Healthcare Update Satellite – 07-13-2015
Boy bitten by a mouse, mother brings boy and mouse to emergency department, wants rabies testing done. Nurse brings the mouse outside and lets it go. Mom fumes because no one recommended that her son go through rabies shots and that because the animal was released, now she’ll never know if the animal had rabies. She decides to put her son through rabies shots which are paid for by Medicaid. If the shots end up not being covered, she’ll ask the hospital to pay for them. Only problem is that according to the CDC, small rodents “have not been known to transmit rabies to humans”, so the child is going ...
Source: WhiteCoat's Call Room - July 13, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
14 Ways To Know Whether You Are Failing As A Hospital Administrator
I’ve been an administrator.
I’ve seen hospitals in which a strong leadership team has improved the hospital’s market share and I’ve seen hospitals that have closed and that are struggling to stay open due to a failed administrative team. Here are some common traits I’ve seen in the failures:
1. You don’t know the names of the people who work in your corporation. You aren’t fooling anyone when you walk the halls without addressing people by their names. All this shows is that you don’t care to take the time to know them. If you don’t take the time to get to know them...
Source: WhiteCoat's Call Room - July 5, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Policy Random Thoughts Source Type: blogs
Healthcare Update Satellite – 06-08-2015
To increase access to medical for our nation’s veterans, the Veteran’s Choice Act authorized the VA to pay for more medical provided to veterans from community health providers. How did the VA save money in that scenario? It either “lost” claims in which providers had proof of submission or it just delayed paying the claims so that veterans would be billed for the treatment. Now providers are refusing to contract with the VA due to all of the hassles. The VA said that it was making interest payments to providers who received delayed payments, but none of the people testifying to a Senate subcommitte...
Source: WhiteCoat's Call Room - June 8, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Survey
Quick request …
If you haven’t taken this short survey, it would be much appreciated. Looking to publish the results in a future journal article. Many thanks for your help.
http://www.esurveyspro.com/Survey.aspx?id=8ee4bd68-04a7-4b43-b07b-652af4088ddd (Source: WhiteCoat's Call Room)
Source: WhiteCoat's Call Room - June 3, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Uncategorized Source Type: blogs
Rodent Control
A crotchety old fellow from the nursing home gets brought in for trouble breathing. After looking at the swelling in his legs and listening to the crackles in his lungs, it’s pretty obvious that he’s in congestive heart failure.
We started an IV, drew labs, and performed a chest x-ray. Then he got some nitroglycerin, some captopril, and he even got Lasix just to spite all of the #FOAMed wonks.
About 45 minutes later, the patient needs to go to the bathroom. We didn’t want him walking since he didn’t appear to be the steadiest on his feet, so he got a urinal. He grabbed the urinal and the nurse walked out of the roo...
Source: WhiteCoat's Call Room - May 26, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Memories …
A sweet little lady was brought to the emergency department by her caregiver after having difficulty breathing at home. She got a few breathing treatments and some steroids and was doing much better an hour or so later.
When I went back in the room to evaluate her, several family members were present.
“Oooh. You got the good doctor. No wonder you’re doing better.”
I thanked them because … obviously they were right … but I mentioned that I didn’t recall seeing their mother in the emergency department before.
“She hasn’t been here in a long time. You took care of our father.”
“Oh. I see. How is he doing?...
Source: WhiteCoat's Call Room - May 20, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Healthcare Update Satellite — 05-14-2015
Morally corrupt and illegal at any other hospital, but the VA system will sweep it under the rug and absolutely nothing will happen about it. Patient in car just a few feet outside the emergency department calls emergency department for help getting out of car so that he could come in for treatment of his broken foot. Seattle VA Hospital tells him ”No, we’re not going to come get you. You’re going to have to call 911 and you’ll have to pay for that.” A fire captain and three firefighters end up coming to help him out of his care and wheel him into the emergency department.
Meanwhile, the VA...
Source: WhiteCoat's Call Room - May 15, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Healthcare Update Satellite — 04-26-2015
This article questions whether Obamacare is to blame.
Good way to save money. Veterans Affairs just keeps denying claims until the veterans die. Then they mark the files as “no action necessary” so that the surviving family members don’t get benefits, either. Records falsified, employee whistleblowers being retaliated against, management lying to Congress, oh, and a supervisor who required staff members to pay $30 for fortune telling by the supervisor’s wife. If you think things are expensive now, wait to see how much they cost when they’re free.
Another example of the Golden Rule. EnglandR...
Source: WhiteCoat's Call Room - April 27, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Healthcare Update Satellite – 04-15-2015
You’ve heard of a CAT scan? Get ready for the dog sniff. Dogs can identify bladder and prostate cancer with a 98% accuracy rate when smelling male urine samples.
Not into the whole dog sniffing thing as a screen for prostate cancer? A $1 screening test using gold nanoparticles 10,000 times smaller than a freckle is more accurate than PSA screenings and gives results in minutes. When blood is mixed with the nanoparticles, tumor biomarkers cling to the surface and cause clumping. I’m guessing the test will cost consumers several hundred dollars.
Doctors are using scorpion venom to create “tumor paint”...
Source: WhiteCoat's Call Room - April 16, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Semantics and the $28 Million Unnecessary Test
There’s been an awful lot of Internet hullabaloo about “unnecessary testing” lately. The Choosing Wisely program keeps trying to assert that we should not perform any “unnecessary” tests. Recently, a paper was published in the Journal Academic Emergency Medicine alleging that “overordering of advanced imaging may be a systemic problem” since many emergency physicians believe that such testing is “medically unnecessary.” The paper was based on surveys that were presented to emergency physicians and the work was at least partially funded by the Veterans Administration and the National Institutes of Health...
Source: WhiteCoat's Call Room - April 10, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Policy Source Type: blogs
Healthcare Update Satellite — 03-04-2015
Homeless North Carolina VA patient comes into the ED to be evaluated for the sores on his feet. His shoes are falling apart. Nurse Chuck Maulden bandages up the patient’s feet and then gives the patient the brand new Nike sneakers off of his own feet. Chuck then works the rest of his shift in a pair of shoe covers and doesn’t say anything about it. Only way that people found out was because the patient’s family called to say thank you. We need more people like Chuck.
I’m not aware of too many uses for virtual reality in medicine, but this seems to be a good one: seeing what it’s like to suffer...
Source: WhiteCoat's Call Room - March 4, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Healthcare Update Satellite — 02-10-2015
This article calls testosterone the “drug of the future” and compares its use to estrogen – which isn’t a controlled substance. One person interviewed for the article noted that “almost everything we treat in medicine is age-related. Aging is related to bad eyesight, bad hearing, bad joints, bad hearts, bad blood vessels, and cancer. We treat all of these without trying to minimize or diminish them that they are age related.” Why pick on testosterone use?
Damn. Boyfriend secretly records himself having sex with his 17 year old girlfriend. Video “somehow” gets uploaded to inte...
Source: WhiteCoat's Call Room - February 10, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Healthcare Update Satellite — 02-03-2015
Thanks for the patience in putting up with my lack of regular posting. Life has been challenging lately. Still working on it.
When government pays for your care, government may try to force its values on you. Learning-disabled mother of six children in England deemed at “grave” risk if she has any more children. Now the government wants to forcibly remove her from her home and sterilize her. A lawyer representing the woman stated that sterilization was “therapeutic.”
This process will come to medicine sooner than you think. Just watch. Uber drivers now get to rate their passengers after a ride. When...
Source: WhiteCoat's Call Room - February 4, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Healthcare Update Satellite — 01-19-2015
Penicillin allergy? It’s associated with increased bad outcomes, but not for the reasons you think. The allergies themselves are mostly not allergies. And no, “my mother said I had a rash when I was a baby” isn’t an allergy. However, when compared with patients who don’t have penicillin “allergies”, patients with penicillin allergies have longer hospital stays and are between 14% and 30% more likely to get resistant infections while in the hospitals – possibly because the penicillin “allergic” patients are being treated with much stronger antibiotics that kill of...
Source: WhiteCoat's Call Room - January 19, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
How Can You Be Sure?
“How can you be sure?”
That question stopped our discussion for a second.
During some down time, several nurses and I were talking about childhood coughs. Her 6 month old child had just started daycare 2 weeks ago and has been coughing ever since. The child was put on amoxicillin and then Zithromax by her pediatrician but … [GASP] … her cough wasn’t getting any better. The nurse thought her child had pneumonia.
“What should she be taking now?”
I was in a particularly snarky mood, so, with a smirk, I said “probably vancomycin … maybe add gentamycin just for the gram nega...
Source: WhiteCoat's Call Room - January 13, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs
