Authentic Medicine Blog

AP article and new location

noreply@blogger.com (Authentic Medicine Blog) — Mon, 19 Dec 2011 13:34:00 +0000

If you had read this story:

http://www.therepublic.com/view/story/1d27943cb29442cfb5a9b04429855707/ME--Funny-Doc/

Then please check us out at our new location at:

www.authenticmedicine.com

Authentic Medicine Blog Has Moved

noreply@blogger.com (Authentic Medicine Blog) — Thu, 01 Dec 2011 00:32:00 +0000

At this time everything from this blog is being switched over to:

www.authenticmedicine.com

Please follow me there for:

1. Daily Blogs

2. Observations

3. Medical Humor

4. Video bits

5. Much, much more!

Thanks, Blogger, for all the good times but it was time to change.

Authenticmedicine.com

noreply@blogger.com (Authentic Medicine Blog) — Wed, 30 Nov 2011 11:20:00 +0000

I will soon be moving this blog and a lot of my other works to www.authenticmedicine.com. I am in the process of building this site now and hope to get it launched for the new year. I also will be doing some videos that talk about and mock some of the lunacy in our healthcare system. That will go on there as well. I would be honored if you can check out the site and tell me what you like or dislike so far. Also, any recommendations for adding stuff would be great. For example:

1. listing of docs doing cash pay practices

2. classified job listings for docs

3. more stuff from old PJ

4. anything else you think

You get the drift, right?

A New Video by ZDoggMD

noreply@blogger.com (Authentic Medicine Blog) — Tue, 29 Nov 2011 10:13:00 +0000

Marriage bliss between two physicians!

Fraudulent Fraud Finders

noreply@blogger.com (Authentic Medicine Blog) — Mon, 28 Nov 2011 10:23:00 +0000

Here is some reassuring news. Contractors paid by the government to detect fraudulent Medicare claims used inaccurate data. The Department of Health and Human Services cited repeated problems and systemic failures by federal health officials to supervise these contractors who were paid tens of millions of dollars. In summary, the fraud finders were actually defrauding the public as well. What's next? The government will hire some contractors to examine the contractors who were hired to examine the Medicare data? It could keep going like an M.C. Escher painting.

Once again the common theme is "inaccurate data" and yet we move full speed ahead with quality initiatives that are unproven and quite possibly fraudulent. These same contractors will be in charge of interpreting other data used to see which doctors are supposedly good or bad. Still not buying it.

Gobble, Gobble!!

noreply@blogger.com (Authentic Medicine Blog) — Thu, 24 Nov 2011 13:04:00 +0000

Happy Thanksgiving!!

Enjoy your family, friends, football and food.

I am off until next Monday. See you then.

Cutting the Cost of Medical Care by Ted Bacharach MD (retired)

noreply@blogger.com (Authentic Medicine Blog) — Tue, 22 Nov 2011 12:48:00 +0000

One of the ways it was thought medical care costs could be decreased was by cutting the cost of hospitalization. The simplest way this could be accomplished was felt to be by limiting hospitalization. If less people were hospitalized it should cost less. This it was felt could be accomplished by getting patients out of the hospital sooner, thus lessening the cost of hospitalization. To accomplish this hospitals began to employ “discharge coordinators”. The “discharge coordinator” was charged with making rounds daily on all hospitalized patients and if they did not require monitoring or i.v.’s they should be discharged. Another way to limit hospitalization was to set a predetermined number of days for certain diagnoses. If the hospital could get the patient discharged even sooner than the allowed number of days they could reap better financial benefits.

The result of these measures has not shown to be significant judging by the rapidly increased costs of hospitalization nor the increased overall cost of medical care. The simple solution that when you buy less of something it should cost less has not been true in this instance. Why??

Medicare has allowed a certain number of days for patients having a hip replacement, regardless of age, other medical problems or complications. On a trip to India I was surprised to learn that for a hip replacement a 10 day stay was mandatory to observe for possible post operative infections and to be sure that starting physical therapy is started promptly.

Less days of hospitalization should result in less cost. This has not occurred as the cost of hospitalization has risen as the cost per day of hospitalization has increased rapidly. If the severity of the illness and the requirements for increased care increase the cost of hospitalization will rise rapidly. More nurses, more care all cost more. The savings expected have not occurred and may well have resulted in unexpected results. Patients discharged early may well have unanticipated infections as well as other complications. Re-hospitalizations increase and occasionally outcomes are less favorable.

The cost for hospitalizations depends on the medical and nursing facilities required by the patients being taken care of, and the number of individuals being needed to provide for their care.

Reasonable care should be determined by the physician. Hospitals and insurance companies should not determine length of hospitalization.

School Lunches

noreply@blogger.com (Authentic Medicine Blog) — Mon, 21 Nov 2011 13:38:00 +0000

How sad is it that there is a real food fight going on between Congress and the Obama administration on what to feed our kids in school. The debate is around the free lunch program and what counts as a vegetable. It seems Congress has sided with ConAgra foods in deeming pizza sauce a vegetable. OMG! This is how bad it is getting. Our politicians are so bought out that they have to agree that tomato paste should count as a vegetable. One of their arguments (which is sadly valid) is that kids just throw away the other vegetables so pizza is all they will eat. What chance does this country really have to fight the diabetes and obesity epidemic when we are down to one food group and that is crappy pizza? And last I remember the tomato was actually a fruit!!!

Human Touch

noreply@blogger.com (Authentic Medicine Blog) — Sun, 20 Nov 2011 13:47:00 +0000

I like to point out other industries as comparisons to the healthcare system. It is important to realize that you can learn from them. Heck, hospital administrators and managed care executives do it a all the time as they try to tinker with (read: f%ck up) our industry and justify their exorbitant salaries. Here is an article in the USA Today talking about the banking industry. One can argue that no one really needs a brick-and-mortar structure with bank tellers anymore but it isn't true. As the article states, customers value the human touch. If that is true in such industries in banking then it is exponentially true in healthcare. Virtual medicine is just not going to happen.

Cholesterol Testing for Children

noreply@blogger.com (Authentic Medicine Blog) — Sat, 19 Nov 2011 14:48:00 +0000

The National Heart, Lung and Blood Institute and the American Academy of Pediatrics have come out with the recommendations that the first cholesterol check should occur between ages 9 and 11 and the test should be repeated between ages 17 and 21. Wow. That is what it has come to? We are unable to hold back the tide of obesity and now we are going to get kids on statins. I see a massive controversy coming and I see a lot more money being spent on testing. I am sure the labs around the country are salivating over this. Instead of figuring out why our kids are so fat with high cholesterol and more diabetes we are instead doing more testing.

The "guidelines seek to address lifestyle factors from birth with a recommendation that babies be breastfed, adding that after age 1, children can be given low-fat milk and after age 2 can be given fat-free milk". Is that so? I thought kids need fat for their brains. In fact, there is more and more evidence that the appropriate fat (even saturated fat) is not the issue causing obesity. Read this article about skim milk versus whole milk.

It seems to me that our whole grain and low fat recommendation has been an utter failure. I have a 1% success rate in getting patients healthier on this diet. Maybe, just maybe, carbs are the issue. We may want to delve into that before we have every kid in this country on a statin.

Compliance and the Doctor

noreply@blogger.com (Authentic Medicine Blog) — Fri, 18 Nov 2011 10:25:00 +0000

It is a well known fact that patients often don't fill their prescriptions or even take the medicine if they do fill them. That is what makes it so insane to "grade" doctors depending on their patients' cholesterol, blood pressure, blood sugar average, etc. In a study involving patients who had a recent heart attack, only half of them took the statin, beta blocker and aspirin recommended. Even better, the medications were given to the pateints for......FREE!!!!!!! Maybe this is a problem with communication? I doubt it as this was a study and they have more time to explain things and educate the participants. Maybe this is a cultural issue? Who knows but to give "quality" grades to doctors that depend on patients' compliance is like basing an educational system where teachers are paid depending on what tests scores the students achieve. Who is crazy enough to do that?

We are heading towards "No Patient Left Behind" which will fail miserably.

Fired For Refusing Immunizations

noreply@blogger.com (Authentic Medicine Blog) — Thu, 17 Nov 2011 10:44:00 +0000

I have fired patients before in my career. The main reasons are:

Abusive to the doctor or the staff
Narc seeking or selling

This article in the USA Today talks about how more and more pediatricians are firing patients (parent and kids) who refuse to get their kids vaccinated. As brutal as this may seem, there is now MORE than enough evidence showing that there isn't any link between vaccines and autism. Pediatricians, as this article states, are just fatiguing on this issue and are willing to let families find healthcare in other places if mom or dad disagree on this issue. I believe these docs have a valid point but firing them seems kind of harsh. Maybe pediatricians just don't have enough patients who are:

Abusive to the doctor or the staff
Narc seeking or selling

If they did they may get a better perspective on who they should keep or not.

What If Committees Were Wrong?

noreply@blogger.com (Authentic Medicine Blog) — Wed, 16 Nov 2011 10:35:00 +0000

About ten years ago an important committee recommendation from the American Heart Association came out to endorse the switch to automated defibrillators in hospitals taking out the "human" variability. It was done on a hunch that these new devices would make their use speedier. The problem is that evidence now shows that they save fewer lives. It seems the decision by the brilliant experts was made without clinical research answering a crucial question: Did the new devices, when used in hospitals, produce better results than the old equipment? Huh, seems like a valid question. Now, a 1000 more patients die every year. Interestingly enough, a quarter of the members of the heart association committee that recommended the automated defibrillators had business ties with manufacturers of the devices. Pathetic.

In my humble opinion, there are too many chiefs wanting to make the big decisions to justify their salaries. Regardless of whether these members were paid off, it bothers me that any new technology is just assumed to be better than what humans can do. Isn't this really the trend we are seeing in all of medicine? Idiotic and overpaid administrators, which are multiplying as we speak, want to get rid of the doctors and bring in the computers. This AED example is just the kind of thing that happens when you do that.

Makes Us Look Bad

noreply@blogger.com (Authentic Medicine Blog) — Tue, 15 Nov 2011 10:34:00 +0000

In a recent JAMA study on 17,847 patients who had cardiac bypass surgery or coronary angioplasty, it was found that doctors prescribed nuclear stress tests and/or echocardiograms later than 90 days after discharge more often if they had financial interests in the tests. For stress tests, it was 12.6 percent of docs who prescribed the test versus 5 percent of those who were not paid for testing. For echos, it was 2.8 percent versus 0.4 percent. This sucks. It makes us look bad. Doctors are human and if they are on the fence in any way about doing a test then it seems they will lean towards ordering what pays them better. That being said, there are some outliers in any occupation who just don't care and abuse the system. Also, some teaching programs don't follow the same rules. Heck, I remember in medical school the hot shot cardiologist ordering an "echo, Holtor, MUGA" test on EVERY patient. And he was the chief editor of Circulation, a prestigious journal! Yes, I am well aware that mentioning the MUGA test does give away my age.

Don't Believe The Hype

noreply@blogger.com (Authentic Medicine Blog) — Mon, 14 Nov 2011 12:07:00 +0000

A job search portal called CareerCast.com has a list with the twelve jobs that are "traditionally believed to be great occupations but that actually look a lot better on paper than they might be in reality". Looks like being a physician made the list. Sadly, I am not convinced they are wrong.

Do We Really Need To Study This?

noreply@blogger.com (Authentic Medicine Blog) — Sun, 13 Nov 2011 11:21:00 +0000

It turns out that men who have sex with animals (SWA) are at risk for penile cancer. Boy, I am sure glad this is being studied. Do the researchers think that those people who engage in this type of activity are now going to think to themselves, "Well, I would like to have sex with that goat and I can get past the social stigma and grossness of the whole concept but, heck, I sure don't want to get penile cancer. I'll just stop". I don't think so.

No Protection

noreply@blogger.com (Authentic Medicine Blog) — Sat, 12 Nov 2011 11:28:00 +0000

I have always felt that my safety is at risk as a physician. I have seen some very interesting characters in my day and have been threatened numerous times with violence. Most or all of this revolves around chronic narcotic seekers. I am not alone. When you read this article about how ER nurses have to endure spitting, cursing and violence it really makes you sick. The problem is that it never changes. Hospital administrations do the bare minimal to protect their people and little more. In a recent survey, more than half of nurses in the ER -- 53.4 percent -- reported experiencing verbal abuse and about 13 percent said they had encountered physical violence at work in the previous week. Wow. One nurse had a patient who was drunk and high on drugs grab her around the neck, choked her until she couldn’t breathe and then spat in her face. The hospital wanted her to drop assault charges against her attacker and then fired her when she refused. Feel secure yet? Want more? An unidentified man fired a gun inside an ER in a Bronx hospital leaving a 37-year old nurse and 42-year old security guard wounded from the ricocheted bullets. This job is tough as it is. Our personal safety should not be at risk as well. Anybody else have some war stories that they want to share?

Making The Tough Call

noreply@blogger.com (Authentic Medicine Blog) — Fri, 11 Nov 2011 10:41:00 +0000

We only have limited funds to pay for our healthcare system. Actually, we have no funds, but that is another story. Time and time again we are told that our system is way too expensive and I agree. There are tons of reasons why this is true but part of the problem is the inability to make the tough calls. We cannot change our minds about mammogram frequencies because it is a politically incorrect decision. We do studies showing that CT scans can find lung cancer earlier in smokers but is that really where we want our money going? Now comes a study trying to make the argument that non-sober alcoholics should still have the right to get a new liver after they destroyed the one they have. To be fair, this was not an American study but the point is the same. Where does one draw the line and still remain humane?

Dr. Walmart

noreply@blogger.com (Authentic Medicine Blog) — Thu, 10 Nov 2011 10:31:00 +0000

It looks like Walmart wants to be in the healthcare business. NPR reports that Walmart "wants to dominate a growing part of the healthcare market, offering a range of medical services from basic prevention to management of chronic conditions like diabetes and heart disease". Remember, it started with little quick care clinics and now they want to do chronic disease management. Weird, huh? I wonder if it is going to work.? Walmart is good at what they do. They sell cheap wares because they squeeze suppliers with bulk purchasing. How that carries over to healthcare is beyond me but if anyone can pull it off it would be them. It is reported that they intend to build a national, integrated, low-cost primary care healthcare platform and become the largest provider of primary healthcare services in the nation. In a shopping store? One can imagine the payer mix of their customers! Something tells me this could be Walmart's Netflix moment. Or, better yet, Walmart's Waterloo.

Interestingly enough, Walmart has backed off and are now denying they want to dominate the healthcare system and the information put out by NPR was "overwritten and incorrect". Not buying it.

We Promise

noreply@blogger.com (Authentic Medicine Blog) — Wed, 09 Nov 2011 10:20:00 +0000

Here is an interesting article in the Boston Globe about "alarm fatigue". It details the problems behind having so many monitors on so many patients . This results in nurses who are constantly dashing to see patients for overly sensitive warnings. Why so many alarms? Lawsuits and CYA. There is a risk to the patient’s safety if they made the monitor less sensitive but there is also a risk of desensitizing the nurses. So what is the answer? Get ready:

A new “we promise’’ campaign requires a nurse or technician to ask a patient every hour whether they have pain, need a drink, or require help using the bathroom — a program intended to reduce falls but that nurses on LaRocca’s floor said also has reduced bed alarms and call button alerts. The cardiac unit has hired a monitor technician who sits at the central nurses’ station to help triage the alarms.

I understand the need for better systems to improve patient care and safety but look at what they did. They added more responsibilities to already overworked nurses. Also, you will see the word "technician" used twice in the above section. Can you see a trend? Why not hire more nurses so they have less patients to care for? Then you wouldn't have to pay a consultant, form three committees, create two action groups and hire three new administrative positions to oversee this issue. You would have enough nurses who just care about people that they would naturally do their job and do it well.

Sugar Sweetened Beverages

noreply@blogger.com (Authentic Medicine Blog) — Tue, 08 Nov 2011 10:55:00 +0000

A new study found that school bans on sugar-sweetened beverages (SSBs) made no difference on the amount the students drank. About 85 per cent of students reported consuming sugar-sweetened beverages at least once a week and 26 per cent to 33 per cent of students reported daily consumption.
The report in the newest issue of the Archives of Pediatric and Adolescent Medicine also suggested that students who often drank the beverages increased their consumption outside of school when they couldn't buy them in school. Wait a minute. Does this mean that there should be responsibility for a child's health from home? What is this world coming to?!?

Worthless Accreditation

noreply@blogger.com (Authentic Medicine Blog) — Mon, 07 Nov 2011 10:40:00 +0000

A recent study found that rule changes that allowed Medicare to pay for laparoscopic adjustable banding, which is less invasive than gastric bypass, brought the cost down significantly and cut the amount of deaths in half. This sounds logical. If Medicare can be flexible enough then elderly patients can be steered to the safer, easier and cheaper procedures. What was really AMAZING about the study, however, was that it made little difference to cost or safey whether the surgery was done in a accredited institution. Hospitals receive accreditation through the American College of Surgeons or the American Society for Bariatric Surgery by performing a certain number of procedures each year and by having staff and facilities that meet certain standards. Wouldn't that be weird? All these third parties making tons of money "accrediting" institutions, all the while driving the doctors and staff nuts and creating more and more administrators, could be worthless? I am officially asking the world to produce a study proving whether the time, cost and effort of using the Joint Commission (or pick another company) is worth it or not. I think it is time for them to be held accountable as well.

Chinese Medicine

noreply@blogger.com (Authentic Medicine Blog) — Sat, 05 Nov 2011 10:20:00 +0000

You may want to think twice about getting your medications on the internet. Actually, do I really need to write that? It should be obvious. Who knows where these pills come from or what is in them? If it is from China, like almost everything else, then you may want to worry. Police in China have seized more than 65 million fake pills and arrested 114 suspects during a four-month investigation into counterfeit medicine. These repackaged drugs were found to contain found animal feed, chemical pigments and other ingredients that are harmful to people. Think about that the next time you pop an unauthorized erectile dysfunction drug or else don't coming running to your doctor when your penis falls off. Actually, I am not sure if that has ever happened but you get my point.

Circling The Wagons

noreply@blogger.com (Authentic Medicine Blog) — Fri, 04 Nov 2011 09:27:00 +0000

The phrase "circling the wagons" comes from the Wagon Box Fight in 1867 where an amazing battle of 32 soldiers and workers held off over 1000 Indians. By barricading themselves behind behind wagon bodies that had been removed from their running gear, they held off several thousand Sioux and Cheyenne, attacking in waves of several hundred at a time, for over four hours. In a similar move, the number of physician practices involved in mergers and acquisitions in 2011 has already beat the numbers from 2010. This only accounts for large and publicly announced deals so there probably are a lot more. Hospitals are the ones accounting for most of these purchases. Why? The new healthcare reform act. It seems to be forcing this awkward relationship so that docs and hospitals can "circle the wagons" which would allow them both to defend themselves against the savage regulations on the attack. But with wave after wave of useless bureaucratic bullsh%t, I would say that they don't have a chance.

Medicare Fraud

noreply@blogger.com (Authentic Medicine Blog) — Thu, 03 Nov 2011 09:49:00 +0000

The Feds are at it again. Agents "swarmed in" and arrested 12 people on charges of running Medicare fraud schemes that defrauded the government and us out of $95 million. Hooray! Some of those arrested included three medical doctors, a doctor of osteopathy and a chiropractor and maybe a partridge in a pear tree though I am not sure about that last one. The Feds have their own task force to get people like this and so far have charged more than 1,130 defendants across the country with false billing. These cases really seem egregious and thankfully they were solved. That being said, what about those little cases? What if the Feds get frisky and are really want to make some money? Physicians do their best to code each visit but what if the Feds hire bounty hunters to go in an aggressive audit docs and find stuff that was not to their liking? I am talking about doctors who are not malicious but just aren't great coders. Or, what if companies that are hired by docs or their employers to aggregate data to report to the CMS for "quality" bonus monies make mistakes? With this new P4P trend there is a lot of cash at stake and docs seem to want it. It sure seems some fudging may happen. Could CMS send people to "swarm" in on them? I would think not but I do think we could end up with another slippery slope here. Where is Nucky Thompson when you did him?