Our unrealistic attitudes about death, through a doctor’s eyes

We all die. Here’s just a snippet from this doctors’ experience:

…Sometimes an estranged family member is “flying in next week to get all this straightened out.” This is usually the person who knows the least about her struggling parent’s health; she’ll have problems bringing her white horse as carry-on luggage. This person may think she is being driven by compassion, but a good deal of what got her on the plane was the guilt and regret of living far away and having not done any of the heavy lifting in caring for her parent.

via Washington Post.

I’ve seen this many, many times in my ED; the child of the nearly-deceased who has been doing all the caring comes in, says essentially ‘let them die comfortably’, then come in the ones who haven’t been doing the work, haven’t seen the daily decline, and they browbeat the first into a retreat. ‘I think I misunderstood, we need to do everything’ they say to me while watching the floor; my job is nothing compared to the needless suffering they’ve consigned their dying parent to experience.

Shame on us for making dying foreign, and not the end of a life well spent.

All health-care systems have ‘death panels’ of one sort or another | Full Comment | National Post

Via @medskep on twitter:

Many scoff at the term “death panel” — Sarah Palin’s morbid, if misleading description of the powers contained in U.S. government health-care legislation back in 2009. Yet there was a grain of truth in that infamous noun phrase. The fact of the matter is that all health-care systems have “death panels” of one sort or another. It’s just a question of who sits on them — bureaucrats, insurers or doctors — and what label we put on their functions.

via All health-care systems have ‘death panels’ of one sort or another | Full Comment | National Post.

There’s the truth, let’s not act like it isn’t.

An open letter to central line packaging engineers

Dear Sirs,

First, thank you for putting all the tools I need into one sterile package, minimizing the amout of running around finding little pieces to start central lines on my patients. (A central line goes into the central venous circulation, allowing the use of hypertonic medications and monitoring of venous pressures to guide fluid resuscitation).

Now, to my gripe: apparently none of you have thought about the order in which these devices are used when starting a line. Yes, everything has a special place, but it tells me you haven’t thought out the actual use of the kit when I have to dig the Seldinger wire out of the bottom of the kit despite its use being necessary very early in the process, and getting it out dislodges many of the other items from their pockets, then making the whole shebang a mess.

Therefore, I offer my assistance in designing a kit that makes more sense when it’s used.

Respectfully,

GruntDoc

FYI, here’s a nicely done animation of how to place a central line:

I do mine a little differently (direct sonographic guidance usually), but this is good for the gist. (The wire is there, but it’s really hard to see…).

Health-Care Costs: A State-by-State Comparison – WSJ.com

Nice graphs of spending by state, then another breakdown of where the money goes per state. Click through and enjoy the graphics.

Health-care spending in the U.S. averaged $6,815 per person in 2009. But that figure varies significantly across the country, for reasons that go beyond the relative healthiness, or unhealthiness, of residents in each state.

via Health-Care Costs: A State-by-State Comparison – WSJ.com.

An open letter to UnitedHealth Group CEO Stephen Hemsley about my family’s canceled COBRA insurance | Mike Holden’s blog

It’s stuff like this that makes even trying to support the idea of private insurance untenable.

Mr. Stephen Hemsley:

I made an honest mistake, wasn’t given a fair opportunity to correct it and now my family’s COBRA coverage has been canceled by your company.

via An open letter to UnitedHealth Group CEO Stephen Hemsley about my family’s canceled COBRA insurance | Mike Holden’s blog.

UnitedHealth, fix this!

Obamacare Incompetence | TIME.com

I link to Ezra Klein approvingly about one a decade, so…

Let me try to understand this: the key incentive for small businesses to support Obamacare was that they would be able to shop for the best deals in health care superstores — called exchanges. The Administration has had three years to set up these exchanges. It has failed to do so.

This is a really bad sign.

via Obamacare Incompetence | TIME.com.

Defense Department says giving Purple Heart to Fort Hood survivors would hurt Hasan trial | Fox News

Appalling decision.

The document (from the DOD) reads in part:

“Passage of this legislation could directly and indirectly influence potential court-martial panel members, witnesses, or the chain of command, all of whom exercise a critical role under the Uniform Code of Military Justice (UCMJ). Defense counsel will argue that Major Hasan cannot receive a fair trial because a branch of government has indirectly declared that Major Hasan is a terrorist — that he is criminally culpable.”

via Defense Department says giving Purple Heart to Fort Hood survivors would hurt Hasan trial | Fox News.

But saying it’s not a terrorist attack doesn’t influence those same people? This is sophomoric at best, but bizarrely this is the Line from DoD officials.

Also, there’s a systematic robbing of the Fort Hood victims of benefits and now military awards, which is unconscionable.

For Shame.

Delusions of Benefit in the International Stroke Trial | Closer to the Truth

More TPa for stroke…

Delusions of Benefit in the International Stroke TrialResults of the largest and arguably most important trial ever of thrombolytics clot-busting drugs for acute stroke were published last week in The Lancet, and the study’s conclusions are breathtaking. Not because of the study results, which are unsurprising, but because the authors’ conclusions suggest that they have gone stark, raving mad.

via Delusions of Benefit in the International Stroke Trial | Closer to the Truth.

Well, that’s not good.

NYC painkiller poster

From NPR:

Doctors who follow the advice will consider alternatives to opioids and prescribe only a few days’ worth of the drugs, if they decide that’s the best course for short-term pain relief. They’ll also avoid starting patients on long-acting opioids, like Oxycontin, and will refrain from replacing lost, or allegedly lost, opioid prescriptions without lots of due diligence first.

painkiller-poster_vert-41d783296ca44c5e35a435dd8c25bf5217907c5e-s3

 

I like it.

Some studies that I like to quote

Wow! Very nice.

Press Ganey, meet Wong-Baker

For those not actively engaged in the practice of medicine, this will mean nothing to you. For those of us in the trenches:

IMG_0847

I cannot wait for the day the government realizes this misguided effort is costing them Billions (and harming patients and providers).

 

IRS: Cheapest Obamacare Plan Will Be $20,000 Per Family | CNS News

“Affordable” Care act.

Under Obamacare, Americans will be required to buy health insurance or pay a penalty to the IRS.

The IRS’s assumption that the cheapest plan for a family will cost $20,000 per year is found in examples the IRS gives to help people understand how to calculate the penalty they will need to pay the government if they do not buy a mandated health plan.

The examples point to families of four and families of five, both of which the IRS expects in its assumptions to pay a minimum of $20,000 per year for a bronze plan.

“The annual national average bronze plan premium for a family of 5 (2 adults, 3 children) is $20,000,” the regulation says.

via IRS: Cheapest Obamacare Plan Will Be $20,000 Per Family | CNS News.

Unbelievable. Enjoy the Sticker Shock.

Feds get specific on ACA individual mandate rules  : ACEP NEWS

After years of legal wrangling and a showdown in front of the Supreme Court, the federal government has finally begun to implement the Affordable Care Act’s controversial individual insurance mandate.

Starting on Jan. 1, 2014, Americans will have a choice: Buy basic health insurance, qualify for an exemption, or pay a penalty when filing federal income taxes, according to proposed regulations issued Jan. 30 by the Treasury Department and the Health and Human Services Department.

via Feds get specific on ACA individual mandate rules  : ACEP NEWS.

Go and read all the exclusions. For an incredibly intrusive and expensive mandate there sure are a lot of people that still won’t have to be covered.

Health Insurance Brokers Prepare Clients For Obamacare Sticker Shock – Forbes

(emphasis added):

By Dr. Scott Gottlieb, M.D.

A California insurance broker, who sells health plans to individuals and small businesses, told me that she’s prepping her clients for a sticker shock. Her local carriers are hinting to her that premiums may triple this fall, when the plans unveil how they’ll billet the full brunt of Obamacare’s new regulations and mandates.

via Health Insurance Brokers Prepare Clients For Obamacare Sticker Shock – Forbes.

You. Don’t. Say.  Thanks, Obamacare!

Don’t open wide: Annual check-ups are pretty much useless

I suspect this underestimates the problem. I think a lot of ‘chasing incidentalomas’ in medicine start here:

Two doctors in Colorado scanned through 14 randomized, controlled studies involving 182,000 patients. The articles spanned from 1963 to 1999. The doctors looked at whether those who had regular check-ups had higher mortality rates than their counterparts who dodged such visits. They could not find a difference.“General health checks do not improve important outcomes and are unlikely to ever do so based on the pooled results of this meta-analysis spanning decades of experience,” write authors Allan Prochazka and Tanner Caverly. ”There remains a belief in the value of general health checks despite the accumulating evidence. This belief is buoyed by screening advocacy groups and insurance coverage, and they have ramifications for patient welfare and health care costs.”

via Don’t open wide: Annual check-ups are pretty much useless.

They point out that Canada actually stopped paying for ‘routine checkups’ in 1979.

(Please understand I’m not including chronic condition maintenance in this category, like CHF or diabetes visits, as once you’ve got a chronic condition that’s where office visits probably really do help).