Come on. Allergies to fresh fruit and vegetables?

Guess all the chemicals used in processing are good for the immune system.

I don’t rant a lot about my personal life, but tonight you’ll have to bear with me.

I’ve had problems with chronic pain due to a disease I have. It comes and it goes. Some days I hardly realize it’s there, sometimes it is significant. The past couple of days have been particularly bad pain days.

I went to bed last night and Mrs. WhiteCoat was trying to talk me to going to the emergency department as a patient and I basically told her that would not occur unless one of my vital bodily functions ceased to function. Even when trying to hide the pain, I had difficulty moving around and difficulty finding a comfortable position. A few ibuprofens gave me a sour stomach, but took the edge off the pain enough for me to fall asleep.

Today was a little better until I tried to put on a shirt. When I reached over my head, I felt like someone shanked me with a hot knife. I couldn’t take a deep breath and started wondering whether or not I had collapsed a lung. Slowly the pain died down to the point that I could move again.

I sat at the computer and typed out a few e-mails, shallow breaths and all, trying to find the position that caused the least amount of pain. When I was done, I had to decide what to try to do with the rest of the day.

I took our new dog outside for a little walk in the snow. Watching him run around and flip snow in the air with his nose took my mind off of me. By the time we got back, I decided to shovel the driveway.

Yeah pushing the shovel hurt at first. As I tossed the snow in the air, the dog started to jump up and bite at the snow in the air. I started to laugh. Then he started to run along side the shovel and bark at the snow. I started flipping snow at him randomly as I was shoveling. He jumped up in the air and flipped backwards into the snow banks biting at the snow I had flipped in the air. Before I knew it, half the driveway was finished and the dog was running in circles in the yard like he had just snuck a couple of Red Bulls out of the fridge in the garage.

Funny thing happened. The pain was better.

Don’t get me wrong. I still hurt. But when the kids came home from school, I wasn’t chewing a hole in my lip when I gave them hugs and had them sit on my lap to tell me how their day went.

Sometimes the less you dwell on pain, the less you have pain.

Goes back to the difference between life and living.

You have to live your life, but you do it living with a disease, not living for a disease.

Sometimes it does you good to tell the disease to get lost for a while.

Had a couple of things come up and am going to be away from the computer until next week.

Enjoy all the other great blogs on my blog links page in the meantime. If your blog isn’t on the list, drop a comment in the comments section on the page and I’ll add it when I get back.

If you’re interested in doing a guest post in my absence, there’s an open mic. Whip something up and submit it to the editors at EP Monthly (editor@epmonthly.com). The jucier, the better.

Let’s see what you’ve got.

I heard stories of something like this happening during my residency training in a large city hospital, only in my case, it was a psych patient trying to escape from the guarded psych room. I thought it was just one of those urban legends.

Here’s proof from Serenity Now Hospital – pictures and all – that patients really do try to escape the emergency department by crawling through the ceiling.

Unfortunately, the tensile strength of ceiling tile usually has an adverse effect on those attempts.

Amazing.

By a vote of 32-66, today the Senate rejected an amendment to the health care bill that would cap plaintiffs’ lawyers fees to one-third of the first $150,000 of any judgment and one quarter of any amount above $150,000. Democrats reportedly stated that the amendment was “unfair” because it did not limit fees for defense lawyers in malpractice cases.

Ahhhh. Legislation will be rejected if it doesn’t apply fairly to people on both sides of an issue.

So are Democrats next going to toss out the whole bill because it is unfair that Democratic members of Congress vote against accepting the same public option health plan they have designed for the American citizens?

If you haven’t done so, please take a few minutes to complete the survey about health care patient satisfaction surveys located at the following link:

http://www.esurveyspro.com/Survey.aspx?id=3b65eb2c-4246-480a-89da-d4f1a78cb4dd

If you have already taken the survey, thanks!

by Mark Plaster MD

Some of the proposed health care reform bills that are currently winding their way through Congress contain an “opt out” clause for those states who do not wish to participate in the ‘public option’ insurance plan, which is simply an expansion of Medicare.  First, why would any state opt out of a government handout?  There are some states who are dominated by one or two powerful insurance companies who have tremendous lobbying strength in those legislatures.  Those states might opt out to protect those interests.  But a larger reason might be that the state government might see the hand writing on the wall.  The future of government health care is an expansion of state Medicaid.  If states feel that they can escape this flood of red ink in the future they may opt out of the gift from the government in the short run.  It’s entirely possible that the federal government will encourage states to opt out, thereby relieving the Congress of the responsibility for the uninsured.  Further, those states that do opt out will subsidize those that don’t.  But to think that states will opt out because “we are doing just fine without your money” is naive.  Politicians are short sighted.  States will take the money.  

We already have a model for opting out.  It’s the private school system. If you feel that the public school system is not for your child, either because it’s not safe, the education is poor, or the social influences are not up to your standard, you can take your child from the public sector and place them in private education.  You can ‘opt out’ of public education.  In fact the state plans on a certain number of these privately educated children not showing up on the first day of school.  However, taxes from their parents are counted on to support public education.  Despite this cost shifting, inefficiencies in public education cause cause district after district across the country to teeter on bankruptcy.  If all the privately educated children came flooding into the public school system to get what is owed to them, the system would collapse.  Similarly, in most universal health systems there is a ‘private tier’, where patients dissatisfied with their health care, the wait, whatever, can go to a private physician.  It serves as a pressure valve for the system.  In many ways, the US has served that purpose for Canadian patients who can’t find the health care they need in Canada.  But what would happen if there was no opt out for them.  The demand on the system would likely bring about its implosion.  The incoming President of the Canadian Medical Association made this observation recently.

So even though you can opt out of the service, can you opt out of paying for the ‘public option’?  Can you opt out of the tax increases?  Of course not.  The current Senate bill includes a mandated payment by the manufacturers of medical devices, such as pacemakers, artificial limbs, etc.  Similar to the penalty on tobacco companies, they are not allowed to pass this on to consumers of these products.  But pass-throughs  are inevitable.  Costs of other items will go up and these costs will be borne universally whether your state opts out of the public option or not.

Just as you can’t opt out of the taxes to pay for the system, seniors can’t opt out of the changes to their Medicare.  Many elderly have chosen the private health plans of the Medicare Advantage programs.  Many of these are slated for big cuts.  Despite promises by President Obama that everyone can keep their insurance if they like it, seniors will not be able to opt out of these changes to their plans. 

While current plans may allow states to opt out of participation in government administered health plans, there is currently no provision for the young and healthy to opt out of insurance coverages that they do not want or need.  In fact these premium dollars are seen infusion of cash needed to pay for the health care of the poor.  This is the reasoning behind why all health care plans need to be ‘qualified’ by the government.  Young healthy people tend to opt out of buying expensive health plans that they feel they do not need.  Requiring everyone, young and old, those with healthy lifestyles and those without, to buy the same ‘qualified’ insurance plan will insure that there is enough cash.

In the end, how much choice will states have?  How much choice will individuals have?  Not much.  And that is why the opt out provisions are so politically palatable.  They ‘allow’ states and individuals to make ‘choices’ where there are essentially no other options.

For those of you who don’t know him, Mark Plaster is the executive editor of Emergency Physicians Monthly magazine. He has grown the magazine from a little stapled together newsletter passed around between friends to one of the largest read publications in emergency medicine. Mark also a great writer and is the author of EP Monthly’s Night Shift column. If you’ve ever heard the term “don’t feed the bears” used in the ED, it’s probably from his column.

Mark has already added his first post and will hopefully become a regular contributor. Please welcome him to the blog.

Just remember, Boss … this whole blogging thing is addicting. Watch out.