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Healthcare Update Satellite – 06-04-2014

Wednesday, June 4th, 2014

See more medical news from around the web at my other blog … DrWhiteCoat.com

Car crashes into VA Hospital emergency department in Boston. Elderly driver taken to emergency department … then put on a secret waiting list and will be seen within 2 weeks … if he’s lucky.

What happens when someone calls an ambulance in South L.A.? Same thing that happens in most other places in the country. The stories are the same, only the faces change.
Patient evaluated by EMS for dizziness, hard time breathing, chest pain. Paramedics arrive within 4 minutes. Symptoms resolve. Likely a panic attack. Patient wants ride to hospital anyway. Sits in the hospital with paramedics for up to 3 hours waiting for a bed to open up.
“In many cases people who live in low-to-middle-income neighborhoods like those served by Martin Luther King Jr. Community Hospital choose to take ambulance rides even when deemed unnecessary, all with the public picking up the tab.”
When ambulances are transporting patients with fevers instead of strokes, however, these varying states of crisis weaken the entire system. “They’re not going to a clinic and pay; they’re going to go wherever they can go the fastest, and they use ambulances to get there.”
“The number of people using EMS as a taxi is, not only way to high, it’s alarming,” said Weiss who sees the effects of this first hand as he works in Emergency Departments at various facilities around Los Angeles each day. “We’re using precious resources for a process that isn’t valid.”

Florida Supreme Court decision to invalidate medical malpractice caps may have a ripple effect throughout the nation. Five of seven justices held that there was no malpractice crisis and that the caps don’t hold medical costs down. Of course, when the caps were created, the legislature held differently, but who cares about that.
And if the justices think that there is no malpractice crisis, then why don’t they also rule that the state must provide malpractice insurance to all Florida physicians? Shouldn’t be much of an expense since there isn’t a crisis, right?
Don’t practice medicine in Florida.

Study from Detroit’s Henry Ford Hospital presented at SAEM’s annual meeting shows that 77% of emergency department “super users” have some type of addiction disorder and half were seeking narcotic pain medications. And they still get satisfaction surveys.

Another hospital emergency department closing. Latest victim is Long Island College Hospital in Brooklyn. It is losing about $13 million per month. May get converted into condos. Housing apparently pays better than medical care.

Half of all medical school deans say that their students aren’t competent to treat patients with disabilities. Enlightening article describes how our ignorance about patients with disabilities affects our ability to provide emergency department care. We need to do a better job at this.

ProPublica report shows that even though Medicare is able to export its data for the public to review, Medicare officials are still too dumb to actually look at the data themselves. Average “Level 5″ visit billing by physicians is about 4% of patient volume. 1800 health professionals across the country bill that level in 90% of their patients … yet Medicare keeps paying them. Idiots.
Medicare is just as guilty for paying these providers as the providers are for submitting the bills.

“I am so pleased that justice was served.” Now give me my 30%.
Quote from Florida malpractice attorney after winning $7.5 million medical malpractice case against a doctor who failed to evaluate and treat a conduction disorder of a 13-year-old girl’s heart.
Couldn’t find out more about the case during a web search, but did find another recent $7.5 million malpractice judgment in Alabama after patient brought to Brookwood Medical Center and admitted for back pain, then developed incontinence and paralysis of the legs. The patient had developed cauda equina syndrome and wasn’t treated quickly enough. But remember … imaging in patient with back pain (which is the only way to diagnose cauda equina syndrome) is considered “unnecessary” testing according the Choosing Wisely campaign.

Connecticut woman wins $12 million in medical malpractice case after surgeon punctures her colon during routine hernia surgery. Doctors didn’t realize the complication until after patient developed abdominal infection and went into septic shock.
I’m betting that one reason for the large verdict was because defendants started pointing fingers at each other. Surgeon alleges that it was the resident who punctured the colon. Resident denies it. Hospital says it shouldn’t be responsible for the resident’s actions. Patient says she didn’t know a resident would be operating on her.

CPAP machines soon to become an “uncovered benefit” for our country’s veterans. Veteran’s sleep apnea claims have increased by 150% in the past 5 years with total costs more than $1 billion per year. 90% of patients with the disease are rated at 50% disabled, enabling them to receive monthly payments of $822 in addition to their pensions.
But the winds of change are a-blowing. A military budget expert is now on record saying “sleep apnea is not a combat injury, especially if it’s caused by obesity.”

Sasquatch Music Festival overloads local emergency department every year, increasing its volume six- to seven-fold. Them’s the breaks.
I used to work at a trauma center near an outdoor concert ampitheater like this. Same thing used to happen to us. ED and ambulance services were constantly busy with people passed out from unknown drug cocktails or who had drank too much. We would plan our schedules around which bands were playing. Jimmy Buffet and OzzFest used to be the worst. The ampitheater owners were at least somewhat cool about it, though. Every summer, the owners would show up with dozens of free tickets to each concert for the people in the ED who weren’t stuck working.
Or maybe that was a secret plan to have more emergency medical personnel available on scene ….

Pardon me while I pick my jaw up off of the ground. Poll states that there are MORE emergency department visits due to Obamacare? That can’t be. They told us that there would be LESS emergency department utilization once people had insurance.

Healthcare Update Satellite — 05-21-2014

Wednesday, May 21st, 2014

See more healthcare related stories from around the web at my other blog: DrWhiteCoat.com

19 year old Baltimore teen dies in hospital after involved in altercation where 5 security guards were unable to control him, police were called to hospital and used Taser on patient, then left once he had been subdued. Now State’s Attorney is looking into matter.

$25 million lawsuit filed against Las Vegas hospital when pregnant woman enters, has several symptoms and risk factors for tuberculosis on mandated screenings, but hospital does not evaluate or treat her for tuberculosis. She is then allowed to hold her newborn twins in the nursery without wearing a mask. All three patients ultimately die from tuberculosis.
Also of note is that there was a tuberculosis outbreak in the hospital at the time with at least 20 hospital employees contracting the disease.

Feds consider whether to spend billions of extra Medicare dollars to screen former smokers for lung cancer. Doing so could cut a high-risk patient’s chances of dying from cancer by 20%.
I remember someone in a position of leadership once saying that if we can save one life, it’s worth it. Therefore, spending this extra money should be a no-brainer.

At Queen Elizabeth II Hospital in Great Britain, you can only have emergencies between 8 AM and 12 midnight. The emergency department is closed between 12 AM and 8 AM due to staff shortages. To be fair, it seems as if most patients have already gotten the memo on this issue. Severe cases are already referred to Lister Hospital which is 20 minutes away and the QE2 emergency department only sees 5-10 patients per night.

VA Medical Center in Cheyenne, Wyoming busted for “gaming the appointments system” to make it look as if patients are being seen within 14 days of an appointment request when they really weren’t. I’m sure the VA is alleging that this is an isolated incident.
Or maybe not
And if you want a good laugh, watch Jon Stewart’s discussion of the whole debacle.
His summary:”Somehow, we as a country were able to ship 300,000 troops halfway across the world in just a few months to fight a war that cost us $2 trillion.” But it takes veterans hurt in that war longer than that to receive “needed medical care or reimbursement, all while we profess undying love for their service.”
All animals are equal, but some animals are more equal than others.

VA Chief Eric Shinseki grilled about issues in medical care in the Veteran’s system. To his credit, he did put three VA employees on leave after discovering that they may have contributed to the deaths of 40 patients. Of course if that happened in the public sector, the employees would be arrested and charged with murder by now.
All animals are equal, but some animals are more equal than others.

About a third of Australian patients waiting longer than 20 minutes in ambulances once they arrive at hospitals. In some hospitals, more than half of patients wait longer than 20 minutes.
Hopefully they’re not baking their statistics like the governments in some other countries do …

Doctor gets romantically involved with a patient who then commits suicide. Doctor removes medications and suicide note when he finds patient dead in her apartment. Pled guilty to obstruction of justice charge for removing evidence and now is being sued for medical malpractice and wrongful death.

I like this concept. Let’s expand it. If you’re unhappy with a hospital stay or an emergency department visit, do you have to pay? Heck no. If you don’t get perfect medical care, you should demand a refund. Where do these hospitals get off charging us for imperfect care?
If we’re not happy with our state or federal government, we shouldn’t have to pay taxes.
If we’re not getting good gas mileage, we should get a refund on our automobiles.
And if our bosses aren’t happy with our work, they shouldn’t have to pay us.
Others aren’t happy with the way that people on government assistance are utilizing their assistance, they get cut off.
Heck, if everyone just acts pissed at everyone else, everything could be free.

Is non-celiac gluten sensitivity all in your head? Study shows that the effects of having gluten in one’s diet may be due to FODMAPs and not duet just to gluten. Although the sample size is small, it’s an interesting concept. A diet low in FODMAPs has been shown to decrease the amount of gas and, in some cases, the symptoms of irritable bowel syndrome.

This study will give the antivax crowd fits and nightmares. Patients with terminal multiple myeloma injected with enough toxic waste — er, um — measles vaccine to inoculate 10 MILLION people. They didn’t die. They didn’t get sudden onset autism. They didn’t even get Guillian Barre Syndrome.
They got better.
One patient remained relatively disease free at 9 months, the other developed worsening disease after 6 months.
I know. I know. It must be that small doses of toxic waste — er, um — vaccines, are lethal while large doses are curative.

Issues with large medical malpractice judgments in India where the author compared them to the Code of Hammurabi in 2030 BC:
“If the doctor has treated a gentleman with a lancet of bronze and has caused the gentleman to die or has opened an abscess of the eye for a gentleman with a bronze lancet and has caused the loss of the gentleman’s eye, one shall cut off his hands”
Wonder how maiming the healers affected the provision of medical care.

Healthcare Update Satellite — 05-13-2014

Tuesday, May 13th, 2014

Interesting story on how an Indiana hospital discovered the first case of MERS in this country. Patient came in with influenza like symptoms and was placed in negative pressure room immediately. By the time he was admitted to the floor and was interviewed by an ID specialist, everyone coming into contact with him was required to wear full gowns, gloves, and eye protection. MERS was suspected based on his travel history – he was a US resident working in a health care facility in Saudi Arabia.

Don’t ride in a car with pregnant drivers. During a woman’s second trimester, her odds of being in an accident that is bad enough to send her to the emergency department increases by 42%. By the third trimester, the risk is gone.

Obamacare health insurance tax could cost 286,000 Americans their jobs and result in $33 billion in decreased retail sales.
Well of course the right-wingnuts are going to say that. What do you expect?
Wait. The article was written in the official blog of the US Chamber of Commerce? Nevermind. Carry on.

Nice summary article about a physician’s duty to a suicidal patient. Dispels some myths and offers good basic advice. For example, HIPAA doesn’t prevent doctors from disclosing a patient’s psychiatric information if the patient is in imminent risk of self-harm.

Obamacare “MAY” boost hospital emergency department profits. Then again, when you consider that a vast majority of newly “insured” patients under Obamacare have what the article admits are “money-losing Medicaid” patients, that the hospital will have to spend more money to staff the departments to treat the “money-losing” patients, and that the hospital will have to pay more in insurance and consumables to lose this money, Obamacare also “MAY” put more hospitals out of business.
Oh, and I “MAY” have found missing flight 370 in the Sahara Desert.

Since Obamacare was implemented, emergency department visits for the Tenet Healthcare system haven’t seen any decrease in patients. In fact, the number of patients they are seeing in the ED is going up … as their profits go down

OK, I still can’t imagine how this show stays on the air. But this story just has to be repeated. Woman ends up in a hospital emergency department after putting pop rocks in her hoo hah before having sex with her paramour.
All I can do is shake my head and think about all the perfectly good politically incorrect jokes that are going to go unsaid right now.

Why would Americans travel to one of the most dangerous towns in Mexico? To get dental care. The dentist is an American who commutes to Mexico each day and offers care for about 30% of what it would cost in the US. She has low overhead and she has no malpractice insurance, so her costs are less — and she passes those savings on to her patients while still earning a good living.

Doctor and US Vet warns other veterans that their lives are in danger from the care being provided at VA Hospitals.
The medical chief of staff is Dr. Darren Geering. He is a physician but it appears he had no function for protecting the VA patients from this egregious action causing the death of at least 40 patients who were on a “secret waiting list” from which these patients died, waiting for any kind of medical care.

A couple of tangentially medically-related articles.

Jail starts doing body scans on inmates entering the facility. Finds dark object on scan of one perp’s lower abdomen. Turns out that he had a cell phone inside his rectum. The comment section to this article is a riot … must have had crappy reception … taking butt dialing to a whole new level … ring tone set to “”pbthpbthpbth”.

Survey shows that 1 in 9 people want an android child like the kid in the movie “A.I.” and that 20% of people would have sex with an “android.” One of the comments to the article downplayed the results, noting that 20% of the population would probably have sex with a baked chicken.
Now I can’t decide whether I’m hungry or want to watch some crappy Steven Spielberg movie.

 

Healthcare Update Satellite — 05-07-2014

Wednesday, May 7th, 2014

They’ve got “insurance” but they still can’t find anyone to provide them with dental care. In Oregon, dental problems are the second most common emergency department discharge diagnosis in patients 20 to 40 years of age and have a 25% repeat visit rate, costing the State more than $8 million annually — just in hospital costs. Problem is that Obamacare’s coverage doesn’t include adult dental care. Even if patients have Medicaid coverage, the reimbursements are so low that dentists won’t treat patients with that type of “insurance.” But don’t worry, everyone, 7.1 million more people now have health “insurance.” Full report can be found here (.pdf)

Belfast emergency department has 100 patients in its waiting room with one patient reportedly waiting 11 hours just to be evaluated. Strain on resources indeed …

New Jersey Supreme Court throws out a malpractice case against an emergency physician who failed to report suspected child abuse when child brought in for ingesting cologne. Child was discharged to parents who later abused the child. Placed in foster care and foster parents sued physician for failing to report suspected abuse as required by New Jersey statutes. The Appellate Court agreed with the parents. Fortunately, the Supreme Court had some common sense and noted that upholding such a decision, every accidental ingestion case presenting at a hospital’s emergency department give rise to a mandatory child abuse reporting obligation. New Jersey medical providers dodged a bullet with that case.

San Francisco General Hospital in the midst of a “culture of chaos” because hospital is failing to provide enough staff to care for the patients. Because the emergency department is short 23 nursing positions, the remaining nurses are often doing clerical and other work instead of caring for patients.
And I’m sure some member of the clipboard brigade will cite one of the remaining nurses for failing to make sure that patients were screened for domestic violence, tuberculosis, wearing seat belts, substance abuse, and guns in the house. Oh, and making sure that there are safety caps on all medication bottles, too.
Decreased staffing in the food services department has decreased quality of meals and resulted in long waits for patients to get meals because no one is available to deliver meals to patient rooms.
Another example of getting what you pay for in health care.

Patient wins $1.9 million judgment in malpractice case where Massachusetts oncologist diagnoses him with non-Hodgkin’s lymphoma then order several rounds of chemotherapy and a stem cell transplant. The patient never had lymphoma, but instead had an “immunodeficiency” that mimicked cancer.
Doctor claims his treatment was based on a pathology report. Pathologist found not negligent.

How often should you shower? Daily showering may not be as healthy as you’d think. Frequent showering may wash away the natural body oils that protect the skin from drying out and from bacteria. Then again, I imagine that most active people would rather sacrifice a little health to avoid smelling like a used tube sock.

Megan McArdle writes about the “ugly spike” in healthcare spending. Is the spike due to the effects of Obamacare or is it that there was a transient slowdown in spending related to the recession – which is now resolving … or neither … or both?

With healthcare reform and increasing “insurance” coverage comes more emergency department use. Happened in Massachusetts with RomneyCare and it is already happening in the US with Obamacare – regardless of what statistics you see.

Elderly patient sent to nursing home. Lives there three weeks before dying. Jury awards $90 million verdict against nursing home, agreeing with plaintiff’s attorneys that patient’s death was due to inadequate staffing in the nursing home and failure to provide patient with food and water.
Now verdict is under review by the West Virginia Supreme Court to determine whether medical malpractice caps apply to the verdict, which would reduce the award to $500,000 for non-economic (pain and suffering) damages. I wonder if the administrators were named in the suit.

Healthcare Update Satellite 04-24-2014

Thursday, April 24th, 2014

Kudos to staff at Blessing Hospital in Quincy, IL for its excellent management of a rollover bus accident with 27 kids. You all do us proud!

Stock up on your Norco pills now, folks. This study shows there’s no difference in pain relief when compared with codeine, and when the DEA changes hydrocodone to a Schedule II drug, the supplies will dry up quickly.

Mammography may be diagnosing too many cancers. The idea is that some of the tiny cancers found on mammography would never progress or threaten a patient’s life. Overdiagnosis and overtreatment is expensive and potentially dangerous. So the question becomes: Why are radiologists overcharging patients and insurance companies for reading these unnecessary exams and why are surgeons performing these unnecessary surgeries?
Hey ACR – kind of sucks when your own dumbass logic is used against you, doesn’t it?

Catholic Health Initiatives settles lawsuits relating to unnecessary heart stenting procedures performed by Dr. Mark Midei. Total payouts will be $37 million, with each patient receiving payment of at least $134,000.

Patient with potential measles left sitting with other patients at Rhode Island Hospital. Rhode Island Department of Health descends upon hospital and demands immediate action to prevent “potential harm to the public.” Hospital now must re-educate and re-train staff regarding “care and treatment, including emergency room assignments and required precautions, for patients presenting with contagious or potentially contagious conditions.” The patient presented with “flu like symptoms with fever (which is a symptom of the flu).” Given that every snot nose is a potentially contagious condition, there are going to be a lot of cases of “potential harm to the public” regardless of what training takes place.
All because some brainiac decided not to get immunized.
And the patient didn’t even have measles. Sheesh.

California malpractice cap could be raised from $250,000 to $1.1 million during November ballot vote.
Notice now: If you practice in California, get licensed in other states and start working on hospital privileges. California has officially become runner up to Florida for states in which you don’t want to practice medicine.

Florida Supreme Court rejects medical malpractice caps.

Kansas also planning to raise the limits on non-economic damages – from $250,000 to $350,000.

Pennsylvania considering increasing the standard for malpractice in emergency settings from simple negligence to gross negligence and increasing the standard of proof to “clear and convincing” as opposed to a preponderance of the evidence.
Cue plaintiff attorney wailing and gnashing of teeth in … 3 … 2 … 1 …

You have your robot’s lawyer call my robot’s lawyer and we’ll just see about that. How do human laws apply to robots performing surgeries?

Cleveland Clinic neurosurgeon wins $7.7 million malpractice judgment against Cleveland Clinic. The neurosurgeon was using a saw during surgery when a bone chip flew into his eye. During surgery to repair the damage, the Cleveland Clinic ophthalmologist damaged the neurosurgeon’s iris, making it impossible for him to ever practice neurosurgery again.
The big question in the comments section was whether the neurosurgeon was wearing protective glasses.

California family files malpractice suit after elderly family member declared dead of heart attack, placed in morgue, but allegedly was still alive. Morticians who received her body several days later found her face down in the body bag with broken nose and disfiguring cuts and bruises to her face.
Video about the incident here.

Healthcare Update Satellite — 04-16-2014

Wednesday, April 16th, 2014

Ouch. Tree trimmer using chainsaw mistakes his neck for a branch and shows up in the ED with the chainsaw embedded into his neck and shoulder. Trauma surgeons removed the saw and the patient is expected to make a full recovery.

You think eating all of that nasty salad and tofu is doing you any good? Think again. Vegetarians may have lower Body Mass Index, but they’re twice as likely to have allergies and they are 50% more likely to have heart attacks and cancer. The silver lining is that vegetarians also have a higher socioeconomic status. Does that mean that meat costs too much or that eating vegetables will make you rich?

It is both scary and disappointing that this story is even in the news at this point in civilization. Measles is spreading rapidly across New York City’s Lower East Side. Health officials are urging people to get vaccinated since unvaccinated patients who are exposed to the virus have a 90% chance of getting the disease and up to 33% of infected patients can suffer some type of complication such as pneumonia or encephalitis … which is why civil and potentially criminal liability should attach to those who refuse to vaccinate themselves or their children.

A Canadian hospital emergency department so overwhelmed that an elderly patient allegedly develops bedsores while waiting five days for a hospital bed after being admitted. As horrible as it sounds, it is unlikely that five days laying in a bed would cause bedsores “full of pus” and “almost down to the bone”. Those had to be there before the patient arrived.
But a wait of 5 days for a general medical hospital bed is still pathetic.
More hospital closures and more ED patients in the US every year. Is this a look into the future of US healthcare?

California’s Palm Drive Hospital goes bankrupt and plans to close its doors. Board members base the decision on falling Medicare/Medi-Cal reimbursements, competition from other hospitals, significant loss of patients and the general costs of health care. Community members “pleaded with the board to reject the proposal to close the emergency room.”
Unfortunately, many people are learning the hard way that health care insurance and timely health care access are two very different things. Create a hostile environment to services and you won’t have those services any more.

Louisiana’s Governor Bobby Jindal is shooting for a big fat “F” on the next ACEP report card. Louisiana got a D in the latest ACEP report card due to high rates of uninsured and lack of access to primary care. Now Governor Jindal is proposing a flat-rate triage fee for emergency departments that is “significantly less than the cost of providing care.” Look for such a plan to increase the number of “triage out” patients in the emergency department.

Arizona patient gives multiple names to emergency department staff in attempt to obtain pain medications. Now 27 year old Emily Ingerick … or is it Deborah Peel … or is it Jim Dwyer? Whatever her name is, she’s spending the night in the Greybar Motel … sans pain medications.

FedEx employee is exposed to nontoxic food additive powder at home, but develops breathing problems and vomiting. Goes to Methodist University Hospital emergency department where hazmat crews unnecessarily shut down hospital emergency department for three hours to decontaminate it from a substance that was “not hazardous in any way.”
What a waste of time and taxpayer money.

Is Chicago the gun death capital of the US? Last weekend four people were killed and 37 people were wounded in Chicago gun violence … which makes no sense at all because Chicago has such strict gun laws.

Good news and bad news. If you’re looking for a new job and have a scienctifically-oriented mind, going into medical laboratory science may be something to look into. At least according to this article, there is a desparate need for lab techs in Northeastern Louisiana, and one of the people interviewed for the article notes that there is a shortage of lab techs nationwide.
The bad news is that if the University of Louisiana can’t find more students to fill its spots, the program may disappear, which would have a negative impact on health care in the area – including emergency departments that depend on quick turnaround for lab tests.

Why isn’t this show off the air yet? Sex sent me to the ER turns to “sexism” sent me to the ER when doctor passively watches patient get beaten by wife in the ED after patient thrown out of third story window by prostitute when he tries to write her a check.

Healthcare Update Satellite – 04-08-2014

Tuesday, April 8th, 2014

See more healthcare-related news from around the web on my other blog at DrWhitecoat.com

Emergency physicians more likely to miss signs of strokes in young patients – often headaches with dizziness. Those misdisgnoses may account for 40,000 to 80,000 preventable deaths each year.
Of course, the answer to save lives is to perform MRIs/MRAs on everyone with those symptoms.
Until some beancounter tells you that the MRIs and MRAs are “unnecessary”. Then you’re a bad doctor for ordering the tests. So you don’t order as many tests.
Then you miss a stroke and the news media references a journal article about missing strokes with those same symptoms, points to your care and tells everyone what a bad doctor you are.
Then some administrator tells you that your failure to order a test that missed the uncommon presentation of a disease cost them a million dollar settlement.
Then you order more tests to keep from missing another case of a stroke.
Then the beancounters tell you that your testing is unnecessary …

Kansas City area pain clinic gets hit with $2.88 million verdict when patient commits suicide due to pain from MRSA meningitis. Clinic physicians allegedly performed spinal injections through an abscess that had formed on the patient’s back and seeded his spinal canal.

Speaking about pain, the American College of Medical Toxicology meeting had research showing that there was a 65% increase in opioid prescribing for headaches. For hydromorphone (Dilaudid), the increase was 450%. Investigators noted that “we are concerned that providers are prescribing these medications, despite guidelines recommending against their routine use” but also noted that patient satisfaction scores and regulatory requirements (pain is the fifth vital sign, right Joint Commission?) are likely driving these prescribing trends. These types of unintended consequences are exactly what happens when you have clueless people trying to regulate health care.

Physicians finding it more and more difficult to deal with online trolls. “Because the Health Insurance Portability and Accountability Act (HIPAA) of 1996 prevents doctors from discussing patients, disgruntled and anonymous individuals can pick fights over their quality of medical care with little chance of being successfully hit back, leaving physicians almost powerless to defend themselves. In some instances, aggravated patients use that advantage to mount calculated attacks with the intention of inflicting irreparable damage to careers and reputations.”
Anyone willing to donate to a Kickstarter campaign to create a HIPAA compliant web site for doctors to rate patients?

Physician describes how he prescribes more Adderall and Dexedrine to increase his satisfaction scores on Yelp. He also notes how he “hasn’t advised a single patient to exercise regularly or maintain a healthy diet since 2011, saying he learned his lesson after receiving a devastating one-star review.” Courtesy of the Onion – America’s Finest News Source.

Former nurse jailed for 20 years for killing her infant … by breastfeeding. The woman was taking morphine for chronic pain due to a car crash and prosecutors convinced a jury that there was sufficient morphine secreted in the woman’s breast milk to kill the infant. A pathologist testified that there was enough morphine in the infant’s system to kill an adult.
Yet the American Academy of Pediatrics actually recommends using morphine over other pain medications when breastfeeding.

How can you spot a psychopath? This article gives 20 psychopathic traits and also gives a good discussion of what makes a psychopath. “These people lack remorse and empathy and feel emotion only shallowly … it’s like colour-blind people trying to understand the colour red, but in this case ‘red’ is other people’s emotions.”

Breath-actuated nebulizers and traditional handheld nebulizers showed no difference in clinical effectiveness when compared in the emergency department. Guess which one is more expensive.

Healthcare Update Satellite — 04-02-2014

Wednesday, April 2nd, 2014

See other medical news on my other blog at DrWhiteCoat.com

Liberal use of blood transfusions may increase the incidence of serious infections. I don’t have access to the entire article, but wonder if the study also looked at overall mortality. In other words, is the increased risk of developing a serious infection outweighed by preventing more deaths from severe anemia (lower oxygen carrying capacity, increased cardiac demand, etc)

Traumaman … Traumaman goes wherever a trauma can. Sprayable nanofibers may soon replace sutures and may revolutionize trauma care. I imagine it’s only a matter of time until the idea is weaponized. One splat in the face and you’re through.

I’m with Skeptical Scalpel and SurgeryWatch on this one. If patient satisfaction and doctor ratings are of such value to the medical industry, we really need to expand the concept to other industries as well. Enter Airline Pilot Ratings. One of you flyboys hits turbulence and you’re ratings are through. If my ticket price is too high, you’ll be lucky if I give you a single “fair” rating on your whole report card. And if there are any delays, I mean ANY delays … I’ll give you friggin negative numbers. You hear me? NEGATIVE! Oh, by the way, I don’t like how your voice is muffled when you talk on the speaker. You get points off for that, too.
Yep. That’s how all enterprise should work.
Next up: Patient ratings.

Can charm be taught? Meet this generation’s version of (a female) Dale Carnegie and decide. The article is long, but well-written and enjoyable, so grab a cup of coffee before clicking on the link.

Another hospital closes its doors. Hospital board votes to close North Adams Regional Hospital in Massachusetts with only three days’ notice. The hospital had previously been open for 129 years. Nearby Berkshire Medical Center is going to attempt to preserve services at the hospital, but a source for funding has yet to be identified.

Give me the girl. Judge gives permanent custody of a Connecticut girl who is hospitalized in a Massachusetts hospital to the Massachusetts Department of Children and Families. “Closed-door juvenile court hearings late last year” allegedly proved that the parents were unfit to handle their child’s complex needs. It probably didn’t help that the girls dad was being a tool, failing to work with healthcare providers, threatening the social worker assigned to the girl’s case, and calling hospital personnel “Nazis.”
But if these types of things are sufficient to take custody of a child away from the parents, then we’re a few virtual reality computer programs and a holodeck away from the real life Hunger Games.
Another story on this case in the Boston Globe.

Association for Comprehensive Energy Psychology (the “other” ACEP) tries to get Wikipedia to open up its policies to encourage more articles about topics such as Emotional Freedom Techniques, Thought Field Therapy, and the Tapas Acupressure Technique. Wikipedia co-founder responds rather thoughtfully.
“If you can get your work published in respectable scientific journals—that is to say, if you can produce evidence through replicable scientific experiments, then Wikipedia will cover it appropriately. What we won’t do is pretend that the work of lunatic charlatans is the equivalent of “true scientific discourse.” It isn’t.”
Lunatic charlatans, eh? If advancing directives without having work published in reputable scientific journals and without those directives resulting form replicable scientific experiments is what defines the term, then the Joint Commission, Press Ganey, and most of the people who created Hospital Compare fit the definition.

Right on, brother. A leading neuroscientist asserts that ADHD is not a disease, it’s a label that is used to prescribe dangerous medications to children. The medications given to ADHD patients cause long-term changes in the brain and “their rewards systems change.”
Maybe that’s why some people call Ritalin and similar medications “kiddie cocaine.”

Another interesting article about the human microbiome. Certain bacteria in a woman’s vagina may protect against HIV infection. In the study, patients with bacterial vaginosis and taking an antiviral medication had significantly reduced antiviral activity while those patients with healthy vaginal bacteria and treated with the antiviral produced significantly less HIV.

High school teacher forced to resign after taking a 20 year old student (an adult capable of consenting to the actions) to the emergency department for an undisclosed problem and then paying for the cost of the student’s medical treatment.
Huh?

Bwaaaaaaah. District Court Judge Carter Schildknecht has open and closed door meetings with hospital administrators after her husband had a heart attack in the emergency department at Medical Arts Hospital. Ellis Schildknecht apparently had a gag order imposed by his wife as he remained silent during the meeting … and because of HIPAA laws, the hospital can’t respond publicly to the Judge’s complaint, leaving District Court Judge Schildknecht’s vague question “Is this the reputation that you want our hospital to have in this community?” out there for debate.
Saving the life of a patient suffering from a heart attack? Yes. That’s the reputation we want.
Perhaps you could order that your husbands files be released to the public so everyone could review the care that you deem so deficient and worthy of contempt.

Healthcare Update Satellite — 03-25-2014

Tuesday, March 25th, 2014

Patients gone wild. Really wild. 70 year old Brookdale Hospital nurse Evelyn Lynch gets knocked to the ground by patient Kwincii Jones and has her head stomped. She was knocked unconscious and suffered severe facial fractures. Also underwent brain surgery, so it is likely she suffered a brain bleed or has brain swelling as well.

Congratulations to the antivaccination movement for increasing the worldwide incidence of pertussis and measles. Measles and mumps are now “crushing” the UK. Patients with “religious exemptions” to receiving vaccinations were reportedly the source of one recent California pertussis outbreak.

Rise of the machines. I thought I was pretty good at spotting patients in fake pain. Turns out that most observers are only slightly better than chance at picking out fakers from the real deal. This computer program can achieve 85% accuracy in picking out patients who are truly in pain just by analyzing their facial expressions. Of course, watching the surveillance video of people skipping in the parking lot, then limping into the ED hunched over in “pain” is also a dead giveaway.

Machines are also pretty darn good at sniffing out cancer. A device called BreathLink can detect changes in a woman’s breath that suggest breast cancer and has a diagnostic power similar to mammograms. The device may also be able to test for tuberculosis.
The article also has a neat table about the odors different disease processes cause. Did you know that rubella may cause your sweat to smell like freshly plucked feathers or that schizophrenia may cause your sweat to smell like vinegar? Typhoid fever may cause your skin to smell like fresh-baked bread.

Wrapping that rascal is more and more important lately. The CDC is warning that gonorrhea may soon become untreatable. The “love dart” – otherwise known as an injection of Rocephin – has been a stalwart of treatment and now gonorrhea is showing resistance to this class of medications as well. Another article on the topic in The Verge here.
By the way, do you know what you get when you kiss a parakeet? Chirpes … fortunately that’s still tweetable.
Stop groaning. That thar’s funny and you know it.

What do you do if you’ve been diagnosed with cancer? Take a deep breath. Own it. Don’t run to consult Dr. Google. Dr. Peter Edelstein has some more suggestions here.

Utah Senate passes bill allowing doctors to prescribe Narcan to third parties to administer to patients who may be suffering from opiate overdose.
Initially, I had problems with this idea. Would people be able to inject it IM or assemble the intranasal administration assembly? How would the lay public deal with patients who are suddenly thrown into withdrawals?
Then I thought that it would be better to at least attempt to reverse an opiate overdose and deal with the consequences rather than having a patient die.
So why require a prescription? Shouldn’t Narcan just be made over the counter?

Rhode Island emergency department becomes first in nation to incorporate Google Glass into patient care.

Call of Duty – Dialysis Edition. 14-year-old Norwegian kid drinks 4 LITERS of an energy drink over 16 hours so he could stay awake playing Call of Duty. Ends up in a coma in a hospital for two weeks with “kidney failure” but is expected to respawn and live to fight another day.

Many people in New York contracting rare skin infection called Mycobacterium marinum. All of the 30 cases diagnosed were in people who were handling seafood.

Trying to change the message again. Obamacare architect Dr. Ezekiel Emanuel asserts that “you don’t need a doctor for every part of your health care.” If you like your high school sophomore with a 16 hour course in basic first aid, you can keep your high school sophomore with a 16 hour course in basic first aid.

Healthcare Update Satellite — 03-04-2014

Tuesday, March 4th, 2014

Science reporter Miles O’Brien suffers a freak accident while packing equipment after a reporting trip. Case falls onto his arm and causes bruise/injury. The following day, pain and swelling in his arm got worse. The day after that, he was being rushed to the operating room for compartment syndrome. His blood pressure dropped during surgery and the surgeon had to amputate his arm.
Best wishes for a speedy recovery, Miles.

Patients who have had strokes are 50% more likely to have iron deficiency anemia as are control populations. Authors suggest a couple of possible mechanisms for the correlation including decreased oxygen delivery and a secondary thrombocytosis, but no one is quite sure why the risk increases.

Eastern Ontario Children’s Hospital asks patients to stay away unless they have a “true emergency”. The hospital is just too busy.

New Hampshire hospital employee makes “offhanded” comment about strangling and shooting man who was divorcing her daughter. “Antagonistic” co-workers notify police that she was making homicidal threats. Police then come and arrest her and take her to hospital emergency department … where she waits six days before a bed in a psychiatric hospital opens up. She is discharged from the psychiatric hospital the following day. Now she’s suing for false imprisonment and wrongful discharge … from her job, not from the hospital.

The good news is that we have these tests to give us a better idea of your medical “frailty.” The bad news is that if the tests are abnormal, you’re substantially likely to die sooner. Tests include alpha-1-acid glycoprotein, albumin,  very-low-density lipoprotein particle size, and citrate. Those whose tests were in the highest 20% were 19 times more likely to die in the following 5 years than those whose tests were in the lowest 20%. Patients whose tests were in the 99th percentile had a 23% likelihood of dying in the next 12 months and 49% likelihood of dying within the following 5 years.
So … do you still want to have the testing done?

78 year old farmer takes a nap, then wakes up with a bunch of people at a funeral home trying to embalm him. Coroner was called to the house, said the patient had no pulse, and declared him dead. Family surmises that the patient’s pacemaker stopped working.
I’ll say.

Maybe a better title to this article would be “The Way We DON’T Pay Primary-Care Doctors Is Insane”. Some people commenting on the article are advocating use of NPs and PAs to replace the primary care physicians.

Paul Hsieh writes a nice article in Forbes about whether you can trust what’s in your medical records. Uses the case of a Dragonism where “DKA” was transcribed to “BKA” to illustrate the point that sometimes erroneous information can be unintentionally propagated in future medical record entries. Also gives some good advice on patients can minimize errors in their records. Best suggestion: Obtain copies of your medical records and request copies of all testing performed on you.

Louisiana patient sues cardiologist for failure to stent which allegedly resulted in permanent disability when the patient suffered a heart attack a few weeks later.

Should Zohydro be removed from the market? Ten milligrams of hydrocodone in one pill. Opponents are concerned that it will cause further addiction and deaths from drug overdoses. Proponents say that patients may need it for proper pain relief.
Another important issue is whether many doctors will even be willing to prescribe it with the increasing number of criminal actions against physicians whose patients die from drug overdoses.

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