- Story Time
- Where Else Can We Put Them?
- Placebo Journal Update
- Health Care Costs Money
- Who Cares If I Die? I Look Great.
- Join The Bandwagon
- Joke of the Week
- Ridiculous Study of the Month
- Bacharach’s Beliefs by Ted Bacharach MD, retired
- And The Winner Is…
- Filling The Docket
- Bully For You
- Not Smart Enough
- Feedback About The Placebo Gazette
1. Story Time
We are beginning our efforts to start the 41st issue of the Placebo Journal. This is where you come in. Do you have a great medical story? You know the kind that you tell at parties or in the doctors’ lounge? Well now all you need to do is share it with the rest of the world by submitting it here:
submit
Remember, there can be no compromise of care. Everyone should be anonymous. Lastly, it has to be true (no urban legends) so it cannot have happened to a friend or colleague of yours.
The stories that go into the Placebo Journal are ones that show the absurdity of our healthcare system. You do NOT have to be a doctor to submit something. We love stories that come right from the patients themselves. We love stories from nurses, receptionists or anyone that can give us a different perspective. Remember, the goal is to make others laugh and humanize us a little bit more.
If we publish your story, then you will receive a FREE subscription to the Placebo Journal. Not ALL stories can be used for many reasons (not funny enough, inappropriate, etc.). Please do not be discouraged. Just try another one.
2. Where Else Can We Put Them?
A recent story looks at the proliferation of walk-in health clinics at airports. It seems to be all the rage now. Again, like retail clinics, they are manned by mid-levels and just focus on a narrow range of services. Part of me totally understands this venture. Long wait times and delays make the potential customer base endless. Also, you can’t forget that once you are stuck in the airport you have given in to the fact that you are almost in another universe and the price for things are ridiculous. It always amazes me when I buy a bottle of water for $2.50 or have a crappy slice of pizza for $7 and never bat an eye over the price. It’s like Disney World but much less fun. I can just see airport clinics charging a lot more money in the future once this catches on.
It makes me wonder where else we would start seeing these “clinics” pop up? How about the men’s room at strip clubs? You can have plenty of STD business there. Or what about at car washes?. Don’t forget churches? Right after confession one can slip to the next room and get a colonoscopy to wash away some more sins. Any other ideas? Send them my way and I will rank the top 10 and give you credit as well.
This story is also blogged here: http://placebojournal.blogspot.com/
3. Placebo Journal Update
So have you been thinking about subscribing to the Placebo Journal for some time now but just haven’t pulled the trigger? Have you been reading the Placebo Gazette and watching Placebo Television and now you would like something that you can rip up and tape to the walls? Well, I am here to tell you that now is the time to subscribe to the only medical journal that will make you laugh….on purpose. We have no advertising. We have no editorial conscience or constraints. Sometimes we have no class. Sorry about that one. But what we do have is something unique that may need to put a smile back on your face. Guaranteed or you money back. If you are interested, subscribe here:
SUBSCRIBE HERE
4. Health Care Costs Money
Hopefully everyone is watching the grand experiment going on in Massachusetts. Premiums are going up around 10% as the state is figuring a way to pay for all these newly insured people. Unfortunately, even this increase will not cover the shortfall that is needed to balance the program’s budget. Uh oh. How are they going to get more money then? Options include getting more contributions from hospitals, insurers, businesses or even cigarette taxes. My guess is that they are going to have to get it also from the doctors by paying them less. They are usually the easiest, low lying fruit and have shown that they have little will in fighting back. Sorry. The truth hurts. This will only continue the cycle of problems because right now there are not nearly enough primary care doctors to take care of these patients. What good is health insurance if you can’t use it? My favorite little tidbit that adds to this story is the fact that Harvard Medical School is proclaiming on their website that 44% of their medical students are going into primary care. Hogwash. We all know that most of them are going into internal medicine and after three years they will somehow miraculously choose a higher paying specialty to switch to. Can someone help me? I was browsing their website and was unable to find their department of Family Medicine. Anyone? Bueller. Bueller. Anyone?
5. Who Cares If I Die? I Look Great.
Dr. Steven Nissen is in the news again. He is the cardiologist at the Cleveland Clinic that outted Avandia and more recently, Vytorin. I recently went to a lecture from a cardiologist friend here in Maine and asked him after the talk if he has a poster of Dr. Nissen in his office. He wasn’t amused. I prodded him some more and told them there should be one of Nissen in a Farrah Fawcett- like pose in that infamous poster from the seventies. Again, no smile.
Anyway, Nissen once again was quoted in the Wall Street Journal when news spread that though the Sanofi-Aventis drug (Accomplia) may help people lose weight it may not slow the progression of coronary artery disease. Two different measures were looked at and the findings were split. The drug did not pass the FDA muster last year because of its link to suicidal thoughts and behaviors. My hunch is that if this thing makes people look better by getting them to lose weight, then it really doesn’t matter if it packs their arteries with plaque like blood sausages or if they start turning their garages into a carbon monoxide palace. It will still sell like blockbusters.
By the way, this information all came out of the American College of Cardiology conference in Chicago. Placebo Television had its first “live via satellite” feed from there. We had some “sound” issues on Google so we uploaded it again on blip.tv as well. Check out our correspondent here:
http://placebotelevision.blip.tv/#818998
or here:
http://video.aol.com/video-detail/placebo-television-11/1315036136
6. Join the Bandwagon
Gastric banding is now in the spotlight as the newest and most cosmetic way to make some cash. As described in a recent piece in the WSJ, Johnson & Johnson is battling Allergan for superiority. So are venture capitalists trying to back outpatient surgical centers. And then there are the surgeons. Giving free seminars like the old snake oil salesman of centuries past, they are peddling their surgical wares and making a nice buck at the same time. Good for them. I’ll just spend an hour with an obese diabetic patient with heart disease and a list of 17 problems and get paid $84 before overhead. Sounds fair.
The problem with gastric banding is it may not last and then the patient would need another one. You know what that means? Ca-ching! Hard, cold cash. We family docs need something to make that kind of money. My colleague thinks we need cerumen catheter centers with pretty fiber optic cameras to show the patient how tough it is to remove ear wax. Anyone else have any good ideas?
7. Joke of the Week
A woman went to the emergency room, where she was seen by a young new doctor. After about 3 minutes in the examination room, the doctor told her she was pregnant.
She burst out of the room and ran down the corridor screaming. An older doctor stopped her and asked what the problem was. After listening to her story, he calmed her down and sat her in another room.
Then the doctor marched down the hallway to the first doctor's room.
"What's wrong with you?" he demanded. "This woman is 63 years
old, she has two grown children and several grandchildren, and you told
her she was pregnant?!!"
The new doctor continued to write on his clipboard and without looking up and said, "Does she still have the hiccups??"
8. Ridiculous Study of the Month
The New England Journal of Medicine did it again. A lung cancer study published in 2006 suggested that an annual CT scan could reduce the death rate for smokers. Forget the fact that this study would only detect the cancer earlier but not really change the outcome; that being death. Forget the fact that there is no way we could afford doing CT scans on smokers every year. Forget the fact that it is ridiculous for the rest of us to pay for the continual misgivings of others. Now the NEJM states that the lead authors received royalties from GE, a big maker of CT scanners. They were paid for “pending patents on ways to manipulated and interpret CT scans and other medical images”. Whoops. And people call the Placebo Journal sophomoric.
9. Bacharach’s Beliefs by Ted Bacharach MD, retired
JCAHO Tales
It was a quiet day in the pulmonary lab when a JCAHO inspector appeared. He was busily trying to inspect all of the twenty or so loose leaf manuals that covered all of the procedures in which the lab was involved. One of the technicians, seeing the inspector and responding with the usual nervousness these inspectors inspire, dropped a vial of blood. The tube broke and the blood spilled on the ground. Donning a pair of gloves she began to clean up the spill. NO WAY!! The inspector responded with alacrity. “Show me the procedure
you will follow in cleaning up this spill.” Thus began a 2 hour search of all of the procedures manuals to find the method to be followed in the case of blood spills. In the interim the blood on the floor was given a wide berth by all and allowed to dry. I am not sure but it was either the nineteenth or twentieth loose-leaf binder that contained the pertinent instructions which permitted the technician to clean up the spill. The fact that the technician had told the inspector what she was going to do carried no weight until chapter and verse were found to correlate.
Being old I remember some of the first inspections (circa 1954) when pertinent principles, methods and procedures were inspected. During those early days even the temperature of the tap water was considered and looked at. The items inspected made sense and participation was voluntary.
Growth. Maturation. Development. They are all terms that can be applied to individuals or organizations that improve refine and carry out their mission with increased efficiency and expertise, Unfortunately JCAHO is an excellent example of how time can bring about changes the result in defeating almost all of their once lofty ideals and goals. The only goals they have achieved are self perpetuation, destruction of all endeavors involving innovation in the operation of medical facilities, as well as repeated “disruptive inspections”. A return back to basics might be worthwhile also an appreciation for variations that in some cases are an improvement should be considered. The expansion of JCAHO into outpatient and clinics has made the organization profitable as well as ubiquitous. Revision and a return to basics should be considered.
10. And The Winner Is…
Big news from the American Contact Dermatitis Society. They have proclaimed nickel to be its 2008 Allergen of the Year! In the Journal of Dermatitis, Dr. Kathryn A. Zug stated that, “to dismiss nickel’s importance and relevance to public health and skin disease, would be a mistake”. Wow. Now thems are fightin’ words.
As far as I know, nickel has not responded or sent any other allergen to accept this award on its behalf. My hunch is that if nickel was to send a reply it would be similar to what I was thinking. That being said, the doctors behind the American Contact Dermatitis Society may need to get a social life or find some friends.
11. Filling the Docket
I have been getting a recent influx of queries to have me lecture at different venues. For that I am very thankful. My current topic “Seven Essentials to Becoming a Happy Physician” is really a fun lecture. The talk is inspirational and motivating and for me, it is nice to give back a little. Okay, not enough to do it for free, but you get my point. I still am a full-time family doc and as you know produce the magazine, this gazette, my blog and Placebo Television so I have to get these dates down in advance. If you have an organization that sponsors an event in need of a speaker that really knows what is going behind the scenes of health care, then please call 207-782-1115. Emails are great but sometimes my responses go unnoticed due to spam or fear. The usual crowd that would support such a talk and me traveling from Maine is usually a few hundred to a full sports stadium. The latter is my delusion of grandeur.
12. Bully for You
This is what happens when someone doesn’t really know what they are talking about. The NY Times uses an ethicist, Randy Cohen, to expound on appropriate questions from their readers. In this piece, a woman asks a about gynecologist who is requiring his patients to waive their right to a day in court. Patients are required to sign a binding arbitration to settle any potential disputes or the doctors won’t see the patient. Nearly all ob-gyn practices in the area make the same demand. His response was interesting but ignorant.
Though the law allows it, he feels that her doctor “has instituted a dismal policy that compels patients to surrender a basic legal right in order to receive medical care.” He states that “a fundamental right is eradicated” and that “conduct that is merely inconvenient if pursued by a few people can become intolerable when widely adopted.”
The problem is that doctors are damned if they do and damned if they don’t. Nowhere does he explain how malpractice rates are so overbearing that doctors also have little choice. They could either go bare (no malpractice insurance) or go to another state that may have more reasonable rates. Since he thinks the first choice is despicable, then I guess he would like doctors to go broke or just leave. Then where would the patient be?
“The right to our day in court should be among the inviolable” but in today’s litigious climate we really are running out of options. Maybe he could have mentioned fighting for tort reform to fix this problem instead of shuffling a few papers in his ivory tower office and espousing how disgusted he is.
13. Not Smart Enough
As explained in an editorial in the NY Times, Congress is contemplating having government-funded health professionals visit doctors to give unbiased guidance on the safety and effectiveness of drugs. This is an attempt “to counter the one-sided sales pitches they get from pharmaceutical company representatives.” When is enough, well, enough? Why are doctors made out to be the bad guys who unable to make decisions of their own? This supposed objective advice would theoretically result in better and lower costing care. Please. Skip to next paragraphSenators Herb Kohl, a Democrat from Wisconsin, and Richard Durbin, a Democrat from Illinois, are planning to introduce legislation that would authorize federal grants to prepare educational materials and train health professionals to conduct visits to prescribing physicians. Yeah, that sounds great. Let’s get the government more involved with healthcare and spend tons of money teaching those stupid physicians on what medications to use. Don’t they know that the managed care companies tell us what we can prescribe already? We have lost so much control that even when we prescribe a drug for a patient it will be kicked back if it is not on their formulary or if the patient is swayed by the amount of the co-pay. Here is another crazy idea. How about getting rid of lobbyists who coerce these same senators into passing earmarks that cost us billions?
14. Feedback About The Placebo Gazette
I WANT TO KNOW WHAT YOU THINK. Please go below and post your thoughts under the WRITE A REVIEW section. You can also see some more of these articles on our blog:
http://placebojournal.blogspot.com/
Until next time, keep smiling, keep laughing and keep out of the sample closet.
Doug
King of Medicine
