Saturday, July 31, 2010

A Sith Lord

I received this in my email this morning.

What, that cant be you say. Or can it? Consider the following.

Barack Obama became the leader of the free world after a brief career as a virtually unknown and unimportant US Senator. Chancellor Palpatine became Emperor after a brief career as a virtually unknown and unimportant Senator from Naboo.
In 2008, Barack Obama campaigned on a platform of "Hope and Change", (after a carefully orchestrated crisis). Similarly, Chancellor Palpatine, prior to seizing emergency powers and declaring himself Emperor, raised everyones hopes at the prospect of ending the Clone Wars. (after a carefully orchestrated crisis)
And take a look at this Obama speech here at . I could swear he sounds just like Palpatine.
Coincidence? Sure, That's what THEY want you to think....
(my little edits)

Thursday, July 29, 2010

Driving Ms. Disabled

It was one of those days. I lost count of how many of the patients I saw were "disabled". I mean, full fledged, on Medicare and Social Security disabled. One was 28 and was disabled due to chronic pain from her obesity. Another was 30 and was disabled because of headaches. Of course, there were the buch with fibro. The one thing that got me was, all of these people drove themselves to the office. They are so disabled that they cant work and get free healthcare as well as checks from the govt, but they can drive! Why cant they get a job driving? For that matter, why cant they get a job putting gas in cars? They all are very good at talking on the phone and texting while at the visit, why cant they get a job doing that?

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

Add a D to the MD, Drop the M for an S

It is hard enough to get qualified applicants to go to medical school, much less into surgical specialties but now this one takes the cake. We had one of our interns leave the surgical program, to go to dentistry. Not to be an oral surgeon, to be a general dentist. I cant fault his decision making, he put it this way. He will be his own boss. There is far less regulation. Obama hasnt messed with it yet. It can be cash pay and you dont have to deal with insurance if you dont want. Dental emergencies are not covered by EMTALA. If you dont pay, you dont get squat.

He was our sharpest intern.

Wednesday, July 21, 2010

Obamatrophic parasites

Parasites are a problem, but they are a fact of life. They live by feeding on the host, taking not earning. Many organisms have atleast learned to use them, at at least get something from them. These organisms have made the parasites, biotrophic parasites, parasite that actually can help the host. They are not symbionts because the host can live well without them but at least the parasites are partially paying their way and the host might actually do better. Like all parasites, however, if there are too many, the host dies. There are also necrothrophic parasites that just eventually kill the host. Then there are Obamatrophic parasites. These are necrotrophic parasites that just live on the host and try to multiply to the point that the host dies, and biotrophic parasites that are organized to believe that they dont have to contribute to the host anymore and in fact that they are entitled to the hosts resources. These Obamatrophic parasites work only to support the condition that helps them not contribute.

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

You Know, the blue one!

I should not have done this, but I could not resist it. I was picked to give one of the short welcome lectures to the new interns. (again, I blew off a meeting and look what happened!) Following my administrative motto of "do it good enough that you dont get in to trouble but not so good that they ask you to do it again," I titled my lecture, "Things that they didnt teach you in medical school." My first slide whas a pile of different colored pills. I explained that many times when you ask what medicines your ER patient takes, they will tell you that they take "one green one, one blue and two yellow". If you ask if any of them are blood thinners, they will look at you like your are stupid and say "you know, the BLUE ONE", but I only take it when I think my blood is thick. When you ask if they have any medical problems, they will say no and have no idea why they are on the blood thinner. They will deny that they have had any major surgery but you will notice the medial sternotomy scar and the off center midline abdominal incision.

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.

Throck Multi-tool

I was in my usual state of disbelief last night on rounds. Why is it so hard to get a pair of surture removal scissors or a staple remover? Why can you always find the hemocult cards but never the developer? It seems that to make it through rounds I end up hoarding all these things so that once I find them I can put them in my pocket so I dont have to hunt them down for the next patient. Then I got an idea. I love my little Leatherman multitool! It has got me through camping trips, military deployments, and car break downs. Why cant we come up with one for medicine? Kind of a swiss army knife for docs.

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

Not Treat but Street

Up til now, if you went to the ER they would see and treat you regardless of your ability to pay. Often, even if you did not have enough for a prescription, they would give you some medication or at least samples. For these non-emergency condition, the old term was treat and street. This is getting to be no more. First, we cant get sample meds. The Feds are taking care of that. Secondly, the hospital just cant afford it. Unfunded mandates have wiped them out. So, we are now seeing the new trend in EMTALA triage evaluation. If it aint an emergency, you are out of there. If you twisted your ankle and it has a good pulse, you are out of there. (unless you want to pay there and then) . Emergency means you are about to lose your life, limb, eye or baby. If it aint one of these, you get a copy of the phone book with numbers of doctors offices you can call.

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

Medicare not!

While on call I saw and treated a patient from another state who had just moved here. He asked me it I could set him up with a primary care physician. I said, sure no problem and referred him to our university medical centers department of internal medicine. I then got a letter back that stated that the university internal medicine department as well as family practice departments are no longer accepting new Medicare patients. The Geriatrics department is going non-participating and will only see Medicare patients if they have certian secondary insurances.

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.