VA rant

[eits]

The Emergency Medicine and Active Labor Transfer act makes it illegal to transfer a patient to annother facility until they have been stabilized. So Ambulance crews will ask where the patient wants to go, or they will go to the closest facility. However, the last thing anyone should be worrying about in an emergency is payment. Ambulances dont ask, the clinical staff don't ask in the ER, and that is not the right time to be looking over the menu to see what you can afford.
I am talking about clinical care only. If the insurance co, bank, lawyers and the rest of the useless scum want to work 10-2 monday through thursday so be it. They just need to get out of the way when I am trying to keep people alive.

wasn't aware of that act. however, i do know that there are some people who would be worried the entire time they're being treated at a facility their insurance won't cover. these are tough financial times and the last thing someone wants is to worry about how to afford living after receiving the bill for having their lives saved. better hope it's a catholic hospital lol.

 

[Pliablemoose]

Let me get this straight, you're working on Sunday, and you're a physician, and you've dealt with the VA before and you have the expectation of being able to contact an overloaded clinic doc on the weekend?

Unless your patient has carefully cultivated a relationship with his PCP, he doesn't have the docs home or cell #, and you know you're wasting your time.

Unless you patient is in need of immediate attention, you'll have a very difficult time contacting anyone at the VA on a weekend.

If your patient is in need of immediate attention, treat, admit and transfer him.

And seriously, what good is the on call doc going to do today? Just call tomorrow.

Otherwise, it can wait till tomorrow.

 

[MagnusTheBrewer]

The Emergency Medicine and Active Labor Transfer act makes it illegal to transfer a patient to annother facility until they have been stabilized. So Ambulance crews will ask where the patient wants to go, or they will go to the closest facility. However, the last thing anyone should be worrying about in an emergency is payment. Ambulances dont ask, the clinical staff don't ask in the ER, and that is not the right time to be looking over the menu to see what you can afford.
I am talking about clinical care only. If the insurance co, bank, lawyers and the rest of the useless scum want to work 10-2 monday through thursday so be it. They just need to get out of the way when I am trying to keep people alive.

After twenty years, you should realize that "the insurance co, bank, lawyers and the rest of the useless scum" don't care. I hear what you're saying and empathize because I'm someone who cares as well. Sadly, most people view their work as something they have to do to support their real life.

 

[eits]

I am not trying to make the appointment, I just need to discuss the case with an on-call physician, like I would with any private practice group. ( hell I have home numbers and cells on most of them)

Since I am my own doc, and I am working today it should be no problem. You see I have been working weekends, nights and holidays for the last 20 years and sometimes I need others to do so as well.

how can you be your own doc? you can't exactly give yourself a physical (abdominal exam, prostate exam, reflexes, eent inspection, etc).

 

[BoomerD]

Aside from Pliablemoose's argument that it is Sunday...and a damned good argument it is...FUCK the VA.
The last time I set foot in a VA facility was 1973 after I got out of the Corps. Never again.

 

[RiDE]

I did my clinicals at the VA. The people working there really couldn't give sht about anybody else once they get their foot in the door. All they really care about is the benefits of working for the 'government'. lol

 

[eits]

I did my clinicals at the VA. The people working there really couldn't give sht about anybody else once they get their foot in the door. All they really care about is the benefits of working for the 'government'. lol

yup.

 

[Pliablemoose]

Guys, he's talking about a wanting to touch bases with a doc that is paid specifically to work M-F in a clinic.

His patient is stable and will be discharged from his ER today, his patient needs to actually agree to take control of his own health care (or a family member does) and agree to call the VA tomorrow and make an appointment, or to go to the clinic there that sees unscheduled patients tomorrow.

Once the patient is plugged into a specialty clinic, they should be in good shape.

Sigh...

I'd go on a massive VA rant, but it would serve no purpose

Don't get me wrong, I think the VA is pretty miserable, I quit after 20 years of working there, got tired of begging everyone else to do their damn job, and the politics. The director of our pharmacy went to flipping prison for trying to extort a drug manufacturer, and IMHO most of management should have gone right along with him.

The worst thing about the VA is how they save money, a nurse or doc quits, and they suck up those salary funds for six months before they replace them, and give each other massive bonuses...

 

[mattpegher]

Let me get this straight, you're working on Sunday, and you're a physician, and you've dealt with the VA before and you have the expectation of being able to contact an overloaded clinic doc on the weekend?

Unless your patient has carefully cultivated a relationship with his PCP, he doesn't have the docs home or cell #, and you know you're wasting your time.

Unless you patient is in need of immediate attention, you'll have a very difficult time contacting anyone at the VA on a weekend.

If your patient is in need of immediate attention, treat, admit and transfer him.

And seriously, what good is the on call doc going to do today? Just call tomorrow.

Otherwise, it can wait till tomorrow.

It just isn't possible in emergency medicine to put off contacting the guys PMD, until tomorrow. One, I am off. My replacement will be too busy to try to contact the PMD, and wont know enough about the case.
Standard of care is that I contact the on-call physician covering the practice to initiate a physician to physician dialogue for continuity of care. Sure that physician may not be the patients primary but it will be someone in the group who can make sure that the patient recieve the care he needs. Mistakes are made most when care is transferred from one physician to another. Maybe I shouldn't care, but telling the guy to just call his PMD try to have his appointment expeditied, and leaving the details for him to explain to the PMD, is just not likely to be successful without something getting fucked up.

 

[mattpegher]

how can you be your own doc? you can't exactly give yourself a physical (abdominal exam, prostate exam, reflexes, eent inspection, etc).

Yes to all, but its difficult and requires a series of mirrors , Seriously, I do manage my own health primarily, using speciallist as needed. Eventually, I may need to have an internist, as well, but for now I subcontract most of the maintainance.

 

[zinfamous]

that must be why when the head enlisted of each of branch went before congress they all said military medicine/care was severaly lacking. those partisan hacks!

Oh, I totally agree that the VA is complete shit.

but using what it is now, with the current and past system, to show what Government run healthcare, in a new system can be, is a hack argument. It is also part of the military/defense budget, is it not?

(and I don't mean hack as in partisan hack--I mean straight up hack. It's simply a flawed and duplicitous argument)

 

[shortylickens]

I've been dealing with VA for several years and I know they are a damn mess.
My father, grandfather, uncle, and most of the guys at my local VFW are filled with stories of the VA fucking them up like a Democrat fucking up the budget.
Also, they tell stories of Democrats fucking up budgets.

I really with they would just admit its a mess and give us health insurance instead of spending billions on those shitty hospitals.
Of course, I already know that wouldnt work either. No good solution I guess.

 

[mattpegher]

I've been dealing with VA for several years and I know they are a damn mess.
My father, grandfather, uncle, and most of the guys at my local VFW are filled with stories of the VA fucking them up like a Democrat fucking up the budget.
Also, they tell stories of Democrats fucking up budgets.

I really with they would just admit its a mess and give us health insurance instead of spending billions on those shitty hospitals.
Of course, I already know that wouldnt work either. No good solution I guess.

Or give the senators, VA only healthcare and see how fast things change. It took a senator having to pay cash for his son's medical bills, before we could offer cash pay discounts to people.

 

[eits]

Yes to all, but its difficult and requires a series of mirrors , Seriously, I do manage my own health primarily, using speciallist as needed. Eventually, I may need to have an internist, as well, but for now I subcontract most of the maintainance.

aren't there laws against prescribing yourself certain meds? you'd need another medical physician to do it for you. at least that was the impression i was under.

 

[zinfamous]

aren't there laws against prescribing yourself certain meds? you'd need another medical physician to do it for you. at least that was the impression i was under.

um. I believe it's illegal to prescribe for yourself any meds. And that extends to your family members, as well.

It's easy enough, though. Just get a pal/colleague to do it for you.

 

[eits]

um. I believe it's illegal to prescribe for yourself any meds. And that extends to your family members, as well.

It's easy enough, though. Just get a pal/colleague to do it for you.

yeah, i thought that too, but i wasn't sure, so i said "certain meds". didn't know if antibiotics were ok or not.

even if your pal prescribes you something, aren't you legally required by the oig to have some form of documentation in the form of medical records (i.e. soap note)? i mean, yeah, who's gonna check, but... i dunno...

 

[mattpegher]

yeah, i thought that too, but i wasn't sure, so i said "certain meds". didn't know if antibiotics were ok or not.

even if your pal prescribes you something, aren't you legally required by the oig to have some form of documentation in the form of medical records (i.e. soap note)? i mean, yeah, who's gonna check, but... i dunno...

It is only illegal to prescribe controlled substances to yourself or family members. As requirement of the DEA any precription for controlled substance must be documented and availble for review.
As for non controlled medication, documentation of record is a requirement if you submit to an insurance company for payment.

So, for example I prescribe for myself an antibiotic, I do not need to document or keep a record. I do have some extended family members that request non controlled substances for which I keep records. The extent of the note can be minimal because I dont submit for reimbursement.

I knew a rheumatologist that didn't accept any insurance, neither did he submit claims for his patient, he kept the shortest crapiest notes, but he wasn't legally bound to do anything different.

 

[BoomerD]

I've been dealing with VA for several years and I know they are a damn mess.
My father, grandfather, uncle, and most of the guys at my local VFW are filled with stories of the VA fucking them up like a Democrat fucking up the budget.
Also, they tell stories of Democrats fucking up budgets.

I really with they would just admit its a mess and give us health insurance instead of spending billions on those shitty hospitals.
Of course, I already know that wouldnt work either. No good solution I guess.

Blaming the Democrats for fucking up the budget is funnay as hell to me.

People bitch about "tax and spend Democrats," yet want to give a pass to "borrow and spend Republicans"...which fucks up the budget far worse than anything the Dems have ever done.

 

[nanette1985]

However, the last thing anyone should be worrying about in an emergency is payment. Ambulances dont ask, the clinical staff don't ask in the ER, and that is not the right time to be looking over the menu to see what you can afford.

I respectfully disagree with you. Coming out of an emergency situation with six figures in med bills isn't going to be good for the long-term health of a patient. You HAVE to know what youre getting into.

In a fantasy world, you'd be right, but this is reality , which can be pretty grim.

 

[mattpegher]

I respectfully disagree with you. Coming out of an emergency situation with six figures in med bills isn't going to be good for the long-term health of a patient. You HAVE to know what youre getting into.

In a fantasy world, you'd be right, but this is reality , which can be pretty grim.

I'm not saying that the patient doesn't have the right to ask before being seen if they accept his insurance, I am saying I can't tell him to go elsewhere, nor can I choose to do less than standard of care because of his insurance. He can however, discuss with the physician what tests are necessary and choose to forgo some of them. Do realize that if the physician says the only way he can tell if you have appendicitis is to do a CT scan (only test with 95% negative predictive value) and you choose not to his alternative may be to admit you for observation or take you to surgery and cut it out good or bad. Or you may choose to go home and take your chances but he is not obligated to give you any myriad of medicines that you wish to ask for.
Any discission should be the patients with thorough education from the physician. Within reason. You arent getting morphine for your tooth ache.

 

[Slew Foot]

Ahhh VA stories...


Once at the San Francisco VA during 3rd year med school rotations, I came in the morning and was going over some computer notes. The nurse comes up to one of the residents sitting nearby and says, "Doctor your patient is dead." The resident flips out and runs to the guys room and I follow. The nurse walks off away somewhere. We get to the room and the guy is stiff as a board, he's been dead all night and no one noticed.


Also at the SF VA, there was this one big fat male nurse who worked to ngiht shift who spent the entire time surfing the internet for "Craigslist erotic services."


I did an away rotation at the Long Beach VA, and that place was a dump. Piles of days old food piling up inpatient rooms, covered in flies. Fucking gross.

 

[eits]

It is only illegal to prescribe controlled substances to yourself or family members. As requirement of the DEA any precription for controlled substance must be documented and availble for review.
As for non controlled medication, documentation of record is a requirement if you submit to an insurance company for payment.

So, for example I prescribe for myself an antibiotic, I do not need to document or keep a record. I do have some extended family members that request non controlled substances for which I keep records. The extent of the note can be minimal because I dont submit for reimbursement.

I knew a rheumatologist that didn't accept any insurance, neither did he submit claims for his patient, he kept the shortest crapiest notes, but he wasn't legally bound to do anything different.

yeah, that's the thing with cash practice... you don't need documentation worth a shit. the colleague whose office i work out of keeps shitty notes and documentation. for a while, he didn't really keep any. he runs a 95% cash practice, so it didn't really matter to him.

he's a friend of mine and i'm trying to slowly whip his ass into shape.

 

[eits]

I respectfully disagree with you. Coming out of an emergency situation with six figures in med bills isn't going to be good for the long-term health of a patient. You HAVE to know what youre getting into.

In a fantasy world, you'd be right, but this is reality , which can be pretty grim.

yeah

 

[lupi]

Let me get this straight, you're working on Sunday, and you're a physician, and you've dealt with the VA before and you have the expectation of being able to contact an overloaded clinic doc on the weekend?

Unless your patient has carefully cultivated a relationship with his PCP, he doesn't have the docs home or cell #, and you know you're wasting your time.

Unless you patient is in need of immediate attention, you'll have a very difficult time contacting anyone at the VA on a weekend.

If your patient is in need of immediate attention, treat, admit and transfer him.

And seriously, what good is the on call doc going to do today? Just call tomorrow.

Otherwise, it can wait till tomorrow.

I went to an ENT this year for the first time, by the time I left that appointment I had his biz card with home and cell # on it.

 

[mattpegher]

I went to an ENT this year for the first time, by the time I left that appointment I had his biz card with home and cell # on it.

Some specialist will do that if they are sure that you wont abuse the privilege. You arent going to see a pain management doc do that. Nor a psychiatrist. Also depends on the money involved, a good number of high end plastics guys give out cell #'s, because you just paid a few 10's of thousands for that boob job, you paid for conscierge service.

I know of a internist that became a "concierge doctor", you pay him an extra 5k/year on top of what he bills for insurance and he limits his practice to 500 patients and is available 24/7. Sort of like the tv show.