WhiteCoat

Healthcare Update Satellite — 02-24-2014

More medical posts from around the web over on my other blog at DrWhiteCoat.com

Another Pennsylvania hospital closes its obstetrics department, citing clinical and financial viability of the department with only one obstetrician on staff. Interesting point in the article is that in 14 years, more than 40 obstetrics units have closed in Pennsylvania. One site lists about 240 hospitals in the state total. Why all the closures? How does that affect care provided to the pregnant patients?
The article notes that the emergency department is trained to handle emergency births, but if a baby is breach or needs emergent delivery, the outcome is likely not going to be good. Emergency physicians can’t do emergency Caesarian sections and we don’t specialize in high-risk maternity care.

Paramedics frustrated at having to provide care to patients for hours in parking lot at University Hospital Limerick before being able to move patients onto a bed inside the hospital. During that time, the paramedics are unavailable to make other runs to other hospitals.

More and more Kentucky patients dying from heroin overdoses, but benzodiazepines still cause most emergency department visits for overdoses in Kentucky. According to the CDC, the number of patients using heroin nationwide has increased by 80% between 2007 and 2012 and much of that increase is attributed to a clampdown on pain medication prescriptions.

Interesting arguments for NOT treating a child’s fever. Fevers won’t fry a child’s brain. That whole egg on a frying pan comparison only works for drugs. The magnitude of fever is not related to seizure risk. I always believed that high fevers made additional febrile seizures more likely, but was unable to find any literature to support that belief. Fevers may help your body fight infection better. And lowering a fever increases transmissibility of influenza.

More of the Obamacare Chronicles.
Patients who are happy to have “insurance” then overcome with shock when they can’t find a doctor who takes their insurance. “Covered California” leaves many Californians “uncovered” for medical care and the doctor directories that it posts on its web sites are often inaccurate. Consumer fraud, anyone?
Remember my prior post about how doctors would be vilified for refusing to participate in low-paying insurance plans? This article is just one of what I’m sure will be many more to come.
Another article on the same topic is here.
And another.
Receiving healthcare insurance doesn’t guarantee you medical care any more than receiving automobile insurance guarantees you a car.
And California is getting close to Florida as one of the states in which doctors should NEVER consider practicing medicine.

Topeka, Kansas VA Hospital is converting its emergency department into an urgent care clinic. As a result, the hospital no longer has to take ambulance runs. Hospital cites staffing shortages. Kansas Senator Jerry Moran alleges that the VA’s failure to hire appropriate staffing is “causing a … backlog of our nation’s heroes who are not receiving the heath care they need.”

Do doctors need to lie to patients? Is it ethical to tell a patient that everything will be alright when the doctor knows that is not the case?

Another example of selective government “transparency.” Feds want to release payment numbers to physicians for providing medical care, but refused to disclose how much money grocery stores were earning from government food stamps. Government attorneys argued that the data was privileged and exempted from the Freedom of Information Act. The 8th Circuit Court of Appeals shot down that argument.

3 Responses to “Healthcare Update Satellite — 02-24-2014”

  1. Beth says:

    I can understand the motivation behind keeping a fever and letting the body’s natural immune response take care of an illness; however, children are more prone to dehydration than adults which can be concerning.
    I agree with what the article states- that reducing a fever DOES help a kid feel better- but I’d like to expand further than that. Kids who feel better drink, feed, and rest better. A well-nourished sick kid would probably get better faster, no? A feverish kid doesn’t want ANYTHING. They’re fussy, picky eaters, and you can’t reason with them; i.e. “here, you have to drink a lot of pedialyte because reasons a, b, c…etc.” That would probably work with teenagers, but kids don’t understand the whys yet.
    ~Beth, Pediatric ER RN.

  2. LawDragon says:

    Perhaps I’m the exception, but it seems the ObamaCare policies in Oregon are much better than in Cali. For the last ten years my wife was on the OR ins. pool due to various med conditions. I’m a self-employed lawyer so I don’t have employer provided coverage. Me and the kids had a catastrophic plan coverage where we never met deductible. As a result, I didn’t get some routine care that I should have got because I’m too cheap to pay when I’m not sick. Yeah, I know that’s dumb. Now I’m certainly NOT A FAN of Mr.Obama but the gold plan we have through CoverOregon is cheaper than the sum we were paying and much better than the insurance we had. We have not been turned down by any insurer, including in Washington as we live right on the border. Granted, we had trouble getting enrolled, but we had a agent take care of it. I’m actually very happy with my insurance; its the only good thing I can say about the current administration. And the free screening colonoscopy I just had may very well have saved my life. So, once in awhile even badly thought out ideas work.

    LawDragon

  3. PaulB says:

    1) With the exception of one of the top 5 metro areas, I see no reason for a VA Hospital to have an emergency department. These places are generally responsible for large geographic areas. If it is acceptable to drive 3 hours to be seen in a VA ED, then you probably didn’t need to be seen in the ED in the first place.

    2) The rapid increase in heroin use highlights a tough policy issue linked with medical ethics. Does the fact that someone dies from a heroin overdose – as opposed to an oxycodone overdose – make the person any less dead? Should it make us feel any better?

    I have always viewed this as a two part issue. Definitely be extremely careful about who you start on narcotics. However, once you have a patient who has been on hydrocodone for three years, is immediately cutting them off in the patient’s – or in the public’s – best interest? I view physicians who run “pill mills” as the lowest of the low. However, from a macro public health perspective, is it better to have an addict see someone who might take a blood pressure and then prescribe pharmaceutical grade medication than have unlimited access to questionable heroin that supports crime/terrorism? I really don’t know.

    However, I am extremely wary of “simple solutions” that ignore the fact that every action will necessarily have at least one, negative, unintended consequence. (See ObamaCare.)

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