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Partly Sunny and Beautiful

Forecast Fox tells me that it’s beautiful outside in San Juan Capistrano. I’ve never seen a forcast exactly like that for the city of Blitzburgh, (as awesome as it is).

Sigh. The older I get, the more I like California.

The Collapse of Primary Care

“Medicare will pay tens of thousands of dollars … for a limb amputation on a diabetic patient, but virtually nothing to the primary care physician for keeping the patient’s diabetes under control,” said Bob Doherty, senior vice president for the ACP.

The article doesn’t comment on the fact that many patients end up in the emergency room for primary care visits, even those patients who have a doctor and insurance because doctors schedules are so packed that they have no room left for urgent visits.

When your loved one needs true emergency care for a heart attack, stroke, anaphylactic shock or severe asthma, do you want your emergency physician backlogged with colds and rashes or would you rather have them in the room with the truly emergent patients?

Juicy Fruit Man

Remember the Juicy Fruit man? Well I saw him again. That makes twice that I’ve seen alcoholic ketoacidosis in my career. I’m getting better at diagnosing it, but of course it helped that I knew his previous diagnosis! This time the juicy fruit smell was cheaply blended with a strong odor of ETOH. Ethanolism has a nice ring to it, a little more sophisticated than just plain drunk. Maybe I should just put juicy-fruitism on his admission papers from now on. Or esterism…after all, isn’t that what the sweet smell is from, the esters giving off a fruity smell? Maybe I should review my organic chemistry in my free time.

I can’t imagine…

…being the parent of a teenage son and being told he needs to be seen by a neurosurgeon. Mom’s initial comment to the triage nurse was that he’d had an inoperable brain tumor. After some investigating, and talking to the father, it turns out that he had a condition that didn’t NEED an operation…he had a cyst that needed to be drained. There is a big difference between an inoperable tumor and a drainable cyst. Anyway, he had a headache. A really, really bad headache. His scan suggested an aneurismal bleed, so I transferred him to the specialty hospital where his neurosurgeon was. I felt bad for the kid, he was crying, not because he was in pain, but because he was frightened by the whole situation.