psychotic Disorder NOS - Purely based on strange behavior and poor judgment, we don’t actually know if she has lost touch with reality (like hearing voices, seeing and/or smelling things, delusions). Unlikely since she is a bit old for a psychotic break..though still within the age range for women.

4. Postpartum Depression with Psychotic features -
Britney did just have a child within the past six months so we can’t totally remove it from the differential; it is unlikely because this diagnosis is usually diagnosed within the first 6 weeks postpartum…and it is kind of like she doesn’t have any children at all…so what is she depressed about? Hormones.

5. Bipolar Disorder - High on the differential because it is so hot and hip these days with the famous set. Britney’s impulsive behavior..partying (i.e. self-medicating), flying all over the country, checking in and out of rehab within a day, hyper -sexuality, shopping, irritability. True bipolar will generally see an approx 3 months manic period followed by deep depressive period for approx 9 months. So, we could be in the downward spiral anytime.

Friday, February 16, 2007

Notre Dame Head Coach Sues for Botched Bypass

Charlie Weis, head coach of the Notre Dame Fighting Irish and former Super Bowl winning offensive coordinator, testified yesterday in his lawsuit against two surgeons from prestigious Massachusetts General, who he claims were negligent following his gastric bypass surgery.

According to, the now svelte Weis said he spent more than a month in various hospitals, and following his release, had problems walking and could get around only with the help of a wheelchair or electric cart. His lawyer, Michael Mone, told the jury during opening statements Tuesday that Weis still suffers nerve damage in his legs.

How was his ambulation when he tipped the scales at 400 lbs? And his diabetes? And HTN? And obstructive sleep apnea, etc etc?

I am astonished that someone who signed a contract for $30-40 million over 10 years and is now healthy enough toWeis2.jpg walk the sidelines and handle a high-stress job like his, would sue doctors who are at the top of their field and clearly did not mean any harm.

Gastric bypass is inherently a complicated procedure and when a morbidly obese individually undergoes the surgery, this is explained to him or her. If the physicians made a erred during the surgery and corrected their error enabling him to successfully drop weight and return to coaching, what is he suing for?

Obviously, we are not privy to the details of the case but we do know he is coaching and that hey are Harvard surgeons who want the bet for their patients - especially high-profile ones like Weis.

Can the Fighting Irish fans sue Weis every time he makes a bad call or for their pitiful performance in Bowl games?

Doctors explained to Weis the risk of the surgery and he, in fact, waived a psychological assessment period so that he could be ready in time for football season. Now he is suing them?

Weis, as a head football coach, and a man who is familiar with risk-benefit analysis, whould recognize the complications inherent in such an invasive procedure - particularly in such an unhealthy individual. Big rewards can be gained form big risks - but like the deep pass and the double reverse, catastrophe can also occur. Weis is lucky that he is alive, healthier than before, and actively coaching a marquee program. And who does he have to thank for that? His team? His family?

No. His doctors.

Friday, February 02, 2007

Money for Nothing

An interesting article appeared in today’s New York Post. Turns out that the recently elected Governor Eliot Spitzer has caught on to the fact that several NY area hospitals were being paid for residents and fellows that were not actually training in the paid institution.

This is laughable to anyone who trains in a large city as hospitals are changing leadership and affiliations so frequently these days but medical education is rarely, if ever a real consideration in the transition.

Since hospitals are now run by administrators whose concern is to make money, they are much more concerned with the bottom line rather than medical education or the quality of academics at their hospital.

The Centers for Medicaid and Medicare Services (CMS) have been given the responsibility of paying hospitals for educating medical students and house staff based on the number of medical residents and doctors in training.
In New York, Spitzer and his staff discovered that for years, the state budget provided funding based on antiquated data. Through 2004, the state paid for resident-interns based on staff figures from 1981 and 1990. Does this surprise anybody?

"This [physician] education is critically important, but we're currently funding it in an excessive and irrational way that isn't directly correlated to the actual students being taught - thus costing the state exorbitant amounts of money in what amounts to general subsidies to teaching hospitals," Spitzer said.

"In fact, when we looked closer at this broken formula, we discovered that many of those dollars are going to pay for phantom residents and doctors who don't even exist. We will no longer pay for graduate medical residents who don't exist."
The problem is even more drastic then Spitzer knows. Hundreds of residency and fellowship vacancies exist in medical training each year. From esoteric heart failure fellowships to OB/GYN residency spots, ACGME-accredited spots go unfilled and there is no national database to feature them.

Instead, all of these medical training opportunities, which hospitals often get additional funding for, remain unfilled. Perhaps if training doctors were better informed of these existing training spots, they might be encouraged to apply for additional training or, training at all.

Often, medical training is the last consideration in the day-to-day running of a hospital which is ironic since so much of the care provided, particularly at large academic centers, is by those same residents, fellows and even medical students.

Thursday, February 01, 2007

Top 5 Most Annoying Hospital Noises

1. Telemetry – Beep, beep, beep, beep, Booonng! Booonng! Booonng! Annoyed yet? Multiply that times 400,000 and you have recreated the telemetry floor experience. Sitting next to alarming monitors and trying to write your notes is almost as torturous as resisting the urge to put your foot through one of them.

2. The Unanswered Phone – Will no one pick up that friggin phone? Nurses and ward clerks have developed some weird defense mechanism to a ringing phone. Not only do they lack the natural guilt that should go along with ignoring someone’s call but they almost relish the annoyance that others feel after the 9th, 10th and even 11th ring.

3. The Repeating Patient – I know, this one will not make the Top 5 Politically Correct list but at least we’re honest. Whether it is the aye-fibbers (“aye-aye-aye-aye”) or the Help-Me’s (no explanation needed), hearing a patient yell anything over and over and over again often makes you want to gauge your own eyes (or ears) out. If you’re lucky, they might throw in an inappropriate phrase occasionally to keep you on your toes.

4. Suction – Do we really need to elaborate on this one?

5. Pager – This website didn’t get its name for nothing. Go ahead and switch the beeper tone all you want, it won’t help. Even more annoying is when someone’s pager goes off in grand rounds and everyone in the room checks their pager, even if they are 100 yards away. Putting your pager on vibrate solves all of the above problems, except of course the annoyingness of being paged. We fear the day of downloadable pager tones.