Notes from your Doctor: Protecting Yourself

One of the microbiology journals recently reported on the transference of MRSA and C.diff in hospitals. Why do you care? Because you, or someone you love, is going to end up in the hospital and this may save a life. A group of researchers were puzzled about how secondary infections often showed up in patients who were in rooms where the patient a week earlier had had the infection. Over that week, the room was cleaned top to bottom, and possibly had an uninfected patient in said room. What they found was that MRSA and C.diff were washed down the sink, where the bacteria colonized and grew in the S-curve of the drain pipe and then worked its way up the drain, and ended up splashing out when someone washed his/her hands. How long did that process take? Yup, a week.

They’re still experimenting to see how to best take care of this issue. My guess is that they’ll need a viscous bleach that clings like drain cleaner to make sure all the bacteria is killed. But while they’re still working on it, what can you do? Personally, I’ll be pouring a cup of bleach down the sink in any hospital rooms I visit.

Next: The Muslim Ban may affect your health. Any idea how many doctors are from foreign countries? Tens of thousands. Of note, 8,400 are from Syria and Iran. And we need them, we have a huge doctor shortage because we don’t produce enough doctors to meet demand. (More on that further down.) The effects are in two general areas: newly minted doctors for hospital residency programs, and practitioners in Appalachia and the Rust Belt. If you think people won’t die because of the ban, you’re wrong. (Source 1, Source 2.)

In answer to the question of why we don’t have enough doctors, it comes back to why so many of us left private practice in the late 80’s and early 90’s. The answer is the corporatization of medicine, most notably “Managed Care.”  There was a specialty neurology practice a few doors down from my office in the early 90’s. What these four men did was to diagnose and treat conditions that a lot of other people wouldn’t touch. Realize that now, we have much more advanced diagnostic equipment and treatment protocols. Back then, they had a BEAM scanner. While not in common use now, it was cutting edge back then, allowing them to diagnose lesions other methods couldn’t find, thus allowing for earlier and more successful surgery. They charged $400 for a scan. A scan actually cost them about $250 to perform, given the cost of the lease on the machine and related overhead. When managed care got through with them, they could be paid $150 from the insurance company, and about $25 from the patient. They were all in their 50’s, and when they left the practice, one opened a book store (for any millenials, small bookstores used to be incredibly popular), one took up being a charter captain in the Caribbean, one joined his son’s roofing business, and the last one went into teaching. Countless lives lost.

It’s becoming increasingly difficult for the medical and allied professions to attract young people. The high cost of education, the long hours (they just reinstated the 36-hour straight residency “days”), the forced lack of patient interaction, the litigiousness of society, it all adds together to people selecting other professions. This occurs as the need for additional professionals are necessary due to population growth. Further when people do choose to join the profession, they tend to practice in cities and suburbs, leaving rural areas under-served.

Finally: I’m not personally convinced that the GOP health disaster plan is going to fly. Numbers to keep in mind: Ryan can only lose 23 votes, the Freedom Caucus (30 members) is calling RINOCare. Both the Club for Growth and FreedomWorks are opposed. In the Senate, Cruz, Lee and Paul are not buying in. And that’s just on the right. On the “moderate” side, a number of Senators are opposed to defunding Planned Parenthood (Collins and Murkowski, yes really), and others are apoplectic about the rollback of the Medicaid expansion (Murkowski, Gardener, Caputo and Portman). McConnell can lose 2 votes, there are 8 at risk. McConnell is a detestable ferret but he’s not stupid, and he won’t bring the bill, in its current form to the Senate floor.

Further, when it’s scored, it’s going to add substantially to the debt, scaring off actual Republican conservatives. To get past the scoring problem, there will be no way to avoid raising taxes. Never a huge sell to the crazies. You’ll hear that Ryan will try to get this passed prior to the 3 week April recess BEFORE its scored, but large groups, with huge ad budgets are going up on the air to activate their constituencies. This includes the AARP, the American Hospital Association, plus the insurance companies.  Yes, you read that right — this bill screws the insurance companies in addition to anyone who would ever be a patient in need of health care.

So fight — write your reps, get your neighbors involved, read the actual bill….but don’t panic!

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