Meth heads do the “shake and bake” … on their face. New process for making methamphetamines in a 2 liter soda bottle often backfires, causing explosion and burns to the junior chemist. Because most people suffering these burns don’t have insurance and because the mandated care from this activity averages $130,000 per person (60% more than other burn patients), the financial strains are contributing to the closure of several burn units across the country – leaving fewer resources available for everyone.

Correlation or causation? Study shows that elderly patients who visit the emergency department are almost four times as likely to develop a respiratory or gastrointestinal infection in the following week as are elderly patients who do not visit the emergency department. The patients developing the infections were also “sicker” at baseline, though.
Interesting hypothesis, although I wonder whether this is similar to asserting that almost four times as many patients who die in the emergency department arrive by ambulance and therefore drawing an inference that ambulances cause patients to die.

Patients gone wild. Minnesota man arrested after “throwing items around the emergency room” then assaulting emergency physician and nurse.

Emergency department patient complaining of suicidal tendencies left alone for less than 5 minutes, some incident occurs, patient ultimately discharged from hospital, yet now Medicare is threatening to pull hospital’s funding. Did someone not buy all of the Joint Commission books before the inspection and upset the Joint Commission inspector? Notice how the hospitals are condemned for some heinous act yet how the Joint Commission doesn’t disclose what the acts were? Can’t find any mention of High Point Regional Hospital anywhere on its web site. Makes it a lot more difficult to question the judgment of the inspectors, doesn’t it?

Scranton area hospital closing its doors. Marian Community Hospital closing by mid-February. Community loses emergency department and behavioral health services.

Texas jury awards $1.9 million to patient who suffered complications after resident performed part of surgery on her without her knowledge and caused bowel perforation requiring permanent colostomy.

In the State of the Re-election, er, um, the State of the Union Address, how much was health care mentioned? Hardly at all. How often were unfulfilled campaign goals from 2010 and 2011 repeated almost verbatim? Quite a bit more.

Some people get jail time for pulling a tooth without a license. One man was awarded $22 million when he was locked up by a judge in solitary confinement for two years without a trial and had to pull his own tooth. The judge and the prosecutors who locked him up for so long should have to pay the verdict. But … negligence doesn’t apply to the judiciary.

Interesting article on why a government unfunded mandate has made Medicaid enrollment mandatory for most hospitals.

Covington, LA hospital sued for more than $600,000 when patient falls while trying to get up from the toilet. According to the article, the hospital was negligent for …
“failing to use consistent, coordinated, multi-disciplinary approach to fall precautions, for the failure among team members to effectively establish an individualized plan of care concerning fall precautions, failing to instruct the patient and her family regarding fall precautions, failing to adequately monitor the patient’s response to pain medications and failing to properly observe, supervise, and assist the patient with ambulation, failure to implement nursing measures required to monitor patients and to implement nursing considerations for a patient receiving narcotic analgesics”

When patients refuse to accept a settlement for an injury, some hospitals recommend malpractice attorneys to the patients. If the attorneys know that they are getting referrals from the hospitals, does this practice constitute a conflict of interest? Better yet, if the patient sues the hospital and loses, can the patient then sue the hospital for a negligent referral?

This malpractice attorney is a moron and a thief. Malpractice plaintiffs refuse to settle case for less than $350,000. New York attorney takes $70,000 settlement check, deposits it in his account and forges settlement papers. Now he’s facing 15 years in the Greybar Motel.

Woman gets 18 months in jail after trying to steal more than $250,000 from the medical malpractice settlement in her mother’s estate then lying to the probate judge about where the money went. Lawyer walks away with $450,000 of the $1 million settlement and nobody bats an eye.

Two emergency physicians in Granite City, IL hospital fired after patient death. According to a news report from KMOV in St. Louis (that was taken down shortly after being posted), Anthony Burkey entered the “Granite City Emergency Room” having hallucinations. He was being restrained by several people when he suddenly became unresponsive and later died. Gateway Regional Medical Center is the only hospital I can find in Granite City, IL. But why was the article pulled by the news station?

Funny description from a patient’s perspective of a “ruckus” taking place in room next door to his in the emergency department.

Leave questions, opinions, and any other medically-related comments below and I will try to get to them Monday night.

Remember, no personal attacks.

When I was a student, one of the attendings on my ICU rotation told me a story that I still have not forgotten.

When I was in your position, I thought it was cool to be a doctor because you got to have a pager. Everyone wanted you. You were the “go to” guy. If someone needed help, they called you. Then I wore a pager for a couple of days and found out that being wanted 24 hours a day wasn’t very much fun. In fact it caused me so much stress that I didn’t want the pager any more. But by then, it was too late.

As I went through my training, I thought it was cool to be a doctor because you’d make lots of money. I’d be rich and could retire at the age of 40. That idea came to an end rather quickly. I got a hard lesson in economics. College loans. Medical school loans. Malpractice insurance. Lawsuits. Taxes. Licensing fees. You make more money because you work more hours. Sure, your paycheck is larger, but your expenses are unbelievable. There are a lot of easier ways to become wealthy.

Now that I have settled into practice and I have my nice little house with a picket fence, I know the real reason I’m glad I became a doctor. Helping people is great. Making money is good, too. But being able to protect yourself and your family in a medical crisis – that is something that no one from any other profession can do for you.

When we walked in the house, the first thing we noticed was that it smelled like cleaning products. There were a mop and a bucket sitting in the wet room by the garage.
The fishtank in the kitchen was a ruddy brown color. We could barely see the fish. One fish was floating. Half of a large can of fish food that we had just bought was gone.
Instead of coming home to relax, we came home to a CSI scene. We began to explore further.

One of the things that I noticed was that our coat rack had been moved. It was sitting to directly block the view through the windows by the front door. I also noticed that there was a piece of tape over the side of the kitchen window. Our neighbors told us that all the window shades were pulled. Our kitchen window doesn’t have a shade. I’m sure that something was taped over it.
Two of our security cameras were unplugged and the third one was pointed at the ceiling.
Something big happened here.

We paid the kid to walk the dogs. We were gone for more than a week. We had just purchased a package of doggie doo bags before we left and we had put a brand new roll in the holder on one dog’s chain. Not one bag had been used.
The girls came down from their rooms upset.
“Someone went through my drawers and messed my clothing all up.”
“Someone rearranged all the clothes in my closet.”

We went downstairs. There was a hole in the wall from one of the legs of a bar stool. The house abuser had said that one of the dogs knocked the chair over while playing catch with a tennis ball. The angle of the hole made it clear that the trajectory of the chair was from up to down – as if someone was holding the seat and forcing the chair downward. An Ansel Adams print hanging on the wall had the glass broken.

There was a run in the seam of the basement carpet and the carpet had been unraveled. Looking closer, there was a stain on the carpet all around the seam. A pair of my youngest daughter’s underwear was hanging off the barbell sitting on my weight bench.

We called the kid’s mother. She brought her son over to see what we were so upset about.

I brought him down in the basement and asked him what happened. He stuck to his story. The dog knocked over the stool and put the hole in the wall. I asked him about the stain on the carpet. The dog urinated on the spot. He cleaned it and then the other dog urinated there again. I told him it seemed that he spent an awful lot of time cleaning. He said that he just wanted us to come home to a clean house.
Like we left the house in that much of a mess?

Oh, and he was concerned about the Ansel Adams print.
“Was that cracked already? Sometimes I get clumsy and don’t remember falling into things.”
“Yeah, it was broken when my son’s friend whacked it with a baseball.”
“OK, good. I mean I’m glad that I didn’t break it.”

We walked back upstairs. It was then that I heard house abuser’s mom tell Mrs. WhiteCoat that we were overreacting. After all, there couldn’t have been that many kids over and if we had just called her, she would have taken care of it.

Whatever.

The next two days at home were spent cleaning up the house that our house abuser had so thoughtfully cleaned for us. We also tried to taken an inventory of the things around the house to make sure that nothing was missing. The only other thing I noticed was that the house abuser cleaned out most of the soda and all of the Red Bulls in the refrigerator in my garage. However, there wasn’t a single can in the garbage or in the recycling bin. Why was that? We soon found out.

The following day, Daughter WhiteCoat banged her head on a dresser and I went to the freezer to get an ice pack. The house abuser just got busted. A bottle of whiskey was buried in the ice maker. And we don’t drink whiskey. A little while later, my son brought up a “Rolling Rock” bottle cap that was in the seat cushion of his official Xbox 360 chair.

This weasel and his buddies were boozing it up in our house while we were gone.

House abuser’s school has a policy that all athletes must sign. Get caught with alcohol or get caught at a party where there’s alcohol and you’re off the team instantly.

We called back his mother and asked her if she wanted to come and pick up his whiskey and beer cap or if we should just drop it off at the school for him.

Thirty minutes later, he was ringing our doorbell. When we opened the door, his dad threw him inside by the scruff of his neck.

His first words were “I want you to know that I’ve lost everything.”

Never really got around to saying he was sorry. Never really admitted having a party. Just said that some of his “so called friends” took advantage of him and were drinking here when he wasn’t watching.

His dad said that he had “misgivings” about letting him watch the house and that junior let him down again.

Would have been nice to know about that before we gave junior the keys.

We were still going to go to the school about the alcohol, but figured that we’d let things go and move on with our lives.

And for the first time in three weeks, we can see through the fish tank again.

Next time we leave, we’re taking the dogs with us.

Look no further than the Wall Street Journal: “What if the Doctor is Wrong?” by Laura Landro.

As a substantive basis for the conclusion that initial treating physicians are “wrong” when they haven’t yet reached a diagnosis, Ms. Landro interviewed two patients who, in the midst of a workup, left the doctor who was trying to diagnose and treat their problems. Said patients then went to a “mecca” to have their workup completed where … amazingly … the problem is “discovered” and “properly” treated. Even though the initial provider in all likelihood would have done the same testing that the “mecca” performed after reviewing the results of the initial testing – had the patient stuck around long enough to have the testing performed. Even though the “standard of care” may have been to do things exactly the way that the initial provider was doing them. Nope, they’re wrong because they didn’t get to the answer sooner.

When reading about all these “errors” I couldn’t help wondering: Did Ms. Landro have a neutral physician review the patients’ medical records to see whether the care provided to the patients was appropriate? Did Ms. Landro interview the initial treating physicians to determine what the next step in their treatment plans would have been? If so, she kind of left those points out of her article.

I understand the idea that second opinions can be useful and I agree that misdiagnoses are sometimes made. Until we find a single test that is 100% sensitive and 100% specific for diseases such as cancer or complaints such as abdominal pain, there will always be misdiagnoses made. Even once a diagnosis has been made, there are disagreements about how to proceed with treatment. Some prefer one medication for treating certain types of cancer, some prefer another medication. Does that make one side “wrong” and the other side “right”? Hardly.

The title of this article and the slant of this reporting make it appear as if doctors are “wrong” just because they don’t make a diagnosis after the first round of testing. Did Ms. Landro even explore how often the “meccas” get their diagnosis “wrong” on the first visit? Are the “meccas” that much better?

If patients want to mortgage their house to get the tens or hundreds of thousands of dollars necessary for a “down payment” at MD Anderson (original link to WSJ article here) or some other “mecca” when they likely would have gotten similar testing done had they stuck with their initial providers, that’s free market medicine at work.

When journalists imply that excluding diseases on a list of differential diagnoses in the midst of a workup or coming up with “inconclusive” results during testing is “wrong”, shouldn’t we start looking into journalistic malpractice?

What if the Journalist is Wrong?

I bet the teacher sits in her class every morning just chortling away at this book.

The story of “Dr. Douchebag” and why morale is declining in many of this country’s emergency departments. Even if you say “thank you, sir” for the abuse, your job may still be threatened because of bad Press Ganey scores.

More than 80% of medical mistakes go unreported by hospitals. Let’s just get this out of the way: Doctors kill every single patient that they treat and plaintiff attorneys should be paid even more money to sue our way to better health care. That should do it.

Indiana woman awarded $1.5 million after surgeon did not operate on abdomen soon enough. Two days after initial presentation, she required emergency surgery for ischemic bowel requiring that a large portion of her intestines be removed.

Sorry, Grandma, I know that your bone cancer is causing you excruciating pain, but you can’t have any more pain medication. As Florida cracks down on doctors who treat chronic pain patients, the patients are having more difficulty getting their medications. Where do the patients end up? In the emergency departments.
When pill abusing patients go to the emergency department and don’t get their medications, some become abusive and violent.
Now some Florida hospitals are implementing a “chronic pain management plan” which requires doctors to “help educate patients about the dangers of abusing prescription drugs and addiction.” Got that, Granny? You have bone cancer and you have six months to live, but abusing oxycontin is dangerous and can kill you.
As part of the “plan,” emergency physicians then will “refer the patient to a primary care physician” – who has already been “cracked down upon” and who won’t prescribe the pain medications, either.
End result? In an attempt to curb abuse by criminalizing the prescription of pain medications, Florida is now affecting the ability of patients who are legitimately in pain to receive necessary treatment. Cancer pain patients in Florida now more likely to get bounced around the system and die in pain.
And people blame the physicians instead of the legislators.

Why let a little thing like a gangrenous appendix get between you and your wedding? Ceremony held in hospital. Both bride and groom wear “gowns.”

New York jury awards 18 year old patient $3 million for delay in c-section at birth that allegedly caused patient’s cerebral palsy.

Patients gone wild in Pennsylvania. Woman gives medical staff hard time in ED, pulls out IV, threatens to infect everyone around her with HIV, kicks a security guard in the cha-chas when trying to escape, then is wheeled out of the hospital by police kicking and screaming in a wheelchair. Initially charged with three felonies, but those charges were dropped by persecutors er, um prosecutors. Of course, if the security guard was an off duty police officer, the patient would be doing 20 to life in Leavenworth.

Patients gone wild then … police gone wild? Patient becomes combative in emergency department. Police called, then allegedly “strike the patient, place him in a headlock, pull and twist his head and forced handcuffs on him with force and violence.” Another officer allegedly “pushed the handcuffed man over a metal chair arm with the force of his weight pressing upon him.” The officers could face jail time and fines if found guilty.

Patients gone wild — Twilight Edition. Toledo woman allegedly tries to steal baby from hospital. When ED nurse approaches her, the woman turns around and bites her. Then she hisses, turns into a bat, and flies away.

The Medical Marijuana Advocates create even more safety policies. Now they’re recommending that health care organizations assess “fatigue risks” and develop a “fatigue management plan” which includes “strategic caffeine consumption.”
My kid kept me up last night. I’m a little fatigued. I want to come to work and sleep, then when I wake up, I want free double mocha lattes. OK, nanny?
The problem is that “fatigue” is determined in a retrospective manner and the Marijuana Advocates don’t tell anyone how to determine fatigue prospectively. Make people afraid of it and tell people who’s to blame for it. That’s how you win elections.
Of course, it didn’t take the plaintiff’s attorneys much time to jump on how providing services while “fatigued” is negligent and will kill people.

While many patients can’t afford health care at all, some hospitals cater to the ultra-rich, charging them between $450 and $4,500 per day in order to have a butler, swank hospital rooms, and an exclusive menu. Meanwhile, other patients wait in the emergency department for days before a hospital bed opens up. Oh, and medical residents aren’t allowed on the units, either — only attending physicians.

Kevin Pho from Kevin, MD wrote an article in USA Today providing some suggestions on how to reduce malpractice lawsuits. Some people commenting on the article demanded that physicians’ hours be cut back so that they aren’t overworked while trying to pay for their “expensive houses, cars, and boats” (see comments section).
I say “be careful what you wish for.”
In other countries, people are demanding that physicians work more hours because patients can’t get the care they need when the doctors work banker’s hours.

Patients using Coumadin who have any head injury need repeat CT scans.

The study looked at 116 patients who were taking Coumadin and who had any head injury with a GCS of 14 or 15 – regardless of loss of consciousness (patients with lower GCS were presumably at higher risk of intracranial bleeding). CT scans were performed on all patients. Of those initial 116, nineteen patients (16%) had bleeding on their initial exam. Of the remaining 97 patients with normal initial CT scans, ten refused to be in the study. Repeat CT scans were performed on the remaining 87 patients 24 hours after the first normal CT scan and showed 5 cases of new hemorrhage. Three of those patients required hospitalization and one delayed bleeding patient required brain surgery.
Even after a normal CT scan 24 hours later … two additional patients still developed symptomatic subdural hematomas — one patient 2 days later, one patient 8 days later. Both of those patients had INRs greater than 3.0. The study recommends admitting patients overnight and repeating CT scans in 24 hours. Original study here (.pdf).

While admission and repeat CT scan for minor head trauma hasn’t become the standard of care in the United States, this study raises questions about the optimal care of minor head injuries in patients taking blood thinners.

Also at issue is the Medicare policy not to pay for “normal” CT scans of the head in atraumatic headaches. Will this policy spill over to deny elderly nursing home patients from receiving CT scans when they can’t remember whether they have hit their heads?

Not too long ago I got a letter labeled “URGENT” in my mailbox at work.

The letter was from Walgreens regarding a patient I had seen several weeks earlier. I cut and pasted parts of the letter to make it fit on one page above.

As the prescribing physician, in order for our government to pay for the prescription I wrote for the patient … several weeks ago … I had to sign a statement stating the following:

“I, the undersigned, certify that the above prescribed supplies/equipment are medically necessary for this patient’s well being. In my opinion, the supplies are both reasonable and necessary to the accepted standards of medical practice in the treatment of this patient’s condition and are not prescribed as convenience supplies. By signing this form, I am confirming that the above information is accurate.”

Seriously? To get reimbursement for a medication on the $4 list, the government is forcing health care providers to take the following steps:

A pharmacist has to receive the denial from Medicare, look at the medication, enter all the information into the CMN and generate a letter to me. The pharmacy must then spend 44 cents to mail the letter to me
Once I receive the letter, I don’t remember the patient, so I am then forced to waste time looking up the patient’s chart, reading through it so I could find the diagnosis and make sure that the flipping $4 albuterol prescription wasn’t for the patient’s “convenience.”
The pharmacy then spends another 44 cents for the self addressed postage paid envelope.
Once the pharmacist receives the certificate saying that the patient really does need his albuterol solution, he then has to spend more time going back on the computer, matching the signed statement with the visit and then forwarding the claim onto the government for medication that has already been dispensed.
Then the pharmacy waits months and hopes that it gets back $3 in reimbursement for a $4 medication.

In essence, health care providers waste 50 times as much value in time getting paid for something after the fact than the item is worth. And the government knows it. It is just hoping that one of the providers won’t do all the paperwork so that someone else gets stuck paying for the medication – other than the government. No paperwork, no payment.

Is this what medicine has come to? Harassing providers so much with pre-authorizations and post-authorizations because they don’t have enough to do? What other ways can we concoct to steal services and supplies from medical providers?

Then I thought that since the government uses these authorizations so much, that they must be a good idea.

Before I send in my next tax payment, I’m thinking about sending in a similar authorization to the IRS.

“I, the undersigned, certify that the above tax payments are necessary for this country’s well being. In my opinion, the government purchases made with this money are reasonable and necessary to the accepted standards of accounting practices and are not spent on wasteful or potentially wasteful projects or items. By signing this form, I am confirming that the above information is accurate.”

Any accountants out there? Would this work?

There was a parent in the stands several rows in front of me. She was cheering on her son, which we all do.
Her son was 13 years old and weighed 229 pounds. I know because wrestlers have their weights written on their arms in magic marker after they weigh in.
The lady easily weighed 300 lbs. She was cheering loudly and bouncing up and down on the stands.
Then her son won his match.
She stood up and put her arms over her head and cheered. Fair enough. We do the same thing when our kid wins.
In the woman’s left hand was a partially eaten doughnut. In the woman’s right hand was a partially eaten peanut butter and jelly sandwich.
There she stood jumping up and down cheering while jelly dripped down her hand.

I did a double take and then unzipped my backpack to grab my camera.
But as luck would have it the evidence was eaten before I could get the picture.

That will teach me once again.
In photography, timing is everything.