June 7th, 2011 by Lucy Hornstein, M.D. in True Stories
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Say you’re a bariatric surgeon. You’d think Americans would be beating a path to your door. After all, this is the land of Instant Gratification! Who wants to just eat less for the better part of a year to lose 50 lbs when one can be cut open and have one’s gastrointestinal anatomy rearranged — resulting in the necessity of eating less, but why quibble — to lose that same 50 lbs (or more)? Changing lifestyles is boring; surgery is exciting!
Funny how it turns out that in order for the surgery to succeed long-term, patients have to commit to lifestyle changes anyway. In fact, before any reputable bariatric surgeon will operate, patients have to demonstrate their dietary commitment by actually losing some weight on their own, prior to surgery. What I don’t understand is why people then go ahead with the damn surgery anyway? Logically, it’s almost like you have to prove you don’t need it before you can have it. Hey, I’ve never said I understand people.
Perhaps overcoming this paradox is the explanation for the behavior of a certain bariatric surgeon, brought to my attention by a mutual patient. Read more »
*This blog post was originally published at Musings of a Dinosaur*
May 16th, 2011 by Lucy Hornstein, M.D. in Health Policy, True Stories
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Insurance companies are supposed to pay for health care, although they do everything they can think of to avoid doing so. One company in particular (a small player here though a much bigger gorilla in other markets) does so by playing with words, even when another behemoth lost a lawsuit over the same issue.
The topic involves paying for preventive services while a patient is in the office for care of an acute illness or management of a chronic condition. The way we communicate with insurance companies about what we do in the office is by way of codes; CPT codes, to be precise. There are separate codes to differentiate between preventive services and the so-called Evaluation and Management (E/M) services. The latter are your basic office visit codes covering all the “cognitive” services I offer — as opposed to procedural codes, where I actually do something to you other than talk with and examine you. Read more »
*This blog post was originally published at Musings of a Dinosaur*
May 4th, 2011 by Lucy Hornstein, M.D. in Humor, True Stories
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9:00 pm:
Hello. It’s Mrs. Mumbledimumbler; I need the doctor to call me right away. My hip is driving me crazy. Please call me.
I listen to the message three times so I can sort of make out the name. The problem is that even though I think I can understand it, I don’t recognize it at all. But I call her because she said she needed me to call her right away.
Hello. I need you to call me in some tramadol right away.
“What was your name again?”
She repeats it clearly enough for me to confirm that I really don’t recognize it.
“Have I ever seen you in the office?”
No.
Let me get this straight: it’s 9:00 at night and your hip is hurting, so you call a doctor who’s a complete stranger and insist that they call you in a powerful painkiller without ever having seen you, taken your medical history, or examined you? I don’t think so.
“Um, I’m sorry ma’am, but I really can’t do that unless you’re an established patient in my office.”
Oh, okay; never mind.
I suppose I should count my lucky stars that she didn’t want vicodin.
*This blog post was originally published at Musings of a Dinosaur*
April 21st, 2011 by Lucy Hornstein, M.D. in Health Tips, Opinion, Quackery Exposed
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Imagine hearing a commercial on the radio:
Send us money, and we won’t send you anything in return.
No one would do that, right? How about this:
Send us your money and we’ll send you an empty box.
Better? Not much. Now how is that different from:
Send us money and we’ll send you stuff we’ll call medicine that we claim will help you, but there’s no actual active ingredients in it at all.
I don’t think there’s one bit of difference. Wouldn’t you agree that that commercial is fraud, pure and simple? The problem is that the general public doesn’t understand that the word “homeopathic” means “diluted beyond the point where it contains any active ingredients.”
I’ve recently heard commercials for homeopathic vertigo treatments, eye drops for allergies, irritable bowel, and spider veins on legs. I’m tempted to contact the radio station and complain, but stopped short realizing that their first question is going to be, “But is it legal?”
That’s the problem: it is. So what I want to know is, why? Read more »
*This blog post was originally published at Musings of a Dinosaur*
April 11th, 2011 by Lucy Hornstein, M.D. in Humor, True Stories
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Like many offices, we have a policy of calling patients to remind them of upcoming appointments, usually one to two days ahead of time. With the advent of our new EMR, we have the option of having the system send them email reminders. The vast majority of folks who’ve received these just love them. But there are still several patients a day who get phone calls.
The other recent change in the office, cutting the staff by 50%, means that my one remaining staffer is the one who makes the calls. She has other stuff to do, though — lots of other stuff, actually — so that she may not get around to these calls until later in the day.
Thank goodness our patients are right on the ball: Read more »
*This blog post was originally published at Musings of a Dinosaur*
