Who Am I?

Apparently there is a regulation that healthcare workers wear an ID tag.  It is not clear whether this is to ensure the safety of the public, remind absent-minded workers who they are, or protect the innocent.

For 23 years, I have performed eye surgery at a number of hospitals and locations.  I have NEVER worn an ID badge at any point while operating.

For one thing, we wear sterile hospital gowns over our scrubs, which would cover any name badge.

For another thing, I do not operate on patients I don’t know or have never met.  I certainly wouldn’t want someone I have never met to operate on me.  All my patients have seen me at least once in my office before any surgery is scheduled.  They KNOW me.  Badge or no badge.

The staff I work with knows me.  I have operated there since 2003.  Sure, there are new people hired now and then.  They get to know me.  No badge required for that little exchange of information.  Some may regret meeting me, but that’s another story altogether.

So while this well-meaning regulation may have some use in certain situations–I fully understand that a patient or family member in a hospital setting might be interested to know who is coming into their room and for what reason–is this person a nurse, a nurse practitioner, a physician’s assistant, a respiratory therapist, or a janitor, or is it someone who just stayed at a Holiday Inn Express last night?  I still think simply asking if you are curious would be sufficient, but no one asked me.

But there is no legitimate reason on God’s good earth, why I should wear an ID badge while operating at an institution that knows me, with people who know me, on patients who know me.  And for crying out loud, they have cataracts!  They couldn’t read the name tag anyway!

But today, the Board of Health (Bom, bom bommm!) came to our tagless institution for the supposed purpose of evaluating and certifying the place.  Basically this means they want to make sure that we are following their rules, even if those rules interfere with basic patient care.  None of this regulatory crap has anything to do with “patient care” anymore than Obamacare has anything to do with patient care (whereas it has everything to do with the government controlling your healthcare for better or worse, but again, that is a story for another day.)

But as I prepared to give patients the gift of sight today, I was accosted by a supervisor at our surgery center who insisted that I wear an ID tag–because the Board of Health (Bom, bom bommm!) is coming.

“Did we check the lights in the old north church?”

One if by land, and two if by sea.

The Board of Health is coming!  The Board of Health is coming!  (Bom, bom bommm!)

Seriously?  Are you freaking kidding me?

And this serves what purpose in the treatment of my patients today????

The healthcare system in this country is sinking, and apparently the Board of Health is rearranging deck chairs on the Titanic.

I was not the only doctor wearing these make shift labels today–we all were.  Misery stupidity loves company.  None of us routinely wear ID badges. WE DON’T NEED THEM.  Doesn’t improve patient care.  And what’s to keep some criminal on the street from stealing a pair of scrubs and using a Sharpie pen to make his/her own name tag?

BTW–the Penn State badge is there because I am not allowed to wear my PSU scrubs anymore–only hospital issue uniforms.  Another brilliant regulation dreamed up by someone who doesn’t have a real job, doesn’t do my job, but knows they can do my job better, and has to justify their existence on this planet by enforcing said regulation.  The PSU badge does improve patient care–it makes me a happy doctor to wear it, and happy surgeons are BETTER surgeons.  Trust me on that one.  (Really, would you want someone unhappy to be putting sharp objects in your EYE!)

At least after I was done pounding my head against a wall in frustration, I could look down and remember who I was!

 

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Why did the chicken cross the road?

To keep from getting arrested!

Have you read about the woman in Whitehouse, TX, who was arrested (tackled and handcuffed) for walking on the wrong side of the road.

So basically, she is walking on the wrong side of the road.  A cop pulls up on a motorcycle and starts asking her questions, such as “are you from around here?”  She thinks he’s flirting and she’s uncomfortable.  (I don’t think he asked her what her sign was or if she walked there often.)  She continues to walk.  He continues to follow her on his police cycle.  Maybe he’s not a cop.  She runs.  He tackles.  Cuffs her.

Sound like a case of over-zealous police brutality?

Sounds like a case of someone who should have been smart enough to know which side of the road to walk on!

I’m sorry, folks, but I gotta side with the cops on this one.  This is a pet peeve of mine, as a runner.  You can argue whether his “arrest” of her was necessary or extreme, but the bottom line here is she was breaking the law, and it’s NOT SAFE.

I was taught in kindergarten that you walk and run AGAINST traffic if there is no sidewalk available.  You bicycle WITH traffic and not on sidewalks.  We also learned about stop, drop and roll if you catch fire while walking against traffic, and that eating crayons or paste is not good for you, especially if you are on fire and on the wrong side of the street.

If you are running, jogging, or just walking Fido, and you are on the right side of the street, then you cannot see the cars coming behind you.  You have no idea if they see you and if they are going to hit you.  You might get clipped by a mirror.

If you are walking on the left side of the street, you can see the on-coming traffic.  You can make eye contact with them.  You can tell if they see you or if they are busy texting.  If they don’t see you, you can get out of the way.

I am amazed by the number of adults who walk or run on the wrong side of the street.  Maybe they’re from England.   It makes me want to tackle them and handcuff them.  (Not because they’re English, but because they’re too stupid to know which side of the street to be walking on!)  Well, if I’m in a bad mood, I’ll at least yell at them to get over on the other “proper” side.  I usually get a confused look in return.  Maybe they are immigrants.  But I get that a lot.  And I digress.

In Pennsylvania, the pedestrian law is the same as Whitehouse, TX:

However, even if there is a shoulder to walk on, safety considerations generally would favor walking/running against traffic.  Vehicles frequently drift off the side of the road accidentally if the driver isn’t paying attention.  There may be instances when traffic patterns, or the presence of structures like bridge abutments, retaining walls or the presence of road construction dictates walking with traffic as being safer, but for the most part, you should run against traffic.

Let’s be safe out there.

 

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Meaningless Use

Has your eye doctor asked you to disrobe and bend over for a prostate exam?  You might want to think about getting a new eye doctor if your answer was yes, but that scenario might not be as absurd as you think.

The United States government, in all its infinite wisdom and good intentions, is changing the way your doctor takes care of you.  Now this is a government that can’t adequately fund or run the Social Security System, Medicare or Medicaid, but they know what is best for your health.  They can’t run the Post Office without a loss, but they know the best way to deliver your health care, and starting in the near future, in addition to no mail you likely won’t be able to get health care on a Saturday.

After all, what would a doctor know about delivering health care?  They went to medical school instead of business school!  They weren’t elected to protect your rights!

Enter Electronic Health/Medical Records (EHR or EMR).  Physicians are “mandated” to computerize medical records.

According to Michelle Malkin:

Buried in the trillion-dollar stimulus law of 2009 was an electronic medical records “incentive” program. Like most of President Obama’s health care rules, this top-down electronic record-sharing scheme is a big fat bust.   Oversight is lax. Cronyism is rife. The job-killing and privacy-undermining consequences have only just begun.   The program was originally sold as a cost-saving measure. In theory, modernizing record-collection is a good idea, and many private health care providers have already made the change. But as with many government “incentive” programs, the EMR bribe is a tax-subsidized, one-size-fits-all mandate. This one pressures health care professionals and hospitals across the country into radically federalizing their patient data and opening up medical information to untold abuse. Penalties kick in for any provider that hasn’t switched over by 2014.

Like so many federal programs, the EHR incentive is advertised as an optional program.  I don’t have to convert to medical records if I don’t want to.  But, oh, by the way, if I don’t convert by 2014, Medicare is going to penalize me.  The federal government has a long history of such extortion–think of the 55 mph highway speed limits that were enforced in the 70’s and 80’s.  States could legalize higher limits, but then they would lose federal funding.  You don’t have to participate . . . but we know you will!

I don’t have to participate in Medicare, but here is the reality:  80-90% of my ophthalmology practice is Medicare.  If I don’t participate, my waiting room will be empty.  The vast majority of Medicare covered patients can’t afford to pay for services out of their own pockets, so they will go to physicians that do accept the coverage. I can’t blame them–I would too.  So I participate because I have to–not because I want to.

And such is the case with EHR.  I can’t afford to collect less from Medicare.  Seriously.  The reimbursement for a cataract surgery today is 1/3 what it was when I started in practice in 1994 and about 1/4 of what it was in 1986 (I now perform THREE surgeries to get paid the same as I used to get paid for ONE!)

Think about that for a moment.  If you are a farmer, you must now plant and harvest three fields to make the same profit you used to get for farming one field.  If you are a salesperson, you must now sell three times as much to keep your salary the same.   Or keep it even more simple–if you are paid an hourly wage, you must now work three hours to take home the same pay you used to work one hour for.  That sounds fair, doesn’t it?  And that is without taking into account inflation and the fact that a 1986 dollar is worth more than a 2013 dollar, not to mention the fact that cataract surgery today is safer and more predictable than it was in 1986.  When you factor in inflation, it is criminal what the federal government has forced upon physicians.  And now there is the 2% sequestration loss on top of all that.

The worst part of the whole thing is that I spent 12 years of my life (four years of college, four years of medical school and four years of residency) and well over a $100,000 for my education, and I am only trained to be an ophthalmologist.  It’s not like I can take my training and skills set and join another company.  I’m not qualified to do anything else, except consulting in some capacity or teaching ophthalmology.  Judging by the page views on this blog, I couldn’t make a living doing this!

So the government dragged me into EHR kicking and screaming, but I have not yet seen one cent of any “incentive” that was promised.  Why?  It’s not because we aren’t using EHR–all of my new patients and 90% of my old patients are now computerized.  It was a long, arduous and frustrating process.  It was expensive.  Anyone in our office that needs access to a chart–from technicians, schedulers, phone operators and insurance filers–must now have a computer and each computer has to have a rather expensive software license.  And every time we submit to get our incentive, there is a new reason why we failed to meet the criteria. No soup for me!

And if the computers go down–I can not access a new patient’s information.  It’s backed-up somewhere, but I can’t get to it until IT figures out what the Hades is wrong with the software or server.

The whole process of computerization and data collection sounds nice on the surface.  This site outlines the process like this:

Improved communication, quality measures, patient access and efficiency are all wonderful buzz words that make it sound like a fairy tale come true.  But it’s the details of the process that are horrendous. It’s the “meaningful use” of that technology that is problematic.  The fine print for meeting these criteria include 15 CORE objectives for physicians, apparently regardless of specialty (“one size fits all”):

1.  Computerized provider order entry (CPOE)
2.  E-Prescribing (eRx)
3.  Report ambulatory clinical quality measures to CMS/States
4.  Implement one clinical decision support rule
5.  Provide patients with an electronic copy of their health information, upon request
6.  Provide clinical summaries for patients for each office visit
7.  Drug-drug and drug-allergy interaction checks
8.  Record demographics
9.  Maintain an up-to-date problem list of current and active diagnoses
10.  Maintain active medication list
11.  Maintain active medication allergy list
12.  Record and chart changes in vital signs
13.  Record smoking status for patients 13 years or older
14.  Capability to exchange key clinical information among providers of care and patient-authorized entities electronically
15.  Protect electronic health information

If you are a non-physician and you look at this list, you are probably thinking to yourself that physicians should probably be doing these things anyway–and in fact, good physicians have been doing most of these things on paper for years.

Who wouldn’t want an electronic prescription as opposed to a scribbled, illegible one from the doctor?  Or an office note that is typed and legible rather than scrawled by a dyslexic platypus?   Have you ever used a computer?  Have you ever mis-typed a text message or email?  Clicked the wrong icon?  Have you ever tried to submit an on-line form that was refused because you missed one of the starred items or entered something incorrectly?  Have you ever sent a text or email that someone didn’t get?

In the short period of time we have been adhering to the eRx mandate, we have had multiple calls from pharmacies where patient’s are waiting to pick up their eye drops but no prescription was received.  Our computer says it was sent.  I know you probably find that impossible to believe because computers are perfect and people are not, but how many essential prescriptions do you think might be lost and the patient not realize they didn’t pick up all the meds they were supposed to?  Or what if the doctor clicked the wrong medication in the drop down menu by accident and didn’t pick up the mistake because he was trying to save encounter time so he could ask you about smoking (see below)?

It’s not as though folks couldn’t forge or change their prescriptions before to get controlled drugs.  They did.  But how long do you think it will take hackers to figure out ways to illegally transmit prescriptions for controlled substances, if they haven’t already?  (Actually, I think controlled substances still need a paper Rx, but as an eye doctor, I haven’t written for a controlled substance in 21 years, so don’t quote me on that.)

We are on the Titanic chugging along here folks, and this is only the TIP of the iceberg.  Medicare is telling us to move ahead full speed!

Number 12 mandates that we “record and chart changes in vital signs.”  Sounds like a good idea, doesn’t it?  Why didn’t a doctor think of that?!

Here is what your hard-working government–and I swear they employ people to stay awake all night thinking up ways to screw all of us–is doing for you:

Record and chart vital signs: height, weight, blood pressure, calculate and display BMI, plot and display growth charts for children 2-20 years, including BMI

So you show up for your eye appointment.  Your doctor’s assistant asks you to step on the scale.  They calculate your BMI (body mass index) and determine that you are overweight.  Wait a minute, you came here for glasses, didn’t you?   Or a cataract?

Your podiatrist now is asking you about smoking.  And they are handing you materials about smoking cessation.  All you had was an in-grown toenail.  WTF?

How long will it be before I have to put my patient, who is getting glasses, into a paper gown and ask them to turn their head and cough?

Or better yet, “I’m sorry Mrs. Jones, but before I can take out your cataract, Medicare requires I document a rectal exam!”

Don’t laugh!  They are changing these rules as we speak.  And I’ll give you a hint–they only make it worse.  The Academy of Ophthalmology fought the Centers for Medicare Services (CMS) for relief from having to buy scales and waste clinical time discussing your weight instead of your eyes, but I am still being forced to ask my patients about smoking.  And while that does have a modicum of relevance for macular degeneration patients who are at higher risk for the wet type as smokers, for the vast majority of patient encounters, it is just one more thing we must document for no other reason than to make Mr. Obama and his merry band of legislators happy.

We are treating the computers (and legislators)–not our patients.

Seriously, if you are a smoker, you probably know already from the media and lawsuits that smoking is bad for you.  Your general medical doctor, lung specialist or cardiologist should discuss that with you.  But if you are being checked for cataract or getting contact lenses, is that really necessary?  How many people are really going to stop smoking because their eye doctor or foot doctor or proctologist told them to do so?

But wait!  There’s a pamphlet for that!

Vital signs should be appropriate to the specialty–blood pressure and pulse for the cardiologist, respiratory rate for the pulmonologist, vision and eye pressure for the ophthalmologist, etc.  But the government system won’t allow for individuality or common sense.  There are universal protocols for everything, from infection control to marking a surgical patient, regardless of what the infection or surgery may be.

And it only continues to get worse.

So maybe you don’t care if your eye doctor is making less money as you sit in the over crowded waiting room (because I now have to see three times as many patients to maintain my income AND pay for this new computer system I don’t want.)

But if you have to disrobe and bend over, you might just start to care.

I just hope it isn’t Obamacare.

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Where’s the Outrage?

While mainstream media and well-meaning, but utterly clueless politicians are diverting your attention to the “problem” of gun control, another threat to our civilized society is going unnoticed.

January 21, 2013 in Chesterfield . . . “County police have arrested one man in connection with a fight in which multiple victims were stabbed.”

January 1, 2013 in Reynoldstown . . . “An argument between two men at a party resulted in several stabbings and the arrest of the suspected stabber, Atlanta police said. . . All five stabbing victims, including two who had stab wounds to the abdominal and legs, were transported to Atlanta Medical Center for treatment. All victims were reported in stable  condition with the exception one  victim who was rushed to surgery in  critical but stable condition.”

February 1, 2013 in Vancouver, Canada . . .”Vancouver police on Thursday night arrested a seemingly deranged man who ran through the hallway of an apartment building stabbing and slicing people at random.  The stabbing rampage left seven people injured, six of which were taken to the hospital and one remains in critical condition, according to officials. Three of those individuals had been released from the hospital as of Friday morning. . . “It appears that a lot of these victims were unrelated to each other and they had no dealings with each other tonight,” Fincham said.  “It was a very vicious, very serious attack. There were multiple victims in this,” he added.

I could provide other examples but I am Googled out at the moment, and distraught with fear that at any moment, a mad suicide knifer could enter my house and slice and dice his way through my unsuspecting family.  And this could happen if our lawmakers don’t take notice and pass stricter knife control laws.

How many people have to suffer before we ban Ginzu’s?  Is it really worth the health and vitality of our children to be able to cut our steak with a steak knife?  Cavemen ate meat for years before anyone invented the Iron Age and tools to cut the meat.  I would rather gnaw my Outback Special without utensils than risk being stabbed by these potentially lethal weapons.  Have you ever looked at that guy sitting all by himself in the booth over there?  With the knife in his hand?  Who knows when he will snap!?  It could be during dessert!  Oh, the inhumanity!

With proper knife legislation, perhaps Mary would have survived the shower attack by Norman Bates.  The movie would still have been suspenseful, but he would have had to bludgeon her with his bare hands (or would it have been his mother’s bare hands?) if we outlawed all potential weapons.

Apparently Al Sharpton agrees, but I’m not sure whether that strengthens or weakens my argument here.

Echoing the commonly-made argument that when guns become too difficult to obtain for even the most determined criminals, they will find other means of violence such as knives, a caller asked: “What happens when the criminal goes to knives, Al?”

“Then you deal with knives,” Sharpton pointedly replied.

But why wait?  Why not be proactive and control all knives and sharp objects now, before more people suffer.  And while we’re at it, why don’t we just make it illegal to kill and maim people with anything?  We should probably make drugs illegal too.

That will solve a lot of problems, won’t it?

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Political Astronomy

Politician. (n) Someone who doesn’t know his anus from uranus when it comes to passing laws, but when it comes to screwing somebody, they sure know that it goes up uranus and not theirs.

Neptune? It looks more like uranus if you ask me!

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New Debt Initiative

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Picking Your Noes

Today was Election Day here in Pennsylvania (also known as Erection Day in Japan).  I performed my civic duty such as it is.

No I don’t want this person.

No, I don’t want that person.

I dutifully picked my noes today.

After carefully studying the issues, watching untold commercials, praying, and flipping my lucky quarter, I selected my choices.

Granted, this was just a primary, and we’re not electing a new czar or anything important  like that, but it is always a frustrating exercise in futility to elect anyone to any office.

There’s no one on this list I want to vote for.  Actually, one of my good friends is running for school board so I voted FOR him.  This may be the first time since I cast a vote for Ronald Reagan that I actually picked someone because I wanted to pick them; not because I didn’t want the other guy to win.

I am basically choosing the least of several evils.  I am not picking who I want to be President as much as I am picking who I don’t want leading this country.  I wasn’t even choosing–or not choosing as the case may be–a President today, but you get the idea.  Today I was not choosing judges and county commissioners.  Being that it was a primary, all the candidates were Republican on my ticket, so I didn’t even have the option of choosing against the democrat.  I had to become more creative in how to discern one candidate from another.  

I suppose things could be worse–I could live in a country where there is only one choice on the ballot, or no ballot at all.  There was only one choice for Township Supervisor and I don’t like him.  I left it blank.  That’ll teach him a lesson!

The older I get, the more I am convinced of this truth:  the people who are most capable of running this country and who would do the best job are all smart enough not to want the job.

I recently received an email about a wet monkey theory and its application to politics.  Obviously, when I think of politics, the image of wet monkeys leaps to mind, but bear with me here.

Basically, you take five monkeys in a cage.  There is a banana suspended from the ceiling and a step ladder that would enable a monkey to climb up and get the fruit.  Every time a monkey climbs the ladder to get the banana, you hose down the other four monkeys with cold water.  Apparently, monkeys do not like this, especially those that did drugs and sang in the sixties.  After a few times, the monkeys learn what is going to happen, and if one of them tries to go up the ladder, the other four take it upon themselves to prevent said monkey from bringing about a good soaking on the rest.  This more or less makes sense, but it remains to be seen whether this would stand up to clinical trials by the FDA.

Now you change this closed system by taking out one of the “trained” monkeys, and replacing him/her (I’m not going to check out the private parts but feel free to do so yourself if you please) with a new monkey.  This monkey knows nothing about the cold water, sees the banana, and heads for the ladder wondering why the others haven’t already taken the food.  The four “trained” monkeys proceed to beat the living crap out of this monkey every time he/she tries to go up the ladder.  He/she eventually learns not to do that, even though he/she doesn’t know why.  Maybe the FDA has ruled bananas to be bad for our health and he/she didn’t get the memo.

Now, you proceed to remove “trained” monkeys one at a time as above.  The scenario repeats itself.  Eventually, you end up with five monkeys who are willing to beat the living crap out of one of their own kind if he/she tries to go up that ladder.  But NONE of these monkeys have any idea why.  None of them were ever doused with water–only victims of being newcomers themselves and learning the system.

Hence it is with Congress.  We voters think we are going to change things by sending a new monkey to Washington.  He/she gets the living crap beat out of them for trying to change things, and the monkeys go about business as usual.

Maybe they should just hose us voters down each time we try to vote, and we could end the pretense that we can make a difference.  Perhaps I am getting too cynical in my old(er) age.  Maybe it’s just senility.  There are three signs of senility:  forgetfulness . . . and I forget the other two.

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It’s a POM Wonderful Life

Every time the cash register rings, an angel loses its wings.

My hometown, Altoona, Pennsylvania has apparently sold its soul to the devil.  What’s the going price for a city of about 50,000 residents?  About $25,000.

Fruit Juice or City . . . YOU decide!

According to Business Week, the City of Altoona has officially changed its name to POM Wonderful: The Greatest Movie Ever Sold in exchange for $25,000 for the next 60 days.

How in the hell am I going to fit that on an envelope?

1313 Mockingbird Lane, POM Wonderful: The Greatest Movie Ever Sold, PA 16601

I just don’t see it catching on.

Does everything associated with Altoona have to change its name?

Is the hospital now The POM Wonderful Regional Health System?

POM Wonderful Savings Bank?

The POM Wonderful Area School District?

Are babies born in the next sixty days going to have POM Wonderful listed as their city of birth?

Do I still need to pay Altoona City Taxes for the next sixty days, or do I have to send the check to POM Wonderful?

Isn’t this just wonderful?

According to the article, only five people were protesting.  I guess we’re all numb to crap like this or we just don’t care.  And after all, surely the police department will find a way to waste use this cash windfall to make things safer for me.

The purpose of the documentary is to start a national conversation about the naming trend.

I’ve already noticed this in the arena of sports, from the naming of ball parks down to the naming of a power play in hockey.  You have the Lexus Half-time show and  College Gameday brought to you by the Home Depot.  Will baseball follow the trend with the seventh inning stretch brought to you by Preparation H?  Or the Tough-actin’ Tinactin ball scratch?  Where will it all end?

The Rapture, brought to you by Verizon.  The AT & T Armageddon.  The New York Times End of Times.

Call it what you want: sign of the times, basic greed, an advertising gimmick, or just plain old-fashioned stupidity.

Just don’t call me POM Wonderful.

Then again, scratch that.  I’d temporarily change my name in a heartbeat for $25,000.  People have called me worse names than that for free!

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