Re: VBAC
From: Braun, R. Daniel (rbraun@iupui.edu)
Mon Oct 30 05:56:07 2000
So what was the emergency?
Dan
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: Monday, October 30, 2000 7:31 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: VBAC
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
> > >> Solo Practice uBid,more.com,JCrew,800-flowers,Avon, WWF & hundreds
> more.
> > >> 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.
