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jmj11

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Everything posted by jmj11

  1. I do believe that there is space for redemption. I've seen ex-KKK members, who now fight for the rights of minorities and against the KKK. However, I do think patients were hurt. You can't have his attitude toward minorities and still give them excellent care. I worked with two different doctors in my career, that both hated patients. They hated all patients and would say so. They demeaned almost every patient that they saw (they weren't racist as far as I know). I also observed what horrible care they delivered. It wasn't because they didn't know better (at least one of those two was very smart) but was because they didn't give a damn. Both said they went into medicine for the money. So, my point is, your attitude does effect the care you give. Now, this guy in the video, maybe he could go through some type of deprogramming treatment and save his career, but I would take a lot of work.
  2. https://www.ebay.com/itm/2005-Icd-9-cm-Volumes-1-2-3-Hcpcs-Level-Ii-Ama-Cpt-2005-by-n/312484552830?epid=46470267&hash=item48c187e07e:i:312484552830
  3. If he is correct that the Docs did the same, all their asses should be fired. Some of you work for Team Health, I would assume (at least for liability issues, not to mention the ethical) they would have zero tolerance for this.
  4. Yeah, as a man I've grown weary of the mythological "locker room talk." It is a sorry excuse. I've been in many locker rooms and have never heard men talking this way. But an ER is not a locker room, and this "talk" should not be acceptable even in a locker room.
  5. I don't know where to find the statistics, however, the percentage is tiny. When I owned my practice, I knew of only about 4-5 others in our state of 6,000 medical practices. There could have been others I didn't know about. So, less than 1%.
  6. Should not be in health care at all. What is this, the 1930s? What a disgrace to the profession. You cannot give good care to minorities if you are a racist pig.
  7. I trust what you say as HTN is not my area, no pun intended. But here is a paper I reviewed and my FP-MD agreed but said he was not getting involved by prescribing me anything.
  8. I agree. It is not always good to believe everything a patient tells you. I will come back to my story, only because I know it is accurate. Again, don't get bogged down in the specifics as I'm talking about the principles. So, out of the blue I developed hypertension (probably related to my renal disease) in July. The cancer center (which did get involved with every complaint) started me on a beta blocker. The first dose did not help and it was doubled. For the three weeks I've been home, the higher dose also hasn't make any difference. I am scheduled to see nephrology for follow up, but their first appointment is mid Sept. I went to my Family doc. I showed him my B/P readings (all high). He said yeah, he didn't like the med I was on (and I agreed having done my own research) and I asked him to change it to something (ACE-I) better. He refused because he said he wasn't getting involved with my hypertension care. That was puzzling to me as he knew the soonest I can see the nephrologist is 6 weeks and have only seen him as a inpatient consult. So, it is about me or hypertension, it is this pattern where providers don't want to get involved, even when it is within their usual scope of practice.
  9. I probably should not have used Dr. B (the gynecologist) as an example as he was the extreme, but I was staking out the argument. I am trying to think of a better example, without resorting to my own stories. because I don't want to give the impression that I'm seeking medical advice, which I'm certainly not. But I get confused (from my own experience and from what my patients have told me) that when, at the primary care things like hypertension is not addressed, or depression, or a new rash and etc. So here's an example. A migraine patient comes to see me for a routine follow up and they show me a new rash all over their body. I certainly look at it. First, I want to make sure it has nothing to do with what I'm prescribing or maybe it is something I can easily diagnose, (eg. Pityriasis rosea). Then I ask, "Did you show your primary care provider?" They respond, "Yeah, I went to see her and she has no clue." I then ask, "Then, what was her plan?" They say, "She didn't have a plan. She just shrugged her shoulders and said she didn't know what it was and that wasn't her area." I ask, "Did she refer you to a dermatologist?" Patient: "No." Me: "Well, I will, because I'm not sure what it is, but someone does."
  10. Some of you know that I was in a perfect state of health until January of this year. Then, virtually overnight, I became seriously ill and have remained quite ill since. Multiply Myeloma is the primary cancer, but it has taken out several other body systems. I completed an autologous stem cell transplant on June 22nd. So, I went from being a “no-health care system user,” to racking up about 1 million dollars’ (so far) worth of care in the past 8 months. This translates to hospitalizations, ER, and multiple outpatient visits with a variety of specialists and generalists, including PAs and NPs. During this process, I have learned a lot about being a patient and how our care looks from the outside. One of the things, which I find astonishing, is how many providers refuse to touch anything “outside their area.” But, with one disease effecting so many body systems, the lanes are not well-defined. For example, my bone marrow cancer created so much light-chain proteins that is killed my kidneys. My kidney failure has caused serious and chronic anemia, as well as uncontrolled hypertension, neurological problems, and now (we think it is from the kidneys) resting tachycardia. During these months I have seen many providers who shrug their shoulders and say, “I don’t know, that’s not my area.” Even my primary care will not address my uncontrolled hypertension as he says it is out of his area in someone as complicated as me. Now, the one exception to this, was that I spent the summer at the Seattle Cancer Care Alliance and there they took on every facet of this terrible disease. But I’m back in the community and no longer under their care (they do the stem-cell transplants but don’t do chronic care). I’m really in a no-man’s land now and an often on my own, except I can’t prescribe for myself, nor do I want to. I will switch gears from myself to mention another example of this. In mid-July I was so sick, that I gave up on reading or studying (which I had been doing up until that point) and watched mindless TV (TLC, or the “Loser’s Channel”) for a couple of days. One of the shows, which I had heard of before, was The Pimple Popper. If you are unaware, it follows a dermatologist (Sandra Lee) who excises a variety of cysts, such as epidermoid, pilar, or even lipomas. I have to say that the doctor was more professional than I had expected. But on the show, I saw patient after patient with these huge, like 5-7 CM cysts. She asked them how long they have had them, and the patient says years. Dr. Lee looks perplexed each time and ask what they have done about it and most say (if you can believe patients) they have been to a variety of caregivers, Primary Care, Urgent Care, even ER, and they are told, with shrugged shoulders, “I don’t know what it is. There is nothing that can be done. Leave it alone and it will go away.” The doctor had the same reaction that I do. “Say what?” They didn’t know what this is? It will not go away.” If the patient is telling an accurate story, I have a feeling that someone just didn’t want to take the time to address the problem. I shared an office once with a gynecologist. He was a great guy. I would notice him doing things like taking off ingrown toenails, excising pilar cyst, and treating hypertension. I asked him why was he doing these non-gyn things? He answered me, “I was a doctor before I was a gynecologist. If I did these things as an intern, surely, I can help my patient out who has no other resources.” Now, certainly, we should not get in over our heads in things we don’t know. But, as a headache specialist, I can’t count how many times I’ve treated non-headache issues, for the sake of the patient. In the case of something like a cyst or rash (and we don’t have the equipment to care for that such as a punch bx) I would tell them that it can be treated and give them the name of a good dermatologist and never do the shoulder shrug. So, what do you think? Do we ignore complaints because of the tight schedules that we must keep? Or, is this a good thing that we stay focused on the narrow lane in front of us? Mike
  11. Well my whopping WBC count of 46 k is, as of this morning 0.71 k. This drop is from the nasty (and intended) work of Mephalan. My new stem cells have been "on-board" for 6 days, however, they will not start to set up "house keeping" for another week. This is my vulnerable week of little defense. But, back to my original point, the human body is amazing. It is incredible what the human body can endure. I've known people who see their (very healthy) bodies as so fragile that they only drink lukewarm water, fearing the cold or heat of drinks.
  12. I don't want to talk about "back in the day," but with the point of helping you to feel a bit more encouraged, I will. I graduated in 1982 from the University of Kentucky. Jobs were very tough to come by. I wanted to stay in Kentucky and made contact with 124 (if I remember right) practices and not one interview was offered. In my class of 16, by 6 months after graduation, only 2 had PA jobs, and both had these jobs arranged before going to PA school. I was poor as a church mouse and would go through the lobby of dorms, looking for loose change under the cushions. I took two part-time jobs, one at Sears and one with "Manpower" (which was the bottom-dweller job place, and I met other PAs working there, and that was sad). But I had to, to buy food. So, I finally decided that I had to go out of state. I had to borrow money from a roommate (which I don't recommend, but he is still one of my closest friends after these years) to drive to Michigan for my first interview. It was a bad job at the BOP. But, I eventually got it (and it was much worse than I had expected). But I worked this terrible job for six months. Then, I started to look in Michigan and found many good jobs advertised and they all wanted to interview with me. I took a fantastic job and that launched my career after a very hard start. Mike
  13. This is not a simple yes or no. The reality is that some do and some don't. Being "corporate" doesn't exclude the ability to care for patients first, if they are willing.
  14. Of course advance directives are a good idea. However, the insurance companies are pushing advance directives like crazy. I have been approached over and over about my AD and I do have one on file. But it saves the insurance companies a huge amount of money to end life early. My brother just recovered from MRSA septicemia. It looked bad with him on a vent, doing dialysis and was given up as hopeless. The hospitalist wanted to pull the plug but his oncologist (he has leukemia was in for a stem cell transplant) fought to give him a few more days. He's home and doing well. So, we have to be careful as not to pull the trigger too soon just to save the insurance some money. Thinking of which, I need to call him.
  15. Here is where I'm perplexed. The Dutch are civilized with advance medical care. There are so many options in treating depression, I just cannot believe all those options were exhausted. I read a previous debate (in a BBC report I think, but see the report belowhttps://www.vice.com/en_us/article/434yaj/a-doctor-built-a-machine-that-helps-people-die) were a proponent of assisted suicide decided that depression, at any age, was reasonable for suicide. In a pure Darwinist (the way I use the term here would upset Darwin himself) view, you might reach that conclusion. But has compassionate care givers, we must always give hope. I was distressed when I was in ICU in January, just diagnosed with cancer, and a new-grad RN said to me, after I mentioned this long-hard road ahead, and she said, "Well, you are 63. Some people in your position would say that you have lived enough and to save the money and suffering, they would end their life now). I asked her, "Can't anyone talk of hope?"
  16. I owned my own clinic for 4+ years. I advise you to read a couple of books (at least) on running a business. When you do your business plan, under-estimate your collections by 25%. Insurance companies find a millions excuses not to pay you. Have a very good biller (or billing system that you can monitor). Don't over-spend on support stuff, like software. My downfall was having to constantly fight with insurance companies and using a front office + back office software. It was expensive to purchase and failed terribly in the billing and collection department. I almost sued them but was too burnt out. If I were to start over, I would be bare-bones at first. I would be very leery of vendors. If possible, don't get a business loan. If you do, as I did, it will set you back 4-5 months of paperwork. It can be very frustrating. I met roadblock after roadblock when mid-level underwriters would call me and said they are cancelling my loan because (as if they were trying to educate me) "Medical Assistants cannot own a medical practice in our state." Very frustrating to have that conversation over and over again.
  17. I have quoted (in the chart) specialists, including their names, when I've received curbside advice. It has been to protect my own ass. I've been in situations where people (SPs, other physicians) have asked, "Why did you do X?" I want to be able to say, "Dr. Y, the head of the Z department a the local University Medical Center recommended that I do X, so that they would not think I just pulled the idea out of my ass. But I think it is a travesty to hold Dr. Y responsible for the out come as he/she did not know the patient or the full story. Only I, the immediate provider knew both the patient and the adviser and I should be held legally responsible. However, in a court of law, me mentioning the name of Y shows that I did due diligence in trying to find the best treatment and not just throwing darts at a wall of options.
  18. Ironically, a long time ago I could find a job in Kentucky (horrible job market in 1982) and had to move to Michigan to find a job. Lived in Michigan for about 10 years. Loved the UP but at that time (mid 90s) the job market there was not so good. Eventually had to leave the state. Good luck, but like others have said, be open to relocating.
  19. How does one have space for RBCs in such a leukocytic enviroment?
  20. As I've endured my battle with Multiple Myeloma, I have been amazed about the resilience of the human body. This past week I witnessed the highest leukocyte count I've ever seen . . . and it was my own, 46,000. This was after three days of high-dose Filgrastim to mobilize my stem cells, for collection, in preparation for an autologous stem-cell transplantation. I thought it would have been funny to walk into the local urgent care center and complain I have a fever and watch their eyes when they drew a CBC. Of course, they would think leukemia.
  21. I watched a documentary yesterday on vitamins. Today, virtually all vitamins come from just a handful of chemical factories, most are in China. Most vitamins are created from petroleum (source of the carbon chains) and end up as a powder in big barrels. From there they are shipped to all the major supplement companies. The companies then create the pills and labeling. The labeling says, "Vitamins from an all natural plant source." There is no federal guidelines to ensure safety, consistency, or labeling of these supplements. If the "natural" patient only knew.
  22. Has anyone read this book? I just heard a review this morning and it sounds very interesting. Spending more time as a patient than a provider these days, I am disappointed at the basic level of compassion within our system. Compassion means things like knowing the patient's name, knowing their diagnosis and medical history before going into the room. Those simple things that I had always took as granted as what I should do. https://www.amazon.com/Compassionomics-Revolutionary-Scientific-Evidence-Difference/dp/1622181069/ref=sr_1_1?crid=130FY276ZGZCD&keywords=compassionomics&qid=1556408042&s=books&sprefix=compassion%2Ctoys-and-games%2C217&sr=1-1
  23. One patient had a related cerebellar infarct and had significant ataxia, forcing him to loose his company (a house painting company). Chiropractic manipulation was the cause.
  24. That sucks! Just had a patient who broke her radius (right and she is right-handed) during a self-defense class and I felt sorry for her, can't imagine what you've been through. Seen it after chiropractic manipulations but never after martial arts.
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