 Archive for September, 2011Big and LittleThursday, September 29th, 2011Our youngest daughter couldn’t understand why her parents, both medical professionals, were laughing uncontrollably when she read the workbook page that she had colored so well. While you read the short passage, look at the face of the sitting baby and look where the dad’s hands are. Who writes this stuff?
. . . . . . . . . . . . . . . . True LoveWednesday, September 28th, 2011A nice 89 year old man was brought to the emergency department by ambulance complaining of chest pain. While I was talking to him, he mentioned that he and his wife would be celebrating their 65th wedding anniversary in a few days. So I asked him “What’s the key to your long marriage” “We don’t communicate much. When I complain, she doesn’t listen. When she complains, I don’t listen. It works out well that way.” A little while later, Harvey’s wife Marge came to see how he was doing. She was petite, well-dressed, and sharp as a tack. I wished her a happy 65th wedding anniversary. She gave me a funny look. “It’s our 64th anniversary and it’s not for six months, but thank you.” “Did he tell you it was our 65th anniversary?” she asked. Ahhhhh. True love.
This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me. Healthcare Update — 09-26-2011Monday, September 26th, 2011See more health care stories from around the web over at the satellite edition of this week’s update at ER Stories.net. Innovative ideas for tort reform. If states don’t establish malpractice caps, doctors can contract with patients directly “to establish pre-determined rules for compensation in the case of injury due to physician negligence.” Can’t afford a dentist? You can always pull your kids’ teeth with pliers. Just don’t let the police catch you doing it. You might get charged with felony child abuse and spend 13 or so years in prison. Patients gone wild … again. Midland, Michigan emergency department patient tries to bypass triage and walk directly into department after he burns himself when using gas to start a fire. When triage nurse tries to assess him, he beats her bloody with computer keyboard, then has to be tasered by police. Now he’s been charged with felony assault, obstructing police, and other assorted crimes. The kicker is that several people in the comments section of the article don’t think he should have been charged. After all, the pain he was in was causing him to act that way, and assault is “a risk of [the emergency department staff’s] jobs.” Some patients delay seeking medical care due to the cost. By the time they see the doctor, diseases such as cancer can get worse … and patients end up paying with their lives. Foley Catheter Greeting CardFriday, September 23rd, 2011When we opened up our hospital’s new Foley insertion kits, we found that they contained the card below. What’s next? Dinner mints with Hemoccult cards? I don’t even want to know what colonoscopy patients have in store.
. . . . . . . . . . . . . . Emergency Department ComplaintsThursday, September 22nd, 2011Recent patient complaints requiring emergency department evaluation: 1. “Belly button problem”. White and blue stuff keeps growing in belly button and thinks that there may be fungal infection there. Brought some in a plastic bag for analysis. Diagnosis: Umbilical Lint 2. Ambulance transport for rectal itching. The patient was having difficulty reaching his bottom to wipe himself due to his size. Diagnosis: Buttock Dermatitis Another reader looked at patients’ presenting complaints during a shift. This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me. Healthcare Update — 09-19-2011Monday, September 19th, 2011More health-related news from the past week over at the Satellite Edition at ERStories.net. —————- Chinese patients take different approach when they believe that medical care has been substandard … they hire professional protesters. Protesters then attack hospitals with pitchforks and clubs with hopes that the hospitals will pay the patients to make the protesters go away. Protesters receive 30-40% of any money that is paid to the patients. The Chinese have even coined a word for the paid protesters: yinao, meaning “medical disturbance.” Tennessee family of brainiacs makes it into this week’s patients gone wild. Mom and two adult kids thought it would be funny to put a box under a chair in the ED waiting room then call the hospital switchboard and tell them that it was a bomb. Ooops. Forgot about those surveillance cameras in the lobby that recorded your little scheme, did you? Now you’ll have 2-15 years in the Greybar Motel to laugh about your felony conviction. Woman wins $23 million verdict against home health care agency and nurse when nurse allegedly failed to report a bacteria-infected catheter that caused a bloodstream infection resulting in amputation of both the patient’s legs. NY Times article discusses how health care reform will expand Medicaid coverage for the poor and provide subsidies to help others purchase private health insurance, stating how “such steps will make health care much more affordable…” Open Mic WeekendSaturday, September 17th, 2011I got the message. OK, everyone, what’s on your mind? Leave questions, comments, opinions, and any other medically-related comments below and I will get to them on Monday or Tuesday. Remember, no personal attacks. Who Was That Guy?Saturday, September 17th, 2011An elderly patient with Alzheimer’s Disease was brought by concerned family members after reportedly having blood in his stool. I introduced myself to everyone in the room and to the patient. When I tried to obtain a history from the patient, it was clear that he didn’t recall what happened. So I began obtaining the history from the family members. Midway through the history, the patient interrupts and says “HEY! Who IS that guy?” We finished discussing the history and then I asked the patient if it was alright that I examined him. I went back over to the bed and explained to the patient “You’re going to feel a little pressure, now.” This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me. FDA: Zofran May Be DEADLYFriday, September 16th, 2011Get ready for a “black box” warning on Zofran. The FDA has just issued a “safety alert” stating that Zofran may now be potentially deadly. The FDA is now recommending ECG monitoring in patients who receive Zofran who have potential “electrolyte abnormalities (e.g., hypokalemia or hypomagnesemia), congestive heart failure, bradyarrhythmias, or in patients taking other medications that can lead to QT prolongation.” After all, Zofran has now gone generic like previous anti-nausea medications that have also received black box warnings. The FDA approved Zofran for use in 1991, meaning that Zofran has been on the market for twenty years. Now, through diligent research, the FDA has decided that that Zofran may cause QT prolongation — just like most of the other anti-nausea medications. As a result, GlaxoSmithKline has been ordered to perform studies to determine whether Zofran could prolong QT intervals, and, if so, to what extent. Since the FDA states that it has been performing “ongoing safety studies” … for the past twenty years … why doesn’t the FDA actually publish the results of those safety studies that led to the posting of its alarming “safety notice”? Now we have one less medication in our armamentarium to treat nausea and vomiting. I suppose we can always give ginger root until that gets a black box warning, too. It’s only been around for a few centuries. Whoa. I think that my heart just skipped a beat. Reading FDA safety notices may have caused me to have QT prolongation. I think that we need to put black box warnings on FDA safety notices and no one should read them without proper EKG monitoring. Who do we get to study that? |
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Pennsylvania Medicaid’s Cost “Savings”
Wednesday, September 21st, 2011While scanning the news this morning, I laughed out loud at Pennsylvania’s newest proposal to cut Medicaid costs.
According to this Kaiser Health News report, Pennsylvania plans to pay Medicaid recipients up to $200 to visit “higher quality and lower cost hospitals and doctors.”
Gary D. Alexander, the Pennsylvania secretary of public welfare, compared the idea to a shared cost savings. “If the state saves $1,000 on a medical procedure we may give the beneficiary $100 or $200 as a reward.”
Does anyone see a problem with this approach?
Let me lay it out for Mr. Alexander, just in case someone who reads my column has his e-mail address.
In some of the inner-city emergency departments where I have worked, there used to be a policy that patients would be given subway tokens … or bus fare … or cab vouchers at the conclusion of their ED visit. The theory was that hospitals didn’t want patients loitering in the emergency department waiting rooms after their visits trying to find a ride home. The policy was also viewed as creating good public opinion since the hospitals were making sure that patients had a way home if they came by ambulance and had no other means of transport. Ambulance transport to the hospital is provided at no cost to the patients. Ambulance transport home must be paid with credit card.
Once the general public got wind of the cab voucher policy, guess what happened. Patient volumes increased. Ambulance transports increased. Wait times went up. People waited hours for free medical care so that they could then get their free subway token … or bus fare … or cab vouchers at the end of their visit. The policies were quickly discontinued.
If Pennsylvania begins paying people to go to “better” hospitals, the cab voucher fiasco will occur in Pennsylvania, only on a much grander scale. Once Pennsylvania Medicaid recipients learn that they will be paid to go to a certain hospital for medical care, those hospitals will be deluged with patients. To those receiving public medical assistance, the medical care is free, the medical testing is free, and the medical procedures are free. Now, with a monetary incentive to have a procedure done at a given facility, what do you expect will happen? Patients get $200 if they get a cardiac catheterization at one hospital versus another? Twelve year olds will go to those emergency departments complaining of crushing chest pain. Patients get $50 if they go to one emergency department that provides “higher quality”? There will be lines out the door.
Medicaid will end up footing the bill for an increase in medical care because it has incentivized the patient population to seek out that care.
Brilliant. Just brilliant.
Mr. Alexander even went to a meeting of “300 health insurance executives” in Washington and pitched his plan. I’m sure he got a little round of golf claps for his innovative approach to reducing health care costs.
This is what happens when people who make policies have no practical experience in the industry in which they are making the policies. Mr. Alexander was a political science major in college and has a law degree.
You want to decrease utilization? Pay Medicaid patients that same $200 at the end of a year only if their medical resource utilization (ED visits/prescriptions/whatever other variable you want to control) is below the average utilization for other Medicaid recipients for that year. Kids get $50 per year. Send out letters to those who didn’t get the money telling them why they didn’t get their “incentive payment”.
That policy will pay for itself within the first two years.
But what do I know? I’m just a dumb ER doc without a political science degree.
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