A QUESTION TO ASK YOUR DOCTOR

Imagine that you are in your doctor's office and the doctor proposes to send you for an expensive high technology test. or even a series of blood or urine tests at the laboratory.  What questions should you ask, and of those questions, where should you start?

The first question that I suggest you ask is: "doctor, how will the results of this test affect the recommendations you will make or treatment you will offer?"  If the doctor can't answer that question, the test should not be done.  Your high technology test, or blood specimen, should be critical to the physician's decision-making process and the outcome of the test should be an important treatment issue.  Technology tests often involve radiation or other potentially toxic exposures and there are small, but real risks associated even with what seem to be"simple" blood tests, not the least of which is an erroneous result which results in more and riskier testing.


If your physicians seems to be offended by your question, find another doctor.  You have a right to know the answer before you expose yourself to the expense, inconvenience and risk of what may be an unnecessary testing procedure.

CDC Melanoma Information

CDC press release worth reading: CDC melanoma information.
For more information (be patient, the connection is slow), click here.

It's My Lump

If you have read my recent blog about lumps, you may recall that I described a series of steps frequently followed by physicians (and other medical health care providers) to determine the cause of a patient's lump.
That blog wasn't just an academic discussion: for me it predicted what would soon be my reality.

Because of my years of medical experience caring for patients with malignancies, I had a disquieting impression that I had found a facial lymph node lump containing metastatic malignant melanoma which had spread from the lesion near  my brow which had been removed several months earlier.   My physicians went through the same steps as I described in my recent blog, including the biopsy and soon confirmed my impression.

The work-up is still in progress. When it has been completed, the next step will be sitting down with my physician and (individually) with the expert consultants who are, or will be, involved in my care to determine whether therapy which is likely to help is available.  I have had the good fortune to have good people who have offered various means of help and access to help. But the simple fact remains that I have an aggressive  metastatic malignant disease.

I will share some of my experience navigating Our Health System as I travel the melanoma pathway. But for now, my advice to readers is - use appropriate sunscreens and garments that prevent sunburn, avoid tanning beds, and locate a competent dermatologist in your area.  If you, or someone who knows you, finds a mole that has changed, see a physician promptly.

HIV and DEMENTIA

A few months ago, I sent my update of my Chapter concerning the HIV-infected health care worker off to  the American Health Lawyers Association who, in turn provided it to Reuters, the publisher of the encyclopedic legal text, Health Law Update.  Again, I emphasized the problem of dementia associated with HIV infection and the possible subtle effects of dementia on the judgment of  health care providers infected with the virus. I suggested that those with HIV who work in health care be evaluated periodically for evidence of neuro-psychological impairment to protect patients, the infected providers and the institutions in which they provide care.

Today (10/07/2011), Medline Plus (HealthDay) , from the National Institutes of Health and the U.S. National Library of Medicine issued a report by Robert Preidt describing medical research at the University of North Carolina concerning  identification of "....  two genetically distinct types of HIV in the cerebrospinal fluid (CSF) of patients with HIV-associated dementia...  may help explain why the risk of developing neurological difficulties increases as AIDS patients live longer, and may also help predict which patients are at greatest risk for the problem, according to the U.S. scientists."

This is an important scientific advance which may lead to improved diagnosis and treatment of  those  who are HIV-infected and, if they are health care providers, to safeguarding the people to whom they render medical care and services. 

Fiscal Year 2012 HHS OIG Work Plan

The Federal Inspector General for Health and Human Services performs the vital function of preventing (when it is feasible) and finding (when it has occurred) health care fraud and abuse.  The OIG is involved in bringing order and justice to the system. Because health care comprises about 17% of our gross domestic product, the potential financial reward for fraud is enormous and the opportunity  for individuals and organized criminal groups to steal from the citizens of the United States is substantial.

The OIG's Green Book "sets forth various projects to be addressed during the fiscal year by the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General."

If you are health care provider, health care attorney, administrator, financial advisor or involved in payment for health care services, the Green Book is an important read. And if you plan to make your living by defrauding our government, taxpayers, those who pay health care bills, the Green Book sends a clear warning: our government goes after cheaters.

Federal Over & Under Payment for Health Care-How Much & For What?

The Affordable Care Act has brought us significant new information about federal over and under payments to providers, including physicians, hospitals and durable medical equipment providers. The report has been marked as "confidential" but has been released and is available on the internet from the government site. Whether you are an auditor, provider, patient,  taxpayer,  or a lawyer who represents providers who have been charged with overbilling the government this report on our government's audit program is worth a read. Click here.

Melon Colic

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm60e0930a1.htm?s_cid=mm60e0930a1_e&source=govdelivery

All you want to know about one of the current outbreaks of listeriosis. And more.

10/3/2011 And more.