Middle Man Mess

TCS: Tech Central Station – Middle Man Mess

If employers bear the cost of health insurance, then I’m the Easter Bunny. It is fairy-tale economics to believe that “nice” employers give away health insurance, while “mean” employers withhold it. In reality, employers compensate their employees using a combination of cash and non-cash benefits. Workers bear the cost of health insurance.

As an Independent Contractor, I buy my own insurance; it’s high-deductible, and it’s expensive. Is it worth it? Hard to say, but I don’t want to be left without it.

I just saw a guy lose the Gold

…and I couldn’t feel worse for him. FOXSports.com – Emmons loses gold medal after aiming at wrong target
Ahead by a comfy margin with 1 shot left, he basically just had to hit the target for a gold. He hit the target, all right: his neighbors’ target. There’s a D’oh! moment.

He already has a gold, so he’s not completely left out, but I cannot imagine how many times he’s going to kick himself in the next few decades.

I’m kicking myself out of sympathy, that’s how much it hurt to watch it happen.

Same Day Doctors Catching On

CNN.com – ‘Same-day’ doctors catching on – Aug 21, 2004

The idea, which experts say is gaining steam, is that scheduling patients immediately for even routine physicals will keep them healthier and happier, while saving money in the long run. If people know they’ll get quick appointments, the reasoning goes, they’re less likely to ignore their health problems, which will reduce costly emergency-room visits.

“We’ve seen it work in every kind of clinic imaginable,” said Marie Schall, a training director at the Boston-based Institute for Healthcare Improvement, an organization pushing for same-day service, known in the industry as “open access.”

I’d love for this to really catch on, but I’m also afraid I’d starve to death. As much as all of us in the ED gripe about ‘urgent care’ patients with complaints that could easily be handled by their doctor, we also know that they pay the bills. Multi-trauma doesn’t pay the bills, and the few deaths-door patients we see wouldn’t pay to keep the lights on, so we need the urgent care patients.

I like the idea, though.

Happy Birthday, Mom!

Happy Birthday, Mom!

Marvalynn's Wedding, 1969?

Wow. #1 on Google

So, you type in “doctor blog” into the search engine: Google Search: doctor blog
And who’s number one? Yr. Hmbl. Svnt.

And many thanks to the five of you for reading!
[Read more...]

First HIPAA Conviction

symtym links to the first ever conviction under the new HIPAA laws.

…age 42, of SeaTac, Washington pleaded guilty today in federal court in Seattle to wrongful disclosure of individually identifiable health information for economic gain. This is the first criminal conviction in the United States under the health information privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA) which became effective in April, 2003. Those provisions made it illegal to wrongfully disclose personally identifiable health information.
As set forth in the Plea Agreement, (criminal) admitted that he obtained a cancer patient’s name, date of birth and social security number while (criminal) was employed at the Seattle Cancer Care Alliance, and that he disclosed that information to get four credit cards in the patient’s name.

The case looks open and shut, and the defendant plead guilty, so that takes care of the “did he do it” thing.

The part of this that bothers me is that what he did was plain old identity theft, which is a crime all its own, and is covered by a lot of laws having nothing to do with medicine. My legally-uneducated mind thinks HIPAA was used because it is much more ‘guilty until proven innocent’ than a more conventional criminal charge.

I could be wrong, and I really hope I am, but this HIPAA law was written by and for lawyers, and patients and their healers are second-thoughts.

Oh, and join me in begging Symtym to change the colors on his blog (or do what I do, use Opera and turn off the style sheet, or use Firefox and apply your own style sheet). That white and purple on black is hard to read.

Updated to include the facts of the case, at the behest of Dr. Winters, whose blog is still malfunctioning.

More tips from the Nurses

I was perusing the contents of a “transport box” the other day, and marvelled that there were so many drugs in it. This isn’t our code/resuscitation box, this is taken with the patient when a transport is made from ER to another critical care area.
push faster, please

I mentioned the surplus of meds to the senior (but very very youthful) nurse present, who held forth with the following advice: “If you use this many drugs, you’re not pushing fast enough”. Words to live and transport by.

A Colleague Returns

The colleague who told me the Fort Worth ED Truism left our hospital last year, as he wanted a chance to be an ED Director. He’s accomplished what he wanted to do, and found it to be dull after that, so he’s coming back to work with us!

This is a little problematic, as we’ve hired a replacement, and would never let someone go in this circumstance (it’s not up to me, but it’s not that kind of a group). So, he’ll be part-timing all over the groups’ system until something opens up.

Anyway, it’ll be nice to have him back. Not only is he terribly smart, he’s personable and entertaining. Welcome back, Tad!

Another PSA: Helmet Wear

In my series of Public Service Announcements, this is one that I feel strongly about: if you’re going to try assisted suicide motorcycle riding, please Wear A Helmet.

A visual reminder:
scarred but alive
This rider went home with scrapes and bruises, but he went home. And he didn’t have a head injury.

I cannot tell you how many tearful families have told me “…he has a helmet at home”. So, put it on.

MJ’s shoulder wasn’t dislocated?

CNN.com – Report: Jackson not ‘manhandled’ in custody – Aug 19, 2004

The article mentions an investigation into allegations made by permanent child Michael Jackson that he was “manhandled” by the cops when originally arrested. I called this BS when he did it.

His foray into victimhood didn’t turn out like he wanted.

Homeland Security Failure?

The Onion | Local Sheriff Suspects Al-Qaeda Or Teens


hat tip to Richard[Winters]

Fort Worth has the most dangerous…

Just as I began working here, one of my colleagues related a truism to me:

“Fort Worth has the most dangerous spiders, porches and WalMarts in the world.” His observation has been borne out many times over.

Everyone in Fort Worth with a skin abscess (and there seem to be a whole lot of them) was ‘bitten by a spider’. Many were probably not bitten in the shower, if you catch my drift.

A terrific number of orthopedic injuries are caused by ‘falling off the porch’. I have no idea why our porches are so dangerous.

And I think I have seen everyone who has slipped and fallen at a WalMart for the last two years. I don’t see that many people who slip and fall at Target, or Sears, etc, just WalMart. I don’t know why, either.

So, there you are. While visiting Fort Worth, just avoid this dangerous triad, and enjoy your stay!

Is this your Liver Donor Card?

CNN.com – Man launches multimedia search for liver – Aug 12, 2004
Reminding me darkly of a Month Python sketch, this unfortunate has liver cancer, and has to get a new liver or die. It’s that simple.

I applaud his, and his families’, courage and determination. I know I’d do everything possible to get a transplant for my family member, so this makes sense on an emotional level. Also, as has been pointed out, even if the individual seeing tthese ads (billboards in Houston) doesn’t have a spare liver, it will sensitize them to the issue of transplant waiting lists, etc.

Setting emotions aside, this should not change what we do in the ED, or in the organ donation organizations. I understand the idea of directed, non-family donations, and I also understand that the organ donor organizations don’t want to say “no, this recovered alcoholic will die this week without a new liver, while your relative has several weeks left.”

I’d be interested to know whether this aspect of their approach makes you more or less interested in a directed donation: from their site:

You can help! Unfortunately, tragedies happen every day. If you hear of anyone that is in a situation where they could be a donor, they or their family can request that the liver be designated…

What do you think?

Update in the comments.

Very funny (Inside) Medical Joke

code: theWebSocket; ?Dying patients and their physicians

The article he discusses from MedRants is a thinker of a piece, but the joke following is priceless.

Best EMS Chief Complaint of the night

Last night, an exasperated Paramedic made the following call in to med control: “we’re bringing in a 30y/o male with a mosquito bite on his butt”. When asked for details, like vital signs, etc, the reply was “I’ll tell you when we get there”, in a tone that communicated a lot more than the words.

Yes, Virginia, people call the ambulance for all manner of complaints; most are reasonable, but some are just stupid. Like people, I suppose.