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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Tuesday, November 20, 2012

Thoughts for the day

Sitting in my dirty scrubs, too tired to get a cup of fresh brewed coffee, I wonder why I have not done more with this blog.

Reading the facebook news, I see an Eleanor Roosevelt quote, "When will our consciences grow so tender that we work to prevent human misery rather than to avenge it."

Four years ago I felt I could change a lot.

This morning, I feel the only thing that has changed is me.
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Sunday, November 4, 2012

An extra hour

Well, I have managed to stretch the extra hour from falling back into three.  I have been assisted by the fact that this is the first morning in eight that I wasn't at work or going to work.  Seven days of twenty four hour every other day shifts cannot be healthy but that is not what I have been contemplating this morning.

I began by updating my facebook time line.  I know, everyone else did that three years ago but it is the reason I found the next activity, which was watching Jonathan Haidt (  Also, I am not very good at writing on my iPad via facebook.

Anyway, I am now going to enjoy some of this glorious weather with a walk.  This is the day I will be thankful for not only this hour but all the hours in it.
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Saturday, September 8, 2012

'Modern' Medicine

I haven't written here in awhile.  It is not that I haven't written.  The reason for my absence is job related and I really cannot get into that story at this time.  Yet, I need a place to keep all my thoughts about medicine, the practice of it, and what it is like to be a physician in this time we call postmodernism. 

Take my father's stay in the rehabilitation facility for instance.  (I will write about his admission to the hospital in another post.)  He has been here now for a little over a week.  I must say, I have seen real progress.  But last night they restarted his the intraveneous fluids that he needed two weeks ago.

I was shocked when I came in this morning.  He ate and drank yesterday better than he has in over two weeks.  When I ask, I was told his creatinine is elevated.  Yes, it is.  It has been for TEN YEARS.  We have gone to the same hospital system for the past two years.  I have discussed this elevation with nine different physicians.  I have discussed it twice with his current admitting physician. But the tenth doctor was on call last night when someone notice the blood work which was drawn 12 hours before.  So the pearl for the day?  The electronic medical record is only valuable when someone reads it. 
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Monday, January 16, 2012

"the difference"

You have heard it before.
Termed "The Serenity Prayer," the saying goes something like "God grant me the courage to change the things that I can change, the patience to accept the things I cannot change, and the wisdom to know the difference." 

Wisdom is key. 

Yes, you need courage to tackle the tough issues especially those of injustice and inequality in a land flowing with, well, if not milk and honey, then certainly flowing with information and money.  Patience is also required.  Real change comes slowly usually with Herculian effort, especially where hearts and minds are concerned. 

Knowning the difference in what can be changed and what must be accepted, even termporarily, to bring about a since of community and peace, is real wisdom. 
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Saturday, January 14, 2012

I will ...

not complain.

If I have in the past I am sorry. Please accept my apology and remind me, should I voice my discontent in the future that each day is a gift. While I am not perfect, it is my sincere hope that I can be grateful for each breath and live the moments, hours, and days given to me with grace.
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