Placebo Journal - Medical Humor With A Purpose

The big news this week is that Medicare is going to stop paying for medical mistakes. That was the headline put out in every paper around the country. Sounds ridiculous, right? Why would the government pay for mistakes (Iraq, FEMA, etc.) in the first place? Well, the answer is not that simple. According to the administration, Medicare will no longer pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.” This includes bedsores, injuries caused by falls, and infections resulting from the prolonged use of catheters in blood vessels or the bladder. They also won’t pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.

Intuitively, this sounds pretty smart. But is it? Obviously, the intention to stop neglect is a good one. There are, however, times when bad things do happen and it is not anyone’s fault. The future fallout from this will be very interesting. This means more administrative oversight to double check everything on each patient in the hospital which means more, well, administrators. That can’t be a good thing.

I am fully aware that we can always do better. But a UTI from a catheter? Trust me, there is going to be a lot of fudging in future documentation. No doc is going to want to be dinged for making these “mistakes”.

Yes, it is wrong to leave a sponge in someone’s peritoneal cavity. A bed sore, however, in a quadriplegic 400 pound man is going to be tough to stop. Did that sore start before they came in? I guarantee that there will be more “diagrams” on the chart highlighting anything close to looking like a sore. Doctors will have to get some extra blood and urine tests before the patient gets admitted just in case something shows up later. This won’t cost too much; now will it?

The bottom line is that while I agree on the intention, I am very suspect of the initiative. There are now going to be infection police roaming the hallways like elementary school hall monitors looking for bathroom passes. There will also be accident teams that will be skilled in the art of documentation manipulation that will allow the hospital to show that they were not at fault. The cost of these new jobs will, in my estimation, equal what it was before they were created. And don’t forget the new MRSA wings that keep these patients in total isolation from everyone else. That has got to cost a pretty penny as well. Oh well, I guess the hospital will just have to raise its rates somewhere else to make up for it. It’s not like they are going to cut their CEO’s salary.

Lastly, hospitals are going to have to report this data on how good they are doing. Ranking systems will be constructed and nice new awards will have to be created so the “cleanest” hospitals will enable their marketing team to brag to the media. Alabash County Hospital winning the Golden Catheter Award is good PR and a great story for the local paper. This is going to be fun and in the long run, a pain in the ass.

Each year, state medical boards are finding new ways to punish doctors. The pressure is on them to show they are ruling with an iron fist. Groups like Public Citizen are basing their performance on how many penalties they distribute. If that isn’t good science, then I don’t know what is.

Our state board sends out a bulletin detailing ways not to get into trouble. In a section entitled “Open Mouth, Insert Foot” they listed 13 remarks that licensees have made directly to patients or have been overheard and have precipitated complaints to the board. Here it is:

Some of these remarks only remind me that you can never predict how stupid or racist someone is, whether it be doctor or not. Some of these remarks I don’t even understand (what is CRS?). It also proves that everyone has the ability to be an idiot. Saying someone has beautiful eyes or SOL probably isn’t the worst thing but it just goes to show you that patients can complain to the board over anything and the board is very receptive to slamming us. For the record, none of these are mine but for there but grace of God…..

We are pushing hard on our October issue of the Placebo Journal. So far our parodies look great – Drugopoly, Med School Musical and so much more. Isn’t it about time you received our hard copy magazine so you can laugh away from the computer? On the bowl, for example. If you answered yes then click below:

What was once thought of as taboo has now been deemed acceptable. Nathan Koppel’s piece in the Wall Street Journal describes how some lawyers in NYC have crossed the $1000 an hour line. Oh my God! I know some specialty surgeons make a bunch of coin (and probably too much) as well but I am just a family doctor. This blows me away. Interestingly enough, one of the nation’s best-known trial lawyers, David Boies, stated, “Frankly, it’s a little hard to think about anyone who doesn’t save lives being worth this much money”. Amen.

The lawyer’s are having a field day with the big recall due to lead paint contamination in certain toys coming from China. A piece in the Wall Street Journal describes how families are trying to sue the toy makers even before any children are showing injuries. How can they sue without evidence, you ask? Easy, first you need to create what is called medical-monitoring funds. Then you exhaust a lot of money that would be paid if injuries did occur by setting up these surveillance systems; all the while the lawyers get to pocket some nice cash.

To be fair, some of the lawyers quoted in the piece are actually against this practice and it has become a big division in the legal community. The costs in these cases rises into the multi-millions even though it probably is doubtful that anyone will be truly proven to get sick from it. The bottom line is that kids would have to have been sucking on these toys like lead lollipops. Then they would have to bake it in their defective Easy Bake Oven (they need to be careful not to burn their little hands) and then serve it at an imaginary tea party. Even so, the stuffed teddy bear and Bratz doll would have a better chance of getting sick than these kids. No, I recommend the lawyers wait until the kid swallows the teddy bear’s eye in order to get rich. That would be the most prudent way to go.

Now that Dr. Anna Pou is legally out of hot water the AMA is addressing the issue by developing legislation to protect physicians who in the future, end up in a situation like hers. They want medical liability immunity for physicians when a state or federally declared disaster is declared.

My question is this: where was the great AMA when Dr. Pou needed them now? Wouldn’t it have been nice if they formed their own investigative committee, like the NFL did with Michael Vick, to see if she was indeed innocent? They then could have helped her out financially and with pressure on the moronic DA’s office to get her life back earlier. Instead, it was nothing but crickets. Nice way to stand up for your people!

“Son, there’s been a bit of a mix-up,” admits the surgeon. “I’m afraid there was an accident, and we were forced to perform a sex-change operation. You now have a vagina instead of a penis.”

“What!” gasps the patient, “You mean I’ll never experience another erection?”

A recent JAMA study spells bad news for the elderly protective equipment industry. The investigators looked at the efficacy of an energy absorbing hip protector to prevent hip fractures from falls. After 20 months, the hip fracture rate did not differ between those wearing it and those who did not. Too bad. I am wondering how they got these people to fall in the first place. I understand that some old people are just going to hit the deck naturally but I bet it was very tempting to tip some of them over to improve the statistical significance of the study. Can’t you just see some of the lead researches teaching their minions to set up obstacles like foot rests and IV poles to get their numbers up? Okay, that is a little dark. Anyway, the companies that produce this kind of equipment will have to go back to the drawing board. This could be big money in the future if they get it right. Medicare is guaranteed to overpay for $5 worth of cushioning if it works. A successful hip protector that is certified will probably go for over $100 in my estimation. Of course they have to make them look sexier because right now they are really ugly. I can see the day where granny is wearing a crotchless Victoria Secret style brand when she goes to the cafeteria for the Polka Ball. Okay, that was bad taste as well. Sorry.

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We all love Gary Larson but isn’t it time you start trying something new that is medically related?

Publix Supermarkets is giving away seven common prescription drugs for free. They are all antibiotics. This is an attempt to lure patients into their pharmacies and hold them hostage. Okay, maybe it is not that extreme but marketing is marketing. Drugs like amoxicillin, cephalexin, penicillin VK, erythromycin, ampicillin, bactrim, and cipro are all for the taking with a subscription. The STD that brought you there, however, is probably slightly more expensive. Disregarding the fact that these meds are basically resistant to all bacteria, they are work the same for viruses and that is good news for the practitioners at the retail medical clinics nearby. Word on the street is that other enticements are coming to these big box pharmacies as well. They include: massage with or without the happy ending, lap dances by the “special” staff and free cigarettes. I can’t wait to get sick.

I want to thank all of you for the great feedback I have been getting about Placebo Television. It’s not easy being an idiot on film. And no, The Daily Show and The Colbert Report have not called to offer me a job yet. If you haven’ t seen it, check it Placebo Television #4:

New York Attorney General Andrew Cuomo is leading the charge to push back against the ranking systems by managed care companies. He states the ratings of doctors are deceptive and confusing. He is worried about how prone these rankings are to error. The managed care companies, however, are holding their ground because their goal is just to aid patients by calling attention to the best physicians. They are just being good Samaritans. Yeah, right! This is all about cost and manipulation. The data is flawed and unproven. No doctor signed up for this garbage when they joined these plans but it doesn’t matter to these companies. They are going to give blue ribbons to whomever they want to and trash others while they are it. The companies are stating that they consulted with physicians when constructing these rankings but who are these doctors. Are they being paid a nice stipend or are they just stupid? As you may know from past Placebo Gazettes, we haven’t heard the end of this travesty to the medically system. Thought there is nothing evidence-based about this fad, it will not stop them from moving forward to bully doctors even more. Hey, Mr. Cuomo, why not sue the federal government and Medicare while you are it? They are doing the same damn thing!

13. Fishy

A Minnesota law has uncovered the fact that drug companies pay a lot of money on members of state advisory panels who help select which drugs are used in Medicaid programs for the poor and disabled. No sh$t! This has been going on forever. The panels are made up mostly of physicians and determine where the $28 billion spent on drugs goes each year for Medicaid patients nationwide. An AP article came out showing that a doctor and a pharmacist on the eight-member state panel in Minnesota simultaneously got more than $350,000 from pharmaceutical companies for speaking about their products. They claim that this cash did not influence their work on the committee but who are we kidding here? In Maine there are tons of drugs that go on and off the formulary in what seems like months. Many of these medications are new and expensive and somehow get to the top of the list very quickly. I know for a fact that “rebates” are given back to the state just to get the drug on the list. What do you call these rebates other than bribes? And though an individual panel member may or may not be getting some of the cash, how much do third-party vendors get when they do the negotiating “tiering” of these drugs? It smells awfully fishy to me.

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