Doing more with less - Thursday August 5th

What I'm starting to really like about the Dotter institute is the 'can do' attitude of the staff. My perception of medical healthcare in the states before my visit was that it was exceptionally well funded and that insured patients routinely received the gold standard of diagnostic tests and treatments.

The reality that I've seen is quite different. Medical insurance companies demand value for money and in the context of a rapidly evolving specialty like interventional radiology this often means that the latest equipment and technologies simply aren't funded. The Dotter institute is particularly good at adapting to these constraints. "We do more with less" is an unofficial motto here.

One of the interventional rooms at the Dotter. Note the vending machine style equipment lockers.

A nice example of this is the set up of the interventional labs themselves. Rather than shelves of equipment on the walls, all the wires, catheters and other kit are kept in computer controlled storage lockers, similar vending machines. Rather than just taking a different catheter of the shelf when it is needed, the rad techs have to request the kit via the computer to ensure that everything is billed to the insurance company.

In the UK if we are unable to access a vessel with a particular shaped catheter we will open a new catheter (at about £100 a go). Here, to avoid opening unneccesary kit and incurring additional expense, a large flask is kept boiling on the side and catheters are held in the steam until malleable and then reshaped.

A constantly boiling flask kept on a hot plate to reshape catheters.

Keep Portland Weird! - Wednesday August 4th

The working day at the Dotter finished a bit earlier yesterday, and my jetlag is beginning to wear off a little, so after work I got on the free street car and headed north into downtown Portland.

The Portland streetcar

Portland is fairly compact as American cities go and once you're downtown it's easy to get around on foot. I walked through the old town and Chinatown where I had Thai food "a-la-cart" at one of the numerous food carts which fill any empty parking lot. Then I walked into the  cultural district where I watched a bit of live jazz in the street outside the art museum.

Eating "a la cart" in Portland - a massive Thai meal for $5

Shopping in Portland is fairly quirky. I was looking for a big music and video shop to buy a couple of DVDs but instead I found off-the-wall art shops, second hand book shops and little independent coffee shops, restaurants and micro-brewery bars.

Portland also has it's fair share of random weirdness boasting several small museums including the hat and vacuum cleaner museums. I saw lots of cars with the "Keep Portland Weird" bumper sticker, and this pretty well sums ups this side of Portland life.

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