Thursday, May 28, 2009

health care reform

I have a ton of thoughts on this subject, but not enough time to really get into it in depth. So I am going to touch on little details as they strike my fancy.

I read Ted Kennedy's thoughts on Health Care Reform today. This is very worrisome for me. I agree we need to work on the system, but our current administrations plans to rush and bully reform through Congress without adequate research or planning. This makes me very concerned about the future of health care in this country.

Teddy's 2nd point in his plan to reduce cost was to reduce waste in government spending. First he wants to educate doctors in how to treat patients correctly. This does not mean better medical care, people! This is simply government speak for cost shaving and cost containment. This means if your treatment for your disease is too expensive, even if it is your best chance for help, you will be denied coverage. Remember the outcry when HMOs tried this in the 90's? Of course not. Nobody learns from the past. Well, look at what happened then, and think of that travesty occurring as the result of Federal law. Now how much do you support this plan?

Teddy says the government will no longer pay for medical mistakes. Sounds great. Doc screws up, why should he get paid? But the problem is the definition of medical mistakes. The government currently has plans to refuse payments for any patient readmitted to the hospital within a month of going home from the hospital. If they get readmitted, there must have been something messed up, right?

WRONG. I readmitted 2 patients this week. They both were over 75 with chronic medical problems and new problems had popped up. They were fine when they went home, but belonged in the hospital within a few days of going home.

Now imagine a system where the government is already putting great pressure on doctors to discharge patients from the hospital as soon as possible. Add to that a plan where the government refuses to pay if they have to go back into the hospital. Add to that our current system where the local hospitals are losing money from lack of payment for government insured patients.

If your grandmother under this system has multiple medical problems and has been in the hospital recently, do you think the hospital administrators are going to allow her to be readmitted within a month for any problem, even if she needs it? How many of the most sick people in this country are going to be denied medical care because of this plan to cut costs.

I am scared when our government relies on bean counters and attorneys to formulate health care plans. Don't trust them. Don't support them. Speak out to your Representative and hope they actually care about representing you.

Monday, May 11, 2009

Swine Flu

Today the CDC confirmed what I posted last week. The Swine flu is spreading at a vigorous rate, typical of a flu epidemic. The reported cases are only the tip of the iceberg. It is likely in every state and moving around the world especially to the southern hemisphere where they are entering their normal flu season.

It is a typical flu in all respects and those that need to take precautions are those who need to take precautions in cold and flu season every year. But the general public does not need to be overly fearful at this time.

Sunday, May 10, 2009

quick post

Just a bit of advice. If you're afraid of Hini flu, don't wear a mask. They just make you look silly. They don't work unless you have a respirator and even they may not do anything. Instead, just use hand sanitizer, stay 6 feet from sick people and wash your hands.

Saturday, May 9, 2009

Not much change. The increase in cases continues at the same rate. 2254 cases in the US today. 100 or so in the hospital. One real US death. And this is just the tip of the iceberg, folks. These are CDC confirmed cases only. they are still catching up from last week and at this rate of increase in cases they are falling farther and farther behind. The Flu is out and we are in a national epidemic whether or not the WHO is willing to acknowledge it is a pandemic yet.

And IT'S NOT THAT BAD> This bug is on the level of any other flu. It is not 1918 killer flu. It is last winters pain in the butt flu. It is the fever and aches and stay home from work flu. If however you have chronic lung disease or immune deficiencies or other such chronic illness, you should take precautions just as you would in normal cold and flu season. Elderly patients and infants should be protected as well. Otherwise, take reasonable infectious disease precautions, and go about your daily lives.

I will update on the flu only periodically from now on unless things change.

The one thing about illness is it creates work for me. This is my usual slow time of the year and I'm seeing as many if not more patients than I usually do in the real cold and flu season.

Tuesday, May 5, 2009

I am working myself to death with this outbreak and cannot find time to get a good update with research. What I can say with certainty is there are 400 confirmed US cases now and 700 probable cases. There are many many more under investigation. The rate of spread seems to have slowed a little but it is still spreading at a fairly rapid rate. Yet there is only ONE death.

A 33 year-old American in a border town with chronic diseases apparently and who was pregnant died of the disease. This is horribly tragic. But from an epidemiological perspective does not increase the perceived threat level from this virus. I cannot imagine the grief her family must feel. I am glad the baby survived. But this is the kind of person the flu kills every year. It is tragic but expected.

I have also seen the Swine flu fatigue set in. I hear constant jokes and criticism of the handling of this disease. I am reminded of living in hurricane country before Katrina with all the cavalier attitudes people had after surviving storms that did not pay off as they had threatened. I fear for this country's ability to handle a killer flu if one arises.

My advice, relax. This virus is still just as likely to keep spreading as it is to fizzle out, but it is not currently dangerous. If you are in a high risk group (young children, elderly, pregnant, chronic disease) or if you are around people in high risk categories, continue to protect yourself. But stay wary. Don't completely let down your guard. This virus can still mutate as flu does. It is still a novel virus and we are not immune to it. And it can become a severe one.

Saturday, May 2, 2009

Hiney flu fears

People have been stockpiling tamiflu and relenza, the 2 drugs that treat Swine Flu. Pharmacies that fill one tamiflu script every week are now filling 25 a day. The problem is there is a growing shortage of these meds and nobody is sick yet. People have them sitting on their shelves to protect every member of their family. Now if we have outbreaks especially in poorer communities with out easy medical access and funds, there will be no medicine to treat them. This can worsen an epidemic as disease spreads much more quickly in this type environment. Those privileged people who have bought up the meds also can cause additional harm by taking it unnecessarily and breeding resistance.

Why does this matter? Hiney flu is going out with a whimper not a bang. But the flu is a squirrelly bug. It may have shifted to something harmless as a kitten, but can mutate into a tiger and hit the world again next winter. This time we may have nothing to treat it.

Who's to blame. I hold my colleagues largely responsible. Those who are unable to or refuse to say "no" to unreasonable requests by their patients. It is a sad commentary on our professional ethics.