Families Thrilled to Know Comfort Care Chemotherapy is an Option.

Boston, MA -  After years of poor patient satisfaction scores threatened to get Dr. Betty Jensen kicked off the medical staff at Monroe Hospital, she became the first Palliative Care physician in the country to start offering end-of-life comfort care chemotherapy last year and the results have been nothing short of remarkable.

Comfort Care Chemotherapy provides peace of mind.
"I could actually feel the tingling deep inside of my patient satisfaction scores rising in real time as patients called out for one last dose of deathbed comfort care chemo before passing peacefully on the vent surrounded by friends and family in the ICU," said Dr. Jensen, who went from worst to first after implementing her chemotherapy protocols.

But life wasn't always so good for Dr. Jensen.  "For years, I was living in fear of my next patient complaint.  Then it hit me one day.  I am a palliative care service.  Cancer patients seem to love palliative chemo.  It just made sense for me to start offering end-of-life palliative chemo to optimize the patient experience," said Dr. Jensen, who now works closely with several oncology groups to maximize her patient satisfaction scores.

At Monroe Hospital, every palliative care consult now gets an automatic oncology referral to make sure no end-of-life patient dies without chemotherapy.  For the last six months palliative care and oncology have been working side-by-side in a symbiotic relationship, maximizing end-of-life comfort care patient satisfaction scores.  Patients and their families have had nothing but praise for this aggressive approach to death with dignity.

"My mother was 92 years old and hadn't been in an upright position in three years.  We knew it was finally time for comfort care when the surgeon said enough was enough after  172 decubitus ulcer debridements failed to make her better.   We thought they would just pump her full of sleeping drugs and let her die a miserable death without food and water, but we were thrilled when the hospice doctor recommended comfort care chemo.  That's why we love this hospital so much. I just wish end-of-life comfort care chemotherapy was available when my father died.  We could have prevented so much suffering," said the daughter of one satisfied patient, who prides herself on being an excellent advocate for patient rights.

Dr. Jensen agreed.  "We used to tell families and patients about dying with dignity but that just got them all riled up.  Now we tell them about dying with chemo and their ears perk up.  They become excited to hear more.  They are thrilled to know end-of-life doesn't mean end of treatment.  And word must getting out about our great service because we've already been asked by several nursing homes this year to start providing end-of-life skilled nursing home chemo."

Finding the right mix of chemotherapy was not always easy.  Dr. Jensen spent many months trying to find the perfect combination of drugs for her protocols.  "Comfort care chemo is more of an art than an exact science.   In the early days, we caused a lot of unnecessary pain and suffering by being too cautious with our dose adjustments for age and renal function. But we got over that fear after time and time again our patients and their families told us not to hold anything back because their mother was a fighter."

Hospitalist vs ICU End of Life Palliative Care Video

Hospitalist vs Oncologist Video

Weather Forecasting Accuracy Joins Medicare Value Based Purchasing Program.

Baltimore, MD  -  Just days after Medicare announced their historic timeline for shifting fee-for-service  to alternative payment models that focus on quality and value and just hours after New York meteorologists inadvertently shut down New York City with their failed Blizzard of the Century forecast,  the Obama administration announced the addition of weather forecasting accuracy to a value added payment mix used to determine how much doctors and hospitals are paid.

Bad weather forecasting now linked to Medicare penalties.
"After careful consideration, we have determined that doctors and hospitals should be punished for inaccurate weather forecasts that affect the safety and wellbeing of our Medicare seniors and we plan to hold them accountable," said HHS secretary Sylvia Burwell during a conference call with reporters.

New York public transportation was ordered shut down by New York Mayor Bill de Blasio after meteorologists predicted several feet of snow would wreak havoc on the city.  That forecast proved grossly inaccurate and upset millions of residents caught without a way to travel about the city.

Many New Yorker residents were thrilled with the federal government's call to action.  "It's about time those rich doctors suffered for these ridiculous weather forecasts day after day. Those people have no idea how hard it is to plan a day around bad weather forecasts," said Tom, an uninsured street vendor  who gets his healthcare from a charity clinic staffed by volunteer doctors and nurses on their days off.

By tying the accuracy of weather forecasting to payments, Medicare continues to push the envelope on creative ways to blame doctors and hospitals for failing to control costs.

Next week,  Medicare will publish their highly anticipated list of future additions to the value based purchasing program which is expected to include 2016 payment penalties tied to satisfaction with local DMV services and the availability of power scooters during peak shopping hours at Walmart.

Elderly Woman Admits to Family She's Not Really a Fighter.

Tuscaloosa, AL -  Ethel Burman shocked her family this week after admitting to them she wasn't really a fighter after all. Despite their insistence over the years, the elderly nursing home patient told her family she's never been a fighter and all their talk about her being a fighter is just made up gibberish in their own minds.
Son always requests WTF order:  Wants To Fight

"I just got tired of hearing my kids tell the doctors to do everything because I am a fighter and I snapped.  I'm not a fighter.  I'm 98 years old.  Last week I wrote a thank you card to my poop for being the only thing to show up on my birthday,"  said Ethel, who has suffered through debilitating illness at the nursing home for years.

Ethel is known hospital wide for her frequent hospital admissions to intervene on any one of her dozens of chronic medical conditions.  Ethel is part of a close knit group of frequent flyers being kept alive at all costs by their family's grit and determination.  "I've taken care of Ethel for years.  Her son always makes us write an order for Wants To Fight.   I say to the son 'WTF?' and he nods his head yes," said Angela Hanes, a veteran nurse who has seen it all.

Angela admits the nursing team on pod seven prominently displays a constantly updated list of WTF patients so nurses can mentally prepare for their day of pain.  "We have an agreement on the floor that if we are assigned a WTF patient, we don't have take anyone else on that day.  They require 1:1 cares all day long," said Angela.

Despite his mother clearly expressing her wishes, Ethel's son spent hours trying to convince hospital staff she didn't know what she was saying.  "My mother is crazy.  I'm her POA.  I know what's best for her," said her son with a straight face and exceptional insight.

Hospitalized Woman with New Complaint Everyday Diagnosed with Broken Furnace Syndrome.

Fargo, ND - Bertha Jensen was hospitalized two weeks ago for chest pain rule out, but a new complaint every day has prevented doctors from sending her home during the cold winter months.  That is, until a breakthrough in discharge planning was discovered by her current Hospitalist.

Consider Broken Furnace Syndrome for difficult winter discharges.
"When I was a resident in Minneapolis, I took care of at least a dozen cases of Broken Furnace Syndrome every winter," said Hospitalist Dr. David Penter, who is known for his uncanny ability to spot patients with ulterior motives from a mile away.

Broken Furnace Syndrome is any 12/10 symptom that presents during a patient-doctor encounter on the day of planned discharge from the hospital, followed by a completely unrelated symptom after the physician minimizes the first complaint. For example, having a 12/10 headache that is then followed with a complaint of diarrhea after the physician minimizes the headache complaint  is pathognomonic for Broken Furnace Syndrome.

Broken Furnace Syndrome occurs in the cold winter months when patients refuse to go home because of problems with their utilities or other social dynamics that have nothing to do with their hospital stay.  While often the result of a broken furnace, physicians should also consider variations of the disease in their differential diagnosis, including I Didn't Pay My Gas Bill, My Pipes Froze and I Don't Have Water and even My Mother-In-Law Is in Town and She Thinks She's Going to Stay With Me as the reasons for avoiding discharge.

Every time Bertha's doctor told her she was stable for discharge, a new complaint was suddenly described.  "We ruled her out for MI in less than 12 hours and 12 days later she's still laughing it up with the nurses, except for the three minutes the doctors are in the room, then she's complaining of 12/10 nausea,"  said Dr Penter.

A normal litany of complaints for an 88-year old has kept Bertha hospitalized for nearly two weeks, including headaches, nausea, chest pain, blurry vision, sore throat and restless legs.  On day seven of her observation stay, she even complained of diarrhea and constipation in the same night.

On day four of the observation stay, one hospitalist tried to put an end to the madness by spending four hours - on a Saturday - coordinating a stat laprobroncathoscopy between the surgeon, pulmonologist, cardiologist, gastroenterologist, anesthesiologist and pathologist, in anticipation of a Sunday discharge.  Despite everything coming back normal, her Sunday discharge was aborted after she complained of not having a ride home.

Dr. Penter confirmed the diagnosis by having his medical student stand outside Bertha's room all day listening to her phone conversations for clues.  This allowed Dr. Penter to get his work done while making the medical student feel important.

"We caught her taking to Dan the Furnace Man at around 3 p.m. yesterday.  When I presented my findings to her, she complained of 12/10 restless arms, followed by a lump in her throat that she wanted thoroughly checked out."

Am I a Good Parent? Two Question Quiz!

Many mothers and father often find themselves wondering whether they are good parents or bad parents.  The answer is really quite simple.   If you vaccinate your children and you don't spank, you're a good parent.   Good job parent!  If you vaccinate your kids but feel it's alright to spank them, you're a bad parent.  Stop it!  This flow chart diagram on parenting skills will help you understand.  Be a good parent.  Vaccinate your kids and don't spank them and you'll be a great parent.

 photo bd9cdefc-02b9-4e0d-b74e-16dbe073f588_zps3b447057.jpg

You can find many great books on Amazon about gentle parenting techniques that provide a positive experience for your kids.   The Happy Hospitalist is hoping 2015 will be filled with great parent experiences that bring joy to your childrens' hearts.  Fill their love tanks.  Say no to spanks and yes to vaccines.