Placebo Journal - Medical Humor With A Purpose

Placebo Gazette #147

(Keeping Our Finger On The Prostate Of Medicine)

3/24/10

Something To Be Proud Of

Health Care Reform Passed

Paper Clip Defense

Placebo Journal Update

British Mistakes

Happy Trails

Bureaucracy As Seen By The Patient by Ted Bacharach MD (retired)

Visual Integrity

Food Insecure

Has It Really Come To This?

1. Something To Be Proud Of

A mother in NJ is aiming to becoming the "World's Fattest Woman". Wow, that is great news. I couldn't believe it when I read it. In a time where the health debate roars, this idiot is all over the media with her ridiculous plan. There is so much wrong with this that I don't even know where to begin. But I will. She already is 600 pounds and wants to get to 1000 pounds by eating 12,000 calories a day. Boy, that sounds healthy. Who is paying for all that? If you look at the article it says that other men are doing it through a website she is on. Hmmm. Sounds fishy. She is already in need of a scooter. Who is paying for that? The article doesn't say. What horrible reporting. The bottom line is that the media celebrated her lofty goals but didn't dig deeper. This lady is sick already. She already can't walk 20 feet without being SOB. It doesn't look like she works so she is parasitically engorging herself while others pay for it and then will eventually cost the healthcare system a huge amount of money in her lifetime due to personal choices. Sure doesn't sound fair to me.

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2. Health Care Reform Passed

I recently received an email from my state chapter of the American Academy of Family Practice asking me to call my legislators and beg them to pass the healthcare reform bill. I didn't call, but Congress still passed it. Though there was nothing in this behemoth of legislation to get more docs interested in primary care, our local physician leaders were gung ho for the massive changes on the way. I have to wonder why? Were their own political ideologies seeping through and clouding their judgements? Or were they truly convinced that this bill is the best we can get? I have no idea. All I can do is quote from a famous man name Ishmael who once said, "Run for the hills everybody, there's a giant shit-cloud coming". No, that wasn't from the Bible. It was from the movie Kingpin.

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3. Paper Clip Defense

A dentist in Massachusetts is being accused of using paper clips instead of stainless steel posts for his root canals on Medicaid patients. Even worse, he billed for the more expensive procedure. Now he is in big trouble for fraud. I wonder if he billed for the paper clip price (the amount reimbursed by Medicaid) would that get him a lesser sentence? Probably not, but it would be really cool if he used the McGuyver defense. Actually, the guy is in more trouble for making false billing claims under other dentists' names who he employed as well as prescribing drugs to his staff and then asking them to return them to him for his use. Nostradougus believes he will claim the "addiction to drugs" defense in order to get off. More to come.

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4. Placebo Journal Update

You have until March 30th to get in on the next issue of the Placebo Journal. Wait until you meet Dr. Gaga!!! The interview will both confuse and entertain you.

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

5. British Mistakes

I know it seems that every mistake made by American surgeons is publicized but you haven't seen anything until you've gone to England. The Sun UK is running a series on the NHS and found:

A total of 722 objects were left inside patients following operations in 2008 alone - including pliers, scalpels, coils and swabs.

Check out the article here as the paper rips all the problems going on in that country's medical system. It is pretty impressive. I am not sure how we compare but I am willing to go on a limb and say we are better. The question is, are we better because we don't have socialized medicine or are we better because we are very litigious country?

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6. Happy Trails

There is evidence now that men who have heart heart disease and erectile dysfunction die sooner in life than those men who just have heart disease. Boy, can life deal us guys any worse a hand? In effect, those patients who need drugs like Viagra may have widespread cardiac disease. This came out in the journal Circulation. The author's conclusion to the study is way too long and filled with boring facts. Let me summarize in a more palatable way: Just because ED drugs work on hardening of the penis doesn't mean they do anything for hardening of the arteries.

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7. Bureaucracy As Seen By The Patient by Ted Bacharach MD (retired)

Before conspiring to see a physician it is necessary to make an appointment. The call involves several possibilities. If the doctor is a member of a clinic you may be greeted by a common roadblock—the automated switchboard. After discovering which numbers get you to someone breathing who can take your information, you will be faced with more roadblocks. Which health insurance are you involved with? Who did you see last and when was that? Did you see the doctor you are requesting an appointment with previously? Are you a medicare member? How old are you? Is there any reason for you to be seen soon? Once these simple questions are answered you may be given an appointment. If urgency is a problem you will be directed to the emergency room.

Your appointment is at 11:30. You arrive at the office on time and are asked to sign in. Your Medicare card, your insurance card, your address, next of kin as well as your driver’s license are examined. (I guess they want to be sure you are who you say you are!).

The clinic prides itself on promptness and with luck you make it to the inner office only 36 minutes after your scheduled appointment. This gets you to the nurse who weighs you, takes your pulse and blood pressure and tells you the doctor will be with you right away. Only ten minutes later you are in the presence of the “almighty”. A history is taken and the cause of your visit is determined. More than one complaint may result in a request that you make another appointment. A brief appropriate examination is accomplished and a working diagnosis is established. (This is necessary if the physician is to be paid. A “unknown” diagnosis is not allowed if payment from an insurance carrier or Medicare is expected.

The next problem is medication. A prescription may be called in to the pharmacy. Be assured that this will not be immediately available. The pharmacist has to look at it and will have to determine whether the patient’s insurance carrier allows this medication and a copayment must be determined. The patient will be requested to sign in at the pharmacy where all of the insurance information must be verified. Care must also be taken so that HIPPA will be properly observed and no one can overhear or find out any patient information.

Laboratory work is usually requested and must be obtained at a laboratory that recognizes the patient’s insurance. The doctor has to determine which laboratory can do the tests that are requested. Errors may occur and the patient may have to visit more than one lab. Once again the laboratory has to get all of the patient information so they can get paid. If the requires fasting there may be quite a large number of patients waiting especially since most people will get to the lab early before they have breakfast.

There must be some method to streamline this process or will all attempts result in just another level of frustrating maneuvers. The good old days were really great.

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8. Visual Integrity

You know what would have been cool? I think that it would have been awesome if the following conversation would have occurred:

President Obama (to his doctor): "Why do I need a colonoscopy? I'm only 48".

His Doctor: "Because you are the President of the United States".

Obama: "Yes, I know, that is why I keep sneaking a cigarette now and then. The stress is killing me. But aren't I supposed to wait until age 50 for colon cancer screening?"

Doctor: "Yes."

Obama: "And while I am at it, is this virtual colonoscopy universally recommended to the general public as a method for screening?"

Doctor: "No".

Obama: "Well, let's start this whole healthcare reform with me. I just want to do what's recommended by the United States Preventive Services Task Force. That way I can be an example for the American people and tell them 'Do what I do and not just what I say'".

Doctor: "Yes, sir".

Unfortunately, President Obama did not do the above. I am not singling him out. Every other President in our history received the "works" from their team of doctors as well. It's just that I watched most of the Blair House meeting with the Republicans and distinctly remember him talking about how hypocritical it is that Congress gets a different healthcare system than the general public. He's right. That should change, too. But how much more powerful a statement would it have been if he refused services for himself that are not universally recommended?

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9. Food Insecure

The South Bronx, where my parents and grandparents grew up, is now the leader of "food insecurity". What is food insecurity, you say? Well, it is a new term to explain how areas of the country can statistically be the "hungriest" yet still be morbidly obese. Don't get it? Neither do I. Check out the discussion in a piece in the NYT. The concept is that "the scarcity of healthful options in low-income neighborhoods" drives the people to eat these empty calories. The debate is whether the poor would even choose healthy options anyway.

Much of this topic comes from a Gallup survey which asked more than 530,000 people across the nation a single question: “Have there been times in the past 12 months when you did not have enough money to buy food that you or your family needed?”

I am not sure that this type of question proves that they don't have enough money for food. Many have subsidies (food stamps). Many choose to purchase cigarettes for an excessive price. One could argue that we should lower the price of cigarettes so that they would have enough money to buy healthy food. I don't advocate that but this is the kind of logic that speculation and postulating gives you. Personally, I don't think one-question surveys are the answer. Someone has to get in there and do some real research and real trial and error attempts at change. Later in the piece the NYT talks to a professor at Columbia who says:

Poor people “often work longer hours and work multiple jobs, so they tend to eat on the run,” said Dr. Rundle of Columbia. “They have less time to work out or exercise, so the deck is really stacked against them.”

Maybe. But what about those who are not working? The good professor makes way too many assumptions. I have many patients who are not working and still don't eat right, exercise and now have tremendous health problems including obesity. They may be food insecure but giving them a label sure doesn't help their motivation or my ability to help them. Anybody have some other ideas?

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10. Has It Really Come To This?

Project Prevention, a group from North Carolina,is offering addicts in Honolulu $300 if they agree to pregnancy prevention methods such as hormone shots, patches or IUDs. To date they have paid more than 3000 addicts. By my calculation that is about $900,000. One could say that this also adds to the drug problem because these same people are probably using the money to feed their habits. How does a group convince people to donate money for this? Do they have a commercial that shows how for just $3 a day you can adopt and fulfill the drug needs of Tommy, age 26?

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

Doug

King of Medicine

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