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Blue Cross has been taking full advantage of the law to use as an excuse to raise rates. So far, they've been denied. They had to pay back customers for overcharging recently in North Carolina. Of course, they're trying to take credit for the 85% bit here, forgetting to mention that it's a requirement of the PPACA in their commercials. When the pool of insured becomes larger, premiums will go down because you'll have a better and larger mix of the healthy and sick. In the meantime, I fully expect insurers to skim what they can using reform as an excuse.
Or maybe not . . . :o
Doubtful. The GOP doesn't get it . . . and doesn't want to.
So . . . a bank forges signatures on a legal document, and the attorneys here think that is OK, and that there will be no harm to the chain of custody as far as a clear title is concerned. No wonder people hate lawyers. I'm not as sanguine as you that no harm would be done. You are assuming facts not in evidence. What we have here is a symptom. Symptoms can indicate a greater underlying disease, and should not be ignored blithely. The question I have is, if they'd forge these documents, what else have they forged that we DON'T know about? Don't you think it appropriate we find out?
Toggle Commented May 5, 2011 on Mr. Deeds makes a list at EdCone.com
1 reply
Maggie . . . how do you think the ACA and IAPB will affect hospice care?
Dr Lippin: "Not only do we have to say "I'm sorry that I hurt you" much more often we also need to say "I don't know" (the latter statement requires more patient maturity as well)" I couldn't agree more. Nurses need to be able to say the same thing. Sometimes the public has an unrealistic expectation of what nurses should actually know . . . and I've heard many colleagues try to BS their way out of admitting they don't know something. I encourage my nursing students to say, "I don't know . . . but I will find out." I have never had a patient get upset for admitting a lack of knowledge as long as I research an answer. Jackie: "Nurses arent trained or qualified to diagnose ear infections (unless you are talking about NPs)." Let's get real a minute, here. You'd be surprised at what an RN knows. I'm not an NP . . . but I took a 16 week course in physical assessment, including the use of an otoscope. I can look in an ear and know what otitis media looks like, as well as make a determination based on other findings (fever, loss of appitite, pulling at ears, fussiness). Legally, nurses don't diagnose. Practically, we do it all the time . . . that's the dirty little secret of medicine. What nurses lack is in depth training in differential diagnosis. Common problems are easily recognized by the nurse with little effort, and I am often asked for my input on diagnosis by physicians who trust my judgment. However, I and all nurses I know recognize there are nuances to diagnosis we lack that would cause us to miss certain conditions, particularly rare ones. And diagnosis, quite frankly, is not our role. But please don't underestimate what we can do. As to your comments re residents vs med students. While I agree in principle, in practice I think we need greater recognition that residents are in fact, still students. If they weren't, attendings and senior residents wouldn't have to approve everything new residents do. Residents are very much beginners, with loads left to learn, and need considerable supervision. We should start treating them as the students they are . . . it would reduce the rate of preventable errors they make. Re your comment on IVs. I do agree that most doctors will never be as good as the nurse who does IVs all the time. Most nurses aren't as good as the nurse who starts IVs all the time: IV therapy nurses, ER nurses, ICU nurses, OR nurses, and other critical care specialties. However, in a crisis, when the nurse can't get the IV, she often turns to the doctor to do it. So doctor's should acquire and maintain competency in this basic skill. It takes 3-4 successful sticks to acquire basic competency. It takes dozens to achieve mastery. IV starts are common enough that residents can reasonably be expected to achieve mastery of this skill, and it's like riding a bike . . . you never forget. I seldom start IVs anymore now that I am teaching . . . but when I do, I find I have no difficulties. I also agree with your commment on unpacking wounds . . . nursing staff are far too busy to do this, and in many cases surgeons want to do the first dressing change of a surgical wound. The change needs to come in that the residents/med student is given sufficient time to unpack the wound . . .that they don't do it in a hurry. And nurses could certainly teach med students how to do it correctly as not to hurt the patient. I don't think Maggie means inexperienced people should not be allowed to do things. I think she means they should get sufficient supervision and mentoring to help them learn how to do things quickly. We have this culture in nursing of "if you want it done right, do it yourself," so many experienced nurses don't want to take the time mentoring new staff so they learn these skills adequately. We have to accept that we simply can't teach everything in nursing school any more. There's just too much to squeeze it into a two year curriculum anymore (and let's face facts, even in a BSN program it's still a 2 year curriculum--the first two are spent on gen eds). Which is why I like Maggie's suggeston of nursing residencies. New grads should spend time in a specialized training program similar to medical residencies to help them adjust from the 1-3 patients a student cares for to the total care of a team of 6-10 patients most med surg nurses care for. One hospital in my area does something like this in their GNOSIS program: new grads spend time in the classroom learning nursing policies and procedures, refining skills like IVs, then rotating through the hospital working with a mentor for 12 weeks before they ever begin work on their assigned units. Jackie makes good points about the ear exam, and that's the way I do them in the ER. I also find, however, that some people are just better with building trust with toddlers than others. I know a great ER doc who can perform an ear exam with nary a cry of protest . . . because he's just that good with kids in general. Some people got it . . . some don't.
Maggie said, "Nevertheless, in the early 1990s, when we were debating Clintoncare, few patients wanted to hear that drug-makers and device-makers conceal evidence that their products might hurt us." No offense, Maggie, but patients STILL don't want to hear that drug makers and device makers conceal evidence that their products might us. When the ACA was being debated I talked to a lot of people opposed to reform that claimed we have the best health care system in the world simply because we have all this marvelous technology and pharmacology. According to reform naysayers, these marvelous are worthy of worship all on their own accord . . . regardless of what the best thing to do is. Big Pharma and the device makers DESERVE to make billions . . . they're entrepreneurs! Entrepreneurs make America great! The actual consequences and costs are immaterial.
I recall quite vividly talking to recent immigrants to California (when I lived there in the early 2000's) how their states had encouraged them to move to California to take advantage of California's more generous welfare programs (including Medi-Cal) . . . thus reducing their home state's rolls. Federalizing Medicaid would discourage that practice and force states to start dealing with the problems of their own poor at home, instead of dumping them on others. As for the Tea Party, signs of the feeding frenzy are already starting in Delaware. I suspect other parts of the country will follow suit, though whether it is enough to keep ultra conservatives from undoing Obama's successes I don't know.
I recall quite vividly talking to recent immigrants to California (when I lived there in the early 2000's) how their states had encouraged them to move to California to take advantage of California's more generous welfare programs (including Medi-Cal) . . . thus reducing their home state's rolls. Federalizing Medicaid would discourage that practice and force states to start dealing with the problems of their own poor at home, instead of dumping them on others. As for the Tea Party, signs of the feeding frenzy are already starting in Delaware. I suspect other parts of the country will follow suit, though whether it is enough to keep ultra conservatives from undoing Obama's successes I don't know.
I recall quite vividly talking to recent immigrants to California (when I lived there in the early 2000's) how their states had encouraged them to move to California to take advantage of California's more generous welfare programs (including Medi-Cal) . . . thus reducing their home state's rolls. Federalizing Medicaid would discourage that practice and force states to start dealing with the problems of their own poor at home, instead of dumping them on others. As for the Tea Party, signs of the feeding frenzy are already starting in Delaware. I suspect other parts of the country will follow suit, though whether it is enough to keep ultra conservatives from undoing Obama's successes I don't know.
Jenga: I would point out that just because Prop C passed, doesn't mean that more than 70% will actually opt out. How many people actually choose to opt out will tell us a lot more about what the state as a whole thinks about health care reform.
Maggie, I am surprised and saddened by Dr. Rossi's attitude towards the Hippocratic Oath. Traditional vs modern--aren't we just splitting hairs here? Of course, what makes me more sad is I've heard the same thing from other docs: no Medicare, no Medicaid. So the sick get sicker, wind up in the ER, and cost everyone in the community more because of the lack of preventative care. It may be legal. But it's not right. And it just highlights the need for a single payer system in this country.