WhiteCoat

Archive for April, 2009

Your Friends Play Baseball?

Thursday, April 9th, 2009

A woman calls our ED and is rather upset. She wants to speak to a doctor for medical advice.

After a couple of sentences, it is readily apparent that the woman has been drinking.

“I want to talk to a doctor NOW.”
“Ma’am, the doctors are busy treating patients and they aren’t allowed to give medical advice over the phone, anyway. Do you have a family doctor?”
“No. I want to talk to an EMERGENCY doctor.”
“An emergency doctor would be happy to see you if you came to the emergency department, but no one can give you advice over the telephone.”
“I don’t want advice, I just need to talk to the doctor.”
“What’s this regarding, then?”
“I’m babysitting my girlfriend’s cats and I’ve had a couple of drinks. I found a bottle of Xanax pills in the closet and took a couple of them to get high. I want to know how much Xanax is too much.”

The secretary repeats what the woman has said. She has now caught the attention of me and one of the nurses who are now listening to the secretary’s side of the conversation.

“Too much for what?” The secretary asks.
“Well, I don’t want to pass out and have these cats eat my face.”
The secretary repeats the woman’s statement so that the nurse and I can hear it. We exchange puzzled looks. Then I motion for her to give me the phone.

“You should really call an ambulance and come to the hospital to be seen.” I tell her.
[click] … the woman hung up.

The secretary then quipped “You should have told her to go dig a catcher’s mask out of the closet. That would have stopped the drinking and the cats.”

Money Is A Strong Motivator …

Thursday, April 9th, 2009

… so are ice cream sundaes.

Our hospital recently offered an ice cream sundae party for each department or floor that completed a feedback survey about hospital operations and hospital management. The surveys were anonymous and only contained the identifying information about where the computer was located in the hospital so the administration could track where the feedback came from.

Administration totaled up all employees in each department and used that number as the base. In order to qualify to attend the ice cream sundae party, the department or floor had to have an 85% participation rate.

Most departments had more than 100% participation, one having a record 166% participation.

See how seemingly small things can motivate people to act?

I’m Not Paying For It …

Tuesday, April 7th, 2009

Gramma WhiteCoat is getting foot surgery this week. She’s in her Golden Years, so her care is paid for courtesy of the Medicare National Bank.

I spoke to her last week and she stated that she was examined by 4 different doctors, 2 nurse practitioners and 3 nurses for preoperative procedures. Her primary care physician (not one of the 4 doctors providing a preoperative exam) saw her about a month prior to her surgery, cleared her for surgery, and ordered preoperative labs. Because the labs were more than 3 weeks old, the surgeon wouldn’t accept the normal results and ordered a second set of preoperative labs.

Grandma WhiteCoat’s response: “I know they’re doing all these exams and blood tests to pad the bill. But I don’t care — I’m not paying for it.”

From the mouth of my own mother.

Just another example of why any system in which the consumer has no stake in cost containment is doomed to fail.

FREE = MORE

Patients must have some skin in the game in order for any medical system to work.

Science Helps Catch A Killer

Monday, April 6th, 2009

d1s80demoThere was a serial killer roaming about the German foothills.

DNA from the same person – a woman – was linked to 39 different crime scenes and 7 murders throughout Germany.

According to scientific literature, the odds of finding an exact DNA match between unrelated people is 1 in 1 quadrillion. For those of you who have been desensitized by the “illion” factor in the recent rounds of government spending, one quadrillion is 1000 trillion or 1,000,000 billion or 1,000,000,000 million or just plain 1,000,000,000,000,000

Since there are only 400 million people in the United States, if a DNA “match” is found at a crime scene in this country, it’s likely that a defendant is guilty until proven innocent. DNA analysis involves examining 13 alleles from evidence samples and from suspects. If 9 of those sites are the same between samples, they are considered a “match.” Here is a more in-depth Wiki about “genetic fingerprinting.”

DNA evidence may not be as reliable as prosecutors would have you believe, though.

In this article from the LA Times, a database of 30,000 DNA profiles contained 32 “matches” at 9 of 13 loci and three “perfect” matches at 13 of 13 loci. Another search of 6 million DNA profiles from two states found more than 1,000 matches at 9 of 13 loci (article is fascinating read if you’re into DNA evidence).

When the German serial killer’s DNA was found at the scene of a murdered 22-year-old police woman, the stakes changed. A 300,000 euro reward was offered for information leading to the killer’s arrest. Police released a sketch of a man they thought might be the killer, hypothesizing that the killer was a transsexual. Eight hundred female criminals were interrogated.  Thousands of saliva tests were taken. No luck.

A hunch by a veteran detective helped crack the case.

The woman whose DNA was linked to so many crimes and murders lived quietly amongst her neighbors, cooked dinners for her family at night, but by day …

she worked in the factory that made the cotton swabs used to obtain the DNA specimens from the crime scenes.

Contaminated specimen swabs, not a serial killer, were to blame for the DNA matches.

See news stories here and here.

And now you know … the rest of the story.

I miss Paul Harvey.

Hat tip to Overlawyered for the link.

Hospital Beds Per 1000 patients

Sunday, April 5th, 2009

From Physician’s Practice Magazine
With all of the hospital closures in the US, our number is steadily decreasing. Be interesting to compare the hospitalization rates and perceived quality of care between these countries.

hospital-beds-per-1000

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Rosen’s 7th Edition Out By September

Saturday, April 4th, 2009

Info forwarded to me from a friend …

If you’re considering purchasing the hard copies of Rosen’s Emergency Medicine (as opposed to Rosen’s Emergency Room Medicine), hold onto your $450.

New 7th edition is scheduled to come out by September 1, 2009.

Alternatively, you could purchase a subscription to MD Consult (or have your hospital purchase a subscription), and you’ll have access to Rosen’s plus a slew of other textbooks and journals for $350/year.

Don’t blame the software for EHR failure

Saturday, April 4th, 2009

The following is a guest post by Houston Neal of Software Advice

You’ve heard about the $850 billion American Recovery and Reinvestment act of 2009 – the stimulus bill recently passed by Congress. The bill is aimed at spurring economic growth across multiple industries by way of government spending. What’s in it for healthcare providers?

Providers can take advantage of $19 billion, which will be used to incentivize medical practices to adopt and implement Electronic Health Records (EHRs). Starting in 2011, providers deemed to be “meaningful users” of EHR systems will be eligible to receive $40,000 – $60,000 in incentive payments paid out over five years in the form of increased Medicare and Medicaid premiums. The table below illustrates the amount of a subsidy paid each year (columns) based on the year the provider first becomes eligible (rows):

hitech-blog-image

For the first year a physician is deemed to be a meaningful user, he or she will be eligible for payments of 75% of that year’s Medicare and Medicaid charges, up to a maximum of $15,000. The maximum payment is increased to $18,000 if the first year is 2011 or 2012. The incentive payments decline for each subsequent year within the five year period; $12,000 will be paid in year two, $8,000 in year three, $4,000 in year four, and $2,000 in year five.

No incentive payments will be available after 2015, and no payments will be offered to physicians who first become eligible after 2014. This creates a decreasing incentive for late adopters.

The EHR subsidy has stimulated demand for EHRs, but will “free” EHR software lead to meaningful use? Will providers consider the critical implementation and change management practices that are critical to success?

Software Advice, a website that offers reviews of electronic medical records, suggests that “free” EHR software will result in a lot of failed implementations over the next few years. They’re concerned that the subsidies won’t change healthcare providers’ late adopter mindsets about information technology. They have outlined their thoughts on why IT projects fail and how providers can avoid that fate while capitalizing on the subsidy: “Get Ready for EHR Failures, But Don’t Blame the Software.”

Many Doctors Opting Out of Medicare

Friday, April 3rd, 2009

This NY Times article notes that many patients who become Medicare eligible are finding that the “insurance rug has been pulled out from under them.”

More and more physicians are dropping Medicare and patients can’t find physicians to take care of them.

“The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.”

There is already a shortage of internists in the US and the ones that are available are unwilling to accept new Medicare patients. Universal coverage doesn’t mean much if no one takes your insurance.

The more I think about this, the more I wonder whether this is exactly what the feds are looking for. They keep taking 15+% out of everyone’s paychecks to fund a Medicare system that fewer and fewer doctors participate in – until everyone pays a lot of money to end up with little or no access to medical care.

Pâté, Anyone?

Friday, April 3rd, 2009

stool-sampleWord was going ’round the hospital about a stinky envelope dropped off at one of the primary care physician’s offices.

A patient was given three stool sample cards and three flat wooden sticks with which to retrieve three samples of stool from the toilet bowl. You probably know where this is going.

The aforementioned envelope contained said stool samples. When opened, fumes from said envelope caused the eyes of the primary care physician’s secretary to water and burn.

The patient had used the wooden sticks as makeshift knives to cut up pieces of stool about a half inch thick and to place these “stool samples” onto the cards.

No word on whether the stool samples were positive or negative for blood.

I think the secretary’s puke got in the way.

In case anyone gets to this post by searching “how much stool should I include on a stool sample card” … remember the old “Brylcreem” commercials?

“A Little Dab’ll Do Ya”

Nevada Supreme Court clearing malpractice backlog

Thursday, April 2nd, 2009

According the the San Jose Mercury News, the Nevada Supreme Court is going to resolve a “backlog” of medical malpractice lawsuits by creating a “settlement marathon” next month.

In other words, the court is saying something along the lines of “Nevada hasn’t hired enough judges to deal with all of these cases, so regardless of the merit of these lawsuits, you defendants better pay the plaintiffs off now so we can get these cases off our books.”

Nice.

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