Sunday, September 21, 2008

Oxymorons for Dummys

I recently heard a story that is emblematic of something that is all too prevalent in our society.
For reasons that defied explaination, a teenaged girl suffered from a mysterious illness. She was "unable" to go to school several days per week because of her condition. Miraculously, she was able to go out with her friends in the afternoons, and attend parties on the weekends.
Her mom took her to several doctors including community pediatricians and various community specialsits. She even resorted to taking the child to the large referral medical center. At each turn, the kid underwent numerous expensive tests and evaluations, but no diagnosis was forthcoming. The consensus amongst the physicians was that there was nothing wrong with the child, and likely the teen was successfully manipulating her mother.
Unwilling to accept the opinions of the physicians, the mom finally took the kid to a local family doctor. His assessment was that the young lady suffered from "fibromyalgia". Finally, she had a "diagnosis".
The mother is telling anyone who will listen about the inadeqacies of the medical community. The numerous physicians who were truthful with the mother were defamed as "idiots". Of course, she is threatining to sue several of them for their "misdiagnosis". As predicted, the doc who created a diagnosis to pacify the mother is touted as "a genius".
The mom is now home schooling the girl and is so angry with the medical community, she is supporting Obama because she believes that "Universal Health Care" will create a better, more well informed health care system.


  1. LOL...

    I bet with that doc, every headache is 'migraine', every ache without an etiology is 'fibro'.

    And now another 'leech' that will, undoubtably, go throught the rest of her life sucking at the government teat!

    BTW, if an idiot homeschools a child, what will that make the child upon 'graduation'?

  2. Do you have a link to the original source material for this one? The home school community likes to keep track of these cases.

    The vast majority of us do a better job of education in our homes than the giagntic American Education Collective do in their hives, IMO, but these few high profile cases get all the publicity.

    Oh, and my teenager has a hard time getting out of bed to get to her work. A little postitve and progressive parenting usually does the trick. If this kid was too lazy to get to school and get an education, even a motivated genius won't be able to get her 'well larned' at home.

  3. I have no medical background, but even I know that Fibromyalgia is a crock. I have random pains all the time, but I have found that with proper diet and excercise, I feel great. As a parent, why did she think it was okay to let the girl stay home from school, but let her go out and party? This is the "princess" culture people think it is okay to raise. Put your foot down and tell the girl to go to school!

    Why did the mother not take her daughter to the family friend in the first place? Why did she wait so long to see this doctor if they are such a "genius"? I would want my child to see a "genius" right away.

    I may have thought my parents were harsh as a child by making me go to school when I really didn't want to, but They did it for my own good. The rule of the house was: If you are too sick to go to school, you are too sick to go out and play. It was amazing how much better I felt when they reminded me of that birthday party I was going to miss out on because I was so "sick". I still think this was today about calling in sick to work, and I will be using it on my children as well.

  4. Hee hee. In my family, we call that condition fibromycrap.

  5. Okay. I don't know anything about fibromyalgia, but I did think it was a real affliction. I used to work at a mental health center where I took care of insurance and billing type stuff. I remember a couple addictions patients had fibromyalgia or claimed to have it -- addicted to pain meds and alcohol dependent if I remember right. Can you write a post about what it is and why it's not legit? Thanks.

  6. I can't even think straight when I see crap like this.

  7. As a (now retired) Social Security Disability attorney, I can almost guarantee the daughter will be using this as grounds for receiving a life-time dole from the taxypayers.

  8. I'm in a very 'no-whiny butts allowed' mood right now and vote for the mother being shot at dawn. Freaking enabler.

  9. I wonder whether you'll suddenly become a horrible, apathetic, disinterested doctor when the droves of people who have never had health care and suddenly do seek treatment from you. I would be excited at the opportunity to offer quality health care to those people who haven't had the opportunities you and I have had. How exciting at least for them!

  10. Great education that girl will get! I guess the pain is all in her head because there is certainly nothing else in there...

  11. I totally agree that the child needed parenting. As to why the mother acted the way she did...well, she's pretty goofy. I might even classify her obsession with having her daughter given a medical malady as a case of Munchausen by Proxy.

    m.e: I can not provide you with a reference for this case. It is not a published case, rather one in which the "fibromyalgia sufferer" is a family friend.

    esther: You ask a good question. "Fibromyalgia" is a wastebasket term that many unexplainable symptoms are lumped into. There ARE legitimate cases of fibromyalgia. However, I'd say that this represents about 10% of the people who carry the diagnosis (IMHO). The majority are more psychiatric conditions (anxiety, hypochondriasis, depression, drug-seeking, bipolar, etc). Seems that every generation has it's diagnosis that is used to lump unexplained symptoms into (mitral valve prolapse, chronic fatigue syndrome, ADD, etc). I would suspect that the resaon you saw this in psych billing would support my opinion. One more comment...the fact that there's a billing code for something doesn't make it a valid medical condition. There are lots of laughable billing codes.

    cannedam: I don't have a clue what you're saying. It's probably because I'm not smart enough (seriously), but the point I was making about the mother's support for universal health care was the idiocy of her belief that her daughter would be BETTER DIAGNOSED AND TREATED under such a system. Also, the fact that she wanted to punish the medical community for being honest with her. As for the poor and downtrodden finally being able to get quality health care from me...I'm an Emergency Doctor...I provide almost half of my quality health care for free now. No one is missing out on my services because of an inability to pay.

  12. Yeah, I got fibromyalgia. But someone stole all my medications. I'm in a lot of pain. Allergies? Thank goodness you asked. I'm allergic to aspirin, tylenol, nubain, naproxyn, ibuprofen, toradol, talwin, morphine, and fentanyl.

    The only thing that helps my horrible 10/10 pain is a warm blanket, something to eat, a nice cup of coffee, a few pillows (ok a few more) a soft bed, (can you pull that curtain?), a cab voucher or bus pass if you can't, and the most important, that d-drug. It's the only one I can take. Something d_. Dill? Dilladud or something. Dilauded? Yeah, that's the only thing I can take. Oh my pain is so bad! OhggHhhhh!

  13. But wouldn't it be better to actually get paid.

    No, the mom doesn't make sense. She's an idiot. Same with the fibromyalgia nonsense. I don't get her logic that UHC will will somehow allow for speedier quack diagnoses, either. Shop around long enough and you'll find a doctor who will tell you what you want to hear or prescribe you what you think you need. That won't happen with UHC. Not if it manifests itself anything like Canada's government run HMO. (Not a perfect system but sure is nice to know that I don't need to pay 90% of my previous take-home income in Cobra charges to tide me over between jobs.)

    I just can't seem to wrap my brain around the idea that health care for everyone is a terrible thing. We have socialized education, police forces, child protection. Yes, they have their issues but would you want those services to disappear and everyone have to pay privately for those things?

    Why would it be so terrible to see only patients who are paying because they've managed to get some bottom-line government insurance?

    Why do ERs HAVE to treat non-emergent patients? Why can't they tell people to go home and see their family doc? I don't get that.

  14. I had a doctor diagnose me with fibro once. Darn it, he was pressing so hard on my joints and stomach that he left bruises. I didn't have fibro. He also made me have a hydascan for some undiagnosable flank pain. I suffered with that damn pain for at least a year with no pain meds mind you. Finally it magically went away when I was being treated for something entirely unrelated.

  15. Ahh yes I can not wait for UHC, what life will be like knowing that I will be reimbursed at medicaid rates for all patients. Where do I sign ?

    Cannedam, we can not turn a patient away due to the EMTALA act.

    Feel free to read up on this.

  16. cannedam: I can't wrap my brain around why we would want to diminish the quality of our health care system and absolve people of personal responsibility. We have drifted into the "nanny state" far too much as it is. Whenever the government gets involved in anything, it gets more expensive, more bureaucratic, and less efficient.

    I have Canadian friends (through several years as the team doctor for a hockey team). They constantly griped about the limited access to care, the long waits, and the overall malaise in the system. In addition, I know several docs who fled the Canadian system. I have never heard a positive thing about the function of the system (not the concept...the function).

    I just don't get why I'd want to take a pay cut just to claim that I "get paid" for every patient while at the same time pay for other people's health care by drastically increased taxes.

    If we embrace Socialism in our health care system, there will be no financial incentives for physicians or ancillary services. Once the health care options become limited, I can only envision more visits to the ER. These issues have been discussed ad nauseum in this blog.

  17. God, ERdoc, I swear I just had an Ayn Rand moment. Bless you.

  18. erdoc: Thanks. That answers my question. It's a good thing I'm not a doctor because I am so dang empathetic I would probably believe every drug seeker out there . . .

  19. I just can't wrap my head around the idea of how people except the government to pay for UHC at this point. Seeing the current financial situation that we are facing, it seems to me that we would need to limit spending in ways of entitlement programs.

  20. Well, considering how the goverment and the associated fucks just found $700 billion in the cushions to purchase shitty loans, I think there's money to go around.

    BTW: I cannot believe I am hearing Republicans clamor for a goverment bailout, and in fact a goverment purchase of, private business. Did the poles just switch? Is North now South? Republicans are crying rivers for a goverment bailout? This is the party of "smaller goverment". What the fuck insanity is the world in now.

    I don't get it. I'm all about smaller goverment, but how the fuck is this the answer?

    Republicans on the site who regurgitate what they are told: enlighten me what your talk show masters say. I await.

  21. I can't wrap my brain around the idea that ya'all truly believe that UHC = deficient health care. Read this:

    Will you become a worse doctor once everyone has the ability to attain medical care? Will you suddenly become apathetic and inattentive?

    Why does it have to be a money grab? That's what American medicine is now.

    Why does UHC have to be bad? Why is it impossible for you folks in particular to see any way through the fog of "don't touch my paycheck or increase my taxes" to a solution that is workable, still profitable, and allows you to continue earning quite possibly more than you are now?

    Open your minds. There are systems other than the one in Canada.

    Anonymous awaiting a reply: do you really need to hear the bleating of sheep to know they just say 'baaaaah'? Line up, wooly ones, we're headed for slaughter. Baaaaah sign me up!

  22. Anon, Cannedam: I am quite irritated (but not surprised) that you believe every Conservative gets marching orders, or bleats like a sheep for a talk show host. I don't even listen to them. Very few of my friends do either. Typical sterotype that if I disagree with you, I must be stupid and "regurgitate" someone else's opinion.

    I believe that if you paid attention, you would know that it's the DEMOCRATS who are calling for the bailout (along with the Bush admin...don't get me started on them). The reason that it hasn't passed is that REPUBLICANS in the Senate are blocking it.

    Another misconception that you have (maybe because you're parroting Air America...just kidding...kinda) is that the government is purchasing these loans and that $700 billion is going to be paid to these companies. It's not a purchase, it's a loan guarantee. Granted, it could end up being an expenditure of almost a trillion dollars, but it isn't yet.

    As with most Conservatives, I'm pissed about it and I don't want to see it happen...but the alternative is predicted to be another great depression. So, maybe it's the lesser of two evils.

    As for smaller government, bring it on! Ronald Reagan and subsequently Newt Gingrich were the only successful fiscal conservatives since John Kennedy. Since the mid 90's the Republicans have lost their moral compass and will likely not be successful again until or unless they find it. This is why many of us weren't thrilled about McCain.

    As for my opinion that UHC = poor care, I have heard from near a hundred Canadian citizens and 5 expatriated physicians about how poor the system is. Cannedam, if you think it's great, you'd be the first.

    Finally, yes we are aware that there are other countries with UHC. Look at your own link. The UK is the only "free" one. Health care delivery in the UK is far inferior to the US. You want to wait 6 months for a CT scan or have it in 6 minutes? The Japanese health care system, and the Sweedish health care delivery is good, but you'll note that Japan's system is going bankrupt and the Swiss system's premium is about $750 per month!

    In all of these models, the physicians aren't saddled with predatory lawyers and lawsuits which drive up the cost of everything and result in large malpractice premiums and the practice of defensive medicine.

    Also note that your reference source is PBS which is not an un-biased source.

    In the future, an honest debate would be appreciated without the insinuation that anyone who disagrees with you can't think for themselves. Maybe we American doctors know just a little more about American health care, eh. But I heard that from Rush Limbaugh.

  23. i'm a canadian university student, and i'm interested in possibly pursuing a career in emergency medicine once i'm done my graduate degree. i read this blog pretty religiously because i find it interesting and insightful, but i also can't help but disagree with alot of the political opinions that get voiced here. personally, i've never had any problems or complaints with the healthcare system here. sure, the waits in the emerg are long, but i only go to the emerg for EMERGENCIES, so i don't have to suffer waiting very often. i wonder (but couldn't say for sure) if these long waits serve to deter some of the frivolous patients that are often complained about in this blog? also, the few times that i've had a SERIOUS EMERGENCY have all resulted in extremely expedient treatment. as far as i'm concerned, the universal health care system in canada works fine.

    furthermore, the idea of some rich sob getting to skip to the front of the line just because he's got the cash to fly to some private clinic and pay for his treatment out of pocket disgusts me. philosophically, the idea of universal health care is attractive to me because it is in many ways a great socio-economic equalizer, in that illnesses of a given severity are each treated on a first-come first-served basis rather than a highest-bidder sort of thing.

    anyways, i'm with cannedam on this one.

  24. SRT: I am glad that you're satisfied with your healthcare system. You now make exactly one person I have heard comment positively who had actual experience with the system.

    I must question your assertion that people with money "jump the line" for care. There are a small number of docs that have opted out of insurance plans and accept cash only. In these cases, I imagine that it routinely happens, but it's a very small minority. If you think that it doesn't happen in the Canadian system, you would be naive. I refer you to the article referenced below.

    As for Emergency Medicine, it is illegal for us to treat patients by preference based on ability to pay.

    You will note that it is common for Canadians to cross the border to obtain health care services in the US rather than waiting months to obtain those services in Canada. In many cases, the patient's decision to come to the US saved their lives. See this guy's experience with UHC.

    Mortalities for certain treatable diseases (breast and prostate cancer to name two) are higher. Could it be due to long waits for needed consultation, imaging, and treatment? I wonder if you have ever needed specialty care or advanced imaging technology. This is where the Canadian system really breaks down. In one 12 month period, 71 patients in Ontario died waiting for bypass surgery, while another 121 were removed from the surgery list because they became too sick to undergo the surgery. Canadian docs report that it takes an average of 18 weeks to receive specialty care. These things happen overnight if not sooner in most instances in the US system.

    If you feel like an indepth discussion of the issues and advantages/disadvantages of the American and Canadian health care systems - as well as offered solutions, I refer you to this link.

    The above article is where I obtained the above statistics. It is long, but it's a must read for anyone interested in this subject.

    Good luck in your studies.

  25. Cripes. Does nothing exist in this world unless it touches you personally?

    You all kill me.

    people with normal circadian systems:

    can wake in time for what they need to do in the morning, and fall asleep at night in time to get enough sleep before having to get up.
    can sleep and wake up at the same time every day, if they want to.

    Either the girl is actually lazy, or she has bigger problems than ya'll not believing that such a situation could exist.

    I would know about this, of course, because I have fibro... ok, ok, actually I do not. I have another condition that causes sleep disturbances, but you probably don't believe in pituitary or hypothalmus tumors either.

    *blah blah blah*

  26. And, in answer to another question, "Why don't you tell non-emergent patients to go home?" EMTALA. By law, in the US, anyone who shows up must be examined. Now, you are asking physicians to bet 1. their incomes, 2. their life savings and 3. their future employment that they're right. Hospitals don't want the bad publicity, so folks get treated, and the rationing is in the wait.

    The girl in question was perfectly able to go have fun. She was screened for the zebras. She suffered, not from fibro, but from chronic hickory deficiency. And she'll NEVER get better

  27. "Why does it have to be a money grab? That's what American medicine is now. "

    Let's do some math here:

    I'm in my second year of medical school, and I'm $65,000 in debt. By the time I'm done (in the year 2011) I'll be about $130,000 in debt. Interest on these loans is accumulating while I am in school and while I am repaying the loans. The actual amount that I will repay is over $200,000. Lets say that I pay $1,000 per month on my loans as soon as I finish school at the age of 26. It will take me approximately 17 years to pay off my debt, so I will be medical school debt-free at the age of 43. Yay! Just in time for my child's college graduation! I would hope that my salary as a physician would allow me to repay my loans before I become a grandmother.

  28. ERDOC85 had it dead on.

    Universal Healthcare as currently practiced in Canada is a joke. Don't get me wrong, there are a couple of good aspects. First, the preventative care is really good (IF you can find a doctor) and it doesn't cost you anything out of pocket (but the income tax rates are greater than 30% for an average joe working for a living wage). Free it isn't. Good care is a myth.
    UHC is rationed care. Waiting lists for common and life saving procedures are months or longer. You WAIT for chemo. You wait months for a CT scan. If you are a smoker, you won't get some surgeries AT ALL. If you are fat, same thing. And once you hit 70years old, it's medical management for you baby. We ain't wasting no money cutting on you.
    Oh yeah, I forgot to mention that the government caps MD's salaries too. So, you can bill all you want. But if you reach the cap in June, you can take the rest of the year off, since otherwise you would be working for free. Why would I work as an MD in such a system?

    There has to be some sort of happy medium between socialized healthcare and the current system in the US right now. I don't know what it is..... but having worked as an RN in both, neither function efficiently.

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  31. dear speakeredtext,

    first, good luck in your studies. there will be plenty of work for you when you are done.

    as to how the canadian health care system actually works i'll take your word for it mostly but since you are young and, i assume, healthy, i would not expect you to have witnessed how it actually functions for folks in need of expedient diagnosis and treatment of potentially fatal conditions or folks near the end of life.

    erdoc85 has spoken on this so i'll let it be. in my personal experience with the british NHS my grandmother would have died there as she was 'too old' for a CABG and got one here instead. gave her over ten years of quality life she wouldn't have had under the rationed care system.

    people like you are not the problem in our current system for, as you point out, you only go to the ER for 'real emergencies'. this is most assuredly not the case here and the uninsured or underinsured (medicare/medicaid) have no problems with using it as their primary care source.

    also, long waits are terribly dangerous because, and i disagree with this, often our worst nurses are put in triage and they miss a lot of sick folks who then sit for hours or simply leave. having midlevels do triage is a potential solution which is being tried with great success but you can only cram so many folks through an ER and if the ER is busy enough the consultants will eventually pull their priveledges or go to the protection of academic centers or large groups where their obligations to give away care are much less.

    as far as 'some rich sob getting to skip to the front of the line' this does not happen. what DOES happen is that POWERFUL sob's get to skip to the front of the line.... politicians in particular. no congressman or congresswoman has to negotiate an 8 hour wait, they do not have to use the system they have created.

    and finally, why does is always have to be a 'rich sob'. certainly there are many rich sob's but how much money someone has has nothing to do with whether they are an sob or not.

    until recently the assumption was that they earned it. our current hipster/slacker culture has demonized those with money as they are an easy target. personally, i would love to be a rich sob but i chose to be a doctor instead. it seems that in your mind the poor and uninsured should skip to the front of the line. when all kids have ponies and money grows on trees i think we will be able to do this without any problem. as long as institutions have to turn a profit to survive then we are stuck with those dastardly rich folks always being able to get the care they need quicker than the virtuous poor. this will not change with universal health care.

    economics is not taught anymore. before EMTALA the access to care for all comers was better than it is now. whole hospitals, usually training hospitals, existed solely for this purpose and while you might have your appendix removed by a third year resident you got it removed just the same (but maybe had to share a hospital room with a few others).

    the kind of solution you propose is socialistic and nearly communistic and if you can simply show me one place where this has produced superior results to the capitalistic then i'll shut my mouth. you might be interested in this entry...

    again, good luck in your studies.

  32. Why do you guys think that doctors who work for socialised healthcare systems make bad money???
    I'm an Irish doc, still reasonably junior. Irish consultants make a base pay of 250,000 euro just for their public work ,and they are allowed to see private patients in their own time too, plus any pay from academia or research bumping up their pay to around 400,000 euro a year.
    Our juniors don't get paid crap like American juniors either-I made 79,000 euro before tax in my intern year.
    Socialised medicine is the only way!

  33. "I only go to the emerg for EMERGENCIES, so i don't have to suffer waiting very often."

    In my defination of an emergency if you have to wait your dead. Something tells your defination of emergency differs from mine.