WhiteCoat

Healthcare Update — 02-27-2012

See the Satellite edition of this week’s update over at the new and improved MedBloggers.org site.

$15 million judgment against radiologist that misses early breast cancer on a mammogram despite palpable lump. 16 months later when patient returns for follow-up mammogram, the mass is “as big as a golf ball” and has spread to the patient’s bones.

Social security disability “becoming the new norm.” Comments section to the article has interesting discussions about how many people are gaming the system, how disability declaration cancels debts for student loans (is this true?) and how people on government assistance should no longer have the right to vote – due to the conflict of interest.

Waiting room patients gone wild. South Carolina woman charged with public intoxication, disorderly conduct and child neglect after smelling of alcohol, yelling at everyone in the ER lobby, slurring her words, and then attempting to leave the hospital emergency room with her 3-year-old daughter.

The rise of the superbugs. According to the article, experts say the growth of antibiotic resistance now poses as great a threat to global health as the emergence of new diseases such as Aids and pandemic flu.
In addition, drug companies have lost interest in developing new antibiotics because it is hard to find new agents and they often are not able to obtain their return on investment.

Atlanta Medical Center posts QR codes on buses to find wait times in emergency department … which would come in handy if you ever get run over by a bus and have your iPhone handy, I guess. And no, the QR code to the right does not take you to the Atlanta Medical Center’s wait times.

Another story of a hospital administration taking unfair actions against a medical provider? Physician alleges that he is getting “muscled out” of an emergency department by the administrator and a national emergency medicine contracting group.

Louisville University’s hospital emergency department is being overwhelmed. Total visits have increased by 75% in 3 years and more than half of the visits are from uninsured patients. As a result, the hospital has added 12 permanent hallway beds to help cope with the overflow.

It’s happening all over. Italian government investigating “intolerable” hospital emergency room conditions after comatose woman spent four days on an ER stretcher without nutrition. Pictures were also published allegedly showing patients having medical procedures performed while laying on hospital floors.

Time to can the “pan scan”? In letter to editor, Australian radiologists/emergency physicians urge trauma physicians not to perform CT scans from head through pelvis because only a “few” critical injuries would be missed without them. Sure. Let me introduce you to the American Association for Justice.

Want to decrease all the emergency department use? Hook patients up with a family physician.

Finally, a thanks to both Kevin, MD for the link and to Those Emergency Blues for the article about Amanda Trujillo’s case. Lots of lively discussion in the comments section.

9 Responses to “Healthcare Update — 02-27-2012”

  1. Eric Atkinson says:

    “South Carolina” woman.

  2. Kipper says:

    I like how that blog post about disability assigns some grand plan to the administration rather than just assuming that individuals of their own volition are taking advantage of an available benefit during hard times.

    • WhiteCoat says:

      I think that the issue is more about why hard times should somehow cause more disability claims:
      “a quarter of those who are dropping out of the job market, and hence out of the unemployment statistics, are going on disability instead.”

      Look at these Bureau of Labor statistics: 14 million non-disabled persons unemployed, 63 million non-disabled persons out of labor force.
      805,000 disabled persons unemployed, 21 million disabled persons out of labor force.
      Total labor force is 152 million. Total number of people either unemployed or not in labor force is just under 100 million. A 39.7% unemployed/not working rate sounds a lot worse than the 9% unemployment rate that is quoted. Then there’s the issue with how people are “not seeking work” within the prior 4 weeks don’t count as “unemployed” for purposes of the government statistics.

      If the government is relying on lower unemployment as evidence that it is doing a good job, shouldn’t there be a clarification of the terms if “unemployed” persons are switched to “disability” in order to keep government benefits?

      People need to have a clear picture of our economy if the economy is important to them when they vote this year.

      • Kipper says:

        I’m familiar with the statistical reporting, and looking at it the way you describe is also misleading without further breakdown of the population out of the labor force. Housewives, voluntary retirees under 64, people in the early stages of starting up a business, and so on all fit into that category.

        Regardless, the reporting is not the *cause* of increased claims. No one from the government is going door to door encouraging people to consider disability. I do think the stress of economic instability is adequate to drive vulnerable people bonkers, though.

  3. Aaron says:

    Disability and bankruptcy together are the only way to discharge student loan debt without paying the full balance (which may include rather substantial penalties for many people). Thus has long been a requirement for discharging statutory student loans like Stafford and Perkins and as of 2005 has been a requirement for private student loans.

    Disability does not guarantee the discharge of any student loans though. The bankruptcy judge has to decide a higher level of disability than that which may award disability benefits in order to discharge student loan debt.

    Personally I’d make private student loans discharged at the end of a Chapter 13 bankruptcy, the kind that requires payments. That way we’d cut down on the people who just can manage to ear enough to pay the loans making the jump to a lifetime of support from SSDI and medicaid in addition to discharging this debt. Right now Chapter 13 can modify the monthly payment, but it does so without touching the principle balance of the loan. Once you leave Chapter 13 you may owe more student loan debt now.

    Over the last few years the rights of borrowers to pay their Federal student loans in manageable ways has increased with income related payment options and more. The problem is the private loans where there is neither the option to change repayment terms or modify the loan. With private loans the only options for people who can’t make payments are going from Chapter 13 filing to Chapter 13 filing until death or getting a declaration of substantial disability.

  4. markps2 says:

    Regarding “conflict of interest” and the patient should no longer have the “right to vote”.
    That is hilarious.

    Combine that with forced medications of Edwin Fuller Torrey, M.D.
    and we will have thousands of people waiting in a vegetative state until they die.

  5. megan lee says:

    Looking at the mammogram image connected with the story on the missed pathology, I’m not toally surprised that the radiologist called it negative. It’s tiny, not marble sized, it has smooth borders, at first glance just doesn’t look suspicious. An ultrasound might have given a different picture, but a lesion that small might have been missed on u/s.
    The retrospectoscope is a marvellous diagnostic tool, but does have limitations in treating patients.

  6. Beenthere says:

    The malpractice suits are insane. You can’t be responsible for every possible contingency. You just can’t. You can only do your best, based on the possible diagnoses on presentation. End of story. The fact that lawyers milk the sad situations for more is unconscionable.

    As for student loans, there are major problems. I am a US citizen, with 2 degrees from the US, studying medicine in a European nation. I can’t get any relief for my private loans, but for my Govt loans, I can. This is interesting to me, as my private loans are significant- 700 USD per month. Yet, my degree transfers to the US. My school is accredited by all accrediting bodies associated with the US, and the whole thing just pisses me off. I just have to do well on my USMLE, and do some rotations in the US to make myself marketable for a residency. Easier said than done, I know.

    The whole thing pisses me off.

    I would never be here, were it not for the craptastic economy in the US. I had a fantastic job as a sedation nurse in the US. I loved the work. My husband, however, is a pilot and lost his job in the US, found a job in Europe, and we moved. No input from me (sometimes that is how it goes…). And, I found myself in medical school, as the country I am in does not understand my advanced nursing qualifications. I miss nursing. I miss my job. I miss my responsibilities. It’s hard memorizing all the ins and outs associated with the anatomy of the human body. But, I do it in the hopes that I can return to my home, the US, and make a difference there. Yikes. What a mess.

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