spring in the hood

I saw 5 eagles soaring together round and round over the mississippi river today. I am going to take that as a good omen and signal that winter really is coming to an end.

Meanwhile back to the hood, where the hood rats are out in full force shooting at each other. Its like a rite of spring. Four shootings in the last couple of days. Two ended up in our ER, one died. Somebodys child, perhaps somebodys parent. Somehow the one who didn't die, but was shot, managed to drive the two of them in by car from about 6 blocks away. We lock down the ER in this situation, not knowing its gangbangers or if they are coming to the hospital for revenge. I have the feeling its gonna be a long summer

oh no you can't order that CT

Well it seems that if docs cannot regulate their use of such things as CT scans, the government is going to do it for them. For example, CMS (Center for Medicaid and Medicare Services) has decided that CTs ordered for nontraumatic headaches will not be paid, and in the future MDs may be financially penalized for ordering what they deem as unnecessary.

Another sign of the coming crash and burn of the healthcare system. There are three players in the coming meltdown:

1) Government and insurance payers who are starting to refuse to pay for what they deem as unnecessary tests.
2) Doctors who say they have to order such tests in order to avoid potential liability.
3) Patients who expect expensive tests to be done.

Radical change is coming, no doubt about it. Without it, the government will go bankrupt with healthcare costs and insurance premiums will become unaffordable. Malpractice awards will have to be limited or doctors are just going to have to deal with assuming more risks. Patients expectations will have to be drastically lowered.

In the end, government and insurers will drive change because, bottom line, they pay the bills. Its time for doctors to accept the changes coming to their practice. The fact of the matter is the days of docs ordering any test they want are gone. Their autonomy is decreasing. Its reality. You can accept it, work with it, be part of it or not. Research based medicine is the future.

Now don't even get me started on all the ridiculous MRIs being ordered in the ER...

wasting away in frequent flyerville

A small town hospital in my state decided to do something about the bane of every ER nurses life: frequent flyers. The ones that come up to the triage desk and you tell them to have a seat in the lobby, you don't need their name because it is etched in your brain.

Anyway, this hospital decided to hire a social worker whose job it became to identify these people and work with them to decrease their visits. She started with 24 people and reduced their visits from 294 to 178 in a years time. Saved almost 300,000 dollars. Many of the people had untreated mental illness or stress related problems, were unemployed or homeless. She hooked them up with psychiatrists or social workers, etc.

Why doesn't every ER do this? Sometimes I think that the hospital doesn't want them to stop coming. Medicaid money is better than no money I guess

UNCLE

UNCLE. Okay? UNNNNNNNCCCCLLLLLLLEEEEE!!!! I have been defeated. By this winter. I can't take it anymore. A few days ago the snow was melting, heading toward being gone. Then we had another annoying few inches which due to the cold temperatures remains on the ground. It has again covered everything. I am waving the white flag. Surrendering as it were. Okay winter you have defeated me. I give up.

I have lived here all of my oh so many years and this year did me in. It has gone on forever and I don't think its ever going to end. It may be permanent. It has made up for the last few winters that have been mild and had us saying hey maybe our winters are changing.

So I will be under the covers, feeling sorry for myself, and I won't come out until its all gone and I see tulips..

the day Joe died

Welcome to the wonderful world of drug abuse. Average intellectual requirement: that of a gnat.

One day a gnat surfing the internet, talking to the other gnats, hears about a new dope that will blow your mind, bend you into a pretzel, "you gotta try this man....." Somehow the gnat comes up with the scratch to order it on the internet from China or Vietnam or someplace. Once he gets it, he thinks to himself: hey I think I'll have a party and invite some of my other gnat pals.

So the day arrives and here come his gnat pals. A course his buds are down with the dope, in fact they can't wait to try it. They snort it. Some mix it with their Jack. We got us a Lucy in the Sky with Diamonds situation on our hands. Damnnnn this shit is great! shouts one of the gnats. Hey wait a minute whats wrong with Matt? He don' look so good. Shit he's having a seizure! MATT! Are you okay man!? Shit i'm outta here! Matt ain't the only one having problems, Sheila and Joe don't look too good either...One of the gnats calls 911. EMS and the cops get their and Matt is taken to the ER. He dies in the hospital. Sheila and Joe are in critical condition. The police round up the other gnats and they go to the ER too. In all eleven people go to the hospital.

The gnat who bought the shit? He's in jail with various charges, no doubt one of which will be negligent homicide at the very least. The other gnats will survive. They will be alive to mourn the death of their friend Joe, who by the way, had a son. The drug: 2CE. This happened in the last couple of weeks where I live.