Sunday, June 28, 2009

Baker Act vs Stark Law

For those outside of medicine, Democratic US Representative from California Pete Stark is the one who has added many laws to regulate medicine into other bills to hide their initial effects. Many of us consider his laws to be at the root of why their is not more competition in medicine and why it is regulated into a beurocratic mess. Anyway, if you had any doubt of Congressmans Starks sanity, here he is explaining that "the more our country is in debt, the better we are off" and many more of his great "insights"!

I wonder when some California physician will just use the Baker Act on him in the middle of the House of Representatives?

Sunday, June 21, 2009

Agricultural Stimulus

I got to see an old patient in follow up. I love him to death and he has been fighting different cancers for years. As I looked for another, I teased him about the smell of smoke on his clothes, by saying "Gosh, how much are those cancer sticks now with all those taxes?" His answer was priceless, "I know that you cant get around death, but the taxes are easy!" Before I went into my stop smoking talk with him for the 50th time, I had to ask him what he meant. Well, he is an old farmer and it isn't that hard to plant a half acre of tobacco for his personal use and the use of some of his friends. Infact, they have sort of a co-op. He grows it, another person cuts and drys it while another grinds it. They then roll their own. He did confide that sometimes people give him some money for it. Turns out enough to pay the rent. As to the taxes, he said "I'm 79 and I have had cancer 4 different ways and it aint licked me yet, I'm going to roll in that social security as long as I can until I break even on all the money the governement took from me!"

I wonder how many others are growing tobacco in their gardens?

COPD vs Obamanomics

In several ways patients with COPD (Emphysema) are like small business. In these patients the lungs are having a hard time getting oxygen into the blood. As a result the patients body compensates. As the lungs start to fail, the body starts shutting down all nonessential functions. The pateints lose weight, the kidneys and other organs barely function. To keep things going, the body then concentrates the blood by making sure that every cc of blood has as many red cells as it can to carry the vital oxygen to the deprived organs. The hyperconcentrated blood compensates for the lungs failure and the patients keep going. If these patients lose blood, bad stuff happens fast. Their body is already on the edge. You have to replace their blood. If you just give them fluid and dilute what blood they have bad things happen fast. In other words, you dilute the blood, they die.

Small business is very similar. As the economy decreases and people buy less, the business has to compensate. At first it can lower prices temporarily to try to keep the volume up. This is like breathing faster. Eventually however you burn up what ever profit you have and start to lose money. Because you have certain demands to stay in business (overhead) you cut where ever you can. Since the vital organs of a business are its employees, they get cut as much as possible. You then get to a point that you have cut all that you can and volume of business is low. So low that the only way you can stay in business is to increase the price of your product. This causes inflation because you had to raise the price just to compensate for the economy. This inflates the dollar because it takes more dollars to buy the same thing. So, what decreases this whole process? The answer is to decrease overhead or the stress on the system. For business, one of the big stressors is taxes! The other thing that needs to be done is to make the dollar stronger!

Instead, in Obamanomics you increases the taxes on business to further decrease their ability to stay afloat and mandate more costs per employee which speeds up and increases the cuts that have to made in the staff and lastly devalue the dollar by massive unbacked spending. So now you really have to increase the cost of your products just to stay in businees and really have to lay off as many people as possible just to stay in business. Thus raising unemploment and letting inflation run wild.

In other words, it is like a making a patient with COPD carry another patient on his back while running on a treadmill which you are making up hill while you literally suck the blood out of him.

Friday, June 19, 2009

"Not the Disabilty I was looking for!"

Saw a patient today with a plethora of complaints. She had worn her internist out with various complaints from low back pain to headaches, she had every article she could print out on the internet about fibromyalgia and after presenting these to her doc, she wanted him to back date forms so she could get both temporary and permanent disability. She was well known for hitting different ERs for narcotics and actually had been fired from her job because she had taken off for the beach when she claimed she was out sick. I ended up seeing her because in her work up he saw something. It was unrelated to any of her complaints. In fact it was asymptomatic. The problem was that it was very malignant. Melanoma is like that. The node meant that it was stage 4. The primary site can not be found. She will get her disability. It wont be some paperwork and checks from the government. It will be seizures, liver failure and death.

Wednesday, June 17, 2009

Anton-Babinski Syndrome

It is so hard to watch the politicians try to figure out the healthcare mess that for the most part they created. Rather that look at what is obvious, they turn a blind eye to the results of their meddling and continue to press on. When they are confronted with the damage that has been done by their actions, they act like the Black Night in Monte Pythons "Holy Grail".

It is all very simple, they have done to healthcare what they have done to our governmental spending. Long and short, its like the income tax. Those that support the "Fair Tax" are quick to point out that you would pay a lot more attention to what the government was spending its money on if you had to write a check out of your own pocket each month. Because they get the money before you do in the income tax, we really dont see it so they can spendit before we know it. The same is with employer paid healthcare and government healthcare. You dont feel the money coming out of your pocket so you dont care how much it is spent.

So, if you paid for healthcare out of your own pocket, you would be much more careful how you spent it! You would shop around to get the best deal. Oh, wait a minute. Congress made it so you cant shop around. They fixed the prices of all Medicare/Medicaid so there is no real competition for who can give the most for the money.

If you want to help more people get healthcare and drive down the cost, its easy. Give the people the money and let them spend it. Sure, some will decide not to spend it and pocket it. Then its their own problem. I would love to see hospitals become Wallmart and have specials and deals. I can just see it "After Thanksgiving Sale on mamograms and PSAs, we will even throw in a colonoscopy". (Of course, you cant do that because of Pete Stark).

Lets get rid of physicians having to contract with health insurance companies. Let physicians and hospitals post rates for their services and compete for patients and let patients spend their healthcare dollars as they wish. You pick if you want Hilton on Motel 6 healthcare. Get rid of insurance contracts with pharmacies. If the drug companies want to sell more meds, let them make it cost effective enough that the patient will want to pay for their drugs.

Of course none of this will happen as our elected officials turn their blind eyes to the results of their meddling in our healthcare system and ingnore the results of all the other countries who have already been done the same road.

Saturday, June 13, 2009

Auditory and Visual Hallucinations

I was flipping channels and came accross someone explaining that the price of gas is going up because of the inflation of the US dollars in overseas markets. They went on to describe how unmatched federal spending and huge US debt is causing the price of commodities to rapidly increase of which oil is one. They then had an expert come on and show how inflation causes loss of jobs, increased interest rates and overall stagnation of business. The overall message was that the "Stimulus" was causing oil to go up which will further stagnate US businesses and then the rest of inflation will cause further US economic decline.

I couldn't believe it, it was on CNN! I must have been hallucinating.

Friday, June 12, 2009

"It's the ECONObama Stupid"

Survived another meeting this morning. It was with the medical center board of directors where they explain what business decisions have been made and relate it to the department chiefs of the medical staff. The long and short of it is that as there has been such an increase in self pay and medicaid patients, the hospital is going broke. They had been waiting it out but with the prospect of the proposed healthcare changes, expected impact of the taxing healthcare benefits and it larger government re-embursement they dont think they can make it. So, they are cutting 500 jobs across the medical system. Becuase many of the jobs are mandated by various regulations, the cuts will be in the clinical/nursing staff. So essentially, there will be cuts in the people who actually take care of patients, not in the paperwork pushers. Its the ECONObama!

Thursday, June 11, 2009

Throwing a "Metric" Wrench in the works

I really hate early morning meetings and I hope that soon those others in the meeting will hate me being there as well so I will be able to get out of them. I tend to ask the questions that throw a wrench in the works. This morning was a perfect example. It was a quality management review meeting. This is basically a group of clipboard nurses analysing things that are supposed to be about quality healthcare but are actually about JACHO compliance. Anyway, they present a "Quality Metric" which was the number of nosocomial urinary track infections. They presented a new form that they have spent weeks developing that the nurses are to fill out to follow each patient with a foley catheter. They then state that the JACHO determination of the rate of these infections was such and how they will follow their data to see how we keep up. In my sleep deprived stupor I asked what the criteria were to determine if these infections were really nosocomial. The answer I got was a positive UA after admission. Then I asked how did they know that the patient didn't have a positive UA before they got to the hospital?

The answer was of course, we dont know, it does not fit our JACHO mandated metric.

They then presented another "METRIC" which was time from pre-op to actual start of surgery and recoovery. They had data of turn around times in the OR, time of Anesthesia start, number of times instruments are flashed, time spent in each stage of recovery. Time it took to get the pre-op labs, etc. I raised my hand. Man did I get some leers. I asked who in the OR enters all the metric data? One of the clipboard nurses pipes in and explains that each pre-op nurse enters the data into a special program in the EMR and then data is entered by the circulating nurse and eventually the recovery room nurse. I said, Oh. Can I seen the graph of the metric that shows how much time is lost because all the nurses who are supposed to be taking care of the patients are actually entering all this stuff into the computer.

Lets just say, my question was not well received! Got another early morning meeting tomorrow! I cant wait!

Saturday, June 6, 2009

Reverse Medical Tourism

I saw a post on KevinMD that caught my eye. The post was that perhaps there are not more medical tourists from the US going outside of the country for medical care because there it would be harder to sue their doctors for malpractice. This got me thinking. At our medical center we have a fairly large percentage of patients from outside of the US. Most are Canadians who come because they cant have their elective surgeries there or that it would take forever to get them. Things like knee replacements etc. So, do they come here so they can get better care, or do they come so they can sue the doctors easier than they could back home?

I posed this to the CFO of the medical center and he explained that our medical tourism business has exploded and in fact is now over 7% of all admissions and represents 60% of all births. There is of course no revenue becuase these are all illegals who have come accross the border. They also are very good at filing lawsuits! So, his opinion was that US medical tourism is alive and well. You get to come to the US, get quality healthcare for free and get to try your hand at the medical malpractice lottery!

A "Steve Austin"

At one of our hospitals there is a system set up that when medical records are requested to be sent to an attorney, they are reviewed after being sent to evaluate if there was a deviation of care by risk management. I have the unfortuante job of reviewing some of them if surgery is involved. (I blew off too many early morning meetings). The latest was amazing. This was a patient who had been shot while performing armed robbery as a 20 y/o and had been in prison for 9 years. He is on full state and Federal disability due to low back pain from the GSW. He had been back to prison 2 other times, one time for climbing into a pharmacy through a 2 story window and trying to steal drugs. He has a 50 pack year smoking history and is an alcoholic. He gets methadone at a pain center and does not take his oral hypoglycemics for his DM. He has three stents for his cardiac disease but does not take coumadin for his afib. When he tried to break into the pharmacy, he fell and shattered both hips. These were first repaired but he has since had to have the whole hips replaced. Anyway, he was brough in from a strip club with severe chest pain and cardiogenic shock due to a massive MI. He was brough back and was found to have complete occlusion of one of his coronaries by cardiac cath and had urgent bypass. After bypass he had respiratory failure, renal failure but eventually pulled through.

I reviewed the chart and all I could thick of was that it was amazing that this guy pulled through. Not to mention that he had consumed so many tax dollars with his disability and medical care! Anyway, after I went through the chart I told them that I though everything was appropriate. They then apoligized to me and said that they meant to call me and I did not have to review it. The patient had the records sent because he is suing the hospital and a drug company claiming it was the heparin that he got in bypass surgery that caused his renal failure and not the fact that he had cardiogenic shock. He is suing for 3 million. I figure he has already sucked up three million dollars of tax money, so I guess with his lawsuit he is hoping to be a real "Steve Austin".

Thursday, June 4, 2009

The Pander Bear is Running the Zoo

I had one of the early cases this morning in the OR and even before I got there the surgeons' lounge was full of discord! All I could hear was that "he pandered to the muslims, he pandered to the hispanics, he pandered to the abortionists." I looked to see who it was and was supprised at it was one of our more quiet surgeons. I asked him to expound further which was like turning of a fire hydrant! He said, "look, he's the pander bear. He is half white and half black so he can pander to both. He tells people he is Christian, and then he is a Muslim so he can pander to both." "He gets up there and talks and says nothing but people think he is cute and ignore the fact that he is clueless and destroying the country." "It is like the Panda's at the Zoo, oh, how cute!"Except, this Pander Bear is running the Zoo!"

With that he stormed out.