Push you know I’m in agreement with you and Doc on this issue but I do sorta think you need to ease up on James here. I came down hard on him earlier too but he definitely clarified his statement and apologized and is amenable to trying to be a bit clearer. He’s wrong, but let’s just focus on the argument as a whole, yeah?
[quote]csulli wrote:
[quote]DrSkeptix wrote:
Had the hospital administration followed my legal order, instead of working to block it, it would have saved $50-100K.
[/quote]
I guess working for a small business, I have no concept of the bureaucracy that must be involved here. I just wonder who you could have talked to and said “Listen, if you just do what I say this will save you like 100 grand.” And they would have probably said “Na.” Do you ever feel like you’re living in crazy town where people stop using common sense?[/quote]
Because I am utterly unimportant to the whole process in a hospital, my opinion has no weight.
Here is a clue: my “not-for-profit” hospital system was found, just a few years ago, to be making more money from their investments than from all its a health-care activities. In other words, medical care is a “loss-leader,” and it is charity and tax-free earnings which were the real business of the hospital.
I do not know if the same conditions apply this year. But real attention is paid to those doctors who raise money for the hospital, not those who provide care within it.
But you are correct in your estimate of the bureaucracy. There are hoards of workers who are paid, quite simply, to get in my way. Oh, they call it “quality control,” or “compliance enforcement” or the b.s. known as “pay for performance” --Orwellian terms for the obstruction to humane care.
Get ready for more such nonsense, elevated to governmental enforcement in 2014 with the 20,000 pages of regulations which will follow the ACA.
Update 3
The patient improved unimpeded by the hospital’s attempts to interfere: no bleeding , he is healing, and soon he will be weaned off the ventilator and the tracheostomy will close. Dialysis may continue a while longer. I have worked with the BigPharma Company to get his medicine for him in a rehabilitation hospital soon (so that another series of denials–and death–will not follow).
I discussed with the hospital administrator the problems inherent in this case, and the liability which faces the hospital: denial of care, elder abuse, violation of MediCare rules. He did not care to argue except to say, “There is a policy. The policy is in place. We need to have policies.” Even if they are construed to cause unnecessary death? Even if lawsuits are filed? “You are overly dramatic.”
Always, in hospital administration, it is the messenger, and not the message which is at fault.
On the other hand, I should claim the powers of prophecy. Recall that I present ed my little scenario as the model by which ObamaCare will constrain costs, limit care, and do so, silently and without appeal:
Note the essence of the “Death Panel”–IPAB:
–appointed, with no oversight
–its laws are just and righteous, altogether; above approach and above appeal
–its policy will be in place, and we need policies. Lots of them. By real “experts.” Policies without appeal.
Even if some may die needlessly in the process.
[quote]DrSkeptix wrote:
Update 3
The patient improved unimpeded by the hospital’s attempts to interfere: no bleeding , he is healing, and soon he will be weaned off the ventilator and the tracheostomy will close. Dialysis may continue a while longer. I have worked with the BigPharma Company to get his medicine for him in a rehabilitation hospital soon (so that another series of denials–and death–will not follow).
I discussed with the hospital administrator the problems inherent in this case, and the liability which faces the hospital: denial of care, elder abuse, violation of MediCare rules. He did not care to argue except to say, “There is a policy. The policy is in place. We need to have policies.” Even if they are construed to cause unnecessary death? Even if lawsuits are filed? “You are overly dramatic.”
Always, in hospital administration, it is the messenger, and not the message which is at fault.
On the other hand, I should claim the powers of prophecy. Recall that I present ed my little scenario as the model by which ObamaCare will constrain costs, limit care, and do so, silently and without appeal:
Note the essence of the “Death Panel”–IPAB:
–appointed, with no oversight
–its laws are just and righteous, altogether; above approach and above appeal
–its policy will be in place, and we need policies. Lots of them. By real “experts.” Policies without appeal.
Even if some may die needlessly in the process.
[/quote]
Doc, I’ve always been impressed by you but I really gotta say I admire the things you do for your patients (this and others included) which you are standing on principle for rather than “job description”. That makes you a man of great character.
In other news–every single person for the last 20+ years who said this was going to happen is simultaneously smashing their head against a wall and shouting “I TOLD YOU SO!”
I do not recall ever being this disturbed about any administration’s actions, D or R. Or about the direction my country is headed in.
[quote]Aragorn wrote:
In other news–every single person for the last 20+ years who said this was going to happen is simultaneously smashing their head against a wall and shouting “I TOLD YOU SO!”
[/quote]
If they are like me, no, they are not.
We are poolside, with a beer, enjoying the decline.
Come, join us.
[quote]orion wrote:
[quote]Aragorn wrote:
In other news–every single person for the last 20+ years who said this was going to happen is simultaneously smashing their head against a wall and shouting “I TOLD YOU SO!”
[/quote]
If they are like me, no, they are not.
We are poolside, with a beer, enjoying the decline.
Come, join us. [/quote]
Barbequeing poolside to the end of the world sounds like a great idea. Unfortunately the barbeque only lasts as long as you don’t need the system to work (e.g. as long as you remain healthy). Some day I might need things to get done for me or loved ones and I’d really not want to fight even MORE bureaucratic BS than we already have to right now. So, I suppose I fight on.
But you could toss me one of those stout Austrian brews so I can enjoy one at work!
[quote]Aragorn wrote:
[quote]orion wrote:
[quote]Aragorn wrote:
In other news–every single person for the last 20+ years who said this was going to happen is simultaneously smashing their head against a wall and shouting “I TOLD YOU SO!”
[/quote]
If they are like me, no, they are not.
We are poolside, with a beer, enjoying the decline.
Come, join us. [/quote]
Barbequeing poolside to the end of the world sounds like a great idea. Unfortunately the barbeque only lasts as long as you don’t need the system to work (e.g. as long as you remain healthy). Some day I might need things to get done for me or loved ones and I’d really not want to fight even MORE bureaucratic BS than we already have to right now. So, I suppose I fight on.
But you could toss me one of those stout Austrian brews so I can enjoy one at work![/quote]
I am grateful for the anterior accolade, but frankly, I am not someone of great character. As for principles, I quote Marx (Groucho, not Karl): “These are my principles, and if you don’t like them, well…I have others.”
Whether head-smashing or poolside, “we” have run out of principles. They have been ground to dust. When I related this whole story to one of my (younger) colleagues, his response was, “I would never have bothered [to expend the energy and time.] The patient would have died and no one would have known that something could have been done about it.”
This display of medical insouciance should strike any reader with dread. We all will need the compassion or the wisdom of others, and it cannot be left entirely to chance. A society which values “bureaucratic BS” above the meticulous and personal care, will certainly be doomed by the former and not receive the benefits of the latter.
The pessimist in me will decline the Austrians’ poolside beer, and once again quote Thomas Gray:
[i]Still, where rosy Pleasure leads,
See a kindred Grief pursue;
Behind the steps that Misery treads
Approaching Comfort view:
The hues of bliss more brightly glow
Chastised by sabler tints of woe,
And blended form, with artful strife,
The strength and harmony of life.
See the wretch that long has tossed
On the thorny bed of pain,
At length repair his vigour lost
And breathe and walk again:
The meanest floweret of the vale,
The simplest note that swells the gale,
The common sun, the air, the skies,
To him are opening Paradise.[/i]
[quote]DrSkeptix wrote:
I discussed with the hospital administrator the problems inherent in this case, and the liability which faces the hospital: violation of MediCare rules.
[/quote]
Can you clarify this?
[quote]kpsnap wrote:
[quote]DrSkeptix wrote:
I discussed with the hospital administrator the problems inherent in this case, and the liability which faces the hospital: violation of MediCare rules.
[/quote]
Can you clarify this? [/quote]
Not really. Here is a snippet of bureaucratese:
"If a Medicare health plan denies service or payment, in whole or in part, the plan is required to provide the enrollee with a written notice of its determination. Additionally, Medicare health plan enrollees receiving covered services from an inpatient hospital, skilled nursing facility, home health agency, or comprehensive outpatient rehabilitation facility have the right to a fast, or expedited, review if they think their Medicare-covered services are ending too soon. Plans and providers have certain responsibilities related to notifying beneficiaries of Medicare appeal rights. "
…and if you lose a leg, we will help you find it.
The dead do not appeal in timely fashion; the grave offers no “expedited review.”
[quote]DrSkeptix wrote:
[quote]Aragorn wrote:
[quote]orion wrote:
[quote]Aragorn wrote:
In other news–every single person for the last 20+ years who said this was going to happen is simultaneously smashing their head against a wall and shouting “I TOLD YOU SO!”
[/quote]
If they are like me, no, they are not.
We are poolside, with a beer, enjoying the decline.
Come, join us. [/quote]
Barbequeing poolside to the end of the world sounds like a great idea. Unfortunately the barbeque only lasts as long as you don’t need the system to work (e.g. as long as you remain healthy). Some day I might need things to get done for me or loved ones and I’d really not want to fight even MORE bureaucratic BS than we already have to right now. So, I suppose I fight on.
But you could toss me one of those stout Austrian brews so I can enjoy one at work![/quote]
I am grateful for the anterior accolade, but frankly, I am not someone of great character. As for principles, I quote Marx (Groucho, not Karl): “These are my principles, and if you don’t like them, well…I have others.”
Whether head-smashing or poolside, “we” have run out of principles. They have been ground to dust. When I related this whole story to one of my (younger) colleagues, his response was, “I would never have bothered [to expend the energy and time.] The patient would have died and no one would have known that something could have been done about it.”
This display of medical insouciance should strike any reader with dread. We all will need the compassion or the wisdom of others, and it cannot be left entirely to chance. A society which values “bureaucratic BS” above the meticulous and personal care, will certainly be doomed by the former and not receive the benefits of the latter.
The pessimist in me will decline the Austrians’ poolside beer, and once again quote Thomas Gray:
[i]Still, where rosy Pleasure leads,
See a kindred Grief pursue;
Behind the steps that Misery treads
Approaching Comfort view:
The hues of bliss more brightly glow
Chastised by sabler tints of woe,
And blended form, with artful strife,
The strength and harmony of life.
See the wretch that long has tossed
On the thorny bed of pain,
At length repair his vigour lost
And breathe and walk again:
The meanest floweret of the vale,
The simplest note that swells the gale,
The common sun, the air, the skies,
To him are opening Paradise.[/i][/quote]
I have not run out of principles.
I just refuse to be made a fool by sticking to them while nobody else does.
My reaction is to avoid the areas where the rot has spread deep.
Which is why I have a lot of time to be poolside.
[quote]orion wrote:
[quote]DrSkeptix wrote:
[quote]Aragorn wrote:
[quote]orion wrote:
[quote]Aragorn wrote:
In other news–every single person for the last 20+ years who said this was going to happen is simultaneously smashing their head against a wall and shouting “I TOLD YOU SO!”
[/quote]
If they are like me, no, they are not.
We are poolside, with a beer, enjoying the decline.
Come, join us. [/quote]
Barbequeing poolside to the end of the world sounds like a great idea. Unfortunately the barbeque only lasts as long as you don’t need the system to work (e.g. as long as you remain healthy). Some day I might need things to get done for me or loved ones and I’d really not want to fight even MORE bureaucratic BS than we already have to right now. So, I suppose I fight on.
But you could toss me one of those stout Austrian brews so I can enjoy one at work![/quote]
I am grateful for the anterior accolade, but frankly, I am not someone of great character. As for principles, I quote Marx (Groucho, not Karl): “These are my principles, and if you don’t like them, well…I have others.”
Whether head-smashing or poolside, “we” have run out of principles. They have been ground to dust. When I related this whole story to one of my (younger) colleagues, his response was, “I would never have bothered [to expend the energy and time.] The patient would have died and no one would have known that something could have been done about it.”
This display of medical insouciance should strike any reader with dread. We all will need the compassion or the wisdom of others, and it cannot be left entirely to chance. A society which values “bureaucratic BS” above the meticulous and personal care, will certainly be doomed by the former and not receive the benefits of the latter.
The pessimist in me will decline the Austrians’ poolside beer, and once again quote Thomas Gray:
[i]Still, where rosy Pleasure leads,
See a kindred Grief pursue;
Behind the steps that Misery treads
Approaching Comfort view:
The hues of bliss more brightly glow
Chastised by sabler tints of woe,
And blended form, with artful strife,
The strength and harmony of life.
See the wretch that long has tossed
On the thorny bed of pain,
At length repair his vigour lost
And breathe and walk again:
The meanest floweret of the vale,
The simplest note that swells the gale,
The common sun, the air, the skies,
To him are opening Paradise.[/i][/quote]
I have not run out of principles.
I just refuse to be made a fool by sticking to them while nobody else does.
My reaction is to avoid the areas where the rot has spread deep.
Which is why I have a lot of time to be poolside.
[/quote]
I am not a fool. I do not choose to have the option of abandoning principles. That is called responsibility.
Some men will never know it…they are the happy fools at poolside, perhaps.
Who values privileges above principles will lose both.
[quote]Chushin wrote:
Hey Doc,
Just curious: If you had failed in getting your patient what he needed because of all that BS, and he’d died, would you have pursued it even further? If so, how?
I find some of the characters in your stories both appalling and frightening. [/quote]
Good question…
First, there is the legal issue. I do not have “standing” in case of his death. In the case of a malpractice suit against the doctors and hospitals, I would surely be named, and perhaps dropped as a percipient witness for the plaintiffs.
Next, barring legal action, the hospital has “mechanisms”–“policies”–to adjudicate “risk.” Were I to complain, I would be formally labelled as “over dramatic,” “disruptive,” and “inappropriate.” (And in fact, I have been so called in recent hidden e-mails.) These terms are used to define a doctor who is right, but in contravention of The Barrier. Also, it establishes “a pattern of abuse,” so that the hospital system now has documented the bad behavior of the doctor and can use it against him at extrajudicial hearings.
Some extrajudicial hearings are legally privileged, and mistakes and risk management is supposed to learn from this. What they learn, often, is to protect themselves from inspecton or criticism.
It has been suggested to me that I become a whistle-blower. This is thankless, time-consuming, and ultimately a terrible strain on the (surviving) family. Is that what I really want for those innocent individuals?
I guess the most I could do is to appear at some legally privileged meeting–the Pharmacy Policy meeting–and bring individuals to shame. I know I have left my mark when the implicated party is left in tears–trust me, I am “over-dramatic”–but nothing ever changes “policy.”
Blood is thicker than water, but money is thicker than blood.
[quote]DrSkeptix wrote:
I am not a fool. I do not choose to have the option of abandoning principles. That is called responsibility.
Some men will never know it…they are the happy fools at poolside, perhaps.
Who values privileges above principles will lose both.
[/quote]
Na, you misunderstood me.
I did not abandon them.
But in some areas you would have to, or be taken to the cleaners.
Those areas I tend to avoid.
It seems that the IPAB–which will cause all sorts of lethal mischief–won’t even save any money…and Howard Dean agrees:
Update 4
The patient left the hospital last week: he had healed the tracheostomy, was able to stand and walk–but not well, because a rheumatoid confined to bed for weeks is either stiff or collapsing. He is transferred to a charnel called “Long Term Acute Care Hospital” where he can be weaned from dialysis, a requirement that may persist for 4 more months.
But he his not out of my life. Still able to joke, and flub the punchline–in seven languages, three of which I can understand–he is now cleared of the tests which were the measures of his misery. I will be able to treat him–via ambulance, to my hospital, and back, all for the sake of a 35 minute infusion.
If this sounds crazy, welcome to the reality of my world. Whether directed by the IPAB, or by a “Death Panel” we are told does not exist and cannot exist, or hospital “policies” designed to confuse the family and defeat the practitioner–this is the future he faces, I face, we all face. Kafka did not write fiction.
There are fools who write in this forum of a “healthcare system” and somehow are able to prescribe a solution perfect to every human situation. A fool may read all this and conclude, “He should have died…‘they’ should have put him down at the first event…a waste of money.”
What value the man, measured by his DRG?
“Full many a gem of purest ray serene,
The dark unfathomed caves of ocean bear:
Full many a flower is born to blush unseen,
And waste its sweetness on the desert air.”