Thursday, November 30, 2006

Discounts

Discounts for Medical Services have always raised questions and fears among many in the Medical Profession. As physicians, we have our hands tied when we accept and sign contracts with 3rd party payors and especially with Medicare. Medicare and all government programs are stringent on giving discounts and hefty fines can be placed on the violators.

Here is the official position statement from the Office of Inspector General (OIG).
http://oig.hhs.gov/fraud/docs/alertsandbulletins/2004/fa021904hospitaldiscounts.pdf

This position statement was directed at hospitals in particular, but the Indiana State Medical Association (ISMA) states it equally applies to all providers. Based on the reading of this statement, it is acceptable to give discounts when there is a documented need for Medicare patients.

In addition, there should be no problem giving discounts to patients who is on an insurance plan that the physicians have no contract with or in patients who actually have no insurance.

Documentation of why the discount is given would always be helpful if for some reason you were challenged later.

Wednesday, November 29, 2006

Commissioner's ordinance




Here is a copy of the newest ordinance by the Commissioners. This will add two additional Board Members to the hospital board. What is interesting is the timing of this. It was requested back in January when they did not reappoint a physician to the board. It was requested as a mechanism to place a physician back at the table and to provide input to the Board they were not recieving. It was never acted on until after the election in november and in just 1 month, there are going to be two more positions to fill by members whose terms expire.

The other interesting thing is the appointments are for a 1 year term. This also seems a little unusual as it takes much more time for any new Board member to even feel comfortable with the volume of information and the learning curve.

I would love to see the commissioners have many applications to choose from. We need progressive, independent thinkers who are not afraid to challenge current thoughts and processes.

If you are one of those people, please send a letter to the Commissioner's office stating your desire to be considered for one of the positions.

Tuesday, November 28, 2006

Medicare cuts

As reported at the Indiana State Medical Association Indiana State Medical Association - e-Reports, Oct. 23, 2006, our congressmen have let physicians down again.

They have failed to pass legislation to prevent the proposed 5.1% cut in reimbursement slated to begin on January 1, 2007.

The goal was to have them stop the proposed cuts that the decade-old formula in physician payment was to trigger and to then tie Medicare payments and any increase to actual practice costs.

The AMA and physicians believe it is critical that Congress return during the lame-duck session. Otherwise, just as with Medicaid here in Indiana, more and more physicians will cease seeing new Medicare patients. With the baby boomers increasing in age, this will become a huge burden.

Monday, November 27, 2006

Successful Hunt



I hope these pictures are not offensive to anyone, but is was a successful hunt this Thanksgiving holiday.

I was able to bag 2 deer on Saturday morning and it will keep my freezer full of venison for the next year.

For me and many of my friends, being able to observe nature and be a part of it is truly awesome.

Watching the sun rise and everything in God's creation spring to life each day reinforces my belief in the design of our world.

I feel blessed to be a part of it and strive to keep a healthy balance with all of nature.

Thursday, November 23, 2006

Being Thankful


Be thankful that you don't already have everything you desire.
If you did, what would there be to look forward to?
Be thankful when you don't know something,
for it gives you the opportunity to learn.

Be thankful for the difficult times.
During those times you grow.
Be thankful for your limitations,
because they give you opportunities for improvement.
Be thankful for each new challenge,
because it will build your strength and character.

Be thankful for your mistakes.
They will teach you valuable lessons.
Be thankful when you're tired and weary,
because it means you've made a difference.




It's easy to be thankful for the good things.
A life of rich fulfillment comes to those whoare also thankful for the setbacks.
Gratitude can turn a negative into a positive.
Find a way to be thankful for your troubles,
and they can become your blessings.

Author unknown.

Wednesday, November 22, 2006

Study on Medical errors

In a recent report published in the Annals of Internal Medicine Missed and Delayed Diagnoses in the Ambulatory Setting: A Study of Closed Malpractice Claims -- Gandhi et al. 145 (7): 488 -- Annals of Internal Medicine, it was concluded that diagnostic errors that harm patients are typically the result of multiple breakdowns and individual and system factors. Awareness of the most common types of breakdowns and factors could help efforts to identify and prioritize strategies to prevent diagnostic errors.

This study, I think, is the beginning of really defining problems that are almost always multifactorial. It is rarely just a simple single oversight or error on an individual but a general breakdown in procedures and processes.

A recent example is the coumadin overdose at Methodist Hospital in the neonatal department. There were multiple chances to catch the error and for some reason, all of them seemed to fail, be overlooked or ignored.

Complacency with routines is sometimes the cause of these errors. This is why routine orders, critical pathways, defined treatments often create a laxity in critical thinking and leads to careless oversight. “Cookbook Medicine” as some doctors refer to it may help meet governmental standards for documentation of things, but it is not the sole answer to eliminate errors.

The report states that poor documentation, scheduling problems and miscommunication played a role in the errors, and it added that these findings reinforce the need for system interventions that reduce reliance on memory, force consideration of alternative diagnostic plans or second opinions, and provide clinical-decision support systems.

Tuesday, November 21, 2006

Chantix

Here’s the newest drug to help smokers kick the habit. It is called Chantix and it is manufactured by Pfizer.



The Active ingredient is Varenicline (as tartrate) and it comes in a 0.5 mg and 1 mg; tablets.

The drug works by binding to a nicotinic receptor in the brain thereby stimulating the receptor while preventing nicotine from binding. It stimulates receptor-mediated activity but at a lower level than does nicotine and by preventing nicotine from interacting with these receptors, varenicline blocks the ability of nicotine to stimulate the part of the central nervous system believed to be the neuronal mechanism underlying reinforcement and reward experienced with smoking.

Trials so far have shown very good results with quit rates of about 44% compared to bupropion SR at 30% and placebo at 17%.

The most common adverse reactions included nausea, other GI effects (e.g., constipation, flatulence, vomiting), sleep disturbance (e.g., abnormal dreams, insomnia), headache; nicotine withdrawal symptoms (due to smoking cessation).

So far, my patients have reported very good results and many say it is better than anything they have tried.

Monday, November 20, 2006

Why do certain costs rise and others not?

Here is an enlightening article dealing with rising costs and contrasts them to certain areas of medicine that have minimized the inflationary rise.

NCPA Brief Analysis #572, Update 2006: Why Are Health Costs Rising?

One paragraph states:


  • Health Care Costs Rise When Others Pay. A primary reason why health care costs are soaring is that most of the time when people enter the medical marketplace, they are spending someone else's money. When patients pay their own medical bills, they are conservative consumers. Economic studies and common sense confirm that people are less likely to be prudent, careful shoppers if someone else is picking up the tab. Thus, the increase in spending has occurred because third parties — employers, insurance companies or government — pay almost all the bills.

  • For every $1 worth of hospital care consumed, the patient pays only about three cents out of pocket, on the average; 97 cents is paid by a third party.

  • For every $1 worth of physician services consumed, the patient pays less than 10 cents out of pocket, on the average.

  • For the health care system as a whole, every time patients consume $1 in services, they pay only 14 cents out of pocket.


Plastic surgery, certain eye procedures and many dental procedures all fall into this category. The reason is pretty straight forward. These are all areas where the consumer actually has to pay out of pocket and usually before or at the time the service is rendered. This is the true open market, consumer driven principle that has repeatedly proved to work.

Friday, November 17, 2006

Opening Day

OPENING DAY of GUN SEASON

Starts on Saturday and this is what we are after. This is taken earlier in the year by a friend of mine. It is a 10 pointer still in full velvet. Rare picture.

I have been out bow hunting several weekends and have many deer on video, but have not yet taken one.

I'll be out all weekend looking to bag the big one.

Thursday, November 16, 2006

New York Lawsuit

New York doctors are filing a class-action suit against Oxford Health. It concerns a “take it or leave it” policy that Oxford and UnitedHealthcare have mandated. Both companies merged in 2004 and now are telling physicians that if they want to be in one plan, they also have to accept the other plan. If they do not agree, they would be terminated based on the “all-products” clause in the contract.

The Medical society and 11 individual physicians allege the rules violate antitrust laws. What happens is once a physician is in both plans, patients eventually get shifted into the lower paying inferior plan. If physicians do not accept this clause, they risk losing many of their patients.

The health plans are using their economic leverage with one plan to force physicians into accepting a plan they otherwise would not take. UnitedHealthcare and Oxford representatives declined to comment when interviewed by AMA news.

AMA policy opposes tying a physician’s membership in a managed care panel to that physician’s participation in any other managed care panel. AMA is continually working on legislation to prevent this from occurring.

Wednesday, November 15, 2006

Lawsuit in Washington

The Washington State Medical Association has filed a lawsuit against Regence BlueShield. The claim states the health plan defamed physicians when they told patients that physicians did not meet the quality standards needed to be included in their network.

The information came from claims data. This is a common source of information by the insurers, but it is very limited and rarely accurate or up to date. W. Hugh Maloney Jr., MD, WSMA president elect said “the information was not corroborated with patients; medical records and in many cases was based on information 4 years old.” He gave examples of a physician being given a low rating for not ordering mammograms on a patient with bilateral mastectomies, and another for not doing pap tests on a patient who had a total hysterectomy.

In a number of instances, “there was egregious misapplication of data that has affected physicians’ reputations, their livelihoods and their relationships with their patients”

The executive VP of Regence did not directly respond to the allegations and they have delayed the implementation of this program.

The buzz word of the times “Pay for Performance” is what this really has to do with. When you use garbage data as the source, there will be no way to get accurate results in the results. Who will this hurt financially? Once again, it will be physicians taking the impact.

We hope they win this lawsuit to put a little more accountability on the insurers before they can publish garbage data for physicians or hospitals.

Tuesday, November 14, 2006

Changes at UnitedHealthcare

Well, the scandal must have been too much for even his money to overcome. As reported on every major news channel, Chief Executive William W. McGuire was forced out of the CEO position for UnitedHealth Group. He was forced to resign from the company and was required to give up a portion of the $1.1 billion he holds in the much criticized stock options.

UnitedHealth Group continues to face potentially negative reactions from customers and possible legal fallout from federal investigations because of stock options granted McGuire and other senior executives. But even with this, the health insurer is likely to record 15% to 20% annual earnings growth according to some analysts

Also dismissed were its general counsel and a member of its board in an overhaul of the leadership and governance.

Maybe this is the beginning of a system-wide overhaul that is drastically needed.

Monday, November 13, 2006

Charity Care's new rules


Under the threat of legislation, the not-for-profit hospital industry is taking a giant step forward in establishing a standard for defining the community benefits provided by the hospitals that are supposed to provide charity care. The strong urging of Finance Committee Chairman Sen. Chuck Grassley (R-Iowa) has sparked the recent steps.

In recent years this industry has struggled to both define and communicate its larger community benefits it provides. This has recently been questioned because of its sometimes aggressive billing and collection practices that many have encountered. These practices are necessary to continue to financially survive in the tougher healthcare environment. These practices have come under the scrutiny of Congress, the Internal Revenue Service, state attorneys general, patient advocates and plaintiff’s attorneys -- all of whom question whether the taxpayer is getting enough bang from the tax-exempt buck.

Grassley suggested that the guidelines CHA developed in conjunction with hospital alliance VHA "can serve as a starting point." About 90% of the CHA's which is approximately 565 hospitals and 400, or 35%, of VHA's nearly 1,200 member hospitals have agreed to begin this new reporting methodology.

One of the biggest changes in the CHA's guidelines is how they count charity care. The new methodology will count charity care and Medicaid payment shortfalls based on costs, not charges, as community benefits. This will markedly change the numbers that are now being reported as Charity care. In addition, they don't count bad debt or Medicare underpayments as Charity care. All of this will dramatically lower the supposed amount of charity that is being provided.

"Nonprofit doesn't necessarily mean pro poor patient. Nonprofit hospitals may provide less care to the poor than their for-profit counterparts," Grassley said in a written statement. There also appeared to be "very little difference on executive compensation" between the two sectors as well. "I'm afraid if nonprofit hospital boards are focusing so little attention on what they're paying executives, they're giving even less attention to how the hospitals are helping the community and the poor," Grassley said.

What is at stake for non-profit hospitals are the billions of dollars from local, state and federal tax breaks. It is approximated that about 5% of hospital expenditures is reduced by tax exemptions and another 5-6% is received from disproportionate share payments from the government for charity care. These standard tax exemptions have not changes substantially since 1969.

Significant changes in these policies will make reporting much more accurate, but may show that non-profit facilities do not provide as much charity care as they would like some to believe.

Friday, November 10, 2006

Laughter heals



Laughter is a very powerful aide in health. Studies have shown that when we laugh, natural killer cells are increased. These are known to destroy tumors and viruses. Laughter also increases Gamma-interferon (a disease-fighting protein), T-cells (important for our immune system) and B-cells (which make disease-fighting antibodies). It can lower blood pressure, increases oxygen in the blood; all of which encourages healing

The sound of laughter is far more contagious than any cough, sniffle, or sneeze. Humor and laughter can cause a domino effect of joy and amusement, as well as set off a number of positive physical effects. A good hearty laugh aides in the following:
• reduces stress,
• lowers blood pressure,
• elevates mood,
• boosts immune system ,
• improves brain functioning,
• protects the heart,
• connects you to others,
• fosters instant relaxation
• makes you feel good.

Many studies link depression, anger, anxiety, and stress to heart disease and the ability to laugh at stressful situations helps mitigate the damaging physical effects of distressing emotions. It does this by lowering blood pressure and causes deeper breathing which sends oxygen enriched blood and nutrients throughout the body.

Other benefits include giving a good workout to your diaphragm, abdominal, respiratory, facial, leg, and back muscles. It massages abdominal organs, tones intestinal functioning, and strengthens the muscles that hold the abdominal organs in place. Not only does laughter give your midsection a workout, it can benefit digestion and absorption functioning as well. It is estimated that hearty laughter can burn calories equivalent to several minutes on the rowing machine or the exercise bike.

So here are some helpful hints:

• Attempt to laugh at situations rather than bemoan them – this helps improve our disposition and the disposition of those around us.
• Use laughter to release pent-up feelings of anger and frustration in socially acceptable ways.
• Laugh as a means of reducing tension because laughter is often followed by a state of relaxation.
• Lower anxiety by visualizing a humorous situation to replace the view of an anxiety-producing situation.
• Remember that even in the most difficult of times, a laugh, or even simply a smile, can go a long way in helping us feel better
• Laughter is the shortest distance between two people.
• Humor unites us, especially when we laugh together.
• Laughter heals.
• Laughs and smiles are enjoyed best when shared with others.
• To laugh or not to laugh is your choice.

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Thursday, November 09, 2006

Seniors reaching the doughnut hole

We talked earlier last month about the Medicare Part D doughnut hole and as the end of the year approaches, more and more seniors are finding our first hand how this affects them. Some patients may have to choose between food, gas, rent or their medication.

It is estimated that 3 million seniors will reach this coverage gap before the end of the year. Many patients who face this coverage gap are already on a fixed income and have very little wriggle room. If their health worsens, they will end up in the emergency rooms and hospitals where their regular Medicare will cover the expense. This adds to the overall burden to the system.

The Part D plan has enabled some seniors a reprieve from the high cost of medication, but this doughnut hole was a known problem and probably not thought out well enough at the legislative level.

We are still not where we would like to be based on our economy and resources. We should be doing a better job for basic medical care. The problem will only worsen as the baby boomers reach the Medicare age range.

Wednesday, November 08, 2006

New California Law

First off this morning, congratulations to all the winners yesterday and a praise to all those who took their civil responsibility and cast their vote. We have a great country that affords us this opportunity!

In an effort to protect uninsured and those patients at the lowest income levels, California is enacting some new laws that will apply to all licensed, general acute-care hospitals, with some exceptions for rural hospitals and will become effective January 1, 2007.

The details are as follows:

ELIGIBILITY: Uninsured patients who earn up to 350% of the federal poverty level or low-income patients whose out-of-pocket medical expenses exceed 10% of their annual income

REQUIRES HOSPITALS TO: Maintain written policies; post charity-care policies publicly; provide patients with written notice of discounts, payment plans and public insurance programs; provide copies of their policies to state regulators; wait at least 150 days before pursuing civil action against an eligible patient for nonpayment or reporting a patient to a credit-reporting agency; and reimburse any patient who is overcharged

PROHIBITS HOSPITALS FROM: Charging eligible patients more than what government-sponsored insurance programs pay; sending an unpaid bill to collections as long as the eligible patient is making a good-faith effort to pay; garnishing an eligible patient's wages to collect on unpaid bills; placing a lien on an eligible patient's home; and charging interest on extended-payment plans

Source: Summary of California Assembly Bill 774, Modern Healthcare reporting and Modern Healthcare

This is far different than what has occurred historically in many hospitals. Patients without insurance used to be charged full fees for services and then some hospitals would give discounts off the full charge. These discounts were often far less than the write-offs that insurance companies received and these patients had bills that were extremely large. Many unable to pay would be sent to collections or have legal actions taken against them.

Private insurers would off-set the losses from charity care in the past, but this will prevent that from happening as well. Eventually, we will get to the point where the charges actually reflect the true cost and cost-shifting ceases.

Tuesday, November 07, 2006

Election Day

As we decide to cast our vote today, here are some thoughtful words from Dr. Del Tackett who I heard speak a month or so ago. This was sent out by email yesterday to encourage everyone to vote and especially those holding a Christian Worldview.

Doing What is Right

For our American readers ...

Unless you have been in a Rip-Van-Winkle nap, it has to have been abundantly obvious that, leading up to this election, the mainstream media has been on a desperate mission to persuade the populace towards its worldview. The deep bias in reporting has been breathtaking, to say the least. It used to be just a sly wink or the well-timed smirk. Now it is blatant.
None of this, of course, should be surprising to any of us. The Pew Research Poll of 2004 showed what anyone with a half-discerning eye and ear already knew: "liberals" outnumber "conservatives" by a whopping 5 to 1 ratio in the old mainline media outlets. And, it clearly shows.


Why?

Because our worldview shapes everything we do, both professionally and personally, and it is especially evident in the creative works of man. The painter seldom paints that which does not come from his own passions. The filmmaker rarely produces a movie that does not send an underlying message about which he deeply believes.

So, the lofty notion that a journalist or a newscaster can be totally "unbiased" in their work is virtually impossible to achieve--on either side. The selection of stories, their order and timing, the wording of a headline, the data reported versus the data left on the floor, page one versus buried in Section D--all of it is going to be crafted, consciously or subconsciously, according to one's worldview.

Now, this is not meant to be partisan, but it is meant to make us aware that we have all been affected by this. We live in a culture in which much of the media that bombards us is heavily slanted and often represents a worldview standing diametrically opposed to God's truth.
So, on this election eve, I want to remind you how deeply possible it is that you and I have been swayed by this onslaught. In many cases it has been carefully orchestrated, not so much to get you to change your position, but to get you to remain at home on Election Day. In today's world, the way to win at the ballot box is not so much to change minds, but to get more of your people to the polls and discourage more of the opponent's people so that they stay home. The people who stay home lose.


This is not an option for us.

In God's design for the state, He has placed the civil magistrate in a position of authority and holds him accountable for how he wields that authority. He is to punish evil and not allow it to reign. He is to condone what is good. In our constitutional republic, part of that authority has been delegated to us and placed into our hands. We bear the authority of appointment, the selection of those who will provide leadership within the civil government. This is a high responsibility and we are bound by duty and obligation to act righteously with that authority.
I know that this is sometimes very frustrating, especially when we are faced with having to make a selection between two imperfect alternatives. But, my friends, that is always the case. No one is perfect. So, spend the time and effort to determine which appointee will do the best job at diminishing evil and condoning good. Do not stay at home as the media has been persuading you to do. To do so is to let the greater evil reign.


See you at the polls.

Monday, November 06, 2006

Should we vote?

Many of the readers and bloggers agree that our current system could be improved. But besides improving on the two-party system, the lack of appropriate term limits, the outside PAC’s and huge sums of money, we also need to consider the voters themselves.

How do we really get people involved and educated on the issues?

As we enter into the 24 hours prior to Election Day, I was reminded of an op-ed from the Wall Street Journal back in 2004.

The Other Campaign
Why should we want lazy idiots to vote?

BY CATHERINE SEIPP
Friday, October 15, 2004 12:01 a.m. EDT
With every election season comes yet another flurry of what I've come to think of as Nurse the Vote stories. You know the type: suggestions that democracy is undermined when people who can't figure out whom to vote for, or even how to get to the polls, choose to stay home. The solution, the voter-outreach panderers propose, is hand-holding and nagging. But why should the lazy-idiot demographic be encouraged to influence society even more than it already does?

"I am not disengaged, I'm worn out," a Michigan State University senior named Traci E. Carpenter wrote in a Newsweek essay explaining why she and her peers are "not necessarily available Nov. 2." Traci had won a contest for college journalists sponsored by Newsweek and MTV's college channel, MTVU. MTV also sponsors the Choose or Lose youth-vote campaign; thus the topic of the winning essay.

"Sometimes I feel that no matter how I vote, there will still be war, crime and poverty," Traci continued in what read like a dead-on parody of adolescent cluelessness and self-absorption, except she wasn't kidding. "And I have other things on my mind. I am worried about skin cancer, drunken drivers, eating disorders . . ."

I saw the dimmest minds of Traci Carpenter's generation, destroyed by watching too much MTV, nodding their heads and thinking: "Dude, like, I know! They tell us to vote, but when we do, it still doesn't stop war and skin cancer and eating disorders. That's so totally harsh!"

It seemed that nothing could beat this for sheer dopiness, but then along came a toy creator named Ken Hakuta and his Adopt-a-Vote campaign, which aims to give the underage set a voice in the 2004 election. His idea: Parents could promise to vote according to their children's wishes as long as the kids have done their homework.
Right, that's what we need in this campaign--more bribery and condescension. A better lesson for parents to teach their children might be that, while many things in life are hard, voting is not one of them. Compared with getting your DSL or cable TV fixed, in fact, it's easy.

Speaking of bribery and condescension, Michael Moore is now touring the country offering first-time voters joke prizes like ramen noodles or clean underwear in exchange for promising to make it to the polls. "Underwear" and "Michael Moore" are two concepts I'd hoped never to have to consider in the same sentence, but life is full of disappointments, as winners of youth-vote essay contests haven't quite realized yet.

The grande dame of shameless youth-vote pandering is Madonna, who in 1992 wrapped herself in an American flag for a Rock the Vote ad even though (as it turned out) she herself had never bothered to register. Still, voting is important, Madonna told the Rock the Vote Web site last year, especially now that "anybody who has anything to say against the war or against the president or whatever is punished." Punished? How? And for speaking out against the war and the president or for just, you know, whatever?

Rock the Vote has now sunk even lower, with its current campaign to get out the hoax-believers demographic. Never mind that a stagnant bill to reinstate the draft was just rejected, 402 to 2, in the House and that neither President Bush nor Sen. Kerry supports conscription. Rock the Vote ads still insist that the draft is "one of the many issues that could be decided this election." In a similar spirit, a University of Southern California student told the Los Angeles Times this week that she thinks Mr. Bush might reinstate the draft even though he has repeatedly said otherwise. "People lie," she said. They sure do.

My 15-year-old daughter follows election news closely, without the benefit of Michael Moore (whom she can't stand) or MTV commercials (which she doesn't watch), but I'm still not handing my vote over to her. No matter; she feels that she is voting anyway. As she explains it: "There's such a thing as voting mentally, Mom."
All those do-gooders rallying 'round the youth vote might consider this concept for a moment. Perhaps nascent voters should be encouraged to vote mentally--through actually informing themselves--before voting physically. And anyone telling others to get to the polls might practice a few mental exercises first. This could avoid fiascoes like Cameron Diaz's announcement, on Oprah's "voting party" show, that "if you think rape should be legal, then don't vote."

Maybe Ms. Diaz was simply channeling the fear message of rap impresario Sean "P. Diddy" Combs's Vote or Die campaign. But then maybe not. Ms. Diaz is a movie star, and there now seems to be a Screen Actors Guild contract clause that prevents members from speaking in public about voting unless they say something absolutely embarrassing.

Remember when Ben Affleck, who had worked on getting out the youth vote in the 2000 election, began telling interviewers he was thinking of running for Congress and it turned out he hadn't voted in 10 years? At least P. Diddy voted in the 2000 presidential election, though not since. When asked during a Vote or Die rally at New York University this summer why he hadn't voted in the New York City elections of 2001, he explained that he had felt "just as disenfranchised as the younger disenfranchised voters."

In Hollywood, we're used to this sort of thing. Once I was sitting next to a TV producer at some function, listening to an actor at the dais go on and on, when the producer reached over and wrote on my notepad: "Actor minus script equals incoherence." "South Park" creators Trey Parker and Matt Stone, whose movie "Team America: World Police" opens today, are equally cynical about celebrity political opining.

Commenting to Rolling Stone on the Vote or Die effort, Mr. Parker said sarcastically: "Hey, 19-year-old who doesn't know anything--you choose!" Mr. Stone had this to say about the voter-effect of "Team America": "If anyone walks out of this movie, or a Michael Moore movie, thinking about voting a certain way, then they're . . . stupid and shouldn't be voting." Such comments brought the pair an angry letter from Sean Penn (the puppet version of whom is in "Team America").
Mr. Penn thought that Messrs. Parker and Stone shouldn't mock youth-vote campaigns because (a) they themselves are too young to know better ("You guys are talented young guys but, alas, primarily young guys") and (b) they haven't personally visited Jordan and Iraq the way Mr. Penn has. The actor signed his letter, "All the best, and a sincere f--- you."

Now, celebrities are one thing. But I expect more from someone like journalist Ann Louise Bardach. When I saw she had written a Los Angeles Times op-ed last month headlined "How Florida Republicans Keep Blacks From Voting," I thought: Gee, that sounds awful. Let's see what she means.

What she meant was that Florida (like several other states) doesn't let ex-felons vote, and most ex-felons in Florida are black, and . . . well, let's just hope Cameron Diaz doesn't hear about this.

Ms. Seipp writes the column "From the Left Coast" for National Review Online.
So no matter what you think or how you feel, please make every effort to educate yourself, make informed decisions and perform your civic duty tomorrow by casting your ballot.


So even though we disagree on some issues, lets everyone try to agree that we have an opportunity and obligation to vote. Let each one of us perform our civic duty and head to our voting stations Tuesday.

As for me, I believe that the majority of my votes will be going to the Republicans. Although not perfect, their values and goals seem closer aligned with my own and I believe the country will be better off with them in leadership.

Friday, November 03, 2006

EMBARRASSING MEDICAL EXAMS

1. A man comes into the ER and yells, "My wife's going to have her baby
in the cab!" I grabbed my stuff, rushed out to the cab, lifted the
lady's dress, and began to take off her underwear. Suddenly I noticed
that there were several cabs ---and I was in the wrong one.
Submitted by Dr. Mark MacDonald, San Antonio, TX.

2. At the beginning of my shift I placed a stethoscope on an elderly and
slightly deaf female patient's anterior chest wall. "Big breaths," I
instructed. Yes, they used to be," replied the patient.
Submitted by Dr. Richard Byrnes, Seattle, WA

3. One day I had to be the bearer of bad news when I told a wife that
her husband had died of a massive myocardial infarct. Not more than five
minutes later, I heard her reporting to the rest of the family that he
had died of a "massive internal fart."
Submitted by Dr. Susan Steinberg

4. During a patient's two week follow-up appointment with his
cardiologist, he informed me, his doctor, that he was having trouble
with one of his medications. "Which one?" I asked. "The patch, the nurse
told me to put on a new one every six hours and now I'm running out of
places to put it!" I had him quickly undress and discovered what I hoped
I wouldn't see. Yes, the man had over fifty patches on his body! Now,
the instructions include removal of the old patch before applying a new
one.
Submitted by Dr. Rebecca St. Clair, Norfolk, VA

5.. While acquainting myself with a new elderly patient, I asked, "How
long have you been bedridden?" After a look of complete confusion she
answered..."Why, not for about twenty years - when my husband was
alive."
Submitted by Dr. Steven Swanson, Corvallis, OR

6. I was caring for a woman and asked, "So how's your breakfast this
morning?" "It's very good, except for the Kentucky Jelly. I can't seem
to get used to the taste" the patient replied. I then asked to see the
jelly and the woman produced a foil packet labeled "KY Jelly."
Submitted by Dr. Leonard Kransdorf, Detroit, MI

7. A nurse was on duty in the Emergency Room when a young woman with
purple hair styled into a punk rocker Mohawk, sporting a variety of
tattoos, and wearing strange clothing, entered. It was quickly
determined that the patient had acute appendicitis, so she was scheduled
for immediate surgery. When she was completely disrobed on the
operating table, the staff noticed that her pubic hair had been dyed
green, and above it there was a tattoo that read, "Keep off the grass."
Once the surgery was completed, the surgeon wrote a short note on the
patient's dressing, which said, "Sorry, had to mow the lawn."
Submitted by RN no name

8. I once interviewed a 6 year old and his mother while he was in the hospital. I asked the mom if anyone smoked in the house. She replied “no” and immediately the little boy spurted out, “but mommy, what about those funny cigarettes”. Needless to say, that led to another discussion with the mother.
Submitted by Daniel Eichenberger M.D.

AND FINALLY!!!................

9. As a new, young MD doing his residency in OB, I was quite embarrassed
when performing female pelvic exams. To cover my embarrassment I had
unconsciously formed a habit of whistling softly. The middle-aged lady
upon whom I was performing this exam suddenly burst out laughing and
further embarrassing me. I looked up from my work and sheepishly said,
"I'm sorry. Was I tickling you?" She replied, "No doctor, but the song
you were whistling was, "I wish I was an Oscar Meyer Wiener".
Dr. Wouldn't submit his name


*all of these were emailed to me by a friend.

Thursday, November 02, 2006

Voter's Guide


Here is a non-partisan voter’s guide distributed by Indiana Family Institute.

http://hoosierfamily.org/docs/VoterGuide06.pdf

As you look through the report, what becomes overtly obvious is that many more democratic candidates declined to answer the survey questions.

The questions are pretty straight-forward and none are really tricky. Many hit some important topics that concern most Indiana residents while others are certainly geared toward more conservative viewpoints. But there still should be no reason to decline answering the questions unless there is a problem with actually standing up for your beliefs.

I believe this is a common trend with the Democratic Party. They are more than willing to state what they believe to be wrong with everyone else and what is wrong with current policies, but I rarely see any of them actually stating publicly what they stand for and how they propose to implement their ideas.

Wednesday, November 01, 2006

EMR conversion

Electronic Medical Records (EMR’s) appear to be the wave of the future. There are certainly benefits, but there are also many shortfalls and a huge expense. Converting from paper to electronic records is time-consuming and very anxiety-provoking for both physicians and staff. Yelling, cursing, silent treatments and behind-the-back griping are all part of the upgrade processes, but none of these are helpful and all can sabotage the process. We have undertaken this task and definitely have had our share of difficulties. But now that we are in our second year, it is very nice.

Some helpful hints to lessen the trauma of the upgrade are:

1. The Practice works together as a team fairs better

Making sure your entire staff climbs on board the EMR training is a key to success.

There is no perfect EMR and each practice will have a workflow that will need adjusting. Change brings anxiety, so talking about the processes ahead of time will help.

2. Lesson No. 2: Choose the captain

All consultants agree that at least one physician should champion the process and be integrally involved. This is the one area that many practices fail.

3. Lesson No. 3: Keep negative comments in check

In many practices, there will be a third very enthusiastic, a third not caring and a third opposed. It is the one’s opposed who can really jeopardize a smooth transition if there is such a thing. It must be made clear up front that the naysayers should be kept in check by whatever means is appropriate. Some employees may not be capable of making the transition. If it happens to be a physician, there needs to be serious talks amongst the partners. Communication with the employees is critical during this time.

4. Lesson No. 4: Training is key

Training is often minimized for cost savings, but it is very critical. No system is perfect and it will take many trials and tweaks to get any system up and running in a manner that fits your practice style.

5. Lesson No. 5: Learn From Others’ Mistakes

Having a reputable dealer and other practices that you can call on for questions will make the transition a lot smoother and the learning curve a lot less steep.