Tuesday, August 31, 2010

Take the money and run

I called my health insurance carrier because I received a letter stating I was eligible to continue my health care coverage on an individual policy when my COBRA terminates in 2 months. It was mailed to my home address in Great Big State. With hope I called to initiate this conversion. After giving my name, social security number, and home address, I was told "you are not eligible."

"Well, then why does the letter say that I am eligible?" I replied.

"I don't know but you live in Big State. Any one who lives there is not eligible." said the voice on the other end of the line.

"Well your company mailed me this letter, to my home address in Big State. Did someone at your company think I did not live in Big State, I mean, I have been receiving bills and making payments from this address for the last 16 months?" I asked.

"I don't know about that but you are not eligible, I don't care what the letter you have says."

Who do I believe? The person who mailed the letter or the one on the telephone. I can tell you this, after searching for health insurance for over a year, there is not an honest person out there associated with an insurance company. The insurance industry holds are the cards and the Affortable Health Care Act dealt them a sweet hand. While health care is now becoming a requirement, I am not sure it is something the middle class will be able to afford.

Until this country is ready to do something about the insurance industry who has the largest lobby in both Washington DC and your local state house, they will continue to take our money and work hard not to pay for care.
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Monday, August 23, 2010

Changing the world

Since it is Monday and the beginning of a new school year for many, I am thinking about the impact each of us has on the world. When I was younger, middle school and high school, my greatest desire was to make some world changing discovery. A cure for a deadly disease or an invention to ease human suffering was my goal.

With time and age, by about my second year of college, I realized these types of discoveries where a combination of brilliance and luck. Since I possessed neither in large quantities, I settled down to the slow, grinding task of preparing myself for medical school. In another couple of years, I realized that some combination of brilliance and luck were required for medical school admission also. Since I was short on the first, I would have to say it was the second of those two commodities which landed me in that now Well-Known Medical College of the south.

Getting back to change, it seems it comes in one of two forms. Change is either slow and insidious, something we are not able to appreciate in our life time. A physical example of this is the Grand Canyon. Or change is cataclysmic, the death of the dinosaurs (and many other forms of life) in a short span of time.

In the last 18 months, I have learned I am not going to have any type of meteoric change on the health care system, even in Major Metropolitan City. Hopefully, however, I am making some type of difference in the landscape, at least where the lives of my patients and colleagues are concerned.
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Wednesday, August 18, 2010

American medical care

Two months ago I saw a woman who was employed and has insurance, both medical and disability through her employer. I am not implying I never see patients like this any more but this woman was not really ill enough to be in the hospital. She and her husband moved to a community south of the Metropolis 6 months ago from another state. For reasons I will not go into her that community does not have women's services at their hospital.

She woke up on a Saturday morning with some mild pain which increased over the day. Having no physician to call, she went to the local emergency room. With no gynecologist to refer to, the ER physician got out his protocol book and began ordering tests. Pregnancy test was negative, white blood count was normal, ag. ain she really was not sick, but the next step was a sonogram.

When the sonogram was done by the technician, who was called in from home, she informed the ER physician that the radiologist would read it on Monday. The sonogram did, however, show something abnormal in the region of the right ovary. Hearing this the ER physician called the ER physician at my hospital. The result was the transfer of this woman, by ambulance, 45 miles to the hospital where I was on-call. No one told me about the patient until she arrived in the emergency room at my hospital 5 hours later. By this time it is 1 AM on Sunday morning.

Seeing the patient, reviewing her laboratory values and her sonogram, I explained to her that she had a hemorrhagic corpus luteum cyst or a blood clot on her ovary from ovulation, which had grown slightly larger than normal, probably causing the pain she had the day before but had now resolved. Her blood counts had been repeated by the ER doctor at my hospital. He needed to have something to do and bill for, right. These tests were all stable and now she was pain free.

Her husband was there. He had followed the ambulance to be with her. Following my exam and review of all that had been done, both were relieved to find out it was nothing serious. They packed up and went home. I gave her a follow up appointment in my post op clinic the next week to make sure she was feeling OK along with the names of several gynecologist who have practices in the area.

When I saw this woman 4 days later, she was doing great. She had an appointment in a couple of weeks with her new gynecologist AND she had four or five pages of paper work for me to fill out to get the ER visits and the ambulance ride paid for. I did my best.

And why am I bringing this story up now. Well, at the time I thought about how pointless all this was. Her pain resolved with a little bit of time and not much else but she got several thousand dollars worth of tests. I am now really irritated because I am still filling out paper work for the expensive items: sonogram and ambulance ride while I have little hope of being paid for my part in her care.
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Tuesday, August 17, 2010


As I have alluded to before, most physicians do not practice medicine because we love people and hate money. After endless years of training, we spend countless hours working for the best possible outcomes for our patients because we crave approval. First we sought the approval of our parents, then our teachers, and now it is the approval of our patients. "Thank you!" sincerely spoken goes along way with most of us. A note or a card will likely be kept in a special place for years.

Perhaps you can imagine how devastating it is to have a patient who is dissatisfied. Three days ago I took a young woman to surgery after she had a Cesarean section at another hospital. On arrival to our emergency room she was hemorrhaging internally as well as vaginally and also out of her abdominal skin incision. Only her first baby, I was afraid I would have to do a hysterectomy to save her life.

Now that we are three days out from this crisis and the patient is getting better, with the aid of surgery, blood transfusions, and IV antibiotics, I am more optimistic. And, I was hoping for a grateful patient. Alas, she is tired, sore, and angry. Some of this is to be expected. The father of the baby is miles away, driving his truck. Her family consists of an 18 year old male cousin, who tells me he needs to learn about babies because his girlfriend is pregnant. He has been sleeping in her room because the hospital requires a responsible party be present to care for the baby.

Continuing to do the best that I can to provide good medical care, I am reminding myself that healing of my patient is reward enough.
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Saturday, August 7, 2010

"I can't...."

My mother use to say, "I can't never could do anything." She was correct. I hate those words. I cringe when they come out of my children's mouths. You will see from this post that I am very adverse to speaking them myself and I don't even like the thought to rattle around in my own head. Lately I seem to hear "I can't" everywhere.

This morning "I can't walk down the hall!" came out of the mouth of a young patient with a wound infection. I do have some sympathy for this woman. She has a chronic disease and she has had a difficult pregnancy. Three difficult pregnancies to be exact. Yet, she refuses to do almost anything to help herself and I am beginning to feel that she will never be well enough to go home. She needs to be up moving to prevent blood clots and pneumonia.

"I can't never could do anything" is connected to my comments about entitlement programs and how they create entitled people. The unemployment rate is very high but it seems most of my clientele are trying not to work. We are in a state where it seems rather simple to qualify for Medicaid coverage, yet no one wants to make the effort to walk 2 blocks and turn in the paper work.

There are two clinics with in three blocks which will provide services for Medicaid recipients, but you have to have a photo ID and a Medicaid card. (The photo ID is because several individuals have been caught using the same card.) I realize this all takes time and a small amount of money for bus fare.

"I can't..." are not words heard in conjunction with "get my nails done" or "pay the cell phone bill."
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Friday, August 6, 2010

Something new

Little surprises me. I was not surprised when I walked down the hallway to a patient's room and three police were standing in the hall way. I was not surprised when I heard a patient screaming and protesting his inocence. I was not surprised when the nurse told me this particular patient was caught going into other patient's rooms uninvited and stealing money and belongings.

I was surprised when police reported they had searched the patient-suspect and found $150 in his colostomy bag. Any of you who have been patients know there are no pockets in those gowns. I guess this guy thought he had a place where no one would look. Fortunately, the police were smarted than he thought.
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Tuesday, August 3, 2010

"You know it is a bad day when...

I believed it would be a good day. It was certainly too hot to do anything outside. With temperatures soaring into the triple digits, the rates of preterm labor soared also. Not to mention the rates of unassigned term patients who made it into my hospital in labor. So it was busy when I arrived. My feet were not off the ambulance dock before another five patients were added to the labor board.

The first was from an outlying community. No prenatal care. The baby's head measured thirty-six weeks and his femurs (leg bones) measured twenty-five. I only had a few minutes to contemplate the cause because she was in active labor, completely dilated and a double footling breech. In doing an emergency C-section we found a baby with almost no lung tissue who died 2 hours after birth. Maybe that is how I was suppose to know the flavor of the day. I was only 2 hours into my twenty-four hour shift.

The other deliveries were more routine. Two couples who were probably actually married to each other. Neither spoke much English but both had their emergency Medicaid paper work. Perhaps if I could learn more Spanish I could open a clinic for these people. We could swap outpatient services for prenatal care.

In this scenario, my grass would be cut, my house cleaned, and I would have a good solid roof over my head. The government actually pays for the delivery. This would all go well until all the John Kyl supporters figure out how to take these undocumented workers children's citizenship away. Then none of us will have our grass cut, our houses cleaned, or a stable roof over our heads. (And no, I did not see Senator Kyl making this statement on TV. I simply read about it the next day in the newspaper.)

One twenty year old I was delivering had three other children in the waiting room. Her mother had the eleven month old at home. A bright spot in the afternoon was the woman who begged us to transfer her to the county hospital. The ambulance would not take her there because it was 15 minutes further. Her car wouldn't start so her mother could not drive her. But she was only in early labor and she knew she would get her tubal at the county hospital because she had signed the paper work well in advance. This was to be her fourth C-section.

As the labor rooms emptied of deliveries and the day slowed, the emergency room got busy for me. I saw a woman miscarrying. No one, not she, her husband, her brother-in-law, or their three year old son, spoke English. This is less of a problem for me this year than last. Maybe I am learning some Spanish. I also am on a first name basis with most of the translators. I always use the translators for the surgery consent forms.

Three more admissions from the ER and I know who is having the worst day of their lives. It is not me. Not by a long shot. It is now 3 AM. In trauma room one, a family is surrounding the stretcher with a body on a ventilator. They are being told this 18 year old boy, their son and brother, will not survive. He stole a car. He was chased and he crashed. He is now likely brain dead. Oh, it will take another twenty-four hours for this to play out. With more neurological testing, organ donation, and the like. As I stare into the room from where I am writing admission orders for yet another gynecology patient, I feel a bit of their pain. Any "bad" in the rest of my day pale in comparison.
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