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I received the following posting, and have absolutely no idea what is being
discussed. No idea as to who is responding to whom about what.

Obviously, some colleagues have been discussing something, (I have no idea)
and then I receive the following message: I have not deleted anything.
Please see if you can make sense of it, and tell me what I shoud do with my
browser in order to understand what is happening.
cheers
chris gianoou

2009/5/8 <trauma-list-request at trauma.org>

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> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of trauma-list digest..."
>
> Today's Topics:
>
>   1. RE: trauma-list Digest, Vol 71, Issue 12-Doc Holiday (Doc Holiday)
>   2. Re: trauma-list Digest, Vol 71, Issue 12-Doc Holiday
>      (Andr? de Castro Carneiro)
>   3. Doctors vs. Pilots (Doc Holiday)
>   4. Re: Doctors vs. Pilots (Charlene M Morris)
>   5. Re: Doctors vs. Pilots (Andr? de Castro Carneiro)
>   6. Re: Doctors vs. Pilots (Rangraj Setlur)
>   7. RE: Doctors vs. Pilots (Doc Holiday)
>   8. Re: Doctors vs. Pilots (Krin135 at aol.com)
>   9. Re: Doctors vs. Pilots (Krin135 at aol.com)
>  10. Re: Doctors vs. Pilots (Andre Carneiro)
>  11. Re: Doctors vs. Pilots (Jedidiah Peterson)
>  12. RE: ketamine drip (Joe Nemeth, Mr)
>  13. Re: ketamine drip (jduchesn at tulane.edu)
>  14. Re: ketamine drip (CyBerg66 at aol.com)
>  15. Re: Doctors vs. Pilots (Stephen Richey)
>  16. Re: Sleep deprived Critical Care? (William Bromberg)
>  17. Re: Doctors vs. Pilots (CyBerg66 at aol.com)
>
>
> ---------- Forwarded message ----------
> From: Doc Holiday <drydok at hotmail.com>
> To: ".Trauma List" <trauma-list at trauma.org>
> Date: Fri, 8 May 2009 16:53:35 +0000
> Subject: RE: trauma-list Digest, Vol 71, Issue 12-Doc Holiday
>
> From: Tidewater001 (tidewater001 at aol.com)
> > my TYPICAL day of seeing patients in the office... e-mails at 2145...my
> day started at 0600. Typical day for me and I enjoyed most all of it
>
>
>
> --> Just goes to show how specialties differ and how we may need to train
> differently - even in the number of hours...
>
> You've described 16 hours of work!
> I do that as well, but it takes me TWO days ;-)
>
>
>
> In my department we don't tend to work more than 8hrs at a time. Emergency
> Medicine and other specialties may well not require the same length of week
> or shift - some types of medicine are more suited to fragmented working...
>
>
>
> BTW, we already know that different specialties take different number of
> years to train, so why not different lengths of week? What we need is a
> decent analysis BY DOCTORS of what it takes to train someone to do
> something.
>
>
>
> We also need to AVOID GENERATING THE EXPECTATION that a certain level of
> competence will be achieved in a programme of X years of Y weeks each. I
> honestly believe that the same bell curve applies to the number of years it
> should take to get doctors to a "graduate" level from their
> residency/training. Think about it - if 99% of trainees of a certain
> specialty take EXACTLY a certain number of years to finish residency and if
> we assume that the average finisher is good enough, then surely some are not
> good enough and others could have been good enough some months earlier!
>
>
>
> > ...patient comes first and last and really does not care if you are tired
> when they are the ones in need of your help!!
>
>
>
> --> I believe you will find that patients would prefer, if offered the
> choice, a surgeon who is not tired.
>
> Again, I fully agree that it is WRONG to simply reduce the hours to 80 or
> 48 or whatever and do nothing else to compensate for this. But this does not
> mean that the only way to provide a decent level of care is to work 120
> hours a week, or else 130 would be better!
>
>
>
> We need to find ways to reduce the hours without reducing the training or
> care!
>
>
>
> From: Gross, Ronald (Ronald.Gross at baystatehealth.org)
> > please show the rest of us that there are or will be any less "victims of
> Substance abuse, broken marriages and even suicide or mental illness"...
>
>
>
> --> Good point, actually.
> Reducing the numbers of hours, in itself, will not likely solve these
> problems sufficiently, although it will likely reduce it significantly. Not
> that it will be simple to produce evidence of this...
>
>
>
> From: André de Castro Carneiro (a.carneiro at enflurane.com)
> >... interested in knowing on what evidence you base your assumption that
> more hours equals better training
>
>
>
> --> He did not assume this.
> He stated his belief that merely reducing hours (i.e. without compensating
> for this in some way) will likely affect training negatively.
>
>
>
> I work only a couple of hours South of Leeds and I can introduce you to
> many senior surgeons as well as MANY TRAINEES/Registrars who would agree
> with him on this point, as do I.
>
>
>
> If you are looking for evidence, perhaps you could run a study to monitor
> the opinions of this among senior surgeons.
>
>
>
> Do YOU not agree that a simple reduction in hours, by itself, may well
> reduce not only tiredness?
>
>
>
> > The works based on the Airline industry have given us plenty of evidence
> that human behaviour is a core component of error (with or without fatal
> consequences) and as such has looked deeply at human factors suchs as
> exhaustion for a LONG time.
>
>
>
> --> Arrrrgggghhhh!
> Not the airline comparison again!!!
>
>
>
> If I were a bus driver then maybe I'd be interested in what airlines do,
> but I am NOT.
>
>
>
> > We like to feel more than human. We all do...
>
>
>
> --> Believe it or not, some on this list actually like dinosaurs better ;-)
>
>
>
> > We have to reduce working hours. It's law and it's not open to
> discussion, whether we all like it or not
>
>
>
> --> The day the first person suggested that we should reduce hours, he was
> also probably told it was not open to discussion. Laws MUST remain open to
> discussion, or else what's the use of a democracy? What we need (and are
> currently doing on this list) is discussion. Hopefully, we will raise some
> more ideas of what we can do about getting the law changed or providing
> evidence that it should be, IF WE AS EXPERTS on how doctors should be
> trained, think a change is necessary.
>
>
>
> From: Gross, Ronald (Ronald.Gross at baystatehealth.org)
> > please don't call me "Dr. Gross" - it makes me feel far older than I
> wanna be
>
>
>
> --> Right...
> You might just have a problem here, if you want to feel young, but YOU call
> yourself a dinosaur ;-)
>
>
>
> > ...to err is human, I know that all to well - and when I forget, the love
> of my life will quickly remind me of that fact (thank God!)
>
>
>
> --> As I have heard said:
> To err is human,
> To point it out is woman...
> (To point it out repeatedly, without being asked, as if one is the world's
> leading expert... is mother-in-law...)
>
>
> _________________________________________________________________
> View your Twitter and Flickr updates from one place – Learn more!
> http://clk.atdmt.com/UKM/go/137984870/direct/01/
>
>
> ---------- Forwarded message ----------
> From: "André de Castro Carneiro" <a.carneiro at enflurane.com>
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> Date: Fri, 08 May 2009 18:15:00 +0100
> Subject: Re: trauma-list Digest, Vol 71, Issue 12-Doc Holiday
> I am sorry that you're so eager to dismiss important and significant
> research into human factors so quickly, just because you're "not a bus
> driver".
>
>
> Oh, and this was no comparison to the airline industry, if you read my post
> again. Merely stating that THEY have a far greater appreciation of the
> impact of human factors in performance.
>
> Now if you'll excuse me, I have a night shift to go to (ugh!)
>
>
>
>>  The works based on the Airline industry have given us plenty of evidence
>>> that human behaviour is a core component of error (with or without fatal
>>> consequences) and as such has looked deeply at human factors suchs as
>>> exhaustion for a LONG time.
>>>
>>
>>
>> --> Arrrrgggghhhh!
>> Not the airline comparison again!!!
>>
>>
>> If I were a bus driver then maybe I'd be interested in what airlines do,
>> but I am NOT.
>>
>
>
>
> ---------- Forwarded message ----------
> From: Doc Holiday <drydok at hotmail.com>
> To: ".Trauma List" <trauma-list at trauma.org>
> Date: Fri, 8 May 2009 17:23:40 +0000
> Subject: Doctors vs. Pilots
>
> The next person I hear comparing doctors and pilots will be the subject of
> much abuse. I've had enough. There are a few similarities between the two
> professions, but there are many major points which simply do not match. Here
> is how I see it:
>
>
> - Pilots do indeed endeavour to get one from A to B but, unlike doctors,
> they never have to do so when one presents already in a spiralling dive
> downwards towards Z, which began without prior warning.
>
>
> - Passengers may only board their plane if they arrive for a flight well
> before it takes off. Patients, on the other hand, often first meet their
> doctor when they are already some way on their clinical journey to
> obstructed-airway-land or peritoneal-abscess-airport...
>
>
> - Pilots and their airlines may well be relied upon to get MOST of you to
> your destination, but often some "organs" will be missing (i.e. your
> luggage) and there are many layers of protection in the way to guarantee
> that the pilots will be spared any involvement in the resulting aftermath.
> They will not even be personally informed that some of your stuff has gone
> missing, perhaps forever. And it seems that the compensation you get for
> missing luggage is limited rather more strictly than what you could expect
> should a surgeon "misplace" an organ...
>
>
> - Pilots receive their “patients” on the planned day of travel. These
> patients will have been screened and vetted by many resources (security,
> visa check, etc.) but to the ED patients present "as is".
>
> - When things begin to go wrong for pilots, they have a couple of
> colleagues seated with them, ready to assist and support them. And, even
> thus assisted, when things still go wrong, they may well end up losing
> significantly more than one patient...
>
>
> - Isn't it nice for pilots that they only have to fly one plane at a time,
> unlike, say, an EP or surgical intensivist who often has more than one
> patient on the go at one time, perhaps in different wards.
>
>
> - Take a GP/FP. He/she must "pilot" the patient through many little
> crashes, until the inevitable final one. There is no mechanism whereby
> “defective” patients can be replaced by newer models to facilitate easier
> piloting...
>
>
> - Finally, the actual proof that even pilots know the real truth of this
> ridiculous comparison: How often do doctors find themselves taking care of
> pilots with their chest pains, headaches, etc.? Pilots always see doctors
> when they need medical assistance. They know whom they can trust! There is
> no-one but us. But doctors can travel on trains, buses, ships...
> _________________________________________________________________
> View your Twitter and Flickr updates from one place – Learn more!
> http://clk.atdmt.com/UKM/go/137984870/direct/01/
>
>
> ---------- Forwarded message ----------
> From: Charlene M Morris <cvmmorris at gmail.com>
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> Date: Fri, 8 May 2009 13:31:11 -0400
> Subject: Re: Doctors vs. Pilots
> HA!! THE best tome I have read in a while.
>
> cmm
>
> On Fri, May 8, 2009 at 1:23 PM, Doc Holiday <drydok at hotmail.com> wrote:
>
> >
> > The next person I hear comparing doctors and pilots will be the subject
> of
> > much abuse. I've had enough. There are a few similarities between the two
> > professions, but there are many major points which simply do not match.
> Here
> > is how I see it:
> >
> >
> > - Pilots do indeed endeavour to get one from A to B but, unlike doctors,
> > they never have to do so when one presents already in a spiralling dive
> > downwards towards Z, which began without prior warning.
> >
> >
> > - Passengers may only board their plane if they arrive for a flight well
> > before it takes off. Patients, on the other hand, often first meet their
> > doctor when they are already some way on their clinical journey to
> > obstructed-airway-land or peritoneal-abscess-airport...
> >
> >
> > - Pilots and their airlines may well be relied upon to get MOST of you to
> > your destination, but often some "organs" will be missing (i.e. your
> > luggage) and there are many layers of protection in the way to guarantee
> > that the pilots will be spared any involvement in the resulting
> aftermath.
> > They will not even be personally informed that some of your stuff has
> gone
> > missing, perhaps forever. And it seems that the compensation you get for
> > missing luggage is limited rather more strictly than what you could
> expect
> > should a surgeon "misplace" an organ...
> >
> >
> > - Pilots receive their “patients” on the planned day of travel. These
> > patients will have been screened and vetted by many resources (security,
> > visa check, etc.) but to the ED patients present "as is".
> >
> > - When things begin to go wrong for pilots, they have a couple of
> > colleagues seated with them, ready to assist and support them. And, even
> > thus assisted, when things still go wrong, they may well end up losing
> > significantly more than one patient...
> >
> >
> > - Isn't it nice for pilots that they only have to fly one plane at a
> time,
> > unlike, say, an EP or surgical intensivist who often has more than one
> > patient on the go at one time, perhaps in different wards.
> >
> >
> > - Take a GP/FP. He/she must "pilot" the patient through many little
> > crashes, until the inevitable final one. There is no mechanism whereby
> > “defective” patients can be replaced by newer models to facilitate easier
> > piloting...
> >
> >
> > - Finally, the actual proof that even pilots know the real truth of this
> > ridiculous comparison: How often do doctors find themselves taking care
> of
> > pilots with their chest pains, headaches, etc.? Pilots always see doctors
> > when they need medical assistance. They know whom they can trust! There
> is
> > no-one but us. But doctors can travel on trains, buses, ships...
> > _________________________________________________________________
> > View your Twitter and Flickr updates from one place – Learn more!
> > http://clk.atdmt.com/UKM/go/137984870/direct/01/
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
>
>
>
> --
> The one important thing I have learned over the years is the difference
> between taking one's work seriously and taking one's self seriously. The
> first is imperative and the second is disastrous.
> Margot Fonteyn
>
>
>
> ---------- Forwarded message ----------
> From: "André de Castro Carneiro" <a.carneiro at enflurane.com>
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> Date: Fri, 08 May 2009 18:39:41 +0100
> Subject: Re: Doctors vs. Pilots
> I'm sorry that you feel aggrieved at the comparison, and I applaud you for
> coming to the defense of "The Profession", although I feel it unnecessary.
>
> But if I may make a few points:
>
> Nobody was comparing Doctors and Pilots. It's like comparing Salad with the
> Alphabet. It's a non-comparison.
>
> There are plenty of references to the Airline Industry because we as a
> group are paying more attention to Safety, which has always been championed
> by said Industry. And not by us.
>
> One of the issues that we are adressing now is Human Factors and
> Limitations. And if there is research done in that field already, then it
> makes perfect sense to refer to it instead of trying to reinvent the wheel.
>
> So go ahead, hurl as much abuse at me as you possibly can, because I can
> take it. But if there is knowledge to be pooled from the Airline Industry
> that we can apply to our own practice then it would be arrogant and stupid
> to dismiss it simply because it doesn't fit in with some people's ideal of
> greatness for "The Profession".
>
> André de Castro Carneiro
> Specialist Registrar
> Anaesthetics and Critical Care
> The Leeds Teaching Hospitals NHS Trust
>
>
>
> Doc Holiday wrote:
>
>> The next person I hear comparing doctors and pilots will be the subject of
>> much abuse. I've had enough. There are a few similarities between the two
>> professions, but there are many major points which simply do not match. Here
>> is how I see it:
>>
>>  - Pilots do indeed endeavour to get one from A to B but, unlike doctors,
>> they never have to do so when one presents already in a spiralling dive
>> downwards towards Z, which began without prior warning.
>>
>>  - Passengers may only board their plane if they arrive for a flight well
>> before it takes off. Patients, on the other hand, often first meet their
>> doctor when they are already some way on their clinical journey to
>> obstructed-airway-land or peritoneal-abscess-airport...
>>
>>  - Pilots and their airlines may well be relied upon to get MOST of you to
>> your destination, but often some "organs" will be missing (i.e. your
>> luggage) and there are many layers of protection in the way to guarantee
>> that the pilots will be spared any involvement in the resulting aftermath.
>> They will not even be personally informed that some of your stuff has gone
>> missing, perhaps forever. And it seems that the compensation you get for
>> missing luggage is limited rather more strictly than what you could expect
>> should a surgeon "misplace" an organ...
>>
>>  - Pilots receive their “patients” on the planned day of travel. These
>> patients will have been screened and vetted by many resources (security,
>> visa check, etc.) but to the ED patients present "as is".
>>  - When things begin to go wrong for pilots, they have a couple of
>> colleagues seated with them, ready to assist and support them. And, even
>> thus assisted, when things still go wrong, they may well end up losing
>> significantly more than one patient...
>>
>>  - Isn't it nice for pilots that they only have to fly one plane at a
>> time, unlike, say, an EP or surgical intensivist who often has more than one
>> patient on the go at one time, perhaps in different wards.
>>
>>  - Take a GP/FP. He/she must "pilot" the patient through many little
>> crashes, until the inevitable final one. There is no mechanism whereby
>> “defective” patients can be replaced by newer models to facilitate easier
>> piloting...
>>
>>  - Finally, the actual proof that even pilots know the real truth of this
>> ridiculous comparison: How often do doctors find themselves taking care of
>> pilots with their chest pains, headaches, etc.? Pilots always see doctors
>> when they need medical assistance. They know whom they can trust! There is
>> no-one but us. But doctors can travel on trains, buses, ships...
>> _________________________________________________________________
>> View your Twitter and Flickr updates from one place – Learn more!
>> http://clk.atdmt.com/UKM/go/137984870/direct/01/
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>
>
> ---------- Forwarded message ----------
> From: Rangraj Setlur <rangraj at gmail.com>
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> Date: Fri, 8 May 2009 22:50:23 +0500
> Subject: Re: Doctors vs. Pilots
> try this essay.biggles ,for those not familiar with childrens books of
> the commonwealth was a world war II pilot and adventurer. rangraj
>
> Biggles FRCA..................................by Mark Hearn
> If one more person tells me that giving an
> anaesthetic is like flying a plane, I will swing for
> them, I really will.
> Look. The whole point of a plane is that it is
> designed to fly, and if it´s not working properly
> then you don´t take it off the ground. Human
> beings, in contrast, are not designed to be
> anaesthetised, and are often not working properly
> when the occasion arises. They are also rather
> poorly provided with back-up systems and spares,
> and frequently have long histories of inadequate
> servicing.
> So if giving an anaesthetic is like flying a plane,
> then this must be what flying a plane is like:
> Captain James Bigglesworth DSO stepped out into
> the thin sunlight, and took a deep breath of the
> damp air. It was good to be alive. He was taking
> up a new crate today, and he relished the little knot
> of mixed tension and anticipation that always
> formed at the pit of his stomach under such
> circumstances. He strode briskly towards the
> hangar.
> The Junior Engineer was waiting next to the
> aeroplane. He handed Biggles a single sheet of
> paper, on which he had scrawled a haphazard note
> of his work on the craft. "Is this all?" asked
> Biggles. "Where is the service record?"
> "It seems to be lost. The filing department say it´s
> maybe still at the previous airfield." "and the
> manual?" The Junior Engineer looked startled. "I
> don´t think there is one. We thought you knew
> how to fly a plane." A cloud drifted slowly across
> the sunny sky of Biggles´ mind. He began his
> walk-round. "Where´s this oil coming from?"
> The Junior Engineer frowned seriously. "I don´t
> know." Biggles sighed. But he too, long ago, had
> once been a Junior Engineer. "Where do you think
> it might be coming from?"
> "The engine?" hazarded the youth.
> "Of course. So what´s the oil level in the engine?"
> "I don´t know."
> "Have you checked the oil level?" "No."
> Biggles could feel his voice becoming a little tight,
> a little cold. "So could you check it now, please?"
> "What? Now?"
> "Now." "But you´re just going to take off. The
> Chief Engineer wants you to take off right away."
> "Not without an oil level. And this undercarriage
> strut is broken. And the port aileron is jamming
> intermittently."
> At that moment, the Chief Engineer arrived.
> "Biggles, old chap! Ready to take her up? Good
> man." "She´s not remotely airworthy. I need an oil
> level and some basic repairs."
> The Chief Engineer sighed. "What do you want an
> oil level for? You know it´s going to be low.
> We´ve got to get her into the air before we can
> control the leak. And that undercarriage and
> aileron aren´t going to get any better while we
> stand here. She needs to be in flight before I can
> properly assess them. Come on, old chap - the
> tower´s given us a slot in ten minutes´ time. If we
> don´t take off then, we´ll be waiting all day." He
> eyed the plane despondently, and tapped a tyre
> with the toe of his boot. "And, frankly, I don´t
> think she´ll last much longer."
> Biggles rippled the muscles of his square jaw. The
> Bigglesworths had never balked at a challenge, but
> this ... Well, there seemed to be no way out of it.
> He was going to have to take the old crate into the
> air, just as she stood. Deuced bad luck, of course,
> but no point in whining.
> Twenty minutes later, they were aloft. The plane
> kept trying to fly in circles, and the engine
> temperature gauge was sitting firmly in the red.
> The Engineer was out on the cowling with a
> spanner.
> "Just turn her off for a bit," he bawled over the
> clattering roar of the sick engine.
> Biggles was astonished. "What?"
> "Turn off the engine. There´s nothing I can do
> about this leak until the engine´s stopped."
> Reluctantly, Biggles turned off the engine, and
> trimmed the aircraft for a shallow glide. The
> weight of the Engineer, out there on the nose, was
> not helping matters at all. Four minutes passed in
> eerie silence, as the treetops swam up to meet
> them. "I´m going to need power again soon."
> There was no response from the Engineer.
> Another thirty seconds passed. "I need power." No
> answer. "I´m turning on now." The engine roared,
> and the Engineer recoiled, cursing, in a cloud of
> black smoke.
> "What´s your game, Biggles, old man? I almost
> had the bally thing fixed, and now we´ll need to
> start all over again!"
> Biggles bit back an angry retort, and concentrated
> on guiding the crippled plane upwards. This time,
> now that he knew what was going on, they would
> start their glide from a lot higher.
> After another protracted glide, the Engineer
> clambered back into the cockpit, beaming. "All
> fixed!" Biggles tapped the oil pressure gauge.
> "Pressure´s not coming up," he said.
> "It will, it will," said the Engineer breezily. "Don´t
> be such a fusspot. Now let´s get the aileron
> sorted." He crawled out onto the wing, and began
> to strike the recalcitrant aileron with a hammer. A
> minute later, the plane rolled violently to the right.
> Biggles struggled momentarily for control, his lips
> dry. By cracky, they´d almost lost it completely,
> there.
> "Don´t do that!" he called hoarsely to the
> Engineer.
> "Do what?" "Whatever you did, just then."
> "I wasn´t doing anything, old man." Almost at
> that moment the plane lurched again, more
> fiercely, and rolled through forty-five degrees.
> "That!" screamed Biggles, fighting the controls
> for his very life. "Don´t do that!"
> "Fair enough," said the Engineer, cheerily. A
> minute later he did it again, and the plane was
> inverted for ten long seconds before a sweating
> Biggles regained any vestige of control.
> "Fixed! Undercarriage next!" called the Engineer,
> and clambered out of sight below the fuselage.
> Ten minutes later, Biggles caught brief sight of a
> set of wheels dropping away earthwards.
> "Couldn´t save `em," said the Engineer when he
> regained the cockpit. "Better off without them,
> frankly."
> "I still have very little oil pressure," said Biggles,
> worriedly. The Engineer pursed his lips and
> tapped the pressure gauge reflectively. "Well, the
> leak´s fixed, old man. Must be something about
> the way you´re flying her." He reached under his
> seat and pulled out a parachute. "Look, I´m most
> frightfully sorry about this, but the nice men from
> Sopwith are taking me out to dinner tonight, so
> I´ve got to dash. Be a brick, Biggles old fellow,
> and just put her down anywhere you like. I´ll cast
> an eye over her in the hangar tomorrow morning."
> And with that, he was gone.
>
> Biggles thought longingly of his own parachute.
> But he couldn´t abandon the old girl now. It wasn´t
> her fault, after all. Black, oily smoke was already
> billowing out of the engine cowling, however - he
> needed to put her down soon. He began to peer
> around for a flat place to land and, almost
> immediately, he spotted a distant grassy field. He
> moved the controls a little so that he could take a
> closer look.
> He flew around the field once, and it certainly
> looked flat enough. Oddly, someone had painted
> huge white letters across the level green grass -
> ICU, it read. He had no idea what that meant, but it
> seemed vaguely comforting, for some reason.
> The engine coughed once, and then stopped. He
> could see a fitful orange glow beneath the cowling.
> This rummy ICU field would just have to do, it
> seemed.
> As he swung the ailing aircraft around to make his
> final approach, he realised that the field was just a
> little too short for comfort. He licked his lips, and
> prayed that there would be enough room.
> --
> Lt Col Rangraj Setlur
> Classified Specialist-Anaesthesia and Critical Care
> India
>
>
>
> ---------- Forwarded message ----------
> From: Doc Holiday <drydok at hotmail.com>
> To: ".Trauma List" <trauma-list at trauma.org>
> Date: Fri, 8 May 2009 18:18:47 +0000
> Subject: RE: Doctors vs. Pilots
>
> From: Krin135 at aol.com
> > ...willing to work weekends, nights and on call, but want far more than
> what new grads in primary care are being offered (ca 100-120K/year, with
> limited benefits, for roughly 2000 hours in clinic/year)
>
>
>
> --> Can you elaborate further?
> Is ANY USA doctor being offered $100K a year for 2000 clinical hours
> annually?
>
> I'd be very grateful if you pointed me in the direction of adverts/articles
> which show this. It would come in handy for a major presentation I am
> writing for an international audience...
>
>
>
> From: André de Castro Carneiro (a.carneiro at enflurane.com)
>
> > airline industry...THEY have a far greater appreciation of the impact of
> human factors in performance
>
>
>
> --> That they (and other money-making businesses) have the funds to study
> and publish on performance, efficiency and human factors is accepted. But
> their INDUSTRY does have so many conveniently numerical and finite concepts
> to evaluate and plot on charts. They have components which their computers
> can trace throughout their lives and exclude out of the analysis. They have
> so many other factors which they can exclude from confounding their results.
> So they SHOULD have stuff to publish.
>
>
>
> But at the end of it all, 99.9% of the outcomes they analyse are objects
> and numerical measures, even when they do look at the effects of human
> factors on these. That's the thing with INDUSTRY - objects mean a lot to it.
> Medicine and surgery are much more about concepts one cannot measure
> accurately with numbers. So much of what we do or the pathologies we see are
> not predicted by formulae.
>
>
>
> If you have a machine, with a finite number of components which YOU have
> made and put into it. Which are in most cases in a fit condition to fly and
> proven/tested to show this. Which are placed where they are exactly as per
> plan and monitored by computers as of the instant they are installed. Which
> are given a pre-determined load to carry on a path charted with excellent
> meteorological predictions and evidence from another flight which has just
> recently crossed the same bit of sky. etc. etc. etc. THEN, perhaps, you have
> eliminated enough performance variables to allow you to get some statistical
> measure of how the human factors affect this performance. Then also you may
> be able to more easily change pilots mid-flight.
>
>
>
> In much the same way, if we had patients "built" out of pre-tested
> components, loaded mostly with pre-determined loads, allowed to perform
> within specified parameters, connected to computers and continuously
> monitored from birth right through to their current illness, etc. etc. etc.
> - THEN we could also use such patients to research the effect of changing
> surgeon training hours, without confounding variables, AND publish it...
>
>
>
> See what you've done!
>
> You've made me do the airline metaphor things again! I hate it...
>
>
>
> And, as you have probably guessed, I am basing my opinion not on ignorance
> of airline research, but on having spent much professional time in the past
> on attempting to "copy" some of their "stuff" into medicine and being paid
> to do so...
>
> _________________________________________________________________
> Share your photos with Windows Live Photos – Free.
> http://clk.atdmt.com/UKM/go/134665338/direct/01/
>
>
> ---------- Forwarded message ----------
> From: Krin135 at aol.com
> To: trauma-list at trauma.org
> Date: Fri, 8 May 2009 14:21:10 EDT
> Subject: Re: Doctors vs. Pilots
> Considering that as a group, doctors and lawyers make some of the pilots
> least likely to become 'old pilots,' there are some areas of congruence.
> One
> interesting point is that a pilot's decisions often involve significant
> risk of  his/her own life, something that most docs, outside of those who
> work
> in the Hot  Zone, don't really have to face.
>
> As a matter of full disclosure, I have spent time as a military  medical
> air crew member, and as an Aviation Medical Examiner, so I have  some
> knowledge on both sides of this coin.
>
>
> In a message dated 5/8/2009 11:24:43 Central Standard Time,
> drydok at hotmail.com writes:
>
> The next person I hear comparing doctors and pilots will be the subject  of
> much abuse. I've had enough. There are a few similarities between the two
> professions, but there are many major points which simply do not match.
> Here
>  is how I see it:
>
>
> - Pilots do indeed endeavour to get one from A to  B but, unlike doctors,
> they never have to do so when one presents already in a  spiralling dive
> downwards towards Z, which began without prior  warning.
>
>
>
> ck: no,  but when problems occur suddenly, both the pilots and physicians
> have to be  able to make cool, calculated decisions on which life and death
> rest. Flame  out over NYC and landing in the Hudson, anyone?
>
>
> - Passengers may only board their plane if they arrive for a  flight well
> before it takes off. Patients, on the other hand, often first meet  their
> doctor when they are already some way on their clinical journey to
> obstructed-airway-land or peritoneal-abscess-airport...
>
>
> ck: given, but unless you are an EP, or in isolated practice,  most
> surgical candidates will at least be evaluated  by a  team before the
> surgeon gets
> called.
>
>
> - Pilots and their airlines may well be relied upon to get MOST  of you to
> your destination, but often some "organs" will be missing (i.e. your
> luggage) and there are many layers of protection in the way to guarantee
> that  the
> pilots will be spared any involvement in the resulting aftermath. They
> will not even be personally informed that some of your stuff has gone
> missing,
> perhaps forever. And it seems that the compensation you get for missing
> luggage is limited rather more strictly than what you could expect should a
> surgeon "misplace" an organ...
>
> ck: Irrelevant. A similar argument could be made that the surgeon should
> be responsible for the accuracy of the hospital's billing system for all
> charges, not just the ones involving his/her own work.
>
>
> - Pilots  receive their “patients” on the planned day of travel. These
> patients will  have been screened and vetted by many resources (security,
> visa
> check, etc.)  but to the ED patients present "as is".
>
>
> ck: see above. the vast majority of surgery is scheduled ahead of time,
> and a team of physicians, nurses and ancillary personnel have 'vetted' the
> patient...right down to marking and signing the appropriate limb to be
> operated on.
>
>
> - When things begin to go wrong for pilots, they have a couple of
> colleagues seated with them, ready to assist and support them. And, even
> thus
> assisted, when things still go wrong, they may well end up losing
>  significantly
> more than one patient...
>
> ck: yes...here's where the pilot has a LARGER role than the surgeon- his
> life is on the line as well. As the old saw about breakfast goes...A  day's
> work for the chicken, a life changing experience for the pig... and even
>  if
> you are an EP working in a small town, isolated ED, you have a team of your
> own to assist you, if you are willing to listen to them. It would be a rare
>  surgeon to have the level of isolated responsibility that the pilot of an
> airliner in trouble has to manage.
>
>
> - Isn't it nice for pilots that  they only have to fly one plane at a time,
> unlike, say, an EP or surgical  intensivist who often has more than one
> patient on the go at one time, perhaps  in different wards.
>
> ck: ok, accepted. however, when things start to go wrong in the air,  there
> may be more than one plane involved. The ATC folks would be a better
> 'match' here for the EP or intensivist.
>
>
> - Take a GP/FP. He/she must  "pilot" the patient through many little
> crashes, until the inevitable final  one. There is no mechanism whereby
> “defective”
>  patients can be replaced by  newer models to facilitate easier piloting...
>
> ck: Some FPs also have been known to do intensive care medicine, as well
> as operative management of pregnancy, etc. Those areas are fraught with the
> possibility of more than 'little crashes.' And the 'no deposit, no return'
> clause in life is something that all of us deal with every  day.
>
>
> - Finally, the actual proof that even pilots know the real  truth of this
> ridiculous comparison: How often do doctors find themselves  taking care of
> pilots with their chest pains, headaches, etc.? Pilots always  see doctors
> when they need medical assistance. They know whom they can trust!  There is
> no-one but us. But doctors can travel on trains, buses,  ships...
>
> ck: again, irrelevant. Among other things, many if not most pilots  have
> other medical options than seeing a physician for the bulk of their  care.
>
> One of the biggest things we can adopt from the airline industry is the
> idea of Crew Resources Management...the idea that improved communications
> between team members benefits the whole team (including the patient as a
> model
> for the aircraft in flight).
>
> The first pre flight checklists were developed by Boeing right after the
> first model of the B-17 crashed, due to some gust locks being left engaged,
> causing loss of control on take off. Over the last several years, we have
> started to see 'critical care checklists' starting to become more and more
> visible in medicine, with some improvement of outcomes, even at the expense
> of  additional tests in some cases (viz., ordering multiple blood cultures
> on
>  pneumonia patients, even though the cultures rarely have any clinical
> impact.)  Critical matters are thus less likely to be missed (aspirin
> during
> anginal  events, antibiotics prior to admission for pneumo or uro sepsis
> patients,  etc.
>
> Another point made by CRM is that well rested crews perform better when
> the chips are down. As physicians, we often accept risks on a retail  level
> (working fatigued, etc and only a few patients at a time), that pilots  are
> not allowed to handle on a wholesale level (their own lives on the line,
>  as
> well as up to 400 additional souls on board) due to the findings from
> fatigue research done by both the airline industries AND various military
>  systems
> over the past 60 plus years.
>
> Again, I agree that as physicians, we need to understand our own
> limitations, and like the folks on the 'pointy end of the spear' (troops in
>  combat),
> we also need to know how to compensate for those limitations  when the
> chips are down. To denigrate well founded studies on fatigue factors  and
> critical decision making just because it was not done on physicians is to
>  claim
> that we, as physicians, are somehow supra human....There in  lies the open
> path for folks outside our profession to further regulate  our actions 'for
> the good of the patients.'
>
> ck
> Charles S. Krin, DO
>
>
>
>
>
>
> **************A Good Credit Score is 700 or Above. See yours in just 2 easy
> steps!
> (
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> )
>
>
>
> ---------- Forwarded message ----------
> From: Krin135 at aol.com
> To: trauma-list at trauma.org
> Date: Fri, 8 May 2009 14:24:32 EDT
> Subject: Re: Doctors vs. Pilots
> I'll dig through my stack of mail to be burned as fire starters and see
> what I can get you.
>
> ck
> Charles S. Krin, DO
>
>
> In a message dated 5/8/2009 12:19:11 Central Standard Time,
> drydok at hotmail.com writes:
>
>
> From: Krin135 at aol.com
> > ...willing to work weekends,  nights and on call, but want far more than
> what new grads in primary care are  being offered (ca 100-120K/year, with
> limited benefits, for roughly 2000 hours  in clinic/year)
>
>
>
> --> Can you elaborate further?
> Is ANY USA  doctor being offered $100K a year for 2000 clinical hours
> annually?
>
> I'd  be very grateful if you pointed me in the direction of
> adverts/articles which  show this. It would come in handy for a major
> presentation I am
> writing for an  international audience...
>
>
>
> From: André de Castro Carneiro  (a.carneiro at enflurane.com)
>
> > airline industry...THEY have a far  greater appreciation of the impact of
> human factors in  performance
>
>
>
> --> That they (and other money-making  businesses) have the funds to study
> and publish on performance, efficiency and  human factors is accepted. But
> their INDUSTRY does have so many conveniently  numerical and finite
> concepts
> to evaluate and plot on charts. They have  components which their computers
> can trace throughout their lives and exclude  out of the analysis. They
> have
> so many other factors which they can exclude  from confounding their
> results. So they SHOULD have stuff to  publish.
>
>
>
> But at the end of it all, 99.9% of the outcomes they  analyse are objects
> and numerical measures, even when they do look at the  effects of human
> factors on these. That's the thing with INDUSTRY - objects  mean a lot to
> it.
> Medicine and surgery are much more about concepts one cannot  measure
> accurately with numbers. So much of what we do or the pathologies we  see
> are not
> predicted by formulae.
>
>
>
> If you have a machine, with  a finite number of components which YOU have
> made and put into it. Which are  in most cases in a fit condition to fly
> and
> proven/tested to show this. Which  are placed where they are exactly as per
> plan and monitored by computers as of  the instant they are installed.
> Which
> are given a pre-determined load to carry  on a path charted with excellent
> meteorological predictions and evidence from  another flight which has just
> recently crossed the same bit of sky. etc. etc.  etc. THEN, perhaps, you
> have eliminated enough performance variables to allow  you to get some
> statistical measure of how the human factors affect this  performance. Then
> also you
> may be able to more easily change pilots  mid-flight.
>
>
>
> In much the same way, if we had patients "built"  out of pre-tested
> components, loaded mostly with pre-determined loads, allowed  to perform
> within
> specified parameters, connected to computers and  continuously monitored
> from
> birth right through to their current illness, etc.  etc. etc. - THEN we
> could
> also use such patients to research the effect of  changing surgeon training
> hours, without confounding variables, AND publish  it...
>
>
>
> See what you've done!
>
> You've made me do the  airline metaphor things again! I hate it...
>
>
>
> And, as you have  probably guessed, I am basing my opinion not on ignorance
> of airline research,  but on having spent much professional time in the
> past on attempting to "copy"  some of their "stuff" into medicine and being
> paid to do  so...
>
> _________________________________________________________________
> Share  your photos with Windows Live Photos –  Free.
> http://clk.atdmt.com/UKM/go/134665338/direct/01/
> --
> trauma-list  : TRAUMA.ORG
> To change your settings or unsubscribe  visit:
> http://www.trauma.org/index.php?/community/
>
> **************A Good Credit Score is 700 or Above. See yours in just 2 easy
> steps!
> (
> http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd
> =May5509AvgfooterNO115<http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd%0A=May5509AvgfooterNO115>
> )
>
>
> ---------- Forwarded message ----------
> From: Andre Carneiro <a.carneiro at enflurane.com>
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> Date: Fri, 8 May 2009 19:35:43 +0100
> Subject: Re: Doctors vs. Pilots
> Those are indeed wise words, but what we are discussing here is not the
> object of healthcare or aviation (namely the patients or the aeroplanes)
> but
> the subjects in them (namely doctors and pilots).
>
> We are all human and as such the "rules" that govern our performance are
> the
> same. And they have looked at them and investigated them a  whole lot more
> than we have, regardless of what their motivation for doing so is...
>
> The rules of human limitations and exhaustion apply to everyone regardless
> of what they do (allowing, of course, for interpersonal variability), but
> not every profession is life-critical to the point where poor performance
> may lead to serious injury or death.
>
> I think we may be digressing a bit from the original thread, and it seems
> to
> me that you and I agree more than we disagree on this issue.
>
> Andre
>
> 2009/5/8 Doc Holiday drydok at hotmail.com
>
> > --> That they (and other money-making businesses) have the funds to study
> > and publish on performance, efficiency and human factors is accepted. But
> > their INDUSTRY does have so many conveniently numerical and finite
> concepts
> > to evaluate and plot on charts. They have components which their
> computers
> > can trace throughout their lives and exclude out of the analysis. They
> have
> > so many other factors which they can exclude from confounding their
> results.
> > So they SHOULD have stuff to publish.
> >
> >
> >
> > But at the end of it all, 99.9% of the outcomes they analyse are objects
> > and numerical measures, even when they do look at the effects of human
> > factors on these. That's the thing with INDUSTRY - objects mean a lot to
> it.
> > Medicine and surgery are much more about concepts one cannot measure
> > accurately with numbers. So much of what we do or the pathologies we see
> are
> > not predicted by formulae.
> >
> >
> >
> > If you have a machine, with a finite number of components which YOU have
> > made and put into it. Which are in most cases in a fit condition to fly
> and
> > proven/tested to show this. Which are placed where they are exactly as
> per
> > plan and monitored by computers as of the instant they are installed.
> Which
> > are given a pre-determined load to carry on a path charted with excellent
> > meteorological predictions and evidence from another flight which has
> just
> > recently crossed the same bit of sky. etc. etc. etc. THEN, perhaps, you
> have
> > eliminated enough performance variables to allow you to get some
> statistical
> > measure of how the human factors affect this performance. Then also you
> may
> > be able to more easily change pilots mid-flight.
> >
> >
> >
> > In much the same way, if we had patients "built" out of pre-tested
> > components, loaded mostly with pre-determined loads, allowed to perform
> > within specified parameters, connected to computers and continuously
> > monitored from birth right through to their current illness, etc. etc.
> etc.
> > - THEN we could also use such patients to research the effect of changing
> > surgeon training hours, without confounding variables, AND publish it...
> >
> >
> >
> > See what you've done!
> >
> > You've made me do the airline metaphor things again! I hate it...
> >
> >
> >
> > And, as you have probably guessed, I am basing my opinion not on
> ignorance
> > of airline research, but on having spent much professional time in the
> past
> > on attempting to "copy" some of their "stuff" into medicine and being
> paid
> > to do so...
> >
> >
>
>
>
> ---------- Forwarded message ----------
> From: Jedidiah Peterson <jedpeterson at gmail.com>
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> Date: Fri, 8 May 2009 14:48:01 -0400
> Subject: Re: Doctors vs. Pilots
> Well played Charles.
> During my Navy career, one of my duties was crash/rescue for our little
> helo
> deck. My job was to stand there, in an aluminum suit, and watch the helo
> land. If it was to crash on deck, my role was to put on my aluminum
> headgear
> and go into the wreckage with my partner and pull out the flight crew. One
> day while out at sea on training ops, the helo came back from a short hop
> over the horizon, and the pilot disembarked and headed directly towards me
> and my partner. He offered us an issue of Stars and Stripes, an odd gift,
> and it was not neatly folded, it was mashed into almost a ball. Without
> missing a beat, we took it right into our locker and opened it. Inside was
> a
> McDonalds meal, still warm.
>
> It was a neat little gesture, it let us know that he knew we were there.
>
> Now I'm an RN, but I got the same feeling in reading your post. We know you
> guys know there is a ground crew, but the gesture is appreciated.
>
> jed
>
> "There are Old Pilots, and there are Bold Pilots, but there are no Old Bold
> Pilots!"
>
>
>
> ---------- Forwarded message ----------
> From: "Joe Nemeth, Mr" <joe.nemeth at mcgill.ca>
> To: "trauma-list at trauma.org" <trauma-list at trauma.org>
> Date: Fri, 8 May 2009 14:49:48 -0400
> Subject: RE: ketamine drip
> Anyone using ketamine drips to maintain sedation in intubated trauma
> patients?...dose?...literature?...as far as I am aware mainly prehospital
> lit. available...
>
> thx,
>
> Joe
> McGill
> MGH
> Montreal
> ________________________________________
>
>
>
> ---------- Forwarded message ----------
> From: jduchesn at tulane.edu
> To: "Trauma and Critical Care mailing list" <trauma-list at trauma.org>
> Date: Fri, 8 May 2009 18:58:42 +0000
> Subject: Re: ketamine drip
> Joe- 2 years ago the research fellow from OSU under Martin Schreiber
> presented an animal model with ketamine drip. Very good presentation. I
> believe it was published in JTrauma last year.
> Hope this help :o>
> Duchesne
> CharityOne- New Orleans
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: "Joe Nemeth, Mr" <joe.nemeth at mcgill.ca>
>
> Date: Fri, 8 May 2009 14:49:48
> To: trauma-list at trauma.org<trauma-list at trauma.org>
> Subject: RE: ketamine drip
>
>
> Anyone using ketamine drips to maintain sedation in intubated trauma
> patients?...dose?...literature?...as far as I am aware mainly prehospital
> lit. available...
>
> thx,
>
> Joe
> McGill
> MGH
> Montreal
> ________________________________________
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
>
>
> ---------- Forwarded message ----------
> From: CyBerg66 at aol.com
> To: trauma-list at trauma.org
> Date: Fri, 8 May 2009 15:20:23 EDT
> Subject: Re: ketamine drip
> Ketamine as the primary sedative, no. As another analgesic in addition to
> opioids, yes. The dose as described in a 2005 review in Anesthesiology is
> 60-120  mcg/kg/hr for the postoperative patient who is not intubated. Very
> useful in the  patient who presents challenging pain control issues.
>
> C. Bergstrom, MD
> **************A Good Credit Score is 700 or Above. See yours in just 2 easy
> steps!
> (
> http://pr.atwola.com/promoclk/100126575x1221322931x1201367171/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072&hmpgID=115&bcd
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> )
>
>
>
> ---------- Forwarded message ----------
> From: Stephen Richey <stephen.richey at gmail.com>
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> Date: Fri, 8 May 2009 16:06:03 -0400
> Subject: Re: Doctors vs. Pilots
> >
> > - Isn't it nice for pilots that  they only have to fly one plane at a
> time,
> > unlike, say, an EP or surgical  intensivist who often has more than one
> > patient on the go at one time, perhaps  in different wards.
>
>
> Have you ever experienced a crisis in the air?  Having multiple systems
> fail
> on a jet (which I've never experienced in flight but have had thrown at me
> in a regional jet simulator by one of my sadistic associates) is as
> unnerving and often bewildering experience as anything I've seen in
> medicine
> and I've seen my share of "oh ****" moments.  It's about as close to the
> fecal material striking the fan as one can get outside of combat or EM/CCM.
> That being said, I think the comparisons between physicians and pilots have
> serious limitations but there is a lot more overlap than you seem willing
> to
> accept.
>
> I agree that as physicians, we need to understand our own
> > limitations, and like the folks on the 'pointy end of the spear' (troops
> in
> >  combat),
> > we also need to know how to compensate for those limitations  when the
> > chips are down. To denigrate well founded studies on fatigue factors  and
> > critical decision making just because it was not done on physicians is to
> >  claim
> > that we, as physicians, are somehow supra human....There in  lies the
> open
> > path for folks outside our profession to further regulate  our actions
> 'for
> > the good of the patients.'
> >
>
> Well said Dr. Krin.
>
>
>
> --
> Stephen Richey, CRT
>
> "It is not unreasonable that we grapple with problems....Our responsibility
> is to do what we can, learn what we can, improve the solutions, and pass
> them on."- Richard Feynman
>
>
>
> ---------- Forwarded message ----------
> From: "William Bromberg" <brombwi1 at memorialhealth.com>
> To: "Trauma and Critical Care mailing list" <trauma-list at trauma.org>
> Date: Fri, 08 May 2009 16:28:08 -0400
> Subject: Re: Sleep deprived Critical Care?
> Well, I’ve been following this debate on this listserve and in the
> surgeons’ lounge, and in the pages of the Bulletin of the ACS for it
> seems eons. This, along with my own experience as both a pilot and
> basically one of the last resident classes to go through the “old”
> way (admittedly we were mandated 3 days off a month and no every other
> night call more that 2 calls in a row) leads me to make a few points
> that I hope some will find interesting:
>
> Much of the fatigue data to which I’ve been privy reports decrease in
> ability in repetitive, boring tasks of low motivation e.g. pressing a
> button in response to a signal at random time intervals or doing reams
> of math problems after sleep deprivation or flying a simulator in
> similar conditions. Whether or not these models apply to residency
> training is a HYPOTHESIS not an obvious fact.
> There is no decent data in my experience (if someone on the list knows
> of some please post) that shows that medical outcomes are made worse by
> sleep deprivation. This probably has a number of reasons such as:
> 1. It’s hard to study
> 2. Tired residents usually have not-so tired attendings to backstop big
> decisions
> 3. Medical decisions of import tend to be non repetitive and of higher
> motivational content (no-one falls asleep during surgery unless you’re
> just hanging hook)
> 4. Systems are in place to backstop those “routine” decision
> mistakes (i.e. mistakes in drug dosing due to math problems, etc.)
>
> There is NO data (and I’m fairly certain of this, correct me if I’m
> wrong) that limiting work hours from the “unlimited” system to the
> current 80 hours system has had ANY positive effect on patient outcome,
> resident education, resident research, resident reading time, and for
> that matter divorce rate, suicide rate, car accidents or any of the
> other myriad of things that people quote as reasons the old system was
> “bad”. It’s been 20 years since the Bell commission
> recommendations have been implemented in NY and 6 since they went
> nationwide – where’s the data?
>
> All the studies on this issue I’ve seen report that they found no
> difference in anything objective at all and then fall back on
> “resident satisfaction” surveys.
> I’ve seen one study that reported a decrease in medical errors in the
> ICU using interns, no difference in patient outcomes, no mention of
> handoff errors (they just followed each physician)
>
> There IS decent data that error rates go up with increasing number of
> “hand-offs” mostly from the ED physicians.
>
> So based on this crappy or absent data the boffins in medical education
> have decided NOT that limiting work hours is useless, or unnecessary, or
> at the very least needs a better implementation plan to work but that
> THEY DIDN’T DO IT HARD ENOUGH!
>
> This is the equivalent of the FDA allowing a drug company, after
> trialing a drug that is found either to a) not do a damn thing or b)
> kill exactly the same number of people that it cures to release the same
> drug in a higher dose because they are POSITIVE the drug really works.
>
> And in the end the government with the help of the PhD Educrats and the
> craven compliance of those that have climbed the political ladder to the
> leadership of the medical societies will destroy a system of education
> that has produced well-trained, dedicated physicians for 200 years. In
> return we will have “satisfied” clock punchers, buck passers,
> wage-earners, and expensive, interchangeable, replaceable employees
> accelerating the downward slide of our profession to yet another
> “job”. In my most cynical moments (usually after my 2nd
> scotch) I come to the conclusion that this is actually the plan – and
> then I have my 3rd and don’t care any more (kidding, I get headaches
> after 2).
>
> William J. Bromberg, MD, FACS
> Savannah Surgical Group
> 912 350-7412
>
>
>
> ---------- Forwarded message ----------
> From: CyBerg66 at aol.com
> To: trauma-list at trauma.org
> Date: Fri, 8 May 2009 16:36:49 EDT
> Subject: Re: Doctors vs. Pilots
> Drunk drivers don't believe their ability to drive is impaired by  alcohol.
>
> Cell phone users believe they don't drive any worse while talking on  the
> phone.
>
> Physicians, particularly surgeons, believe fatigue produces negligble
> effects on performance.
>
> There is a tendancy to believe we can do more than we really can. Along
> with that is the denial of human performance limitations and how those
>  limits
> are smaller when you are inexperienced vs. highly experienced. A junior
> resident may expend significant cognitive effort to deal with problems that
> appear to be solved effortlessly by the older attending who is also working
> long  hours. It is not that the attending has 'learned' to work tired, it
> is
> that the  cognitive processes used by the attending are different from
> those
> used by the  resident. As long as the problems stay within the patterns and
> scripts that the  attending has learned, the attending does not have to
> engage in the more  error-prone cognitive processes that an inexperienced
> resident relies upon to  deal with the same problems.
>
> The exhausted resident exposed to additional "learning  opportunities," may
> pickup a nugget or two but at what cost? How many  errors have been made?
> How many lessons have been squandered because the  resident wasn't able to
> absorb what was happening due to fatigue?
>
> C. Bergstrom, MD
> **************A Good Credit Score is 700 or Above. See yours in just 2 easy
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-- 
christos giannou
Monemvasia Lakonia
23070 Greece
tel & fax: (++30) 27320-61772
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