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Archive for the ‘Medical’ Category

In response to GSK verdict

The recent verdict of Glasco Smith Kline really should mean little to me.  After all, I have never taken payment from them.  There might be the occasional lunch so they could pitch their product to me, but I finished residency after the first set of Pharm D laws were passed.  Actually I think that I might have been in medical school when they were passed, but in residency when they went into effect.  What does this mean?  Well, I have never taken a trip to Hawaii on a drug company, I have never gotten a membership at a fancy golf course, nor did I ever accept any money from them.

In the interest of full disclosure, I believe that either Merck or Pfizer paid for my graduation from residency (It has been 7 years, and the program was responsible for details) I have received numerous meals, and pens, and writing tablets.  Did these items influence me?  Maybe, if I am writing a blood pressure medication, and the pen that I was writing with was for a blood pressure medication.  But I would have to believe that it was effective.  I wouldn’t write Norvasc (amlodipine) for a patient in heart failure for example, because they already have problems with swelling.   But most of the time, I didn’t even think about the pen in my handle.  Mostly because it is a stylus that only works on a computer and is black without label.  I rarely use a pen except to sign the few prescriptions that I cannot send electronically.

As for samples, yes I utilize them.  Before the antidepressants started going generic, it was nice to be able to give a patient a two week supply to see if a certain medication was going to work, prior to putting out cash for a high dollar prescription.  Now that there are generics, well that is typically the first choice I write for.  If the generics don’t work, well then I make my next selection with what I can give the patient a sample for, because it is nice to try a medication without spending an ungodly amount, only to find that it doesn’t work.

Now why the verdict means something to me.  With the announcement the Dr Drew Pinsky took at least $275,000 to “provide services for Wellbutrin” (whatever that means) the internet has lit up with claims that this is what physicians do.  They are all on the till for Big Pharma.  Slate online discusses Dr Drew and then implies that most doctors collect checks from Big Pharma.  Lew Rockwell (the founder of the Mises Institute) actually says on his blog “Here is much of the medical profession in a nutshell, since most doctors are in the pay of Big Pharm from medical school onwards.  They get commissions for all those drugs they tell you to buy.”  I guess my check is still coming, since I have yet to see one, yet.

Now it is easy to blow off the likes of Lew Rockwell, since I don’t know if there is a conspiracy that he doesn’t believe (that is my opinion) but his large following is where the problems come in.  He has some of the most rabid of followers and even helps to continue the vaccines cause autism fallacy.  But he is only one of many that are helping to spread the idea that all doctors accept payment from Big Pharma.

Why Dr Drew accepted money from GSK to promote Wellbutrin should even register is beyond me.  He is one of a growing number of charlatans who have traded their respect for media fame.  Dr Drew is worse than most, in that he has also traded on the fame of his patients who are struggling with addiction to create television.  The man let’s face it appears to be a media whore.  I don’t know where in the Hippocratic Oath the statement of except in the case of a television show comes in, but apparently it is there.

I don’t have a problem exposing those that do take commissions, maybe we should be more transparent.  I don’t mind discussing with patients why certain medications would work better for that patient than others.  It is part of my job.  But there are times that the generic is not the best choice for the patient, or maybe there is not a generic equivalent, but this should be a conversation that I have with the patient because it is for the good of the patient, not because some blogger without a medical degree has decided that the whole profession is suspect just because there are a few (alright more than a few, but no where near the majority) corrupt practitioners.  Based on the blogs I have seen on the issue, I have been convicted merely because I hold a medical degree.

Few physicians receive payments from the pharmaceutical companies.  An occasional meal for listening to a drug lecture or spiel but rarely anymore than that.  In fact, I don’t know the last time I accepted a dinner from a drug rep due to preferring to spend my evenings with my children and running them to their activities.  As for those who are paid to promote their drugs, there is supposed to be disclosure for doing so, both in lectures at Continuing Medical Education events.  And believe me, every rep tells me their drug is better than their competitors and all of the generics, I have a medical degree, I think I can figure out that they are in my office to sell their product.

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My thoughts on ObamaCare- insurance exchanges

If you are anything like me, your Facebook page, twitter feed and everyone you meet have some opinion on the Supreme Court’s decision on the Affordable Care Act, otherwise known as ObamaCare.  And it is either the best plan ever or the worst decision and Justice Roberts is a traitor to his country, and blah, blah, blah.  Well that was Thursday.

Friday, it was well if we don’t overturn this mess, I am moving to Canada, Australia, Costa Rica, or other English speaking, industrialized nations all with some form of Universal Healthcare or Socialized medicine.  Also countries with a tougher immigration policy than we have, so I am not sure that unless you are super wealthy that is actually an option.

And then there is the stand by the Republican governors to not enact an exchange because they will fight this to the bitter end.  You all know that the exchange was originally a republican idea don’t you?  And probably my favorite part of the bill.  Why?  Well because I own a small business, I have 8 employees, when I started I had two employees, my husband and I, which accounted for a pool of 4 people.  Why does that matter, because when I went to purchase insurance in 2005, I was 7 months pregnant, covered under a policy which I COBRAed through the hospital that I did my residency in.  At $750 a month.  Now I was just out of residency and started my practice on my own, and well $150,000 in debt from medical school, with a new baby on the way.  So I looked for something, and the best I could find that would cover that baby was $1500 a month.  They could not deny me pregnancy coverage as pre-existing at the time, because I live in a states that if I had insurance that previously covered a condition within the last 6 months, there was no pre-existing condition.  However, do NOT ever shop for insurance when 7 months pregnant.

I called 4 insurance agents, and several companies on my own, the best that I could do was to COBRA my current policy ($750 a month) until the baby was born and then start the following month with the new insurance.  Though I actually COBRA for one additional month, because there was some question as to coverage of the brand new baby.  Anyway, this policy I could afford was roughly $400 a month per person in pool, oh and it didn’t cover pregnancy.  And I had an employee who would like to have a baby, so we changed our pool to three, and I covered her on an individual policy, that would cover pregnancy a year after it started.  (Which didn’t work because as it happens, she stopped trying to get pregnant and she had a baby 11 months after the policy started, and ended up on Medicaid for the pregnancy anyway)

Now being as I had insurance for all but my 3rd year of medical school (I had gotten married and could not stay on the plan, and well we couldn’t afford it until my husband started his internship year and it was covered) I could not believe the difference in rates.  I saw what had been taken out of my check at the hospital while I was employed, and it was not that much.  I talked to others as to what they paid working for bigger companies, and the talked the agent, and what the answer was the size of the pool.  My pool was three, and one was diabetic, I was a bigger risk, than those with thousands of employees, who could afford better coverage for less.  But if I got to 5 in the pool, or 10 the rates drop significantly, and then if I have 50 employees, well that is an even better drop.

But with an insurance exchange, here is the deal.  Let’s say your exchange becomes the state for instance.  Larger states might decide to have multiple pools, or smaller states might decide to join into a regional pool, doesn’t matter.  The pool becomes big enough that smaller businesses or the individual could choose a plan that actually works for them within their budget.  If you want to cover pregnancy care, great, here is the plan for you.  I don’t cover it for my employees because it would increase my costs $200 a month per employee, and that includes the two males, who if they become pregnant, I think I would sell their story, me who has had a tubal, and another employee or two that are menopausal.  There was only two of my current employees that would even desire pregnancy, and well at $1600 a month, well it is not even affordable for me to do so.  And as it stood before, they could not even add the coverage as an option because my pool is too small.

While I would have preferred for the market to develop something like an insurance exchange on its own, it is highly unlikely under today’s highly politicized system, it ever would have.  An insurance exchange would allow for those healthier to choose coverage to benefit them better, would allow for people to choose coverage for preventative care.  At least it would ideally, but it would also allow for those with diabetes and other chronic conditions to find a plan that would cover them.  I didn’t say that they all had to cost the same in my world, but prior to ObamaCare finding a plan with a pre-existing condition was impossible without high deductibles, and being astronomically expensive.  And then there was a year of paying for the plan before it would cover any pre-existing condition, so you can understand the frustration for those that tried, and for those that decided against buying insurance.

Like I said, I look at it from a small business who while not required thought that it was right to cover my employees.  I am in healthcare after all.  I actually like this part of the ACA, there is much of the plan that I don’t.  But the opposition to this part, is something that does not make sense, yes the free market should have produced it, but it didn’t.  But this is a natural progression of medicine since the development of Medicare and Medicaid, a natural progression from EMTALA.  I find myself frustrated at both sides on this issue, the surprise that the bill stood, the gloating that this bill is the best thing ever (it is not).  In the last 6 months it was obvious it was going to stand, and if not most of the major components were going to be put in a new bill.  Besides an estimated 60% of the costs in the infrastructure to support the system had already been put into place.  Repealing it would have been of little use.

That is just my two cents worth.  But what do I know, I merely own a small business and see patients everyday.  Do I agree with the plan in whole, no.  But I don’t see the alternative offered by the other side as much different.

To all those graduating residency this month (or close to anyway)

OR What I wished someone told me when I was about to graduate.

Congratulations, welcome to the world of medicine.  Does it seem a little belated?  After all you have been licensed anywhere for 2 to 5 years depending on your specialty, you graduated from medical school and have been officially a doctor for 3 to 6 years, not to mention the 4 years of medical school before that.  So while I grant you it seems a little belated, it is not.  You are now officially on your own.  There is no back up.

For the last 6 months or so you have been counting down the days, the nights on call, weekends on call, or some variation until you were done.  You have taken board exams, presented research and have either had a graduation or are about to have a graduation that is not quite like the ones from medical school and college, but they are still nice, and they are still a big deal.  (I seemed to have forgotten that, and didn’t think to invite my parents to mine.  Whoops)  But you have been counting down the days until your time in now your time and you don’t have to answer to anyone else.

And a funny thing happens, the moment you graduate, you instantly become one of us.  In a way you weren’t before.  Those that are staying close to the program that they graduated from will find it a little more amazing the change from resident to the next morning ATTENDING.  And for the easy stuff it is amazing.  Ear infections, I got that.  Hypertension, well I will use my favorite ACE or beta blocker.  You have bronchitis, and you will be super doctor until “What the heck is that?”  Well that is what you will be thinking, and you will have to stop yourself from saying “I am going to grab my attending to come in here and look at that.”  Because you no longer have an attending you are the attending.  So you will pull out your books or go online to your favorite site and you will figure out to your best opinion what it is.  And if you are right, you will be a hero, and if you are wrong well they will either return and you will try something else, or they will go somewhere else.  You are now the EXPERT.

But don’t think that you are alone.  I made that mistake.  The profession is quite willing to help its fellow physicians, you only have to ask.  Which EMR is best, ask.  Most are more than willing to let you look at their systems and try them out.  You need help with a case in the hospital, you can either officially or unofficially consult one of your colleagues, we love being asked for advice from fellow physicians.  Just don’t ask investment advice, some are really good at it, and some are really bad, best to find a financial advisor on your own.

Make sure you have a good accountant, a good lawyer and a good relationship with a bank.  Seems silly, but those will save you time and again especially if you are starting out on your own.  Rare now a days.  I did it 7 years ago, and it is probably due to the accountant and bank that I am still standing.  You didn’t go to business school, you went to medical school, but school and residency failed to teach you about the business of medicine.  And it is a business.  You want to get an MBA, great idea in a few years.  The first couple you need to work on getting your feet wet in the medical field.  So surround yourself with a great support staff.

Your spouse/significant other who went through all of this with you, was not trained in billing and coding for the most part.  So if they are going to run your business, they need to get trained.  While the motivation is their (It’s their money too) the knowledge may be lacking and you are probably not qualified enough to teach them.  They need to either get some training or hire someone who is trained.

Take time off.  No not the first month, but you cannot go constantly.  It does not serve you and it does not improve the care you provide to your patient.  And all of  your patients are going to get sick and they are all going to be mad that you left them when they were the sickest ever, but that first day back your lobby will be filled because that guy down the street that was covering you, just doesn’t know what they are doing.

And if you are at the program you trained at DO NOT ever in that first year use the line. “When I was a resident…”  Most of the program was just a resident with you, and it loses its meaning when they can come back and say, “You were a resident just last month.”  My fourth year in medical school, I witnessed that from one of the new attending, who went around saying that.  You can say it after everyone who was ever in residency with you has graduated, but until then, they knew you in residency.

And if you use that line don’t follow it with something ridiculous like “I would have liked to get up at 2 am and do an H&P if my attending would have asked me to.”

No you wouldn’t have, and you didn’t like it.  You complained to your fellow resident the next day.  There are crappy things that residents have to do because they are learning and are residents don’t insult them by pretending they aren’t.  And remember you were once a resident, don’t just abuse them because you can.  It doesn’t make you a better doctor among your colleagues.  It just makes you an ass.

This list is far from exhaustive, and I am sure if I had time I could keep going, but I don’t and this blog is getting a little long.  So congratulations on your achievements and hard work.  And welcome to the club.  You membership fees are now due.  (This is only half a joke, you have no idea how expensive it becomes to keep all these groups fees paid)

The Obesity Epidemic

I don’t know if epidemic is the right word, since it is not an infectious disease, but the rate of growth that it is spreading (no pun intended) certainly mimics an epidemic. From “The Weight of a Nation” documentary recently shown on HBO 1 in 3 children that was born in the year 2000 will develop Type 2 diabetes” Those numbers may seem ridiculously large to the general population, but in my patient population in rural America, lower socio-economic population, it is hardly surprising, other than I might estimate it closer to 1 in 2. Scary, isn’t it? And I don’t think it is because I am a bad doctor, and I don’t think it is because of bad parenting (or at least not intentionally). It is a combination of a lack of education, loss of physical education, a loss of parks and ability to play outside, and the easy availability of fast food and other quick processed foods.

In my practice, I see all ages from 2 weeks to 94 (I think that is the age of my current oldest patient) And throughout the group there is a definite problem that spans the generation. Now am I going to focus on diet and nutrition with the 94 year old, probably less so, but on those that are younger it is very necessary. Today, I had a long talk (or three of them) with patients who told me that they didn’t know why they gained weight or didn’t lose this month. They aren’t eating anything. First of all, I am going to call you on that one. It is physically impossible to gain weight, if you don’t eat anything (I including drinking in the eating). Now once you become morbidly obese, your metabolism does slow down significantly, and it is more difficult to burn the calories that you do take in, but really you have to be honest with yourself about the intake.

Please stop saying that you eat a normal diet. You don’t. How can you? I don’t even know what a normal diet is anymore? The diets that get described to me when I finally get them to tell me what they are eating are far from my typical diet. A large slice of Cheese Pizza from Pizza Hut has 390 calories. (One slice) Multiple that by 8, and 3180 calories are found, which is more than anyone needs in a day, much less a meal. (And yes, I do have patients that eat that as their meal. Well, no, I don’t, it is a supreme pizza or pepperoni) And I am not saying that I never eat pizza, merely that it needs to be in moderation, it is not a terrible food, but really needs to be done in a portion size.

And a portion size can Fit in the palm of your hand. (Give or take) A serving size of meat is about the size of a deck of playing cards. I don’t care it you can eat the 72 ounce steak from the big Texan, that is 12 serving sizes of meat. Hardly healthy. I find that the type of meat you eat is less important than the size and method of preparation. Frying fish, takes out all the heart healthy benefits that are found in the Mediterranean diet. Those Omega 3’s are drowned in a sea of saturated fat.

If you go to the grocery store, a nutritionist that I know, told me shop the edges. All the unprocessed foods are on the edges, fruits, vegetables, milk, cheese, deli, etc. Even the frozen food section with the frozen fruit is often on the edge. You don’t need the mac and cheese, the canned meats, and the like. If it can’t go bad, it probably should not go into your body in any significant amount.

And at the very least keep track of the calories you are taking in. We are terrible as adults in estimating the amount of calories we consume. The journal of Clinical Nutrition estimates that we underestimate our calorie consumption by as much as one third. So if you think you are eating 1800 calories, it is very possible that your intake is closer to that of 2400 calories. Over time that adds up. We are not as bad as kids. Think about it, children who are not forced to clean their plates, tend to stop when they are no longer hungry. Those children tend to be leaner.

We have shut off our thirst mechanism, and instead believe it to be water. It takes 20 minutes for your body to realize that it is full. So if you eat slower and chew your food, you are bound to get up from the table eating less calories. However, during the day, that hunger pain you feel? Well if might not be a hunger pain at all, but your thirst mechanism. By the time you feel thirsty (dry mouth) you are already partially dehydrated. So I tell all my patients, make sure that you eat, in portion sizes, but if you feel hungry, take an 8 ounce glass of water and drink it, wait 30 minutes. If you are still hungry, then eat. This would cut down on quite a bit of intake.

I also see several people who say that they can’t eat until 10 pm, so that is why they retain their weight. Well, I am not quite as tied to the rule of no food after 7 pm for them. Why did this weight loss gem come about? Think about what the “typical” American does after 7 pm. They are tied, so they sit down and watch television. (For those of you whom this does not apply, well that is great) And what do you grab while in front of the television? Fruits and vegetables? Hardly- that is when the junk food comes out in the greatest quantity. Eating an apple at 9:02 pm is hardly going to ruin your diet, but eating a whole tin of Pringles and washing it down with a 20 ounce Mountain Dew, well that is not so good. There are legitimate reasons for not eating that late- reflux tends to be worse in those that eat within two hours of bedtime, and your activity level does decrease so their is some slowing of the metabolism, but seriously if you eat 1200 calories throughout the day, you will probably lose weight, regardless of whether you have your dinner at 10 pm or 5 pm.

And those sodas- just stop. They are empty calories and sugar. And the diet ones are less calories, but artificial sweeteners and both trigger your appetite and make it difficult to manage your portion size.

And for those of you in the South. That sweet tea, which is mostly sugar, well that is not helping either. It is not helping you hydrate, and there is little benefit from it. So other than occasionally, really don’t down it thinking that it is healthy.

And then the gorilla in the room, EXERCISE. At some point we as a nation stopped exercising. Our kids no longer get to play outside, Physical education programs are cut, and with the lack of exercise they see their parents doing, is it any wonder that our kids are growing larger? Type 2 Diabetes, a disease previously named Adult Onset diabetes is becoming more and more common in this group. And if they are not diabetic, they are insulin resistant so they are within 5 years of the diagnosis of diabetes. We have got to get our kids (and parents) moving. Kids learn more from watching their parents then from anything that they say. You can’t expect your kid to exercise, if you don’t get yourself moving. And it doesn’t have to be running. Walking is good, Bike riding, roller blading/skating, swimming or anything else that you find enjoyable. But get up and move.

I like to suggest a pedometer. They range in prices from around $5 to the $99 one from FitBit. I actually own the Fit Bit one, and while you might ask, “Why would anyone pay $99 for a pedometer?” I like mine because I can keep track of it online. Add to it the FitBit app for my iPhone, and I can keep track of my meals and my exercises, and they recently came out with a scale that will link with the site. Allowing for all of the sats in one place. It is nice, and convenient. But regardless, a pedometer is nice, because you can shoot for 10,000 steps a day. It is difficult not to lose weight if you take 10,000 steps in a day. And if you have that goal, you know where to shoot for. And that is something that everyone can do.

We all need to worry about obesity. Especially as it helps to escalate health care costs. There are great bariatric surgeries available but they are not without risk, and really wouldn’t you rather prevent the need for surgery and the complications of obesity for both you and your children?

;

My data on the calories from a single slice of cheese pizza of 390 appears to differ from that posted on the Pizza Hut website of 360 calories. I should have gone to the website itself than using a different more general website.
As for the statement that diet sodas have less calories, it is true that they have no calories. I was more illustrating that drinking them over regular soda you eliminate the empty calories but recent studies are showing increase in the risk of heart attacks and may stimulate your appetite, and may cause you to gain weight in the long term. This is the result of a recent study from Harvard University

Allergies and why they matter

As we travel through this allergy season, I am actually having an easier time of it than usual, in what is apparently one of the worst in Southeastern Oklahoma in several years.  Due to the lack of a cold winter, we did not have the period to kill off the normal plants and decrease the load, so I have a great deal of patients in my office complaining of allergy symptoms that in many instances never had.

What exactly are allergies?

According to the Institute of Public Health allergies are defined as “an exaggerated immune response or reaction to substances that are generally not harmful.” 1.   The key to that definition is “generally.”  Because of that word we are aware that there are those that are harmful.  Today more than ever we hear about children who have anaphylactic reactions to foods such as peanuts and nuts.  And yes, I did mean to separate them, because a peanut is technically a member of the legume family and not a nut at all.  Other foods that commonly trigger an allergic reaction include shellfish, eggs, wheat, milk and soy.  These are not always as serious as anaphylaxis but they can be.   Today there is a big attempt to remove milk from the diet, and creates gluten free diet, and unless you are a celiac (allergic to the binding protein in wheat, rye and other common grains) it is found to be a limited benefit in others.  However, limiting your gluten intake may make you feel better, if only due to removing most of the processed food from your diet.  And for those that are allergic to soy, well this diet would cause more problems than not, since many of the replacement foods contain soy.

Another issue that is appearing with soy is that in males in may lead to hypogonadism and infertility.  Now these studies are early and they are still looking closer, but one of the beliefs is that the link may be the result of soy breaking into down into estrogen like compounds and at least temporarily decreasing the sperm count.  Soy can also as I learned in the past week cause anaphylaxis.

 

This picture is actually my son, 30 minutes after his school gave him a large dose of benedryl, which may have been more than the recommended dosage, but with his whole face swelling up, I think it was the better of the two choices.

I myself have food allergies, and hay fever, and everything else that goes with it.  I spent years wearing long sleeves in hot weather, and other ridiculous things to hide arms so that I didn’t have the ridiculous questions about the “track marks” on my arms, and “how I couldn’t hit the vein.”  This is my arm today

This is my arm today.  It actually is relatively under control  Yes you can see the eczema- but there are only a few spots that are terribly red and irritated.  And there is the scratch on the arm.  Must have done that in my sleep.  I am better most days now that I am older and more aware of the damage that I do so I can at least attempt not to scratch.  Those white spaces scarring from the years of scratching.  It makes my skin fairly tough, and hard to take blood, well at least getting through the skin- once through the veins are right there.  But this is enough of an issue that I had to argue with the people at the blood back that they could take my blood.  I mean there is a blood shortage, and you want to not take my blood because of a little scar tissue.  Once the needle is in the vein it all comes out the same

Anyway, other than the unsightly skin, and itchy, watery eyes, and sneezy nose- why do allergies matter?  I mean if those reasons are not enough.  The National Institute of Public health states that most children outgrow their allergies- I am not so sure.  I haven’t outgrown mine yet.  But the Allergy and Asthma Foundation of America estimates that allergies cost $14.5 billion a year.  This includes the direct costs of $1.3 billion for office visits and $11 billion for medication, both prescription and over the counter.  The rest are the indirect costs of missing of work and decreased productivity.  “For adults, allergies (hay fever) is the 5th leading chronic disease and a major cause of work absenteeism and “presenteeism,” resulting in nearly 4 million missed or lost workdays each year, resulting in a total cost of more than $700 million in total lost productivity.” 2  This makes allergies the 5th leading cause of doctor visits in the United States.

If possible removal of the allergen is recommended for those that suffer from allergies, and those that suffer heavily may benefit from allergy testing and immunotherapy.  At the very least, there might be an improvement in the allergy sufferers quality of life.

 

 

1. “Allergies” A.D.A.M.  Medical Encyclopedia  PUBMed Health  last reviewe October 2011, obtained online at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001815/(May 6, 2012)

2. Allergy Facts and Figures.  Asthma and Allergy Foundation of America found online at http://www.aafa.org/display.cfm?id=9&sub=30 (May 6, 2012)

 

 

Attitude is everything

Or my self serving whiny post, which does nothing, teaches nothing, and is merely in existence for no other reason than it makes me feel better.

Sometimes I have days like today. Where when I walk into the room, and ask the patient how they are doing, and today is the worst day of their life. If it is one or two, well that is well not ok, but feasible, because at some point you will have the worst day of your life. This morning however, it seemed like it was everyone’s worst day ever. It improved somewhat this afternoon, in that only half of the patients were having their worst day ever, the rest just have multitudes of complaints

In reality, dealing with a couple patients who view everyday as the worse day ever is tiring, a whole morning is exhausting and mind numbing. It is enough to wish for a fully stocked bar in the office. (I said wish, I rarely drink, so much more that a glass or two of wine would make for a bad idea, especially in the middle of the morning, er I mean the afternoon.

Anyway, it is in those patients you realize how important one’s attitude is to their health. Patients who believe that everyday is terrible never seem to be getting better, and while it might be my doctoring skills, I have patients that seem to improve. So that gives me some hope for my skills. I have patients who have their diabetes under control, their blood pressure looks good, and sometimes walk in and say “I am all better.”

And then there is the others. The ones that despite running ALL the possible tests, you still cannot find a reason for their worst day ever, which by the way is worse than their previous visit that was also the worst day ever. They have pain that is a 12 on a 10 point scale where 10 is being caught on fire currently. And then the mention a random surgery were half of the bowels were removed 15 years ago, that they forgot to mention previously. (Not really, pretty sure I would have seen that scar) But there are unmentioned surgeries, medications, and dietary factors that they neglect to mention. Or other doctors that are prescribing medication. (Sometimes the same medication and sometimes one causing side effects that you are treating.)

And then when you do the workup for a condition, you find out that even though their symptoms scream gallstones, they had that removed 5 years ago, and well they didn’t think it was important to mention. I mean after all they no longer have that organ so how can it be the problem? Though I have been told that they didn’t mention it, because they thought that it might have grown back.

Back to the attitude mentioned in the title. Those with an overall positive outlook in life really do seem to heal better, they are healthier. They try, they are not hoping for a magic pill to cure all. And some of them have significant medical diseases. They have the belief that things can get better, that there is something in life worth living for. And they are living life. This does not mean that they don’t have pain. They may, they might not, but they are trying to experience and live. There is some purpose to their lives.

It is not that they don’t have pain in their lives, some have significant tragedies. Death of spouse, child, fighting disease, but they are looking for a greater meaning. They accept that bad things happen, and maybe just maybe these events help you to appreciate the good times. The understand the need to experience everything that life has to offer. And just by seeing them, you feel better. They make your world better just by them being in it.

Attitude is not the end all, cure all. But it is a necessary component to improve one’s life. It helps with healing, it helps to give strength and motivation. It is what makes one successful in life.

My 5010 nightmare- maybe coming to a close?

It has been a little longer than normal since I have posted, and my excuse is that I have been busy.  Not that everyone else hasn’t been, but well work life seems to have been busier than normal.  Previously, I have written blogs about a firewall that was blocking payments and how I could not get through, and that maybe things were finally getting better and they are.  This week we finally got our first check from Medicare for claims since 12/19/2011.  It was for $12.45.  Woohoo, I can finally retire!

I laugh because I actually think that it is hilarious, all this time and work, and complaining about not getting paid for almost 3 months, and when we finally get through, the amount is not quite the amount you expect, because the deductible started over on January 1, and most of the claims on that sheet went to deductible.  All this work and time waiting, listening to the crickets chirp.  Or wishing their were crickets chirping, because it would be something better than silence.

After this time, arguing with the clearing house about their responsibility only to be told to look at their website, which for the longest time said absolutely nothing, and then eventually outdated and somewhat misleading information.

First it was my fault, no, it wasn’t.  I did all the steps, I was told were required for a smooth transition.

Then it was my EMR vendors fault.  Well,. they sent me a new update on January 1, which was downloaded within that week.  Followed by one more update the end of the month.  So maybe slightly- though I did send them a not so nice email as well during my frustration, to which they replied within 10 minutes intially, and then 5 more times within 30 minutes and able to fix the problem by the next morning, and considering it was 5 pm when I sent the first email, I was happy enough with their response.

So that takes me to the end of January, where the clearinghouse has yet to notify me of any problems, or to answer why I have not heard anything in a month from ANYONE (insurances included) to looking at my balance sheet saying “Holy (insert profanity here)!  Why haven’t I gotten paid.  How am I going to make my bills, pay my employees, …”  To only get told I am 1700 in line with a waiting time of 7 and a half hours.  Well that was when their system did not cut me off and hang up on me.  And after all that time I was on hold what was their answer.  “Well you should look at our website daily.”  Well at least they are consistant.  Though they continue to refuse to answer my question “how can you take my money without at least warning me that there is a problem?”  Their answer is still I am sorry for your difficulties and your disatisfaction, but we post things on our website daily.  You should read that.  And when I threaten to leave them, it isn’t any better.  Still with the damn website quote, and does not answer my question, and that I am required to give them 30 days written notice.  Which I will, as soon as I know I am up and running with the new group.  Just have to wait for Medicare approval.

Finally, the clearing house appears to have gotten their job done (only 60 days late, and not willing to take any responsibility).  However, that day Trailblazer crashed.  Nice.  It takes them about 4 or 5 days to get back up and going, and then we get messages that we are not an eligible provider.  Apparently even though Medicare claims that our contract is still good so far this year (we will have to renew this year, it is just not our turn yet) Trailblazer has forgotten to tell us, we need to sign a new form.  OK done.  Now for the new denials- all of our claims are duplicate claims.  Seriously?  It is a wonder, I haven’t gone postal yet.  All of this, filing and refiliing, denials and everything else to get the anti-climatic check of $12.45.  Awesome

However, I have gotten in contact with some great people that have helped.  Apparently, I helped my professional organization find out there was a problem, and they narrowed it down to Trailblazer having the biggest issues.  They determined that the physicians in Oklahoma and Texas appeared to be having the biggest problems.  Talking to some billers across the country, those using a clearing house seemed to have more problems than those that didn’t.  So guess what?  I had both issues.

And in the middle of this all, apparently Trailblazer is installing new software to help fix the problem (which apparently started last year)  I have heard from my congressman and Senator and one state Senator, but since things are improving we are hesitant to have them do anything.  Because there is no desire to cause further stalling on the issue, especially now that payments (did I mention $12.45) are finally slowly coming in.

As for my relationship with my clearinghouse- Well it will come to an end when I receive approval from Medicare for my new billing company to file how the prefer to do it.  After 6 years, I think it is time, and my loyalty apparently means little to them.  But I did let my colleagues in the area know that their clearinghouse was at least partially responsible for them not getting paid.  Helpful website indeed.

But I had good news on Thursday, I finally had enough money to catch up all of my bills.  I didn’t have to take out a loan.  I still didn’t get to take home a paycheck, nor did my husband, but maybe next month.  It is really sad that Wednesday, I saw 40 patients, and my hubby saw 33 patients in the office and 7 in the hospital, and we were longing for the days that we saw 17 and took home a paycheck.  But maybe as things start rolling, we will be able to see some of what we have worked for.  I hope so, because I didn’t go to medical school hoping to support 6 other people and not get paid myself  (we are now down 2 employees, after one dying at the beginning of the month, and the other being fired).

Anyway, as the computer glitches resolve, we will move foward.  Looking ahead to the crashes and glitches that will come with the conversion to ICD-10.  Oh happy days ahead/

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