I’m Talkin’ About My Generation.
**Update: Treasury has just issued its reports on Medicare and Social Security, the results making this article more timely and relevant than I had intended. Together SS and Medicare make up 36% of federal spending. The Social Security trust fund is predicted to run dry in 2033, while the Medicare hospital trust fund (for inpatient services) is slated for extinction in 2024. Link to the report here.
Over the past few months i have struggled with how to portray the recent changes coming down the pike for medicare, what with ACO’s, and impending cuts due to mounting deficits and the ever increasing costs of medical care. What viewpoint, I wondered, should this blog take on these issues?
Should I take the role of the traditional physician-blogger, and share the viewpoint of the myriad other physicians around me who live with uncertainty about how to run their practices in the current fiscally deprived environment? Should I write about the constant worry about whether congress will extend the recurrent doc-fix or let the draconian cuts in reimbursements go through? Will I write about whether there will come a time when it will no longer be feasible to accept Medicare or Medicaid?
Continue reading “Healthcare Armageddon 6: Medicare and Generation X”
K. Raghavadas was born into the world on the earthen floor of a meager straw hut on a small parcel of land in a small south Indian village, the youngest of four children. He had the fortune of being born to an industrious father who, through hard work and luck had been able to secure the purchase of that small parcel of land which contained an orchard and rice fields which sustained the family through many lean years. He had the misfortune of losing his father a few years later and, through no fault of his own, being born into the bottom rung of a caste system whose basic premise is that all men are not created equal.
Growing up in a small village in Kerala, he realized early on that his best chance to escape poverty, the low expectations of his situation, and the notion that he should not accomplish anything in his life was to educate himself. Hoping that it might help his chances, early on in his childhood his eldest brother, who was forced to be the head of the family, changed his low caste name to Ramachandran, a name normally reserved for higher castes. And so a young Ramachandran entered into school, worked hard and excelled, enduring an occasional beating by low caste teachers who did not understand why a backwards caste person could dare have an aspirational name. Continue reading “An “Untouchable” Who Became a Doctor, and Touched the Lives of Many.”
If you’ve ever been admitted to a hospital, you (hopefully) were asked questions about your “code status”. Though it was likely not put in those words, patients are routinely asked what they would want to have done if there were a “code” situation. The code status is essentially a standing order that instructs the medical team what to do in case a patients heart were to stop or breathing became distressed.
Recently my health care facility adopted a new approach to addressing code status. Instead of using the traditional DNR status, we are replacing that term with the term “Allow Natural Death” (AND). The push to change from Do Not Rescucitate (DNR) to Allow Natural Death (AND) began as a movement rooted in the 1990’s and attributed to Reverend Chuck Meyer who felt that the current Do Not Resuscitate (DNR) order was inadequate. He proposed that rather than using a negative phrase (DNR) that describes what will not be done, a positive phrase (AND) which describes what will be done, will be more likely to be accepted by families. He reasoned that families struggle with the decision to remove care, and worry that their loved one will be left to suffer if they changed the code status to DNR. He thought that the change to AND will both provide reassurance that their family member will be kept comfortable, and that the change to a kinder and more positive wording is more likely to be accepted by families who are struggling with a difficult decision. AND detractors argue that the change is little more than semantics. They say that there is nothing inherent in the AND term itself that implies that a patient will be kept comfortable on their way to death. Continue reading “Code Status and Living Wills. . . And Why They Might Not Matter.”
Docs are docs, and unfortunately, try as I might, I can’t stop being one just because I put on a printed Hawaiian shirt and hop on a plane. For many of us, there will come that moment, when the words “is there a doctor in the house?” are uttered. And we will approach the situation, hair standing on end and queasy feeling in stomach at being out of our usual element, to assess and comfort. If we’re lucky, the situation will be little more than a simple malady, but for this group of doctors, it was much, much worse. Terrifying even. Continue reading “CPR in Flight”
I have a confession to make, it pains me to write this post, about the removal of over-the-counter epinephrine (a.k.a. primatene) inhalers, the only inhaler available to asthmatics without a prescription. I mean, it literally causes me a visceral pain. But it’s not for the reason you might think. It has nothing to do with all the hoopla concerning the politics of right vs. left . Neither is it necessarily the strange notion of telling people that they have to breathe worse, so we can save the ozone layer, so they can breathe better (though you must admit that does sound weird).
No, it has more to do with the simple fact that I (and undoubtedly other physicians as well) hate this inhaler. It is a dangerous, possibly addictive, unforgivably poor substitute for a real asthma regimen, and should have been banned from the market long ago.
And so for me, here’s the painful part; I don’t think that simply removing it from the market is the right thing to do.
Continue reading “In Asthma vs. Ozone Layer, Ozone Layer Wins.”
Will the The Needs of The Many Outweigh The Needs of The Few?
That was the axiom a dying Spock posed to Captain Kirk just after he saved Kirk’s behind (again). Well in that case, (spoiler alert),the needs of the many did outweigh the needs of the few. . .until they didn’t (if you’re really curious watch Star Trek 3, or better yet, don’t and just take my word for it). Curiously, I wonder if things will unfold in a similar fashion in regards to findings reported by the National Cancer Institute in its CT lung cancer screening trial published last June in the New England Journal of Medicine. Continue reading “CT Lung Cancer Screening, Star Trek 3, and Other Disappointing Things”
An Announcement from The Holy Profit Medical Center.
“Holy Profit Medical Center” is a series of fake satirical press releases and news articles from an imaginary hospital. . .
The Holy Profit Medical Center today named Bess E. Morass to the new post of Executive Vice President in Charge of Lobby Christmas Tree.
“We are very excited to have Bess here”, said HPMC CEO Haywood Jabuzov. “Ms. Morass received her MBA from Northwestern Michigan University, which is nationally recognized as being slightly better than Southwestern Michigan University.”
Continue reading “The Lobby Christmas Tree”
I’m used to getting the endless stream of useless notifications. Whether they be a fed-ex parcel with the latest black-box warning of sneezing from a new brand name skin emulsion, that I never prescribe. Or a an urgent fax, with an important announcement that the medication that was previously labeled as a 0.0083% solution is now going to be labeled as 137 mcg solution.
So it was with a mixture of surprise, delight, and disbelief that I scanned over the following fax message from an insurance company in regards to a patient that I see:
Apparently this insurance company is informing me that one of my patients has been naughty and is not refilling their inhaler prescription on time. I can already see the follow up appointment. . .
Patient: Well doc, my breathing doesn’t seem to be all it could be.
Me: Well, let me see, I’m going to concentrate really hard, and look into your past. Hmmm, wait a minute, I think I see your problem . . . you haven’t filled your inhaler prescription in over a month!
Patient: Well doctor, I actually have been taking it. I’ve been getting my prescriptions filled overseas for a third of the price of what my co-pay was.
Me: Crap. Just when I thought this job was getting easier.
As i enter the hospital in which I work, I am struck by a number of signs that denote that my place of employment is a Christian hospital, with Christian values, and a Christian ‘vision’ of health care. I don’t have the vaguest clue as to what that means. And I don’t really mind either, it’s not like they’re paying me with Jesus biscuits and Christmas ornaments, nor does it seem to impact the day-to-day routine of how I take care of patients.
As a child of immigrants, I was born and raised in this country. As someone of the Hindu faith, I am quite comfortable living and working in a world in which my viewpoint is usually in the minority. But as I make my way through the routine of my job amongst these often constant reminders, I can’t help but feel different, foreign. It’s a situation that often spurs the mental soundtrack of my workday to begin with Sting’s “Englishman in New York”.
I don’t drink coffee I take tea my dear, I like my toast done on one side You can hear it in my accent when I talk, I’m an Englishman in New York
Continue reading “A Hindu Doctor in a Christian Hospital”
. . .To Remember All These Reminders!
Walking around the hospital the other day, I came across a notice reminding physicians about documentation requirements. I had seen the note when it was first posted a few months earlier, but it had since faded into the background wallpaper, and I don’t remember noticing it since. It made me wonder about all the notices that go un-noticed around the workplace. So I decided to start looking out for them, and was surprised to find just how many reminders there were. Here a but a few for your perusal.
Continue reading “I Need a Reminder. . .”