WhiteCoat

Healthcare Update — 03-25-2013

Another medical issue with overweight patients: Intramuscular injections. An Epi-Pen may not work in patients who are obese since the distance through the subcutaneous fat to the muscle is greater than the length of the needle. This study showed that in more than 4 of 5 obese children, the subcutaneous fat layer was too thick for an IM injection one quarter of the way down the thigh. In nearly 1 of 5 obese children, the subcutaneous fat layer was too thick three quarters of the way down the thigh. In those patients, the study suggested injecting the calf.
I suppose the manufacturer could be forced to make autoinjectors with longer needles, but then non-obese patients would theoretically risk getting a bone marrow injection of epinephrine.

How good are emergency physicians at dispositioning psychiatric patients when compared to psychiatrists? Not horrible, not great.
95% of patients assessed as “definitely admit” were admitted by the psychiatrist. For other emergency department psychiatric patients, there was an 87-90% concordance rate.

Sugary drinks may kill 25,000 people each year. That’s nothing. SALT [allegedly] causes one out of 10 deaths in this country each year and more than 2.3 million deaths worldwide in 2010.
Wonder what that sphincter Michael Bloomberg is going to do with this information. Salt tax? Force NY City hospitals to draw serum sodium levels on all patients? Outlaw salt shakers in restaurants? Or maybe he could just go after the salt shakers with the larger holes and call them “asSALT” weapons.
Bwaaaaaahahaha. Sometimes I crack myself up.

Another nice article by Alicia Gallegos at AM News. Liability involving patients who overdose on medications is increasing. Families of suicidal patients who overdose on medications are blaming physicians who prescribe the medications … and winning.
According to the article, physicians are having also disciplinary actions taken against them if they prescribe medications to a “doctor shopper”.
This is getting ridiculous.
When pain patients complain that they are treated like “drug seekers,” this is part of the problem why.
Maybe the next step should be forcing all patients to sign a statement requiring them to list any doctors that have prescribed them medications, any medication that they have at home or have access to at home, and any medications or street drugs they are using or have used in the past 12 months.

Lawsuits involving robotic surgeries increasing after patients suffer bad outcomes related to the machines. Intuitive Surgical’s da Vinci machines are common targets. This news in the wake of the ACOG recommendation against using robotic surgeries for certain gynecologic procedures.  “[T]here is no good data proving that robotic hysterectomy is even as good as—let alone better—than existing, and far less costly, minimally invasive alternatives.”
Yet hospitals spend $1.5 million on these machines and a lot more in advertising them to the public.
Where are our patient safety advocates the Joint Commission amid all of these patient safety issues? [crickets] But they’ll sure cite you and make you come up with an action plan if holiday peel off stickers are on the windows of trauma bay rooms, though.
Would you pay several thousand dollars more for your surgeon to use a robot on you?

US Supreme Court nixes North Carolina state law declaring that one third of a Medicaid beneficiary’s medical malpractice lawsuit recovery is attributable to medical expenses and therefore may be taken by the state. Justices called the law too arbitrary.

New lethal strain of meningitis concerning New York City health officials. Thus far it seems to be largely confined to men who have sex with other men. The NYC Health Department released a warning that men “who regularly have intimate contact with other men through a Web site, digital application or at a bar or party” should be vaccinated for meningitis. Men who have intimate contact with other men through a digital application can get meningitis? Wow. Talk about a computer “virus”.

Scary video of how a lifeless child was resuscitated by a shopper in an Australian grocery store. Not unlike a pediatric code in an emergency department – just with less medical equipment. Notice the tension during the event and how the rescuer keeps his cool. Outstanding job, mate!

Sixty percent of patients in the UK wait more than 48 hours to see a primary care physician. Patients who need cataract surgery, hip replacements and knee replacements are facing “rationing” of resources as the government tries to cut costs. Coming to a health care system near you?

More on why ObamaCare should be renamed the UnAffordable Care Act.
Cost explosions and several other facts we have learned about ObamaCare since it was signed into law three years ago.
Insurance rates for individual policies could more than double while those for small businesses could rise by 50%
Another article about insurance premiums doubling.
Also, a funny quote I read on Twitter (but I can’t find the tweet to credit the source). How is the Affordable Care Act like stool? You have to pass them to see what’s in them and neither one smells very good.
Want some advice? If you still have insurance and are considering having an elective procedure performed, get it done now. 2014 is going to be ugly.

Influenza killed 105 children this year … and most of those children had not been vaccinated against the flu. But … the flu vaccine didn’t protect much against the circulating strains of flu this year. So were the childrens’ deaths preventable?

Legislators from both sides of the aisle are in favor of repealing a medical device tax that was implemented with ObamaCare.

CVS creates a “better mouse/better mousetrap” conundrum. If ObamaCare forces employers to offer employees insurance, employees are going to have to jump through a lot more hoops to get it — such as revealing a lot of personal health information. Want to keep your information private? You’ll have to pay a $600 annual penalty. Or you can always go and get health care somewhere else …
Now will legislators have add a few hundred more pages to Obamacare to prevent requiring such disclosures?

New EM blog up – from an emergency nurse. I overlook the name of the blog because the content is good. Hope he can keep up his pace.

22 Responses to “Healthcare Update — 03-25-2013”

  1. Peebles says:

    “How is the Affordable Care Act like stool?”

    That was Neal Boortz I think: https://twitter.com/Talkmaster/status/314725604031352832 Funny guy!

  2. swampleg says:

    Physician liability for suicides using prescribed medicine is increasing to create a constituancy (doctors and insurance companies) for reduced patient privacy and greater third party access to individual medical records.

    This is basic public choice economics. The liability makes doctors (and their insurance companies) responsible for something they cannot reasonably be expected to control. They will have a strong incentive to seek such control. The argument that they need such control will appear reasonable to reasonable people and they will support such efforts. Government agencies and other will be able to crack yet another layer of privacy (and privledge) they have long sought to crack.

    The relationship between trial attorneys and those who seek an ever intrusive and controlling state is a symbiotic one.

  3. NurseHubba says:

    Thanks for the shout-out! Am I going to have to do Nurse K style disclaimers every time I use the term “emergency room” now? Lol.

  4. LL says:

    My company does a version of that CVS thing. We are self-insured and spend about $1mil/yr on paying medical bills for about 80 employees. They started doing a 3rd party “health check” every year about 4 years ago. Here’s the thing…the average age of employees is about 52 years old. They are mostly male (about 70:10). They NEVER went to the family physician for yearly checkups or anything. Diabetes was out of control, one guy had to have a triple bypass, on and on. So the question is, do you try to at least run herd on these guys, make sure they know their cholesterol, blood sugar, and blood pressure numbers, or do you just ignore the fact that they are not doing a dang thing for themselves and therefore hurting the company and the insurance pool of all of our premiums? By the way, I have fought this policy for all 4 years mostly because the first two years, we did it in the office, sitting next to our coworkers as we got our blood drawn (less than 12 inches away) and our blood pressure checked. They changed it so we can see our family doc, then changed it again so that we have to see a 3rd party storefront place that does blood draws. It’s an interesting intellectual exercise except now, they are probably going to drop our insurance because it is hella cheaper to pay the $2K/employee fine for not insuring than to keep the coverage they provide.

  5. Kipper says:

    I’m frequently puzzled by the articles about rationing or poor access abroad that you post because they complain about better health care access than I’ve had for most of my adult life (and I’ve been continuously insured). Where is the magical part of the US where you can get a primary care appointment in less than 2 days time, and not have to take time off of work to do so?

    • former Scot says:

      Better health care access? Prime “features” of the NHS include arbitrary rationing by NICE and the scenic (and money-saving!) Liverpool Death Pathway, which government doctors and nurses will probably never even tell you or your family that they’ve started you down.

      I could go on and on about cancer patients waiting weeks for scans and then more weeks for radiation, anyone over 70 basically being written off as not worth treating, patients being left for over 24 hours on trolleys in Casualty with no-one to help them toilet, so they just have soil themselves and then lie in the waste, not being able to choose your own doctor but simply accepting whoever’s been assigned you, and for fun google “NHS waiting list scandal” to see how they’re getting around their pledge that nobugger should have to wait more than 18 weeks to be seen in hospital.

      As for GP appointments, some GPs will only book appointments on the day, which means that you might try getting through on the phone till 9 or 10 am, only to find when you finally do get through that all appointments for the day have been booked, and of course they won’t let you pre-book for tomorrow, so tomorrow it’s the same thing, ring up in the morning and hope you beat the crowd.

      Many Labour supporters are saying the Tories are deliberately letting the NHS fall apart so they have an excuse to bring in a more American-style privatised system. Who knows.

      • DefendUSA says:

        You are describing my friend in the UK. He had prostate cancer and had to wait 3 months to begin treatement!!

      • Mandy says:

        When some Americans speak longingly of the NHS and wish America had a similar system, what they’re really doing if you talk to them long enough about it is imagining a system where they still get top-notch state-of-the-art patient-centered American-quality healthcare on demand, except it’s all “free!”. I think they have a hard time imagining the trade-offs they’d have to make.

  6. memphisblues says:

    I do like your blog but I wish you would stop posting denigrating articles about the NHS in the UK as you obviously do not understand the details of health care provision in the UK. Thinking a patients association survey (a pressure group of small minded individuals)reflects reality is a bit like setting equality and family planning policy based on a survey conducted by the Westboro baptist church. It may be that it is difficult to book an appointment in advance but this is because of political meddling setting the priority to SAME DAY access. You cannot set up a system to have lots of appointments that allows people to phone up and be seen that same day but also then conjure up time out of nowhere to have full bookable appointment slots in advance. Politicians meddled and screwed up the smooth running of the healthcare system. Sound familiar?

  7. Doc99 says:

    WC – that Tweet Of The Day was by Neil Boortz aka @Talkmaster.

  8. No, but thank you for asking. says:

    Yeah, being seen as a drug seeker sucks. I occasionally (once per annum, on average) wind up in the ED for severe pain related to… stuff.

    How not to be seen as a seeker:

    I start off with a detailed history, all physicians (including specialists and those who have performed procedures), list of current meds, etc.

    I explain the pain, and insist that we try non-narcotic treatment first:
    1. Toradol.
    If that doesn’t work or isn’t medically appropriate:
    2. Tramadol.
    If it doesn’t work, and the pain isn’t life threatening, I’ll ask the doc for non-narc suggestions that may be appropriate. If that doesn’t work:
    3. Codeine or other low potency narc.
    If that doesn’t work… well, it’s only not worked once, and that was a lumbar puncture. That needed a little something that I don’t remember (because it was a more potent narc).

    If you follow these easy steps, you’ll likely deal with the pain, and the doc will love working with you because you both have the same goal: non-narc pain management.

    For what it’s worth, Toradol is flipping awesome. I rarely move down the hierarchy.

  9. DefendUSA says:

    Every time WC posts about the UNaffordable Act passed by The Pied Piper, I will chime in with the fact that my premium already went up 100%!!And next year I will be paying the tax so someone else can be insured. How mother-effing bizarre is that, I ask you?

    • Mandy says:

      Various lapdogs in the media used to go off their nut when commoners called it Obamacare… “That’s RAAAAACIST!” They’d demand that it be given the respect of its proper name, the Affordable Care Act. But have you noticed how they’ve backed off that one in the past few months? There’s been a tipping point, as it’s become increasingly harder to hide the fact that the LAST thing this bill is about is “AFFORDABLE Care”. Now, the selfsame presstitutes who were damning us as raaaaacist for calling it Obamacare are doing so themselves, and and more and more critics of the act are taking pains to call it the Affordable Care Act… usually with no small be of much-deserved snark.

      If you really want to piss off a Hopey-Changer, catch them whining about how their insurance premiums have skyrocketed lately, and casually ask them, “So how’s that Affordable Care Act workin’ out for you then?” Then, duck.

  10. Matt says:

    While it’s easy to criticize the ACA/Obamacare, what exactly are providers doing about it or trying to change about it?

    • Aesop says:

      You mean besides retiring en masse, and sending large donor checks to the other political parties?

      What would you suggest? After suggesting that the entire trip was unnecessary back when we were told “we have to pass this thing to see what’s in it” (which documents that it is the legislative equivalent of a kidney stone) and having it shoved down the nation’s throat with a plumber’s helper behind it, why be surprised when what you’ve forced down comes back at you like projectile vomit, and tastes just about the same.

      Maybe suggest your congeress-tards LISTEN to provider input up front, and pay attention when they get it. It has the novelty in D.C. of never having been tried before.

  11. Matt says:

    In more “Doctors are their own worst enemies” news:

    http://dish.andrewsullivan.com/2013/03/29/are-doctors-overpaid-ctd-3/

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