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Wasting government money because it is "free".

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For a few months now I have been looking for the perfect new job. I am at a federally qualified health service agency and the amount of paperwork and bureaucracy and policy and meetings etc is mind boggling and has taken priority over actually providing health care. In fact we do less care and less quality care because of the administrative burden.

Today I was taken to task for not doing an annual pap on a 40ish woman who had a normal exam a year ago, has had a total hysterectomy for a non-cancer problem, and has no symptoms or complaints. I was told, essentially, the current screening guidelines don't matter because we have a grant that requires an annual pelvic exam. This grant also requires every woman to have a GC, chlamydia, and trich annually regardless of their symptoms or sexual history.


I am fairly certain I have stepped through the looking glass. Because the government gave us this "free" grant money they get to make the rules regardless of their foundation (or lack thereof) to screening and practice guidelines. Worse my SP puts out in an email to everyone that before any of us "deny" a patient an exam we call him and he will tell us whether or not we have to do it.


All peripheral issues aside I think it is simply unethical to put a patient through a needless exam and tests and waste health care dollars that could be better used in many other places just because someone gave us some money and said "do it".


I have a partnership opportunity that begins in Jan. Today I'm not sure I'm going to make it that long.

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It's not just grant money that drives the train. AcOs and PCMH have similar criteria to follow and I am to offer chlamydia screening and lipid screening to every patient whose "red box" is highlighted on the ehr. The MA'S pre-order thectests. I then have to discuss why these tests must be done. If the patient declines I need to document why. If they agree to the tests then I get a quality score and my ACO and PCMH are successful and get money. It does not matter if the patient needs the test or not or if it will improve their health. Medicine is becoming check boxes as the quality markers and demanded by administrators who dictate to us what must be done. It's not real medicine we practice.

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I'm sorry, but placing anything inside the vagina of a patient for any reason other than 1) their best health interest and 2) with informed consent is sexual assault--it really doesn't matter whether it's for the provider's personal gratification or the financial benefit of the organization that employs him or her: patient best interest is the only reason we get to do what we do.


If you say "Well, there's no medical reason to do this to you, since all the relevant organizations switched to three-year schedules years ago, but it will help our organization keep getting grants to keep our services available" and the patient consents anyways, fine.  Anything less than full disclosure and informed consent is assault.

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I document the patient's declination and I explain why a pelvic is not necessary, explain the guidelines, etc. My red boxes more often than not say declined.


Sent from my SCH-I545 using Tapatalk



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I worked in a FQHC Clinic and had a State grant to do paps on women over 40 and their mammo.

These women were usually working poor.

They (and their spouse) usually had jobs making $12 and hour or so and couldn't afford any offered insurance as it would cost them 1/2 to 2/3 of their take home pay.

They were the working poor that the whole Affordable Care Act was supposedly designed for.



We were allowed to work up DUB and abnormal pap smears. I could order pelvic ultrasounds and the occasional CT or MRI if I felt an enlarged uterus or they had DUB.


That is where the buck stopped though.


NO SUPPORT for abnormal paps, no payment for seeing a gyn for massive fibroids, adenomyosis with anemia and horrible bleeding.

NOT EVEN funding for the "mass in uterus, not likely fibroid".


So, I could tell a woman she could possibly have endometrial cancer or ovarian cancer but couldn't send her anywhere for further evaluation after her "FREE" women's health screening.


Same thing with the mammograms. This lovely grant would pay for the mammogram but then nada for follow up.


It made me not even want to do the exams. Once the abnormal finding was made, I turned into the Social Worker I have always had to be and begged and pleaded to get them into a gyn for evaluation on a sliding scale. DSHS wouldn't take them because they "made too much" and had insurance "available".


Grants are a true double edged sword if not a grenade with the pin pulled out.

They are unbelievably specific and inane and have ZERO allowances for what to do with the "what if's".


The US Healthcare system is such a mess. As long as the CEO of a major private insurance company is making 7 figures - there is something wrong with the world.


My very old 2 cents....................................

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