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A Humorous ER Admission For Marijuana Use

Whenever drugs are involved in a patient’s admission, the outcome is either craziness or comedy.  Methamphetamines and cocaine seem to be the popular drugs of choice requiring admission. These people are usually angry and agitated.  However, it seems like pot humor always adds a little touch of the unexpected to an otherwise boring admission.

Take for example the 27 year old truck driver who was brought in by his roommate for “acting weird’. What happens when you mix a little marijuana and a little alcohol?  You get Happy’s pot humor post of the day. Read more »

*This blog post was originally published at The Happy Hospitalist Blog*

The Game of Life & American Tragedy

A game worth learning

Three of my children love to play the game ‘Life,’ where players choose college or career and are paid, take out loans, pay taxes, have families and all the rest as they navigate towards retirement.  I especially love playing with them when they each become frantic, not for the highest income, but to finish the game with the most children.  Along the way, my daughter is even naming her kids as the tiny blue and pink pegs fill up her little plastic car.  (Talk about your parental validation!)

But after playing, then thinking back on my week at work, I fear that we could easily make a new game that was more familiar to many modern kids.  I suppose we’d have to call it ‘The Game of Death,’ or maybe just ‘The Game of Pain.’ Read more »

*This blog post was originally published at edwinleap.com*

Funding Health Reform From Savings Associated With Curtailing Waste, Abuse & Fraud?

beforehand lotionWell, I lead a double life but it isn’t out dancing in formal wear!

“There is time for only fleeting thoughts about that dance you’ll attend during off duty hours.”

There isn’t even time for that.

Besides, who attends a dance during on duty hours?

Well, I guess the most important thing is that our hands are “soft, smooth and free from redness” because “your patients like it and your date expects it”.

Oh yeah?

The day they use a hand sanitizer thirty times in a shift and wash their hands another twenty, they can talk to me about soft hands.

********************

My husband won’t watch football with me because I tend to get hyped up and throw things at the TV when I get upset.

That explains why there were Notre Dame pom poms and a Cleveland Browns jersey at the base of the set this weekend.

I also like to talk back at the President when he is speaking on TV. Usually it’s things like “Say WHAT?” or “Give me a break!” “Get. A. Clue!” is usually a good one.  This last speech, the one to Congress about health care, was no exception.  My first comment came a bit into the speech when I noted a few times that “I haven’t heard a single thing I disagree with yet” and “he’s right on that point”.

I was afraid hubby was going to need smelling salts.

But I’m like, “let’s hear how he is going to pay for this…let’s hear him out”.

And then I heard it.

And then he lost me.

*****

There were two comments that I could not let go. I looked them up in the text of the speech to make sure I had heard them correctly.

“…we’ve estimated that most of this plan can be paid for by finding savings within the existing health care system – a system that is currently full of waste and abuse.”

“The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud…”

Hundreds of billions of dollars? Billions? With a capital “B”?

Waste. Abuse. Fraud.

This means that in order to pay to the proposed health care reform, we have to find enough waste, abuse and fraud to cover expenses.

*****

But I have some questions.

What is the definition of “waste”? To the extent that “waste” means inefficient bureaucratic practices that use up monetary resources, I can get on board with that.

Abuse?  What kind of abuse? Using the system inefficiently, like calling an ambulance for a stubbed toe? Remember, the President is using the term “abuse” to represent a potential income stream for the new system, so it would have to encompass behaviors that spend money that should not be spent.  Money is spent on patient care, so is he talking about patients abusing the system?

And then there’s fraud…

That’s a crime, folks.

Hundreds of billions of dollars in waste and fraud?

The President must think that there are an awful lot of criminals in the health care system.

So what’s my point?

*****

My point is this: funding for the new proposed health care system (see “most of this plan…”, above) is based on finding waste, abuse and fraud.

What happens when all the waste is taken out, all the abusers are stopped, the fraudsters jailed and the system needs more funding? Does that not make it imperative that we keep finding waste and abuse and fraud? Does that not mean that what constitutes waste, abuse and fraud must be constantly expanded to make up for rising costs?

This can’t be good.

I am in total agreement that our system can be streamlined, big time.

And maybe we could find enough money in waste, abuse and fraud to make it pay for itself, but I doubt it.

If we could do that, wouldn’t we have done it already with Medicaid and Medicare? The budgets for both are getting slashed on a regular basis. Drop the waste, abuse and fraud in those programs and then come back and tell me how much better their budgets are.

If  we  can’t do it in an existing government-provided system, how on earth do you expect us to believe it can be done on a larger scale?

*This blog post was originally published at Emergiblog*

ADHD Drugs Abused By College Students

This week’s episode of CBS DOC DOT COM took me to a college campus where I got schooled by two students about the widespread use of ADHD (Attention Deficit Hyperactivity Disorder) meds – by kids without a diagnosis of the condition – to study, stay attentive, and sometimes just to feel good.  A 2005 Web survey found that 5% of US undergraduates reported having used stimulants over the previous year for non-medical reasons.  But the real number may be much higher, especially if you listen to the students I interviewed with Dr. William Fisher, a psychiatrist at Columbia University Medical Center.

Features of ADHD include inattention, hyperactivity, and impulsiveness.  A national survey in 2003 reported that about 4.4 million children in the US have been diagnosed with ADHD and 56 percent take medication to treat it. It’s estimated that about one to two thirds of the children with ADHD continue to have symptoms in adult life.

ADHD medication was in the news last week with a report that medication use in elementary school children improved math and reading scores.  The gains – equal to about a fifth of a school year in math and a third of a school year in reading – still left the treated children lagging behind kids without the disorder. The study fans an ongoing debate on who should receive medications such as Adderall and Ritalin.  These medications – along with behavioral/psychological therapy and educational interventions – help patients with ADHD; but they’re also being used by students and adults who have not been diagnosed with the disorder.

These drugs have potentially serious side-effects such as high blood pressure, irregular heart beat, and dependency.  Doctors prescribing them for patients with ADHD should be carefully weighing the risks and benefits.  People taking them on their own are rolling the dice with their health.  No matter what you may feel philosophically about using these stimulants, the risk-benefit of their use in patients without ADHD has simply not been established.

I feel strongly that ADHD medications should only be used under the guidance of a physician. But that’s apparently often not the case.  In today’s segment, we explore this issue further. Why do people without ADHD take stimulants? How do they start? How does it make them feel? Is society’s metronome pulsing so much faster today that people feel pressured to take drugs just to keep up?  Click here for a fascinating related article which appeared recently in The New Yorker.

Click here to see a video on this topic.

Latest Interviews

The Surprising Economic Burden Of ADHD (Attention-Deficit Hyperactivity Disorder)

If you can read this you need to download a more recent browser It is estimated that as many as million U.S. adults have ADHD Attention-Deficit Hyperactivity Disorder A recent research study publication-pending suggests that the economic burden of ADHD on America could be as high as billion annually. I…

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Is The Adderall Shortage A Harbinger Of Future Drug Supply Problems?

If you can read this you need to download a more recent browser Today most- if not all- Doctor’s offices are strained by the shortage of some prescription medication or vaccine. A month ago President Obama signed his executive order directing the FDA to take steps to reduce drug shortages…

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Latest Book Reviews

Book Review: The First Step To Improve Health Care Is A Close Examination Of How It’s Delivered

My friend and former Chair of the CFAH Board of Trustees Doug Kamerow has written a book that I think you will like. Besides being a mensch and witty as heck Doug is a family doctor and a preventive medicine specialist. In his new book Dissecting American Health Care Commentaries…

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“Your Medical Mind” Explores Factors That Influence A Patient’s Medical Decisions

Recently I had a conversation with Shannon Brownlee the widely respected science journalist and acting director of the Health Policy Program at the New America Foundation about whether men should continue to have access to the PSA test for prostate cancer screening despite the overwhelming evidence that it extends few…

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Book Review: Food Truths, Food Lies

Food Truths Food Lies written by family physician Eric Marcotte M.D. may be the most refreshingly evidence-based diet book of the decade. You will not find a single mention of super-foods magical berries or supplement must-haves in the entire book. What you will find is the cold hard truth about…

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