Home / Blog

Blog

1209717_19610439The focus of this web site is medicine. In this blog, you’ll read about patient stories. The situations have been changed to be HIPAA compliant. Factual statements may or may not be true. I may change ages, gender or presenting complaints about patients. I may even entirely make up complete patient encounters from my fertile imagination. Trust me, if you think I’m writing about you, I’m not. There are billions of people in this world and readers send me stories about patients all the time. It isn’t you.
You’ll also read a lot about health care policy. I may throw in posts about life lessons, computers, and will even throw in family stories once in a while. If you’re looking for articles about politics, sports, or celebrities, you’re in the wrong place – unless the topics have some relationship to medicine.
If you want to add a guest post or to cross-post something from your blog, or if you have a patient story you want me to write about, e-mail me. See more information in the “About Me” page.

That Hesitation When …

Angry Man

… a patient’s family member comes up to you and asks “Hey. You’re Dr. WhiteCoat, aren’t you? Didn’t you work at University Medical Center like 6 or 7 years ago?” You casually look to see if there are any weapons in his hand and, seeing none, you cautiously say “Yeah.” Then the family member says “I thought that was you. Yeah. You’re a good doctor. You saved my father’s life. He talked about you up until he died a couple of years ago. Always told everyone what a good doctor you were and how if you ever had an emergency you should go to University Medical Center and ask for Dr. WhiteCoat.” Then you get a little grin on the inside and have to hold it back while you tell the family member you’re sorry about his father passing but you appreciate his comment. Then you go into the lounge with a dumb smirk on your face and think about how an offhand comment like this can make your whole day. Then the nurse sees you smirking and asks “What warped thoughts are running through your mind THIS time?” “Oh nothing.” Then you can’t decide whether the nurse’s suggestion that you have a warped mind is making you happier or is worrying you. Who cares. It’s still a better day hearing that you’ve had that much of a positive impact on someone’s life.

Read More »

Healthcare Update — 02-01-2016

HC Update 13

Another example of why Dr. Google and the links Dr. Google produces may lead you into poor choices for your health care. Some sites scrape the Web for keywords about drugs and side effects, then use a program to combine the pages in a manner that may cause patients to stop taking the medications. Very informative article! Dermatologist accused of rubbing his genitals against female patient’s thighs during examinations uses unique defense – his huge gut covered over his penis, making it impossible for him to rub his genitals against the womens’ legs. That defense backfired. The doctor had to go to a urologist for a formal examination and the size of his penis – a whopping 2.5 cm (a little more than an inch) was published in a Toronto newspaper. Even worse, he was then given a chemically-induced erection and forced to “assume various positions” to see if his penis was visible. I just shake my head in disbelief when I read some of these stories. Your tax money hard at work. NASA spent $80,000 to see what effect space flight has on herpes virus. I was going to ask how they cleared a certain TV commentator for rocket travel, but then thought better of it. Wouldn’t want to be unprofessional, now, would I? More of your tax money at work. NIH spending more than $400,000 using “state of the art technology” to send texts to Latino men telling them to exercise more. What’s the risk of letting algorithms judge us? Once people know the algorithm, they game the system. But algorithms also cause a chilling effect on behavior. Stifle dissent. Make the people judging you happy so your score goes up. That doesn’t work so well in certain arenas, though … including medicine (hack hack Press Ganey cough). An older article, but interesting nonetheless. Nine things you didn’t know about cursing. I saw an experiment about one of them – how swearing helps alleviate pain. About 0.7% of the words we use during the course of a day are swear words. That seems like a f*cking lot to me. Larry the Cable Guy contributing to the kidney disease and fractures of elderly patients? All of those proton pump inhibitors (such as Prilosec, Protonix, Nexium) may help with your reflux symptoms, but they also increase your risk of developing infections like Clostridium difficile (“C. diff”), increase the risk of chronic kidney disease by 20-50%, cause decreased magnesium levels in your system, and contribute to osteoporosis and fractures.

Read More »

CMS Announces New ICD-10 Code for Sleeping Nursing Home Patients

Sleep

Wondering if GomerBlog has any openings … In its continuing effort to improve the accuracy of medical coding, the Centers for Medicare and Medicaid Services has announced a new ICD-10 code related to emergency department medical care. CMS spokesperson Marcella Skinner explains: We have noticed an increasing trend of payments for emergency department patients sent from the nursing home in the middle of the night for evaluation of lethargy and being difficult to arouse. Initially, this appeared to be an anomaly, but when we analyzed the data over the past 10 years, we saw that this phenomenon has been occurring even before implementation of ICD-10, but under a different billing code – V60.5 (patient caregiver wants an afternoon off). Of course, this new code will be paid at a lower level since all patients in REM sleep are difficult to arouse, but at least it helps us track the sleep/wake cycles of our nation’s nursing home residents. The new CMS ICD-10 code will be ZZZ317x – “Difficult To Arouse Due To REM Sleep – Nothing Really Wrong.” This code will supplement current ICD-10 codes of FULMA06c – Difficult To Arouse Due To Annoyance with Nursing Staff and OOPS08a – Difficult to Arouse Due to Previously Unnoticed Rigor Mortis. Dr. Laurence Carmichael, Director of the VA Medical Center in Plucksburg, VA applauded the new change. “For years we’ve been making up symptoms so we get paid when wide awake smiling nursing home patients get transferred to the emergency department in the middle of the night. Now the government has finally recognized our plight and has created this new easy-to-remember code so that we can be compensated for our services. What a great step forward!” Mary O’Leary, president of the American Nursing Home Association, had no comment. ———————– This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on Dr.WhiteCoat.com, please e-mail me.

Read More »

Healthcare Update — 01-28-2016

HC Update 4

All those antibiotics for ear infections early in life may be causing your children to develop asthma and obesity later in life. Antibiotics appear to cause long-lasting changes to the mibrobiome – even when the microbiome returned to baseline several weeks after the antibiotics were finished. Macrolides (i.e. the much-coveted “Z-pak”) seemed to be the worst offenders, although amoxicillin also had a weaker but similar effect. Seen somewhere on Twitter. Enter your age and gender and this web site will tell you how you’re most likely to die as you age. Kind of creepy. External causes tend to predominate for younger people. Cancer and cardiovascular problems dominate for older folks. Child reportedly develops scurvy from drinking almond milk. Symptoms – including bone fractures and rash – improved with Vitamin C supplementation. The implication is that the almond milk caused the scurvy, but keep in mind that cow’s milk has very little Vitamin C, so it was a complete lack of Vitamin C in the diet, not just a switch from cow’s milk to almond milk. Why drink almond milk when “breast is best”? In fact, a new antibiotic developed from human breast milk could help treat superbugs in the future. The protein lactoferrin reportedly kills bacteria, fungi, and viruses on contact. Big Pharma doesn’t want to hear about breast milk as a way to fight superbugs. They want incentives, dammit. Antibiotics are only used sporadically and are generally don’t generate as much profit, leading many manufactures to abandon antibiotic research. Drug companies therefore want “prompt reimbursement” at higher prices to incentivize research. Here’s a better idea. Make antibiotics a controlled substance to stop people from prescribing them for every runny nose and cough that they come across each winter. Reduction in antibiotic use causes reduction in resistance. Although some may disagree … Pure awesomeness. If you ever want to see examples of the difference between “causation” and “correlation”, just visit this site. For example, US spending on science, space, and technology is 99.79% correlated with suicides by hanging, strangulation, and suffocation. Obviously we have to stop so much spending on science. It’s for the children. Irish hospital canceling elective surgeries due to overcrowding. Instead, surgical wards are being used to accommodate patients admitted from the emergency departments.

Read More »

Defibrillating with Soup Spoons

Spoon

So I’m treating this patient the other day. He’s a little intoxicated. Got whacked in the head and needed some staples to close his scalp laceration. When I’m fixing patient’s various injuries, I feel like a barber sometimes. I strike up conversations … ask how their families are doing … how did they get in this predicament … that type of thing. This fellow comes straight out with a doozy. “When I was growing up, our next door neighbor was famous.” “Really, why?” “The husband was a surgeon in a small town hospital. There was a kid whose heart stopped beating after surgery and he saved the kid.” “That’s awesome. What did he do?” “He used two spoons to defibrillate the patient back to life.” “Spoons. Like silverware?” “Yup. Heart started beating and he lived.” By this time I already messed up one staple trying to process what happened. “Wait. Wait. Wait. He used two spoons. How did he keep from being shocked himself?” “I don’t know.” “Mmmmm hmmm. And what did he use for an electricity source? A car battery or something?” “Nope. A fan cord. He ripped it out of the fan and wrapped it around the spoon.” “Mmmmm hmmm.” “In fact, there was a story in Time Magazine about him.” “Mmmmm hmmm. Wow. That’s a great story. Must have been a great doctor.” “He was. Nice guy, too.” I don’t even know why I bothered, but I wrote myself a note to look this up online. Snopes.com … nothing. So I did a search on DuckDuckGo.com with “doctor spoons fan cord”. First result? Time Magazine. October 1959. Dr. Russell Simonetta defibrillated a 19 year old whose heart stopped after surgery – using spoons and an electrical cord. Whiskey Tango Foxtrot. One of the reasons I love my job so much is that I couldn’t make stuff like this up if I tried. I owe this guy a beer.

Read More »

Healthcare Update — 01-18-2016

HC Update 19

As if stool transplants weren’t bad enough … Now some people are recommending urine cocktails to treat illness. Retiree in London was diabetic, had kidney problems, and swollen ankles. After starting to drink her own urine, she is suddenly cured and looks like Taylor Swift! OK, she really looks like Bea Arthur, but her kidney problems went away. Article tries to legitimize the urine drinking experience by noting that women already take medicine made from urine of pregnant horses – Premarin. Another person interviewed for the article rubs urine on his face every day as a skin treatment. Oh, and drinking urine is supposedly in the Bible, too. As I told my kids … “Urine BIG trouble if you ever try this.” Florida’s Medicaid managed care becomes more like Medicaid managed REFUSAL of care. With private companies now operating the system instead of the state, the added requirement of prior approval for many services and dealing with a myriad of billing procedures and rules are just two areas that are far more complex. “In this area, there are four different plans with four different sets of rules, four different provider handbooks, four different billing processes,” said Maggie Labarta, the president/CEO of Meridian Behavioral Healthcare, which provides mental health care and substance abuse counseling services in 10 counties. “For us, the administrative burden attached to billing has grown much more complicated. It is a lot of paper and a lot more bureaucracy.”  Some of the insurance plans will only pay for one day of the three days required for involuntary psychiatric admissions. Most plans require pre-approval for many routine services. As a result, Medicaid has become “more cumbersome and more difficult.” But don’t worry because the patients have INSURANCE! Award-winning screenwriter, producer, and director goes to Quebec hospital with abdominal pain. Later found unconscious in waiting room ultrasound showed ruptured aortic aneurysm. Newspaper claims patient was “denied potentially life-saving surgery.” Hospital reportedly revoked the privileges of its only vascular surgeon as part of Health Department reform and budget cuts. Patient was transferred to another hospital but died before he could make it to surgery. This patient had insurance, too. Interesting concept. When state laws become too onerous for doing business, companies close shop and leave. GE leaving Connecticut due to Connecticut’s high-tax, high-regulation, and anti-business policies and moving to Massachusetts which is presumably more business-friendly. California’s MemorialCare Health System wants to close a hospital and emergency department in San Clemente and replace it with an outpatient medical center and urgent care center – that wouldn’t be required to take ambulance runs. I wonder why that is. San Clemente residents fighting the proposed closure of the emergency department. California legislators refused to allow the new facility to operate as a stand-alone emergency department. As a result, there will be a 40 mile gap between the next closest emergency departments. Quite a bit of extra travel. Hope they have extra ambulances ready. When seconds count in a medical emergency, help will only be 30 minutes or more away. I’m sure a lot of those patients have insurance as well. Is that a hernia under your shirt or ….  Leicester patient finally has 8 in x 12 in hernia repaired. Before the repair, he was arrested for shoplifting when store clerks thought he had merchandise under his shirt. Yes, this patient had insurance, also. Shocked. Shocked I am. The Unaffordable Insurance Act continues to implode. 49 of 50 states will see premium hikes in 2016. The reporter is a little math-challenged, noting that “more than one in three states, or 17 percent” will see premium increases of 20% or more, but it doesn’t take away from the fact ...

Read More »