Physicist,

I agree with the above assessment, except I would go for Tuesday, in case the doctors and staff do some heavy partying over the weekend....and it happens. Monday 6:00a rolls around pretty quickly, especially with a hangover.

Weekend death rates are bad enough, but I learned the hard way that being hospitalized and having something go south (get worse) late at night or on a weekend may significantly increase the amount of time that you are in agonizing pain screaming for pain drugs.

It's scary-- even nightmarish -- to suddenly be in horrible pain and have to wait for a nurse to page the on-call doctor (who doesn't know you from Adam and worries that you might be a drug addict) to get an order for a badly needed immediate dose of narcotic pain medicine.

I believe I was given a big injection of Demerol and more every few hours after that. It caused hallucinations, but I certainly was in no pain.

The next morning, a Saturday, my specialist came in unscheduled and apologized for his oversight which led to my pain emergency. I told him how terrifying it was to be in that much pain so he would make sure not to make this mistake again.

Of course I know to avoid hospitals at certain times and on weekends/holidays. But my baby was born on Super Bowl weekend and when the doctor on rounds came in Sunday afternoon to see me, he sat on my bed and watched the game on TV! He only took a break during a time out to pay attention to me for a minute before dashing to the next room to catch the game again. True story.

I suspect that if a patient did NOT have the Super Bowl on their room's TV that the doctor would rush in and out even faster. The TV at the nurses' station was also tuned in to the Super Bowl. It was Sunday, after all...

ttmadison, c-section rates also skyrocket prior to the Super Bowl and college bowl games.

physicist,

what serious problem was it, if you don't mind sharing?

This holds true for nursing homes also. While visiting my father on a Saturday morning, I found him lying in bed in pain and unable to sit up. When asked what was wrong, he said his bladder hurt. Knowing he had a catheter I glanced at the bag and, though it wasn't full, it was very obvious that it had not been changed for quite some time. I buzzed for a staff member to inquire about this situation and found out that there was only one working that weekend. Clearly my father's catheter tube was plugged and in need of changing. Guess what? The young man working that weekend by himself didn't know how to change a catheter. Upon my insistance, he ended up calling the supervisor who 'suggested' two options - 1.) "Call for an ambulance to take him to the hospital emergency room to be treated." Or... 2.) "Sit it out and it will be taken care of, first thing Monday morning." I could not believe what I was witnessing. Needless to say, that was the last day my father stayed in that establishment.

Take him home and care for your father yourself.

Nightnurse06 - Don't know if you're trying to be a smartass or not, but just for the record - I did that very thing for six years prior to my father's medical condition declining to the point of needing more professional help that I was not able to provide. I also helped my father take care of my mother until she passed away twelve years earlier. Hope that satisfies you. However, if it doesn't... Well, Ain't that just too bad.

Eric,

what serious problem was it, if you don't mind sharing?

Not at all.

I had a heart stress test just before my annual physical (my regular doctor ordered it based on a few symptoms I was having), and my cardiologist did routine bloodwork as part of the stress test. It had been a little more than a year since my last bloodwork.

When the results came in, my hemoglobin was almost half the normal level. Even worse, the average size of my red blood cells was extremely small. In other words, my body was creating blood cells like crazy, but losing them even faster.

If I'd lost half my blood rapidly, like in a car accident, I would have been in a coma (at least), and probably died. Instead, I was still riding my bike 20 - 30 miles several times a week. So I was losing blood (lots of it), but losing it slow enough for my body to 'adjust'. My cardiologist called me on Friday afternoon with the news.

He didn't tell me until later that he expected to find an advanced tumor - hence his caution in making me wait until Monday. If I'd known that weekend what I know now, I would have been terrified.

As it turned out, it was slow internal bleeding (not a tumor), and it was resolved.

Not many people walk into a hospital with half their blood, and are still riding their bike years later. I dodged a bullet on that one.

Glad you're doing better!

Thanks, eric.

BTW, I enjoyed your posts on this thread.

Physicist

I know we're getting really personal here, so please don't answer my question if it feels it's in anyway invasive, or you can just answer yes or no. You are fantastic on your updates on the nuclear problem in Japan, and I think more people should be following it, because it's really important. I've noticed that you've skipped a few days because of a serious problem....is that is any way connected. As I say, you can just answer yes or no....but you were missed because you're a wealth of information and and a very valuable member of the Vine....plus a friend.

rescue dogs,

Wow - thanks. Those are kind words indeed, and much appreciated.

No, my illness described above was years ago. The current issue involves two family members, who are both out of state (one down south, the other out west). Big families are great when you're young. We aren't young any more.

My uncle was taken from the hospital to a nursing home, where he was to undergo physical rehab for a few weeks before being sent home. He was weak but able to walk with a walker. He was admitted to the nursing home on the weekend and the first time he requested help to get to the bathroom (in his own room) the staff member looked at his chart and saw nothing saying he could get up and go to the bathroom. She told him he'd have to use a bedpan until Monday when they could find out if it was ok for him to go on his own.

My uncle told her to either help him out of bed immediately or call his wife to come pick him up. She helped him to the bathroom.

It's like - the weekend staff aren't allowed to think for themselves? They can't observe a patient and determine if he's able to do what he needs to do? They can't make a phone call to ask his doctor if it's ok? Ridiculous.

There are a lot of reasons for increased mortality on weekends. A lot of hospitals reduce staff on weekends because there are fewer, if any, elective procedures being done. Having fewer staff nurses, lab techs, x-ray techs, etc. means that if a patient crashes or a major disaster occurs then initially there are fewer people who are readily available to fill the gap in patient care. The fewer people that are available to jump in and help, the more likely care is to be less than adequate. A disaster that results in multiple weekend admissions is likely to require people to be called in unexpectedly, including staff members that are not "on call" and might be hard to locate. Also, most hospital administrators and nursing supervisors are hesitant to call additional personnel to come in to work unless the under-staffing is blatant.

Also, most medical groups will have one doctor rounding for several of his partners on weekends. Even the best doctor is not a likely to be familiar with a complicated illness as the doctor who has been seeing the patient for several days in a row. This is going to get worse since new rules require 1st year residents in training to work no more than 16 hours straight. The more times a complicated case gets handed off from one doctor to another, the more likely the quality of care is going to suffer, especially with doctors in training.

Another reason for the increased death rate just occurred to me as well. Most doctors do not have elective admissions come in on the weekend. This means that there are more emergency admissions on weekends. There are a lot of ways this data could be skewed. For example, recreational accidents are more likely to occur on weekends. If there are more unexpected/emergency admissions I would expect the death rate to be higher.

Jack,

Many hospitals no longer have ERs

rescue dogs,

Right, which adds pressure to those that still do. General surgeons are telling me that they don't even try to schedule elective procedures if they are on call. The majority of emergency cases they handle are non-paying but intensively ill. A couple of surgeons even tell me that they don't schedule procedures for the day after taking call. They are working in an underserved, mostly rural area and are having trouble finding partners to fill the gap.

Renee-252019 I worked in a nursing home on the weekends and do you wanna know what the problem is? Doctors don't work at the nursing home. The whole time I worked there, the doctor came in once a week. That's bad about your uncle, but you have no idea how much trouble workers can get in trouble if he fell. They probably tried to get a hold of the doctor or more importantly the physical therapist and couldn't. Many of the residents I worked with at the home said they could walk even though they really couldn't. If the workers would have helped him and he fell, they would have gotten fired. Bedpans aren't the best, but they're not going to hurt him. So between the choice of possibly getting fired or putting him on a bedpan, I'd choose the second. Don't blame the workers because they wanted to keep their jobs.

The situation damned near kill my father in law recently. This situation gets exponentially worse if the Patient is Elderly. We made sure that a family member was with him 24/7. And yet the incompetents still get well paid while they kill patients.....

Dave..I agree...and being a nurse, you got your head chewed off if you dared call the on-call doc for anything...the docs that did do rounds, came in in their golf clothes and glanced around for all of 15 minutes and left-never to be heard from again. You maybe had one nurse supervisor fo the whole building....speciality procedures were staffed by on-call people....noone was around......it's not surprising more deaths occur on weekends....

Dave, I agree but, lets take into account the types of patients admitted over weekends...gotta fill those empty beds lest the Medical Machine loses $$.

I worked in medical for 35 yrs. and I saw first hand what types of patients came in on Friday afternoon. The medical teams are on call for nursing homes in the area. Healthy post-ops are disch. by Fri. and the beds are filled with nursing home patient that are on deaths door step.

Also, skeleton crew for weekends that are far less experienced.

Not everyone wants to work weekends and an evening nurse can be in charge of 56 patients plus have two of the sickest patients to take care of. Thats why I went into the OR no help on these floors and this was the 1980's so I can't imagine what its like now. My advice is that you need your family to help out and its only going to get worse. You have to thank the people who decided to reduce the nursing schools and medical seats in the US and Canada in the 1980s and beyond for this mess and the incompetent finance and nurse managers that they keep rotating through these hospitals. Good luck.

Could be worse. In most countries that have national health care, people die in parking lot waiting to get into the hospital due to a lack or resources on a Monday-Sunday basis.

LMAO, so true. I have to say that nurses are very horny. I can attest to many encounters in my day with nurses especially on the weekend when all the bosses are not around. I loved working the weekend because there were no bosses. I love nurses, they are great and a lot of fun. Enough said!!!!!!!!!!!!

Amen. Nurses are great in the sack and overall much fun. I lived next door to one once. YeeHAW!!

Bingo!!

Stal...You hit the nail on the head exactly. I've been working as a clinical case manager at in a large hospital system, could be we're working at the same one by your description of the way things are run.

i also agree...but I don't think its all to save money

doctors and nurses are human, and want to take the weekends off. One person takes turns covering the practice's patients on the weekends, and doesnt know them as well, so things like this happen

I dont doubt this happens in ALL systems, maybe worse in socialized systems as they truly have NO incentive to come in (at least US docs get paid if they do a procedure or see a patient over the weekend)

And I think your being a little hard on your collegues. I doubt anyone on this message board works 7 days a week/365 days a year

And I find some of the biggest culprits that are soooo poor are the big corporate chains. I installed OR software for a large corporate chain and those nurse were runned ragged. I just want to know how much the CEO and all of them make...its just sickening how they treat nurses in this country.

nurses are overworked and underpaid

I hear you and feel your pain! Although I am not a Nurse, nor do I work within the health care profession, I am well aware of the plight which you describe, and know it to be completely true. It is simply my humble opinion that this country is predominantly run by politicians consumed by greed who have allowed, and even aided, the insurance companies with getting the citizens of this country by the short hairs. I must say also that the court system has helped with this regard as well by entertaining frivolous law suits and even awarding them with unbelievable settlements. Simply amazing...

i don't recall you saying anything like that...

had you said that more people do worse on the weekends than weekdays I would have agreed

Same goes for night shift vs day shift

Listen, we're all human, we sleep at night and like to have weekends off. IF you have doctors work 24/7 youre going to have a bunch of overworked physicians making mistakes from lack of sleep

But, obviously this is a problem, and we need to try and address it.

If you could tell me exactly what you said, and what I disagreed with, that would help

But i think you're being vague on purpose...

let me save you the trouble...i found the post I think you are talking about...

"And just try getting into a doctors office on Wednesday, Saturday or Sunday..Don't dare have a coronary on the weekend you will get an intern..."

Again, false! An intern cant do your cath! Not even a resident! And even a cardiology fellow 7 years out of medical school needs an attending present! And your rant has almost nothing to do with INPATIENT medicine--thats the focus of this article

I seriously question your reading comprehension

And I'm on call tomorrow. So while youre in bed, SLEEPING, I will be at work trying to prevent the above from happening. Even to you

Eric,

I believe you're incorrect that you need an attending with a cardiology fellow of 7 years to do a cardiac cath....let's get real here.

This guy has to be one of the STALKER visitors who show up AFTER hours and DEMAND to talk to the doctor at nine O'clock at night. ..people who are too stupid to understand ANYTHING you tell them

These people are hardly worth replying to.

Nightnurse,

Who what guy are you talking about?

rescue dogs,

Yeah, actually, to do one unsupervised you do. A first year cardiology fellow can do cath if the attending is present in the room, scurbbed in and assissting. But even 3rd year cards fellows get shoved aside for STEMI calls. Maybe the 4th year (interventional) fellow can do the STEMI (acute heart attack), but again, only with the attending present

That's the way it is...and I finished cards fellowship not that long ago. And its the same for everyone in fellowship, across the country, so don't try and tell me its institution dependent.

You have to remember, trainees have no privveleges at a hospital. They see patients and do procedures under their staff's privelege rights--usually means he has to be present for something like a cath, especially an acute heart attack

Rescue Dogs - I did not realize you were a physician or cardiologist? So - how is it suppose to work -- since Eric is incorrect -- according to you?

so i assume YOU work EVERY saturday and sunday

yeah, right

Wouldn't it be something if restaurants and gas stations cut their staff to the bone on weekends, and said tough luck just wait until Monday. Hospitals get away with it because the medical system operates as a single business, like a giant monopoly. There is no competition in the usual sense. An ER doc told me once that our medical system is a combination of the worst of socialism and the worst of capitalism.

The main reason for this, whether people choose to accept this as fact, or not, is that the *American* Healthcare system is PROFIT-BASED and hospitals are run like corporations, and operate toe-in-toe with for-profit insurance companies, as such. All these people complain about taxpayer-funded Universal Healthcare... and then they turn around and complain b/c hospitals are operating on skeleton shifts, off-hours. As long as you have private insurance companies screwing over people and hospitals, this is the way things will always remain. First, you'll get screwed over by the insurance companies and then you'll get screwed over by the hospitals because they want to keep operating costs minimal, so as to maximize profit in the even that people can't afford their hospital bills because the insurance companies find some BS reason to reject your claim and drop you. Try watching the Michael Moore documentary, "Sicko", and I guarantee that by the end you'll be fuming in your chair over what the American health care system is like compared to other countries.

you better believe canadian and english doctors on salary are NOT coming in for anything after they clock out

This is actually the one time the profit motive WORKS. If you can make a grand working a weekend, that's pretty good motivation for working

Now I can already hear the responses--doctors should do it anyway, because lives are at stake

True...but how many days did you work for free?

Well "Nightnurse" - we know that is not true -- don't we? Those in the health care field are there to save lives - not take them by intentionally providing haphazard or less than professional service. The very idea that health care professionals do not take their job seriously is just absolutely ridiculous and anyone who intimates such - clearly has a serious disconnect.

As with any job - there are some performers who have challenges and those individuals must be re-trained or removed - if the problem is serious enough that it cannot be addressed through re-education or training. Our margin of error is much smaller and our errors are much more visible than in most other professions.

Nightnurse06, That is not the point I was making. People wouldn't put up with gas stations and restaurants running on minimal staff during the weekends. There would be some that did run full service on weekends and they would get all the business. People shouldn't put up with minimal staff on weekends at a hospital. Patients can't take time off on the weekend from their medical problems. Trouble is, the medical system gets away with it because the medical system operates like a giant monopoly or socialist mini-government.

That's right...I get paid no matter if you live, or you die.

and if you are ugly...we DO let you die quicker..we actually have paper work that rates your level of attractiveness on a scale of one to ten...so make sure you get your hair and makeup done before you are admitted.

( holy crap...there are a ton of a$$ holes in the world)

Nightnurse -

The thin disguise of your moniker is giving way to reveal the true shallowness of your character.

Particularly with all the inflammatory and abusive name-calling you seem to have a need for in practically all your postings on this thread. It would appear that you may well be the very foundation of characteristic traits for horror movies involving a psycho-pathelogic megalomaniac in a hospital or nursing home setting. And with your posting directly above, one might even venture to suspect that it wouldn't be beyond you to assist someone being shuffled off this mortal coil sooner than they should. You certainly are not worthy of the respect and pride that goes out to anyone serving honorably in the nursing profession. Matter of fact - You are quite the contrary. It's actually shameful what you bring to the discussions being carried out here.

Bravo

You my very verbose friend, are probably just another A$$ hole that we thinly disguised shallow psycho-pathelogic megalomaniac nurses have to deal with on a daily basis. We love caring for the sick...but then...... a jughead, boob, bozo, buffoon, numbskull,numbnuts, lummox, dunce, moron, meatball, doofus, ninny,nincompoop, dipstick, lamebrain, chump, peabrain, thickhead,dumb-ass like you.... walks into our unit and makes it all seem like torture. We smile to your face..and here come the thinly veiled part....smile to your face as we curse you under our breath....

Bravo to your cute little diatribe however. :)

nightnurse,

I'm beginning to thing you're a troll. "psycho pathological megalomaniac"?

You're not a nurse, and give anyone who reads this gives an incredible impression for those of us who have put in number of years of education, and many years of service. Go and troll somewhere else.....and that you feel you need to do this to get attention, perhaps you might check with a local psychiatrist, or perhaps an anger management specialist.

...

tsk tsk...i've done all this with a smile...you my dear are the one who is angry recue dogs62

"psycho pathological megalomaniac"?...these are the words thunder proof used ...I was quoting him....

by the way..talk to nine out of ten nurses who have been in the field for over ten years...and you are going to meet someone with s sense of humor very much like my own....one has to be this way...the horrors we deal with every day are enormous....and the pain in the butt people we run into are abundant....if you could hear how we vent in the back room...you would see that there are a lot of pretty awesome nurses just like this.

Nightnurse06,

I've was in nursing for more than 25 years, worked days, nights, speciality units, out patient specialties, at a number of facilities including for profit hospitals and those affiliated schools of medicine, and as a director and have certainly had my own group of horrors including trying to debride the braids and scalp of a nine month infant who had been held against the radiator by her drug addicted parents. She couldn't be given any additional pain medications because she had received them with paramedics and ER. I could list a number equally as horrible.

Yes I've heard humor, but in all my years I've never been around nurses who have so much disrespect for their patients. If I seem angry, it's because I believe that you represent the very worst of nursing. I don't see what you are saying as being funny, and I'm familiar with black humor. Perhaps the people you run into who you see as a pain in the butt, are that way because that's the way you treat them. I've had the totally opposite experience., so maybe our approach is different.

Nightnurse, I apologize. My comment was not aimed at any particular person, nor was it meant to offend any doctors or nurses (at least the ones that do their job correctly). My comment was aimed at the doctors and nurses "that are only in it for the money and the lavish lifestyle". Some doctors make millions and some make far less, but I doubt you will ever meet a doctor that doesn't live comfortably. And many people have taken the position for that reason. That's not a good thing for obvious reasons. A doctor should be a doctor because they enjoy helping others, not because the pay is good. That kind of choice leads to a dangerous path.

We all need to pray...that we can be more like Rescue Dogs 62....special in every way..and living with his/her head so far up his/her arse that he/she can't laugh, or even read the sarcasm between the lines....pull your head out and laugh...and tell me that in your "25 years" of extensive service to humanity that you never ever made an inappropriate joke on the job...then you can throw your stones.

Nightnurse06,

As I sat by my Dad's bed for 14 days as he was dying, I'm so thankful you weren't there. I wonder what type of nurse you want there, if you're even in that place.

I actually am quite good at what i do. as are all the other people i work with.

watching one's parent pass is devastating my sympathy goes out to you.

But rather than live in a lofty fantasy world where people don't annoy us....we admit that the whole field can be overwhelming....we laugh....and vent some pretty strong stuff to each other. If you never did so...that is wonderful.

stay well

Nightnurse06

I appreciate you sympathy, thank you.

We all need to pray...that we can be more like Rescue Dogs 62....special in every way..and living with his/her head so far up his/her arse that he/she can't laugh

I have never indicated that I've never had a laugh, or had patients or families that are difficult and frustrated me., and certainly not that I'm special in every way. I've worked acute locked psych, for heavens sake.

I certainly don't have some lofty fantasy as you say. It's your overall attitude about your patients and families in your postings that I don't find funny, nowhere do you indicate that what sounds as contempt for patients, families, etc. is unusual.

Are you perhaps an ER nurse?

You may be very good technically in what you do, but I stand by what I said before, I wouldn't have wanted you there.

I can start and regulate I.V.s, draw bloods, suction patients, watch monitors, measure and records I &Os. Watch for infiltration, assess levels of consciousness and any other myriad of things that nurses have to do, some of which I did when my Dad was there, to take some load off the nurses and they were appreciative.

I didn't complete my posting before I had finished editing my post of 16.11.

The reason I asked if you worked ER is that trauma nurses have fantastic skills, and have to deal with difficult families in crisis, but don't usually have a longer relationship with the patient or family, and if that's so I could have a better understanding of where you're coming from.

Nightnurse,

If your point on this thread is to prove that healthcare professionals are intelligent, compassionate, and capable, you really aren't communicating that point very effectively with posts like #18.1 (and many others above). Quite the contrary, in fact.

No one here is slamming all health professionals. My own daughter is a hospital-based radiologist. But the data in the linked article (based on a study of 30 million people) shows that weekends in a hospital are more deadly. Period.

And if you really are a nurse, you aren't representing the best side of your profession with statements like 'BUTT WIPE', 'A$$ hole', 'NUMBNUTS', 'A-holes', and the like.

You might want to rethink your strategy. It's embarrassing. And it's demeaning to all those hospital professionals that really do care about their patients.

Um, nightnurse, I did not take her to the hospital. I was not even consulted about the stupid decision to do so. I live 400 miles from where she was then located (it was her choice not to relocate to where I am.) I begged repeatedly that the assisted living facility where SHE chose to be NOT call 911 and cart her off in an ambulance for these episodes, to no avail. She is now living two miles from me; and, trust me, will NOT be hospitalized for this again. Not that it is your business, but had I signed her out against medical advice, she could not have returned to her home. AND while not in need of hospitalization, she was not in a condition to make a 400 mile drive.

Sorry about your mother...having an ill parent is very difficult

Thank you for your concern. I appreciate it much more than your first post, which made several unwarranted assumptions.

Wow, just wow

So you want a doctor who just worked 280 hours in a row doing your surgery?

Smart

Eric,

You seem to be playing a pity potty role, or just haven't been around that long. Without government regulations, physicians certainly were getting kick backs from lab works and other procedures. I've worked in several renowned School of Medicine and private practice for more than 30 years, and I've seen med students, interns, residents and fellows come and go., and this is not unknown.

As far as you, with a 7 year cardiac fellowship needing an attending present, give me a break. I've had a cardiac cath and there's no way is a requirement, unless you're talking about "signing off." You have heard the old adage, "see one, do one, teach one" haven't you?

alrino333..just another a$$ hole with a sense of entitlement who thinks medical professionals owe him/ her something....though he/she has contributed NOTHING.

rescue,

you have the sound to me of someone who may have been on the sidelines for years and thinks he knows the way the game works

I don't know what a "pity potty" is nor do I understand the rest of the first part of your post. All I know is that kickbacks and the like are illegal, and if you saw it happening, you saw crime and fraud being committed. If you have proof this was widespread at some place other than your institution, I would love to see it. Otherwise, i'm forced to believe it was just some scattered incidents that will happen no matter what you do when human beings are involved

Every cath I did in fellowship, there was an attending in the room or in the control room. For the routine cases, sure, it was more of a supervisory role. However, this article deals with poorer care on weekends, and someone implied that that was due in part to "interns doing caths"

My first comment was two fold--one, interns never, ever, ever do caths

Two, even on the weekend, in an emergent situation (typically the only caths that happen on the weekends are emergent) an attending is present and ACTIVELY involved. Moreover, the fellow in those cases is almost invariable an intervential cardiology fellow who is a PGY 7

I would get your facts straight since this is the second incorrect post of yours in a row

Eric,

I haven't been on the sidelines for years, but I've been in health care for years at a number of different well known facilities. You are relatively new, and yes kick backs occurred, and were not that infrequent. The point I was making was yes, with government intervention it is NOW illegal. I was not speaking of interns, residents and fellows getting kickbacks, I was speaking of physicians who owned or partially owned labs,radiology centers, surgicenters, etc which benefited directly from the number of tests that were being ordered. A MAJOR hospital chain provided physicians bonuses for the number of patients they admitted, until they were caught, and this occurred with in the last 15 years.

That is not an incorrect statement.

I realize that the article is about weekends, but you made a general statement,

Again, false! An intern cant do your cath! Not even a resident! And even a cardiology fellow 7 years out of medical school needs an attending present! And your rant has almost nothing to do with INPATIENT medicine--thats the focus of this article

I'm challenging you on that, not all cardiac caths are done following MIs.

Lastly, although I've been out of bedside inpatient nursing for quite some time, going into nursing specialty fields and finally as a clinic director of research at a major school of medicine, I believe, unless it's changed that a hospital is reimbursed a certain amount for a specific diagnosis, i.e. DRGs. If a patient is discharged more quickly and the hospital still has the same reimbursement for the diagnosis, if they're a complication, or they need to stay in the hospital longer the hospital takes a loss, if the patient is discharged earlier than expected they make money, but that's not a paid bonus for early discharge.

That, also is not a false statement.

of course not all caths are done following MIs, whats your point? When did I state otherwise? I've performed plenty of diagnostic caths in my life

I even stated that earlier the ONLY caths that happen on weekends are emergent--implying that other, nonemergent caths are scheduled during the week.

The whole cath issue started because someone said interns do caths on the weekends. I said that is false because A)interns don't cath, and b) most caths happening on the weekend ARE likely emergent and as such, an attending will be actively involved if not doing most of the case. IN addition, at the very least, it is a PGY-7 fellow assisting, not an intern

As for self referrals, when did I say anything about residents/fellows getting kickbacks? Im not sure where that is coming from. Anyway, the whole deal was made illegal in 1992--almost 20 years ago--if you saw it occuring more recently than that, then again, i have to say its probably an infrequent occurence unless you have proof showing otherwise

http://en.wikipedia.org/wiki/Stark_Law

As for the last part of your post, you are confusing who the bonus is paid to. I didn't say it is paid to the hospital, i said HOSPITALISTS. A hospitalist is a physician who sees people exclusively in the inpatient setting. And yes, they get bonuses if their LOSI (length of stay index) is below the national average.

Speaking of that, its not as bad as it sounds. INcreased complication rate, mortality, morbidity, need for rehab, decubitus ulcers, and UTIs are all positively associated with longer hospital stays. Discharging people as soon as medically is safe is a good thing. And remember, if you rush and do it too soon, and they get readmitted within 30 days, that counts against you ,and the hospital is not reimbursed for the re-admission. People are aware of that, and physicians do their best to avoid it

Eric,

Yes, I know what hospitalists are, please see my post #5.2, I apologize for my error, regarding hospitalists, I read your post too quickly and thought you said hospitals.

I also apologize for my comment about the pity party. It was a heat of the moment response, and uncalled for. BTW a pity party is like a "woe is me" comment.

haha..no need to feel bad...i do the same thing on these boards--it allows me to blow of some steam...i didn't take any offense

Good Job Eric - the Stark Law and Anti-kickback Statue are alive and kicking - if you are found in violation - you will be in some serious trouble. You are very knowledgeable even about the financial piece - which is not normal. It is nice to hear a physician that can articulate the entire scope of the health care regime. Many are so focused - that the financial piece and its repercussions are far from their mind. I think the majority of it should be for the most part. I feel safe saying this - after being in health care for over 25 years and a part of senior management for a majority of those years.

I can't tell you how many physicians I have had to pull privileges for violation of Stark or address issues of violations with Anti-kickback in conjunction with a federal investigation. The medical director and myself are almost one in order to keep everything above board even as we move through the medical "due process" to address a patient care issue at any level.

I enjoy health care and I chose this field for a reason - to do my part to enable facilities to provide quality care to patients and bring new and cutting edge procedures to the table in an effort to save more lives. No matter what role you play in the healthcare organization - it is an important one.

thanks...my parents are involved in insurance billing so I have a little more background than most

yikes...i had no idea fraud and self-referral was so widespread...it certainly gives credibility to rescue dogs claims..

thats actually a very astute observation

I borrow from churchill and always tell people "the worst place to be is the hospital, especially when youre sick"

I live in Vegas and that's especially true if you live here. Medical care here is a joke.

as i said earlier, i think the greed portion actually works in our favor. Try getting a salaried doc in on the weekend

Yes, I read that article. The most disgusting thing about it is that was that the insurance companies are now poised to raise rates for NO other reason than they have become accustomed to collecting premiums and not paying out for services. They are raking in the dough and have decided to continue to do so. Therefore, they plan to PREEMPTIVELY raise rates because people will start to actually USE their health insurance again. Imagine that. Rapists.

excellent points. I agree with just about everything you said

I remember getting sign out in residency--almost useless. You just prayed you could keep people alive until morning

What specialty are you?

I am not a hospitalist. My motivation for becoming a physician was from my Mother (a nurse) and older sister (an occupational therapist). They showed me that is a honor to help make people feel better in there time of need. Medicine has unfortunately become tainted by big business (insurance companies, etc), litigation, financial uncertainty and man power shortages. It no longer allows you to focus your undivided attention on who matters most, the patients.

Student Loan'd,

Then listen to your mother. I agree that insurance companies have made patient care a disaster. The fact that some want a mastectomy done as an outpatient surgery, or at most a one day hospital stay is more than a travesty.

I find it interesting that most of my specialists, who have thriving practices are in favor of universal health care without having to deal with all the private insurance, for profit, garbage. Medicine, whether by physicians, nurses or other auxiliary medical staff should be about making a difference for the better in a person's life, and being able to meet the individual need of that patient. As a retired nurse, I found specialities where I could do that, and although I didn't make a fortune, I could pay my bills and go home knowing that I made a difference because I was there. That's what you need to seek for, because it's possible. Don't give up, if that was really what motivated you, then strive for that.