Placebo Journal - Medical Humor With A Purpose

1. United We Steal

You got to give Andrew Cuomo, the attorney general of NY, some credit. This dude is a serious ball buster for the managed care companies. He just got UnitedHealth to cough up $50 million for allegedly causing patients to overpay for care outside the insurer's network. Any doctor not in the network got paid up to 28% less than in-network physicians and if the doctors didn't accept those amounts as full payments, the patient had to make up the gap. What UnitedHealth and other insurers do to run this scam is to use a database called Ingenix which tweaks the payments any way the insurer wants. The patient never knows why the insurance won't pay the whole price and blames the "greedy" physician; all the while the insurance company licks its chops and cashes in. Of course UnitedHealth never admitted to being guilty (not mentioned in the linked article) and states it only settled to put an end to the lawsuit and move on. Yeah, right.

Who knows how NY will use the $50 million it is getting. They say it will go to some yet unnamed non-profit agency "that will calculate how much doctors and hospitals should be paid in the future". I won't hold my breath but I do give Cuomo credit. It seems he is going to go after other insurers as well. Why don't all the AG's of different states do the same thing? This all may force the managed care companies to stop bullying doctors and pay them appropriately as well as make it easier for patients to see the physicians they want to. Of course UnitedHealth will never allow themselves to take this financial hit and will subsequently pass this fine down to the patients one more time by raising rates by double digits again. And so it goes.

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2. Show Me How To Do It Dr. Chopra, et. al.

I am a big fan of Dr. Andrew Weil. I have heard him speak live a few times. I enjoy some of the stuff Dr. Deepak Chopra talks about as well. I do like the concept of alternative or integrative medicine and try to read as much about it as my free time allows. That does not mean I like it all. I was recently reading a health magazine and saw an ad offering courses to the lay people on how they can be natural health practitioners. In this blog, however, I do not want to debate the validity of alternative medicine. I want to discuss the article authored by DEEPAK CHOPRA , DEAN ORNISH , RUSTUM ROY and ANDREW WEIL in the WSJ. This open letter to the public and the President-elect tries to show how lifestyle and exercise are the best cures for America's health problems. Duh! They throw some references in there and quote some studies but to me it proves something that I hadn't realized reading their stuff all these years. When I read these gentlemen's books I personalized what they were saying because I wanted to improve my own health. I am a well-off physician and have the motivation and means to buy the right food and go to the gym. What I realize now is that these authors HAVE NO IDEA about the general public or the patients that I see in my practice. They have always been "speaking" to the well-off. My medical partner and I had both read this article and even though we both are fans of the authors who wrote it, we could not see the point to the whole thing. How does one preach "joy, pleasure and freedom" to a diabetic who won't take his meds? How do I get my patient off her blood pressure meds and get her some Yoga and exercise as she raises five kids in a cramped apartment in a poor neighborhood? To be fair, I don't have the answers either but these authors sure seemed to think they do. I just want them to follow me for a day and tell me what I should be doing differently.

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3. This Crying Wolfe May Bite

Dr. Sidney Wolfe has been appointed to a four-year term on the FDA's Drug Safety and Risk Management Committee. The FDA's job is to tell us which drugs are safe. Dr. Wolfe has been the head of the health advocacy organization Public Citizen for three decades and they were responsible for getting many drugs off the market. Without any more information than that you would say that his appointment is a good thing. I am not so sure. I like to think that I am cut from a similar disruptive cloth as Sidney but he has a history of being really extreme in his decisions. It seems to me that he rips on almost every drug there is and tries to get it off the market. The WSJ articles points out the the risk of putting Dr. Wolfe at the FDA could make approvals for new drugs involve more bureaucracy, raise the costs of drug trials and keep life-saving drugs from reaching dying patients. I can't wait to see the ruckus he causes in the future. I promise we will all hear his name in the a lot more often now. This was recently told to me after delaying my requests to get on some high power committees at my own hospital: "We would rather have you on the train then trying to blow up the train". I can easily see Dr. Sidney Wolfe be on the train AND still try to blow it up. This is going to be fun.

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4. Ridiculous Study of the Month: Post-Traumatic Fatigue

A study in the the Archives of General Psychiatry is getting some headlines because it shows that suffering a trauma as a child may predispose some people to chronic fatigue syndrome later in life. Really? First of all, the study really doesn't show any causation. Another problem is that chronic fatigue syndrome, no matter how hard some advocacy groups scream otherwise, is still questionable as to whether it actually exists. Those same groups claim that some yet to be found virus is the culprit. So does trauma during childhood make you susceptible to still some unknown virus? The study's design basically took 113 people with CFS compared to 124 without it and asked if they had any childhood trauma (sexual, physical, and emotional abuse; emotional and physical neglect) or psychopathology (depression, anxiety, and posttraumatic stress disorder). Sixty-two percent of the first group versus twenty-four percent of the latter group said they did. There's a surprise. The authors tried to make some correlation with lower cortisol levels as well but I think that was a red herring as cortisol levels has been linked to bad things whether it is low or high. Who even knows what it means anymore? So is this study saying that CFS is really a cloaked form of PTSD and these patients don't have a physical cause for their fatigue but a psychological one instead? Hmm, maybe this study isn't so bad after all?

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5. Placebo Journal Update

We are going to print soon with the next issue of the Placebo Journal. You have only until Jan 30th to make the deadline! Don't miss out on such items as:

Cyberchondrimatch - online dating
My Favorite Munchausen - Jocelyn the Jaw Dropper
X-ray Files
Wonderballz

If you are interested in subscribing to the only print medical journal that will make you laugh (on purpose) then just click below:

6. New Images for PowerPoint Presentations Are Up!

We have started adding some new JPEGS to our presentation slide cart. These come right from the Placebo Journal (and are streamlined a bit). Gary Larson has stopped drawing decades ago yet some medical presenters still use his stuff. I love him as well but isn't it time you get into the 21st century? Here are some of the new images we have uploaded. They are easily downloaded (yes, for a small cost). There is a 50% discount for purchasing more than 10. These images can be pasted into PowerPoint or used for a screen saver, etc.

Carbon Monesta (insomnia med)
The CPT Code (DaVinci Code parody)
Dialysis (pedaling to make it cheaper)
Drug Rep Pinatas (great office Halloween fun)
Drug Rep Whistle (ultrasonic way to get rid of them)
DSM Mood Ring (easy way to treat your psyche illness)
Fall OYG Anemic Ale
Faux Medical Book Panels (make yourself look smart)
Hygiene Hood (a better way handle those patient smells)
Irod (get a new hip with a music player included)
KydKontrol (stick it to responsibility with this ADHD drug)
Madam Lau's Pharmaceutical Finishing School (happy endings for docs)
Placebo Journal's Most Wanted (you need to see this one!)
Prozak Spring Water (essence of serotonin)
Pumpkin Stencils (medically oriented)
Rock'em Sock'em RoDocs
ScooterMD (now you roll with your patients)
ScrewLoose (like Blue Tooth but for schizophrenics)
Seventy Magazine
Small Pox Party (one of our cartoons)
WTF-486 (maybe you shouldn't have slept with that person)

Click HERE if you want to see our whole inventory. It is not easy to categorize these so you just have to scroll through them. The new ones are on the last few pages.

7. I Want To Be Sanjay Gupta

The news of Sanjay Gupta's appointment to Surgeon General was probably the biggest buzz that had hit my little world of doctors, bloggers, Placebo Journal followers, and friends in a very long time. The majority of these people sent comments like this to me:

"Oh my God!""Are you f%cking kidding me?"

One of my writers stated:

I have to vote for Sanjay. Hey, at least he would be visible...and like Obama, he seems to be ready to do photo ops showing off his chest....The guy went to Iraq, maybe he would be willing to do something. I don't know, I may just be desperate....On the bright side, at least he is NOT appointing Tom Cruise and making Scientology the official religion...I was kind of worried about that.

Personally, I really couldn't care less if Sanjay gets appointed. If you never liked him before,then this role is a blessing because you will rarely see him again. The Surgeon General is a "mouthpiece" for the President and has little power and influence. Sanjay probably has more power on CNN.

I think the real issue is that a lot of people, me included, are jealous of Dr. Gupta. He is young and good-looking. He has had every great media and reporting opportunity ever granted to a physician on TV. He probably makes more than me as a family doc.......(sorry, I had to wipe the tears out of my eyes as I was laughing so hard as I wrote that). Now, Sanjay has been handed a plum role that is more about prestige than about money. He is set for life. Talk about being blessed.

I say let's leave Sanjay alone. The Surgeon General role is basically meaningless, unless I am missing something. More importantly, let's give Sanjay's CNN responsibilities to someone who is worthy and needs a real paying job. Anyone in mind? How about, oh...I don't know, a family doctor who has been in the trenches of primary care for the past 15 years? Someone with a sense of humor who calls himself the King of Medicine? Anyone come to mind? Yes, Sanjay, I want your job. I have all the attributes that you have without the skills and good looks. Where do I send my resume?

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8. Nursing Shortage

The nursing industry is again going through a shortage crisis. As per this AP report, many hospitals and companies are desperate to get new hires. My favorite attempt mentioned was Residential Home Health, which provides in-home nursing for seniors on Medicare. They "lavished registered nurses and other health care workers with free champagne and a trivia contest hosted by game-show veteran Chuck Woolery. Prizes included a one-year lease for a 2009 SUV, hotel stays and dinners." First of all, I am so sad for Chuck Woolery. Has his life gotten that bad that he has to hang out at a nursing home or is he so old that he just lives there now?

The article focuses on recruitment and shows the many unique ways being used to get new hires including offering: chair massages, lavish catering and contests for flat-screen TVs, GPS devices, shopping sprees worth as much as $1,000, and gas cards. This is all well and good but the there has to be a bigger issue behind all of this. The key paragraph was this:

The shortage has been operating since World War II on an eight- to 10-year cycle, industry experts say. Each time the number of nurses reaches a critical low, the government adds funding and hospitals upgrade working conditions. But as the deficit eases, those retention efforts fade and eventually the old conditions return, often driving nurses into other professions.

The nursing shortage is very similar to the physician shortage, with primary care in particular. The philosophy has always been that “retention starts with recruitment” philosophy. You need to find the right physician to match the elements and the community. The right fit. More importantly, I think, is the reverse of this or “recruitment also starts with retention”. Satisfied physicians recruit better. There is a feeling of being a team and any recruited physician can feel that. It’s palpable. Upgrading working conditions applies to doctors as well. It is my opinion that after the first 6 months, employers start taking employees for granted and that is when they lose them. I have been unimpressed with the "physician retention programs" that are out there. The warning signs are on the horizon. As the physician shortage goes up the physician turnover rate goes up proportionately which overburdens those doctors that are left. All this leads to a vicious cycle that even Chuck Woolery won't be alble fix.

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9. Medical Joke of the Week

An 80-year-old couple is having trouble remembering things, so they go to see their doctor to make sure there's nothing wrong.

After an exam, the doctor says, "You're physically okay, but you guys might want to start writing notes to help you remember things."

That night they're watching TV when the old man gets up from his chair.
His wife says, "Where are you going?"

He says, "To the kitchen."

She says, "Will you get me some vanilla ice cream?"

He says, "All right."

She says, "Don't you think you should write it down?"

He says, "I don't have to write it down...vanilla ice cream."

She says, "Could I have strawberries and whip cream?"

He says, "All right."

She says, "Don't you think you should write it down?"

He says, "I don't have to write it down...vanilla ice cream with strawberries and whipped cream."

Twenty minutes later he walks in and hands her a plate of bacon and eggs.

She says, "You forgot my f%cking toast."

10. Common Theme

According to the American Medical News, Florida physicians are struggling with the burdens of bureaucracy as they try to work with a new Medicaid pilot. Similar to the issues of the "medical home" pilot I have written about before, the people who create these new programs tend to always forget who the customer really is. In this example, a five-year pilot Medicaid reform in Florida designed to improve care access and quality has not yet lived up to its expectations and has some physicians considering dropping out of the program rather than dealing with its new hassles. Those hassles include restricted drug formularies, confusion about which actual plan the patient is on, and specialist access. What the administrators of this genius plan don't understand is that the doctors ARE the customers! I know that sounds pompous and not the politically correct thing to say but, sorry, it's the truth. Medicaid pays so little as it is that the people in charge need to make any pilot as battle tested and streamlined as possible. There has been pilot after pilot out there that has failed due to new states trying to reinvent the wheel. And by the way, no matter what new "pilot" is ushered in there has to be a plan in place to sell it to the customers; that being the physicians. If they fail in doing that then you don't have anyone who wants to see these patients even if you give them a better plan. Oh yeah, you also might want to find a way to get more primary care doctors into the system as well. Are you listening President-elect Obama?

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11. Feedback About The Placebo Gazette

I WANT TO KNOW WHAT YOU THINK. Please go to each individual story and follow the link the Placebo Journal Blog. If you do not have access to the blog you can also post your thoughts under the WRITE A REVIEW section.

Until next time, keep smiling, keep laughing and keep out of the sample closet.

Doug

King of Medicine