kbordson

For what it is worth I AM salary. I am typically double booked and even sometimes triple booked. (being an employee, I have little control over that) I try to avoid unnecessary tests - I get no bonus for labs, no kickback for ultrasounds, no personal benefit at all. I try to avoid unnecessary test .... until patients become threatening. And I don't just mean physically threatening. I mean manipulative. Even tonight, I got a call at 8:30pm. A patients husband didn't make it to her appointment and he was concerned about plans for delivery. So he called at 8:30 at night to "discuss." Since patients have a VERY VESTED interest in his/her/their health, they only want the BEST and they want it guaranteed. But there are no guarantees. (except for the fact that we ALL will die - but they don't want to hear that from their doctor) So they tend to become more demanding .... and would want lil Walker (from the story above) to get a CT and be monitored overnight. Or.... So... explain to me what changes you think that I should make.

Then Bobby gets Reyes Syndrome from the ASA and has to go to the ER... Now a VERY SICK lil Bobby.... maybe even a dying Bobby And the parents then go to the lawyers. How is the above clinic different from any other HMO PCP or family practice? You're on the inside, how do you propose getting the non emergency cases out of the ER? A change in mentality of THE PEOPLE. You can go to acute care clinics without insurance. Here in Kansas City, we have multiple services Swope Childrens Mercy and others that I don't want to google. Both of those have payment option plans. As a parent, one should acknowledge that having children comes with costs. Just cuz you got knocked up doesn't mean that society should step up just because. NOW... there are some situations that public assistance IS important.... but if you have the ability to take Bobby to Childrens Mercy for a clinic appointment (even if it might cost you $25 or $50), why would you think "I'm just gonna take him to the ER"? But... MANY do. The culture change is very unlikely to happen.... But that is the preferred solution.

Then Bobby gets Reyes Syndrome from the ASA and has to go to the ER... Now a VERY SICK lil Bobby.... maybe even a dying Bobby And the parents then go to the lawyers.

Bacon. Lots of it. BLT. Filet wrapped in bacon. Bacon and eggs. Bacon wrapped turkey. Medical answer? Diet. Exercise. Medications. Close monitoring by cardiology peoples. But... where's the fun in that?

so if we see YOU screw yourself into the ground we should just throw a cell phone onto YOUR carcass and say ' hey, call your insurance company, I'm sure you planned all this out' and walk away ? according to you we have NO responsibility at all and can happily watch you croak while we sip the latte's we pay for. Absolutely Correct. I have NO personal responsibility fix to someone elses problem. HOWEVER, I can CHOOSE to assist by focusing my practice on that population. I can CHOOSE to assist by donating to inner city hospitals. I can CHOOSE to assist by stopping and asking people if they need help. OR I can CHOOSE to sip my latte that I bought with money that I made. I don't want the government telling me to buy EVERYONE a latte. I don't want the government telling me to bail everyone out of jail. I don't want the government telling me to take care of every bad decision made by someone in a moment of passion. I help because I feel it's the right thing to do. Some people don't. I don't want the government telling us we HAVE TO.

Wanna know about the pregnant patients on medicaid with iPhones?

Agreed. But you are being VERY NAIVE to think that socialized health care will be a happy shiny wonderful rainbow. There is a culture change that will need to occur if that is going to work. Lets talk about YOUR version of the future. Socialized medicine starts tomorrow. Everybody is covered. Everybody is happy. EXCEPT..... more people present to the system. ER's get more bogged down. Family Practice clinics are now booked (or double booked) months into the future. So rather than actually see these people, the PCP's refer out some of them without even seeing those people. Specialty clinics get overbooked with inappropriate referrals. Those specialists now complain about the work that the PCP should be doing and file complaints against the PCP and the PCP gets fined for the inappropriate referral. (cuz rest assured, "Big Brother" will be watching over) Also... pay schedules... trust me, Medicaid does NOT pay so very well. The majority of my practice is made up of that population. (Luckily, I'm not needing to do this job for the money) More patients complain because they're "entitled" to health care. More people get mad and indignant about not being seen in the right time frame or by the right doctor. More lawsuits. (there will always be more lawsuits) More doctors get frustrated with the system. Increased work with ungrateful and demanding patients that think they are "owed." Increased risk (not personal, but rather professional) Decreased return (despite high cost and sacrifice) Then you get... Less doctors. How's that future looking? Let me parallel some things for you here. In the post above, the one where I mentioned the family member that wondered if she should sue her OB for her ventral hernia. Well... she also tried to advise me on some things when I broke my ankle a year and a half ago. I broke it during a landing on New Years Day... at Z-Hills. Can you guess the line of her thinking? (Just so you don't feel too threatened, not only did she mention Z-Hills, but also thoughts about the ortho that I was seen by at the Z-Hills hospital.) Now, imagine her and 30 patients (jumpers) like that a day. Even if they don't all sue for things that you had no control over, even if you win the lawsuit (and don't think that signing those lil sheet will save you) ... at what point do you become frustrated and just shut it down? At what point do you consider the risk not worth the return? It's WONDERFUL to enjoy your job, whether it's as a physician or running a dropzone... but when that job starts to become threatening - and yes.... there are MANY parts about the socialized medicine plan that are threatening... how long do you do it?

As far as I understand, at least some of the malpractice suits are filed because the treatment to fix the medical error is expensive, and without such a suit the patient would have to pay for it out of pocket because the system provides no other way to recover the costs. Putting this into 'government tier' responsibility layer - because in the government doctor scenario the government is ultimately their malpractice insurer - might get rid of at least this type of lawsuits. Drug research is also a large scale problem. As far as I know, vast majority of the countries around the world does little to no drug research on their own, and just getting a free ride on research done by U.S. and Germany. This is something to decide on international level as well. You are right. Some of the lawsuits are brought on due to true negligence and fault of the physician. And if that person has no insurance, than it would be the responsibility of the individual to cover those costs and those are valid reasons to seek legal assistance IF talking with the hospital and physician group doesn't progress.... but MANY suits are NOT due to negligence. Seriously. I know that I'm using a sample size of one, but this personal example (from a family member) is a VERY COMMON issue for physicians. My relative had a upper abdominal hernia (meaning the tissue had separated and the bowel was pooching through the upper abdomen) She is on medicaid (one of those already getting health care from the government) and had the surgery about 2 weeks ago. It was repaired. She's recovering, but she called wanting to know if I thought it was the fault of her OB/Gyn from her cesarean that was done 2.5 yrs ago.... Cesarean scar is right above the pubic bone... NOT in the upper abdomen. But people look for someone to blame... and in many cases, for someone to sue. She doesn't have a job, and searching for a job was limited by having to have the hernia repaired, so she's trying to get (extort) money from SOMEONE. It's becoming the norm to find someone to sue for money. I don't think that will change. I can't even change my family.... how could I possibly think to change the mindset of a nation? Your points on the pharmacologic research are valid too. Only thing that I would add in the defense of the international community would be to comment that A LOT of the trials are done in foreign countries, so that could be included in their assistance. They might not give monies, but that does help with testing. (reason again goes back to the paragraph above) [-and maybe I am becoming jaded... but I really do get tired of working for those that wont, for taking care of those that will not take care of themselves, for having to support other adults as I would for children. I do have some compassion. I do not want to see others in pain. And I do help to try to fix problems.... but I can't be the only one.]

Very well thought out with some good ideas on some of the main problems.... but I doubt there will be much malpractice reform here. I can hope, but I doubt it. It's too indoctrinated into the culture and the lawyers on Capital Hill have no desire to blame the medical-legal side of the house for any portion of the problem

There are A LOT bigger problems than the "right wing nut-jobs." But it's so much easier to simplify and demonize those with opininions different from yours. But, since you seem to think that there are only two problems and one of them is a part of the American population themselves... then by all means, make all changes that YOU seem to think would be best. (sarcasm there... I am in NO WAY granting you approval to make my vote for me)

Thank you for clarifying that. I commend both of you for helping with those that truly need help.... but the actions that you have done have worked to help children; children that have been abandoned, abused and are in need of someone to trust. It takes true grace to give them that. But... that discussion is not the same as discussing abortion beliefs. Then why did she bring it up? Cuz I think she was offended by the "killing foster kids" type comments. (as I would be too if I were adopting) So she was trying to let you know more about her history/background. Her opinion is as valid as yours and in reality she has no need to defend the WHY's of her beliefs, but I believe that your comment was so caustic to her that she felt she had to respond in defense. But if you had read post #59, the initial paragraph was restating to PREVENT THE PREGNANCY.... (the second paragraph was just to allow you the benefit of knowing her background) - note: This is just MY opinion on why she brought it up. Ask her.

Thank you for clarifying that. I commend both of you for helping with those that truly need help.... but the actions that you have done have worked to help children; children that have been abandoned, abused and are in need of someone to trust. It takes true grace to give them that. But... that discussion is not the same as discussing abortion beliefs.

I appreciate your adoptions, and while it is not at the same level, I spent 2 years of my life looking after 12 DJJ kids 24 hours a day 5 (and sometimes 7) days a week at a wilderness facility. These were kids who's parents had abandoned them or didn't care enough about them to teach them how to be "decent human beings" so we spent between 9 months and 18 months teaching them how to be civilized. This was sleeping in a bug net in the middle of the everglades. So while I apperciate you saying you are "helping the problem" but my 2 years with 12 kids equals about 24 years looking after 1 foster kid. NOt trying to say you are not doing something, more so that I have also done my "trying to make the world a better place one kid at a time". I'm trying understand what you're saying here but it's NOT coming off how it should. It's rather confusing to read. Are you arguing against her beliefs or her acts? Or are you saying "ok, you help, but I do 'x'." This post really just makes you look rather ... rude (I guess would be the correct word) I might not always agree with perengrinerose about other things, but I'm having a VERY HARD TIME finding fault with her comments and even a harder time understanding if your post is an insult or a "me too." type statement. I guess I'm just trying to say: I think you might want to rephrase or rethink those comments.

Although we've never met and don't even regularly chat on here, I hope you heal well! The body generally wants to recover... hopefully with the right care and a positive attitude, you'll amaze everyone!! Good Luck!!!

Congratulations!! I love my Macs!

You could buy her a beautiful Tommy gun. Or a taser. Or something sweet like that.

Sushi IS fucking awesome. Compared to dog shit it is! Pickle juice. Olive juice. Sushi. No love for the salty taste. So... ummm. can we imply what your opinion is on swallowing? Actually, that's one thing I'm all for! Good girl!! Protein is good for you. (but it is kinda odd that you would dislike other salty "liquids"... maybe a consistency thing)

Sushi IS fucking awesome. Compared to dog shit it is! Pickle juice. Olive juice. Sushi. No love for the salty taste. So... ummm. can we imply what your opinion is on swallowing?

Mmmm...and Waffle House! I GREATLY enjoy going to the "awful house"!! The people watching there is AMAZING!! Love the smell of: baked cookies wet canvas - old military tents bleach or chlorine in a swimming pool musty old books in a quiet dark library wet leaves wood burning (stove, bonfire) cigars I need to add shotgun powder (went to the rifle range today... ) cilantro

That is SUCH A CUTE STYLE!! Tell her she looks wonderful!!!

That association make sense. I went on pubmed and found Are nonpharmacological induced rewards related to anhedonia? A study among skydivers. Franken IH, Zijlstra C, Muris P. Prog Neuropsychopharmacol Biol Psychiatry. 2006 Mar;30(2):297-300. Epub 2005 Nov 21.Click here to read

It has been a lovely weekend so far. Too windy/gusty to jump. Too many tasks on the list. But lovely!! Went to a lecture on "Proteomic biomarker discovery in preterm birth - learning to walk before we can run." Then a dinner with some friends years ago. Then some rum.

I'll concede that fact! Hey, stand by for some linkage to the week long vacation to Glacier National Park we just returned to. I'm about 1/2 through the picture upload to Picasa. Sounds wonderful.. I loved Banff when I visited there.

Mmmm...and Waffle House! I GREATLY enjoy going to the "awful house"!! The people watching there is AMAZING!! Love the smell of: baked cookies wet canvas - old military tents bleach or chlorine in a swimming pool musty old books in a quiet dark library wet leaves wood burning (stove, bonfire) cigars

Dug through the whole clinic. Nope. No long plastic spoons. Lots of speculums. some biopsy stuffs. a pap thing or two... but couldn't find no long plastic spoons. So that spoon my doc used came from home? kitchen down the hall. for the root beer floats. just wash them between uses.