Yes, the VA is without doubt the model for American healthcare

Well, let’s consider their actual track record:

Shot:
The Pentagon reported Friday that 265 active-duty service members killed themselves last year, continuing a trend of unusually high suicide rates that have plagued the U.S. military for at least seven years.
http://www.usatoday.com/story/news/nation/2016/04/01/us-military-suicides-remain-stubbornly-high/82518278/

 

Chaser:

A VA suicide hotline designed to help distressed vets, at times instead sent their calls to a voicemail message, provided no immediate assistance, and did not even return some calls, according to a new report. … The crisis center was recently the focus of a HBO documentary praising the workers’ tireless efforts to help vets. The film, “Crisis Hotline: Veterans Press 1,” even won an Oscar last year.
http://www.cnn.com/2016/02/18/us/va-crisis-line-report/

A former Marine intelligence officer told the Senate Veterans’ Affairs Committee on Wednesday he waited more than a year for care, and when he finally saw a VA psychiatrist, he was prescribed a medication for depression. When he reacted poorly to the prescription, however, he was not able to make a follow-up appointment for another two months.
http://www.militarytimes.com/story/military/benefits/veterans/2015/10/28/report-vets-still-face-long-waits-mental-health-treatment/74734474/
Two former Minneapolis VA employees … say they were instructed to falsify records to make it look as if veterans were canceling or delaying appointments, a practice they allege allowed VA managers to hide long appointment delays. … Investigators have said efforts to cover up or hide delays were systemic throughout the agency’s network of nearly 1,000 hospitals and clinics.
When Anthony McCann opened a thick manila envelope from the Department of Veterans Affairs last year, he expected to find his own medical records inside. Instead, he found over 250 pages of deeply revealing personal information on another veteran’s mental health.
http://www.npr.org/sections/health-shots/2015/12/30/461400692/patient-privacy-isn-t-safeguarded-at-veterans-medical-facilities
One complaint against an employee found they accessed a veteran’s medical records—in violation of the Health Insurance Portability and Accountability Act—61 times. The employee even posted the private medical information on her Facebook page and “discussed it with her friends.” … The only punishment this employee received was a two-week suspension.
http://observer.com/2016/01/this-couldnt-have-been-a-more-scandalous-week-for-the-veterans-affairs-department/

Katherine Mitchell, a VA doctor in Phoenix, said that shortly after she complained to the Veterans Affairs inspector general about safety concerns, the department punished her, citing patient privacy.https://www.washingtonpost.com/politics/federal_government/va-uses-patient-privacy-to-go-after-whistleblowers-critics-say/2014/07/17/bafa7a02-0dcb-11e4-b8e5-d0de80767fc2_story.html

The Department of Veterans Affairs has not listened to whistleblowers or protected them, and it also has not punished employees who tried to stop or interfere with whistleblowers, according to a letter the U.S. Office of Special Counsel sent to the White House and Congress on Thursday.
http://www.cnn.com/2015/09/17/us/veterans-affairs-whistleblower-osc-findings/

Last May, a three-judge panel of the United States Court of Appeals for the Ninth Circuit accused the department of “unchecked incompetence” and ordered it to overhaul the way it provides mental health care and disability benefits.
http://www.nytimes.com/2012/03/25/us/recent-california-suicides-highlight-failures-of-veterans-support-system.html?_r=1

A study by a VA researcher found that veterans with PTSD were nearly twice as likely to be prescribed opioids as those without mental-health problems. They were more likely to get multiple opioid painkillers and to get the highest doses.
http://www.wsj.com/articles/SB10001424052702304672404579181840055583388

We gathered data from five of the states with the most veterans. We found they are dying of accidental narcotic overdoses at a 33 percent higher rate than non-veterans.
http://www.cbsnews.com/news/veterans-dying-from-overmedication/

“Veterans are now required to see a prescriber every 30 days, but at the El Paso VA, they are unable to get an appointment, so they go without, or they do something they shouldn’t — they buy them on the street.”

“The VA let them get wound up on all these drugs and now they cut them off completely. … These guys are coming into my office and they are a goddamn mess and the VA is just blowing them off.”
http://www.startribune.com/cut-off-veterans-struggle-to-live-with-va-s-new-painkiller-policy/311225761/

HT: Tig (thanks, brother).

Joint Commission – Anti-Safety in Action | WhiteCoat’s Call Room

“Severe pain can trigger suicide in hospital ERs” the headline reads. If they’re still calling it an “ER” you already know they’re clueless.

Since 1995, there have been 827 reports of patient suicides in the United States. Of those, about 14% are in non-behavioral health units, making a total of about 116 non-psychiatric inpatient suicides in 15 years.  That’s about 8 inpatient suicides per year out of 198 million inpatient days per year (644 inpatient days per 1000 population in US x 307 million US population) for a total chance of an inpatient committing suicide on any given day of … 1 in 24.75 million.  Now I admit that the numbers may be off by one in a couple million or so because reporting suicides is voluntary for hospitals, so not all suicides get reported.

via Joint Commission – Anti-Safety in Action | WhiteCoat’s Call Room.

Again, I went into medicine as I understood there would be little math.  Others are good at it, and thanks to White Coat for doing the heavy lifting.

Read his post, and enjoy the probably well-intentioned silliness.

And, marvel at what happens to every organization that outlasts its original mandate: it eventually has to keep ‘doing something’ to make all its parts relevant.  Unfortunately, what it does makes it more irrelevant than had they done nothing.

It must take a lot of fortitude to do nothing when that’s what is the right thing to do in these realms…which is why it seldom happens, if ever.

Want To Avoid Unnecessary Tests? Stick To One ER, Researchers Say – Kaiser Health News

On a recent Friday night at the Boston Children’s Hospital ER, Dr. Fabienne Bourgeois was having difficulty treating a 17-year-old boy with a heart problem. The teen had transferred in  from another hospital, where he had already had an initial work-up – including a chest X-ray and an EKG to check the heart’s electrical activity. But by the time he reached pediatrician Bourgeois, she had no access to those records so she gave him another EKG and chest X-ray. He was on multiple medications, and gave her a list of them. But his list differed from the one his mother gave doctors, neither of which matched the list his previous hospital had sent along.

via Want To Avoid Unnecessary Tests? Stick To One ER, Researchers Say – Kaiser Health News.

This is excellent advice.

Every ED has seen a patient, probably today, with “they saw me at the ER across town, but they didn’t do anything and I’m still sick”.  While it makes some sense not to return to a restaurant that gave you a meal that wasn’t to your tastes, medicine is quite different.

If a patient gives me this history, I now have a blank slate, and need to essentially start at zero with them.  So, I will do the correct workup to exclude the life threats based on the history and physical exam, which may be exactly the tests they had yesterday.  I’m not going to assume they did the same tests, or that they were normal.  It’s the standard of care at this time, and I have very very few alternatives.

Let’s flip this around: it’s a patient we saw a day or three ago who comes back to us and says “I’m not better”, that’s so much better for the patient, and us!  We have immediate access to their records and tests, and will not have to repeat studies we already know the result of.  Therefore, the patient avoids unnecessary testing, and gets better care.

Yes, you say, you could get the records from the other hospital, and the answer is, maybe, someday, better during M-F business hours (when hospitals are set up to work, still), less on Sunday AM on a 4 day weekend.  Someday EMR’s will be inter-operational, but frankly that’s going to require legislation as hospital systems want to own ‘covered lives’ and they see contro of medical records as proprietary information as theirs and theirs alone.  (Also, who’s going to spend money to give away their information)?

So, stick to one ED.  Yeah, sometimes you have to go back a couple of times.  That’s okay.  It’s the right thing for you.

Segway Scooter Injuries On the Rise; ER Docs Recommend Helmets

Injuries sustained while riding Segway transporters are significant and on the rise, according to a study of emergency department visits published online in Annals of Emergency Medicine.

“The Segway may seem cool, but there’s nothing cool about a head injury,” said Mary Pat McKay, MD, MPH, FACEP, of George Washington University in Washington, D.C. “One-quarter of the patients who came to our emergency department with Segway injuries were admitted to the hospital. Forty percent of the admitted patients were admitted to the ICU because they had traumatic brain injuries.”

via Segway Scooter Injuries On the Rise; ER Docs Recommend Helmets.

Wow, sobering data.

I have enjoyed riding Segways, and if I had any use, any at all, I’d have one.  And a helmet, which I’d wear.

Segways are pricey, good helmets aren’t cheap, but the ER visit is going to bill out for about 15-30 really nice helmets, so get one, and wear it.

I think I’ve found my ‘retirement’ job

I’m going to be a CMS investigator looking into EMTALA violations.

Would be therapeutic.  I think.

Texas okays partner treatment for STD’s without an exam

TMB Allows Expedited Partner Therapy

I hadn’t heard this, and think it’s a generally good idea.

Physicians now may treat the sex partners of patients diagnosed with chlamydia or gonorrhea without first examining the partner, thanks to an amendment adopted by the Texas Medical Board (TMB).

The amendment allowing expedited partner therapy took effect June 24.

TMB amended its rules to allow a physician to provide for a person with whom he or she does not have a "proper professional relationship … the prescription of drugs for a partner of a patient who may have a sexually transmitted disease."

The Texas Register notice of the amendment says TMB "determined that the amendment to the rule addresses a serious public health issue and is intended to allow physicians to treat persons with sexually transmitted diseases as early as possible or prevent such persons from contracting sexually transmitted diseases from their partners. The board finds that the amendment will allow for the immediate treatment of sexually transmitted diseases contracted by partners of patients and therefore remove a current peril to the public health, safety or welfare."

The Texas Department of State Health Services has developed a fact sheet [PDF] on expedited partner therapy.

This specifically excludes treatment of men who have sex with men due to their need to be tested for HIV, etc.

From a Public Health standpoint this makes sense.  I wonder about how to write a prescription for a partner, and documentation requirements surrounding that.  Double the Rx for the patient in front of me and tell them to share their pills like other things?  Get the partners’ name, and write a second Rx (which then has me potentially writing a prescription to a patient who’s allergic to the medication…).

 

Advice from the peanut gallery?