Friday, December 24, 2010
So, it used to be a nurse took care of the patients and a doctor managed their care. Now it is lpn who actually sees the patients, a nurse and a arnp who spend all the time documenting on the patient, and a doc who tries to see the patient and has to manage all the others paperwork.
I had to open my mouth. I asked if the nurse practitioners where going to actually see patients and write orders. I got the of course from the nursing supervisor. I asked what training do they have. She gave me a look like she wanted to kill me. She said, "well, they are BSRNs and then have their nurse practitioner's degree". I asked again, what again is their training. Before she could answer, I said, "if a patient is admitted by infectious disease, does the anrp have an infectious disease fellowship?, what about cardiology?" She said that some of the nurse practitioner's have been cardiac nurses. I said, "so she does cardiac patients only?" Of course the answer was no. I looked at the applicants for the nurse practitioner position. All of them had gone straight through school, there was no clinical experience at all. I told her. If your mother is admitted to the hospital with a pe and right heart failure, how do you want her care managed? You can have an experienced nurse watching her and taking care of her, or you can have a lpn and a arnp who doesn't have a singe ounce of clinical experience charting away to make sure JACHO and CMS are happy while the doc is getting pummeled by all the other anrps that are in way over their head.
About that time the hospital head administrator said something that made me like him a lot, he said "look, our job is to try to find out how to take care of patients and stay in business while the government tries to do the opposite."
Saturday, December 18, 2010
Thursday, December 16, 2010
Our ever wise, observant, master of all things receptionist, biller, scheduler decided to call that Medicare Fraud line that has been so common on the TV. (these are part of the multimillion dollar ad campaign launched by the government about reporting Medicare fraud). She tried to report suspected Medicare and disability fraud. Turns out, there is no where to really report it. There is really no one to talk to. In fact, they don't care. So, she called the Social Security Administration. Guess what? She got the same thing.
Just goes to show you, reporting Medicare Fraud is a fraud!
Sunday, December 12, 2010
Earl said that it seemed to him that the problem with politics and government is that people want other people to pay for things that they want. He said, here is how to fix it. There is your base tax. This is to pay for what the Constitution says the government is to do. No more, no less. There is nothing to pay for anything else that the government has tacked on. Then you put on your tax form a bunch of boxes that say, would you like to pay extra for any or all of these, and how much? That way, those that feel strongly about something that they want the government to pay for can chip in and the people who don't want to pay for it wont. "I call it ala carte taxes." You want an earmark, put it in the form. People and politicians will find out real quick what people really want to pay for. Also, this way, the people set the budget, not the politicians. Also on the form you can have boxes that say, the government has no business paying for. Seems to me, we fix things real fast if we do it this way.
Wednesday, December 8, 2010
Saturday, December 4, 2010
Anyway, I saw an elderly lady in the office yesterday. Like many Seniors she has Social Security and Medicare and is barely making it. She needed a medication that she just could not afford. For that matter she could barely afford food. We called around, searched and begged and finally got a sample card that gives you the first month of the medication free to try. We were so excited! Then we read the card, it was not valid for anyone with Medicare or Medicaid! We looked at all the other vouchers and discount cards that we could find. Guess what, they all said the same thing!
Sunday, November 28, 2010
Monday, November 22, 2010
I though about it and wondered how that would affect the practice of medicine if we followed the ACLU anti-profiling school of thought. We would be ordering PSA levels, pregnancy tests and sickle cell smears on every 80 y/o Caucasian female. Of course every male would need to have a pregnancy test before surgery not to mention a mammogram. We wouldn't want to profile of course, that might be discrimination.
Sunday, November 21, 2010
I started to think about how much JACHO costs and how all that money could be used to actually take care of patients, but I stopped myself because it is not good to go into surgery p****ooo****!
Saturday, November 20, 2010
Anyway, I was in clinic and it was chaos. I was on call so I had my patients and then all the ER calls. Right in the middle of it my partner comes around the hall and shuts the door. He says "Remember my lawsuit? The Judge is here. He has a big " " mass that was found and remembered me from the case. He wants me to do the surgery. I asked him why me, and he said it was because all the experts witnessess on both sides seemed to agree that you were one of the best."
Tuesday, November 16, 2010
Sunday, November 14, 2010
I had that thing happen just the other day. I had a patient in the office who is a local liberal radio personality. On his show there was an argument about "dont ask, dont tell" which he really hates. A caller asked the host if it was ok for men to shower with his daughters. He said no. The caller then asked if men shouldnt shower with his daughters, why should gay men be allowed to shower with other men? The host got flustered. He then said, "people dont always get sexually excited in the shower". The caller said, why then can men not shower with your daughters? The host got slustered and then fell back on "it shouldnt be that way".
I had to give the host some medical news. It didnt go so well, all I got was it "shouldnt be that way". The problem was, it was what it was.
Sunday, November 7, 2010
I bet if I had insurance and did not have to pay out of pocket I would have said run all the tests and then I want a new gold plated top of the line valve. Since everything was out of my pocket, I went with the cheapest, fasted way. Of course the Action Auto guy was not responsible if I did something stupid or if my car died and I got into or caused an accident.
Sunday, October 31, 2010
They also said that people who are high risk could buy insurance in "co-ops", these dont exist, so these people dont have insurance and still need medical care. The hospital in the Blue Dogs home town is now closing at the end of the year.
Friday, October 29, 2010
I then started to wonder. We see the pateints in the office because that is how we get paid. What if we got paid for the phone calls? What if the standart of care included telephone consultations? I could see a lot more patients so the shortage of specialists in rural areas might be decreased. The cost of these consultations would be cheaper.
Oh, wait a minute. The last thing Medicare would ever do is something that would allow more patients to be cared for in a cheaper way. Afterall, they set what is and what is not paid for.
Saturday, October 9, 2010
Friday, October 8, 2010
Sunday, October 3, 2010
When the presentations ended there were all kinds of questions about how to market to the "customers" and why certain ones do not come to the downtown hospital. Finally, it was my turn. I asked "Where do our patients come from?" I got the look of looks, and then with exacerbation, the MBA of marketing pulled up the slide of the demographics of the referral area. I just look at him and stared. Finally, I said. "Look, patients have primary care docs. You chased them all out of the hospital. They want nothing to do with you. When Mrs. Smith calls her doctor because she is not feeling well, he is going to tell her where to go. Hospitalists are great, when they work with or for the internists and family docs, not when they work for and only for the hospital. When is the last time you have seen or talked to any of the primary care docs in your pretty demographic slide?"
"If you want to market, work with the primary care docs in the referral area. Show them that you are going to give their patients' the best care. Streamline admissions, testing and follow up care. The referring docs are your customers." "If you want to market you are the best heart center, convince the PCPS and the outside cardiologists." "Ms. Smith is going to go where her doctor tells her she will get the best care."
The rest of the people at the meeting just started at me like I was an alien and then began to discuss their confustion why the biggest Ortho group was moving its cases to the other medical center.
Saturday, September 25, 2010
It turns out that a while back there was a study that showed there may be a decrease in accidental needle sticks in OR personnel if blunt needles were used because they were less likely to penetrate a surgical glove. At one point it was even recommended that they be used in some closures. On more careful examination, it turns out that the real reason there were less needle sticks was that the blunt needles were useless and pushed to the side.
So, some government suit decided to mandate blunt needles (OSHA and JACHO), so all the needles were replaced without letting the surgeon know! I had to to fill out 3 forms for each needle that I use now that I want sharp to satisfy these new mandates!
I wonder what will happen next, will they take away scalpels and make us use plastic sporks?
Thursday, September 23, 2010
When I was a resident, we would put a yellow Omega sign on the inside bottom corner of patients charts who were crazy or obnoxious. That way the poor sod who had to take care of them next would be prepared. I wonder how we can do that now in the digital age? Think of it, we could identify those that are faking disability, those who are hypochondriacs, those who are noncompliant, drug seekers, the whole bit.
Wednesday, September 22, 2010
Saturday, September 11, 2010
So, we are now having patients arrive not by ambulance but by cab and airport limo!
Anyway, part of my duties as "Chief" is to be the physician who oversees the risk management committee. It is amazing at what it tracked, everything from patient complaints, to infections, to food quality. On my desk last week was a thumb drive full of data from the ED. Outcomes and encounters are all tracked. They are broken down by diagnosis, provider, and shift. In all these data streams, we look for trends.
One of the things that jumped out was that there was a big difference in the number of patients seen by different physicians, this was independent of shifts. It also showed that the physicians were seeing the same number of true emergencies but that the difference was in patients there for back pain or "acute fibro". To find out what was going on, I called over to our head patient registar for the EDs. As a side note she is amazing. When people ask her how long she has been there she tells them that she was always there, they just built the ED around here). Anyway, she explained it all. She went down the list of docs and said, Candyman, Candyman, Candyman, HardA***, HardA***, B*****, Candyman and so one.
Sure enough, she matched the list. The word gets out quickly which docs are in the ED. In fact, people call the EDs to see which doc is where. The Candyman docs will write for a little pain meds to get you through until you can follow up with your own doctor for your long standing pain. After all, your "pain is a vital sign". When there is a Candyman, everybody runs to the ED to claim that their pain is "horrible" to get their fix. When there is a HardA***, the ED is quiet. She even explained to me that they alter their staffing depending on which providers are where.
As I was leaving she took a piece of paper off the stack of Memos next to here. It was from the med center administration. It was about a decrease in the Press Gainey scores for the ED during certain shifts. It recommended that they try to find the problem and then report back. I looked at the memo and then went to the office. There on the flash drive was the Press Gainey data. You guessed it, the scores were higher for the Candymen!
Wednesday, September 8, 2010
Tuesday, September 7, 2010
It seems that acute ORS (Obama Regret Syndrome) is spreading like an epidemic. Unfortunately, it has already destroyed the medical system that could have treated it.
Friday, August 20, 2010
Did anybody notice that the superbugs began to emerge at the same time the FDA banned mercurochrome? It is extremely active against all strains of staph and gram negs. In fact, it is one of the most effective topical agents.
The FDA banned it because of the mercury which was never shown to be absorbed to any degree or to lead to any problems. Just like the thermosol scare, mercurochrome became the enemy. Even though it is now proven to be very safe, no one will produce or sell it because of fear of lawsuits.
Like many sureons, I add a bit of bleach to the bath water every now and then to help decrease staph colonizations but I think I am also going to bring back some mercurochrome from our next mission trip! (That it, with the way things are going with healthcare, the next medical mission trip may be to Washington DC!)
Tuesday, August 17, 2010
Saturday, August 14, 2010
In the event of a serious problem or one in which the patient client does not have the cash, the doctor could take the case on a contingency agreement where if the patient survives, the doctor gets 1/3 of all future earnings, plus expenses, time etc.
Better yet, lets pay attorneys like doctors. If you show up at the court house, they have to take care of you regardless of your ability to pay and you can sue them at any step.
Wednesday, August 11, 2010
We stole some and got the pateint better. Good thing the FDA has stepped in to make it so hard now to produce generic drugs and to make it so easy to sue!
Friday, August 6, 2010
Sunday, August 1, 2010
Interesting thing. The cats mewed at everyone and screamed through the windows for what seemed like weeks, and then went away. The exterminators caught up with the mice. A few weeks later there were couple of cats living in the crawl space. They could be seen in the morning hunting mice. No one saw any mice in the building.
Saturday, July 31, 2010
What, that cant be you say. Or can it? Consider the following.
Thursday, July 29, 2010
If the government wants to help decrease the fraud in Medicare and Social Security, I suggest that it revokes the drivers liscence of anybody who is on Social Security disability!
Friday, July 23, 2010
He was our sharpest intern.
Wednesday, July 21, 2010
I operated on a HR rep from a large company. They are looking for 300 people. The jobs start at $13/hr plus benefits. They cant get enough applicants (well there are enough but they are illeagals). Why would you want to go to work when you can get $300/week for free from the Feds and state, free healthcare, housing, food? Especially when it is just extened for another 4 months. Hey thats over two years of just sleeping in, watching TV and playing XBOX! Why would anyone want to work?
Tuesday, July 20, 2010
The next slide was the "yellow pill". At least it was yellow from this pharmacy. It was hydrocodone. I explained that this pill makes everyone hurt. Because they take hydros all the time, they will tell you everything hurts becuase their pain receptors are messed up, so you cant tell what is what. (you will wish the previous doc left a little chip like dogs have in the wound so you could just scan the patient and find out what was done.) They will have no idea what their abdominal scar was from and will look puzzled at you because you asked. (the scar is supposed to tell you what surgery they had.) They will all be in so much pain that they cant do anything, except they can walk outside and smoke.
The next slide was a wooden shoe. I explained that their are many people at the hospital to help you, but dont rely on them or believe them. Double check everything becuase you cant tell the saboeteurs from the allies. Check your own xrays and verify your labs. When you look at xrays, first check to see if it is the right patient, secondly look at the xray to see if there is anything in the xray that might kill the patient, such as your shadow!
The next slide was a phone. I said it is always easier to call and ask for help then it is to call and ask for forgiveness. Lastly, I said, if you dont know spanish, start learning!
I think I will probably not be asked to do this again.
Then I started thinking about what it should have. It needs suture removal scissors and staple removers of course, but what else? Flashlight, stethascope, #3 mac blade, hemostat, 16 guage needle for those darned popped lungs, could add one of those portable US things, oh, something to remember all those darned EMR passwords that change every few days at all the hospitals we have to cover, nurse GPS locator, food finder, hemocult developer, gloves, culture swab, IV pump shut upper, bandage swabs, cast cutter and above all bad odor eliminator.
The device would have to be disposable of course and I would have to get it JACHO mandated. Oh, wait a minute. They would keep them locked up in the Suremed and you would still have to find a nurse and get the patients number to get the thing out anyway.
Saturday, July 17, 2010
One of the hospitals in the area has the same policy for all Medicaid patients. These patients dont get the list of phone numbers, they just get the number of the Medicaid service agent because there are no docs in the area that will take them.
Friday, July 9, 2010
By the way, the University Medical Center is Federally funded as are its residency programs. I called the Chairman of Medicine and asked whats up. He said that they were getting creamed with so many patients because everyone in the community is fed up with Medicare and dropping it. They also are going broke trying to see Medicare and feel that the only way they can survive is to decrease the amount they see which means no more government insurance.
Tuesday, June 22, 2010
Over the course of the meeting it became clear, that the same thing was happening to the other medical centers in our area. I guess Obama was right that this healthcare bill was going to be great for the economic growth, In the collections industry.
Monday, June 21, 2010
So, when you have to have your emergency surgery just think, Attorneys and politicians have taken away your anesthesia!
Saturday, June 19, 2010
As I made my way around the hospital, the blue phones there everywhere. They are only brought into the rooms of the patients who dont speak english. Suddenly, I was called stat to the ED. I had to explain to this MS-13 hombre that he needed to go to the OR asap. There was no translator, so I asked for one of those D+++ phones. I was told that we were out of them. I said "what do you mean, we have 160 of them!". The answer was that they were all in use, there were over 45 in use just in Labor and Delivery!
People wonder why healthcare is so exensive, somebody has to pay to take care of all the illegals and their mandated phones!
Friday, June 18, 2010
This week was rough. One of our physicians "fellout". That is to say, he had more complications that his peers and those nationally. When this happens, all his complications are immediately sent for review. In this review, we inspect to check for clinical decision making, technical competence, wisdom and knowledge base. Many times the review finds that the particular surgeon just happened to be on call when bad things happen such as dead bowel from mesentaric ischemia or STEMIs with right main disease. This week the review brought out more questions than answers. So, I had to suspend the doc pending further investigation.
I have heard all these attorneys say the problem is that we physicans do not police ourselves. In fact we will stop a doctor from practicing while we investigate to be sure patients are not harmed. It is all part of the bylaws that you practice in the hospital. Do attorneys suspend each other from practicing while they investigate their competence?
Saturday, June 12, 2010
This past week has been horrendous. I have had 5 of seven days on ER call with busy days including 30+ patient office days (half days actually) while instituting and impossible EMR, and doing 2-3 cases each night from the ER and 6 to 7 cases per day in the general OR. As I was driving back to the hospital last night at 11pm for the third time, I thought of a great idea. The American College of Surgeons or the AMA should suggest that President Obama and some of our Congressmen/women join us for TAKE YOUR PRESIDENT TO WORK WEEK! I'm not talking about some p****Mayo Clinic or Harvard surgical service. I'm talking about some grassroots bluecollar down home time on the surgical service of everyman's community hospital. Just follow a general surgeon around for one week, Monday to Monday. He'll see:
1) The EMR slow us down like those puncture strips that cops throw infront of criminal vechicles.
2) The amount of non-reimbursed time that we spend answering phone calls, doing charts, waiting, driving and caring for patients.
3) The complete joke the 80 hour work week is for residents.
4) The incredible effort put forth by the entire medical team at our hospitals and the ridiculous risk we take from from opportunistic attorneys.
5) Just how good our healthcare system is even in the far corners of this country, and how misleading the "experts" are when they see otherwise.
6) Most of all, he will see the good job our doctors are doing before they start to rapidly exit the profession that he is making more and more frustrating every day.
Mr. President, come along for one week and educate yourself before you destroy the good things in our system. As you finish your one week on Monday, I'll remind you that for us the next day is never a day off.
I have a few to add of my own:
7) See how many illeagals we are seeing and taking care of and how they deplete the resources that allow us to take care of our citizens.
8) See the amount of fraud that is our disability system.
9) See first hand the incredible heroism of our police, fire and EMTS who put their lives on the line for others.
10) See how government red tape and Stark Laws have made medicine so expensive.
11) Let the President order the diagnostic studies and be responsible for all the outcomes so he can decide what is defensive medicine or not.
Sunday, June 6, 2010
Monday, May 31, 2010
So, with Google we get people who come to the ER convinced they have a tumor or bleed who dont believe us when we say it is a migraine and others who go home convinced we are idiots because we didnt prescribe the herbals that they saw on the internet.
I cant even go into medications because I am fed up with all the people who come in with seizures becuase they stopped their dilantin once they looked it up and saw all the attorney adds.
I made sure that she got a copy of my findings and a copy of our new policy that transfers will only be made between physicians. I made sure that her hospital medical director and CEO got copies as well.
Another Patient Death - Patient Saw NP And Was Sent Home
Family settles lawsuit with Heartland
May 22--A family and Heartland Regional Medica... avoided a jury trial in a wrongful death lawsuit this week.
The parties settled on a $725,000 judgment Monday in Buchanan County Circuit Court. The lawsuit accused medical malpractice by Heartland's Urgent Care Clinic, Heartland Health and James Weaver, a nurse practitioner, in the death of Timothy Allen Weber.
Mr. Weber's wife, Michele Weber, his parents and his three children were plaintiffs in the suit, filed in March 2009. The case was set for a jury trial this week. The parties reached a settlement and the case was dismissed on May 17.
According to court documents, Mr. Weber went to the clinic at
With valid complaints and ailments, he was discharged about two hours later without normal vital signs and no testing or treatment for gastrointestinal bleeding, which led to his death.
It is also reported that he was never examined by a physician while at the facility.
Mrs. Weber found her husband at their home approximately four or five hours after his discharge from the Urgent Care Clinic.
He was pronounced dead at 5:40 p.m. at Heartland's emergency room.
An autopsy determined the cause of death to be hemorrhagic gastritis
Monday, May 24, 2010
Saturday, May 22, 2010
Sunday, May 16, 2010
Monday, April 19, 2010
I know the guy was trying to do what was right and his intentions were the best. A good thing to do though is when you dont know what you are doing and someone does, it might be good to listen to them. I dont know if the victim could have been saved, I do know though that he had no chance when you dont ventilate.
Sunday, April 18, 2010
"Thank you for calling Greater Metro Cardiothorasic Consultants' appointment line. Keeping your heart healthy is our business. If you have private insurance such as Blue Cross, United, Etna or Cigna please press 1 and one of our schedulers will be right with you to schedule a timely and convenient appointment. If you have Medicare, Medicaid or other government funded insurnance press 2 and you will be directed how to submit an appointment request in writing. Please be aware you will need your primary care doc to personally call one of our physicians. We will then get back to you in writing in 9 to 12 weeks with an answer to your request. If you are granted an appointment, it will on a space available basis."
Sunday, April 11, 2010
I know that to stay in business, JACHO does its best to invent new ways to create paperwork and to decrease actual patient care, and that the government likes to make new regulations without thinking of the consequences, but this just seems stupid.
Thursday, April 8, 2010
What ever happened to axe handles and baseball bats. Well I know about baseball bats. A good wood baseball bat will set you back a bit. An aluminum just doesnt seem bad a+++, and a composite is both expensive and flashy. You cant buy lead pipes anymore, copper can be sold for top dollar and no one is afraid of PVC. I guess 2x4s are the only way to go. I wonder if my nexy SP/GAK will be a 2x4xface?
Monday, April 5, 2010
Friday, March 26, 2010
Yeah, I guess Congress and the President are right, it is the drug companies and the insurnace companies that are screwing us!
Thursday, March 18, 2010
I looked at what we could do in our practice to cut costs and at the same time continue to provide the best care we could. The big thing would be to move more testing and treatments in house. This way we could package care plans for a cheaper price. Well, it turns out, the reimbursement is set by the government and the Federal Stark Law prevents us from consolidating.
So, we cant lower the prices of our care because they are set by the government, and we cant cut costs because of the government. Now, they think the solution is more government. Its like they want to make a sandwitch to feed the nation that has no bread and nothing between the slices.
Sunday, March 14, 2010
I wonder if Congress could pass the healthcare bill if they just erased the words healthcare in the whole thing with legal care?
Saturday, March 13, 2010
Obama had a physical recently.Hes 48yo.His physical included a virtual colonoscopy and a cardic CT scan.Do any of you think you would have been able to get prior authorization for either of these procedures?I dont think so.Niether were indicated .Too bad for him...he was just exposed to a serious amount of unnecessary radiation.What a contradiction this man is.Have any of you ever included these procedures as part of a physical in an asymtomatic ,healthy 48yo man?And what does this say to the country when hes ramming thru healthcare legislature that many Americans oppose.
Sunday, March 7, 2010
There is this belief that the problem is that we have so many uninsured and we have to get them insurance. The insurance is worth not when it does not pay what it costs to take care of the patients. Sure, you can jump up and slap your back and say you got people insurance, but you have done is make it worse. The state that the Feds tout about healthcare reform, has actually just pushed its patients out of state and stuck someone else.
If we want to make medicine cheaper, we have to make it more efficient and more competitive. We cant be efficient when the nurses who do most of the healthcare have to spend 85% of their productivity doing Federal CMS JACHO mandated paperwork. Where patients are not able to negotiate the price of their own care. Where diagnostic tests and procedures are determined because of potential lawsuits rather than evidence based studies. When the healthcare industry has to support the trial lawyer industry. Where the Federal Government is the one who actually sets the prices of all medical care. (All Medicaid, Tricare, BCBS etc fees are tied to the Medicare rates).
If the Feds expand Medicaid, the rest of healthcare will collapse. It is like a 25 guage IV in a septic patient. Not really good for much.
Saturday, March 6, 2010
Friday, March 5, 2010
First and formost, I want them to take their dog to the vet. The vet does not take insurance. The vet gives you an itemized bill for the care. Interestingly, for a check up that includes vaccinations and routine blood tests, the vets in our area charge $115. For the same exam with one fewer test and vaccination for a child, Medicaid pays $27. Hmm! What would happen if the vet had to see dogs who had, Medicaid? He would have to charge others more!
When you mandate that someone gets a service at a rate below what it actually costs to do, you have to make up the difference somewhere. Since Medicaid and Medicare have not increased their reimbursements, the shortfall has to be made up by the private payors. So, private insurance goes up. Congressman are yelling because the healthinsurance rates in the state for private insurance companies are going up by 20 to 30 % and blame the insurance companies. The reality is that the state has cut its Medicaid so to keep its healthsystem running the money has to come from private payors. The state has also increased the number on Medicaid and done nothing to decrease the number of illeagals.
Who is really to blame for the cost of healthcare?
Saturday, February 27, 2010
So, physicians accross the country are deciding this weekend. If we participate (Par) in Medicare, you get at least the 21% cut. So if you shoot for the par, the government gives you a bogey. If you opt out, Medicare patients must pay you out of their pocket and then try to get reimbursed from the government. There is one catch, if you opt out you have to wait 2 years to opt in. Anyway, it looks like many docs are opting out. I can only imagine the outrage when all the seniors who have to pay for their care and then try to get the government to reimburse them!
It is what it is. Perhaps this is what is needed to knock some sense into Congress. People might see how screwed up the government is because now its their money that they have to get back!
Friday, February 19, 2010
I told the Senator, its like Kaiser Soze, Medicaid is everywhere but when you call and try to get an appointment, it is nowhere.
So, was the doc ordering the tests to get money? No, we dont get paid by the test. Why was the second scan ordered, CYA? The result of the defensive medicine? The patient got intubated, spend time in the ICU and had a MI from the epi given during the contrast reactionn
Tuesday, February 2, 2010
Monday, February 1, 2010
Sunday, January 31, 2010
I found out the only reason I could buy the meds from the wholesaler was my medical license but I could not be a distributing pharmacy. You see here in the US, a patient can only get medications from a distributing pharmacy which can mark up the price as much as the market can bear. The big pharmacy chains can be their own wholesalers and also negotiate with each insurance company a cost for each medication. As a a result of this their proffit goes through the roof.
There is a reason why there are pharmacies on every corner and why drugs cost so much. It isnt so much the drug companies but the pharmacies. (When you get meds from Canada you get them from wholesalers). So, ignore the man behind the screen at the pharmacy because he is robbing you blind.
Friday, January 29, 2010
OK, HUGE annoyance that just won't go away! You see a patient for a sprain/strain (not work comp) and then at some undefined time in the future you get a request from the patient for a return to work note. Ummmm never had you OFF work to start with, so I probably don't need to say it's ok for you to go back (you weren't supposed to be gone from work!).
Better yet, you didn't even see the patient (they were referred because you were the schmuck on call for the ER). And 3 weeks later they call you to request a return to work note. Ummm still NO.
Even better (and today's scenario), the patient went to the ER, you see the patient after for free follow up (medicaid or no insurance) and 3 weeks later you get a call from them saying they want you to send a note for return to work to their "turn the book over" Lawyer! Good God! NO you can't have a RTW note if I didn't take you OFF work to start with. And yes, I know that puts your job in jeopardy, and yes you might lose your job (while you are obviously trying to win some settlement for your terrible fictitious injury). But I'd be happy to send your lawyer a note (for a charge) stating that I never took you off work to begin with!
What is with people???
Wednesday, January 27, 2010
Saturday, January 23, 2010
I was hoping that the Massachusetts election might make Congress look at different ideas and consider getting away from the laws that presently make it so that there are only really two insurance companies and do things like allow out of state competition. Why cant we have GEICO, ALLSTATE, PROGRESSIVE, STATE FARM all fighting it out for our health insurance dollars?
I was thinking of this and had my fingers crossed when I sam Obama being interviewed as well as Pelosi and Harry Reid. They just seemed to ignore and come up with a new idea (one that they had before) and just think that if they blame Bush and increase taxes it will all just fix itself.
Wednesday, January 20, 2010
Thursday, January 14, 2010
Our death panel pulmonologist now has his father in the neuro ICU after a massive stroke. He wants everything done, a trache, peg, longterm rehab vent unit. The works. I though I was having an acute attack of Capgras' syndome, but then remembered liberals what to decide on how to spend everyone's money except their own.
Sunday, January 10, 2010
Saturday, January 9, 2010
Friday, January 8, 2010
Just out of curiosity, when is the last time the President had to answer questions from the public or the press?