Healthcare Update Sattelite Edition – 09-18-2013


Copeptin levels may revolutionize chest pain evaluations in the ED. When standard treatment was compared with early discharge after normal copeptin levels were obtained, there was no significant difference in major adverse cardiac events at 30 days.
Need to review the study data, but this is a promising new test.

Marco Rubio calls federal government’s $8.7 million advertising campaign for Obamacare a “blatant misuse of federal dollars.”

International Longshore and Warehouse Union dumps affiliation with the AFL-CIO, citing support of Obamacare and immigration reform as two reasons for the disaffiilation.

Good thing to keep in mind with start of school – heavy backpacks can cause or can aggravate back problems with children. Ideally, the article states that a backpack should weigh less than 15% of a child’s total body weight.

Kind of amazing ingenuity. When horse bites off one-third of man’s finger, surgeon forms a mold of the missing finger from a pig bladder, attaches it to the patient … and the finger regenerated – bone, nail, and all. Of course, now he has a permanent aversion to bacon, but it is a small price to pay for a new finger.
I started wondering how the surgeon came up with the idea, so I did a little research. The whole pig bladder idea isn’t new. This man grew back a finger with powdered pig bladder after cutting off the tip while working on a model airplane in 2008. This 19 year old war vet grew back 70% of his injured leg muscle using a pig bladder matrix – which saved him from amputation.

Another example of unintended consequences when doctor performance is measured in the inexact science of medicine. When surgeons and hospitals in Massachusetts were labeled as being “outliers” for having excessive death rates after cardiac stenting, they stop treating the patients most likely to die. Can’t get dinged for trying to save a patient who dies if you don’t try to save the patient.
In the study the doctors didn’t come out and say that they stopped treating the sickest patients, but the pre-operative likelihood of patients dying after the procedure dropped by more than 30% after hospitals got the “outlier” label.

cb090613dAPR20130905104555What a bunch of hypocrites. In 2009, Chuck Grassley inserted a provision in Obamacare ending their subsidies and requiring all members of Congress and their staff  to get insurance through the health exchanges – like everyone else. Congress pressured the Office of Personnel Management to change it.
Recently, Senator David Vitter from Louisiana sponsored another bill to end the subsidies and force everyone on Capitol Hill to purchase their insurance through the exchanges. Now Congressional leaders like Harry Reid and Barbara Boxer are attacking him.
A requirement for government employees to obtain their insurance through the health care exchanges like everyone else should be the sine qua non of the Unaffordable Insurance Act.

Lawsuit Abuse Reduction Act of 2013 is moving through Congress. Would change federal rules of civil procedure to REQUIRE courts to impose sanctions on attorneys who file frivolous, unwarranted, or factually unsupported claims or briefs. Under the current Rule, the decision to impose sanctions is discretionary.
It would still be left to the court’s discretion whether a claim has met those criteria, so the Act doesn’t have as much bite as it appears, but it would be a step in the right direction.
Then we can sanction our way to better legal representation. Hey … it works for medicine, right?

Interesting study on estrogen requirements in … men. Lower estrogen levels in men may be associated with increased fat deposition and decreased libido. It may not just be about “low T.”

Computer programmer comes up with app for smartphone that may put a lot of optometrists out of business. Place a small viewer against a smart phone screen, use dials on the viewer to align the red and green lines on the smartphone screen, then the app calculates the strength of the glasses you need.
The article also links to descriptions of other apps that perform EKGs and diagnose children’s ear infections.
I’m personally waiting for an app that sues the other apps when they make a mistake. Where’s the smartphone courthouse, anyway?

Interesting story about the investigation of a mother with Munchausen’s and Munchausen’s by proxy.

CMS creating more of a regulatory morass for patients admitted less than “two midnights.” Hospitals now instructed that patients expected to stay less than two midnights should be classified as observation status (and will therefore pay more money out of pocket). Doctors also must certify that inpatient stays are “medically necessary.”
Remember that if the government is charged for care is determined to be medically unnecessary, fines, penalties, and criminal charges can be filed against the health care providers.

Australian girl left laying on the floor of the emergency department for nine hours because there were no beds available to treat her. Hospital overwhelmed with sicker patients and a line of ambulances was waiting to offload patients at the time.
Does Australia have the same socialized medical system that the US is heading toward?

Canadian doctor with multiple tweets about safety concerns in Canadian emergency department. “Second ER doc at QEH considering resigning due to safety concerns. Doctors outside the ER need to pull their weight.” Emergency physicians being required to round on inpatients.


    • “Sorry, can’t pull those code meds for you. I’m not finished mopping the floor.”
      “I’ll get you your pain medications as soon as I’m through taking out the dirty linens.”
      Some administrators just have no foresight. When the administrators start being liable for their dumb decisions, maybe things will change.

    • How about putting non-medical hospital admin & executive staff on cleaning rosters?

      A manager writes in the email, “We have undergone some major budgetary changes … this means we will need to pull together like never before.”

      With the liberal use of the royal “we” throughout the missive, I assume this means that the various managers, administrators and executives are going to be chipping in? I’d start by assigning each and every one of them a two-hour bloc of janitorial duties daily, and take it from there.

  1. Matt Perl, M.D. on

    Today’s EPMonthly email with link to ths blog, as well as the second and third paragraphs in this blog, are disingenuous. I expect a medical journal to present accurate, non biased health information. Instead you link to a Fox News story promoting a right wing agenda desperate to undermine the Affordable Care Act. Your reporter should also consider reading the actual ILWU letter to the AFL-CIO ( The ILWU has three pages of complaints about actions of the AFL-CIO going back at least 4 years. The reference to disagreements with Obamacare net a few lines on the third page. And their complaint is not with the healthcare initiative, but with payroll taxes. Finally they are not unhappy with the prospect of immigration reform, but with the fact that the proposal supported by the AFL-CIO doesn’t protect undocumented workers.

    There is plenty of room for intelligent debate on healthcare reform in this country. Your references mislead and choose to ignore facts which might actually promote such debate.

    • The referenced letter contains a page and a half of complaints, not three pages. The letter specifically states “The ILWU has also become increasingly frustrated with the Federation’s moderate, overly compromising policy positions on such important matters as immigration, labor law reform, health care reform, and international labor issues.”
      The post stated that support of Obamacare and immigration reform were two reasons for the disaffiliation, as did the linked article.
      You want to have an intelligent debate on health care reform, I’m all for it. E-mail me and we can do a point/counterpoint.
      Making inaccurate statements and engaging in ad hominem attacks such as you have done adds nothing to the dialogue.

  2. Matt Perl, M.D. on

    Mea culpa. My browser opened the ILWU letter in a three page format.

    My misrepresentation was unintentional; yours is apparently meant to mislead. You choose to emphasize one of a litany of reasons as to their breakaway, and, again, fail to explain that they wanted more in the reform package.

    I’m not interested in debating you on healthcare reform. It’s already been done in your publication. I can apparently scan “fair and balanced” Fox News to find where your opinion comes from.

    • I kinda wish you’d forgo the saccharine snark and just start shrieking FAUX NEWS!! FAUX NEWS!!!!!

      C’mon. You know you want to. 😉

    • The fact that you decline to engage in an intelligent debate about healthcare reform and instead prefer to engage in ad hominem attacks and whine about some perceived “bias” in these posts tells me all I need to know about you.

      Maybe we could all go read your blog for “fair and balanced” opinions.

      • Matt Perl, M.D. on

        Now look who’s getting all “ad hominem.” You write a blog; you invite comments. Characterizing my comments as whining is not particularly constructive.

        I’ll try to make my original post more clear for you. Your selective inclusion of one line from a litany of reasons for the ILWU to break-away from the ACL-CIO creates a false and misleading impression of the reason for the separation. Your choice to link to, rather than the actual letter, demonstrates a clear bias in your editorial decision process. That I’ve perceived your bias, does not obviate the fact that it is bias.

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