Obamacare Nearly Repealed & Replaced! 2+2 =7!

Everyone likes R & R.  In fact, I’m enjoying some R & R right now as I sit lounging on the backyard deck.  I have a full frontal of 3 birdfeeders who are all being attacked by avian assaulters.  It’s a microcosm of society – Lord of the Flyers, if you will.  The hummingbirds are working their wings off for a sip of nectar.  The finches politely share space on the feeder.  The male and female cardinals hang together – true love birds. The blue jays bully all the other birds away.  And, the lazy squirrels simply hang out below capturing seeds that the birds above spill to the ground.

The Bully

Senate Majority Leader Mitch McConnell is trying hard to get some R & R also.  Doesn’t he look like he needs it?  Poor guy.  The R & R on his agenda is not exactly like my backyard, bird gazing Rest and Relaxation.  The senator from Kentucky’s R &  R is Repeal and Replace!

The senator is a trained lawyer and must be skilled in logic, reasoning and interrogation techniques.  I have a sense that mathematics was not one of the senator’s stellar academic disciplines.

Here’s the situation:

• There are 52 Republican senators
• Two Republican senators are on the record as unwilling even to let the bill proceed for consideration. (52 – 2 = 50)
• Within the past week, 10 Republican senators have raised serious concerns about the senate’s health care bill.  (50 – 10 = 40)
• None of the 48 Democratic senators will support the bill.
• Any Democratic senator who uses the word ‘repeal’ even by mistake will be sent to GITMO by Senator Chuck Schumer.
• The bill’s public approval rating is a whopping 17%.  Great political cover for legislators who vote Aye!
• Senator McConnell needs 50 GOP votes so Vice President Pence can push the bill into the end zone.

Can any of my brainiac readers with mathematical acumen show us simpletons a pathway to 51 votes?

McConnell Needs Magic to Repeal and Replace Obamacare

To this observer of the political scene, it does not quite seem that the Repeal & Replace effort has yet been clinched.  I have already opined on the House of Representative’s passage of their repeal legislation, which was passed for reasons unrelated to healthcare.  Remember, how smoothly that process went?  I wonder what ‘techniques’ were utilized to convince a few wavering House reps to choose wisely?  Hopefully, these methods do not constitute torture, at least as defined by the Army Field Manual.

The world’s most deliberate body, The United States Senate, has not distinguished itself with the same task these past few weeks.  Majority Leader Mitch McConnell was attempting to defy gravity by promising passage, let alone a vote, on a horrendous bill that was rejected by factions within his own party.  Hence, he delayed the vote until after the July 4^th recess hoping that there will be a providential act in the coming days that will cause the legislative lions to lie down the lambs.  In other words, prayer may be McConnell’s only recourse and hope for success.   So far, the Almighty has remained silent.

Can McConnell Pull a Rabbit Out of a Hat?

It’s hard to fathom how the calculus could change over the coming days and weeks.  It’s a tough math problem when he has only a bare GOP majority to rely on.  If he seduces a Republican moderate by changing a punctuation mark in the bill, then he may lose a conservative who demands that the semicolon be reinstated.  What a fun time to be the leader!

The fundamental failing is that the House and Senate bills fail the country.   While many GOP politicians disagree with me, I don’t measure success by the mere passage of a bill.  Shouldn’t the content of the bill determine its value and not simply its passage?   Most of our legislators and most of us do not believe that these bills would deliver on their promises of better health care, increased access and lower costs.

As readers know, I have penned at least a dozen posts opposing Obamacare.  I wondered then, and still surmise, that its true purpose was to transition us to a single payer system – a model that the Sanderites and Warrenites now unabashedly champion.   Many folks want ‘Medicare-for-All’ where the government controls all.  I have more faith and confidence with the private market playing a role, admitting that much reform of the system is still needed.   Which business model and performance do you admire more, Google or the Division of Motor Vehicles?

Can McConnell pull a rabbit out of a hat next week?  Or, will he shift blame elsewhere?  Will his threat to bring in a few Democrats into the process spook wavering GOP senators into submission?

Or, should we repeal the repeal effort and start over?

Whistleblower Wishes All a Happy Fourth of July 2017

How's our sacred Honor doing?

"And for the support of this Declaration, 

with a firm reliance on the protection of Divine Providence,

we mutually pledge to each other our Lives, our Fortunes,

and our sacred Honor."

Why I Don't Prescribe Pain Medicines

It may seem strange that a gastroenterologist like me does not prescribe pain medicines.  Let me rephrase that.  I don’t prescribe opioids or narcotics.   I write prescriptions for so few controlled substances that I do not even know my own DEA number.  You might think that a gastroenterologist who cares for thousands of patients with abdominal pains would have a heavy foot on the opioid accelerator.  But, I don’t.  Here’s why.

I truly do not know my DEA number.

I believe that one person on the health care team should manage the pain control.  In my view, this should be the attending hospital physician or the primary care physician in the out-patient setting.  There should not be several consultants who are prescribing pain medicines or changing doses of medicine prescribed by another physician.   With one physician in charge, the patient’s pain is more likely to be managed skillfully while the risk of fostering drug dependency and addiction is lessened.  We all know addicted patients who obtain medicines from various physicians and emergency rooms.  It’s cleaner when a patient on pain medicines knows that a single physician is in charge of managing this issue. 

While my argument of single physician authority can be applied to other medical conditions, this is even more important with narcotic agents.  For example, if a patient has an internist a cardiologist and a kidney specialist, only one of them should be managing the patient’s high blood pressure, at least in my view.   Since narcotics and related medications have addictive potential, it is even more important to have a limited prescribing source for patients. 

When I am seeing patients with abdominal pain, particularly in the hospital, I’m often asked for narcotics or to increase the dose or frequency of pain medicines that were already prescribed.  I counsel these patient that the attending physician is in charge of this and that the patient should discuss the request with this doctor. 

Other gastroenterologists and medical consultants may approach this issue differently.  I’d love to hear from them or from patients who have faced this issue. 

We can all agree that pain is the enemy.  But, the medical profession in its zeal to eliminate it, has contributed to the ravages and suffering of drug addiction.  In my state of Ohio, we lose thousands of our people every year to drug overdoses.  For many of them, their tortured path toward agony started with a medical prescription prescribed by a doctor like me.

Yikes! When Your Doctor's Computer Crashes!

Earlier this week, as I write this, our office lost a skirmish against technology.  It was my procedure day, where lucky patients file in awaiting the pleasures of scope examinations of their alimentary canals.  A few will swallow the scope (under anesthesia), but most will have back end work done.  We are a small private practice equipped with an outstanding staff.  We do our best every day to provide them with the close personal attention they deserve.

The first patient of the day is on the table surrounded by the medical team.  The nurse anesthetist and I have already briefed the patient on what is about to transpire.  Propofol, the finest drug in the universe, is introduced into her circulatory system, and her mind drifts into another galaxy.  I pick up the colonoscope, which is locked & loaded for action, and the screen goes dark.  Our nurse goes through a few steps of messing around with plugs and doing a quick reboot, but we are still in the dark.  I glance at the back of the scope cart and have an eye-popping moment when I see dozens of wires and connectors coursing off the cart in a collage of chaos. 

Ready, Willing, but not Able!

After 5 minutes, when it is clear that the Almighty has not declared, Let There Be Light, we transport the patient into the recovery area where she is awakened.  Patients in the recovery area never remember their procedure.  This time, there was no procedure to remember.

There was tension in our office as we contemplated our options for colonoscopy patients who took the day off, arranged for a driver and swallowed the required liquid dynamite to cleanse their bodies and souls.  We called the hospital who could not accommodate on short notice request for multiple procedures.  I was not willing to cancel anyone and told my staff that I would stay until midnight to get the work done.

Our IT professional was in our office in 30 minutes.  I think he was the youngest person in the building.  When your IT guy is sweating and stumped, you know you’re in trouble.

So, here we were with an able gastroenterologist, a crack staff, patients ready for probing, but we were paralyzed because a computer monitor was in a coma.  It’s a reminder that we have all had of how totally dependent we are on our technology.  Even at home when the modem goes out, we feel that our oxygen supply has been compromised. 

Here’s the denouement of the drama.  About 2 hours after the first case was to have started, we concocted a ‘work around’, which allowed our cases to proceed.  So, we won this skirmish against Technology.  But, I fear they are regrouping, lying in wait for their next strike.

Obamacare - Repealed and Replaced!

The House of Representatives enjoyed success weeks ago, depending on how one defines success.  Unquestionably, the passage of TrumpCare was a great political success that was not easily achieved.  I can’t fathom the intensity of threats and pressure that was utilized to convert a few ‘no votes’ into TrumpCare supporters.  The president and his team desperately needed a win after so many setbacks domestically and internationally.  And, this is a clear win, at least in the short term.  We will see if this vote becomes one that GOP House members can run on or will try to run from in 2018. 

Indeed, the GOP high-fiving and Rose Garden ceremony seemed premature considering that they have ascended only about 20% of their upward trek on an icy mountain as they hope to slog to the summit.  They may never get there.  The Senate, who have been quietly working on their own reform bill, are unlikely to endorse the House bill which contains antagonistic policies toward Medicaid expansion and pre-existing condition coverage.

The White House Rose Garden

Like Obamacare, this bill was passed without a single supporting vote from the opposition party.  Like Obamacare, this means that the effort is unlikely to attract the nation’s support, which is so critical for an issue that affects every American.  Imagine if Congress passed a declaration of war with votes from only one political party.  Would this be good for the country?   Could such a war be maintained when half the country opposed it initially?

The GOP’s mission was to achieve a win at any cost.  The Democrat’s response is to hope the reform effort soars over a cliff so they can benefit politically.  Does any reasonable person challenge me on these assertions?   

Leaving your own partisanship aside, do you feel that our legislators from either party care about our medical health or their political health?   Which institution – the Congress or the Health Care System – needs reform more?   Guess which one I’d like to repeal and replace?

Are You A Victim of Abuse or Neglect?

Words matter.  Patients can get spooked by the words we use.  All of us have heard vignettes of how some inadvertent harsh words from a physician have caused injury.  I know there were times that I wish I could rewind and erase some errant words. 

Sometimes, an innocent remark from the doctor doesn’t land innocently.   When I ask as a matter of routine, ‘is there a family history of colon cancer’, as I do with every patient, this may provoke anxiety in a patient who is seeing me for a bowel disturbance.

Words Matter

We ask every patient who arrives at our ambulatory surgery center if they have a living will.  This often causes the patient to utter a nervous joke.  We then go on to ask if the patient has ever been ‘a victim of abuse or neglect’.   We are required to ask this..  It would seem rather unlikely that a patient who has just purged themselves for the pleasure of a colonoscopy, would confess to a nurse that (s)he is meeting for the first time that (s)he has been victimized.  Keep in mind that this a question follows a barrage of very routine medical inquiries.

• Did you complete the laxative prep?
• When did you last eat or drink?
• Did you take any medications this morning?
• Have you ever been a victim of abuse or neglect?
• Who will be driving you home after the procedure?

Let me state unequivocally, that I am dead against all forms of abuse and neglect, both foreign and domestic.  I acknowledge that this is a serious problem that is clearly under-reported, particularly among the elderly.  I am skeptical, however, that querying our patients who are poised for an endoscopic adventure about a personal abuse history is likely to be enlightening.  A better case could be made for having these conversations in our office practices after we have developed rapport.

Who makes up these silly rules?   This is but one example of the documentation abuse that has been foisted upon the medical profession by the government and others.  I wish we could simply neglect to comply, but this boldness would only generate more government abuse on us.