August 2nd, 2008 by Dr. Val Jones in True Stories
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I posted this true story on my blog previously, but I think it bears repeating (especially with the recent news of increased violence against physicians and threats at gunpoint). Details of the story were altered to ensure privacy of all involved.
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The son of a business tycoon experienced some diarrhea. He went to his local emergency room immediately, explaining to the staff who his father was, and that he required immediate treatment.
Because of his father’s influence, the man was indeed seen immediately. The physicians soon realized, however, that there was nothing emergent about this man’s complaints. After several blood tests and a stool sample were taken, he was administered some oral fluids and monitored for several hours, they chose to release him to recover from his gastroenteritis (stomach flu) at home.
The man complained bitterly and said that he wanted to be admitted to the hospital. The physicians, with respect, explained that he didn’t show any signs of dehydration, that he had no fever, his diarrhea was indeed fairly mild (he had only gone to the restroom once during the hours of his ED visit – and that was when he was asked to produce a stool sample). The man’s pulse was in the 70’s and he had no acute abdominal tenderness.
The man left in a huff, and called his father to rain down sulfur on the ED that wouldn’t admit him.
And his father did just that.
Soon every physician in the chain of command, from the attending who treated him in the ED right up to the hospital’s medical chief of staff had received an ear full. Idle threats of litigation were thrown about, and vague references to cutting key financial support to the hospital made its way to the ear of the hospital CEO.
The hospital CEO appeared in the ED in person, all red and huffing, quite convinced that the physicians were “unreasonable” and showed “poor judgment.” Arguments to the contrary were not acceptable, and the physicians were told that they would admit this man immediately.
The triumphant young man returned to the ED for his admission. Since the admitting diagnosis was supposedly dehydration, a nurse was asked to place an IV line. The man was speaking so animatedly on his cell phone, boasting to a friend about how the doctors wouldn’t admit him to the hospital so his dad had to make them see the light, that he moved his other arm just at the point when the nurse was inserting the IV needle. Of course, the poor woman missed his vein.
And so the man flew into a rage, calling her incompetent, cursing the hospital, and refusing to allow her to try again.
At this point, the ED physicians just wanted him out of the emergency room – so they admitted him to medicine’s service with the following pieces of information on his chart:
Admit for bowel rest. Patient complaining of diarrhea. Blood pressure 120/80, pulse 72, temperature 98.5, no abdominal tenderness, no white count, patient refusing IV hydration.
Now, this is code for: this admission is total BS. Any doctor reading these facts knows that the patient is perfectly fine and is being admitted for non-health related reasons. With normal vital signs, and no evidence of dehydration or infection, this hardly qualifies as a legitimate reason to take up space in a hospital bed. And when the patient is refusing the only treatment that might plausibly treat him, you know you’re in for trouble.
The man was discharged the next day, after undergoing (at his insistence) an abdominal CAT scan, a GI consult, an ultrasound of his gallbladder, and a blood culture. His total hospital fee was about $8,000.
Do you think he paid out of pocket for this? No. He submitted the claim for payment to his insurance company. Their medical director, of course, reviewed the hospital chart and realized that the man had no indication for admission, and refused medical care to boot, so he denied the claim.
So the son appealed to his father, who then rained down sulfur on the insurance company, threatening to pull his entire business (with its thousands of workers insured by them) from the company if they didn’t pay his son’s claim.
The medical director at the insurance company dug in his heels on principle, assuming that if he continued to deny the claim, the hospital would (eventually) agree to “eat the cost.”
In the end, the insurance company did not pay the claim. The CEO of the insurance company called the hospital CEO, explaining that it was really the doctor’s fault for admitting a man who didn’t meet admission requirements. The hospital CEO agreed to discipline the physician (yes, you read that corretly) and eat the cost to maintain a good relationship with the insurance company that generally pays the hospital in a timely manner for a large number of patient services.
Welcome to the complicated world of cost shifting in healthcare.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 2nd, 2008 by Dr. Val Jones in Uncategorized
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I’m planning to attend a ScienceBlogger event next weekend. Hope you can join me and Gene Ostrovsky from
Medgadget.com… Here is the email invite I received:
So far, we’re expecting about 50 readers and a dozen ScienceBloggers.
We’ll be meeting at 2:00 pm on Saturday, August 9, at the Arthur Ross Terrace at the American Museum of Natural History. Once there, please head to the cafe tables and chairs set by the trees on the upper terrace, facing the Rose Center. The terrace is accessible from the Theodore Roosevelt Park at 81st Street and Columbus Avenue.
Here’s more information about the site:
This is an outdoor location with tables and shade, which we thought was best for the large numbers we’re expecting. After we’re all assembled in this spot, if smaller groups are interested in grabbing a coffee or sitting in air conditioning, then we’d be happy to point them to one of several nice cafes nearby.
Please pass this on to anyone who might be interested. We’re all very excited to interact with readers in RealSpace!
Cheers,
Ginny
Addendum: due to overwhelming interest, the venue has changed (Ginny’s new email):
Hey guys,
So due to our increasing numbers and the chance of rain, we’ve decided to change the location of Saturday’s Reader Meetup. The new spot will be at a bar on the west side called Social. We’ve reserved a room in the back, and it’s three floors in case we need even more room. We’ll buy the first round of pitchers (alcs and non-alcs).
Details:
2pm-4pm on Saturday, August 9
Social
795 8th Ave (close to 48th St.)
New York, NY 10019
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 30th, 2008 by Dr. Val Jones in Health Tips, News
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New research suggests that people who live in “walkable” neighborhoods weigh about 6-10 pounds less than those who live in pedestrian-unfriendly communities. Scientists at the University of Utah calculated the body mass index (BMI) of about half a million Salt Lake county residents from a state drivers license database. They then compared the “pedestrian friendliness” of the zip codes associated with the various BMIs.
They found that people who live in more densely populated zip codes (designed to be more friendly to pedestrians) tended to have lower BMIs. This research has not yet been published, so I can’t comment on the details of the study. However, it makes intuitive sense that walking more can make people lighter on their feet.
The study authors mentioned that city planners used to design communities with pedestrian activities in mind, but since the 1950’s this practice has become less common. Many new housing developments are built around the assumption that vehicles are the main form of transportation, making that a self-fulfilling prophecy.
Earlier this year I participated in an 8 week walking program promoted by the Department of Health and Human Services. At their recommendation, I purchased a pedometer with a goal of achieving 10,000 steps per day. It was an eye-opening experience for me (left to my own devices, I naturally walked about 2000 steps per day – and I don’t own a car). Americans simply don’t get the amount of exercise that they need to be healthy. We are seeing the result of our sedentary lifestyle in our country’s increasing overweight and obesity rates.
All I can say is that I’m struggling along with the rest of us – doing what I can to increase my activity level and walk as much as possible. I’m lucky to live in an area where walking is fun and easy to do. I have the utmost sympathy for those who are striving to become more active against the odds. Why not join my weight loss group and we can commiserate? There are over 2600 people in there, encouraging one another to get fit! Don’t let your zipcode determine your destiny.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 30th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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I recently interviewed former Congresswoman Nancy Johnson about her views on health information technology (IT). She described her vision of an ideal IT solution, and what it should be able to do for physicians and patients. For the full interview, please check out my post at Medpolitics.com
Dr. Val: What would the ideal IT system look like?
Ms. Johnson: It would offer continuously updated evidence-based guidelines at the point of care for physicians. It would give patients clear information about what they should expect. It would enable physician social networks to promote learning and experience sharing with one another. It would promote continuous improvement of care practices, and track outcomes and results to continue refining healthcare delivery. Patients should be given check lists and preventive health guidelines, and be asked to provide feedback on any complications or unanticipated events.
If we could aggregrate deidentified patient information we would gain powerful insight into adverse drug events (or unanticipated positive effects) at the very earliest stages. It could be useful in identifying and monitoring epidemics or even terrorist incidents. This could advance medical science faster than ever before. Until we have all this information at our finger tips, we can’t imagine all the potential applications.
Dr. Val: Are you describing a centralized, national EMR?
Ms. Johnson: Not necessarily. But if systems are interoperable, it could function as one. I imagine it as a series of banks run by local administrators, but with the capability of sharing certain deidentified data with one another.
Dr. Val: Do you think the government should design this information system?
Ms. Johnson: No. You don’t want the government doing it alone. As much as I love the government and have been working in it for decades, it’s simply not good at updating and modernizing systems. You have to have a public-private partnership in this. The government should be involved to protect the public interest, and the private sector should be involved so that the system can be innovative, nimble, and easily updated.
Technology will bring us extraordinary new capabilities to manage our health, prevent illness, minimize the impact of disease on our lives, improve the ability of physicians to evaluate our state of health, allow us to integrate advances in medicine in a timely fashion, and quantify the impact of new inventions and procedures. All this, and IT will help us to promote prevention and control costs associated with acute care.
We have a high quality system now, but because it’s so disorganized, the patient doesn’t receive the quality they should. The incredible advances in technology that we have created should be available to all who need it. Unfortunately that’s not the case now.
If you look at Canada’s use of the specialist and specialist equipment along the US’s border with Canada, it says a lot about government run healthcare.
*See full interview at Medpolitics.com*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 28th, 2008 by Dr. Val Jones in Uncategorized
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Now this is an historic moment… I finally get to meet my hero medblogger Gene Ostrovsky, editor and webmaster of Medgadget.com at a blogger conference tomorrow in Washington, DC. Gene is driving in from NYC and we’ll plan to have dinner with hubby and any other folks we can lure from the all-star conference:
Welcome and Introduction Drew Altman, President and Chief Executive Officer, Kaiser Family Foundation
Keynote Address The Honorable Michael O. Leavitt Secretary, U.S. Department of Health and Human Services
Panel Discussion Vicky Rideout (moderator) Vice President, Kaiser Family Foundation and Director, Kaiser Forum on Health Journalism and the News Business
Jacob Goldstein, Wall Street Journal
Michael Cannon, Cato Institute
Ezra Klein, American Prospect Magazine
John McDonough, Office of Senator Edward Kennedy and formerly of Health Care for All in Massachusetts
Tom Rosenstiel, Center for Excellence in Journalism
I’ve spent the last year and a half producing a weekly newsletter featuring the best of Medgadget’s posts – this one about the asthma inhaler “spacer piggie” is just one example of the innovative gadgets that Gene has enthusiastically gathered into one place for geeks like me. So it will be fun to meet the man behind the piggies… See you tomorrow, Gene.
Anyone else care to join us?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
