Tuesday, December 29, 2009

Wenis Flytrap

I make sure the residents and students always come with me to talk with the families after surgery. I stress that the families have been there waiting, hoping and praying and are staring at the door waiting for us to come out and tell them that their loved one is ok. Long before you get to say anything, they will see you and immediately jump to conclusions based on your body language and manner of step. It is essential that you make sure your body language matches the results of surgery. If your body language does not match what you tell them, they will read your emotions and think that no matter what you say is untrue. Even though you may be tired and have a hundred things to take care of , when you meet the family, 100% of your body and mind needs to be theirs. Your body languange always tell the truth. When things are bad, you need to honestly let them know to the best of your ability. If there is a problem or there is a complication, be honest and let them know. If you are worried, let them know.

I wish politicians would talk to us like we try to talk to the families of our patients. After the recent bombing attempt of the Detroit bound flight, I saw the Homeland Security Chief come out, and try to pin her wenis to the side of the body to keep them from flapping as she said "the system worked". Clearly in panic mode, her body language showed she was in the wenis flytrap, way over her head, clueless. I'm glad that her boss got of a golf cart to tell the press that there is a systemic breakdown and he will make it a priority as he wmt back a picked up his golf club.

Friday, December 25, 2009

Constitutional Rights Obamified

The 4th Amendment gives us protection from unreasonable search and seizure and is a major part of limiting governments invasion of our privacy. Obama who taught Consitutional Law has just amended Executive Order 12425 that gives Interpol immunity in the US from the 4th amendment. This gives Interpol, an international organization, the ability to invade your home and seize your property without having a warrant or probable cause. I wonder what the next consitutional right he will waive? This is the same guy who thinks healthcare is a right, but protection from unreasonable search and seizure isnt!


Freudian Slip!

It always seems that when people are tired or in crisis that their guard is let down and they tend to say what is really on their mind and what they have been trying to suppress and the truth comes out.

I guess this is why Senator Reid first voted NO on the Senate Healthcare Bill before one of his aides pointed out his error. He then claimed it was because he was too tired! Was this a sense of morality that was suddenly blinked out?

Acute Fibro!

For those who dont understand why many of us are cynical about fibromyalgia, here is a great video that pretty much sums it up!


Friday, December 18, 2009

Health reform in one sentance

Medical care providers and facilities must bill and recieve payments from patients only.

There it is. Simple and to the point. Right now there is no competition. If you need a ct scan, do you call around to find the best deal? Of course not. The CT place only gets paid what your insurance company contracted them. They can try to get as many in that insurance to come there but it certainly did not affect the price. If you dont have insurance, you can call around and I think you will be suprised at the discounts you can get. Imagine if that was for everyone. I dont think the problem is that we have so many uninsured, I think the problem is that we have so many insured.

I propose that your insurance company gives you so much for routine health exams. You would then shop around and find out where you can get the best care for that amount. Doctors and hospitals would then advertise and try to entice you with low prices and better care to sway you to use their facilities. The same should be true with Medicaid and Medicare. Sure there are patients who wouldn't make the effort to get insurance but now everything would be cheaper.

I have said it again. Health insurance is like Federal Income Tax. They get the money before you see it and spend it before you know it. Dont seperate healthcare dollars from the patients, give it to them and let them decide how to spend it.

Wednesday, December 16, 2009

Frying Pan or Fire?

It is that time of year again, the time where we have to negotiate not only our contracts with health insurance companies for our reimbursement but also when we have to try to get the best insurance for our employees. In our area, there are only two insurance companies that we can get health insurance for our employees through. Blue Cross and United Health. There are some other complanies and they have better deals but they wont talk to you unless you have over 100 employees. So, we are stuck with the expensive ones. Because we have several employees with serious health problems, their extra cost is spead to the rest of our employees. We cant group ourselves with other medical practices to get a better rate or to take advantage of these other companies by law. We also cant get insurance from outside of the state or our area.

When we tried to form a supergroup, the Feds told us that since we had over 33% of the doctors our geographical area, this meant that we could be considered a monopoly and this was agaist statues.

The long and short of it. I cant get better health care insurance and cheaper insurane for my employees because of existing federal laws. Our health insurance is going up because federal law prohibits competition and better business practices. We have two choices now for health insurance for our folks, the frying pan or the fire? I think Congress should have to go out and get and pay for their own insurance as well as that of their staff in their own state. I think they would rapidly change how they want health insurance reformed.

Saturday, December 12, 2009

A Huff-ington Post

I guess it is a sign of the times when our usual cadre of drug abusers are having a hard time affording their preferred drugs and resorting to huffing paint. I asked one of them who was in the hospital for an exacerbation of another problem when I saw the gold paint on his lips. He told me that moneys tight so people are raising the price of the good stuff and he cant "ford his percs and vikes no mo" and "other shi**s spensive". I saw in his chart that the case managers are filling out all the forms so he can get Medicaid for his now chronic "paint induced pulmonary conditions" so the hospital can get paid. Once he is on Medicaid the state will try to pass the buck of to the feds to get Medicare to cover it, so if all goes well he will soon have disability and be able to use tax dollars for his "vikes and perks and the spensive sh***".

Aint no free hotel

I went to discharge a patient today. She is doing a lot better and the oral meds are doing her just fine. She doesnt want to go home. I asked her why and she said because when she gets home she will have to do a lot of cleaning to get ready for the holidays and that right now her sister is there doing it and will expect her to help. She said if she went home Monday, it would be all done. I checked her chart, sure enough she had Medicare and Medicaid, was only 31 and her disability was "fibromyalgia". (She was admitted for cellulitis). I checked with the nurse who explained that the patient was going outside to smoke which is no easy task given the size of the medical center at least every hour.

When I explained that I was discharging her, she said that it wasnt costing her anything to stay in the hospital so why cant she stay. I wanted to say that it was costing our country but fell back on the "I would hate for you to catch one of those hospital acquired infections" and signed her discharge orders.

Friday, December 11, 2009

Informed Consent

Unknown to me, the medical center apparently had some big inservice that only the clip board toting administrative non-patient caring for nurses had a chance to go to about proper informed consent. This including the use of attorney developed forms and proper statements to document that consent was obtained for a procedure and that all realistic risks, benefits and alternatives were discussed. These forms of course make sure that all outcomes are the responsibility of the physician and in no way should the medical center be held responsible for the patients misinterpetation of what was about to happen.

So here I am in the middle of the night with a patient that comes into the ED from an accident bleeding out. We are rushing into the OR and the adminoRN stops us and says that we have to have informed consent before we can procede! I look at the patient and said, "there's something bad wrong in there, we gotta open you up", he looked at me and said, "Fix me doc!" and scribbled a line of the paper. Consent obtained. As we rolled in to the OR, the patient looked at me and then looked at the consent Nazi and muttered "what a b****"!, cant she see Im dying here!"

Sunday, December 6, 2009

Galliean Peer Review

I love how the press is blowing off all this Climategate stuff by saying that all the research has passed peer review. Somewhere they dont seem to get it that your peers are quite often the ones that share your own views or share in your paycheck. Look at Gallieo. He proved that the world revolved around the sun yet his peer review was to be imprisoned because it went against the opinion of "the peers". We have a journal club were we all take recent papers in our field and have to present them. This is a great exercise for the residents. The first thing you do is look at the question the research is hoping to answer. You then check to see how they are getting the data and if analysis of the data will lead to an answer. You then check the statistics on the data. Only then can you say if the research is of merit. I stress that the comments and discussion are just that, or better expressed an editorial. It is amazing how many of the papers dont support the conclusions. I cant help but feel this way with the whole "Climategate" thing. It seems that this a classic example of having an opinion and then trying to backtrack to make the research support you and your peers opinion. This is why they destroyed the original data and only have the "corrected data". There original data did not show warming, in fact it showed the opposite which was against their "peers" in the global warming religious and grant funding movement. An essential part of research is to openly publish your research so that someone else can reproduce it an come to the same conclusions. When you cant do that you have to suspect that there is major bias in the research. Then it appears they contacted their "peers" to make sure that they too purged their data and anything that would bring to light the faults of their study. In Gallileo's time you had to publish what the church agreed to. I wonder is Gore the pope of Global warming. Oops, forgot, its snowing in Houston better call it "climae change".

Saturday, December 5, 2009

Grey Lady Down

The old Gray Lady closed it doors. It was the big charitiy hospital downtown that took care of many of the indigent and government payors. It just couldn't support itself. Its overhead kept increasing and it lost more and more of its private pay patients. I know that many would argue that this is a sign of the times but I am afraid that it is more than that. Hospitals lose money on the self insured, lose a bit less on the Medicaid and lose a bit on Medicare. They make the money to offset these losses with the private insurance. To give you an idea, if we use the Medicare reimbursement as the basis, you lose about 5% if you just have every patient in the hospital having Medicare. Medicaid pays 60% of Medicare, so you lose about 45% of cost with Medicaid. Self pay, you are lucky to collect 5%. Now these are not charges, this is the actual cost of doing business. Depending on how well you negotiated your contracts, BlueCross might pay about 115% of Medicare. So, to make it you need as many private pay patients as possible to offset the losses.

Now here is the kicker. The present debate in Congress is to have a public option that is basically an expansion of Medicaid, which again pays at a rate that causes the hospital to lose 45%. The pateints who would get this public option are those that would have otherwise had a private insurace. So, the long and short of it is the hospitals are going to fall just like the Old Gray Lady. Our other hospitals are at 90 to 100% occupancy. They have to be just to meet expenses.

The Gray Lady took care of those who were in most need, too bad no one bothered to take care of her.