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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.

Healthcare Update — 04-04-2011

Lots of health care-related news this week. Read more on the satellite edition of this week’s update over at ERStories.net. Yeah, um, I’m calling in sick today because I had to go to the emergency department for treatment. You just nevermind what the treatment was for. I can’t be seen in public until I soak my head in water, that’s all. And don’t give me grief about the incident taking place 6 months ago. The story was just published last week. Low health literacy in older Americans is linked to poorer health status and a higher risk of death. That means 75 million Americans – about 25% of the population – are in trouble. Now the government has created a plan to “improve jargon-filled language, dense writing, and complex explanations that often fill patient handouts, medical forms, health web sites and recommendations to the public. That way when lawyers sue medical providers, they can allege that there wasn’t informed consent because of the lack of jargon-filled language, dense writing, and complex explanations. How’s that “insurance for all” thing working for ya? Have a psychiatric emergency in Massachusetts? Sorry, there aren’t any beds available for your “insurance.” Instead, we’re going to force you to sit in this conference room for a few days with 15-20 other psychiatric patients. You won’t get treatment while you’re waiting and you can’t leave. That should make you never want to complain of psychiatric problems again. If not, maybe each and every discharged psychiatric patient could be given a bus ticket and cab fare to Governor Deval Patrick’s house to ring his doorbell and personally discuss why he repeatedly cuts funding for psychiatric care. Ditto for South Carolina where mentally ill patients are “staying in emergency departments longer, clogging the system, creating a financial drain, and heightening the danger to other patients and staff. One patient’s mother described to state legislators how her daughter had been waiting in an emergency department for 8 days and still couldn’t find treatment. Another patient waiting 12 days in the emergency department prevented approximately 84 patients from being seen in the occupied bed. The emergency physician in the hospital predicts that “something bad is going to happen — and that will get people’s attention.” Not getting treatment from the emergency department quick enough? Try leaving the waiting room, driving to a grocery store, and calling an ambulance. That will get you brought back to the hospital and dropped off … right back in the waiting room. Emergency department in Huntsville Memorial Hospital in Texas institutes new policy. First, you get screened for an emergency medical condition. If you don’t have one, you have three options: see your primary care physician, go to the hospital’s Medical Clinic, or stay in the emergency department and pay for your care. Insightful article in the NY Times about the changing attitudes toward practicing medicine in the US. More medical practitioners are “getting off the hamster wheel” and value quality of life much more than finances as the most important factor in their job searches. In addition, the public perception of physicians has changed. “Doctors were once revered, but a host of intermediaries — insurers, lawyers, the Internet, growing patient needs and expectations — have intervened, to the point that many patients now see doctors as interchangeable. Younger doctors are deciding that the personal price of being at their patients’ beck and call is too high ….” “[My medical insurance card] is a useless piece of plastic,” says a patient who has three ruptured discs in her neck but can’t find a surgeon or pain ...

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Medical Malpractice Firms Get Taste of Their Own Medcine

Remember Charles Cullen? The Angel of Death nurse who killed at least 29 patients in various hospitals throughout New Jersey and Pennsylvania? He admitted sneaking into the patients’ rooms at night and injecting them with overdoses of medications – usually either insulin, digoxin, or epinephrine. Many law firms sued Cullen and the hospitals at which he worked for the patient deaths and won substantial judgments. But several of the law firms took things a little too far. Charles Cullen obviously didn’t kill every patient that he cared for during his 16 year career. But some law firms sued the hospitals that Cullen worked at solely because Cullen cared for patients who later died. Their lawsuits alleged that Cullen killed patients even though there was a “complete lack of evidence” to support those claims. The cases were dismissed by the trial judge and the dismissals were affirmed on appeal. During depositions in the cases, family members admitted that they had no evidence linking Cullen to the death of the patients, only a “hunch” that the nurse “might” have been responsible. Now one of the hospitals is suing the law firms for filing these frivolous cases. St. Luke’s Hospital in Lehigh Valley, PA is suing Cohen & Feeley in Bethlehem, PA and John R Vivian of Easton, PA for proceeding with cases that the attorneys knew were “baseless and lacking in evidence.”  In addition, St. Luke’s sued the medical expert who certified the cases, Dr. John J. Shane, alleging that he used a “boilerplate” certificate of merit to allow the cases to proceed and did not even review the medical records of the victims before certifying the cases. Dr. Shane has been in trouble with the law before. In 2008, he was indicted by the Department of Justice for conspiracy and wire fraud (.pdf file) when he and two attorneys allegedly forged the will of a deceased person in an attempt to become beneficiaries of a multimillion dollar estate. Sounds like St. Luke’s Hospital needs to add a cause of action for “negligent hiring” to its lawsuit against the law firms. The hospital seeks more than $500,000 in legal fees that it paid to defend the baseless lawsuits in addition to punitive damages. A “loser pays” system in this country would probably have prevented the lawsuits from even being filed. Instead, now the hospital has to spend even more money on attorneys’ fees and file a counterclaim in order to obtain justice. The hospital should get at least $30 million for noneconomic damages in this case. Maybe more. After all, who can put a value on how much distress the hospital administrators and the hospital staff went through based on the unprofessional actions of these attorneys?

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My Rules of the ER

A guest post by Hueydoc After almost 30 years in the ER, I have found that many of the Rules from “The House of God” are oh so accurate. But let me add a few new ones, based on my own experiences: 1)  The correct answer to any problem is “Whatever screws the ER the most”. All policies and procedures end up leaving the patient as the ER’s problem. Period. 2) The staff in the ER are the only people in the county who are responsible for anything. Not the nursing home. Not the police. Not EMS. 3)  Yes, it is true that if you say “Boy, it sure is quiet tonight,” you will immediately experience the worst night in the history of the hospital. This is also a felony — punishable by death in certain states. 4)  The quickest cure for severe diarrhea is to ask the patient for a stool sample. 5)  No hospital policy ever changes until an administrator is a patient and is adversely affected by the policy. 6)  Administrators will never back you up. Ever. Get used to the view of the underside of the bus. 7)  When you are firmly convinced that the patient with the bizarre complaint is a crock, you’ll be wrong.  When you are firmly convinced the narcotic seeker is finally legit, you’ll be wrong. 8 )  If you page two different doctors, both will call back at the same time, no matter how far apart you paged them. 9)  The more demanding a patient is, the less likely it is that they need medical care. 10)  I have never, EVER seen a patient who told me “I can’t afford this medicine – you have to give it to me” who wasn’t smoking 2 packs a day. When you point out to them that they are spending over $200 a month to kill themselves but can’t afford their $4 prescription, they either get very upset or sit there with their mouth open like a stunned fish. 11)  NEVER ever go to work sick. Not only will it be an incredibly busy day, but you will be sicker than most of the patients you see. 12)  All ER physician schedulers are either hopelessly clueless, or evil and insane. I suspect the latter in most cases. 13)  The more difficult the stick, the more likely the lab is to lose your patient’s blood sample. 14)  There is a sensor on the bottom of the doctor’s bed that, when the doctor actually lays down, activates a Batman like beacon into the sky advertising “Free Vicodin” to the entire community, resulting in numerous patients suddenly checking in to the ER. 15)  No extra shift that you reluctantly volunteer to work will ever be an easy shift. 16)  You are more likely to see Elvis in the ER than a staff pediatrician. 17)  No specialty will complain about the treatment their patient received in the ER more than the pediatricians – yet pediatricians are most likely to dump their patients in the ER. 18)  The nicer the patient and family, the worse the outcome will be. 19)  I can not tell the difference between very rich patients and very poor patients – they both act the same. “When it comes to my health, money is no object!” Feel free to add your own!

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Just so that everyone doesn’t think I’ve bitten the dust … Surgery went fairly well. First couple of days post-op were a blur. Developed a post op ileus which resolved by Day 4. At home now and trying to get my body to heal. Had a little setback when part of the surgical wound popped open and began draining clear fluid. Guess I’ll have to hold off on doing those upside-down crunches for a while. Jotted down a few notes while in the hospital and will try to put them to a post in a few days. Thanks to everyone for their e-mails and text messages. All the positive energy gets directed right to the surgical site. And as an added benefit, they make me smile. Will try to get back to regular posting soon.

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REPOST – Fix the Problem, Doc!

One of my favorite stories. Originally posted October 2007 An old fellow got brought in by ambulance. His wife was waiting for him as he rolled into the room. A tire fell off of his bicycle, he fell, hit the curb, and got banged up. Ripped his shirt, ripped his pants, knocked the lens out of his glasses. He had a good sized hematomato and laceration to the side of his head. And he was not happy. The paramedics sarcastically told us “he’s in a good mood.” He wouldn’t give the registration clerk any information at all — his wife had to give us his name. Taking his vital signs was a chore. The nurses tried to get a history from him. In a gruff voice, he would tell them “There’s nothing the matter with me!” One of the laws of nature is that defecation follows gravity down an incline. In other words, now it’s my turn to deal with him. The way my day was going, I was not in the mood for an argument. I walked in the room and his is sitting on the bed. Fully dressed in ripped pants and torn shirt. Cervical collar in place. Obviously upset. Doing his best to fiddle with his glasses without being able to move his neck. I asked him why he was so upset. “There’s nothing the matter with me, that’s why!” “Well you have a nasty looking cut on the side of your head that I need to fix up. That looks like a problem.” He was obviously tuning me out. Still fiddling with his glasses. I cleared his cervical spine and took off his collar. “Can I look over the rest of you to make sure nothing else is hurt?” “I just want to get out of here.” Still no eye contact. As he was trying to pop the lens back in the frame of his glasses, the lens popped out again and dropped on the floor. I picked it up for him. “Can I see your glasses for a second?” He stopped, frowned for a second and handed the frames to me. While I continued getting a history from him, I washed the glasses off in the sink, cleaned them with a washcloth, bent them back into a pretty good semblance of their proper shape, and (with a little difficulty) popped the lens back into place. Then I handed them back to him. “You know, I’ve been fiddling with these ever since the ambulance came and got me. You’re the first person who even tried to help me with them. Thanks, doc.” All of a sudden he was a different person. Laughing, smiling, even cracked a joke. We got his head fixed up, radiated, and he was on his way. His eye was already starting to swell up, but as he was walking out the door, I got a nod, half a smile, and a wink from behind that scratched glass lens. That was a therapeutic encounter for both of us.

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Healthcare Update — 03-28-2011

Johnny Stickyfingers. Patient in Chicago suburbs arrested after breaking into a code cart and attempting to steal an I.V. catheter syringe, tourniquet band, roll of clear medical tape, several electronic monitoring pads, assorted bandages, and 25 thermometer probe covers. What was he going to do with these things? Montana is the latest state to consider increasing the level of negligence for EMTALA mandated care to “clear and convincing” rather than ordinary negligence. Montana’s trial lawyers object to the bill, stating that it will make it much harder to pay for their multimillion dollar ranches “provide unmerited protection for those folks who really aren’t doing their job.” What’s wrong with Obamacare? Authors of the book “ObamaCare Is Wrong for America” say that, among other things, it will “cause a staggering increase in the national deficit, will limit the creation of new jobs by discouraging companies from hiring, and will cripple innovation and research.” Indiana family awarded $13 million after physician fails to diagnose lung cancer in family member. Doctor still faces more than 350 malpractice suits against him. New Jersey family awarded $8.5 million in settlement for child born with permanent brain damage allegedly due to delays in performing a Caesarian section. Law firm plans to file class action suit against West Virginia hospital for overradiating patients during CT scans. Chicago area man gets charged with felony and possible five years in prison for threatening to kill judge because the judge’s scolding “made him cry.” Of course, when patients threaten to kill hospital employees, the hospital employees get in trouble for not “empathizing enough” with the patients and the patients get flowers sent to their homes because their low satisfaction scores forced them to threaten the employees. Sounds to me like all those sissy judges need to toughen up a little. What stresses out surgeons? Phone calls? Fresh air? Patients? All of the above? According to the conclusions of a study in the Archives of Surgery, “surgery was associated with stress on surgeons ….” Longer surgeries and increased patient blood loss made the stress even worse. The next wave of superbugs hits California. Carbapenem resistant Klebsiella pneumonia. The infection is resistant to most antibiotics and about 40% of infected patients die. But hey – keep popping those Zithromax and Levaquin prescriptions for your coughs and nasal congestion. CRKP is already resistant to those. The only thing that will cure it is colistin which, in one study, caused renal failure in 27% of patients who took it. Violence against women increases by 10% on days in which an underdog beats the home team in NFL football. The logical response: Have JCAHO ban the NFL as a patient safety violation. Look at all those “never events” we could prevent. If you build it, will they come? Cayman Islands looking to increase medical tourism by decreasing prices, limiting medical malpractice awards, changing doctor registration laws and changing organ donation laws.

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