Hourly Rate - Frightening Charge in Auto Accident Attorney Fees

In previous post, we present contingency fee info that auto accident attorney will charge you in percentage. From now on, we will talking about another fee that made clients got a terrible time, "hourly rate".

This second fee might make you feel creepy if you didn't read fee agreement very well before accept lawyer's offer.

Normally, when you want to hire auto accident attorney to fight for your compensation, he/she will offer fees info for you to decide. In case of your lawyer win the case, he/she will gain money from contingency fee.

However, if the hourly rate is the one of fees you accept to pay to attorney too, you need to pay whether your attorney will win the case in the court or not.

This fee is relevant to the time it takes to prevail.

Hourly rate - one of auto accident attorney fees.

Hourly rate (or you can call it "hourly billing rate") is the fee that you will pay for every hour your lawyer works on your auto accident case. Hourly rate of each lawyer is different. Some lawyers will charge you this fee very much for every hour that spend in the court but less in every hour to prepare for the case.

Actually, when your attorney want to charge the hourly rate or contingency fee to you, both of them are indicators that point your case can't be winnable or not.

For the best answer, you should ask auto accident attorney about this hour rate in detail as much as possible. So you can save money and looking for reasonable expenses.

Next time, we will focus on the last charge in three auto accident attorney fees, "flat fee".

How to make your own ultrasound gel (which is also sterile and edible and environmentally friendly)

I have been doing lots of bedside ultrasound lately and realized how useful it would be in areas far off the beaten track like Haiti, for instance. With a bedside ultrasound (mine fits in my pocket) I could diagnose heart disease, kidney and gallbladder problems, various cancers as well as lung and intestinal diseases. Then I realized that I would have to take a whole bunch of ultrasound gel with me which would mean that I would have to check luggage, which is a real pain when traveling light to a place where luggage disappears. I heard that you can use water, or spit, in a pinch, or even lotion, though oil based coupling media apparently break down the surface of the transducer. Or, of course, you can just use ultrasound gel.

Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glycerine, perfume, dyes, phenoxyethanol or carbapol R 940 polymer along with lots of water. It is hard to find this information, but it is available in the material data safety sheets for the various companies that make it. The recipes are proprietary. Ultrasound gel is not super expensive, but it is not that easy to find in a store or in a developing country. It costs about $25 for 5 liters on Amazon, or $5 for a nice 8.7 oz squeeze bottle. It smells ever so slightly medicinal and leaves a sticky, then dry white residue as it dries.

There should really be some sort of powder that you mix up with water that makes ultrasound gel so we don't have to be shipping the water part of it, which is undoubtedly about 99% of the contents, long distances. But there isn't a powder. I have been looking. No instant ultrasound gel.

With a mixture of optimism and singularity of purpose I went to the kitchen and tried out 6 different recipes for an aqueous goo that would transmit sound waves. I thought that I could make ultrasound jam out of water and pectin, but that doesn't really work. Obviously there is something magic about fruit that makes pectin gel, maybe the acid or the sugar. Without fruit, even no-sugar pectin becomes about the consistency of spit. (I also tried spit, which does work, but has various obvious drawbacks.) I tried plain gelatin and water and got beautiful clear jello, which falls off the transducer, but kind of works, but is also messy. I tried corn starch and water, as if making extremely boring gravy. That was lovely and white, but the water wants to come out of it so it just slides off the transducer. I tried tapioca flour which I boiled with water, producing a nice clear, very mucoid gel which dries like glue on the skin and is very uncomfortable. I tried xanthan gum, a bacterial polysaccharide used to bind and thicken, boiled and cooled, and although it thickens the water it is slimy and falls off the transducer and makes a mess.

The recipe that worked (and worked great) is guar gum, salt and water. Guar gum has been used for a very long time in countries like India and Pakistan to thicken food and is now used often by people who can't eat gluten, to thicken gravies and make breads. Guar gum is the ground endosperm of the guar bean, which is very rich in a carbohydrate that avidly absorbs water. Guar beans are also eaten green and the pods are used as a vegetable ingredient after shelling out the beans. Guar gum is available in the flour section of many grocery stores and costs about $10 for a 220 gram bag. It is purported to be good for diarrhea, constipation, diabetes and lowering cholesterol. It has been added to infant tube feed formula in intensive care units to decrease stool frequency.

I messed with the recipe awhile and came up with a very nice slightly caramel tinged ultrasound gel this way:

1. Mix 2 teaspoons of guar gum with 1-2 teaspoons of salt. (The amount of salt isn't vitally important since it is just added to keep the guar gum from clumping. Using slightly less than a teaspoon of salt per 2 cups makes a gel with which is isotonic, which would be ideal for use near eyes or other mucus membranes or on open wounds).

2. Boil two cups of water.

3. Slowly sprinkle the guar gum/salt mixture into the boiling water while stirring vigorously with a fork or whisk.

4. Boil for about 1-2 minutes until thick and well mixed.

5. Cool before using. Save lives.

This is wonderful ultrasound gel (see photo above). I tried it and it works at least as well as the proprietary stuff, and probably doesn't dry out quite as fast. It wipes off easily and doesn't leave a sticky film. Even though it is not entirely transparent, there is no reduction in the quality of the ultrasound image compared with the standard clear ultrasound gel. It costs about 25 cents for a half pint, is sterile when you have finished making it and is completely non-toxic. The ingredients are available in many developing countries, not to mention the US. It is edible. It is not particularly bacteriostatic, though it could be made bacteriostatic with a little EDTA (but then it wouldn't be edible). It is probably best made and used for a couple or 3 days, then discarded if unused, though I kept some in a clean bottle at room temperature and it was stable and smelled fresh for over a week.

It is quite thick, like regular ultrasound gel, so it is a bit of a trick to get it into a squeeze bottle. A large bore funnel works, or the cooled gel can be squeezed into the bottle out of the cut end of a plastic bag. It can also be kept in a jar and used with a spoon.

This is kind of exciting. Now I will no longer be dependent on ultrasound gel manufacturers. If I was in Haiti, either I or someone at the house where I was staying could make up a batch of this the night before clinic and I would have fresh clean ultrasound gel with which I could be generous in my scans.  The water wouldn't even have to be sterile since the stuff is boiled when it is made. Let there now be ultrasound in places that Amazon.com does not reach!

Here's a YouTube video of how to do it.

Practicing Zen meditation and being a doctor

I just got back from a 7 day Zen meditation retreat in Northern California. I have done 3 of these in the last 10 years, about as frequently as I get my teeth cleaned, and similar in some ways. They are time consuming, not particularly cheap or comfortable and I feel much better afterwards. Zen, however, unlike preventive dentistry, is really interesting.

I started meditating about 15 years ago when the stresses of being a mother of small, often irritating children as well as a small town physician had made me into a person I didn't particularly enjoy being around. My sister had started meditating and recommended that I just count my breaths up to 10 and then start over again while sitting on the floor for 20 minutes. It sounded simple, and I figured I would do an experiment, counting breaths every morning for a month and I would see if I was a better person. It was difficult. I kept falling asleep and could rarely actually count my breaths up to 10 without becoming distracted. At the end of a month I was converted and would no more have given up sitting than brushing my teeth. It turned out that I didn't have to be good at meditating in order to be calmer and happier, I just had to do it. I also had more interesting thoughts, even though I was kind of trying not to think while I was meditating, and I could sit still better when that was called for. I got better at listening to my patients. Things that should have been funny, were funny.

A few years later I attended a meditation retreat with the Zen group my sister had joined (Pacific Zen Institute) and was MUCH better afterwards. I didn't like the fact that I never got enough sleep at the retreat (that is part of the routine, getting up at 4:30) and my knees and butt protested the sitting in one position for hours every day. But that actually didn't matter. I started to realize all sorts of really obvious things that made me happier. Life was more interesting when I got back home. I started writing, mostly poetry, which was kind of an extension of meditation.

During this first retreat I first made the acquaintance of a koan. Koans are brief stories or conundrums that make a person think, and then make the person realize that thinking will not work. They invite mental gymnastics and frustration and then unfold into something unexpected at some random time, days weeks, months or years after taking them up. Many students of Zen will go through a curriculum of koans with a teacher, with feedback from the teacher about whether the student really got the message that the koan was meant to give. Over generations and across continents, the messages that each koan gives are remarkably similar. I had no easy access to a teacher, in the wilds of rural Idaho, so I did my own koan curriculum, finding the most irksome koan, or one that seemed to specially talk to me, and chewing on it until all of the realizations that it seemed to have within it became clear to me. There is precedent for this, though teachers think it works better if you have a teacher.

During my second retreat I continued to work on koans, continued to sit and be sleep deprived, and had various transformative experiences which are better experienced than described. This recent retreat a couple of weeks ago helped me unwind a few delusions which now seem obvious but didn't before it started.

One of the other people there was a physics professor at one of California's state universities, and we were dinner cooks together. Like me, he came from a place of pragmatism and skepticism, and practiced meditation because it was one of those things in life that turns out to need doing. We tried to figure out, from personal experience, what it is in sitting and not thinking about a baffling ancient story makes our minds richer and calmer. Of course we didn't figure it out, but agreed that there was something about stillness that the brain needs. I also think that my mind appreciates having something to play with, and a koan is a good toy. Wiser folk than I have and still are thinking about what is important about meditation and why it does all these good things, so it is probably perfectly OK for me not to trouble myself with this question.

Apparently all Zen groups and all meditation retreats are not created equal, and I was probably lucky to have happened upon Pacific Zen Institute. I am violently allergic to that which seems unkind orinsincere, and some Zen groups have these elements. The US has a rich and diverse Zen tradition, with subtleties of practice of which I am, and will remain, mostly ignorant. Buddhist meditation is even more diverse, much bigger than just Zen, and includes a myriad of Asian teachings as well as very westernized forms like Jon Kabat-Zinn's mindfullness based stress reduction. These all have passionate proponents and do the peace and happiness thing for those who practice them. Doctors such as Herb Benson at the Harvard Medical School have tried to figure out how to bottle what is good about meditation for easy consumption by patients, some of them who have been failed miserably by standard health care. Although such medicalized meditation doesn't appeal to me personally, it is wonderful that it exists to help folks who need it.

Contingency Fee - One of Auto Accident Attorney Fees

Auto accident attorney fees are the main topic that everyone who will hire auto accident attorney should collect tons of info for decision.

Most of these lawyers will charge these legal services to the their client. Actually, there are three fees...

1. Contingency Fee
2. Hour Rate
3. Flat Fee

But today, we will talk about the first of list above.

Contingency Fee

One of auto accident attorney fees.

In some states, contingency fee is the expense that often will pay to your lawyer. It will be calculated based on pre-arranged percentage of the money from the total settlement amount or compensation amount.

This means that if your attorney can't win the case for you, you will not to pay this fee to your auto accident attorney. However, in case of your lawyer can't recover injury money for you, it doesn't mean that you don't need to pay any expenses to him/her.

With good will...
So we recommend you to read fee agreement many times. Understanding it will help you know the contingency fee percentage that attorney will charge to you when he/she recovered your money. For other question about contingency fee, you can ask attorney to get the right answer.

OK, this is contingency fee info for you. Next time, we might present you the second in car accident lawyer fee - "Hour Rate".

How to become a locum tenens hospitalist and why you may or may not want to

Locum tenens (literally "place holder") is professional work done to fill in where help is needed. It is what I have primarily been doing for the last year, and has been an interesting ride.

When I decided to leave my practice related to losing a couple of partners and wanting to update my knowledge base and re-evaluate my career, I decided to do locum tenens work. I had always thought that having the skills of a physician would be able to allow me to travel and interact with places and people in a meaningful way, have adventures, roll up my sleeves, get my feet wet, that sort of thing. It turns out that this is true. Doctors with certain skills, especially internal medicine and hospital medicine, are wanted all over the country, especially in small towns and rural hospitals, and locums are hired often to avoid catastrophe while a hiring a permanent physician.

I have worked in California, Washington, Oregon, Idaho and Alaska in the last year and it has been really interesting and mostly gratifying. I have met new colleagues, made friends for life, seen lots of patients with mysterious and interesting problems and fascinating life stories and felt like I was useful and appreciated. I have also felt frantic and overextended, gotten lost, slept and ate less than was ideal.

There are many locum tenens agencies in the US that find jobs for physicians like me. They take care of helping facilities make sure that I am a legitimate doctor, not a serial killer or child molester, facilitate licensing in new states and make and pay for the arrangements that include travel, lodging and advocacy with the various organizations which hire me. For this they get about the same amount of money per hour that I do, so the client pays about double the amount that I am compensated to have me work. This is a LOT of money. It is a painful amount of money for the hospital to pay, so they really only use locum tenens doctors if they are desperate. Which means that, no matter how much they may like me at a given facility, they will rejoice when they can replace me with someone permanent. This means that I go to places, get to know people and systems, get good at them, am appreciated, then leave and never come back. They have the right to cancel my work within 30 days if they find someone cheaper to do it, and this has happened a couple of times. It is disconcerting, because it is often not possible to find new desirable work to replace what was planned with such short notice.

Becoming a locum tenens physician is easy: one simply contacts an agency online and then begins to fill out application forms and send countless documents to various places. It is time consuming but simple. Then a locums recruiter will call and begin to offer all sorts of jobs. If a job is interesting, the recruiter will send curriculum vitae information to the client and if the client is interested, phone interviews follow and if what they want is what the physician wants to provide, credentialing and scheduling follow.

I have found that different locums companies have different job opportunities and that I like some recruiters more than others. I have worked with Staff Care, CompHealth and Weatherby and have found them all to be honest and mostly easy to work with. The recruiter, though, makes money when I work, so they are all pretty proprietary about my time. In order to have a job when I want and where I want, I need to apply for more than one job at a time. If more than one comes through, I either have to work more than I want to or disappoint someone which makes me feel like a flake.

Full time work that pays much more than I made as a full time primary care doctor is 7 days a week, every other week, about 12 hours a day. This allows me to have real time off, which is great. Still, I spend lots of time on travel and lots of time away from my home, friends, family and dog. If I decide to do something creative in my off week, like attend a meeting or go on a trip, then I am away from home for 3 weeks in a row, which I virtually never did for the 20 years preceding starting locums. This is a little bit disruptive to anything that I have established at home, plus my dog gets really depressed.

Locum tenens work is a truly great option. It allows me to know that I will be able to stay busy in my field and make enough money to support my family and to have breathing space to do other important things. It is also not something that I will want to do as a primary occupation for very long.

Find Out Auto Accident Attorney Before Too Late

Auto accident attorney, the lawyer who can give you help in auto accident case. Sometimes, even though people have their own auto insurance and are happy from car protection, luck is not always by your side.

OK, let us try to stimulate that you have a car accident. Of course, you feel very upset. However when you think very carefully, you think another driver is a fault. So you want to claim for personal injury for your injury and etc.

Auto Accident Attorney

But if the situation is the opposite?
You are injured but can't get money after car accident!? Auto accident attorney is the right answer.

Auto accident attorney

"The professional in personal injury case, because of auto accident."

Auto accident attorney is one of personal injury attorney, the lawyer for car accident. He or she is the lawyer who can help you get what you deserve, this specialized lawyer was trained and help you recover from losing money because of auto accidents. After you or your loved one are hurt, these victims have the legal rights to compensation.

When you explore in internet, you will realize that there are many auto accident attorney sites and some websites will offer free consultation. After you win the case, he will charge fees.

New Idea!
For some reason, talking about fees made us decide to write about auto accident attorney fees. Let us start with one of them - contingency fee.

However you should not determine about hiring them after read our info. We recommend if you are interested and want to hire them, you should learn info well form other sources before deciding.

More on fecal transplants: a less icky alternative, but why?

The bacteria that live in our healthy guts are a garden of cooperating and competing species that help to determine our intestinal health. When we take antibiotics, we kill countless bystander bacteria in our guts and sometimes develop changes in our digestion which can be severe. Clostridium Difficile infection is one of these conditions, a superinfection with a bacterium which is pretty resistant to antibiotics and causes infection of the colon with diarrhea, sometimes fever, nausea and vomiting and occasionally death. We treat Clostridium Difficile (C. Diff) diarrhea with a couple of antibiotics to which it is sensitive, but they don't work very well and some patients become chronically infected.

What does work for C. Diff, when all else fails, is a fecal transplant, that is to say taking stool from a healthy person and putting it into the gut of a person who has the infection. This is a stinky procedure in which genuine human poop, from a human who has been tested for diseases like HIV that can cause their own problems, is diluted with saline and instilled into the gut either with a colonoscopy, a naso-enteric tube or a simple enema. It works quickly, like in one or two days and the patient, once cured, usually stays cured. It doesn't work on every single person, but very nearly.

Various physicians around the country do real fecal transplants, but it is surprisingly difficult to find a doctor who will. I saw a successful fecal transplant at our office a few years ago which was, in fact, very easy and instantly rendered the recipient well. The poop was mixed to a liquid consistency in a blender with saline and instilled by enema into the patient with the chronic C diff.

Researchers from Canada recently reported the successful treatment of two patients with Clostridium Difficile diarrhea with a combination of 33 bacteria isolated from the stool of a single healthy woman.  They tested an original group of over 60 bacteria for antibiotic resistance and chose the bacteria that did not appear to have any significant levels of resistance. The bacteria colonized the recipients' guts after being introduced by a tube into the duodenum from the nose, and the two patients, who had recurrent severe C. Diff infections, were symptom free 24 and 26 weeks after the procedure, despite being treated with antibiotics for other infections (which often leads to relapse in conventionally treated patients.) It sounds like these researchers have created an excellent human derived probiotic, but I'm thinking that if fecal transplant is actually successful, it makes sense to consider doing real fecal transplants with real feces, which will never cost very much and are much more diverse as far as bacterial species are concerned. The artificial poo extract is more likely to be adopted as standard of care, though, because it is not brown and stinky and will eventually be backed by a major pharmaceutical company.

Patients die frequently in the hospital as a result of C. Diff infection. Because fecal transplants are so yucky that nobody wants to even discuss them, much less perform them, we allow many people to die every year of colitis due to C. Diff. It is difficult to imagine that our cultural aversion to the products of our lower intestines regularly results in patients actually dying. A study in the New England Journal of Medicine reported this month was stopped early by the institutional review board in the Netherlands because fecal transplant was so much more effective than antibiotic therapy that continuing to offer patients the inferior option was considered unethical. For a good long while it will continue to be ethical to offer only antibiotic therapy for C. Diff at American hospitals, and to not even discuss fecal transplants except perhaps as a way to make physicians and nurses squirm.

It is clear that intestinal bacteria populations are responsible for more than making us poop regularly. Fecal diversity is related to weight gain in mice, for instance. Fecal transplants have been used successfully to treat inflammatory bowel disease such as ulcerative colitis. I've wondered if the spreading epidemic of gluten intolerance has to do with the huge amounts of antibiotics that humans in the US are prescribed and if that, too, might be treated with repopulation of the gut with the diverse collection of bacteria that make up the feces of healthy and ideally antibiotic naive people (if there are any of those left.) It seems to me that widespread antibiotic use in our communities in general has probably significantly affected the bacteria in all of our guts, even those of us who rarely or never take them. Antibiotic use in food animals probably contributes as well to a shift in our normal flora. Perhaps some of this recent research will push us to begin to venerate our bacterial symbionts and strongly consider their well being when considering taking or prescribing antibiotics.