Re: VBAC
From: jkulkin (jkulkin@mindspring.com)
Mon Oct 30 05:29:54 2000
looked like a dermoid on sono
JK
"Braun, R. Daniel" wrote:
> R. Daniel Braun, MD FACOG
> Clinical Professor
> Department of Obstetrics and Gynecology
> Indiana U. School of Medicine
> Indianapolis, IN 46202
>
> OBGYN.net
> International Representative for United States
>
> Certified AllExperts Expert
> Check out my bio/ratings page!
> http://www.allexperts.com/displayExpert.asp?Expert=1236
>
> -----Original Message-----
> From: jkulkin [mailto:jkulkin@mindspring.com]
> Sent: Sunday, October 29, 2000 9:03 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: VBAC
>
> Very unfortunate and I share your frustration. I invite any of you to spend
> a day
> with me in a managed care setting. I invite you to review the medical
> records
> of 25 yo women with 2cm ovarian cyst scheduled for emergency laparotomy and
> oophorectomy. When I talked to the doctor about this case and suggested a
> laparoscopy he said, "Good idea".
>
> WHAT IS WRONG WITH "OBSERVATION"??????? Come on a 2 cm cyst in a
> 25 y/o????????????
> WOW!!!!!!!!!
>
> Dan
>
> Should I have to do this. I see myself as a
> patient advocate. I invite you to review records of proposed diagnostic
> cardiac
> caths with a follow up angioplasty proposed for 3 days later if disease is
> found
> . For list members this is like doing a diagnostic laparoscopy on Monday
> and
> ablating the discovered endometriosis on Thursday.
>
> After 3 full years in this new arena I can safely say there is good and bad
> managed care as there are varying qulaities of any service or business.
> There are
> several companies with excellent programs in place and they are also working
> hard
> to improve. There are available data on the internet on hosptal
> profitability.....so understand that well managed hospitals today are in
> fact
> quite profitable. Some of these hospitals even have mobile cardiac cath
> labs
> (that's right...mobile) with no ability to do interventions.
>
> I am with a managed care company that actually includes community physicians
> in
> the development of HMO policy. These physicians also review cases against
> community developed guidelines. Georgia is one of 3 states in the country
> with a
> mandate that insurane companies must pay for chlamydia screening. Why is it
> then
> that only 25% of patients in the 16-26 yo age group have this screening. We
> are
> in the middle of a quality initiative to be certain this number increases
> substantially. And yes, we do pay for it to be done.
>
> Actually, I left practice after having a hysterectomy denied...18 week
> fibroids
> with a Hb of 7. The medical director wouldn't take our phone calls and the
> patient had an emergency hyst at a county hopital at 3 am on a Sunday. We
> are now
> in bad need of moving this health care transition to a sytem of care
> delivery that
> is more effective from both a quality and cost perspective. Patient
> satisfaction
> is very low. I have a personal friend who today is 2 days post total knee
> replacement and a PA made rounds on her. NO DOC. Explain that to me as I
> just
> don't get it?
>
> I could probably go on for hours expressing the passion I have for working
> on the
> system on behalf of the patients. I hope you'll all find a way to
> contribute to
> the change. I don't see a turnaround to medicine as practiced 20 years ago
> just
> as I don't see the present system prevailing. The final model is to be
> determined.
>
> Jay
>
> "art fougner, md" wrote:
>
> > that was then - this is now - today hospitals are up against it, thanks
> > to the shrinking reimbursements. we were recently told last week that
> > unless something radical develops, LIJ in New Hyde Park will be cut off
> > by Aetna. not a question of whose fault or who wins - answers are
> > everyone's fault and nobody wins. insurance companies always tell us
> > that of course the docs determine policy - perhaps all should reread the
> > Peeno testimony again - the HMO industry's equivalent of tobacco's
> > "Insider" - come to think of it, i wonder what Dr. Peeno is doing now?
> >
> > for those who want the url - http://www.sepp.net/Peeno1097.html
> >
> > for the umpteenth time - medicine is NOT cost effective because nothing
> > that we do alters the eventual outcome - everybody dies.
> >
> > just my opinion, i could be wrong.
> >
> > art
> >
> > At Sun, 29 Oct 2000, jkulkin wrote:
> > >
> > >A good point but in my experience the medical staff sets "guidelines" or
> the
> > >physician/midwife writes orders when patients are admitted. For instance
> I
> > >remember our OB-GYN dept had a rule that a patient would have an NST
> prior to
> > >"walking" to R/O labor when they arrived at L&D prior to being admitted.
> I
> > >don't recall the hospital telling us that every patient had to be
> monitored
> > >electronically. In fact the many nurses preferred intermittent
> auscultation.
> > >Hospitals have a whole other issue when it comes to controlling costs.
> L&D
> > >nurses are probably the ones with the most ROI in view of the legal
> liability
> > >that the labor suite represents..
> > >
> > >Jay
> > >
> > >Paul Prior MD wrote:
> > >
> > >> On Sun, 29 Oct 2000 16:33:34 -0600, evsono@pipeline.com (art fougner,
> > >> md) wrote:
> > >>
> > >> >and pls tell the HMO's to pay the hospitals sufficient to increase the
> > >> >nursing staff accordingly.
> > >> >
> > >> >art
> > >>
> > >> LOL, sure now -that- is going to happen. I agree that the biggest
> > >> thing driving continuous EFM of all patients today is the fact that it
> > >> saves hospitals money.
> > >>
> > >> The public wants cheap health care, they get cheap health care. You
> > >> can't have your cake and eat it too....
> > >>
> > >> --
> > >> Paul Prior MD Get rebates from online purchases - up to 30% cash
> back.
> > >> Coshocton, OH Includes: Disney,Borders,Wine.com,800.com,Dell,petstore
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> > >> OB/GYN Try: http://www.ebates.com/index.jhtml?referrer=pprior
> >
> > --
> > art fougner, md
> >
> > A series of 1000 cases begins with but a single anecdote.
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