Handled By the Medical Safety Administration

Rejoice America! Help is on the way to rescue you from those ham-fisted unprofessional exams at airport screenings!

Soon, the Medical Safety Administration (MSA) will emerge from the Obama Health Insurance law to deliver you from unneeded medical screening exams, and will then (certainly) move on to non-medical ports of entry.

The US Preventative Screening Task Force (USPSTF) is the sole arbiter of medical screening in ObamaCare, so here are some highlights of USPSTF recommendations for the bashful:

NO recommended skin checks (visual or using scanner)

NO recommended ovary checks!

NO testicular exam!

NO rectal exams!

NO breast exams! Not even self breast exams!

SO, at your local MSA outpost(aka doctor's office)----no one will "TOUCH [YOUR] JUNK".

When the U.S. puts the MSA in charge of both medical and airport screening, all you hassled travelers can rest easy, at least until we get out the colonoscopes.

Risk Management

Today a cardiologist's office called. My referred 49 y/o patient refused her scheduled radionuclide cardiac imaging fearing danger from radiation exposure. Perhaps I can convince her that her cigarettes, liquor and methamphetamine are radioactive.

Peculiarities of Class

Nearly 20 years ago I had a young man present with a fractured a rib from a fall. I noted aloud the codeine allergy "documented" in his chart when I had first seen him 3+ years prior. I've never forgotten his response.

"Doc, I'm not allergic to codeine. I used to say that when I was still doing drugs so I could get Vicoden instead. We'd take 6 or 8 Vicoden at a time to get high, when I tried that with codeine, I'd just throw it up".

Drugs within the same class may (or may not) have significant differences in side effects (as above), intended pharmacologic effects(ditto) and cost. These differences are exploited by every player in the medical care bazaar.

My patient exploited differing intended and unintended side effects of two narcotics.

Drug reps exploit the most miniscule distinction to try to sell me on a product while talking down price disparity.

Insurance companies force choices due to cost while ignoring other considerations, regarding generic (same chemical) and same class (similar chemicals) as synonyms.

Recently I had a patient's spouse who explicitly adopted the latter view and was angry when I tried to explain the distinctions between one of his meds and her proposed substitute. "They're the same, there's no difference, they're in the same class".

The medicrats are smiling.

Dr. Rob's 10 Rules for Good Medicine

This superb post from Dr. Rob comes via DB's excellent blog.  Please go read it all.

A taste:

Rule 2: Minimize

Many doctors and patients have a “more is better” mentality. This not only costs more money to the system, but it can cause harm to the patient. Here’s what I think should be done:
1.  Patients should only be seen when a visit is appropriate.
2. Use as few medications as possible, and when necessary, use the cheapest one that will do the job.
3. Order as few tests as possible. No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always be answerable. If it is not, the test should not be done.
4. When changes are made, make only a few at a time. Many simultaneous changes make it hard to tell what helps and what hurts.

If Dr. Rob's rules were followed, we'd waste less money to achieve better outcomes with less hassle and heartache.  Contrast these precepts of of professionalism to modern mandates by medicrats. 

The "Missing Targets Sign"

Several years ago I had an elderly patient who was an excellent competitive trap-shooter. He came to my office one day with this specific complaint: "Last weekend I was missing targets and losing to guys who have no business beating me". 

He had no other symptoms and had a normal neurological exam, but related that he had fallen a few weeks earlier and sustained a small scalp laceration which was sutured at an ER. His CT scan subsequently showed a subdural hematoma so I referred him to a neurosurgeon for treatment.

When he returned four weeks later for followup he reported,  "I'm fixed Doc, I'm beating those guys again".

The Health Commission (THC) Bans "Daily" Orders

A new standard for Health Care Organizations was announced today by The Health Commission (THC) [formerly known as the Joint].

As of today, March 14, 2010, in medication orders, use of daily, weekly and monthly are now considered a Type 1 violation of patient safety. Medication orders must be written in this format:

x(quantity) every y(time period in hours, minutes, or seconds); e.g. 10mg every 24 hours, or 5ml every 12 hours.

This new rule is necessary due to thousands of overdoses which began earlier today in hospitals across most of North America. Patients receiving medications scheduled for "daily" or "twice daily" administration were dosed one hour early, exposing them to possible drug toxicity. There will be a ripple effect with further inappropriate dosing of "weekly" and monthly" in the next doses. This phenomenon is thought to comprise a large portion of the hundreds of thousands who die each year of medical errors. This can be seen in that there were no cases in Hawaii or Arizona which have 2 of the 4 lowest mortality rates in the USA.

THC has enforced previous crucial safety standards to protect patients from harm such as banning "qd" in typed as well as handwritten records, requiring writing out "magnesium sulfate" instead of its chemical formula, and enforcing the 24 hour rule for signing physician verbal orders.

Note: an equivalent rule will soon cover other orders such as vital signs, therapy, and weighing the patient.