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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.

Defibrillating with Soup Spoons

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.

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Healthcare Update — 01-18-2016

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 ...

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Dear Diary #20

Dear Diary This week has been hectic. Today capped it off. The emergency departments have been consistently overcrowded. We’re running at more than capacity lately. Patients are calling all the different emergency departments in the area to inquire about the shortest wait times. Some patients have even told me that they set their alarms for 3AM to wake up and come to the ED to avoid the wait. Still doesn’t work. The wait may be shorter, but there’s still a wait. And we haven’t even hit flu season yet. I’m worried what things are going to look like when that happens. One of the consultants on staff at our hospital is a jerk. I’m officially fed up with him and his attitude. He treats our secretaries and nurses like crap (which I didn’t know up until recently). I called him about one of his patients in the middle of the night. I’ve been practicing a while – longer than Craftsman the Consultant (see explanation below) – and had never seen a presentation quite like what the patient had. I described what was present on physical exam, labs, and x-ray, then gave him an idea of what I was thinking. He wigs out. “All you’re giving me is symptoms and physical findings. What do you want me to do about it?” “First, I also gave you x-ray and lab finds as well. Second, I’m looking for your help trying to figure this out.” “Well you have to admit you gave me a pretty piss-poor reading of the x-ray” “I’m not admitting anything. You want me to text you a picture of it so you can do a better job?” “No. That’s not the point! You’re supposed to be a doctor and you need to make a decision!” “Fine, I’ve decided that you need to come in and see the patient. Now.” “Who is your boss? Because I’m going to call him RIGHT NOW with this bullshit. You hear me?” “Don’t worry, you can talk to him when you’re explaining your attitude at the next Medical Executive Committee Meeting. I’m writing all of this conversation in the medical record and then forwarding a copy to the chair of your department and the MEC tomorrow morning.” “Whoa. Wait a minute. We’re obviously both a little upset. Now let’s figure this out.” “No, you’re upset and you’re coming in to see the patient so you can figure this out.” “I’m NOT coming in to see the patient. You can have her see me in the office in two days.” “Unacceptable. If you don’t come in to see the patient, then I’m admitting her and noting in the chart that it was because you wouldn’t come in at my request. Then you’ll get consulted on her for the morning.” “You do what you have to do.” “Don’t worry. I will. Have a nice evening.” The thing is, after the phone call, about four people magically appeared from around the corner and started high-fiving me. “That was great! Someone finally put him in his place.” “What a dick. It’s about time someone gave it back to him.” Only then did I hear about how miserable he’s been to other staff. So we decided to name him Craftsman – because he isn’t just a tool, he’s a power tool. Today pissed me off. I had planned to write several posts today, but it didn’t happen. First, Daughter WhiteCoat’s car wouldn’t start. When it did, it made some horrible grinding noise that sounded like the transmission is going bad. This is just after Mrs. WhiteCoat’s car needed $2000 in work (including new ...

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Healthcare Update – 01-06-2016

Study in American Journal of Clinical Nutrition shows that by consuming less sugar, our tastes change. Study participants who replaced 40% of simple sugars in their diet with fats/protein/complex carbohydrates rated foods 40% sweeter than control subjects who made no changes. The study suggests that, just as with so many other body processes, our bodies become tolerant of certain stimuli and we need more of the stimuli to obtain the same effect. In other words, we may be able to decrease our sugar cravings simply by avoiding sugar for a couple of months. Note how in the study, there was no difference between groups at the first month. The effects in the study took two months to become apparent and became even more pronounced at three months. Unfortunately, most people who diet don’t hold out for three months. Related article in Time Magazine. UK closing more hospitals to save money. Government stripping resources from emergency departments so that patients needing surgery have to be transported more than 40 miles away. Described as a “surreal situation – like a Wild West film set, with the fronts of the buildings in Main Street but nothing behind the facade.” The correct term is “Potemkin Village“. But at least the care is free – right? Added bonus: This is the system that our government is moving toward. Irish patient waits for 20 months to have surgery for correction of severe scoliosis then has surgery canceled at last minute because hospital had too many admissions the day before. But don’t worry, folks. She has insurance! Should patients who overdose on opioid pain medications receive future prescriptions for opioids? This study suggests that discontinuing opioids after an overdose results in a lower risk of repeated overdose. In a related article, the authors are “highly concerned” that 91% of patients in pain would continue to receive pain medications after an overdose. If doctors prescribe opiate pain medications after an overdose, we’re playing with patients’ lives. If we don’t prescribe opiate pain medications after an overdose, we’re heartless bastards who let patients suffer in pain. Either way, we get negative publicity. Another drive-by medical article. And you thought that the guy Martin Shkreli was a dick for hiking up the price on Daraprim. Wonder whether other pharma CEOs are going to get investigated for similar actions: Potentially life-saving drug Sovaldi that cures Hepatitis C costs $1000 per pill in the United States, but only costs $4 per pill in India. According to the article, drug companies gouge US citizens on prices of many medications. Advair is $150/month in the US, $10/month in India. Crestor is $86/month in the US and $3.60/month in India. Many cancer drugs cost several thousand dollars more per month in the US than they do in other countries. I know, I know. Shkreli was arrested on securities fraud, not for hiking the price of a potentially life-saving unique medication … like Sovaldi.

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Interesting Emergency Department Complaints

Here are a few of the more memorable recent emergency department complaints. My mother has had early onset dementia for 40 years. We need to see what’s wrong before the end of the year. Patient arrived December 30. Hangnail on the finger for month. She pulled it off today at work and had to leave work because she saw blood. It was her typing hand. A patient was playing with her dog earlier in the day. She was laying on the ground and the dog jumped on her stomach. She has had severe back pain since this occurred and is out of pain medications. The dog was a chihuahua. Child was in the emergency department 2 days ago and diagnosed with a cold. Mother brought 4 other children in to be checked to see if they have colds. Constipation for 4 days. Had a bowel movement the day before he came to the emergency department, but didn’t have a ride to get to the hospital until now. Wants to know why he was constipated. Patient has had a BB lodged in his elbow for several years. Wants it taken out. “I just got that Obamacare insurance.” House was cold last night. Got chills. Wants to be checked. Lips are dry. I’m guessing that the responses to some of these complaints would be amusing as well ….

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Healthcare Update – 01-04-2016

Drug use (especially Ecstasy) at Australian music festivals has increased significantly over the past few years. One emergency department director noted that if people knew where the dealers had concealed the drugs to get into the festival, a lot of people would “nearly vomit.” I can tell you from experience that those places of concealment aren’t limited to music festivals, either. Patients gone wild. South Carolina belle Megan Whit drives pickup truck into a couple of telephone poles, then asks responding officers for drink of antifreeze. Proceeds to channel the Queen of Hearts from Alice in Wonderland and repeatedly yells “Off with your head!” at the officer. Taken to the emergency department where she insisted she was pregnant and that she overdosed on narcotics. Then shouted obscenities in the emergency department for several hours before testing showed she had used cocaine, crystal meth, and marijuana. This is your brain on drugs. Any questions? Welcome to Crazy Town. Well-written article about a day in the life of Indianapolis trauma surgeon Jamie Coleman. Many excellent pictures accompany the article. If you’re interested in medicine, this article is a must-read. Suppose one of your New Year’s resolutions is to stop drinking. What can you expect in the next 30 days? Here’s one person’s experience. Connecticut attorneys accused of misappropriating $4.3 million from malpractice client’s settlement and of failing to provide proof of more than $600,000 in legal expenses. Initial retainer agreement calculations would have resulted in fees of $2.66 million from the child’s $25 million settlement. Attorneys from Koskoff Koskoff & Bieder allegedly took $7 million in legal fees. Grievance committee investigating the matter finds “probable cause of professional misconduct” against attorneys in the case, but article notes that they were still allowed to keep all of the money. According to the Koskoff web site, Kathleen Nastri and James Horwitz represented the client during the trial. Employees snooping in the medical records of a patient who committed suicide. Co-workers accessing a patient’s medical records that were then used against him in divorce proceedings. HIPAA violations are “widespread throughout the VA” according to one whistleblower – who was put on administrative leave shortly after filing a complaint. This ProPublica investigation revealed more than 10,000 privacy violations by the VA system since 2011. The Office for Civil Rights cited the VA for more privacy violations than any other health provider in the nation, yet the VA has reportedly never been sanctioned for these violations. But if a patient suffering from a heart attack at a non-VA facility gets tPA at minute number 31, the doctor’s employment is on the line. Nice system we have, huh?

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