Sunday, January 22, 2017

Repeal and Replace Obamacare - STAT!

Am I referring to Obamacare here or Obama himself?

I am glad that we have a new president.  Like most of the country, I was ripe for a change of direction and a new approach to foreign and domestic affairs – and we are certainly getting that.  New readers here might erroneously suspect that I voted for Trump.  I didn’t.  For the first time in my presidential voting history, I wrote in my choice for our top two office holders.

I have written multiple posts on my unfavorable views of Obamacare since it was jammed through congress without a single Republican vote.  (Do I sound slightly partisan here?)  Interested readers are invited to peruse posts on this blog within the Health Care Reform Quality category, if you dare.

There are two kinds of people who oppose Obamacare
  • Folks who believe it is wrong on policy grounds
  • Folks who wield it as a political cudgel to bash Obama.
Some opponents are a hybrid of both of the above.

I was also suspicious that the Affordable Care Act (ACA) was always an interim step preceding a full nationalization of our health care system.  Obama is on the record favoring such a policy during his 2008 campaign.  If Obama could have achieved this politically in one step, he would have.  The ACA represented the political upper limit that he could achieve, hoping that this would make a full would bring us within reach of a government takeover.   Some conspiratorial skeptics believe that the ACA was designed deliberately to fail so that private insurance companies would have to abandon it – as they have.  Then, the beneficient government would have to step in to rescue Americans who needed medical coverage STAT!  While I offer no opinion on this wild charge, there were many smart people who averred when the ACA was delivered to us, that the numbers would never add up. And they didn't.


Derailing the Obamacare Runaway Train

It is my belief that government is simply not equipped to assume control of the entire health care system and operate it at the highest level of quality possible, while controlling costs.  Remember how smoothly the healthcare.gov web site release was?  Do you think this would have happened if Google, or Facebook was in charge?  Which company do you have a higher opinion of in terms of quality and efficiency, the Bureau of Motor Vehicles or Amazon?  If folks want to have a government insurance plan like Medicare, I am fine with this.  But, give us access also to the free market.  I like choice because competition breeds excellence.  When FedEx came onto the scene, it forced the U.S. Postal Sevice to really step up, which they have. 

And, we all know that the plan’s proponents were somewhat less than truthful.  Feel free to GOOGLE Jonathan Gruber to become reacquainted with his 2014 comments which make reference to stupid American voters and other niceties.  How long did it take the Obamians to admit that the statement, “If you like your doctor, you can keep your doctor”, was known to be false from the outset?

Let’s face it.  The ACA promised us quality and cost control and in my view it has failed on both counts.  I do congratulate the president here, as I have previously, for taking on the challenge of health care reform.  Republicans over several presidential administrations failed to seriously confront this challenge.  And the plan does cover more Americans, which we all agree is a necessary goal.  But, the collateral damage of this achievement warrants a new direction, admitting that it may not be possible to uproot the entire tree.    

The replace part is going to be tougher than the repeal part.  Will the GOP take a lesson from their adversaries and jam it through without a single Democrat vote?

Sunday, January 15, 2017

Insurance Company Helps Patients Who Don't Speak English

When I was a kid, it was fun to get mail.  Now, not so much.  My mailbox at home is a receptacle for junk mail, various solicitations for services I will never need, and bills.  Office mail is not much more fun.  Each day I look through the stack and separate them into 3 categories.
  • Important stuff
  • Garbagio
  • Not sure

The latter category is the most vexing.  Some stuff is cleverly designed to appear important when, in reality it is drivel and nonsense.  We’ve all seen this stuff.  Sometimes, the envelope will include a teaser label, such as ‘Time Sensitive Material’, or ‘Signature Required’.   Once I have been duped to open up the envelope, I’ve lost the game.  Then, I am forced to scan the printed page as fast as my retinas can process the image with the hope that in a few nanoseconds I can send the page sailing into the waste bin.  Sometimes, however, even after reading the entire page, I simply can’t determine if the document merits calling an office meeting to discuss the contents or if it should be simply burned, with the ashes scattered over Lake Erie in a solemn ceremony.  One must choose wisely when facing these conundrums.  If a document is shredded instead of scanned into a patient’s chart, the potential consequences are simply too grisly for me to detail here on a blog that children can access.

I received a notification from a pharmaceutical company indicating that the heartburn medicine I prescribed so casually to an elderly patient was not the ‘preferred agent’.  These was a form letter which demonstrated the same level of warmth and human emotion that one expects when you call the Internal Revenue Service for assistance.  But, there was a 2nd page in the envelope, appears below.  Kindly note that I was able to technically reproduce the image here without the assistance of a 13-year-old child. 


This letter, sent to the patient, advises that customer service agents at WellCare are available to discuss the issue with the patient.  I am not certain if my patient intends to contact them, but my own experience is that making these phone calls is about as fun as undergoing oral surgery.  But, what struck me was all of the languages contained in the letter, many of which I could not recognize.  At the bottom of the letter is a Yiddish translation.  Yes, Yiddish.  Yes, the moribund language that many of our grandparents spoke.  I can’t speak it or read it, but I can recognize it.  Obviously, WellCare must include so many Yiddish speakers that they need to include this language in their correspondences.  My guess is that not a single Yiddish speaker is a WellCare customer.

Maybe, I am wrong and that Yiddish is roaring back.  Kudos to the linquists at WellCare for providing their customers with this essential service.  I may politely suggest that they include hieroglyphics on future mailings.  Why should these folks be left out?

So, was this letter worth saving?  Probably not, but I just couldn’t part with it. 


Sunday, January 8, 2017

Is Informed Consent Overrated?

Physicians now practice in the era of patient autonomy.  Most agree that the era of medical paternalism should not be resurrected.  During those days, doctors simply told patients what to do, and patients complied.  The informed consent process then was a shadow of what it should have been.  In general, physicians did not proffer medical options and alternatives for patients to ponder over.  They were told, ‘you need a hysterectomy’.
Sometimes, I think we physicians today have over-corrected for past arrogance.  Yes, I believe in informing patients, but I often wonder if many patients today really only want us to tell them which path they should pursue.  Even the most informed patients are not medical professionals who can grasp every medical nuance or ramification of a decision.  It can be vexing for them to choose among different medical options that are presented to them in an effort to meet our obligation to apprise patients of all reasonable treatment alternatives. 
Consider this scenario.
"You can proceed with surgery to treat your condition or try a new medication instead. The medication has risks and if doesn’t work, you can certainly have surgery.  Keep in mind that if surgery is delayed while you are trying the medication, it is less likely to be effective.  Additionally, the medical center downtown is doing experimental treatment for your condition.  Finally, some experts advise against any treatment, advocating watchful waiting instead.  What is your decision?" 
Not an easy labyrinth for a normal patient to navigate through.
Such a presentation is often followed by a patient asking, ‘what do you think I should do?’


What should I do?
I’m not advocating depriving patients of information they are entitled to in order to make rational health decisions.  I believe in informed consent and have written many essays supporting it on this blog and elsewhere.  However, I often believe that this process overwhelms patients and their families with competing choices that torture and confuse them.  As a statement of fact, many patients today are only seeking our best recommendation, even though physicians today go much further in an effort to meet our ethical obligation and to protect against a medical malpractice charge.  

I am very interested in what readers think on this issue.  Inform me, please.

Sunday, January 1, 2017

Happy New Year 2017!

The Whistleblower wishes all readers all good things for the coming year.  2017 will launch us into uncertain times where many of us are a mélange of hope, worry, fear, resignation, optimism, anger, skepticism, validation and self-doubt.  Will the ship of state sail straight and true or will we find the nation steaming off course into dangerous waters?   I suspect that it will not be simply one path or the other.  There will be times when we will stray and other times when we will more closely hit the desired target.  This is how every government, and indeed every person, lives and breathes.


Off Course or On Target?


We can accept the inevitable zigzagging with the hope and belief that the overall trend will take us forward. 

Let us celebrate our successes and exercise some forbearance when we or others miss the mark despite good intentions.

This blog enriches and challenges me and I hope it brings some small measure of delight to all of you.  Please continue to let me know (with forbearance!) when I have missed the mark.


I wish all of you well.

Sunday, December 25, 2016

Whistleblower Wishes Readers Merry Christmas!

A close acquaintance of mine voiced objection to the lighting of the National Christmas tree, which occurred on the first day of this month.  Red, white and blue LED lights were illuminated.  I find no offense in this practice, which for me is a secularized event, even though I acknowledge its connection to the Christmas season.   Kids who visited Santa, as I did decades ago, do so in the days and weeks before Christmas.  Neither Santa nor his elves visit us during Arbor Day, the Fourth of July or Veterans Day.  He is connected with Christmas, although like the tree, his purpose is far removed from the true religious meaning of December 25th

A Christmas tree is not quite the nativity scene.  Readers who have more knowledge of the New Testament than I can inform us if a Christmas tree with a star on top and wrapped gifts underneath is mentioned in the Gospels.  Perhaps, Santa truly is a religious figure, since like the three wise men, he comes bearing gifts.


Religious icon?  
Santa and saint are separated by only 1 letter.  Hmm...

I am sure that many children have contemplated the mystery of how Santa was able to appear in so many department stores simultaneously.  Any thoughts here?   I assumed that his reindeer simply transported him at supersonic speed, although, perhaps, there is another explanation.

Similarly, I do not fine our national motto ‘in God we trust’ offensive or a violation of the separation of church and state.  It has taken on, in my view, a secular meaning.

Fear of offense has led many individuals and organization to sanitize their Christmas greetings using phrases that contain all the mirth and meaning of a recorded phone menu message from airline companies.  Doesn’t Seasons Greetings really nail it?  How about Happy Holidays?

At 4 p.m. today the National Menorah will be kindled on the White House grounds.  The menorah, arguably more of a religious symbol than a tree, is generally not the object of public protest. Both the menorah and the tree are illuminated.   Who would object to bringing a little more light into the world?

Sunday, December 18, 2016

Whistleblower Holiday Cheer 2016!


Jingle bells, jingle bells,
Romney’s at the door,
Standing there with cup in hand,
“Please sir, may I have some more?”

Who will be the chief at State?
Mitt or Dave or Rudy?
How ‘bout tough guy JR Bolton?
Isn’t he a beauty?

Kellyanne, she’s our man!
Smiling like a shark,
Oh what fun it is to see
Her ever present snark.

Hillary, gets shellacked!
Trump has doused her flame,
Except for Comey, racists, assorted haters, Fox News, deplorables, poor messaging, Russians and Wiki leaks,
She freely accepts the blame.

How did he win? How did she lose?
Did she have disdain
For forgotten heartland’s pleas,
While he felt their pain?

Will we ever see the wall?
Mexico pays the bill?
Or was that just campaign red meat.
A huckster’s ‘sugar pill’?

The game is done. We must move on
And think of lessons learned.
Demonizing couldn’t halt
Millions who’ve been spurned. 

I challenge you to reach inside
And summon your good sense
Is President Trump scarier than
President Mike Pence?

Joy and Peace!





Sunday, December 11, 2016

Hospital Consent Forms and Other Stories

Even though I am over 40 – by a long shot – I am familiar with the abbreviation TMI.  We are inundated with so much noise, chatter and static.  I feel that we are bombarded with information that we must sift through and ultimately delete.  The news cycle is 24 hours and hits us from so many electronic sources simultaneously.  I am deluged each day with so many unwanted and unsolicited e-mails from organizations that I have never heard of.  One of my favorite words on their e-mails can be found when I scroll to the end.  UNSUBSCRIBE!

Another genre of information assault is the panoply of warnings and disclaimers that we confront.  Of course, we are all numb to them since we have been so supersaturated.  I’ll prove it to you.  The next time you are about to take off on an airplane, the flight attendant will review safety information in the event that a catastrophe occurs.  While one might think that folks would be attentive to information that might be useful if the plane loses altitude or is headed for a ‘water landing’; no one is paying any attention at all.  Most of us are browsing through the Skymall catalogue which showcases amazing gadgets, such as a device that can dispense feedings to your cat during a week of your absence.  For the cat’s sake, I hope there won’t be a power failure.  Moreover, the flight attendants who are issuing the briefings seem more bored than the passengers. 

How often do we hear the nonsensical phrase, this product is not intended to diagnose, treat, cure or prevent any disease?  In other words, we admit our product does nothing, but please buy it to for your ailing bones and prostate glands.

How often do we hit the I Agree icon, which follows pages of lawyerly small print, just to get to the next page? 

We have been over-warned, over-disclosed and over-disclaimed. 

While rounding at the hospital, I saw the following sign posted on a coffee machine.

Newsflash!  Hot Coffee is Hot!

Look what fear of litigation has done for us.  Prior to ligitomania, we might not have realized that hot coffee is actually hot and might injure of us if we spilled its steaming contents onto us.  Now, we are all much safer knowing that hot beverages, which we desire to be hot, are hot.

Of course, these protections extend beyond steaming beverages.  If I were in charge, I’d issue rules and regs that would mandate the following warnings.
  • Caution: these steak knives are sharp and not intended to remove feet callouses
  • This chain saw is for industrial use by trained lumberjacks.  It is not intended as a toy for children under the age of 7.
  • This lighter fluid is dangerous and should not be stored in a child’s crib.
The medical profession is a part of this game also.  Every day, I have informed consent discussions with patients regarding procedures that I have advised them to undergo.  These are informal conversations when I try to give patients sufficient information so that they can make informed decisions.  This is reasonable and a fundamental part of the doctor-patient relationship.

The hospital, however, is not satisfied with my efforts and requires that patients sign lengthy consent forms, which most patients sign blindly without reading them.  For any readers here who have had the pleasure of having enjoyed hospital life, I’m sure that you can attest how many different forms you have signed from the moment you arrived at the hospital door to your discharge.  Most patients and physicians regard these signings to be mere formalities, which are intended to protect hospitals, and not patients.  If patients actually took the time to read through all of these legal CYA forms, it might grind the hospital to halt.  There's not enough time for patients to read and understand all this drivel.

Caution readers!  This blog is not intended to inform, enlighten, provoke, challenge or amuse readers.  Readers accept all responsibility for any resultant angst or mental torment and hold blogger harmless for any and all perceived damages until the end of time.  Click I AGREE.




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