Dear Readers,
You have heard many of us say that medicine is not a business and that patients are not customers. Let's try a little exercise here. I really am interested in what you have to tell me. Just for fun, call up your local hospital and ask the following...
1. How much is an EKG in the ER?
2. How much is a set of cardiac markers in the ER?
3. How much is a chest XRAY in the ER?
Make a couple of calls on different days. One time say you are uninsured and are concerned about your bill and the tests above are what you have been told you will need and you want to be able to pay. Another time, tell them you have medicaid, another time tell them you have kick-ass private insurance with gold-plated benefits through the railroad or IBM or some shit like that. Let me know what you find out.
I suspect you will not be able to get this information at all. If you are able to get the information I bet you get different answers based on your level of insuredness (if that's a word), which will prove my point. In a business you know the price before you buy. In a cost-shifting game the price is hidden because some pay none and others pay a lot. Have fun!
Не волнуйтесь по поводу мужчина скрывался за занавесом. он с правительством и находится здесь, чтобы помочь вам.
EDITOR'S NOTE: THE HAPPY HOSPITALIST IS DOING SIMILAR WORK HERE SO LET'S GET THIS INFO TOGETHER. 911DOC
Saturday, May 17, 2008
M.D.O.D. Scavenger Hunt
Resubscribe Please! (sticky post)
Dear readers, we changed our email feed program to feedblitz a few weeks ago. If you want updates please do sign up again in the box to the right. And just so I can make money off of charlatans... "JCAHO, JCAHO, Complimentary and Alternative Medicine, Fibromyalgia Cure, Chronic Fatigue Syndrome Cure, remedies doctor's don't want you to know about, HIPAA compliance software, homeopathic cure". Do me a favor and click on these ads as they robotically show up on the site. These folks are fantastic and we stand behind their rite to advertise idiocy and snake oil! Mo-money bizzle.
Friday, May 16, 2008
Incomprehensible Grief
As a parent, can you imagine anything that could remotely come close to the grief of losing a child? This photo shows parents saying 'goodbye' to their child killed Monday in the earthquake centered in Sichuan Province, China.
There is no time to prepare...no chance to say goodbye.
Lofty's family has been particularly saddened by this disaster because we adopted a little girl from Sichuan Province a few years ago. Her hometown of Deyang has been decimated. We pray for her birthparents and the wonderful people we met who care for the children in the orphanage in Deyang.
Our little girl is six years old...smart, funny, beautiful, and so full of life. We are blessed to have, apparently, been lucky enough to have saved her life twice.
There is no time to prepare...no chance to say goodbye.
Lofty's family has been particularly saddened by this disaster because we adopted a little girl from Sichuan Province a few years ago. Her hometown of Deyang has been decimated. We pray for her birthparents and the wonderful people we met who care for the children in the orphanage in Deyang.
Our little girl is six years old...smart, funny, beautiful, and so full of life. We are blessed to have, apparently, been lucky enough to have saved her life twice.
Wednesday, May 14, 2008
All Your Medical News Right Here
Hate to blow our own horn but we've been saying this stuff for a couple of years now and the Wall Street Journal is late to the party.
Tuesday, May 13, 2008
Consults Circa EMTALA
PHYSICIAN TO PHYSICIAN CONSULT PRIOR TO EMTALA
Dr. A: Hey Bill, I've got a patient down here that has a lung mass. She has no insurance and no job and is quite distressed. She needs a biopsy and maybe surgery and chemo. Can you help?
Dr. B: Well jeez doc, my schedule is full for the next few days, but maybe I can work her in between appointments on Friday. Tell her not to worry, I'll see her in my office. I'm sure we can get her plugged in.
Dr. A: Thanks Bill, she really feels badly about not being able to pay you much and her husband says they can pay some over time... They are really nice folks and will try their best.
Dr. B: Yeah, okay, probably won't see a dime but let's get her in. I'll ask the oncology folks to get involved too. Jim will jump on this. Maybe we can fix her.
Dr. A: Thanks so much. See you at dinner on Saturday, got a few days off coming up.
Dr. B: See you then.
PHYSICIAN TO PHYSICIAN CONSULT POST-EMTALA
Dr. A: Hey Bill, I've got a patient down here that has a lung mass. She has no insurance and no job and is quite angry. Had to wait three hours to be seen and all. She needs a biopsy and maybe surgery and chemo. Can you help?
Dr. B: What, am I on call for the ER?
Dr. A: That's what it says on the schedule.
Dr. B: You guys are killing me. That's four patients over the weekend that will cancel my clinics on Tuesday. You guys just cost me over five grand from paying patients.
Dr. A: Yeah, us too. Thirty people waiting to be seen. Twenty walk-outs today. Eighteen ambulances and four of them reasonable calls. This woman was actually diagnosed with a lung mass last year but never followed up. Still smokes. Came in tonight because she's been coughing up blood. Says she 'can't afford to see a doctor so she came here.
Dr. B: Fucking incredible! What does she think that the ER is free?
Dr. A: It is free to her. She will never pay for any of this, says she's disabled. Drove herself in, has a cell phone that she's been talking on half the time I've been in the room. Seems quite unconcerned except for the wait. Says her lawyer said to come here and that we have to treat her.
Dr. B: Do we?
Dr. A: Yes.
Dr. B: Lawyer?
Dr. A: Yeah, she's suing the poor sap who took her chest film a year ago. Says he didn't explain the consequences of the XRAY findings to her adequately... says she didn't understand this was dangerous. Went to the lawyer before coming here.
Dr. B: Holy shit, now I really don't want to take care of her! Hey can't you transfer her to the General?
Dr. A: No, EMTALA prohibits it.
Dr. B: But she can't sue the city hospital but she can sue the hell out of me! Can't you get Dr. C to take this one?
Dr. A: No, his privileges are suspended for not signing his charts on time.
Dr. B: Suspended for not signing charts?
Dr. A: Yes.
Dr. B: Well, come to think of it, I haven't signed my charts in a while. Maybe I can get suspended too?
Dr. A: Worked for him.
Dr. B: Can we get oncology to consult?
Dr. A: They aren't on call tonight?
Dr. B: Well will they help out after the biopsy?
Dr. A: Don't know, you will have to ask them, we only heave oncology ten days out of the month.
Dr. B: Fuck this! I knew I should have gone to business school. I can't wait till I retire. Just so you know, I'm seriously considering dropping my privileges and doing all outpatient stuff, surgery center, the whole bit.
Dr. A: Join the club. Sorry.
Dr. B: Well jeez doc, my schedule is full for the next few days, but maybe I can work her in between appointments on Friday. Tell her not to worry, I'll see her in my office. I'm sure we can get her plugged in.
Dr. A: Thanks Bill, she really feels badly about not being able to pay you much and her husband says they can pay some over time... They are really nice folks and will try their best.
Dr. B: Yeah, okay, probably won't see a dime but let's get her in. I'll ask the oncology folks to get involved too. Jim will jump on this. Maybe we can fix her.
Dr. A: Thanks so much. See you at dinner on Saturday, got a few days off coming up.
Dr. B: See you then.
PHYSICIAN TO PHYSICIAN CONSULT POST-EMTALA
Dr. A: Hey Bill, I've got a patient down here that has a lung mass. She has no insurance and no job and is quite angry. Had to wait three hours to be seen and all. She needs a biopsy and maybe surgery and chemo. Can you help?
Dr. B: What, am I on call for the ER?
Dr. A: That's what it says on the schedule.
Dr. B: You guys are killing me. That's four patients over the weekend that will cancel my clinics on Tuesday. You guys just cost me over five grand from paying patients.
Dr. A: Yeah, us too. Thirty people waiting to be seen. Twenty walk-outs today. Eighteen ambulances and four of them reasonable calls. This woman was actually diagnosed with a lung mass last year but never followed up. Still smokes. Came in tonight because she's been coughing up blood. Says she 'can't afford to see a doctor so she came here.
Dr. B: Fucking incredible! What does she think that the ER is free?
Dr. A: It is free to her. She will never pay for any of this, says she's disabled. Drove herself in, has a cell phone that she's been talking on half the time I've been in the room. Seems quite unconcerned except for the wait. Says her lawyer said to come here and that we have to treat her.
Dr. B: Do we?
Dr. A: Yes.
Dr. B: Lawyer?
Dr. A: Yeah, she's suing the poor sap who took her chest film a year ago. Says he didn't explain the consequences of the XRAY findings to her adequately... says she didn't understand this was dangerous. Went to the lawyer before coming here.
Dr. B: Holy shit, now I really don't want to take care of her! Hey can't you transfer her to the General?
Dr. A: No, EMTALA prohibits it.
Dr. B: But she can't sue the city hospital but she can sue the hell out of me! Can't you get Dr. C to take this one?
Dr. A: No, his privileges are suspended for not signing his charts on time.
Dr. B: Suspended for not signing charts?
Dr. A: Yes.
Dr. B: Well, come to think of it, I haven't signed my charts in a while. Maybe I can get suspended too?
Dr. A: Worked for him.
Dr. B: Can we get oncology to consult?
Dr. A: They aren't on call tonight?
Dr. B: Well will they help out after the biopsy?
Dr. A: Don't know, you will have to ask them, we only heave oncology ten days out of the month.
Dr. B: Fuck this! I knew I should have gone to business school. I can't wait till I retire. Just so you know, I'm seriously considering dropping my privileges and doing all outpatient stuff, surgery center, the whole bit.
Dr. A: Join the club. Sorry.
Monday, May 12, 2008
The Heroes and the Vultures
Helicopter transport is dangerous. Read about these fallen heroes, and then read about the vultures.
Sunday, May 11, 2008
Drackman Goes to Free Agency
As often happens in the world of big-money blogging, lawyers and agents have interrupted the smooth-running snark-machine known as MDOD. As a result Dr. Frank Drackman has started up his own blog here. We will miss Frank and his well travelled wit, but are sure that Frankie's Hideout will soon be well known amongst the cognoscenti as a place where one may go for a fine cocktail and some eclectic conversation. Best to you Frank, or, as they say in the Navy, "fair winds and following seas".
Saturday, May 10, 2008
Ciao, Baby
Its been real, but I'm blowin' this Pop Stand for a little outta the way place called Frankie's Hideout. Bring your Broads, Tired and Weary, check your Heater at the door, and enjoy some of the driest Martinis on the strip, just don't touch the dancers unless your lookin' for a free knuckle sandwich. Not sure about this Ringo Cat who's takin' my place, sure he beats some mean skins, but don't know about that whole English Music thing catchin' on. Gotta run baby, hitchin' up with Sammy, Dino, joey, and Pete, for a little pre-party party. Later.
Friday, May 09, 2008
I Vant to Bite your Neck
Must have been a Vampire in a former life cause I
love necks. Met my wife based on her cute Sternocleidomastoid (she thinks it was the implants). Hey Reverend Wright, you want to talk about discrimination, just try putting an internal jugular line in left handed. You can't do it because in training they make you use your right hand just like English boarding schools did with lefties in the 1800s. Same thing with intubations, even if you could find a left handed Laryngoscope, no one would let you use it. True, you will give the patient a few nasty elbows to the nose doing a line left handed, but since when did patient comfort become an issue? One of my favorite operations to do anesthesia for was Carotid Endarterectomies under local. Basically you just inject a shitload of local anesthetic in the neck and ask to patient to be still for an hour or so. He even gets a bicycle horn he has to honk every so often to assure everyone his grapes getting enough circulation. You walk into the OR during one of those cases and you wonder where Groucho is hiding. The kids nowadays have fancy schmanzy Ultrasound machines to help them find the Jugular, but I prefer Drackies old school method. I don't trust any device that has a Probe and requires Lube.
Thursday, May 08, 2008
Future American Physician
http://youtube.com/watch?v=lj3iNxZ8Dww
More and more bright young Americans are figuring out that there are much easier, faster, less painful and time-consuming ways to make money than being a physician. Hence, you may soon learn that your major surgical procedure, for example, is going to be performed by a gal like the one shown above. I imagine that being a physician will still be important enough, and will remain held in such high esteem by families like that of our little debutante above, that you may someday meet Miss Teen South Carolina just before you head into surgery to remove the meningioma from your cranium. Keep in mind that her valedictorian classmates are all working on Wall Street and at Microsoft.
Have you guys ever heard of 'word salad'? Word salad is a string of words that vaguely resembles language, and may or may not be grammatically correct, but is utterly meaningless. You will never see better videotape evidence of word salad than what I have shown you above.
Imagine the conversation you could have when Miss Teen South Carolina becomes Dr. Teen South Carolina M.D., neurosurgeon.
You: Good morning, Doctor. I have to say that I am a bit afraid of anesthesia and having the tumor removed this morning. Can you answer a few questions for me before we go to the operating room?
Dr. Teen S.C.: Oysters sucking giraffes have not...don't be afraid...alfalfa.
You: What?
Dr. Teen S.C.: Tramway flogging into my question, are you why is it thirty letters down under peanut butter, what is it?
You: Doctor, are you OK?
Dr. Teen S.C.: Hold the patient's nose squarely, waiter, or friendly milk will countermand my trousers. Opossum.
You: What the fuck?!?
Dr. Teen S.C.: I personally believe...that colorless green ideas sleep furiously.
You: Wow. That shit was gramatically correct. NURSE!!!!!!
Have you guys ever heard of 'word salad'? Word salad is a string of words that vaguely resembles language, and may or may not be grammatically correct, but is utterly meaningless. You will never see better videotape evidence of word salad than what I have shown you above.
Imagine the conversation you could have when Miss Teen South Carolina becomes Dr. Teen South Carolina M.D., neurosurgeon.
You: Good morning, Doctor. I have to say that I am a bit afraid of anesthesia and having the tumor removed this morning. Can you answer a few questions for me before we go to the operating room?
Dr. Teen S.C.: Oysters sucking giraffes have not...don't be afraid...alfalfa.
You: What?
Dr. Teen S.C.: Tramway flogging into my question, are you why is it thirty letters down under peanut butter, what is it?
You: Doctor, are you OK?
Dr. Teen S.C.: Hold the patient's nose squarely, waiter, or friendly milk will countermand my trousers. Opossum.
You: What the fuck?!?
Dr. Teen S.C.: I personally believe...that colorless green ideas sleep furiously.
You: Wow. That shit was gramatically correct. NURSE!!!!!!
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