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Friday, March 23, 2012

NOT TRUE: Leaving the hospital A.M.A (Against Medical Advice) will cost you

I heard this piece of Marketplace tonight on my way home and felt
compelled to share

Can ignoring medical advice hurt your wallet?


Kai Ryssdal: Largely lost in all the talk about the health care law is
that a lot of things haven't really changed yet. Most of its
provisions are going to phase in over time, which means millions of
people still don't have health insurance and health care costs
continue to climb.Commentator and physician John Schumann says
conventional wisdom among his peers is sometimes responsible for those
rising costsJohn Schumann: Nora, a third-year medical student, came to
me in distress. Ms. DiFazio, one of the patients on her hospital
rotation, was frightened to undergo an invasive and expensive medical
procedure in which a catheter would be inserted into the heart to test
whether she had heart disease.

At the bedside, the doctor Nora was shadowing demanded to know why Ms.
DiFazio refused the procedure. When no reason beyond "I don't want to"
was offered, the doctor told Ms. DiFazio that there was no longer any
reason for her to stay in the hospital.

But by declining the procedure, he informed her she would have to sign
out 'against medical advice' or AMA. She would have to acknowledge
that leaving AMA could result in serious harm or death. And that she
would bear responsibility for all hospital charges not reimbursed by
insurance because of her decision.

"The threat of a huge hospital bill got Ms. DiFazio to stay and take
the test," Nora told me. "It just seems so wrong to bludgeon a patient
this way," she said. "Can it possibly be true?" Ethically, the notion
that patients must do our bidding or pay the price seemed dubious. Yet
in a world of co-pays, deductibles, and "preexisting conditions," the
idea seemed plausible.

To find out for sure, I elicited the help of some colleagues and we
sifted through nearly 10 years of discharges against medical advice
from our teaching hospital. Out of the hundreds of cases we examined,
not one resulted in an unpaid bill because of the AMA discharge.

I also went to source and talked with folks from some of the nation's
largest private insurance companies. Each of them told me that the
idea of a patient leaving against medical advice and having to foot
the bill is bunk: nothing more than a medical urban legend.

So patients beware: The next time you or your loved one has decided
that it's time to leave the hospital, don't let us doctors coerce you
into staying by threatening you with the bill. It simply isn't true.

Ryssdal: Dr. John Schumann specializes in internal medicine at the
University of Oklahoma School of Community Medicine in Tulsa.


Thursday, March 15, 2012

Hall of Tolerance

I am very proud that I just received the following announcement from my daughter's middle school. This is a wonderful project that will hopefully have a lasting impact on the students, their families and the town. 

Tomlinson Middle School PTA


March 15, 2012   

Dear Parents,


Hall of Tolerance


TMS is extremely proud to announce that the Hall of Tolerance, a project seven years in the making, will be dedicated on Flag Day, June 14, 2012. While this is not a PTA Program, it is a significant school project that merits community-wide attention as we all work together to break the grip of intolerance.  


What is the Hall of Tolerance?


The Hall of Tolerance will be a permanent exhibit on the school's main floor, showcasing the school's ongoing efforts to maintain a positive and productive social and learning environment. Each display along the hallway is intended to evoke emotion about past intolerant behavior, or promote inspiration and thought about making right choices in our own lives. The Hall will include the following:

  • Three cases housing over 1.5 million toothpicks to represent the deaths of 1.5 million children age 15 and under during the Holocaust
  • A quilt sewn by TMS students encompassing positive words and expressions
  • A wall of heroes depicting people who have fought intolerance in their own lives
  • A flat screen TV monitor linked into the school's computer network featuring school and commercially developed visuals and videos  
  • Students' artwork, poetry, and literature, depicting themes such as anti-bullying, prejudice, and diversity
  • A sculpture by renowned artist Dexter Benedict representing and highlighting the significant work of our students
  • The inspirational lyrics of John Lennon's "Imagine"; Yoko Ono has graciously granted TMS permission to include her husband's powerful message in the TMS Hall of Tolerance
  • The twelve Habits of the Mind that TMS emphasizes throughout the year

All eighth grade students will be in attendance during the dedication ceremony; sixth and seventh grade students will view the live ceremony on television monitors in their homerooms.  


How can you help?


We urge every student at TMS to get involved in this special project. We hope that all enjoyed the recent "Penny War," and are grateful to all who participated. Together, our students raised over $2,000 for this project. Over the next few weeks, students are encouraged to bring in toothpicks for the Holocaust exhibit. Toothpicks will be collected by homeroom teachers.  


Over the past five years many donations to the Hall of Tolerance Fund have made it possible for this project to enter its building phase. Additional contributions will allow for the project to become self-sustaining, assuring that it will be well maintained and upgraded through the years. If you would like to contribute to the Hall of Tolerance Fund, please make your check payable to TMS/Hall of Tolerance Fund, and drop it off in the main office, in an envelope marked the same. Thank you for your support.


For further information or if you would like to become involved, please contact Tony Andrade at aandrade@fairfieldschools.org or Laura Rigney @laurarigney@yahoo.com.



Tomlinson Middle School PTA

Saturday, March 3, 2012

A Chill Pill for Food's Thrill?

A great article on one of the reasons it's so hard to lose weight and stop eating
So much

"A Chill Pill for Food's Thrill?"

Read more with Readability: http://rdd.me/imjhqric

Last week, a U.S. Food and Drug Administration advisory committee voted overwhelmingly to recommend approval of Qnexa. If officially approved later this spring, it will be the first new prescription…


Original URL: http://online.wsj.com/article/SB10001424052970204653604577249450115938044.html?mod=wsj_share_tweet

Thursday, March 1, 2012

Effect of Perioperative Statins

On the heals of my last post, I just read this article which discusses the benefit of statin use in patients naive to statin therapy prior to undergoing cardiac and noncardiac surgery.


Statin Benefits vs Safety

Earlier this week this week the FDA issues new changes to the safety labels of statin medications.

There are a few things I want to clarify.
  • Statins overall are safe. 
  • Statins work. 
They are extremely effective in lowering cholesterol levels. There is very strong evidence that they help in reducing the risk of recurrent cardiac events in patients who have suffered a heart attack, in patients with established coronary artery disease, and in patients with vascular disease. They have also been shown to help prevent the development of symptomatic heart disease. They have even been shown to induce cholesterol plaque regression in the walls of the arteries. 

Despite the new labeling I will explain below, the take home message needs to be stressed: The risk vs. benefit ratio supports the use statin therapy in combination with lifestyle modification to prevent cardiovascular events, as the benefits of statins continue to outweigh any associated risks. Please remember this as you continue reading.

The new changes to the labeling of statins include the following:
  1. It is no longer recommended to to periodically monitor liver enzymes. The risk of liver enzyme abnormality is extremely rare and unpredictable and routine screening does not seem to help.
  2. Some patients seem to develop memory loss or forgetfulness. These symptoms are not permanent and are reversible after discontinuation of treatment
  3. There does appear to be a potential increase in blood glucose levels. This may increase the chance that a patient be classified as diabetic while on this medication. But remember, the cardiovascular benefits of statins outweigh the small increased risk associated with increases in blood glucose levels. 
Remember, that the overall benefit of statins + lifestyle have towards preventing cardiovascular events far outweigh the rare increased risk of the above side effects.

Please do not stop your statin medication without discussing with your physician first.