Anti-Evolution

I was going to jump in to the conversation in the locker room today but couldn't.  One of the other docs was on a rant.  He had just removed the second infected valve of the heart of a young IV drug abuser.  It went something like this.  "Evolution is BS! You don't see animals evolving into  species that grow some plant only to grind it up, mix it with water, boil it and inject it into themselves.  Then in a stupor fall out of a tree only to have other animals drop everything to save them, support them, rehab them, and then pay for them to go out and do it again!"

STD's

I think I am just going to give in and file for Medicare Disability for writers cramp, trigger finger and depression.  In addition to all the other forms, there is now a new plethora of other forms that must be filed out for Medicare compliance according to JACHO, CMS and WGF. (WGF is "who gives a +++!")  I didn't even have clinic today and only had to round on a few patients but still I had to sign, time and date 87 separate forms!  I daydreamed about a pen that after I scrawled an unitelligible swirl as a signature it would shoot a laser that burned the time and date into the paper as it set off smoke detectors in the administrators offices. To be even more passive/aggressive I wanted to date and time the orders in ancient Mayan but one of the other surgeons said their calender was over as the world ended!  Some guy in a suit said it would all be better once all the records were paperless as the date and time would be automatic.  Yeah, sure.  We are "paperless"!  Somehow, paperless means I have to sign more papers that the computer just spits out one after the other.

VA Spa

Like many surgeons, part of my training was done at the VA Medical Center or the VA Spa as it was known.  We called it the "SPA" because it was the place where you had to learn to  relax.  In our training at the University Hospital it was not uncommon to be working 17 hours a day.  You get  to the VA and they wouldn't even start any OR cases until 830 or 900.  If you happened to be operating after 230 you could look out the window of the door of your operating room and see that all the other lights were off and they had closed shop.  There was never a problem parking because even though the clinics were supposed to start at 8, most employees didn't show up to 830 or 900.  Everyone got 1 1/2 hours off for lunch not to mention every holiday. 

I say it was the place you had to learn to relax because yelling at the staff for not doing their jobs accomplished nothing.  In fact, they did even less.  There were those who really cared and tried, but the whole system seemed to be set up to punish those who tried to correct the problems.  I hope this recent publicity will finally bring attention to the whole problem.  Then again, the VA is government single payer healthcare!  Who knows the VA may be the model for the final Obamacare.

Patient Grades

When I strolled into the surgeons lounge I saw one of our best surgeons sitting there with her head in her hands.  I sat down and asked if she needed to talk to someone.  Usually when I see a surgeon like that she just had to give someone bad news or no matter what she did he could save the patient and they were going to die.  Its a lonely place and sometimes it helps to be able to talk to a colleague to get it all out.

I wasn't prepared for what she had to say.  A few months before she had saved a patient from certain death, a bad mesenteric ischemia with perforated bowel.  The patient had a rough course but pulled through.  The patient was an IV drug abuser and the bowel infarction was a septic emboli.  Because the surgeon would not give the patient all the narcotics he wanted and instead set him up in a treatment program, the patient went on HealthGrades and slandered the surgeon up and down.  This is now the first thing you see when you google her name.  I did my best to console her but all I could think of is "We need a PatientGrades where we can list all the drug seekers, psychopaths and Munchhausen's patients!"

Lordy Lordy, we just hit 40!

Just finished a week on call where I cover several emergency departments.  On average there will be about 60 consults for "emergencies".  In the past one third would be uninsured.  This week it was 2/3rds.  Worse 7 had insurance but had to drop it because it became too expensive. 

I guess I'm confused, I thought Obamacare was going to cover the uninsured and make it affordable.

McCarthy Orchitis

As of this morning there were 23 cases of mumps at Ohio State University with the epidemic expected to increase as the result of so many students that have not been vaccinated.  I wonder how many of them are also following Jenny McCarthy's other areas of advise and smoking E cigs?

Going Postal

I had to renew my passport and went to the Post Office where I thought I could get the picture and mail it right away as that is where I got the last one.  When I got there a sign was posted that said they had met their passport quota for the day and  were now closed.  I went to a  nearby shop that took the photo and I attached it to my application and went back to the post office to mail it.  When I got there, the passport window was now open!  I asked the person, "I thought that you had met your quota for the day?".  He said, "Oh, we put that up when we go to lunch".  I was about to ask "why don't you put a sign that says gone to lunch" but then the answer hit me.  People would line up and wait for them to come back.  By saying "quota met", people would just leave.  Gotta to love the Federal work ethic!

The Sound of Silence

I was called to a code last night, luckily everything turned out ok but it was one of those things that make me just wonder about the people.  A patient with bad lungs secondary to COPD was in the hospital secondary to an exacerbation.  He was on oxygen and a pulse oximiter.  The patient had a family member who decided to stay with him that night but they couldn't sleep because the oximeter alarm would go off if the patients sats dropped below 89%.  So they could sleep better, they silenced the alarm on the pulse ox.  Luckily for the patient, the nurse saw the sats go to 70 and she was able to get him on 100% O2 about the time he went brady.

Obama Math

In our area we had a huge increase in the cost of health insurance and big changes in health care plans as the insurance companies prepare for the costs of Obamacare.  As a result, we are seeing patients come to the office where their office copay is more than the cost of the visit! Talk about a disincentive to seek medical care!  Some insurances allow us to then refund the difference to the patient but if the insurance is one of the "Obama Compliant" plans we have to send the difference to the insurance company!

As near as I can figure it the math works this way "The Affordable Care Act saves you money by costing you more!"

F20.1

I saw Harry Reid's take on Obamacare and I was relieved.  Did you ever notice that his affect is getting more and more flat with fleeting of ideas?  Anyway, It let me tell the patient who cant have his surgery because his insurance premiums, deductible and out of pocket costs have tripled that its "all a lie".  I was able to tell the uninsured patient that he really has insurance, that its "all a lie".  I was able to tell the patient who had their policy cancelled and now they can no longer afford insurance, its "all a lie".  I was able to tell the college student that he is covered by his parents insurance but their costs have went up so much that none of them have insurance, that these problems are "all a lie".  I was able to tell the medical oncology nurses, physical therapists that they are not being fired because of the medicare cuts, that its "all a lie".  I'm glad all these Obamacare horror stories are lies.  Oh, wait a minute, it may just be Harry Reid's schizo/delusional disorder.

Molly, molly, molly get your adverbs here!

Looks like we have another of Darwin's herd culling drugs.  Sooner or later the IV drug shooters die of ODs and endocarditis, the crack addicts die of MIs and stokes and the meth heads fry their brains.  All of which serve to self limit the epidemic.  Molly seems to be doing the same thing.  These users show up hypermetabolic in renal failure and seizing,  permanent brain damage occurs and they end up in a SNF where they slowly die of aspiration and bedsores.


Here are molly's adverbs : stupidly, hastily, fatally, painfully, hopelessly, violently and permanently

Unsolicited Medical Advice

I cant imagine being a pharmacist!  It must be horribly boring and tedious and I am so grateful when they catch a stupid mistake I made regarding a dose, allergy or interaction.  They drive me nuts though when they starting suggesting other medical treatments.  One of my patients recently had a script filled for flagyl.  The pharmacist asked her what it was for, and the patient replied that it was for some problems she had "down below".  The pharmacist then suggested several vaginal douches and also recommended that the patient be tested for other STDS.  The patient was horrified that she might have something else and called the office upset.  We had to explain that the flagyl indeed for her antibiotic induced diarrhea and not for the vaginal issue the pharmacist was discussing!

Code Brown Boomerang!

All to often a patient from the ICU will have to go to the OR for a procedure.  These patients are usually on vents with lines everywhere.  A code brown will happen, usually right before they have to go to the OR.  Our basic rule is if it happens on your watch, you take care of it.  So if it happens in the ICU, the ICU team cleans it up. If it happens in the OR, the OR team takes care of it.  There are some who try to hide it in the ICU because it is hard to move the patient and they think "well the OR team will have to move them to the OR table, so it will be easier for them to clean it!" but this doesn't happen to much.  The real problem, is what happens during transport.  One patient had a bad blow out in the ICU and they cleaned it, in the OR they were clean and they were clean when they went back on the ICU bed.  When they got back to the ICU, there it was again.  the blow out happened right between the OR and the ICU.  The ICU nurse got all mad and demanded the OR team come back and clean it up.  There was a huge discussion on the rules of code browns and "he who smelt it must deal with it", but when it was all over both teams took care of the patient, who had another code brown a few minutes later.

Clinical Summary

If having to use the EMR is not bad enough, we now have to provide each patient a printed out summary of the visit before we leave.  Given we are a tertiary referral center and each patient comes with multiple records, films and studies there is no way that we can go through everything and as soon as they leave the exam room hand them a summary without it being totally useless.  Too make matter worse, patients now come to their consults with their clinical summaries from other doctors thinking these things actually help.  Yesterday a patient come in with a handful of these, one of them simply said "in order to comply with Federal Regulation, this is a clinical summary of your visit.  We saw you as a patient on this date.  These tentative diagnosis were discussed but they were not confirmed."


We have now told patients that they are more than welcome to wait for their clinical summaries, it may be until very late at night until we can personally talk to their referring doctors and review all of their studies.  Invariably, they leave before then.