License Plate Of The Day
*This blog post was originally published at GruntDoc*
Latest Posts
Can Patients Commit Medicaid Fraud?
We hear so much about health care fraud and how much it costs us all in terms of higher Medicaid, Medicare and private insurance costs, and if we could just rein in this fraud we could make our health care system pay for itself.
My trusty Mac widget dictionary defines fraud as:
- a person or thing intended to deceive others, typically by unjustifiably claiming or being credited with accomplishments or qualities and
- wrongful or criminal deception intended to result in financial or personal gain.
Well, I’m wondering, what is actually considered fraud?
Let me give some examples, and help me understand whether or not this is fraudulent behavior. The examples are purely hypothetical and do not represent any known individuals, living or dead, or specific situations in any known emergency department, living or dead. Read more »
*This blog post was originally published at Emergiblog*
Does Medical Education’s High Price Tag Drive Some Healthcare Costs?
My column in Sunday’s Greenville News.
‘Medical education shouldn’t cost an arm and a leg.’
I was talking to a young man who is starting medical school this fall. His tuition at one of South Carolina’s newer schools will be $40,000 per year. That’s admittedly on the high end. On the low end, it runs a paltry $33,000 per year. And this is all after college, of course. He and others like him are taking out loans to the tune of $240,000 to pay for their medical educations. Another young woman I recently met is in residency and her loan payments are around $2000 per month.
Thinking back on my own medical education, it seems my tuition was around $5000 per year. But then, what with all the Saber Toothed Tigers, Neanderthals and stone surgical tools, things were simpler.. These days, I don’t know how students will do it.
The thing is, American healthcare is expensive. But so is medical education. As we embark on this century, what are the odds that physicians with $240,000 loans for medical school will be able to offer inexpensive care? What are the odds they will enter low-paying specialties? They might be interested in charity care at first, but when the first loan payments come due all the good intentions in the world won’t change the fact that lenders want their money back. Likewise, it won’t change the hard reality that it will be extremely hard for these young physicians to pay for their student loans, buy a house, have a practice (pay malpractice) and raise a family; at least without making a large amount of money in their practices. And then there’s this striking (but seldom mentioned) fact: student loans are non-bankruptable. Student loans are friends for life, or until payed off. Whichever comes first. Read more »
*This blog post was originally published at edwinleap.com*
The Devastating Emotional Impact Of Missed Diagnoses
Bongi is an amazing writer, and if you haven’t, I strongly urge you to read his latest post, titled “The Graveyard.”
I imagine that a huge number of doctors know exactly what he means. I remember being told by a surgeon, while I was in medical school, that “you’re not a real doctor until you’ve killed someone.” I thought at the time (and still think) that there was a puerile bravado behind that admonition, but there is also a grain of truth. I have my own graveyard. Curiously, not all of its inhabitants are dead. They are the cases where I screwed up, or, charitably, cases that went bad where I feel that maybe I could’ve/should’ve done things differently.
The missed SAH
The missed DVT/PE
The missed AAA
The missed Aortic dissection
The missed MI
I remember them all, clearly and in detail. Read more »
*This blog post was originally published at Movin' Meat*
How To Gross Out A Medical Student
We have (mostly) non-EM studs rotate through our ED on their sometimes mandatory, sometimes killing a month elective ED tour. There is little reason for EM destined students to rotate in our place, as we don’t have a residency and we’re not part of the club of EM residency directors ( i.e. letter of rec writers). So, usually not EM hard chargers. Nothing wrong with that, but they’re not my cuppa tea.
Today’s lesson: shoulder reduction for the non-EM Stud, and for me in What We Do Isn’t Usual.
As is our norm, after a thorough Hx, PE, Xrays and Time Out, was in on a 2 doc reduction; One does the sedation, one the reduction. I don’t typically have students follow me: I don’t dislike the students, but I don’t have them. Personal preference.
Today, a shoulder reduction. My colleagues’ student. Not destined for a life in the ED (already matched, not in a remotely EM specialty). My colleague is on the sedation, and I’m on the reduction. I, after discussing the technique, in my presence and under my direction, allowed the stud the first attempt at reduction after sedation. No go. Good effort, not enough muscle. Read more »
*This blog post was originally published at GruntDoc*
