Sandy Hook Elementary, Boston Marathon, ricin in the President's mail...

Boston PD dispatch responds quickly, professionally and efficiently. By 8-10 minutes into the first response, they are coordinating with social media and additional agencies (Kit Up!).

Hospital disaster training pays off in treating mass casualty incidents (Boston Globe).

Lessons learned in combat apply: early use of tourniquets, using felt pens to write vital signs on the chest, team decision-making in the OR...(New York Times).

Shrapnel removed in the OR may become physical evidence (MedPage Today).

If we allow terrorists to make us give up liberty for safety or to respond in fear or panic, then the terrorists win (Atlantic).

Fallin' Down Funny

Scientific American's Brainwaves blog posts a series of Dear Evolution letters from various animal species: fan mail from a few, but mostly gripes.

In Memoriam, Roger Ebert

This link was originally re-posted by one of the many who eulogized Roger Ebert since he died of cancer late last week.  He is pictured here with his wife Chaz.  There were so many memories and tributes written I have forgotten who exactly re-posted this.

"My name is Roger, and I'm an alcoholic" was written by Ebert, and posted on his blog in 2009.  It is one of the best descriptions of Alcoholics Anonymous I have ever read, and like everything else Ebert wrote it is direct, compassionate and rings true whether you agree with him or not.

Hospitals get dinged on re-admissions

As part of the Affordable Care Act, hospitals are now subject to financial penalties if MediCare patients have to go back to the hospital within 30 days of going back home. 

On the face of it, this is not a bad idea.  It creates a disincentive for patients to be sent home before they're entirely stable, and also creates an incentive for hospital-based systems to co-ordinate follow-up care.

However, this penalty does not recognize that in many cases the causes of re-admission may be economic and not medical.  For example, patients may not be able to afford new medications, co-payments for follow-up visits, or may not have reliable transportation.  Additionally, it puts hospitals that admit a lot of poor or elderly patients at higher risk due to the complexity of medical conditions that they treat, and the additional economic and logistical problems their patients may have.

As one healthcare policy expert put it, we’re using a proxy because it’s a convenient proxy — it’s just not a very accurate proxy.

For my own part, I think 30 days after going home is an unreasonably long duration of time.  A lot can happen in a month after going home that may be unfortunate, but is no fault of the doctors or the hospital.

This article also talks about the elephant in the room, which is patient responsibility.  Is it really reasonable to expect hospitals to make appointments for patients, or to arrange transport or pharmacy deliveries?  At what point does the patient become responsible for being pro-active in their own health?

Don't Buy Your Medications at Big Chain Drugstores and Save Yourself a Lot of Money

Big chain drugstores like CVS and Rite Aid make most of their profits on prescriptions.  On the other hand, wholesalers like Costco and Sam's Club use the pharmacy as a way to get people into the store.  Note that you don't have to be a Costco member to use a Costco pharmacy. Independent pharmacies are in between.

A few years ago, the price on pills at Rite Aid and Long's was 500-600% above MSRP (manufacturer's suggested retail price), whereas it was cost + 2-3% at WalMart.  At this point, the price difference can amount to about $780 a year for the average patient.

h/t AlterNet, Consumer Reports