Thursday, March 29, 2007

Doctors are underpaid.

Doctors are underpaid. If a job is measured on skill required vs. ability to muck things up... we are getting the right ass-end of remuneration. People can die if we make mistakes.

Take this example. First, we study for SIX YEARS! Then work a compulsory term in government for 2 years (at a calm, relaxed 90 hours per week). That's 8 years we could have been earning tom.

A GP earns medical aid rates for a patient. That's R180 per consultation (if you get paid). 30 patients a day (fully booked). So that's an income of R108 000 per month. Whoah there big daddy - you think that sounds good?

Practice Overheads: Nurses, receptionist, premises, office costs, disposable items (gloves, swabs, needles etc.).

Practice Equipment: An ECG machine costs R35000. And we can't survive on just that.

Medical Licenses: HPCSA registration. R800 per year. Malpractice insurance. R7000 per year. Loss of income insurance. R12000 per year.

Actually giving a damn about your patients after paying all of this: Priceless.

And that's a practice that's positively rolling in patients. AND a practice that's managed to get reasonable payment terms out of Discovery.

Did I mention we have to study for 6 years? And we have to continue studying to keep up with health patterns, developments in the industry and refresher course on the 3 billion diseases that we could face alongside the snotty noses.

I'm bitching. And saving lives. Such a philanthropist.

Monday, March 26, 2007

Gary Larson has a flea named after him?

This is OLD news. But I didn't know. And with the plethora of tropical nasties that we've been talking about lately, somehow this came up. Fascinating! And richly deserved I suppose.

An extract from the letter send to Larson:

Obviously it is common practice for entomologists to name new species of insects after colleagues, relatives, friends, enemies and people in the public eye... With your permission, I would like to name a new species of insect after you. There is a catch, however. I do not work on cute insects. I am a specialist on the order Mallophaga, the "chewing lice"... Your species, Strigiphilus garylarsoni belongs to a genus only found on owls... - Dale H. Clayton (University of Chicago).

And a picture of the critter.

I wonder, if one day, when this blog has risen to conquer the world of humourous medicine, someone would name a flea after us. Or a rare tropical disease.

Saturday, March 24, 2007

Rare Tropical Diseases - Dengue Fever

Number 2 on the Wikipedia Gross-Stuff-You-Catch list, although I'm starting to think it's not really in order of seriousness. TB?! T?! B!?

So, Dengue Fever. It's caused by a virus transmitted by a mosquito found in the tropics. This doozy begins with high fever, chills and aching bones, accompanied by sore throat and depression. That's a mixed bag if there ever was one. Could be malaria. Could be flu.

Then, you get a skin eruption (isn't it wonderful how medical books use such descriptive words!? - Andy) that starts on the hands and feet and spreads to the rest of the body. Maybe, if you're very unlucky, followed by desquamation (mmmm, skin peeling off).

If you're even unluckier and you catch the one variant you begin to bleed and bleed and bleed and bleed. And bleed. Luckily, most times it's not fatal because your doctor will top you up with a couple of pints (blood, that is) and the disease will heal over a period.

And if you weren't convinced about the popularity of this cretin. There's even a band!

They make music that's both familiar, yet eerily unique. Apparently. Visit their site here!

Monday, March 19, 2007

Why South African Doctors are hardcore (when it comes to rare tropical diseases)...

With much amusement, I noticed that TB (tuberculosis) was number 6 on that Wikipedia Watch-Out-For-This list we've been talking about.

In South Africa, TB (next to HIV) is the highest prevalent infectious disease. Even as a first year fledgling, we were taught it's TB, TB, TB until proven otherwise. I can diagnose it in my sleep. Even interns (especially interns because they deal with the crap) treat this shit for breakfast.

AND. We don't wear masks everytime we deal with patients. Our immune systems are THAT hardcore. American medicine might think that foolhardy. We just call each other Chuck and carry on with business.

Sunday, March 18, 2007

Rare Tropical Diseases - Leishmaniasis

Now, this obtuse word even pops up in the Wikipedia Top 10 infectious nasties.

A kind lady posted a comment on our intro to rare tropical diseases about something her husband picked up while in Iraq, that seems to be under the radar of American doctors. It sounded interesting, and Andy asked me to look it up and post something.

Leishmaniasis is a parasitic disease transferred by the bites of sand flies. There are many different forms of this parasite, depending on which part of the world you're in. Evidently, it also resides in the Iraqi desert. Specfically, the Middle Eastern version is L major. NOT to be confused with:

*L tropica (the vector could get you while lazing in the hammock)
*L braziliensis (never known to wear revealing swimsuits)
*L mexicana (can not be cured by excessive tequila consumption)

So, what happens? All leishmania cause slightly different physical symptoms but can be divided into visceral (body organs), cutaneous (skin), mucocutaneous (wet mucussy skin - inside mouth and nose).

Simply put, you get multiple ulcerating or nodular lumps on your body. The visceral one even causes enlarged liver and spleen, gum bleeding and wasting. Yummy.

Worst part of all, as suspected by our kind commentor, treatment remains inadequete because of drug toxicity, long courses required and frequent need for hospitalisation.

Best of luck to the American Military Doctors who have to differentiate it from leukaemia, lymphoma, tuberculosis, brucellosis and typhoid (that's just a few).

Friday, March 16, 2007

Rare Tropical Diseases - An Expose!

I remember when I was a kid - I used to read the FHM. Now being half-married... the FHM's are hidden under the bed (alongside Scope, ooo). And I don't get to read them that often :)

But the memories persist. And one of those memories is of a lesser-known feature they used to run: Rare Tropical Disease of the Month. Mmmm. Tasty. Which got me thinking about rare tropical diseases.

Wikipedia defines them as:

Tropical diseases are infectious diseases that either occur uniquely in tropical and subtropical regions (which is rare) or, more commonly, are either more widespread in the tropics or more difficult to prevent or control.

Since the advent of air travel, people more frequently visit these regions and contract many of these diseases, most notably malaria and hepatitis. Any nontropical condition however should never be overlooked in those returning from the tropics.

The world's most knowledgeable website goes onto to list them! Joy!

The Special Programme for Research and Training in Tropical Diseases (TDR) of the World Health Organization focuses on neglected infectious diseases that disproportionally affect poor and marginalized populations. The current disease portfolio includes the following ten:

*African trypanosomiasis
*Dengue fever
*Chagas disease
*Lymphatic filariasis

Although leprosy and tuberculosis are not exclusively tropical diseases (they have occurred everywhere), their highest incidence in the tropics justify its inclusion. Cholera and yellow fever also fall into this category.

Some tropical diseases are very rare, but may occur in sudden epidemics, such as the Ebola hemorrhagic fever, Lassa fever and the Marburg virus. There are hundreds of different tropical diseases which are less known or rarer, but that, nonetheless, have importance for public health, such as:

*Oropouche virus
*West Nile disease
*Lábrea fever
*Rocio disease
*Mapucho hemorrhagic fever
*Trachoma Guinea worm
*Chikungunya etc.

Yikes. Sounds sore. I think we need to get SA Doc onto this. No more snotty noses. Rare Tropical Diseases. An Expose! Yes!

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Tuesday, March 13, 2007

Digg users and their misguides views about HIV...

I don't want to bite the hand that feeds. Don't get me wrong. Although come to think about it - All Scrubbed Up has never been super digg'd. But here's to hoping.

I keep an eye on our Medically Dugg section bottom right of this blog. It's always interesting to see what mass audiences of voting as the interesting medical stories of the day. Some are great. Some... Well.

Take this one for example. It popped up a few days ago and tries to lay a groundwork for supporting the fact that circumcision might INCREASE the chance on contracting HIV. We argued differently. And there's a reason.

Scientists found that infected men who resumed sexual activity before their circumcision wounds healed were more likely to spread the virus than infected men who didn't have the surgery.

"This is a complicated situation ... but it seems that HIV-positive men initiating sex before wound healing is potentially dangerous for transmitting HIV," said Dr. Kevin M. De Cock, head of the World Health Organization's HIV/AIDS department.

Oh. My. Now THAT's a mind-blowing glimpse of the bloody obvious.

The results of the research so far are not statistically significant, scientists noted.

Oh. Really? Excuse the sarcasm!

I guess I'm ticked for 3 reasons. One. We've never been super digg'd - but dangerous, stupid articles like this do. Two. The articles add fuel to an already full fire - on a subject where too many non-medical people care to make medical judgement. Three. We've never been super digg'd.

Friday, March 9, 2007

A Doctor's Drivethru

What a week. You think MY job is glamorous?

60 Itchy Throats
50 Snotty Noses
30 Episodes of Gastro
10 Depression Cases
ZERO Rare Tropical Diseases.
And a patridge with a swollen knee.

ER is a but a dream right now. I'm going to start a doctor's drivethru.

State your 5 main symptoms. Answer 3 easy questions. 40% of patients get Combo Script 1 (Nose spray Deluxe, no cheese, side order paracetomol). 40% get Combo Script 2 (Super Size Probiotics with the Anti-Spasmodic special). Only 20% get to sit down and order off the menu.

I'm going to bed.

Tuesday, March 6, 2007

More YouTube Doctors...

It's amazing what you can find with a simple search for "Doctor" on YouTube. Perhaps indicative of mankind's misunderstanding with this mysterious profession. Now, this particular one is a little bit risque for All Scrubbed Up. Risque? Hmm. Maybe. But it's a perfect complement to Will Ferrel. Enjoy. Har. Har.

The New All Scrubbed Up

Many thanks to Mathew Payne for his help in getting this header up... It's done. Just a domain to go. What do you think?

It was a mission, let me tell you, so if you're interested in how to get headers aligned and how to remove the titles that Blogger just won't. Let. You. Remove.

Then read here.

Header Operation...

Excuse us. In the eternal quest to provide you, our dear readers, with something better to look at - we're buggering around with the header. These Blogger things aren't as easy as they look. Someone at lot more adept at speaking code is having a look at it.

Monday, March 5, 2007

Bedside manners - Saturday Night Live Style...

Will Ferrel... He's a bad, bad doctor.

PS. Such a lot of posts that we want to get out, just no time to write. Hang in there - and enjoy the best of YouTube while you're at it :) There's another one coming tomorrow - British version of our illustrious Ferrel.

Bara on a Saturday night? Nah!

Thursday, March 1, 2007

Medical insurance heading the automotive route?

I spotted a Google Ad popping up on the left, in fact I spotted 3... All advertising local South African medical insurance brokerage lists and quotes. Visited one and read this:

Not all medical schemes are open to the public. In fact, of the 160 medical schemes, only about 40 is open to the public. This number might decrease over the years as the larger schemes take over the smaller ones.

So how do you choose a medical scheme or hospital plan, a specific option of the scheme, which benefits to include or exclude? In this ever-changing environment, you need the services and advice of an independent intermediary. Someone who doesn't only have the interests of a specific medical scheme at hart, but one who can guide you to ensure your needs are met.

I don't know whether to be interested, happy or sad about this. It might be indicative of medical aids going the way of car insurance. Middle men, middle middle men, middle men who cut out the middle men.

Fact is, this is medical insurance. There's a lot more to be careful about don't you think? A lot more at stake than a ding on your bumper.

AND, I'm not sure how it is oversees - but in SA, medical insurance is complicated. Plenty of hidden clauses, fancy words and limitations.

I'm watching this one with interest.