Rolling the Deductable Dice

We are being over run by patients who were advised to have an elective procedure who were waiting to see if they were going to meet their deductibles.  (rolling the dice)  Now they are finding out that their deductibles and out of pocket costs are going way up next year so they want everything done between now and the end of the year.  This seems to happen every year, but this year it is magnified by the huge jump in costs.  In our area the deductibles and out of pocket costs are doubling and patients are panicking.  Welcome to Obamacare.

Kwaulity with a K

This EMR stuff is driving me nuts.  Now we have to have all these quality measures that are mandated by the government.  All of these require more work that has nothing to do with why the patient is there.  In addition we have to complete all of these "quality measures" so the patient can have them  in the huge report that we have to generate while they are there.  The sad thing is the one most important quality measure that patients ask for is "that the doctor spend more time with them answering their questions".  So, in order to provide "quality" we have to spend less time with the patient on the reason they are there so we can focus on what they don't really want.

8 Ball to the side pocket

Boy we are seeing a lot more IV drug abuse lately in addition to the meth.  When the IV drug users are having a hard time finding a vein, they start shooting into their neck right in the little pocket between the heads of the SCM.  When they hit the jugular vein, the crushed up junk goes straight into the heart where it crashes into the heart valves and the bacteria in it grows and before you know it, they have septic endocarditis sending little abcessess everywhere including their brain.  When they stick the needle in too far, they hit their carotid and get a nice little psuedoaneurysm that also gets infected and in enough time will rupture.  No matter what though, they always seen to come in to the ED at about 200am. IV antibiotics, open heart for valve replacement, carotid bypass graft, craniotomy for stealth guided abcess drainages, counselling, treatment program.  Back in 3 months to do it all again, priceless.

Scab Eaters

We have just been overrun by scab eaters.  We already had quite a few but the number seems to just have exploded.  For those who aren't in the hand sanitized trenches, meth heads get the pops which are little blister zits on their skin.  These scab over and then they pick and eat them because some of the meth is concentrated in the scab.  Our ICUs have closed circuit cameras so we can watch for emergencies and it is amazing how often we catch family members trying to syphon off some fentanyl from the IV drips, but what is worse is how many we see pick off the scabs of the comatose patient and eat them.  These scab eaters are the worse because if you didn't have the camera, you wouldn't know they are scab eaters.  You pass them in the hall and see them in the ICU waiting area where they just cant wait to go back and "be with their loved one".

Meaningful misuse

We just got informed of all the things that we have to do to satisfy the ObamaCare "meaningful use" electronic records mandate.  At every patient visit we must determine the patients body mass index and then counsel them on weight loss, diet and nutrition.  We must also inquire about domestic abuse and offer counseling and arrange resources.  We then must discuss smoking, smoking cessation and discuss medications to help smoking.  Then in the little time that is left, we can discuss the tumor that is trying to take your life, that is unless there is another "meaningful" mandate.

Circlage

I had heard a medical tall tale of newborns who were given medical names their mothers had heard.  The classic is FEMALEm(fee-mal-ee) because the baby had already been named.  There is also a little girl named Meconium and another named Placenta.

I no longer doubt these names because I have just taken care of SirClage.

Your Government Check is in the Mail

I saw a recent interview from one of our congressman who was stressing how physicians are overpaid. I couldn't help but look at the Medicaid payscale. This is what the Federal Government pays doctors to take care of you.

To admit you into the hospital and manage a severe pneumonia in a patient with diabetes and CHF an internist gets $74 and then gets $24 each additional day he or she manages your care while you are in the hospital.

When we had a problem with our furnace, the HVAC man got $75 to come to the house, $65/hr after that plus parts and labor.

Oh, the Federal Governement pays attorneys at a rate of $200/hr.