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Saturday, March 21, 2009

Fundamental,Rebuild,Minor Changes

During the past several months I was certain that the public, congress and others were edging toward health care reform. However, Matt Holt points to a report from the Pew Research group, that change is 'not what we need'.


What's in a word?  Rebuild,fundamental change, minor changes, don't know....

Can we liken this to the annual  automobile re-designs? Complete rebuild---unrecognizable new model.  Fundamental changes---new fenders and bumpers. Only minor changes--new badges, relocate chrome, rename model.

Only time will tell which one of these  'revolutionary, evidence based, cost effective solutions will rise above the frey.

Health Train Express--KIA

Incredible as it may seem, the province of Quebec in Canada does not have an emergency medical helicopter transport service.

Did this contribute to the 'window of opportunity" to save Natasha Richardson's  life?

This is pure speculation on my part, but the question also arose in an article posted on the Associated Press' web site this morning.

The high visibility of this tragedy should awaken the medical community and it's provincial medical authorities to the sad nature of a system that does not meet a standard available in most of the North  American Continent.  While fairly remote and isolated Mount Tremblant

Galleries & Cams

is a world class ski resort which draws an international crowd of ordinary, famous, stars and celebrities.

While skiing is not  considered a dangerous sport, in reality it is a fairly high risk activity, witness the presence of many orthopedic surgeons and/or urgent care centers dedicated to treating sportsmen with fractures, sprains, and concussions.

The Mt Tremblant web site now displays the following warning:


The helmet is now mandatory for all snow parks users.


Is this the inevitable outcome of a nationalized health care system, where everything is planned and budgeted years in advance or simple negligence?  Natalie Richardson and Mr Neelsen will not benefit from this lack of services, however hopefully it will stimulate a provincial outrage in Quebec. The lack of speedy medical  helicopter transportation effects not only this ski resort but the entire province and cities in Quebec.  Undoubtedly this accident will create mandatory ski helmet rules at all ski facilities around the world. Some of the helmets are "way cool".. I might even take up skiing once again.

Sunday, March 15, 2009

Rodney Dangerfield MD on the Health Train Express

" I don't get no respect' is the mantra we have   heard from Dangerfield.  According to many pundits, public policy advisors, health insurance companies, utilization reviewers, CMS, and more than the number of ABMS approved specialty categories, we  physicians are complete 'fools'.


from "Dave" 's commentary on the Wall Street Journal blog

Where have you been all my life?
What a numbskull I’ve been!
First, I get a BS in Biology, then an MS in Molecular Biology, then 4 years in medical school, 4 more years of training, triple-board certification, 20 years of seeing patients honing my diagnostic skills, none-stop study, dozens of medical conferences, thousands of internet searches…
When all I really needed was your “cookbook.” Is it on Amazon?
By the way, I have no patience for idiotic CEOs who recommend cookbook medicine when no such cookbook exists.

Health Train Humor

Marge, it takes two to lie. One to lie and one to listen.

Homer Simpson


If you want a short brief read, don't go further.  This edition will ramble, rant and rave about all things in healthcare and it's accompanying political parasites, and doctor wannabees. (those guys who could not quite get into med school, who write blogs, author medical articles, and become spokesmen for the rest of us who are too busy with patient care to have time to write much until we either semi retire, stroke out or have disablity.  Let's face it I did not go into medicine primarily to become a civil servant, although I did chose it to help my fellow man with what I then thought was my superior intellect, good looks, and the unending ability to get dates. I also thought it would never become boring.


Injection of Humor:



I am also wondering how our health insurance industry is enmeshed in  the AIG fiasco.  Are they the next AIG, and will they get bail out funds in several months?  You know that all these crooks and thieves play golf at the same club, don't you??


Admittedly I am biased about many things. One of my favorite sanctimonious and self centered prejudices is that doctor wannabes (health care pundits, consultants, hospital administrators, utilization reviewers, health policy writers, and planners, ad infinitum and nauseum in their efforts to contain health care costs actually increase them enormously.

Monday, March 2, 2009

Health IT Update


Some of you may have wondered why I have been absent from blogomania.  Wel it is because my time has been drastically impacted by the necessity of learning how to use an EMR.

In my setting I have had all the 'advantages' of having a full time IT staff to quell my frustration at not being able to perform my duties as a physician.  It is not saving me time nor is it increasing my is exactly the polar opposite.

It takes me about ten minutes to correlate and coordinate  the information my assistants and data gatherers bring to me as well as perform my physical exam during which I also take relevant history from the patient.  Now it takes me an additional ten to fifteen minutes to enter it into the EMR (that is an optimistic estimate). 

I previously would see an average of 35-40 patients/day. If I add on ten minutes (conservatively) that is 350 minutes/day or almost 6 hours, leaving me with two hours to work.  So even with using my 'EMR"  I can now see about  ten patients/day.

Makes sense to me...sounds like the military.....