Friday, February 14, 2014

New Twists In The World Of Medicine In These Times

The days where you can feel like this with your physician are coming to a rapid close.

Let us take a few moments to discuss some of the changes that are happening around us that will affect YOU...and it's not Obamacare--its MORE than that---so no politics, okay?

  1. When You Pay Peanuts...You Get Monkeys:   My babysitter's Gynecologist has decided not to take any insurance whatsoever. This surgeon is becoming a 'boutique' service, where each 'thing' done has a cash price. The doctor is getting rid of the insurance to cut out the middle-man, and is willing to work for the low rates negotiated by insurance (typically they pay much less than the asking fee, and is a ridiculous barter that takes sets the doctor and the patient against each other) when these low rates are paid directly to them by the patient. I think this is the way the Healthcare system is going to be able to dramatically change--by getting the payors out of the equation. Medicine was like this for many years in the past.  This frees the Gynecologist from restrictions on their practice (did you know how much an electronic medical record COSTS to install? And to renew? Tens of thousands of dollars!), saves them from a great deal of hassle, and allows them more time to spend doing what they were trained to do.
  2. Beware The Lone Cowboy--or Cowgirl:  I've seen this--the primary care doc interpreting a film in the office. By themselves. Without a radiologist. Without a specialist. And making the call. Today I saw a dead joint. A foreign body--a thorn or splinter--got in and the primary care doc gave antibiotics and ignored it. For three months. Surgery that done early after consultation with a specialist could have easily saved the joint and kept usefulness in the limb. Now infection has set in to the bone and joint. The joint will need to be fused or the joint replaced. 'This is a tragedy' the surgeon said. I agree. Your gut feeling and ability to keep asking for treatment until your gut says 'it's okay to rest' is what is going to save you in this situation. Don't let some yahoo decide on their own on matters that are important to you! Doctors Talk To Each Other! And they look things up, too.  My mother had 'bladder infections' but not follow up cystoscopy at her 'Big Box' medical care system. She ended up having the primary care treat her--and they never knew a kidney transplant patient is at super high risk for bladder cancer because of the anti-rejection medications. If her bladder outlet hadn't been blocked off by tumor, we would have never known. If it had been caught early, she wouldn't have to wear a bag to collect her pee 24/7, or spent six months in the hospital.

  3. Appreciate The Non-Medical Staff In The Hospital--They Are Healers Too: Mama Flor told this story. She cleans the O.R. She had been praying for a mother she saw who was distraught in the waiting room. Her daughter worked at the hospital, and was taken to surgery for something seriously wrong. Flor didn't understand what was the disease, exactly, but she prayed hard in the O.R. for this young patient. 'Dear God, St. Jude, Jesus! Help this woman! Help her mother not to have to say goodbye! She has to WORK God! Do SOMETHING! Do something to help her!'  Today Flor said, recently, she saw the worker in the hospital. No one ever figured out what was wrong, but now she is okay. Flor got her miracle. Flor knows how to ask for them. She asked for a miracle for my thyroid, too, and gave me her rosary to wear for months until it straightened out. Now, she hugs me and smiles, and says she can smell my fragrance on the wood rosary beads, and she loves that so very much. She is pleased I am her miracle too...
  4. Know The Score:  Today I was relieved of work around eleven a.m. I had a short day. A friend of mine was needing some help in the O.R. with a patient. Everything was difficult--the airway, the art line, the large bore i.v. I brought in the ultrasound to help image the vein and got a large i.v. in place. Then we tried and tried on both arms to get the line in. It was a big case, and the arteries weren't normal. It took over an hour to get them in. With two board-certified anesthesiologists. So sometimes it's not so simple, and we're not going to tell you this. We are going to tell recovery room (those lines are hard! Airway wasn't easy! be careful! And be sure to tell the nurse on the floor!). There is no way you will know except perhaps there are a lot of poke holes from our trying.  I also was 'called back' to do a GI procedure that needs x-ray. I showed up on time, but guess what? There was no surgeon! They were scrambling to find one to do the procedure. I've seen this in surgery. I've seen this with senior surgeons wanting the younger ones to do the work even through the older ones were on call. I've seen nurses who worked with a vascular surgeon for years asking the junior general surgeon to do a triple A (abdominal aortic aneurysm) in the middle of the night. The surgeon gets woken up unnecessarily, and has to convince the exchange and the nurse that the senior is the one to do that case...
  5. Look For The Obsessive Compulsive M.D. : I do things early. And I had all of the history and physical on the computer, except for the labs. I checked them and saw sky high potassium and low sodium. This was in the danger zone, enough to cancel the case. But that combination made me think--was the blood hemolyzed? I called the lab number, who referred me to ANOTHER number, then I asked the technician, did the blood cells rupture in that specimen? (blood cells have lots of potassium inside them). They had me wait while they went and looked. It was in fact, hemolyzed 'a little'. I agreed to do the case. I double checked on the EKG in the OR--no tall peaked T-waves, we are going to be okay. And the case went fine. Patient never knew. Doctor-surgeon-didn't have a clue. Nurses were like, 'Oh, Wow! are you going to cancel?'. Also this week I read the study results on a heart test. Area of the myocardium was at risk but the cardiologist cleared it anyway. I did that case because it was urgent, but I took extra precautions (monitors) to make sure the patient was OKAY. I saw a note from a cardiologist, a sloppy one that didn't do the test but was consulting, that said, 'the ischemic area was not reversible to is was not at risk in the first place'. This cardiologist wrote this to make me look bad, in the charts, and also didn't understand the written interpretation of the test by his colleague. This kind of stuff happens every day! So go for the one who is going to go the extra mile for you. Always look for their attention to detail. You will know when you notice and know what to look for. It saves lives without bells and whistles and fanfare. And if I didn't mention it here and now, no one would ever know...

    That is enough for today.

    Aloha and Mahalos,

    Reiki Doc


    There is a long-acting local anesthetic called exparel. It is making surgeons able to not write for a PCA (patient-controlled analgesia) device. One surgeon accidentally stuck his finger through and through with a clean needle during surgery. He never felt the accidental injection. He looked down and saw the needle and shook his hand but never felt anything. Not for three days. That stuff works! But it costs three hundred dollars for twenty milliliters--which is a single use dose. So he doesn't use it as much as he would like for his patients...pretty neat, huh?