tag:blogger.com,1999:blog-5883634615775822475.post3095248305865638934..comments2024-03-18T09:00:31.992-04:00Comments on Doctor Grumpy in the House: Balancing actGrumpy, M.D.http://www.blogger.com/profile/09858110332436246760noreply@blogger.comBlogger54125tag:blogger.com,1999:blog-5883634615775822475.post-4257671307424737452012-06-18T11:59:33.472-04:002012-06-18T11:59:33.472-04:00[url=http://ieftine-bilete-avion.com/Beirut]Beirut...[url=http://ieftine-bilete-avion.com/Beirut]Beirut[/url]<br />[url=http://ieftine-bilete-avion.com/Hamburg]Hamburg[/url]<br />[url=http://ieftine-bilete-avion.com/Vilnius]Zboruri Vilnius[/url]Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-13648176481556005462012-06-18T10:35:56.484-04:002012-06-18T10:35:56.484-04:00[url=http://ieftine-bilete-avion.com/]germanwings[...[url=http://ieftine-bilete-avion.com/]germanwings[/url]Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-63750326891822205402011-08-02T10:44:44.564-04:002011-08-02T10:44:44.564-04:00The cost of stuff is amazing. But it varies so muc...The cost of stuff is amazing. But it varies so much - here in Houston area, MRIs vary from $380 (incl. your CD of it) up to over $4,000. I recently had labs done, over $1,000 at the hospital, with over $300 disallowed by insurance as 'excessive'...called the local medical clinic - total there for all the labs - $155. I'm tired of supporting those that don't pay.Dianehttps://www.blogger.com/profile/17765443131151220391noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-65467865457731013022011-07-25T21:10:22.074-04:002011-07-25T21:10:22.074-04:00I'm a zebra and had the opposite experience......I'm a zebra and had the opposite experience...had every test known to humankind over 5 years and was told repeatedly what the test said wasn't really the problem...I guess because they weren't sure what to do with what they were seeing? Weird. Now I finally had surgery for said problem, and am healthy for the first time in years.<br /><br />MelissaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-82603137211744279222011-07-25T20:19:28.118-04:002011-07-25T20:19:28.118-04:00To anonymous about "WET READ" Yes, wet...To anonymous about "WET READ" Yes, wet read and stat are the same thing. I'm just pointing out that that expression is old hat. Films are no longer read when they are wet and dripping with fixer or rinse. It took a few minutes to get from exposed film to readable image. <br />Some techs would crank up the temp so the films would process faster. Once it was fixed, you could look at it and see what was there. It still needed to be rinsed and dried, but the film could be read when it was LITERALLY (correct use of the word) wet.<br />In fact, seldom are images even recorded on film now. Most places have gone to computer recorded images, that are ready if not instantly, within 5 seconds of instant. <br />So, no dripping fixer. That stuff stunk, but it was the developer tht stained the clothes. (And probably the lungs)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-18453543342549894552011-07-24T10:47:38.226-04:002011-07-24T10:47:38.226-04:00The problem with chronological age is, it's qu...The problem with chronological age is, it's quite relative. For example, a 78 year old person might not be "old". Yet, their 62 year old friend might be quite "old" because they're suffering from more of the collection of end of life symptoms. <br /><br />I guess the way I look at it, is the person's overall health. If they're 78 years old and have no other diagnoses (not uncommon!) Why shouldn't we treat them? <br /><br />But if they have CHF, HTN, DM, and Renal Failure, then we should start looking at scaling back the heroic measures. Most of the time, getting to that sort of stage means you were quite non-compliant with your treatment.<br /><br />Bottom line - take care of yourselves or pay the price. *Hides in the bunker*Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-27888633226807384892011-07-23T22:00:15.890-04:002011-07-23T22:00:15.890-04:00Move to Canada, dude. We don't sue much at al...Move to Canada, dude. We don't sue much at all and we're all insured. Oddly enough, doctors stick together like glue here so no worries there. Sure, you may not become filthy rich but you can have both a comfortable life and peace of mind!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-66213816016004149262011-07-23T15:54:34.656-04:002011-07-23T15:54:34.656-04:00I hear ya, Dr. Grumpy. I hear ya.I hear ya, Dr. Grumpy. I hear ya.Frantic Pharmacisthttps://www.blogger.com/profile/15804872250102867314noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-79971513664569793362011-07-23T13:34:56.524-04:002011-07-23T13:34:56.524-04:00I wonder what would happen if there were laws that...I wonder what would happen if there were laws that made it illegal to pay doctor's for their testimony. <br /><br />Or they get paid what the jury gets paid for their time.mikraashttps://www.blogger.com/profile/14246190630308001394noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-88400848983184118152011-07-23T09:30:47.980-04:002011-07-23T09:30:47.980-04:00Tort Reform. Thats all I gotta say.
DMTort Reform. Thats all I gotta say.<br />DMChrishttps://www.blogger.com/profile/15452688960252791529noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-57707451890196452602011-07-23T00:05:01.216-04:002011-07-23T00:05:01.216-04:00"I had a discussion with a neuroradiologist r..."I had a discussion with a neuroradiologist recently who had an unnecessary CT head ordered and an incidental aneurysm was found. Because it was found, it was clipped and she suffered a major complication during the procedure. And from the standpoint of worrying about lawsuits it was actually the doctor who ordered the initial CT head without a good indication who got sued (successfully)."<br /><br /><br />So an informed person, a neuroradiologist, is informed about an aneurism and the possibility of treatment -- clipping it in surgery. She has to choose whether she wants to leave it there or clip it and decides to clip it. Being an informed person, she understands there are risks involved in every procedure, but she chose *inspite* of them. <br /><br />And then she has her procedure, chosen by herself, and complications happen. And she sues -- *successfully* -- a doctor that first ordered the exam that found the aneurism??? WTF? Did the exam implant the aneurism there as per doctor's requests?<br /><br />That's just so sick and twisted.Vickynoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-4518201492643629512011-07-22T18:47:02.420-04:002011-07-22T18:47:02.420-04:00Despite having a life expectancy of at least 95 my...Despite having a life expectancy of at least 95 myself, I am in favour of palliative care only for all those over 75. (Joins Packer in the bunker).Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-61680070965008448412011-07-22T14:10:27.776-04:002011-07-22T14:10:27.776-04:00I'm in Canada and I chose medical transcriptio...I'm in Canada and I chose medical transcription because I really respect our healthcare system and its professionals. I'm convinced that two things need to happen: People need to be educated early on about the tendency to deify doctors and start treating them as human beings; people need to have healthcare as a subject taught in high school, at least, in both Can/US. <br /><br />I think many would be shocked to discover just how similar the two systems are. People would grow up with a sense of responsibility for their own healthcare and could handle a pop quiz about different levels of care with ease. <br /><br />Better informed general public could mean doctors wouldn't be pressured, we'd save money and build respect for the very systems that need the money to save us.<br /><br />(Oops! Don't mean to go on so. It's 117 F with humidity where I am.)Suzannenoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-21560248367683866862011-07-22T12:05:12.112-04:002011-07-22T12:05:12.112-04:00I feel your pain. As a veterinarian, where our cl...I feel your pain. As a veterinarian, where our clients actually have to PAY the bill, and our patients cant even talk, its always a struggle. If you do to little and they don't get better quick enough, then you are a terrible doctor, if you start running tests to try to figure out what the heck is wrong then you get accused of doing things just to pad the bill and make money...mcb05https://www.blogger.com/profile/01728823222741279220noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-61495786079066972762011-07-22T10:16:39.262-04:002011-07-22T10:16:39.262-04:00According to the lawyers, there is no such thing a...According to the lawyers, there is no such thing as defensive medicine. If you just provide the standard of care, you'll be fine!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-52604438411126603152011-07-22T08:55:01.455-04:002011-07-22T08:55:01.455-04:00There was a time when your doctor KNEW you and you...There was a time when your doctor KNEW you and you knew him. It was possible to have complete faith in him and his judgment because a person could confidently "bet the farm" knowing he had their best interests at heart. I had a doctor (he is dead now) and we went through everything together. He delivered my sons, fixed their broken bones, sutured their cuts, and treated their ear infections. He saved my oldest son's life. One time he slept down the hall, even though he only lived four blocks from the hospital, because he wanted to BE there just in case I needed him. If he had told me to go home and spin around three times under the full moon I would have done so because I knew I could trust him. Was he infallible? Absolutely not. Was he ever sued? Absolutely not. He was a beloved member of the community. Alas, those days appear to be gone and do not even get me started on those f***ing insurance companies.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-10202381283662297842011-07-22T05:16:23.898-04:002011-07-22T05:16:23.898-04:00I just don't get why doctors have to be sued a...I just don't get why doctors have to be sued all the time. they are human and some things they just cannot possibly recognize. i get why you'd sue the doctor who left his car keys in your belly but other than that.. maybe grandpa's time has just come after he lived 90 fulfilling years.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-61623102808987405322011-07-22T04:57:44.316-04:002011-07-22T04:57:44.316-04:00You are so professional, I sometimes wonder if you...You are so professional, I sometimes wonder if you are too good to be a doctor!<br /><br />WV: backc<br /><br />That's me, Back-you-up - Cliffcliffintokyonoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-48038411859313072812011-07-22T01:01:43.856-04:002011-07-22T01:01:43.856-04:00> Some patients unfortunately are not [ respons...> Some patients unfortunately are not [ responsible ]. Some would have no idea what to do if <br />> they were told "You have a 98% probability of being OK. Do you still want tests anyway?"<br /><br />Indeed, one of the most harrowing and frustrating posts Grumpy has put up here concerned the wife of a stroke victim who pathetically couldn't decide what to do within the typical 3-hour window for giving tPA, despite ample time to decide. Her husband almost certainly had a worse outcome because he married a ninny. And I personally am not sure how I'd react if a doctor said we're 98% sure you didn't have a stroke, mind if we don't do a MRI?<br /><br />The two points I'm making are just this: first, you could design interactive programs for different specialties that requested all the information you had, it could suggest both diagnoses AND the cheapest/lowest harm ways of making the differential diagnosis more accurate. That is, it would tell you what to test next or what to clarify in terms of patient history. It could avoid some of the agita, and narrow in on some issues in a rapid way. This would supplement the doctor's skill, and could never replace it.<br /><br />Second, insurance companies are doing a <i>much</i> cruder version of these programmed diagnoses now, maximizing their profit. they frequently override doctors on treatment options, and doctors have to regularly fight with them just to give the standard of care.Rathskellernoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-89121064739018188502011-07-21T22:05:51.020-04:002011-07-21T22:05:51.020-04:00Rathskeller,
I think the fear around a program is...Rathskeller,<br /><br />I think the fear around a program is two-fold. First, who dictates what goes into the program? Risks and algorithms are not determined by a single study alone. Guidelines for heart failure, for example, are set up by a panel of experts who analyze the studies out there, determine which ones are good designs with solid results, and make a conclusion based on them. Second, doctors don't want to be replaced, or feel like a program is overriding their own decision. How much power is given to the program?<br />------<br />As for the rest of your first comment and your second comment, you sound like an intelligent individual and a responsible patient. Some patients unfortunately are not. Some would have no idea what to do if they were told "You have a 98% probability of being OK. Do you still want tests anyway?"Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-20332178192338472852011-07-21T20:30:11.002-04:002011-07-21T20:30:11.002-04:00> God help us if the "point" is just ...> God help us if the "point" is just decided from a chart or an <br />> algorythm because everybody really is not equal in the life expectancy area and a lot depends on <br />> the individual and his/her overall condition. <br /><br />I think you've missed something important about the status quo. On the one hand, you have the physician's judgment and experience combined with whatever information they're aware of. Not good, but better than roots & berries or whatever they used in the 19th century. On the other hand, you have for-profit companies that DO use algorithms and charts to decide what procedures and medicines to pay for, on top of additional flim-flammery. <br /><br />You're talking in a general, fear of the future sense when you speak of avoiding charts and algorithms, but you're ignoring the reality that this is happening right now, sometimes explicitly against physician's strongly-felt opinions. I presume that older patients suffer the most in these type of situations, although I do not know for certain.<br /><br /><br />I vividly remember my physician a few years ago talking about a potential medicine, then stopping herself, checking my insurance, then continuing the discussion. If that medicine had not been on the formulary, her judgment would have been effectively overruled. Who benefits from that? Me? I don't think so...Rathskellernoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-57597889320691620852011-07-21T19:33:06.405-04:002011-07-21T19:33:06.405-04:00Anon 3:21:
I understand it was an aside.
Are yo...Anon 3:21:<br /><br />I understand it was an aside. <br /><br />Are you saying that WET READ is not the same as STAT? <br /><br />Not trying to cause an argument, just looking to be informed.<br /><br />Thanks!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-53726512959239681192011-07-21T19:31:10.399-04:002011-07-21T19:31:10.399-04:00the older the patient, the more likely you will fi...the older the patient, the more likely you will find something else wrong if you do more tests...boyfriend's grandmother, however, lived to be 111, so for her, 78 was young...I agree with Packer that "after a certain point" less should be done, but God help us if the "point" is just decided from a chart or an algorythm because everybody really is not equal in the life expectancy area and a lot depends on the individual and his/her overall condition.Chttps://www.blogger.com/profile/11823118794294237278noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-14650377286979006022011-07-21T18:35:29.259-04:002011-07-21T18:35:29.259-04:00I can appreciate the comments from people who foun...I can appreciate the comments from people who found something early or unexpected because of a barrage of tests but sometimes that can backfire. I had a discussion with a neuroradiologist recently who had an unnecessary CT head ordered and an incidental aneurysm was found. Because it was found, it was clipped and she suffered a major complication during the procedure. And from the standpoint of worrying about lawsuits it was actually the doctor who ordered the initial CT head without a good indication who got sued (successfully).<br /><br />Sometimes ordering things just to cover your a** doesn't work either.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-53949971804603498992011-07-21T17:16:35.955-04:002011-07-21T17:16:35.955-04:00Well, the only thing I can say is that most medica...Well, the only thing I can say is that most medical professionals do a damn fine job with dealing with modern medicine. I appreciate their work and concerns.Jessnoreply@blogger.com