Sunday, October 19, 2008

Unfunded mandate = unfunded liability

A physican was recent sued and had to pay $400,000 because a patient claimed that because the physician did not hire an interpeter they did not understand the risks of the medication that they were prescribed. In this case the patient was deaf and the risks were printed on the information they received from the pharmacy. Even so, they sued the doc because Medicare mandates that a translator be available at all times. Of course Medicare does not pay for the translator. If you do get a translator, the translator will of course state that they are not responsible if the patient misunderstands the instructions and your hospital attorney will tell you that you are ultimately responsible. So here you go, a pateint comes into the ER, you have to see them by law regardless if they can pay, you then have to pay out of your own pocket what ever it costs to have an interpeter and even then, they can still sue claiming that they didn't understand the instructions. Then of course you must see them in follow up so you do not get sued for abandonment and must hire the interpeter every time they come to the office. (Because, even then it is your not the patient's responsibility to have an interpeter.) Something tells me that they will always be able to find an attorney as attorneys by law dont have to hire an interpeter.

Saturday, October 18, 2008


(*67 = Verizon's way to block your cell phone number) It is another week on call and I can not help venting on the crazy calls that come in. When you call the office it immediately states that if there is an emergency to call 911 and then goes on to state that prescriptions will not be refilled after hours and only after prompting that there is a problem with surgery or an urgent medical condition will the call be passed on to us. The answering service sends the message to us to call via a text message. The patients usually tell the service something other than why they are really calling. It doesn't matter though, the service does not want any liability so they patch everything through. We call them back *67 which lets us call the patient without the patient having our home number or when we can we connect through the service who can record the call. Again for legal reasons. So, here are some of the urgent medical conditions that have resulted in calls this week between midnight and 6 am. "I have a MRI next tuesday and wanted to see if it could be rescheduled?., "I can't sleep.", 19 calls from people who all claim to have just had surgery and run out of their pain medications. (I have copies of the last month's surgery lists), "My breath is really bad and I was hoping that you could call in some antibiotics.", "I need some Viagra". "What time is my appointment next week?" Oh, wait here come another one.

Friday, October 17, 2008

Null Hypothesis

I recieved this email from a friend who is finishing a detailed research project that shows common sense can not be applied to the practice of medicine. He gives the example of several of his patients who seem to prove the Null hypothesis.

A patient who has low self esteem, who was always yelled at as a child and gets very anxious when talking to others just got a job as a telemarketer.
A patient who tells me they can't afford to buy medication even for just 4 dollars always has a cell phone and smokes 2 packs of cigarettes a day.
A patient who has social anxiety and panic disorder who tells me they stay in their bedroom all the time at home and go nowhere except to come to my appointment can manage going somewhere to score some pot.
A patient who dropped out of school in the ninth grade and gets angry with everyone especially when it is a job where a boss tells them what to do wants a job where he makes all the decisions.
A patient with 15 piercings states that he is afraid of needles and has a low pain tolerance.
A patient who is disabled due to low back pain currently has a 3 handicap in golf.

Thursday, October 16, 2008


(Sensitive Compartmented Clearance) The surgeons lounge is often a free for all of discussions that are often fueled by the pressure of the days surgeries, delays and overall stress of operating. This leads to many ways to vent, with the most common being politics. Today, several of us that have been or still are military got into the subject of our security clearances. If you have never been through a clearance investigation, it is something that you would not believe. For a SCI they talked to everyone from my gradeschool teachers, neighbors, classmates, college friends and former lovers. In fact they gave me some extra credit for lovers that I never had! They whole process took over a year. One thing that amazed me was all my credit card receipts. Anyway, they knew the lot. We got to talking, if a politician is elected, what happens if they fail their clearance? I mean, what if a terrorist is elected or for that matter a spy? I mean, can they tell a Senator he cant be part of a discussion or a vote because it is above his clearance? I had to ask a friend of mine who is with the FBI, he gave me the sobering answer. The clearance comes with the job, meanining, if you get elected you get the clearance. They don't even bother to investigate.

Tuesday, October 14, 2008


(The immediate immature Defensive mechanism prefered by children and politicians) I know that it is human nature to hide one's own culpability by immediately blaming others. It is kind of like, "he who smelt it, delt it". This economic crisis though takes the cake. There is the frontal assualt by those whose job was to oversee Freddy and Fannie Mae who want to point the finger at the President, others in Congress who want to blame only Wall Street instead of the laws that were enacted and the former President who wants the blame to be shared by all except himself.

It is like watching children try to explain how a tennis racquet ended up through the front living room window. No one seems to know what exactly happened but they all are sure that it is the other guys fault. One thing that I think you can always count on, when push comes to shove, politicians act like children without mindful parents.

Wednesday, October 8, 2008

Roe'd right up the river by the courts

A recent court case got me just fuming. In Oceanside, California, a court ruled that a doctor can not refuse to do a procedure based on religious objection. The specific case involved a lesbian couple who went to a fertility doctor for artificial insemination. When he refused based on his religious background they sued stating that he discriminated against them. This is on top of a case where a transexual sued because a hospital would not approve them to have breast augmentation in their religious charity hospital.

I cant but wonder how long it will be before people sue Catholic Hospitals because they wont do tubals or some patient comes into the ER in labor and demands that the ER doc or OB perform an abortion and sues the religiosly objecting doctor. I guess in America, there is freedom of religion unless you are a doctor.

Health Insurance Flatline

I was wondering, with all the recent financial problems in the market and insurance companies failing, how soon will it be before health insurance companies begin to feel the heat? An old patient of mine said that "don't buy insurance, buy stock in insurance companies!" Insurance companies make their money off the interest they can get by investing in the market the money that they take in from premiums. When the market does bad, they do bad. How do they keep their bottom line? They stall on payments and pre-certifications.

I have asked our office if the have noted any changes. The big thing that they have seen is a new middle man. A firm that is contracted by the insurance providers to control pre-certifications. Working with them is next to impossible. In fact they even have hours that don't correspond to when doctor's offices are open just to decrease the number of cases that they have to approve. Every case seems to need a peer-to-peer review just to add to the burden of the whole process.

I can't help to think that perhaps the CEO's of the health insurance companies will have to take a pay cut this year. Then again, if it is only half, they will still get millions!

Monday, October 6, 2008

M4A3 Election

One of the great things about my job is that I get to meet all kinds of people who do all kinds of things. After the medical stuff is done there is sometimes time for a little personal chat. As I was removing sutures (I used 6-0, and no one else in the office would remove them) I asked my patient what he thought of the up comming election. He was elated and said that it was fantastic for bussiness. I could not help but as what kind of business he was in. He owns a local gunstore! He said that he can hardly keep up with demand and that there is a huge run on M4s (the carbine version of the M16) and handguns. (Oh, the Bersa 380 was the big seller there). I asked if this happens every election and he said not really. Sales stayed the same for Bush/Kerry and Bush/Gore. He did see a big run for each of the Clinton elections.

I wonder what other types of business are booming because of the election?