Hi again -
This one is for a little bit of fun again. I do love watching my medical shows. This week they fared much better.
I watched two different shows - Mercy and Three Rivers. I do love both of them.
I only found one mistake between the two of them this past week.
On Mercy, they were very busy saving a young Asian man who had an injury and became septic. When his heart stopped, the team was doing everything they could to save him - which they eventually did. They were doing CPR, ordering and giving all the correct medications - and then .............. placed a pacemaker - which was a last ditch effort to save him. Well, they placed the pacemaker, captured the rhythm and voiced all of these actions out loud. Too bad when they showed the monitor, it didn't show a paced rhythm like they said. Oh well - good job anyway.
On the other side, no errors this week at all on Three Rivers that I saw. But I do need and want to say one thing. Can any one say EMMY for Mandy Patinkin? Wow - he was amazing - although I guess he usually is. He played an ALS guy who was in an automobile accident. Post recovery, he found out he was going to have to be bed bound on a ventilator. He decided to make himself a DNR and remove himself from life support so he could donate his organs to other people and die a respectable death. He had it all down - even the voice and the movements. I must say I cried multiple times due to interactions with his daughter, the staff and the other patients vying for his organs. This show had a lot of ethical issues that were addressed and they handled them all well as far as I could tell.
Anyway - off this thing for today. I hope everyone is having or will have a Safe, Great and Happy Thanksgiving. I hope everyone is either spending their week with family or friends - or in our case, treating the ill and spending the day with co-workers. Keep the less fortunate in your thoughts.
Thursday, November 26, 2009
New Study shows Uninsured Trauma Patients 80% More Likely to Die than Insured
Hi there everyone -
As I walked into work the other day, I was surprised to find an article posted on the board with the above headline. Wow - Uninsured Trauma Patients 80% more likely to die than the Insured.
The study was conducted by Harvard University and Brigham and Women's Hospital in Boston and the information was extrapolated from the National Trauma Data Bank. They looked at 2.7 million patients from 900 different trauma centers across the US.
This surprised many trauma hospitals, physicians and staff because of the EMTALA laws. These laws are supposed to protect patients without insurance. Anyone presenting to an emergency room is supposed to be treated equally without regard to insurance coverage.
The study seems to conclude otherwise. Patients with private insurance, HMOs and Medicaid all seems to fair equally. Medicare patients died 56% more often and the Uninsured patients died 80% more often.
The researchers thought that the Medicare population was adversely affected by their chronic medical conditions and age. So, they next decided to remove the age and chronic condition criteria - they concentrated on 200,000 + patients from 18 - 30 years of age. Surprisingly the numbers got worse, those uninsured individuals died 89% more often than their insured counterparts.
So why is this happening???? I work in an ER and I still think that we treat anyone that walks through our doors - I don't believe that we withhold care from the uninsured. Anyone else experiencing anything different?
Some studies do show that the uninsured do wait longer to go to the hospital for treatment, maybe too late. Others don't seek care for their chronic conditions so this could make recovery from a trauma more complicated. Studies do show that uninsured individuals do get less testing done and are transferred to rehab. facilities less frequently.
I believe it could also have to do with the type of traumatic injuries these patients are suffering. The age range seems to indicate that maybe the high risk behaviors they participate in and the injuries they suffer from them attribute to these numbers. But then again, why are the insured in this age group surviving more?
I also believe it may have something to do with the course of the treatment of the uninsured. I believe that the uninsured do get the same treatment in the ER or trauma center- but I do believe at some point after stabilization, these patients may get transferred to some other hospital or rehab centers. Post -stabilization care, treatments, tests and maybe even staffing or after discharge followup and compliance may also be hidden factors in these outcomes.
So I hate to sound like a broken record - but how much money do we sink into these bad outcomes? Would it change if we insured everyone? Would it cost less to save them? Maybe they would get out of the hospital sooner if we were already treating their chronic conditions.
Are we proving that we give sub maximal care to the uninsured?
What do you think?
As I walked into work the other day, I was surprised to find an article posted on the board with the above headline. Wow - Uninsured Trauma Patients 80% more likely to die than the Insured.
The study was conducted by Harvard University and Brigham and Women's Hospital in Boston and the information was extrapolated from the National Trauma Data Bank. They looked at 2.7 million patients from 900 different trauma centers across the US.
This surprised many trauma hospitals, physicians and staff because of the EMTALA laws. These laws are supposed to protect patients without insurance. Anyone presenting to an emergency room is supposed to be treated equally without regard to insurance coverage.
The study seems to conclude otherwise. Patients with private insurance, HMOs and Medicaid all seems to fair equally. Medicare patients died 56% more often and the Uninsured patients died 80% more often.
The researchers thought that the Medicare population was adversely affected by their chronic medical conditions and age. So, they next decided to remove the age and chronic condition criteria - they concentrated on 200,000 + patients from 18 - 30 years of age. Surprisingly the numbers got worse, those uninsured individuals died 89% more often than their insured counterparts.
So why is this happening???? I work in an ER and I still think that we treat anyone that walks through our doors - I don't believe that we withhold care from the uninsured. Anyone else experiencing anything different?
Some studies do show that the uninsured do wait longer to go to the hospital for treatment, maybe too late. Others don't seek care for their chronic conditions so this could make recovery from a trauma more complicated. Studies do show that uninsured individuals do get less testing done and are transferred to rehab. facilities less frequently.
I believe it could also have to do with the type of traumatic injuries these patients are suffering. The age range seems to indicate that maybe the high risk behaviors they participate in and the injuries they suffer from them attribute to these numbers. But then again, why are the insured in this age group surviving more?
I also believe it may have something to do with the course of the treatment of the uninsured. I believe that the uninsured do get the same treatment in the ER or trauma center- but I do believe at some point after stabilization, these patients may get transferred to some other hospital or rehab centers. Post -stabilization care, treatments, tests and maybe even staffing or after discharge followup and compliance may also be hidden factors in these outcomes.
So I hate to sound like a broken record - but how much money do we sink into these bad outcomes? Would it change if we insured everyone? Would it cost less to save them? Maybe they would get out of the hospital sooner if we were already treating their chronic conditions.
Are we proving that we give sub maximal care to the uninsured?
What do you think?
Monday, November 16, 2009
This Week in Medical Show Critique - I Play a Doctor on TV - BUT Do I ever Wear a Mask????
Hi everyone -
I thought I'd once again do a little critique on the medical mistakes we see on TV. Maybe you've seen some as well - if so feel free to post them here.
It's kind of funny to think we live this every day and some of the shows do a really good job, others not so much. But I still love to watch them - for me, it's more about escapism - I love it when they make me laugh and cry. I still do have the urge to scream though when they're doing a great job and then mess up - medically speaking.
So the theme of the last week or so shows seem to be their ability to screw up the use of masks - any kind of masks.
First I was watching Three Rivers - which I love. The medical consultants were doing such a great job with all medical aspects of the show. I was very impressed with their portrayal of the "John Ritter syndrome" case. The patient was having chest pain and had ST elevation on his EKG. The star of the show wanted to wait for the CXR results - but oh no, the other doctor just wanted to give TNK and head to the cath. lab. Oops - guess what - dissecting aneurysm and now the thought of this patient dying on the table.
After a lot of show casing - first they tried a balloon expandable stent graft - which I must say was pretty amazing to watch. I've never seen one in person - but they used fluoroscopy and it showed it in real time which was way cool. Of course, it didn't really work.
A few hours later when the patient was ready to crash, they cut him open and repaired it surgically - of course after giving him lots of FFP to reverse the thrombolytics they had pumped him full of earlier. And success, the patient lived. All in all, pretty impressive.
So it was with great dismay that they could pull something off this complicated, and they can't put a nonrebreather mask on correctly - it was flat as a pancake. The whole scene was killing me - I was saying, "could you please blow that darn bag up just a little so the patient doesn't suffocate?"
Then the next show was Mercy. Again, loving this show. Love all the drama - all the dysfunctional family dynamics and all the whackiness of some of the characters.
I also think they do pretty good with the nursing aspects - they're not too over the top. They do just basic medical things so far, a lot of bedside stuff and stay away from portraying complicated medical practices.
So this show was about a chemo patient who was going to get a bone marrow transplant. They were sooo good in portraying the cleanness of the room - the patient's kids had given her a teddy bear and it was in plastic. The staff all had on gowns and hats and shoe covers and MASKS - but they were around their necks. Now, why oh why go to so much trouble to show the white room but make it not so white. lol. Now, I know they're actors and we want and need to see their faces - but ...... oh well.
And one more thought on last week's Mercy. I don't think we needed to give the family another blow to deal with - they're already dysfunctional enough - they didn't have to give the dad Alzheimers too.
And by the way - can you say hot fireman-nurse sex in the storage closet? Oh yes they did.
Of course, they hit the nail on the head about the whole firemen thing. They made him a hot dog - and what I mean by that - he's hot - but he's a dog - he's married and the nurse he's having sex with in the closet doesn't know. And all her nurse friends told her not to fall for him - "he's just to play with, not to get hooked on." lol
Anyway, off this thing for now. Just having some fun. Got a diamond today !
I thought I'd once again do a little critique on the medical mistakes we see on TV. Maybe you've seen some as well - if so feel free to post them here.
It's kind of funny to think we live this every day and some of the shows do a really good job, others not so much. But I still love to watch them - for me, it's more about escapism - I love it when they make me laugh and cry. I still do have the urge to scream though when they're doing a great job and then mess up - medically speaking.
So the theme of the last week or so shows seem to be their ability to screw up the use of masks - any kind of masks.
First I was watching Three Rivers - which I love. The medical consultants were doing such a great job with all medical aspects of the show. I was very impressed with their portrayal of the "John Ritter syndrome" case. The patient was having chest pain and had ST elevation on his EKG. The star of the show wanted to wait for the CXR results - but oh no, the other doctor just wanted to give TNK and head to the cath. lab. Oops - guess what - dissecting aneurysm and now the thought of this patient dying on the table.
After a lot of show casing - first they tried a balloon expandable stent graft - which I must say was pretty amazing to watch. I've never seen one in person - but they used fluoroscopy and it showed it in real time which was way cool. Of course, it didn't really work.
A few hours later when the patient was ready to crash, they cut him open and repaired it surgically - of course after giving him lots of FFP to reverse the thrombolytics they had pumped him full of earlier. And success, the patient lived. All in all, pretty impressive.
So it was with great dismay that they could pull something off this complicated, and they can't put a nonrebreather mask on correctly - it was flat as a pancake. The whole scene was killing me - I was saying, "could you please blow that darn bag up just a little so the patient doesn't suffocate?"
Then the next show was Mercy. Again, loving this show. Love all the drama - all the dysfunctional family dynamics and all the whackiness of some of the characters.
I also think they do pretty good with the nursing aspects - they're not too over the top. They do just basic medical things so far, a lot of bedside stuff and stay away from portraying complicated medical practices.
So this show was about a chemo patient who was going to get a bone marrow transplant. They were sooo good in portraying the cleanness of the room - the patient's kids had given her a teddy bear and it was in plastic. The staff all had on gowns and hats and shoe covers and MASKS - but they were around their necks. Now, why oh why go to so much trouble to show the white room but make it not so white. lol. Now, I know they're actors and we want and need to see their faces - but ...... oh well.
And one more thought on last week's Mercy. I don't think we needed to give the family another blow to deal with - they're already dysfunctional enough - they didn't have to give the dad Alzheimers too.
And by the way - can you say hot fireman-nurse sex in the storage closet? Oh yes they did.
Of course, they hit the nail on the head about the whole firemen thing. They made him a hot dog - and what I mean by that - he's hot - but he's a dog - he's married and the nurse he's having sex with in the closet doesn't know. And all her nurse friends told her not to fall for him - "he's just to play with, not to get hooked on." lol
Anyway, off this thing for now. Just having some fun. Got a diamond today !
Monday, November 9, 2009
The Military and the Ball and Chain that Holds Their Members
Hi everyone -
Just a little note today - curious about what every one's thoughts are on the military contract with it's members.
In light of the tragedy at Fort Hood this week, I'm questioning the responsibility that a member of the Armed Forces has with the establishment. I'm wondering if things could have been different if they had just left this person out of the military. What do you think? Is there a way they could have discharged him? Is there another way he could have repaid his financial obligation?
Being an ex-military wife, I'm fully aware of the adage "If the military wanted you to have a wife, they would have issued you one." They've always been known for their bold and brass techniques to keep you in their fold, to beat you down so you can't really think for yourself, to stay loyal to the beast, to be strong in hard times.
Now, be clear, I'm not saying the Military isn't a wonderful place for a special kind of person. I totally respect and honor every member of the service that is there due to their personal beliefs and desires, those that are loyal - those who fight for our freedoms and country - those who love this tight knit community. But I do think, it's not for everyone. And I do feel that a great many people of my generation joined the military for the wrong reasons.
At the very least, in the 70s and 80s, it was a time of peace. It still remains a time of opportunity to escape the high unemployment rates of our small home towns, the towns where blue collar jobs are disappearing. It is still a time of educational opportunities where most young people will never be able to afford to continue their education, learn a skill, climb the ladder, move away from their small towns. And maybe it is even a time of opportunity to escape the violence of our towns and cities - either in our own families or a life of crime and violence that we have chosen. It used to be the only choice young people had - when the local law enforcement said you had to join the military or go to jail.
Obviously this person who shot many co-workers was in a lot of turmoil and for years. He apparently tried many times to get out of the military. He even offered to pay back the money he felt he used to get his education. I'm guessing, and I do mean just that, as I didn't know him, that there were moral and religious beliefs that were involved. And I truly believe there were a lot of emotional problems - both personally and also because of the travesties that he heard day in and day out from the soldiers returning from battle. If I recall correctly, some of the most affected people from times of war are the mental health professionals and the chaplains. Both have to hear people struggling everyday because of what they'd been through and their problems with reintegrating into society. And I do believe no one took him seriously. He had been investigated and nothing happened. Maybe he was calling out for help?
So what do we do now? Times are different. We're at war. Some people don't believe in war.
Why do we not question some people's internal conflicts when their own religious beliefs or cultural background are in play? In World War II, some of the Japanese men who were in internment camps fought for our Country - but our Country was sensitive to them - either because they didn't trust them or they didn't want them to have to kill their own people. They didn't ask them to fight against their own - they fought in other countries instead and proved their loyalty without this internal conflict.
Do we change the way we handle these situations in the future? Does the military determine how much money they spend on a members education so that if this same situation happens in the future, these members can be discharged? Can they repay the military in a dollar amount instead of a "years due" manner?
Why does the Military actually want to keep someone who isn't there 100% mentally and physically? Why would they want to keep someone who is bad for other soldiers' morale? Why would they want to keep someone who then chooses to open fire on innocent victims.
Will anything change? Well, I think I know the answer - they'll apologize to the families of the innocent victims for missing the tell tale signs. But unfortunately nothing will really change. Members won't be discharged. This man's mental health will be blamed. The government will need to step up their commitment in addressing the mental health toll it's taking on it's members.
What a shame - so many lives lost on our own ground. What is the price of war - a war that may or may not even be ours to fight???
At some point, I'd like to visit a subject close to this one - requiring young people to actually volunteer for a Country's welfare - something like a mandatory draft - but not all on a military scale. I think it would help with the unemployment rate. It would help these young people find their way when they aren't sure what they want to do. It could help them see the world, get an education, learn a skill and give back. What do you think?
See you soon.
Just a little note today - curious about what every one's thoughts are on the military contract with it's members.
In light of the tragedy at Fort Hood this week, I'm questioning the responsibility that a member of the Armed Forces has with the establishment. I'm wondering if things could have been different if they had just left this person out of the military. What do you think? Is there a way they could have discharged him? Is there another way he could have repaid his financial obligation?
Being an ex-military wife, I'm fully aware of the adage "If the military wanted you to have a wife, they would have issued you one." They've always been known for their bold and brass techniques to keep you in their fold, to beat you down so you can't really think for yourself, to stay loyal to the beast, to be strong in hard times.
Now, be clear, I'm not saying the Military isn't a wonderful place for a special kind of person. I totally respect and honor every member of the service that is there due to their personal beliefs and desires, those that are loyal - those who fight for our freedoms and country - those who love this tight knit community. But I do think, it's not for everyone. And I do feel that a great many people of my generation joined the military for the wrong reasons.
At the very least, in the 70s and 80s, it was a time of peace. It still remains a time of opportunity to escape the high unemployment rates of our small home towns, the towns where blue collar jobs are disappearing. It is still a time of educational opportunities where most young people will never be able to afford to continue their education, learn a skill, climb the ladder, move away from their small towns. And maybe it is even a time of opportunity to escape the violence of our towns and cities - either in our own families or a life of crime and violence that we have chosen. It used to be the only choice young people had - when the local law enforcement said you had to join the military or go to jail.
Obviously this person who shot many co-workers was in a lot of turmoil and for years. He apparently tried many times to get out of the military. He even offered to pay back the money he felt he used to get his education. I'm guessing, and I do mean just that, as I didn't know him, that there were moral and religious beliefs that were involved. And I truly believe there were a lot of emotional problems - both personally and also because of the travesties that he heard day in and day out from the soldiers returning from battle. If I recall correctly, some of the most affected people from times of war are the mental health professionals and the chaplains. Both have to hear people struggling everyday because of what they'd been through and their problems with reintegrating into society. And I do believe no one took him seriously. He had been investigated and nothing happened. Maybe he was calling out for help?
So what do we do now? Times are different. We're at war. Some people don't believe in war.
Why do we not question some people's internal conflicts when their own religious beliefs or cultural background are in play? In World War II, some of the Japanese men who were in internment camps fought for our Country - but our Country was sensitive to them - either because they didn't trust them or they didn't want them to have to kill their own people. They didn't ask them to fight against their own - they fought in other countries instead and proved their loyalty without this internal conflict.
Do we change the way we handle these situations in the future? Does the military determine how much money they spend on a members education so that if this same situation happens in the future, these members can be discharged? Can they repay the military in a dollar amount instead of a "years due" manner?
Why does the Military actually want to keep someone who isn't there 100% mentally and physically? Why would they want to keep someone who is bad for other soldiers' morale? Why would they want to keep someone who then chooses to open fire on innocent victims.
Will anything change? Well, I think I know the answer - they'll apologize to the families of the innocent victims for missing the tell tale signs. But unfortunately nothing will really change. Members won't be discharged. This man's mental health will be blamed. The government will need to step up their commitment in addressing the mental health toll it's taking on it's members.
What a shame - so many lives lost on our own ground. What is the price of war - a war that may or may not even be ours to fight???
At some point, I'd like to visit a subject close to this one - requiring young people to actually volunteer for a Country's welfare - something like a mandatory draft - but not all on a military scale. I think it would help with the unemployment rate. It would help these young people find their way when they aren't sure what they want to do. It could help them see the world, get an education, learn a skill and give back. What do you think?
See you soon.
Sunday, November 8, 2009
Inching Towards Health Care Reform
Hi it's me again.
I'm writing just a little update on the Health Care Reform Topic. Good news - ever so slow, but inching towards a bill being passed.
Last night, the House passed their Health Care Reform Bill by a narrow margin. They got 220 votes, needed 218. Yikes!
Anyway, it's good news because it means now the Senate can call for their vote as well. The House Bill was pretty wide and all encompassing, so expect the Senate Bill to be more conservative so that in negotiations, they can meet somewhere in the middle. Politics, politics, my pretties!
I'd like to urge everyone to actually read this bill. It's huge, a lot of verbage. But if you really want to know what's actually there, please feel free. And it's a lot better than listening to all the negative talking points and little snippets out of context that everyone has. Yes there are some regulations, OK a lot of them - but they are there to protect the citizens. There is also a lot of reform and change in this bill.
Stayed tuned here for updates and talking points. I'm going to try to read a little each day so that I can keep everyone informed on what's actually in the final bill.
I think it's important to remember that this is all a slow process. I know a majority of Americans voted for President Obama wanting change. If you remember, he always said it in his speeches - he said that things may not be different for years, some things wouldn't get accomplished even in his first 4 years. Change is slow, a lot slower than we'd all like. We're a generation of instant gratification. And it's hard to ask people who aren't working or who are drowning in debt, to be patient. But we all need to do just that.
Once we get past this big hurdle and I sure hope we do - at least in some effective form, we can all move on to other important issues that will get our economy back on track.
So if you want to check out the bill, click here. It's not a great copy. You have to click back and forth on all the sections. I'm guessing in a few days, there will be a complete copy online. Or you can go to this link - this is a copy of the 1990 page bill without the amendments.
Anyway, take care and keep checking back.
I'm writing just a little update on the Health Care Reform Topic. Good news - ever so slow, but inching towards a bill being passed.
Last night, the House passed their Health Care Reform Bill by a narrow margin. They got 220 votes, needed 218. Yikes!
Anyway, it's good news because it means now the Senate can call for their vote as well. The House Bill was pretty wide and all encompassing, so expect the Senate Bill to be more conservative so that in negotiations, they can meet somewhere in the middle. Politics, politics, my pretties!
I'd like to urge everyone to actually read this bill. It's huge, a lot of verbage. But if you really want to know what's actually there, please feel free. And it's a lot better than listening to all the negative talking points and little snippets out of context that everyone has. Yes there are some regulations, OK a lot of them - but they are there to protect the citizens. There is also a lot of reform and change in this bill.
Stayed tuned here for updates and talking points. I'm going to try to read a little each day so that I can keep everyone informed on what's actually in the final bill.
I think it's important to remember that this is all a slow process. I know a majority of Americans voted for President Obama wanting change. If you remember, he always said it in his speeches - he said that things may not be different for years, some things wouldn't get accomplished even in his first 4 years. Change is slow, a lot slower than we'd all like. We're a generation of instant gratification. And it's hard to ask people who aren't working or who are drowning in debt, to be patient. But we all need to do just that.
Once we get past this big hurdle and I sure hope we do - at least in some effective form, we can all move on to other important issues that will get our economy back on track.
So if you want to check out the bill, click here. It's not a great copy. You have to click back and forth on all the sections. I'm guessing in a few days, there will be a complete copy online. Or you can go to this link - this is a copy of the 1990 page bill without the amendments.
Anyway, take care and keep checking back.
Thursday, November 5, 2009
Wednesday, October 28, 2009
When It's Your Time, It Must be Your Time
Hi everyone -
I have just enough time, to write a short little bit about something that happened at work this week. I haven't really been able to get it out of mind for a couple of days.
I was having this wonderful day the other day - I was totally in love with my job and all my patients for the day - which isn't always the case. No one could seem to get on my nerves.
I had this cute little 5 year old girl who was such a joy. She never made a peep when I poked her for her IV. And she even told me, it didn't hurt at all. I could not believe it. How can some people just scream and cry and carry on - and this little girl, who really wasn't sick, not make a peep. Amazing.
I also had this nice guy whose wife worked somewhere in the hospital. He was just a crackup with a sick sexual sense of humor.
Then, there was this really nice lady with this amazingly nice family. We joked around all day long and talked about a lot of personal things - mostly gardening and some hot peppers that I had been growing and sharing with my co-workers. Thanks to Duane, we were having a good laugh - especially with his translation from Spanish to English for habanero.
Anyway, I knew this lady had a new diagnosis and probably a weakened heart. But at 80+, she'd been doing pilates, yoga and some aerobic exercises less than 2 weeks later. She was feeling a little short of breath and weak - but her troponins were negative. We thought she'd just spend the night, get an echo of her heart and go home with some new medications and a few more good years. I left that day without saying good bye to her or her family.
A couple hours later, she coded - not once, not twice - but probably 8 - 10 times before finally moving on to some place else - hopefully very peaceful and joyful.
I guess that just really does prove when it's your time, it's your time. When you're in the hospital and on the monitor and you go into VFib - get shocked and shocked and shocked - keep coming back - and you still don't make it. Sometimes, it's just so bizarre to me.
I'm guessing I wished at this point, I had gone back in the room before I left, to say what I usually do - I'm leaving. I hope you get better and get to go home quickly. It's been fun spending the day with you. I hope I run into you at Walmart or McDonalds sometime.
I have just enough time, to write a short little bit about something that happened at work this week. I haven't really been able to get it out of mind for a couple of days.
I was having this wonderful day the other day - I was totally in love with my job and all my patients for the day - which isn't always the case. No one could seem to get on my nerves.
I had this cute little 5 year old girl who was such a joy. She never made a peep when I poked her for her IV. And she even told me, it didn't hurt at all. I could not believe it. How can some people just scream and cry and carry on - and this little girl, who really wasn't sick, not make a peep. Amazing.
I also had this nice guy whose wife worked somewhere in the hospital. He was just a crackup with a sick sexual sense of humor.
Then, there was this really nice lady with this amazingly nice family. We joked around all day long and talked about a lot of personal things - mostly gardening and some hot peppers that I had been growing and sharing with my co-workers. Thanks to Duane, we were having a good laugh - especially with his translation from Spanish to English for habanero.
Anyway, I knew this lady had a new diagnosis and probably a weakened heart. But at 80+, she'd been doing pilates, yoga and some aerobic exercises less than 2 weeks later. She was feeling a little short of breath and weak - but her troponins were negative. We thought she'd just spend the night, get an echo of her heart and go home with some new medications and a few more good years. I left that day without saying good bye to her or her family.
A couple hours later, she coded - not once, not twice - but probably 8 - 10 times before finally moving on to some place else - hopefully very peaceful and joyful.
I guess that just really does prove when it's your time, it's your time. When you're in the hospital and on the monitor and you go into VFib - get shocked and shocked and shocked - keep coming back - and you still don't make it. Sometimes, it's just so bizarre to me.
I'm guessing I wished at this point, I had gone back in the room before I left, to say what I usually do - I'm leaving. I hope you get better and get to go home quickly. It's been fun spending the day with you. I hope I run into you at Walmart or McDonalds sometime.
Tuesday, October 13, 2009
The Public Option Broken Down
Hi all -
Good news today - well at least fair news on the health care reform front - the Senate Finance Committee got a bill through their committee. Although it's a really watered down bill, at least it's a start - and it's progress. Now on to meshing them all together. I need to get back to reading now that they've actually gotten somewhere.
And with the report out yesterday from Pricewaterhouse Coopers, there's no time like the present to talk about the Public Option.
First, let me review their report with you. I have to say, I think it's a bit funny and sad at the same time. It seems like the insurance companies, which may have been feigning their support all along, holding out for the last minute to drop a bomb or two, got caught up in the circus over the last couple of days.
It seems that the insurance companies had an "independent" review board conduct some kind of a study after reviewing just part of the Senate Finance Committee bill - the part they paid them to review. Surprise, surprise. They predict that insurance rates will increase by 111% over the next 10 years. Let's put that in more tangible figures - By 2019:
Single people will see their premiums increase $1,500.00 per year. Families will pay $4,000.00 more per year.
A further breakdown shows that single people now pay approximately $4,600.00 yearly. With the current system, these rates will increase to $8,200.00 yearly. Under the Baucus plan, these rates will increase to $9,700.00 yearly.
Families pay approximately $12,300.00 yearly. With the current system, projected rates would increase to $21,900.00 yearly. Under the Baucus plan, these rates would be $25,900.00 yearly.
Now keep in mind, under the current system we have, they are still projecting a 79% inflation rate.
Now, that's just ridiculous - especially since wage growth only averages 3 - 4 % annually.
And even more ridiculous - the insurance industry just shot themselves in the foot by releasing that report. Maybe they thought they could scare the people or the congress by talking about how high premiums would continue to rise. I guess no one stopped to think, well, if they can't control their own growth in their own premiums - maybe, just maybe we should have a public option.
Let's talk about what a Public Option is and how it could benefit or hinder health care reform.
Let's hit the basics first - what is a Public Option when we're talking about health care?
Basically, all it is is another company, the government, competing for business in the health insurance industry.
Right now there are a lot of different insurance companies -Aetna, Blue Cross/Blue Shield, Cigna, Kaiser, etc.... Technically speaking, because there are so many different insurance companies, they should be able to keep each other in check - to help keep prices competitive and affordable. Unfortunately, in most of the country, more than 70% of the market is controlled by one insurance company. This is bad for the market, as there is no competition from other companies to help keep premiums affordable. Plus, there is no way that providers, doctors or hospitals, can negotiate for better prices for services. And as the companies get bigger, they just keep buying each other out. In the last 10 years, there have been more than 400 health care related mergers.
With the Public Option, congress is hoping it would keep the insurance companies under control. Because the government has fewer overhead expenses, they can run their "business" a little cheaper. They can also negotiate cheaper fees for services provided, and this would force the insurance companies to be more competitive with their prices, to offer superior plans and to give excellent service.
Let's review some of systems that have a government agency in force already, ones that compete with the private sector.
First up - the obvious choice to discuss is the US Postal Service. Now granted, private companies like UPS, DHL and FedEx came about partly because of this agency's inefficiency and poor service. But let's be honest, someone would have eventually figured out they could make money off of something that most of us need daily in our lives - sending stuff from one place to another.
So let's take a look at these companies. They all seem to compete on a fairly even level. They all ship packages for about the same prices. They each have their own little niche they fill.
DHL, who tried to compete in the US, finally turned their domestic shipping over to UPS, I think. Guess why - they weren't making any money here. They still are excellent and competitive with international shipping services.
FedEx is relatively more expensive but they're known for their excellent service and speedy deliveries. They also provide some of their shipping materials for free. They have the best online package tracking system of them all.
UPS's fortes are their speed of service and their 100.00 worth of insurance for free. They also have cheaper shipping rates for larger packages.
The US Postal Service is still the cheapest form of shipping for many things. None of the other companies can ship - or do they try to ship - a letter for $.44. Guess why - they can't compete. Plus in comparison, a small priority mail package can be shipped by them for $4.95. The other three carriers can't compete with that. Their cheapest packages ship for over $10.00. The USPS also offers some of their shipping materials for free. They do have a 70 lb limit on packages though and their online tracking system isn't very efficient.
Funny, I think the private companies have made the Public Option pick up it's game. I have to say it's been a long time since the USPS has lost something I've sent. I think they've learned to become more efficient and concentrate more on their customer service.
So when making your choices on who you give your business to, it's on a very personal level - what kind of package are you sending, what kind of expectations do you have, what will the cost be. These are all things you consider and I don't think you really say, "Well, I'm not going to pick the Public Option because they don't compete fairly with the private sector." Maybe I'm wrong, do you?
Now, let's move on to our Education System. There are plenty of public and private schools - in primary, secondary and collegiate level education. Public schools are subsidized by our tax dollars; private schools are owned and run by private companies for a profit and charter schools are somewhere in between. Charter schools are subsidized by our tax dollars, but run by private companies for a profit. 75% of schools are public, 25% private.
Interesting enough, private schools have been good for the Public Option. They've made the public schools pick up their game. And public schools are good for private schools as well. Private schools now have to offer something special - something worth paying more for.
In comparison - public/state school tuition is generally less than $10,000.00 a year; private school tuition is anywhere from $30,000.00 - $120,000.00 a year. On the other hand, there are more grants and scholarships available for private schools.
There are a lot of regulations for public schools, where as next to none for private schools. The private schools pretty much make up their own rules. Some private schools don't even require their teachers to have college degrees or state licensure. Public schools have to follow all the anti-discrimination laws as well - private schools, not so much. And believe it or not, recent studies show that public school scores are as high and even higher in some areas.
Now, again, when making a decision about where you or your family goes to school, a lot of personal choice comes to mind. I think it's nice to be able to choose. I think we choose what works best for our family, our children - I'm guessing we decide with a lot of factors in mind - what the school has to offer, curriculum, location, costs, etc. I'm sure there's also some perceived thought that if we're paying more, we must be getting more for our dollar. I'm not sure that's always the case. Again, I'm not sure we think, well, we aren't going to even look at that school as it's a Public School.
Let's move on to another Public Option in the insurance industry. This one should make you chuckle a little bit - especially if you read my earlier blog about how the government programs take the biggest hit on the sickest and poorest people - while the insurance companies make billions off of us.
Have you ever heard of the National Flood Insurance Program? I know, in the past, I almost bought a house that was in a flood zone - not knowing of course, how much it would cost me to insure the place and it's contents.
Well after some of the horrible hurricanes over the past few years, most insurance companies started to drop their clients and they refused to pay a great deal of flood claims, through loopholes in their policies. After Hurricanes Rita and Katrina they denied numerous claims saying that the water destroyed the properties before the wind could. The private insurers decided there wasn't any money to be made. Well, guess who stepped in - the government. The private insurance companies still run these programs, but it's 100% backed by the government with our tax dollars of course. And this insurance is MANDATORY.
Funny, some of the senators that have been so nasty about the Public Option in Health Care - like Grassley, Enzi, Snowe and some other 44 Republicans - voted for this flood insurance program. And even funnier, the more conservative states have used the most money from the program - North Carolina, Mississippi, Wisconsin, Florida, Illinois, Missouri, Indiana, Iowa, Louisiana - and ........ wait for it ....... Texas. Texas has benefited the most. They've taken 1.5 billion dollars in claims. 682,000 people have turned in claims under this program.
So, I say what's the harm in having a Public Option? Come on people, weigh in.
I know, some people are going to say that the government competes unfairly in business against the private sector - they may put the private companies out of business. On the other hand, a lot of us choose to spend a little bit more money going to the UPS or Fed Ex store to ship our packages because we want to, because it's an option, because we can. I say bring it on, I'll choose it if I think it's just what I'm looking for, what's right for me and my family, for a price I can afford - because I can if I want - it's my choice.
I also say the insurance companies should say the same, bring it on. If they think they have a great product, give excellent service, are as efficient as they can be and their clientele are satisfied, then it should be a non-issue for them as well. My question to them, do they actually have a product or service to offer me that is worth paying more for????
And in closing, I must say, that the Public Option in itself will not solve the inflationary problems we have with the health care system. Competition can only help control costs so much. I'm guessing that's why Pres. Obama said it was only a small part of the whole picture.
From 1970 - 2000, Health Care spending increased by 11% in the private sector and 9.5% in the Medicare system. From 2000 - 2004, it increased by 9.5% in the private sector and 6.7% in the Medicare system. So although, you can say the government program is inefficient, just by price comparisons alone, you can see that the government program still does a little better than the private insurance industry. But sadly, the increases on either side are just too much.
What we really need more than anything is health care reform. A strong Public Option and Health Care Reform has to happen and has to happen now. We need to control costs, reduce waste and fraud. We need to restructure the payment system to pay for performance programs - quality of care, not quantity. We need to have a national information technology system - all computers, all providers talking to each other, sharing their tests and results - prevent duplication of services. We need transparency in the health care delivery system - we need to know who is charging how much for what and what their outcomes in care are. We need to form a committee that studies and implements best clinical practices for all patients. And last but not least, we have to find ways to increase access to all Americans. I can not say it enough ACCESS, ACCESS, ACCESS. We need more community health centers, more primary doctors and staff. We need to start now.
Let's do some brainstorming together to see where we can cut costs - what we can do to turn this machine around. Tell me your ideas.
More later. Off this thing for now.
Good news today - well at least fair news on the health care reform front - the Senate Finance Committee got a bill through their committee. Although it's a really watered down bill, at least it's a start - and it's progress. Now on to meshing them all together. I need to get back to reading now that they've actually gotten somewhere.
And with the report out yesterday from Pricewaterhouse Coopers, there's no time like the present to talk about the Public Option.
First, let me review their report with you. I have to say, I think it's a bit funny and sad at the same time. It seems like the insurance companies, which may have been feigning their support all along, holding out for the last minute to drop a bomb or two, got caught up in the circus over the last couple of days.
It seems that the insurance companies had an "independent" review board conduct some kind of a study after reviewing just part of the Senate Finance Committee bill - the part they paid them to review. Surprise, surprise. They predict that insurance rates will increase by 111% over the next 10 years. Let's put that in more tangible figures - By 2019:
Single people will see their premiums increase $1,500.00 per year. Families will pay $4,000.00 more per year.
A further breakdown shows that single people now pay approximately $4,600.00 yearly. With the current system, these rates will increase to $8,200.00 yearly. Under the Baucus plan, these rates will increase to $9,700.00 yearly.
Families pay approximately $12,300.00 yearly. With the current system, projected rates would increase to $21,900.00 yearly. Under the Baucus plan, these rates would be $25,900.00 yearly.
Now keep in mind, under the current system we have, they are still projecting a 79% inflation rate.
Now, that's just ridiculous - especially since wage growth only averages 3 - 4 % annually.
And even more ridiculous - the insurance industry just shot themselves in the foot by releasing that report. Maybe they thought they could scare the people or the congress by talking about how high premiums would continue to rise. I guess no one stopped to think, well, if they can't control their own growth in their own premiums - maybe, just maybe we should have a public option.
Let's talk about what a Public Option is and how it could benefit or hinder health care reform.
Let's hit the basics first - what is a Public Option when we're talking about health care?
Basically, all it is is another company, the government, competing for business in the health insurance industry.
Right now there are a lot of different insurance companies -Aetna, Blue Cross/Blue Shield, Cigna, Kaiser, etc.... Technically speaking, because there are so many different insurance companies, they should be able to keep each other in check - to help keep prices competitive and affordable. Unfortunately, in most of the country, more than 70% of the market is controlled by one insurance company. This is bad for the market, as there is no competition from other companies to help keep premiums affordable. Plus, there is no way that providers, doctors or hospitals, can negotiate for better prices for services. And as the companies get bigger, they just keep buying each other out. In the last 10 years, there have been more than 400 health care related mergers.
With the Public Option, congress is hoping it would keep the insurance companies under control. Because the government has fewer overhead expenses, they can run their "business" a little cheaper. They can also negotiate cheaper fees for services provided, and this would force the insurance companies to be more competitive with their prices, to offer superior plans and to give excellent service.
Let's review some of systems that have a government agency in force already, ones that compete with the private sector.
First up - the obvious choice to discuss is the US Postal Service. Now granted, private companies like UPS, DHL and FedEx came about partly because of this agency's inefficiency and poor service. But let's be honest, someone would have eventually figured out they could make money off of something that most of us need daily in our lives - sending stuff from one place to another.
So let's take a look at these companies. They all seem to compete on a fairly even level. They all ship packages for about the same prices. They each have their own little niche they fill.
DHL, who tried to compete in the US, finally turned their domestic shipping over to UPS, I think. Guess why - they weren't making any money here. They still are excellent and competitive with international shipping services.
FedEx is relatively more expensive but they're known for their excellent service and speedy deliveries. They also provide some of their shipping materials for free. They have the best online package tracking system of them all.
UPS's fortes are their speed of service and their 100.00 worth of insurance for free. They also have cheaper shipping rates for larger packages.
The US Postal Service is still the cheapest form of shipping for many things. None of the other companies can ship - or do they try to ship - a letter for $.44. Guess why - they can't compete. Plus in comparison, a small priority mail package can be shipped by them for $4.95. The other three carriers can't compete with that. Their cheapest packages ship for over $10.00. The USPS also offers some of their shipping materials for free. They do have a 70 lb limit on packages though and their online tracking system isn't very efficient.
Funny, I think the private companies have made the Public Option pick up it's game. I have to say it's been a long time since the USPS has lost something I've sent. I think they've learned to become more efficient and concentrate more on their customer service.
So when making your choices on who you give your business to, it's on a very personal level - what kind of package are you sending, what kind of expectations do you have, what will the cost be. These are all things you consider and I don't think you really say, "Well, I'm not going to pick the Public Option because they don't compete fairly with the private sector." Maybe I'm wrong, do you?
Now, let's move on to our Education System. There are plenty of public and private schools - in primary, secondary and collegiate level education. Public schools are subsidized by our tax dollars; private schools are owned and run by private companies for a profit and charter schools are somewhere in between. Charter schools are subsidized by our tax dollars, but run by private companies for a profit. 75% of schools are public, 25% private.
Interesting enough, private schools have been good for the Public Option. They've made the public schools pick up their game. And public schools are good for private schools as well. Private schools now have to offer something special - something worth paying more for.
In comparison - public/state school tuition is generally less than $10,000.00 a year; private school tuition is anywhere from $30,000.00 - $120,000.00 a year. On the other hand, there are more grants and scholarships available for private schools.
There are a lot of regulations for public schools, where as next to none for private schools. The private schools pretty much make up their own rules. Some private schools don't even require their teachers to have college degrees or state licensure. Public schools have to follow all the anti-discrimination laws as well - private schools, not so much. And believe it or not, recent studies show that public school scores are as high and even higher in some areas.
Now, again, when making a decision about where you or your family goes to school, a lot of personal choice comes to mind. I think it's nice to be able to choose. I think we choose what works best for our family, our children - I'm guessing we decide with a lot of factors in mind - what the school has to offer, curriculum, location, costs, etc. I'm sure there's also some perceived thought that if we're paying more, we must be getting more for our dollar. I'm not sure that's always the case. Again, I'm not sure we think, well, we aren't going to even look at that school as it's a Public School.
Let's move on to another Public Option in the insurance industry. This one should make you chuckle a little bit - especially if you read my earlier blog about how the government programs take the biggest hit on the sickest and poorest people - while the insurance companies make billions off of us.
Have you ever heard of the National Flood Insurance Program? I know, in the past, I almost bought a house that was in a flood zone - not knowing of course, how much it would cost me to insure the place and it's contents.
Well after some of the horrible hurricanes over the past few years, most insurance companies started to drop their clients and they refused to pay a great deal of flood claims, through loopholes in their policies. After Hurricanes Rita and Katrina they denied numerous claims saying that the water destroyed the properties before the wind could. The private insurers decided there wasn't any money to be made. Well, guess who stepped in - the government. The private insurance companies still run these programs, but it's 100% backed by the government with our tax dollars of course. And this insurance is MANDATORY.
Funny, some of the senators that have been so nasty about the Public Option in Health Care - like Grassley, Enzi, Snowe and some other 44 Republicans - voted for this flood insurance program. And even funnier, the more conservative states have used the most money from the program - North Carolina, Mississippi, Wisconsin, Florida, Illinois, Missouri, Indiana, Iowa, Louisiana - and ........ wait for it ....... Texas. Texas has benefited the most. They've taken 1.5 billion dollars in claims. 682,000 people have turned in claims under this program.
So, I say what's the harm in having a Public Option? Come on people, weigh in.
I know, some people are going to say that the government competes unfairly in business against the private sector - they may put the private companies out of business. On the other hand, a lot of us choose to spend a little bit more money going to the UPS or Fed Ex store to ship our packages because we want to, because it's an option, because we can. I say bring it on, I'll choose it if I think it's just what I'm looking for, what's right for me and my family, for a price I can afford - because I can if I want - it's my choice.
I also say the insurance companies should say the same, bring it on. If they think they have a great product, give excellent service, are as efficient as they can be and their clientele are satisfied, then it should be a non-issue for them as well. My question to them, do they actually have a product or service to offer me that is worth paying more for????
And in closing, I must say, that the Public Option in itself will not solve the inflationary problems we have with the health care system. Competition can only help control costs so much. I'm guessing that's why Pres. Obama said it was only a small part of the whole picture.
From 1970 - 2000, Health Care spending increased by 11% in the private sector and 9.5% in the Medicare system. From 2000 - 2004, it increased by 9.5% in the private sector and 6.7% in the Medicare system. So although, you can say the government program is inefficient, just by price comparisons alone, you can see that the government program still does a little better than the private insurance industry. But sadly, the increases on either side are just too much.
What we really need more than anything is health care reform. A strong Public Option and Health Care Reform has to happen and has to happen now. We need to control costs, reduce waste and fraud. We need to restructure the payment system to pay for performance programs - quality of care, not quantity. We need to have a national information technology system - all computers, all providers talking to each other, sharing their tests and results - prevent duplication of services. We need transparency in the health care delivery system - we need to know who is charging how much for what and what their outcomes in care are. We need to form a committee that studies and implements best clinical practices for all patients. And last but not least, we have to find ways to increase access to all Americans. I can not say it enough ACCESS, ACCESS, ACCESS. We need more community health centers, more primary doctors and staff. We need to start now.
Let's do some brainstorming together to see where we can cut costs - what we can do to turn this machine around. Tell me your ideas.
More later. Off this thing for now.
Monday, October 12, 2009
My Latest You Tube Video - Country in Crisis
Hi there -
Well here's my 3rd you tube video. Let me just say this one was not easy. It took me like 20 hours to finally get it all together and then get the editing software to actually do it's thing. I would not be defeated though and finally beat it.
This is not for the faint at heart. The message is clear - we better get it together as a country - all the fighting has never really worked out well for us. Time to play nice and take care of things that need to be taken care of.
Let's muscle through the rest of the health care reform stuff so we can move on to the wars and the energy situation. Once we start talking about green energy, more jobs can be created and we can start to be on the road to some sort of financial recovery.
Have a great day everyone. More on health care and the public option next.
Well here's my 3rd you tube video. Let me just say this one was not easy. It took me like 20 hours to finally get it all together and then get the editing software to actually do it's thing. I would not be defeated though and finally beat it.
This is not for the faint at heart. The message is clear - we better get it together as a country - all the fighting has never really worked out well for us. Time to play nice and take care of things that need to be taken care of.
Let's muscle through the rest of the health care reform stuff so we can move on to the wars and the energy situation. Once we start talking about green energy, more jobs can be created and we can start to be on the road to some sort of financial recovery.
Have a great day everyone. More on health care and the public option next.
Saturday, October 10, 2009
Weekly Medical Show Critique
Hi everyone -
Well, today I thought I'd start out on a lighter note - it came to me last night while watching tv that it might be fun to write about some of the medical writing errors of today's tv shows.
Last night I watched the pilot of Three Rivers - which I have to say, I kind of enjoyed. I think it was a bit of a new idea for a medical show - set in a transplant hospital - with the hot Alex O'Loughlin from the undead Moonlight. I have to admit that I only watched it because I wanted to see O'Loughlin again. I was pleasantly surprised at the direction of the show, I enjoyed a lot of the subtle things about the medical field - sense of humor, use of our need for food all the time. lol. Then I caught the writers with their pants down a couple of times - at least 3. 2 may be forgivable - but one I just can't let go.
Mistake #1 was at the bedside of a dying patient - the doctor taking care of the patient brought up the whole donor aspect with the distraught wife. This just doesn't happen anymore. The medical professionals taking care of the patient are not supposed to be involved in the harvesting conversation. Here in CA, we're to call Legacy One and their representative is to come out and discuss this with the family to assure that there aren't any conflicts of interest. But, on my scale, forgivable sin - because this opened up the conversation later in the show to actually talk about the process and the conflicts involved.
Mistake #2 near the end of the show - showing the circle of life. It was a wonderful scene - the saved new mother with a new heart getting to see her brand new newborn on video. The electronic records and information technology aspects of the show are amazing. They have computer screens everywhere on the walls and windows. Anyway, just not realistic to think someone who just woke up from her heart transplant would already be extubated with a little nasal cannula on - and that her beautiful 28 weeker would be held by her husband in the nursery looking like a 6 month old. Again, forgivable for tv delivery. Cute moment for closing.
Mistake #3 - never ever forgivable. They were so on cue during the code in the beginning of the show. I was impressed. Then, when the pregnant girl codes again later, they defibrillate asystole. Oh noooooooooo. During CPR, there's only two heart rhythms that you can defibrillate safely and they are ventricular fibrillation/vfib and pulseless ventricular tachycardia/vtach. Not forgivable - who on earth was the medical adviser on this scene?
Anyway, overall an enjoyable fresh new show with a good pretty cast. We'll see how long it lasts.
Anyone else out there catch this show and see anymore medical mistakes? Let me know.
And then on a personal note, it was kind of funny watching the show because they were talking about cardiomyopathy and 10% ejection fractions and it just so happens that my favorite KP patient was in the ER yesterday. I always enjoy this man, he's just a joy for someone who is so chronically ill. He's been my patient many times over the last 9 years and even when he's not my patient, I actively seek him out to say Hi and see how he's doing.
I'd like to give a kudos to KP here and applaud a look into the future of health care reform. This is a man that normally would have died years ago. His heart is just a weak, weak muscle. He's got multiple chronic conditions - COPD, Diabetes, CHF, Cardiomyopathy just to name a few. He made himself a DNR years ago with a lot of discussion with his family and medical professionals. Yesterday he told me that he may be taken off Hospice/Palliative care now as he's doing so well. The Chronic Condition Department has been working with him and his family now very diligently, trying to keep him healthy and out of the hospital - which is one of the big goals of health care reform - cutting down on costs be preventing readmissions for the same diagnoses.
Apparently it works. So wow, if we're going to start paying for preventative services and better outcomes - to me, it looks like it just might work on several levels - the patients do better and we can cut costs and save money. Kudos.
Take care. More later on the public option.
Well, today I thought I'd start out on a lighter note - it came to me last night while watching tv that it might be fun to write about some of the medical writing errors of today's tv shows.
Last night I watched the pilot of Three Rivers - which I have to say, I kind of enjoyed. I think it was a bit of a new idea for a medical show - set in a transplant hospital - with the hot Alex O'Loughlin from the undead Moonlight. I have to admit that I only watched it because I wanted to see O'Loughlin again. I was pleasantly surprised at the direction of the show, I enjoyed a lot of the subtle things about the medical field - sense of humor, use of our need for food all the time. lol. Then I caught the writers with their pants down a couple of times - at least 3. 2 may be forgivable - but one I just can't let go.
Mistake #1 was at the bedside of a dying patient - the doctor taking care of the patient brought up the whole donor aspect with the distraught wife. This just doesn't happen anymore. The medical professionals taking care of the patient are not supposed to be involved in the harvesting conversation. Here in CA, we're to call Legacy One and their representative is to come out and discuss this with the family to assure that there aren't any conflicts of interest. But, on my scale, forgivable sin - because this opened up the conversation later in the show to actually talk about the process and the conflicts involved.
Mistake #2 near the end of the show - showing the circle of life. It was a wonderful scene - the saved new mother with a new heart getting to see her brand new newborn on video. The electronic records and information technology aspects of the show are amazing. They have computer screens everywhere on the walls and windows. Anyway, just not realistic to think someone who just woke up from her heart transplant would already be extubated with a little nasal cannula on - and that her beautiful 28 weeker would be held by her husband in the nursery looking like a 6 month old. Again, forgivable for tv delivery. Cute moment for closing.
Mistake #3 - never ever forgivable. They were so on cue during the code in the beginning of the show. I was impressed. Then, when the pregnant girl codes again later, they defibrillate asystole. Oh noooooooooo. During CPR, there's only two heart rhythms that you can defibrillate safely and they are ventricular fibrillation/vfib and pulseless ventricular tachycardia/vtach. Not forgivable - who on earth was the medical adviser on this scene?
Anyway, overall an enjoyable fresh new show with a good pretty cast. We'll see how long it lasts.
Anyone else out there catch this show and see anymore medical mistakes? Let me know.
And then on a personal note, it was kind of funny watching the show because they were talking about cardiomyopathy and 10% ejection fractions and it just so happens that my favorite KP patient was in the ER yesterday. I always enjoy this man, he's just a joy for someone who is so chronically ill. He's been my patient many times over the last 9 years and even when he's not my patient, I actively seek him out to say Hi and see how he's doing.
I'd like to give a kudos to KP here and applaud a look into the future of health care reform. This is a man that normally would have died years ago. His heart is just a weak, weak muscle. He's got multiple chronic conditions - COPD, Diabetes, CHF, Cardiomyopathy just to name a few. He made himself a DNR years ago with a lot of discussion with his family and medical professionals. Yesterday he told me that he may be taken off Hospice/Palliative care now as he's doing so well. The Chronic Condition Department has been working with him and his family now very diligently, trying to keep him healthy and out of the hospital - which is one of the big goals of health care reform - cutting down on costs be preventing readmissions for the same diagnoses.
Apparently it works. So wow, if we're going to start paying for preventative services and better outcomes - to me, it looks like it just might work on several levels - the patients do better and we can cut costs and save money. Kudos.
Take care. More later on the public option.
Wednesday, October 7, 2009
A Special Commentary - A Must See Video
Hi everyone -
Since the health care debate started, I've heard and seen a lot of stuff that's irritated me, angered me, inspired me - made me laugh, made me cry and made me cuss. Today, while I was at my desk getting caught up on some emails and paperwork, I had MSNBC on in the background. I do like to watch a few of their shows on occasion - but was ultimately surprised at what I heard today.
I always thought of Keith Olbermann as a little over the top - he does report the news - but was a little over the top in the delivery. I've listened to him many times over the last several months - and I was sure that he was the greenest of the commentators on health care issues. He never really seemed to grasp the policies or bills. He was quick with the rhetoric - but didn't seem to hone in on the details like some of the others did.
Well tonight was a lot different. If you have time, watch the video to listen to his own personal family story about health care and his personal views on the need for health care reform.
These are the stories we all need to hear while all this fighting and lying is going on - personal stories of real life health care in crisis and people being genuinely emotional and impassioned.
Hang in there - sometimes he's ranting and raving, sometimes he's angry - but he's truly moved by the illnesses that have occurred recently to his own mom and dad. He's near tears many times - and Kevin and I were in tears several times just listening.
I especially appreciated his challenge at the end. He asks free clinics to set up a day in each of the cities of Senate Finance Committee members that are against some of the reform. It's a challenge I'd certainly like to see.
Enjoy:
I promise - this weekend back to blogging on my own.
Take care.
Since the health care debate started, I've heard and seen a lot of stuff that's irritated me, angered me, inspired me - made me laugh, made me cry and made me cuss. Today, while I was at my desk getting caught up on some emails and paperwork, I had MSNBC on in the background. I do like to watch a few of their shows on occasion - but was ultimately surprised at what I heard today.
I always thought of Keith Olbermann as a little over the top - he does report the news - but was a little over the top in the delivery. I've listened to him many times over the last several months - and I was sure that he was the greenest of the commentators on health care issues. He never really seemed to grasp the policies or bills. He was quick with the rhetoric - but didn't seem to hone in on the details like some of the others did.
Well tonight was a lot different. If you have time, watch the video to listen to his own personal family story about health care and his personal views on the need for health care reform.
These are the stories we all need to hear while all this fighting and lying is going on - personal stories of real life health care in crisis and people being genuinely emotional and impassioned.
Hang in there - sometimes he's ranting and raving, sometimes he's angry - but he's truly moved by the illnesses that have occurred recently to his own mom and dad. He's near tears many times - and Kevin and I were in tears several times just listening.
I especially appreciated his challenge at the end. He asks free clinics to set up a day in each of the cities of Senate Finance Committee members that are against some of the reform. It's a challenge I'd certainly like to see.
Enjoy:
Visit msnbc.com for Breaking News, World News, and News about the Economy
I promise - this weekend back to blogging on my own.
Take care.
Friday, October 2, 2009
Health Care Reform You Tube Video #2
Hi everyone -
Here's my second You Tube Video. This one is for some TV ad competition. It could only be 30 seconds. That was by far much harder than I imagined - Getting a message out in 30 seconds or less.
Click here.
I'll be back blogging in no time flat - next up - the public option .......
Here's my second You Tube Video. This one is for some TV ad competition. It could only be 30 seconds. That was by far much harder than I imagined - Getting a message out in 30 seconds or less.
Click here.
I'll be back blogging in no time flat - next up - the public option .......
Tuesday, September 29, 2009
The New Public Option - Traveling Abroad for Health Care
Hi everyone -
Today as the Senate Finance Committee plays some more head games with American lives, I decided to do some research on a different aspect of universal health care - what I think I'll call The New Public Option.
I've been hearing very little scuttlebutt on what I'd consider a pretty good option in health care - medical tourism - traveling abroad for affordable, comprehensive health care packages. I find it particularly funny that I don't hear a whole lot of media or government officials discussing this particular option we now have as Americans. There are a lot of companies out there offering travel abroad for the needed affordable care that our own country is not offering our citizens. Of course, I've heard numerous party representatives talking about how Canadians or Britains come to the US for their care because they just despise their socialized medicine. But I find it quite interesting that a lot of Americans are going abroad as well as our own system is failing just way too many of our citizens.
At first glance, I think it would be pretty scary to go to some other nation, where I've always heard they give second rate care, you get what you pay for, no regulation or FDA approval, etc... But when I did a little research and also looked at numerous forums, I'm finding something quite to the contrary. People are getting affordable, top rated comprehensive care for their needed and elective procedures and care. And they're being treated like kings and queens during the process. I think the US has a lot to learn about medical care meets outstanding customer service.
Many of the larger hospitals in major metropolitan areas like India, Thailand, South Africa, Costa Rica, Argentina and Dubai offer medical tourism packages which include your surgery and a short recovery vacation. Some of these hospitals even have big names attached to them - like John Hopkins International Hospital in Singapore. Many have several accreditations including US endorsed. Many other citizens go across the borders to Canada and Mexico to save money on medications and treatment. It's estimated that anywhere from 150,000 - 1 million people cross the borders annually for their medical care. Some employers are now offering medical tourism packages to their employees as a way of saving big dollars for their employees needs.
I was surprised to read about the advanced technology and treatments for complicated diseases as well as world-wide known doctors these places have snagged. And surprisingly, I found most studies show that some foreign nations have about the same and even better patient outcomes as far as cure and remission rates for chronic illnesses like cancer and seizures. Also, the foreign country infection rates are far below some of the US facility rates.
Costs alone are a huge motivator in people going abroad for their care. With our 40 million plus uninsured and under-insured population, employers and people a like would be crazy not to take advantage of some of these packages. For instance, a hip replacement in the US costs approximately $65,000.00, only $8,000.00 abroad; a face lift costs approximately $20,000.00 in the US, only $1250.00 abroad and a heart valve replacement costs approximately $200,000.00 in the US and only $10,000.00 abroad. Keep in mind that these abroad costs cover everything - round trip airfare for two, all pre-op and post-op costs, a short stay-cation with a personal nurse and room service in a 5 star hotel setting. It's kind of like surgery meets spa day.
Click here to read a little bit about this publication - "Patients beyond Borders". Just look at the slide show that shows these amazingly aesthetic facilities.
Now I'd be irresponsible to think that all abroad care is up to "our" standards or safe, but I think it might just be something to look into, research, visit, compare, etc.. Fair Market anyone???? I think if the insurance companies and some of the US citizens are afraid of government run programs or getting control of costs through major reform, what will they think of outsourcing our health care as well??? Talk about something that could put all the insurance companies out of business. New Public Option anyone???
Let me know what you think ! Would you go abroad for an elective surgery, prescription refill, dental work. I think it would be pretty scary - but then on the other hand, if I weren't insured or weren't insured enough, I'd think I'd consider it. No waiting list, great doctors, great facilities, a spa week - you bet ch'a.
Take care until next time.
Today as the Senate Finance Committee plays some more head games with American lives, I decided to do some research on a different aspect of universal health care - what I think I'll call The New Public Option.
I've been hearing very little scuttlebutt on what I'd consider a pretty good option in health care - medical tourism - traveling abroad for affordable, comprehensive health care packages. I find it particularly funny that I don't hear a whole lot of media or government officials discussing this particular option we now have as Americans. There are a lot of companies out there offering travel abroad for the needed affordable care that our own country is not offering our citizens. Of course, I've heard numerous party representatives talking about how Canadians or Britains come to the US for their care because they just despise their socialized medicine. But I find it quite interesting that a lot of Americans are going abroad as well as our own system is failing just way too many of our citizens.
At first glance, I think it would be pretty scary to go to some other nation, where I've always heard they give second rate care, you get what you pay for, no regulation or FDA approval, etc... But when I did a little research and also looked at numerous forums, I'm finding something quite to the contrary. People are getting affordable, top rated comprehensive care for their needed and elective procedures and care. And they're being treated like kings and queens during the process. I think the US has a lot to learn about medical care meets outstanding customer service.
Many of the larger hospitals in major metropolitan areas like India, Thailand, South Africa, Costa Rica, Argentina and Dubai offer medical tourism packages which include your surgery and a short recovery vacation. Some of these hospitals even have big names attached to them - like John Hopkins International Hospital in Singapore. Many have several accreditations including US endorsed. Many other citizens go across the borders to Canada and Mexico to save money on medications and treatment. It's estimated that anywhere from 150,000 - 1 million people cross the borders annually for their medical care. Some employers are now offering medical tourism packages to their employees as a way of saving big dollars for their employees needs.
I was surprised to read about the advanced technology and treatments for complicated diseases as well as world-wide known doctors these places have snagged. And surprisingly, I found most studies show that some foreign nations have about the same and even better patient outcomes as far as cure and remission rates for chronic illnesses like cancer and seizures. Also, the foreign country infection rates are far below some of the US facility rates.
Costs alone are a huge motivator in people going abroad for their care. With our 40 million plus uninsured and under-insured population, employers and people a like would be crazy not to take advantage of some of these packages. For instance, a hip replacement in the US costs approximately $65,000.00, only $8,000.00 abroad; a face lift costs approximately $20,000.00 in the US, only $1250.00 abroad and a heart valve replacement costs approximately $200,000.00 in the US and only $10,000.00 abroad. Keep in mind that these abroad costs cover everything - round trip airfare for two, all pre-op and post-op costs, a short stay-cation with a personal nurse and room service in a 5 star hotel setting. It's kind of like surgery meets spa day.
Click here to read a little bit about this publication - "Patients beyond Borders". Just look at the slide show that shows these amazingly aesthetic facilities.
Now I'd be irresponsible to think that all abroad care is up to "our" standards or safe, but I think it might just be something to look into, research, visit, compare, etc.. Fair Market anyone???? I think if the insurance companies and some of the US citizens are afraid of government run programs or getting control of costs through major reform, what will they think of outsourcing our health care as well??? Talk about something that could put all the insurance companies out of business. New Public Option anyone???
Let me know what you think ! Would you go abroad for an elective surgery, prescription refill, dental work. I think it would be pretty scary - but then on the other hand, if I weren't insured or weren't insured enough, I'd think I'd consider it. No waiting list, great doctors, great facilities, a spa week - you bet ch'a.
Take care until next time.
Saturday, September 26, 2009
Should we really send more troops to Afghanistan???
Hello everyone -
I'm going a little off track today because of something that piqued my interest
today. I was watching the Bill Moyers Journal today on PBS and saw this interview with Rory Stewart. I took a look at his credentials - he was in the British military and worked for the foreign ministry as a diplomat - but I think I'd call him more of a scholar and humanitarian. His demeanor, which was very calm and gentle impressed me. And his knowledge about the Afghans and their culture as well as his 6000 mile trek across their country and his humanitarian efforts there interested me. I think our government needs to entertain some of his ideas - just maybe a little bit. I think possibly we need more people like this consulting with our government and military leaders when we fight on foreign lands.
Now, granted I pretty much know nothing about war or policy on war. I've always buried my head in the sand about it. I even, as an ex-military wife, just despised the fact that my husband, my family or my friends would ever have to deal with the misery of someone I know and love being some place far away and in danger. Or worse yet, they would be captured, tortured and killed or come home in a body bag.
I am very concerned about our soldiers safety - but also don't know whether we doing more harm than good to the innocent citizens of this foreign country as well. Don't misunderstand me, I want to be able to protect our country, I want to get rid of Al-Qaida as much as the next person - but what I'm questioning now is - are we doing it the right way? Do we continue to go in full force, all in the name of national security and state building? - at the risk of not accomplishing a whole lot of national security and doing more state destroying because we aren't successful on our reasonably short time table. After hearing this interview - I'm concerned that we'll go in with a lot more troops, lose a lot of men/women and not stay in long enough to accomplish the task at hand. Then we'll leave suddenly when the US citizens get tired of it - and leave the country in more shambles.
Take a watch and listen to what the man says. Tell me what you think. Do we need to refocus our goals on what's more realistic and attainable - with some more practical short and long term goals - protecting our national interests, conquering Al-Qaida and starting some humanitarian efforts - with more intel, more special forces - less ground troops.
Copy and paste this link to your browser.
http://www.pbs.org/moyers/journal/09252009/watch.html
I want to say again that I don't know a whole about this subject and am still learning. I don't want to offend anyone or belittle at all what we've done so far and what it's cost anyone.
I'm going a little off track today because of something that piqued my interest
today. I was watching the Bill Moyers Journal today on PBS and saw this interview with Rory Stewart. I took a look at his credentials - he was in the British military and worked for the foreign ministry as a diplomat - but I think I'd call him more of a scholar and humanitarian. His demeanor, which was very calm and gentle impressed me. And his knowledge about the Afghans and their culture as well as his 6000 mile trek across their country and his humanitarian efforts there interested me. I think our government needs to entertain some of his ideas - just maybe a little bit. I think possibly we need more people like this consulting with our government and military leaders when we fight on foreign lands.
Now, granted I pretty much know nothing about war or policy on war. I've always buried my head in the sand about it. I even, as an ex-military wife, just despised the fact that my husband, my family or my friends would ever have to deal with the misery of someone I know and love being some place far away and in danger. Or worse yet, they would be captured, tortured and killed or come home in a body bag.
I am very concerned about our soldiers safety - but also don't know whether we doing more harm than good to the innocent citizens of this foreign country as well. Don't misunderstand me, I want to be able to protect our country, I want to get rid of Al-Qaida as much as the next person - but what I'm questioning now is - are we doing it the right way? Do we continue to go in full force, all in the name of national security and state building? - at the risk of not accomplishing a whole lot of national security and doing more state destroying because we aren't successful on our reasonably short time table. After hearing this interview - I'm concerned that we'll go in with a lot more troops, lose a lot of men/women and not stay in long enough to accomplish the task at hand. Then we'll leave suddenly when the US citizens get tired of it - and leave the country in more shambles.
Take a watch and listen to what the man says. Tell me what you think. Do we need to refocus our goals on what's more realistic and attainable - with some more practical short and long term goals - protecting our national interests, conquering Al-Qaida and starting some humanitarian efforts - with more intel, more special forces - less ground troops.
Copy and paste this link to your browser.
http://www.pbs.org/moyers/journal/09252009/watch.html
I want to say again that I don't know a whole about this subject and am still learning. I don't want to offend anyone or belittle at all what we've done so far and what it's cost anyone.
Thursday, September 24, 2009
Life in the ER - Another Day, An Uninsured
Hi -
I'm just sitting here, taking a break from my day - to think another time about how the health care crisis affects us every day.
I decided that once in awhile, I'll just write a short blip about events that come to mind.
So, today - although I know I've told this story to some people, it's worth repeating.
Not so long ago, I had a patient in the ER that I won't be forgetting any time soon. I was just infuriated at the cost this gentleman has to pay for not being insured.
I don't know a lot about him - except that he was a hard working middle class American. He hadn't had insurance for at least 10 years; he just couldn't afford it. He worked hard to support his family and just hoped that he wouldn't get sick.
Well, in July, 4 weeks from when his Medicare would kick in - he would soon be 65, he dropped a board on his foot at home. It left a little wound on the top of his foot. He cleaned it up and kept an eye on it. About 3 weeks later and only a week before his Medicare would kick in - he woke up having pain. He noticed that his foot was now red and painful and looking kind of bad. Of course, he proceeded to the ER where he knew he would get treatment - like so many other uninsured individuals.
Gangrene had already set it. He was probably diabetic for awhile and didn't even realize it.
Now this was and is very sad - not just for this man and his family, but for all of us.
The man will lose his leg, not be able to work or support his family and have a lot of medical
bills and emotional trauma to come for years - all because he was just trying to hang on for 1 more month. As a nation, we will also lose - this man and probably his family will be our dependents. We'll have to pick up the tab for his uncompensated care. This will also probably take him out of the work force, requiring us to help support his family through other public programs.
I don't know about all you - but I just do not understand why this happens in America and in the 21st century.
My thoughts are with him and his family and the other Americans who suffer needlessly due to the way our health care system is today.
I'm just sitting here, taking a break from my day - to think another time about how the health care crisis affects us every day.
I decided that once in awhile, I'll just write a short blip about events that come to mind.
So, today - although I know I've told this story to some people, it's worth repeating.
Not so long ago, I had a patient in the ER that I won't be forgetting any time soon. I was just infuriated at the cost this gentleman has to pay for not being insured.
I don't know a lot about him - except that he was a hard working middle class American. He hadn't had insurance for at least 10 years; he just couldn't afford it. He worked hard to support his family and just hoped that he wouldn't get sick.
Well, in July, 4 weeks from when his Medicare would kick in - he would soon be 65, he dropped a board on his foot at home. It left a little wound on the top of his foot. He cleaned it up and kept an eye on it. About 3 weeks later and only a week before his Medicare would kick in - he woke up having pain. He noticed that his foot was now red and painful and looking kind of bad. Of course, he proceeded to the ER where he knew he would get treatment - like so many other uninsured individuals.
Gangrene had already set it. He was probably diabetic for awhile and didn't even realize it.
Now this was and is very sad - not just for this man and his family, but for all of us.
The man will lose his leg, not be able to work or support his family and have a lot of medical
bills and emotional trauma to come for years - all because he was just trying to hang on for 1 more month. As a nation, we will also lose - this man and probably his family will be our dependents. We'll have to pick up the tab for his uncompensated care. This will also probably take him out of the work force, requiring us to help support his family through other public programs.
I don't know about all you - but I just do not understand why this happens in America and in the 21st century.
My thoughts are with him and his family and the other Americans who suffer needlessly due to the way our health care system is today.
Tuesday, September 22, 2009
The Old, The Sick, The Disabled - and Insurance Companies
Hi there everyone -
I have time for a quick note - one that I've been thinking about for a couple of days - one I'd like to get your opinions on.
So - what do you think the purpose of insurance companies are? And do you think they should be making money off of sickness and disease???
I was thinking about it. I think that the government has been providing them with a windfall.
If the government runs Medicare, then all people over 65 are covered under Medicare. If the indigent and disabled people of the country are covered under Medicaid, then the government pays for their health care as well. If you're in the military, your health insurance is covered by the VA or Tri-care - so if you were disabled while in the military, the government pays for your medical care.
Now on the flip side, if you have insurance with a private insurance company, and you're not sick or don't really use your insurance much - they keep you as a client. But if you get sick, they drop your coverage. If you meet your lifetime maximums, they don't pay any of your bills. They don't pay your medical bills until you reach your yearly deductibles, cost-sharing and co-pays. And if you have a pre-existing medical condition, you can't get insurance.
How much sense does this make to everyone???? We, or our employers buy insurance just in case we get sick, right???? Then what are the private insurance companies insuring if they aren't insuring us against sickness and disease?
And why are we all afraid of the government providing or running an insurance exchange or public option???? It sure seems like the government is the only one that is actually insuring the sick. I think I've concluded that Medicare, Medicaid, VA, Tri-care - all these government run programs have been a gift to the insurance companies. So while they are off making billions of dollars off of us - until we're sick - then we're all actually footing the bills of the sick. Because it's our tax dollars that are paying for the government run medical programs.
So what's up with all that? In closing, we're paying for insurance we don't need or use through the private insurance companies - plus we're actually paying for everyone else - including ourselves again - when we get sick. So we (the employers and the employees) are actually paying health care premiums, plus the cost of the government run programs (through taxes) - as well as the uncompensated care of the uninsured.
Sure doesn't seem right to me - how about to you??
I have time for a quick note - one that I've been thinking about for a couple of days - one I'd like to get your opinions on.
So - what do you think the purpose of insurance companies are? And do you think they should be making money off of sickness and disease???
I was thinking about it. I think that the government has been providing them with a windfall.
If the government runs Medicare, then all people over 65 are covered under Medicare. If the indigent and disabled people of the country are covered under Medicaid, then the government pays for their health care as well. If you're in the military, your health insurance is covered by the VA or Tri-care - so if you were disabled while in the military, the government pays for your medical care.
Now on the flip side, if you have insurance with a private insurance company, and you're not sick or don't really use your insurance much - they keep you as a client. But if you get sick, they drop your coverage. If you meet your lifetime maximums, they don't pay any of your bills. They don't pay your medical bills until you reach your yearly deductibles, cost-sharing and co-pays. And if you have a pre-existing medical condition, you can't get insurance.
How much sense does this make to everyone???? We, or our employers buy insurance just in case we get sick, right???? Then what are the private insurance companies insuring if they aren't insuring us against sickness and disease?
And why are we all afraid of the government providing or running an insurance exchange or public option???? It sure seems like the government is the only one that is actually insuring the sick. I think I've concluded that Medicare, Medicaid, VA, Tri-care - all these government run programs have been a gift to the insurance companies. So while they are off making billions of dollars off of us - until we're sick - then we're all actually footing the bills of the sick. Because it's our tax dollars that are paying for the government run medical programs.
So what's up with all that? In closing, we're paying for insurance we don't need or use through the private insurance companies - plus we're actually paying for everyone else - including ourselves again - when we get sick. So we (the employers and the employees) are actually paying health care premiums, plus the cost of the government run programs (through taxes) - as well as the uncompensated care of the uninsured.
Sure doesn't seem right to me - how about to you??
Monday, September 21, 2009
My First YouTube Video - Health Care Reform Circus
Hey all -
I finally finished my first Health Care Reform You Tube Video. It's the funny, making fun of people one. There will be a couple more. Hopefully they get easier. Enjoy !
Click here.
http://www.youtube.com/watch?v=PDqX5EXG7pc
I'll be back blogging in a couple of days.
I finally finished my first Health Care Reform You Tube Video. It's the funny, making fun of people one. There will be a couple more. Hopefully they get easier. Enjoy !
Click here.
http://www.youtube.com/watch?v=PDqX5EXG7pc
I'll be back blogging in a couple of days.
Saturday, September 12, 2009
Emergency Room Visits for Non-Urgent Medical Needs
Good Morning to Everyone !
Let's tackle another hot topic of health care - non-urgent use - abuse of ERs. I would like every one's opinion on why people use ERs for their primary care or non-urgent needs. I did a little research and have found that the media, the government, the patient population and medical personnel really have differing thoughts on this - which I find very interesting. As a health care professional, I do like to try to be convinced of the other sides' viewpoints.
So let's take a spin around the googling world. I read several forums and news articles on this subject and there are varying views on the reason people come into ERs and how these costs affect our already broken health care system.
The governmental agencies seem to realize that a big factor in ER use is the broken health care system. They think with broad reform and insuring the entire population, these numbers will decrease significantly. They feel that many more ERs would be able to stay open and the lines would diminish if everyone was insured. The President, the Democrats and Republicans alike all think that if we insured everyone, increased our funding in the public programs and rebuilt our infrastructure to include strong community-based and home-based medical services, we would all be much better off.
The media has an entirely different view of the subject. They claim that most people come to the ER with non-urgent needs for two reasons - that they either are uninsured or have Medicaid and don't have access to providers they can see - as doctors are refusing care in the clinic settings for nonpayment. So they trickle into the ER where they know legally they have to be seen due to EMTALA laws. Interesting concept and one I hadn't really considered. And secondly they feel that most patients do not know what is emergent or urgent or routine. They feel that in the moment any amount of pain or suffering that people are feeling is real and they can't differentiate between something that is life-threatening or not. Again, interesting.
Next on to people in general - what I found online is almost next to nil. People don't really weigh in too much online about health care issues. There are a lot of right wing and left wing spouting off about the health care system in general - but I didn't find a whole lot of people just asking general health care questions. I did find a few real life stories of the pay offs of going to the ER - and then some nightmare stories of private sector clinic care. Again, interesting enough, it seems we do too good of a job in the ER of giving patients just what they want and what they need. There were many stories of patients not being able to get into their doctor's office for routine or non-urgent needs - having to wait weeks to months to see their doctors. Plus there were many sightings of patients wanting a fast track to getting the xrays, CTs, MRIs and specialist referrals they have been having trouble getting from their own doctors. Plus, where else can you go to get IVs, medications, tests, etc.. - one stop shopping for your needs - in a relatively short period of time.
On the other hand, there were also several stories about how the general population feels they get the best care from the best trained personnel in the system. They talked of nightmare stories of their loved-ones dying from delayed treatment and missed diagnosis in the primary care setting. And they also expressed that they weren't sure when they should or should not use the ER. There seems to be a little confusion about what is emergent and what is not. Most people seem to know if you're having chest pain or shortness of breath, they should go - or if they have an ear ache or a sore throat, they shouldn't go. But with the Internet and the symptom checking on web sites, they are confused about is emergency in the abdominal pain, nausea and vomiting, back pain, headache, broken bone and laceration categories. And truthfully, there leaves a lot to desire with telephone triaging - if you can't see the patient, you don't know where to send them - so you send them all to the ER. Great ! I know, you're all worried about being sued for liability for missing something - but come on.
Now, let me just say, there are a lot of online forums from health care professionals. Some are constructive - some are just plain mean. Some people have definitely identified a lot of factors in the use/abuse of the ERs. And some people just get soooo frustrated about the piddly little things that come in.
Let me just give you some real-life examples from my friends and co-workers - you tell me what you think. Are they emergencies - could they be - or come on, should you just stay home for a day or two - go to urgent care - or wait for an appointment with your doctor? Let me know what you all think !
Examples:
2am STD check
Sore Throat for 3 Days
Knee Pain for 10 Years
Bug Bites
I need a Note to go back to work because I called in sick last Friday.
I had a Fever ....yesterday.
My Child was at a Party yesterday and was exposed to Chicken Pox. Is there a Shot for that?
Cold Sore
Dandruff
Pregnancy Test
Prescription Refill
Rash for 14 Years
The Cops or the Airport Security took my Prescription for Pain Medicines, Can I have Another?
I drink too much but I don't want to be here - but called the Paramedics anyway?
A Zit?
Someone concerned about getting AIDS from a Bite.
The ultimate and funniest and saddest one of the bunch - a Dialysis Patient was sent to the ER because of a necrotic belly button - OK, did any one look? It was a blueberry that missed his mouth in the morning. Come on !
OK - now, I know people aren't just feeble-minded - at least not everyone - but in all these cases, we all know - us and patients alike - these are not emergencies and do not belong in the ER. I'm not sure that even one of them, in the worst-case scenario would be urgent or emergent. OK - maybe one - the sore throat could be something cooking - I'll give them one - maybe - unless of course, it was just a sore throat with no other symptoms.
I want to tell you what I think about all this. I'll give the government, the media, the people and the health care professionals all kudos. Everyone has touched on at least one aspect of the system that is just all or partly wrong in the US.
But I think we're missing one important aspect - and I'm not sure how to fix it - well I have a few ideas that I'll touch on a little later. This is the generation of instant gratification - and not wanting to be inconvenienced by anything. It's all about me, me, me. And I can attest to this as I know, I have a little bit of that in me as well.
So let's be a little constructive and talk about how we can fix some of these issues.
#1 - Health Care Reform, Health Care Reform, Health Care Reform - can I say it any more??
We so need to refocus our infrastructure. We need to insure everyone in this Country - well everyone here legally. There is a certain sub-population that is always going to end up in the ER and not have coverage. With EMTALA laws, we have to see anyone who shows up in the ER. Sorry, that includes illegal aliens. There's no way to get around that - they are always going to cost all of us some money. But if we insure everyone else, then we cut down on all the uncompensated care we give to the poor and the homeless, uninsured and under-insured population. It just has to be done.
#2 - Let's rebuild - increase funding for our community health systems. We need more community health centers, more urgent cares, more primary doctors who see all people. We just really need more Primary Care Doctors - they need to be compensated more. People need more access to their doctors. There are not enough doctors to go around. We need to refocus our funding on the home-health field as well. People would love to stay in their homes if only they could afford to be taken care of there - or in residential homes.
#3 - Education, Education, Education. Patients need to be educated on where to get their care, how to get their care, the costs of their care, alternatives to care, what's emergent and what's not. Transparency is all too important. Maybe a big sign in front of the hospital with all this information would be good. Maybe simpler plan books or brochures with easily understandable language would be nice. Written instructions at discharge from the doctor's office, the ER, the inpatient setting could be mandatory. Maybe some big organization could take on this task - the American Heart Assoc., Blue Cross/Blue Shield, Kaiser Permanente, maybe the government could launch a big advertising campaign about this???
#4 - There needs to be some sort of sliding scale co-payment system in the ER- in my opinion.
If someone comes to the ER with a true urgent or emergent condition, the co-pay should be less. People should be charged more for non-urgent, routine ER visits to discourage them from coming in on just a whim. I don't know exactly how to restructure this, but I believe if people have to pay $200.00 + for an ER visit (if that's what the estimated cost would be to see an ER doctor), I believe that it would only take once to figure out that you shouldn't do it. I think that the pocket book hit would squash some of the instant gratification drive.
#5 -And lastly from me, I think that every hospital should have some sort of in-person triaging system. The ERs should have a triaging doctor in front - and the hospitals should have a system of deflecting patients to the clinics, PMDs, urgent cares and clinics. If everyone is insured, this should not be a problem. If your clinics don't have any openings, then the patients get sent down the street to a place where there is an opening. I like the idea of a concierge service. I feel it would help everyone involved. The ERs would be used for emergencies - the uncompensated care would go down and the people would get the care they want, deserve and need in a fairly short period of time.
And to Stan - I love your philosophy on our ER specialty - I'll call it your mantra -
"Common Sense is Not that Common"
"Job Security - There will always be plenty of "Emergencies""
So come on everyone - brain storm - what do you think? Do you have any other solutions to the health care crisis that is happening in our ERs???
Comments, Fixes, Bitches !
See Ya back here Later !
Let's tackle another hot topic of health care - non-urgent use - abuse of ERs. I would like every one's opinion on why people use ERs for their primary care or non-urgent needs. I did a little research and have found that the media, the government, the patient population and medical personnel really have differing thoughts on this - which I find very interesting. As a health care professional, I do like to try to be convinced of the other sides' viewpoints.
So let's take a spin around the googling world. I read several forums and news articles on this subject and there are varying views on the reason people come into ERs and how these costs affect our already broken health care system.
The governmental agencies seem to realize that a big factor in ER use is the broken health care system. They think with broad reform and insuring the entire population, these numbers will decrease significantly. They feel that many more ERs would be able to stay open and the lines would diminish if everyone was insured. The President, the Democrats and Republicans alike all think that if we insured everyone, increased our funding in the public programs and rebuilt our infrastructure to include strong community-based and home-based medical services, we would all be much better off.
The media has an entirely different view of the subject. They claim that most people come to the ER with non-urgent needs for two reasons - that they either are uninsured or have Medicaid and don't have access to providers they can see - as doctors are refusing care in the clinic settings for nonpayment. So they trickle into the ER where they know legally they have to be seen due to EMTALA laws. Interesting concept and one I hadn't really considered. And secondly they feel that most patients do not know what is emergent or urgent or routine. They feel that in the moment any amount of pain or suffering that people are feeling is real and they can't differentiate between something that is life-threatening or not. Again, interesting.
Next on to people in general - what I found online is almost next to nil. People don't really weigh in too much online about health care issues. There are a lot of right wing and left wing spouting off about the health care system in general - but I didn't find a whole lot of people just asking general health care questions. I did find a few real life stories of the pay offs of going to the ER - and then some nightmare stories of private sector clinic care. Again, interesting enough, it seems we do too good of a job in the ER of giving patients just what they want and what they need. There were many stories of patients not being able to get into their doctor's office for routine or non-urgent needs - having to wait weeks to months to see their doctors. Plus there were many sightings of patients wanting a fast track to getting the xrays, CTs, MRIs and specialist referrals they have been having trouble getting from their own doctors. Plus, where else can you go to get IVs, medications, tests, etc.. - one stop shopping for your needs - in a relatively short period of time.
On the other hand, there were also several stories about how the general population feels they get the best care from the best trained personnel in the system. They talked of nightmare stories of their loved-ones dying from delayed treatment and missed diagnosis in the primary care setting. And they also expressed that they weren't sure when they should or should not use the ER. There seems to be a little confusion about what is emergent and what is not. Most people seem to know if you're having chest pain or shortness of breath, they should go - or if they have an ear ache or a sore throat, they shouldn't go. But with the Internet and the symptom checking on web sites, they are confused about is emergency in the abdominal pain, nausea and vomiting, back pain, headache, broken bone and laceration categories. And truthfully, there leaves a lot to desire with telephone triaging - if you can't see the patient, you don't know where to send them - so you send them all to the ER. Great ! I know, you're all worried about being sued for liability for missing something - but come on.
Now, let me just say, there are a lot of online forums from health care professionals. Some are constructive - some are just plain mean. Some people have definitely identified a lot of factors in the use/abuse of the ERs. And some people just get soooo frustrated about the piddly little things that come in.
Let me just give you some real-life examples from my friends and co-workers - you tell me what you think. Are they emergencies - could they be - or come on, should you just stay home for a day or two - go to urgent care - or wait for an appointment with your doctor? Let me know what you all think !
Examples:
2am STD check
Sore Throat for 3 Days
Knee Pain for 10 Years
Bug Bites
I need a Note to go back to work because I called in sick last Friday.
I had a Fever ....yesterday.
My Child was at a Party yesterday and was exposed to Chicken Pox. Is there a Shot for that?
Cold Sore
Dandruff
Pregnancy Test
Prescription Refill
Rash for 14 Years
The Cops or the Airport Security took my Prescription for Pain Medicines, Can I have Another?
I drink too much but I don't want to be here - but called the Paramedics anyway?
A Zit?
Someone concerned about getting AIDS from a Bite.
The ultimate and funniest and saddest one of the bunch - a Dialysis Patient was sent to the ER because of a necrotic belly button - OK, did any one look? It was a blueberry that missed his mouth in the morning. Come on !
OK - now, I know people aren't just feeble-minded - at least not everyone - but in all these cases, we all know - us and patients alike - these are not emergencies and do not belong in the ER. I'm not sure that even one of them, in the worst-case scenario would be urgent or emergent. OK - maybe one - the sore throat could be something cooking - I'll give them one - maybe - unless of course, it was just a sore throat with no other symptoms.
I want to tell you what I think about all this. I'll give the government, the media, the people and the health care professionals all kudos. Everyone has touched on at least one aspect of the system that is just all or partly wrong in the US.
But I think we're missing one important aspect - and I'm not sure how to fix it - well I have a few ideas that I'll touch on a little later. This is the generation of instant gratification - and not wanting to be inconvenienced by anything. It's all about me, me, me. And I can attest to this as I know, I have a little bit of that in me as well.
So let's be a little constructive and talk about how we can fix some of these issues.
#1 - Health Care Reform, Health Care Reform, Health Care Reform - can I say it any more??
We so need to refocus our infrastructure. We need to insure everyone in this Country - well everyone here legally. There is a certain sub-population that is always going to end up in the ER and not have coverage. With EMTALA laws, we have to see anyone who shows up in the ER. Sorry, that includes illegal aliens. There's no way to get around that - they are always going to cost all of us some money. But if we insure everyone else, then we cut down on all the uncompensated care we give to the poor and the homeless, uninsured and under-insured population. It just has to be done.
#2 - Let's rebuild - increase funding for our community health systems. We need more community health centers, more urgent cares, more primary doctors who see all people. We just really need more Primary Care Doctors - they need to be compensated more. People need more access to their doctors. There are not enough doctors to go around. We need to refocus our funding on the home-health field as well. People would love to stay in their homes if only they could afford to be taken care of there - or in residential homes.
#3 - Education, Education, Education. Patients need to be educated on where to get their care, how to get their care, the costs of their care, alternatives to care, what's emergent and what's not. Transparency is all too important. Maybe a big sign in front of the hospital with all this information would be good. Maybe simpler plan books or brochures with easily understandable language would be nice. Written instructions at discharge from the doctor's office, the ER, the inpatient setting could be mandatory. Maybe some big organization could take on this task - the American Heart Assoc., Blue Cross/Blue Shield, Kaiser Permanente, maybe the government could launch a big advertising campaign about this???
#4 - There needs to be some sort of sliding scale co-payment system in the ER- in my opinion.
If someone comes to the ER with a true urgent or emergent condition, the co-pay should be less. People should be charged more for non-urgent, routine ER visits to discourage them from coming in on just a whim. I don't know exactly how to restructure this, but I believe if people have to pay $200.00 + for an ER visit (if that's what the estimated cost would be to see an ER doctor), I believe that it would only take once to figure out that you shouldn't do it. I think that the pocket book hit would squash some of the instant gratification drive.
#5 -And lastly from me, I think that every hospital should have some sort of in-person triaging system. The ERs should have a triaging doctor in front - and the hospitals should have a system of deflecting patients to the clinics, PMDs, urgent cares and clinics. If everyone is insured, this should not be a problem. If your clinics don't have any openings, then the patients get sent down the street to a place where there is an opening. I like the idea of a concierge service. I feel it would help everyone involved. The ERs would be used for emergencies - the uncompensated care would go down and the people would get the care they want, deserve and need in a fairly short period of time.
And to Stan - I love your philosophy on our ER specialty - I'll call it your mantra -
"Common Sense is Not that Common"
"Job Security - There will always be plenty of "Emergencies""
So come on everyone - brain storm - what do you think? Do you have any other solutions to the health care crisis that is happening in our ERs???
Comments, Fixes, Bitches !
See Ya back here Later !
Thursday, September 10, 2009
Miscellaneous Info., Statistics, Etc. - Food for Thought - a Pawn
Hi everyone -
Well another day, more policy reading. I tackled Max Baucus's Call to Action that he wrote back in November 2008. I'm going to talk a little about it today here - but I'm going to reserve my kudos for now. After reading some news posts today - I believe his health care proposal to the President is different from the Call to Action he wrote last year. So, I actually want to read the new plan before committing to it.
He did have some interesting statistics:
46 Million UnInsured Americans - 15% of Population
25 Million UnderInsured Americans
158 Million Americans are Covered by Employer-Offered Plans
U.S. spends 16% of GNP on Health Care - Over Twice as Much Averaged as Any Other
Industrialized Nation
U.S. is 19th in World in Unneccesary Deaths
U.S. is 29th out 37 Nations in Infant Mortality
Adults get Recommended Care only 55% of Time
Children get Reccommended Care only 47% of Time
People get Preventative Care only 41% of Time
At first look, I was pretty impressed. It's obvious he's coming at it from a Finance perspective.
The Call to Action had a lot of the same stuff in it that the House Bill 3200 has in it.
Here are just a few of the similar points:
You can Keep your Doctor if you Like Him/Her
No Pre-Existing Conditions Allowed
Electronic Records Integration
Preventative Services for Free
Subsidies to Individuals and Small Businesses who Need Assistance with Premiums
Expansion of the Medicaid Program and Indian Health Plan
No Waiting Period for Disabled or other Legal Immigrants (children and pregnant women)
Reform for Medicare/Medicaid to Control Fraud and Abuse and Quality vs Quantity HealthCare
Heath Care Exchange with a Public Plan
So a lot of similarities - but:
I did find a few interesting additions - although maybe they are in the House Bill as well - I haven't gotten all the way through the 1000+ pages yet. It's a bit boring after awhile and I needed a distraction.
I can entertain some other talking points.
He has proposed an early buy-in for Medicare for people between 55 and 65. This could work two fold. It could help those people in this age range that don't have affordable options to health care. Plus, it would also help the Medicare fund as these people would be paying premiums. Something to think about.
Plus, his plan also concentrated a great deal on expanding the community health programs. He thinks it would be cheaper to transfer some of the care of the elderly back into the community - ie) funded community medical centers, medical homes, home health programs, etc... as opposed to institutionalizing everyone in nursing facilities. He feels most people would prefer to stay in their homes - and he feels we need to train more health care professionals to care for these people - to give some relief to their families.
And he concentrates a great deal on quality care vs quantity of care. He calls for malpractice reform to get doctor's away from defensive doctoring.
Interesting, while reading his proposal, I found myself a pawn in someone's program - unknowingly so. It seems that some governmental agencies - I believe The Joint Commission and Medicare, in particular - has been experimenting with quality health care measures. It appears that that they have been creating what I'll call, well what they call core measures - which basically are best clinical practices for certain diseases. For example, making sure heart attack patients have aspirin given on arrival to the ER, making sure pneumonia patients have antibiotics started on them within 4 hours of arrival to the ER, making sure patients with CHF have certain tests and medications depending on the outcome of those tests, etc.... Well this is all great stuff - finally someone is making sure we're treating patients according to best clinical practices - practices that have produced better patient outcomes and decreased morbidity. Well that's all fine and dandy- wonderful for patients and the world in general. The only thing I was dumbfounded by was the comment in Baucus's proposal that said Medicare was actually paying hospitals for this. Well no wonder all our yearly bonuses are based on the adherence to these "core measures". Again, it's all good news - it's in the patients' best interest - but I wish at some point, the hospital that I worked for had some transparency on this issue.
So how would you feel if you found out that your yearly bonuses were based on the hospital's reimbursement by the insurance company???? instead of just the mere fact that the facility was on the cutting-edge of health care in best clinical practice???
I guess at first take, I felt a little betrayed for not being told - but in the end, if it's better for the patient, then it's better for us all. And if the new guidelines for payment are going to be based on quality outcomes, it's an interesting concept - and why not be one of the first systems that are using it.
Anyway - more later. Let me know what you'd like to hear about next?
Goodnight.
Well another day, more policy reading. I tackled Max Baucus's Call to Action that he wrote back in November 2008. I'm going to talk a little about it today here - but I'm going to reserve my kudos for now. After reading some news posts today - I believe his health care proposal to the President is different from the Call to Action he wrote last year. So, I actually want to read the new plan before committing to it.
He did have some interesting statistics:
46 Million UnInsured Americans - 15% of Population
25 Million UnderInsured Americans
158 Million Americans are Covered by Employer-Offered Plans
U.S. spends 16% of GNP on Health Care - Over Twice as Much Averaged as Any Other
Industrialized Nation
U.S. is 19th in World in Unneccesary Deaths
U.S. is 29th out 37 Nations in Infant Mortality
Adults get Recommended Care only 55% of Time
Children get Reccommended Care only 47% of Time
People get Preventative Care only 41% of Time
At first look, I was pretty impressed. It's obvious he's coming at it from a Finance perspective.
The Call to Action had a lot of the same stuff in it that the House Bill 3200 has in it.
Here are just a few of the similar points:
You can Keep your Doctor if you Like Him/Her
No Pre-Existing Conditions Allowed
Electronic Records Integration
Preventative Services for Free
Subsidies to Individuals and Small Businesses who Need Assistance with Premiums
Expansion of the Medicaid Program and Indian Health Plan
No Waiting Period for Disabled or other Legal Immigrants (children and pregnant women)
Reform for Medicare/Medicaid to Control Fraud and Abuse and Quality vs Quantity HealthCare
Heath Care Exchange with a Public Plan
So a lot of similarities - but:
I did find a few interesting additions - although maybe they are in the House Bill as well - I haven't gotten all the way through the 1000+ pages yet. It's a bit boring after awhile and I needed a distraction.
I can entertain some other talking points.
He has proposed an early buy-in for Medicare for people between 55 and 65. This could work two fold. It could help those people in this age range that don't have affordable options to health care. Plus, it would also help the Medicare fund as these people would be paying premiums. Something to think about.
Plus, his plan also concentrated a great deal on expanding the community health programs. He thinks it would be cheaper to transfer some of the care of the elderly back into the community - ie) funded community medical centers, medical homes, home health programs, etc... as opposed to institutionalizing everyone in nursing facilities. He feels most people would prefer to stay in their homes - and he feels we need to train more health care professionals to care for these people - to give some relief to their families.
And he concentrates a great deal on quality care vs quantity of care. He calls for malpractice reform to get doctor's away from defensive doctoring.
Interesting, while reading his proposal, I found myself a pawn in someone's program - unknowingly so. It seems that some governmental agencies - I believe The Joint Commission and Medicare, in particular - has been experimenting with quality health care measures. It appears that that they have been creating what I'll call, well what they call core measures - which basically are best clinical practices for certain diseases. For example, making sure heart attack patients have aspirin given on arrival to the ER, making sure pneumonia patients have antibiotics started on them within 4 hours of arrival to the ER, making sure patients with CHF have certain tests and medications depending on the outcome of those tests, etc.... Well this is all great stuff - finally someone is making sure we're treating patients according to best clinical practices - practices that have produced better patient outcomes and decreased morbidity. Well that's all fine and dandy- wonderful for patients and the world in general. The only thing I was dumbfounded by was the comment in Baucus's proposal that said Medicare was actually paying hospitals for this. Well no wonder all our yearly bonuses are based on the adherence to these "core measures". Again, it's all good news - it's in the patients' best interest - but I wish at some point, the hospital that I worked for had some transparency on this issue.
So how would you feel if you found out that your yearly bonuses were based on the hospital's reimbursement by the insurance company???? instead of just the mere fact that the facility was on the cutting-edge of health care in best clinical practice???
I guess at first take, I felt a little betrayed for not being told - but in the end, if it's better for the patient, then it's better for us all. And if the new guidelines for payment are going to be based on quality outcomes, it's an interesting concept - and why not be one of the first systems that are using it.
Anyway - more later. Let me know what you'd like to hear about next?
Goodnight.
Tuesday, September 8, 2009
House Bill - Health Insurance Exchange
Hi again -
Today's feature will be the first 215 pages of the House Bill. This is the part of the bill that focuses on the Health Insurance Exchange Program. The rest of the bill - about 800+ pages is about health care reform which we'll touch on later.
As you'll see - the key points of the House Bill pretty much match the key points of Obama's Vision, that we discussed earlier.
OK so here we go: Let's start with the basics.
The Health Insurance Exchange will offer an affordable health insurance option for the people who fall through the cracks in our system - those who don't qualify for any other plan whether it's Medicaid, CHIP, Tri-care, VA, Medicare or an Employers'-offered health plan.
It offers an affordable essential benefit plan package with some consumer protections. It would consist of private insurance companies and a public option. For those of you who don't know what a Public Option is - it's basically an insurance plan ran by a government agency - which would have to meet all the requirements of the private insurance companies so as to guarantee a fair playing field.
This health plan would make the individual, the employers, the insurance companies and the government responsible and accountable for insuring all Americans in one way or another.
If you like your current insurance plan, you can keep it. You can keep your doctor as well.
If at any time your employer decides not to provide insurance for you, or if you lose your job, there will be other options. You can shop for a more affordable plan - and odds are the company you're insured with already will have a package available in the Health Insurance Exchange.
Many companies will be grandfathered in - and they will have 5 years to meet the requirements of the Exchange.
The government will be offering subsidies/credits to individuals - those who can't afford the insurance premiums or the co-payments - those too poor to qualify for Medicaid, but those who still can't afford the premiums. Employers who qualify as small businesses who offer health insurance to their employees will also have some tax credits/subsidies - some as high as 50% of the premiums paid. Also a very nice incentive - if after the year is done and all the figures are in, and the Exchange finds out that we actually saved money during the year - ie) a low medical loss ratio - the money will be returned to the people. This is to insure that our health care dollars are used for health care - not going into some fat cat's pockets.
OK - interjection here: speaking of fat cats - did you know that Blue Cross/Blue Shield of Michigan's Executives -just 2 of them - CEO and CFO - gave themselves $1,286,000 in bonuses in 2008 - that's on top of their over $1 Million Salaries - right before laying off 1000s of workers and instituting salary freezes on lower employees in the beginning of 2009. Crazy huh?
Companies will also get money to help convert their medical records to electronic records. You know where I stand on this - everyday we struggle with those darn computers and it's software - but information technology will save so much money in duplication of services and a reduction in medical errors. It will also help us establish best clinical practice standards. Check out some of my figures on the previous subject - earlier in my blog.
Again the companies participating in the Health Insurance Exchange will have to abide by certain rules. They have to be licensed in the State they want to participate in. States can run their own Exchange if they like. They have to participate in risk pooling so that no one company will be burdened with the sickest or poorest population.
Companies must offer a basic plan and may offer an enhanced plan, a premium plan or a premium plus plan. The basic plan must include Hospitalization, Dr's Visits, Clinic Visits, ER Visits, Dr's Fees, Equipment and Supplies, Maternity and Free Well Baby and Preventative Services.
They can't drop or deny any one's coverage for health reasons - pre-existing conditions, use of insurance, age, race, lifestyle, etc... There won't be any lifetime or annual caps on amounts needed for coverage. There is protection for age, family size and geography ratings - at no time can the premiums be more than a 2:1 ratio. Benefits will not be taxed. And the rules can't interfere with Union contracts.
As of governance, there will be a Health Care Commissioner that will be in charge of running the exchange, enforcing rules and monitoring compliance. There will be an Ombudsman who will be there for the people if they have any questions, grievances, etc...
Everyone will have a medical ID card - that may be scannable - so that when someone shows up at a hospital or doctor's office, we'll know they're covered and what kind of coverage they have - who their doctor is, etc...
In year 1 - which is down the road, I think 2013 - only uninsured individuals and small employers with less than 10 employees can join.
In year 2, everyone above plus employers with less than 20 employees can join. Plus anyone who is paying more than 11% of their yearly income in premiums may join.
In year 3, everyone above plus larger employers as determined may join.
So I don't see that there will be a mass exodus of people leaving their current plans to run to the exchange - at least not in the first 3 years.
Now onto the responsibility part - every one sharing in paying for the system - which I'm all for.
The people, us, will have annual out of pocket expenses - a max. of $5000.00 for individuals and $10,000.00 for families. I, personally still think this is too much. I realize that a lot of families are paying much more than this in deductibles, co-insurances and co-pays. I guess I'm just spoiled by the plan I have. Now, this is not to say that your employer will then downgrade what you have already. If you don't have a yearly deductible now, you won't then. This is just a max. that the Exchange companies can ask for. If someone chooses not to be insured, there will be a tax penalty of 2.5% of their adjusted gross income for the year - or the premium amount they would have paid - whichever is less. Now, there is leeway with this penalty - if it's a hardship, there's a loophole.
Employers in the Exchange must pay at least 72.5% of the employee's premium and 65% of the family premium for full-time employees. It will be pro-rated for part-time employees.
There will be a tax penalty for those employers who don't cover their employees. If the employers have an annual payroll of between $250,000 - $300,000, their penalty will be 2%; if between $300,000 - $350,000, it will be 4%; if between $350,000 - $400,000, it will be 6%; and for any company with an annual payroll over $400,000, the penalty will be 8%. This penalty will help defray the additional costs of the Exchange having to insure the people.
And now the big question - where do we get the money to fund all this?
Well I know there is great discussion on this matter. There are some possibilities floating around out there - I think we'll save a great deal in reform - just in electronic records, there may be some redistribution of Medicare Advantage money, the drug companies may be offering to help with the donut hole money, the richest Americans may not get their big tax deductions - and the richest 1% people in America will have an increase in their taxes. According to the House Bill, the richest people in America will be taxed as follows: Now - keep in mind these percentages apply only to the money they make over this limit in Adjusted Gross Income. So, anyone making between $350,000 - $500,000 annually will be taxed an additional 1%; anyone between $500,000 - $1 Million will be 1.5% and anyone over $1 Million will be taxed 5.4%. So if someone makes more than $1 Million in Adjusted Gross Income in any given year, the amount over $1 Million would be taxed by 5.4%. Their first Million would not be taxed further. FYI - according to compiled figures, this tax would only affect 1.9% of Californians. And for my home state of PA, this would only affect 1% of the population. Oh and by the way, this percentage is just part of tax cuts that the Bush administration has given to the richest Americans since 2001 - and it extends until 2010. This richest 1% will receive over $700 Billion dollars in tax cuts before it's over - so I think they can afford to give some of it back. Do you know many of these people?? I sure don't.
OK so lots to process in only 215 pages. Again though, I don't see a lot of bad stuff - maybe the annual limits of $5000 and $10,000. All I know, as a health care professional, is that everyone has to be covered. I don't care exactly how we get there - but we need to. Not only do all Americans need coverage, they deserve it. Our companies and our nation can not continue to compete in the global market without taking the health care equation into account.
Any ideas? You know if anyone out there has any ideas - whether better or worse or how to get there - on paper or money-wise, speak up. Let's do it together.
Take Care - more later. I'm reading Max Baucus's Call to Action plan today. I must say I'm liking what I'm reading so far.
Today's feature will be the first 215 pages of the House Bill. This is the part of the bill that focuses on the Health Insurance Exchange Program. The rest of the bill - about 800+ pages is about health care reform which we'll touch on later.
As you'll see - the key points of the House Bill pretty much match the key points of Obama's Vision, that we discussed earlier.
OK so here we go: Let's start with the basics.
The Health Insurance Exchange will offer an affordable health insurance option for the people who fall through the cracks in our system - those who don't qualify for any other plan whether it's Medicaid, CHIP, Tri-care, VA, Medicare or an Employers'-offered health plan.
It offers an affordable essential benefit plan package with some consumer protections. It would consist of private insurance companies and a public option. For those of you who don't know what a Public Option is - it's basically an insurance plan ran by a government agency - which would have to meet all the requirements of the private insurance companies so as to guarantee a fair playing field.
This health plan would make the individual, the employers, the insurance companies and the government responsible and accountable for insuring all Americans in one way or another.
If you like your current insurance plan, you can keep it. You can keep your doctor as well.
If at any time your employer decides not to provide insurance for you, or if you lose your job, there will be other options. You can shop for a more affordable plan - and odds are the company you're insured with already will have a package available in the Health Insurance Exchange.
Many companies will be grandfathered in - and they will have 5 years to meet the requirements of the Exchange.
The government will be offering subsidies/credits to individuals - those who can't afford the insurance premiums or the co-payments - those too poor to qualify for Medicaid, but those who still can't afford the premiums. Employers who qualify as small businesses who offer health insurance to their employees will also have some tax credits/subsidies - some as high as 50% of the premiums paid. Also a very nice incentive - if after the year is done and all the figures are in, and the Exchange finds out that we actually saved money during the year - ie) a low medical loss ratio - the money will be returned to the people. This is to insure that our health care dollars are used for health care - not going into some fat cat's pockets.
OK - interjection here: speaking of fat cats - did you know that Blue Cross/Blue Shield of Michigan's Executives -just 2 of them - CEO and CFO - gave themselves $1,286,000 in bonuses in 2008 - that's on top of their over $1 Million Salaries - right before laying off 1000s of workers and instituting salary freezes on lower employees in the beginning of 2009. Crazy huh?
Companies will also get money to help convert their medical records to electronic records. You know where I stand on this - everyday we struggle with those darn computers and it's software - but information technology will save so much money in duplication of services and a reduction in medical errors. It will also help us establish best clinical practice standards. Check out some of my figures on the previous subject - earlier in my blog.
Again the companies participating in the Health Insurance Exchange will have to abide by certain rules. They have to be licensed in the State they want to participate in. States can run their own Exchange if they like. They have to participate in risk pooling so that no one company will be burdened with the sickest or poorest population.
Companies must offer a basic plan and may offer an enhanced plan, a premium plan or a premium plus plan. The basic plan must include Hospitalization, Dr's Visits, Clinic Visits, ER Visits, Dr's Fees, Equipment and Supplies, Maternity and Free Well Baby and Preventative Services.
They can't drop or deny any one's coverage for health reasons - pre-existing conditions, use of insurance, age, race, lifestyle, etc... There won't be any lifetime or annual caps on amounts needed for coverage. There is protection for age, family size and geography ratings - at no time can the premiums be more than a 2:1 ratio. Benefits will not be taxed. And the rules can't interfere with Union contracts.
As of governance, there will be a Health Care Commissioner that will be in charge of running the exchange, enforcing rules and monitoring compliance. There will be an Ombudsman who will be there for the people if they have any questions, grievances, etc...
Everyone will have a medical ID card - that may be scannable - so that when someone shows up at a hospital or doctor's office, we'll know they're covered and what kind of coverage they have - who their doctor is, etc...
In year 1 - which is down the road, I think 2013 - only uninsured individuals and small employers with less than 10 employees can join.
In year 2, everyone above plus employers with less than 20 employees can join. Plus anyone who is paying more than 11% of their yearly income in premiums may join.
In year 3, everyone above plus larger employers as determined may join.
So I don't see that there will be a mass exodus of people leaving their current plans to run to the exchange - at least not in the first 3 years.
Now onto the responsibility part - every one sharing in paying for the system - which I'm all for.
The people, us, will have annual out of pocket expenses - a max. of $5000.00 for individuals and $10,000.00 for families. I, personally still think this is too much. I realize that a lot of families are paying much more than this in deductibles, co-insurances and co-pays. I guess I'm just spoiled by the plan I have. Now, this is not to say that your employer will then downgrade what you have already. If you don't have a yearly deductible now, you won't then. This is just a max. that the Exchange companies can ask for. If someone chooses not to be insured, there will be a tax penalty of 2.5% of their adjusted gross income for the year - or the premium amount they would have paid - whichever is less. Now, there is leeway with this penalty - if it's a hardship, there's a loophole.
Employers in the Exchange must pay at least 72.5% of the employee's premium and 65% of the family premium for full-time employees. It will be pro-rated for part-time employees.
There will be a tax penalty for those employers who don't cover their employees. If the employers have an annual payroll of between $250,000 - $300,000, their penalty will be 2%; if between $300,000 - $350,000, it will be 4%; if between $350,000 - $400,000, it will be 6%; and for any company with an annual payroll over $400,000, the penalty will be 8%. This penalty will help defray the additional costs of the Exchange having to insure the people.
And now the big question - where do we get the money to fund all this?
Well I know there is great discussion on this matter. There are some possibilities floating around out there - I think we'll save a great deal in reform - just in electronic records, there may be some redistribution of Medicare Advantage money, the drug companies may be offering to help with the donut hole money, the richest Americans may not get their big tax deductions - and the richest 1% people in America will have an increase in their taxes. According to the House Bill, the richest people in America will be taxed as follows: Now - keep in mind these percentages apply only to the money they make over this limit in Adjusted Gross Income. So, anyone making between $350,000 - $500,000 annually will be taxed an additional 1%; anyone between $500,000 - $1 Million will be 1.5% and anyone over $1 Million will be taxed 5.4%. So if someone makes more than $1 Million in Adjusted Gross Income in any given year, the amount over $1 Million would be taxed by 5.4%. Their first Million would not be taxed further. FYI - according to compiled figures, this tax would only affect 1.9% of Californians. And for my home state of PA, this would only affect 1% of the population. Oh and by the way, this percentage is just part of tax cuts that the Bush administration has given to the richest Americans since 2001 - and it extends until 2010. This richest 1% will receive over $700 Billion dollars in tax cuts before it's over - so I think they can afford to give some of it back. Do you know many of these people?? I sure don't.
OK so lots to process in only 215 pages. Again though, I don't see a lot of bad stuff - maybe the annual limits of $5000 and $10,000. All I know, as a health care professional, is that everyone has to be covered. I don't care exactly how we get there - but we need to. Not only do all Americans need coverage, they deserve it. Our companies and our nation can not continue to compete in the global market without taking the health care equation into account.
Any ideas? You know if anyone out there has any ideas - whether better or worse or how to get there - on paper or money-wise, speak up. Let's do it together.
Take Care - more later. I'm reading Max Baucus's Call to Action plan today. I must say I'm liking what I'm reading so far.
Friday, September 4, 2009
Medical Personnel Roles
Hi again -
Well, I'm back after a couple of days off again. Seems like I'm starting to need a few days in between to gather my thoughts. I'd like to go off course a little bit from the health care reform issue today.
I think today I'm going to touch a little bit on medical personnel roles in the health care field - education level, job responsibilities, etc.... Then I want to wrap it up a little bit talking about the so-called nursing shortage - and my views on that. And in the end, I want to pay tribute to someone special who we recently lost, someone who had a calling to take care of others and did so so very well- in our ER.
I'll start with some of the ground level positions and work my way up the so-called ladder. Although, I don't want to imply that any position is any better or worse than any other position. It's important to remember that when a person is in the medical field, they land either where their heart lies or where they can afford to stay for the time being. That's why it's such a dynamic field - you can play where your strengths are and move around until you find what suits you best.
How many different hands-on patient care positions are there? To name a few, there are CNAs, Orderlies, EMTs, MAs, Psych. Techs., LVNs, Paramedics, RNs, PAs and NPs. Of course, these positions aren't all inclusive. There are still Techs in other departments - Radiology, PT, OT, Pharmacy, Cashiers, Clerks, Volunteers, etc... We all need each other to take care of patients.
I'll touch base on a few of these positions and their roles.
I suppose the entry level for many new people to the health care field would be the CNA - Certified Nursing Assistant. This is a very difficult job to do and one that requires a very special kind of person. These are the people who are most in touch with the patients - those who work at the bedside, taking vital signs, feeding, bathing, dressing and toileting patients. Although the hourly educational requirement isn't that high -usually around 75 + hours of classroom and clinical training - interpersonal skills are very important. I remember many a time a CNA saved my butt on the floor - coming to me to alert me that something was wrong with one of my patients.
Orderlies, though few and far between anymore, have similar educational requirements and job responsibilities of the CNA. Because a lot of orderlies are males, they also have the added responsibilities of working with equipment and lifting the patients. Ouch, my aching back.
Next we'll go to the pre-hospital side of the fence, the EMT, Emergency Medical Technician. The EMT certification class is usually around 140 hours of classroom, clinical and field training. EMTs in the field have varying tasks depending on what state you live in, where you work and how rural an area you live in. EMTs in the hospital mostly do task-oriented noninvasive procedures - splint applications, dressings, EKGs, lab draws, etc... EMTs in the field usually ride in the back of the ambulances and take care of the patients or assist the paramedics. Tasks may include splinting, dressing wounds, oxygen administration, spinal immobilization, CPR, etc... Many times, they are firemen or police officers as well. This field is very close to my heart. It's where I started - where the medical bug bit me. One summer I decided to take this class just for the fun of it. I thought it would be a great place to meet guys. True. I didn't even like blood, or couldn't imagine taking care of people, but that sure changed fast. It made me want more.
MAs - Medical Assistants again are an integral part of the health care team. Most vo-tech colleges and some nursing schools have MA classes. They can either go for a year - or two years and earn their Associates Degree. These are the people that usually work in clinics and doctor's offices. They are the ultimate assistant. They answer phones, schedule appointments, assist with billing, put patients in rooms, take vital signs, etc.... They can also do other tasks as long as they have been taught those tasks and the doctor they work for assumes responsibility for those tasks- ie) medication administration, blood draws, assisting with procedures.
Now, let's move over to another specialty field - Pysch. Tech. The educational requirement for these licensed personnel is usually around 1500 hours. This is a parallel field to a LVN/LPN with more emphasis in mental health. These people work in psychiatric facilities, spending time daily with the patients, handing out trays, doing classes and activities with the patients and looking out for the patients' ultimate safety when they're out of control.
Next, we'll move on to the LVN or LPN - Licensed Vocational or Practical Nurse - depending on which state you live in. The LVN actually has a license as well and is ultimately responsible and accountable for their actions. LVN School is usually 14 months long and includes classroom and clinical hours. LVNs have different roles in different states. I personally worked in 4 states as an LVN and each state is very different. In most states, LVNs do bedside nursing, have their own teams and are pretty much independent in their duties. There are some restrictions on medication administration - they can't do initial assessments, care plans, IV push or titratable medications. In California, the LVN role is more limited. LVNs usually work in clinics and doctor's offices as assistants. They usually work along side RNs doing more task oriented skills.
Some hospitals do use them at the bedside. Most patients don't realize there is a difference between LVNs and RNs.
Now back to the pre-hospital field. Paramedics, again, have different roles in different states. Some work in doctor's offices doing cardiac tests, some work in ERs or out of ERs as first response personnel. In big cities, paramedics usually run with the fire departments or private ambulance companies. Their course which includes classroom and clinical training varies from state to state again - usually anywhere from 600 - 1500 hours. Their skill levels are somewhere between a LVN and a RN - they can pretty much do everything a LVN is licensed to do, some things a RN is licensed to do, plus they can do advanced emergency procedures, airway management, intubation, needle decompressions, etc.. These people are usually the true adrenaline junkies. There is a high rate of burn out in this field due to all the tragedies they see.
OK, back to home base for me again. On to the RN - Registered Nurse. Now this is probably one of the most diversely educated and employed career of the bunch. RN's work everywhere - public health systems, schools, clinics, doctor's office, psychiatric facilities, hospitals, skilled nursing facilities, home health agencies; they work for private home care companies, private ambulance companies, air transport companies, the American Heart Assn., the American Red Cross, the military, the Motion Picture industry, private employers, etc.... There are so many endless possibilities out there for RNs. The education levels vary as well. You can go through a Diploma program, get your 2 year Associates degree, 4 year Bachelors degree - actually you can also have your Masters or Doctorate in nursing as well. One of the really nice things about nursing is you can find your own little niche, you can move around until you find what you really like, what fits you best. RNs have their own license and a lot of responsibility and accountability for their actions. They are the bedside nurse, the educator, the task oriented person, the assistant to the doctor. They often do research work or even work for the insurance companies. They are the telephone triage nurses. You see them, well, us, everywhere.
And when you want to move further up the ladder, you can - you can become a Nurse Practitioner, a Physician's Assistant or move into Administration or Education with your Master's or Doctorate Degree.
I think that sums up the roles and educational requirements. I hope I didn't put everyone to sleep - at least not yet.
Now, I want to talk about the nursing shortage - or what they call one anyway. Weigh in with me - do you really think there is a nursing shortage. I just listed all these positions - how can there be so many different positions -and be such a nursing shortage.
Well I may be wrong, but I have never really thought there was truly a nursing shortage. I've worked in 4 different states. They're all cranking out many, many classes of new graduate nurses. And nursing is a long career - well potentially anyway. You can be a nurse for 40 years at least - if you want. I've always felt like there are a lot of nurses and ancillary medical personnel. I just don't believe that we all stay in the field. I think we come and go as our lives change so that we can live our lives around that career. It's one that's easy to go in and out of. The pay is good. The hours are fairly flexible. I also am of the belief that facilities just can't afford to hire - or choose not to hire as much staff as they need. We've all worked in facilities where our ratios are ridiculous. I hope the days are gone on the floors where you're 7 - 10 - 15 patients to 1 nurse. It's not safe and I don't believe that it's that way too many places anymore. We all work short for one reason or the other - sick calls, vacations, budgetary restraints. And because of this, we lose a lot of nurses because they're just too overworked, stressed out and just plain tired. They feel under appreciated and choose to change careers. Such a shame we can't covet what we need the most - caring, trained and diligent patient care personnel. People taking care of people.
So they say we're in big trouble as time goes on, as we baby boomers become old - and as the nursing schools don't have enough funding or teachers. So what do you guys think? Is there a shortage - for real - or is it all just a figment of the countries imaginations?
And lastly, I just want to say nurses are not just numbers, we can't easily be replaced with the next one, any one - sometimes contrary to some people's beliefs. Once you find one or two or as many as you can find, you need to nurture them, connect positively with them, shower them with respect, listen to their concerns, and yes, complaints. You need to encourage them with positive reinforcement to get them to the next step. And sometimes, you need to pick them up off the floor and give them a hug and a kind word when things get tough. It's what keeps us here. It's what we need to keep going in such a highly charged emotional and stressful field.
And one more thing, we need to take care of ourselves first - before we can take care of our families, friends or patients. When our bodies are so tired and stressed, we sometimes get sick - physically or mentally - and we just can't go on without recharging. We can't minimize this - we must listen to what our bodies are telling us - and we must look out for each other and encourage self-care first. I fear we let one of our down recently - she just pushed herself too far - further than her body could handle. So to you Trisha, may you rest in peace. You had truly found your calling, your niche - you were a great person, a great ER nurse - good to your patients and co-workers alike. You'll be truly missed.
More on health care reform coming up. I've got to get back to reading that bill - next thing you know, there will be another out.
Well, I'm back after a couple of days off again. Seems like I'm starting to need a few days in between to gather my thoughts. I'd like to go off course a little bit from the health care reform issue today.
I think today I'm going to touch a little bit on medical personnel roles in the health care field - education level, job responsibilities, etc.... Then I want to wrap it up a little bit talking about the so-called nursing shortage - and my views on that. And in the end, I want to pay tribute to someone special who we recently lost, someone who had a calling to take care of others and did so so very well- in our ER.
I'll start with some of the ground level positions and work my way up the so-called ladder. Although, I don't want to imply that any position is any better or worse than any other position. It's important to remember that when a person is in the medical field, they land either where their heart lies or where they can afford to stay for the time being. That's why it's such a dynamic field - you can play where your strengths are and move around until you find what suits you best.
How many different hands-on patient care positions are there? To name a few, there are CNAs, Orderlies, EMTs, MAs, Psych. Techs., LVNs, Paramedics, RNs, PAs and NPs. Of course, these positions aren't all inclusive. There are still Techs in other departments - Radiology, PT, OT, Pharmacy, Cashiers, Clerks, Volunteers, etc... We all need each other to take care of patients.
I'll touch base on a few of these positions and their roles.
I suppose the entry level for many new people to the health care field would be the CNA - Certified Nursing Assistant. This is a very difficult job to do and one that requires a very special kind of person. These are the people who are most in touch with the patients - those who work at the bedside, taking vital signs, feeding, bathing, dressing and toileting patients. Although the hourly educational requirement isn't that high -usually around 75 + hours of classroom and clinical training - interpersonal skills are very important. I remember many a time a CNA saved my butt on the floor - coming to me to alert me that something was wrong with one of my patients.
Orderlies, though few and far between anymore, have similar educational requirements and job responsibilities of the CNA. Because a lot of orderlies are males, they also have the added responsibilities of working with equipment and lifting the patients. Ouch, my aching back.
Next we'll go to the pre-hospital side of the fence, the EMT, Emergency Medical Technician. The EMT certification class is usually around 140 hours of classroom, clinical and field training. EMTs in the field have varying tasks depending on what state you live in, where you work and how rural an area you live in. EMTs in the hospital mostly do task-oriented noninvasive procedures - splint applications, dressings, EKGs, lab draws, etc... EMTs in the field usually ride in the back of the ambulances and take care of the patients or assist the paramedics. Tasks may include splinting, dressing wounds, oxygen administration, spinal immobilization, CPR, etc... Many times, they are firemen or police officers as well. This field is very close to my heart. It's where I started - where the medical bug bit me. One summer I decided to take this class just for the fun of it. I thought it would be a great place to meet guys. True. I didn't even like blood, or couldn't imagine taking care of people, but that sure changed fast. It made me want more.
MAs - Medical Assistants again are an integral part of the health care team. Most vo-tech colleges and some nursing schools have MA classes. They can either go for a year - or two years and earn their Associates Degree. These are the people that usually work in clinics and doctor's offices. They are the ultimate assistant. They answer phones, schedule appointments, assist with billing, put patients in rooms, take vital signs, etc.... They can also do other tasks as long as they have been taught those tasks and the doctor they work for assumes responsibility for those tasks- ie) medication administration, blood draws, assisting with procedures.
Now, let's move over to another specialty field - Pysch. Tech. The educational requirement for these licensed personnel is usually around 1500 hours. This is a parallel field to a LVN/LPN with more emphasis in mental health. These people work in psychiatric facilities, spending time daily with the patients, handing out trays, doing classes and activities with the patients and looking out for the patients' ultimate safety when they're out of control.
Next, we'll move on to the LVN or LPN - Licensed Vocational or Practical Nurse - depending on which state you live in. The LVN actually has a license as well and is ultimately responsible and accountable for their actions. LVN School is usually 14 months long and includes classroom and clinical hours. LVNs have different roles in different states. I personally worked in 4 states as an LVN and each state is very different. In most states, LVNs do bedside nursing, have their own teams and are pretty much independent in their duties. There are some restrictions on medication administration - they can't do initial assessments, care plans, IV push or titratable medications. In California, the LVN role is more limited. LVNs usually work in clinics and doctor's offices as assistants. They usually work along side RNs doing more task oriented skills.
Some hospitals do use them at the bedside. Most patients don't realize there is a difference between LVNs and RNs.
Now back to the pre-hospital field. Paramedics, again, have different roles in different states. Some work in doctor's offices doing cardiac tests, some work in ERs or out of ERs as first response personnel. In big cities, paramedics usually run with the fire departments or private ambulance companies. Their course which includes classroom and clinical training varies from state to state again - usually anywhere from 600 - 1500 hours. Their skill levels are somewhere between a LVN and a RN - they can pretty much do everything a LVN is licensed to do, some things a RN is licensed to do, plus they can do advanced emergency procedures, airway management, intubation, needle decompressions, etc.. These people are usually the true adrenaline junkies. There is a high rate of burn out in this field due to all the tragedies they see.
OK, back to home base for me again. On to the RN - Registered Nurse. Now this is probably one of the most diversely educated and employed career of the bunch. RN's work everywhere - public health systems, schools, clinics, doctor's office, psychiatric facilities, hospitals, skilled nursing facilities, home health agencies; they work for private home care companies, private ambulance companies, air transport companies, the American Heart Assn., the American Red Cross, the military, the Motion Picture industry, private employers, etc.... There are so many endless possibilities out there for RNs. The education levels vary as well. You can go through a Diploma program, get your 2 year Associates degree, 4 year Bachelors degree - actually you can also have your Masters or Doctorate in nursing as well. One of the really nice things about nursing is you can find your own little niche, you can move around until you find what you really like, what fits you best. RNs have their own license and a lot of responsibility and accountability for their actions. They are the bedside nurse, the educator, the task oriented person, the assistant to the doctor. They often do research work or even work for the insurance companies. They are the telephone triage nurses. You see them, well, us, everywhere.
And when you want to move further up the ladder, you can - you can become a Nurse Practitioner, a Physician's Assistant or move into Administration or Education with your Master's or Doctorate Degree.
I think that sums up the roles and educational requirements. I hope I didn't put everyone to sleep - at least not yet.
Now, I want to talk about the nursing shortage - or what they call one anyway. Weigh in with me - do you really think there is a nursing shortage. I just listed all these positions - how can there be so many different positions -and be such a nursing shortage.
Well I may be wrong, but I have never really thought there was truly a nursing shortage. I've worked in 4 different states. They're all cranking out many, many classes of new graduate nurses. And nursing is a long career - well potentially anyway. You can be a nurse for 40 years at least - if you want. I've always felt like there are a lot of nurses and ancillary medical personnel. I just don't believe that we all stay in the field. I think we come and go as our lives change so that we can live our lives around that career. It's one that's easy to go in and out of. The pay is good. The hours are fairly flexible. I also am of the belief that facilities just can't afford to hire - or choose not to hire as much staff as they need. We've all worked in facilities where our ratios are ridiculous. I hope the days are gone on the floors where you're 7 - 10 - 15 patients to 1 nurse. It's not safe and I don't believe that it's that way too many places anymore. We all work short for one reason or the other - sick calls, vacations, budgetary restraints. And because of this, we lose a lot of nurses because they're just too overworked, stressed out and just plain tired. They feel under appreciated and choose to change careers. Such a shame we can't covet what we need the most - caring, trained and diligent patient care personnel. People taking care of people.
So they say we're in big trouble as time goes on, as we baby boomers become old - and as the nursing schools don't have enough funding or teachers. So what do you guys think? Is there a shortage - for real - or is it all just a figment of the countries imaginations?
And lastly, I just want to say nurses are not just numbers, we can't easily be replaced with the next one, any one - sometimes contrary to some people's beliefs. Once you find one or two or as many as you can find, you need to nurture them, connect positively with them, shower them with respect, listen to their concerns, and yes, complaints. You need to encourage them with positive reinforcement to get them to the next step. And sometimes, you need to pick them up off the floor and give them a hug and a kind word when things get tough. It's what keeps us here. It's what we need to keep going in such a highly charged emotional and stressful field.
And one more thing, we need to take care of ourselves first - before we can take care of our families, friends or patients. When our bodies are so tired and stressed, we sometimes get sick - physically or mentally - and we just can't go on without recharging. We can't minimize this - we must listen to what our bodies are telling us - and we must look out for each other and encourage self-care first. I fear we let one of our down recently - she just pushed herself too far - further than her body could handle. So to you Trisha, may you rest in peace. You had truly found your calling, your niche - you were a great person, a great ER nurse - good to your patients and co-workers alike. You'll be truly missed.
More on health care reform coming up. I've got to get back to reading that bill - next thing you know, there will be another out.
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