In Fort Worth, MedStar’s Community Health Program cutting costs, improving patients’ well-being …

Kudos to MedStar (our Fort Worth EMS provider) for their excellent work on this project:


The Community Health Program was started in 2008 after MedStar officials discovered that 21 patients were using a big chunk of ambulance and emergency department resources. Those patients triggered more than 800 ambulance calls and cost the system more than $962,000 in charges, most of which were never collected because the patients lacked health insurance.

Nine of the 21 were selected for the program. They experienced a 77 percent reduction in their need for services during a 30-day test.

via In Fort Worth, MedStar’s Community Health Program cutting costs, improving patients’ well-being ….

Physicians ask for injunction against ‘Docs v. Glocks’ law – Central Florida Political Pulse – Orlando Sentinel

TALLAHASSEE — The physician groups suing to block a new Florida law that bans doctors from asking patients about guns in their homes asked a federal judge in Miami Friday for an injunction to block enforcement of the law.

via Physicians ask for injunction against ‘Docs v. Glocks’ law – Central Florida Political Pulse – Orlando Sentinel.

Good. And, good luck with that.

If physician organizations are going to try to play in the Deep End of the pool politically (like the AAP has, endorsing outright gun control) then they need to be ready when their political opponents make docs a target (shooting joke unintentional).

via Instapundit.

Doctors and dentists tell patients, “all your review are belong to us”

We (especially doctors themselves) like to think docs are smart. While all are very well educated in medicine, it doesn’t mean they’re actually smart at much else. Docs are well know to lose gobs of money in stupid ‘investements’ like Avacado farms and ostrich ranches (and yes, there are those with the chicken ranch problems, as well).

Here’s a dumb thing some docs are adopting I hope goes away quickly, as it’s actually not in the best interest of medicine:

When I walked into the offices of Dr. Ken Cirka, I was looking for cleaner teeth, not material for an Ars Technica story. I needed a new dentist, and Yelp says Dr. Cirka is one of the best in the Philadelphia area. The receptionist handed me a clipboard with forms to fill out. After the usual patient information form, there was a “mutual privacy agreement” that asked me to transfer ownership of any public commentary I might write in the future to Dr. Cirka. Surprised and a little outraged by this, I got into a lengthy discussion with Dr. Cirka’s office manager that ended in me refusing to sign and her showing me the door.

The agreement is based on a template supplied by an organization called Medical Justice, and similar agreements have been popping up in doctors’ offices across the country. And although Medical Justice and Dr. Cirka both claim otherwise, it seems pretty obvious that the agreements are designed to help medical professionals censor their patients’ reviews.

via Doctors and dentists tell patients, “all your review are belong to us”.

Read the article to get a good flavor of the problem, but here’s the moral objuection I think eviscerates their doing this (from the article):


When Ars asked Schultz about medical professionals who ask their patients to sign these agreements, he was scathing. “It’s completely unethical for doctors to force their patients to sign away their rights in order to get medical care,” he said. He pointed out that patients seeking treatment can be particularly vulnerable to coercion. Patients might be in acute pain or facing a life-threatening illness. Such patients are in no position to haggle over the minutia of copyright law.

Do good work, take charge of complaints, and live well.


Physician Employment Protections

The Art of Politics.

I’m not going to bang on the Texas Medical Association just yet, but wonder if this isn’t just spinning an inevitable loss:

Employment WITHOUT protections is the corporate practice of medicine. Employment WITH protections is part of the practice of medicine, and that’s what we stand for.

via Physician Employment Protections.

Basically, realizing hospital employment of docs was coming this session, the TMA apparently focused on making a deal that legislatively empowered the docs.


Also, why on earth would a hospital want to employ docs? I know it’s happening, I just don’t get it.

amednews: Revised ‘don’t ask’ gun bill advances in Florida :: Apr 25, 2011 … American Medical News

Florida still hasn’t figured out they’re being played by the NRA:

Revised “don’t ask” gun bill advances in Florida

A compromise removes civil and criminal penalties for asking about gun ownership but would refer physicians to the medical board for “harassing” gun-owning patients.

via amednews: Revised ‘don’t ask’ gun bill advances in Florida :: Apr 25, 2011 … American Medical News.

It’s going to pass in Florida.

Wonder which special interest will want to punish speech they don’t like next?

Doctors, Gun Groups Compromise on Gun Ownership Questions | Sunshine State News

Rant follows the pull quote here:

The National Rifle Association and other gun rights groups had pushed for a much stronger bill that would have precluded doctors, in many cases, from asking patients about whether they own guns. Backers of the measure, sponsored by Sen. Greg Evers, R-Baker, had said patients were being harassed over gun ownership.

But citing the confidentiality of what is said between doctors and patients, and a broader desire to protect other members of patients’ families, doctors had pushed back hard against the bill (SB 432). The issue had promised a fight between two of the most powerful lobbies at the Florida Capitol.

But an amendment adopted before the committee’s vote on Monday would now generally allow doctors to ask questions about gun ownership, as long as the physician doesn’t “harass” the patient, and doesn’t enter the information into the patient’s record without a good reason. That leaves enough room that doctors now support the measure, as does the NRA.

via Doctors, Gun Groups Compromise on Gun Ownership Questions | Sunshine State News.

Nobody should support this bill. I’ve said so before. And to remind everyone, I’m a doctor who owns a gun.

Your doctor harasses you about guns? Stand up, walk out, get another doctor. Tell your shooting friends to avoid that doc. That’s fine. Look, if you own a gun, ostensibly for self defense, but cannot say ‘no’ to a question you think is out of bounds you need to sell your gun. Use the money to buy a sign that says “Please don’t hurt me, I’m unarmed (and don’t ask me questions in an offensive manner either)”.

What kind of sissies live in Florida that if their doctor ‘harasses’ them about guns they need a law affecting all doctors in their state so they don’t have to say ‘none of ya beezwax’? Really, this rose to the level of insult to the patient population that legislation was required? This is where our Republic is, we need to regulate speech so nobody gets offended?

Nothing good will come of this special interest encroachment into what can be discussed in a physician patient relationship. This sets a terrible precedent going forward. ‘Well, it was okay to ban conversations about guns, so now the (insert special interest group) manufacturers have this bill, see, and…’.

Shame on the Florida docs for agreeing to this travesty. Opposing this, and taking it to court had it passed, would have been the right thing to do. For your profession, your patients, and your country.

HIPAA Bares Its Teeth: $4.3m Fine For Privacy Violation | threatpost

The health care industry’s toothless tiger finally bared its teeth, as the U.S. Department of Health and Human Services issued a $4.3 m fine to a Maryland health care provider for violations of the HIPAA Privacy Rule. The action is the first monetary fine issued since the Act was passed in 1996.

A copy of a penalty notice against Cignet depicts a two year effort in which HHS struggled with what appears to be a dysfunctional Maryland provider unaware of the potential impact of HIPAA non compliance, and unwilling or unable to cooperate with HHS in any way.

via HIPAA Bares Its Teeth: $4.3m Fine For Privacy Violation | threatpost.

At first reading of the title, I was willing to rail against HIPAA, as I’m tired of it.

Then I read the post.

Wow. It’s like a test case designed to see just how far you could push HHS, and frankly how incompetent you can be while pushing.

Seems HHS was having trouble getting Cignet’s attention. Bet they have it now.

Meet the first Congressional EM Physician

Dr. Joe Heck, NV:

I was unaware this was the first Emergency Physician to be elected to Congress. Good for him!

I suppose that leave me to be the first for the Senate…

I’m actually very heartened by recent events

In some Northern State there has been a lot of protesting about teachers, unions, etc. This isn’t about that, at least not directly.

At this protest were a few doctors who were supplying ‘sick notes‘ for protesters. Let’s leave aside for the moment the desire to protest but not want to face the music for your actions, wanting a sick note to explain your absence. Not terribly brave. I wonder what would have been thought of a Declaration of Independence signed “anonymous”.

What I’m heartened about is the criticism leveled at the doctors who provided these notes, with (reportedly) no real history, exam, or documentation (beyond the note). It seems everyone expects doctors to be above obvious political motives, and not to offer a service even as seemingly trivial as a work note without, you know, practicing medicine.

Doctors: expected to be ethical. I think that’s great.

Proposed Law would Ban Docs from Asking if Patient Owns Gun | | Local News

TALLAHASSEE, Fla. — A state lawmaker has filed a bill that would ban doctors from asking their patients if they have a gun in the home.

Rep. Jason Brodeur, R-Sanford, said he has heard of a number of cases in which doctors asked their patients that question, which he thinks should be off limits.

“What we don’t want to do is have law-abiding firearm owners worried that the information is going to be recorded and then sent to their insurance company,” he said. “If they’re on Medicaid maybe it’s sent to the government. If the overreaching federal government actually takes over health care, they’re worried that Washington, D.C. is going to know whether or not they own a gun and so this is really just a privacy protection.”

Under the legislation, a doctor could face a fine of up to $5 million or be sent to prison for up to five years for asking about guns in the home.

via Proposed Law would Ban Docs from Asking if Patient Owns Gun | | Local News.

Oh, geez.  I understand the stated intent as recorded in this news item: gun ownership is being recorded, lots of things are reported to insurance companies and the government, and this bill is an attempt to keep this information out of those circles, at least as obtained in a doctors’ office where people still believe what they say is between them and their doc.  It should be, but lots of things should be absolute aren’t.

Also, as a gun owner, I’m aware there are individuals and groups who want to do away with private firearms ownership.  I don’t believe in black helos or vast conspiracies. I do believe that given the right crisis guns have been grabbed on flimsy pretense (New Orleans after Katrina, for instance).  I do not believe making more lists of gun owners is a terrific idea. (Standard ‘no violent felons’, etc disclaimer here: if you’re not allowed by law to have them, then don’t, and I won’t cry when yours are taken legally).

Guns are able to be kept safely in homes provided the gun owners (and parents of children) exercise diligence. I think pediatricians asking about guns in the home (providing it’s not “Do you have an Eeeevil Gun! Gun! in your home?!) can be useful to prevent tragedy. Before you start typing, shot kids are a tragedy.  A preventable one, when precautions are taken; from a public health standpoint asking about guns in the home is on par with car seats from a ‘used right’ standpoint.  One dead kid from an unsecured weapon is too many.  Shot adults are a similar tragedy, but they’re not the group impacted by the usual docs (pediatricians) asking about guns in the home.

And now: this law is wrong.  I have no doubt it’d be overturned in court as a restriction on speech (which it certainly is), and it’s, well, kinda dumb. Want to keep lists like this out of the hands of insurance companies and Medicaid? Use you legislative authority and prevent them from keeping such lists.  Problem solved, nobody’s free speech rights are infringed, and docs can get back to public health interventions.

(As an adult ER doc I never ask this: I live in Texas and presume everyone has a gun in the home. Also, ER doc…).

Oh, and my personal way to prevent firearms accidents in kids: lock them up (the metal things) until they’re old enough to get right from wrong, then demystify the guns.  They’re no longer forbidden objects to be sought out, they’re tools they know about, know (generally) how they work, and to leave a house where their friends find a mysterious gun.

Update: The Volokh Conspiracy weighs in.  I’m in good company, though it’s troublesome the author feels there’s legal authority to restrict doc-pt speech.  via Snowflakes in Hell (a terrific, frequently updated gun blog).

Retracted autism study an ‘elaborate fraud,’ British journal finds –

(CNN) — A now-retracted British study that linked autism to childhood vaccines was an “elaborate fraud” that has done long-lasting damage to public health, a leading medical publication reported Wednesday.

An investigation published by the British medical journal BMJ concludes the study’s author, Dr. Andrew Wakefield, misrepresented or altered the medical histories of all 12 of the patients whose cases formed the basis of the 1998 study — and that there was “no doubt” Wakefield was responsible.

“It’s one thing to have a bad study, a study full of error, and for the authors then to admit that they made errors,” Fiona Godlee, BMJ’s editor-in-chief, told CNN. “But in this case, we have a very different picture of what seems to be a deliberate attempt to create an impression that there was a link by falsifying the data.”

via Retracted autism study an ‘elaborate fraud,’ British journal finds –

I’m guessing First Do No Harm isn’t in his lexicon…

Dr. Wes: Our Health Care Reform Illusion

The idea of a fit for all is an illusion. Justice and equity are seen differently. We imagine some public consensus at our own peril. But honesty has been in short supply. To paraphrase Oprah: what do we know for sure?

Some people want a relationship with a trusted doctor who knows them well. They want to pick the doctor, the neighborhood and the hospital they attend. Others want immediate access and have little trust or interest in a personal relationship with a doctor.

Some people want…

via Dr. Wes: Our Health Care Reform Illusion.

What, one-size-fits-all isn’t a good plan?  It’s almost like we’d need a market to fulfill these disparate desires…

Dr. Wes: The Need for Doctors’ Right To Investigative Free Speech

For medical device companies that pay doctors as consultants, they have to be willing to have the knife cut both ways during clinical testing of their devices, regardless of the implications to their investors

via Dr. Wes: The Need for Doctors’ Right To Investigative Free Speech.

Damn right.

AMA Policy on Social Media

New AMA Policy Helps Guide Physicians’ Use of Social Media

For immediate release:
Nov. 8, 2010

SAN DIEGO – Millions of Americans use social networks and blogs to communicate, but when those users are physicians, challenges to the patient-physician relationship can arise. New policy adopted today by the American Medical Association (AMA) aims at  helping physicians to maintain a positive online presence and preserve the integrity of the patient-physician relationship.

It’s not surprising there is some guidance on social media from the AMA.  I suppose the only surprise is that it took this long.

Follow the link above to read the policy, which I find remarkably reasonable.  I have some litle heartburn about this one:

(e) When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.

Plenty of thoughtful people disagree with things I’ve written (and a few unthoughtful folks disagree with everything), but I’m not a fan of giving AMA blessing to harass. 

Yes, there’s some things written out there I’m not a big fan of.  I take it as a sign of strength that we can disagree but not make a federal case of it.

And, for you aspiring to get into a professional school, f) is not just for practicing physicians:

(f) Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students), and can undermine public trust in the medical profession.

You’d have to go a long way to damage the medical profession, but it takes one facebook post to damage yours.  “Dude, I was so wasted when I…” doesn’t instill confidence in you or your judgement.  Just putting that out there.

So, rare kudos from me for the ever-shrinking AMA.

Another satisfied ABEM Diplomate

I get emails after bemoaning the inefficient / laughable requirements being imposed by ABEM for continuous certification, and while I thank them for writing I’m not interested in being the Lonely Critic who Wails at ABEM.

So, allow me to publish (with their permission) someone elses’ lament at the current state of ABEM:

Thank you so much about your column about ABEM! It is making me feel like I am not the only one going thru this. We have 150 hours of CME required now, 4 through my state, 8 through my insurance, and now I find we can’t count the LLSA’s as continuous ed! Plus the articles in LLSA are horrible.

I took my CONCERT this year and the scores still aren’t out 8 weeks later for a computerized test. Someone needs to rise up against ABEM, they are not our advocates. I felt like maybe ACEP can help but I don’t think they can. ABEM I think is run by a lot of ivory tower guys who work 4 shifts a month in a University Hospital with the residents doing all the work. Thanks again for your columns!

One of my colleagues recently took the recertification test, which is now computer-based, and his description was less than flattering. “It’s like they scanned a photograph of a slide, and then uploaded that for the test”. He’s also about 8 weeks out from the test, and awaiting his scores…

I don’t want to be the anti-ABEM forum (is EMED-L still around?) but when I get emails like this it tells me I’m not alone in wanting ABEM to perform better. Significantly better.