Non-Traumatic Lower Back Pain

Most of us will have lower back pain in our lives (80–90% lifetime prevalence) and it accounts for 2–3% of ED visits (so quite a bit).

As with everything in EM, there are benign and serious causes and we need to differentiate between the two. The serious causes include diagnoses in the back and those in the abdomen or retroperitoneum.

  • Benign: muscular and ligament strain, sciatica (posterolateral disk herniation) and spinal stenosis
  • Serious back: cancer, spinal epidural abscess, vertebral osteomyelitis, infectious diskitis, spinal epidural hematoma and giant (central) disk hernation (cauda equina syndrome).
  • Serious non-back: AAA, renal stones, renal infarct, tumor, pancreatitis, pancreatic cancer, PUD, cholecystitis, retroperitoneal hemorrhage, psoas abscess

Continue reading “Non-Traumatic Lower Back Pain”

Non-Traumatic Lower Back Pain

Graham-Cassidy Bill Doesn’t Add Up

The latest Republican health care bill meant to replace the Affordable Care act comes from Senators Bill Cassidy (LA) and Lindsey Graham (SC). This one presents a more substantial change to the way things are run. Most of this comes from an article in the 9/23/2017 issue of the Economist.

  • The Federal government would play a much smaller role, giving money to the states proportional to the number of inhabitants between 50% and 138% of the Federal Poverty Level.
  • The decisions on how to structure care is passed down to the states. They can petition Health and Human Services to drop ObamaCare provisions such as the Essential Health Benefits that were meant to provide a basal level of care in each plan.

The thought is that this may encourage experimentation in each of the states, however three problems exist.

  1. States are now responsible for structuring care. There is no guarantee they can do a better job. States are also required to have a balanced budget, so the Medicare money may go instead to paying other debts.
  2. There is no increase in money if conditions change. If a state is hit with a disaster, say an opiate epidemic, and requires more money to address this… there is no more money.
  3. Doesn’t fix existing problems with the health insurance marketplace. Premiums have already risen under the ACA and insurers are leaving markets. This new plan has the potential of further raising premium prices (with healthy people leaving the market without the pressure of a mandate) and discouraging insurers from participating (with less healthy people, they are taking more risk).
Graham-Cassidy Bill Doesn’t Add Up

My Email Rules

Email can consume hours of your day stealing opportunities to do real work. Several people have devised plans to reclaim this time, so I stole the ones that work for me.

These rules have one main goal: to respect my time and that of the receiver.

1. Keep as short as possible.

“I’m sorry to write you a long letter, as I did not have time to write a short one.”

Mark Twain

Continue reading “My Email Rules”

My Email Rules