minutiarum said: I understand your gripes about reimbursement and EMR. But if it was properly implemented (give doctors money for equipment and staff training), do you think that EMR would improve patient care? What are your thoughts on the other aspects of the bill (Coverage for pre-existing conditions, requirement to have health-insurance, research on the effectiveness of treatments, etc)?

Thank you for taking the time to answer my questions. Your blog is amazing.

cranquis:

cranquis:

Ok, first of all — where is that money for EMR supposed to come from? That’s right: my taxes. Where will a greater proportion of the tax money come from? Hmm, well, who pays higher taxes: the patients who don’t have health insurance, or the doctors? Hmm

But yes, in some magical world where real-life in-practice doctors could design an EMR program from the ground up, and be able to re-design/adjust it easily without layers of bureaucracy and non-medical software programmers clogging up the works, YES: EMR could improve patient care. 

I think the concept of “pre-existing conditions" is an annoying yet realistic component of determining which patients will likely consume a greater portion of the insurance "pie". Now, if you have nationwide health care insurance that automatically covers all pre-existing conditions WITHOUT finding a way to compensate financially for the extra burden incurred by a diabetic-hypertensive-smoker, compared to a non-smoking healthy specimen of manliness (like myself), then the end result is: everyone pays the same amount into the pot (taxes), but some people will consume WAY more of that money. Fair? I think not. So then how do you make the math work out? Well, here’s an easy way: don’t pay the doctors equitably for the extra care and effort required for those complicated patients! DOH.

Requirement to have health insurance: I repeat, if nationwide health insurance has to cut back on reimbursement to doctors in order to make ends meet in the budget, why would any doctor want to accept that insurance? (“Will you be paying cash today, Mr. Brown, or will you be providing free car repairs for the doctor for the next month?”) So at that point, what good did it do to give everyone health insurance?

Research on the effectiveness of treatments = EBM (Evidence-Based Medicine). YES, I AM TOTALLY IN FAVOR OF THIS! It’s a concept which has really only showed up in med schools in the past 10-15 years [citation needed], so the “older generations” of doctors still tend to use a lot of “in my experience" and "well I heard somewhere" (Anecdotal Medicine) to back up there current treatment practices without actually checking to see if the research backs it up! EBM is awesome.

But something else needs to go hand-in-hand with EBM in order for doctors to be able to practice medicine safely, relying on the research without having to worry so much about “But what if this patient is the 1 in a thousand/million patient that DOESN’T fit the research, and I get SUED?” — TORT REFORM. As long as patients can sue the pants/underwear/scrotal skin off of doctors because of a “random” unexpected poor outcome while attempting to follow EBM guidelines, doctors will continue to use the Shotgun Approach for patients: BLAST THEM WITH ANTIBIOTICS AND FULL-BODY SCANS AND UNNECESSARY HOSPITAL/ER VISITS AND TOO-SOON SPECIALIST REFERRALS, so that a future judge/jury can’t say “You didn’t do enough for this patient!” I can’t begin to estimate just how much $$ is WASTED each day by doctors ordering tests that won’t change their treatment plan, just to appease the patient (either because the patient is currently demanding the test, or because the doctor imagines the patient complaining later that the doctor DIDN’T do the test).

I have a colleague who regularly walks out of exam rooms with a throat culture swab, hands it to the nurse, and says, “Go ahead and do the strep test, but I’m sure it’s going to be negative." 5 minutes and one pointless test later, he goes back in the room and tells the patient, "Well, it appears you don’t have strep throat, because the test was negative.” ARRGH! You already knew the patient didn’t have strep throat, based on your physical exam! But that’s Defensive Medicine for ya — doctors are running scared of patients and their lawyers.

(So this whole post makes me sound like a greedy elitist doctor. Not at all. Our country should not have so many un-insured patients — it’s shameful. But the current health-care-reform bill(s) are really “Health-Care-Insurance-Coverage-Reform.” Hence my skepticism.)

Hope this helps. Sorry I took a while to reply — I always procrastinate replying to these “political” questions, cuz I hate the whole topic. :p

From the Archives: Cranquis and healthcare-politics do not get along.

There are a few good points here but the rest of it is so awful I don’t even know how to respond. I guess I’ll just address the pre-existing conditions rant.

Is it “fair” that some people get cancer? Is it “fair” that I was born with excess bone in my foot that keeps regrowing and requiring surgery (4 times so far!)? Nope, not really, unless you think people with cancer somehow deserve it. Why should people be penalized for things that are often not “fair”? Being healthy isn’t some wonderful thing you did. Much of it is luck. Why should you deserve a cash bonus for being lucky? Is that fair?

On average, smokers have lower incomes than non-smokers. A doctor I know in an area with mostly affluent patients has very few patients who smoke. People who smoke also literally pay a tax for doing so. You do not. In much of the northeast, it’s $2-$4 per pack, plus the federal $1.01 tax. A pack a day smoker is paying up to around $1800 a year that you do not.

People with lower incomes also often face grocery deserts and lack access to fresh fruits and vegetables. They often work multiple jobs in order to survive. If I worked 16 hours a day, I wouldn’t want to spend my precious hours of sleep and free time cooking a meal. The Dollar Menu would seem pretty enticing.

We live in a country full of unfairness. Your complaints suggest punishing the people already losing in our system simply for not living the way you think they should (and most likely, how they wish they could). I’m more than happy for “my taxes” to go to helping people out. It’s better than the 25% going to “national defense,” which means 10% for “ongoing operations” (see http://www.whitehouse.gov/2013-taxreceipt for a breakdown).

sentientarboroform:

spiritsflame:

If whats happening in Ferguson was happening to an all white community, it would be called a dystopian novel

#and all actions against the police would be heroic and daring#and the plucky white protags would be encouraged to use violence to stop the injustice

It’s literally what happened in V for Vendetta.

(via thisiswhiteprivilege)

starscreamsiren:

tiffranosaurusrex:

pleasefireme:

Please fire me. The senior partner at our firm badgers us about meeting our billable hour requirement while our office manager wastes our time with passive aggressive “memos” about the refrigerator: “Seriously folks, let’s keep the refrigerator clean. You spill, you clean. The unclaimed food items circled in the attachment have been in the refrigerator for over a week.  Please throw out your old, dried up food. Join the effort to maintain a clean environment for your food.” I’m pretty sure we can find someone who doesn’t bill $240 an hour to throw away an old sandwich. 

You know what, no. That’s bitchy. Clean up after yourself, don’t expect someone else to do it. I don’t care what your fucking position is. No one is too important to ACT LIKE A HUMAN BEING. Grow the fuck up.

Normally I really sympathize with the submissions on this blog because I too have a shitty job, but this one I just don’t understand. This isn’t about having a shitty job, this is about someone being a whiny asshole because they were asked to have respect for a communal area. Are they saying they can’t meet your billable hours because you have to clean up after themselves? Because that’s fucking arrogant. Be a grown up, throw away your own trash. Jeez. 

Exactly, it’s literally someone saying they’re too important/rich to have to throw away their own trash. That’s absurd and infuriating. Do they expect the manager to hire a fridge cleaner to clean the fridge once a week rather than them just tossing their own damn sandwich? Entitlement at its peak.

starscreamsiren:

tiffranosaurusrex:

pleasefireme:

Please fire me. The senior partner at our firm badgers us about meeting our billable hour requirement while our office manager wastes our time with passive aggressive “memos” about the refrigerator: “Seriously folks, let’s keep the refrigerator clean. You spill, you clean. The unclaimed food items circled in the attachment have been in the refrigerator for over a week.  Please throw out your old, dried up food. Join the effort to maintain a clean environment for your food.” I’m pretty sure we can find someone who doesn’t bill $240 an hour to throw away an old sandwich. 

You know what, no. That’s bitchy. Clean up after yourself, don’t expect someone else to do it. I don’t care what your fucking position is. No one is too important to ACT LIKE A HUMAN BEING. Grow the fuck up.

Normally I really sympathize with the submissions on this blog because I too have a shitty job, but this one I just don’t understand. This isn’t about having a shitty job, this is about someone being a whiny asshole because they were asked to have respect for a communal area. Are they saying they can’t meet your billable hours because you have to clean up after themselves? Because that’s fucking arrogant. Be a grown up, throw away your own trash. Jeez. 

Exactly, it’s literally someone saying they’re too important/rich to have to throw away their own trash. That’s absurd and infuriating. Do they expect the manager to hire a fridge cleaner to clean the fridge once a week rather than them just tossing their own damn sandwich? Entitlement at its peak.

thetemperamentalgoat:

Since I’ve been getting a fair number of messages asking me about my pregnancy, I figured I’d just make a text post about it so I can stop explaining myself to everyone haha.

Read More

I was looking into some research about how long it takes to get pregnant after going off the pill and it looks like older studies with much higher levels of hormones showed delayed returns of fertility but newer studies are saying that people can get pregnant pretty much immediately.

"Reproduction after discontinuing COCP was once thought to be delayed in early British and American studies using older, higher dose COCP products (Vessey et al., 1978; Speroff and Fritz, 2005)."

-Misconceptions about oral contraception pills among adolescents and physicians

"Some women conceive immediately after they stop taking the pill. While the pill doesn’t cause fertility problems, it does mask problems that were already there, such as irregular periods. As soon as you come off the pill, you can get pregnant. It’s therefore important to use another form of contraception, such as condoms, straight away."

-NHS: When will my periods come back after I stop taking the pill?

ancientcosmonaut:

scotchtrooper:

howidiotic:

came across the best mug ever the other day

Story of my life

Oh my god I need this.

This one I saw was sad:

):

ancientcosmonaut:

scotchtrooper:

howidiotic:

came across the best mug ever the other day

Story of my life

Oh my god I need this.

This one I saw was sad:

):

7. The only difference between your actions being romantic and creepy is how attractive the other person finds you. That’s it, that’s all.

18 Ugly Truths About Modern Dating That You Have To Deal With | Thought Catalog (via briandgregory)

No, no, no. So wrong. And this is super creepy of whoever wrote it and I don’t know what they look like.

  • I once had a very attractive guy from my neighborhood who I’d let know that I was not interested show up to my house in high school and give me flowers and a card that said that when I realized I was into him, he’d be waiting. It was super creepy.
  • Another guy in high school who I was not attracted to at all asked me out by posting a letter on his online journal. I thought it was very sweet albeit somewhat awkward but I declined for various reasons. I did not consider it creepy.

The writer is excusing their responsibility in making a person feel uncomfortable and blaming the person for not being attracted to them and that is not okay.

(via briandgregory)

ilovecharts:

I went to Sprinkles and was given this adorable cupcake schedule.
-anneymarie

Yay!

ilovecharts:

I went to Sprinkles and was given this adorable cupcake schedule.

-anneymarie

Yay!

nevver:

Gorey

My dad had an Edward Gorey alphabet book when we were kids (he probably still has it). I don’t think he ever specifically read it to us but I distinctly remember getting it off the shelf to look carefully through all the pictures multiple times. I wonder what effect this had on little me…

nevver:

Gorey

My dad had an Edward Gorey alphabet book when we were kids (he probably still has it). I don’t think he ever specifically read it to us but I distinctly remember getting it off the shelf to look carefully through all the pictures multiple times. I wonder what effect this had on little me…

(via robdelaney)

pleasefireme:

Please fire me. No one is calling in today so my coworkers are talking in detail about why they think the moon landing was staged.

Mine spent today talking about how Whitney Houston was murdered by an unknown person (for some unknown reason) who forced her to take a bunch of drugs, killed her and then bribed the coroner. This was followed by a discussion of the Illuminati and Free Masons. They evidently rule the whole world and include members such as Beyonce, Obama and Bush. When I questioned how such a group could have Obama and Bush in it, I was condescendingly met with statements about how “politics” work. Any questions I asked about how the whole world could possibly be in on something when countries are constantly fighting were immediately dismissed.