If you were around in the 1950's you might remember the beginnings of the Interstate Highway System under the leadership of President Eisenhower. It officially started in 1956 and the original system was proclaimed to be completed in 1992. With that freeway system came many other "industries" such as the motel (Arthur Heineman built the first motel in San Luis Obispo, California and wanted to call it the "Milestone Motor Hotel" but has to shorten to mo-tel after he could not fit the entire name on his rooftop). Motels reached their peak in the 1960's but were largely replaced by larger chain hotels at highway interchanges. With those motels and hotels came fast food restaurants. Again, springing up like weeds along the freeways and designed for people on the move who wanted a bite to eat but didn't want to spend a lot of time looking for a restaurant. And naturally, people moving along the freeway needed gas and car service so "service stations" evolved in these same areas. A family of 5 (like mine) could embark on a long trip from southern Oregon to southern California and save large amounts of time by stopping at a freeway exit that had food, gas [...]

I thoroughly enjoyed reading a blog on KevinMD.com by Dr. Linda Girgis entitled "These McDonald's practices should be avoided in health care". I agreed with her premise and her conclusions but I began to wonder if there are now ways that healthcare can learn from the way McDonald's does things and therefore we should advance them rather than avoid them. I am old enough to remember when McDonald's started as a fast food eatery in San Bernardino, California. The original brothers, Mac and Dick McDonald, had the idea of providing an efficient and clean "walk-up" restaurant that ran like an assembly line. Not everyone liked it. Some thought they were too hurried. They wanted to sit down, order, and eat their meal without the rush. But others found the pace to fit them and their situation. I see McDonald's as the "urgent care center" of restaurants. It's not an expensive restaurant, it's not a "hospital". It's a facility where you can go where a sore throat doesn't take 2 hours to figure out, where an earache in a toddler does not require an extended time to diagnose. I am not a frequenter of McDonald's but I occasionally stop in there especially when [...]

I think it's important to talk about the anesthesia we use at QuikSurg because it's a big part of who we are. We use local anesthesia called lidocaine that is absolutely adequate for all the procedures we do. It is the safest form of anesthesia because it numbs the area... I tell my patients "After this medicine is in, you should have NO pain, not a little pain, but none." As a resident in general surgery, I was interested in ways to eliminate pain so I studied the local anesthetic medications and ways to make the experience better. Turns out, there are 3 things that make a big difference: 1) The speed of injection of the medicine- if you get in a hurry and inject too fast, the injection really hurts. This is probably the most common cause of pain while giving this medication. 2) The pH of the medicine- pH is a measure of acidity or basicity of any fluid. Body fluids having a nearly neutral pH. Most local anesthetics are on the acid side so we buffer the local with normal saline or bicarbonate to bring the pH more towards neutral. This significantly diminishes the pain of injection. 3) The [...]

Kristin Prentiss Ott has written a very informative blog called "10 Things You Might Not Know About The Emergency Department" and the very first one is: "Wait times in most emergency departments are ridiculous. But, if you have a real emergency, you won't have to wait." I couldn't agree more. I think the ED is clearly one of the most valuable places in any hospital IF you have an emergency. Many ED docs will tell you that many people abuse the ED. Case in point: The man who has chronic back pain for 2 months and then suddenly decides he has an "emergency" and heads to the ED to be seen by a doctor. That man will likely have to wait a long time to be seen especially if there are real emergencies going on around him. Which is why Urgent Care Centers were invented. They don't see people with heart attacks, gunshot wounds or stroke victims (which are true emergencies!), they see people who have had the "stomach flu" and need some nausea meds and a liter of IV fluid or people who have an angry "boil" on their back and need it drained or that back pain guy [...]

"I know there's a wire right here in my arm. I saw it go in but I couldn't stop it and I couldn't get a hold of it, but I know it's in there" And he was right. There was an inch long small gauge wire in his left forearm. Although it was difficult to feel, I could feel something that felt like a wire so I knew I could probably get it. I injected a small amount of local anesthesia and made a small incision right over that area. Sure enough, there it was. It was removed and given to the patient in a small container. "Foreign bodies can be anything that doesn't belong... from splinters to fishhooks to bullets to glass pieces to well... wires. The general rule for the surgeon is, if you can feel it, you can go after it. If a patient says "there's something there" but you can't feel it, it's a hunting expedition and they are seldom rewarding. If the FB is in a finger, a splinter, for example, a finger block is done (with plain lidocaine) so that the entire finger is made numb. That allows the surgeon to dissect out the splinter without [...]