Sunday, December 25, 2011

Whistleblower Holiday Cheer 2011!

Jingle Bells, jingle bells,

Romney cracks a smile,

Oh what fun it is to watch

The Gingrich pompous style.

Bachman bleats, Cain retreats,

Huntsman tries to please.

Oh what fun it is to watch,

When Perry’s brain goes freeze!

Ron Paul’s weird, Very weird,

Santorum has no chance,

Oh what fun it is to watch

His Tea Party romance.

Who will win? Who will Spin?

Who won Debatorama?

The winner dancing in the streets

Is Barack Obama!

Wishing you Joy & Peace

Sunday, December 18, 2011

Colt McCoy's Concussion Fumbled by Team Physicians

The Cleveland Browns have been in the news this week, and not because of newfound success on the gridiron. While sports is not among my highest priorities, I have developed increasing interest over the years since professional sports is religion to so many here in Cleveland and in Ohio. Cleveland sports teams all enjoy great success, provided that success is not defined by victories. It’s not if you win or lose but how…

I watched the Cleveland Browns compete against the Pittsburgh Steelers two Thursdays ago. I cringed as I witnessed our young quarterback, Colt McCoy, take a blow to the head that could have landed the perpetrator a 10 year prison sentence had this act occurred on the street. I wasn’t worried that McCoy would have to miss the rest of the game. I feared that he might have to miss the rest of his life. Violence sells tickets.

If an activity requires a participant to don a helmet and a coat of armor, then clearly it is an unwise activity for a human to engage in.

McCoy was taken off the field and reentered the arena 2 plays later, after an exhaustive evaluation that was completed in about 100 seconds. Since everything in sports and medicine is now measured, we know that McCoy was sidelined for a total of 3 minutes and 50 seconds before his soggy head reentered the arena. Perhaps, emergency room physicians should consult the Browns’ medical staff to learn how they can expedite their medical evaluations in their emergency rooms. With a little training, a heart attack patient, for example, can be treated in 3 minutes or less.

McCoy’s father went public chastising the Browns for the decision and the process that led to his son Colt returning to the field. While the NFL is now investigating, the Browns maintain that proper procedures were followed.

As more facts dribble out, we learn that McCoy did not receive the standard medical evaluation that is required after a suspected concussion known as the SCAT2 (Standard Concussion Assessment Tool , version 2). Apparently, Browns’ medical personnel were attending to others and did not witness the helmet-to-helmet collision. Are these folks aware of the futuristic technology commonly known as instant replay?

If the only medical training you ever had was how to swallow aspirin or apply Band-Aids, it is likely you would know that a 4 minute time out is not a sufficient assessment period after a cannon ball blow to the skull. Initially, the Browns were vague on the extent of neurologic testing that was performed on the concussed quarterback. We now know that there was no evaluation.

As a physician who has been sued, I am sensitive to applying blame retroactively. I can understand based on the available facts why McCoy was sent back in. But this event shows that either the process is flawed or that proper procedures were not followed. This episode warrants investigation for the right reasons, not simply to apply the broad brush of blame to make some folks feel good.

Nevertheless, this is a particularly galling vignette for physicians like since we are trained and dedicated to practice high levels of patient advocacy. We advise our patients on what we believe to be in their best interests. Sometimes, we take heat for this. We may, for example, advise an individual that they should surrender their driver’s license. We may counsel a patient not to travel even though a family trip was planned months ago. We may warn a patient that his job is threatening his health.

Our advice should not be contaminated by external considerations. We would not, for example, clear a patient to return to work prematurely because this would serve the employer’s interest.

In professional sports, team physicians advocate for the team. Obviously, there is an enormous conflict between serving the team and serving the player. If McCoy’s primary care physician were consulted after the head thrashing incident, do you think he might have offered a second opinion? Let’s hope so.

Sunday, December 11, 2011

Colonic Hydrotherapy and Colon Cleansing; Time to Bend Over?

Garden Hoses in Assorted Colors

A few times each month, a patient asks me for my opinion on colonics. They ask me because I am a gastroenterologist, and I am supposed to know this stuff. After 2 decades of performing colonic intrusions, I should be well qualified to respond to these alimentary inquiries.

To those who are unfamiliar with the concept of colonic detoxification, I offer a brief rationale of the procedure. Those who have been lured into the Fraternal Association of Rare Toxins (acronym not provided) have been persuaded that stagnant stool within the colon is a source of toxins that seep into the body causing disease. According to the anti-toxin crowd, when stool overstays its colonic welcome, it can lead to chronic fatigue, lassitude, restlessness, irritability, mood disorders, skin rashes, arthritis, cardiac rhythm disturbances, seizures, allergies, dementia and the murky diagnosis of candidiasis, or yeast infection. This symptom list could apply to half of my medical practice. So far, I've never prescribed a colonic to any of these sufferers. Have I been medically negligent to withhold this treatment from them?  Could a plaintiff attorney accuse me for failure to cleanse?

This is a scary symptom list, which is only a partial listing of the maladies attributed to a slothful colon. Patients reading through these symptoms, might be inclined to use a garden hose for an unintended purpose. Amateurs, however, are strongly advised not to do try this at home. Leave it to the professionals, who are trained to separate you from your stool and you from your money. They succeed on both counts.

To assist you in your research efforts, be aware that there are various names for colonics.
  • Colonic cleansing
  • Colonic hydrotherapy
  • Colonic irrigation
  • High colonics
  • Wallet cleansing
Then names may change, but the mission doesn’t. The objective is to get the colon toxins out. The motto of the Society of Hydrotherapists Investigating Toxins (acronym not provided)  is, Don’t just die, detoxify!

If any readers at this point are tremulous over your toxins, let me reassure you.  There is no science that supports colonic cleansing and no responsible medical doctor will prescribe them.  Indeed, if a health professional does recommend that your colon gets hosed down, I'd look for a second opinion.  Obviously, stool is waste matter.  That's why your intestinal system reliably and regularly eliminates it from your body. There is no persuasive scientific evidence that dangerous 'toxins' in your stool leech into your body and cause disease in normal folks. Hydrocolonic power washing can't compete against millions of years of human evolution. 

But, colonic hydrotherapy is big business, and I'm aiming to get a piece of the action.When health care reform gets underway in a few years, and doctors are on salary working supervised by government bureaucrats, I’ll need a side job to make a living. The colon can again be my pathway to success, particularly as colonscopy becomes obsolete. I’ll need a niche as the colonics competition will be fierce, from out-of-work gastroenterologists who will be on the street corner with a sign that reads, Will Do Colonic for Food. However, it won’t be enough to offer routine colonics to gain a foothold in the marketplace. I will need to provide a Bionic Colonic, or perhaps a Supersonic Colonic to turn a profit. Of course, there will be family discounts and volume pricing. Kids under 12 will be half-price. Tuesdays will be Ladies Night. Pets? Endless possibilities.

A year ago, I was worried that health care reform legislation, if it became law, would erode my livelihood. More wiser now, I realize health care reform will be a fountain of opportunities for resourceful physicians. For this gastroenterologist, there’s light at the end of the tunnel.

Sunday, December 4, 2011

Pay-for-Performance Attacks Hospitals - Shake Down or Fair Play

This blog has tried to support the virtue of personal responsibility. If you smoke, don’t blame Joe Camel. If you surrender to Big Mac attacks, don’t go after Ronald McDonald. If you love donuts, and your girth is steadily expanding, is it really Krispy Kreme’s fault? And, if you suffer an adverse medical outcome, then…

Medicare aims to zoom in on hospitals, suffocating them with a variation of the absurd pay-for-performance charade that will soon torture practicing physicians. Of course, a little torture is okay, as our government contends, but pay-for-performance won’t increase medical quality, at least as it currently exists. It can be defended as a job creator as several new layers in the medical bureaucracy will be needed to collect and track medical data of questionable value.

Medical quality simply cannot be easily and reliably measured as one can do with a diamond, an athlete or a wine. Most professions resist being graded or claim that the grading scheme is a scheme. Teachers, for example, refute that testing kids is a fair means to measure their teaching performance. Conversely, any individual or profession who scores well on any quality review program will applaud the system’s worth and fairness. Shocking.

Under the government’s new program, hospitals could be financially responsible for the cost of medical care that a patient requires for up to 90 days after discharge. One can imagine why this provokes angst with hospital administrators. It’s easier to defend the government’s concept if a heart attack patient is discharged prematurely and is readmitted two days later with congestive heart failure. The case is harder to argue is a stroke patient falls at a rehab facility 2 months after discharge and needs to be hospitalized. There will be spirited arguments as to whether the post-discharge events were preventable by higher quality and better coordinated out-patient care. Paradoxically, it might influence hospitals to prolong discharges, which increases costs and the risks of various hospital adventures, including infections and C. difficile colitis.

Government lexicographers have concocted a new phrase, ‘Medicare spending per beneficiary’, which will be used to compare costs among hospitals caring for the same types of patients.

How much responsibility can fairly be assigned to hospitals for bad stuff that happens once patients are released? If a medical event occurs at the nursing home, for example, would this be the hospital’s fault or the nursing home’s? It will be fun to watch the two institutions, who both champion patient care, duke at out. Cash breeds competition.

One item is beyond dispute. It’s a lot easier to measure cost than medical quality. I fear that many of these quality initiatives are veiled attempts to save money, but are camouflaged as medical quality incentive programs.

The ironic flaw in all of this is the absence of any quality control over pay-for performance and its cousins who claim they can raise the medical quality bar. I wish there was a way that we could pay these guys depending upon their performance. The government would resist this as it would be a job killer when all of these newly hired bean-counting bureaucrats would lose their jobs.