Oz scintillation retinopathy

(When you cant see the man behind the curtain.) I was watching the news and one of our Congressman was going off on how the drug companies are behind the high cost of medications and how they are so much cheaper overseas. (Part of the Progressives view that all corporations are bad!) Anyway, I thought about it and did a little checking. When we go on our medical missions we stock up on meds. I can get 1000 Cipro tabs for $24 from a medical wholesaler. I then got on the phone to Walgreens and they told me 20 would be $16. I then ran a bunch of common meds, propranolol, amoxicillin, predni sone. It was all the same, the mark-up at the pharmacy was enormous! I tried some brand names that were not generic, and guess what, it was the same!

I found out the only reason I could buy the meds from the wholesaler was my medical license but I could not be a distributing pharmacy. You see here in the US, a patient can only get medications from a distributing pharmacy which can mark up the price as much as the market can bear. The big pharmacy chains can be their own wholesalers and also negotiate with each insurance company a cost for each medication. As a a result of this their proffit goes through the roof.

There is a reason why there are pharmacies on every corner and why drugs cost so much. It isnt so much the drug companies but the pharmacies. (When you get meds from Canada you get them from wholesalers). So, ignore the man behind the screen at the pharmacy because he is robbing you blind.

MAR de Debarquement Syndrome

(When you get dizzy discharging the patient from the hospital). Whenever we go to discharge a patient from the hosital we have to fill out this form that shows all the meds they were on while in the hospital and we have to decide if we want the patient to continue them. The problem is that often we are not the ones who put them on the meds to begin with and further, the list has the meds the patients say they were on before they came in to the hosital. I love it how all the older men always say they are on Viagra and need a script before they go home. I have had anabolic steroids on the list and of course the ever present, I wont be able to go to the pain clinic for a while so I need my Oxy and Percs. I tell the residents the only scripts patients get from us are for the meds that we put them on, none other. When the ever present JACHO form nurse asks about the other meds, I write on the form that "other meds are at the discretion of the original prescribing physician and patient can not be discharged until these medications have been reconciled". I know that by doing this I am "ticking off" alot of the long white coat clipboard carrying administrative types, but it sure does get them moving in a frenzy to check on all the patients medications and make sure that they have someone accountable. Everytime they come back to me and ask me to be the one to approve some of these medications, I explain that I am here to fix the trauma, no be responsible for their their pre-existing narcotic dependence or erectile dysfunction and they can find someone else to admit these patients and I will just consult!

RTW NFW!

Got this in the email this morning! I't looks like I am not the only one!


OK, HUGE annoyance that just won't go away! You see a patient for a sprain/strain (not work comp) and then at some undefined time in the future you get a request from the patient for a return to work note. Ummmm never had you OFF work to start with, so I probably don't need to say it's ok for you to go back (you weren't supposed to be gone from work!).
Better yet, you didn't even see the patient (they were referred because you were the schmuck on call for the ER). And 3 weeks later they call you to request a return to work note. Ummm still NO.
Even better (and today's scenario), the patient went to the ER, you see the patient after for free follow up (medicaid or no insurance) and 3 weeks later you get a call from them saying they want you to send a note for return to work to their "turn the book over" Lawyer! Good God! NO you can't have a RTW note if I didn't take you OFF work to start with. And yes, I know that puts your job in jeopardy, and yes you might lose your job (while you are obviously trying to win some settlement for your terrible fictitious injury). But I'd be happy to send your lawyer a note (for a charge) stating that I never took you off work to begin with!
What is with people???

Umbilical Abortion

I just recieved an article from a friend that shows that in Rustberg, Virgina a woman gave birth and then suffocated the child to death. She was not charged with murder because the umbilical cord was still attached and she had not delivered the placenta. I wonder then where the abortion rights folks think murder begins?

Déjà pensé and Magical Thinking

I was trying to hold back my excitement with Scott Browns elections the other day. My excitement was that hopefully there might be some meaningful discussion about the good and bad of our medical system and a true attempt to tweat it to make it better. In medicine we straddle both the consumer and producer fence of healthcare. As a small businessman, I have to negotiate health insurance contracts for my employees and try hard to pay for it. As a deliverer of healthcare, I have to negotiate contracts with insurance companies to hopefully get paid for what we do. The biggest problem is that there is no competition, both are take it and leave it. There are only two insurance companies that will write small business health insurnace in our area of the state. The difference in price is minimal between the two for the same policies. Interestingly, one if for proffit and the other isn't but that is another discussion. As to how much we get paid, guess what. There is the government which has a set fee schedule, and then the same two insurance companies.

I was hoping that the Massachusetts election might make Congress look at different ideas and consider getting away from the laws that presently make it so that there are only really two insurance companies and do things like allow out of state competition. Why cant we have GEICO, ALLSTATE, PROGRESSIVE, STATE FARM all fighting it out for our health insurance dollars?

I was thinking of this and had my fingers crossed when I sam Obama being interviewed as well as Pelosi and Harry Reid. They just seemed to ignore and come up with a new idea (one that they had before) and just think that if they blame Bush and increase taxes it will all just fix itself.

Collating all the form ID-10ts

I hate administrative meetings. I especially hate meetings whose whole purpose is to come up with a standard form to meet yet another JACHO mandated paperwork boondoggle. These never actually have anything to do with patient care, they are just to document, document, document. Then administrators look at the forms and come up with metrics to keep track of just how good we are at filling out the forms! Forms, forms, forms. I would love to have all these people who want all these forms just to go and fill out ID-10ts on themselves!

Capgras' syndrome

A while back we were having a discussion about government panels that might determine the limits of care for patients. (i.e. death panels) The discussion focused on how much is spent on patients in the last 6 months of their life. One of our pulmonologists who is on the liberal side had pontificated on how we spend so much resources keeping these people alive that he didnt think the panels were a bad thing. I expressed that these patients are usually spending their own resources as they had been the ones that paid into Medicare and their private insurance all these years and are getting their money back. They and their families are deciding how they want their money spent.

Our death panel pulmonologist now has his father in the neuro ICU after a massive stroke. He wants everything done, a trache, peg, longterm rehab vent unit. The works. I though I was having an acute attack of Capgras' syndome, but then remembered liberals what to decide on how to spend everyone's money except their own.