Saturday, August 29, 2009

Government Mandated Phones

Sitting down in the lounge between cases, I went to dictate my op note and grabbed the phone. It was bright red and next to it on the wall was a sign that informed me that this was a phone that would still be usuable in the event of a fire or electrical failure. The sign was one of those government signs that showed that this complied with the various federal laws that require such phone. It also said that in accordance with the Federal Law, the list of phone numbers of all the Red phones in the hospital is maintained on the hospitals intranet computer system where Federal Law mandates all emergency plans be located. I tried not to look, but had to. Yep, the computer was not red. I guess if there is an electrical failure, you first have to get the power back on to use the computers! Better yet, you could just fix the phones! Dont you just love how the government works!

Friday, August 28, 2009

Kennedy/Kopechne Health Care Bill

I saw that several attempts to insert an ammendment in to Obama's healthcare bill to require members of Congress to participate in a "public option" were killed in committee. Now some of the people sponsoring the bill want to rename the bill, the Kennedy Bill. Given Senator Kennedy's approach to healthcare I think it is appropriate, but should be called the Kennedy/Kopechne Health Care Bill. This way if you are a member of the elite such as a Senator and get an incurable tumor, you can fly by private air ambulalance to a medical center in another state for an expensive surgery and chemotherapy to prolong your life. If you are an average tax paying citizen, you just get driven off a bridge, left to drown and your family notified the next day by some random civil servant.

Thursday, August 27, 2009

Emanuel's principles of triage

This was just forwarded to me. More of the wisdom from Obama's man in charge of healthcare reform.

Complete Lives System - by Dr. Ezekial J. Emanuel et al.
Dr. Ezekial Emanuel, brother of Rahm Emanuel - chief of staff to the President, writes in the Lancet that: "The death of a 20-year-old young woman is intuitively worse than that of a 2-month-old girl, even though the baby has had less life. The 20-year-old has a much more developed personality than the infant, and has drawn upon the investment of others to begin as-yet-unfulfilled projects." Lancet, Volume 373, Issue 9661, Pages 423 - 431, 31 January 20, 2009.

Principles for allocation of scarce medical interventions
The Lancet, Volume 373, Issue 9661, Pages 423 - 431, 31 January 2009
Authors: Govind Persad BS, Alan Wertheimer PhD, and Ezekiel J Emanuel MD

Tuesday, August 25, 2009

Always take the history!

I stress to my students and residents that the key to diagnosis and treatment is taking the patient's history. I then have then research what is known about the disease state and tell me what treatment options have been tried and what seems to work. I am glad that none of them are politicians as our elected officials seem to want to ignore the history. I started looking at Massachusetts attempt at mandidate insurance and found that the costs are skyrocketing, access is lower and overall it is collapsing. Even better, I found Tenncare. This was the implementation of Hillary Clintons health plan in Tennessee. It was a massive government public option that was designed to be a to compete with private insurance in the state. So what happened? First, the cost tripled and the state went bankrupted. Second, it reimbursed so low that hospitals closed and refused to see patients with the government option. It got so bad, that the state did not pay some hospitals for over 3 years. Since the Tenncare paid less than what it cost to provide care and the cost was to be made up by the privare insurance companies, they left the state. Lastly, because it was given for free, people from other states flocked to Tennessee to get free drugs and care. So in a nut shell, Tenncare bankrupted the state, decreased access and care to patients and disrupted the whole healthcare system. Now, Obama and his team want to institute Tenncare to the whole nation. What did Tennessee do? It went back to a Medicaid form of governmental medical assistance and encouraged private medical insurance providers to come into the state. It made sure that it kept taxes low to bring in industry and business and enacted tort reforms.

Tuesday, August 18, 2009

Mind the Queue

I had the chance to watch some British television last week and came accross some interesting things. First, the minister in charge of the National Health Service in the UK was responding to US criticisms. He stated that there were no waiting lists in the UK for specialist referrals or hospitalization. He was then forced to say that the official waiting lists did not start until someone had been in the referral queue for 18 weeks! Then it came out that there was at least 250,000 on the over 18 week list. There was also another story that explained because of the UKs liberal immigration policies, UK citizens between the ages of 19 to 25 have a 23% unemployment rate because all the entry level jobs are taken by immigrants. They have their own "cash for clunkers program" and the result is all the government money is being sent overseas instead of their own economy.
I wonder if we can make it possible for our voters to watch British television?

Friday, August 7, 2009

Hypocratic Oath

Zeke Emanuel who is Obama's man for healthcare said today that he thinks the oath that physicians swear is outmoded and should be eliminated. Although it is called the hippocratic oath, since the 70's this is the oath that we swear. It is the Oath of Maimonides. He swore the same oath, but I guess his idea of what swearing an oath is like saying, "well, I sort of swear unless it is politically incovienent". I guess he swore a hypocratic oath that is above all others. I wonder which parts he objects to? After all, it mentions God (bad for atheists, and which God); (It warns to resist charlatans and others who interfere with care like politicians).

"Almighty God, Thou has created the human body with infinite wisdom. Ten thousand times ten thousand organs hast Thou combined in it that act unceasingly and harmoniously to preserve the whole in all its beauty the body which is the envelope of the immortal soul. They are ever acting in perfect order, agreement and accord. Yet, when the frailty of matter or the unbridling of passions deranges this order or interrupts this accord, then forces clash and the body crumbles into the primal dust from which it came. Thou sendest to man diseases as beneficent messengers to foretell approaching danger and to urge him to avert it.
"Thou has blest Thine earth, Thy rivers and Thy mountains with healing substances; they enable Thy creatures to alleviate their sufferings and to heal their illnesses. Thou hast endowed man with the wisdom to relieve the suffering of his brother, to recognize his disorders, to extract the healing substances, to discover their powers and to prepare and to apply them to suit every ill. In Thine Eternal Providence Thou hast chosen me to watch over the life and health of Thy creatures. I am now about to apply myself to the duties of my profession. Support me, Almighty God, in these great labors that they may benefit mankind, for without Thy help not even the least thing will succeed.
"Inspire me with love for my art and for Thy creatures. Do not allow thirst for profit, ambition for renown and admiration, to interfere with my profession, for these are the enemies of truth and of love for mankind and they can lead astray in the great task of attending to the welfare of Thy creatures. Preserve the strength of my body and of my soul that they ever be ready to cheerfully help and support rich and poor, good and bad, enemy as well as friend. In the sufferer let me see only the human being. Illumine my mind that it recognize what presents itself and that it may comprehend what is absent or hidden. Let it not fail to see what is visible, but do not permit it to arrogate to itself the power to see what cannot be seen, for delicate and indefinite are the bounds of the great art of caring for the lives and health of Thy creatures. Let me never be absent- minded. May no strange thoughts divert my attention at the bedside of the sick, or disturb my mind in its silent labors, for great and sacred are the thoughtful deliberations required to preserve the lives and health of Thy creatures.
"Grant that my patients have confidence in me and my art and follow my directions and my counsel. Remove from their midst all charlatans and the whole host of officious relatives and know-all nurses, cruel people who arrogantly frustrate the wisest purposes of our art and often lead Thy creatures to their death.
"Should those who are wiser than I wish to improve and instruct me, let my soul gratefully follow their guidance; for vast is the extent of our art. Should conceited fools, however, censure me, then let love for my profession steel me against them, so that I remain steadfast without regard for age, for reputation, or for honor, because surrender would bring to Thy creatures sickness and death.
"Imbue my soul with gentleness and calmness when older colleagues, proud of their age, wish to displace me or to scorn me or disdainfully to teach me. May even this be of advantage to me, for they know many things of which I am ignorant, but let not their arrogance give me pain. For they are old and old age is not master of the passions. I also hope to attain old age upon this earth, before Thee, Almighty God!
"Let me be contented in everything except in the great science of my profession. Never allow the thought to arise in me that I have attained to sufficient knowledge, but vouchsafe to me the strength, the leisure and the ambition ever to extend my knowledge. For art is great, but the mind of man is ever expanding.
"Almighty God! Thou hast chosen me in Thy mercy to watch over the life and death of Thy creatures. I now apply myself to my profession. Support me in this great task so that it may benefit mankind, for without Thy help not even the least thing will succeed."

I am proud of this oath, it is the oath that I swore, and where I am from, when you swear an oath, it means something. I guess for others especially in Washington, that is not so.

Party of Parasites

A host can often tolerate a few parasites without severe effects. As the load of parasites increases, the host has to expend more metabolic effort to maintain itself. Eventually, the load can increase to the point that the host begins to fail. Some parasites can modify the hosts immune defenses to protect themselves making them harder to remove. Also some hosts make it easier for other parasites to enter the host. I think this applies to Congress, the Country and the Democratic Party.

Sunday, August 2, 2009


I generally do not get to ask questions to our "political elite" but happened to have one cornered in the hospital so I let them fly. I asked "If we shift our medical spending to prevention and early detection of diseases, doesn't that mean that people will still get sick and die but later and of different things? So, how does this save money?" He replied "well, we wont have the cost of chronic preventable diseases." I asked him "which ones", and "how does this make any savings", he started gulping air, so I went on. I mean, say we "prevent" cancer. People are going to get other things, like chronic renal failure, congestive heart failure, other "chronic diseases", it is not like people are not going to need medical care and just suddenly drop dead (about Medicare age). "So, are you going to stop treating these other things?" He started to have blepharospasm and I was worried that any minute he might code. He went to his fall back party line quote "most medical expenses occur in the last months of life", of course I threw back, "How does prevention change that?". I would love to have had him on telemetry to see what his st segments and t waves were doing, but then one of the residents paged with a crisis and I had to leave. I am sure that I will be in the hospital CEOs office soon, why do we have our names on our white coats.