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MedicalTuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party or single-payer health care felt these meetings were counter productive and they essentially disappeared. Rationing, a common component of government medicine throughout the world, was introduced into the United States with Health Maintenance Organizations (HMOs), under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision making, the reverse of what was needed to control health care costs and improve quality of care.

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In This Issue:
1. Your Medical IQ (Imagination Quotient) Is Critical for Survival
2. U.S. Attorney Promised to "Root out Doctors like the Taliban"
3. British Medicine Kills - Or so Professor Ralph R. Reiland Reports
4. A Continuing Review of Corporate Socialized Medicine - HMOs
5. Medical Gluttony: Using Health Care Resources Waiting in Emergency
6. Medical Myths: Shaken Baby Syndrome (SBS)
7. Overheard in the Consultation Room - A New Way to Commit Suicide
8. The MedicalTuesday Recommendations for Restoring Accountability in Medical Practice, HealthCare and Government

As the production of goods and services increasingly becomes routinized, the cost advantages across a growing array of industries accrue to China and India. Our companies will continue to prosper only if they push to the higher ground of innovating.

The upshot, says Martin, is nothing less than the emergence of the design economy -- the successor to the information economy, and, before it, the service and manufacturing economies. And that shift, he argues, has profound implications for every business leader and manager among us: "Businesspeople don't just need to understand designers better -- they need to become designers." His words, we think, also speak to the Health Care, Hospital and Insurance business.

In a global economy, elegant design is becoming a critical competitive advantage. Trouble is, most business folks don't think like designers. When confronted with a mystery, most linear business types resort to what they know best: They crunch the numbers, analyze, and ultimately redefine the problem "so it isn't a mystery anymore; it's something they've done 12 times before," Martin says. Most don't avail themselves of the designer's tools -- they don't think like designers -- and so they are ill-prepared for an economy where the winners are determined by design.

And that, Martin claims, means traditional organizations must reinvent themselves to perform more like design shops. In this new world, there are fewer fixed, permanent assignments. Instead, work flows from project to project, and people organize their lives around their projects, just as in a design shop. Accenture, for example, is more efficient in part because it's a project-based organization -- it doesn't staff up for things that aren't projects, and it doesn't allow projects to become permanent.

To read Breen’s entire article, or subscribe to Fast Company, go to www.delmeyer.net/hmc2005.htm.

2. U.S. Attorney Promised to "Root out Doctors like the Taliban"
The U.S. attorney who promised to "root out doctors like the Taliban" has recommended that a federal judge sentence Virginia pain specialist, William Hurwitz, M.D., to a life sentence.  Most other convicted pain-management doctors have received sentences much shorter than the one recommended in this case.

Dr. Hurwitz was convicted on 50 federal charges in December in relation to his prescriptions of legal painkillers. The government claimed that Dr. Hurwitz knowingly prescribed medications for patients to sell.

Dr. Hurwitz's defense demonstrated that the patients in question were experienced con artists who also managed to con the DEA as well.  At least two of the prosecutor’s “star witnesses” were getting prescriptions from other doctors even while being “handled” by the DEA as they went undercover to gather evidence against Dr. Hurwitz.

As defense attorney Hallinan said, "these people were predators...and had played doctors for years" to get drugs.  And that it was because of Dr. Hurwitz's belief in his responsibility to treat patients in pain without making judgment about whether they were good enough people to “deserve” treatment.  “His belief in his ethical duty is the key to the door of his office for these thieves and predators.”

The Washington Post quotes the stunned reaction of Russell Portenoy, chairman of pain medicine at Beth Israel Medical Center in New York:  "That's really something. That's unbelievable...Such an extreme sentence sends the message to the medical community that the government will continue to go after doctors."

It would be important for the AMA as well as our state and local medical societies to vigorously support the autonomy of physicians to practice clinical medicine without the burden of playing prosecuting attorney and judge on every patient we see.

3. British Medicine Kills - Or so Professor Ralph R. Reiland Reports 
In "Die in Britain, survive in U.S.," the cover article of the February 2005 issue of the British magazine the Spectator, James Bartholomew details the downside of Britain's universal health care system.

    * Among women with breast cancer, for example, there's a 46 percent chance of dying from it in Britain, versus a 25 percent chance in the United States.

    * If you're a man diagnosed with prostate cancer, you have a 57 percent chance of it killing you in Britain; in the United States, the chance of dying drops to 19 percent.

"That is why those who are rich enough often go to America, leaving behind even private British health care. In America, you are more likely to be treated," writes Bartholomew, "and going back a stage further, you are more likely to get the diagnostic tests which lead to better treatment."

    * More specifically, three-quarters of Americans who've had a heart attack are given beta-blocker drugs, compared to fewer than a third in Britain.

    * Similarly, American patients are more likely than British patients to have a heart condition diagnosed with an angiogram, more likely to have an artery widened with angioplasty, and more likely to get back on their feet by way of a bypass.

Taken as a whole, Britain's universal health care system has evolved into a ramshackle structure where tests are underperformed, equipment is undersupplied, operations are underdone, and medical personnel are overworked, underpaid and overly tied down in red tape. In other words, your chances of coming out of the American medical system alive are dramatically better than in Britain, explains Bartholomew.

Source: Ralph R. Reiland, "Survivors More Common in America," Pittsburghlive.com, March 2, 2005; based upon: James Bartholomew, "Die in Britain, survive in U.S.," Spectator, February, 2005. For Reiland's complete text, go to www.delmeyer.net/hmc2005.htm.

4. A Continuing Review of Corporate Socialized Medicine - HMO
Last week, we were asked to pull 29 charts for review. (The other physicians in my building received similar requests.) The request came from the Centers for Medicare and Medicaid Services (CMS) and the Medicare-HMO stating that they had entered into a Business Associate Agreement with a vendor in accordance with the Health Insurance Portability and Accountability Act of 1966 (HIPAA). This allowed them to disclose Personal Health Information (PHI) to another covered entity without an enrollee's (patient's) authorization or consent. The purpose was for quality assessment, disease management, competency review of health care professionals, evaluation of physicians’ professional performance and evaluation of health plan performance.

They reminded us that a signed consent from the patient is not required for us to release this confidential information to Medicare, the HMO or the private vendor. They required the use of my duplicating machine, since they were going to copy each patient's entire record for all of 2003 and 2004, and the use of one room of my office for the entire day. Since the duplicating machine is next to our 1000-patient chart file, we reminded them that they could not work in that area because of HIPAA requirements. So they brought their own duplicating machine. They did not feel obligated to pay for the $125/day rent, or for my staff or myself. Since they were looking for specific items, such as patient's demographic data,  problem lists, history and physical examination and progress notes, I had to review each chart to make sure the data was in order for their review. Even at 10 minutes per two-year record for 29 patients, that does add up to 290 minutes or five hours of my after-hours time, without pay. How many workers, including professional people like nurses, attorneys or accountants, would be willing to work an extra five hours after closing their office without pay? The medical profession has been taken hostage by the government-insurance complex with the acquiescence of the profession and without a significant fight by either the doctors or their professional organization.

When I inform my patients that their Medicare-HMO was in to make photostats of their confidential file, which in the current milieu has to include drug, alcohol and sexual matters, they react in horror that the government can intrude to such an extent.

The contract worker for the day stated that when the government completes the Electronic Medical Record (EMR) requirements currently on the federal health care agenda, it will be much easier for them to acquire every patient's record electronically from every doctor or hospital that sees Medicare, Medicare-HMO or Medicaid patients. If the government ever controls the electronic medical records in this country, they can more easily transfer every medical record into their own computers. With four million federal employees reaching into every major city throughout the country, every patient could have a federal employee that knows them and probably could access their confidential file. That would be equivalent to publishing the patients confidential record in The Wall Street Journal, The New York Times, and the Los Angeles Times. Since there are so many federal contracts with states in health care, the states have an additional 18 million employees in their work force. We all know state employees who would love to access our confidential file. That would be tantamount to publishing the patient's medical record in every major newspaper in every state of the country.

We've accomplished more government intrusion with HIPAA in this country than the Bolshevik revolution ever dreamed of and without firing a single shot. www.delmeyer.net/hmc2005.htm

5. Medical Gluttony: Using Health Care Resources Waiting in Emergency
A forty-year-old lady with a tender breast bone that she called chest pain in the hospital emergency department, spent four hours in an exam cubicle from, 8 PM to 12 MN. The triage team had ordered a chest x-ray, electrocardiogram and a number of lab tests. She was told at midnight that it would be another six hours before a doctor would be able to see her. She then left with the pain did not changed. The next morning, she scheduled an urgent office visit, went by the emergency departments and brought the x-rays, ECG and lab work to the office with her.

Her tender chest pain was costochondritis, a benign painful cartilage between the sternum and the ribs, which took ten seconds to diagnose. I immediately gave her two extra strength acetaminophen tablets and continued to see other patients. On returning to her room twenty minutes later she felt much better and returned home. The chest x-ray, ECG and laboratory work were all unnecessary costs, as was the entire emergency visit.

How can this be avoided? As long as ER visits are relatively free to the patient ($15 to $50 ER copay are not market based and thus have no major effect on excessive utilization), there will continue to be overutilization and exorbitant costs. A percentage copayment returns the ER to the market-based controls. If the patient pays a percentage of every test and procedure, the patient will put a stop to excessive utilization and use normal channels of health care, like the doctor’s office visit, which is the most cost-effective health care expenditure. www.delmeyer.net/MedInfo2005.htm

6. Medical Myths: Shaken Baby Syndrome (SBS)
Publicized Shaken Baby Syndrome (SBS) charges or convictions have now risen to two a day according to the counsel for the Association of American Physicians and Surgeons.  Prosecutors like these cases because it gives them almost guaranteed high-profile convictions.  Jury acquittals are very rare, though I see that defense testimony by Dr. Janice Ophoven, a pediatric forensic pathologist from Minnesota, just won a jury acquittal yesterday for a teenage baby-sitter accused of SBS in Colorado.  He faced 48 years in jail if convicted.

    Here are five SBS examples from just the past two weeks (article excerpts below):

    1.  Boyfriend faces 25-years to life for SBS of a girl who had fallen to a pavement days earlier.
    2.  Father faces 1st degree murder for SBS; denied child abuse but admitted "bouncing" baby.
    3.  Boyfriend charged with SBS despite lack of any external injuries.
    4.  Pregnant baby-sitter charged with SBS: prosecutor stated that "no evidence that anyone [else] caused the ... death."
    5.  Father sentenced to nine years for SBS that he adamantly denies.

    These common themes underlie the prosecutions:
    1.  Mothers are rarely tried for SBS, but fathers, boyfriends and baby-sitters frequently are.  Prosecutors exploit juries' prejudices.
    2.  Possible natural causes of death by infants are ignored.  As in the fourth story below, prosecutors take the view that the defendant must be guilty because no one else could have done it.
    3.  The "confessions" to shaking are usually descriptions of an attempt to revive the infant, or merely routine jostling ("bouncing") of a baby.  Sometimes the confessors speak poor English.
    4.  Childrens' hospitals, which rely on child abuse funding, seem to allege SBS more often and more quickly than other hospitals.

For the entire article, go to www.delmeyer.net/hmc2005.htm.

7. Overheard in the Consultation Room - A New Way to Commit Suicide
A patient with obstructive sleep apnea came in for his annual evaluation. He had been snoring for decades, but about six years ago, his wife noted that his snoring stopped abruptly in the middle of the night. She observed her husband and noted that his chest was still moving, as if he was breathing, but there was no snoring. She then put her hand over his mouth and nose and did not find any air movement. She woke her husband immediately and after a loud striker, he began breathing. She insisted he see his pulmonologist as soon as he could obtain an appointment. He was immediately place on a Continuous Positive Airway Pressure (C-PAP) device to wear at night and scheduled a Polysomnogram (sleep study). This confirmed the diagnosis of sleep apnea (no breath) and determined the optimal pressure to set the device to assure continuous breathing while asleep.

As I was finishing my exam and writing his prescriptions, he casually mentioned that a friend of the family, who had sleep apnea, also had severe respiratory failure requiring oxygen. His C-PAP was powered by oxygen pressure rather than compressed air. The friend was getting increasingly depressed over his disability and told my patient that sometimes he thought that he would just turn the machine off and end it all. Although my patient tried to joke him out of this approach, he apparently decided one night that he'd had enough. He apparently turned off the machine and the oxygen and quietly died during the night.

With all the emphasis on physician-assisted suicide, it is indeed unfortunate, if not absolutely heinous, that physicians should play the role of executioner. That such a proposition can be passed by public vote underscores the lack of basic medical knowledge we have been unable to provide to the public. They don't need an executioner to write a lethal dose of barbiturates. The patients have numerous lethal doses already in their possession. Most patients now get a 90-day supply of medications. If there are any cardiac, blood pressure, narcotic, hypnotic or psychiatric medications among them, it would not even take a full bottle to do the fateful tragic deed. Whether in The Netherlands, Oregon or Europe, we should never have to worry about whether our doctor is wearing the white coat of healing or the black cloak of an executioner.

A doctor in The Netherlands confided in me during a break in a medical meeting in Amsterdam that he once admitted an elderly lady to the hospital. She said she worried about being put to death while in the hospital. The doctor I was speaking with assured her that he would watch over her to make sure that didn't happen. The next weekend, he signed her out to a colleague. When he came back on Monday, he looked for her and couldn't find her. The nurse said she had "died." He quickly summoned his colleague as to what happened. He was told, "We needed the bed." He said he now felt it was a horrible tragedy for physicians to be involved in assisted suicide. It is more often an execution.

Statistics in Oregon, the first state in which physicians are allowed to kill patients who request it, indicate that perhaps as many as half of these patients have not signed a valid request that they wanted to be executed. These hospital mistakes are completely permanent. They are not simple medication errors that the Institute of Medicine feels are so tragic. Many of them are inconsequential and can be reversed. Physician execution of patients can never be reversed. www.delmeyer.net/MedInfo2005.htm

8. MedicalTuesday Supports These Efforts of the Medical and Professional Community in Restoring Accountability in Medical Practice, HeathCare and Government

• PATMOS EmergiClinic, www.emergiclinic.com, where Robert Berry, MD, an emergency physician and internist, provides prompt care for many of the injuries and illnesses treated in Emergency Rooms at a fraction of the usual emergency room fees. To read Dr Berry's testimony in Congress, click on the sidebar. Read Dr Berry’s response to Physician’s Support of Single-Payer Health Care or Socialism at www.delmeyer.net/hmc2004.htm.

• Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network, www.simplecare.com. Any patient or provider may become a member of SimpleCare. A number of brochures are available on line about a practice that is becoming increasingly popular.

• Dr David MacDonald started Liberty Health Group, www.LibertyHealthGroup.com, to assist physicians in controlling their own medical benefit costs for their staff and patients. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

• John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment, and apart from the government. Please visit them at www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information.

 For those that have been following the Terri Shiavo case, the following remarks by Dr Eck in the Health Benefits Reform columns may be of interest to you.

 In 1992, I had a 27-year-old patient who developed the worst case of multiple sclerosis I have ever seen. She went from normal to paralyzed, demented, blind, and screaming in pain. Over the few months I cared for her, she had urinary retention (requiring a catheter) and intractable vomiting, requiring us to feed her intravenously. All the consultants said I should "let her go." Her husband became conflicted and unsure of whether we should keep feeding her. I was insistent that we needed to continue to feed her and let her body decide on when to give up. She stabilized and was transferred to a rehab center. I honestly thought we would never see her again.
 
Well-- she did recover. Her husband left her. But I had a pleasure of attending her wedding to a wonderful man this January. She is completely normal now, except for a slight limp. Her parents and her new husband hugged me, thanking me for "saving" her. All I did was support her and let her body heal on its own. I am so glad we did not stop feeding her when she was unable to express her own wishes. I think that it is wrong to stop feeding Terri Shiavo. Alieta Eck, MD

• Madeleine Pelner Cosman, JD, PhD, Esq, has made important efforts in restoring accountability in health care. Please visit www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government’s efforts in criminalizing medicine, and the introduction to her new book, Who Owns Your Body. For other OpEd articles that are important to the practice of medicine and health care in general click on her name at www.healthcarecom.net/OpEd.htm.

• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. Dr Gibson recently edited the March/April historical issue. To read his "Lessons from the Past" go to www.ssvms.org/articles/0403gibson.asp. For additional articles such as Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm. For his OpEd article on Health Care reform, go to OpEd article at healthplanusa.net/DGFundamentalHealthCareReform.htm.

• Dr Richard B Willner, President, Center Peer Review Justice Inc, reports his latest success story and the secret of helping doctors keep their medical license. On a daily basis, doctors are reviewed, are suspended, lose their medical licenses and go to jail on trumped-up charges. These "extra"-legal services are necessary services that your lawyer does not offer. Stay posted with a wealth of information at www.peerreview.org.

• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. The maternal mortality was 25-30 percent in the obstetrical clinic in Vienna. He noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He observed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. He then went to St Rochus Hospital in the city of Pest and reduced the epidemic of puerperal fever to 0.85 percent. The rate in Vienna was still 10-15 percent. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: All we ask is that peer review be done with “clean hands.” To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeer.htm. To see Attorney Sharon Kime’s response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD. To view the current website and to see some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.

• Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), www.sepp.net, for making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals, with a special page for our colleagues in nursing. Several free newsletters are available. Be part of protecting and preserving what is right with American HeathCare–physicians, nurses, pharmacists, psychologists, all health professionals and all concerned individuals are urged to join.

• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column that is at NewsMax. Please log on to review the last five week’s topics or click on archives to see the last two year’s topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week’s column is on the real story of "Infant Mortality Myths and Mantras" and can be found at www.newsmax.com/archives/articles/2005/3/9/184540.shtml.

• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians.  Be sure to scroll down on the left to departments and click on News of the Day. The “AAPS News,” written by Jane Orient, MD, and archived on this site, provides valuable information on a monthly basis. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. If you missed the scientific articles on the Shaken Baby Syndrome, be sure to click on the Fall issue to read Ronald Uscinski’s, M.D., real story on why shaking a head cannot cause internal brain injuries, as well as the report by C. Alan B. Clemetson, M.D.

Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same
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Read the latest medical news of the day at www.healthplanusa.net/MedicalNews.htm, which will also lead you to the headlines for the past month.

If you would like to participate in this informational campaign on behalf of your patients or the HeathCare community, please send your resume to Personnel@MedicalTuesday.net.

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Del Meyer

Del Meyer, MD, CEO & Founder
DelMeyer@MedicalTuesday.net
www.MedicalTuesday.net
6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

Robert J Dole, former U.S. Senator: If you're hanging around with nothing to do and the zoo is closed, come over to the Senate. You'll get the same kind of feeling and you won't have to pay.

William Durant: The experience of the past leaves little doubt that every economic system must sooner or later rely upon some form of the profit motive to stir individuals and groups to productivity. Substitutes like slavery, police supervision, or idealological enthusiasm prove too unproductive, too expensive, or too transient.

Charles B Clark, MD: A Piece of the Pie: What are we going to tell those bright-eyed little boys and girls who are going to be the doctors of tomorrow? When there isn’t anything left for them, are we going to tell them we didn’t fight because the changes were inevitable anyway? What are we going to say when they ask us why we laid down and died when things got a little tough? Are we going to feel good about ourselves when we tell them it’s all right because we got a piece of the pie? Read Dr Clark at www.healthcarecom.net/CBCPieceofPie.htm. To read his latest, go to www.healthcarecom.net/CBCFeedingMonster.htm.

Ada P Kahn, PhD: Foreword to "Encyclopedia of Work-Related Injuries, Illnesses and Health Issues." Dr Kahn came to Sacramento in February and I joined her on a Channel 31 interview about her book. I was privileged to write the foreword which we’ve posted at www.delmeyer.net/MedInfo2004.htm. To purchase the book, go to www.factsonfile.com/ and type in KAHN under search. To read a foreword on her revision of Stress A-Z, go to www.delmeyer.net/MedInfo2005.htm

Henry Chang, MD: WEIGHT LOST FOREVER - The Five-Second Guide to Permanent Weight Loss suggest daily weights to stem the weight loss before it becomes a problem and, if it does,  how to take it off and keep it off. Congratulations to Dr Chang for winning the Sacramento Publishers and Authors 2004 award for “Best Health Book of the Year.” Read our review at www.healthcarecom.net/bkrev_WeightLostForever.htm.

Tammy Bruce: The Death of Right and Wrong (Understanding the difference between the right and the left on our culture and values.) www.townhall.com/bookclub/bruce.html. Reviewed by Courtney Rosenbladt

An Alzheimer's Story: To read a touching story by a nurse about her Alzheimer's patient, go to www.delmeyer.net/MedInfo2003.htm.

An Entrepreneur's Story: AriadneCapital (www.AriadneCapital.com) provided the initial funding for MedicalTuesday and the Global Trademarking. Julie Meyer, the CEO, has a clear vision in her mind of the world that she wants to live in, and it's considerably different from how it looks now. If you're an entrepreneurial woman, or if you lost hope or are having difficulty envisioning success, (if you'll forgive a little nepotism), the following article may be of interest to you: observer.guardian.co.uk/business/story/0,6903,1237363,00.html.

First American non-aggression treaty was signed on this date in 1621. This was not modern diplomacy, but a pack made between Governor John Carver of Plymouth and Chief Massasoit of the Indians. As agreements go, this was a good one lasting half a century.

The Moslem countries of the Middle East organized the Arab League on this date in 1945. Unity among the Arab states is a comparatively recent development and not quite what the world had in mind when Israel came into being.