Patient-Surgeon, Rebel-Doctor

As a surgeon, I am 100% responsible for my patients. As a patient, I learned the hard way that absurd bureaucratic, governmental interference in the patient-physician relationship is lethal. I learned that as a patient-surgeon, I must actively protect my patients from the insanity of government-run medicine.

When I arrived for my mastectomy, an arm band was placed on my wrist. The arm band had a bar code. I don’t read bar code, do you? Everything that happened to me from that point on involved swiping my barcode. I awoke from surgery to my surgeon assuring me that everything had gone flawlessly. I thanked him and God. The hospital was full, so I was stuck in Recovery for hours. When I finally settled into my hospital room, I was startled by a warm, wet sensation- that of bright red blood flooding from my bandages and drains through my gown and into the sheets. My pulse quickened, and I grew faint. My surgeon returned emergently and adeptly stopped the hemorrhaging. He was superb. We were perplexed.

Flashback: As a young medical school faculty member in the early 1990’s, I felt honored to serve on our county hospital’s “Quality Assurance” committee. The University and County Hospital district had discovered they could get easy money from Medicare and Medicaid to supplement what they got from the State and County if only they did a “few little extra things” in return and complied willingly. Federal Government (CMS) required that we create “indicators” which could be monitored, as if to prove or judge that we were doing something worthy of getting paid, with their money, to treat our patients (as if they actually knew anything about medicine). In reality, they were trying to justify their existence and gain control over us.

I naively helped produce indicators and unquestioningly followed subsequent orders from the “powers that be”- being that I was a type A, pleaser, rule-following, too-trusting-in-government, doctor. The ensuing years beheld a massive transfer of power from physicians and patients to bureaucratic government entities and their pals, the hospitals. Government held the medical purse, and now government holds the power over our lives. I am partly to blame for the sophomoric laminated “5 moments of hand washing” and “fire triangle” signs posted in my OR as lame responses to lame indicators.

Flash Forward: As a seasoned surgeon in private practice, amidst the storm of my battle against Obamacare, I was diagnosed with breast cancer.  Untested rules and regulations (new indicators which now came from top down) were set in place. These had never been tested on patients but were established by government fiat as “the new way of doing things”, and money would go to only those who complied. The perfect storm for medical disasters was brewing.

Obamacare operates through a series of perverse incentives and a few carrots which are ultimately traded for many sticks each passing year. For example, CMS will penalize hospitals that have readmissions. Likewise, CMS will not pay surgeons for their services if patients develop post op problems (even if the problems are acknowledged consequences of life-saving surgery). These are the new top down indicators. Combine Obamacare’s “pay for performance”, with HIPAA, and the requirement for “meaningful use” electronic medical records, and it is medical tsunami time.

To prevent monetary penalization for readmissions from postop DVT’s, many hospitals opted to require that orthopedic patients receive post-operative anticoagulation as a standing order. To avoid not getting paid for surgery if a patient gets a post op DVT, the surgeons agreed. To comply with HIPAA, hospitals came up with absurd ways to identify patients without calling them by name, and out of fear of hefty fines, again, doctors went along. Electronic medical records (EMR) were “deemed” excellent and not only mandated for physicians, but government actually bribed physicians with $44,000 per doctor to adopt EMR. The safety and truth of any of this was never tested. It is all just false speculation from medical Utopia.

Back in the real world, after significant blood loss and sensing something not right, I determined to stay alert. In the middle of the night, the nurse came in, opened her med cart, scanned my arm band and then the electronic chart, and told me to take the meds. I asked what they were and determined they were not indicated for me. To her dismay, I refused. I left the hospital as soon as I could, in less than 24 hours, fearing further problems. We ultimately discovered that in the recovery room, my barcode had been inadvertently scanned to a different patient’s chart-that of an elderly man having orthopedic surgery- a patient for whom the hospital required anticoagulation for DVT prevention because of Obamacare style medicine.

Once my wristband was on, no one asked my name again. The electronic record, the impersonal HIPAA-born barcode, and the mandated DVT prophylaxis to prevent not getting paid, all culminated in an event that almost killed me. Had I not been a physician, who knows what else might have happened had I stayed in the hospital and continued to get someone else’s meds.

At my last two operations, instead of being assigned a barcode, I was given a sticky note labeled “A” for one and “B” for the other. When the nurse came out and called “Patient A” or “Patient B” , at least one or two elderly, hearing impaired or nervous, patients stood up with me to head back to the OR. Let’s restore sanity. I have a name. I am not a barcode, an A, or a B. I am a unique patient.

It is our duty as physicians to stand for tested, proven, individualized medicine and against the false assertions of untested government group medicine. It is time to say “No, We Won’t” to those who defile the practice of Hippocratic medicine. If we won’t stand up for our patients and profession, who will?

I am no longer naively trusting of the government and its deadly false assertions and mandates. I will not do those “few little things” just to get paid. I will not comply with the insanity and inhumanity of Obamacare. And now, more than ever, I am 100% empowered to fight for the safety of my patients and the sanctity of the patient-physician relationship. I am now a rebel doctor. What are you?

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11 thoughts on “Patient-Surgeon, Rebel-Doctor

  1. My kind of doc! I own a healthcare billing and consulting business. Besides collecting money for practices, we design and provide HIPAA policies, compliance policies/standard operatingprocedures. In the 21 years we have been in business, things have changed dramatically. Besides being significantly more difficult to collect for the services our clients provide, the compliance issues are to the point of bizarre. Several years ago when private practice physicians started being harassed to join large hospital owned Accountable Care Organizations, I told my clients this was not a measure to improve care, but rather the beginning method to control what services and care providers were allowed to provider their patients. Your experience with the barcodes sadly is not an isolated one. Obamacare was designed to dehumanize the patient to make it easier to deny the old or chronically ill advanced care. It is pretty easy to review a nameless chart and make decisions strictly based upon statistical data. It is easier to rationalize that it is more cost effective to spend greater resources on a moderately healthy younger person than a chronically ill old person, when there is no name or face associated with the statistics. Under Obamacare highly specialized advanced care will no longer be routinely provided to Americans over the age of seventy regardless of the prognosis if the care is provided. Am I saying I support providing a quarter of a million dollars worth of care to anyone over 70? NO! I am saying that based upon the individual’s potential for recovery, projected quality of life and the doctor’s best knowledge of a patient is the criteria – the ONLY criteria that should be considered in making decisions for patients. As to the bizarre interpretations of HIPAA policy by some hospitals-every time a nurse or doctor enters a patient room, even with personal knowledge of the patient, they should verify the identity of the patient by asking the patient’s full name and date of birth prior to administering anything, including meds, food or beverages. Patients have names and personal identifying information for a reason, use them! I annoyed hospital staff during a recent hospitalization for my husband because I stayed with him continuously (by permission of the attending physician) even in NICU. Because my husband could not speak for himself for the first 72 hours, I asked (sometimes demanded) what meds they were administering and why. Twice the meds brought were wrong and I refused to allow the nurse administer them. All I can say is, if your loved one can’t advocate for themselves, as a parent, spouse or guardian, you must advocate for them. Thankfully, here in North Alabama, Obamacare has yet to gain a firm grip on our hospitals and in most situations good old common sense is the order of the day!

  2. Thank You
    I trust You are well.?
    Prayers are with You and all.
    This is at once shocking, disturbing, disgusting and not at all surprising.

    Jim

  3. First, don’t confuse the PPACA with HITECH. Obamacare says nothing about EMRs or Meaningful Use. That is what HITECH, part of the American Recovery and Reinvestment Act of 2009 (stimulus), does.

    It sounds like you had a bad experience with the hospital’s implementation of their EMR. You should talk to someone you know at the hospital to ask their vendor about bringing up a snapshot of the patient’s record when barcodes get scanned so that nurses can match your face and name to the medications and not just the barcode.

    I understand your complaint that the indicators are “top-down”. The quality of your practice probably won’t shine through as clearly as it should. That is OK, because the value of the indicators isn’t necessarily for finding good practice (although that could happen) but, instead, finding bad practice (or practices that prevent finding bad practices, like poor documentation). Hopefully, the data-entry part will become increasingly streamlined as device standards are developed and embraced so that doctors can stop complaining about data-entry and get back to talking with patients.

    • You are correct HITECH came as phase one of Obamacare in the Stimulus early 2009 (American Reinvestment and Recovery Act) along with The Federal Coordinating Council on Comparative Effectiveness Research.The money to establish HITECH and THE COUNCIL was taken directly from Medicare. PPACA is part 2 of Obamacare. Thank you for engaging in this important discussion. Yes, the top down is bad on so many level. The tail is wagging the dog and politically expedient medicine is harming the patients. Pleas see recent pieces on our Rebel.MD wordpress blog regarding this and please see the next bloggers comments. We can and must do better.

  4. You are correct. The tail is now wagging the dog. I have been a physician (NOT a “provider”) for 30 years and I am definitely “old school.” We created a monster with the original Joint Commission, which was supposed to survey hospitals and then tell us what appeared to be the standard of care based on their findings. Somehow, we let them DETERMINE the standard of care and DICTATE to us what the standard of care should be. Then, it was only a matter of time when they colluded with the government and forced us to comply with their absurd mandates! Ironically, we practiced better medicine 20-30 years ago before all these “safeguards” were imposed in order to protect us from ourselves. Now, in most hospitals, I’d say there are at least 2 administrative/compliance employees for every employee involved in hands on patient care. This is the source of “the skyrocketing cost” of healthcare – layers upon layers of bureaucracy and regulations. As mentioned in the story, there is too much focus is on compliance with various policies and regulations such that we are documenting quality of care while the actual care of the patient is being ignored! This must stop!!

  5. I am a (young, uninsured and inexperienced) mother that is trying to educate herself on Obamacare so I can purchase the proper plan for myself and my toddler son. Ive read what the government says i should purchase and why, and Im glad i first decided to gain insight from other perspectives before making a purchase… I haven’t obtained any from blogs by other moms as there are none about these issues coming up in pediatric care. Reading these posts make me a little panicky and I definitely fear for my own medical safety, but even more so for my child. We had an incident a couple of weeks ago that sent us to the ER for staples in my sons head. He fell down some stairs and hit pavement head first. They gave me a pat on the back and a list of symptoms to look for in case his condition worsened. I was surprised that they didn’t do or offer a CT or neck xray. I’m assuming because my medical insurance was to be terminated the very next day. My son developed fevers and nosebleeds and confusion and agressive behavior a week later…took him to a children’s hospital instead and they treated and fixed him, he’s fine now. What do I need to know to protect my son in the future?

  6. Pingback: Patient-Surgeon, Rebel-Doctor |

  7. I have functioned as head of my department or medical director of my department for 12 of my 21 years in practice. Over these years, I have witnessed absurd regulations grow and advance. I have been asked, in the name of “safety”, to compromise the quality of the care I give my patients. I have found that the only thing worse than a bad regulation is a hospital’s ridiculous attempt to comply with the regulation. Like you, for many years I attempted to comply and even improve on the regulation. I did this even when I knew that inherently I was doing nothing unsafe. About five years ago, I stopped this behavior. I know that my position as medical director depends on me assisting my hospital in complying with these regulations. However, I refuse to agree to something that will put my patients at more risk and goes against what I know to be best for them. I feel like I have won a few minor battles. Hearing you story has inspired me to continue this fight. Thank you.

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