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| Monday, June 8th, 2009 | | 1:35 pm |
Last night I arrived home from the desert. It was hard, and I am glad to be done, but I am also glad I went. I will post more in detail about it later. | | Saturday, March 28th, 2009 | | 7:19 pm |
| | Sunday, March 22nd, 2009 | | 5:19 pm |
www.microplace.comThis is a website run by people from eBay. It is a microfinance site. You make a donation, it gets passed on to a microfinancing agency in a poor country. They use your money to give small-business loans to poor people. This allows the poor people to better their lives. They pay the loan back to the agency. The agency, via MicroPlace, pays you your money back, with interest. It is simultaneously charitable giving and investment. I like this. www.kiva.org - This website also passes money on to microfinancing institutions, also via loans. However, they do not pay you back interest, and you must pay them a processing fee. | | Tuesday, March 17th, 2009 | | 11:25 am |
| | Sunday, March 1st, 2009 | | 1:20 pm |
So the newest trend in the world of EMS is firing people for blogging about patients, even when those patients aren't actually identified. So I've culled all patient-care information from my LJ today. Which is too bad, as it's probably the most interesting stuff in here for the last couple of years. | | Friday, February 20th, 2009 | | 7:08 pm |
I am signed up to take this course: http://www.boss-inc.com/0214Day.html at the end of May. It's a 14-day desert hiking & survival course. Map & compass, fire from sticks, that kind of thing. Check it out. I am looking forward to this! | | Wednesday, September 10th, 2008 | | 8:33 am |
| | Monday, July 28th, 2008 | | 10:28 am |
Saturday Claire and I went a-walking on this trail around a nearby lake. At one point we were standing on some rocks looking at a tiny waterfall, when Claire says "Jason, there is a snake behind you." So we scooted out of the way, then turned to look at the snake. It started jumping around, and we realized - it had caught a little fish, and was trying to eat it. The snake dragged the fish away from the water, and was trying to get it in his mouth. But his mouth was tiny, and he was still unsuccessful when we moved on. Claire looked his kind up on the internet later and thinks the snake probably managed to eat the thing eventually. Anyway, it was very cool. Made me wish I had a camera. | | Monday, July 7th, 2008 | | 7:38 pm |
| | Tuesday, June 24th, 2008 | | 9:42 am |
| | Sunday, June 22nd, 2008 | | 7:18 pm |
This weekend Claire & I went to the beach. We stayed at a Holiday Inn, ate Cold Stone's ice cream, and swam in the ocean. Claire also dug in the sand and collected sea-shells, while patiently suffering my incessant forays into the waves. Once this morning I got totally flipped over by a wave, in a kind of underwater cartwheel. It was great. I had much fun. | | Sunday, June 8th, 2008 | | 5:45 pm |
Today I saw a little squirrel curled up in the roots of a tree, resting. Cute. | | Friday, June 6th, 2008 | | 7:22 pm |
Here are some things I've been thinking about. None of them are medical.
1. I am big into numbering things on LJ. It's a lazy way of organizing the page. I like it.
2. Swimming: I having finally gotten fairly smooth (though not fast) with freestlyle. Now I am working on breast stroke. Today, for the first time, I swam one full lap of breast. 27 strokes for 25 yards. I will keep working on it. (As a comparison, freestyle I swim 14 strokes to 25 yards).
3. I read today an hypothesis that science has had such drastic success since the 17 and 18 hundreds not because of The Scientific Method, but due to the open-source nature of the scientific community, which allows each scientist access to all the work currently being done; whereas in the past people were limited to their own experience, or to the experience of a few people they know. I find this interesting.
4. People always talk about how animals are afraid of humans, as if humans are intrisically separated from nature. It occurs to me that animals are probably scared of people because humans are inside all the time, and have nothing to do with them. If some stranger wandered through your home, you'd probably freak out too. People that hang around animals in a given area regularly are often accepted by them, i.e. animal field researchers. The rareness of this, I think, probably has less to do with the animals than it does with how uncommon it is for humans to really spend much time with them. 5. I think I might like to take a survival or tracking course somewhere. They tend to be expensive, though. Maybe.
6. I think it might be interesting to start a cadet program at work. This would involve letting high-school-aged kids ride on the ambulance and do basic patient care activities. Educational, like. We have a lot of volunteers riding already, though. So maybe not.
My thoughts are petering out. So, fini. | | Wednesday, June 4th, 2008 | | 2:26 pm |
Here is an interesting link to do-it-yourself medicine. Be forewarned that it's an end-of-the-world type document. It's still interesting. Also contains the most morbid description of a medical procedure I've ever seen, in the childbirth section under the heading "What happens if the baby cannot be delivered?" http://www.endtimesreport.com/Survival_Medicine.pdf | | Tuesday, June 3rd, 2008 | | 7:53 pm |
Here is an old-time country doctor. His work hours are crazy. But look at the range of treatments he provides! I wish family physicians and pediatricians were more like this today. EVERYTHING gets referred to a specialist anymore. See prior rant. http://www.life.com/Life/essay/country_doctor/sec1/page1.html | | Monday, June 2nd, 2008 | | 12:22 pm |
Several things:
1. Addition to hunter-gatherer post: hunter-gatherers generally sleep 8hrs per 24 like we do, but not necessarily all at night, and not usually in one 8-hour stretch. Also, not normally alone or in pairs; large groups often sleep close together.
***Material Removed***
3. I have a crush on cute waitress at the Moonlight Pizza. This amuses Claire. ***Material Removed***
4. House fire at work last night. It was raining. People are always setting their stuff on fire in the rain. It must be a special talent.
5. I swim fairly regularly. A few times a week. Yesterday swimming went swimmingly, as I was suddenly better at several things. Outdoor pool is being overrun by summer swimmers, but lanes of indoor lap pool are still mostly available.
6. Went to court today, to testify in drunk driving case (not mine-work related). Defendant pleads guilty, so we left pretty quickly. Paid $2 to park in parking deck.
7. Lots of calls at work last night. Ate dinner at 930pm; other truck did not eat until 1045pm. Finally got to bed and stayed in bed at 130am. Up at 730 for shower and to court. Sleepy. Napped this morning after court. Will nap again soon. | | Sunday, June 1st, 2008 | | 4:11 pm |
Hunter-Gatherers
I have been reading online about hunter-gatherers lately. I happened across some articles about them, and have taken some interest in their lifestyles. Here are some interesting things I have found; most are related to activity and health: 1. I will put this one first, because if true, it is a pretty awesome feat. Supposedly, women in many hunter-gatherer societies can prevent pregnancy without external contraception. That is, if they don't want to get pregnant, they don't. I don't know if this is correct, though. The article I read cited "Silberbauer 1981," I am unfamiliar with this person.
2. Adult hunter-gatherers generally live/lived to a mean age of 72 or so, same as modern first-world people. Their life expectancy was much lower though, like around 25, due to high infant mortality. Most deaths are due to GI illness, followed by trauma and various fevers. Degenerative and related diseases like heart disease, stroke and most cancers are almost un-heard-of.
3. "Hunter-gatherer" was the original term. It later became "gatherer-hunter" as studies were published showing that plant foods dominated forager's diets. Now it's "hunter-gatherer" again, as it was noted that the gatherer-hunter studies grouped fishing and collection of insects, reptiles and etc. under gathering, and used a too-limited group of sample populations. At any rate, 90+% of these people got 50+% of their calories from meats, but a hunter-gatherer also generally had over 100 different plant foods in his or her diet (compared to today, when there are probably not 100 fresh plant foods in most grocery stores). The meat, naturally, was all lean, as there were no fat, domesticated animals around. Much was eaten raw.
4. Hunter-gatherers generally averaged a VO2max (measure of maximum oxygen consumption, i.e. maximum aerobic capacity) at levels only slightly below those of our olympic athletes. They also displayed about a 20% greater power output than us, and have been noted to be significantly more agile than us ("us" referring to settled, civilized aggriculturalists).
5. Hunter-gatherers walked many miles per day in search of food, which was good for them. Amazingly (to me, at least), many hunting groups could actually chase prey such as deer until the animal dropped from exhaustion. That's pretty astounding. Yet, overall, hunter-gatherers had much more leasure time than we do, averaging only 3-4hrs a day of work, the rest being free time. Interestingly, this refers to contemporary hunting-gathering groups, who live on lands considered unfit by aggriculturalists, indicating that they would probably work even less if they had decent land to live off of.
6. Hunter-gatherers generally have far sharper senses than hours. This refers not only to their being more attentive to their surroundings, or their tracking skills and knowledge of the natural world, but also such feats as seeing Venus in broad daylight, or accurately tracking the positions of stars visible to us only by telescope.
7. "Pure" hunter-gatherers (i.e., those who have not adopted any significant aggricultural activity) generally form small, egalitarian bands, or tribes of no more than 150. No specialized leaders or administrators. Decisions are made by consensus, and social standards are enforced through relationships, i.e. those behaving inappropriately are shunned. Men and women are generally of equal status; often there is no division of labor between the sexes (there's generally no real specialization in these societies at all, other than the natural semi-specialization that comes from some individuals simply being more talented at certain tasks than others). Rape is rare. Intraspecies violence in general is rare, and generally related to personal matters such as vendettas, as opposed to war. Children are often raised communally. As non-aggricultural societies produce no surplus, there is no concept of wealth, and food and other items are shared.
There's other stuff, but this is good for now. | | Sunday, May 25th, 2008 | | 7:37 pm |
This post is related to the previous three, but on a slightly different track. I want to talk about medical education.
First of all, in this country, the MD/DO (hereafter just MD) is the legally-enforced standard for medical care. Modern scientific medicine can only be practiced by or under the authority of an MD. MD training looks like this:
4-year bachelor's degree
4-year medical degree
3-5 year residency period (paid on-the-job training)
possibly 1-3 additional years for an optional fellowship in various subspecialties
That's at least 11 years of training to be a full-fledged, independently-functioning physician; supposedly the minimum qualification to provide medical care and supervise assistants of various sorts (which can include nurses, PAs, paramedics and others). ELEVEN YEARS to be MINIMIALLY qualified?
As an analogy, consider the following scenario:
There are some good mechanics out there, but there are also a lot of incompetent folks, self-taught folks, and just a general lack of standards. There are licensing agencies, but they're not quite universal enough. So what we're going to do is say that, to be a licensed mechanic, you're going to need a Ph.D. in automotive engineering, plus 3+ years of field experience in some automotive specialty, say drive trains or electronics, or maybe Subarus or Hondas. That's M.D., Doctor of Mechanics. Now of course, there are lots of cars out there, and such a time-intensive and expensive educational process isn't going to produce enough mechanics, so what we'll say is that you can hire folks of lower educational levels to help you out, provided they have appropriate certification or licensure; but they can only work under your supervision. If any non-M.D. is caught working on cars without appropriate oversite, they will be charged with a crime. That includes working on your own car, i.e. changing your own oil is against the law.
It's just nonsense! Yet that's exactly how American medicine is!
Here's what I want to suggest: think about all the times you've been to your family doctor, or your pediatrician, over your whole life. Unless you have some serious chronic disease, I am willing to bet that you could, with a few months of training, learn to perform 90% of their services for yourself. I would be that doctor could teach you to do a basic yearly physical in an hour. I could teach you to draw blood in ten minutes, and I bet a doctor or phlebotomist could teach you which tubes to use w/in another hour. So in two hours you could learn to do yearly physicals and bloodwork on yourself and your family and friends. (If you do have a serious chronic illness, I bet that after the first year or so of your disease you know it better than your family doctor did anyway.) I imagine that in an eight-hour day a doctor could teach you the symptoms & treatments of the most common infections, i.e. ear infections, strep throat, etc. You could learn basic stitches in an hour or two as well (you're likely to get an inexperienced medical student sewing on you in the ER anyway, so what difference does it make if you do it yourself?). Even more, what you don't know, is probably available online, or in other easily-obtainable resources.
You know what? Doctors graduating from med school know a WHOLE LOT of stuff. I've no doubt they know things about medicine the average person is clueless about. But you know what else? I bet they never think about 50% (or more!) of it again. Hey, if you're a surgeon, I bet you need to know a boatload of anatomy. But when you're a family doctor assessing for a sprained ankle, do you really need to know the name of the attachment points of the various tendons and ligaments? No. Doctors are provided with a huge amount of background information that will turn out to be irrelevant to most of their daily clinical functions.
I'm not suggesting we get rid of doctors. I'm not saying we shouldn't have medical professionals with a decade of training. I'm not suggesting we don't need them for a whole lot of stuff. Our society thrives on specialization, and having highly-educated specialists standing by to save life or limb, or "health" in general, is a great thing. What I'm suggesting is that many aspects of routine healthcare can be handled at-home by minimally educated folks.
Let me give an example from my own life: I don't know what an anaesthesiologist knows. Not even close. I would never claim that I can do what they do. But I can sedate, paralyze, anaesthetize and intubate someone. No as well. Not with as many drugs. Not with the same level of understanding. But I can do it. I learned how in an hour. I knew most of the necessary anatomy & physiology in high school, and I learned the rest in five minutes. Sometimes you need an highly-educated anaesthesiologist. Sometimes you just need a breathing tube. Similarly, I was taught to place chest tubes in an hour, learned to place ugly stitches in 15 minutes, learned how to identify and treat SVT out of a book, on my own, in 5 minutes. None of this as well as a doctor trained in those fields.
Two conclusions:
(1) Health care professionals other than MDs and DOs shouldn't need MD/DO supervision to practice, as long as they're honest with their client-patients. This is especially true of folks practicing within a given scope of practice for which they've been licensed or certified.
(2) Individuals ought to be able to see to their own health care needs to the best of their abilities. Professionals will be available if they need them and choose to use them. Making self-care illegal is a travesty. | | 7:31 pm |
This is my third post about issues in medicine. The other two just so happen to be the two previous posts. So the third issue I want to bring up consists of several factors, which together serve to over-stratify the health care professions and rob individuals at large of the freedom to control their own health care. The first issue is the total lack of carry-over between education for different medical tracks. For example - paramedic education is 2 years; nursing education (for an RN) is also 2 years; and probably about half of that material overlaps. That is one year's worth of school. Yet, in many/most states, nurses cannot challenge paramedic exams, paramedics cannot challenge nursing exams, and the vast majority of schools do not give students in one field credit for training in another. Basically, if you want to switch jobs, you have to start all over. Similarly, nurse practitioner and physician assistant training are both master's programs, meaning they require a 4-year degree. Previous health care training or experience does not count, unless it was part of your 4-year degree program. Again, in the same fashion, MD or DO (doctor of osteopathy, equivalent degree with more "homeopathic" emphasis) training requires 4 years of schooling post-bachelors. Previous health care experience is meaningless, to the extent that it isn't even particularly helpful on an application. I.e., a 22-year-old biochemistry/microbiology double major and a rockin' MCAT score will in general have a better chance of acceptance than a 30-year-old nurse with 10 years of health care experience and a good-but-not-awesome MCAT. Furthermore, there is absolutely no such thing as carryover credit. I.e., if you have a Ph.D. in anatomy, you still have to take anatomy class in med school. Not only does this take lots of extra time, it takes lots of extra money. Medical school is not cheap, and no matter how highly-educated or highly-experienced you are in related fields, you are going to pay every penny. Which brings me to the second point: money. Medicine is a racket. In particular, the American Medical Association is a racket. Let's say your dream is to be a doctor. You go to college, take your science, make good grades. You need the MCAT, which you pay the AMA a sizeable chunk of money for. When you send out your med school applications, you will not be allowed to send them straight to the programs you're interested in. You must send each one to the AMA - for a sizable per-application fee - and they will forward them on for you. You will eventually be liscensed largely through the auspices of AMA, and you will in various ways pay the AMA money for the rest of your career. If calling the AMA a racket seems to you to be over-stating the case, consider the following: Chiropractic and osteopathic medicine are, in general, poorly supported by evidence (not necessarily their efficacy, but their explanatory theories). It doesn't matter whether you agree or disagree. What matters is that the AMA thought such therapies were bunk. They tried to put them out of business. That is no longer the case because the AMA was sued FOR BEING A MONOPOLY and lost. So now they have to let other people exist. The AMA, along with a few other, comparatively minor players, commands a near-monopoly on modern scientific medicine. The worst part, however, isn't the AMA in and of itself. The AMA is just a business - other folks can still set up shop, right? But no, they can't - because it's illegal. The worst part of the monopolization of medicine is that it is legally enforced. Only licensed MDs and DOs can legally practice. This extends even to other health care professionals. Nurses, paramedics, technicians and so on, can only practice under the direction of an MD or DO. More importantly, this legal prohibition extends even to the level of individual freedom. If I have an ear infection, I am not legally permitted to purchase an antibiotic to treat myself. The information regarding symptoms and treatments is readily available, but I cannot self-treat. It's AGAINST THE LAW. Legally, I must go to a license doctor (who will charge me for care), then purchase the medication from a licensed pharmacist. This means that, for any health care need you have, the law leaves you only the following options:
(1) Pay a member of the AMA or one of a few smaller organizations for care
(2) Seek "alternative" treatments, which are generally unproven
(3) Continue to suffer Now, members of both the government and the AMA will tell you these regulations are necessary to protect the public from quacks and swindlers. Many or most of them probably believe it. The problem is that it's just not true: (1) Admittedly, right now, most people who aren't part of the "system" probably are pushing questionable or unscientific therapies. But that's only because it's illegal to provide modern scientific healthcare outside of that framework, whereas you can legally sell all the herbs, supplements and "traditional" remedies you like, evidence or no evidence. You just need a disclaimer.
(2) Which brings me to the second point: the AMA can do whatever it wants, as long as it's not a monopoly or otherwise breaking the law. But legislatures ought not be supporting the organization. Truth in advertising standards are sufficient for most all fields, and medicine is one of them. As long as you honestly appraise clients of the source of your training and methods, the law ought not prevent you from providing services that individuals ask you for. For example, if I tell you up front that I'm a paramedic, not a doctor, and you still want to offer me $5 to give you IV saline for your dehydration, that shouldn't be illegal. But it is.
(3) What consumers really need to protect them is education. I pointed out the current lack thereof in a previous post. Keeping people ignorant, then limiting their freedom to prevent them from harming themselves through ignorance, is parochialism, and is anathema to the ideals of freedom and democracy our society and government supposedly espouse. | | Saturday, May 24th, 2008 | | 10:44 am |
This is a continuation of the previous post, so read that one before this one.
The second issue I notice is a mis-use of higher eschelons of care. "Eschelon of care" is actually a military term, but it sounds pretty cool.
To set the stage for this discussion, I want everyone to think back to the family doctors of years past. If you had fever and diarrhea, or your kid fell and smacked his head, or just about anything else, your family doctor would show up with his medicine bag and deal with it. You didn't go to the hospital, basically, unless you needed surgery, or you were fixin' to die.
Now let's talk about today's medical care, again using examples from my own experience:
***Material Removed***
I think the pattern should by now be clear. Basically, if you have anything more than a routine infection, or need anything other than an antibiotic or a physical, your doctor is probably going to have you sent to the ER. What is more, they probably won't give you any care at all before the ambulance arrives, and even if they do, they probably will do it wrong. Now, there are good doctors out there, and my sample group is probably biased, since I'm only seeing the doctors who are calling 911, i.e. the ones that feel like they can't handle their own patients.
But within this large segment of the medical profession, you have MDs with 10+ years of college and residency, who do basically nothing. Physicals and prescriptions. Anything more, they refer you to the ER. And then you have ERs that want to refer anyone who's honestly sick to the ICU. It's nonsense. Family physicans and pediatricians should handle sick people, ERs should handle emergencies, and ICUs should be handling people with on-going ventilator, line or med drip care, i.e. patients in a continuing FUBARed state, or people coming out of open heart surgery or similar specialty-care situations. But that isn't how it works. Combined with peoples' general lack of medical knowledge, it ends up working out like this:
a. You have a very minor illness that will probably resolve itself, and that you can probably treat at home if it doesn't. Instead, you go to the doctor (or sometimes straight to the ER).
b. You have an actual illness that any doctor ought to be able to treat in his or her office. Instead, they send you to the ER, probably via 911 ambulance.
c. You are actually really really sick; you actually need short-term ED care. Instead, you may be admitted, possibly to the ICU.
There are various negative results from all this unnecessary upgrading of care:
1. Doctors' offices, ERs and hospital beds are always full, and it takes a long time to be seen/admitted. Similarly, ambulances are busy, so you may have to wait for one to come from farther away when you call.
2. People are paying bills for levels of care they didn't need.
What are the causes of all this unnecessary upgrading? I think there are two:
1. Incompetence; but most of the time I think it's...
2. Liability. Everybody is scared to do anything. What if something goes wrong? They will be sued out the wazoo. People are always talking about the monetary costs of health care resulting from all the lawsuits. I think people haven't yet notice that the quality of care paradoxically goes down too, simply because health care providers are afraid to treat patients to the fullest of their abilities. |
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