Category Archives: Hospital

If I am to pick one low-cost way for ruralia and other places with physician shortages, it would involve waiving residency requirements:

Dr. Faris Alomran, a British-educated vascular surgeon working in France, says, “My first choice after medical school was to practice in the U.S. In fact, for most [English-speaking] people, in terms of language options, they are somewhat limited to Australia, Canada, and the U.S.”

But he didn’t end up crossing the Atlantic. “In the U.S. I would have had to do five years of general surgery and a two-year fellowship in vascular surgery to be a vascular surgeon. Seven years total. I got an offer in Paris to do a five-year vascular surgery program. They also reduced my training by one year since I had done two years in the U.K.”

Juliana, a physician originally trained in Brazil and currently in an American residency program, agrees that migrating to the U.S. could have been easier, especially if redundant training were removed. “Repeating the residency is not an easy thing, and many times it’s very frustrating. I do not think the internship [that I’m in] will add much to my future career. Having trained in America for the last four months has helped me understand cultural differences [between the U.S. and Brazil], but it has also made me wish I were allowed to skip some steps.”

This article seems to focus on attracting the best and the brightest, though that’s less my primary concern. (It’s a heck of a secondary concern, though!)

There is a perception that doctors aren’t going to come here to work in Idaho, and that may be true for the best and brightest. But there are a lot of doctors who would be willing to come here for a paycheck (which, by international standards, are just fine in Idaho). A lot of them wouldn’t stay there, but some would even after released from a 5-10 year requirement. (Yes, even some non-European ones would.)

I’m not optimistic on this happening, though, because while many argue the requirements are self-enriching gatekeeping, in my experience even those places where the doctors are suffering from the shortage (by having to work insane hours, for instance), they are pretty resistant. It’s a matter of professional pride. If another country (besides Canada) aligned their medical training with ours, it would be possible. But… other countries aren’t anxious to bend over backwards to make it easier for their doctors to leave.

That said, people make the AMA the bogeyman for all things gatekeeping-related, but they’re actually open to it. As it happens, and as I will keep saying from now until the end of the time, they don’t weird very much power. The power belongs to the states, and the medical board within the states. The AMA may have some influence with them, but they are extraordinarily conservative and inflexible institutions as far as such things go. They recognize the problem, but don’t see it as their problem.

And from a more cynical standpoint, the looser the restrictions the less important they are. There is a reason that one particular state ran my wife through the ringer over (her own person) medical records that were destroyed in a hurricane, let the process drag on for over a year, and then demanded another application fee (of $1000) because the original one had lapsed. In a state where her skills and professional interests aligned perfectly with a state, and a shortage precisely where she would have gone.

Across the board, the credentialism is just crazy. My wife has delivered over 1,000 babies, and performed more than 300 c-sections, and she could still never be given privileges in county hospitals covering some 70% of the US population. Doctors just out of obstetrical residency, who have delivered far fewer babies, would have no problem at those same hospitals. It’s a long story as to why this is the case, but the long and short of it is that if she wanted privileges at these hospitals, she’d have to go back to residency for three years. All of her experience would only let her skip a single year.


Category: Hospital, Statehouse

I know that health sciences are always being updated and yadda yadda, but what the hell?

The AP looked at the most rigorous research conducted over the past decade, focusing on 25 studies that generally compared the use of a toothbrush with the combination of toothbrushes and floss. The findings? The evidence for flossing is “weak, very unreliable,” of “very low” quality, and carries “a moderate to large potential for bias.”

“The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal,” said one review conducted last year. Another 2015 review cites “inconsistent/weak evidence” for flossing and a “lack of efficacy.”

One study review in 2011 did credit floss with a slight reduction in gum inflammation — which can sometimes develop over time into full-fledged gum disease. However, the reviewers ranked the evidence as “very unreliable.” A commentary in a dental magazine stated that any benefit would be so minute it might not be noticed by users.

The benefits of flossing seem so transparent to me that I find it difficult to believe that there’s no science to back it up. I mean, when I floss and white gunk comes out, is it just as well that it stay resting there in my gums? That doesn’t seem right, especially when it can sometimes cause inflammation.

There’s also the blood thing. You floss irregularly, you bleed. Floss regularly, you don’t. Blood and no blood seems like one of those cases where one of those things is better than the other.

There is this, however:

Aldredge also said many people use floss incorrectly, moving it in a sawing motion instead of up and down the sides of the teeth. Pressed about the origins of his organization’s endorsement of flossing, he said it may simply have “taken the ADA’s lead.”

Who doesn’t floss up and down the teeth? That’s where you get the white stuff.

So if that’s the issue, I’m no longer confused about the evidence and more confused about a nation of people who don’t know how to floss regularly.

Whatever, I’m going to keep flossing because what can it hurt?

Floss can occasionally cause harm. Careless flossing can damage gums, teeth and dental work. Though frequency is unclear, floss can dislodge bad bacteria that invade the bloodstream and cause dangerous infections, especially in people with weak immunity, according to the medical literature.

Are you freaking kidding me?

They’re still telling us to floss, though. Though not in this article, they say that even if it doesn’t help in the aggregate it can be very helpful to individuals or something. That’s cool. I dig that. Except when vapers explain how ecigarettes helped us quit, we’re told by the same community that we’re just anecdotes.


Category: Hospital

On July 1st, my wife had surgery. It was not the end of the world, but they did have to knock her out and, well, it was surgery. Afterwards we stopped by the pharmacy to pick up medication and almost everything was denied. Not “pending decision” denied but “Nopenopenope” denied. It turned out the issue was that our health insurance had, at the end of June, changed something-or-another and so we had to fill out a completely different form and had a different account number.

Our problems only started there. As it happens, the surgery itself was no longer covered at the hospital where it was performed. We live in a tri-state area where a lot of our services are provided across state lines. New policy is nothing non-emergent can occur across state lines under any circumstances. We can’t go to the hospital that’s twenty thirty minutes away, or the one that’s thirty minutes away. The nearest major hospital in the state is actually three hours away. This new policy of course took effect July 1st, the day of the surgery.

We will grant that the policy was not necessarily tailored around denying us coverage. Most people don’t live in the odd geographical nook that we do. We would even be understanding if we weren’t already sitting on about eight thousand dollars of medical bills that they are either evading or outright denying. Some of them we knew would be a long shot. For example: Not only is one of my wife’s doctor’s not covered because they’re across state lines, but they are also denying coverage for the prescription that doctor wrote. They are, in fact, doing this mid-prescription.

Every insurance company and insurance plan we’ve had seems worse than the last, but this one is really ambitiously bad, and it’s getting worse every year. We’re at the point where if we could, despite our significant medical expenses, we’d just get a high-deductible plan and pay out-of-pocket just so that we know what our outlays are. PPACA makes that difficult, unfortunately, and more expensive because I am still considered a smoker.


Category: Hospital

Russell Saunders is (probably rightly) nonplussed about the inappropriateness of this headline: Teen high on anesthesia is having the best time ever. It came, though, on an interesting week. One in which my wife had surgery, for which she was put under.

The conversation between her and Anders, the anesthesiologist, was actually kind of surreal. Almost like that between a patron and a waiter (or chef).

Clancy: So what drugs are you going to be using?

Anders: Well, we’re going to start with some zebrafan and heifferdol..

Clancy: Will you be putting in sprinkles of girafferon?

Anders: Actually, I prefer a wisp of platypon.

Clancy: Oh, platypon is great. It’s so hard to get, though! None of the hospitals I work at keep it in stock.

Anders: Oh, that’s very tragic. When I worked at a hospital it was a problem as well. At this clinic, though, they give me much wider rein.

Clancy: That’s great. Not that I don’t like girafferon, but sometimes a dallop of platypon just hits the spot.

Anders: Quite so, madam. Quite so.

{Obviously, I don’t remember the names of any of the drugs.}


Category: Hospital

So when I finally got the mail after the Great Snowstorm, there was a letter from a bill collector stating that we were very delinquent on a medical bill from College Medical Associates (CMA), the physician group from which we receive medical care. It was… odd. I am very aggressive about paying medical bills as they arrive. As soon as they arrive. Before I even see what the bill is for, as often as not. Medical providers are especially aggressive about turning things over to bill collectors because when they don’t get paid quickly they are abnormally likely never to get paid at all. And on the other side, if you overpay they are good about sending you back a check. so if it’s under a couple hundred dollars, and it usually is, we can float that.

So what happened? Did I miss one? I wasn’t sure, but I did what I always do and immediately paid the $89.44 the bill was for.

The next day I got a very stern letter from CMA asking me to please stop remitting overpayments, along with a check for $26.57. They made their case that I am ridiculous because here are the amounts of the overpayments you have been making. So for the love of god, please stop. Don’t pay anything further until you get a new bill.

And today I got a new bill! From CMA. For $26.57.

Which of course lead me to compare the bill to the bill collectors to the list of overpayments I’ve made. Wouldn’t you know it: $89.44.

Given their inability to actually keep track of such things and willingness to come down hard on the patients, I’m almost tempted to say “screw these people.”

I’d rather not, though, because CMA is my wife’s employer.


Category: Bank, Hospital

A hard coughing fit, the kind where you cannot stop and you cannot draw breath, is an overwhelming emotional experience for me that leaves me mentally drained.

I had severe asthma as a child. It wasn’t the debilitating non-stop puff-the-inhaler-between-every-word stereotype you see on television. I’ve never met anyone like that, and doubt there are many. I was very physically active, taking long bike rides through the country, playing countless hours of basketball in our driveway with my brother, and enjoying hiking and camping. I played trumpet and french horn in the band, which requires a bit of wind.

I have the kind of asthma that comes suddenly and leaves you frantically gasping to suck in air, and that can last for days or weeks. (more…)


Category: Hospital

When I first started using ecigarettes, it was a pretty big adjustment. It wasn’t all negative, as ecigarettes gave me a greater degree of flexibility to indulge in my rituals and habits. I no longer needed to worry nearly so much about lingering odors. I could do it indoors within certain limitations. I could punch things up with different flavoring. But there were other things involved as well. It was, contrary to expectation, more expensive than smoking. It was more complicated. But more than anything else, it was less satisfying. The brand I used at the time was so much less satisfying that, looking back, I am surprised I was able to jump that chasm. I believe I wanted to quit smoking more than I realized to be able to do it. (Just not enough to stop altogether – yes, I’d tried.)

Vaping was, and to a lesser extent is, uncharted territory from a health perspective. Few seem to really believe that ecigarettes are actually as dangerous as cigarettes, even if some make that argument. But how much safer? Are they safe? I came to the pretty early determination that they were not completely safe. While transitioning from smoker to vaper did leave me feeling better, it still… felt… like I was breathing in some stuff that wasn’t good for me. There was no more coughing through the night, and a lot less coughing in general, but some (albeit less) of the short-windedness was still there. But smoking is the motherload of all legal health evils, and once I still couldn’t quit after my daughter was born, I had practically resigned myself to being a lifelong smoker until I died from it. Things were that bad.

The science is starting to come in, and it’s presenting something of a mixed message. As I had hoped, so far nothing has arisen that makes me feel any differently than I originally did: I have made a substantial improvement to my health. As I had thought and feared, though, it’s not all good. Here are some of the areas of concern:

  • Nicotine – While nicotine isn’t the worst ingredient in cigarettes by a long shot, there are still a large number of heart-related health concerns about it. While less worrisome than smoke, there may also be concerns about it being delivered as ecigarette vapor. I have myself been cutting the nicotine levels downs, but mostly to reduce and eliminate the addiction rather than from concern over my heart. Even so, this one is my doctor wife’s biggest concern. I should also add that, while I don’t know for certain, until I cut back nicotine levels I am pretty sure that my nicotine consumption had increased over smoking. Nicotine for tar is probably a good deal, but the inefficiencies of the delivery mechanism may mean (until technology improves, if it is allowed to) that more overall nicotine is consumed generally, without specific attempts to cut down and cut back. Another concern about nicotine levels is that some suppliers have been caught using more (or less) nicotine than their advertised level.
  • Formaldehyde – This is the one that scares the bejesus out of me because formaldehyde. Worse, some studies have suggested that ecigarettes have more of it than combustibles. However, those studies don’t stand up to scrutiny. They essentially burn the liquid at a temperature so hot that it creates, if not smoke, something close to it. These are not real-world circumstances, because when you do that, it tastes awful. When they used low voltage (3.3v) they found no formaldehyde; it was what they found when they used high voltage (5v) for extraordinarily long puffs that made the headlines. It is analogous to burning a Salisbury steak to an absolute crisp and finding carcinogens in the char. Which you would, but even people who like their meat well done wouldn’t burn it that much. Having said all of this, most voltage falls in between 3.3v and 5v (the one I use is 3.7v), and we don’t yet know at what point it becomes a problem even if you’re not burning it to a crisp.
  • diacetyl

  • Diacetyl and Acetyl Propionyl – While not as scary as formaldehyde because people haven’t heard as much about it, this is the most significant concern. While formaldehyde is generally only produced through burning, these chemicals are often in the eliquid itself. Potentially unsafe at any temperature, these chemicals can cause serious lung problems. A recent Harvard Study turned up a lot of D/AP and has gotten a lot of publicity. However, Dr Konstantinos Farsalinos – who has been investigating this a while and previously produced a study that had similar results – points out that the levels of D/AP found in the Harvard study were pretty low (lower than in his own study, in fact): below that of occupational safety standards and significantly lower than those found in cigarettes. Also noteworthy, like the formaldehyde findings, they had an unusually long draw (heating period) at eight seconds. One of my batteries actually has a timer on it and I rarely go above three and almost never above four. This may not make a difference because, while the formaldehyde is produced by the heat, D/AP is in the liquid itself. Even so, I find it noteworthy that they didn’t seem to use real-world conditions. (Either that or I am an atypical user. Which is possible, but I assume that I go in the other direction since I tri-puff when I drag. On the other hand, I don’t inhale.)
  • Other things – There are concerns about kids getting into the eliquid and getting nicotine poisoning. There are some misconceptions about this because articles seem to present the ejuice as something a child might drink. They wouldn’t. It tastes awful. Most come in containers that limit output so, with the right packaging, people shouldn’t worry about chug-a-lug. It’s cause to be mindful, and to childproof packaging, but not much beyond that. Also, some of the cheaply produced imports have batteries that don’t charge correctly and explode. That’s pretty scary, but fortunately pretty rare and fixable.

Now, let me let you in on a little secret. I am pro-vaping. I am skeptical of regulation, at least in the abstract. I would, however, welcome the right regulation in this domain. Pretty enthusiastically. While I might prefer everything be handled with labels and certifications, I’ll take regulation.

For effective regulation, though, we need to move beyond particular parts of the debate. (more…)


Category: Hospital

There are many things that Windows does that drive me crazy. One of which is the file copy. When you’re copying a lot of files, and it runs into a problem or a question, it stops everything in order to get an answer. So if you want to move 300GB of files and go to bed, you wake up and it’s moved 2GB and wants to know whether you want to merge the source and destination folder or skip, or whether you want to replace a file or leave the current one there. These are reasonable questions, but there’s no reason to stop everything while waiting for an answer. There are 298 more GB to move! And I wanted it done before I woke up!

It’s like having a secretary where you give him ten things to do and when you check in with him in the afternoon he had a question about the first one and did nothing. Such a secretary would be fired. But Windows file manager has persisted in this behavior for years and years. I blame unions.

My wife is having some tests run regarding a potential sleep disorder. Two weeks ago, she had some tests taken and sent to be analyzed. In rural Arapaho, it takes 2-3 days for test results to come back. So no problem, right? Well, of the 16 tests they had to run, they had an equipment problem with one of them. So… they did nothing until they could get someone out to fix it. They didn’t run the other 15 tests or anything. So they did nothing. Including informing Clancy that there is any sort of problem. So Clancy calls and is told they are a couple of days away from being able to run the other tests. They didn’t want to send it to another lab because there were fifteen tests they could run. But they didn’t run them because they couldn’t run the 16th.

Which it turned out didn’t matter anyway. The next round of tests that they were going to run were canceled. The crafty insurance company declined to sign off on them. They had a few questions. But since the appointment, made a month ago, wasn’t until this week, they didn’t review it until this week. They didn’t send it out until the day before. Which nobody could do anything about in time to clear it. The result was that her sleep study was cancelled, and she won’t be able to do anything more about it until late January.


Category: Hospital

Chuck Schumer wants to change some regulation to “make eyeglasses cheaper.” Specifically, he wants to do three things:

  1. Require that optometrists give customers their prescriptions, so that they do not have to purchase their glasses from the optometrist.
  2. Require optometrists to verify prescriptions in a timely manner.
  3. Allow people to go more than one year without getting their eyesight checked.

Some of you may remember a story a while back:

In other news, my optometrist’s office apparently refuses to send my prescription to the Redstone Walmart because the optometrist is on vacation. I cannot for the life of me figure out why that matters and why they don’t have my prescription on file so that they can send it out. Meanwhile, Redstone Walmart won’t let me place an order with a prescription to be named later, nor will they let me order over the phone even though they have my frame preference on file. This is going to set back my glasses order by a couple of weeks, most likely. My glasses are getting scratched up.

Two Weeks Later The situation with the optometrist has not been resolved and has in fact gotten worse. When they finally send the prescription to Walmart, they sent a contacts prescription. I don’t need contacts, I need glasses. I haven’t been able to check with them in order to see whether or not they even have a glasses prescription or whether they were under the impression that it was specifically for contacts. I’m never going to get my new glasses. If I have to get a glasses prescription, I’m just going to go to the Walmart eye center. The most frustrating thing about all of this is that my vision hasn’t changed. This was confirmed on my last visit.

The situation did get resolved at some point.

It seems rather weird to me that I apparently let the optometrist not give mt he prescription. Maybe I lost it? Or maybe they would give it to me, but not in a form that Walmart could accept. Whatever the case, the inability to get it verified was certainly quite the hassle and #1 and/or #2 were to blame.

I’ve also long complained about #3, and of course did so in a post from long ago. I won’t blockquote it because my narrative is not especially clear, but to summarize I found myself in a position where an old glasses prescription was actually better than a new one and there was nothing I could really do about it because the only prescription I could get them to take was the new one.

So, three cheers for Chuck Schumer!

However!

This will actually do me no special good. I just got new glasses and contacts earlier this year. I had from the start intended to order them online, so I made darn sure that I had my prescription on paper (which they had no problem providing, despite imploring customers not to order glasses online). Now, because I did go to the doctor first, my prescription is no longer out of date. But as long as I can see, the online vendors don’t even look at the piece of paper nor do I have to refer them to the optometrist that wrote it, so… yeah, I can pretty much flout the regulation that Schumer rightly wants to relax.

Of course, I’m not supposed to do that, and I have to admit that a part of me worries that somebody, somewhere is going to make a big deal out of this regulatory hole. Someone like Chuck Schumer, come to think of it…


Category: Hospital

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There is a rather significant post up at Ordinary Times. It can’t easily be reproduced here, but you’re welcome to comment here if you are disinclined or unable to comment over there.


Category: Hospital

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Queenland

Greetings from Stonebridge a fictitious city in a fictitious state located in a tri-state area in the interior Mid-Atlantic region. We're in western Queenland, which is really a state unto itself, and not to be confused with Queensland in Australia.

Nothing written on this site should be taken as strictly true, though if the author were making it all up rest assured the main character and his life would be a lot less unremarkable.


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