Thursday, July 26, 2007

what your doctor is really thinking

I read a lot of blogs written by doctors. It's a fascinating read. I understand now why US doctors are in such trouble. There are laws in the US that state that anyone who goes to the ER must receive treatment. Now in theory that sounds wonderful right?
There are three kinds of people that go to the ER: Medicare/Medicaid, HMO or other insured and the uninsured. Medicare/Medicaid have set reimbursement rates. Your ER doc can treat you for an acute MI(heart attack) that can take four or five hours and use incredibly expensive medications and even more costly interventions.
The doc will then bill Medicaid. Say he bills $5000 for the whole thing.. well Medicaid/Medicare can reimburse them as little as $500 for the complete care of a heart attack. HMO's base their reimbursement rates on Medicare/Medicaid reimbursement rates with a tiny increase. Maybe the doc gets paid $1000. The uninsured get billed the whole $5000 and they are expected to pay it. Of course they never pay so the doc must eat that loss.
Remember most docs are not hospital employees. They work on contract and are bound by fee for service reimbursement. Meaning they don't get paid until the insurance provider pays up.
And we all know how efficient and cheerful insurance companies are. Though most docs will say the government program pays reliably, they also don't pay very much at all.
Can you imagine having to sit around and hope that your pay check will resemble even remotely what you expect?
And that the work that you do no matter how difficult or time consuming will never be reimbursed?
What incentives are there for any doc to keep working in the ER?

Worse George Bush has decided he will veto legislation that continues health coverage for 4.5 million children. George says why should they care is available to everyone in the US."just go to the emergency room".
Yes, the President of the United States is as dumb as the proverbial rock. There is actually a reason the word EMERGENCY is used when describing the ER. Getting your vaccinations so you can start preschool isn't an emergency but George Bush thinks it's just fine to bring 4.5 million children into the ER for well baby check ups and vaccinations, ear infections and common colds. According to the decider poor people shouldn't get the health care he gets. Even more brilliant? George, in his enviable wisdom didn't bother to figure out who would be responsible for paying for all this brand new "heath care". It has been left unfunded.

It has crossed the minds of hospital administrators who realize their hospitals will sink into bankruptcy if they have to absorb the costs of caring for 47 million uninsured US citizens or uncounted non citizens.
Did it never occur to anyone that hospitals actually have to pay for the supplies and drugs they use? They have to pay the staff that work there. They have to get the money from somewhere right?
Well have a look at your HMO premiums. You are beginning to pay for the new onslaught. HMO's will agree to higher reimbursement rates to keep the hospitals afloat as long as they can jack up the premiums and keep the shareholders happy.
And by the way what kind of sick bastard do you have to be to own shares in a HMO? Making money from disease and death but offering nothing to the suffering.

In Canada we have a same but different problem. We have a set schedule fee for service. It sucks. Which causes family docs to see an army of patients every day so they can pay their mortgage and the office costs. The doc always gets paid, there are no uninsured but the reimbursement ain't much. You aren't going to get rich being a family doc so no one wants to work in primary care. We have a shortage of family docs because it is hard work with not great pay. I do have to qualify this by saying not great pay for them $100,00-$200,000 a year would be hitting the lottery for a lot of us so let's not be all that sad . But we do have to remember docs incur a ridiculous amount of debt going to med school, sometimes up to $100,000. That is one hell of a student loan that has to be repaid.

And to bust the myth about wait times in Canada, they aren't any different than a Medicare/Medicaid patient in the US. Sixty percent of all insured US citizens are covered through these two programs...60%.....They are already enrolled in a Canadian system of health care but everybody pretends it's not. This system has all the same problems we have, waste, fraud, lengthy wait times but we don't have the biggest problem...a majority of US docs refuse to care for patients on Medicaid/Medicare.
So, you have insurance but you can't find a doc willing to look after you so what must you do?
Go to the ER..the President said it was okay.

Sunday, July 22, 2007

why Canada is the best country in the world

The Indo- Canadian community built the most amazing, beautiful ..damn, I hate to say of peace? That sounds way too pretentious. A really cool building where ANYONE can go regardless of faith or ethnicity. It's a place for the contemplation of peace.
They had it hand built, no wood, no steel. Hand carved stone.
It cost 40 million dollars and every dime was private donations. And still? Open to any Canadian.

Think about this for a moment. They don't care what religion you are or even if you don't believe at all. They want to talk about peace, harmony..happiness.

So, while the Catholics are molesting children and the Muslims and Jews are blowing up children here in Canada we are talking to our children about peace and what being a good citizen is all about.
I'll give you a hint. Being a good Canadian citizen is all about trying your best to get along, it's about looking out at the world and offering help and protection.
We don't want anything from you except your happiness and your desire to make your world a safer, happier place for your children.
I wont say Canada is a perfect place despite Micheal Moore's rose coloured glasses. We have some very bad people living here too. We have American immigrants that have brought their violent culture of guns,gangs, drugs and murder with them. We have immigrants that have bought into that violent culture. I have no sympathy for any of these people. After all Canada has free health care, a free public education, welfare and housing, loans available to anyone to go to University. Hell, we have laws in place that state anyone who is eligible for University cannot be denied due to financial hardship.
Being poor in Canada is the equivalent of middle class in ninety percent of the rest of the world.
And yet they still whine they want more, more, more.
I have the urge to send them to Africa for a year, maybe they will be more appreciative of the home they have.
All countries have a tiny minority that can never be satisfied. This minority will always have one excuse after another for why they can't be expected to succeed. I guess having to go to work is just too much to ask for some people.
Happily, so far they are a tiny minority that can and should be marginalized and deported if at all possible.

Canada has great schools, great far we haven't left anyone on the floor of the ER to die of a perforated bowel because they had the audacity to come to the ER three times complaining of agonizing belly pain. We have an extensive safety net that includes welfare and housing , pensions for the elderly and disability payments for the disabled.
We have a four party political system that creates checks and balances. We would never have a King George problem here.
We try to highlight and celebrate our differences instead of dropping them all in a "melting pot" and then attacking them when they don't burn off their different culture fast enough.
We accommodate language here. We understand that English is the most difficult language to learn..well some Chinese can be harder but that's because you have to learn to listen when someone is speaking. Not something we in the west are very good at.
Yes, sometimes we get impatient with the new guys, we wish they would hurry up and figure everything out quickly but we are compassionate too. We know they are trying and it's scary.

I support the war in Afghanistan. I support the work our soldiers are doing. Not because I am some doltish patriot with a flag on my house but because I understand that we have gone there to support and assist a beautiful country. We aren't there in a war on terror like some idiot Bush supporter. WE actually thought about what we were fighting and dying for. Our mission is to help build roads, schools and hospitals. We are there to protect the rights of the people who want these things. We are there to protect the government. To support them until they have enough infrastructure and economy to care for themselves.
We aren't there to peer in caves calling Osama's name. We don't give a shit. But if you slink out of your cave and try to disrupt the lives of the people then we will kick your ass so hard you will either die or slither back into your cave and be thankful you have it.
Afghanistan is Canada's little brother and you should know the shit you can get into when you screw with someone's family.
There will come a time when little brothers grow up and don't need anyone beating the shit out of bullies anymore. Afghanistan, if we in Canada have our way will grow up to be a tough little shit that can and will kick the crap out of anyone or anything that threatens it . Until that day I fully support our soldiers doing the ass kicking. Cowards that can't fight and use sneak bombs? We have bigger bombs and we are more sneaky than even you can imagine, you use a baseball bat? We will use a 2x4 when you are walking out of the toilet.
My advice to anyone trying to stall Afghanistan? Get back to Pakistan, they like you and your crazy shit there.

I also don't believe we are in the same danger England has found itself in. Despite appearances England is not multi cultural. It has marginalized it's immigrant population because England is ridiculously expensive. Everything that means survival; food, clothing, housing is too expensive. In England success is nearly impossible. They have created a massive underclass that has no hope. That makes people bitter as shit. Bitter, poor people are angry and very,very violent.
Allowing too many immigrants when you don't have the economy to support them is a disaster waiting to happen.
Open immigration is a bad, bad thing. Look at France, Germany and England. They should have closed the door but instead they opened it even wider and now? They have a pissed off population.

Canada has a pretty good immigration system. We are the largest country in the world, it used to be the USSR and we all know how that turned out. We have a ton of room except that room? Damn cold in the winter and over run with black flies in summer. We can't get the new immigrants to move north, hell can you blame them? So we pretend half the country doesn't exist and plan our immigration on that. So far it has worked okay. Personally I think no Americans should be allowed into the country and that includes state visits from moronic presidents but since I like Florida in January I guess we have to let a few in to keep the peace.
God knows you Americans can get nasty if you aren't treated like perfect little princesses.
I do wish you would consider building that cool new fence up here but if I know you guys you will make us pay for half and take us to court if we refuse.

I think Canada is a good country. We do the best we can most of the time. We aren't prone to religious fanaticism and so far we haven't had to suffer from a delusional Prime Minister who believes that God speaks to him.
Only in America or Iran do the leaders believe God is whispering in their ear.

Saturday, July 14, 2007

what would you do?

I have this weird re-occurring almost obsessive thought running through my head lately. It started after SARS.
For any nurse that was forced to work during the SARS incident thinking about the end of the world comes naturally.
The idea that the world could be suddenly and violently depopulated seemed very real and painfully close.
The idea of a sudden depopulation actually made me cheerful.
Of course I have a thousand caveats. All my family and friends would be immune.
All doctors, nurses , tech guys and engineers would also be immune.
Farmers would be immune.
I want good health care, great food, running water, sanitation and electricity. I don't want to have to go camping after the apocalypse.
It would be nice to have a clean start. I would like to see all the animals of the world get a second chance, to creep away from the edge of extinction.
I would like to see the concrete world eaten away by vegetation and thick, lush forests.

It would also be nice to never have to pay for another damn thing with cash. I would rather pay with sweat.

Maybe with the collapse of civilization television would disappear and with it any knowledge of what other countries are doing. Then we could all stop obsessing and stop dropping bombs on our suspected enemies.

Of course with my luck the only other survivors would be born again Christians and fundamentalist Muslims and they would end up lobbing nuclear weapons over their fences finishing off the rest of us.

Could you even imagine how pissed off a radical Christian would get if they survived the end of the world and no God showed up with four horsemen?

So much for a new eden...........

Thursday, July 05, 2007


I don't use that word lightly. As a health care professional hearing the word makes me sick with dread.
Sometimes it's true though.
A few months ago I hurt my back, again. Because I have already had one surgery and have had a re occurrence of pain I knew I couldn't ignore this new injury.
So I went to my family doctor. I had to wait three days for an appointment. My family doctor started some new drugs and then called my neurologist. I waited three weeks to see the neurologist. He is a lovely man and a fine doctor. His response? None. No recommendations, no treatment plan. I asked to see my neurosurgeon.
Six weeks later..six weeks ..I got a phone call to tell me my neurosurgeon was no longer seeing spine patients, he was semi-retired. He passed me along to a co-worker. This guy avoided all calls for another two weeks. Finally I went into the office. His secretary told me she had no idea when I could get an appointment as this guy carried his appointment book with him and "wouldn't let her know when he was free".
So I went home.
A week later I got a call from my first neurosurgeons secretary. I was now to see another guy.
The very next day.
So I went. He was about twenty five. Obviously right out of fellowship. Worse he was a dick that didn't bother to read my chart and had no idea why I was there. He did a full exam without realizing I had no current MRI.
Oh, you guessed it...six weeks later I got my MRI. I have called this idiots office three times. I can't get a follow up appointment. His secretary tells me he likes to do his follow ups on the goddamn phone.
Does he tell his brain tumour patients they are going to die over the phone too? Shit, I wouldn't put it past him.
So, I called my neurologist and begged his secretary to have him please read my damn MRI.

I am sitting here waiting to find out if there is a surgical fix for this mess I am in.
This idiot neurosurgeon was so fucking cheerful about not needing surgery. I told him if there is no surgical fix then I am living a life sentence of unremitting pain. There is not one fucking good thing about being non-operable and any idiot with an ounce of compassion would know this.

I know I don't have something awful like cancer or something emergent like a bleeding aneurysm but holy shit I am still entitled to care. It shouldn't take four months to find out whether my back can be fixed or it can't.
The radiologist reads the MRI and generates a report. All the idiots have to is read and then call me.
This would take about three minutes.
I guess the fact that I cannot sit or stand for more than thirty minutes at a time and the fact that I fall a lot and break skull and toes is meaningless.
Will it be so meaningless when I fall and hurt myself so badly I need round the clock care and I sue your ass for malpractice for the limit of your policy?
Malpractice covers not only active care , it covers the lack of care.

Right now my care is "here, take some of these pills and shut up, no one wants to hear it".

What happened to continuity of care? If my neurosurgeon who had previously performed a completely successful surgery hadn't gone into semi retirement would I have had a better experience?
Who knows? But it doesn't really matter cause I am stuck with the dregs and it's malpractice.

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