And Balls make four.....

Another day, another patient, another diagnosis....

Each day of the rotation starts out very similar....see about 15 patients in the office, go to the hospital and round on as many patients as i can until 2pm, go to the other office and see patients until 4pm, then head back to the hospital to see the patients i did not get a chance to see during my lunch break...

And when i say lunch break, the hours between 12-2pm (when i thought my doctor took a 2 hour lunch....) is when we see patients, and try and eat lunch....the more i can get done between these hours the earlier i go home at the end of the day...


today, was long.....but i don't have to work this weekend because my doctor is not on call (YAY!) I think i am going to stop in anyway because i want to check up on my patients that i have been following, but anything i do is my own time, my doctor is not responsible.


We had 15 patients in the hospital to see, so the best method is to divide and conquer (even though i still have to present to him and have the Dr sign all my orders)... i started off seeing a women with HTN, Bells palsy and Zoster....next, we have Fever of unknown origin, suspecting infectious waiting for Dengue fever Ab's to come back. Moving to a different floor I go and see a patient who is a known drug seeker with Crohn's disease, nothing new there just wants dalaudid refuses to be seen by pain management, the last patient i got the pleasure of seeing before leaving at 2pm is a man with a testicle swollen to the size of a softball. The swelling came down and the man with swollen balls actually thanks the doctor and asks for his card to bring the rest of the gang to see him. So when my doctor asks how many patients i have seen...i list through them and basically say, say "and balls makes four."

After my attending had a good laugh, i realized how horrible that sounded and made sure to apologize since i had no intention of mocking my patient....but it does help break some tension and keep things in perspective..

After lunch i saw some more crazy patients in the office and had a moment of truth...

I saw another example of how insurance companies dictate care instead of doctors. The doctor i am working with is trying to have approval for a service for his 3yr old daughter and had been denied...the reason was ludicrous i could not believe what they told him....he got mad, up until this point i have not seen the man raise his voice, or even get slightly frustrated with anything...but now he is clearly frustrated and upset. But i notice that he channeled his energy to a more productive manner.

here are some helpful hints i learned about dealing with insurance companies...even some items that they probably don't want you to know...

1) be sure to ask that the medical director of the insurance company that denied the claim is actually licensed to practice medicine in your state.
- in the state of Florida, if the medical director that denied the claim is not licensed to practice medicine in the state of Florida, notify the Florida medical board, and the insurance commission. Charges can be brought for malpractice, "practicing medicine without a license" and in FL this carries a 7yr prison sentence. Its illegal in this state.
- i spoke with a case worker at the hospital, she mentioned this trick to me, she helped a friend who had $42,000 medical bill the insurance company refused to pay...she called and asked about the license of the medical director, threatened to press charges for malpractice..after 4 years of fighting the company, the $42,000 bill was erased within 48hours.

2) have your doctor write a letter to insurance company (using his own letter head, nothing from the insurance company) stating that it is his/her legal and medical decision that the following treatment is necessary and the best course for treatment. Because the letter is not on insurance paperwork, and is a personal communication it is filed as a grievance. In the state of FL, the insurance co by law has 30 days to respond. If they deny the claim (legal document), and something happens as a result, they can be held liable....
- because every insurance company has a risk management department, they will flag the letter, and have push the approval through because denying the claim will open the co. to liability. Settling the claim is easier and potentially less risky for the insurance co.

there are more, but these were some of the methods used and i thought they were great....the one case worker i have been working with has nearly a zero denial rate with insurance companies. She is awesome.....finally a lawyer who is advocating for the patient!

basically more reasons why we have to get rid of the profit driving environment in order to advocate for the patient.

ahhh business, politics, and medicine.....i have finally found a great balance....not to mention some interesting cases..

here are a few more of the highlights from the afternoon...

female with meningioma and neurosyphilis, man with dengue fever, woman with NSTEMI developing retroperitoneal bleed....

these are the types of cases where i feel bad, because part of me hopes the patient actually gets worse....so i can see what happens....its kinda bad to think that, but i cant help but have it run through my head at the same time as how to fix it.

......another pearl from the day....i got to the floor where my patient was the night before, he is scheduled to be back from surgery, and i am there to check in on him....for some reason i cant find his chart, his name is no longer on the board.,....

i asked a nurse, "have you seen Patient X"

her reply, "he went for surgery and just never came back"


i later discovered that there were complications and they put him in the ICU.......but after nearly ending up in the ICU myself after thinking my patient died on the table from a routine procedure, she could have simply mentioned that he got transferred...seriously...

no seriously...that was a bit much....i thought i had a patient die on me....

not yet, that bridge has not been crossed yet, but soon enough.....i have 4 patients in the ICU....the post about breaking the news is coming soon....

for some reason i don't think its going to go nearly as well as when i watched my attending tell a patient he has cancer......my smooth talking doctor nearly had the patient thank him....i hope i am around to hear my attending deliver the bad news about death to a family...that will be a great learning experience...(i hope that doesn't sound as bad i think it may come across....but really we are all going at some point, so learning how to deliver the bad news will be an invaluable experience)