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Tag Archives: News Commentary

No Health Care

Three recent published articles about the health care crisis caught my attention while surfing the internet. First, in the article “Forget good; any doctor is hard to find,” a mother laments because she has to drive all over the Coachella Valley in California to find a doctor to evaluate her 2 year old child with a cough. After going to four different providers, she finally went to the emergency department and was seen by a PA because “a good doctor is hard to find.” I sympathize with her, but if you read the article, it wasn’t that she couldn’t find a physician to see her child (although a couple of the clinics she went to didn’t see children under 3 years old). The problem was that the physicians that *were* available didn’t take her insurance and she didn’t want to pay out of pocket. The article did not say what type of insurance she had, but my guess is that the insurance was MediCal. Given the low payments MediCal makes to physicians, fewer and fewer physicians are willing to accept it. This mother’s ordeal just highlights the fact that universal coverage doesn’t mean much if no one takes your insurance. Kind of like having $10,000 worth of Japanese yen in your pocket and trying to buy a hoagie in downtown Pittsburgh with them. Another article that caught my eye was from Canada, where protesters were planning a sit-in at a hospital emergency department because the hospital will longer perform emergency surgeries and will instead ship the emergency cases to another hospital across town. If there is no incentive to provide emergency surgeries, then it is difficult to force a hospital to continue performing them. The article also notes that several other hospitals in the area have already stopped performing emergency surgeries – also deciding to ship them to different facilities. As fewer and fewer facilities perform emergency surgeries, more and more emergencies will pile up. At some point it will be a case of “when everything is an emergency, nothing is an emergency.” Think that care will be good? But at least the care is free … right? Then finally was the article from Florida’s Gainesville Sun, titled “ER care for kids ‘stinks’“. Fewer and fewer specialists are willing to take call from the emergency departments and there is difficulty finding emergency specialty care for children. The unfunded federal mandate EMTALA is backfiring. If you’re an “on call specialist”, EMTALA requires you to provide emergency stabilizing treatment for any patient that needs your services – even though many patients needing emergency services will never pay their bill and can sue for millions of dollars if the care they receive is not deemed adequate. So specialists just stop taking emergency calls. Now emergency physicians treating people with emergencies scramble to find emergency specialist care when in some subspecialties, there is little or no emergency care nearby. Neurosurgery, obstetrics, and psychiatry are just a few of the specialties in very short supply in some states. In trying to legislate “perfect” and “equal” care for all, now more and more people are finding that there is “no” care for anyone.

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Avoidable Medical Mistakes

Emergency Emily sent me a link from Woman’s Day Magazine titled “25 Most Avoidable Medical Mistakes” The article is actually pretty good, although the title is a little misleading. It actually contains 25 “self-help” tips that patients can use to improve their own medical care. Don’t double up on medications, get a living will, keep your personal health records up to date, fight insurance denials, get a primary care physician (if you can find one) are just some of the recommendations. Out of 25, the only one I “kind of” have an issue with is recommendation not to ask for antibiotics for sniffles. The article is very clear about stating that antibiotics don’t work for a cold – even putting the statement in italics. The article also correctly notes that the increase in inappropriate antibiotic use contributes to a widespread increase in drug-resistant bacteria. But it drops the ball when it states that “If you develop a persistent fever, or have discolored phlegm or sinus pain, you probably need antibiotics.” Discolored phlegm and sinus pain may be signs of sinusitis or they may not. But even if you have a true “sinus infection”, antibiotics are not proven to help. Bust out the nasal decongestants and nasal washes. The comment section to the article also has some other good ideas, including having a “patient advocate” if you are hospitalized. Unfortunately, some of the other comments to the article also show how far the respect for the medical profession has fallen in the public’s view. Sad.

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You Get What You Pay For

An article in yesterday’s Los Angeles Times titled “Pediatric care shrinks across California” shows that as funding for pediatric care has decreased in California, so has the number of hospitals that are willing to provide pediatric care. California’s reimbursement rates for children’s health care is ranked last in the country. It shouldn’t come as a shock that more and more hospitals are focusing on treating adults – because they get paid more for doing so. In the last decade, the number of children in California has increased, but the number of inpatient pediatric beds dropped by 19% – more than 800 beds. Sixty five hospitals either eliminated their children’s units or shut down altogether. The article states that “most counties north of Sacramento now lack even a single dedicated pediatric bed.” What happens when your child becomes severely ill and there are no pediatric ICU beds within several hundred miles? LA County – USC Medical Center dropped from 135 pediatric beds 2 years ago to just 55 beds now. There is now a question as to whether the LA County will be able to provide care for the 7,000 foster children treated annually at the Medical Center. The cuts may also affect pediatric training programs. The hospital now reportedly has the smallest university-affiliated pediatrics teaching program in the nation. The LA County Supervisor states that the program will become “noncompetitive to intern applicants except the poor performers from low-ranked medical schools.” One parent who brought her child to a hospital emergency department with no licensed pediatric beds describes waiting for 11 hours for her son to be seen and then noted that the medical providers “seemed unaccustomed to treating infants and had difficulty inserting an IV.” A Stanford children’s health policy researcher was quoted as saying “In California, things are a mess”. Once the balance billing issue takes full effect and emergency physicians are paid even less for the care they provide, I predict that medical care in California will be an even “bigger” mess. Is everyone starting to get the idea that you get what you pay for?

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Death By "Unvaccination"

An article recently published in the Minneapolis-St. Paul Star Tribune describes an outbreak of Hemophilus Influenza B (HiB) in Minnesota. There were five kids diagnosed with the disease last year and one 7 month old died from the disease – the first death from the disease in Minnesota since 1991. The article noted how Hemophilus influenza is “a disease that had been nearly wiped out across the United States after a vaccine that is given to babies in the first months of life was introduced in the early 1990s.” This CNN article also notes that “Before vaccines became widely used, about 20,000 HiB cases were reported each year in the country. After children began receiving the vaccinations in the early 1990s, CDC officials said, there was a 99 percent drop in cases.” Yup, you guessed it. Three of the five kids, including the 7-month-old who died, “had not been immunized because their parents did not want them vaccinated.” One of the other kids hadn’t received all doses of the vaccination, and the last child had an immune deficiency – making it less likely that the immunization would work. Should parents who fail to take steps to prevent a largely preventable illness be held accountable if their children suffer a bad outcome? As an aside, does anyone know the specifics of the “religious exemption” that some parents use to avoid vaccinating their children? Isn’t that kind of like stating that my religion prevents me from paying taxes?

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Does Refusing to Hire Smokers Amount to "Discrimination"?

The Los Angeles Times Health Blog posted an article about how increasing numbers of employers are refusing to hire people who smoke. Happy Hospitalist should have a field day with this one, given his previous thoughts on cigarettes. One company cited in the article doesn’t hire smokers, fires workers if they smoke during their non-work time, and even fires workers if their spouses smoke. Researchers studying the growing trend stated that firing workers because they smoke was “not appropriate” and that “widespread adoption of such policies may make smokers nearly unemployable, cause them to lose their health insurance and affect their health and that of their families.” News flash … smoking already does affect the ability of people to obtain health insurance and already does affect the health of patients and their families. Is there something about this concept that requires further study? Smoking decreases productivity while workers go on “smoking breaks,” increases health care costs for employers who provide health insurance, and may affect a company’s image if customers repeatedly witness a gaggle of employees outside puffing away at the “butt hut.” If it is OK to fire workers for having drugs or alcohol in their systems – even though they are not using these substances at work – why shouldn’t employers be able to include cigarettes as well? The authors note that smoking is a powerful addiction, but if people can’t get a job, they won’t have the money to purchase cigarettes and the problem will eventually take care of itself. Right now, employment is a buyer’s market. There are more applicants than there are jobs, so employers can be choosy. In the future, if employers with rigid requirements are unable to find enough employees, they may need to relax their standards. So is cigarette smoking another “right” that we need to add to the list, or are we just increasing the “nanny state” effect by micromanaging everyone’s lives? [wp_campaign_2]

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Do NOT Give This Kid A BB Gun

I just can’t help wondering – was it a “double dog dare“?

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