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Old 09-13-2007, 11:44 AM   #21
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Man, I would rather have pain killers than antibiotics over the counter. Can you imagine how much faster antibiotic resistance would grow?
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Old 09-13-2007, 12:10 PM   #22
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Quote:
Originally Posted by teejayevans View Post
I went to a urgent care facility because I had an infection from bug bite,
we spent 2 minutes on the bite, 28 minutes on golf. I'm guessing I paid
for 1/2 hour consultation. If antibiotics were over the counter, I could
have saved $125.
TJ
sounds familiar. I had some nasty bites that I couldn't identify. Was on a bike trip to Sturgis, so I went to the clinic. The doc was sure they were scabies, but a test showed they were not. He finally diagnosed "topical skin irritation." Gee--that sounds a lot like "I don't know." Prescribed cortisal creme--which helped the itching. The fee for the visit wasn't bad--$80. Except that all it really represented was a finders fee for the creme since I got no diagnosis.

My wife finally made the diagnosis--chiggers. She's a doctor, but a PhD in education. But thanks to the internet and some online photos, the symptoms and pattern were a dead match.

The confusing thing is that I had been to central Oregon and Southern Idaho at the time the bites occurred. This was fairly far north for chiggers, and probably a South Dakota doc wasn't familiar with them. Guess the little buggers are moving north.
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Old 09-13-2007, 09:00 PM   #23
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Man, I would rather have pain killers than antibiotics over the counter. Can you imagine how much faster antibiotic resistance would grow?
With prescription narcotics the fastest growing drugs of abuse I don't see OTC pain killers in our future.

DD
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Old 09-13-2007, 10:20 PM   #24
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With prescription narcotics the fastest growing drugs of abuse I don't see OTC pain killers in our future.

DD
Your reference, doctor?
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Old 09-13-2007, 10:22 PM   #25
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Some people seem to think that antibiotics are basically all one drug with a few variations on the theme. Not so. Some are very focused in their action (only affect one category of bacteria) while others are very "broad spectrum." Some have potentially fatal side effects while others are extremely safe in nonallergic patients. The wrong antibiotic creates risks of resistant infections without benefit.

Already we are fighting drug resistant germs I would no have dreamed of decades ago. I see lots of patients with no white cells and blood stream infections; it can be very challenging as the race for new drugs loses ground to the emergence of multiple drug resistance.

And some people feel that "colds" need antibiotics (they don't and are viral not bacterial) but even antiviral drugs, spawned by AIDS, are beginning to create drug resistent viruses.

I shudder when I see them available in other countries like Mexico, and am glad they are controlled here. More generics would be nice.
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Old 09-13-2007, 10:47 PM   #26
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Here is an interesting article from the Medical Journal of Australia about change in demographic of doctors and nurses and their transition to retirement. eMJA: Baby boomer doctors and nurses: demographic change and transitions to retirement
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Old 09-13-2007, 11:20 PM   #27
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Here is an interesting article from the Medical Journal of Australia about change in demographic of doctors and nurses and their transition to retirement. eMJA: Baby boomer doctors and nurses: demographic change and transitions to retirement
Excellent article, thank you Spanky. The situation in Australia mirrors that in north America. Baby boomer nurses in particular are leaving the profession just as the wave of baby boomers needs more health care. Expect nurses' earnings to rise with demand over the next few decades. And many different models of care will be explored.
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Old 09-14-2007, 11:23 AM   #28
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With prescription narcotics the fastest growing drugs of abuse I don't see OTC pain killers in our future.

DD
I don't either. I said it more for emphasis than as a desire for easy to get oxycodone.
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Old 09-14-2007, 11:32 AM   #29
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Originally Posted by bosco View Post

My wife finally made the diagnosis--chiggers. She's a doctor, but a PhD in education. But thanks to the internet and some online photos, the symptoms and pattern were a dead match.

The confusing thing is that I had been to central Oregon and Southern Idaho at the time the bites occurred. This was fairly far north for chiggers, and probably a South Dakota doc wasn't familiar with them. Guess the little buggers are moving north.
Yep. It's all those folks who head south for the winter and haul back all sorts of hitchhikers when they return home. Seen any scorpions?
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Old 09-14-2007, 11:38 AM   #30
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My experience with doctors here in the US is that a large portion of them are "large hat, no cattle".
Same goes for many other professionals in private practice, e.g. dentists, lawyers and accountants. One would think the latter profession in particular would know better, but no ...

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Old 09-14-2007, 11:52 AM   #31
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Yep. It's all those folks who head south for the winter and haul back all sorts of hitchhikers when they return home. Seen any scorpions?
fortunately, chigger larvae die from human blood.

Didn't see any scorpions. But I figured John Day Oregon and Twin Falls Idaho weren't very far 'south.' Guess I need to revise my sense of geography :confused:
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Old 09-14-2007, 03:59 PM   #32
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I don't either. I said it more for emphasis than as a desire for easy to get oxycodone.

Perhaps one of the physician-members would like to comment on the substantial undertreatment of pain here in the USA.

And listen to Dr. Rich's advice on antibiotic abuse. He's giving sage advice. If you have not yet, you will soon hear stories about MRSA or their flesh-eating step cousins.

Probably getting off-topic for an ER forum, but then again, no.
Most of us would prefer to retire both pain-free and alive.

B. the U.
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Old 09-14-2007, 10:14 PM   #33
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Your reference, doctor?
Heres some numbers for you. I also see it daily in my practice...

Reuters Health

Thursday, September 6, 2007


WASHINGTON (Reuters) - More young U.S. adults are abusing prescription medications, particularly painkillers, according to the government's annual report on substance abuse released on Thursday.
Overall, in 2006, 22.6 million people -- 9.2 percent of Americans ages 12 and up -- either abused or were addicted to drugs or alcohol in the prior year, according to estimates in the report from the U.S. Substance Abuse and Mental Health Services Administration.
That is up slightly from an estimated 22.2 million people, or 9.1 percent of the population, in last year's report.
The 2006 report found that non-medical use of prescription drugs, mostly pain relievers, among young adults increased from 5.4 percent in 2002 to 6.4 percent in 2006.
"The abuse of prescription drugs for non-medical reasons is of increasing concern," agency chief Terry Cline said in a statement.
"These are potent drugs that can have serious and life-threatening consequences if misused. Parents in particular need to be aware of this problem and take steps to prevent these medications from falling into the wrong hands," Cline added.
The agency said 3.2 million Americans were dependent on or abused both alcohol and illicit drugs and 3.8 million were dependent on or abused illicit drugs but not alcohol.
Another 15.6 million were dependent on or abused alcohol but not illicit drugs, the agency added.
The report showed that fewer adolescents ages 12 to 17 said they had used illicit drugs in the prior month -- the rate dropped from 11.6 percent in 2002 to 9.9 percent in 2005 and 9.8 percent in 2006.
Current marijuana use among those ages 12 to 17 dropped from 8.2 percent in 2002 to 6.7 percent in 2006, with the decline seen particularly among boys, according to the report.
The agency also found that the level of under-age drinking among those ages 12 to 20 remained unchanged since 2002, at 28.3 percent in 2006. The legal age for drinking alcohol in the United States is generally 21.
The findings were based on responses given by about 67,500 people to a government survey.

Reuters Health

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Old 09-14-2007, 10:22 PM   #34
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Back to the OP I have an interesting anecdote. One of my colleagues, who seemed to be getting his financial ducks in a row listening to Dave Ramsey DVD's, considering downsizing his house etc, bought himself a new iphone today. I guess he is still living the dream...

DD
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Old 09-15-2007, 07:34 AM   #35
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After the burst of the dotcom bubble, a surgeon of my acquaintance who makes at least $500K annually began to ramp up his surgery slates at the expense of aftercare of his patients. His operating income was insufficient to meet his (extravagant) needs wants. His sloppy practices led to complaints and disciplinary action with his professional licencing body and his healthcare organization. This is not medical professionalism.
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Old 09-15-2007, 11:24 AM   #36
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... to ramp up his surgery slates at the expense of aftercare of his patients.
I understand the dictionary definitions of the words, but what exactly does this phrase mean? What does a doctor do to get accused of this behavior?
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Old 09-15-2007, 11:27 AM   #37
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Back to the OP I have an interesting anecdote. One of my colleagues, who seemed to be getting his financial ducks in a row listening to Dave Ramsey DVD's, considering downsizing his house etc, bought himself a new iphone today. I guess he is still living the dream...

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He saved $200.00!

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Old 09-15-2007, 03:58 PM   #38
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I understand the dictionary definitions of the words, but what exactly does this phrase mean? What does a doctor do to get accused of this behavior?
Rushing patients through the office, inadequately documenting their procedures, failing to visit them post op, not being available when paged, dumping on his residents, being discourteous to patients and team members......thought he could get away with it because of superb technical skills in short supply (NOT!)
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Old 09-16-2007, 11:04 AM   #39
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Unfortunately the system is set up to promote this. Procedural medicine such as surgery is highly compensated for the procedures, not for post-op care or office visits. A surgeon would make significantly more money if they spent each and every day in the operating room and never saw a patient in clinic either before or after the surgery...

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Old 09-16-2007, 11:17 AM   #40
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Unfortunately the system is set up to promote this. Procedural medicine such as surgery is highly compensated for the procedures, not for post-op care or office visits. A surgeon would make significantly more money if they spent each and every day in the operating room and never saw a patient in clinic either before or after the surgery...
Yes, a common lament at the lunch table. If I spend 45 minutes with a diabetic discussing lifestyle, adjusting insulin, detecting small problems that can easily become big (a small sore on the foot; a subtle vision complaint, selectively doing a cardiac stress test, etc.) on a good day I may get reimbursed $200 gross (forget expenses). If my ophthalmologist buddy down the hall does a 45 minute cataract extraction she may get reimbursed $2000. My services extent good quality life by a few years. Hers do the same for vision.

Both are valuable services, I believe. Still, I have made a good living and had a fulfilling career. But as we face health care reimbursement issues, these discrepancies probably will need to be addressed.
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