Dr Fragen in the operating room


  • Not on My Watch

    OK, I was sent a nice, likely canned, email asking if I’d point to [Kimberly-Clark Health Care’s Healthcare-Associated Infection website][1]. It seems to have a bunch of information.
    Remember to use your Kleenex™.
    [1]: http://haiwatchnews.com/

  • Baby Steps to Healthcare Reform

    Since I’m sure all members of Congress will have the opportunity to read and comprehend the entirety of whatever is the current healthcare legislation the following small steps to improve the situation will be meaningless. I have 3 simple proposals that could fit on a single page. Heck, it fits in a single post.

    1. Eliminate pre-existing conditions as a reason to deny insurance.
    2. Allow insurance companies to sell in any market in the US.
    3. Malpractice reform — Loser Pays

    I think the first 2 are self evident so lets focus for a moment on the third.
    Loser Pays
    What I mean is that all legal fees will be paid by the losing party to the litigation. This would include naming a doctor in a med mal suit and then dropping them from the suit.
    You see, just because a doctor gets dropped from a suit doesn’t mean that his malpractice carrier doesn’t incur costs. In fact, it’s usually about $20K to defend a suit that is dropped.
    Interestingly, anytime a doc is dropped from a suit, they must sign a release stating that they will not sue the plaintiff’s attorney. I once tried not to sign this but my lawyer told me he’d never seen it done before.
    Yeah, I know, it doesn’t solve many of the problems facing our healthcare industry. But I bet it would improve the situation with minimal effort.

  • Nationalized Healthcare and the Free Market

    Nationalized/Universal healthcare will happen. Obama ran on it and he intends to deliver. What’s more, I can see a manner in which the country will flock to it under the current free market insurance system.
    First, the federal government will expand Medicaid to cover the unemployed and uninsured. Second, the Congress will pass some law that mandates employers to provide health insurance for not only full-time employees, but part-time employees too.
    Oh, by the way, the federal government will also make available a _government-sponsored_ insurance plan to _compete_ with the other available HMO and PPO choices. Of course the government plan will cost you (the employer) 40-50% less than the next most expensive plan.
    You (the employer) will offer your employees the _government plan_ as per the terms of the new law and they (the employees) will have the option of spending almost twice as much for a different commercial plan. I don’t really expect many employees to avail themselves of the opportunity to spend more money for little perceived increase in services.
    Soon 80-90% of the country will be on the _government plan_ and physicians and hospitals will effectively have a single payor.
    Welcome to nationalized/universal healthcare.

  • Appendiceal Duplication

    I had a very interesting case the other evening. First, for the uninitiated, it’s usually a bad sign when the surgeon says it was a very _interesting_ case. Generally routine is best.
    Anyway, nice 50ish year old female with few days of diffuse abdominal pain now localizing to RLQ. Nausea and vomiting. Anorexia. Acute peritoneal finding in RLQ with percussion. Outside CT reportedly showing acute appendicitis.
    I look at the patient. Story is great. Almost sounds like she’s read [Cope][1]. I take her to the OR. I feel a mass on exam after induction. Sorry guys I do open appys. 3 cm McBurney incison and mobile the cecum. There’s a 5cm mass but seems to be mobilizing from the superior aspect of ascending colon not inferiorly. Anyway, I deliver what appears to be an appendiceal phlegmon into the wound and fire a GIA-55 across its base. The base is along a tinea adjacent to the ileocecal valve. Doesn’t look like there’s any free perforation so I irrigate and start to close.
    I’ve got a couple of clamps on the peritoneum and then I see a relatively normal looking appendix starting at me. Naturally it comes out.
    Patient home in less than 24 hours.
    Path report shows:
    * appendix – acute appendicitis
    * pericecal diverticulum and phlegmon – appendiceal duplication with acute perforating and gangrenous appendicitis
    Comment on path report is _duplication based upon the presence of circular muscle around the diverticulum, its location and gross appearance_.
    I’ve never seen that one before. All I can say is I’m glad I saw what I considered to be a _relatively_ normal appearing appendix prior to closure.
    [1]: http://www.amazon.com/Copes-Early-Diagnosis-Acute-Abdomen/dp/0195175468

  • General Surgery in NY

    So here I am in NYC at the American Society of General Surgeons clinical meeting. The program is correctly termed controversies as I’m quite certain many of the described treatment paths would cause you to fail your oral boards.
    Of note is that it seems that most of the attendees have been in practice for over 10 years. The lecturers are mostly all teaching faculty at the local ivory tower and they seem to use less invasive treatment and laparoscopy far more than I would.
    For example, laparoscopic closure of diverticular perforation with irrigation and drainage but no resection. Not sure I would ever do this open so I can’t see why it’s an acceptable treatment plan laparoscopically. Maybe I’m just old fashioned.

  • Doctors Cannot Withhold Care From Gays

    The [California Supreme Court has just handed down a ruling][1]. Discrimination is bad, I get it and it shouldn’t happen.
    I’m not going to argue the merits of the case but I’m curious to know if anyone else thinks that this decision might be interpreted to mean that physicians no longer can say no to anyone for any reason.
    [1]: http://www.foxnews.com/story/0,2933,405801,00.html