The SGR S-U-C-K-S!

So as I transition to my PJ's I realize that there is nothing finer than this feeling. At home. Resting. What a long week it has been. Not sure why it has been so tough, aside from the fact that I need a vacation and really didn't want to be at work. My day was capped off by realizing that my government truly has let me down. Congress today failed to stop the SGR (sustainable growth rate) formula for Medicare reimbursement. So as not to bore you with the intricate details of Medicare regulations, the SGR calls for roughly a 5% cut in reimbursement to physicians per year. Nevermind that Medicare only pays roughly 35 cents for every dollar I bill. Problem is that Congress has been putting this off for the past 3 years so the effect is cumulative-by inaction today to change the SGR, I am now going to have my reimbursement from Medicare cut by 21% on Monday. Because what is good for the government must be good for private pay insurance companies, I am sure that they will follow suit soon and I am looking at probably a 21% pay cut across the board. Tell me what other business would allow this to occur? I am not sure where healthcare is headed, but pissing off the ones who deliver it is NOT a good idea. Trust me. I expect doctors to still do well, don't get me wrong. I just expect it to get ALOT worse for the patients-all because partisan politics and public grandstanding is more important to politicians. I expect elderly patients to suddenly lose their doctor because the Medicare population has now become too much of a financial liability, too much work for not enough reimbursement. I expect doctors to begin to take cash only and let the patient file their insurance-trust me, that is a nightmare physicians deal with daily and it is not for the faint of heart.

Sorry. I just got carried away there....Just really not sure what is going to happen with Medicare and this silly SGR. I do know that what Washington doesn't want is a bunch of pissed off octogenarians that still believe in their individual right to vote. Politicians know that it is political suicide to f*ck with social security and with Medicare, yet they continue to play this game of political chicken. Good luck with this one Washington. It's an election year, and I see a lot of Medicare patients....

The Fire List

It is freezing here in my office. That is the one good thing about being busy-too little time to be cold. I have been moderately busy this week which is concerning since I leave for Rome in less than 2 weeks. If papa ain't working, papa ain't gettin' paid and I won't be getting bank for 3 of the upcoming 5 weeks (10 days in Rome then 10 days in La Jolla, CA for Spring Break). I am busy enough however to fire a patient. Yep. That's right. I fired my Arch Nemesis. And it felt GOOOOD. This woman has been a pain in my side for over 3 years, requiring countless hours of busy work and rearranging my schedule to fit her needs. She was never appreciative, never said thank you-she just expected me to drop everything and fix her issue, right then, right there. No concern that I had over 3000 other patients that I care for....HER issues came first. I found the opportunity to cut the strings and I did it, and I felt and currently feel great. No remorse. No second thoughts. In my opinion, maybe I should fire more people that absolutely terrorize my day, get under my skin and make me want to quit medicine and work as a Walmart greeter. I think it would be good for everybody to fire those in their life that weigh them down and jettison the baggage that is dumped on people daily. Life would be better, anger and frustration would diminish and depression rates would take a nose dive. I am not saying piss off everyone by telling them to take a hike. No, I am talking about a dedicated few, lets say less that 5, people that really agitate the remaining nerve you may have left. We all know who they are, and if you don't, you may want to make sure you are not on somebody's "fire" list. By decreasing the drama in your life, maybe, just maybe, you can get up out of bed again tomorrow...

After reading the above blog I realize how pessimistic I sound. Geez. I need a vacation I think. Good thing I have a bunch coming up. I think sometimes just the act of writing out the frustrations calm the demons and cooler heads prevail...

I hate waking up in the morning....

So I haven't blogged in a while. It seems I have to be struck by the moment...Anyway, today was busy. It started off with my normal misery of crawling out of bed at 6 am. Mind you my wife was already up exercising (she is THAT good) but 6 was plenty early for me to roll out of bed. My dog seems to have an alarm clock in her tummy. 6 am-Daddy wakes up. 6:10 am- FOOD. 6:15 am-back to sleep. For her. Not me. Her alarm clock has no bells or whistles, buzzes or music. then paw Daddy's face. Nice...

I proceed to groom myself then head out the door to the hospital. It is always an interesting visit with my patients. They act as if I am visiting them in the dead of night, bringing with me news they can't understand, words too big to comprehend. I examine them, tell them the plan for the day, leave the room then wait the standard 2 minutes it takes for them to realize that they just dozed through my entire conversation with them. I then have to go back in and go over it all again. What a waste of time. I have considered going into their room, turning on all the lights, pulling back their covers and saying "WAKE UP! Now I will be back in 5 minutes to talk to you. Just wanted to give you some prep time...." That, of course, doesn't happen as that would be considered cruel and unusual punishment....That reminds me of a story from my days as a Nurse's Aide...****Harp music accompanied with dream sequence inserted here****. It was 430 am and the charge nurse said "Hey Captain O (story behind that name for another blog entry), go give Mr. Jones his enema this morning to prep him for his rectal surgery." I get the bag, fill it with water and soap (it was a SSE after all-soap suds enema), get the tubing all set up next to his bed then turn on his lights and say "Mr. Jones- wake up please. It's time for your enema." Mr. Jones responds "what's an enema?" I just smile and say, "Just roll over please..." ****Cue the harp music and dream sequence again****.

I guess what it boils down to is that no one really likes to be awakened from their deep, unencumbered slumber-Not me, with a paw to the face; not the patient with the early morning rounds; and certainly not Mr. Jones by the freckly red headed sadistic Nurse's Aide wielding his sudsy bag of ass cleaner...

Boredom at work on a Snowy Day...."Live Blog"

9:17 am: My printer is being a bitch. I am going to treat it as such...

9:23 am: Listening to Squeeze's song "Black Coffee in Bed". It is exactly where I would like to be at this moment. Damn sick people...

9:38 am: Waiting for my 1st patient. Excitement abounds...

9:59 am: My pants are intermittently vibrating. Probably a good idea to stop drinking coffee now...

10:03 am: Getting to a point where I may have to ask people walking by on the street if they feel sick and want to be seen. SLOWWWWW.....Or should I say SNOWWWWWWW....

10:41 am: Hooray! Just saw my first patient! Although I am a little sad that I missed the no hitter...

10:47 am: Reading up on the latest treatment for Hypertension. Man, this sh*t never gets old...

10:59 am: Just received this picture from my sister. It is of Abby, my middle child...So cute...It has just made my day...



11:42 am: Just had a patient say that they were watching Nash Bridges the other day and had to fast forward through the commercials. I call foul on 2 points: Watching Nash Bridges in the first place, and second, setting your DVR to record it....

12:05 pm: I wish I were home sledding with my children...

12:40 pm: This "Live Blog" thing is taking its toll on me. I think I will sign off for the day....I am sure everyone would agree that this has gone far enough...

My Little Greek Tragedy...

My daughter Abby is being a bear. Not to me, but to my wife. It seems there is some sort of personal angst directed at my wife but not at me. I know people say "Get used to it. Mother/Daughter relationships are like that" but good God, this is near schizophrenic. Example: Abby: "Don't look at me!." 2 minutes later: "You didn't wait for me! Hold me!" Really? What is going on in that little brain is beyond me. She is fine at school but saves it for my wife. I don't seem to be invited to her own personal vendetta/love affair. I wish I could help but I am not the target...Very frustrating and irritating....Oh well. Will just keep plugging along and making myself available if Abby ever decides to change her focus...