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Showing posts from January, 2008

United Health hit with $3.5 million fine

United Health has been hit with a $3.5 million dollar fine by the Department of Managed Healthand it couldn't happen to a more deserving company! The department of Insurance investigated the company and found it had violated more than 130,000 claims and improperly denied 30% of claims that were reviewed during the investigation. That is not an accident. Underpaying or denying 130,000 claims is a company culture!

Here's one little example of what they do.

This after noon I received a letter from United Health regarding a patient I saw December 7, 2007. The charge was $115.00, submitted on the usual standard claim form with the proper codes and descriptors. Get this...instead of a payment for services rendered seven weeks ago, they are requesting the Doctor's name (!!!), title (!!!), and medical license number. Yes, I have been seeing United Health patients for years, but they are requesting, from Dr. Toni Brayer, my name. If this isn't the most blatant delay in …

The Law of Unintended Consequences

Health care is filled with the unintended consequences of laws, regulations and poor planning that plague our ability to care for patients. Here are a few, in no particular order. You may have more to add.
Lab laws. I used to be able to contract with labs to do tests on my patients. I negotiated a low fee, kept a few dollars for lab draw and my services and everyone won. Enter California Legislature. Now patients have to go to another lab for blood tests. Pap smears cost $55 rather than $7 and a blood panel that was $22 now costs $180. Unintended consequence: Primary care lost a revenue stream, patients get gouged on test costs. (By the way, this law was sponsored by the big laboratories.)Employee break legislation. A wonderful new law says all employees (think nurses) must take a lunch break within 5 hours of starting a shift, even if she is taking care of a patient, in the OR, dieting, or just not hungry. To stagger breaks some nurses will be eating lunch at 9:30 AM. Yes, m…

IQ - Why do Men Think They are Smarter?

A number of studies have shown that "men" think they are better looking than they really are and "women" often underestimate their good looks, thinking they are less attractive. It should come as no surprise that the same holds true when it comes to intelligence.

Adrian Furnham, a professor of psychology at University College London, reported that men and women have fairly equal IQ's but men think they are smarter than they really are and women underestimate their own brain power. In 30 international studies, the men overstated their intelligence and women underplayed it. This happens in Japan, Argentina, Britain, Zimbabwe and America. What is going on here?

Another interesting fact is that both men and women think their sons are smarter than their daughters. So those perceptions are passed on to the kids and keep the myth going.

Women in the workplace talk about this all the time. Men are so confident about their abilities and they think they are capable of…

Handwashing Reduces Diarrhea

Here we are with fantastic technical advances of the 21st century and surprise! A new study shows that hand washing reduces episodes of diarrhea by 30%. Since diarrhea is caused by pathogens (read: germs) that get passed from human to human or human to food to human...hand washing interrupts this cycle.

What was interesting about this report is that hand washing was as effective in preventing diarrhea as is providing clean water to developing countries. The challenge is without clean water, how are people supposed to wash? The World Health Organization reports more than 3 million cases of diarrhea annually and more than 2.2 diarrheal deaths in low and middle-income countries. Access to clean water is something we take for granted but 2.6 billion people do not have access to adequate sanitation and over a billion do not have clean water to drink.

We are lucky to have fresh water. We are blessed to have easy access to sanitation. This study is a reminder of what is still possibl…

Amswer Quiz #4

The answer is #5 Mandibular fracture. This patient was struck on his left lower jaw and suffered a comminuted fracture. The open fracture caused the left half of his mandible to be pushed upward. Surgical wiring of the jaw puts it back in alignment but he'll be drinking from a straw for a good period of time.

Medical Quiz 2008 #4

How smart are you? What is your Diagnosis? Click on the image to get a better view. #1. Dental abscess #2 Neurofibromatosis #3 Cleft jaw #4 Hemiatrophy syndrome #5 Mandibular fracture Check back tomorrow for the answer!

Medical Journal Update

Ultrasounds for aortic aneurysms:
Abdominal aortic aneurysm ruptures occur suddenly and are almost always fatal. They are about 4 times more common in smokers, than in people who have never smoked. The researchers studied 67,770 men ages 65-74 and found that performing an ultrasound to screen for an enlarged aorta significantly reduced death. Aorta's enlarge slowly until they rupture but do not cause any symptoms. The aneurysm can be surgically removed if found in time. This study showed men over age 65, especially if they have ever smoked, should have screening abdominal ultrasounds. (Women who smoke may also benefit but the study didn't look at the gals.)
(Annals Internal Medicine, 2007)

Patients with gastroesophageal reflux disease (GERD) can use PPIs intermittently:
GERD is a chronic condition that needs long-term therapy. Most doctors prescribe proton pump inhibitor (PPI) medication for daily ongoing treatment. Researchers compared people who used PPIs daily with pat…

The Shape of a Mother

I just wanted to share this link of a woman who gave birth to triplets (at home no less). She bravely photographed her growing belly and it is awesome to see. For those who are dismayed at the flabby tummy afterward...keep in mind that it takes a year for the post pregnancy abdomen to resolve...although I am sure the loose skin will remain. Who cares? The result was worth it. Check it out.

Remember Martin Luther King, Jr.

Martin Luther King, Jr. (Jan 15, 1929 -April 4, 1968)

"I have a dream that one day this nation will rise up and live out the true meaning of its creed" 'We hold these truths to be self-evident, that all men are created equal."'"I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character.""Now is the time to lift our nation from the quicksand of racial injustice to the solid rock of brotherhood. Now is the time to make justice a reality for all of God's children.""Every man must decide whether he will walk in the light of creative altruism or in the darkness of destructive selfishness.""History will have to record that the greatest tragedy of this period of social transition was not the strident calmor of the bad people, but the appalling silence of the good people.""Injustice anywhere is a threat to justice …

Oatmeal for Cholesterol

The recent news about Vytorin and Zetia not being effective for lowering cholesterol was front page headlines across America and in the medical blogosphere. What didn't get any attention was the new research that shows "oatmeal lowers cholesterol even more than we thought 10 years ago ".

Dr James Anderson looked at new studies and compared them with the original conclusion reached by the FDA 10 years ago. He found, without exception, that oat consumption lowered total cholesterol as well as the "bad" LDL cholesterol. He says "Whole grain products like oatmeal are some of the best foods one can eat to improve cholesterol levels."

Other benefits from eating oatmeal have also been found. It can reduce the risk for hypertension, type 2 diabetes and weight gain. It may supply unique compounds that may reduce early hardening of the arteries.

So what's not to like? Whole Foods sells steel cut Irish oatmeal for under a dollar a pound. Statin drugs c…

Medical Quiz #3- Answer (see prior post)

This was a toughy. The answer is #4 Furuncular myiasis. This is a human botfly larvae (Dermatobia hominis) emerging from a nodule on the patient's upper arm. The fly's eggs are carried by mosquitoes after the female fly catches the mosquito and attaches its eggs to the body. The eggs hatch and enter the human body when the mosquito is feeding on it. The larvae develops in the subcutaneous skin and after 8 weeks the larvae emerges (like in the photo) and drops off into the soil. They develop in the soil into small gray botflys.

Believe it or not, the wound doesn't usually become infected because the larvae can only survive for 8 weeks in an uninfected body. It may even secrete an antibiotic. The larvae are difficult to remove but duct tape can cut off their air supply and kill them. Yet another great use for duct tape!!!

This species is found in the New World tropics. Fortunately infection is not common. Just remember to travel with your duct tape.

Medical Quiz 2008 #3

This one is really really hard. I missed it myself but I guarantee, when I see it in a patient...I will know what it is. Click on the image for a better view.

What is the diagnosis?
1. Cutaneous leishmanaisis
2. Cutaneous larva migrans
3. Epidermoid cyst
4. Furuncular myiasis
5. Tungiasis

Check back tomorrow for the answer.

Clorox Goes Green

I love the green movement because it helps people think about the environment. The first step to any change is conscious thought. We can't change what we don't know.

Now The Clorox Co., the Oakland firm that introduced bleach to America a century ago, is marketing natural, biodegradable household cleaners called "Green Works". More than 99% of the ingredients in "Green Works" are natural and nonpetrochemical. They break down within 28 days and do not harm the environment. And they are not tested on animals. What's not to like?

Think about it. We are closed ecosystem. Nothing goes anywhere except back to the earth or it's atmosphere. Conventional cleaning products are made from petrochemicals that do not biodegrade. They get into our groundwater and watersheds. If you have to wear gloves to use them, that is a tip you don't want them in the soil.

Most of us don't have the time, extra money or inclination to drive (using gas) to a spe…

Emergency Room Call-Another Doctor Shortage

Across the United States, and certainly in Northern California...hospitals are facing increasing difficulty with the availability of certain specialties to cover emergency rooms. In the past, if a patient is seen in a community hospital by the emergency physician, she can call on a panel of specialists to come in when needed to see the patient. Physicians in Neurosurgery, Orthopedics, Psychiatry, OB, Oral Surgery and even General Surgery are saying "no-more" and these hospitals now either need to transfer the patient out, or pay the doctors to be on call. (If they can even find the doctors)

There are numerous reasons why physicians have little interest in taking call. Hospitals are required to treat everyone, regardless of their ability to pay. With the increasing ranks of uninsured patients, the doctor is also treating for free. There is a perceived higher-risk of malpractice litigation if things don't go well. Since a good "relationship"is the best w…

Medical Quiz 2008 - #2

Here is your 2nd medical diagnosis challenge of 2008. This patient has fatigue, fever, anorexia and weight loss and this appearance of her gums. What is the diagnosis? Click on the image for a better view:
1. Leukemia
2. Scurvy (Vit C deficiency)
3. Acquired Immunodeficiency syndrome (HIV)
4. Sarcoidosis
5. Pellagra (Vit B3-niacin-deficiency)

Check back tomorrow to see if you are correct.

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Doctors and Sexual Misconduct

The Ventura County Star reports some alarming statistics from the California Medical Board about prosecution of doctors who engage in sexual misconduct with patients. They looked at reports over the past 6 years and found only 1 in 7 cases had any action taken at all. Of 680 reports of bad sexual behavior, only 123 doctors received any sanction.

As a physician, I pay $805 as a licensing fee to the Medical Board and that is to support them in their oversight role. We want them to make sure physicians live up to the ethical standards of the profession. Along with that, it is important for doctors to have due process against unwarranted complaints. Some patients might not realize that touching in a physical exam is not sexual in nature. Of course these reports need to be ferreted out.

A study was done in 2004 that showed only one analyst at the Medical Board covered all complaints of sexual, alcohol and drugs reported by patients or others against a physician, podiatrist or physicia…

Childbirth Classes - Not Too Popular

I remember the "60's" and one of the off shoots from the women's movement was women getting in touch with their bodies and reproduction. It is hard to imagine now, when Brittany is flashing her bare crotch to photographers and soft porn is on family time TV, but back then women actually came together in "feminist" groups to learn about their bodies. An entire industry of prenatal "Childbirth Classes" sprang up to prepare moms and dads for giving birth.

When I had my daughter in the late 1960's we had no such prenatal education. I don't remember ever being told about childbirth classes so I presume they weren't mainstream, if offered at all. Questions I asked my OB about childbirth were waved off with the admonition "We'll see about that when the time comes". Anyone who has had a baby knows that during labor is not the time to ask questions or get any reliable education. It's like learning the basics of atmos…

Do Doctors Make Too Much Money - Volume II

I am truly amazed that the #1 most read post I have ever written was (read the link after!) "Do Doctors Make too Much Money?". Thousands of people from around the world have "googled" that phrase and found EverythingHealth. Every day there are several visits to that one old piece. I am amazed because I wouldn't have thought there was that much interest in Doctor's incomes. Apparently there is A LOT of interest and many have strong opinions if you read the comments.

I think some doctors are probably paid too much. But the other 99.99% deserve what they get or, if they are primary care physicians...they deserve A LOT more. The doctor group I know the most about is primary care and general Internal Medicine. I can tell you that, on average, these doctors are underpaid and overworked. Now don't write back and compare it to a teacher or a fireman and tell me how underpaid they are too. This is not a is a fact.

If you have been readin…

Answer 2008 Quiz #1

The answer is #1-Rhinophyma.
This condition enlarges and distorts the nose with prominent pores and thickened skin. The nose becomes larger and irregular due to hyperplasia of the sebaceous glands. The cause is unknown and it was previously thought to be related to alcohol abuse, but that has been debunked. It is most common in males and once the deformity occurs the only treatment is plastic surgery or laser treatment.

Good job, players!

Medical Quiz 2008 - How Smart Are You?

This common condition was seen in the oldie actor and comic, W.C. Fields. Can you pick the right diagnosis? Click on the image for a closer view. The answer will be posted tomorrow.

Imagine 2008- It's not hard to do

Happy New Year across planet Earth. My wish is for a world of compassion, peace and abundance for everyone.

John Lennon

Imagine there's no heaven
It's easy if you try
No hell below us
Above us only sky
Imagine all the people
Living for today...

Imagine there's no countries
It isn't hard to do
Nothing to kill or die for
And no religion too
Imagine all the people
Living life in peace...

You may say I'm a dreamer
But I'm not the only one
I hope someday you'll join us
And the world will be as one

Imagine no possessions
I wonder if you can
No need for greed or hunger
A brotherhood of man
Imagine all the people
Sharing all the world...

You may say I'm a dreamer
But I'm not the only one
I hope someday you'll join us
And the world will be as one
Grand Rounds: For great Medical blogging and beautiful photos check out this weeks Grand Rounds from South African doctor …