Wednesday, July 13, 2016

Cage Fight At The VA

There is a cage fight going on at the Veterans Affairs hospital near you. It involves the VA's recent proposal to allow advanced practice nurses (APRN's) to practice to the "full extent of their education, training, and certification without the clinical supervision of physicians, regardless of individual state regulations." The ASA is having none of this.

This is the number one battle right now for the ASA. It's importance to the society and specialty is bigger than Obamacare, bigger than MACRA. Though NP's could potentially supplant physicians in other specialties like internal medicine, anesthesiology is uniquely susceptible to being replaced by nurses in clinical practice.

Medscape has lined up the president of the ASA, Daniel J. Cole, M.D. and the president of the AANA, Juan Quintana, DNP, MHS, CRNA, to go mano a mano to breakdown this controversy. Reading the interviews tells me that the two sides will never come to terms with each other. It's war. It's a fight to the death. Both sides are talking past each other, reciting their respective journal statistics without acknowledging the merits of the other. This will not end until one combatant is down on the mat, bleeding profusely out of every orifice, barely conscious. Then victory will be declared until the next president of the U.S. is elected, fresh lobbyists are hired, and new members of Congress are bribed. Then the fight will be renewed once again.

While the entire article is worth reading, I could barely get past the terrible picture of Dr. Cole in the article. Here's a screenshot.

Why is the man purple? He looks like he got some terrible spray tan going on where they loaded the nozzles with blueberry juice instead of tanning pigment. Or maybe he just came back from a blueberry pie eating contest where the contestants aren't allowed to use their hands. Regardless this horrible picture is very distracting and unfortunately lowers the quality of Dr. Cole's arguments. Looks count.

By comparison, Mr. Quintana's skin tone is more appropriate in his picture.

Not to sound too paranoid, but I think there is some conspiracy going on in the graphic design studio at Medscape to make the anesthesiologists' side less credible. Step it up Medscape. There is no place in your supposedly nonpartisan news coverage for this kind of blatant favoritism.

Tuesday, July 12, 2016

The Hypocrisy Of Natural Childbirth

I love this editorial in the New York Times. Titled "Get the Epidural," the author Jessi Klein explores why some women think it is better and more natural for deliveries to be performed without the comfort of an epidural anesthetic.

Says Ms. Klein, "But how often do people really want women to be or do anything 'natural'? It seems to me the answer is almost never. In fact, almost everything natural about women is considered pretty horrific. Hairy legs and armpits? Please shave, you furry beast. Do you have hips and cellulite? Please go hide in the very back of your shoe closet and turn the lights off and stay there until someone tells you to come out. (No one will tell you to come out.) It's interesting that no one cares very much about women doing anything 'naturally' until it involves their being in excruciating pain. No one ever asks a man if he's having a 'natural root canal.' No one ever asks if a man is having a 'natural vasectomy.'"

There it is. Not only do women have to undergo unnecessary pain during labor for the questionable benefits of "natural" delivery, it is also a highly sexist attitude to condescend women who do choose to have an epidural. So get the epidural. You and your newborn baby will enjoy their birth day more.

Monday, July 11, 2016

Pokemon Go For Doctors

The worldwide craze of the new game app Pokemon Go has people wandering all over the streets looking for Pokemon characters. Some are getting into trouble by running into signs or even getting robbed. Wouldn't it be wonderful if we could harness that kind of intensity from medical students so they devote their energy into improving their medical skills? How about planting Pokemon characters into different body surfaces and orifices to motivate students to examine their patients more thoroughly? Here are a few suggestions.

Yes sir. With a treasure hunt like this for students to explore, they will all become expert clinicians in no time.

Monday, June 6, 2016

Finding The Anesthesiologist In The Bathroom

This is another sad story about how addiction ruins careers, reputations, and lives. Carlisle, PA anesthesiologist Gregory Theodore was found to have overdosed on Demerol while working at Carlisle Regional Medical Center.

His surgeon was trying to find him when wasn't answering his page. He went to the bathroom and could hear the beeper going off behind a stall door. When he managed to get the door open, he found the anesthesiologist unconscious on the seat with a syringe in his lap. When awakened, Dr. Theodore claimed he didn't feel well and had given himself some Zofran. However when he was sent down to the ER, he told the emergency physician that he had been taking Demerol for several years.

He is being charged by the Attorney General with administration of a controlled substance, acquiring a controlled substance, refusal to keep records of controlled substance, theft by unlawful taking, and possession of drugs with intent to manufacture or deliver. Dr. Theodore, your life is now totally f****d up. I hope you get the treatments you need, and a very good lawyer, to turn your life around. His formal arraignment is scheduled for July 21st.

As thousands of medical students graduate shortly and start their residencies, remember that no amount of stress is worth starting an addiction for. It may make you feel better for a very short period of time, but eventually it will completely devastate your life.

Sunday, June 5, 2016

The Purple Patch

When King of Pop Michael Jackson died from propofol abuse, the drug became forever known colloquially as the "Michael Jackson drug". Now the devastating news that Prince has died from an overdose of fentanyl may bring notoriety to that pharmaceutical. Will fentanyl forever be linked to the singer's death? Can we expect to hear people call a fentanyl patch the Purple Patch?

Or maybe a fentanyl lozange a Purple Pop?

It's probably making the marketing department of these drugs start singing "Let's Go Crazy."

Wednesday, June 1, 2016

The Stress Of Running Late

"Oh dear! Oh dear! I shall be too late!"
From Alice In Wonderland

The stress of driving through LA rush hour when you're running late. There is nothing you can do except crank up the radio to your favorite chill music and accept your fate.

Tuesday, May 24, 2016

California Wants Its Money Back From Radiologists

Imagine when you were a teenager and you mowed your lawn to earn your allowance every week. Then suddenly your parents announce that they think they've been paying you too much and will withhold a portion of your money until the overpayments have been returned. How would you feel? Would you continue to mow the lawn or go on strike? What if you can't go on strike and have to keep mowing that lawn with the reduced payments?

That is exactly the predicament facing California radiologists now. Back in 2010, California was facing an historic state budget deficit, mainly due to its own fiscal incompetence. To help balance the budget, the legislature enacted cuts to Medi-Cal payments to doctors, the state's Medicaid program. The law said that no radiology services could exceed 80% of Medicare's already measly reimbursements.

Unfortunately the Department of Health Care Services did not get around to implementing the new rule until July 20, 2015. Now the DHCS wants to claw back money from radiologists to right this oversight. It wants the radiologists to return the excess money they've been receiving since October 2012.

Normally when the government says they've overpaid you, they want the whole amount returned in one big lump payment. But since they feel for the little guy and understand that would probably bankrupt most of the radiologists in the state, the DHCS has decided that they would reimburse the doctors 20% less than what they should be receiving until the money has been returned whole to the state.

The irony is that now the state is swimming in a budget surplus. Every special interest group is hungrily eyeing that extra money for themselves. Yet they are taking back money from doctors for services fairly rendered years ago. And the radiologists have no say in this travesty. Goes to show that when you sleep with snakes, you're gonna get bit.