Can't We Keep This Civil?

Once again, I've been spending time responding to the nonsense propagated by CJD and Elliott over at KevinMD and RangelMD. One thing that has struck me in following these comments is the near lack of civil discourse that is occurring in some of the responses, both from physicians and the legal side alike. But, the ultimate insulting attack came out of nowhere from Elliott today. (http://www.kevinmd.com/blog/2005/12/plight-of-uninsured-analysis-of-10000.html#comments).

While I may be tempted to slam, slander and villify the "other side" (and I often feel that way), name calling and insults make one look utterly foolish, does nothing to advance one's cause, and just detracts from what should be a civil conversation. We, as physicians, need to listen, and counterattack with facts, not emotion.

Just May Be The Best Doonesbury Ever

I couldn't stop laughing after my wife showed me today's strip.

http://www.uclick.com/client/wpc/db/2005/12/18/index.html

Cures sought for ER doctor shortages
(via KevinMD)

The problem with specialist call in the ER isn't just happening in Florida (link). It's also occurring in the ER at the hospital where I work in South Jersey, and all over the country. The major problem is one of liability risk, whether real or percieved. Given the current lawsuit happy climate in this country, it's no wonder that there are decreasing numbers of specialist physicians who want to take any ER call at all. Factor in the increasing numbers of ER cases, the crappy lifestyle of adding ER coverage to on call responsibilities, and the lack of reimbursement (ie large numbers of indigent/charity care) patients, who can blame these physicians for not wanting to cover the ER. Our neurosurgeon (and we're damn lucky to have him) only covers the ER part time, and when intracranial cases come into the ER when he's not on call, they get transferred into Philly. Obviously, this poses a risk to the patient in terms of possible delays in treatment, and potential increases in morbidity and mortality. Plastics and hand surgical coverage are problematic for us also.

While nowhere near an ideal solution, payment for ER coverage by the hospital may make taking call a little more palatable. A better solution would be to decrease the legal risks in taking ER call (ie tort reform, etc), because right now the only way to avoid that risk is to avoid the ER altogether.

Random Thoughts

Sorry I haven't posted in awhile. Mom's been in the hospital - she's doing OK, and will hopefully be discharged tomorrow. I've also spent way too much time responding to CJD over at KevinMD - I should know better and just let him spout his nonsense.

Anyway, looks like healthcare in NJ will be going further down the tubes in the coming months. Senator Corzine, a foe of caps, has been elected governor. I had the chance of meeting with his Senate and campaign healthcare advisors during the last few months, and caps are definitely dead in this state. The future of specialty healthcare courts is very cloudy. Further malpractice and tort reform is unlikely. The Corzine healthcare insurance plan is vague and undoubtedly will be onerous to physicians. The new Speaker in the Assembly, George Norcross - oops! Joe Roberts - is no friend of ours, and so the ambulatory tax will continue to plague us, as will charity care reimbursement. Cooper Hospital will continue its slow takeover of medicine in South Jersey. There is hope of some managed care reform bills on the horizon, but I a'int holding my breath. More to come on these subjects.