[HSF] Too scared to touch.....
hgrmd at aol.com
hgrmd at aol.com
Thu May 3 18:30:25 EDT 2007
Prasanna,
All an uninsured patient has to do to ultimately reach me is to merely show up in the hospital ER. From what I've seen, the patient is managed exactly the same if not better than if he had insurance. We err on the side of doing what's indicated, since we certainly don't want to give such a patient access to the malpractice lotto.
Hal
-----Original Message-----
From: prasannasimha at gmail.com
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 3 May 2007 8:56 AM
Subject: Re: [HSF] Too scared to touch.....
Not the factoring of you but the ability of the patient to reach you
ultimately. You would not be the problem. the system would be the problem.
Prasanna
On 5/3/07, hgrmd at aol.com <hgrmd at aol.com> wrote:
>
> Prasanna,
> Actually, I've done plenty of uninsured patients, the majority of whom
> are immigrants. In fact, the last case I did was about 2 weeks ago, and I
> spent about 6 hours working on a man with a huge inferolateral LV aneurysm.
> I can assure you that my clinical decisions are never based on the patient's
> ability to pay.
>
> Hal
>
> -----Original Message-----
> From: prasannasimha at gmail.com
> To: OpenHeart-L at lists.hsforum.com
> Sent: Thu, 3 May 2007 4:54 AM
> Subject: Re: [HSF] Too scared to touch.....
>
>
> This is the story in all places with rationed resources - beneficiance
> versus justice. This is a basic ethical conflict that always will affect
> health care. Places with so called "unlimited" resources also have
> problems.
> I bet if we ask the uninsured in US they will have a different story to
> tell.
> Prasanna
>
> On 5/3/07, bbiocina at kbd.hr <bbiocina at kbd.hr> wrote:
> >
> > Hal, Don ,
> > it seems that my anecdote spiced the discussion little too much.
> > My point was completely different; how to deliver fair ( if you are not
> > able to deliver complete and appropriate) treatment with limited
> > resources available. It is obvious that the record from the spa
> > hospital is ridiculously fake , but it has been partially based on
> > presumption that LM disease must have the highest priority.
> > Let's take the case of Bojan Biocina : by today 297 pts. on the
> > waiting list , possible workload 4 cases/wk . There is at least 50 LM
> > , another 50 severe tripple vessel disease patients. If we forget
> > other pathology ( valves , combined etc. for a while ) , if you were me
> > , how would you handle the list : to operate LM first ( and to allow
> > any new LM to jump the queue), to mix the order with more serious
> > tripple vessel ( criteria?) , or to try to judge clinical criteria
> > of "stability"?
> > With almost unlimited resources ( often seen today in Western countries)
> > medical/moral responsibility ih still high enough , but with limited
> > resources it could be much higher. In light of all of that , I think
> > studies like the Canadian one might help ( although , obviously ,
> > judgment based on them might hurt a particuklar individual).
> >
> > Bojan
> >
> > On 5/3/2007, "hgrmd at aol.com" <hgrmd at aol.com> wrote:
> >
> > >Don,
> > > Let's kick Prasanna's butt!
> > >Hal
> > >
> > >-----Original Message-----
> > >From: donross at bigpond.com
> > >To: OpenHeart-L at lists.hsforum.com
> > >Sent: Wed, 2 May 2007 6:45 PM
> > >Subject: Re: [HSF] Too scared to touch.....
> > >
> > >
> > >Prasanna,
> > >Indeed, a lot of what we practice will be found to be imperfect , but a
> > lot of the so called evidence based practice is also bullshit.
> > >Do you really believe all Bojan's waiting list deaths had critical LM
> > disease?
> > >Remember the bikini and statistics?
> > >Don
> > >
> > >PS It is great to have Hal onside for a change!
> > >
> > >On 02/05/2007, at 9:20 PM, psimha wrote:
> > >
> > >> Hal,
> > >> Please read carefully, In never said anything about critical left >
> > mains.
> > >> Also if you carefully see what I said I said where is the > evidence
> .
> > Some things that we practice need not necessarily be right.
> > >>
> > >> Prasanna
> > >> hgrmd at aol.com wrote:
> > >>> Don,
> > >>> I agree with you. If Prasanna wants to send out critical LM's >> or
> > LAD's hanging by a hair after an MI, that's his business. >> Around
> here, if
> > such patient went home without surgery and boxed, >> we'd definitely
> hear
> > about it.
> > >>> Hal -----Original Message-----
> > >>> From: donross at bigpond.com
> > >>> To: OpenHeart-L at lists.hsforum.com
> > >>> Sent: Wed, 2 May 2007 4:40 AM
> > >>> Subject: Re: [HSF] Too scared to touch.....
> > >>>
> > >>>
> > >>> When they have LM or TVD + poor LV....... most of my patients. I >>
> > hope, therefore, you are not trying to put me out of a job? Don On >>
> > 02/05/2007, at 10:53 AM, prasannasimha wrote:
> > >>>> Where in literature has it been shown that a patient who is >>>
> > stable > after an MI benefits from urgent in house >>> revascularization
> ?
> > Prasanna
> > >>>> Donald Ross wrote:
> > >>>>> Also, one wonders about the not infrequent peri-op AMIs during
> >>>>
> > non->> cardiac surgery that come our way for revascularisation >>>>
> prior to
> > >> discharge. Is this unnecessary surgery as well, >>>> given it carries
> the
> > same >> indications as regular coronary >>>> surgery? Don On 01/05/2007,
> at
> > 10:04 PM, Hgrmd at aol.com wrote:
> > >>>>>
> > >>>>>> Ajit, I invested the time it took to read all of Prasanna's >>>
> > >>>>> abstracts. I'm still not convinced that medical therapy with >>>>>
> > beta-blockers is >>> the way to go for nearly every case. >>>>> Again,
> if a
> > stress test in an asymptomatic >>> patient shows a >>>>> lot of
> myocardium
> > with reversible ischemia, it would be >>> >>>>> potentially foolhardy
> not to
> > cath that patient. Over the years, >>>>> we've been >>> referred lots of
> > patients with left mains or >>>>> critical 3vd that were cathed prior
> >>> to
> > an elective >>>>> noncardiac procedure (usually carotid, ischemic leg,
> or
> > AAA). >>>>> >>> We did the CABG, they eventually got the vascular >>>>>
> > procedure, and they did >>> fine. I've yet to recall "graft >>>>>
> closure"
> > while the subsequent case was done. In >>> light of >>>>> the problems
> with
> > DES, the cardiologists are much more likely >>>>> to use >>> bare metal
> > stents in such scenarios. I do agree that >>>>> beta blockade, possible
> > Swan, and a competent >>> ca
> > > rdiac >>>>> anesthesiologist suffice for the vast majority of cardiac
> > >>> >>>>> patients getting noncardiac surgery. However, there are plenty
> > >>>>> of asymptomatic >>> cardiac time bombs waiting to explode for
> >>>>>
> > those that never cath and treat >>> preemptively. Hal
> > >>>>>>
> > >>>>>>
> > >>>>>> ************************************** See what's free at >>>>>
> > http://>>> www.aol.com. >>>>>
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> -- Prasanna Simha M
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