Comedy Bracket Voting Extended

Sunday, August 16, 2009

Due to embarassingly low voter "turnout" this week, I am extending the voting period for the Sweet 16 round by an entire week. You may vote right here. I emphasize once again that you may vote as many times as you want.

Universal Health Care: A POV from an ER Doc

Monday, August 10, 2009

Note: I did not write this. It was written by Dr. Jeremy Spinks, who used to work in the Emergency Room at Parkland Hospital (where Jodi currently works) here in Dallas, and I have reposted it with permission. I find it to be a very articulate argument for universal health care. I don't consider this to be the final word, but a start to healthy and reasonable discussion. Let me know what you think.

A striking phenomenon occurred in the emergency department at Parkland Hospital every morning around 6AM: about twenty to thirty patients with kidney failure would show up at the emergency department, would have their blood drawn and EKG checked, and each person would hope that he was sicker than the other, because only a lucky few would be selected to receive emergent dialysis that day. Patients with insurance who have kidney failure normally receive dialysis three times a week; without it, fluid builds up in their lungs, making them feel like they are drowning; nitrogen levels build up in their bloodstream, causing severe abdominal cramps and muscle aches; their blood pressure becomes drastically elevated, causing intractable headaches and putting them at risk for a brain hemorrhage; and their potassium levels grow unchecked putting them at risk for sudden death. The swarms of uninsured kidney failure patients that would come to the emergency department every morning were lucky if they were chosen to receive dialysis once every few weeks. The “lucky” ones in this scenario were the people whose potassium levels were the most elevated, the ones who might die from a heart rhythm abnormality at any moment. I once had one of these patients go into cardiac arrest while waiting to be seen in the ER. We rushed her into a resuscitation room, performed CPR and defibrillated her, and we were fortunately able to get her back, after which she quickly received the life-saving dialysis treatment that she needed. I later found out from her that she had consumed numerous bananas and soft drinks that morning in a deliberate attempt to elevate her potassium level so that she would be chosen to receive dialysis. That’s why her heart stopped. This is how desperate she was to get the treatment she needed, and the only way she knew how to do it.

This is the situation that millions of Americans face today – access to health care only when their situation has become so grave that they are knocking on death’s door. And what I came to discover very quickly in my training as an Emergency Medicine physician is this: the vast majority of people who do not have health insurance are hard-working, good people who simply cannot afford it. And because they cannot afford health insurance, they receive no preventative or maintenance health care, which leads to worsening of their illnesses. They are then forced to visit the emergency department where thousands of dollars are spent to deal with the complications and consequences of their untreated illnesses that could have been prevented if only these people had received access to regular, basic, and much cheaper health care from a primary care physician. The system, as it stands today, refuses to provide basic services to persons who need those services the most, but then is forced to provide far more expensive services to these same people when it is already too late.

When I finished my residency and started working at a private community hospital in the suburbs of Washington, D.C., I was eager to see what it would be like to work in a system in which the majority of patients have health insurance and good access to health care. I’ve been here for two years, and I am still eager to see what that would be like. In talking to numerous colleagues that practice emergency medicine in a variety of settings, the consensus I get is that the situation is the same at all emergency departments across this country – a very large percentage of the patients seen have no health insurance and no decent access to health care once they leave the emergency department. I’ve seen far too many patients come to the ER in very difficult situations that shouldn’t be allowed to occur, like the gentleman who comes in with an arm splint that he has been wearing for months, originally placed for a broken bone. This splint should have been taken off and replaced with a cast a few days after his injury, and now his broken bone will never be able to heal properly, and he can no longer function in his job. But no orthopedist is willing to see this patient and provide this very basic service because the patient doesn’t have health insurance. And more and more, specialists are refusing to take call for emergency departments because they know that they will wind up having to care for numerous patients without health insurance. This results in a dangerous situation for emergency department patients because the expert help required for certain emergencies is no longer available. I often have to transfer patients who have a very treatable problem to other facilities because I have no specialist on-call to treat the patient. These transfers result in dangerous delays to patient care and are extremely expensive, putting a drain on the health care system’s valuable resources, and so the cycle of inefficiency continues.

I’ve been fortunate to experience health care in our country from many angles – as a resident training in a county hospital that serves the poor, as an attending physician working in a private, community based hospital, and as a patient who must fend for himself in the private health insurance system. The issue has become very dear to me – every day I see numerous patients that deserve so much more than what we as a country give to them. It is wrong to have to prescribe a man an inferior antibiotic for his pneumonia because he can’t afford the more expensive antibiotic that he really needs. (By the way, he will later come back to the Emergency Department and require admission for his pneumonia.) It is wrong to tell a patient to follow up with an endocrinologist to manage her thyroid condition when I know the endocrinologist will refuse to see her because she can’t afford his fees without health insurance. (She’ll be back, too.) It is wrong to have to intubate a patient who has a brain hemorrhage caused by uncontrolled high blood pressure that existed simply because the patient couldn’t afford to see a primary care physician. It is wrong to have to send that same patient by helicopter to another facility, dangerously delaying the patient’s care, because my hospital can’t convince a neurosurgeon to take call for the emergency department because he doesn’t want to have to deal with uninsured patients. Day in and day out, the inadequacies of our current system force me to do things as a physician that are not in the best interest of my patients.

I used to believe that healthcare was a privilege, but what I have come to discover is that when healthcare is treated as a privilege, only the privileged receive it. I now fervently believe that health care is a fundamental human right. It is morally wrong for a society to have the basic resources that are necessary to save lives and prevent suffering and to distribute those resources in a fashion that favors the lucky few and ignores the millions of people who need those resources the most. Furthermore, denying millions of uninsured and under-insured persons access to basic healthcare results in a system that is appallingly inefficient, costly, and impotent; it costs us more as a country to persist in restricting access to healthcare than it would cost us to provide that care. And health care, much like education, a police force, and a military, is something that is so crucial to the welfare of our society that it cannot and should not be relegated solely to a for-profit system whose goal is not the welfare of the public but the financial profit that can be made at the expense of the public. Every day that I work in my emergency department and see patients coming in whose needs I cannot meet because of the inadequacies of our system, I become more steadfast in my belief that it is our duty as citizens of this country and as members of the human race to work quickly towards finding a system in which we all have access to basic health care, a fundamental human right.

(If you agree, please contact your district's representative and more importantly both of your state's senators and let them know! Specifically, let them know that you support a public health insurance option as an alternative to compete with private health insurance. Here's a website where you can get your senators' and representative's contact information - just click on "contact elected officials": )

Comedy Movie of the Decade - Sweet 16

In case you missed it:

Round 1

Round 2

The results for Round 2 are in. Check out the bracket.

For the second week in a row, we had one unanimous decision. In Round 1, Anchorman: The Legend of Ron Burgundy took home the honors, while Dodgeball: A True Underdog Story came away with the prize in Round 2. We sure do love those hyphenated movies.

We have one double-digit seed still alive, and that Cinderella is one Kung Fu Panda. It faces a tough opponent this week, going against #1 seed Anchorman. Just about every matchup this time around has some sort of intrigue, but there are 3 that particularly catch my eye. Two films that feature Will Ferrell, Wedding Crashers and Elf, face off against each other, while Simon Pegg fans will have to choose between Shaun of the Dead and Hot Fuzz. Meanwhile, Zoolander and Napoleon Dynamite come together in a battle of mentally challenged lead characters.

This week, I've asked two other committee members to list their favorite moments from each of the remaining movies. I haven't received their submissions yet, but once I do, I'll update the post, so check back. For now, I'll just include my own. Note: I've included links to video clips when available. Some clips may contain language you find unsuitable.

(1)Dodgeball: A True Underdog Story
RB:Dodgeball is packed with memorable scenes and quotable quotes, but the best part for my money is the scene in the bar where Average Joe’s celebrates after defeating the Girl Scout Troop to qualify for the national tournament. The full scene isn’t on the internet as far as I can tell, but here’s a partial.

(5)Talladega Nights
RB:I don’t think anybody really prayed to Baby Jesus before Ricky Bobby came out. Now, I imagine there may be one or two people that actually do.

(3)The Simpsons Movie
RB:Don’t tell me you don’t know this song.

(7)Meet the Parents
RB:Sorry if this seems obvious, but the funniest part of MTP is when Gaylord first meets the parents – and then they share dinner. Greg’s prayer alone makes the movie, but there’s also a hilarious exchange about milking a cat…

(1)Shaun of the Dead
RB:Listen, I love zombie movies (no, really), but anything that spoofs one is automatically funny. Probably the best part, though, is when Shaun and Ed finally figure out what’s going on, then go about learning how to actually kill the zombies. Couldn’t find the clip, sorry.

(4)Hot Fuzz
RB:This clip contains major spoilers. The death at 3:10, in context, made me laugh so hard I had to pause the movie.

(3)Wedding Crashers
RB:Vince Vaughn’s delivery in this scene is spot-on: “I felt like Jodie Foster in ‘The Accused’ last night.”

RB:Every time I pass “Santa” in the mall, I get the itch to expose him a la Buddy the Elf.

(1)Anchorman: The Legend of Ron Burgundy
RB:I don’t like this movie as much as a lot of people I know, but Jack Black’s cameo will always be hilarious to me.

(13)Kung Fu Panda
RB:The Kung Fu Panda is awesome – and attractive. Lucky for us, there’s no charge for such things.

(6)Knocked Up
RB:Paul Rudd and Seth Rogen do mushrooms in Vegas and talk about chairs in a hotel room. Hilarity ensues. Unfortunately, I could not find a clip anywhere.

(2)The Hangover
RB:There’s a lot of good material to choose from here, from Stu’s song about Mike Tyson's tiger to the tazing in the police station to the naked man jumping out the trunk, but when I think of The Hangover, the scene that immediately comes to mind is Alan’s speech on the rooftop.

RB:The walk-off.

(5)Napoleon Dynamite
RB:Even if you haven’t seen this movie, you probably know it because everybody (myself included) does a really bad impression of the title character. All of that quotable quote stuff is great, but Napoleon Dynamite is not the same without the dance scene.

(3)The School of Rock
RB:TSOR is about the songs, and this is the best one.

(2)Forgetting Sarah Marshall
RB:Russell Brand’s ludicrous portrayal of a douchebag rocker takes the cake in this one. Sodomize intolerance!

EDIT: I just figured out that you could embed the poll. Happy voting!

Deadline is Sunday, August 16 at 11:59 pm.

The Comedy Movie Bracket, Round 2

Monday, August 3, 2009

In case you missed it, here is the Introduction & Round 1.

Let's get to it.

The results for Round 1 are published. You can see the bracket here:

Best Comedy Movies of the 2000's

Out of the 32 first round matchups, there were only 5 upsets, two of them being 9 seeds. The lower-seeded movies moving on are Starsky & Hutch, Shanghai Noon, The Emperor's New Groove, Kung Fu Panda, and Juno. I find several interesting matchups in Round 2. In the Vince Vaughn Region, Dodgeball and Starsky & Hutch face off in a battle of Ben Stiller movies that were released in the Summer of 2004. The 2-7 matchup features one movie that is already considered a classic in The Royal Tenenbaums going against recent success The Hangover. Meanwhile, there's a chance that Owen Wilson movies Shanghai Noon and Meet the Parents could meet in the Sweet 16. In any case, there are some good movies that will not advance to the next round. Which will survive? Vote here:

Round 2

Voting ends on Sunday, August 9 at 11:59 pm.

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