Order Of Complimentary Bread. The Newest Leading Economic Indicator: The Recession Is Back

Groupons Will Change Health Care Retail Forever. It Could Do For Primary Care What Facebook and Twitter Did For Social Media.

Last week, sister Happy introduced me to Groupons.  I was too busy to check it out.  But now that I've had a chance to review the site and the Groupon Deal of the Day, I just have to say WOW! Why didn't I think of that?  It's going to change health care retail and perhaps physician marketing  forever, especially as all public and private insurance markets implode under the weight of FREE=MORE

Groupons are a fascinating new concept in group and social marketing for retail sales.  Here's the skinny on the Groupon Deal of the Day.  Every day a local business offers to sell their product at a discounted price but ONLY IF a certain number of people sign up to purchase a Groupon for the item. It's local and it's hot.  It's an exciting new way of doing business.

Let's say a pizza joint wants to sell 20 pizzas.  They will offer a Groupon Deal of the Day.  Perhaps they'll sell a $20 pie for for only $10, but only if 20 people purchase a Groupon for the pizza.  So you go to their site and based on your zip code, your local market deal of the day comes screaming out of your computer monitor.  

If you like the deal, you buy the Groupon.  Your credit card will only be charged if the deal is completed.  In other words, if only 19 people purchased the same Groupon before the deal expired, your card will not be charged.  But, if 19 others buy the Groupon Deal of the Day as well, your card will be charged and you will receive your Groupon for the $20 pizza, the one you only paid ten bucks for. 

This is a fascinating new way of doing business.  It allows the average Joe to get a volume discount that businesses offer to their larger clientele.  Perhaps someday, we will do most of our shopping using the concept of group coupons.   Just like Facebook and Twitter have revolutionized the real time inter connectivity of all our lives, the idea of a Groupon Deal of the Day will  do the same to the retail market.

Perhaps someday physician offices and hospitals will offer  Groupon discounts for everything from school physicals and cash colonoscopies to elective boob jobs and botox.  It's a concept worth exploring as the insurance model, both public and private, has no alternative but to implode. 

The idea of Groupons in primary care is intriguing.  It could be the new business model for rapidly building up a concierge practice by allowing physicians the security of knowing that they could rapidly exit Medicare, Medicaid and other poorly paying private insurance models only when they know they have a predefined number of patients who sign up for their concierge model of care.  It's WIN-WIN.  If a physician needs at least 200 patients to sign up, they could implement the model only when those 200 patients have purchased their Groupon.  

Then  they can tell the Medicare National Bank to shove their RVUs where the sun don't shine.  The socialization of  health care retail will do more for doctors and patients than all the Obamacare could in a 100 years. 

Head on over  every day.  I've made it easy by placing a banner at the bottom of every post (in the post page) and in my right sidebar.  You can also  join Groupons and get a daily email with your local savings.   Either way, you'd better get familiar with the site. Some day, you might just need one to see your doctor.

Grand Rounds Heads To the OR

As Inside Surgery gives us the best medical posts of the week in this week's Grand Rounds.  Do yourself a favor and go check them out.

How Can I Lower My Doctor's Bill? Physician Billing Secrets Revealed!

Some people need help with hospital bills.  And some folks need help with their doctor's bill.  So you think the doctor's bill is out of control?  You're probably right. And you're probably asking yourself, "How can i lower my doctor's bill?"  If you don't have insurance, the cash price a doctor charges you  is probably  determined by the following formula.

1. The doctor's office determines how much their highest paying insurance will pay for any specific encounter (this is where knowing the ins and outs of CPT medical coding comes in handy).
2. Once the office determines which insurance is the highest paying for any specific code, they will add an additional 15-50% or more on the top line charge on their defined fee schedule.
3. This fee schedule applies to everyone, whether they have insurance or not.  Insurance reduces the amount by their contractual agreed upon price and the rest is forgiven.
4. If you are a cash paying customer, you have no contract to receive the service at a discounted price
5. If you don't have insurance, you get screwed.

Why do doctors' offices do this?  Let's imagine if a physician billed $100 for a high level outpatient consult but the insurance company would have paid $200.  If the physician only submitted a bill for $100, he will only get paid $100, even if the insurance company would have paid $200.   But if he had submitted a bill for $250, he would have been paid $200.  He captured 100% of the allowable insurance fee schedule.

You see, physician billing is all about maximizing the insurance fee schedule from third party insurance companies.  That's no secret at all. The people who get screwed in our current health care system are the people with no insurance.  These folks pay the highest prices with the lowest overhead.  It's all backwards. 

It should be the other way around.  If the office is not submitting a claim to insurance, their cost of collecting that claim goes down.  The cost of business goes down and the price of providing the service should goes down.  

Phil Villarreal, contributing editor to the Consumerist.com website, recently wrote a book titled Secrets of a Stingy Scoundrel: 100 Dirty Little Money-Grubbing Secrets.  As the title says, he'll show you how to get through life buy spending less. The NYT recently wrote a piece detailing one of this author'spersonal experiences with getting his medical bills reduced.

Last year, he was able to knock $1,000 off the $4,000 price of his daughter’s birth simply by asking the hospital, obstetrician, anesthesiologist and pediatrician to each reduce their bills by 25 percent if he paid the bill in full over the phone.

As a physician, I know exactly how the system works.  If I didn't have insurance, how would I lower my doctor's bill?  I would ask them for a cash discount.  In fact, I did that last year with fertility treatments.  I asked for and received a cash paying discount of 10% plus free ultrasounds worth several thousand dollars.  It  was a nice gesture and appreciated on both ends.  The contract was mutual.  It was WIN-WIN

I suppose a lot of physicians are used to getting stiffed by the uninsured and will accept steep discounts when given the opportunity to collect 50-70% of their charges. I would never pay full price for a hospital stay any more than I would for a physician's cash price visit, a price which has no relevance in real demand pricing.  I know physician pricing is not relevant in market economies.  But the physician cannot publish their cash paying discounted prices.  Why?  Because the Medicare National Bank would consider it fraud.  If you published a $50 fee schedule and they were paying $70, they would demand the $50 price and expect repayment of the excess funds.

Let the physician charge you $100  and then bargain them down a percentage of their fee.  How much you can negotiate is between you and then.  Every doctor and hospital is different.  But you won't know if you don't try.  Getting anything at all for many docs is a blessing.  If you don't ask, they won't tell you and they won't publish fees below their insurance schedule either.   So get out there and bargain your way to free money. 

Walmart Moonwalk Video. Amazing Hot Mess of Moonwalking. It Might Even Be Michael Jackson.

Watch this Walmart moonwalk video.  This moonwalker looks like Michael Jackson reincarnated.  Now that's a hot mess of moonwalking moves. Enjoy this moonwalking at Walmart

Amish Christmas Lights Displays

Check out this extraordinary picture of an Amish Christmas lights display.

That's funny. I don't care who you are.


             

9 Hidden   Happy

You've found Hidden Happy #9.  Only three more to go.  The game ends December 23rd, 2010.  Click on the Hidden Happy face or link to get the game details.     I don't know if anyone is left playing for the $400, but if you are and you want to win a $15 Amazon gift card "flag prize", be the first person to leave a comment on this post with the URL for Hidden Happy #8.  That's all you need to do.  Make sure you use a real email address when you leave the comment (it won't show up in public and I won't do anything with it) so I can email you the code for your $15 Amazon prize.

To find Hidden Happy #10, use my search bar to find the Disney Gingerbread Carousel. Have Fun. Almost there!

The Power Of Perspective On Patient Decisions

Sometimes it takes the power of perspective to make sense of everything.

Happy:  I understand you voluntarily admitted yourself for detox  from IV morphine

Dude:  Yes.  But I've been able to cut myself down on my own from 1500 mg a day down to 300 mg a day without  help.

This patient was proud of his accomplishments.  And I'm proud he had the power of perspective to realize taking 1500 mg a day was too much.  However, as I tell my patients with uncontrolled diabetes:

Happy:  What was your A1c last year and is it now?

Diabetic:  It used to be 17 but now it's 13.  I'm trying really hard.

Happy:  I'm glad it's going in the right direction, but you've had a year to handle it and it's just not good enough.  Going from 17 to 13 over the course of a year is like jumping off a  building at 50 feet instead of 100 feet.  Either way, it's going to kill you.

 It's just not good enough. The power of perspective has a way of making patients feel like they've succeeded.  Going from 1500 mg of morphine to 300 mg a day or getting your A1c from 17 to 13 is not success.  And  coddling them for trying only does them a disservice.  They need to hear the horrible truth about their current reality.  No matter how much better it is, it's still going to kill them unless they make a change.  Like I tell my smokers who say they've really cut back. Smoking is like being kind of pregnant.  It's all or none.  There is no middle ground.

They  either get it or you don't.  The patient's perspective is they are making progress.   But that's the power of their perspective. Often, the patient can't see the forest from the trees.  The reason they are in the hospital is because it's just not good enough.   That's a perspective they often refuse to accept.

Do Doctors Rat Out Their Own?

Do doctors rat out their own? That's an interesting question. A reader sent me this picture of newspaper text with a similar title. I did a little search and found the source study for this story was a JAMA article that studied the ratting out habits of almost 2000 physicians.  What did they find?  Almost 2/3 agreed they had a professional obligation to report incompetent physicians or physicians under the influence of drugs or alcohol.

Only 17% (about 400) physicians reported having direct knowledge of an incompetent or intoxicated physician and of those 17%, 2/3 (or about 250) of these physicians reported them to appropriate authorities.  That leaves only about 150 out of 5000 physicians, or 6% of physicians who have not reported their colleagues when they should have.

Why did this 6% of physicians not report incompetent or intoxicated physicians?  The most common reasons reported were

 

• Fear of retribution
• It was being handled by someone else
• Nothing would happen anyway
• The physician would be excessively punished
• It wasn't their responsibility

All the Google headlines seem to say no, physicians would not rat out their own. The power is in perspective.  What if the headline said "94% of physicians acted appropriately"  instead of "Physicians don't rat out their own" 

I look at the data and find physicians as a whole carry the highest degree professionalism, compassion and competency.  How many Wall street executives were reporting their colleagues   while the country was looted? How many friends and colleagues turn in their mother, son or neighbor falsifying their disability claims or their mortgage applications?  How many Obama officials are failing to tell the public the truth as they recapitalize banks with record profits at the expense of fixed income  elderly.  How many SEC executives were looking the other way when their colleagues were surfing porn eight hours a day.  How many Congressmen and women ignore their colleagues' flagrant dishonesty by buying votes from special interests.  How many cops let one slide for their brother in the badge.

Every where you look, you are going to have people who lack the courage to do the right thing.  If you believe that physicians are somehow super human and will always turn their colleagues in you might as well write a letter to the tooth fairy. 

What you have here is a tiny part of a tiny problem.  Physicians as a whole are highly competent.  They have passed the test.  They have paid thousands of dollars to certify with their governing boards to declare their competency with certification.  If we are now to believe that physicians are incompetent despite their certification by their specialty board, we then must abandon the model of board certification and find an alternative means to measure the competency of physicians.

And when I am forced to pay money and reapply for state licensure every few years, my colleagues are forced to attest (in uncompensated time)  as to the competency of my skills and the lack of my addiction to drugs and alcohol.  If physicians are practicing drunk, and the state licensure process is meant to prevent it, then the government process is flawed, not the physicians. The process relies on physicians providing truthful answers and physicians as a whole, 94% of them, are truthful.  If the concern is missing 6% of the problem then the government process should be changed.  Just like you can't change your spouse, you're not going to change the moral fabric of the physician.

I'll take a 94% success rate any day of the week.  The other 6% will eventually be found, one way or another.   Besides, there's always a good med mal lawyer or two or three waiting for an opportunity to protect the patient.

Addendum:  So I learn on July 28th, 2010  that the FBI is involved in a major cheating controversy.  It turns out hundreds of FBI agents cheated ON THEIR OPEN BOOK TEST regarding surveillance rules and regulations.  Sounds pretty important to me.  I'd say my civil liberties are just as important as being treated by an intoxicated physician.  If you don't believe me, try speaking out in  North Korea. Cheating is about the individual.  It's not occupation specific.  The moral fabric of the individual will determine who decides to turn in a colleague and who doesn't for doing the wrong thing.   Being a doctor has nothing to do with who makes what decision.  Singling out physicians is ludicrous.  We all have an obligation in all occupations to initiate the process.  The world is full of cheaters, whether you are an FBI agent or a physician.

First Garden Tomatoes Of The Year. Yummy!

First batch of garden tomatoes of the year. 

ICU Bingo Game

Wonder how ICU nurses get through their daily grind?  Why ICU Bingo, of course.  How does ICU Bingo work?  It works just like regular bingo.  Every nurse receives their own Bingo card with different ICU diagnoses.  And every time they take care of one of these conditions, they get to X it out.  Fill out a line or any other predetermined design pattern, and you are the ICU bingo winner.  And you win a prize.

This is quite similar to my 2010 March Madness Hospitalist Bracket, only in this case the game is bingo.  As you can see, this nurse has already cared for a GI bleed, a homeless man, a drug overdose, chest pain, DKA, alcohol withrawal, subdural hematoma, a prisoner and someone with super morbid obesity. 

That's ICU medicine for you. 

Blood Pressure Chart Site For Home Monitoring. An Excellent Free Online Web Based Application To Help You Take Control.

I got an email the other day from a reader looking to increase exposure to their "nonprofit and budgetless project", a free online home blood pressure chart site.  It takes less than two minutes to sign up for. If you've got high blood pressure, this site may help you take control of your life. I'm a visual person.  I've reviewed the site.  It's advertisement free and comes with tables, charts and graphs to help you understand  what it will take to get your blood pressure under control. A graph of frequent home blood pressure checks would definitely affect the way I managed my hypertensive patients.  Go check it out.  You can even link your results to Facebook and Twitter.

Here's what the site designer has to say about his site.  My name is Matt, I'm a 31 y.o. web developer from Krakow, Poland and I have a hypertension that just doesn't want to go away without being pleased with drugs.  I wanted to keep my readings online and didn't find any website I really liked, so I created my own.   It can be used by people with hypertension and other blood pressure or heart rate related problems to keep track of their readings, analyze and share them with their doctor.

A handful of its users seem to like it, so I've decided to try promoting it a bit.  Seeing as you're a doctor and you seem to enjoy geeky stuff, I was wondering if you were willing to review it at your blog and share your thoughts. There is a short video presentation on the front page.   Please feel free to create an account and test the site yourself.

I did.  It's a great program.  It's very user friendly and presents the data in easy to review chart, table and graph form. 

Here's a small cheat-sheet with site's features

• It stores your blood pressure and heart rate records
• It automatically calculates average values from multiple readings (reading is more accurate if you repeat it a few times and write down the average)
• It displays history on an interactive graph
• It displays all records in an informative table
• It shows statistics - average values and "distribution of stages" ("how often was pressure good, how often there was a prehypertension, etc.) for readings taken in the morning, in the evening and all together.
• It lets users share all the above information on a public profile.  This feature can be turned off for privacy reasons. It lets users send their records by email
• It lets users set up daily reminders
• It's a web application - no installation required, it can be accessed from anywhere in the world, it uses large fonts suitable for the elderly
• It's free (I'm not benefiting from it in any way).

If you've got hypertension, this is your future.  Take control of your life and help your doctor understand and personalize your treatment.  Socialize your disease today.
(I received no compensation for this review)

Physicians Billing For Time Spent Filling Out Life Insurance Benefit Claims. Would You Do It?

I received a request to fill out the medical portion of a proof of benefits from a patient that passed away in the hospital.  Requesting the information was the AllstateWorkplace Division for a Walmart group critical illness claim form.

Since this duty has nothing to do with providing medical care under their health insurance benefits I would like to know how readers handle this situation.  Filling out this form involves my time to review the chart and I also face risk of prosecution for not providing accurate information.  Stated right by my signature:

"Remember, it is a crime to fill out this form with facts you know are false or to leave out facts you know are relevant and important.  Check to be sure that all information is correct before signing.  Please refer to page 3 for notice specific to your state."

So I called the only number available on the form 1-800-514-9525 and spoke with a lady.  I told her I was a physician filling out paper work for a life insurance claim.  I asked her if I could obtain some contact information on whom to bill for my time spent filling out the form.  She told me they were a supplemental policy company and all claims payments go directly to the beneficiary.

So I said, "Are you telling me I must bill the beneficiary for payment".  And she said, "That is correct".    

Would you bill the wife of a dead patient for the time spent filling out her life insurance benefit forms?  If not, why not?   It's  issues like this that overwhelm physician offices on a daily basis.  Everyone needs their forms filled out by physicians to verify accuracy of their non health insurance  claims. 

Who pays for it?  If not the patient or their estate, than whom?  Should physicians be expected just to eat the cost as a part of doing business?  If so, where do we as physicians draw the line?  When is enough, enough?  I know it's crass to send the grieving wife a bill for her life insurance benefit. But there is a lot about death that is unpleasant.  The mortician bills the wife.  The estate lawyer bills the wife.  Why shouldn't the physician bill the wife for their time spent filling out these unpleasant forms?

How Do You Hide $100 From A (Name Your Doctor or Surgeon) Joke

How do you hide $100 from a surgeon?  Put it in the patient's chart, next to the lab.

How do you hide $100 from an orthopedist?  Put it in a text book.

How do you hide $100 from a neurosurgeon?  Tape it to his kid.

How do you hide $100 from an OB/Gyn?  Tape it to the patient's head.

How do you hide $100 from an internist?  Stick it under the patient's bandage.

How do you hide $100 from a radiologist? Give it to the patient.

How do you hide $100 from a cardiologist?  You can't.

How do you hide $100 from a plastic surgeon?  You definitely can't.

And last but not least, here's my own personal touch:

How do you hide $100 from a hospitalist? Put it in their mailbox at work.   Chances are, they'll never open it or they're on vacation.

Old Is Twenty Years Older Than You Are

So I'm talking with a 96 year old man admitted with chest pain. And what does he say?

"I'm too busy to spend time in the hospital. I've got things to do."

Definitely not a hospital junkie. Nothing about being too old.  Nothing about being blind and half deaf.  Nothing about aches and pains.   Life is all about attitude and what you choose to make of it.   I told him he's got a good thirty years left in him.I wouldn't doubt it for a second.  For many people, old is twenty years older than they are.  For others, they just can't wait to die.  How sad is that?  Go out and live life.  After hearing overhead trauma calls all day long, you just never know which day will be your last.

Blast From The Past Post From 2008.

Here's an old post of mine on a slow Sunday morning.  I was reminded of this oldy but goody after a reader left a comment on this 2008 post of mine explaining why the mainstream media hates doctors so much.  Go read the post on why the mainstream media hates doctors so much. I'll give you the gist of the post. Doctors are hated because they work with poor people and poor people see doctors as being rich.  All other professionals with post graduate education degrees work mostly with other rich people, so they are out of site and out of mind to the poor.  When was the last time you heard the media complaining about all those rich successful architects or small business men and women?

Go read the post, then read this comment left by a medical student.  These are your future doctors.  They are  emotionally  spent and they haven't even experienced real life medicine yet.   Think they'll work for free after 25 years of continuous education? Think again.

Medical Student:
I am the son of a physician (family doctor) and I must say that I never really understood why people considered doctors to be wealthy. However, I did end up buying into it, yet I then came to the conclusion that maybe we were "wealthy" compared to the guy that works at McDonald's, Target, Blockbuster, etc. However, when I read your blog I realized why it is true that people, wrongfully so, consider doctors to be wealthy. I completely agree with the statement that doctors are compared to the poor and should not be. Doctors should be compared to lawyers, CEOs, stock brokers (a few of my friends went into this field and even during the "rough times" they are still making 200K!!!!) and other professionals. I just looked up to see when the last post was and realized that nobody is probably reading this blog anymore, I wonder how much hell you got for posting this from those that knew you. An MBA or CEO goes out and says we need to make more money, and those working for him cheer him on as a great leader and business man, a doctor tells the nurses and his staff that and they look at him as the greedy guy whom is already making more than they do and should be happy with it. I agree, you get what you pay for. Also, you don't have to accept Medicare and Medicaid (which I personally will not). If other physicians plan on accepting it, so be it. I'm sure it will be rough to turn down people, but that's what I'll pay my staff and office manager for, if not, I'll find another one that will do it, besides let us remember, we are trying to run a business. If you're a doctor and want to work for Medicare or Medicaid pay then go right ahead, don't give me your crap about we're doing this to help people, go and work for free if that's what gets you off. What other field can you say, hey you know what, I think its nice that you are charging 10 dollars for this, but I think I will only pay 3 dollars, thanks. By the way, if I end up using your product and hurt myself, I'm going to sue you. I wish you would keep posting although I'm sure there are a lot of problems with physicians that feel the same way you do posting a blog like this. Such is life right? Since I've posted this sort of commentary in the past and later on I'll get a reply saying something about how much pain and suffering there is in Africa, the Middle East, and other parts of the world, let us keep in mind what the author of this blog was trying to discuss, compare apples to apples. Besides if you want to look for the poor you don't have to go all the way to Africa, just downtown.

Water Charities Have Failed My Community. And Smokers Are Dying.

It's time for water charities to step up to the plate and be accountable for their failures in my community.

Happy:  It looks like you are a bit dehydrated.  Your kidneys aren't working quite like they should.

Dude: Yeah.  It has been really hot and the gas stations wouldn't give me a cup so I could drink water.  They said I had to pay for it.  And I couldn't afford to pay for a cup.
Happy:  It looks like you're a smoker.  I bet those smokes are  pretty expensive these days.
Dude:  Tell me about it. The prices are out of control
Happy:  Good.  Maybe it will help people quit so they can afford to buy cups at the gas station so they don't get admitted to the hospital for dehydration. Maybe you could trade in two smokes for a free water cup. Do you need a nicotine patch while you're here?  Perhaps I could start you on some free Chantix.  My Medicaid, I mean your Medicaid will pay for it.
Dude.  I don't want to quit.  Can I get some dinner and a cup of water?

UPDATE:  Chantix lawsuits, here we come.

The wheels on the bus go 'round and 'round...  Where are all the community water charities when you need them?  Why have our community safety nets failed us?  I'm sure this sad story is played out hundreds of times a day, all across our great country.

What could we have done in the private sector with local water charities to prevent this dude from getting admitted to the hospital?  What could we have done to save the Medicaid National Bank from thousands of dollars in medical expenses?

Perhaps what we need is a little more innovation.  Our communities have  failed our smokers. With a sense of urgency,  we need to implement water charities willing to step up to the plate and fund free water cups for smokers unable to afford them.  It's going to take thousands of volunteers.  But we can make it happen together.  Give a smoker a cup, he drinks water for a day.  Teach a smoker to obtain cups, he drinks water for life.  The time for action is now.

How Do Women Pick Their Mechanic or Doctor?

I found this sign while driving past a mechanic's shop the other day.  Of course.  Now I get it. How do women pick their mechanic? This sign explains it all. Just look for the handsome mechanic "now on duty". sign.  I wonder if it works for doctors too.

Read On

Where Do I Start With My EMR/EHR Search? Free Guide and Consultation To Understanding The Ambulatory EMR/EHR Software Market.

The EMR/EHR software market search can be an intimidating process.  You've probably asked yourself, where do I start? Well, you've found it here at The Happy Hospitalist.  Federal mandates for EMR/EHR technology are only a matter of time. 

With the government offering $44,000 per physician in federal stimulus money to implement EHR technology,  the time to act is now.  But how?  There are over 300 electronic health record (EHR) software vendors in North America, so software buyers can quickly become overwhelmed.

Colleagues fear not.  The Happy Hospitalist has partnered with the EHR experts at Software Advice to bring you a  free guide designed to help you gain perspective on the EHR market, so that you have some context as you start identifying a "short list" of EHRs.

There are five primary criteria that differentiate EMR/EHR software products.   Learn  these criteria and you are well on your way to prioritizing your search for a vendor. These criteria are

•  Medical specialties served
• Size of practice served
• Functionality offered
• Deployment model
• Price range.

Download your free guide to understanding the ambulatory EHR market and receive your free consultation

Other useful information is available at my EHR Resource Center.

Orthopaedics vs Anesthesia Video: Hilarious Teddy Bears Duke It Out

Orthopaedics vs Anesthesia duke it out with this hilarious video about real life  medicine through the different eyes of reality.  There is a fracture. I need to fix it.
 

You'll laugh your ass off with these cute teddy bears reincarnated as  orthopaedics vs anesthesia. (I think an anesthesiologist would say it should say orthopaedics vs anesthesiology, not anesthesia). 

Find other great Xtranormal Medical Videos.  Some are Happy originals.  Some aren't.  I think they're all funny.

Juggie, The Extreme Japanese Snuggie (Picture)

Check out this picture of the Japanese Snuggie.  It's called the Juggie. I think it's a form of birth control, but I'm not sure.

Medication Labels From Patients: Remember, Beano Is Used For Farting.

Here you go folks. A reader sent me this hilarious picture of medication labels written by a patient to remind themselves what all their medications in each bottle are used for.  

• Stomach medication.  Check
• Vitamins.  Check
• Flomaks.  For blood clots.  Check (nice)
• Glimepiride for diabete.  Check
• And of course don't forget your Beano for farts.  Check.

Read On

Low Hanging Cloud Picture During Sunrise

Nothing like driving to work and seeing a low hanging cloud against the back drop of a beautiful sunrise to start the day. To my colleagues at morning report, I apologize for being late that day. I was taking pictures.  It kind of reminds me of the smoke monster from the show LOST.

Read On

How To Qualify for EMR Stimulus Funds: Government Cheese For Physicians

Do you want to know how to qualify for EMR stimulus funds under the American Recovery and Reinvestment Act?  If you don't, you should.  If I told you your government will  start paying you less as a doctor  for not implementing an EMR or EHR would you get the process started?  If you aren't, you should.  Electronic medical records are expensive.   Get it right the first time.  But how?  How do you make sure you qualify for EMR or EHR stimulus funds?  

In classic government fashion, Uncle Sam has made it really complicated.  Don't get fooled by The Man.  Get it right.  Not every vendor will tell you the truth.  You need an advocate and Happy is here to help.

The American Recovery and Reinvestment Act (ARRA) has set aside nearly $20 billion in incentive payments for physicians who adopt EHR technology over the next five years. In order to qualify for the up to $44,000 in incentives, physicians must be using “certified EHR technology” in a “meaningful manner.” 

Don't get stuck with a substandard EMR. And definitely don't get stuck with one that won't get you your government cheese your kids and grand kids will have to pay off.    I've partnered with experts to help guide you to the promise land. If you want to qualify for federal EMR stimulus funds,  download this handy guide below and receive a free EMR consultation from the folks at Software Advice.  This guide will explain

• Meaningful use objectives
• Certified EHR technology
• Required software features
• Meaningful use measurements

Download your free guide to qualifying for EMR/EHR stimulus funds and receive your free consultation.

Other useful information is available at my EHR Resource Center.

How To Become A Notary Public As A Physician

So I learned today how to become a notary from one of Happy's colleagues.  In case you were wondering:

1. You have to have about 30 registered voters in your county sign your application indicating you have integrity.
2. You have to take an open book test on legal stuff.  Supposedly it's really hard.  But it's open book.  So please, don't cheat.
3. Pay your $500 for a five year stint as a notary public
4. Go forth and collect $10 per signature.

Which physician specialty do you think would have the hardest time finding 30 colleagues to vouch for their integrity. 

I Get By With A Little Help From My Friends

Grand Rounds turns to the Beatles for a little inspiration. Go check out this week's excellent presentation of the best of the medical web.

How To Select The Right Medical Software (EHR, EMR) For Your Needs: The Ten Step Program.

So you need an electronic medical record but you don't know where to start.   You want to move away from the paper chart and take advantage of the billions of dollars in free federal stimulus money available for implementing a new medical software (EHR, EMR) platform. You want to avoid the future penalities for not acting now.    The only problem is, you don't know what to do or how to do it.  You are frozen with inaction.

Have no fear. The Happy Hospitalist has teamed up with the experts at Software Advice to give you the  guide Ten Steps To Selecting The Right Medical Software.  As a hospitalist physician, I know first hand how frustrating it is not to get the product you need to maximize efficiency while providing the highest quality patient care experience.

You can download this handy guide and then make sense of it all with a free consultation from the folks at Software Advice.   Get educated.  Get smart.  It's the easiest way to find the right product for your needs.  You won't find anything better.

Download now and get started today



Other useful information is available at my EHR Resource Center.

Is The AMA Losing Power In Washington?

Yes, the AMA is losing power in Washington.

Why would any physician send their money to an insurance agency that fronts as a physician lobbying group? Doctors don't need a lobbying organization.  They need to be prepared to walk away if they don't feel they are being treated fairly.  The best lobbyist is the doctor.

House Struck By Lightning In My Neighborhood and Sends Sparks Flying

One of Happy's neighbors had their house struck by lightning last week.  It's been a crazy year for thunderstorms.  I took this thunderstorm picture gallery back in April, 2010 when the severe weather season was just getting started.

It seems like the lightning and thunder just keep coming.   I can't remember a year where we've had night after night after night of severe weather.  Last week, Mrs Happy and I decided to go for a run.  We saw thunderstorms entering our area, but it looked like we had enough time to get the run in.  

Half way through the run, we saw one heck of a lightning storm out in the distance.  I was wearing my 405 GPS Garmin workout watch and made a comment to Mrs Happy

"I wonder if these satellite watches act like an antenna for lightning."

With that said, we decided to abort the rest of the run and head home. The rain, winds, thunder and lightning eventually came with fury.  While watching a movie we heard crash and boom after crash and boom.  The lightning was incredible.

And then it happened.  The loudest boom I'd ever heard during a thunderstorm.  The sound on our  surround sound speakers surged ever louder and turned into an inaudible mess of noise.  And then everything went back to normal. 

I figured a transformer was hit a few miles away.  It wasn't until the next day while walking Marty and Cooper that we learned two houses down the neighbors had their house struck by lightning.  The lady was on the computer with an attached mouse when sparks came flying out of the mouse and shocked her.  Every light bulb turned on in the house exploded.  They lost both computers, their television, washer and dryer and their air conditioner stopped working.

Another neighbor said he had just happened to be looking out and saw the lightning strike.  There was no fire and no apparent structural damage to the home, but who knows.  I wonder if an inspector needs to look for any lightning strike damage or if such an act needs to be reported on disclosure forms when they go to sell the home.

Mrs Happy and I are 85% complete (update!  home remodel before and after 2010-2011 picture video tour)  with our home remodel project thus far.  We had the electrician install a whole home surge protector  several months ago.  What perfect timing. It's placed directly into the circuit panel that controls all the kill switches in the house.  It took the electrician no time at all to install. I'm glad we did.  That lightning very well could have struck our home. 

And my blogging empire would have been disabled, at least temporarily.

Veterans' Health Insurance Benefits Are An Embarrassment To Our Country

Many policy wanks like to talk about the success of Veterans' health insurance benefits giving them access to life saving therapies at a fraction of the cost of private industry.  Have you ever wondered how that's possible?  I haven't, because I know the truth.  It's called the rationing, something the rest of America is not ready to accept as their reality, yet.  To reduce the price our government pays for veterans' health insurance benefits, you simply have to make access unavailable and shift the cost to the veteran themselves on a geographical and time based axis.

Here is a disgraceful experience I recently had with Happy's hometown VA system. 

Read On

MRI Food Pictures and Videos

Medical Pastiche blogger Peter Zavislak, whom I can always count on for pointing out the unusual and interesting side of medicine, sent me to a website that has nothing but pictures and videos of food in an MRI scanner.

Here's a series of images from their site of a cantaloupe as viewed from an MRI.
 

I just find myself wondering that these MRI machines are not cheap to run and maintain. Doctors and nurses used to be able to get "freebies" by buddying up with the xray or CT or MRI technologist and running a scan for free.

Some hospitals allow their employees to test the machines after being set up or maintained to get images for testing purposes. I'm sure more than a technologist or radiologist or two have found incidentalomas from this practice.

Most hospitals, as a matter of policy, do not allow random doctors or nurses to hit up the radiology department for a free scan if they have a concern, although I'm sure a lot of that stuff still happens off the clock. Though I'm sure most technologists would not want to lose their job if they got caught doing it.

But fruits and vegetables? Makes me wonder who's running these scans and where they have the time to do them. Perhaps these are sanctioned scans at a research facility. Or maybe a rich artist paid a local hospital for the right to borrow their MRI technology to generate these cool images.

Or maybe it's a rouge MRI technologist sneaking fruits and veggies into the scanner while nobody is looking.

If you are a radiologist, what would your report look like on this MRI of a cantaloupe?

Best Zucchini Bread Loaf Recipe Ever. People Are Falling Over Backwards To Taste It.

Do you want the best zucchini bread loaf recipe ever? Here it is.
 

Step 1. Grow zucchini in your garden

Step 2. Give the extra zucchini away to your neighbor.

Step 3.  While talking with your neighbor and touring their home, slip and take a nasty fall  in their stairwell.

Step 4.  Start hobbling around and ask them if they have insurance.

Step 5. Have them unexpectedly return the zucchini back to you the next day in the form of a loaf of zucchini bread.

Now that's the easiest and best zucchini bread loaf recipe ever.  Thank you neighbor.   I can't wait until the pumpkins arrive in Happy's garden.  Perhaps, then  I could step on a rusty nail in  their backyard.

Baltic Dry Index Chart July 2010 Is Screaming Economic Danger Signs Ahead

Our economy is sick.  Trillions of dollars of stimulus money hasn't done anything to gain traction.  It has done nothing to rid our country or the world of the underlying debt issues that must be resolved.  Stimulus has done nothing but added trillions of dollars to our deficit while bailing out big businesses that deserved to go under.
 

It's going to be painful.  But it has to happen. Prices are falling, not rising.  What we have here and now is a serious concern about a double dip recession or deflation coming our way. Just today, we learned that consumer prices dipped for the third straight month.  

How is that possible?  With interest rates and home mortgage rates at historic lows, capital should be flowing freely. But it isn't.  Because the jobs aren't there.  Because businesses are scared to produce and hire when the consumer is afraid to spend.  Banks aren't lending because they fear default.  

It appears nothing has changed since the economic implosion of 2008.  Those trillions of dollars haven't done anything.  Is spending more money the answer?  Of course not.  For every dollar in future taxes that must repay current stimulus, you take another dollar out of circulation.  The same jobs argument used to justify stimulus today must be used to explain why future tax increases will reduce private spending and therefor jobs of tomorrow. 

We have a stock market in shambles. We make lower highs and lower lows.  That is not progress.  That is reality.  We have all major indices below their 200DMA (Dow, S&P 500, NASDAQ) and bouncing hard off resistance today.  With have unemployment showing no signs of easing up.  We have a rising VIX (a  measure of fear) bouncing hard off its 200 DMA.  Fear is associated with bears, not bulls.  

There is nothing to suggest the tax and spend stimulus spending of our democratically controlled Presidency and Congress is fixing anything.  So where are we today and now?   Today, the ECRI has dropped again, now sitting at -9.8%.  Historically, readings below 8% have predicted a recession 100% of the time.  

As if you needed any more information that suggested our economy was in deep trouble, along comes the Baltic Dry Index (BDI)shouting danger.  This index provides investors with an idea of how much it costs to ship raw materials by sea.  What has the Baltic Dry Index done recently?  It is down for 35 straight days, the longest string in nine years.  While many variables can determine price, a rising index generally indicates growth and falling one contraction.  Here's a great segment  on the current state of our economy.

Are you listening?  If not, why not?  Blindly following the herd will get you slaughtered.  The federal government is bankrupt.  States are declaring Chapter 66 Bankruptcy.  If you decide to ride it out, realize you are all alone.  

I am at an all time low in my risk tolerance.  Your government is telling you everything is fine.  Obama is saying he has saved 4 million jobs.  An amazing claim given the current state of our affairs. We are in deep trouble. the truth and magnitude of which only people willing to look for it will find.

Have you asked yourself yet: What should I do with my 401K?  If you haven't asked the question, you aren't listening to the truth. What you do with it is up to you.  I put 100% of my  401K into cash five months ago and plan on parking it there until I have a clear signal that the current economic and political destructive forces of our government have left the building.

Be prepared for your government to continue their hook, line and sinker on the American people with terror.  Bush and Cheney used guns.  Obama et Co. will use jobs.  The fear of losing more jobs will create front page demands for five trillion more dollars in mandatory stimulus spending.  When you hear these drums rolling, you will know the end is near.

I think the sheep are well on their way to the slaughter house.  Are you prepared?

Nursing Education Requirements Are Shaping The Future Of Health Care

I'm embarrassed to say this, but the nursing profession is making a mockery of health care education by downgrading the post graduate degree process. The nursing education requirements in the advertisement below are an embarrassment to the nursing profession.
 

Mrs Happy pointed out this advertisement from her nursing magazine offering advanced nursing education opportunities from Creighton University.  This advertisement for the doctor nurse and nurse practitioner training tracks at Creighton University are a mockery of the rigorous educational requirements necessary to care for patients independently. Check out the nursing education requirements on their advertisement.

No entrance exam required?  No clinical experience?  No thesis required?  What has this world come to?   These are professionals who are going to be taking care of patients in less than two years. Some states allow NPs to manage patients independently with no physician oversight.

That is just plain scary.  This is an embarrassment to the rigorous foundation of anatomy, physiology, pathophysiology, neuroanatomy, microbiology, pharmacology, genetics and on and on required to care for patients independently.

This is scary stuff people.  These DNPs and NPs will be taking care of you in their clinic, independently, with no oversight, limited only by their own personal threshold for referral. 

Mrs Happy brought up a good point  with me though.

Mrs Happy:  Did you do a thesis?
Happy: Yeah, it's called internal medicine residency.

These are your nursing education requirements shaping the future of American health care.   Instead of the academic nursing advocates charging ahead with rigor to guarantee a high level of educational standard,   they pull this crap.   Why?  Why would they do this?  Is it about money?  Is it about keeping their classes full?  Why the dumbing down of nursing educational requirements?

I think NPs are great.  In fact, I enjoy working with them at Happy's hospital in the capacity for which they are trained.  But I question the motivations and integrity of nursing academia with their plans to give away post graduate degrees which grant the right for candidates to see patients independently, candidates who have never passed an entrance exam or taken care of patients.

Oh wait, I forgot.  They did  write an essay on "Why I want to be a nurse practitioner".  I wish getting into medical school was that easy.  This is your future America. The future of nursing education requirements is here and now.

What Should We Do With All This Extra Garden Produce?

I think the neighbors are going to feast. We got our first grape tomatoes and okra today. Another dozen cucumbers should be ready off the vine tomorrow. We're running out of room in the fridge. What do you do with all your extra garden produce?

Goal! Goal! Goal! It Was a Heck of a Shot at Grand Rounds This Week.

Besides the World Cup, South Africa was also the host of this week's medical Grand Rounds. Go check it out.

My Open Source H&P In An I.T. Driven Hospital Revolution

Something's gotta change.   The cost of delivering health care in America is out of control.  Blame it on doctors.  Blame it on hospitals.  Blame it on drug companies.  Blame it on patients.  Everyone is to blame.  The question is, what are we going to do about it?  How can we make is cheaper?  We have to make it cheaper, because the alternative is failure.  Under the current state of hospital based medicine, efficiency is not the driver of  IT support. The perfect example is the  history and physical examination.

Performing an H&P is one of the basic skills learned in a medical school education.  A history and physical has highly defined characteristics. What are these characteristics?  And why are they there?  Are they important just to get paid or do they offer any benefit to patient care?

EMR Comparison

Successful software implementation starts with choosing the right system. This  checklist contains over 50 of the most important features to look for when evaluating:

• electronic medical records
• medical billing software 
• scheduling software
• technology, security and certifications

Download now and get started today Other useful information is available at my EHR Resource Center.

LINK TO E/M POCKET REFERENCE CARD POST EM Pocket Reference Cards Using Marshfield Clinic Point Audit One Hospital: (Admit/Consult) One Side, Follow-Up On Other Side $10.00 One Clinic: (New/Consult) One Side, Established On Other Side $10.00 Two Hospital Cards $16.00 Two Clinic Cards $16.00 One Hospital Card + One Clinic Card $16.00 Two Hospital Cards + Two Clinic Cards $29.00 Click image for high definition view

Here I give an explanation on how to bill the high level hospital admission  CPT 99223 with a 99223 example.   How much of this information is important in the H&P and how much is documented entirely for billing purposes is a matter for debate.  I suggest the vast majority of what is documented in an H&P is wasted time, money and resources.  It takes money to support IT.  It takes money to support transcription.  It takes money to pay for all the ink and paper to print all this stuff up.

And guess who reads this stuff.  Nobody.  The vast majority of an H&P is just killing trees. So how can we make it better?  How can we improve and  simplify the H&P process?

Under current fee for service, every physician must perform an H&P with all required E&M components to get paid. If you have a hospitalist, cardiologist, gastroenterologist, pulmonologist and nephrologist, seeing a patient,  every physician MUST complete their H&P or consult note to get paid.  And if they want to be paid at the highest rate of reimbursement, they must do a complete H&P.

It's time to change all that.  Several months ago I was reviewing a chart from a patient in the ICU.  Every doctor's group had their own H&P.  And every single one of them was different.  The GI doctor only documented a FH for GI issues.  The cardiologist only documented issues related to the heart.  Everyone was doing their own thing.  There was no coherency in the H&P process.  I saw lots of inefficient reproduction of effort and in fact, multiple errors of commission  and omission.

Why does every doctor need to duplicate this ridiculous amount of work?   I'll tell you why, because every doctor must do it to get paid.  Then it hit me.  Why not have an open source H&P?  Open source is a method.    It is a community effort to build upon and improve the final product.  Open source gives community access to all the key players in an effort to create the best possible product.  In this case, an effort to produce one grand H&P that documents key portions of a patient's medical history.

Why can't we have an open source H&P?  Because nobody pays for one unified effort, that's why.  And because nobody pays for it, no hospital's IT is set up to support it.  

Why should we have an open source H&P?  An open source history and physical could be the greatest efficiency weapon to hit patient care in decades. It has the ability to correct rampant inaccuracies in the patient's medical chart,  reduce waste, reduce transcription associated costs and improve and increase the speed and efficiency from which physicians can do their patient evaluations.  That means you need fewer doctors, fewer physician assistants and nurse practitioners spending less time doing data gathering.  

Under what financial model could an open source H&P be implemented?  Why bundled care, of course.  There is no need for every doctor to reproduce all efforts every time.  Having access to an ongoing, constantly updated history could dramatically improve patient safety, reduce costs and increase efficiency.

Build it and they will come.  Talk about a physician recruitment and nurse retention  home run. This is the Holy Grail of medical documentation.  Much like the open source capability of Google's document platform  which allows any invited reader to edit the ongoing document AND the ability to quickly and easily view those changes, some day I hope Happy's information technology department provides physicians and nurses the ability to generate open source documents as a single updated face sheet that can  be reviewed on a daily basis AND screened quickly for all changes in a predefined period of time. 

Physicians fear bundled care because they view it as an opportunity for third party insurance to  pay less for the same service.  So what.  If we can reduce the cost of doing business and share in the savings of new found efficiencies, that's WIN-WIN.  We all pay thousands of dollars a year in premiums.  We need to make health care cheaper to deliver.  I view bundled care as an incredible opportunity to revolutionize the business of medicine.  Open source H&Ps provide a simple solution to an expensive problem.

It's time to free hospitals and doctors from ridiculous rules that kill innovation and allow them to fly again. It's time to bring the open source concept to your hospital's EMR and  to the front lines of health care in an IT driven hospital revolution.

International Hospitalist Opportunities: Pan-American Society of Hospitalists (PASHA)

Dear PASHA:

The hospitalist concept is a fairly new one in American medicine.  It's been around in some countries for decades.  But now the model is spreading south.  To South America that is.  These new international hospitalist opportunities offer a chance  for hospitalists to continue their pursuit of world domination
 

The newly created Pan-American Society of Hospitalists (PASHA) hopes to promote the ideas and practice of hospitalist medicine in the western hemisphere, with focus on South American issues by using experts in the United States to help guide  physicians down under.

The Pan-American Society of Hospitalists will hold its first official meeting in Santa Catarina, Brazil from November 11th-November 15th, 2010.

Call me a cynic, but this organization, co-founded by  Mayo Clinic  hospitalist Dr James Newman, sounds like an incredible international travel opportunity for American hospitalists looking to experience a paid for or at least tax free once in a life  time experience.

Two questions

1. Doe's Brazil allow Italian greyhounds to travel there?
2. Where do I sign up?   

Respectfully waiting to be offered the official position as PASHA's live conference blogger.

Happy                                                                                                     click image to enlarge

The Baby Doctor Club

Some doctors just look really young.  I am one of those doctors.  A recent patient of mine called me her "Baby Doctor".  I'm 37 years old.  I told a colleague of mine about that.  He's in his mid 40's and still gets told he looks too young to be a doctor.

I suppose it's not a bad club to be a part of. 

Does Your Doctor Lie To You Too?

I called an ophthalmologist's office in my town today to talk with the doctor about a patient of theirs in the hospital.  I talked to some front end person who answered the call, took my information and then told me that the doctor was "in on a procedure".  They asked me if they could have my number for the doctor to call back when they were done.  I said sure, gave them my number and hung up.

Read On

Tour de France 2010 and My First Spinning Class

Mrs Happy and I did a spinning class last night. What perfect timing with the Tour de France 2010 on the tube.  It's the first time I'd ever sat my butt down on a spinning bike.  I thought to myself, how hard could this be? I try and run at least 3 or 4 times a week (if I'm not doing other forms of exercise)  and I keep track of my running and walking on my running log.

We got a summer membership to a full service gym to try out their pool.  Mrs Happy wanted to try out some organized exercises classes.  So we headed to the spinning class.  I don't even own a bike anymore.  I sold my 1992 Trek 7000 last week on Craig's list for $50.  The gears hadn't worked well in years.  It was top of the line when I bought it back in my college years. I think I paid $700 for it almost two decades ago.

The guy who bought it said this type of Trek was popular for building into  a rick shaw (que Seinfeld).  He was going to start a business hauling stuff. Who knew.  I probably could have obtained more than $50, but I'm just glad someone is going to get some good use out of it.

Trying a spinning class was a new experience for me.  I hadn't been on a bike in years.  Wow!  Talk about a workout.  It was  a 45 minute class and I'm just glad Mrs Happy and I were able to hang with the rest of them 'till the end. 

I did get a cramp in my calf with about 5 minutes left when I tried to over do it.  And today my butt feels like I'm sitting on rocks.  Hopefully that will pass. No need to worry about a low sperm count either. 

It's official.  I have a new appreciation for those Tour de France riders and anyone who does triathlons.  I bow down to your strength and endurance.

Hospitalists Save Lives. Sometimes, Nobody Else Wants To.

Hospitalists save lives, every night of the week.  Few other medical fields can guarantee continuous intellectual stimulation across a broad pathophysiology experience.   Take for example a recent night call of mine. From 7 pm to 7 am:

• I discharged a patient from the ED after they chose to leave against medical advice with a seizure and malignant hypertensive crisis because they didn't have anyone to take care of their dogs.  I can understand that love with our Marty and Cooper.   I wrote them a script for Keppra,  Norvasc and Chantix  (and I billed a CPT 99406) and hoped to God the Medicaid National Bank didn't reject them from their formulary at 9 pm on a Saturday night. (UPDATE:  Chantix lawsuits, here we come)
• Then I consulted on a patient in the psychiatry floor with end stage COPD and end stage CHF who had  just been transferred there after a three week stay on the cardiology service  for a COPD exacerbation. Strange indeed.   I'm not even sure why he ended up on the psychiatry floor.     Now I get to manage the COPD.
• Shortly after that, I presented to the ER to care for a patient with "cellulitis" that turned out to be a new onset DVT.  It was a nice young man who lay tile all day long, day in and day out, up and down on his hands and knees.  He was seen at the local free clinic by a Nurse Practitioner who he said ordered an x ray, told him everything looked fine and that if it didn't get better in 3 days, to go to the ER. Huh.   His episode of  "I couldn't catch my breath", which I obtained from my history and physical examination  sealed the diagnosis for me in two minutes flat.  The doppler confirmed a   DVT.  I told him he probably had a  venous embolism as well.  I saved him the CT scan radiation exposure and $5000 for a self pay CT scan  and told him he had a blood clot in his lungs.  He should remain on warfarin as long as he does tile work.  Which, for this guy might be forever.  At least it's only $4 at Walmart.  Now, the Lovenox.   That's another story. But Obama gonna fix that.
• Next I moved on to a bounce back of sorts.  A nice woman transferred from a small town's community ER with a suspected seizure because her husband thought he was confused and blankly staring off into space. .  She was recently diagnosed at Happy's hospital  with multiple embolic strokes from a native  mitral valve endocarditis.  She had a fever and confusion the night she came back, both of which were resolved by the time she got to me.  I put her on seizure meds and told her she could probably leave the next day.  Interestingly, she was seen by a neurologist in the transferring ER prior to coming to me.  I guess it's just easier for me to order the seizure medicine.  I am, after all, the hospitalist, otherwise known as the path of least resistance.  Oh well, everything will get paid for.
• Next up I had the opportunity to resuscitate a horribly under resuscitated community transfer patient who started as your garden variety cellulitis in a small town critical access hospital and turned rapidly septic over the next 18 hours.  I don't generally read nursing documentation prose, but the transfer records documented failing vital signs starting at 7am.  When I got her it was 2 am.  The next day.  That's shocking.  18 hours of under resuscitation.  That's not how you manage septic shock.  Unfortunately, it's an all too common scenario I see as a hospitalist accepting patients from small town communities every day of the week..  It is what it is.  We want to believe we get the best care all the time in America.  We don't. I think any hospitalist could attest to that.  These patients never have appropriate IV access.  In this case, a 20 gauge.  I placed a central line and took care of her. If you are going to take care of patients, take care of them.  If you aren't, then let someone else do it.
• After that I got the opportunity to care for a chronically debilitated nursing home patient with a rip roaring UTI who's family asked she  be transferred to the ER at 3 am because they were gravely concerned she had been weak for the last five days and she spiked a temperature at 1 am.  Guess what.  None of the family showed up in the ER.  It was just me and a bag of Rocephin and a nurse complaining that  she wouldn't stop riding the call button.  That's why ERs appreciate the quick emergency department throughput that hospitalists bring to the table.   She was a 4 AM G.O.M.E.R.  That's all there is to it.
• And last but not least, it was a patient with honest to go hypokalemic periodic paralysis.  He couldn't move.  Couldn't talk.  Couldn't swallow.  All that was better by the time I saw him, but the story was classic.  This is the kind of stuff internists and hospitalists train for in our medical school education.  We are born and bred to recognize stuff like this that could be the difference between life and death.    I could go my entire career as a hospitalist and never see another case of this rare condition.  But I saw it that night.  And I recognized it.  And that's all that matters.

And with that, the night was complete.  Only two pages from the nurses that entire night.  And much to my expectation, no patient was harmed by common sense communication of non urgent issues.  I want to thank the nurses of Happy's hospital for understanding and protecting our time as night hospitalists to allow us uninterrupted time to do what we do.   In case you are wondering, if I'm not sleeping, this is what I'm doing. I'm saving lives, sometimes because nobody else wants to.  And it can go on all night long.

My Garden Vegetable Plants July 2010 Update

My garden vegetable plants are growing like crazy.  Here's what the garden looked like a month ago. I've planted

Read On

Motorcycle Sidecar Baby Seat? Seriously? Is That Even Safe?

I'm at work the other day when I saw this great looking motorcycle sidecar parked on the street.  Here's a picture of the motorcycle and sidecar.  It looks like something out of one of those old James Bond movies.  I thought it was pretty cool.

Read On

Chapter 66 Bankruptcy Coming To A State Near You

48 out of 50 have a revenue cliff coming next year.  Over half our states have a revenue shortfall of more than 20%, with Illinois and California leading the charge.  It's aptly called Chapter 66 Bankruptcy, named after Route 66 that stretched from Chicago to Los Angeles.

How bad is it getting?  Your representatives are giving themselves raises while America goes down in flames.  Here come the firedfighters.  Nobody is safe.

Lifestyle Protection Plans (LiPPs) Are A Market Solution To Out Of Control Health Care Inflation

We all know what's coming with Obamacare.  A massive influx of  underfunded, fully insured, high risk, high cost patients with no personal responsibility to control their own consumption of limited resources. I am a 37 year old who chooses to engage in a healthy lifestyle.   When measured over populations, lifestyle choices can dramatically reduce the risk of developing long term chronic disabling illnesses such as coronary artery disease, diabetes, stroke and cancer.

Read On

Mel Gibson Racist Telephone Call Remix Video: LANGUAGE ALERT, NOT SAFE FOR WORK

It seems to me Mel Gibson has gone over the deep end.  He sounds like a man with some serious issues to deal with.  I hope he gets the help he needs to deal with his anger.  This is not the voice of a healthy man in a healthy relationship.
 

But damn, this video is funny.  Here's a remix of the Mel Gibson racist telephone call to his girlfriend  Oksana. 

Here's the original video.  Disgusting.   It sounds like the voice of a man deep in his own pain. Perhaps drugs and alcohol is playing a role.  I seem to remember him having several alcoholic related crimes in the last few years.  I wonder if and when he'll hit bottom.  This certainly can't be good for his career.  Maybe he and Tiger Woods should get together for a little talk therapy.

Classmates.com Lawsuit Shinanigans. I Got $3, But What Did The Lawyers Get?

So I got this email yesterday from a law firm explaining to me my rights under a proposed Classmates.com class action lawsuit settlement.  Nobody admits to anything.  Everybody gets paid.  It sounds like med mal extortion.  For anyone that's been around for a few years,  Classmates.com is that site that would bug you with emails everytime a classmate of yours sneezed.  What was this lawsuit about?

2.      WHAT IS THIS LAWSUIT ABOUT?

In this Litigation, Plaintiffs assert class action claims against Classmates Online, Inc., Classmates Media Corporation, and United Online, Inc. ("Defendants"). Complaints filed in the action allege, among other things, that Defendants sent email messages to subscribers of w ww.classmates.com that were in violation of the law and engaged in conduct that had the potential to violate w ww.classmates.com users’ privacy rights. Defendants have denied and continue to deny Plaintiffs’ allegations and maintain that Defendants have not engaged in any wrongful conduct. Defendants also contend that the Litigation is not suitable for class action treatment. Defendants have nevertheless concluded that it is in their best interests that this Litigation be resolved subject to and on the terms and conditions set forth in the Settlement Agreement. 

This Settlement is the result of arm’s-length negotiations between Plaintiffs in the Litigation, individually and on behalf of the Settlement Class and Settlement Subclass, and Defendants. Both sides agree that, in light of the risks and expenses associated with continued litigation, this Settlement is fair and appropriate under the circumstances. Plaintiffs further believe that this Settlement is in the best interests of the Settlement Class and Settlement Subclass. Please be advised that the United States District Court for the Western District of Washington has not ruled on the merits of Plaintiffs’ claims or Defendants’ defenses and, therefore, you should not make any assumptions about the strengths or weaknesses of the claims or defenses in the Litigation. 

So what am I entitled to?

4.      AS A SETTLEMENT CLASS MEMBER, WHAT AM I ENTITLED TO?

In addition to injunctive relief, as a Settlement Class member, if you do not exclude yourself from the Settlement and if you timely submit a Valid Claim Form, you are entitled to receive a credit of $2.00 off of the purchase or renewal of a w ww.classmates.com Gold Membership. Under the Settlement Agreement, Settlement Subclass members are entitled to receive either a cash payment of $3.00 or a credit of $2.00 off of the purchase or renewal of a w ww.classmates.com Gold Membership.

In addition to its cash and credit components, the Settlement also provides, on a non-opt out basis, for Defendants to provide injunctive relief to all Settlement Class and Settlement Subclass members. A description of the injunctive relief that Defendants are providing is set forth at the following website: www.cmemailsettlement.com. 

 It looks like I've hit the jackpot.  $3.  God Bless these lawyers.  They worked so hard to compensate me for my troubles, all three dollars worth.  That's the value of my pain and suffering.   I don't know what to say.  Thank you lawyers for all your hard work in protecting me, the little Classmates.com consumer from this dastardly company.  How much did the lawyers take home for all their hard work protecting little Americans like me from out of control companies likes Classmates.com?

12.      HOW WILL CLASS COUNSEL BE PAID?

Class Counsel will ask the Court for attorneys’ fees and costs to be paid in conjunction with this Settlement. Defendants have agreed not to oppose Class Counsel’s request to the Court for attorneys’ fees up to $1.3 million, plus costs. Costs may include participation awards of up to $2,500 for each of the two Lead Plaintiffs. Fees and costs that are awarded by the Court will be paid by Defendants separately and will not affect your entitlement to benefits under this Settlement. You will not be obligated to pay any attorneys’ fees or costs as a Settlement Class member, nor will any award of attorneys’ fees, costs, or participation awards by the Court reduce the amount of Settlement benefit available to Settlement Class or Settlement Subclass members. 

$1.3 million dollars + costs.  Wow.  Congratulations lawyers.  I can just see them sitting around a poker table laughing about how easy American justice is.  Let's see how these numbers compare to the value doctors bring to the mother and fathers of members from this law firm.   Medicare pays around $90 for a highly complicated 35 minute hospital follow up visit.  In order for a hospitalist to earn as much money as this law firm did taking care of the little guy,  they would have to care for 14,444 Medicare patients spread out over 8,425 hours.  That means they would have to take care of 20 patients a day over 12 hours a day, seven days a week for 702 days without a lunch break, potty break or sanity break.

Let's see.  1.3 million dollars to help the public get a $3 check in the mail.  Or saving the lives of 14,444 Medicare patients over the span of two years.  And you wonder why tort reform will never happen as long as lawyers are making laws.  How odd that our government of lawyers value the lives of our elderly at a fraction of the value of their own.

Perhaps it's time to implement Medicare based value pricing in the class action lawsuit market.