February 23, 2012
A lie unchallenged becomes the truth. While I admire GOP candidate Rick Santorum’s decision to raise a special needs child, I certainly wish he would keep his political agendas out of my exam room. Yes, it takes love and courage to raise a child with Trisomy 18, a genetic disorder that’s associated with severe physical and mental challenges. However, this does not make Santorum an expert on prenatal tests and to say anything to the contrary, is both reckless and immoral.
Prenatal tests, especially those that tests for chromosomal abnormalities, are optional. A woman can decline the tests if she chooses to do so and I’ve had patients who have exercised that perogative in the past. But first, let me tell you why these genetic tests are so important. If a woman discovers that she has a baby with Trisomy 21, commonly known as Down’s syndrome, both she and her pediatrician will have time to prepare for possible complications. Many genetic disorders are associated with heart conditions and require immediate surgery after birth. There are instances where the baby is born with a pediatric cardiologist in the delivery room who then whisks the baby away to have a life-saving cardiac procedure. This cannot happen if you don’t have the prenatal test.
In my 25-year career as a physician, I’ve only had 2 confirmed cases of Trisomy 21 and both mothers decided to keep their pregnancies. However, please be aware that there are some genetic disorders that are incompatible with life and the baby expires shortly birth. Most mothers do not want to experience that type of emotional trauma.
Mr. Santorum, please stop using Women’s Health as a stepping stone to gain entrance into the White House. If you can’t campaign for President based on truth and merit, then perhaps you’re not cut out for the job.
March 9, 2011
Did you ever love something or someone so much that you had to walk away because it hurt too much to stay? That’s how I feel about medicine. From the moment I saw my first delivery, I was hooked and there was no turning back. Perhaps I’m highly offended at our present state of affairs because I had to work so hard to gain acceptance into med school. I spent countless nights in the library at Columbia School of Physicians and Surgeons studying for the MCATs. Endured physiology, histology, biochemistry, gross anatomy (included the dreaded head and neck) and microbiology so that I could eventually diagnose clinical problems. I walked through the fire of residency training and came out whole on the other side. Yet, despite all of these humble achievements, I couldn’t see the destruction of healthcare coming. And neither did many of my colleagues. However, instead of banning together to save our profession, some of us allowed ourselves to be fiscally co-opted giving rise to the birth of “volume oriented medicine.”
Healthcare is now a business and quality of patient care has flown out the window. Billable procedures with diagnostic codes are the order of the day. “Productivity” is a buzz word, a euphemism for volume. The insurance companies are paying less, yet the healthcare providers are expected to do more. The number of patients on schedules increases and it has become “normal” for some of my colleagues to see 48 pregnant women in a day. A former medical director decided that he wanted to increase “productivity” even more so he paid physicians on a per-patient-basis and of course, his theory worked. When one of his cronies had 80 pregnant women scheduled in 5 minute intervals for one day, I had seen enough. I wrote a letter of complaint to the Florida Board of Medicine and was informed that there was no law that prohibited the number of patients a healthcare provider could see in a day. I then contacted the American College of Obstetrician-Gynecologists (ACOG) and they too, had no protocol or rule about volume. So, it was the wild, wild, west regarding patient care. No rules. No boundaries. And certainly no patient protection. Regime changes occurred, but the “numbers” game continued. I had had enough. So after 15 years of attempting to administer quality care in the midst of chaos and strife, I have tendered my resignation. There is nothing more that I can do except put it in the hands of God.
December 8, 2010
The day Elizabeth Edwards announced that she had breast cancer, my heart sank. Finding a lump in the breast only heightens the suspicion that the prognosis may not be good. In Elizabeth’s case, it wasn’t. We all admired Elizabeth for different reasons. In my case, it was her love for healthcare reform that quickly grabbed my attention and we were both older moms of two small children. Elizabeth advocated universal healthcare and comprehensive insurance for all Americans, not a “compromised” version based on partisanship and politics. As the years wore on, she discussed her diagnosis of incurable breast cancer with passion stating that she knew that she had access to the best possible care but empathized with women who were not as fortunate.
It is said that behind every successful man lies the power behind the throne and we know this to be true about Elizabeth. She was an accomplished attorney in her own right who took a back seat to raise her kids and support the presidential candidacy of her husband. For a while I thought Elizabeth had won the battle against breast cancer during its remission but then it resurfaced its ugly head in the midst of her husband’s presidential campaign. She handled it with both dignity and grace. We collectively winced when she faced the infamous scandal that violated principal and moral authority and embraced her even more. The last years of her life were a celebration of uncertainty as she became more and more vocal about healthcare reform. As recent as last night, members of our healthcare advocacy group, Doctors For America, discussed sending Elizabeth a letter of gratitude for all of her efforts regarding healthcare reform. Alas, we were too late. She made her transition this morning.
Elizabeth might have lost the battle with cancer, but she certainly mastered the art of living. In her own words she explained “I have found that in the simple act of living with hope, and in the daily effort to have a positive impact in the world, the days I do have are made all the more meaningful and precious. And for that I am grateful.”
We’re grateful, too, Elizabeth. Very grateful.
July 28, 2010
Okay, so now they’ve gone too far. Pregnant women are now denied home loans for mortgages because of their pregnant status. Yet another rung to add onto the ladder of maternal distress. The Pregnancy Discrimination Act (PDA) was an amendment added in 1978 to the Civil Rights Act of 1964. Yet, despite its 32-year history, very little has changed.
In light of the mortgage collapse debacle, the rules of lending have tightened. Strict scrutiny is the order of the day but the lenders have taken things too far. Dr. Elizabeth Budde, an oncologist in Washington State was pregnant with her first child and received an email that her mortgage had been approved. However, the email prompted an automatic response announcing that she was on maternity leave and her lenders subsequently rescinded her mortgage. Banks demand “guaranteed” income and do not give credence to short-term disability. Dr. Budde finally obtained her mortgage because she had enough sick and annual leave time that continued to pay her a full salary.
The federal government has vowed to protect the rights of pregnant women and is investigating lenders for possible discrimination. Are you pregnant and in the market to purchase a new home? Here are a few things that you should know:
- The bank may ask you to purchase a home whose mortgage can be paid from one salary even in a dual-salaried household.
- The bank will recheck your financial situation right before the loan closes. This includes calling your employer to verify your employment.
- Your income has to be guaranteed to continue for at least three years.
- According to the Department of Housing and Urban Development (HUD), your mortgage cannot be denied because of pregnancy or short-term disability.
- A letter from your doctor (with a return date to work) and your employer (stating the return date and salary) should be enough to qualify your loan.
- A lender cannot ask whether you are pregnant, but can ask if your employment or income situation will change.
If you have been denied a mortgage because your pregnancy, contact HUD immediately.
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!
April 5, 2010
What short memories Dr. Jack L. Cassell has regarding his humble beginnings. An urologist by training, he now basks in 15 minutes of fame because of an infamous sign that he plastered on the door of his medical practice: “If you voted for Obama seek urologic care elsewhere.” Florida is such a magnet for drama.
I assumed Cassell was a Florida native until I heard him speak during an interview. His distinct Northeast accent grabbed my attention and I quickly reviewed his credentials on the Florida Board of Medicine website. He is now hailed as a great “American patriot” but wasn’t smart enough to attend an American medical school. He subsequently graduated from St. George’s University School of Medicine on the island of Grenada where people look like President Obama. Oh, would I love to review his medical school application to determine the reasons for his rejection.
After leaving Grenada, he began both an internship and surgical residency with the UMDNJ Hospital in Newark, New Jersey, again, training on indigent people. From the inner city of Newark, he found his way to Gainesville, Florida to begin a urologic oncology (cancer) fellowship. The greatest numbers of prostate cancer patients are African American men.
Cassell now has a private practice and does not accept Medicaid. He is well ensconced in the American Dream. He has no further need to interact with the indigent and uninsured. He has become the poster boy for Fox News and Rush Limbaugh. Blonde coquettes show up at his office bearing gifts. He has violated the AMA’s Code of Ethics #9.012 that states “under no circumstances should physicians allow their differences with patients or their families about political matter s to interfere with the delivery of high-quality professional care” but his inflammatory sign regarding President Obama will remain.
Perhaps it’s time for Dr. Cassell to stop practicing medicine. When political views obscure common sense; the Board of Medicine needs to step in.
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.
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.
February 17, 2010
As the Academy Awards draws near, the movie Precious is receiving plenty of buzz. Based on a novel written by Saphire, it tells a sordid tale of a 16 year old teen that is pregnant for the second time by her absent father. Unfortunately the story of Precious is not confined to a novel or a silver screen.
I met my first “Precious” at the age of fifteen, in a housing project in the Bronx. My life was ruined when my family was uprooted from Brooklyn in order to be closer to my uncle’s job. We were greeted with suspicion,ridiculed by our neighbors and not exactly given a “welcome mat.” I was grateful when I discovered there was a girl who was my age living on the second floor. However, we were not exactly peers. She had recently brought home a newborn that looked exactly like her middle-aged stepfather. The uncanny resemblance of the newborn to his grandmother’s husband made me want to cry. I looked at the teen’s mother (who appeared embarrassed) and silently screamed “Why didn’t you protect her? “
President Obama’s oldest daughter, Malia is 11 years old, and to fathom her being pregnant and requiring a C. Section would be totally absurd. Yet this is exactly what happened to an 11 year old child in Texas. (See Man Accused of Fathering a Child With an 11 Year Old) The girl had allegedly been sexually assaulted by her stepfather since the age of six and was now living in protective custody. The stepfather was mandated by the court to supply a DNA sample that confirmed he is the biological father of the child. You can’t tell me that this child was abused for five years and her mother knew nothing about it. And had she not become pregnant, her alleged abuse would probably have continued. Thank God I wasn’t the obstetrician who had to bring her into the operating room to perform a C. Section, because I’d probably need therapy for life.
As a society, we’ve failed this child miserably. I’m sick of women who feign denial and ignorance regarding atrocities committed against their children. Please take off your blinders and have the courage to protect your children.
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.”