Monday, August 26, 2013
I though I was imagining things. I double checked, yes the toilet paper in the hospital was getting narrower. I checked at home, it was narrower as well. I didn't measure but I had the distinct thought that my bottom was getting bigger. This is a problem! A Conspiracy! before I could dwell on the possible regulations and profit motivations of decreasing the toilet paper by a half inch I went into problem solving mode. How do you fold something to make it wider. It turns out that you can fold the paper on itself in kind of a star rosette pattern that makes it at least 6 inches wide but it takes alot more paper. I decided I have two choices, be in the lavatory longer and have people yell "what is taking you so long?" and yell back "origami!", or just go in with a roll of Brawny.
I had an older patient who had afib and a stent and needed surgery for a malignancy. Anesthesia saw him and wanted the opinion of his cardiologist in regards to his cardiac status. The cardiologist then stated that they no longer accepted Medicare and that he would be happy to see him if he paid his usual and customary charge without any discount. Needless to say the patient could not afford it. I got on the phone and found another cardiologist who worked him up and we were able to do the surgery. Today I was walking though the parking lot and saw the cardiologist who no longer accepts Medicare. On his bumper were two stickers. "If you have Medicare, thank a Democrat" and "Change".
Saturday, August 24, 2013
In order to create more jobs and provide less patient care, the Medical Center has decided that all orders will be done through the Computerized Patient Oder Entry "CPOE" or F+++ing Piece of S""" "FPOS" system. As a side note, the medical center also has posted signs saying that "carrying of handguns in this facility is prohibited" to keep the staff from shooting the computers. Anyway, when you go to order a medication the FPOS doesn't let you order it without giving you at least a dozen warnings that you have to go through and mark "seen and approved", or "noted", or something. Of course all the warnings are the legalese, mumbo jumbo ones that have no bearing on what you are actually doing. One of my favorites is "insulin has been shown to decrease levels of blood glucose". Ive looked, when you try to get rid of the warning there is no "No Sh@@" button. As you can imagine, after fighting this for a while you go out of your way to find someone else to do it for you. I think this is why the medical center had to hire so many PAs and RNPs and why so many of the hospitalists quit. As an attending, I make the residents put in the orders. The residents make the interns do it. They new interns are at least trying to make a sport of it. After every one of those stupid alerts they hit the desk. The call it banging the head of Chicken Little. Of course, with warning fatigue, sooner or later there will be a real warning that will be missed. If only we could combine those warning alerts with an electronic version of "whak-a-mole" or you could fling the warnings like "angrybirds".
Friday, August 9, 2013
Last night I got a call from the surgical unit regarding one of my partners patients. The nurse explained that the patient was not having good pain control the "10 out of 10" thing. I asked what she had for pain and it seemed very adequate for the surgery. I then asked what the patients home meds where. The patient had admitted that she had "fibro" and was taking oxycodone 4 times a day and had been for years. My partner who is very astute had ordered a drug screen as part of the pre-op labs. This was positive for benzo's and amphetamines. I had to go in and have the talk where I explain that chronic narcotic use causes your pain receptors to go bezerk and that even the slightest pain will be amplified and that it is essential to seek treatment to come off the narcotics. I also had to explain that because of this it will be hard to keep her pain under controlled. We later found out that the patient was taking her kids adderal and what was worse was that she was a teacher! We have no idea where she got the benzos.
We are in a crisis in regards to Medicare patients who went with the AARP supplement. With the Medicare cuts and now the poor reimbursement by the United Health AARP plan the medical center and all the surrounding hospitals are not accepting it for chemotherapy or radiation oncology. Patients have to pay the out of network costs out of their pockets, that is if they can afford them. I wonder if AARP is still glad that they supported Obamacare?