Sunday, October 18, 2009

My crystal ball

Well, here I am. Back for more work at the big medical center. When I was last here, 2 days ago, I admitted and operated on a patient who came in through the emergency room. Both the emergency room physician and the radiologist who preformed the sonogram felt she had a twisted ovary. I agreed. Her symptoms, the signs on her physical exam, and the sonogram were compatible with this diagnosis.

Problem is this was not the problem. The problem was a large fibroid which had outgrown the blood supply. Painful yes, but not as much of a medical emergency as a twisted ovary. Also the solution to the problem of the necrosing fibroid had to be solved with a hysterectomy due to the location. This resulted in a longer and more difficult procedure than the one I would have used for an ovarian torsion.

The patient is past the age of normal child bearing. She even had a tubal ligation with her last child some fifteen years ago. The problem is she has a government funded health insurance which requires a thirty day consent for hysterectomy. Even with this knowledge, to cover all the possibilities, I discussed hysterectomy as an emergency procedure and ask her to sign a consent form for this in the emergency room.

Carefully reviewing my documentation, I worry this case will be refused payment by the third party payers. Even though I know I preformed the correct procedure for this patient, I am bothered because this will be a mark against me with the hospital administration. The hospital will not be paid for any of the care of this patient. It is the same with tubal ligation in pregnant patients. Even if the woman has had twelve children at home, the consent form must be signed thirty days in advance.

So, I find I not only need a crystal ball to aid in diagnosis but a magic wand. The magic wand would come in handy for situations such as the above. I could make the treatment fit the payers criteria rather than just doing what the patient needs.
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