Aaron Donovan photographed Al Barr of the Dropkick Murphys at a recent Longwood Medical Area rally by the SEIU.

Paul Levy posts a report on a program at Beth Israel Deaconess Medical Center in which clinicians use a variety of "triggers" to take action that helps keep patients from dying or getting worse. Among the findings:

Always beware of unintended consequences: A program designed to let patients order food when and how they want it started causing problems for people who might swallow the food into their lungs (ditto for patients whose family members brought food in from outside).

Doctors really need to listen to nurses, especially when the nurses express "marked concern" about a patient's condition:

... When we implemented the Triggers program, many physicians were very nervous about giving this criterion. They were afraid that they might be called in the middle of the night for things that weren't really important, and that nurses might use this as a weapon if they did not like the physician or if they disagreed with the plan of care.

Well, it turns out that nurses use this Trigger quite judiciously – only 15% of our Triggers are called only for nursing concern. (In another 27% of cases, nurses express "marked concern" but the patient also meets other criteria simultaneously.) It also turns out that if nurse has "marked nursing concern," it means you're really sick. The in-hospital mortality rate for a patient who has a Trigger called for "marked nursing concern" is 10.7%.

This is roughly twice as bad as showing up to the Emergency Department with a heart attack. Literally.

After 45 minutes on the exam table, Steve Nadis gets fed up and leaves:

... Evidently the guy forgot about me and went out to lunch. As I left I saw a guy with a name tag bicycling up, looking nice and relaxed, and I was sure it was the doctor coming back from lunch. ...

Charley on the MTA explains why the state should call Glaxo's bluff and not give into the drug company over the issue of bribes gifts to doctors.

Dr. T explains why:

... This week I was asked to replace an I.V. in a patient prior to surgery. The bag of I.V. solution had been connected to the I.V. tubing by a nurse, as was customary at this hospital and in fact all the hospitals served by my anesthesia group. Most of the I.V.'s, in fact, are placed by the nurses unless they have trouble with them, in which case they call us to help.

I inserted the I.V. fairly easily and hooked up the tubing. Before directing the nurse to open the line and let the fluid start dripping into the patient's vein, I noticed something about the tubing. A subtle difference in the color of it (though it's colorless), or in the way light was being reflected through it (or not), or SOMETHING - I don't know exactly what - made me stop in my tracks. I disconnected the tubing. ...

And a good thing she did.

Who'da thunk? One cat, one skunk.

Kristin Huang is a first-year student at Harvard Medical School. First year means dissection and it's pretty rough (and then, the next day, even rougher). Definitely NOT for the squeamish (her subject lines begin with "Dismemberment" and "Mutiliation"), but it can give you some idea of what doctors in training have to go through.

Whoops: Health-care reform is getting people who don't need emergency care out of the emergency room, but now there aren't enough primary-care physicians outside the Boston area to handle them, the Times reports, leading Mike Mennonno to warn:

... Obviously, "fundamental truths" in the health care equation were ignored for political expediency. When the roof collapses on this thing, it's going to be a lot worse than the Ted Williams tunnel.

Props to the Globe for including a URL in a story about a survey showing how patients rank local hospitals. Points subtracted for getting the URL wrong. Here is the correct link.

Heroin hits home is an A&E documentary (airing tonight) on the growing problem of heroin addiction in Boston suburbs. Narrated by Donnie Wahlberg.

Via Blue Mass. Group, which digs up statistics showing more people die of heroin and Oxycontin addiction than car crashes in Massachusetts.