When Hospitals Make Bigger Profits: Disinformation Debunked

This article makes me see red: http://shiftfrequency.com/noel-brinkerhoff-hospitals-make-bigger-profit-when-surgeries-go-badly-than-when-they-go-smoothly/#more-25742

This is disinformation.

I am seeing safety being cut in patient care due to risk of not being paid because of complications.

For example, a foley catheter is routinely inserted in surgery to allow for the urine to be collected during the operation, and in the recovery period after. This is important because to the anesthesiologist, the kidneys are the proverbial 'canary in the coal mine'--when there is insufficient blood flow to make urine, the anesthesiologist adjusts the amount of fluids given, blood pressure, and heart rate to increase the urine flow. On long cases, over three hours, I insist on foley placement also because in my opinion, no one, conscious or unconscious, can hold their urine for much longer than that. (The bladder stretches too far and is not able to void properly once it has been stretched. It will need a catheter for twenty-four hours to allow the bladder to 'rest'.)

A foley catheter is a tool I use to help manage my patients intraoperatively.

Increasingly surgeons are choosing not to insert them to avoid the penalty of not being paid for a urinary tract infection.

Complications happen. It is part of doing business. Medicine is science but not amenable to 'assembly line' philosophy. Every patient is different.

And many patients present with very high risk for surgery. The airway is un-intubate-able due to obstructive sleep apnea and morbid obesity. The diabetes makes infection of the surgical site much more likely. The underlying cardiac disease makes the patient more vulnerable to the effects of anesthesia.

Long story short--when there is threat of no compensation due to complications, physicians will not do the case.

Let me repeat: when the risk of a poor outcome is high enough that there is a good chance the hospital and care team will not be compensated for their services, only the best candidates for surgery (the healthiest) will be allowed to go to the operating room.

'Do the right thing' is a terrible twist of the facts. Don't buy into it. If you have had complications in the past, surgeons are going to think twice before they decide to take care of you the next time.

Already now, I know they are not providing gowns or taking vital signs for routine post-op visits, and are keeping them as short as possible, because to do what they used to do under the current rates of reimbursement from insurance would simply drive them out of business. Someone I know just retired after forty-nine years in private practice because they could not afford the rent for the office, the malpractice insurance, and all the rest to keep their practice afloat. It just wasn't worth it.

In anesthesia you will see a trend of less physicians and more nurses giving anesthesia, because the insurance companies and hospitals are looking to save cost. Already Medicare is paying twenty cents on the dollar for every anesthesia service that is provided; in no other specialty is the compensation so much lower than insurance rates. In some areas, Medicare patients are not welcome by primary care physicians, and patients have to drive hundreds of miles to the nearest big city to obtain basic medical care.

There is no better time to bring Reiki into traditional medicine, isn't it? Spirit needs to be asked to step up to the plate and help this entire establishment turn itself around.

That is my dream That is my heart's desire--to bring 'Heal' into 'Healthcare' again.

Namaste,

Reiki Doc

Something To Add, Part 2 (1-14)

I just got the October issue of Reader's Digest in the mail. On the cover is an actor in scrubs, with a surgical mask hanging down, cheap latex gloves like they wear at the food court in the mall, making the 'shhhh!' gesture and looking the camera in the eye. 50 Secrets Surgeons Won't Tell You!

I couldn't resist! Shall we go for it?

Readers Digest Says:
They slice us open, remove tumors, reshape our thighs, and give us new hips and kidneys. Yet despite the fact that surgeons have our lives in their hands, most of us know more about the folks who cut our hair than those who cut our bodies. Did you know, for instance, most surgeons are paid based on how many operations they do or that it's better to have surgery on a Tuesday than on a Friday? Use these insider tips to become a savvier, healthier patient.

Reiki Doc Says:
We are going to spill from insiders? Yeah, right. Pull up a chair and sit right next to me... ; )


Choose the Best Doc

#1
 Reader's Digest Says:
"To know which doctor is good, ask hospital employees. Their word trums an Ivy League degree, prestigious titles, and charm."

Reiki Doc says:
Better yet, ask an anesthesiologist, perfusionist, scrub tech, or O.R. nurse. PACU and Pre-Op nurses know too. They work with these surgeons every day. They know their ability, their temperament, and how well their patients do. Don't ask just anybody at the hospital.

#2
Reader's Digest Says:
"Ask about their complication rate. If they don't have one, they're hiding something or haven't operated enough to have one. No one is immune to complications."

Reiki Doc Says:
I stratify my complications like a traffic light. The green light ones are the little things that aren't that bad, are common, and go away on their own, like a sore throat after a general anesthetic. The yellow light ones are less common, such as dental trauma or a hoarse voice after a general anesthetic. The red light ones are the ones you worry about that keep you up all night. Fortunately, they are rare. At a teaching hospital, with very busy operating rooms, we get maybe one case like this a year, and usually it is someone with a problem so serious they would probably die anyway with or without the surgery. Going on the freeway onramp is a risk you take every day, but it is a controlled risk. Much is the same with surgery.

#3
Reader's Digest Says:
"If an airline told you that their pilot is the best one they have but he's not FAA-certified, because he failed the exam, would you get on the plane? For the same reason, always check to see if your surgeon is board-certified in his specialty. Many are not."

Reiki Doc Says:
This is true. Be wary of plastics procedures. There are ENT-trained plastic surgeons, and Plastic Surgery-trained plastic surgeons. Would you want someone who does primarily breast work giving you a face lift? And many dermatologists and other physicians go to a weekend class to learn plastics procedures and do not have the board certification and training you might expect.

#4
Reader's Digest Says:
"Don't assume your primary care doctor's recommendation is best. Referrals may be politically motivated or be given because the doctors work within the same multi-specialty group."

Reiki Doc Says:
This is true. Know your insurance. If you have a PPO, try to stay in network, but ask an O.R. staff for a recommendation and go to them for a second opinion. Never let anyone cut on you without talking to two or preferably three different surgeons in a non-emergency setting.

#5
Reader's Digest Says:
"Ask if you can talk to former patients. It's like getting a references for a babysitter."

Reiki Doc Says:
Use caution and what resonates with you. My talking with a patient who had pituitary surgery before me freaked me out. She had every complication, went on and on and on, and would not shut up. I had to hang up the phone on her, and she was my mother-in-law's best friend!

#6
Reader's Digest Says:
"Some surgeons won't mention procedures they don't know how to do. I'll see patients who were told they needed an open hysterectomy, even though it could be done laparoscopically. That's one reason it's good to get a second opinion."

Reiki Doc Says:
Painfully true. I used to work at a place that pioneered robotic prostatectomy. Impotence rates and blood loss were markedly less. When I left to work in private practice, laser vaporization of the prostate and open prostatectomy were done for three more years before the robot came to the facility. Even now, we are still on the learning curve.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Questions to Ask Before Any Surgery
Reader's Digest Says:
Why do I need this procedure now?
Who is going to be doing it, and how many times has he/she done it before?
What are the most common complications, and how do you deal with them?
What will the recovery be like?

Reiki Doc Says: ASK YOURSELF
What does your intuition tell you about this surgeon? Are they money-driven or mindful?
Would this person have your back if there was a huge complication of walk away?
Would this surgeon recommend this to their mother? Their child?
Do I feel safe with this person?
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++


Before You Go Under the Knife

#7
Reader's Digest Says:
Always ask "Who is going to take care of me after surgery?'. You want to hear 'I will see you on a regular basis until you have recovered fully.' Often it can be residents or physician assistants. Sometimes it's not anybody, especially after you've been discharged from the hospital.

Reiki Doc Says:
I have worked in both academics and in private practice. In academics, there is a team of residents, that is supervised by a Chief Resident. You have many eyes following you, being led by one ready to graduate. As long as it's not July you are going to be okay. (July is when all residents 'move up' a level in training). An attending surgeon will see you once a day, and write a note. It's the law, per Joint Commission. In private practice, you may get the P.A., but really in all cases, you have a nursing team and/or resident team on the front lines in constant communication with the boss, your surgeon. Don't expect a busy, successful surgeon to sit at your bed and share stories. If you thought the office was busy--why should the busy stop in the hospital too? You are going to be fine! Don't worry!

#8
Reader's Digest Says:
It's better to have an elective surgery early in the week because lots of doctors go away for the weekend and won't be around to make sure you're OK. If you go in on a Friday, and then on a Saturday or Sunday something icky is coming out of your incision, you're going to get someone who's covering for your surgeon.

Reiki Doc Says:
I think a well-rested surgeon who has a life is a better doc than one who is a workaholic. Doesn't the blogger 'Skeptical Scalpel' who said this KNOW that next weekend YOUR surgeon is going to be the one covering for the one who covered him? Duh! But seriously, the REST of the hospital kind of shuts down on the weekend. Radiologists hire a central location to read all the images from the hospital remotely at night and on weekends. The O.R. shuts down and a team has to be called back in. It works, but it's not wiki wiki.

#9
Reader's Digest Says:
Go to your preoperative appointment with a family member. That reminds your doctor you're not a gallbladder or a bypass or a valve--you're a person who's par of a family.

Reiki Doc Says:
Oh please! What?!? Hello?! Your doctor KNOWS you are a person! Don't fall for this fear porn. However, sometimes with the stress of surgery, especially with a diagnosis like cancer, your ability to understand and retain critical information for your health is not as good as it usually is. Having someone who cares about you with you will help both of your follow instructions and get all questions answered.

#10
Reader's Digest Says:
It's amazing how diligent people can be about searching for the right surgeon but have no idea who their anesthesiologist will be, which is just as important. So ask, 'Who's going to be putting me to sleep?' or ask me who I think the best anesthesiologist is. In some hospitals, you can request that person.

Reiki Doc Says:
This is true. May I add that your surgeon may think someone is the best because they cut the most corners and are therefore the fastest? Or the one who golfs with him or parties on their boat?
Some surgeons won't even work with some anesthesiologists. If you take what is offered at your hospital, and you LIKE that anesthesiologist, take their name, and request them in the future. I function in this capacity as a 'private anesthesiologist' for many of my patients, especially ones with complex surgical conditions that take them back several times. I also am the one most requested by the staff, inside and outside the O.R. I have the reputation for being 'the best'. Just yesterday I got called to L&D for an obstetric emergency while I was between cases in the Main O.R. My boss requested me, he was panicking (he does not do OB anesthesia, and was covering because the one on call had to be two places at one time). I calmed and stabilized the uterine bleeding in teamwork with the surgeon in under ten minutes. We did not have to transfuse or do a hysterectomy. My skills are that important in the O.R.

#11
Reader's Digest Says:
Years ago, a patient sent his slides to three different pathologists and got three different answers. I got very upset on hearing that. Now I never rely on just one pathology exam. If your doctor finds something, ask him to send your slides to a nationally recognized reference lab-not just one or two slides but the whole lot--and get a second interpretation.

Reiki Doc Says:
This is excellent advice for something that is not common. Some things are more straight forward, like prostate cancer and breast cancer. Either way, this offers 'peace of mind' for the patient. It may be expensive, though.

#12
Reader's Digest Says:
So often the risks on legal consent forms aren't the things we actually worry about, or there may be one complication we're really concerned about. If you truly want to understand the dangers, ask your surgeon, 'What is the risk that give you the most pause?'

Reiki Doc Says:
I stratify my anesthesia risks. Red light equals serious, permanent, rare, like a stroke or an M.I. Yellow light equals bad, but not life-threatening, like a cap that comes off your tooth. Green light equals common, annoying, unpleasant, but not serious, like sore throat or nausea after surgery. It's kind of expected. That would be another strategy to ask your surgeon about risks.

#13
Reader's Digest Says:
Talk to your doctor about donating your blood or asking your family members to donate blood before an elective surgery. Banked blood is a foreign substance, like an organ, and your body can potentially react adversely. If you can use your own blood or blood from your family, there's less chance of reactions.

Reiki Doc Says:
That's a surgeon for you! Do you think going for heart surgery two units of blood down and anemic is safer than having all your red blood cells when you have anesthesia and have an ischemic heart? The donation process takes weeks, and the marrow might not have fully recovered. Yes, it does decrease risk of foreign reaction. But it also carries it's own risks with anesthesia. Family members might have personal habits you don't know about, like needles or unprotected sex. Blood bank will screen their blood and throw it out if it is contaminated. Either way, the process takes weeks in advance of your case. Blood bank blood once is fine. Ask for cell-saver, which collects your blood lost in surgery and gives it back.

#14
Reader's Digest Says:
Residents have to learn how to operate, and it's required that an attending physician be 'present'. But 'present' doesn't mean he has to be in the operating room scrubbed in. At an academic institution, ask whether your surgeon will be actively participating in the surgery or just checking in every hour.

Reiki Doc Says:
Woo hoo! Is this recommendation an antique or what?!
Effective less than ten years ago, an attending surgeon MUST be scrubbed in and at the wound doing surgery. Those days for residents to be independent are over! And that's not so good a thing. Do you know our surgery residents are all taking fellowships now because they aren't getting enough clinical exposure to really be that safe? With the limited work hour restrictions and the attending doing 'more' their opportunity to learn important skills has been reduced. Be sure to ask, 'how many of these procedures have you done in your career? How many in the last year? And how many complications?'

More installments to follow! Click this link to read up to #50: http://reikidoc.blogspot.com/2012/09/something-to-add-part-2-15-50.html

Namaste,

Reiki Doc

Doctor Defends His Life Against Medical Errors

"If you can't take care of your colleagues--you have no business taking care of anyone else."--my favorite gastroenterologist

Today I worked with my favorite Gastroenterologist. He was a pediatrician, a famous one at a famous hospital, back in India. Once he came to the United States, and had to retrain, he decided to become a Gastroenterologist. Back home, his medical school classmates do not understand why he would leave a prestigious field like Pediatrics, and work as a less-respected field.

"There are three kinds of patients. The first are the PPO's. They are nice. The second are the HMO's. They are always angry because the referral did not go through right, and they had to wait for their care. The last are the GNP (an IPA in the area). They think that anywhere else besides the main fancy hospital people don't know what they are doing." he shared.

Apparently the main fancy hospital 'has everything, all kinds of equipment' because of the many donations. They have EUS and another new technology.

A nurse asked about the local teaching hospital. 'Don't they have those technologies too?'

'I would not let them treat my dog, unless I wanted the dog dead!' he said.

Apparently he had a liver biopsy. He wanted transjugular, but the colleague he went to only did transcutaneous. (His colleague of choice went to his alma mater, and he respected their common institution.)

In recovery room, after the procedure, my favorite gastroenterologist knew something was seriously wrong. 'I am bleeding.' he said, and asked the nurse to contact the doctor. The doctor could not be reached, and the nurse sedated him. (The bleeding was internal, and it did not show on the dressing).

He had called his wife at the gym before the sedative. When she got there, he woke up. Nothing had happened. He called his friend, another G.I. attending and explained the situation. He got admitted to the hospital. Again he called his doctor, but only a resident got sent.

He passed out again. When he woke up, he was getting 'a fluid challenge'. 'What is this? Why am I getting a fluid challenge?'
'Your blood pressure is 60 (systolic--a pressure incompatible with life)'
'What is my hemoglobin?'
'Seven' (He had fourteen before the procedure. He had lost half his blood volume).

He called his friend the surgeon. His friend sent up his fellow. In fifteen minutes he was in the O.R.
There were five liters of blood in his abdomen. (He was hanging on to life by a mere thread.)

Anyone else that was not a physician would have not known to pick up the phone, or even whom to call, and would have died. It took four years and half a million dollars to get his health back to what it was before. The reason he keeps working still, is to make sure he has good insurance coverage.

'It was a good lesson for me," he said. "First, I learned to take good care of myself. Second, I learned what it is like to be on the patient side of the doctor-patient relationship."

He took action, not legal, but with the hospital. A review was done. The offending gastroenterologist was offered the chance to leave or be fired. He left.

"But you know what?" he asked, looking me straight in the eye, giving me the chills.
"I had a bad feeling about this. Before the procedure, when we were in the car, I told my wife. She asked me do you want to go back home? I said, no, we are here already. I often wonder what would have happened if I had listened to that feeling and not gone through with it."

Namaste,

Reiki Doc

A New Normal, Part 1

I read an article posted by a friend who has somewhat similar and yet in other areas, highly opposite beliefs from me. It upset me. What was it about? It was about a Family Practice Doc, who had his wife try a VBAC (vaginal birth after cesarean) at home with a midwife. They got into trouble, and he insisted they take the wife in to the local community hospital where he worked. He delivered his son, and then they refused certain protocols, choosing to modify or delay customary treatments for the child. Child protective services was called on the parents. And an investigation opened up.

I wanted to jump in to that argument. I read the comments on the original article, and also attached to the post. But I thought about it. I asked myself the question, is this where we want medicine to be? No, not really. Not adversarial. But not 'botique' where the patient gets to pick and choose what they want either.

I envision a new normal for patient care. One where auras and energetic systems are acknowledged.

For example, the interaction between a former-chief-of-staff who was able to deliver children, but not someone typical in the Labor and Delivery department, must have included auras, trust, mistrust, and turf issues.

Let us rewrite the script.

Mother and father are into empowering women through home birth. They have a lifestyle that is based on the green movement, and holistic concepts. The midwife buys in to all of that herself. Their auras are mutually compatible. They are in the home, and it is harmonious to their belief systems. That is okay.

Father, through intuition and medical experience, senses trouble. He is outside his comfortable 'safety zone'. For the record, he was not completely in agreement with the home birth in a vaginal birth after cesarean in the first place.The couple transfer mid-labor to the local hospital.

Here is where the differences emerge: the belief systems and energetic systems of the facility and the patient do not match. This would have been a perfect opportunity for someone like me to intervene. Countless times, I have been called to what the nurses call, 'the crazy room' to intervene on behalf of their baby. I have seen Bradley Method couples where the wife wants the epidural and the husband, according to the plan, is trying to enforce the intervention-free birth. I have seen VBAC's refusing an i.v. and had to coax epidural insertion, not for analgesia, but for a safety device in the event of imminent c-section so I would not have to put the mother to sleep at the last minute. I am like a radio tuner capable of dialing in on any frequency of energetic aura system. I try to 'match' before I talk to somebody, whether it is a doctor, nurse, patient, or family member. Communication works best that way.

As we transition to the New, and we are well on the path towards it, I see the importance of the energetic system of each form of life on Earth to be recognized and taken into consideration.

Do we really want to deny our animals a chance to live and grow by eating meat?

How about the right-to-life of a tree standing in the way of a football stadium improvement?

Does anything that is not Fair Trade have as healthy a vibration as something that is Fair Trade?

Is your money being spent in ways that help Earth, or hurt her?

When you are sick, is your vibration optimized? Of course not! How can we best 'right' it again, together? For this transition period, we will have to thoroughly assess your system of beliefs, connect with you, and ramp up your energetic system. Be it with tea, chanting, Light, or conventional medicine for now.

There is so much more to it than meets the eye. Or the Mind. And Reiki is an excellent tool to be a part of this transition. By both allowing a Reiki practitioner to sense and to transmit, healing may be fine-tuned to individual needs best.

Namaste,

Reiki Doc