Saturday, February 28, 2009

Bogotiphication by Attorney

There are many things that I would love to fix about our healthcare system and I have described those elsewhere in this blog, but one of the biggest things is that I would love to see is medicine practiced for the good of both the individual and the community. To do this we need to empiracly look at what works and what does not and provide that knowledge to our patients so that they can decide in their minds what would be best for them. An essential part of this process is to seperate the morass of the medicolegal mess that has eroded into medicine like a slowly growing and metasitisizing squaous cell. Unfortunately, we now have a nominee for Health and Human Services whose vast medical and public health experience is being executive director and chief lobbyist for the Kansas Trial Lawyers Association, and then the Kansas Insurance Commissioner, an elected post which she obtained with financial help from the insurance companies. So, the person in charge of medicine and the overall healthcare of the United States is a trial attorney who works for Big Insurance.

Friday, February 27, 2009

Obama Tech Support

Our computers at the hospital are crashing all the time now. There are so many extra programs, virus and outdated programs running that the operating system is unable to handle them. Their power supplies can not handle all the extra hardware that is plugged in to them. Being a surgeon, I wanted to to fix them by operating on them. I wanted to debride all the devitalized and parasitic stuff like viruses and spyware; delete all the outdated programs that suck up memory and cpu; amputate all the un-needed hardware and then cleanse the operating systems by refreshing them to the earliest point at which they seemed to work.

I was out voted, We are going to use Obama tech support. We are going to tell the computer that it has more vitual memory than it really has, add hundreds of new programs to further tie up the cpu, ignore all the viruses and spyware that clog up the whole system and lastly we will get rid of any backups.

Sunday, February 22, 2009

Crichton-Browne sign

My wife loves this new TV show called "Lie to Me" where a Ph.D. who is supposed to be an expert at detecting lies through facial movements helps sove criminal cases. They will often show an expression that represents a lie or feeling and then show photos of famous people who are doing the same expression. She asks me to watch it with her and sometimes I will just sit back and say I already did, "I watched CSPAN". The other day Barney Frank was talking about the banking and mortgage crisis and I got so distracted by his Crichton-Brown signs whenever he tried to answer a question that I frankly didn't hear a word he said. The more he talked the worst he had them. They were very bad when he was asked about who was responsible for the current economic crisis. I wonder what medications he is on and if the dosage needs to be adjusted?

Friday, February 20, 2009

Bilateral Queckenstedt's sign

When you are on call it seems that all too often you are called in for the dumbest reasons and it is important not to blow up and check from Queckenstedt's sign on the poor sod who called you in. Lately though, it seems that that calls are coming far to often. Rather than just complain I decided to investigate the matter. In my groups case, the vast majority of the calls are from nurse practicioners who are now manning some ERs and many Fast Tracks. These nurse practicioners are nurses with 17 months of extra training. I guess the idea is that they can replace a MD or DO who has 4 years of medical education and then 3 to 4 years of speciality emergency medical training. Anyway, stuff that usually could be seen in the ER that is treated and streeted can not be taken care of because the NPs either can't do it or don't know how to do it so you get called in. What is even worse is many times that I am called in I find that there is something totally different going on with the patients. Then I wonder, how many of the patients that they have sent home had something bad wrong! I called up one of the hospitals administrators and asked why the NPs are not discussing the patients with their supervising MD and he informed me that all the supervising MD has to do is review their charts later. Further the NPs can act independently. I asked why they dont hire MDs and the answer was easy, MDs cost too much because of their liability insurance. Nurse Practicioners are cheaper and have minimal insurance because they are not held to the same standards! You put EMTALA in the mix and there you are. You get called in for everything.

Wednesday, February 18, 2009

Elevator Logic

I tend to ask too many questions. I was in an elevator going up to see a patient and noticed that in the elevator was a gentleman from the elevator service company. I couln't help but asking where the emergency exit door was on the elevator. The hospital has these fancy ceilings in their elevators and I couldn't help now and then wondering what I would do if I got stuck. He explained that the door was behind the lighted panel in the ceiling. I asked how you get to it if you get stuck, he said that it was almost impossible and it really didn't matter because the escape doors are locked from the outside b. I asked him why they are locked and he said it was so that you could get out only if someone lets you out. Apparently, there have been lawsuits because people have been stuck in elevators and have hurt themselves climbing out of them or hurt when the elevator starts moving. As a result of the suits, the escape hatches are locked from the outside. I asked him what do you do if you are trapped in the elevator in a fire. He said, "Hope someone can get you out before you burn!"

I later found out that that it is even code to have the escape hatches locked! I wonder if the glass in the fire alarm box that states "break glass in case of fire" is unbreakable to prevent lawsuits because of people cutting themselves!

Saturday, February 14, 2009

Federal Witholding Healthcare

I was asked by our local Senator how we can fix healthcare. I think he was being retorical but instead I gave him both barrels. I told him the problem was that we pay for healthcare like we pay for our government and that has led to uncontrolled spending! He tried to walk away but the comment did create a little audience so I figured I might as well keep going on. I explained that health insurnace companies make their money on the interest of the money that they hold onto that they receive from employers. The more money they can get in and the longer they hold it, they make more. They want the money to come from the employers becuase it goes to them before those who are insured see it. This is the same reason our government adopted the withholding income tax. In both cases, if they get your money before you see it, they can get more. Also, in each case they put the burden on you as far as trying to get it back. Now since insurance companies make money on interest of the money they hold, it is essential that healthcare cost as much as possible so that they can raise the premiums and keep more of your money. This causes the huge inflation that is in healthcare. Things will cost as much as people will pay for. The insurance companies will pay so things will cost more. This inflation is in all aspects of healthcare.

So, how do we fix the problem? Competition is what lowers prices. Right now we really do not have competition. There are only a few big players. Opening up the borders of states to allow other choices for healthcare is one answer. The more insurance companies have to compete with each other, the better the rates for the insured will be. The second part of competition is the publication of healthcare charges by physicians, hospitals, etc. This should include private pay prices and prices paid by each insurance company. (Different physicians and hospitals are paid different amounts by the same insurance company) The long and short of it. We need to allow hospitals, doctors, and insurance companies to compete.

The last thing is what the health insurance companies do not want. Instead of your employer paying the health insurance premium, each of those insured needs to be the one who writes the check. The insurance comany needs to publish how much they will pay and for what and this needs to be given to each person insured. Then the patients are billed directly by the hospital, doctor, etc. and must be re-embursed by the health insurance company. This will cause the smart shopping patient to get their care where they get the most for their insurance dollars.
In many ways, our health insurance system is like the Federal Withholding Income Tax. If you seperate the person from their money before they knowthey have it, you can do anything you want with it. It is often said that our government would be a whole lot different if you paid your taxes in one big personal check at the end of the year. I think a great solution would be to get rid of income witholding tax and employer paid healthcare!

Friday, February 13, 2009

Functional Evelyn Wood Syndrome

I found one one of my old physiology text books today. It is about 1000 pages long. When I was thumbing through it I found a note with a 5 dollar bill attached to it. It said "Dont forget to give this to Sam!" I guess you can hide about anything in a big enough book! I cant remember who Sam was and when I had that class, 5 dollars was alot of money!

I saw today that the House voted on the "Stimulus Bill" less than 48 hours after it come out of committee. It was 1019 pages long. Lets see, at one minute a page, 60 pages an hour, that means it would take 16.9 hours to just read the bill. This does not count time studying it or trying to understand it or even see if you agree with it. The Congressmen did all this in 48 hours! They must be speed readers with amazing comprehension!

I had a whole semester of physiology and studied my brains out for that class and still managed to lose 5 bucks in the book! I wonder what our congressmen are losing in that 1019 page book that is the "Stimulus Bill".

Saturday, February 7, 2009

Obamas economic stimulus plan for lawyers

I guess the possible hard times for attorneys in the present economic climate must have sent shock-waves through the numerous attorneys that comprise our government and they felt obliged to support their collegues in the Stimulus Bill. Hidden deep inside of it, they managed to expand the already messed up HIPPA laws by allowing expansion of the ability to sue for "possible violations" and to be sure that trial-lawyers could even go after "big buck third parties". They also made sure that the door is open for every state attorney general to hire private firms for this. OR better yet, let private firms just bring in the cases to them. Up til now there have not been a lot of HIPPA based suits, I can only imagine that this will now be one of the newest growth areas for trial attorneys. I guess Obama and the trail attorney congress feel that the way to stimulate the economy is to expand the ability to sue over a poorly conceived and understood law and crush what ever business they can.

Thursday, February 5, 2009

Let the SCHIPS fall where they may

Some things have a lot of unintended effects, especially when they are done by those who don't understand the problem at hand. SCHIP seems to be a classic example. Many thought that "oh, great kids without insurnace will now have it and get better care", the problem is that it is the opposite. This is how it works, and how SCHIP will most likely be the death nail for our pediatric hospitals and many the pediatric medical practices.

In the great scheme of things, hospitals break even or lose just a bit on Medicare. They lose money on Medicaid and self pay. They make their money on private insurance. Infact, money from private insurance is what balances the losses from Medicare, Medicaid and self pay. Pediatric hospitals accross the country are cutting back, especially in California where the private insurane is decreasing and government payors are increasing. Now enter SCHIP. This is a government program that is supposed to provide health insurance for children whose parents make too much for Medicaid but who dont want to or cant afford private insurance. The problem is this. If you have a choice of getting a family health plan through your employer or pocketing the cash and taking the free government insurance, which one will you take? Better yet, will your employer even offer family coverage? Anyway, more and more kids will be swiched over from private to government insurance. This government insurace pays at the Medicaid rates. So there is a decrease in the private insurance which keeps the hopitals and medical services open and increases the money losing government insurances. The end result. The pediatric hospitals close and medical services refuse to see Medicaid and SCHIP. You now have effectively limited and decreased the care for the kids.

This is already a problem as it is very difficult to find medical care for kids with Medicaid and SCHIP. In California, where the pediatric cut backs are already huge, there is a crisis already. It is only going to get worse. Our pediatric hospital squeeked by last year because of the telethon, but they dont expect to survive this year.

Sunday, February 1, 2009

Parasitic Amaurosis fugax

(The sudden blind eye secondary to parasitic infections) Our University hospital had 34 deliveries last week of children born to illegeals. Of course, these children immediately get WIC, Medicaid and other state and Federal Support. So do their parents. I can't figure out why a few months ago the whole illeagal immigrant crisis was in the news, but now with huge government spending and massive job losses, no one has pointed out that there are millions of illeagals sapping the very jobs and tax dollars that the American Citizens need.

In medicine parasitic infections make wound healing and growth difficult if not impossible, parasites stagnate the host, when you increase the number of parasites the host dies. Parasitic infections are a common cause of amaurosis fugax in the third world and now apparently in the US.