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Re: Prelim Validation Prediction Rule for DVT
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Re: Prelim Validation Prediction Rule for DVT - July 6, 2005 7:02:00 PM
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Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
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Forget it, I wrote a huge response, but your perspective is simply different. You can't see it as you don't experience the difference. Remember we are talking medicine, not rehab or ortho. My perspective comes from training in both military and civilian environments...I have seen the difference. The military is in the business of military operations medicine, NOT US military base medicine. Let me put it to you this way, if the base charged money for services and competed with civilian hospitals...they wouldn't survive.
By the way, did you read the article, do you understand the implications? It wasn't Madigan, it was Harborview any way.
Forget it.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Prelim Validation Prediction Rule for DVT - July 7, 2005 2:31:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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I did read the article, I did say it was Harborview, which is an affiliate of the Madigan Army Medical Center, not Madigan itself.
Certainly we are both entitled to our opinions, but if that's all we're presenting, then fine.
But let's not make assertions that can't be backed with some evidence. Especially accusations as serious as those.
Also I do not appreciate the patronizing tone I perceive, the "you're not a physician so you don't understand" line. I do not believe that advances the debate any, and in today's healthcare environment, the "me doctor, you therapist" thing comes across as pure arrogance.
I can't tell if you mean this, or it's just a consequence of trying to communicate online, where so many nonverbal cues are absent.
I'm willing to give you the benefit of the doubt, however.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Prelim Validation Prediction Rule for DVT - July 9, 2005 5:15:00 PM
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Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
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Jason it comes down to this...I am speaking of medicine, the practice of medicine and the antiquated approach that I have seen and has been noted by others. It is in regards to things you simply are not accustomed to. Where is the question in that? I have no idea of rehab in the military so why do you debate me regarding medicine in the military? So in this case, I am sorry, but you are speaking out of your realm of expertise. When was the last time you ever treated someone with chest pain, an MI, a PE or even ovarian torsion...never. So where is the debate? Military medicine in the US is in a bad way, they rely heavily on civilian institutions for tertiary care and no longer provide state of the art medicine that they did 10-15 years ago. It is too bad.
As for my approach, we are speaking of medicine, and the standard of practice in such. What do you have to add? I understand your loyalty to the military, but that is not a defense. Perhaps military rehab is the best in the world...fantastic, I won't debate it. I will let another practicing therapist debate you. So why do you debate me on medicine? It makes no sense, I kind of shake my head.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Prelim Validation Prediction Rule for DVT - July 11, 2005 3:13:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Wags, I'm not debating you on medicine, I'm asking you to support your arguments. We are not talking about personal clinical experience here, we're talking about evidence for your opinions.
I have seen none.
Failure to provide higher level tertiary care does not mean that the care that is provided is substandard.
I don't need to be a physician to understand that.
Oh, wait, I see, I'm NOT a physician, so I am not permitted to challenge your unsupported anecdotal arguments.
The arrogance is truly unbelieveable. You sure you're not a surgeon?
Would love to hear you say such things to any one of the competent and caring physicians I work with on a daily basis.
They, and their patients, would beg to differ with your opinions.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 5:43:00 AM
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Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
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What the hell do you want me to give you... a friggin journal article?? And if I did, I suppose you would show some pictures of children in Iraq, to fully pound in the idea that "if you aren't with us, you are against us".
Listen man, sorry...I don't have a journal article (you think that MAYBE it may be difficult to publish an article criticizing care in miltary bases...you think there may be a loss of government funding...hmmmmmm)
Gotta go off my words my friend, you see, with my eyes I have seen two distinct standards of care, and I am not going to give you the email addresses of the military docs that see the same thing. Nor am I giving you the phone numbers or the email addresses of the military doctors that actively moonlight to "stay sharp" with their skills.
I did give you an article from ACEP regarding substandard practice at Harborview...I don't think you understand the weight of that article.
See, civilian surgeons (specifically orthopods, CT surgeons, cardiologists, plastic surgeons, urologists, GI docs etc work and make money based upon referrals...the better they work the quicker they work the more efficient they work...they make money. The VAST majority of military docs I have worked with "put in their time" and get out. There is not incentive. There is no competition (why learn laparoscopic technique if no one else is doing it).
I am not saying they aren't or weren't fantastic medical students or residents or physicians.
Listen man, call me arrogant, dont care. Tell your military docs, don't care. They will certainly tell me things they would never tell you...and ask ANY new doc out of residency that is in the military WHERE they would like to practice. 99.9% would want to be in civilian medicine. I know that is true in emergency medicine. My understanding of the situation is aided by the fact I have seen both types of medicine. Maybe that means zilch to you...too bad. Trust me man, you have a heart attack, you have a major trauma (not in the sands, but hear), you have a major GI bleed, you have a brain tumor, you have a major reconstructive joint procedure, you want a major civilian hospital. Not a military base.
I'm done.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 6:17:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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It is unfortunate that your seemingly angry post addresses issues that I have not challenged you on. For example, much tertiary care not available in smaller military facilities, physicians preferring to practice in the civilian world, or medical specialists and surgeons needing to go elsewhere to get some experience in procedures they don't routinely perform. I agree with all of this.
If I needed major trauma care or tertiary care, I would want to go somewhere that provides that..it usually isn't military facilities, as they are too small. So those cases are routed appropriately.
I never played the "if you're not with us, you're against us" card, and neither did Alex. If you perceive that to be the case, I encourage you to reread our posts.
The ONLY thing I am critical of is your presumption and your statement that military doc "are on the derr side".
You still have not addressed this patently unprofessional cheap shot, and you now are trying to escape it by throwing up red herrings like the difference in the services and funding of military facilities. Which, as I said before, I don't contest.
I will absolutely NOT let you wriggle out from under such a cowardly backstab, I am going to call you on it. Now I see you have no response. You are very big on pursuing and pressing others on the details of their posts, but it seems you don't like it too much when the tables are turned. Now it's you who made the misstep, now it's you who said something you shouldn't have. And it's you who fails to own up to it. By either providing evidence to support it, or to apologize.
Shame on you.
I guess I'm done, too.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 7:27:00 AM
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Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
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You both ABSOLUTELY attempted to pull a George W patriot act bash. This ain't about me saying "it wouldn't surprise me that military docs would be a bit on the derrr side"...THAT IS OFFENSIVE???? Holy crap are you that serious. You could stand in front of me and tell me you were honestly offended? Oh dear Lord in heaven. I am sorry.
And by the way Jason...what is teriary care? Is a cardiac catheterization tertiary care or care that even some of the smallest hospitals provide?
So you ignore EVERYTHING else I state and focus on that small JOKE. Seriously, and you are military and your skin is that thin?
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 8:41:00 AM
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SJBird55
Posts: 2292
Joined: May 10, 2004
From: Michigan
Status: offline
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Can anyone else feel the love?
I got some gloves... I wonder if Jas and Wags would want to duke it out? If they do... I'll take all the wagers! :)
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 9:21:00 AM
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TLB
Posts: 346
Joined: September 13, 2002
From: Arizona
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I declare JAAASON SIIILVERNAIL champion by virtue of a knockout.
Great job Jason!
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Todd
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 10:12:00 AM
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karmzack
Posts: 181
Joined: March 20, 2005
From: Hawaii
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Exerpt from a speech entitled "The Role of Military Medicine in Civilian Emergency Response" from Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS Acting Assistant Secretary for Health United States Surgeon General
"Military medicine has had a huge impact on our ability to take care of our military men and women at war, but it has also had a tremendous impact on how we practice surgery, trauma and emergency care for civilians today. In fact it is the basis for our civilian EMS.
Military medicine has led civilian medicine in many ways; particularly since World War II, when the generation before us first developed ways to provide combat casualty care as close to the battlefield as possible.
The early pioneers of civilian trauma surgery, such as Dr. Tom Shires, and Norm McSwain, developed their expertise first in the military. Military surgeons in all branches since the Civil War have led the way in improving the health of the nation through their wartime experiences. From sanitation to infectious disease and combat casualty care, this country owes the military a huge debt of gratitude.
In Vietnam, we saw, for the first time, the use of rotary air assets in both tactical and strategic support of ground operations. For the first time, we had the ability to provide definitive care to a wounded soldier, due to the availability of ‘medevacs,’ in the ‘golden hour.’
As a Special Forces medic during Vietnam, I saw the coming of age and impact this had on military and civilian operations. I was honored to be a part of this truly revolutionary change in the way battlefield medicine was provided.
The momentum continues in the war with Iraq.
The military is pioneering many advances in telemedicine, moving the clinician farther forward and the patient farther back.
Telemedicine provides for moving ‘intelligence’ forward, meaning providing advice and suggestions to the ‘man on the ground’ from the very best clinicians we have available, while at the same time moving the patient ‘back’ to the clinician by allowing for the movement of information (imagery, information, vital signs) away from the battlefield and back to the experts.
Today we can take full color, high-resolution motion pictures and send them over the cell network. We can sample the atmosphere, perform field wet chemistry tests and transmit the vital signs of hundreds of patients simultaneously from anywhere in the world.
This ability has revolutionized medicine on the battlefield. But it also impacts civilian medicine as well, because there is a need for the technology right here at home. It may be as difficult to treat a patient in rural Tennessee as in the desert of Iraq.
As we work on preparedness issues, those in the civilian sector will continue to rely on our military counterparts for support, for expertise, and for coordination and resources."
[URL=http://www.surgeongeneral.gov/news/speeches/mercy07262003.htm]Full speech[/URL]
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Zack Solomon MPT, OCS, CSCS
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 10:58:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
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SJ/Todd,
We don't need the gloves, I'm sure Wags and I can settle this over the forum. But I am open to other options if he is. :)
Wags,
Where did "george w. bush" and "patriot act bash" ever come into the equation? Are you so angry at the current political situation that you cannot evaluate my statements and arguments independently of that? Such paranoia. You should have that evaluated.
Your "derr side" comment was regarding the ability of military physicians, and it was in reference to recognizing a DVT. If you don't feel that was an insult to their clinical competence, then I would hate to see how you speak to your coworkers. Are you as rude and disrespectful to them as you are toward military physicians? I hope not.
My reaction is not out of being thin skinned, it's about sticking up for my friends and colleagues when someone says something disrepectful behind their back.
They'd do the same thing for me. It's called teamwork, brotherhood, and mutual respect. Are these foreign concepts to you? Politics and "thin skin" never enter into the equation.
But at least you apologized....
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 3:52:00 PM
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SJBird55
Posts: 2292
Joined: May 10, 2004
From: Michigan
Status: offline
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Let's just put this in perspective. Sit back and think about this... a 7 year old boy that has run away, is bi-polar and still hasn't been found since July 1st. He pushed his bed under his window and left after his parents put him to bed with just his blue back pack, some fruit snack things and the $3-4 in his piggy bank. The question in everyone's mind... is he alive, dead or abducted?
Sometimes I think we forget that even though we're sitting here looking at a monitor that there is actually a person on the other side reading whatever is written. That other person has feelings too. I would guess that neither of you like each other - and that's fine, we don't have to like each other. I can almost guarantee that on this issue, neither of you are going to ever agree. Hey, that's fine too. I think it is perfectly fine to agree to disagree. I'm not really sure what the goal/purpose each of you seems to have. But, as Dr. Phil would ask... "how's it workin' for you?"
Maybe it's just my mood and the current sad story in our little community, but I'm sorry, technically, in the big picture of what's important - does your whole arguing even matter?
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 4:09:00 PM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
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Who knew DVT's could spark such controversy? I really think this whole thing has been blown way out of proportion. Seriously, guys.
Sarah
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 4:46:00 PM
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PTupdate.com
Posts: 1433
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Sarah is right, and so is SJ-hottie-bird. There are guys that have not slept in 3 days wondering if they are going to drive by an IED, and other guys wondering which bridge to sleep under tonight. This really is a non-issue.
Duffy
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 6:30:00 PM
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TLB
Posts: 346
Joined: September 13, 2002
From: Arizona
Status: offline
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SJ, Sarah, and Duffy
Thanks for ruining a great thread, I think someone needs to continue with the USPS topic. :)
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Todd
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 7:28:00 PM
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dragonfire
Posts: 61
Joined: January 18, 2005
From: usa
Status: offline
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TLB,
There you go again, trying to put the USPS topic in any thread! :D
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 7:30:00 PM
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Synergy
Posts: 589
Joined: March 11, 2004
From: Forney, TX
Status: offline
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I'm all about derailing a thread as well! I'm planning on smoking some brisket, ribs, and chicken this weekend (I'll throw in some asparagus and other leafy greens too Jason) and kicking back with some serious beer to wash it all down. Whadda ya say...my place about 6 pm?
Todd,
Let's drop the USPS thing and eat some meat instead. :)
Duff,
Do you have confirmation of SJ's hottie-birdness? :)
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Chris Adams, PT, MPT
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Re: Prelim Validation Prediction Rule for DVT - July 12, 2005 11:09:00 PM
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Randy Dixon
Posts: 744
Joined: August 6, 2004
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The USPS made me think of Lance and the TDF, did anyone else see him kick butt today?
(Yeah, he's not with the USPS anymore)
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Re: Prelim Validation Prediction Rule for DVT - July 13, 2005 10:21:00 AM
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TLB
Posts: 346
Joined: September 13, 2002
From: Arizona
Status: offline
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Randy,
Lance is definitely unbelievable, those guys are the best trained athletes in the world.
Chris,
Sounds great, I'll bring the potato salad and beer.
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Todd
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Re: Prelim Validation Prediction Rule for DVT - July 13, 2005 2:29:00 PM
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jma
Posts: 2312
Joined: August 24, 2000
From: NY
Status: offline
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Lance Armstrong is the best athlete I have ever seen. I hope he goes all the way and celebrates in Paris.
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