Medic Interrupted

Seems like one of the only manly outposts left in Long Island suburbia is the barber shop, where dads can go by themselves or with their sons and enjoy discussing sports, women and life in general using vocal tones amplified with testosterone. There was actually a priest sitting in the barber’s chair next to mine, sympathizing with my plight as an attorney. You see, the priest had played in his first poker game the night before. After finishing his third hand, the priest concluded that he couldn’t find the morality to bluff his fellow players, and left the game.

As an attorney, it is never acceptable to tell a lie. Painting a picture for the judge and jury using the facts of the case as colors is more akin to what lawyers like myself do. Using the facts is what makes us advocates. Creating falsities is what would get us in trouble. Yet, there seems to be an art in treading the fine line between these two concepts. Take, for instance, palliative phrases I use as a medic with injured patients and their families: “we are going to do everything we can for your daughter”; “we are going to help you the best we can”; “you’re going to feel some pressure while I start this IV”. So next time someone asks you the riddle of what a priest, an attorney and a medic have in common, you can say the answer .

On the other hand, when my seven year old son asked me whether I knew why the chicken crossed the road, I asked back to him, “why?”. I usually tuck my kids into bed before they go to sleep. But on this night, both my son and daughter bravely professed to me that they wanted to go to sleep on their own. We kissed and hugged downstairs, and up the stairs to bed they went while I finished watching the basketball game on TV. Needless to say, after the game, I heard their scurrying, saw their bedroom light go off suddenly, and found my two munchkins giggling (at absolutely nothing!) in their room in bed under the covers . “Get to sleep – NOW!” I admonished them. “We are trying daddy!” I hope they don’t learn to play poker anytime soon.

Dear Mr. President:
During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone.

While glancing over her patient chart, I happened to notice that her payer status was listed as “Medicaid”! During my examination of her, the patient informed me that she smokes more than one pack of cigarettes every day, eats only at fast-food take-outs, and somehow still has money to buy pretzels and beer. And, you and our Congress expect me to pay for this woman’s health care? I contend that our nation’s “health care crisis” is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a “crisis of culture” a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one’s self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that “I can do whatever I want to because someone else will always take care of me”. Once you fix this “culture crisis” that rewards irresponsibility and dependency, you’ll be amazed at how quickly our nation’s health care difficulties will disappear.

Respectfully,
ROGER STARNER JONES, MD
If you agree…pass it on.

Is there such a thing as Frequent Flyer Benefits? Yes there is, and I’m not just talking about flying across the country on the cheap either.

In the business of EMS, “Frequent Flyer” is a semi derogatory term given to those patients to whom we see often. They are the homeless alcoholics, the poorly managed type II diabetics, and the lonely widow. Anyone who has been in the field for but a few months can tell you who their preferred customers are, and they know their address and chief complaint by heart.

These patients are not just the habitual 911 callers, but are also the weekly scheduled transfers like dialysis and chemo patients. I recently had a discussion about this with a good friend of mine. He is an administrator at a mid sized ambulance company specializing in inter facility transfers, and he has been dealing with a rather problematic trend amongst the field providers. He told me many of his personnel were not doing assessments on frequently transported patients.

When he would ask why they weren’t doing full assessments, he was met with poor excuses like “Mr Johnson has CHF, he’s always tired” or “Ms Conner is post CVA, she’s always altered.”

This is a very dangerous practice. I know at times it is tempting to think of our frequents as static characters that we give rides to. But that is just not the case . And it should be reiterated that for the time on scene and during transport, regardless of your level, you are the person that is most responsible for that patient. And not doing a full assessment is frankly irresponsible and could cause harm.

So you ask where’s the benefits? Why should I be happy to be transporting this patient for the third time this week? Well because you are at a huge advantage to provide really good care. You’re even at greater advantage then the patient’s primary physician.

If you transport Mr Fillips to and from dialysis three time a week, that means you do six assessments a week on the same patient. That’s twenty four assessments a month, and one hundred and forty four assessments every six months! Do you think his primary physician, let alone anyone assesses this mans health twenty four times a month? Probably not. And if anything was out of the ordinary, who do you think would notice first? You would. That is of course if you did an assessment.

When treating a frequently seen patient, we should pretend that it is the first time we have seen them. Sure you know their name medical history but that’s where the familiarity stops. Afterward ask yourself how what you found compares to what you know? Whats different or new about the patients presentation?

EMS, despite what it might claim is not an emergency service. At least not exclusively. Our place in medicine is quickly expanding in many ways. If we can lose the “trauma junky ” hero mentality, and embrace our true role as Health Care Providers, then we will not only benefit ourselves as professionals and our industry, but also provide our patients with better care.

So the next time Mrs Miller starts singing “ca’mon ta my my house, ca’mon ta my house” Be true to your role. Be kind to your patients. And give them the respect and attention they deserve.

My heart goes out to Haiti’s earthquake victims. I have read that the United States of America has pledged financial help in the amount of 100 MILLION dollars. Let me ask you something….. if we, as a nation gave 50 Million instead of 100 Million, wouldn’t it be possible to use the other 50 Million to get people off Medicaid and other public assistance vehicles which would actually save us taxpayers money in the long run? Let’s say we used some of the 50 Million earmarked for Haiti to compensate businesses and families to allow for the absence of volunteer EMS workers? I personally tried to volunteer as an AEMT-CC and firefighter my services in Haiti, and couldn’t find anyone who was grouping them together. I also met many like me online in the same exact situation.

I’m just never gonna get it no matter how much I think it through. I’m never gonna get how I go into homes where the residents are supported by public assistance (e.g., me, you, and the rest of the tax paying world) and I have to ask them to turn the big screen TV and boom box down so I can listen to lung sounds or a pulse. And I’m never gonna get how the mother of the 20 year old girl I picked up for abdominal cramps 3 days post DNC disconnects from her daughter so easily and readily. I’m never gonna get how Jean Wyclef, the operator of Yele, the alleged cause to help Haiti, has filed one tax return in the last 12 years, has enough to donate millions to his native country, and yet chooses not to pay his taxes. I’m never gonna get why we as a nation don’t demand that workfare, not welfare, be put in place. I’m not saying by any means that those being supported by public assistance are worthless. Far from it in fact. I’m never gonna get why, if after a certain amount of time on welfare someone hasn’t found a job, they are not put to work reconstructing places like Haiti. And I’m never gonna get why those on medicare are allowed (even expected) to rely on people like me, a volunteer Medic and Firefighter, but I cannot even think about relying upon them in return- say, someone to clean up the neighborhood on a volunteer basis.

If Haiti was a failed nation before the earthquake, it is most certainly a failed state now. 100 Million isn’t going to fix it. And most of the country’s residents are coming here to New York anyway.

Give it to Doctors Without Borders you say? None of the money from the recently run telethon will go to the wholly admirable Medecins Sans Frontieres/Doctors Without Borders, which has already received enough money over the past three days to keep its Haiti mission running for the best part of the next decade.

How about the Red Cross? The last time there was a disaster on this scale was the Asian tsunami, five years ago. And for all its best efforts, the Red Cross has still only spent 83% of its $3.21 billion tsunami budget — which means that it has over half a billion dollars left to spend. Not to put too fine a point on it, but that’s money which could be spent in Haiti.

I’m never gonna get why the entire world kept hidden the fact that these buildings in Haiti which collapsed were being built on a fault line. It was hidden, right? I mean… who would build such structures on a fault line without proper architectural precautions? I guess next time the buildings in Haiti will be built more solidly…. like the homes of americans all over our nation who can’t pay their mortgages, and aren’t benefitting from 100Million from the feds.

Never….Gonna…. Get It…. Never.

Sing it to me, ladies!!!

NEVER GONNA GET IT!!!!

Tomorrow, January 14th at 3pm EST I’m being twitterviewed by 22Tweets. Follow on Twitter, live, via hashtag #22Twts. Hope I sound intelligent.

Here is the link to the transcript of my twitterview in case you missed it: http://22tweets.com/index.php/2010/01/14/richardjaffe/

My son’s hebrew name is ‘Shalom’ – שָׁלוֹם. I declared his name for the world to know at his bris, and had an opportunity to explain its meaning- Peace. Completeness. But more than a name, Shalom is a sentiment; an esoteric mindset that serves as a light to shine upon the path of principle, which leads to character. It is something that transcends race, religion, language, borders, and humanity itself.

I took my six year old son to hockey practice this morning at 715am. As excited as he was, I think  I was more elated just to watch him take the ice in his little Islander uniform with the rest of his team, the “Mini Mites”. I never have a problem getting Brandon up from his sleep to go to practice early Sunday mornings. And like clockwork, I get up at 6am to get ready to go with him. He is, after all, my son. But more than that, what he does on the ice inspires me. It moves me. And it carries me through my work week. Melodromadic? Definitely. Here is a scene from one of my favorite movies ‘Vision Quest’, that captures what I’m trying to say:

Just the day before, Brandon sunk a basket at his basketball game at the buzzer. He threw his hands up in celebration. He owned the world at that moment. And as his father, so did I. Achievement. Accomplishment. Triumph. Victory. These are the moments to live for and to celebrate. Melodramadic? Definitely. But its this melodrama that, like the name Shalom, transcends race, religion, color, wealth, status, and everything else.

I’m addicted to the drug, and I freely admit it. It’s part of why I ride the ambulance so much- to get that rush. The last call I went on was a “Delta Overdose” in front of Pathmark. Some drunk guy with nothing else better to do on a rainy, cold Sunday afternoon. I asked the bum in Spanish if he had any kids. “Yeah.  These are my kids right here,” as he held up to me his half-filled bottles of rum.  I tried to explain to him the concept of having too much of a good thing, in the midst of which he vomited right next to me. Lovely.

I wonder though, if its possible for me to get too much of my kids, and what would happen to me if I did. I think the difference is this: my  melodrama mush makes OTHERS vomit, not me. I havent barfed yet from it. I suppose I have a built up a high tolerance for it. I feel bad for those who haven’t.

Led Zeppelin- Going To California- Beautiful Song, and a beautiful rendition of it. What a great performance. Enjoy. Play it in HD.

Despite all the alleged infidelities, Elin Nordegren says she will stay with Tiger Woods for the sake of her small children.  According to the Daily Mail, Friends of Elin Nordegren,  say she is devastated by the extent of his alleged infidelities but plans to stay married.

The couple, who’ve been married since October 2004, have a daughter Sam, two, and son Charlie, ten months.

“She is a child of divorce and that’s not something she’s likely going to want to do to Sam and Charlie,” an unnamed friend told American magazine People.

“She really believes in the importance of parents staying together.

The friends also say that Elin heard whispers about Woods’ active sex life before they married but he promised to reform.

“Elin had talked to other golfers and their wives about Tiger’s wild parties. When she asked Tiger about it, he said he would stop doing it. And she believed him. But he never did,” one friend said.

So, let me get this straight… Elin knew that before she married him, he had an ‘active sex life’; she’s a child of divorce- something she didn’t want to happen to her; and believes in parents staying together. So, in order to accomplish her lofty goals, Elin married a rockstar golfer with an ‘active sex life’ and had two kids with him. Great plan babe. Really. You have every right to be angry. But be angry at yourself. You put yourself in this postiion. Hell… I’m angry now. I’m angry that you knew all of this and decided to birth two innocent beautiful children into the situation.  Or was it that Tiger raped you, and you’re just waiting for the right time to press charges? But wait… now you are going to make the entire situation all better by staying together with a husband you don’t want to be with- a husband whose image you helped destroy. Wow. You really know how to set good examples for your kids to follow. I’m sure you’re not staying in the marriage for the money. What would the public think? You’re voluntarily staying in this relationship… for the kids, for Tiger, for the world, just not for yourself. Right. Gotcha. *wink wink *

Let me tell you a little diddy about volunteering. Volunteers do things because they want to, not because they need to. Not because it’s their job. So when my Fire Department pager went off at about 11pm this evening, in the midst of my watching the beautiful Padma Lakshmi on Top Chef, I voluntarily rushed to the firehouse, jumped on the ambulance and geared up on the way to treat the reportedly signal 9 ‘sick male’ .  Turns out he wasn’t really sick. He was in some sort of wheelchair contraption that broke down and needed a ride back home.  The county cop who first discovered this ‘sick male’ figured that it would be best to call an ambulance to take the man back home. So, instead of calling his county buddies, the county dispatcher figured it was a good idea to take volunteers like myself away from their families after working all day (and some of the night) and give this ‘sick male’ a ride. Here’s what I didn’t volunteer for- I didn’t volunteer for the danger created by the dispatcher’s misrepresentation that the ‘sick male’ was in an emergent state. Perhaps, though, much like Tiger’s wife, Ms. County Dispatch didn’t realize that we would respond with lights and sirens, exceeding the posted speed limits. And perhaps she also didn’t realize that volunteers, like myself, have jobs we work at during the day, and spend time with our families when we get home. Or maybe, she didn’t realize the danger of volunteers like me driving to the firehouse. Yes, she must not have known about the law that makes it illegal to have more than one little flashing blue light in my car when responding to emergency call. She must have subscribed to the logic that dictates in such situations, to wit: the smaller and less visible the flashing blue light is, the more likely it is for other cars to yield the right of way to me as I respond to an emergency.  I think that is what the lovely county dispatcher was taught on her first day of dispatch school. Then, on the next day of school, she was taught to call the volunteers for jobs like this sick male, who needed a taxi ride. That must have been the reason why she didn’t call the county ambulance, whose actual job it is to do this sort of stuff and get paid for it by people like me, a county taxpayer. The difference between the affair the county dispatcher and I had tonight was that Tiger liked to get fucked by his babes. I didn’t really like the fucking I got tonight. Strange, right?

Well, at least my son and daughter volunteered to stay up late tonight until I got home from the ‘sick male’ call so my wife wouldn’t be alone. Hope the kids aren’t too tired tomorrow morning. They might miss the bus. In which case I will just call a county ambulance to swing by and take them to school.

My power ranger son Brandon’s hockey game was at 715am yesterday (Sunday!!). Those of you involved in hockey with your kids know that its not just a recreational sport, its a lifestyle- getting up before the sun rises, hot chocolate at the games, donning and doffing all the equipment, its quite an experience.

My son and the other 6 year olds weren’t even the first game scheduled to play. As we entered the arena, we could hear the cheers and scraping noises generated by the two teams already on the ice. Brandon felt the excitement and ran into the rink area. There, he saw the game going on, but also the unexpected- the players were on custom built sleds of a sort. Each of the hockey players had a condition, whether it be a missing leg, a missing arm, or the like. Notwithstanding the sleds, the game was like any other- proud parents cheering, random spectators watching, even the guide dogs watched intently in the bleachers. To answer in a form Brandon could digest the barrage of “why” and “how come” questions that her rattled off was truly an art form. The players got off the ice at the end of the game, most with the help of family. The answer to Brandon’s last question was the shortest, yet most profound: “Daddy, why aren’t they crying?” “Because they aren’t sad,” I told him. Brandon sat in the bleachers, and watched with humility as all the players disengaged from their sleds. His hands lightly touched his own body parts as he looked on. He listened to their comraderie. He felt their triumph. My little power ranger didn’t move from his bleacher seat until they all left. It was his way of saluting them.

Brandon’s teammates began to arrive and ready themselves with their equpment. Another six year old boy near us was accompanied by his father. The boy began to whine about the fact that the neck guard he was required to wear before getting on the ice was uncomfortable. “You shouldn’t cry,” Brandon told the boy. I responded to a car accident later that day. I wanted so badly to say the same thing to the lady I had in the back of my ambulance on the way to the hospital. There wasn’t a scratch on her.

I just got done prepping a client for tomorrow’s deposition. He suffered a fractured ankle, wore a cast for 7 weeks, and did some physical therapy thereafter. As we explored the topic of how the trip and fall accident for which he is suing affected his life, I thought of those hockey players. “Do you like hockey?” I asked my client. “Love it” he said. I invited him to meet me at the hockey rink next Sunday.

www.MedicInterrupted.blogspot.com

Health insurance giant Aetna is planning to force up to 650,000 clients to drop their coverage next year as it seeks to raise additional revenue to meet profit expectations.

In a third-quarter earnings conference call in late October, officials at Aetna announced that in an effort to improve on a less-than-anticipated profit margin in 2009, they would be raising prices on their consumers in 2010. The insurance giant predicted that the company would subsequently lose between 300,000 and 350,000 members next year from its national account as well as another 300,000 from smaller group accounts.

“The pricing we put in place for 2009 turned out to not really be what we needed to achieve the results and margins that we had historically been delivering,” said chairman and CEO Ron Williams. “We view 2010 as a repositioning year, a year that does not fully reflect the earnings potential of our business. Our pricing actions should have a noticeable effect beginning in the first quarter of 2010, with additional financial impact realized during the remaining three quarters of the year.”

Aetna’s decision to downsize the number of clients in favor of higher premiums is, as one industry analyst told American Medical News, a “pretty candid” admission. It also reflects the major concerns offered by health care reform proponents and supporters of a public option for insurance coverage, who insist that the private health insurance industry is too consumed with the bottom line. A government-run plan would operate solely off its members’ premiums.

Aetna actually made a profit in 2009 but not at levels that it anticipated.

“They were surprised by an acceleration in medical costs in 2009 which pressured their earnings,” Josh Raskin, an industry analyst for Barclays Capital, told the Huffington Post. “In an effort to get back to a more profitable level, they are raising their prices to match cost trends. When you raise rates, you run the risk of losing your membership. Health insurance is a very competitive marketplace.”

As Williams told investors on the call: “The pricing that we put in place for 2009 turned out to not really be what we needed to achieve the results and margins that we had historically been delivering.”

Aetna is one of the largest insurers in the private market, covering roughly 17.7 million people according to its 2008 annual report. It is also a major player in the current health care debate and inside Washington D.C. The insurance company has spent more than $2 million on lobbying just in 2009, according to the Center for Responsive Politics.

American Medical News, which first reported the story, noted that this is not the first time the insurance giant has cut the rolls in an effort to boost profit margins. “As chronicled in a 2004 article in Health Affairs by health economist James C. Robinson, MD, PhD, Aetna completely overhauled its business between 2000 and 2003, going from 21 million members in 1999 down to 13 million in 2003, but boosting its profit margin from about 4% to higher than 7%.”

A spokesperson at Aetna did not return calls and emails for comment.

My comments: Here is my favorite part of this article… “Aetna actually made a profit in 2009 but not at levels that it anticipated.” Please… someone explain to me how the people at Aetna sleep at night. Makes me sick.