COMPUTER GEEK: HELP!!!!!!!

Blog Problem – Techno Dinosaur?

If you heard many bad words from the lasermed household this last weekend, it was me.  I was unable to “log on” to the blog to post anything. 

I have no idea what the problem is.  I will see if computer geek can come show me what my problem is.  I’m sure I did something stupid. 

I will have to post from the office until it gets straightened out.

COMPUTER GEEK:  HELP!!!!!!!

Follow up: Big Companies Behaving Badly

Or: Comcast, Where Are You?

Several weeks ago, I posted a rant about Comcast and the difficulty I was having with their customer service department.  I received a reply from someone apparently in the national office.

It took me a while to get back to this person. 

Evidently using the e-mail address he left me gets the same sort of answers that I got when I called my local Comcast office. 

NONE!

It has been a week. 

Comcast, Where Are You?

That might work. 

Leave me an address I can use.

Countries that visit

One of the interesting things that the back part of this blog does is keeps interesting statistics.  It lets me know where the visitors to this blog come from.

I have a large following in:

The United Kingdom

Germany

Canada

France

Canada

Australia

Russia

Spain

Mexico

Sweden

Hello, there!

Today I recorded 100 countries!   Hello, Ghana.

Through the magic of the internet, I am translated into 47 languages.  For the benefit of my Norwegian relatives, I am translated into Norsk.  It is also translated into Danish, Bengali, Persian, Vietnamese, etc.  Magic!

Wow!

 

 

Techno Dinosaur April 8, 2012

Techno Dinosaur April 8, 2012

Today there are multiple issues from me, the techno dinosaur.  When I try to do stuff on the computer or the internet, some days I just get frustrated.

My favorite web site for doctors to bitch and complain has just gone to the cloud.  Now, half the time I try to check in, I get:

 Sorry, we were unable to locate the page you requested.

It might have been removed or might be temporarily unavailable. If you typed the page address in the address bar, please make sure that it is spelled correctly and try again. Or, you can go to our HOME PAGE and try a new Search for Postings.

Return to the (name removed to protect the guilty) homepage

I have posted a question about this, but their tech people won’t be in until tomorrow. 

I also tried to copy you a really cool youtube video that someone had on their web site.  All I could get was the URL.  I have no idea why.

Computer Guy was working on my office computer last week.  He works while gaming with my kids after being fed my Mr. Lasermed.  I took the computer back to the office and found out he had deleted the entire office medical record system.  Unfortunately, the kids were out of school, so I went in late.  I found this out 15 minutes before I was supposed to start patients.

AAARRRGGGHHH!

I hope Computer Guy is having a great vacation with his real family.  My computer is waiting for him when he comes back.  (He restored it before he left).

 

Blog Changes

I made a few changes to the blog’s appearance today.  I thought it was time for some spring cleaning. 

If you have any comments or suggestions, please leave a comment. 

I was thinking about a pattern in the background behind the blog, but I find that distracting when I read everyone else’s.

I think I like the new softer colors.  What do you think?

Around the Web – Misconceptions about Obstetricians by Dr. Amy

This is from a blog I recently discovered.  Dr. Amy Tuteur is well spoken about Obstetric subjects.  She can be found at http://skepticalob.blogspot.com/.  This particular piece is so well written; I decided to reproduce it in full here.  Link to her site is at the bottom if you want to comment to her.  (Note: she has even more to say about the subject than I do.  She says it very well.)

It seems like every day a new visitor parachutes in to this blog and attempts to "educate" me. Inevitably, the visitor finds that almost everything she says is false. Indeed, almost everything she thinks she "knows" is false. So to spare these visitors embarrassment, and to reach those who are attempting to "educate" me on other blogs, I have compiled the following list. Here's what you should not say to me, and why you should not say it.

1. The US does very poorly on infant mortality.

Infant mortality is the WRONG statistic. It is a measure of pediatric care. That's because infant mortality is deaths from birth to one year of age. It includes accidents, sudden infant death syndrome, and childhood diseases.

The correct statistic for measuring obstetric care (according to the World Health Organization) is perinatal mortality. Perinatal mortality is death from 28 weeks of pregnancy to 28 days of life. Therefore it includes late stillbirths and deaths during labor.

The US has one of the lowest rates of perinatal mortality in the world.

2. The Netherlands, which places the greatest reliance on midwives, has low mortality rates.

No, the Netherlands has, and has had for some years, the HIGHEST perinatal mortality rate in Western Europe. It also has a high and rising rate of maternal mortality. The Dutch government is deeply concerned about these high mortality rates and a variety of studies are underway to investigate.

The most recent study published in the BMJ is early November 2010 revealed and astounding finding. The perinatal mortality rate for low risk women cared for by midwives is higher than the perinatal mortality rate for high risk women care for by obstetricians!

3. Obstetricians are surgeons.

I never understand how anyone has the nerve to say this to me. I AM an obstetrician. No one knows better than I what obstetricians are or are not. I went to college. I went to medical school. I spent four years in obstetric training. I delivered thousands of babies. I have cared for thousands of gyn patients. That some doula who is a high school graduate thinks that she can possibly know more than I about the nature of obstetricians defies belief.

Obstetricians do surgery as part of their practice. That does not make them surgeons. If it did, ophthalmologists and dermatologists would be surgeons too, since they do surgery as a routine part of caring for their patients. Is anyone seriously suggesting that you cannot go to an ophthalmologist for an eye exam because he or she will recommend unnecessary surgery?

4. Homebirth is safe.

No, all the existing scientific evidence and all national statistics indicate that homebirth triples the rate of neonatal death. Even studies that claim to show that homebirth is as safe as hospital birth, like the Johnson and Daviss BMJ 2005 study, ACTUALLY show that homebirth with a CPM has triple the rate of neonatal mortality of comparable risk women who delivered in the hospital in the same year.

The Midwives Alliance of North America (MANA) is well aware that homebirth is dangerous. That's why they are hiding their own mortality rates. They spent almost a decade collecting information on more than 18,000 CPM attended homebirths, announcing at intervals that they would use the data to show that homebirth is safe. So why haven't any of us seen it?

The data is publicly available, but ONLY to those who can prove they will use the data for the "advancement" of midwifery. MANA is quite up front about the fact that they will not let anyone else know what they have learned. Obviously, if homebirth had been anywhere near as safe as hospital birth, they would be trumpeting it from the mountain top. It does not take a rocket scientist to suspect that their data shows that homebirth dramatically increases the risk of neonatal death.

5. Homebirth midwives are experts in normal birth.

This one always makes me laugh. Experts in normal birth? That's like a meteorologist who claims to be an expert in good weather.

I guess they're trying to make a virtue of necessity. Homebirth midwives know virtually nothing about the prevention, diagnosis and management of pregnancy complications. That's a problem when you consider that the only reason you need a birth attendant is to prevent, diagnose and manage complications. You don't need any expertise to catch the baby and make sure it doesn't hit the floor. Ask any taxi drive; he'll tell you.

6. Childbirth is safe.

No, childbirth is INHERENTLY dangerous. In every time, place and culture, it is one of the leading causes of death of young women. And the day of birth is the most dangerous day in the entire 18 years of childhood.

Why does childbirth seem so safe? Because of modern obstetrics. Modern obstetrics has lowered the neonatal mortality rate 90% and the maternal mortality rate 99% over the past 100 years. What has the contribution of midwifery been to lowering those mortality rates? Zero? They've invented nothing, discovered nothing and tested nothing that has had any impact on perinatal or maternal mortality.

7. Childbirth used to be dangerous but that is only because sanitation was poor and women were poorly nourished.

No, the great advances of sanitation occurred in the 1800's and the early years of the 1900's. Not surprisingly, this had a big impact on deaths from infectious causes. However, rates of perinatal and maternal mortality did not begin to drop appreciably since the late 1930's and the discovery of antibiotics. In the intervening years, easier access to C-sections, epidural anesthesia, newer and better antibiotics, blood banking, and neonatology led to dramatically lower mortality rates.

8. C-section increases the risk of maternal and neonatal death.

No, women who die in pregnancy are most commonly women with serious pre-existing medical illness (heart disease, kidney disease) or serious pregnancy complications (pre-eclampsia). C-sections are often done in an effort to save the lives of these women. Sometimes it is not enough. The C-section is what is known as a "confounding factor." Both the C-section and the death can be traced back to the mother's health status; the C-section did not cause the death.

MacDorman and colleagues have attempted to show that C-sections for "no indicated risk" increase the neonatal death rate. Their papers have been roundly criticized because they used birth certificates, not hospital record. Unrelated investigations of birth certificates have shown that, while they are highly reliable for data like weight and Apgar scores, they are highly unreliable for risk factors. Indeed, unrelated studies have shown that up to 50% of women who have serious medical illnesses like heart disease, have those risk factors missing from the birth certificate.

9. Induction harms babies.

No, induction lowers perinatal mortality. The yearly CDC data on births shows that as the induction rate has risen, the rate of late stillbirth has dropped by 29% and the neonatal death rate has not increased.

10. If childbirth were dangerous, we wouldn't be here.

This represents a profound lack of knowledge about evolution as well as a profound lack of knowledge about childbirth. Evolution does not lead to perfection. Evolution is the result of the survival of the fittest, not the survival of everyone. Human reproduction, like all animal reproduction, has a massive amount of wastage. Every woman was born with millions of ova that will never be used. Every man produces billions of sperm that will never fertilize an ovum. Even when a pregnancy is established, the miscarriage rate is 20%. That's right. One in five pregnancies dies and is expelled and yet we are still here. Human reproduction is perfectly compatible with a natural neonatal death rate of approximately 7% and a natural maternal death rate of approximately 1%.

11. US maternal mortality is rising.

Despite a rather histrionic political report from Amnesty International making that claim, US maternal mortality is not rising and has even dropped in both of the past two years. Why does it look like it has risen? Because the standard death certificate has been revised twice in the past two decades in order to more accurately capture maternal deaths. The new death certificate has revealed maternal deaths which otherwise would not have been counted. There is no evidence that maternal deaths have increased; it's merely that reporting of those deaths has improved.

12. Women are designed to give birth.

Women are not "designed": they have evolved and evolution involves trade offs. Babies with big heads tend to be more neurologically mature, so having a big neonatal head has evolutionary advantages. A small maternal pelvis makes it easier for a woman to walk and run, providing her with an evolutionary advantage. Those two advantages are often incompatible. The woman with a small pelvis may have been able to survive by outrunning wild animals, but when it came time to give birth, she was more likely to die because that small pelvis could not accommodate a large neonatal head.

***

The above statements have two things in common. First, they are wrong. Second, they are passed back and forth between natural childbirth advocates who "teach" each other they are true. That's why it is impossible to become "educated" by reading natural childbirth books and websites. Most of their information is flat out false, and they are entirely insulated from scientific evidence. Natural childbirth advocates make up their "facts" as they go along. They don't read the scientific literature. They don't interact with science professionals. Indeed, professional natural childbirth advocates take special care to never appear in any venue whether they might be questioned by doctors or scientists. They know they'd be laughed out of the room. That's okay with them as long as there is a large pool of gullible women out there who will believe them and buy their products.

It is important that those who are parachuting in to "educate" me understand that they literally have no idea what they are talking about. Most of what they think they "know" is factually false. And they demonstrate that every time they utter one or more of those twelve statements.

http://skepticalob.blogspot.com/2010/11/ten-things-you-shouldnt-say-to-dr-amy.html

Blog Notes I

Just a few notes on my blog:

February was interesting.  I posted something I borrowed from a friend, who got it from Facebook, and my blog went viral!  I had been getting 40-60 visitors per day.  One day I had over 5000.  I started the blog in August, 2011.  I had about 8000 visitors until mid February.  Now I have over 30,000.  I hope some of those visitors liked what they read and continue to visit. 

I wrote a post about how many different countries visitors had come from on February 4.  There were then just over 40 countries.  Today we hit 80 countries.  If you don’t see your country’s name on the side, I missed it.  Put it in the comments and I will add it. 

I have learned a lot of geography.  Réunion (which only got the little accent because I copied it from Wikipedia) is the newest country that I added to my list.  I have had to look up a lot of countries to see where they are.  [As I was checking before posting, someone from Dominica came to visit.  Hello!]

I have finally found all of the articles on Yahoo! from Dr. Maryellen Smith.  It has been interesting.  Yahoo! has been redoing its site this month.  The last article is: Multiple Pregnancy – the Roller Coaster of Twins, Triplets or More:

http://shine.yahoo.com/multiple-pregnancy-roller-coaster-twins-triplets-more.html

I have to admit that the format of the page (see upper right) that has all the articles on it is a bit crazy.  I may have to copy it to word and redo the whole thing.   I will continue to add articles as I write them.

I am getting somewhat better technologically.  Not great yet.  I am still in the stone ages.  Thanks for hanging in there with me.    

Another Website Issue

Another Website Issue

Does anyone know what happened to HealthCare Roundup? 

This is a site that had lots of smaller blogs, including mine, listed on it.  Each day the new posts would be on there.  It’s where I got my “start”.  I also got a lot of info from there.  The last week or so, I get “this site is active but no information is loaded.”

What is going on?

My Blog is Read Worldwide

Today, with the addition of Morocco and Slovakia, my blog has now been read by someone in over 40 countries.  If you look at the little sidebar to the right, you can see the list.  It is one of the interesting things that the internet and today’s computer magic, these things can be tracked.

The blog itself is translated into a bunch of languages, including Russian, German, French, Farsi, etc.  That’s probably why it is read in so many different countries.

FYI, the most common countries after the USA are:

Russia

Canada

Sweden

Germany

United Kingdom

Australia

Italy

France

India

Interesting? 

Around the Web – Making Your ER Visit Easier

Found another great article. 

This is written by an emergency room nurse.  Title is 4 ways to de-stress your ER visit.  I’ll list the short version, but strongly recommend you actually read the article.

1. Make a list of medications you take and bring it with you

2. Bring no more than two people with you.  Bring at least one in case you need a ride home.

3. Bring something to do.

4. When someone is talking to you, ignore the cell phone and pay attention.

Here’s a link:

http://www.emergiblog.com/2012/01/four-ways-to-de-stress-your-er-visit.html

For all those friends and relatives who wonder how I have time to do all that crocheting, I have the bag perpetually packed.  I just grab it when I go somewhere I think I’m going to wait.  From the local high school sports events to my kids’ medical appointments – it gives me something to do.  Of course, I got a kindle for Christmas, and it fits nicely in the bag.  So there may be less handcrafting.

Great Blogs / Books I

One of the blogs I read regularly is going to do cartoons all week next week.  Dr. Fizzy is a funny woman doc from somewhere in the Midwest who draws great cartoons.  She promised me a mention if I mentioned the book she published on Amazon.  Here goes:

Here’s her web site.  Of course, you can also find it in the column to the right under “A Cartoon Guide to Becoming a Doctor”.   http://doccartoon.blogspot.com/

Here’s a link to her book: 

http://www.amazon.com/Cartoon-Guide-Becoming-Doctor/dp/1105091023/ref=sr_1_1?ie=UTF8&qid=1323646385&sr=8-1

From time to time I may mention other books that other doctors have written.  I figure that any physician who has also taken the time to write a book while practicing medicine full time deserves a hoo-rah!

Around the Web – Medical Blogs Early January 2012

I actually read all those blogs that you see on the side panel.  They are my favorites.  I read a bunch of others, too.  Here are a few articles that I found interesting this week. 

I. Wonderful article about why we are heading towards a major physician shortage:

http://www.kevinmd.com/blog/2012/01/physician-shortage-perfect-storm.html

“Predictable? Yes. This is an expected consequence of American demographics. Since it takes more than ten years to properly train a doctor of medicine, we should be aware of this and brace for the impact.

Have we prepared for the doctor shortage? Of course not. We are talking about your government here. Instead, the Federal Government has interjected itself in between you and your doctor. In spite of ubiquitous protests from virtually every physician group, the Federal Government passed the socialistic and unconstitutional “Affordable Care Act”.”

II. CPR has changed.  We now only do compressions.  I love this short video about how it is done.  Obviously done in Great Britain where they dial “999”

http://torontoemerg.wordpress.com/2012/01/07/making-cpr-fun-and-funny/

It’s worth a watch.

III.  “In traditional Western medical ethics, a doctor’s fundamental responsibility is to practice to the best of his ability for his patient’s benefit. But lately, doctors are being taught a radical new collectivist medical ethics where the “social good” trumps the individual patient’s welfare.”  Interesting concept.

http://finance.townhall.com/columnists/paulhsieh/2011/12/30/who_will_your_doctor_work_for_under_obamacare

Newegg promotional codes are always available for the latest computer.

Techno-Dinosaur 6 – Christmas Post

I worked really hard on my Christmas post.  I figured out how to get my word processing program to translate “Merry Christmas” into a bunch of languages.  I was so proud of myself.

Then the column thingie wouldn’t work and I had to redo the entire page.  I wanted all of it on one page.

Then I found out that clip-art won’t post on the blog.  At least I can’t get it to (yet – oh, Adam……)

So I had to find my old Photobucket account, get a new password, remember how to download and upload pictures…. Did you notice the ones with motion?  I’m particularly proud of them.

I accidently put the same picture under two different languages.  I can’t have that.  I guess I have a little OCD.  So I inserted the one I intended to have there.  The old one didn’t come off.  OMG!!!!  Don’t panic!  Which button do I push now?

This one post has taken me the better part of a week, off and on.   I’m sure there are 6 or 8 hours of work in it.  I learned stuff, thank goodness.  I’m glad it has been a little slow in the office, or I would still be working on it. 

Merry Christmas

Around the Web – Broaching the End of Life Topic with Loved Ones

There is a campaign around the web to have all of us discuss with loved ones how we want our end of life care handled.  It is called The Engage with Grace Blog Rally.  The web site is: http://www.engagewithgrace.org/Default.aspx

There are a few basic questions that every person should answer concerning this time in our lives.  The people behind this organization have decided there are five questions. 

http://www.engagewithgrace.org/content/theoneslide.pdf

If you can’t get this printed from the blog, it is available on their web site. 

I agree that it is wise to have this discussion.  It avoids the family arguments that happen in emergency departments and intensive care units all over the USA.  Settle things now to avoid pain later. 

Doctors and Creativity

When I was in medical school, I noticed that most of my class had other interests besides medicine.  Many of them were and are quite creative people.  While most of us are indeed science geeks, there is also some creativity that has to get out.

I have met some awesome photographers, painters, and authors.  We are also poets, carvers, and sculptors.  Many (mostly women) physicians work in fabric art, making awesome quilts, knitted or crocheted pieces or embroidery. 

Then there are the musicians.  One of my friends writes symphonies.  Many of us play instruments.  And an astonishingly large number of us are singers. 

Even as old as I am, I feel the need to produce music.  I have told my blog friends that my husband plays the organ, and that two of my children are in the marching band (see the photo on the blog).  Three Speed plays the trumpet and Tall Guy plays the saxophone.  Mom is a singer.

I sing with a women’s group.  This is our eighth season together.  Our numbers vary depending on who can spare the time.  Our ages vary from late teens to late 70’s.  Our occupations vary from farmer to teacher to student to shop owner.  Our concert was last week.  This is the web site that has our music posted:

http://www.youtube.com/user/AntietamSingers

The individual pieces are also posted:

Emma Lou Diemer:

http://www.youtube.com/user/AntietamSingers#p/u/0/FVwHc5q0QFY

Afrika Kyrie na Sanctus:

http://www.youtube.com/user/AntietamSingers#p/u/3/AJRkYy0K6Fg

Missa Brevis, Eleanor Daley:

http://www.youtube.com/user/AntietamSingers#p/u/2/BT2Fc1HtjDA

Messe Breve by Leo Delibes:

http://www.youtube.com/user/AntietamSingers#p/u/1/EBsnWiTee5s

Sign In, Please

Blog Visitors from Afar

One of the interesting features of the blogosphere is the ability to let your blog get translated into a number of foreign languages.  I figure, why not?  If people who speak other languages want to read my humble ramblings, I am honored.

Today I got my first comment that was admittedly from someone who did not speak English as a native language.  Whoever you are, you did a great job figuring out how to make yourself understood.  My computer wasn’t sure, though.  It put the comment in “Spam”.  I knew better.

I would love to hear from other visitors from outside the USA.  Just drop a note about where you are from.  This could be an interesting cultural exchange.  The statistics I see are that many visitors are from Russia. 

Comments Are Fixed!

Comments appear to be fixed – and I didn’t need my high school friend.  Try it!  You might like it.  I would. 

Thanks in advance.  Dr. Lasermed

If not - e mail at lasermed@gmail.com Thanks.

Stumbled upon blog

Edwinleap.com

I stumbled upon this man’s blog through a physician’s web site called Sermo.  More about that another time.  This is from a post called: “ER: Theses for an Emergency (Medicine) Reformation”

 I’m certainly no Martin Luther, though I think he was a very cool guy. And in medicine, there’s now place to nail my theses, as Luther did in Wittenberg, and so spark a reformation. But if there were, here are a few of the things I’d say.

Physicians and nurses are weary of being the victims of assault and abuse at work, all the while perceiving that their hospitals and employers are more concerned with the rights and safety of the assailants. Shame on you, if you allowed your staff to be abused while you worried about the criminal who attacked them!

Thesis: Medical providers are under attack and need protection more than their attackers.

In all likelihood, physicians practicing full time emergency medicine don’t need to be recertified by board exams or anything else. And they may not even need documented CME. Actually practicing is its own education, day in, day out and year after year. They actually look things up and learn on the job.

Thesis: We practice medicine on real patients, and learn as we go. No more tests, no more hoops.

The pain scale, and the entire pain management culture, is (to quote my children) an ‘Epic Fail.’ It has led to addiction, abuse, dysfunction, disability, staggering cost in confabulated complaints and worst of all, unnecessary deaths from prescription medications. Regulatory panels and advisory groups need to stop wringing their hands and listen to the reality of people like us, who are asked, on every shift, ‘can I have more pain pills?’

Thesis: Narcotic abuse and addiction can start in the ED. The pain scale is worthless. The age of the ‘candy man’ must end.

The rest of medicine cannot abdicate its responsibilities, expecting emergency medicine to stand in the gap like Atlas, holding it up, so that they can avoid call, avoid poor patients, avoid drunks and have a comfortable life. Remember when they thought our speciality was inferior? Odd that we can now do anything.

Thesis: We cannot be all specialties to all people, and we cannot carry medicine for the convenience and economic prosperity of others.

EMTALA must be reformed. It has cost lives, jobs and entire facilities. And it has, like all entitlements, bred dependency, irresponsibility and abuse. Whatever benefits it accrued have been washed away by a tidal wave of reckless, uncaring misuse of the great gift the government gave the public…the gift of our productivity.

Thesis: EMTALA results in theft and abuse. It has to be reformed, or medicine as we know it will be finished in America.

Customer service has a place, but must be re-defined. A person who steals from you, abuses you and/or assaults you, knowingly, must cease to be a customer. Their satisfaction surveys should be stapled to them as they are escorted to the door.

To read the rest, go here:

http://edwinleap.com/blog/?p=1892

Techno – Dinosaur, Part 2

Setting up the Blog

I am about ready to take a hammer to my computer.

I love writing.  I’m having fun getting my frustrations out on this blog.  However, the whole issue of age has quickly become apparent.  I really did NOT grow up in the computer era.  When I was born, the danged things were as big as a whole room.  When I was in high school, we learned to punch cards.  Do you see my issue?

I have no idea what a RSS feed is.  I don’t know if I have accidently added or subtracted something often until it is too late.  My children aren’t available 24/7 to answer my questions.  You have to know where to go on the computer to get the answers you need, and how to ask the questions you need answers for.  Those of  us who are old people don’t necessarily know these things.

I’m just the writer.  I can put a sentence together.  I’m pretty good at taking apart and putting together a human body.  But ask me to fix a computer problem, and I’m almost guaranteed to get a headache.  I even take several medicines to prevent that.  They are not helping.

I am grateful for things like spell check.  I really love that feature.  I love the back space to get rid of mistakes.  I can touch type over 70 words per minute on this danged machine. 

However, I am trying to add some photos to this thing, and you would think I was trying to solve some complicated physics problem.  I never understood physics.   In almost a month, I still have not succeeded.  You may or may not ever get pictures.   Trying to link another web site (http://healthcareroundup.com/) to this one – they say “just add the logo” like it’s a piece of cake – has raised my blood pressure and given me “excess stomach acid”.  

Pretty soon I will be over in the corner babbling like a small child.  I want my blankie!