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	<title>Comments on: Healthcare Update 12-31-2009</title>
	<atom:link href="http://www.epmonthly.com/whitecoat/2009/12/healthcare-update-12-31-2009/feed/" rel="self" type="application/rss+xml" />
	<link>http://www.epmonthly.com/whitecoat/2009/12/healthcare-update-12-31-2009/</link>
	<description>A blog from inside the emergency department</description>
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		<title>By: GrumpyRN</title>
		<link>http://www.epmonthly.com/whitecoat/2009/12/healthcare-update-12-31-2009/#comment-16014</link>
		<dc:creator>GrumpyRN</dc:creator>
		<pubDate>Sun, 03 Jan 2010 13:03:42 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4057#comment-16014</guid>
		<description>I would back up Steve&#039;s comment, never use the Daily Mail as a reference. It is well known for distorting the truth or only printing parts of the real story. As Steve pointed out, it is the opposition that are saying this - there will be an election in the UK within the next 3-5 months and propoganda is rife and will get worse. The targets that are talked about are that 98% of patients are seen, treated and discharged or admitted within 4 hours. This is seen as perhaps a bit too rigid and that a 95% target would be better. My own hospital achieves 99% and we are a major university teaching hospital. Over the New Year holiday I had to apologise to patients that as it was so busy they would have to wait 2 hours to be seen. I agree though that there can be problems in the NHS, but extrapolating one or two incidents to the whole of the organisation is misleading and wrong.

2 other points; casualty department is an old fashioned term, we now use &#039;Accident and Emergency&#039; or &#039;Emergency Department&#039;, and please stop inferring that the NHS is free, it is not now, nor has it ever been, free. It is paid for by the population as a whole by a National Insurance scheme that everyone pays as part of their deductions from their wages/salary, it is only free in the sense that you do not get presented with a bill when you attend for treatment.</description>
		<content:encoded><![CDATA[<p>I would back up Steve&#8217;s comment, never use the Daily Mail as a reference. It is well known for distorting the truth or only printing parts of the real story. As Steve pointed out, it is the opposition that are saying this &#8211; there will be an election in the UK within the next 3-5 months and propoganda is rife and will get worse. The targets that are talked about are that 98% of patients are seen, treated and discharged or admitted within 4 hours. This is seen as perhaps a bit too rigid and that a 95% target would be better. My own hospital achieves 99% and we are a major university teaching hospital. Over the New Year holiday I had to apologise to patients that as it was so busy they would have to wait 2 hours to be seen. I agree though that there can be problems in the NHS, but extrapolating one or two incidents to the whole of the organisation is misleading and wrong.</p>
<p>2 other points; casualty department is an old fashioned term, we now use &#8216;Accident and Emergency&#8217; or &#8216;Emergency Department&#8217;, and please stop inferring that the NHS is free, it is not now, nor has it ever been, free. It is paid for by the population as a whole by a National Insurance scheme that everyone pays as part of their deductions from their wages/salary, it is only free in the sense that you do not get presented with a bill when you attend for treatment.</p>
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		<title>By: steve</title>
		<link>http://www.epmonthly.com/whitecoat/2009/12/healthcare-update-12-31-2009/#comment-15984</link>
		<dc:creator>steve</dc:creator>
		<pubDate>Fri, 01 Jan 2010 19:10:24 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4057#comment-15984</guid>
		<description>&quot;Democratic Councillor for East Marsh Ward.&quot;  *Choke*, Look at his election results page, he got 825 Votes :)  He&#039;s your man if your bin didn&#039;t get emptied, not quite the person I want to turn to about the best health system for 300 Million Americans though.

Is it true? Yes I imagine it did happen at least one place at one time.  It it common, not at all.  If it was it would be headline news every single day.  Its just a silly anecdotal story.

The truth.  Its been about 20 years since I&#039;ve been in A&amp;E, at the time 3-4 hour waits were common.  I went in again recently and my feet barely touched the ground. Reception, triage, doctor, xray, doctor, cast, and out the door.  Discussing this with others who are more frequent flyers (they have kids) confirmed my impression that things have improved a lot recently.  

As for the rest of the NHS, well I have private insurance, it comes free with the job.  Some years back it was very useful for bypassing long queues to see specialists , these days I don&#039;t even bother to use it, too many forms and phonecalls.  I just let the NHS kick in, and its just fine.

I don&#039;t support the current UK government , but its hard to knock what they have done with the NHS over the last 12 years.</description>
		<content:encoded><![CDATA[<p>&#8220;Democratic Councillor for East Marsh Ward.&#8221;  *Choke*, Look at his election results page, he got 825 Votes <img src='http://www.epmonthly.com/whitecoat/wp-includes/images/smilies/icon_smile.gif' alt=':)' class='wp-smiley' />   He&#8217;s your man if your bin didn&#8217;t get emptied, not quite the person I want to turn to about the best health system for 300 Million Americans though.</p>
<p>Is it true? Yes I imagine it did happen at least one place at one time.  It it common, not at all.  If it was it would be headline news every single day.  Its just a silly anecdotal story.</p>
<p>The truth.  Its been about 20 years since I&#8217;ve been in A&amp;E, at the time 3-4 hour waits were common.  I went in again recently and my feet barely touched the ground. Reception, triage, doctor, xray, doctor, cast, and out the door.  Discussing this with others who are more frequent flyers (they have kids) confirmed my impression that things have improved a lot recently.  </p>
<p>As for the rest of the NHS, well I have private insurance, it comes free with the job.  Some years back it was very useful for bypassing long queues to see specialists , these days I don&#8217;t even bother to use it, too many forms and phonecalls.  I just let the NHS kick in, and its just fine.</p>
<p>I don&#8217;t support the current UK government , but its hard to knock what they have done with the NHS over the last 12 years.</p>
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		<title>By: StorytellERdoc</title>
		<link>http://www.epmonthly.com/whitecoat/2009/12/healthcare-update-12-31-2009/#comment-15976</link>
		<dc:creator>StorytellERdoc</dc:creator>
		<pubDate>Fri, 01 Jan 2010 15:01:36 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4057#comment-15976</guid>
		<description>You always find great posts for your blog.  Well done.  I am a bit nervous about the PA doctor testifying about marijuana use.  God forbid I start having to supplement their supply because they &quot;ran out early&quot;.  We&#039;ll be handing out bongs like MDIs!

Happy and Blessed New Year to you all.</description>
		<content:encoded><![CDATA[<p>You always find great posts for your blog.  Well done.  I am a bit nervous about the PA doctor testifying about marijuana use.  God forbid I start having to supplement their supply because they &#8220;ran out early&#8221;.  We&#8217;ll be handing out bongs like MDIs!</p>
<p>Happy and Blessed New Year to you all.</p>
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		<title>By: paul</title>
		<link>http://www.epmonthly.com/whitecoat/2009/12/healthcare-update-12-31-2009/#comment-15967</link>
		<dc:creator>paul</dc:creator>
		<pubDate>Fri, 01 Jan 2010 01:28:44 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4057#comment-15967</guid>
		<description>wonder what the likelihood of a successful lawsuit is if you walk out before a physician-patient relationship is established. can sue the hospital maybe? for having inadequate staffing?

happy new year.</description>
		<content:encoded><![CDATA[<p>wonder what the likelihood of a successful lawsuit is if you walk out before a physician-patient relationship is established. can sue the hospital maybe? for having inadequate staffing?</p>
<p>happy new year.</p>
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		<title>By: WhiteCoat</title>
		<link>http://www.epmonthly.com/whitecoat/2009/12/healthcare-update-12-31-2009/#comment-15964</link>
		<dc:creator>WhiteCoat</dc:creator>
		<pubDate>Thu, 31 Dec 2009 23:47:01 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4057#comment-15964</guid>
		<description>Don&#039;t know much about the &lt;i&gt;bona fides&lt;/i&gt; of the Daily Mail, but are the facts of the story true or not? 
Would you similarly expect the government to come out and say that the NHS has failed? 
We have to at least consider the contrarian point of view.
Is the Telegraph a good newspaper? &lt;a href=&quot;http://www.telegraph.co.uk/health/healthnews/6865643/Hospitals-dump-patients-in-wards-to-hit-target.html&quot; rel=&quot;nofollow&quot;&gt;It has the same story&lt;/a&gt;. 
&lt;a href=&quot;http://stevebeasant.mycouncillor.org.uk/2009/12/25/nhs-accused-of-fiddling-waiting-times-in-accident-and-emergency/&quot; rel=&quot;nofollow&quot;&gt;So does the Democratic Councillor for East Marsh Ward&lt;/a&gt;.</description>
		<content:encoded><![CDATA[<p>Don&#8217;t know much about the <i>bona fides</i> of the Daily Mail, but are the facts of the story true or not?<br />
Would you similarly expect the government to come out and say that the NHS has failed?<br />
We have to at least consider the contrarian point of view.<br />
Is the Telegraph a good newspaper? <a href="http://www.telegraph.co.uk/health/healthnews/6865643/Hospitals-dump-patients-in-wards-to-hit-target.html" rel="nofollow">It has the same story</a>.<br />
<a href="http://stevebeasant.mycouncillor.org.uk/2009/12/25/nhs-accused-of-fiddling-waiting-times-in-accident-and-emergency/" rel="nofollow">So does the Democratic Councillor for East Marsh Ward</a>.</p>
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		<title>By: Tweets that mention Healthcare Update 12-31-2009 &#124; WhiteCoat's Call Room -- Topsy.com</title>
		<link>http://www.epmonthly.com/whitecoat/2009/12/healthcare-update-12-31-2009/#comment-15963</link>
		<dc:creator>Tweets that mention Healthcare Update 12-31-2009 &#124; WhiteCoat's Call Room -- Topsy.com</dc:creator>
		<pubDate>Thu, 31 Dec 2009 22:17:23 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4057#comment-15963</guid>
		<description>[...] This post was mentioned on Twitter by EPMonthly, Peter Jackson. Peter Jackson said: Healthcare Update 12-31-2009 &#124; WhiteCoat&#039;s Call Room http://bit.ly/4n7oMh [...]</description>
		<content:encoded><![CDATA[<p>[...] This post was mentioned on Twitter by EPMonthly, Peter Jackson. Peter Jackson said: Healthcare Update 12-31-2009 | WhiteCoat&#39;s Call Room <a href="http://bit.ly/4n7oMh" rel="nofollow">http://bit.ly/4n7oMh</a> [...]</p>
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		<title>By: steve</title>
		<link>http://www.epmonthly.com/whitecoat/2009/12/healthcare-update-12-31-2009/#comment-15962</link>
		<dc:creator>steve</dc:creator>
		<pubDate>Thu, 31 Dec 2009 21:41:23 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4057#comment-15962</guid>
		<description>oops lost the last comment...

Please don&#039;t use the Daily Mail as a source of UK news, it a joke newspaper.

Read the story and use your own brain, the *opposition* party says that the government has failed on the NHS, Oh Really!, did you expect them to come out and say what a wonderful job the government has done???</description>
		<content:encoded><![CDATA[<p>oops lost the last comment&#8230;</p>
<p>Please don&#8217;t use the Daily Mail as a source of UK news, it a joke newspaper.</p>
<p>Read the story and use your own brain, the *opposition* party says that the government has failed on the NHS, Oh Really!, did you expect them to come out and say what a wonderful job the government has done???</p>
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		<title>By: Fyrdoc</title>
		<link>http://www.epmonthly.com/whitecoat/2009/12/healthcare-update-12-31-2009/#comment-15956</link>
		<dc:creator>Fyrdoc</dc:creator>
		<pubDate>Thu, 31 Dec 2009 18:19:28 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4057#comment-15956</guid>
		<description>WC -

Check this one out for fun.  Appellate court in Ohio basically wiped out the statute of limitations on med-mal claims by allowing a &quot;John Doe&quot; suit to be brought and in their ruling state that &quot;the statute of limitations begins to run once the plaintiff acquires additional information of the defendant&#039;s wrongful conduct.&quot;  They allow a suit where, during depositions in a suit against one physician, that physician implicates another long after the statute of limitations has run out.  So now, in Ohio, the statue begins whenever a plaintiff decides to investigate if a claim should be filed, not when the injury occurs.

See: http://oh.findacase.com/research/wfrmDocViewer.aspx/xq/fac.%5COH%5C2009%5C20090210_0000755.OH.htm/qx</description>
		<content:encoded><![CDATA[<p>WC -</p>
<p>Check this one out for fun.  Appellate court in Ohio basically wiped out the statute of limitations on med-mal claims by allowing a &#8220;John Doe&#8221; suit to be brought and in their ruling state that &#8220;the statute of limitations begins to run once the plaintiff acquires additional information of the defendant&#8217;s wrongful conduct.&#8221;  They allow a suit where, during depositions in a suit against one physician, that physician implicates another long after the statute of limitations has run out.  So now, in Ohio, the statue begins whenever a plaintiff decides to investigate if a claim should be filed, not when the injury occurs.</p>
<p>See: <a href="http://oh.findacase.com/research/wfrmDocViewer.aspx/xq/fac.%5COH%5C2009%5C20090210_0000755.OH.htm/qx" rel="nofollow">http://oh.findacase.com/research/wfrmDocViewer.aspx/xq/fac.%5COH%5C2009%5C20090210_0000755.OH.htm/qx</a></p>
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		<title>By: hashmd</title>
		<link>http://www.epmonthly.com/whitecoat/2009/12/healthcare-update-12-31-2009/#comment-15954</link>
		<dc:creator>hashmd</dc:creator>
		<pubDate>Thu, 31 Dec 2009 17:27:48 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=4057#comment-15954</guid>
		<description>Re: the last paragraph about antibiotics.

I was called by my county medical society committee which evaluates medical complaints early in my career when I moonlighted in a local ER. I saw a pt. who had just been given an antibiotic by his PCP the day before for a cough and pleuritic chest pain. He complained of continued posterior chest pain. I heard no rales, no friction rub, no dullness to percussion. As he had just been to his doctor and had less than 24 hours of antibiotic, I did not repeat the CXR nor did I change the antibiotic. This was back in the days Ceclor was still brand name!!!

He was hospitalized in a nearby town (where he was from by the way) about 3 days later and required a chest tube for presumably empyema.

The committee suggested I waive my bill and that the ER waive their bill so that the pt. wouldn&#039;t sue.

So ever since I gave out antibiotics like candy, whether needed or not. Only recently have I finally yielded to the logic of the situation and stopped giving out antibiotics, and I am waiting to be sued for not giving an antibiotic despite a clear chest exam and negative CXR  for a fever of 1 hour duration.</description>
		<content:encoded><![CDATA[<p>Re: the last paragraph about antibiotics.</p>
<p>I was called by my county medical society committee which evaluates medical complaints early in my career when I moonlighted in a local ER. I saw a pt. who had just been given an antibiotic by his PCP the day before for a cough and pleuritic chest pain. He complained of continued posterior chest pain. I heard no rales, no friction rub, no dullness to percussion. As he had just been to his doctor and had less than 24 hours of antibiotic, I did not repeat the CXR nor did I change the antibiotic. This was back in the days Ceclor was still brand name!!!</p>
<p>He was hospitalized in a nearby town (where he was from by the way) about 3 days later and required a chest tube for presumably empyema.</p>
<p>The committee suggested I waive my bill and that the ER waive their bill so that the pt. wouldn&#8217;t sue.</p>
<p>So ever since I gave out antibiotics like candy, whether needed or not. Only recently have I finally yielded to the logic of the situation and stopped giving out antibiotics, and I am waiting to be sued for not giving an antibiotic despite a clear chest exam and negative CXR  for a fever of 1 hour duration.</p>
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