Saturday, October 11, 2014

Wouldn't it be nice...

...if there were as much of an uproar in this country over say, gun violence, as there has been over Ebola?  I could pick several other topics for Congress, our state and local governments to get as serious as those institutions have been in the last two weeks about the threat of this disease in the past two weeks.
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Sunday, May 18, 2014

Edgy

The third definition of edgy on dictionary.com is: "daringly innovative; on the cutting edge" I have been a little on edge recently and I hope I am about to be daringly innovative.

Some of this edginess is just my age, I will be fifty nine and a half in a little over a month. For those of you too young to realize this, that is the age when you may, penalty free, drawn money from your retirement account.

Another aspect of my edginess is the time of year. June is when the current resident class will graduate, take their written boards, and enter the world as practicing obstetrician-gynecologists. Yes, this is a time of pride for these physicians and for all of us who hopefully contribute in ways great and small to this accomplishment. The patients contributed in great ways and we professors relatively small ones. I hope these young physician realize that to be successful they will have to keep on learning from patients. That is why we call it practicing medicine and not knowing medicine.

But the reason residents graduating makes me edgy, besides all that they don't know yet, is the fact that everyone moves up a level on about June 15 and some newly minted MDs arrive on July 1st.  That along with the fact that graduate nurses, respiratory therapists, surgical technicians, new social workers, and just about every other type of provider you can imagine will be in a brand new position on July 1st. Some seasoned nurses and administrators take the month of July off.  The problem is illness will not.

Luckily, September, the ninth month after the winter holidays will still be two months away. For those that do not realize it, human gestation is 9 months, and in celebrating the winter holidays most couples hold the belief that their god of creation will not allow them to make another human being despite the lack of effective contraception during this time.  I digress.

Other than my age, and the coming season of healthcare madness, my edginess is most likely due to the blatant bitterness I see exhibited on a daily basis toward the patient that I treat.  I deal with it in myself.  Delivering a set of twins to an eighteen year old mother of a toddler and wondering how she will take care of herself and these three children without a high school diploma is overwhelming.

Rick Santorum and I agree on one thing: A girl having a child before she is educated enough to be able to support herself and that child is a ticket to poverty.

I have watched this played out hundreds of times in the past five years. My city is the national leader of teens having more children before they reach majority.  My edginess is from the fact that I am not seeing much hope for change here.
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Thursday, December 13, 2012

Shell game

A family member just had a recent medical procedure and I reviewed the bills this morning.  Since this has become a rather routine procedure for two members of my family, and because we have a high deductible insurance policy, I have become astute at looking at the claims.  For this procedure, there are always four statements: One from the endoscopy center, one from the anesthesia provider, and two from the physician for both the procedure and the medical assessment justifying the need for the procedure.

In round numbers we paid $200 for the medical assessment.  For this my husband sat in the doctor's office for 45 minutes, answered a questionnaire, got weighed and blood pressured before his 5 minutes with the doctor.  The procedure itself cost $1200 and took 15 minutes of the doctor's time.   He did spend another 5 minutes explaining what he had done but multiply that by the 15 procedures he preformed that afternoon and I believe you will see why every medical student wants to subspecialize.

Now, least you think that is all the income this physician had from his afternoon (1:30 to 5:00 PM) worth of work, let me explain about the anesthesia and endoscopy center.  This endoscopy center is owned by the doctor and 9 other doctor's who do similar procedures.  They built it because of the money they saw the "not for profit" hospital system making in a similar fashion.  The final piece is anesthesia.

When I inquired, I was told there was no anestheologist on the premises.  This is a free standing center, 5 miles from the nearest hospital.  Five miles in city traffic.  The "anesthesia" is IV sedation.  You can sometimes get this in a dentist office (but I would not recommend it).  It is two drugs, fentanyl and versaid.  The first is a pain killer that makes you go to sleep and the second is a short acting valium type drug.  It makes you forget.

The person pushing these drugs is a certified nurse anesthetist.  I use them all the time in the hospital, where there is an anesthesiologist (read that one doctor who has been to medical school and done a residency in anesthesiology).  I have no problem with nurse anesthetists.  This is not the reason I am writing this.

My problem is that the doctor supervising this anesthetist is the same one doing the endoscopy.  He may (or may not) have had any anesthesia training.  He may or may not know how to take care of the patient should his heart or breathing cease.  For this we will pay the same $1500 that we would have if we had been in the hospital.

I ask where the money goes.  While I am asking, I am multiplying the $1500 by all the people I saw leave the waiting room while I waited on my husband.  This is probably somewhere in the neighborhood of 30.  We were only there for 2 hours.  Well, it's complicated, I was told.  Discuss it with the doctor.  Actually, he was quite happy to brag to me that this was the most lucrative operation he had been apart of in his 20 plus year career.

Before, the hospital got the money.  Now he gets a lot more of it.  Which demonstrates what medicine is all about:  Getting the most money possible from each patient.
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