OB-GYN-L Messages for March, 2006: UNSUSCRIBE

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From: maria restrepo (vickyillera@yahoo.com)
Thu Mar 30 17:45:46 2006

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> -------------- Original message --------------
From: ob-gyn-l@obgyn.net
> OB-GYN-L Digest 4749
>
> Topics covered in this issue include:
>
> 1) Re: Pain management
> by islesannie@yahoo.com (Joanne Bulley, MD)
> 2) Re: Brain damaged baby case (long)
> by rmodugno@aol.com
> 3) Re: Pain management
> by "fran wilson" <530rose@msn.com>
> 4) Re: Pain management
> by islesannie@yahoo.com (Joanne Bulley, MD)
> 5) Protocols for NPs
> by
> 6) Re: Brain damaged baby case (long)
> by Babycatchers@aol.com
> 7) Re: Protocols for NPs
> by JSBowpat@aol.com
> 8) Re: Brain damaged baby case (long)
> by Grace Loehr
> 9) Re: Brain damaged baby case (long)
> by "fran wilson" <5! 30rose@msn.com>
> 10) This you will not believe
> by "fran wilson" <530rose@msn.com>
> 11) Re: book
> by Joe
> 12) Re: book
> by Joe
> 13) Re: Protocols for NPs
> by Joe
> 14) HepB/Preg
> by Terrence.Jones@kp.org
> 15) RE: Brain damaged baby case (long)
> by "ainsron"
>
> ----------------------------------------------------------------------
>
> ----------------------------------------------------------------------
> Date: Wed, 29 Mar 2006 13:07:42 -0600 (CST)
> ----------------------------------------------------------------------
> From: islesannie@yahoo.com (Joanne Bulley, MD)
> To: OB-GYN-L@OBGYN.net
> Subject: Re: Pain management
> Message-ID: <200603291907.k2TJ7gg30733@dns.obgyn.net>
>
> Here in Keene, it has gone the other way. They do the water births and
> the staff are so into no meds for labor that when there is a patient who
> really wants th! at intrathecal narcotic - the nurses are almost
> pathologic in how they avoid assessing the patient's labor progress and
> tell her either she is too early in labor for it or "oops" you are too
> late to get it. Really really PO'd a couple of women who are
> professionals themselves and wives of MDs on staff. Along with some
> community folks as well.
>
> Back in the old days I and my two partners did our own epidurals and it
> was great to just do it when it was the right time and not have to put
> up with complaining anesthesiaologists!
>
> Joanne
>
> At Wed, 29 Mar 2006, Henry Gregor wrote:
> >
> >Intersting thoughts, all...in light of Grace's comments...years ago it seemed a
> struggle to avoid patients' repetitively hearing remonstrations and
> disincentives to accepting epidural analgesia, even with patients having
> obviously horrific la! bor pain not responsive to psychoprophylactic or parenteral
> options. Now, its tough for a patient not wanting an epidural to get through a
> delivery without being subtly or overtly encouraged to epidural use, and three
> plus hour second stages with stressed out patients and family are more and more
> common...oh well, must another aspect of geezer hood sounding off here.
> >
> > H
> >
>
> --
> Joanne Bulley, MD
> Keene, NH, USA
>
> "Love is indescribable and unconditional.
> I could tell you a thousand things that it is not, but not one that it is."
> — Duke Ellington, American jazz artist (1899-1974).
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 29 Mar 2006 15:56:41 -0500
> ------------------------------
> From: rmodugno@aol.com
> To: ob-gyn-l@obgyn.net
> Subject: Re: Brain damaged baby case (long)
> Message-ID: <8C8218A69F2A65! 9-1DFC-B6D@FWM-D41.sysops.aol.com>
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> Content-Transfer-Encoding: quoted-printable
>
> Oftentimes, those "rules' are interpreted by the hospital - and very often t> he intrepretations do not make sense.
>
> Robert Modugno MBA FACOG
> Marietta, GA
>
> -----Original Message-----
> From: Seele, Mona
> To: Multiple recipients of list OB-GYN-L
> Sent: Wed, 29 Mar 2006 12:34:26 -0600
> Subject: RE: Brain damaged baby case (long)
>
> JCAHO and other regulatory bodies are the "kings of the kingdoms". Hospita! l> s are herded by them in order to stay in business. There are sooooo many ru> les now that do not make sense to us on the front lines, but we are required> to follow or face sanctions by those regulatory bodies.
>
> Mona Seele, RN, MSN, CNS
>
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Henry Greg> or
> Sent: Wednesday, March 29, 2006 11:17 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Brain damaged baby case (long)
>
> Oh yes,,,, years ago, I was in a hospital that :"disappeared" letters critic> al of its processes, Docs that gave a crap about standards and process were> quickly tagged disruptive and subjected to treatment worhthy of KGB techniq> ues. Saddest thing was the willingness of the administration to devote dozen> s of administrative work ho! urs to denial and coverup and whitewashing, as op> posed to one or two simple corrective hours. Part of the process, I thought,> then and now, involved for profit management contracts by a national firm, > in a non profit institution. Though have seen similar issues in nonprofit wi> th inhouse management.
>
> Hank
>
> Joe Cutchin wrote:
> Lynn: I'll bet that most of us have similar stories. Hospitals are
> little kingdoms unto themselves ,supported by a national and state
> hospital associations ,made legit by JACHO,herd MD's with hy-laws that
> the hospital uses for its own purposes,etc. Oh my, here I am getting
> cynical. Joe C
>
> Lynn Montgomery, MD wrote:
>
> > Now I am not advocating suing physicians, but let me play the devil's
> > advocate here based on my personal experience:
> >=2! 0
> >
> > -Current hospital setting without ANY quality assurance in the OB
> > Section for eight years.
> >
> > -Two JCAHO inspections during that time and
> > passed with flying colors.
> >
> > -Several previous hospitals with QA programs, but when deficiencies
> > identified, no action is taken.
> >
> > -At least two instances where a significant problem was identified with
> > patient management where the physician refused to respond to any inquiry
> > on advice from his counsel - despite the supposed confidentiality of
> > peer review. No action taken regarding the cases.
> >
> > -Two and now possibly three physicians with a literal stack of charts
> > with untoward outcomes. QA recommendation that privileges be suspended
> > pending addi! tional training, etc, only to be laughed at by hospital
> > counsel who state that we will all be sued and the suspension will not
> > likely stand.
> >
> > So, given these issues, how are we supposed to accomplish "Physician
> > police thy self". And if we cannot police ourselves, which we have
> > apparently shown we can't; who is going to?
> >
> > It is easy to be critical of lawyers suing us, but I feel that we bear a
> > good share of the responsibility by engendering a "good ole boys club"
> > and rubber stamping our peer's practice patterns, whether appropriate or
> > not - fearing that if we are critical of a peer's practice patterns, we
> > may be next.
> >
> > I learned quality assurance from Bo! b Carpenter and Ray Kaufman and have
> > been struggling my entire career to duplicate their approach, only to be
> > met with frustration at every turn.
> >
> > Lynn
> >
>
> New Yahoo! Messenger with Voice. Call regular phones from your PC for low, l> ow rates.
>
> Methodist. Leading Medicine.
>
> Named by FORTUNE magazine's "100 Best Companies to Work For" in 2006
> Named by U.S.News & World Report as one of "America's Best Hospitals"
>
> ***CONFIDENTIALITY NOTICE***
> This e-mail is the property of The Methodist Hospital and/or its
> relevant affiliates and may contain confidential and privileged
> material for the sole use of the intended recipient(s). Any review,
> use, distribution or disclosure by others is strictly prohibited. If !
> you are not the intended recipient (or authorized to receive for the
> recipient), please contact the sender and delete all copies of the
> message. Thank you.
>
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> Content-Type: text/html; charset="iso-8859-1"
> Content-Transfer-Encoding: quoted-printable
>
> Oftentimes, those "rules' are interpreted by the hospital - and very of> ten the intrepretations do not make sense.

>

> Robert Modugno MBA FACOG

> Marietta, GA

-----Original Message----- From: S= > eele, Mona <Mseele@tmh.tmc.edu> To: Multiple recipients of list OB-> GYN-L <ob-gyn-l@dns.obgyn.net>
Sent: Wed, 29 Mar 2006 12:34:26 -060> 0
Subject: Re: Brain damaged baby case (long)
>
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>
> ial color=#0000ff size=2>JCAHO and other regulatory bodies are the "king> s of the kingdoms". Hospitals are herded by them in order to stay in b> usiness. There are sooooo many rules now that do not make sense to us > on the front lines, but we are required to follow or face sanctions by those> regulatory bodies.

>

> Mona Seele, RN, MSN, CNS> >

>

>
---------------------------------
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-=
--------------------------------- > l@obgyn.net] On Behalf Of Henry Gregor

-- --------------------------------- Sent: Wednesday, Mar> ch 29, 2006 11:17 AM
To: Multiple recipients of list OB-GYN-L <> B>Subject: Re: Brain damaged baby case (long)
>
> Oh yes,,,, years ago, I was in a hospital that :"disappeared" letters c> ritical of its processes, Docs that gave a crap about standards and pr> ocess were quickly tagged disruptive and subjected to treatment worhthy of K> GB techniques. Saddest thing was the willingness of the administration to de> vote dozens of administrative work hours to denial and coverup and whitewash> ing, as opposed to one or two simple corrective hours. Part of the process, > I thought, then and now, involved for profit management contracts by a natio> nal firm, in a non profit institution. Though have seen similar issues in no> nprofit with inhouse management.
>
Hank
Joe Cutchin <forcep@intercom.net> w> rote:
> > DER-LEFT: #1010ff 2px solid">Lynn: I'll bet that most of us have similar sto> ries. Hospitals are
little kingdoms unto themselves ,supported by a nati> onal and state
hospital associations ,made legit by JACHO,herd MD's with> hy-laws that
the hospital uses for its own purposes,etc. Oh my, here I > am getting
cynical. Joe C
Lynn Montgomery, MD wrote:
> > Now I am not advocating suing physicians, but let me play the devil's &g> t; advocate here based on my personal experience: > > > > -Current hospital setting without ANY quality assurance in the OB <> BR>> Section for eight years. > > -Two JCAHO inspections dur> ing that time and > passed with flying colors. > > -Seve> ral previous hospitals with QA programs, ! but when deficiencies > iden> tified, no action is taken. > > -At least two instances where a> significant problem was identified with > patient management where t> he physician refused to respond to any inquiry > on advice from his c> ounsel - despite the supposed confidentiality of > peer review. No ac> tion taken regarding the cases. > > -Two and now possibly three> physicians with a literal stack of charts > with untoward outcomes. > QA recommendation that privileges be suspended > pending additional t> raining, etc, only to be laughed at by hospital > counsel who state t> hat we will all be sued and the suspension will not > likely stand.> R>> > > So, given these issues, how are we suppose> d to accomplish "Physician > police thy self". And if we cannot! polic> e ourselves, which we have > apparently shown we can't; who is going > to? > > It is easy to be critical of lawyers > suing us, but I feel that we bear a > good share of the responsibilit> y by engendering a "good ole boys club" > and rubber stamping our pee> r's practice patterns, whether appropriate or > not - fearing that if> we are critical of a peer's practice patterns, we > may be next. = > > > > I learned quality assurance from Bob Carpent> er and Ray Kaufman and have > been struggling my entire career to dup> licate their approach, only to be > met with frustration at every tur> n. > > Lynn >
> ---------------------------------
> New > d.yahoo.com/evt=3D39666/*http://beta.messenger.yahoo.com" target=3D_blank>Ya= --------------------------------- > hoo! Messenger with Voice. Call regular phones from your PC for low, low= --------------------------------- > rates. > ---------------------------------
> --------------------------------- > ---------------------------------
> Methodist. Leading Medicine.
Named by FORTUNE magazine'> s "100 Best Companies to Work For" in 2006
Named by U.S.News & World > Report as one of "America's Best Hospitals"
***CONFIDENTIALITY NOTIC> E***
This e-mail is the property of The Methodist Hospital and/or its > >relevant affiliates and may contain confidential and privileged material> for the sole use of the intended recipient(s). Any review,
use, distribu> tion or disclosure by others is strictly prohibited. If
you are not the i> ntended recipient (or authorized to receive for the
recipient), please co> ntact the sender and delete all copies of the
message. Thank you. > G>
> -->
> > ----------MailBlocks_8C8218A69F2A659_1DFC_BAF_FWM-D41.sysops.aol.com-- > > ------------------------------ > > ------------------------------ > Date: Wed, 29 Mar 2006 13:17:29 -0800 > ------------------------------ > From: "fran wilson" <530rose@msn.com> > To: ob-gyn-l@obgyn.net, ob-gyn-l@dns.obgyn.net > Subject: Re: Pain management > Message-ID:> Mime-Version: 1.0 > Content-Type: text/html; format=flowed > > I want to move to Keene! Here in > Kennewick, even women who specifically tell the staff that they don't want to be > offered pain medication get an (at least) hourly question about whether they > have changed their mind, and warnings that if they don't do it now it will be > too late for an epidural. Docile epiduralized women demand so much less of > the nursing staff...
> Fran Wilson, CNM
Kennewick, WA
> > tahoma,sans-serif"> > ---------------------------------
> From: islesannie@yahoo.com (Joanne Bulley, MD) --------------------------------- Reply-To: --------------------------------- > ob-gyn-l@obgyn.net
To: Multiple recipients of list OB-GYN-L > <ob-gyn-l@dns.obgyn.net>
Subject: Re: Pain > management
Date: Wed, 29 Mar 2006 13:09:14 -0600 Here in Keene, > it has gone the other way. They do the water births and
the staff are so into > no meds for labor that when there is a patient who
really wants that > intrathecal narcotic - the nurses are almost
pathologic in how they avoid > assessing the patient's labor progress and
tell her either she is too early > in labor for it or "oops" you are too
late to get it. Really really PO'd a > couple of women who are
professionals themselves and wives of MDs on staff. > Along with some
community folks as well.
Back in the old days I and my > two partners did our own epidurals and it
was great! to just do it when > it was the right time and not have to put
up with complaining > anesthesiaologists!
Joanne
At Wed, 29 Mar 2006, Henry Gregor > wrote: > >Intersting thoughts, all...in light of Grace's > comments...years ago it seemed a struggle to avoid patients' repetitively > hearing remonstrations and disincentives to accepting epidural analgesia, even > with patients having obviously horrific labor pain not responsive to > psychoprophylactic or parenteral options. Now, its tough for a patient not > wanting an epidural to get through a delivery without being subtly or overtly > encouraged to epidural use, and three plus hour second stages with stressed out > patients and family are more and more common...oh well, must another aspect of > geezer hood sounding off here. > > H >

-- Joanne > Bulley, MD
Keene, NH, USA
"Love! is indescribable and > unconditional.
I could tell you a thousand things that it is not, but not one > that it is." — Duke Ellington, American jazz artist > (1899-1974).
> > ------------------------------ > > ------------------------------ > Date: Wed, 29 Mar 2006 15:54:04 -0600 (CST) > ------------------------------ > From: islesannie@yahoo.com (Joanne Bulley, MD) > To: OB-GYN-L@OBGYN.net > Subject: Re: Pain management > Message-ID: <200603292154.k2TLs4514372@dns.obgyn.net> > > Fran > > Feel free to contact the Cheshire Medical Center - Dartmouth Hitchcock > Keene dept of Ob and see if they are recruiting. 590 Court St Keene NH > 03431 603-354-5400 > > http://www.cheshire-med.com/programs/wachu.html > http://www.cheshire-med.com/programs/ob/cbonline.html > > Joanne > > At Wed, 29 Mar 2006, fran wilson wrote: > > > >I want to move to Keene! Here in Kennewick, even women who specifically tell > the staff that they don't want to be offered pain medication get an (at least) > hourly question about whether they have changed their mind, and warnings that if > they don't do it now it will be too late for an epidural. Docile epiduralized > women demand so much less of the nursing staff... > >Fran Wilson, CNMKennewick, WA > > > > -- > Joanne Bulley, MD > Keene, NH, USA > > "Love is indescribable and unconditional. > I could tell you a thousand things that it is not, but not one that it is." > — Duke Ellington, American jazz artist (1899-1974). > > ------------------------------ > > ------------------------------ > Date: Wed, 29 Mar 2006 14:08:12 -0800 (PST) > ------------------------------ > From: > To: ob-gyn-l@obgyn.net > Subject: Protocols for NPs > Me! ssage-ID: <20060329220812.62703.qmail@web80808.mail.yahoo.com> > MIME-Version: 1.0 > Content-Type: text/plain; charset=iso-8859-1 > Content-Transfer-Encoding: 8bit > > As part of my hospital's NP/CNM committee, they want > me to provide protocols for the practice of Family > Nurse Practitioners, CNM's, and NPs in the area of > OB/GYN. > > Does anyone know of a good resource? I'd rather adopt > a book than write all the guidelines. > > I'm currently looking at "practice Guidelines for Ob > &Gyn " by Geri Morgan. > > Thanks, > > Scott Osterling > > ------------------------------ > > ------------------------------ > Date: Wed, 29 Mar 2006 17:16:45 EST > ------------------------------ > From: Babycatchers@aol.com > To: ob-gyn-l@obgyn.net > Subject: Re: Brain damaged baby case (long) > Message-ID: <27a.774f2b7.315c614d@aol.com> > MIME-Version:! 1.0 > Content-Type: multipart/alternative; > boundary="-----------------------------1143670605" > > -------------------------------1143670605 > Content-Type: text/plain; charset="US-ASCII" > Content-Transfer-Encoding: 7bit > > Even in our small rural hospital, because of 1 doc with a 6 foot high (no > joke) stack of unfinished charts (cardiologist) we now get weekly threats to > suspend our privileges in 3 days if we do not complete charts. I had 2 this > week- verbal orders I forgot to sign at delivery. > There was a bad outcome with one of the stack of patients and they couldn't > find the chart. The MDs are reluctant, but are beginning to get the idea. > > Vicki Smith, CNM, MSN > > Midwives- changing the world one baby at a time. > > -------------------------------1143670605 > Content-Type: text/html; charset="US-ASCII" ! > Content-Transfer-Encoding: quoted-printable > > > Arial" > bottomMargin=7 leftMargin=7 topMargin=7 rightMargin=7>> e_document > face=Arial color=#000000 size=2> > Even in our small rural hospital, because of 1 doc with a 6 foot high (> no > joke) stack of unfinished charts (cardiologist) we now get weekly threats to> > suspend our privileges in 3 days if we do not complete charts. I had 2 this > week- verbal orders I forgot to sign at delivery.
> There was a bad outcome with one of the stack of patients and they coul> dn't > find the chart. The MDs are reluctant, but are beginning to get the idea.> IV> >
> > >Vicki Smith, > CNM, MSN
Midwives- changing the world one baby at a > time.
> > -------------------------------1143670605-- > > ------------------------------ > > ------------------------------ > Date: Wed, 29 Mar 2006 17:24:16 EST > ------------------------------ > From: JSBowpat@aol.com > To: ob-gyn-l@obgyn.net > Subject: Re: Protocols for NPs > Message-ID: <205.12d4eaa7.315c6310@aol.com> > MIME-Version: 1.0 > Content-Type: multipart/alternative; > boundary="-----------------------------1143671056" > > -------------------------------1143671056 > Content-Type: text/plain; charset="UTF-8" > Content-Transfer-Encoding: quoted-printable > Content-Language: en > > You may want to consider Nell Tharpe CNM RNFA's clinical guidelines book. > &g! t; > 2006-2009 Clinical Practice Guidelines for Midwifery & Womenâ€™s Hea> lth > presents a compilation of current practices that includes evidence-based, > traditional, and empiric care from a wide variety of sources. Each Guidelin> e moves > through problem identification and treatment using a standardized format fo> r > day-to-day clinical practice with diverse populations. The Guidelines are > currently in use by many practices as a way of meeting the American College> of > Nurse Midwives (ACNM) recommendations, and are acceptable for collaborative> > practice with physician colleagues. > Just a suggestion .... > Susan Paterson CNM > Bay City MI > > -------------------------------1143671056 > Content-Type: text/html; charset="UTF-8" > Content-Transfer-Encoding: quoted-printabl! e > Content-Language: en > > > Arial" > bottomMargin=7 leftMargin=7 topMargin=7 rightMargin=7>> e_document > face=Arial color=#000000 size=2> > You may want to consider Nell Tharpe CNM RNFA's clinical guidelines > book.
>
> > > face="Verdana, Helvetica, sans-serif" size=2>2006-2009 Clini> cal > Practice Guidelines for Midwifery & Womenâ€™s > Health presents a compilation of current practices that > includes evidence-based, traditional, and empiric care from a wide variety o> f > sources. Each Guideline moves through problem identification and > treatment using a standardized format for day-to-day clinical practice with > diverse populations. The Guidelines are currently in use by many > practices as a way of meeting the > ME > w:st="on">> size=2>American > face="Verdana, Helvetica, sans! -serif" > size=2>College > face="Verdana, Helvetica, sans-serif" size=2>of Nurse Midwives (ACNM) > recommendations, and are acceptable for collaborative practice with physicia> n > colleagues.
> > face=Verdana>
> Just> a > suggestion ....
> > face=Verdana>
> Susa> n Paterson > CNM
> Bay > City MI >
> > -------------------------------1143671056-- > > ------------------------------ > > ------------------------------ > Date: Wed, 29 Mar 2006 19:41:43 -0500 > ------------------------------ > From: Grace Loehr > To: ob-gyn-l@obgyn.net > Subject: Re: Brain damaged baby case (long) > Message-ID:> Mime-Version: 1.0 (Apple Message framework v553) > Content-Type: text/plain; charset=US-ASCII; format=flowed > Content-Transfer-Encoding: 7bit > > Re: Joanne, Lynn, &c's comments on physician discipine/ retraining of > problem docs. > > Your comments reinforce the observation of many nurses that docs stick > together and stick up for each other (I know, the example is about > incompetent even the other docs want to ge! t remedial treatment or > license revoked, but I think the principle applies), whereas nurses > will use gossip, lying, maliciousness and not liking somebody to get a > nurse written up, fired, or license suspended. Nurses and management > are very willing to throw the book at nurses for any excuse, it seems. > There are names for this: nurses eat their young, oppressed group > behavior, bullying in the workplace, &c. Very sad. I've liked how > docs stick together, in contrast, although of course this tendency can > be counterproductive and dangerous for pt safety, as with the examples > given. I envy how female MDs stick together and help each other. > > Grace > > ------------------------------ > > ------------------------------ > Date: Wed, 29 Mar 2006 16:48:03 -0800 > ------------------------------ > From: "fran wilson" <530rose@msn.com> > To: ob-gyn-l@obgyn.net, ob-gyn-l@dns.obgyn.net > Subjec! t: Re: Brain damaged baby case (long) > Message-ID:> Mime-Version: 1.0 > Content-Type: text/html; format=flowed >
In my experience, that is very > true. Nurses not only go after other nurses, but also nurse > midwives. Of course, this is a generalization, but it really has been the > trend in the hospitals where I have practiced both as a nurse and a nurse > midwife.
> Fran Wilson, CNM
Kennewick, WA
> > tahoma,sans-serif"> > ---------------------------------
> From: Grace Loehr <divinegracie@earthlink.net> --------------------------------- Reply-To: --------------------------------- > ob-gyn-l@obgyn.net
To: Multiple recipients of list OB-GYN-L > <ob-gyn-l@dns.obgyn.net>
Subject: Re: Brain damaged baby case > (long)
Date: Wed, 29 Mar 2006 18:43:23 -0600 Re: Joanne, Lynn, > &c's comments on physician discipine/ retraining of problem > docs.
Your comments reinforce the observation of many nurses that docs > stick together and stick up for each other (I know, the example is about > incompetent even the other docs want to get remedial treatment or license > revoked, but I think the principle applies), whereas nurses will use gossip, > lying, maliciousness and not liking somebody to get a nurse written up, fired, > or license suspended. Nurses and management are very willing to throw the book > at nurses for any excuse, it seems. There are names f! or this: nurses eat > their young, oppressed group behavior, bullying in the workplace, &c. Very > sad. I've liked how docs stick together, in contrast, although of course this > tendency can be counterproductive and dangerous for pt safety, as with the > examples given. I envy how female MDs stick together and help each > other.
Grace
> > ------------------------------ > > ------------------------------ > Date: Wed, 29 Mar 2006 17:22:18 -0800 > ------------------------------ > From: "fran wilson" <530rose@msn.com> > To: ob-gyn-l@obgyn.net, ob-gyn-l@dns.obgyn.net > Subject: This you will not believe > Message-ID:> Mime-Version: 1.0 > Content-Type: text/html; format=flowed > > href="http://www.msnbc.msn.com/id/12056405/">http://www.msnbc.msn.com/id/1205640 > 5/
> > ------------------------------ > > ------------------------------ > Date: Wed, 29 Mar 2006 20:34:00 -0500 > ------------------------------ > From: Joe > To: ob-gyn-l@obgyn.net > Subject: Re: book > Message-ID: <442B3588.3020202@intercom.net> > MIME-Version: 1.0 > Content-Type: text/plain; charset=us-ascii; format=flowed > Content-Transfer-Encoding: 7bit > > Abdominally so. > > doctorjoe@aol.com wrote: > > Yeah, doesn't John Burch usually do most of his stuff on the far right? > > > > Joe P. > > > > -----Original Message----- > > From: Joe Cutchin > > To: Multiple recipients of list OB-GYN-L > > Sent: Wed, 29 Mar 2006 10! :41:41 -0600 > > Subject: book > > > > Just found copy of "Hysterectomy" by John C. Burch MD 1954. Obviously > > excellent technique described. It just struck me that although the tools > > might be different surgical technique is quite old. Joe C > > > > ------------------------------ > > ------------------------------ > Date: Wed, 29 Mar 2006 20:36:36 -0500 > ------------------------------ > From: Joe > To: ob-gyn-l@obgyn.net > Subject: Re: book > Message-ID: <442B3624.1090100@intercom.net> > MIME-Version: 1.0 > Content-Type: text/plain; charset=us-ascii; format=flowed > Content-Transfer-Encoding: 7bit > > Hank: hard bound book > > Henry Gregor wrote: > > > Interesting post...any chance of listing a reference? Would be worth the > > read, I'm sure. > > > > Hank > > > > Joe C! utchin wrote: > > > > Just found copy of "Hysterectomy" by John C. Burch MD 1954. Obviously > > excellent technique described. It just struck me that although the > > tools > > might be different surgical technique is quite old. Joe C > > > > 666/*http://beta.messenger.yahoo.com> > > Call regular phones from your PC for low, low rates. > > ------------------------------ > > ------------------------------ > Date: Wed, 29 Mar 2006 20:46:51 -0500 > ------------------------------ > From: Joe > To: ob-gyn-l@obgyn.net > Subject: Re: Protocols for NPs > Message-ID: <442B388B.4070702@intercom.net> > MIME-Version: 1.0 ! > Content-Type: text/plain; charset=us-ascii; format=flowed > Content-Transfer-Encoding: 7bit > > Talk about the chicken or the egg. Lets the CRNP's and CNM's develope > the protocols and you approve or adjust. They have the resources. Joe C > > sdoesterling-obgyndotnet@yahoo.com wrote: > > > As part of my hospital's NP/CNM committee, they want > > me to provide protocols for the practice of Family > > Nurse Practitioners, CNM's, and NPs in the area of > > OB/GYN. > > > > Does anyone know of a good resource? I'd rather adopt > > a book than write all the guidelines. > > > > I'm currently looking at "practice Guidelines for Ob > > &Gyn " by Geri Morgan. > > > > Thanks, > > > > Scott Osterling > > > > -----------------------! ------- > > -----------------------! ------- > Date: Wed, 29 Mar 2006 18:27:16 -0800 > -----------------------! ------- > From: Terrence.Jones@kp.org > To: ob-gyn-l@forum.obgyn.net > Subject: HepB/Preg > Message-ID:> MIME-Version: 1.0 > Content-type: text/plain; charset=us-ascii > > Anyone with experience using Lamivudine (in combination with the usual > passive/active immunization) in last month of pregnancy to prevent vertical > transmission (van Zonneveld (2003), J Viral Hepatol, 10:294-7)? Is Rx > stratified to maternal viral load? Any concerns re: NRTI's and mitochondria > in cardiac myocytes? /tj > > CONFIDENTIAL OR PRIVILEGED: This communication contains information > intended only for the use of the individuals to whom it is addressed and > may contain information that is privileged, confidential or exempt from > other disclosure under applicable law. If yo! u are not the intended > recipient, you are notified that any disclosure, printing, copying, > distribution or use of the contents is prohibited. If you have received > this in error, please notify the sender immediately by telephone or by > returning it by reply email and then permanently deleting the communication > from your system. Thank you. > > ------------------------------ > > ------------------------------ > Date: Wed, 29 Mar 2006 19:56:35 -0800 > ------------------------------ > From: "ainsron" > To: > Subject: RE: Brain damaged baby case (long) > Message-ID: <003a01c653ad$f4b94cf0$0728a8c0@DOCTOR> > MIME-Version: 1.0 > Content-Type: multipart/alternative; > boundary="----=_NextPart_000_003B_01C6536A.E6960CF0" > > ------=_NextPart_000_003B_01C6536A.E6960CF0 > Con! tent-Type: text/plain; > charset="US-ASCII" > Content-Transfer-Encoding: quoted-printable > > When my wife was in nursing school, she was warned that "nurses eat > their > own." She has seen evidence of that on a regular basis, ever since > then. > > Ronald E. Ainsworth, MD, FACOG > > -----Original Message----- > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of fran > wilson > Sent: Wednesday, March 29, 2006 4:50 PM > To: Multiple recipients of list OB-GYN-L > Subject: Re: Brain damaged baby case (long) > > In my experience, that is very true. Nurses not only go after other > nurses, > but also nurse midwives. Of course, this is a generalization, but it > really > has been the trend in the hospitals where I have practiced bot! h as a > nurse > and a nurse midwife. > > Fran Wilson, CNM > Kennewick, WA > > _____ > > From: Grace Loehr > Reply-To: ob-gyn-l@obgyn.net > To: Multiple recipients of list OB-GYN-L > Subject: Re: Brain damaged baby case (long) > Date: Wed, 29 Mar 2006 18:43:23 -0600 > Re: Joanne, Lynn, &c's comments on physician discipine/ retraining of > problem docs. > > Your comments reinforce the observation of many nurses that docs stick > together and stick up for each other (I know, the example is about > incompetent even the other docs want to get remedial treatment or > license > revoked, but I think the principle applies), whereas nurses will use > gossip, > lying, maliciousness and not liking somebody to get a nurse written up, > fir! ed, or license suspended. Nurses and management are very willing to > throw > the book at nurses for any excuse, it seems. There are names for this: > nurses eat their young, oppressed group behavior, bullying in the > workplace, > &c. Very sad. I've liked how docs stick together, in contrast, although > of > course this tendency can be counterproductive and dangerous for pt > safety, > as with the examples given. I envy how female MDs stick together and > help > each other. > > Grace > > ------=_NextPart_000_003B_01C6536A.E6960CF0 > Content-Type: text/html; > charset="US-ASCII" > Content-Transfer-Encoding: quoted-printable > > > charset=us-ascii"> > > > /* Font Definitions */ > @font-face > {font-family:Tahoma; > panose-1:2 11 6 4 3 5 4 4 2 4;} > /* Style Definitions */ > p.MsoNormal, li.MsoNormal, div.MsoNormal > {margin:0in; > margin-bottom:.0001pt; > font-size:12.0pt; > font-family:"Times New Roman";} > a:link, span.MsoHyperlink > {color:blue; > text-decoration:underline;} > a:visited, span.MsoHyperlinkFollowed > {color:purple; > text-decoration:underline;} > p > {margin-right:0in; > margin-left:0in; > font-size:12.0pt; > font-family:"Times New Roman";} > span.EmailStyle18 > {color:black;} > @page Section1 > {size:8.5in 11.0in; > margin:1.0in 1.25in 1.0in 1.25in;} > div.Section1 > {page:Section1;} > --> > > > Roman">> style='font-size:12.0pt;color:black'>When my wife was in nursing > school, she > was warned that “nurses eat their own.” She has seen > evidence of > that on a regular basis, ever since then.
> > > Roman">> style='font-size:12.0pt;color:black'>
> > > Roman">> style='font-size:12.0pt;color:black'>Ronald E. Ainsworth, MD, > FACOG
>
> > > Roman">> style='font-size:12.0pt;color:black'>
> > > face=Tahoma>> style='font-size:10.0pt;font-family:Tahoma'>-----Original > Message-----
> From: ob-gyn-l@obgyn.net > [mailto:ob-gyn-l@obgyn.net] On > Behalf Of fran > wilson
> Sent: Wednesday, March > 29, 2006 > 4:50 PM
> To: Multiple recipients > of list > OB-GYN-L
> Subject: Re: Brain > damaged baby > case (long)
> > > face="Times New Roman">> style='font-size:12.0pt'>
> > > Roman">> style='font-size:12.0pt'>
> In my experience, that is very true. Nurses not only go after > other > nurses, but also nurse midwives. Of course, this is a > generalization, but > it really has been the trend in the hospitals where I have practiced > both as a > nurse and a nurse midwife.
> > > Roman">> style='font-size:12.0pt'>Fran Wilson, CNM
> Kennewick, WA
> > > 1.5pt;padding:0in 0in 0in 4.0pt; > margin-left:3.75pt;margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt'> > > > > style='margin-left:.5in;text-align:center'>> size=1 face=Tahoma>> style='font-size:8.5pt;font-family:Tahoma'> > ---------------------------------
> --------------------------------- > ---------------------------------
> > > style='margin-right:0in;margin-bottom:12.0pt;margin-left: > .5in'>> style='font-size:8.5pt;font-family:Tahoma'>From: > Grace Loehr > <divinegracie@earthlink.net>
> Reply-To: > style='font-style:italic'>ob-gyn-l@obgyn.net
> To: Multiple recipients of list > OB-GYN-L > <ob-gyn-l@dns.obgyn.net>
> Subject: Re: Brain damaged baby > case (long)
> Date: Wed, 29 Mar 2006 18:43:23 > -0600
> Re: Joanne, Lynn, &c's comments on physician discipine/ retraining > of > problem docs.
>
> Your comments reinforce the observation of many nurses that docs stick > together > and stick up for each other (I know, the example is a! bout incompetent > even the > other docs want to get remedial treatment or license revoked, but I > think the > principle applies), whereas nurses will use gossip, lying, maliciousness > and > not liking somebody to get a nurse written up, fired, or license > suspended. > Nurses and management are very willing to throw the book at nurses for > any > excuse, it seems. There are names for this: nurses eat their young, > oppressed > group behavior, bullying in the workplace, &c. Very sad. I've liked > how > docs stick together, in contrast, although of course this tendency can > be > counterproductive and dangerous for pt safety, as with the examples > given. I > envy how female MDs stick together and help each other.
>
> Grace
>
> ! >
> > ------=_NextPart_000_003B_01C6536A.E6960CF0-- > > ------------------------------ > > ------------------------------ > End of OB-GYN-L Digest 4749 > ------------------------------ > ***************************

Espacio para todos tus mensajes, antivirus y antispam ¡gratis! Regístrate ya - http://correo.espanol.yahoo.com/ --0-2142950279-1143765933=:50280 Content-Type: text/html; charset=iso-8859-1 Content-Transfer-Encoding: 8bit
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> <DIV>                       george arnas md</DIV> <DIV> </DIV> <BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid">-------------- Original message -------------- From: ob-gyn-l@obgyn.net > OB-GYN-L Digest 4749 > > Topics covered in this issue include: > > 1) Re: Pain management > by islesannie@yahoo.com (Joanne Bulley, MD) > 2) Re: Brain damaged baby case (long) > by rmodugno@aol.com > 3) Re: Pain management > by "fran wilson" <530rose@msn.com> > 4) Re: Pain management > by islesannie@yahoo.com (Joanne Bulley, MD) > 5) Protocols for NPs > by <SDOESTERLING-OBGYNDOTNET@YAHOO.COM> > 6) Re: Brain damaged baby case (long) > by Babycatchers@aol.com > 7) Re: Protocols for NPs > by JSBowpat@aol.com > 8) Re: Brain damaged baby case (long) > by Grace Loehr <DIVINEGRACIE@EARTHLINK.NET> > 9) Re: Brain damaged baby case (long) > by "fran wilson" <5! 30rose@msn.com> > 10) This you will not believe > by "fran wilson" <530rose@msn.com> > 11) Re: book > by Joe <FORCEP@INTERCOM.NET> > 12) Re: book > by Joe <FORCEP@INTERCOM.NET> > 13) Re: Protocols for NPs > by Joe <FORCEP@INTERCOM.NET> > 14) HepB/Preg > by Terrence.Jones@kp.org > 15) RE: Brain damaged baby case (long) > by "ainsron" <AINSRON@SBCGLOBAL.NET> > > ---------------------------------------------------------------------- > > Date: Wed, 29 Mar 2006 13:07:42 -0600 (CST) > From: islesannie@yahoo.com (Joanne Bulley, MD) > To: OB-GYN-L@OBGYN.net > Subject: Re: Pain management > Message-ID: <200603291907.k2TJ7gg30733@dns.obgyn.net> > > Here in Keene, it has gone the other way. They do the water births and > the staff are so into no meds for labor that when there is a patient who > really wants th! at intrathecal narcotic - the nurses are almost > pathologic in how they avoid assessing the patient's labor progress and > tell her either she is too early in labor for it or "oops" you are too > late to get it. Really really PO'd a couple of women who are > professionals themselves and wives of MDs on staff. Along with some > community folks as well. > > Back in the old days I and my two partners did our own epidurals and it > was great to just do it when it was the right time and not have to put > up with complaining anesthesiaologists! > > Joanne > > At Wed, 29 Mar 2006, Henry Gregor wrote: > > > >Intersting thoughts, JSBowpat@aol.com > 8) Re: Brain damaged baby case (long) > by Grace Loehr <DIVINEGRACIE@EARTHLINK.NET> > 9) Re: Brain damaged baby case (long) > by "fran wilson" <5! 30rose@msn.com> > 10) This you will not believe > by "fran wilson" <530rose@msn.com> > 11) Re: book > by Joe <FORCEP@INTERCOM.NET> > 12) Re: book > by Joe <FORCEP@INTERCOM.NET> > 13) Re: Protocols for NPs > by Joe <FORCEP@INTERCOM.NET> > 14) HepB/Preg > by Terrence.Jones@kp.org > 15) RE: Brain damaged baby case (long) > by "ainsron" <AINSRON@SBCGLOBAL.NET> > > ---------------------------------------------------------------------- > > Date: Wed, 29 Mar 2006 13:07:42 -0600 (CST) > From: islesannie@yahoo.com (Joanne Bulley, MD) > To: OB-GYN-L@OBGYN.net > Subject: Re: Pain management > Message-ID: all...in light of Grace's comments...years ago it seemed a > struggle to avoid patients' repetitively hearing remonstrations and > disincentives to accepting epidural analgesia, even with patients having > obviously horrific la! bor pain not responsive to psychoprophylactic or parenteral > options. Now, its tough for a patient not wanting an epidural to get through a > delivery without being subtly or overtly encouraged to epidural use, and three > plus hour second stages with stressed out patients and family are more and more > common...oh well, must another aspect of geezer hood sounding off here. > > > > H > > > > -- > Joanne Bulley, MD > Keene, NH, USA > > "Love is indescribable and unconditional. > I could tell you a thousand things that it is not, but not one that it is." > — Duke Ellington, American jazz artist (1899-1974). > JSBowpat@aol.com > 8) Re: Brain damaged baby case (long) > by Grace Loehr <DIVINEGRACIE@EARTHLINK.NET> > 9) Re: Brain damaged baby case (long) > by "fran wilson" <5! 30rose@msn.com> > 10) This you will not believe > by "fran wilson" <530rose@msn.com> > 11) Re: book > by Joe <FORCEP@INTERCOM.NET> > 12) Re: book > by Joe <FORCEP@INTERCOM.NET> > 13) Re: Protocols for NPs > by Joe <FORCEP@INTERCOM.NET> > 14) HepB/Preg > by Terrence.Jones@kp.org > 15) RE: Brain damaged baby case (long) > by "ainsron" <AINSRON@SBCGLOBAL.NET> > > ---------------------------------------------------------------------- > > Date: Wed, 29 Mar 2006 13:07:42 -0600 (CST) > From: islesannie@yahoo.com (Joanne Bulley, MD) > To: OB-GYN-L@OBGYN.net > Subject: Re: Pain management > Message-ID: > ------------------------------ > > Date: Wed, 29 Mar 2006 15:56:41 -0500 > From: rmodugno@aol.com > To: ob-gyn-l@obgyn.net > Subject: Re: Brain damaged baby case (long) > Message-ID: <8C8218A69F2A65! 9-1DFC-B6D@FWM-D41.sysops.aol.com> > Content-Type: multipart/alternative; > boundary="--------MailBlocks_8C8218A69F2A659_1DFC_BAF_FWM-D41.sysops.aol.com" > MIME-Version: 1.0 > > > ----------MailBlocks_8C8218A69F2A659_1DFC_BAF_FWM-D41.sysops.aol.com > Content-Type: text/plain; charset="iso-8859-1" > Content-Transfer-Encoding: quoted-printable > > Oftentimes, those "rules' are interpreted by the hospital - and very often t= > he intrepretations do not make sense. > > Robert Modugno MBA FACOG > Marietta, GA > > -----Original Message----- > From: Seele, Mona <MSEELE@TMH.TMC.EDU> > To: Multiple recipients of list OB-GYN-L <OB-GYN-L@DNS.OBGYN.NET> > Sent: Wed, 29 Mar 2006 12:34:26 -0600 > Subject: RE: Brain damaged baby case (long) > > > JCAHO and other regulatory bodies are the "kings of the kingdoms". Hospita! l= > s are herded by them in order to stay in business. There are sooooo many ru= > les now that do not make sense to us on the front lines, but we are required= > to follow or face sanctions by those regulatory bodies. > > Mona Seele, RN, MSN, CNS > > > > > > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Henry Greg= > or > Sent: Wednesday, March 29, 2006 11:17 AM > To: Multiple recipients of list OB-GYN-L > Subject: Re: Brain damaged baby case (long) > > > Oh yes,,,, years ago, I was in a hospital that :"disappeared" letters critic= > al of its processes, Docs that gave a crap about standards and process were= > quickly tagged disruptive and subjected to treatment worhthy of KGB techniq= > ues. Saddest thing was the willingness of the administration to devote dozen= > s of administrative work ho! urs to denial and coverup and whitewashing, as op= > posed to one or two simple corrective hours. Part of the process, I thought,= > then and now, involved for profit management contracts by a national firm, = > in a non profit institution. Though have seen similar issues in nonprofit wi= > th inhouse management. > > Hank > > Joe Cutchin <FORCEP@INTERCOM.NET>wrote: > Lynn: I'll bet that most of us have similar stories. Hospitals are > little kingdoms unto themselves ,supported by a national and state > hospital associations ,made legit by JACHO,herd MD's with hy-laws that > the hospital uses for its own purposes,etc. Oh my, here I am getting > cynical. Joe C > > Lynn Montgomery, MD wrote: > > > Now I am not advocating suing physicians, but let me play the devil's > > advocate here based on my personal experience: > >=2! 0 > > > > > > -Current hospital setting without ANY quality assurance in the OB > > Section for eight years. > > > > -Two JCAHO inspections during that time and > > passed with flying colors. > > > > -Several previous hospitals with QA programs, but when deficiencies > > identified, no action is taken. > > > > -At least two instances where a significant problem was identified with > > patient management where the physician refused to respond to any inquiry > > on advice from his counsel - despite the supposed confidentiality of > > peer review. No action taken regarding the cases. > > > > -Two and now possibly three physicians with a literal stack of charts > > with untoward outcomes. QA recommendation that privileges be suspended > > pending addi! tional training, etc, only to be laughed at by hospital > > counsel who state that we will all be sued and the suspension will not > > likely stand. > > > > > > > > So, given these issues, how are we supposed to accomplish "Physician > > police thy self". And if we cannot police ourselves, which we have > > apparently shown we can't; who is going to? > > > > > > > > It is easy to be critical of lawyers suing us, but I feel that we bear a > > good share of the responsibility by engendering a "good ole boys club" > > and rubber stamping our peer's practice patterns, whether appropriate or > > not - fearing that if we are critical of a peer's practice patterns, we > > may be next. > > > > > > > > I learned quality assurance from Bo! b Carpenter and Ray Kaufman and have > > been struggling my entire career to duplicate their approach, only to be > > met with frustration at every turn. > > > > Lynn > > > > > > > > > New Yahoo! Messenger with Voice. Call regular phones from your PC for low, l= > ow rates. > > > > Methodist. Leading Medicine. > > Named by FORTUNE magazine's "100 Best Companies to Work For" in 2006 > Named by U.S.News & World Report as one of "America's Best Hospitals" > > ***CONFIDENTIALITY NOTICE*** > This e-mail is the property of The Methodist Hospital and/or its > relevant affiliates and may contain confidential and privileged > material for the sole use of the intended recipient(s). Any review, > use, distribution or disclosure by others is strictly prohibited. If ! > you are not the intended recipient (or authorized to receive for the > recipient), please contact the sender and delete all copies of the > message. Thank you. > > ----------MailBlocks_8C8218A69F2A659_1DFC_BAF_FWM-D41.sysops.aol.com > Content-Type: text/html; charset="iso-8859-1" > Content-Transfer-Encoding: quoted-printable > > <DIV ?Verdana?; font-size: 10pt;?> <DIV> > <DIV>Oftentimes, those "rules' are interpreted by the hospital - and very of= > ten the intrepretations do not make sense.</DIV> > <DIV> </DIV> > <DIV>Robert Modugno MBA FACOG</DIV> > <DIV>Marietta, GA </DIV>  -----Original Message----- From: S= > eele, Mona <Mseele@tmh.tmc.edu> To: Multiple recipients of list OB-= > GYN-L <ob-gyn-l@dns.obgyn.net> Sent: Wed, 29 Mar 2006 12:34:26 -060= > 0 Subject: RE: Brain damaged baby case (long) > <STYLE> > .AOLPlainTextBody { > margin: 0px; > font-family: Tahoma, Verdana, Arial, Sans-Serif; > font-size: 12px; > color: #000; > background-color: #fff; > } > > .AOLPlainTextBody pre { > font-size: 9pt; > } > > .AOLInlineAttachment { > margin: 10px; > } > > .AOLAttachmentHeader { > border-bottom: 2px solid #E9EAEB; > background: #F9F9F9; > } > > .AOLAttachmentHeader .Title { > font: 11px Tahoma; > font-weight: bold; > color: #666666; > background: #E9EAEB; > padding: 3px 0px 1px 10px; > } > > .AOLAttachmentHeader .FieldLabel { > font: 11px Tahoma; > font-weight: bold; > color: #666666; > padding: 1px 10px 1px 9px; > } > > .AOLAttachmentHeader .FieldValue { > font: 11px Tahoma; > color: #333333; > } > > </STYLE> > > <DIV id=AOLMsgPart_2_2d8ec215-e477-49e7-9335-7f7119a34b7a> > <DIV dir=ltr align=left>> ial color=#0000ff size=2>JCAHO and other regulatory bodies are the "king= > s of the kingdoms".  Hospitals are herded by them in order to stay in b= > usiness.  There are sooooo many rules now that do not make sense to us = > on the front lines, but we are required to follow or face sanctions by those= > regulatory bodies.</DIV> > <DIV> </DIV> > <DIV align=left>Mona Seele, RN, MSN, CNS</FONT= > ></DIV> > <DIV> </DIV> > <DIV class=OutlookMessageHeader lang=en-us dir=ltr align=left> > <HR tabIndex=-1> > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-= > l@obgyn.net] On Behalf Of Henry Gregor Sent: Wednesday, Mar= > ch 29, 2006 11:17 AM To: Multiple recipients of list OB-GYN-L <= > B>Subject: Re: Brain damaged baby case (long) </DIV> > <DIV> </DIV> > <DIV>Oh yes,,,, years ago, I was in a hospital that :"disappeared" letters c= > ritical of its processes,  Docs that gave a crap about standards and pr= > ocess were quickly tagged disruptive and subjected to treatment worhthy of K= > GB techniques. Saddest thing was the willingness of the administration to de= > vote dozens of administrative work hours to denial and coverup and whitewash= > ing, as opposed to one or two simple corrective hours. Part of the process, = > I thought, then and now, involved for profit management contracts by a natio= > nal firm, in a non profit institution. Though have seen similar issues in no= > nprofit with inhouse management.</DIV> > <DIV> Hank Joe Cutchin <forcep@intercom.net> w= > rote:</DIV> > <BLOCKQUOTE class=replbq MARGIN-LEFT: 5px; BOR="<BR">> DER-LEFT: #1010ff 2px solid">Lynn: I'll bet that most of us have similar sto= > ries. Hospitals are little kingdoms unto themselves ,supported by a nati= > onal and state hospital associations ,made legit by JACHO,herd MD's with= > hy-laws that the hospital uses for its own purposes,etc. Oh my, here I = > am getting cynical. Joe C Lynn Montgomery, MD wrote: > > Now I am not advocating suing physicians, but let me play the devil's &g= > t; advocate here based on my personal experience: > > > = > > -Current hospital setting without ANY quality assurance in the OB <= > BR>> Section for eight years. > > -Two JCAHO inspections dur= > ing that time and > passed with flying colors. > > -Seve= > ral previous hospitals with QA programs, ! but when deficiencies > iden= > tified, no action is taken. > > -At least two instances where a physicians with a literal stack of charts > with untoward outcomes. = > QA recommendation that privileges be suspended > pending additional t= > raining, etc, only to be laughed at by hospital > counsel who state t= > hat we will all be sued and the suspension will not > likely stand.<B= > R>> > > > So, given these issues, how are we suppose= > d to accomplish "Physician > police thy self". And if we cannot! polic= > e ourselves, which we have > apparently shown we can't; who is going = > to? > > > > It is easy to be critical of lawyers = > suing us, but I feel that we bear a > good share of the responsibilit= > y by engendering a "good ole boys club" > and rubber stamping our pee= > r's practice patterns, whether appropriate or > not - fearing that if= > we are critical of a peer's practice patterns, we > may be next. = > > > > > I learned quality assurance from Bob Carpent= > er and Ray Kaufman and have > been struggling my entire career to dup= > licate their approach, only to be > met with frustration at every tur= > n. > > Lynn > </BLOCKQUOTE> > <DIV> > <HR SIZE=3> > New <A href='http://mailcenter2.comcast.net/wm/toolbar/3D"http://us.rd.yahoo.com/mail_us/taglines/postman4/*http://us.r=' > d.yahoo.com/evt9666/*http://beta.messenger.yahoo.com" target=_blank>Ya= > hoo! Messenger with Voice.</A> Call regular phones from your PC for low, low= > rates. > <DIV> > <HR SIZE=3> > > <DIV> </DIV> > <DIV>Methodist. Leading Medicine. Named by FORTUNE magazine'= > s "100 Best Companies to Work For" in 2006 Named by U.S.News & World = > Report as one of "America's Best Hospitals" ***CONFIDENTIALITY NOTIC= > E*** This e-mail is the property of The Methodist Hospital and/or its<BR= > >relevant affiliates and may contain confidential and privileged material= > for the sole use of the intended recipient(s). Any review, use, distribu= > tion or disclosure by others is strictly prohibited. If you are not the i= > ntended recipient (or authorized to receive for the recipient), please co= > ntact the sender and delete all copies of the message. Thank you. </STRON= > G></DIV></DIV></DIV></DIV> > > ----------MailBlocks_8C8218A69F2A659_1DFC_BAF_FWM-D41.sysops.aol.com-- > > ------------------------------ > > Date: Wed, 29 Mar 2006 13:17:29 -0800 > From: "fran wilson" <530rose@msn.com> > To: ob-gyn-l@obgyn.net, ob-gyn-l@dns.obgyn.net > Subject: Re: Pain management > Message-ID: <BAY106-F2384B5140FE0A3EE812DC2F8D00@PHX.GBL> > Mime-Version: 1.0 > Content-Type: text/html; format=flowed > > <DIV> <div>I want to move to Keene!  Here in > Kennewick, even women who specifically tell the staff that they don't want to be > offered pain medication get an (at least) hourly question about whether they > have changed their mind, and warnings that if they don't do it now it will be > too late for an epidural.  Docile epiduralized women demand so much less of > the nursing staff...</div> > <div>Fran Wilson, CNM Kennewick, WA</div> > <BLOCKQUOTE style="PADDING-LEFT: 5px; BORDER-LEFT-WIDTH: 2px; BORDER-LEFT-COLOR: #a0c6e5; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px">> tahoma,sans-serif"> > U.S.News & World = > Report as one of "America's Best Hospitals" ***CONFIDENTIALITY NOTIC= > E*** This e-mail is the property of The Methodist Hospital and/or its<BR= > >relevant affiliates and may contain confidential and privileged material= > for the sole use of the intended recipient(s). Any review, use, distribu= > tion or disclosure by others is strictly prohibited. If you are not the i= > ntended recipient (or authorized to receive for the recipient), please co= > ntact the sender and delete all copies of the message. Thank you. </STRON= > G></DIV></DIV></DIV></DIV> > > ----------MailBlocks_8C8218A69F2A659_1DFC_BAF_FWM-D41.sysops.aol.com-- > > ------------------------------ > > Date: Wed, 29 Mar 2006 13:17:29 -0800 > From: "fran wilson" <HR color=#a0c6e5 SIZE=1> > From: islesannie@yahoo.com (Joanne Bulley, MD) Reply-To: > ob-gyn-l@obgyn.net To: Multiple recipients of list OB-GYN-L > <ob-gyn-l@dns.obgyn.net> Subject: Re: Pain > management Date: Wed, 29 Mar 2006 13:09:14 -0600 Here in Keene, > it has gone the other way. They do the water births and the staff are so into > no meds for labor that when there is a patient who really wants that > intrathecal narcotic - the nurses are almost pathologic in how they avoid > assessing the patient's labor progress and tell her either she is too early > in labor for it or "oops" you are too late to get it. Really really PO'd a > couple of women who are professionals themselves and wives of MDs on staff. > Along with some community folks as well. Back in the old days I and my > two partners did our U.S.News & World = > Report as one of "America's Best Hospitals" ***CONFIDENTIALITY NOTIC= > E*** This e-mail is the property of The Methodist Hospital and/or its<BR= > >relevant affiliates and may contain confidential and privileged material= > for the sole use of the intended recipient(s). Any review, use, distribu= > tion or disclosure by others is strictly prohibited. If you are not the i= > ntended recipient (or authorized to receive for the recipient), please co= > ntact the sender and delete all copies of the message. Thank you. </STRON= > G></DIV></DIV></DIV></DIV> > > ----------MailBlocks_8C8218A69F2A659_1DFC_BAF_FWM-D41.sysops.aol.com-- > > ------------------------------ > > Date: Wed, 29 Mar 2006 13:17:29 -0800 > From: "fran wilson" own epidurals and it was great! to just do it when > it was the right time and not have to put up with complaining > anesthesiaologists! Joanne At Wed, 29 Mar 2006, Henry Gregor > wrote: > >Intersting thoughts, all...in light of Grace's > comments...years ago it seemed a struggle to avoid patients' repetitively > hearing remonstrations and disincentives to accepting epidural analgesia, even > with patients having obviously horrific labor pain not responsive to > psychoprophylactic or parenteral options. Now, its tough for a patient not > wanting an epidural to get through a delivery without being subtly or overtly > encouraged to epidural use, and three plus hour second stages with stressed out > patients and family are more and more common...oh well, must another aspect of > geezer hood sounding off here. > > H > -- Joanne > ob-gyn-l@obgyn.net > Subject: Protocols for NPs > Me! ssage-ID: <20060329220812.62703.qmail@web80808.mail.yahoo.com> > MIME-Version: 1.0 > Content-Type: text/plain; charset=iso-8859-1 > Content-Transfer-Encoding: 8bit > > As part of my hospital's NP/CNM committee, they want > me to provide protocols for the practice of Family > Nurse Practitioners, CNM's, and NPs in the area of > OB/GYN. > > Does anyone know of a good resource? I'd rather adopt > a book than write all the guidelines. > > I'm currently looking at "practice Guidelines for Ob > &Gyn " by Geri Morgan. > > Thanks, > > Scott Osterling > > ------------------------------ > > Date: Wed, 29 Mar 2006 17:16:45 EST > From: Babycatchers@aol.com > To: ob-gyn-l@obgyn.net > Subject: Re: Brain damaged baby case (long) > Message-ID: <27a.774f2b7.315c614d@aol.com> > MIME-Version:! 1.0 > Content-Type: multipart/alternative; > boundary="-----------------------------1143670605" > > > -------------------------------1143670605 > Content-Type: text/plain; charset="US-ASCII" > Content-Transfer-Encoding: 7bit > > Even in our small rural hospital, because of 1 doc with a 6 foot high (no > joke) stack of unfinished charts (cardiologist) we now get weekly threats to > suspend our privileges in 3 days if we do not complete charts. I had 2 this > week- verbal orders I forgot to sign at delivery. > There was a bad outcome with one of the stack of patients and they couldn't > find the chart. The MDs are reluctant, but are beginning to get the idea. > > Vicki Smith, CNM, MSN > > Midwives- changing the world one baby at a time. > > ob-gyn-l@obgyn.net > Subject: Protocols for NPs > Me! ssage-ID: <20060329220812.62703.qmail@web80808.mail.yahoo.com> > MIME-Version: 1.0 > Content-Type: text/plain; charset=iso-8859-1 > Content-Transfer-Encoding: 8bit > > As part of my hospital's NP/CNM committee, they want > me to provide protocols for the practice of Family > Nurse Practitioners, CNM's, and NPs in the area of > OB/GYN. > > Does anyone know of a good resource? I'd rather adopt > a book than write all the guidelines. > > I'm currently looking at "practice Guidelines for Ob > &Gyn " by Geri Morgan. > > Thanks, > > Scott Osterling > > ------------------------------ > > Date: Wed, 29 Mar 2006 17:16:45 EST > From: Babycatchers@aol.com > To: ob-gyn-l@obgyn.net > Subject: Re: Brain damaged baby case (long) > -------------------------------1143670605 > Content-Type: text/html; charset="US-ASCII" ! > Content-Transfer-Encoding: quoted-printable > > > > > <META content='3D"MSHTML' name=3DGENERATOR 6.00.2600.0?> > > Arial"=20 > bottomMargin=3D7 leftMargin=3D7 topMargin=3D7 rightMargin=3D7>> e_document=20 > face=3DArial color=3D#000000 size=3D2> > <DIV>Even in our small rural hospital, because of 1 doc with a 6 foot high (= > no=20 > joke) stack of unfinished charts (cardiologist) we now get weekly threats to= > =20 > suspend our privileges in 3 days if we do not complete charts. I had 2 this=20 > week- verbal orders I forgot to sign at delivery.</DIV> > <DIV>There was a bad outcome with one of the stack of patients and they coul= > dn't=20 > find the chart. The MDs are reluctant, but are beginning to get the ob-gyn-l@obgyn.net > Subject: Protocols for NPs > Me! ssage-ID: <20060329220812.62703.qmail@web80808.mail.yahoo.com> > MIME-Version: 1.0 > Content-Type: text/plain; charset=iso-8859-1 > Content-Transfer-Encoding: 8bit > > As part of my hospital's NP/CNM committee, they want > me to provide protocols for the practice of Family > Nurse Practitioners, CNM's, and NPs in the area of > OB/GYN. > > Does anyone know of a good resource? I'd rather adopt > a book than write all the guidelines. > > I'm currently looking at "practice Guidelines for Ob > &Gyn " by Geri Morgan. > > Thanks, > > Scott Osterling > > ------------------------------ > > Date: Wed, 29 Mar 2006 17:16:45 EST > From: Babycatchers@aol.com > To: ob-gyn-l@obgyn.net > Subject: Re: Brain damaged baby case (long) > idea.</D= > IV> > <DIV> </DIV> > <DIV>> >Vicki Smith, > CNM, MSN Midwives- changing the world one baby at a > time.</DIV> > > -------------------------------1143670605-- > > ------------------------------ > > Date: Wed, 29 Mar 2006 17:24:16 EST > From: JSBowpat@aol.com > To: ob-gyn-l@obgyn.net > Subject: Re: Protocols for NPs > Message-ID: <205.12d4eaa7.315c6310@aol.com> > MIME-Version: 1.0 > Content-Type: multipart/alternative; > boundary="-----------------------------1143671056" > > > -------------------------------1143671056 > Content-Type: text/plain; charset="UTF-8" > Content-Transfer-Encoding: quoted-printable > Content-Language: en > > You may want to consider Nell Tharpe CNM RNFA's clinical guidelines book. > &g! t; > 2006-2009 Clinical Practice Guidelines for Midwifery & Womenâ€™s Hea= > lth > presents a compilation of current practices that includes evidence-based, > traditional, and empiric care from a wide variety of sources. Each Guidelin= > e moves > through problem identification and treatment using a standardized format fo= > r > day-to-day clinical practice with diverse populations. The Guidelines are > currently in use by many practices as a way of meeting the American College= > of > Nurse Midwives (ACNM) recommendations, and are acceptable for collaborative= > > practice with physician colleagues. > Just a suggestion .... > Susan Paterson CNM > Bay City MI > > -------------------------------1143671056 > Content-Type: text/html; charset="UTF-8" > Content-Transfer-Encoding: quoted-printabl! e > Content-Language: en > > > > > <META content='3D"MSHTML' name=3DGENERATOR 6.00.2900.2802?> > > Arial"=20 > bottomMargin=3D7 leftMargin=3D7 topMargin=3D7 rightMargin=3D7>> e_document=20 > face=3DArial color=3D#000000 size=3D2> > <DIV>You may want to consider Nell Tharpe CNM RNFA's clinical guidelines=20 > book.</DIV> > <DIV> </DIV> > <DIV> > <div class=3DMsoNormal 0in 0pt?><FONT=20 > face=3D"Verdana, Helvetica, sans-serif" size=3D2>2006-2009 Clini= > cal=20 > Practice Guidelines for Midwifery & Women=E2=80=99s=20 > Health presents a compilation of current practices that=20 > includes evidence-based, traditional, and empiric care from a wide variety o= > f=20 > Nell Tharpe CNM RNFA's clinical guidelines book. > &g! t; > 2006-2009 Clinical Practice Guidelines for Midwifery & Womenâ€™s Hea= > lth > presents a compilation of current practices that includes evidence-based, > traditional, and empiric care from a wide variety of sources. Each Guidelin= > e moves > through problem identification and treatment using a standardized format fo= > r > day-to-day clinical practice with diverse populations. The Guidelines are > currently in use by many practices as a way of meeting the American College= > of > Nurse Midwives (ACNM) recommendations, and are acceptable for collaborative= > > practice with physician colleagues. > Just a suggestion .... > Susan Paterson CNM > Bay City MI > > -------------------------------1143671056 > Content-Type: sources. Each Guideline moves through problem identification and=20 > treatment using a standardized format for day-to-day clinical practice with=20 > diverse populations. The Guidelines are currently in use by many=20 > practices as a way of meeting the <?XML:NAMESPACE PREFIX = ST1 /><ST1:PLACE w:st='3D"on"'><ST1:PLACENA= > ME=20 > w:st=3D"on">> size=3D2>American <ST1:PLACETYPE w:st='3D"on"'><FONT=20 > face=3D"Verdana, Helvetica, sans! -serif"=20 > size=3D2>College</ST1:PLACETYPE></ST1:PLACENA=> <FONT=20 > face=3D"Verdana, Helvetica, sans-serif" size=3D2>of Nurse Midwives (ACNM)=20 > recommendations, and are acceptable for collaborative practice with physicia= > n=20 > colleagues.</div> > <div class=3DMsoNormal 0in 0pt?><FONT=20 > Nell Tharpe CNM RNFA's clinical guidelines book. > &g! t; > 2006-2009 Clinical Practice Guidelines for Midwifery & Womenâ€™s Hea= > lth > presents a compilation of current practices that includes evidence-based, > traditional, and empiric care from a wide variety of sources. Each Guidelin= > e moves > through problem identification and treatment using a standardized format fo= > r > day-to-day clinical practice with diverse populations. The Guidelines are > currently in use by many practices as a way of meeting the American College= > of > Nurse Midwives (ACNM) recommendations, and are acceptable for collaborative= > > practice with physician colleagues. > Just a suggestion .... > Susan Paterson CNM > Bay City MI > > -------------------------------1143671056 > Content-Type: face=Verdana> </div> > <div class=MsoNormal 0in 0pt?>Just= > a > suggestion ....</div> > <div class=MsoNormal 0in 0pt?>> face=Verdana> </div> > <div class=MsoNormal 0in 0pt?>Susa= > n Paterson > CNM</div> > <div class=MsoNormal 0in 0pt?>Bay = > City MI > </div></DIV> > > -------------------------------1143671056-- > > ------------------------------ > > Date: Wed, 29 Mar 2006 19:41:43 -0500 > From: Grace Loehr <DIVINEGRACIE@EARTHLINK.NET> > To: ob-gyn-l@obgyn.net > Subject: Re: Brain damaged baby case (long) > Message-ID: <F5FAA7ED-BF85-11DA-9320-000393DA5060@EARTHLINK.NET> > Mime-Version: 1.0 (Apple Message framework v553) > Content-Type: text/plain; charset=US-ASCII; format=flowed > Content-Transfer-Encoding: 7bit > > Re: Joanne, Lynn, &c's comments on physician discipine/ retraining of > problem docs. > > Your comments reinforce the observation of many nurses that docs stick > together and stick up for each other (I know, the example is about > incompetent even the other docs want to ge! t remedial treatment or > license revoked, but I think the principle applies), whereas nurses > will use gossip, lying, maliciousness and not liking somebody to get a > nurse written up, fired, or license suspended. Nurses and management > are very willing to throw the book at nurses for any excuse, it seems. > There are names for this: nurses eat their young, oppressed group > behavior, bullying in the workplace, &c. Very sad. I've liked how > docs stick together, in contrast, although of course this tendency can > face=Verdana> </div> > <div class=MsoNormal 0in 0pt?>Just= > a > suggestion ....</div> > <div class=MsoNormal 0in 0pt?>> face=Verdana> </div> > <div class=MsoNormal 0in 0pt?>Susa= > n Paterson > CNM</div> > <div class=MsoNormal 0in 0pt?>Bay = > City MI > </div></DIV> > > -------------------------------1143671056-- > > ------------------------------ > > Date: Wed, 29 Mar 2006 19:41:43 -0500 > From: Grace Loehr <DIVINEGRACIE@EARTHLINK.NET> > To: ob-gyn-l@obgyn.net > Subject: Re: Brain damaged baby case (long) > Message-ID: <F5FAA7ED-BF85-11DA-9320-000393DA5060@EARTHLINK.NET> > Mime-Version: 1.0 (Apple Message framework v553) > Content-Type: text/plain; be counterproductive and dangerous for pt safety, as with the examples > given. I envy how female MDs stick together and help each other. > > Grace > > > ------------------------------ > > Date: Wed, 29 Mar 2006 16:48:03 -0800 > From: "fran wilson" <530rose@msn.com> > To: ob-gyn-l@obgyn.net, ob-gyn-l@dns.obgyn.net > Subjec! t: Re: Brain damaged baby case (long) > Message-ID: <BAY106-F24E844C9DF4AEA97C45DC1F8D10@PHX.GBL> > Mime-Version: 1.0 > Content-Type: text/html; format=flowed > > <DIV> <div> In my experience, that is very > true.  Nurses not only go after other nurses, but also nurse > midwives.  Of course, this is a generalization, but it really has been the > trend in the hospitals where I have practiced both as a nurse and a nurse > midwife.</div> > <div>Fran Wilson, CNM Kennewick, face=Verdana> </div> > <div class=MsoNormal 0in 0pt?>Just= > a > suggestion ....</div> > <div class=MsoNormal 0in 0pt?>> face=Verdana> </div> > <div class=MsoNormal 0in 0pt?>Susa= > n Paterson > CNM</div> > <div class=MsoNormal 0in 0pt?>Bay = > City MI > </div></DIV> > > -------------------------------1143671056-- > > ------------------------------ > > Date: Wed, 29 Mar 2006 19:41:43 -0500 > From: Grace Loehr <DIVINEGRACIE@EARTHLINK.NET> > To: ob-gyn-l@obgyn.net > Subject: Re: Brain damaged baby case (long) > Message-ID: <F5FAA7ED-BF85-11DA-9320-000393DA5060@EARTHLINK.NET> > Mime-Version: 1.0 (Apple Message framework v553) > Content-Type: text/plain; WA</div> > <BLOCKQUOTE style="PADDING-LEFT: 5px; BORDER-LEFT-WIDTH: 2px; BORDER-LEFT-COLOR: #a0c6e5; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px">> tahoma,sans-serif"> > <HR color=#a0c6e5 SIZE=1> > From: Grace Loehr <divinegracie@earthlink.net> Reply-To: > ob-gyn-l@obgyn.net To: Multiple recipients of list OB-GYN-L > <ob-gyn-l@dns.obgyn.net> Subject: Re: Brain damaged baby case > (long) Date: Wed, 29 Mar 2006 18:43:23 -0600 Re: Joanne, Lynn, > &c's comments on physician discipine/ retraining of problem > docs. Your comments reinforce the observation of many nurses that docs > stick together and stick up for each other (I know, the example is about > incompetent even the other docs want to get remedial treatment or license > revoked, but I think the principle applies), whereas nurses will use gossip, > lying, maliciousness and not liking somebody to get a nurse written up, fired, > or license suspended. Nurses and management are very willing to throw the book > at nurses for any excuse, it seems. There are names f! or this: nurses eat > their young, oppressed group behavior, bullying in the workplace, &c. Very > sad. I've liked how docs stick together, in contrast, although of course this > tendency can be counterproductive and dangerous for pt safety, as with the > examples given. I envy how female MDs stick together and help each > other. Grace </BLOCKQUOTE></DIV> > > > ------------------------------ > > Date: Wed, 29 Mar 2006 17:22:18 -0800 > From: "fran wilson" <530rose@msn.com> > To: ob-gyn-l@obgyn.net, ob-gyn-l@dns.obgyn.net > Subject: This you will not believe > Message-ID: <BAY106-F33D6A7417B261ED0ED8C69F8D10@PHX.GBL> > Mime-Version: 1.0 > Content-Type: text/html; format=flowed > > <DIV> <div> <A > href="http://www.msnbc.msn.com/id/12056405/">http://www.msnbc.msn.com/id/1205640 > 5/</A> </div> </DIV> > > > ------------------------------ > > Date: Wed, 29 Mar 2006 20:34:00 -0500 > From: Joe <FORCEP@INTERCOM.NET> > To: ob-gyn-l@obgyn.net > Subject: Re: book > Message-ID: <442B3588.3020202@intercom.net> > MIME-V will use gossip, > lying, maliciousness and not liking somebody to get a nurse written up, fired, > or license suspended. Nurses and management are very willing to throw the book > at nurses for any excuse, it seems. There are names f! or this: nurses eat > their young, oppressed group behavior, bullying in the workplace, &c. Very > sad. I've liked how docs stick together, in contrast, although of course this > tendency can be counterproductive and dangerous for pt safety, as with the > examples given. I envy how female MDs stick together and help each > other. Grace </BLOCKQUOTE></DIV> > > > ------------------------------ > > Date: Wed, 29 Mar 2006 17:22:18 -0800 > From: "fran wilson" <530rose@msn.com> > To: ob-gyn-l@obgyn.net, ob-gyn-l@dns.obgyn.net > Subject: This you will not believe > Message-ID: From: Joe Cutchin <FORCEP@INTERCOM.NET> > > To: Multiple recipients of list OB-GYN-L <OB-GYN-L@DNS.OBGYN.NET> > > Sent: Wed, 29 Mar 2006 10! :41:41 -0600 > > Subject: book > > > > Just found copy of "Hysterectomy" by John C. Burch MD 1954. Obviously > > excellent technique described. It just struck me that although the tools > > might be different surgical technique is quite old. Joe C > > > > > ------------------------------ > > Date: Wed, 29 Mar 2006 20:36:36 -0500 > From: Joe <FORCEP@INTERCOM.NET> > To: ob-gyn-l@obgyn.net > Subject: Re: book > will use gossip, > lying, maliciousness and not liking somebody to get a nurse written up, fired, > or license suspended. Nurses and management are very willing to throw the book > at nurses for any excuse, it seems. There are names f! or this: nurses eat > their young, oppressed group behavior, bullying in the workplace, &c. Very > sad. I've liked how docs stick together, in contrast, although of course this > tendency can be counterproductive and dangerous for pt safety, as with the > examples given. I envy how female MDs stick together and help each > other. Grace </BLOCKQUOTE></DIV> > > > ------------------------------ > > Date: Wed, 29 Mar 2006 17:22:18 -0800 > From: "fran wilson" <530rose@msn.com> > To: ob-gyn-l@obgyn.net, ob-gyn-l@dns.obgyn.net > Subject: This you will not believe > Message-ID: by Geri Morgan. > > > > Thanks, > > > > Scott Osterling > > > > > > > > > -----------------------! ------- > > Date: Wed, 29 Mar 2006 18:27:16 -0800 > From: Terrence.Jones@kp.org > To: ob-gyn-l@forum.obgyn.net > Subject: HepB/Preg > Message-ID: <OFDF460D51.CEF9C930-ON88257141.000CCF20@KP.ORG> > MIME-Version: 1.0 > Content-type: text/plain; charset=us-ascii > > Anyone with experience using Lamivudine (in combination with the usual > passive/active immunization) in last month of pregnancy to prevent vertical for the use of the individuals to whom it is addressed and > may contain information that is privileged, confidential or exempt from > other disclosure under applicable law. If yo! u are not the intended > recipient, you are notified that any disclosure, printing, copying, > distribution or use of the contents is prohibited. If you have received > this in error, please notify the sender immediately by telephone or by > returning it by reply email and then permanently deleting the communication > from your system. Thank you. > > > > > ------------------------------ > > Date: Wed, 29 Mar 2006 19:56:35 -0800 > From: "ainsron" <AINSRON@SBCGLOBAL.NET> > To: <OB-GYN-L@OBGYN.NET> > Subject: RE: Brain damaged baby case (long) > Message-ID: <003a01c653ad$f4b94cf0$0728a8c0@DOCTOR> > MIME-Version: 1.0 > Content-Type: multipart/alternative; by Geri Morgan. > > > > Thanks, > > > > Scott Osterling > > > > > > > > > -----------------------! ------- > > Date: Wed, 29 Mar 2006 18:27:16 -0800 > From: Terrence.Jones@kp.org > To: ob-gyn-l@forum.obgyn.net > Subject: HepB/Preg > Message-ID: <OFDF460D51.CEF9C930-ON88257141.000CCF20@KP.ORG> > MIME-Version: 1.0 > Content-type: text/plain; charset=us-ascii > > Anyone with experience using Lamivudine (in combination with the usual > passive/active immunization) in last month of pregnancy to prevent vertical > transmission (van Zonneveld (2003), J Viral Hepatol, 10:294-7)? Is Rx > stratified to maternal viral load? Any concerns re: NRTI's and mitochondria > in cardiac myocytes? /tj > > CONFIDENTIAL OR PRIVILEGED: This communication contains information > intended only > boundary="----=_NextPart_000_003B_01C6536A.E6960CF0" > > This is a multi-part message in MIME format. > > ------=_NextPart_000_003B_01C6536A.E6960CF0 > Con! tent-Type: text/plain; > charset="US-ASCII" > Content-Transfer-Encoding: quoted-printable > > When my wife was in nursing school, she was warned that "nurses eat = > their > own." She has seen evidence of that on a regular basis, ever since = > then. > > =20 > > Ronald E. Ainsworth, MD, FACOG > > =20 > > -----Original Message----- > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of fran > wilson > Sent: Wednesday, March 29, 2006 4:50 PM > To: Multiple recipients of list OB-GYN-L > Subject: Re: Brain damaged baby case (long) > > =20 > > > In my experience, that is very true. Nurses not by Geri Morgan. > > > > Thanks, > > > > Scott Osterling > > > > > > > > > -----------------------! ------- > > Date: Wed, 29 Mar 2006 18:27:16 -0800 > From: Terrence.Jones@kp.org > To: ob-gyn-l@forum.obgyn.net > Subject: HepB/Preg > Message-ID: <OFDF460D51.CEF9C930-ON88257141.000CCF20@KP.ORG> > MIME-Version: 1.0 > Content-type: text/plain; charset=us-ascii > > Anyone with experience using Lamivudine (in combination with the usual > passive/active immunization) in last month of pregnancy to prevent vertical > transmission (van Zonneveld (2003), J Viral Hepatol, 10:294-7)? Is Rx > stratified to maternal viral load? Any concerns re: NRTI's and mitochondria > in cardiac myocytes? /tj > > CONFIDENTIAL OR PRIVILEGED: This communication contains information > intended only only go after other = > nurses, > but also nurse midwives. Of course, this is a generalization, but it = > really > has been the trend in the hospitals where I have practiced bot! h as a = > nurse > and a nurse midwife. > > Fran Wilson, CNM > Kennewick, WA > > > _____ > > > From: Grace Loehr <DIVINEGRACIE@EARTHLINK.NET> > Reply-To: ob-gyn-l@obgyn.net > To: Multiple recipients of list OB-GYN-L <OB-GYN-L@DNS.OBGYN.NET> > Subject: Re: Brain damaged baby case (long) > Date: Wed, 29 Mar 2006 18:43:23 -0600 > Re: Joanne, Lynn, &c's comments on physician discipine/ retraining of > problem docs. > > Your comments reinforce the observation of many nurses that docs stick > together and stick up for each other (I know, the example is about > incompetent even the other docs want to get remedial treatment or = > license > revoked, but I think the principle applies), whereas nurses will use = > gossip, > lying, maliciousness and not liking somebody to get a nurse written up, > fir! ed, or license suspended. Nurses and management are very willing to = > throw > the book at nurses for any excuse, it seems. There are names for this: > nurses eat their young, oppressed group behavior, bullying in the = > workplace, > &c. Very sad. I've liked how docs stick together, in contrast, although = > of > course this tendency can be counterproductive and dangerous for pt = > safety, > as with the examples given. I envy how female MDs stick together and = > help > each other. > > Grace > > > ------=_NextPart_000_003B_01C6536A.E6960CF0 > Content-Type: text/html; > charset="US-ASCII" > Content-Transfer-Encoding: quoted-printable > > > > > <META http-equiv='3D"Content-Type"' content='3D"text/html;' ="<BR">> charset=us-ascii"> > > > <META content='3D"Microsoft' name=Generator Word 10 (filtered)?> > > <STYLE> >  > </STYLE> > > > > > > <DIV class=Section1> > > <div class=MsoNormal>> Roman">> style='font-size:12.0pt;color:black'>When my wife was in nursing = > school, she > was warned that “nurses eat their own.”  She has seen = > evidence of > that on a regular basis, ever since then.</div> > > <div class=MsoNormal>> Roman">> style='font-size:12.0pt;color:black'> </div> > > <DIV> > > <div class=MsoNormal>> Roman">> style='font-size:12.0pt;color:black'>Ronald E. Ainsworth, MD, = > FACOG</div> > > </DIV> > > <div class=MsoNormal>> Roman">> style='font-size:12.0pt;color:black'> </div> > > <div class=MsoNormal>> face=Tahoma>> style='font-size:10.0pt;font-family:Tahoma'>-----Original = > Message----- > From: ob-gyn-l@obgyn.net > [mailto:ob-gyn-l@obgyn.net] On = > Behalf Of fran > wilson > Sent: Wednesday, March = > 29, 2006 > 4:50 PM > To: Multiple recipients = > of list > OB-GYN-L > Subject: Re: Brain = > damaged baby > case (long)</div> > > <div class=MsoNormal>> face="Times New Roman">> style='font-size:12.0pt'> </div> > > <DIV> > > <div>> Roman">> style='font-size:12.0pt'> > In my experience, that is very true.  Nurses not only go after = > other > nurses, but also nurse midwives.  Of course, this is a = > generalization, but > it really has been the trend in the hospitals where I have practiced = > both as a > nurse and a nurse midwife.&