it's come to this

Lots of difficult thorny issues everywhere. I'm totally exhausted and I want to retire. No joke.

Another altercation with an elderly don't-take-away-my-Medicare cohort. This patient actually put white tape over his Medicare Card ID number, photocopied it, and presented this copy to my front desk staff. Sotto voce, he states he will verbally tell us his Medicare ID number because he's been told by the feds to never carry it around because it can be fraudulently used.

***my eyes are rolling into my skull****

Yessirree, BUT YOU NEED TO PRESENT IT WHEN YOU ARE GETTING HEALTH CARE FROM A DOCTOR OR HOSPITAL.

I CAN'T TAKE THE WILES OR THE GAMES FROM THEM ANYMORE!!!!!!

My personal brick wall has gone up. No card, no service. Go home. Go see another doctor. I'm not playing your game.

When the doctor cares TOO much

I've had an interesting scenario develop. A few months ago, a local doctor referred several patients to me for dermatological care, and I was grateful. The patients were happy. Everything was nice. However, a little thing called "snowbird season" happened. In southwest Florida, hordes of retirees from the northern half of the country descend to flee the cold weather from December-May. Often, these patients are in a tizzy to return home in the spring and put off their health issues.
We tried like heck to get a certain lady from Boston with a skin cancer on her nose, referred by this cardiologist. Many faxes and phone calls ensued. She was scheduled. Then she didn't show up. When we called, she said she had to "go back home to Boston".
Today the cardiologists' wife, his office nurse, came in to find out what happened. I told her plainly, you cared more than the patient. The patient didn't care that she had a skin cancer, a colon cancer, a defibrillator, whatever. The patient ultimately is the arbiter of what happens and why. Nobody can force the patient into the medical realm. The nurse looked at me and blinked hard. She is 20 years older than me and she still has a paternalistic view of "we know what's best for the patient". Yes, this is true oftentimes. But people have complicated lives and dramas and if their health isn't their priority, how can it be for us? How can it be for any doctor? We need to step back and accept that people won't do what they need to do. As doctors, we need to accept that maxim, and move on.
Moral of the story, and this is something I stand by 100%: I only want to treat patients who want treatment. Sounds simple, but it's not. I will not treat a husband dragged by his wife who declares there's nothing wrong with him. I will not go to a patient's home and drag them to my office to get a biopsy.

Harsh

These are dark times. Boston terror attacks with innocents killed and maimed, schoolchildren shot up in classrooms in Connecticut, missing and kidnapped women screaming for escape from a run down Cleveland snake pit...it's constant awfulness. I don't have an answer but it makes me want to carry a concealed weapon. I feel scared and vulnerable in crowds and I know law enforcement cannot do what they're supposed to do. Increasingly, ordinary people save the day.

This may sound harsh and brutal but the heinous crimes are demanding this--public bloody executions. Any f***tard thinking about it, doing it, or having done it, will have to take pause.

I cannot imagine the families of these victims, or how the survivors feel, my heart goes out to them.
I'm always astounded when there's invariably an interview with a mother/father/sister and they just seem so grateful and they say,"no, we do not want to wish harm on the criminals". I put myself in their shoes and I'd seriously have a problem being so forgiving. I think I'd volunteer to administer the death penalty myself to these evil criminals if a family member is victimized like this.

stick a fork in me, I'm done

Believe me, I hate having to ask people to fill out 10 forms and get all sorts of data from birthdate to social security number when registering patients in my practice. In particular the social security number is necessary because a) insurance companies identify patients via that number along with other data to make sure the patient is the correct one b) there are people that present fictitious data thus I must protect my business from fraud.
If a patient pays cash then we don't need ID's or anything, of course. But with third party payors, we need a lot of info to file claims and to get paid. I don't make the rules, I follow them.
Here's where it gets sticky and complicated. Patients are urged at every turn to never give out their social security number. But their Medicare is their social security number plus a letter, or if through a private payor then there's that info registered with the home plan. I need that info to get paid. In particular, if people are delinquent in payment and collections have to be retained, a social security number is needed, it's like a loan done by a financial institution. You go anywhere, get a fishing license, get a car or insurance, get labs drawn by a phlebotomist, you must give your SS#. If you don't give it, you may be refused service.

If a patient refuses to give this info then I have the right to refuse service. Period.

I also love it when retired octogenarian FBI agents threaten me for not calling them back within an hour. Yeah, because you're important. Sorry but the cynical side springs to life with these situations.  Don't pull rank. Be nice. 

Sequester=sesquestrar, to take hostage

The sequester, a last minute harikari device employed a few years by Mr. Obama to get the debt ceiling raised, will drop Medicare payments to physicians for some reason on April 1st. I can't find anything on the CMS website about this, au naturel.
The hilarious thing is the guy says the Repubs invented it. Some of us have excellent memory and refuse the obfuscation now thrown at us.

Govt will kill the goose and then what? It's an Orwellian world, we are in it. It's not coming, it's here.

Jr must be included

A whole slew of Medicare claims are rejecting if the last name does not include the "Jr" that the patient may or may not have on his Medicare ID card. Really? This level of nitpicking is unprecedented.

I really will laugh the loudest when they start denying procedures and hospitalizations left and right. It's coming. I, for one, am glad. The abuses that people inflict on Medicare, "I paid into it so I have a right to have this". Dude, it's not your personal account. It's not your personal property. It's an entitlement conferred onto you by the largesse of the US govt.

Inspiring speech by Marilyn Singleton, MD JD

I am re-posting this inspirational speech made y Dr Marilyn Singleton at the AAPS meeting, she is running for congress in California. She is fed up and makes amazing points here. I wish her all the success, more people who think like this are needed everywhere!

"I was born to be a physician. My grandfather was one of two black students in the 1911 graduating class of Starling Ohio Medical College. He dedicated his life to medicine and helping the low-income folks of Lima, Ohio. My father became an Army Air Force flight surgeon at Tuskegee. As a general practitioner in San Diego, he charged patients what they could afford.Many times we were paid in tamales.

Then came Medicaid. It prohibited doctors from being able to use charity like this. We had high hopes when The Great Society was born: the end of poverty, the end of racial strife. These poverty programs were good intentions gone awry. What social engineer devised a diabolical program forcing a mother in hardship to eject her children’s father from the house in order to get financial assistance? The road to hell began with this kind of “social justice.” Common sense tells me that families in trouble would derive strength from staying together.

The results of the disintegration of the family are fully evident. Unwed motherhood has almost tripled since the 1960s War on Poverty. Seventy-two per cent of Black and fifty-three per cent of Hispanic children are now born to single mothers. Single motherhood quadruples the chance of living in poverty.

Things have gotten worse, not better. Politicians are so arrogant they tell people to “Trust me!” based on faith, not facts. Are we to believe that it works to treat people like helpless victims? The fact is the poverty rate has not changed in 40 years. Are we to believe that a check from a distant rich Uncle (Sam) can erase core problems such as distrust of authority figures, poor education, promiscuity, drug addiction, and violence? The facts show no.

Are we to believe that the federal government is effective at public education? The facts show that the high school dropout rate has remained the same for 40 years, despite the fact that trillions of federal dollars were poured into education. We must support alternatives that offer parental options for educational opportunity. A good education leads to self-reliance and social responsibility. This in turn leads to a good job.

Are we to believe that Medicaid “leveled the playing field” for patients? The fact is that fewer and fewer physicians can take Medicaid due to payments below the cost of providing the services. Where is the “social justice” in a health care system where NO one has quality, individualized care?

We have to change Washington’s way of thinking from “if a social program fails, expand it” to “if it fails, dismantle it.” Today’s policies lead to unhealthy dependence on the federal government. We need instead to encourage independence and freedom. Everyone – at all income levels – suffer from these government-controlled programs because we have more fatherless and poorly-educated children.

Safety nets don’t cure poverty. Education and jobs cure poverty. Family and community are the institutions through which we should help each other. Voting for government bureaucracy is not a surrogate for personally giving our time. Community aid is not only direct, more efficient, and more effective, it is personal. Our personal relationships are crucial to maintaining our civil society.

We can’t let politicians use our differences as a wedge to divide. The rhetoric of class warfare fosters resentment and envy. Class warfare does not sow the seeds of success. Our free enterprise system and the free market of ideas have brought more prosperity and a higher standard of living to the greatest number of people, regardless of race or color.

A free market built on integrity should be protected. We cannot let it be destroyed by excessive entanglement of government with business and crony capitalism. We can use existing laws to weed out bad apples. We do not need suffocating regulations and government control for all.

Finally, we must protect one of the most intimate and life-sustaining bonds in our society: the patient-doctor relationship. Patients entrust their secrets to doctors. How comfortable does it make you feel to know that the National Coordinator of Health Information Technology is watching…or using your personal medical records against you?

Touching lives one at a time is why I became a doctor. Fighting for what’s best for patients is what I do as a physician. "

WOW. I don't live in California anymore but if I did, she'd get my vote.