May 2009

Friday I came home from work, docked my computer, fired it up and went to check the movie times at the dollar theater for my big date with Vickie. Fired up Firefox – nothing. Opened up IE8 – nothing. Tried Safari – still nothing. Looked at the DSL modem and router – all seemed fine (all das blinkenlights vas blinken und flashen). My first reaction was that my end is working, it must be that the Internet is down.

Since I was in a hurry to catch up with Vickie for dinner and a movie I didn’t have time to adequately diagnose the problem. Now, I can go a month without cable television. I only watch “The Weather Channel” anyway (it brings my blood pressure down getting “Locals on the 8s”). But the prospect of a weekend without the Internet terrified me. How would I know what was on eBay, what the Octomom was up to and how was I going to download the latest LOLcat in my Fam-spam?

All through dinner and Star Trek I thought about the problem. Was it limited to my computer? Did I have a cable pulled out? Had I paid the bill? Was there any construction on the street yesterday that could have cut my lifeline to Google? Was the Internet really down (there wasn’t anything on the radio about it) or was it something even more sinister?

I put it out of my mind and managed to have a fitful night’s sleep. The next morning, after a cup of healthy green tea to stimulate my mental processes (well process anyway), I attacked the problem fresh. First, I rebooted my computer. Still nada. Second, I fired up Vickie’s computer and, while it was booting, checked all the cables running into my dock/port replicator – all were in place and my network connection light was blinking properly. Third, I looked in the system tray in the bottom right of my screen to see if my LAN (local area network) connection was functioning – LAN was okay.

Fourth, I checked Vickie’s computer – no Internet there either. Problem duplicated so I know it’s not isolated to my computer alone (good news – maybe).

Next I called AT&T to hear the Internet outage report. No problems in my local area. Even though AT&T gave me a clean bill of health, I called them back, punched through all the voice-prompt systems and finally talked to Elvis from Bangalore. Elvis (who’s actually a really nice guy in Toronto who can’t pronounce “Toronto” in Canadian), tells me that he is showing a strong signal going to my router. In other words, it’s not AT&T’s fault I can’t get online, it’s me.

“So,” I ask Elvis, “what’s the next logical step?” He tells me it’s easy – just reboot my modem and router and see if that’s the issue. That’s what I was hoping not to hear; that’s the dirty job, involving crawling under the desk through a passel of dust bunnies to check all the cables on my DSL modem and my router. Elvis wasn’t up to it (but he did offer to stay on the line until the issue was resolved) so someone else had to do it. Vickie was still downstairs drinking healthy green tea oblivious to the impending disaster that would befall us if I couldn’t get the Internet back on. The job fell to me. Everything else had tested negative, it was time to tuck my red cape into my shorts, take Elvis’s advice and pull the plugs.

First, I unplugged the router then unplugged the DSL modem. Das blinkenlights are no longer blinken. I waited a minute to allow any dynamic memory to clear itself out. Once everything was still (not blinken) I took a deep breath, plugged the DSL modem back in and let it fire up (start blinken). Then I plugged the router back in and let it acquire a signal from the modem (and start blinken). Next, still holding my breath, I walked back to my computer, fired up the browser and…Yahoo! It’s back! I started breathing again, thanked Elvis profusely and got on with my day. I also have a WAP – a wireless access point (to give me wireless in the backyard) plugged into the router so I rebooted that too just for good measure.

What’s the takeaway for the Certified Legal Nurse Consultant? When your Internet is unavailable, don’t call your computer manufacturer’s help line. Instead follow these steps:

1) If you have a second computer sharing your network, see if it can connect to the Internet (I know, I didn’t do that first).

2) Reboot your computer to make sure it’s picked up any connections.

3) Check your physical network connections (your LAN) to your computer (skip if you’re connecting wirelessly).

4) Call your Internet service provider (ISP) to see if there are any network outages affecting your area.

5) Reboot/restart your cable or DSL modem and any router/hubs and/or WAPs you have plugged into that modem.

Internet outages are rare – the issue is usually something simple, so attack the problem in a logical order and you should get a simple and fast resolution.

Here’s another takeaway – if you’ve gone to VoIP (voice over internet protocol) for your legal nurse consulting business your phone calls are going through your Internet connection. This means that when your Internet is down you’ll need a cell phone or a landline to report the problem!

Keep on techin’,

Tom

I recently mentored a CLNC^® consultant on how to help her attorney-client learn whether a plaintiff had been given Zimmer Duron Cup hip replacements (sales suspended due to high rates of failures) and I started looking at the sheer number of products that have placed us all at risk.

It’s just incredible. The diversity of recalls is amazing. Foods, products, supplements and, of course, implants – everything is out to get us. Think about it, we’ve learned that the peanut butter we pack for our children’s lunches is potentially contaminated with salmonella. The pistachios we sneak into the movie theatre may also be out to get us (more salmonella). The tuna sushi we snack on at happy hour elevates our mercury levels (I can always tell Tom the current temperature) and the “heart-healthy” salmon we eat for dinner is contaminated with PCBs (if it’s not wild Alaskan). When we microwave butter-flavored popcorn to enjoy with our Netflix movies on Sundays, we risk poisoning our family’s lungs. Even the red wine we drink to forget our other problems may have more contaminants than tap water. Take note for the future, even Poligrip and Fixodent (I’m not there yet) have been linked to peripheral nerve damage (so that’s what’s wrong with grandma!).

What’s a Certified Legal Nurse Consultant to do? We can’t live in a cave or go underground (due to Radon) until all this passes us by – because it won’t. Legal nurse consultants live and practice in a wide, wide world of torts and this world is just going to keep getting more complicated. I don’t believe drugs are the answer to all our problems as the pharmaceutical industry would have us believe. In the past I’ve discussed the medicalization of health issues and feel that the more we come up with cures or medications for conditions, that may not really be conditions, the more side effects we’ll see.

I agree that some people may need Digitek^® to control abnormal heart rhythms (recalled 4/25/09), Fosamax^® for osteoporosis (linked to ostenoecrosis of the jaw) or Ortho Evra^® birth control patches (for you know what) which are possibly exposing women to excessive estrogen (which has been linked to blood clotting, stroke and heart attacks). I don’t even know what Gadolinium is or what it’s used for but I’ll be sure to avoid it because there’s a warning out for it!

Products liability is a great field for Certified Legal Nurse Consultants and there are lots of attorneys practicing in this area – on both the plaintiff and defense sides. Accutane^®, Cipro, Byetta^®, Raptiva^®, Darvon^®, Oral Sodium Phosphate and Avandia^® are all subject to warnings, recalls or worse and the list just keeps growing. Just type any one of these drug names into Google and you’ll find lots of attorneys practicing in this field.

The Internet certainly makes things easier for us – not only to locate clients but to get the word out about what’s possibly harmful to us. Certainly, some of these warnings may end up being overblown, and may cause some panic or anxiety, but don’t you think we as consumers would rather be warned than taken by surprise? Shouldn’t we have the right to choose our drugs after we read about the potential side effects?

We live in tumultuous times and they’re being made into dangerous times. Take advantage of the resources available to us these days and learn about these harmful products not only to grow your legal nurse consulting business, but also to avoid harm to your family.

Success Is Inside!

P.S. Comment on your most recent products liability case.

On my trip from Houston to San Diego to attend the christening of my new great-niece Reese, I experienced a strong dose of branding. Many of you know I enjoy my cups of healthy green tea almost as much as I enjoy a glass of healthy red wine. You probably don’t know that I have a secret addiction for Starbucks^® coffee. One that’s not entirely healthy if I’m not careful to tame it. I don’t get a Starbucks fix on a daily basis, but I manage to fit in two-three cups a week (usually at least one free one) on my morning walks with Tom. So, anytime I hit an airport in the morning (and I tend to fly only in the morning), my internal GPS goes off as soon as I clear security. That GPS will lead Tom and me directly to the airport’s Starbucks for my “red-eye.”

Tom’s favorite part of flying is sitting in Continental Airline’s Presidents Club. It’s all I can do to keep him from getting us to the airport three hours before our flight. He likes the free newspapers and will plow through the Wall Street Journal, USA Today, Houston Chronicle and The Financial Times and then jump on the club’s free wireless Internet to blow through his email on his laptop – all before we head to the gate. Even though I’m a president, I’m not crazy about the Presidents Clubs. From my point of view, although the seats are comfortable and the restrooms are clean, there’s no decent food. We usually fly before the bar is open and, here’s my pet peeve, the coffee is terrible.

As part of the process of being married for almost 19 years, we’ve worked out a bargain (one of many). I agree to get to the airport a little early. Tom agrees to go to Starbucks with me for my Starbucks fix. Then we both go to the Presidents Club so Tom can get his “news” fix. That bargain sometimes turns out to be more than Tom expected and a little frustrating for him as our last few flights have gone out of gates 27 or 30 in Terminal C at Houston’s George Bush Airport (IAH) and the closest Starbucks is way over in Terminal E. In fact, it’s so far that I joke with Tom that it’s in another time zone. What makes it frustrating for him is not just that we’ll have to walk one mile across the entire width of the airport, but that we’ll pass by at least two other brands of coffee shops (Peet’s and Einstein Bagels) and any number of fast food joints serving coffee on the way to the Starbucks in Terminal E. Tom loves to drink coffee, but he doesn’t really care that much about the brand. It can be airline coffee, McDonald’s coffee or even the brown water they call coffee in our office. As long as it’s hot, he’s happy. Me, I’m stuck on Starbucks. In fact, I’m so hooked, I go without coffee if I can’t find a Starbucks. Now that’s brand identification!

Let me ask you about your brand as a Certified Legal Nurse Consultant. Do you provide your attorney-clients with the quality of service that creates that sort of brand identification with you? Will your attorney-clients use only you for their medical-related cases? Are you the first and only legal nurse consultant they think of? If yes, you’ve accomplished what all entrepreneurs strive for. If no, ask yourself what you can do to create the Starbucks experience for your attorney-clients. Make it more than just providing the best CLNC^® work product available. Add a little lagniappe (as we say in New Orleans) – something more. In the technology age when everyone emails each other, show up at the door with bagels and a box of Starbucks coffee, deliver a bottle of champagne after your attorney-client wins or settles a big case or send a handwritten thank-you note.

I’d like you to comment and post some of your favorite tips for fostering brand loyalty to your own CLNC^® business. While you’re doing that, I’ll have another cup of one of my favorite brands.

Success Is Inside!

We all know there’s no one magic formula for prosperity and happiness, but there’s one common denominator I’ve found among successful nurses: they have a passionate drive to do what they do. They are on fire. Some inner spark in the mind, spirit and soul burns intensely, driving them over seemingly insurmountable barriers. Kind of like the passion we feel for a newborn baby. I just got back from my great niece’s christening in San Diego.

I was there the night she was born (March 29, 2009) and it was love at first sight. There’s nothing like the love we feel for a new baby, but wouldn’t it be nice if the love you feel for your work could be almost as strong as the love you feel for a baby?

Ask yourself if you’re passionate about the work you do as an RN. If the answer is no, it’s nothing more than a nursing job. Don’t say you go to work every day because of the family and bills. We’ve all got those. While we can’t all quit our jobs and just play in our garden or hold precious babies all day, we can set up our lives to enjoy our work. Just because we have to make a living doesn’t mean that we have to feel like we’re not living to make it.

When I started my legal nurse consulting business in 1982, I felt like I was birthing a baby. I had to work overtime at the hospital to pay my mortgage. Because my passion for starting my business was so strong, I was willing to give up TV, a social life and every spare minute I had to go for what I wanted. Was it easy? No. Was it worth it? YES! What do women say they remember most from the deliveries – the pain, or the unconditional love they felt? That’s how I remember my business start-up days. I was in love with the business I was creating, launching and growing.

Because I am passionate about my business and the work that goes with it, I am not really working at all. Does that sound strange or counter-intuitive? It shouldn’t. If you love what you do, it doesn’t feel like work. If you do what you love, you’ll never work another day in your life. Will you go to a job? Sure, probably five days a week. Will some days be harder than others? Sure. When Debra from our accounting department is distributing the paychecks, Tom will sometimes be heard to shout, “This is great! I can’t believe I get paid to work here! Woo-hoo!”

Do you have a “Woo-Hoo!” moment when you get your paycheck or do you have a “Ho-Humm” sigh? Without the fire that only passion arouses, success eludes us. If you’re not passionate about an idea, you won’t do what it takes to carry it out, because pursuing that idea would be way too hard without passion. Would a mom be able to go sleep deprived for years and do all that she does to care for her child without love?

To live passionately is to act. If you’re true to yourself, you’ll put energy behind your passions and take the necessary actions to bring them to fulfillment.

Passions are lived out in as many expressions as there are people. Yours are inside you, and they will reveal themselves with ease if you listen carefully. Take some time today and listen for your passion. It might surprise you and you may end up never working a day for the rest of your life.

Passionately yours,

Success Is Inside!

In my “PC to the Cleaners” thread, I’ve dusted you off, cleaned out your private data and today I’ll speed up your computer (at least infinitesimally). My final topic on cleaning is how to clean up (and out) your hard drive.

When you first buy a computer for your legal nurse consulting business, it runs so fast that we wonder why we struggled to live with our old computer. But what happens? The longer we use the “new” computer, the slower it gets. Why? The answer is simple – the more you work, the more data you store on the computer. The more data you store, the longer it takes to find the data you need.

First of all, think of an old vinyl record – 45, 33 or 78 rpm – whatever you grew up with. On a vinyl record, all of the data (the music) is in concentric tracks and you can immediately find a song by dropping the needle onto the correct track (anyone born after 1980 is probably lost by this point). At the risk of oversimplifying, think of your hard drive the same way. Your hard drive begins with its data in localized, easy-to-find places. As you use the computer and the hard drive spins, data is opened and saved into different spaces on the hard drive. Some portions of the data go into vacant spaces and some overwrites older data. At some point the “tracks of your data” are no longer in nice easy-to-find areas – they are spread out all over your hard drive. The more data on the drive, the longer it takes the computer to find and pull together the data when you open a file, photo or document.

What makes up these large quantities of data? First of all there are all those legal nurse consulting reports, LOLcats, photos, slide shows of flowers, movies of people doing stupid things and other attachments stuck onto your old sent and received email (if you use Thunderbird, Outlook, Outlook Express, etc. where copies of email are kept locally). There are also all sorts of old photos, files, file fragments, unused or partially uninstalled programs and other debris that have collected on your hard drive over time.

By cleaning out the junk or no longer needed files, you will free up hard drive or disk space you can then use to store new data. This speeds up the rate at which your computer accesses data (well not really, but it makes it easier for your computer to find so it seems quicker).

Simple things first: Go into your “sent” folder in your email program and delete any email more than 60 days old for personal email and 1 year for your CLNC^® business (or pick dates that work for you). Do the same for your received email and file attachments and dump anything you don’t need. If you can sort email by size (usually with a Size bar at the top of your email program’s window) go into the “sent” folder and click the Size bar until the largest email files are displayed first. Then delete any email with a large attachment (anything over 300 KB that you do not wish to save). If you want to keep an attachment, save it into the proper file on your hard drive (you’ve probably already done this and have a duplicate copy still attached to an email anyway).

Next, delete any unused or duplicate photographs, music, drawings, images or other files you have accumulated over the years. If you don’t feel comfortable deleting those photos from your 2001 summer vacation in Poughkeepsie (the photos you haven’t looked at since you came home) you can burn them to a CD/DVD or move them to a network storage device or portable hard drive, if you wish.

As you surf the Internet for information you need for your Certified Legal Nurse Consulting business, copies of all the web pages you visit are stored (cached) on your hard drive to make subsequent viewings faster. There’s no reason to keep these so you can set your web browser to clear the “cache” files on your web browser after every session and free up that disk space. Internet Explorer 6.0 and later can be set to do this automatically. Go to Tools, Internet Options, Advanced Tab, under Security. Select the box next to Empty Temporary Internet Files Folder when browser is closed and click OK. If you are using the Firefox browser you can look under Tools, Options, Privacy and Private Data Settings.

When a Windows^® user deletes a file, photo, etc., it goes into the Recycle Bin on your desktop to give you a chance to recover it, in case you have second thoughts. On a regular basis you should empty those “trash” files from your Recycle Bin. This maximizes your hard drive free space by freeing Windows to overwrite those files and the space they used to occupy. The files aren’t really deleted – Windows just pretends it can’t see them so it shows them as “free” space and eventually overwrites them.

To speed up file access you can consolidate your files into the My Documents folder. Here you’ll find subfolders such as My Music and My Pictures and you can create additional folders for word processing documents, spreadsheets, etc. By consolidating, you’ll make files easier to find, and you may only need to back up the one folder rather than having to hunt all over your computer for files to back up. (You can then set your Microsoft^® Office programs to open into the correct “default” folder so you won’t have to fish around.)

To gain back even more hard drive space, delete the “shovelware” from your computer. This is what I call the preloaded, “limited time only,” or preview software the manufacturer dumps onto computers due to licensing deals. It also includes the stuff you’ll never use. To get rid of it, open the Control Panel, go to Add and Remove Programs and remove any program you’re not using and don’t plan to use. Be careful though – just because you don’t recognize a program doesn’t mean you don’t need it (or won’t need it).

As I said earlier as you continue to create and save your reports for your attorney-clients, and delete files, Windows fills the “deleted” spaces with newer files, often scattering files across your hard drive? This causes Windows to run slower as it searches your hard drive for those fragments and pulls them together into your file. If you run a defragmenting program on a regular basis it will reconsolidate your files and programs so Windows doesn’t have to look for them. It’s kind of like putting the record tracks I talked about above back into the correct order for each song. After you delete no longer needed programs and data, you should run a defragmenter.

Windows^® XP has a good built-in defragmenting program. Before you run it though, you should empty your Recycle Bin. Then run the defragger from the menu bar by clicking Start, then Programs, then Accessories, then System Tools, then Disk Defragmenter and finally click Defragment. The program will start up, run and you will need to close it when complete.

I recommend defragging at least once a week. Any more often than that is simply compulsive. Any less than once a month is criminal. The key to keeping your computer running fast and smoothly is regular maintenance.

Keep on techin’,

Tom

Making a list,

Checking it twice,

Don’t want to kill a patient,

That wouldn’t be nice…

According to Dr. Atul Gawande, the average patient in an ICU requires “a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them poses risks. Substantial parts of what hospitals do – most notably, intensive care – are now too complex for clinicians to carry them out reliably from memory alone. ICU life support has become too much medicine for one person to fly. Any of us who’ve worked in the ICU shouldn’t be surprised by Dr. Gawande’s assertations. But what to do about it?

Here at Vickie Milazzo Institute we use checklists for everything. There’s not a major project, including the National Alliance of Certified Legal Nurse Consultants (NACLNC^®) Annual Conference (801 action items) that doesn’t have a major checklist. We find it not only keeps us from reinventing the wheel each time we start a new project (saving us time and money) but it also ensures that no moving parts are missed when we put something together. We even joke that we have checklists to make sure we have all our checklists!

Think about your life – you probably send your hubby to the grocery with a checklist. (Car keys – check. Checkbook – check. Grocery list – check). You (at least I do) pack for a trip with a checklist. (Bathing suit – check. Sunscreen – check. Mirrored shades to check out the hunky lifeguards – check). Checklists are part of everything I do and probably a large part of what you do on a daily basis also. Tom even has a checklist to make sure that he’s included all the proper clauses in the contracts that he writes (yawn).

How about using checklists to ensure safety instead of making sure you’ve got the loaf of bread, pound of pastrami and jar of mayo? This really isn’t a new idea. Since 1935 pilots have been using checklists to cover just about every aspect of flying an airplane, starting with the pre-flight inspection, taxiing, take off and landing. (Wings on – check. Wheels down – check. Dinner reservations at destination – check). Millions of passengers are delivered safely to their destinations each day thanks to simple checklists.

Now ask yourself as a Certified Legal Nurse Consultant, “how many patients are harmed because doctors (and maybe even nurses) don’t use checklists when doing complex medical procedures or simply treating patients?” The answer is, too many. Consistent protocols for patient care have been advocated by physicians since 1600 B.C. (Linen robe on – check. Snake-headed staff in hand – check. Leeches on patient – check.), but it wasn’t until 2003 that Dr. Peter Pronovost came up with a simple checklist to help reduce line infections in the ICU. That list was so successful that line infections in his hospital were reduced to almost 0%. Buoyed by this success he created other checklists which eventually were adopted by the state of Michigan for use in its ICUs. The results from implementation of those lists were so successful that Dr. Pronovost ended up publishing them in The New England Journal of Medicine in 2006.

In the almost three years since that study, not much else has happened with checklists. Apparently simple common sense just isn’t exciting enough for cutting-edge healthcare providers. You’d think that the medical and nursing professions would have expanded the use of checklists, but this hasn’t happened on a wide scale other than when you check-in at the hospital. (Insurance card – check. Ability to pay – check.)

That might be about to change though. The New England Journal of Medicine recently published the results of a study that involved using a simple, 19-item surgical checklist. The results were stunning: mortality rates in surgical patients were reduced by almost 50% and the same reduction was mirrored in nonlethal complications. With these sorts of results I hope that we’ll see a profusion of checklists in healthcare. The cost savings alone should get the attention of somebody. Perhaps checklists might be a simple way to reform healthcare. (Patient on table – check. Correct patient on table – check. Anesthesiologist sober – check.)

We know here at the Institute that a simple printed list can make a big difference, in time and money. Now healthcare providers are learning that checklists can save lives too. It’s time for healthcare to catch up with grocery shoppers. Next time you work up a case, have your attorney-client ask the healthcare providers for any checklists used in treatment of the patient. They should also ask each provider during deposition, how they ensure that they take each and every one of the proper steps in treating that patient. With such a line of questioning I can guarantee the jury will wonder why, in a world where a pilot won’t land an aircraft based solely on “memory,” a healthcare provider would do a risky procedure (e.g. brain surgery) on memory alone.

When you are consulting with attorneys on medical-malpractice cases helping to prepare interrogatories, requests for production and deposition questions be sure to ask about the use of relevant checklists in the healthcare setting.

Success Is Inside!

P.S. Comment and share checklists used in your healthcare facility.

When I was a young girl, my father didn’t eat leftovers (still doesn’t). That caused my mom to be very careful about how much food she would prepare for meals. My sister, Karen, still jokes with me that mom would prepare only five pork chops (one of our favorite dishes) and not one more (despite our pleas). I hadn’t really thought about pork since my letter to President Obama or pork chops since the last time Karen and I talked about Mom’s pork chops.

That all changed this week when I was having a skylight repaired in my bathroom. The ceiling is pretty high so it required a long ladder and two repairmen – one to do the work and one to steady the ladder. Naturally the guy holding the ladder got bored quickly and became quite chatty. At one point, apropos of nothing, he mentioned that he couldn’t wait for lunch. I overheard him and asked him if he’d had breakfast (healthy green tea and a healthy breakfast is an important way to start your day). He told me he’d had a small one – his wife didn’t cook him any bacon to go with his eggs. I replied that he was lucky on two fronts: (1) his wife cooked him breakfast (I was glad Tom didn’t hear him say that) and (2) she’s helping him watch his diet.

He replied that it wasn’t his diet she was worried about, it was catching swine flu from the bacon. I laughed and told him he could safely tell his wife that you can’t get the swine flu from eating bacon or other pork products. In fact, I went on to tell him that unless she was sleeping with an infected pig or had a sick pig running around the house she was safe. Just as I was getting started on a lecture regarding the facts surrounding swine flu, I noticed his eyes began glazing over (just like an attorney’s do when a legal nurse consultant goes on too long about their services without engaging in their positioning strategies). I cut to the chase and said, “Tell your wife that the best way to beat the H1N1 Influenza A virus (we can’t call it swine flu anymore because we’re apparently offending pigs) and just about any superbug, is to follow the hygiene practices championed by that 19th Century nurse, Florence Nightingale. Her practices are still valid today: vigilantly wash your hands and stay clear of anyone who is ill.”

For attorneys who are reading this blog, before you call our office, any Certified Legal Nurse Consultant can tell you there is no product liability suit against a pork producer for an H1N1-infected piggy. Those same Certified Legal Nurse Consultants also know that there might be a medical malpractice case for failure to diagnose, since the symptoms of H1N1 Influenza A are so close to those of “normal” flu.

As RNs we can and should contribute to this public health issue by reminding everyone around us (not just our spouses and children) to wash their hands. We should also remember that nursing and medical personnel can be a source of infection.

I’ll be washing all the way up to the elbows for a long time to come. Stay clean and healthy!

Success Is Inside!

P.S. When I walked over to Starbucks this morning for my “free” coffee, the staff must have read my blog about them because they had my tall “red-eye” (bold coffee with a shot of expresso) on the counter by the time I got to the register (darn)!