June 21, 2010
When you try to do the right thing in medicine, it’s a very lonely walk. I’ve been a physician for over two decades but have yet to develop immunity to hospital politics and corporate agendas. It still hurts beyond measure when my patients encounter discrimination simply because they have Medicaid.
Today’s economy has proven that no one is exempt from losing a job; a home; a spouse or their dignity. If the truth be told, we are all just one paycheck away from getting the dreaded pink slip. Medicaid insurance is the government’s safety net for the working poor and has traditionally been shunned by physicians but now hospitals are following suit.
I remember when the only cancer specialists in a small Louisiana town wouldn’t provide cancer patients with chemotherapy if they had Medicaid so the patients either sought care in another town or died from benign neglect. Perhaps it’s the memory of those cancer patients who were denied access to care that makes me fight so hard for my patients to be delivered at a quality hospital despite the hospital’s alleged resistance. In New York City, it’s a well-known fact that a renowned teaching hospital places Medicaid pregnant patients on separate floors but at least they accept them for obstetrical care.
Complicating my dilemma is another community hospital that has had quality care issues in the past and would “love” to have my patients because their patient census is shrinking. Most of the physicians in the community no longer deliver at their institution opting to take their patients to a new competitor hospital that recently opened its doors for business.
Although I have been involved in a recent arm-wrestling match with powers-that-be to “steer” my patients in a certain direction, I ultimately leave the decision up to the patients regarding their hospital of choice. If a hospital accepts Medicaid insurance, then they have to accept Medicaid patients.
The “heart” of medicine has flat-lined and is in dire need of CPR. STAT!
May 24, 2010
Pregnancy is certainly not the optimum time to have a surgical procedure however there are certain conditions when it is necessary. The most compelling reasons to have surgery while pregnant include acute appendicitis, gallstones that block the bile duct, torsion or twisting of an ovarian tumor and trauma to the abdomen that results in damage of an internal organ, bleeding or the threat of harm to the unborn fetus.
Appendicitis is sometimes difficult to diagnose during pregnancy however the location of pain is helpful regarding making the diagnosis. Patients with appendicitis sometimes have fever and abnormal lab results but this is not always the case. Although the appendix is usually on the lower right side of the abdomen during pregnancy is shifts towards the middle. Therefore, when attempting to make the diagnosis, a physician will examine the patient lying down and also tilted to her left side. If the pain shifts to the left side, the pain is probably from the uterus and not the appendix.
The safest time for a pregnant woman to have surgery is during the second trimester. An epidural or spinal anesthesia is safer than general anesthesia for many reasons. It is more difficult to place a breathing tube down a pregnant woman’s throat because hormone’s make the throat smaller. The patient also has an increased risk of aspirating or having food or liquid in her windpipe as opposed to her stomach.
There should always be an obstetrician and pediatrician consultant on hand prior to and during the surgical procedure, especially if the patient is in her third trimester. According to the latest medical literature, there are no anesthetic medications that cause birth defects to the unborn fetus, provided the surgery is not done during the first trimester. The heart tone of the fetus should always be monitored during surgery. Because a pregnant woman has an increased risk of developing blood clots, it is strongly advisable to wear “compression” stockings during a procedures. These stockings are available in the hospital and compress or squeeze the blood vessels in the legs to promote better circulation.
Following these suggestions will greatly improve your chances of having a surgical procedure that will not adversely affect your pregnancy. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
May 12, 2010
If it appears that the number of ob-gyn physicians in private practice is shrinking, it’s not a figment of your imagination; it’s real. There are a burgeoning number of obstetricians who can no longer pay for malpractice insurance but they’re too embarrassed to tell you. Shrinking reimbursements (or payments) from insurance companies coupled with higher medical practice premiums have changed the landscape of obstetrics dramatically.
Some Ob physicians have stopped delivering babies, others have retired from private practice and many have become hospital employees called hospitalists. Hospitalists will take care of you in the hospital while your ob provider sees patients in the office; in some cases, a LOT more patients, but more on that in a minute.
Contrary to popular belief, the days of milk and honey for most physicians are gone. Money previously spent on vacation homes, boats, luxury cars and exotic vacations is now used to pay for billing code specialists, and triple the number of their original office staff in order to fulfill insurance demands. False denials of payments by insurance companies mean additional paperwork and manpower. Delay of payments is the order of the day and higher patient co-pays certainly don’t help. Many physicians can’t provide health insurance for their office staff because of prohibitive costs.
It’s not a coincidence that gyn-“spas” are on the rise and your gynecologist is now doing liposuction, facials and selling vitamins. Some obstetricians opt to see more patients as a way to compensate for their losses and that becomes a dilemma. As the number of patients increases, the quality of their care decreases.
There is also the danger of monopolies forming when hospital systems purchase physician practices which could drive up the cost of healthcare even more and limit your physician’s autonomy. So, what is a patient to do? Empower yourself with information. Ask how many patients your physician sees per day before making an appointment. If your insurance company is delaying payment for your procedure, file an official complaint with your State Commissioner of Insurance or to the Center for Medicare and Medicaid if it’s a self-insured plan. If your OB is honest enough to admit their concerns, ask how you can help.
Small changes CAN make big differences.
March 24, 2010
Why does everything in healthcare have to be so complicated? You would think that the pregnant wife of a Navy seal would receive more respect. While her husband defends our freedom in unknown parts of the world, the bureaucratic knot controlling her healthcare pulls tighter.
The patient had a previous life-threatening complication and is at risk for it to recur. I had personally spoken with a high-risk specialist (Dr. A) who assured me that his institution would see her and when I mentioned her military insurance he didn’t think it was a problem. Unfortunately, he was wrong. His institution did not accept her insurance. Physician employees have no control regarding the patients that we see thanks to our unyielding billing departments.
The number of delivering obstetricians has declined over the years because of exorbitant malpractice premiums. The challenge I faced was finding a high risk obstetrician who would manage her care AND attend to her birth. I contacted a high-risk colleague (Dr. B) who stated that he could provide consultations, but not the delivery. I then contacted the CEO of a specialty hospital in hopes of changing their policy regarding rejecting the patient’s insurance. However instead of speaking with the CEO, I was referred to their hospital’s “business” director. He was extremely helpful and made an astounding discovery. Their hospital will accept the patient’s insurance for the delivery but not for high-risk consultations. He was very apologetic, and offered the name of the very same high-risk colleague (Dr. B) as a referral source. So, tomorrow I will call Dr. B (again), beg him to accept the patient’s insurance and provide the high-risk consultations. If the patient has problems, she should go to Dr. A’s high-risk hospital for further evaluation. The patient has a military HMO plan that pays lower fees and is now runs the risk of falling through the proverbial cracks.
Our military wives deserve better. Can someone PLEASE fix this?
March 22, 2010
The Basil and Spice article, Doctors Will Quit Under New Healthcare Proposals really touched a raw nerve. The author, Dr. Jeffrey English, an Atlanta neurologist proposed that physicians will “quit” because of government healthcare involvement. Dr. English, with all due respect, please speak for yourself.
The time for physicians to “quit” was when the insurance industry took over our profession. They introduced managed care, bribed our colleagues with “capitation” income and then entered the back door of our profession and like a thief in the night, took over. We, as physicians are to blame for this unholy mess. We never stood up to the insurers for fear of being “disenrolled” from their lousy plans. We never protested for fear of being deemed as “antitrust.” We never complained when they redefined us as “providers.” And sadly, many of us never fought for our patients’ rights or dignity for fear of making waves.
The nonsense of “government” takeover is a joke! The “government” wouldn’t have to intervene if we had stood our ground, but we didn’t. We now have to depend on the government to make the insurance companies pry their greedy hands off our profession and patients. I’m an Ivy League grad (Columbia U.) and a board certified ob-gyn physician. I’ve devoted my life to serving vulnerable, public health patients, the kind none of my colleagues want to manage. I live next door to a teacher, a bank manager and live within my means. My kids attend public school. I’ve been taking care of Medicaid patients all my life and I’m not starving, still breathing and living in a country that allows me to be free. Doctors will quit? Really? I think it’s much too late for that now. We, as physicians need to put our egos in our pockets, roll up our sleeves and find some solutions instead of whining like babies.
March 20, 2010
The Russians have a saying: “One who sits between two chairs may easily fall down.” Representative Kosmas, as a constituent in your 24th Congressional District and as a public health physician, thank you for having the courage to vote for healthcare reform. I know this was a difficult journey and that your professional career is on the line. However by voting for healthcare reform, you will be remembered in history as a pioneer who gave the American people a beacon of light and returned the “care” back in healthcare.
The healthcare bill is not perfect, I actually cried when I first read it. As a physician, I have witnessed the devastation that insurance dynasties have created by placing profit before people and billing codes before treatment. They thought they could marginalize physicians and nurses by referring to us as “providers.” They ignored our years of expertise and training. They annihilated the profession of medicine.
I know that the pharmaceutical and insurance lobbyists were bombarding you with temptation that would have been easy to deposit into the bank of future favors. However as a very wise man once said “What good does it profit a person to gain the whole world but forfeit his soul?”
Tomorrow, you will cast your vote and change the course of history. You have pushed through your fears and stepped into greatness. As your constituent, please rest assured that I will have your back. You have earned both my trust and my vote in the next election. I will knock on doors for you. I will volunteer for you. I will be there for you in your time of celebration but also in your time of need. You are now the crown jewel of my congressional district. May God continue to bless you.
March 15, 2010
A blue-ribbon panel of physicians, midwives and other healthcare providers convened at the National Institute of Health to discuss the dilemma of vaginal birth after cesarean (VBAC). At the end of the three-day-conference, they issued a statement that read: “Given the available evidence, TOL (trial of labor) is a reasonable option for many pregnant women with a prior low transverse uterine incision.” Most obstetricians know that, however convincing the hospitals is another matter.
The vacillation of VBAC policies makes me dizzy. In the late eighties and early nineties there was a tremendous effort to promote VBACs and dispel the myth of “once a cesarean section, always a cesarean section.” I recall the days of my residency training when we would call hospitals in foreign countries in an attempt to document a uterine incision of a pregnant patient who had one previous cesarean section and had presented to our hospital in labor. To section or not to section, was the issue at hand. If a woman had a vertical uterine incision, then she must have a repeat cesarean section to avoid the possibility of rupturing the uterus. However, is she had a low transverse or horizontal incision, than ideally, she was a VBAC candidate, barring any other issues such as more than two cesarean sections, fibroid surgery (aka myomectomy) and other uterine procedures that are too complicated to mention.
I blissfully remember taking care of a patient with two previous c. sections who presented in labor at 8 centimeters. She ultimately had a successful VBAC and I was greatly relieved. I dreaded doing repeat c. sections. Fighting layers of scar tissue (adhesions) from previous surgery is not a pretty sight when you’re attempting to reach the uterus and deliver a healthy baby.
Today, most hospitals will not allow VBACs unless the physician remains in the hospital during the patient’s entire course of labor. Since most physicians refuse to do so, a patient is forced to have a repeat c. section. When you deny a woman’s freedom of choice, please be prepared for the consequences. VBAC activism is on the rise and I hope it continues to spread.
March 8, 2010
Kudos to CNN reporter Elizabeth Cohen for reporting on hospital waste; the “open” secret has now been revealed. See Healthcare Industry Sick With Medical Waste. Physicians and nurses have known about inflated hospital charges for years and now the public does too. As Cohen reported about $1,000 toothbrushes and $121 pacifiers I thought about my own horror story. Physicians aren’t exempt from illness and in 2008 I developed an acute eye condition that threatened my vision. At the recommendation of my optometrist, I saw a retinal specialist who admitted me to a local hospital for a same day procedure. In retrospect, I regret both having the procedure (that failed) and being admitted to an institution that provided less than exemplary customer service and gave me a over inflated bill.
As a physician, I know exactly what medication costs and was incensed when I received my $13,000 hospital bill. Charges of $181.00 for a $4.00 generic drug, implausible costs for intravenous medications and “Star- Wars-type” surgical tools made me see red. I challenged the outrageous bill but to no avail. I went through layers of billing clerks who were both rude and useless; and spoke with a hospital auditor who defended the charges. I complained vehemently to my insurance company, advising them that they were being duped but they paid their portion and never investigated my complaints. I ultimately paid my portion of the bill but felt like I had been extorted by the Mafia. In retrospect, here’s what I wish I had done:
- Requested an estimate of hospital charges BEFORE I was admitted
- Wrote a letter of complaint to my state’s Insurance Commissioner; and
- Consulted the services of a medical billing advocate
Most pregnant women will give birth either in a hospital or birthing center so it behooves you to be as pro-active as possible regarding scrutinizing your bill. Healthcare has become a business. Make sure you’re an educated consumer.
February 24, 2010
“Let them eat cake” was the response uttered by a French aristocrat upon learning that her impoverished citizens did not have bread to eat. The US State Medicaid offices have essentially said the same thing. (See US States Slash Medicaid by Tom Eley) If the proposed Medicaid cuts are enacted, being poor will become equivalent to having a death sentence in one of the most prosperous countries in the world. Don’t believe it? A 76-year old woman in Michigan died from dental abscesses in Michigan when her dental coverage was revoked.
If you’re poor and need eye services? Forget about it. Live in Arizona and have children in the CHIP program? It might very well disappear. Have mental health problems and live in poverty? You might not be treated. Pregnant and live in California? You’ll have to be poorer than dirt in order to receive insurance. Your doctors’ Medicaid and Medicare payments have been slashed severely so very few will be able to treat you. No one wants to work for free. Are you incontinent with urine? Sorry, no more adult diapers. If you live in Tennessee, please don’t have a car accident or heart attack. Your state is only going to pay a lifetime Medicaid benefit of $10,000 for inpatient care.
If state legislators need money to fund our healthcare system why don’t they start by commandeering the obscene salaries and fiscal perks of insurance CEOs? Make the lobbyists empty their deep pockets. Raid the trust funds of spoiled brats who never did an honest day’s work in their lives. Empty the bank vaults in the Cayman Island and bring home all of that tax-free money. Tell the oil barons in Dubai to stop milking us dry. How about manufacturing something “Made in the US” for a change?
Billy Graham once said “Hot heads and cold hearts never solved anything.” Performing slash-and-burn maneuvers will NOT eliminate our healthcare’s fiscal problems. The poor are sick and the sick are poor. Please do not increase their numbers.
January 20, 2010
I hope someone out there is just as outraged as I am. Sixty U.S. Senators cut deals instead of doing the will of the American people and now we’ve lost Ted Kennedy’s seat. This is what happens when politicians don’t stand on their principles and our President wavers like the wind. We never wanted healthcare exchanges and piecemeal healthcare run by a conglomerate of self-interests. The people wanted universal healthcare coverage for all.
Well, now that the Democratic Party has received a smack down in Massachusetts, maybe someone will FINALLY listen to the people. Our window of opportunity for change is now apparently closed and my patients and profession will continue to suffer.
MLK said it best: “All that good men need to do for evil to flourish is nothing.”