Bumper Sticker Lib

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".

Chicken Little Bang Bang Bang

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".

Mommy's Little Helper

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.

AARPed!

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?

Dragonese

With many of the EMRs, docs are using Dragon software to dictate.  Dragon is amazing but you "have to train your Dragon" and some dragons are not well trained.  On top of it, there is now pressure to have  a complete note for the patient to have when they check out, as this is another one of those "mandates".  The result is that the note is made entirely of macros with a small Dragon dictated blurb at the bottom that you don't have time to proofread.  As you can imagine, the notes are not very useful but can be quite funny.  Some of my favorites are " the incision was opulent", (instead of purulent), "the patient was singularly pathetic", (the patient was on singular and patanase).  The best is when someone is dictating and then answers the phone, so the Dragon starts typing what he said on the phone. I had one note that ended, "fine, love you too!"

Copay "Triple Pay"

I had to have a prescription filled at the local chain pharmacy.  The pharmacist handed me the script and it was only for 30 days instead of 90 days.  I asked why they altered the script for a smaller amount.  He got a little nervous.  I then said, my copay is 10 dollars for this generic, how much is the cost if I pay cash for all 90?  He got more nervous then said $14.  So, to get it straight they will break a 90 day script in to three 30 day scripts so they can triple the copay.  At first, the people in the line behind me were annoyed because I was taking so much time, after hearing what had transpired it was game on with each of them checking to see if their scripts had been altered.  This is the same chain pharmacy that is so determined on electronic scripts so that people cant call around to see who has the cheaper prices!

"Artists"

It is near the end of the year and the interns are a bit burned out.  We had an avid medical student here on an audition clerkship and overheard two if the interns talking about which one of them was going to see which of the "artists" in the Emergency Department.  After a few minutes he approached me and said something to the effect that there are a lot of artists here in this area.  I didn't want to burst his idealist bubble of sculptors and painters but I finally had to let him in on the meaning of the term.  I explained that "Artists" are those who are really good at drawing.  They are good at drawing disability, social security, Medicare, Medicaid, food stamps, Obama phones and everything else while they sell drugs and sponge off society.