Healthcare Update Satellite – 07-13-2015

Boy bitten by a mouse, mother brings boy and mouse to emergency department, wants rabies testing done. Nurse brings the mouse outside and lets it go. Mom fumes because no one recommended that her son go through rabies shots and that because the animal was released, now she’ll never know if the animal had rabies. She decides to put her son through rabies shots which are paid for by Medicaid. If the shots end up not being covered, she’ll ask the hospital to pay for them. Only problem is that according to the CDC, small rodents “have not been known to transmit rabies to humans”, so the child is going through rabies shots for nothing. On the other hand, larger mammals can transmit rabies. Recently, a feral kitten tested positive for rabies in Maryland.

German scientists discovered that people on low-carb diets can lose more weight if they eat a bar of chocolate every day. Actually, German scientists showed how bad many news outlets were at vetting their stories. The whole chocolate bar study was a hoax orchestrated by John Bohannon who holds a PhD in molecular biology, the Washington Examiner, and a German TV reporter named Peter Onneken. They created a fake organization, bogus data, and bogus press releases. Not one organization double checked their research, sought comments from independent experts or questioned inaccuracies in the work.
This is a tough issue. I link some studies after reading the abstracts but without fully vetting their merits. Difficult problem when some places charge you $35 just to read the entire article.
What’s the right answer?

Then again, there is a problem with “predatory journals” that will accept scholarly articles from just about anyone … for a fee. In one case last year, two journals accepted a paper about Fuzzy Homogeneous Configurations written by Maggie Simpson and Edna Krabappel. In another, two computer scientists submitted a 10 page paper reminiscent of “The Shining” that repeatedly wrote “Get me off your Fucking Mailing List”. Instead of taking the hint, one journal accepted it for publication and submitted an invoice for $150.

New research from the American Urological Association’s 2015 Annual Meeting shows that ejaculation reduces prostate cancer risk. However, the data is only “observational” in nature and relies upon self-reporting of data from the study participants. No. This one is real. At least I think …

Patient falls at the Charlotte airport and initially refuses medical care. However, “authorities” stated that it was airport policy to go to the hospital. So patient goes to hospital, has testing (including CT of the brain) performed and leaves with a $9,000 bill. Then goes to lawyers looking to sue someone. The hospital gave him a discount of 40% for paying cash, so the lawyer’s opinion was that “I don’t believe that an action against the hospital for overcharging would be successful.” I’d be more interested in looking into an airport policy that forces people to go to the hospital against their will.

Then there’s the guy who wanted to go to the hospital but no one would take him. Man in Great Britain mugged, had his bicycle stolen, and had his leg broken in the process. He called emergency services, but was told that his injury “wasn’t serious enough” to send an ambulance. Three police officers gave him a ride home where he had to book an Uber ride to get him to the hospital. Good thing he had medical “insurance,” though.

When enough people stop paying for their medical care – or their insurance reimburses providers for less than the cost of care – some hospitals won’t be able to afford to keep the doors open. Then patients may be in the unenviable position of having to wait in a school parking lot with a dying family member for a helicopter to arrive to fly them to the next closest facility 80 miles away. In this case, the added wait cost a North Carolina patient her life.
The article gave a link to another site listing 55 rural hospitals that have closed in the past 5 years. I’m betting that the number of hospital closures is higher than that.

Michigan’s Oscar Johnson VA Hospital is turning its emergency department into an urgent care center and closing its ICU. Now patients requiring emergency care or ICU stays will have to go to a nearby hospital. But one veteran asks “who’s going to pay the bills?” The funny thing about having “insurance” is that you’re at the mercy of the people providing the services you need. If they don’t accept your “insurance” as payment, or if your “insurance” doesn’t cover the services, then you don’t get the services.

Silly article on how doctors should have a dress code instead of wearing scrubs or other clothing. The authors, both internists, suggest “formal attire with long-sleeved shirts and ties for men, and business attire for women.” I’m not sure if this is a spoof or if they’re serious. I can see version 6.0 of Press Ganey questionnaires asking whether the physician’s ties matched the suit or the blouse matched the shoes. And what of the study suggesting that long sleeve shirts and lab jackets may transfer bacteria between patients like little bees pollinating flowers?

14 Ways To Know Whether You Are Failing As A Hospital Administrator

Failure

I’ve been an administrator.

I’ve seen hospitals in which a strong leadership team has improved the hospital’s market share and I’ve seen hospitals that have closed and that are struggling to stay open due to a failed administrative team. Here are some common traits I’ve seen in the failures:

1. You don’t know the names of the people who work in your corporation. You aren’t fooling anyone when you walk the halls without addressing people by their names. All this shows is that you don’t care to take the time to know them. If you don’t take the time to get to know them, why should they care about your corporation?

2. You spend a lot of time and effort seeking feedback about your employees’ performance, but you spend little or no time seeking feedback about your own performance. All this shows is that you are a hypocrite. People hate hypocrites.

3. Your hospital has a high employee turnover rate. This isn’t an issue with employees, it is a clear and unequivocal issue with management. People don’t leave their jobs, they leave their bosses. If your hospital has a high turnover in one department and you aren’t seriously evaluating that department manager’s work, you have no business running a hospital.

4. Your “help wanted” listings go unfilled. In an economy with high unemployment, the fact that people would choose to stay unemployed rather than work for you and your organization is a good reflection of the public opinion about the business you are running.

5. Your employees leave the room when you walk in or they try to avoid you in the hallways. When no one wants to be around you in your workplace, it isn’t a sign of respect, it’s a sign of disgust. Keep that in mind the next time you see someone duck into a stairwell when they see you walking down the hall.

6. You don’t show up at holiday parties for your employees. If you feel uncomfortable mingling with your employees at a party, you shouldn’t be trying to lead them. The good thing is that if you feel uncomfortable attending an employee party, your employees probably won’t want you there, anyway.

7. You don’t participate in charity events for employees or employee family members. Your failure to support your employees in their times of need will only drive everyone to dislike you even more.

8. You don’t support employees who have been injured. Or worse yet, you try to terminate employees who have been injured. News of these types of actions spreads quickly through the hospital. Again, if you don’t have their backs, what makes you think that they’ll have yours?

9. You care more about your bottom line than you care about your patients’ or your employees’ bottom lines. When you create policies to increase your bonuses, you employees will know and they will resent you for it. They may even make passive aggressive attempts to keep you from reaching your goals.

10. You spend more time criticizing your employees than you do complimenting your employees. Worse yet – you don’t compliment your employees at all.

11. You display favoritism. If you allow anyone to drop your name or to use their relationship with you to gain an advantage at work, your employees will quickly grow to resent you and your clique.

12. You discourage constructive criticism of your organization from within. If you think everything is going just fine in your facility, you’re out of touch and you’re wrong.

13. You don’t act on employee concerns. Your failure to follow up on an employee concern not only shows that you’re unreliable, but it also may serve as a basis for legal action if something related to that concern goes wrong.

14. You don’t visit the departments in your hospital on a regular basis. If it’s been more than a week since you’ve visited any department in your hospital, you have lost a great opportunity to compliment your employees on the job that they are doing. You have also lost the ability to uncover and address small problems before they become big problems.

Healthcare Update Satellite – 06-08-2015

To increase access to medical for our nation’s veterans, the Veteran’s Choice Act authorized the VA to pay for more medical provided to veterans from community health providers. How did the VA save money in that scenario? It either “lost” claims in which providers had proof of submission or it just delayed paying the claims so that veterans would be billed for the treatment. Now providers are refusing to contract with the VA due to all of the hassles. The VA said that it was making interest payments to providers who received delayed payments, but none of the people testifying to a Senate subcommittee had received such payments.
And this is the type of system that we’re all hoping to adopt for our nation’s healthcare?

Thought provoking article in American Thinker where a physician compares defensive medicine to defensive policing. Both professions can involve life-or-death decisions in which not all information is always available. Physicians may respond by ordering more tests “just to be sure.” Police may respond by ignoring criminal activity or by delaying a response to a crime to avoid any conflicts.
“The natural response is to avoid the high-risk situations. Stop accepting new patients, particularly sick patients with a greater chance of complications. Order extra tests to avoid missing a diagnosis, however unlikely. For police, just look the other way. Take your time responding to a distress call. Don’t make the arrest. And watch the crime rate climb.”

Palm microbes

How grubby are children’s hands? This mom put her 8 year old’s hand on an agar plate after he had been playing outside. What grew on the plate appears remarkable on its face, but many microbiologists who commented on the project said the agar would probably have grown out the same material even if the kid had washed his hands before putting it on the agar plate. Still a pretty cool picture.

Speaking about bacteria, a recent study from the University of Iowa shows that chronic exposure to Staph aureus superantigens in rabbits causes type 2 diabetes. According to this article in Science Daily, the researchers are now working on a vaccine to the superantigens and also doing studies to determine whether topical antibiotic gels may affect glucose levels.

Stay off of the internet while you’re working in the hospital … unless you’re trying to game the system to improve the hospital’s ratings on Yelp, HealthGrades, ZocDoc, and other web sites. Hospitals are now hiring “reputation managers” whose job it is to improve the hospitals’ online reputations.

Wait. Patients can die from Z-Paks? Who would have imagined? NY Times Wellness Blog tells story of a patient who underwent surgery to fix a broken arm, got postoperative antibiotics to prevent a wound infection, then developed a recurrent Clostridium difficile infection and died. As the article notes, C. difficile causes almost 500,000 infections per year and more than 29,000 deaths per year.
The expert interviewed for the article noted that “most antibiotics ‘are being used inappropriately, for things like upper respiratory infections that are caused by viruses.’ And eating yogurt or taking commercially available probiotics while on an antibiotic have not proved protective, he said. However, in England, where a program of more judicious use of antibiotics was put into effect, C. diff. infections have declined.

Doing genetic testing for diseases? Be careful about relying upon the results. Not all genetic testing is created equal.

Nonurgent cases account for 80 percent of all emergency department visits in Jeddah, Saudi Arabia. Private health department director notes that “this rush also adds to patients waiting a long time to get treatment and their negative effects on doctors and on other patients whose health conditions are critical.”

Is nitrofurantoin effective for use in patients with reduced kidney function? The simple answer is “yes”, but other antibiotics such as Cipro and Bactrim had half as many treatment failures (6.5% versus 13.8%) in women with a low estimated GFR (average 38 ml/min/1.73m2).

OK, this isn’t medicine, but it is science. And dammit, I wish I knew about it a couple of years ago. How do you get the smell of skunk out of a dog’s fur? Tomato juice? Peanut butter? Nope. Mix a quarter cup of baking soda and a couple of teaspoons of liquid soap into a quart of 3% hydrogen peroxide and wash your dog down with it. The dog might turn blonde, but the smell will disappear.

Survey

Quick request …

If you haven’t taken this short survey, it would be much appreciated. Looking to publish the results in a future journal article. Many thanks for your help.

http://www.esurveyspro.com/Survey.aspx?id=8ee4bd68-04a7-4b43-b07b-652af4088ddd

Rodent Control

Urinal
A crotchety old fellow from the nursing home gets brought in for trouble breathing. After looking at the swelling in his legs and listening to the crackles in his lungs, it’s pretty obvious that he’s in congestive heart failure.

We started an IV, drew labs, and performed a chest x-ray. Then he got some nitroglycerin, some captopril, and he even got Lasix just to spite all of the #FOAMed wonks.

About 45 minutes later, the patient needs to go to the bathroom. We didn’t want him walking since he didn’t appear to be the steadiest on his feet, so he got a urinal. He grabbed the urinal and the nurse walked out of the room to give him some privacy.
A minute later, the patient starts screaming.
“Aaaaah! There’s a RAT biting my PECKER!”
The nurse went back into the room and slowly pulled back the covers. She looked around and didn’t see anything. She looked at the patient.
“Do you still feel something?”
“Nah. It’s gone.”
She walked back out of the room. Sure enough, 30 seconds later he’s screaming again.
“OOOOOW! It’s biting me AGAIN! OOOOOOW!

The nurse picked the covers up from the corner, screamed, and flung them off the bed, thinking that there may have been a rat from the nursing home in his clothing or something. Nothing there. Of course, after hearing the nurse scream, I went in the room to see what was going on.
“There’s something biting my pecker!”
I thought to myself … just when he tries to use the urinal, though? I looked at the urinal. Nothing inside.

“OK, let me see if I can catch it.”
He put his business back in the urinal and tried to go.
“Aaaah!” He yelled, making me jump.
“Where did it get you?” I asked.
“Underneath. Here,” he said, pointing to the area where his woo-hoo was resting on the urinal.
Then I looked at the urinal a little closer. There was a sharp point to the plastic on the edge of the urinal. I showed it to the nurse. Then I got a couple of pieces of tape and taped over it. I gave the urinal back to the patient.
“Better?”
“Yeah. That’s better. Did you catch it?”
“Yep. I’m sending him home with the nurse.”
The patient laughed.
I tossed the roll of tape to the nurse as I walked out the door and said with a wink …
“Make sure to order some rat traps from Central Supply, will ya? I hear those things can be pretty vicious.”

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room please e-mail me.

Rodent Control

Urinal
A crotchety old fellow from the nursing home gets brought in for trouble breathing. After looking at the swelling in his legs and listening to the crackles in his lungs, it’s pretty obvious that he’s in congestive heart failure.

We started an IV, drew labs, and performed a chest x-ray. Then he got some nitroglycerin, some captopril, and he even got Lasix just to spite all of the #FOAMed wonks.

About 45 minutes later, the patient needs to go to the bathroom. We didn’t want him walking since he didn’t appear to be the steadiest on his feet, so he got a urinal. He grabbed the urinal and the nurse walked out of the room to give him some privacy.
A minute later, the patient starts screaming.
“Aaaaah! There’s a RAT biting my PECKER!”
The nurse went back into the room and slowly pulled back the covers. She looked around and didn’t see anything. She looked at the patient.
“Do you still feel something?”
“Nah. It’s gone.”
She walked back out of the room. Sure enough, 30 seconds later he’s screaming again.
“OOOOOW! It’s biting me AGAIN! OOOOOOW!

The nurse picked the covers up from the corner, screamed, and flung them off the bed, thinking that there may have been a rat from the nursing home in his clothing or something. Nothing there. Of course, after hearing the nurse scream, I went in the room to see what was going on.
“There’s something biting my pecker!”
I thought to myself … just when he tries to use the urinal, though? I looked at the urinal. Nothing inside.

“OK, let me see if I can catch it.”
He put his business back in the urinal and tried to go.
“Aaaah!” He yelled, making me jump.
“Where did it get you?” I asked.
“Underneath. Here,” he said, pointing to the area where his woo-hoo was resting on the urinal.
Then I looked at the urinal a little closer. There was a sharp point to the plastic on the edge of the urinal. I showed it to the nurse. Then I got a couple of pieces of tape and taped over it. I gave the urinal back to the patient.
“Better?”
“Yeah. That’s better. Did you catch it?”
“Yep. I’m sending him home with the nurse.”
The patient laughed.
I tossed the roll of tape to the nurse as I walked out the door and said with a wink …
“Make sure to order some rat traps from Central Supply, will ya? I hear those things can be pretty vicious.”

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room please e-mail me.