I discussed whether or not ambulances should be required to add equipment costing $12,000 in order to be able to transport 850 pound patients recently, so I won’t belabor the point here. Providing medical care to morbidly obese patients presents multiple challenges.Then I read an article in the Florida Sun Sentinel about how some obstetrician-gynecologists in South Florida are refusing to provide medical care to obese women. ...
WhiteCoat, MD
How far should hospitals go to treat obese patients?
Boston Emergency Medical Services recently debuted an ambulance with a mini-crane and reinforced stretcher to transport patients weighing up to 850 pounds. It cost $12,000 to retrofit the ambulance.My problem is this: I think we need to do our best to provide medical care to all patients. But patients need to take some basal level of responsibility for their own health. If you’re saying that you got to ...
Debt prevents health insurance from providing more health care access
I read an article in the New York Times that underscores my argument that health care insurance does not and never will equal health care access.Our federal and state governments are being crushed by debt. There are many reasons for that debt, and addressing the reasons for the debt are a necessary aspect of decreasing the debt. For example, if a family household had overdrawn its checking account by ...
Your worth as a physician can be judged by how people invoke God
As I walked into the ED for my shift, the nursing supervisor was fumbling with a syringe attempting to get medication out of a small vial.“Ummmm. Looks like you need to adjust your bifocals,” I quipped. We have a running joke about who is older and bust on each other about our ages every chance we get.When she turned around, the look she gave me signaled that it was no ...
Antibiotics need to become controlled substances and regulated
Antibiotics for viral infections are a big pet peeve of mine. No. Make that a huge pet peeve.Some doctors prescribe antibiotics for coughs and stuffy noses because the patients want them. If you’re one of those patients who think that antibiotics make your coughs go away, or clear up your stuffy noses, or somehow make your sinus headaches vanish, or if you’re a doctor who prescribes antibiotics for these symptoms, ...
How observation admissions affect Medicare patients
A revealing article in Bloomberg recently described the latest way in which elderly patients are getting screwed by the system.Medicare reviews all admissions and if the patients don’t meet indications for admission, the hospital doesn’t get paid by Medicare. Medicare has also recently implemented a mercenary system called Recovery Audit Contractors (or RAC for short) in which third parties audit hospital charts to see whether Medicare “overpaid” for a patient’s ...
Mail order pharmacies have cheap prices, but also problems
After seeing Mrs. WhiteCoat argue on the phone with Medco representatives for 20 minutes about why one of her 80+ year old patients hadn’t received her medicine despite three lost faxes to Medco, I had to write this post to let the public know what is going on with some mail order pharmacies.If you’re like most Americans, you want to try to save some money. One of the ways that ...
The difficulty of regulating x-ray radiation in the ER
A recent article in the New England Journal of Medicine touched off another salvo about how non-clinicians have no problems judging the abilities of clinicians in the world of medicine.The article begins by presenting the case of a woman who awoke with facial paralysis and then went to the emergency department. On arrival, she received CT scans and MRI scans of her brain. When those were normal, she was diagnosed ...
Florida EMTs may go bankrupt because of a malpractice lawsuit
An ambulance service was recently held liable for failing to “do what was necessary” before accepting emergency transport of pregnant patient.A child was born at 25 weeks gestation -- 15 weeks premature -- and was not breathing. Babies born at this age have a viability of 50-70%. In other words, up to half of children born at this age of gestation die. The family called 911. The paramedics arrived, ...
Criminalizing medicine will lead to fewer doctors
I recently read about a case involving the next step down the slippery slope of criminal prosecution of physicians.First Michael Jackson’s physician gets prosecuted when his physician gives him an unintentional overdose of an anesthetic medication when trying to help him sleep. According to a previous discussion on this topic, most people seemed to think that prosecutors were justified in those charges.Now, Dr. Mathew Wallack is being criminally investigated ...
Defensive medicine starts early in residency training
Part of a resident’s job is to learn the ropes in preparing for independent practice. While you’re a resident, you get the benefit of having someone looking over your shoulder to critique you as you determine how you are going to manage patients.I frequently tell residents that different attending physicians practice medicine in different ways. Some practice defensive medicine more than others, some prescribe antibiotics more than others and some ...
