Most ER providers in the U.S. work for staffing companies that have contracts with hospitals. Those staffing companies are losing revenue as hospitals postpone elective procedures and non-coronavirus patients avoid emergency rooms. Health insurers are processing claims more slowly as they adapt to a remote workforce.
[A memo from Alteon Health, a major hospital staffing company] announced that the company would be reducing hours for clinicians, cutting pay for administrative employees by 20%, and suspending 401(k) matches, bonuses and paid time off. Holtzclaw indicated that the measures were temporary but didn’t know how long they would last.
From The Boston Globe:
Emergency room doctors at Beth Israel Deaconess Medical Center have been told some of their accrued pay is being held back. More than 1,100 Atrius Health physicians and staffers are facing reduced paychecks or unpaid furloughs, while pay raises for medical staff at South Shore Health, set for April, are being delayed.
From Twitter, which is what lead me down this wormhole in the first place:
Good thing we paid billions in bailouts to airlines and other corporations. Granted, the coronavirus stimulus bill did provide $100 billion for hospitals and healthcare providers, but it seems that none of that is trickling down to the people on the front lines keeping us alive. Read the rest
In June 1995, physicians Angus Wallace and Tom Wong were waiting for their flight to depart Hong Kong to London when they were asked to examine a woman complaining of arm pain caused by a "fall." After takeoff, the doctors returned to the woman to put a splint on her arm but they quickly realized that her injuries were much more serious than she had first reported. Not only did the woman have arm and rib fractures, her lung was punctured and air leaking between her lung and chest wall had caused a pneumothorax. The condition is life threatening if not treated and Wallace believed the change in air pressure upon landing would kill her. So Wallace and Wong had to improvise. From Wikipedia:
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The medical kit had lidocaine – a local anaesthetic – but the catheter in the kit was designed only for urinary catheterisation and was too soft for use as a chest tube. The doctors fashioned a trocar from a metal clothes hanger to stiffen the catheter, and a check valve from a bottle of water with holes poked in the cap. They sterilised their equipment in Courvoisier cognac, and began surgery by making an incision in the patient's chest, but with no surgical clamps available, Wong had to hold the incision open with a knife and fork while Wallace inserted the catheter. The whole surgery lasted about ten minutes; the doctors successfully released the trapped air from the patient's chest, and she passed the rest of the flight uneventfully, eating and watching in-flight movies.
Doctors who accept pharma industry gifts (which can range from free coffees to lavish dinners to six-figure speaking fees) claim that they're not influenced by these bribes/gifts, which is possibly why doctors are taking more pharma bribes than ever.
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In Louisiana, police arrested Belinda Gail Fondren, 52, for forging doctor's notes that she sold to students skipping school. The notes were $20/each and she reportedly sold 14 of them before getting nabbed. She had been signing the name of a physician who previously employed her. Fondren was caught after the Vernon Parish School Board called the physician's office to look into the sudden increase in excuse notes from his office. It's surprising that the students would waste money on something they could easily make themselves given the endless free templates available online! From Yahoo! News:
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Fondren was arrested on October 23 and charged with filing or maintaining false public records, according to the Bastrop Enterprise. The Vernon Parish School Board did not immediately respond to Insider's request for comment and it's unclear whether or not the students who bought the fake notes will be punished.
If convicted, Fondren could face up to five years in prison.
The northwestern Mexican state of Guerrero’s ocean side vistas, Mayan and Zapotec heritage and mountainous terrain would make it a postcard-pretty place to be—if it weren’t for all the murder and financial destitution.
Because of the extreme poverty in the region, the state has one of the lowest life expectancy rates in the nation. According to the Guardian, close to 70% of the people who call Guerrero home, live in poverty. This misery experienced on a daily basis by those living in Guerrero is compounded by an ongoing turf war between cartels and the Mexican military resulting in one of the highest murder rates per capita, in the world. The violence is so extreme that most professionals who can afford to pick up and relocate, have done so. The loss of lawyers? Meh. However, having no Doctors or other medical staff to care for a population trapped in an already untenable situation is nightmare.
Thankfully, with little fanfare, Médecins Sans Frontières is on the scene, trying to make a difference.
From The Guardian:
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Before patients are seen, the clinical team – three doctors, two psychologists and a nurse – explain that MSF is neutral, independent, free of charge and available to anyone as long as weapons are left outside.
This is the standard pep talk in the state of Guerrero, where MSF has taken over 11 primary health clinics that have closed or are limited by the security crisis in communities long neglected by the state.
In addition to regular clinics, MSF provides rapid response interventions in the aftermath of grave incidents like mass kidnappings, gun battles and massacres, which leave displaced or trapped communities in psychological turmoil.
Being medicated is the best and the absolute worst.
I take a cocktail of anti-anxiety and anti-depressive drugs on a daily basis to help me deal with the symptoms that come with my PTSD. Most of the time, I'm grateful for them: They've helped to numb me, just enough so that I can use the techniques I've learned in therapy to help ground myself during a flashback or panic attack. Now that I'm medicated – I refused treatment for years – I'm able to maintain a healthy relationship.
The rage and detachment I've experienced these past 20 years have been tamped down far enough that I can empathize, fully, with my wife, friends and colleagues. It's hard work, sometimes! But I feel healthier than I have in years. A lot of the time, I'm even able to sleep through the night. The paranoia I deal with and the thoughts that refuse to stop tumbling around in my head give way to slumber, most evenings. It's still a frequent thing for me to wake up, sweat-drenched and alert in the dead of night, but it feels manageable. Before, it was just exhausting and sad.
But then, on occasion, a doctor decides that maybe I should be on something new; something different. This happened two days ago. I'm not digging it.
I was warned: when starting on these new pills (no, I'm not going to tell you what they are) I'd experience more anxiety for the next few weeks as the old drugs leave my system and my new pharmaceutical hotness takes hold. Read the rest
I can't believe I have to write this, but maybe jamming other people's shit up your ass isn't a great idea.
When done by medical professions, under very specific circumstances, a fecal transplant can mean the difference between life and death: implanting feces containing healthy gut microbiome into a patient's body has been used by doctors as a way to help fight antibiotic-resistant super bugs, like Clostridium difficile. A lot of folks online have been blathering away about how research shows that the same sort of treatment could also act as a cure for obesity. As reported by The Guardian, on hearing this news, people are now shoveling other people's crap into their bodies without a doctor's supervision.
What's the problem, you say? Well, before the treatment is administered in a clinical setting, the fecal matter used is screened for disease and other nasties in an effort to make the transplant as safe as possible. Without proper screening, the risk of transferring diseases like Hepititus or HIV from one poo owner to another is pretty high. Additionally, a DIY fecal transplant conducted in the name of losing weight could have the opposite effect. A case study from a few years back illustrated that a woman who underwent a fecal transplant to deal with a drug resistant super bug ended up becoming obese as a result. Oops.
So, if you're feel that you could stand to lose a few pounds, take a look at your eating habits, exercise more or visit a doctor for help in losing weight before reaching for a bag of liquefied shit. Read the rest
Remember how the bad guys got battered on by little Kevin's (Macaulay Culkin) booby traps in the Home Alone series?
Well, in these videos from 2015, a group of real-life doctors watched clips from both early 1990s holiday flicks and gave their professional opinion on what life-altering injuries the movie's burglars, Marv (Daniel Stern) and Harry (Joe Pesci), would have sustained. It ain't pretty.
(Tastefully Offensive) Read the rest
Rolling Stone's Mac McClelland tells the story of the physicians bravely breaking the law by treating patients with MDMA, ayahuasca, DMT, LSD, and other hallucinogens. From RS:
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As an internal-medicine specialist, Dr. X doesn't have any patients who come to him seeking psychotherapy. But the longer he does the work, the more "I'm seeing that consciousness correlates to disease," he says. "Every disease." Narcolepsy. Cataplexy. Crohn's. Diabetes – one patient's psychedelic therapy preceded a 30 percent reduction in fasting blood-sugar levels. Sufferers of food allergies discover in their journeys that they've been internally attacking themselves. "Consciousness is so vastly undervalued," Dr. X says. "We use it in every other facet in our life and esteem the intellectual part of it, but deny the emotional or intuitive part of it." Psychedelic therapy "reinvigorated my passion and belief in healing. I think it's the best tool to achieving well-being, so I feel morally and ethically compelled to open up that space."...
"If we didn't have some idea about the potential importance of these medicines, we wouldn't be researching them," says Dr. Jeffrey Guss, psychiatry professor at NYU Medical Center and co-investigator of the NYU Psilocybin Cancer Project. "Their value has been written about and is well known from thousands of years of recorded history, from their being used in religious and healing settings. Their potential and their being worthy of exploration and study speaks for itself."
Optimistic insiders think that if all continues to go well, within 10 to 15 years some psychedelics could be legally administrable to the public, not just for specific conditions but even for personal growth.
Mine hasn't. At least, he hasn't taken money from any of the 15 companies that have been forced to disclose information about gifts and cash they give to doctors. Pro Publica has put that information into an easily searchable database. It's not total transparency — the drug companies whose payouts are included here only represent 47% of the total market — but it's a good place to start if you want to know whether your doctor has any conflicts of interest that could affect your health. Read the rest
I've got a good doctor, and one of the reasons I like him as much as I do is his "bedside manner"—the shorthand we all use for describing whether or not medical professionals are able to connect with their patients emotionally. But pulling off a good bedside manner isn't just about being kind and empathetic, it's also about time. Part of why I think he had good bedside manner is that he spends time talking to me when I go in for an appointment. He answers questions. He asks about my life. He takes the time to empathize, even if, sometimes, that means that a problem that could have been dealt with in 5 minutes became a 20 minute appointment.
It's hard to make people feel valued and cared about if you've only got a couple of minutes to see them before you have to move on to the next person. Unfortunately, packing as many patients into a day as possible is more efficient in a business sense. A 2005 study of 11 doctors found that they spent an average of 13.3 minutes on each patient—if you combined both face-to-face time and time spent working directly on the patient's case outside the exam room. The next year, anesthesiologist Peter Salgo wrote an op-ed in the New York Times about the pressure put on doctors by hospital administration to see as many patients as possible and move them on through with conveyer-like efficiency.
Now there's a new study that suggests the pressure to behave in a business-friendly way makes doctors more likely to have a brusque bedside manner. Read the rest
A key component of antibiotic resistance is the over-use of antibiotics. We talk about this a lot in the context of over-the-counter antibacterial cleansers, but there's a doctor's office side to this story, as well.
When sick people come into a doctor's office, part of what they are looking for is psychological wellness. They want to feel like somebody has listened to them and is doing something to treat their illness. Sometimes, that means they ask their doctor for antibiotics, even if antibiotics aren't the right thing to treat what they have.
In the past, and sometimes still today, doctors go ahead and prescribe antibiotics almost like a placebo. It's hard to say no to something a patient really wants, especially when it's likely to make them feel better—just because taking anything, and treating the problem, will make them feel better. But that is definitely not a good thing in the long term.
At KevinMD, family physician Dike Drummond offers some really nice advice for doctors who are struggling with how to make a patient feel better, but also want to avoid contributing to the growing antibiotic resistance problem. What I like best about Drummond's advice: It starts with empathy.
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If you have a major challenge working up some empathy one of two things is happening.
You are experiencing some level of burnout. Empathy is the first thing to go when You are not getting Your needs met. This is a whole different topic and “compassion fatigue” is a well known early sign of significant burnout.