Placebo Journal - Medical Humor With A Purpose

Placebo Gazette #161
(Keeping Our Finger On The Prostate Of Medicine)

7/21/10

Think Twice

Defensive Medicine by Stella Fitzgibbons MD

At Least They Caught Them

Placebo Journal Update

Meaningful Use

No Charge

French Heart

1. Think Twice

In the last ten years the rate of substance abuse of prescribed pain medication has gone up 400%! This information from a government studywas released by the White House who states that prescription drug abuse is now the second-most prevalent form of illicit drug use in the country. We, as physicians, have to admit our role in this. There has been a ton of pressure for us to treat "chronic pain" and that has added to the abuse. We need to discriminate and investigate. I know that Maine has a program that can check every person's narcotic prescription history. I am sure other states have it, too. We need to use our chronic pain specialists as resources as well. This trend of narcotic prescription drug abuse will only get worse if we don't.

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2. Defensive Medicine by Stella Fitzgibbons MD

The trouble with defensive medicine is separating the cost of avoiding lawsuits from the cost of avoiding mistakes.

Example: hen I was an intern a female patient came in acting very oddly. She had a long history of anxiety and depression and I was pretty sure her indifference to her surroundings and refusal to speak (though her eyes were open and she was moving all extremities) was something like a conversion reaction. I called the attending and asked which psychiatrist to call.

"Start with Jack Alpert," was his response.

"But he's a neurologist!"

"I know and I have no problem calling psych as well. But a neurologist is easier to justify in court."

So I called the neurologist, who said I was probably right...and did a lumbar puncture, which diagnosed the woman's encephalitis.

So my question to you now is when I see a patient who reminds me of this one, is my LP defensive medicine or simply being careful not to miss something?

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3. At Least They Caught Them

The government has caught 94 people who committed Medicare fraud in scams totaling $251 million. Acts such as fake treatments, kickbacks, billing for unnecessary equipment were all part of this bilking of our country. Many doctors and nurses were part of the crime. This was the good news. The bad news is that there is an estimated $60 to $80 billion more in Medicare fraud out there to be found. I'm rooting for the government on this one as long as it isn't using bounty hunters to find regular doctors who may make small mistakes on an increasingly confusing coding system. There is a difference.

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4. Placebo Journal Update

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Avandiatar - for those that prefer movies over exercise
Sickly Bandz - bracelets for medical disease
DeFraud University - get your bogus degree here
Tons of new and cool x-rays
Much, much more!

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5. Meaningful Use

I have always been confused on the term "meaningful use". Here is what one PJ follower thinks:

I have an idea for "meaningful use" rules for electronic health records. Remember the good old days when a well written note could provide all you needed to know about a patient's status, differential diagnoses, work-up and treatment plans with an approximately 20 second perusal?

I suggest that any computer based EHR system that wishes to compete for the Fed's support must meet that criterion!

Sir Tenthumbs.

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6. No Charge

The White House and the Obama Administration is demanding that managed care companies provide free coverage for dozens of screenings, laboratory tests and other types of preventive care. It is described in more detail in this NY Times piece. As a family doc, I believe in the concept of preventative medicine and I would like all patients to get involved and get screened for the right stuff. Unfortunately, there is something so wrong about the government demanding companies do things for free. As much as I think managed care companies do gouge patients, I just don't like how the government is going about this. My favorite part of the article is that "the rules stipulate that no co-payments can be charged for tests and screenings recommended by the United States Preventive Services Task Force, an independent panel of scientific experts". That is, of course, unless the government doesn't like what the USPSTF recommends (i.e. mammograms). Nothing like giving our good old government all the power. And before you ask, I am an independent and I have nothing to do with the tea party.

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7. French Heart

A French company is coming out with a new artificial heart that shows real promise. The company that makes the device has been at it for 15 years and it is a very competitive market. Even worse is the failure rate in the artificial heart industry. The French company states human trials are coming as it passed their major hurdle of pumping wine and foie gras. I kid. I kid. No, but seriously folks, the biggest snafu is that if any patient who has the transplanted artificial device is harassed, the unit will immediately surrender. Okay, that was bad too.

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Doug Farrago MD

King of Medicine

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