Sunday, November 28, 2010

Monday, November 22, 2010

ACLU Healthcare screeining

I was watching all the talking heads on TV discuss the TSA screening issue and how people are chosen at random to be checked as well as those who refuse the scanner. One of the commentators seemed to hit it on the head when he said "look, we cant just screen and pat down Islamic travelers who are traveling by themselves with one way tickets that are paid for in cash. That would be profiling! That is what the ACLU has filed suit about!"

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


As usual I spent I spent part of the night waiting on the OR for yet another urgent case that would not be urgent if the patient went to see their primary care doc earlier. Well, that is if they could. They had Medicaid which is worse than having no insurance as no doc can afford to take it but that is for another post. Anyway, I was looking at their paper chart. Yes, even though we are on electronic medical records, there is still a paper chart. Guess what it is filled with? HIPPA forms. Over 22 pages of them. Some are the faxes that we have to send to get electronic records, others are all the medical information waiver forms. A lot of trees died for HIPPA. This got me to wonder. When the government passed HIPPA did they have a CBA estimate that said, hey this is going to cost the economy billions, and this cost is going to be taken away from taking care of patients? Lets see, we have all the manhours of staffing that it takes to make sure all of the paperwork for HIPPA is done. We have the HIPPA compliance consultants, we have all the increased costs of the EMRs to make them HIPPA compliant. There is all of the paper and the extra faxs. Then there is the government HIPPA auditors, not to mention the increased liability for a HIPPA breach. I'll bet it is in the billions.

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

Even God cant afford ObamaCare

We just had one of our hospital staff meetings. I was surprised because the place was packed. This is a good sign that something big was going on and I was out of the loop as usual. The medical center was announcing its latest cuts in services. To justify the cuts it showed the financials of each department. OB was a bottomless pit, anchor babies parents tend to not pay thier bills. The only things that made a proffit in the EDs was the parking garage. Then they went into Obamacare. Because of the higher copays coming up this year they expect a huge drop in the elective procedures. Not one of the private insurance companies is offering a contract that will offset the increased costs of Obamacare and the number of uninsured is skyrocketing. The good news was that we are still in business. We looked at some of the other medical systems. Catholic Health Partners which is one of the biggest truly nonproffit, send us your poor is selling off hospitals, equipment, everything. In many areas they are the only rescue net there is for the needy. You know something is bad when even God cant afford it.

Judicial Review

A few years ago one of my partners was raked over the coals in a medmal lawsuit. He won the case but it tore him up emotionally. It was one of those cases where bad things happened and he just happened to be there. Early in the case the plaintiffs attorney kept calling to settle, dragging it out as much as possible in the hopes to just get some cash. My partner and his defense team just said it was up to the court. When it finally went to trial, my partner won, but at a huge cost. He is one of the most caring people I have ever met.

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

Obama and Newtons Third Law

I have noticed that Obama seems to be a physics major as everthing he does seems to follow Newtons third law. This came very true last night when we had a big board meeting where all the health insurance providers for our staff presented their contract offers. The cheapest that would let our folks keep their same coverage had a 27% increase. BlueCross was 43%, United Health 37%, Cigna 54% and Aetna 51%. Perhaps, instead of having him push a bill to decrease our healthcare costs, we could get him to push and pass one to raise them?

Sunday, November 14, 2010

It is what it is

I was listening to several of the news talkers the other day. They were having a big argument about being conservative and liberal. I decided that I think the big argument is about those who are "it is what it is" and those who are "it shouldnt be that way". I think that both are ok because the former deals with the situation and the other tries to change things and somewhere in the middle is a good thing. The problem I see the most though, is when those that are in the "it shouldnt be that way" camp refuse to accept the situation that is present.

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

Action Auto Medicine

I just saw a potential way to fix our medical system by watching a young 20 year old man at Action Auto. He was amazing and far ahead in wisdom and insight. I was there trying to get a idle air control valve. When I went to the counter and told him what I thought I needed, he looked at me and asked why I thought I needed it. I explained what the car was doing and when it was doing it. It would stall at idle so I had to drive with one foot on the brake and one on the gas. He said, we can put it on the computer and run all the tests and then check the mass airflow sensor, the down stream O2 sensor and change the fuel filter, or we can go with the most likely and blame the idle air valve. He then said, there are a bunch of ways to fix a problem. If you want it fixed permanently, you can pay $80 bucks for a new valve. If you want it fixed for awhile, you can just go hit the one in your car with a hammer as it is most likely just stuck. If you want you can try to clean it out, but just keep a small hammer in the car so every six months or so you can just whack it. I thought about it, walked outside to the car. I didnt have a hammer but I did have the baseball bat that cracked at the last game. I whopped the valve and the car ran just fine.

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.