Re: VBAC
From: art fougner, md (evsono@pipeline.com)
Mon Oct 30 07:29:44 2000
asymptomatic 2 cm dermoid on sono would most likely be followed around
here.
art
At Mon, 30 Oct 2000, jkulkin wrote:
>
>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
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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.
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
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