Sunday, March 17, 2013

Metatstatic Medical Regulations and Health Care Reform - Job Security for Bureaucrats

This week I promised you specific examples of dumb rules that we doctors must comply with. Here are just a few.  There are enough ridiculous regulations to fill multiple blogs devoted only to this issue posting hourly around the clock.  Yeah, I sound a mite cranky now.  The truth is that I still enjoy the work of doctoring.  I love my time with my patients.  There is, however, an increasing burden of stuff thrust upon us that takes time, energy and money away from our healing mission.   Perhaps, these regs are solving someone’s problem somewhere.  I suppose that this should comfort me knowing that somewhere in a government cubicle, a bureaucrat is smiling.

Floor Plan of Cubicles Where Health Care is Reformed
  •        We are required to ask patients their ethnicity.  Of course, many of them including myself are uncertain how to respond to this accurately.  I’m sure that our staff conveys an impression of knowledge and professionalism when they shrug their shoulders in cluelessness after patients ask the purpose of this inquiry.      
  •      A few times per week, I am given a several pages of forms to sign off on.  This lists all the patients whom I have joyously performed procedures on recently and the sedation that I administered.  Of course, I cannot recall any of these interactions days later.  I have been told that signing this complies with some requirement issued from a windowless government office located somewhere within the Milky Way.  I can assure readers with total certitude that this act helps no living or deceased human being, or provides any beneficial function for the medical profession or any other occupation.  It is possible that this provides employment for a government sinecure, so perhaps my signature helps to contain unemployment.  Call me a patriot.
  •       We have to report to Medicare on every single patient we perform a procedure on if he suffered a burn or fell down.  Let me come clean with readers and disclose our stats on these two misadventures.  After successfully probing tens of thousands of patients, none has taken a tumble or been singed by lightning.  We are also required to report if pre-operative antibiotics were administered on time.  Sounds good except years pass before we ever give a patient antibiotics before a colonoscopy.  The government, hungry for data, makes us send in a code on every patient that didn’t receive antibiotics, which is 99.97% of them.  So, why the reporting mandates?  Because our endoscopy center is lumped into the same category with facilities that perform actual surgeries.  Ever hear the phrase ‘one size fits all’?  Where do these right wing ideologues get the idea that there’s any waste in Medicare? 
  •       We cannot discuss off label use of medications with pharmaceutical representatives, a silly rule that I discussed in a prior post.  Like many regs, there’s a rational basis for it, but it morphed into OperationOVERKILL.  This reminds me of the anecdote of a young boy who was punished when he kissed a girl in school.  An innocent romantic gesture?  Hardly. This was a brazen violation of an ironclad sexual harassment policy.  Luckily, the third greater only planted a buss on the cheek.  If there had been unwelcome lip contact, then the youngster may have been whisked out of the country to endure extraordinary rendition and enhanced interrogation techniques. 

If a principal of a school is fed up with kids running in the halls, should all kids be required to have their ankles shackled so that compliance with school policy cannot be violated?  If you don’t regard this hypothetical as silly, then please stop reading this blog.  You were probably one of those kindergarten miscreants who played pat-a-cake with a kid of the opposite gender.  Touching another kid’s skin is verboten and is a clear stepping stone to playing tag, flag football and other delinquent activities.  I think that all children under the age of 10 should be required to wear mittens while on school property.  Boys who cannot control their lips should be fitted with muzzles.  Let’s do this for our kids. 

If anyone out there has their own rules and regulations tales, pray tell.

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