Posts Tagged ‘Medical Ethics’

Today Republicans will be voting on healthcare. Apart from a last ditch effort to blame their inability to “repeal” OR “replace” the ACA on Democrats, at least one Congressman from Texas believes the gridlock is a “repugnant” result of his female colleagues.

“Some of the people that are opposed to this, they’re some female senators from the North East… If it was ‘a guy from south Texas’ who was generating so much discord in the party, I would ask them to settle their differences in a gun fight,”  Blake Farenthold said. One woman senator is from Alaska, but I guess if you count West Virginia with Maine that makes it 2 -1

So it’s High Noon on the Hill?

While it is true that three GOP women profess they will not vote on any bill they haven’t seen or don’t understand, they may also be slightly peeved that they were excluded from the bargaining table in an infamous photo of an all men panel. Or maybe their reticence indicates a deeper truth – that women and children will suffer if Medicaid is cut:

“According to the Kaiser Family Foundation, about half of all births are now paid for by Medicaid, ranging from 72 percent in New Mexico in 2015 to 27 percent in New Hampshire.” Oh, and it also pays for about 62% of all nursing home residents, most of whom are women. So the party who calls itself the party for LIFE, would like to cut the life line of those women most in need of health insurance.

In fact, all their so-called “crisis pregnancy centers” will most likely have to close. The irony of it all…and since Planned Parenthood is under attack, your guess is as good as mine as to where our country will fall on the world’s Maternal Mortality Rates. Oh wait,

U.S. women are more likely to die during childbirth than women in any other developed country, leading the U.S. to be ranked 33rd among 179 countries on the health and well-being of women and children. Women in the U.S. face a 1-in-1,800 risk for maternal death, the worst among the developed nations surveyed in Save the Children’s 16th annual State of the World’s Mothers report http://www.modernhealthcare.com/article/20150506/NEWS/150509941

In 1979 when the Bride was born, the entire hospital bill was $2,600. That included a day in the NICU, which I’d rather not explain since I’m sure that doctor would not like my story. We paid for that bill ourselves because we didn’t have insurance at the time. Due to an ancient and unheard of practice, all my pre-natal visits were free, ie “professional courtesy.” Today, the cost for a C-section (I had a breech birth) is most likely tens of thousands of dollars!

Sen McCain will be returning to vote on some form of a healthcare bill that would affect up to 69 million Medicaid patients – there was an increase in 11 million after the ACA passed. This means 15 million people may lose coverage by 2026. It would have a devastating effect on women, on the elderly and disabled, and patients undergoing opioid addiction services. Is that what the heartland wanted when they elected Mr T? http://www.npr.org/sections/health-shots/2017/06/27/534436521/from-birth-to-death-medicaid-affects-the-lives-of-millions

I’d like to think that just like Gary Cooper, who played the marshal in High Noon, McCain will stand alone and face down evil. He will exhibit compassion by doing the right thing. The producers of the iconic western in 1952 were being pressured by McCarthy’s Red-baiting fears to fire the writer and blacklist Carl Foreman, who was Cooper’s friend. John Wayne was leading the charge against Foreman when Gary Cooper said, “If Foreman goes, Cooper goes.”

“They’re making me run, I’ve never run from anybody before,” Marshal Will Kane said to the neophyte Grace Kelly.

Today is the day to get up and move, to call your senators people. Here are my grandchildren under a wishing tree; what will these senators tell their grandchildren?



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“That’s it!” I said to Bob this morning while watching the Breaking News Conference out of Dallas on CNN. This could be your real retirement plan, become a disease detective!

We turned up the sound as Dr. David Lakey confirmed that the first case of Ebola contracted inside the US tested positive in their Austin lab, and that they didn’t want to give his/her name at this time. As reporters questioned Lakey, we learned it was a health care worker who took infectious disease precautions, and not someone who treated their patient from Liberia, Thomas Eric Duncan, at his first fateful trip to the ER – when he was sent home with antibiotics. Duncan has since died.

So now we have our first case here in the US, like Spain, a provider is sick with Ebola. And it wasn’t the janitor who cleaned up the ER room when they first thought Duncan had a cold; when the travel history the triage nurse obtained never made it back to the doctor.

Cue the Mystery Detective music. Our family and friends have always thought Bob was the medical oracle. When signs and symptoms just didn’t make sense, when people were getting the run around from doctors, they would tell Bob their story and the sky would clear. He could somehow always make sense out of a complicated medical scenario. He is our very own Dr House!

But of course I’d rather he do some medical school teaching, or even golfing, rather than run around the world trying to solve real-time medical mysteries. Even though the CDC is probably hiring right now. Here are the facts, and only the facts about Ebola: http://www.who.int/mediacentre/factsheets/fs103/en/

In my dystopian view of the crisis, I can see the GOP blaming this outbreak on Obamacare. I can see the National Guard putting up a fence around Dallas, and I can see some crazy militia taking up arms. As soon as the TX Health Resources guy told people of Dallas not to panic, while ambulances are currently being diverted from that Presbyterian Hospital, I just knew people were going to panic. But let’s get real.

“The Ebola epidemic has killed 3,431 people in Guinea, Sierra Leone and Liberia; it has killed one in the United States.” http://mic.com/articles/100618/one-powerful-illustration-shows-exactly-what-s-wrong-with-media-coverage-of-ebola

So if we can keep some sense of perspective about this whole business, we’ll be alright. If we remember that yet another child in Michigan has died from enterovirus D68, that this upper respiratory infection is something we really need to wash our hands about, we may not panic about Ebola. “Enterovirus is very common, with the Centers for Disease Control and Prevention estimating 10 million to 15 million infections each year in the United States.” http://edition.cnn.com/2014/10/11/health/michigan-enterovirus-68-death/

“…D68 is a particularly virulent strain of this respiratory virus. So far there have been 691 cases of enterovirus D68 in 46 states and the District of Columbia;” six patients who died had the virus strain. It mostly affects children with asthma, or compromised immune systems. And like Polio, there can we some paralysis associated with its symptoms. Enterovirus-D68--EV-D68-jpg-1

Oh, and remember to get your flu shot!

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In all this talk about Syria, we Americans may be forgetting that the biggest public policy shift in our lifetime is about to take place. The Affordable Care Act is rolling out on October 1st, whether Kerry manages to corral Syria’s chemical arsenal or not. Even though employers of 50 or more get a one year delay to implement a health insurance plan for their companies, and smokers get a one year reprieve from being charged more than non-smokers, Obamacare is scheduled to debut on time with:

“…health exchanges (marketplaces), community-rated health plans, tax credit subsidies, individual insurance requirements, prohibiting annual and lifetime limits on coverage, requiring insurers to accept all applicants without regard to their health status (pre-existing conditions) and limiting how much more they can charge them…” http://www.kevinmd.com/blog/2013/08/delays-pose-big-problem-obamacare.html

What a monumental effort, making health insurance available for all just when we qualify for Medicare! Then I heard about thousands of hospital workers being laid off in TN, and naturally asked Bob what’s up. After all, we Boomers are just the beginning of a tsunami of health-related consumers to wash ashore; how could our country possibly be laying off medical personnel? Of course the easy answer is to blame the government, Obama and all his caring, that’s what the GOP would like us to believe.

Actually, hospitals across the country are massively laying off workers for a few reasons. One big one is the sequester – you remember that courtesy of the Tea Party. Our budget was cut by 1.2 Trillion, that’s trillion with a “T.”  Since nobody on The Hill could find a way to stop The Sequester, Moody had this to say: “…sequestration is expected to lower the revenues of hospitals, physicians, and other health care providers by $11 billion in 2013.” That’s Billion with a “B.”

Medicare under from budget sequestration could “exacerbate an already challenging operating environment for not-for-profit hospitals” that are facing “low revenue growth” from government and private insurers, Moody’s Investors Service said this week. The sequester involves about $1 trillion in across-the-board spending cuts, including a 2% reduction to all Medicare reimbursement rates, that took effect on April 1. http://www.advisory.com/Daily-Briefing/2013/04/10/Moody-Sequester-Medicare-cuts-threaten-hospitals

And the funny thing is, well it’s not really funny, but if you happen to live in a red state, with a governor who said thanks but no thanks to the Affordable Care Act, well the chances are that your favorite nurse, or physical therapist, or doctor may not be there is undeniable. http://www.wkrn.com/story/22942014/laid-off-workers-rally-outside-vanderbilt

You decide, is this job loss due to a bill that gives all Americans access to health care? Or is it due to an intractable Congress?DB_medicaid_map



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I remember the first time I went to see my regular doctor at UVA for a general physical exam. The Bride had recommended him and it turns out he is a real life Dr McDreamy. Handsome and smart, plenty of time to answer my questions, not in any rush to shoo me out the door. Maybe this is what academic medicine is all about? I was surprised that he ordered tests for blood and bone density, mammography – and he didn’t actually touch me. I guess my Irish ancestors get the prize for giving me all the right numbers in blood pressure, and remember I didn’t come in with a problem. But my first surprise was the nursing assessment before Dr McDreamy walked in; she asked me if, “I feel safe at home?”

Bob tells me that this is a relatively new question in the battery of things we patients must divulge when we are putting our lives into the hands of someone. I understood, I suppose if I was a battered and abused woman maybe I’d feel safe enough here to break down and tell? It made me wonder what protocol they use if a woman or man answered that question in a different way. How much do we drink, do we smoke, and btw how do we feel in our home? I remember when Bob worked on a baby who had drowned in a hot tub. I’m pretty sure they weren’t asking questions back then about pools and hot tubs.

Last month I accompanied the Love Bug to her 4 month Peds check-up. How’s the nursing going, sleeping? And political junkie that I am, I thought about the small battle that was waged last year to gag doctors in FL. Legislators there were fighting to silence their pediatricians’ general wellness questions; in particular, one question, “Are there guns in the home?” Yes sir, politics has slipped inside that HIPPA protected wall of the doctor/patient relationship – one I liken to a priest/confessor – and is yet again telling our health care professionals what to do.

“The way some doctors see it, asking patients whether they own a gun is no more politically loaded than any other health-related question they ask. So when a Florida law that prohibited them from discussing gun ownership with patients passed last year, they moved to fight it. A federal judge issued a permanent injunction blocking enforcement of the law in July.” http://www.npr.org/blogs/health/2012/11/27/165985266/taking-aim-at-restrictions-on-medical-questions-about-gun-ownership

I relaxed. I thought this will never do, it just can’t happen, if a federal judge in FL blocked this inane law, then it’s over. But no, it isn’t over.

A little known 5 sentence provision was slipped onto the end of the Affordable Care Act. Legislators agreed to slash the language of the bill until all health care professionals could do was ask about guns – there is to be

NO documenting of their conversation about guns,
NO collection of data on guns, and
NO research on gun ownership as it relates to injuries…

Legislators argued and preened around the policy, taking out the part about doctors being jailed if they so much as ask about guns, or even losing their license. As many as 8 states are still fighting to reinstate this criminal provision. Remember the good old days when all we worried about was a transvaginal ultrasound? http://edition.cnn.com/video/#/video/bestoftv/2013/01/09/ac-acosta-gupta-health-care-guns.cnn?iref=allsearch

Why should we care? 1 in 5 deaths of children in our country under age 20 is directly related to firearms – 1 in 5. In a 2 year study, for children ages 5 – 14, guns were shown to be the third leading cause of death. And now, the powerful NRA has basically stopped all research into this public health and safety problem. Let the newspapers print the names and addresses of gun owners. How many more rights are we willing to give up for the almighty money of the gun lobby?

Here is a picture of the graffiti that has appeared on our new bridge over the Rivanna River. “Love” on one side, and “Peace and Faith” on the other. I hope it stays there for awhile, that free speech travels upriver.

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By now you must know I married into a family of doctors. Bob’s father and his two uncles were doctors. He has a cousin on Long island who is an orthopedist, and one who was a practicing OB back in NJ. We have the MD gene and it runs deep. We would pack the kids up for the annual trip back to my MIL’s Seder each year, and one room was always devoted to a pick-up medical clinic – a Woody Allenesque review of sprained joints and aches and pains. So I’ve been hearing the disheartening rumbling with managed care for a long time now; but I’ve only recently heard about the Concierge or Boutique practice model.

Yesterday, a woman at the knitting circle mentioned her Cville doctor was turning his office into a Boutique practice and she was very willing to pay $1,600 a year for his time and attention. Now that’s just the fee to stay one of his patients, he’s whittling down the numbers from around 2,000 to only 500 patients. Some doctors will take medicare and insurance, others have given up completely and bill you, insisting the patient deal with the third party.This woman also said she thought that Proctor and Gamble owned the company that was going to run his new office. Look around, Family Practice and Internal Medicine docs are flocking to this model, officially called “retainer medicine.” This annual fee she felt would guarantee her access to the doctor, via email and phone, immediate appointments and even house calls!

I was surprised at my reaction. I said that’s too bad, because I see it as an ethical dilemma. In our great country, where the public option was taken off the table in the new Affordable Health Care reform act we barely managed to pass in order to appease insurance companies, a Concierge practice will only broaden the socio-economic gap between those who have so much, and those who are struggling to get by. The broad part of the middle class will become more fractured. I became slightly edgy, ranting about our fee-for-service medicine like I was some kind of, dare I say, socialist liberal. My knitting suffered. Intuitively, I just felt it was wrong. How can America be so alone in the world at not providing universal health care for its citizens? Here we are, with Africa…

Yet when I searched a popular physician website for “Concierge Medicine” there were 8,340 articles – all of them positive. They compared it to the choice of a private school over public, they said that while waiting for government to fix the system they decided to “…take matters into their own hands.” They reported about doctors going bankrupt! http://www.kevinmd.com/blog/2012/01/concierge-boutique-label-discredits-retainer-medicine.html They almost made me a believer. Almost. What do you think?

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