How I Began My Day
With this video at the recommendation by a friend. http://www.ted.com/talks/leana_wen_what_your_doctor_won_t_disclose
It's true. I've heard ER docs complain that the patient who was dying of cancer and came in through the OR, and was admitted to the floor to die peacefully, who had to deal with irate Oncologists who wanted to slip in that 'last dose' of chemo (patient hadn't been diagnosed or under their care earlier) before the patient passed!
I've seen someone insert a colonoscope into an obviously poor prep (stool in diaper) just for money.
And I've had a neurosurgeon tell me that not only do some spine surgeons and other orthopedic specialists are DISTRIBUTORS for the things they implant into their patients.
Some even do more levels than needed, for example, one above and one below, because they are paid by the level.
A surgery center established at my institution had one major owner who has since sold off his 'investments'. I wonder if the surgeons and gastroenterologists who OWN the facility disclose that to their patients? I didn't know myself until I saw the list.
I know the founder of this organization. I was invited to join it. And I did. It's the only certificate from all my training I have actually framed and hung up in my office. It means that much. http://www.ethicaldoctor.org
Linda Dunn put this sticker on one of my bracelet order boxes: Jesus didn't heal for profit.
It's a good point!
Recently I went to the bedside for a case and discovered one of my favorite kinds of patients--the kids who are severely disabled. I surveyed this child, who is an adult now in year, but not in development. I saw contractures of the limbs. I saw a gaze that wasn't focused. I saw how clean and well-cared for this child is.
The ultrasound iv PICC line nurse was looking at all of the limbs for a place to start an i.v.
He gave up. I tried too. Nothing.
The only solution that remained is central venous access. Even for a small surgery. I notified the surgeon of the situation, and asked for the case to be moved up to allow time for iv access.
Once asleep (the patient breathes the gas and goes out), we could see cut down scars, where surgeons open the skin to find the vein to create venous access.
In pre-op holding just minutes before, I smiled and told the mom from my heart, 'She is beautiful, your girl.' Then I looked her deeply in the eyes and said, 'You take excellent care of her. It shows.'
The mom confided to me that the child, at nine months, had a study of the hip in radiology. They gave lidocaine and twenty cc's of air into the joint. And the baby coded--full cardiac arrest--and they worked on her for forty-five minutes to get her back.
They told her the child would live only six months after the event...the mom smiled and we both knew the girl is over thirty YEARS old!
Back in the OR, the surgeon, who was once my student--and switched from anesthesia to surgery--and is EXCELLENT at line placement, found the wire wouldn't thread.
I had a vein on the right wrist catch my eye earlier. I was able to put a twenty-two gauge i.v. in it, and it flowed beautifully for the rest of the case.
Some people do not lie 'flat'. They curl up, sometimes into a ball, and positioning is difficult for someone who is 'stuck' in a position with a lot of contractures. That's why in my heart of hearts, I refer to these very beautiful to me patients as my 'pretzels'...They take extra attention and care to carry through their procedures safely, and I enjoy this part of my job very much.
There was a complex case coming. It was a patient of a surgeon who has taken ill suddenly, and a colleague is taking over all of his patients until the sick one recovers.
I don't know why, because I usually don't look, but I saw on the face sheet that there was no insurance and the patient was not paying cash. I showed it to my surgeon, because often times the card is forgotten in the car and an accurate face sheet later shows up. I asked him, 'Am I doing this case for free?'
The answer was yes. And so was he. The patient was the other surgeon's, but there was a complication, and it needs to be repaired.
I had a LOT of lessons in how I treat people on that case. How can society, and Obamacare, come to this? How can I treat the family and the patient 'normal' when I know they are not paying me for my services? Why does it matter? What IS the energy exchange between a healer and a client?
And was Spirit trying to show me that in the eyes of my guides, and my council, that I have no way to EVER pay THEM back...and to have compassion too?
During the case, I asked my surgeon, 'Do you know what it is called when you do work for free and you HAVE to do it?' He didn't know. I said, 'It is slavery.'
He had a huge AHA! Moment. I've seen him do many a case for free, because he is only allowed so much per patient per year, with his contract. Always he says, 'but they need it' and he is right.
He said that for a gallbladder, the hospital will do an MRCP (MRI ERCP), to prove the patient NEEDS the surgery. They will even go to ERCP (endoscopic retrograde looking at the intestine near the gallbladder and pancreas) and if the patient DOESN'T need surgery they send the patient home ASAP.
That's how motivated the hospital is NOT to pay.
You should see the hospitals that run for profit!
Then he paused, and looked up at me--and he made a comment that for having no money for medical bills, this patient has a house, and isn't starving. The entire family was very well nourished!
We SEE things, in the hospital. The unfunded patients who have the FILA shoes...the really nice fingernails (you can't get a manicure or a gel set for free)...the cell phone that is better than your own...lots of jewelry...and we don't understand it.
I know of nurses who postpone pregnancy until they can afford a child, taking care of obstetric teen moms who get everything for free from the state, and the nurses can barely afford insurance!
In PreOp, when I was shocked at how I was having to do the case for free, my surgeon stopped me in my tracks. He said, 'You see the guy I was talking to out there? The husband? Well the insurance paid for the ride to the hospital. But since I am keeping her overnight, he has to find a way home. I suggested Uber--you just give them the credit card. And the man said for financial reasons, he that was not an option.'
That got my attention!
WE are all in this together. Here are my thoughts:
- HIPAA was made up to make the doctors vulnerable. It's a big scary concept with lots of regulation.
- Electronic Medical Records were sold at tens of thousands of dollars to physician offices to buy the 'system'--or else face more violations.
- There is only one 'union' for physicians. At least, one flyer I saw once. It's not widespread.
- Obamacare promises 'healthcare for all'--however--due to the high deductibles, hospitals now are starting a 'cash first' policy for certain elective cases. No co-pay up front? No surgery.
- Whoever wanted to take over Medicine as a business just accomplished that in my years in medicine...It's totally different from what it once was, and when I started it was much worse than those 'golden years' where people had Wednesdays off to golf.
It's bedtime for Carla!
She put in a lot of good work today.
I wanted her to give you some things to think about, and ponder with your heart.
I didn't want her to forget what happened, so I asked her to write.
Good night my beloved.
(This is more than I have had the opportunity to speak with her all day. It's been THAT busy! For both of us.)
Aloha and Mahalos,
Ross and Carla