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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.

Murphy's Law of the ER

Hey, it’s ERP from ERstories.net doing a guest post. The other day during a shift I said to myself “Dang it, it’s Murphy’s Law again” when something went all FUBAR. That made me decide to compile a little list of how that law applies to my job. 1. The GYN cart will only be stocked with the extra large and “virgin” sized speculums when you have a normal-sized patient to examine. 2. The GYN speculum light will not work and you will need to have your chaperon use the odoscope. 3. You will have three or four pages out to various doctors for an hour and no one calls back. The moment one finally does, so do all the others. They get annoyed being on hold and hang up. 4. There is guaranteed to be an issue whenever a patient needs transcutaneous pacing. Of course everything worked fine on the practise, model patients, but the moment you need to use it, the thing does not sense or the wires are not compatible with the pads. 5. The IV is going to blow the moment you have to push Epi – even though it was working fine for an hour before hand. 6. The nurse you need for a patient is always on break. 7. The nurse tells you that the patient in room 15 is getting annoyed waiting for an hour with pelvic pain. When you finally go into the room, the patient is either in the bathroom, waiting room, or fully dressed in a wheelchair. 8 There is never a nursing home’s number on their transfer paperwork, making history taking on a demented, bedridden patient a true joy. 9.The SMA-7 on a critically ill patient is always haemolysed. 10. The rate of RN, tech, and unit secretary “sick” call-ins is directly related to the niceness of the weather outside. I am sure there are many more. Feel free to submit your own!

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Healthcare Update — 06-07-2010

See more health care news from around the web over at the Satellite Edition on ER Stories. “I liked your testimony. By the way … would you mind taking a look at this mole on my back?” Juror in trouble after asking defendant physician for medical advice during medical malpractice case. The now former juror gets to sit in the defendant’s seat while his attorney explains why the judge should not hold him in contempt of court. Another attack on the Feres Doctrine which prevents malpractice victims in the armed forces from suing for their injuries. A patient goes to surgery for an appendectomy and ends up dead. The nurse anesthetist who managed his care put the breathing tube in his esophagus instead of in his windpipe, essentially suffocating the patient to death. The court dismissed the case. Now the family’s attorney vows to take an appeal to the US Supreme Court. Isn’t it ironic how the government can put the big hurt on private hospitals for failing to follow basic safety precautions but how government hospitals can ignore those same precautions, kill people, and suffer no consequences whatsoever? News crew in Bakersfield, California follows around an emergency physician. To make things more realistic, the crew will have to film ten different physicians at the same time, will only be paid 20% of its usual and customary salary, will have to wait several months to get paid, and will have to sit through a malpractice trial for the next 5 years because they didn’t film the physician correctly. He’ll be carrying around an oxygen canister at his senior prom. Two year old smokes 2 packs of cigarettes per day and has temper tantrum when parents refuse to give him cigarettes. Neat idea to curb abuse of prescription medications turned down. FDA nixxes idea to put niacin in Vicodin tablets to deter abuse. Niacin is a vitamin that is also used to lower cholesterol. Take too much niacin at once and you get the undesirable side effect of skin flushing. Higher overdoses can cause palpitations and liver damage. The FDA advisory committee was concerned that adding niacin did not have “a definitive advantage, and it has associated side effects.” The definitive advantage is that it causes side effects to curb narcotic abuse when added to pain medications. Added advantage: Lower cholesterol in chronic pain patients. Oh well. Good idea, anyway. Health care plan savings at work. More than 84,000 seniors in Medicare’s prescription “doughnut hole” will get $250 rebate check for their prescription drug costs, totaling more than $21 million in health care savings. Why don’t we forget the “doughnut hole” and provide generic medications to seniors for free? Make them pay some percentage of the cost (33% perhaps?) of any name brand medications and give them their generic medications. The market forces would create a huge demand for generic medications at that point. Tell me how such a policy wouldn’t cause a downward trend in pricing for most medications — and a huge cost savings for the health care system. More health care plan savings. According to the Congressional Budget Office, the Obama health care plan could add at least an additional $115 billion in costs over the next 10 years, pushing the total cost of the package over $1 trillion. Here’s one way to retire early – file a whistleblower lawsuit against your employer. Christ Hospital in Cincinnati settled a whistleblower lawsuit alleging that it provided improper kickbacks to cardiologists who brought in the most money to the hospital. The Justice Department sought $1 billion in damages. Christ Hospital ...

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Government Declares War on Doctors

I was going to include this article in the rest of the Healthcare Update, but pulled it out and made it a separate post after reading this related article in the Christian Science Monitor – “Justice Department declares war on doctors” Five orthopedists sued for antitrust violations and settle case. Workers compensation in Idaho wasn’t paying enough, so these orthopedists allegedly colluded to refuse to treat any workers compensation patients until the state raised the rates that were being paid. In addition, several of the physicians allegedly threatened to stop seeing Blue Cross Blue Shield patients because Blue Cross payments were insufficient. Orthopedists across Idaho even published articles in the newspapers regarding the Blue Cross dispute. Now, as a result of the settlement, the orthopedists won’t be able do this same thing in the future. Other documents from the antitrust case are contained here. The assistant attorney general stated that “The orthopedists who participated in these group boycotts denied medical care to Idaho workers and caused higher prices for orthopedic services.” No word on when this brainiac is going to file suit against all the state and government hospitals that deny care and cause higher medical prices. Oh. Forgot. States and insurance companies are exempt from antitrust actions, so no one can sue them for colluding to deny care. I think I’ve discovered how patients will be guaranteed care under the new health care proposal. If too many doctors stop seeing Medicare and/or Medicaid patients because the reimbursement is too low, the Justice Department will just step up its antitrust enforcements. Watch what happens to speed and quality of care then …

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WhiteCoat Challenge #6 – Odd Chief Complaints

I was going to just make a post about a weird chief complaint that a patient had recently, but then thought that we haven’t had a good WhiteCoat Challenge in a while. A middle aged female patient presented at the registration window demanding to be tested for “aluminum toxicity.” When she got back to the room, she stated that her genitals were inflamed and believed that it was caused by aluminum in the whisk that she uses in her kitchen. She called the manufacturer of the whisk and confirmed that the metal portion of it was indeed made from aluminum. The nurse didn’t really understand why the patient thought aluminum toxicity might be inflaming her genitals. So, to make small talk, the nurse asked the patient what she had been baking. The patient cast her a strange look. She wasn’t using the whisk for baking. She was using it for … um … how should I say … um … autoeroticism. So here’s the challenge … List the strangest/funniest chief complaint that you’ve had. Top three as judged by EP Monthly editors get a choice of any one product from EP Monthly’s online catalog. We’ll also try to publish as many of the top entries in an upcoming issue of EP Monthly’s print version – which is distributed to more than 25,000 emergency physicians around the country. Contest goes through midnight Monday, June 7, 2010. Make us laugh.

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Videos to Watch

Had to share a couple of videos. One has repeatedly entertained our staff. One repeatedly entertains my kids. One video has been circulating around our ED staff e-mails for a few weeks, although it has been circulating on YouTube since 2006. Totally bizarre. Lots of swearing and f-bombs, so you have been warned. But still funny. Allegedly this guy was dropping acid and sitting in a closet when his roommate taped him … or not. Now we’re all making little quotes in the ED from this throughout the day. Not once, not nevah. Not my chair, not my problem, that’s what I say. Then a video forwarded to me a couple of days ago that my kids play over and over again. Kung Fu Panda has nothing on this bear. Amazing. Finally, can you say “Do NOT Touch Me“?

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Free Market Transparency on the Horizon?

Now THIS is what I’m talking about! From an article in ModernPhysician.com (registration required)… Pricing transparency gaining renewed interest Led by a physician lawmaker, members of Congress on both sides of the aisle have shown renewed interest in mandating a boost in healthcare pricing transparency, including charges for physician services. More on pricing transparency from an article in The Hill. Rep. Steve Kagen, M.D., (D-Wis.) sponsored one bill (H.R. 4700) that would require all medical providers to openly disclose prices or face a financial penalty.”The “Transparency in All Health Care Pricing Act of 2010” would finally allow patients to see the price of a pill before they swallow it.” Rep. Joe Barton (R-Tex.) sponsored H.R. 4803 which is a little more vague, but which still requires that all hospitals in each state report “the charges for inpatient and outpatient services typically performed by such hospital.” This bill has 11 co-sponsors. Sources in the ModernPhysician.com article discussed whether the pricing scheme would be “too complex” and suggested that if competitors knew each others’ prices, they would raise prices in a given market. If hospitals have to list every little thing, I suppose it could be too complex. I don’t go along with the price fixing argument. A few simple solutions: 1. If we’re worried about the complexity of pricing all hospital services, require that providers report pricing based upon CPT codes. That way, consumers can compare apples to apples (or codes to codes). 2. Any charges that do not correspond to a CPT code must be explicitly stated in simple English. No charges of $129 for a “mucous recovery device” when all they’re giving you is a box of tissues. 3. Require that any procedure or test or other charge whose price is not published must be provided free of charge to the patient. Patients have the option of accepting or rejecting items once they know the charges involved. You want to charge $129 for a box of tissues, you better tell me about it first. Then your charges will be out there for people like me to comment upon. This whole pricing transparency thing is catching on. Just read a blog post about transparency from Paul Levy – the CEO of Beth Israel Deaconess Medical Center in Boston. In Massachusetts. You know, that state where they have insurance for everyone, but access for … well … not everyone. “we should measure parties’ commitment to change by the degree to which they advocate and adopt the kind of transparency that exists in virtually every other segment of the economy” Bingo.

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