1. How many medical administrators does it take to change a light bulb?

I want to thank everyone for sending in their answers.  There we so many great punch lines that it made picking a winner very difficult.  In fact, I will try to make a top ten list out of it and put them in the next Placebo Journal.  Anyway, many of the responses were similar; so much so that I am convinced we are on to something here.  The following, however, gets the prize, which is a free subscription for the creator.  It comes from Jennifer Sharp who actually is an attorney.

How many medical administrators does it take to change a light bulb?

This appears to meet the definition of human subjects research as it requires a systematic investigation designed to contribute to generalizable knowledge and therefore this question may not be answered until you obtain IRB[1] approval. You are reminded that as employees of this institution, medical administrators are considered to be a vulnerable population.  Therefore your IRB submission must incorporate additional safeguards to protect the rights and welfare of the administrators. The next IRB meeting will be the first Tuesday after the first Monday in November, unless quorum is not possible.  Also by the very mention of “medical” in the question for which you seek an answer, it is quite likely that HIPAA[2] will apply.   Please ensure that the medical administrators are provided with a copy of the NPP[3], sign an ARNPP[4] and that you obtain an AUPHI[5].   Additionally, OSHA[6] has previously issued a HIB[7] related to light bulbs. Many of the new “green” bulbs contain mercury. All spills, clean-up and disposal processes must meet the requirements of guidelines outlined by the EPA[8].  For additional information on health effects related to a mercury spill, ATSDR[9] provides a MFS[10].  Therefore your protocol must be reviewed and approved by the Institution’s OSHAC[11] prior to implementing any bulb changing procedures.  IRB approval must be obtained prior to submitting to OSHAC.  The next OSHAC meeting is the last Tuesday in October.  If you are unable to obtain IRB approval before then, the next OSHAC will be held in April 2009.Due to the high probability of the need to use a ladder in order to change a light bulb, JCAHO[12] NPSG.09.02.01[13] standards must be followed.

[1] Please see http://www.acronymfinder.com/ in order to discover what this acronym means.

[2] Ibid.

[3] Ibid.

[4] Ibid.

[5] Ibid.

[6] Ibid.

[7] Ibid.

[8] Ibid.

[9] Ibid.

[10] Ibid.

[11] Ibid.

[12] Ibid.

[13] Ibid.

2. Doctor Bashing Alert

"Woman who waited 19 hours and never saw doc balks at bill". That was the front page headlines on the MSN website. The reality, however, is that story is about ER waiting times and not about evil doctors. To sum up, a woman broke her leg and it took hours before a nurse even assessed her. She was then triaged and placed in line to be seen but gave up after a total of 19 hours. A ridiculous wait for anyone. The problem, unfortunately, is that this is the reality at big inner city hospital ERs. They are overwhelmed. The woman left the ER and found out through her chiropractic school, where she attends, that her leg was broken. My hunch is that it must have been a fibula fracture for her to be walking but it is never explained in the piece. She later received a $162 bill for the "nurse's assessment" and refuses to pay. Let's break this down:

1. ERs are overwhelmed so don't go there unless it is an emergency.
2. The cost for an evaluation and treatment at any level in the ER is ridiculously high due to cost shifting.
3. These long waits are due to the ER trying to stratify levels of emergencies. A fibula fracture, in which patients can walk on, will have to wait while gunshot victims are being immediately assessed.
4. If the woman came to my office, as a family doctor, I could have seen her that day and gotten the x-ray quicker. The wet read would have been at my office later in the day and with a return phone call we would have mapped out a plan - all close to the same bill of $162 (including x-ray).
5. Lastly, MSN was wrong in making the headline seem that some greedy doctor, who never saw the patient, sends her a bill anyway. This was about ERs and hospital bills and a patient who went to the wrong place. Stop bashing us!

FOLLOW THIS LINK TO COMMENT ON THIS STORY

3. Rationalizing Rationing

What costs a lot of money, has little evidence proving its benefits, and would be one of the first things that has to go if a universal health plan is put in place? The answer: behavioral therapy for autism. Until that time, however, autism advocates are pushing hard to get other states to follow Indiana's lead by requiring health insurers to cover this intensive and costly treatment. The group called Autism Speaks is endorsing bills all over the country to get insurance companies to pay what could cost upwards of $50,000 a year per child. Lawmakers, sans balls, are afraid of looking bad by not supporting these bills. Who wants to say no to children? I sure wouldn't and as a family doctor, I try to get my patients with autism all the help that I can. This is fraught with problems, however. Autism is not easily diagnosed. There is no blood test for it. In fact, it is a spectrum of problems with some kids showing very little symptoms. The costly therapy, even mentioned in the article, has scant evidence showing any benefit. By forcing insurance companies to pay for this treatment via state laws only increases the cost of health insurance. They just pass the cost on to the other customers. If we go to a socialized healthcare system, then the government pays the cost and it just gets passed on to the rest of us as well. The bottom line is that someone has to pay for this questionable therapy for a medical problem that isn't so easy to diagnose. At $50K per kid per year, there is no way we as a country could afford it. Welcome to reality.

FOLLOW THIS LINK TO COMMENT ON THIS STORY