Saturday, October 31, 2009

Emergency only if it is Before 5 pm

Here in the US, one of the big things that we get cited for is too many scans. In our ER one of the major reasons we do CTs is to check for pulmonary embolism which essentially is a clot in your lungs that can kill you. This is a NHS protocol from Kings Hospital in the UK.

There, if you come in with the symptoms of this life threatening condition, they will do the scan as long as it is before 5pm. That is of course after you have survived 2 hours. They also might just discharge you early to save money and just have you follow up in a few days and put you on a medication that can cause you to bleed to death in the meantime.

Friday, October 30, 2009


Just out of curiosity, I divided my yearly malpractice premium by my yearly patient encounters. In other words, every time I see a patient, it costs me $7.18 just to cover the malpractice insurance.

Thursday, October 29, 2009

Scooter Sign

(In 2008, Medicare paid over 686 million dollars for powerchairs, it is approaching 1.3 billion this year). I was wathcing TV and on came the commercial for the Scooter Store. They basically said that if you had Medicare, they would do all the paperwork to get you a power chair at no cost to you. Of, course I know that they would only do something like that if there was money to be made and sure enough, I found that Medicare would pay $11,000 for a chair that the Scooter Store could get for $6000. Then came the commercial for diabetes testing equipment. Sure enough, if you have Medicare, they will do all the work and you dont have to pay a cent. Well it appears that durable medical goods are the fastest growing Medicare expense. Things like power chairs, hospital beds, home oxygen equipment. Its not physicains fees. In fact, inflation adjusted, physicians make less now than they did in 1984.

It cant wait until I'm old enough for Medicare so I can get me a free power chair, this walking around the hospital on rounds wears me out.

Wednesday, October 28, 2009

Obama's Katrina

The CDC reported today that Children and adults under age 25 have accounted for 53% of hospitalizations for laboratory-confirmed H1N1 and 23.6% of related deaths since Sept. 1. Flu vaccine, its production an distribution are all under strick control of the Federal government. The private market for flu vaccine vanished with lawsuits and regulation years ago. So, we now have shortages of both H1N1 and regular seasonal flu vaccine. I can help but believe if there was not the Federal involvement and trial attorneys sueing like crazy, the pharmaceutical business would have been all over the mass production of the flu vaccines. We most likely would have had so much that we were exporting it and even hiring people to help make it. Instead, the ICUs are filled with the young and dying. Got to love the Federal Government and their single payor system for flu vaccine.

Saturday, October 24, 2009

Sebelius Epidemic

(Deaths due to the appointment of a trial lawyer as Health and Human Services Secretary) I saw today that the president has decided that we are in a H1N1 emergency. Part of this emergency is that there is a huge shortage of the vaccine as well as the regular vaccine for the plain flu. The vaccine is produced under contract for the Federal Government. Most of the vaccine companies are no longer in business or able to produce vaccine because they have been sued or fear lawsuits. So here is the question, if you or a loved one wants the H1N1 vaccine but can not get it because of the governments inaction and the trial lawyers targeting of the vaccine companies and contract the flu, can you sue the government and the trial lawyers for your pain and suffering? How about wrongful death? We had plenty of companies making vaccine before all the lawsuits. We had huge delays because the Obama administration dragged their heels appointing and directing the HHS department. We have over a thousand deaths for the H1N1 already this fall. Oh, wait a minute, I understand. Obama put a trial lawyer in charge, in fact a former head of the trial lawyers, in charge of our public health!

Friday, October 23, 2009

Heathcare a RIGHT to refuse?

I was listening to someone who was arguing that healthcare was a right. I wondered if healthcare is a right, cant you refuse it. I mean, I have the right to an attorney if I am in criminal court but I can refuse one. I have the right to bear arms but I dont have to go out and buy a gun. I have the right to vote, but dont have to face fines if I dont. I cant think of other rights that are government mandates where I can be fined for not exercising them.

As far as I can tell, rights mean that you have the ability to do something if you choose, and the ability to not do them if you choose. Many of the rights that I have require me to make an effort or spend some money to exercise them, where I dont have to spend money or time to not exercise them.

Why sould heathcare be any different. Right now if I am sick, I can go to any ER and be seen an treated. If I want more than that I can pay more or get insurance. I cant be denied. I have the right to "healthcare". If I dont want to go, I dont have to.

Saturday, October 17, 2009

Newtons First Law of Medicine

I got into a discussion of healthcare policy today while watching football in the OR lounge waiting for the OR to get ready. The discussion was with one of the anesthesia folks who is a bit on the liberal side. Anyway, the discussion came to how much we could save with preventitive care. He thought that with national health insurance, everyone would be able to get the preventitive care and the savings would be huge. I thought it was ironic that we were waiting for the OR to be ready so we could operate on a patient who had Medicaid but did not want to go to the doctor for years and then comes into the ER at deaths door. From my experience, people only want to come to the doctor when they are sick or in pain, otherwise they will blow it off. Likewise, the people who are not motivated to get a job or education will tend to just collect wellfare and will not be the ones who get up and get their screening exams. Oh, for what its worth. If you have you Medicaid appointments before 11:00 am, almost none will show up.

Friday, October 16, 2009


I dont know where this came from, but I salute the author!

New Element Discovered
A major research institution (MRI) has recently announced the discovery of the heaviest chemical element yet known to science. The new element has been tentatively named Governmentium. Governmentium has 1 neutron, 12 assistant neutrons, 75 deputy neutrons, and 224 assistant deputy neutrons, giving it an atomic mass of 312. These 312 particles are held together by forces called morons, which are surrounded by vast quantities of lepton-like particles called peons. Since governmentium has no electrons, it is inert. However, it can be detected as it impedes every reaction with which it comes into contact. A minute amount of governmentium causes one reaction to take over four days to complete when it would normally take less than a second. Governmentium has a normal half-life of three years; it does not decay, but instead undergoes a reorganization in which a portion of the assistant neutrons and deputy neutrons exchange places. In fact, governmentium's mass will actually increase over time, since each reorganization will cause some morons to become neutrons, forming isodopes. This characteristic of moron-promotion leads some scientists to speculate that governmentium is formed whenever morons reach a certain quantity in concentration. This hypothetical quantity is referred to as Critical Morass.

Tuesday, October 13, 2009

"But, I'm not dead yet!"

I just saw today on World net Daily that one of Obama's Czars, Cass Sunstein, has written that the state controls your organs and should be able to remove them if you are dead or in a hopeless condition. Futher, he wrote that the state can remove your organs without your permission. When I heard this, I thought that someone was pulling my chain, but guess what, it is right there in his book "Nudge: Decisions about Health, Wealth and Happiness".

Where did the president find these guys and how in the world did they get to be in positions to affect policy? My father always told me that you are judged by the friends you keep.

Monday, October 12, 2009

Taking it below the dentate line

In order to help balance the budget, the lawmakers of the State of Pennsylvania have decided to raid the fund MCARE. This is a fund (100 million dollars) that Pennsylvania physicians were forced to pay in addition to their malpractice payments to cover catastrophic losses. In fact the MCARE (Medical Care Availibility and reduction of Error Fund) was just the renamed Medical Professional Liability Catastrophic Fund. Anyway, the State Legislature just decided to take it and use it for other things. I wonder why they dont make the lawyers pay into a fund and then steal it in the middle of the night?

Saturday, October 10, 2009

Ginormous Headache

The medical center gets all kinds of complaints and in almost every one the person filling the complaint threatens a lawsuit. The latest was from a patient's attorney that claimed she was discriminated against because of her disabilities and requested a cash settlement to prevent a "large lawsuit from moving forward". When I looked into the case, I found that first she was disabled. She had severe arthritis, backpain, diabetes, could not walk, in fact she could not even care for herself. She was on Medicare, Medicaid and had Social Security Disability. Secondly, I found out she was 780 pounds. I looked into the case further and found two notes from the nurse manager of the floor. The patient had filled a complaint two hours after she was admitted because she was not allowed to smoke. Since she was admitted for a respiratory condition amoung other things, the attending physician said no. She then demanded that she be allowed to smoke anyway in the room. When she was told that she could not smoke in the hospital (which is the law) she demanded to be taken outside to smoke. (It took 9 ems personell to transport her to the hospital, 7 to get her onto the "Big Boy Hospital Bed".) When her nurse said that they could not roll her bed outside for her to smoke she then demanded to be put in a wheelchair. (The max load of the Big Boy wheel chairs is 600). When the nurse said that they didn't have a wheen chair big enough, the patient went off further.

So, the long and short of it, this was an attempt to "extort by attorney" money from the medical center by a patient who is disabled because of obesity who claims she was discriminated against because other patients were allowed to go out and smoke!

Sunday, October 4, 2009

Magical Medicaid

I know that many liberals think that the answer to healthcare accesss is government plans. I actually had one in the office on Friday. He was mad that it took so long to get an appointment. As usual I claimed responsibility for the delay, said I was sorry and took care of him. He muttered that he had insurance (Medicaid) so he should have had to wait. This is what I really wanted to tell him.

All of us physicians have templates. These are the schedules that allow us to schedule patients. Right now, if a patient has Blue Cross we get paid three to four times as much as someone who has Medicaid. In fact, a patient who pays $40 out of pocket is paying us twice as much as someone who has Medicaid. If we want to maximise our payments we would see only Blue Cross, if we could not fill our schedule we would see lower reimbursed insured, we would then add self pay, and then if there are any openings left, we would see Medicaid. So, every physician has to decide if they are going to see any Medicaid at all. Since it pays worst of any other insurance if you do take it you put them to the back of the list. I hate to say it but Medicare is just infront of Medicaid. So, if you are going to take government insurance, those patients will be at the back of your waiting list. Our group has decided that it wants to help everyone as best as we can regardless, that being said, we still have to stay in business so we have placed in stone some Medicaid appointments in everyones schedule. I have to admit though, you will wait alot less if you have good insurance.

So, what is going to happen with this government option? It is going to put even more people at the bottom of the list. Face it, if you pay cash, you will get in sooner. This whole thing about preventive care? Medicaid pays $19 dollars for a 30 minute preventative care visit. Blue Cross pays five times that amount. If you are already full, why would you take less money and incur more liability to do preventative visits that aren't worth the money? Of course, there is no medical liability in the healthcare bill either!

Thursday, October 1, 2009

Giving them the middle finger of the Upper Hand

The State of Michigan has been running ads trying to get some foolish business to move into the state. The ad campaign has as it slogan, 'Michigan gives you the upper hand". Michigan is in dire straits with its huge entitlements and policy of increasing everything from the sales tax, gas tax and of course the state income tax. In reality it appears that Michigan is just giving its citizens the middle finger of the upper hand. Well, they have now decided to stick it to the physicians that have not left the state by imposing a 4% tax on all physican payments and other medical fees. By doing this they hope to decrease their multibillion dollar deficit. Since Michigan already has made sure that it has the lowest Medicaid payment rates and chased as many businesses out of the state as possible, it seems that the medical business will be the next to leave the state. On the bright side, Michigans Democratic Majority are trying to overturn what little tort reforms they had on top of all this.