“The Nurse Will See You Now” (but you won’t know it’s a nurse!) – Internecine Warfare in Anesthesia

 

Introductory note on language: In the US, an anesthesiologist is a physician, an M.D. with 4 or more years specialty training in the field after completion of medical school; with rare exceptions, all are board certified by rigorous examination by the American Board of Anesthesiology. An anesthetist is a nurse, a C.R.N.A. (certified registered nurse anesthetist). New graduates have a BSN (bachelor of science nursing and a MSN (master of science nursing); a total of six years of schooling plus one year working in ICU,  for a total of 7 years. A significant number still practicing have neither degree, but are ‘grandfathered’ under the less rigorous former standard. Not so in the United Kingdom, where ‘anaesthetist’ generically  describes whoever is administering ‘anaesthesia.’ Until recently, as far as I know, anesthesia was administered only by physicians in the UK, but the “anesthesia care team” (more below, and likely the best) model has been introduced and is growing in prevalence in order to extend physician manpower.... [Read More]

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This Week’s Book Review – I’m Dr. Red Duke

I write a weekly book review for the Daily News of Galveston County. (It is not the biggest daily newspaper in Texas, but it is the oldest.) My review normally appears Wednesdays. When it appears, I post the review here on the following Sunday.... [Read More]

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Saturday Night Science: Bad Blood

“Bad Blood” by John CarreyrouThe drawing of blood for laboratory tests is one of my least favourite parts of a routine visit to the doctor’s office. Now, I have no fear of needles and hardly notice the stick, but frequently the doctor’s assistant who draws the blood (whom I’ve nicknamed Vampira) has difficulty finding the vein to get a good flow and has to try several times. On one occasion she made an internal puncture which resulted in a huge, ugly bruise that looked like I’d slammed a car door on my arm. I wondered why they need so much blood, and why draw it into so many different containers? (Eventually, I researched this, having been intrigued by the issue during the O. J. Simpson trial; if you’re curious, here is the information.) Then, after the blood is drawn, it has to be sent off to the laboratory, which sends back the results days later. If something pops up in the test results, you have to go back for a second visit with the doctor to discuss it.

Wouldn’t it be great if they could just stick a fingertip and draw a drop or two of blood, as is done by diabetics to test blood sugar, then run all the tests on it? Further, imagine if, after taking the drop of blood, it could be put into a desktop machine right in the doctor’s office which would, in a matter of minutes, produce test results you could discuss immediately with the doctor. And if such a technology existed and followed the history of decline in price with increase in volume which has characterised other high technology products since the 1970s, it might be possible to deploy the machines into the homes of patients being treated with medications so their effects could be monitored and relayed directly to their physicians in case an anomaly was detected. It wouldn’t quite be a Star Trek medical tricorder, but it would be one step closer. With the cost of medical care rising steeply, automating diagnostic blood tests and bringing them to the mass market seemed an excellent candidate as the “next big thing” for Silicon Valley to revolutionise.... [Read More]

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TOTD 2018-06-08: An End to Downs Syndrome?

I understand the concern about the increase in abortion of Downs Syndrome fetuses. That clearly has all kinds of ethical problems, and opens a giant can of worms – what genetic abnormalities get the axe?  That’s not what I am talking about here.  This is about something different. Continue reading “TOTD 2018-06-08: An End to Downs Syndrome?”

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