Posts Tagged ‘tinnitus’

Reflections on medical frauds

May 8, 2017

The system is inherently flawed

They want me to sign and to nod

They have no excuse

It’s all billing abuse

And I’ll say to their face, “You’re a fraud.”

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and short jobs in western Iowa and Alaska, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.

Sunday I visited a web site that promised to cure my tinnitus. It had all the marks of snake-oil fraud: heavy reliance on testimonials, repeated themes that the establishment didn’t want the product to succeed, recounting hard-to-believe medical horror stories for those that relied on established medical practice, and at the end the assertion that the narrator didn’t want to make money, he only wanted to do good for the world but mainstreamers would soon make him take down his website because of jealousy over his success.  Those tools exist because they work, and they nearly worked on me.  I wanted to believe.  But I knew if the narrator really just wanted to help people, he would have made the audio download available for nothing, and relied on contributions to keep the website up.

Towards the end of the video the phone rang. I listened to the robot,  pressed one, and told the live operator, “Your prerecorded announcement said I got the call because I’d responded to a TV back brace commercial.  Is that right?”

“Yeah.”

“How can that be? I don’t have a television.”

The line went dead.

This morning when I dove into my IN box  I found 4 faxes from a physical therapy operation in a nearby town, wanting me to sign off on very general orders for patients that I didn’t know and certainly hadn’t examined. I called the number at the bottom of the sheet, and spoke with a secretary who explained that the firm had a direct access program.  I tried to explain, in turn, that I could not in good conscience sign off on a patient with whom I had had no contact.  But as Mark Twain observed, it is difficult to get people to understand if their jobs depend on them not understanding.  I turned the papers over to our clinic manager.

Yet I also got a similar order sheet for medical supplies, and I checked with the staff; the doc whose place I’m holding indeed orders those supplies yearly, and I signed.

Our country has an enormous amount of medical fraud; vendors interested more in profit than patients buy a lot of late-night TV commercial time, and some people call in to get scooters and other durable medical goods. Over the years I had a lot of requests to sign off on knee, back, elbow and shoulder braces, none were needed.

Yet a few vendors offer diabetic supplies at greatly reduced cost. So I can’t just shred all the requests.  I have to read each one.  After all, the fraudsters only copy successful business models.

 

Nalukataaq injuries continue, my wife arrives, and snowmobiles on the water

July 15, 2010

If there is pressure inside of a cast,

It must be bivalved, I mean fast.

    The noise and the sputter

    Of our deluxe cast cutter

Brought relief to the patient at last.

I’m still taking care of Nalukataaq injuries.  A patient (who gave permission to relate this much information) fractured an ankle during the blanket toss, requiring a trip to Anchorage for surgery.  Weeks later, the patient came in with pressure sensation at the ankle bones and the heel.

Pressure on living tissue inside a closed space like a cast prevents blood entering and leaving; a person can lose a limb that way and I can remember getting out the cast cutter on a snowy night in Navajoland when transport down the Interstate was impossible.

I had the nurse move the patient to exam room 5 where we keep the orthopedic equipment while I went back to my apartment to get my hearing protection.

In my short career as a (failing) rock musician I lost hearing and my ears are still ringing.  Loud noises don’t just annoy, they inflict pain.  Like many baby boomers I suffer from tinnitus. 

We cannot undo the mistakes of the past, but we can keep from making the same mistakes in the future.  Bethany bought me a nice set of noise cancelling headphones a while ago, with the intention that I’d use them on plane trips. I also keep a set of foam ear plugs in the case, and if I anticipate severe noise I use plugs and muffs at the same time.

I rolled the foam plugs and inserted them into my ear canals, then I put on the muffs. 

The circular blade of a cast saw vibrates at right angles to the plane of the blade and cannot cut skin, muscle or tendon though it can tickle like crazy.  While the patient watched, I touched the blade to my palm. 

To relieve pressure inside a cast, one has to make a cut up each side of the cast, turning something conceptually like a tube to something conceptually like a clamshell without the connection between the halves.  In the fissure made in the fiberglass, I inserted a specialized instrument called a spreader, applied pressure on the handles and the jaws spread, forcing the two pieces of cast apart.

The relief  spread over the patient’s face when I started to cut the cast padding with scissors.

***

Bethany flew in last night and I borrowed a truck to pick her up.  She wasn’t prepared for the chaos of carousel-free baggage claim.  We took our time on the way to the hospital, we drove around town for fifteen minutes.  We stopped at the guitarist’s house for carry out Thai and live Irish music. 

Much racket of two-stroke engines awakened us as we were falling asleep.  Bethany thought there were jet skis on the lagoon; we watched snowmobiles making circuits on the water in the midnight sun.