Re: Patient Triumphs in Drain, Oregon

[Guest guest]

Joanne, you are amazing. What a great

example.

T. Ellsworth, MD

9377 E. Bell Road, Suite 175

sdale, Az 85260

From: [mailto: ] On Behalf Of joanne holland

Sent: Monday, September 17, 2007

10:59 AM

To:

Subject:

Patient Triumphs in Drain, Oregon

From Dr Joanne, the Old MD in Drain, Oregon,

This last

Thursday I had a patient walk into my office, using a cane. She had not

walked in the last seven years, being wheelchair bound from pain and

instability. She had a diagnosis of MS, and had been labled a

" non-compliant " patient, because she kept insisting on getting her

pain treated, and getting her muscle spasms treated, and on getting...Oh, the

last group of illness included referrals to 6 different specialists.

One can see why she irritated providers, since she has a psych problem and was

loud about it. She was fired from a number of offices. In one case they

called the police and had her taken out in handcuffs, rolling her wheelchair to

the car for her because she could not manipulate it in her cuffs.

What did we do

different? Well, I established a weekly visit, whether she needed

it or not. I took her pain seriously and treated her with methadone. I

took each of her complaints in order, and in the last year we had visits with

about 8 different specialists. The most serious problem: We did find a

neck spondylosis and a narrowing of her canal that was causing pain and is

going to be surgically treated this coming week: the surgeon wanted to wait

until the other things were stable. We fixed her feet with shoe inserts,

her ingrowing toenails were treated, I treated her GERD and

treated her infected teeth.

At last we treated her swollen feet and legs (lymphedema

and intermittent cellulitis) we cultured, treated with antibiotics.

We found a latex allergy and changed her clothes: no elastic waist bands

on her skirts or under ware, no stretchy cheap socks, no flipflops, no stretchy

throws on the chairs and beds, no stretchy wrist bands, and all cotton or linen

clothing. In the end she totally cleaned her house up with a full

house vacuum that took two days. During that time we treated her with a

two week prednisone taper. Four days later she got up out of the wheelchair,

and was walking with only her neck and arm pain from the cervical

problem. It has taken us a year. I am quite surprised that

she has gone as far as she has.

From this, admittedly difficult, patient I

have been again confirmed in my belief that we have to listen to the patient.

It is good to have some standard management systems, but there is no reason to

just follow some standard system that does not work in the patients

best interest.

By the by, she once was assigned to

an HMO, DCIPA, which did not include easy referrals to some of those

specialists including the neurologist for her MS and the neurosurgeon.

This group takes the OHP money to manage these medicaid patients, and then at

the end of the year, they split any extra money amoung the provider

members. A truely jaded way to see it would be to say they kept her

in a wheelchair so that they could pocket extra money at the end of the

year: but I am not so jaded. I think the accidental end point of

any health care system that uses profit as its primary measurement is

bound to give poor care at high cost.

Joanne Holland DVM/MD

 

Fussy? Opinionated? Impossible to please? Perfect. Join

Yahoo!'s user panel and lay it on us.

[Guest guest]

Joanne,

Good job.  That must have felt great to see her actually

walking.

And you are correct.  Basically all health plans are counterintuitive

to good health care.  The cheapest thing we can do is provide no care and let

all but the must “fit” survive.  Everything else costs money.  It’s

just a matter of whose money.  If it’s our pocket, then we are likely to

provide less care in order to make a profit.  If it’s the Health Plan,

then they try to get us to be more “economical” by doing things

more cheaply.  But worse than that is that the patient’s don’t think

that they should have to pay money for their health particularly if blessed with

poor health.  So how do we cost share these health issues?

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of joanne

holland

Sent: Monday, September 17, 2007 1:59 PM

To:

Subject: Patient Triumphs in Drain, Oregon

From Dr Joanne, the Old MD in Drain, Oregon,

This last Thursday I had a patient walk into my office, using a cane. She

had not walked in the last seven years, being wheelchair bound from pain and

instability. She had a diagnosis of MS, and had been labled a

" non-compliant " patient, because she kept insisting on getting her

pain treated, and getting her muscle spasms treated, and on getting...Oh, the

last group of illness included referrals to 6 different

specialists. One can see why she irritated providers, since she has

a psych problem and was loud about it. She was fired from a number of

offices. In one case they called the police and had her taken out in handcuffs,

rolling her wheelchair to the car for her because she could not manipulate it

in her cuffs.

What did we do

different? Well, I established a weekly visit, whether she needed

it or not. I took her pain seriously and treated her with methadone. I

took each of her complaints in order, and in the last year we had visits with

about 8 different specialists. The most serious problem: We did find a

neck spondylosis and a narrowing of her canal that was causing pain and is

going to be surgically treated this coming week: the surgeon wanted to

wait until the other things were stable. We fixed her feet with shoe

inserts, her ingrowing toenails were treated, I treated her

GERD and treated her infected teeth.

At last we treated her swollen feet and legs

(lymphedema and intermittent cellulitis) we cultured, treated with

antibiotics. We found a latex allergy and changed her clothes: no

elastic waist bands on her skirts or under ware, no stretchy cheap socks, no

flipflops, no stretchy throws on the chairs and beds, no stretchy wrist bands,

and all cotton or linen clothing. In the end she totally cleaned her

house up with a full house vacuum that took two days. During that time we

treated her with a two week prednisone taper. Four days later she got up

out of the wheelchair, and was walking with only her neck and arm pain from the

cervical problem. It has taken us a year. I am quite

surprised that she has gone as far as she has.

From this, admittedly difficult,

patient I have been again confirmed in my belief that we have to

listen to the patient. It is good to have some standard management

systems, but there is no reason to just follow some standard

system that does not work in the patients best interest.

By the by, she once

was assigned to an HMO, DCIPA, which did not include easy referrals

to some of those specialists including the neurologist for her MS and the

neurosurgeon. This group takes the OHP money to manage these medicaid

patients, and then at the end of the year, they split any extra money amoung

the provider members. A truely jaded way to see it would be to say they

kept her in a wheelchair so that they could pocket extra money at the end

of the year: but I am not so jaded. I think the accidental end

point of any health care system that uses profit as its primary

measurement is bound to give poor care at high cost.

Joanne Holland DVM/MD

 

Fussy? Opinionated? Impossible to please? Perfect. Join

Yahoo!'s user panel and lay it on us.

[Guest guest]

JoanneWhen I grow up, I want to be a doctor like you.Lynn HoTo: From: joandvmmd@...Date: Mon, 17 Sep 2007 10:59:07 -0700Subject: Patient Triumphs in Drain, Oregon

From Dr Joanne, the Old MD in Drain, Oregon, This last Thursday I had a patient walk into my office, using a cane. She had not walked in the last seven years, being wheelchair bound from pain and instability. She had a diagnosis of MS, and had been labled a "non-compliant" patient, because she kept insisting on getting her pain treated, and getting her muscle spasms treated, and on getting...Oh, the last group of illness included referrals to 6 different specialists. One can see why she irritated providers, since she has a psych problem and was loud about it. She was fired from a number of offices. In one case they called the police and had her taken out in handcuffs, rolling her wheelchair to the car for her because she could not manipulate it in her cuffs. What did we

do different? Well, I established a weekly visit, whether she needed it or not. I took her pain seriously and treated her with methadone. I took each of her complaints in order, and in the last year we had visits with about 8 different specialists. The most serious problem: We did find a neck spondylosis and a narrowing of her canal that was causing pain and is going to be surgically treated this coming week: the surgeon wanted to wait until the other things were stable. We fixed her feet with shoe inserts, her ingrowing toenails were treated, I treated her GERD and treated her infected teeth. At last we treated her swollen feet and legs (lymphedema and intermittent cellulitis) we cultured, treated with antibiotics. We found a latex allergy and changed her clothes: no elastic waist bands on her skirts or under ware, no stretchy cheap socks, no flipflops, no stretchy

throws on the chairs and beds, no stretchy wrist bands, and all cotton or linen clothing. In the end she totally cleaned her house up with a full house vacuum that took two days. During that time we treated her with a two week prednisone taper. Four days later she got up out of the wheelchair, and was walking with only her neck and arm pain from the cervical problem. It has taken us a year. I am quite surprised that she has gone as far as she has. From this, admittedly difficult, patient I have been again confirmed in my belief that we have to listen to the patient. It is good to have some standard management systems, but there is no reason to just follow some standard system that does not work in the patients best interest. By the by, she once was assigned to an HMO, DCIPA, which

did not include easy referrals to some of those specialists including the neurologist for her MS and the neurosurgeon. This group takes the OHP money to manage these medicaid patients, and then at the end of the year, they split any extra money amoung the provider members. A truely jaded way to see it would be to say they kept her in a wheelchair so that they could pocket extra money at the end of the year: but I am not so jaded. I think the accidental end point of any health care system that uses profit as its primary measurement is bound to give poor care at high cost. Joanne Holland DVM/MD Fussy? Opinionated? Impossible to please? Perfect. Join Yahoo!'s user panel and lay it on us.

Make your little one a shining star! Shine on!

[Guest guest]

Joanne Holland wrote:

" From this, admittedly

difficult, patient I have been again confirmed in my belief that we

have to listen to the patient. "

I would say that patient and provider were triumphant in your

example!

Thank you for sharing this great example of patient centered care and the

reminder of the importance of being on the same page with our

patients.

Judy

[Guest guest]

Ditto. You are amazing Joanne!

Pamela

>

>

>

> Joanne

> When I grow up, I want to be a doctor like you.

> Lynn Ho

> To:

> From: joandvmmd@...

> Date: Mon, 17 Sep 2007 10:59:07 -0700

> Subject: Patient Triumphs in Drain, Oregon

>

>

>

>

>

>

>

>

>

>

>

>

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>

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>

>

>

> From Dr Joanne, the Old MD in Drain, Oregon, This

last Thursday I had

a patient walk into my office, using a cane. She had not walked in the last

seven years,

being wheelchair bound from pain and instability. She had a diagnosis of MS,

and had

been labled a " non-compliant " patient, because she kept insisting on getting her

pain

treated, and getting her muscle spasms treated, and on getting...Oh, the last

group of

illness included referrals to 6 different specialists. One can see why she

irritated

providers, since she has a psych problem and was loud about it. She was fired

from a

number of offices. In one case they called the police and had her taken out in

handcuffs,

rolling her wheelchair to the car for her because she could not manipulate it in

her cuffs.

What did we

> do different? Well, I established a weekly visit, whether she needed it or

not. I took

her pain seriously and treated her with methadone. I took each of her complaints

in order,

and in the last year we had visits with about 8 different specialists. The most

serious

problem: We did find a neck spondylosis and a narrowing of her canal that was

causing

pain and is going to be surgically treated this coming week: the surgeon wanted

to wait

until the other things were stable. We fixed her feet with shoe inserts, her

ingrowing

toenails were treated, I treated her GERD and treated her infected teeth.

At last we

treated her swollen feet and legs (lymphedema and intermittent cellulitis) we

cultured,

treated with antibiotics. We found a latex allergy and changed her clothes: no

elastic

waist bands on her skirts or under ware, no stretchy cheap socks, no flipflops,

no stretchy

> throws on the chairs and beds, no stretchy wrist bands, and all cotton or

linen clothing.

In the end she totally cleaned her house up with a full house vacuum that took

two days.

During that time we treated her with a two week prednisone taper. Four days

later she got

up out of the wheelchair, and was walking with only her neck and arm pain from

the

cervical problem. It has taken us a year. I am quite surprised that she has

gone as far as

she has. From this, admittedly difficult, patient I have been again

confirmed in my

belief that we have to listen to the patient. It is good to have some standard

management

systems, but there is no reason to just follow some standard system that does

not work in

the patients best interest. By the by, she once was assigned to an HMO,

DCIPA,

which

> did not include easy referrals to some of those specialists including the

neurologist for

her MS and the neurosurgeon. This group takes the OHP money to manage these

medicaid patients, and then at the end of the year, they split any extra money

amoung the

provider members. A truely jaded way to see it would be to say they kept her in

a

wheelchair so that they could pocket extra money at the end of the year: but I

am not so

jaded. I think the accidental end point of any health care system that uses

profit as its

primary measurement is bound to give poor care at high cost.

Joanne Holland

DVM/MD

> Fussy? Opinionated? Impossible to please? Perfect. Join Yahoo!'s user

panel and lay

it on us.

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

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>

>

>

>

> _________________________________________________________________

> Capture your memories in an online journal!

> http://www.reallivemoms.com?ocid=TXT_TAGHM & loc=us

>

[Guest guest]

good job. i cant say i would have done the same but i have also

overextended and that in itself is my nemesis. but it truly would be

rewarding.

now another rant. just got back from department meeting and one of

the things they mentioned is that CMS is not paying for inpatient

management of dvt anymore. so in essence they get outpatient tests

which hopefully the one and only hospital will do same day. however

they say that they will not turn away anyone that goes through the

ER and give them the first shot of lovenox. however....

(drumroll) this is the catch.

insurance may not pay for the homecare that entails giving the shot

unless they are homebound

insurance may not pay for the IV therapy that may be needed for

outpatient services

OR

insurance may not pay for the whole course which costs $74 a shot.

so what do we do for uninsureds.... everyone was quiet.

the whole thing was really that the hospital is putting this out to

be a burden for the community because they will NOT get paid.

bottomline... hear me snicker or rant madly...

grace

>

> Joanne,

>

> Good job. That must have felt great to see her actually walking.

>

> And you are correct. Basically all health plans are

counterintuitive to

> good health care. The cheapest thing we can do is provide no care

and let

> all but the must " fit " survive. Everything else costs money.

It's just a

> matter of whose money. If it's our pocket, then we are likely to

provide

> less care in order to make a profit. If it's the Health Plan,

then they try

> to get us to be more " economical " by doing things more cheaply.

But worse

> than that is that the patient's don't think that they should have

to pay

> money for their health particularly if blessed with poor health.

So how do

> we cost share these health issues?

>

>

>

>

>

> Kathy Saradarian, MD

>

> Branchville, NJ

>

> www.qualityfamilypractice.com

>

> Solo 4/03, Practicing since 9/90

>

> Practice Partner 5/03

>

> Low staffing

>

>

>

>

>

>

>

> From:

> [mailto: ] On Behalf Of joanne

holland

> Sent: Monday, September 17, 2007 1:59 PM

> To:

> Subject: Patient Triumphs in Drain, Oregon

>

>

>

> From Dr Joanne, the Old MD in Drain, Oregon,

>

>

>

> This last Thursday I had a patient walk into my office,

using a

> cane. She had not walked in the last seven years, being

wheelchair bound

> from pain and instability. She had a diagnosis of MS, and had

been labled

> a " non-compliant " patient, because she kept insisting on getting

her pain

> treated, and getting her muscle spasms treated, and on

getting...Oh, the

> last group of illness included referrals to 6 different

specialists. One

> can see why she irritated providers, since she has a psych problem

and was

> loud about it. She was fired from a number of offices. In one case

they

> called the police and had her taken out in handcuffs, rolling her

wheelchair

> to the car for her because she could not manipulate it in her

cuffs.

>

>

>

> What did we do different? Well, I established a weekly

visit,

> whether she needed it or not. I took her pain seriously and

treated her

> with methadone. I took each of her complaints in order, and in the

last year

> we had visits with about 8 different specialists. The most

serious problem:

> We did find a neck spondylosis and a narrowing of her canal that

was causing

> pain and is going to be surgically treated this coming week: the

surgeon

> wanted to wait until the other things were stable. We fixed her

feet with

> shoe inserts, her ingrowing toenails were treated, I treated her

GERD and

> treated her infected teeth.

>

> At last we treated her swollen feet and legs (lymphedema and

intermittent

> cellulitis) we cultured, treated with antibiotics. We found a

latex

> allergy and changed her clothes: no elastic waist bands on her

skirts or

> under ware, no stretchy cheap socks, no flipflops, no stretchy

throws on the

> chairs and beds, no stretchy wrist bands, and all cotton or linen

clothing.

> In the end she totally cleaned her house up with a full house

vacuum that

> took two days. During that time we treated her with a two week

prednisone

> taper. Four days later she got up out of the wheelchair, and was

walking

> with only her neck and arm pain from the cervical problem. It

has taken us

> a year. I am quite surprised that she has gone as far as she has.

>

>

>

> From this, admittedly difficult, patient I have been again

confirmed in

> my belief that we have to listen to the patient. It is good to

have some

> standard management systems, but there is no reason to just follow

some

> standard system that does not work in the patients best interest.

>

>

>

> By the by, she once was assigned to an HMO, DCIPA, which did

not

> include easy referrals to some of those specialists including the

> neurologist for her MS and the neurosurgeon. This group takes the

OHP money

> to manage these medicaid patients, and then at the end of the

year, they

> split any extra money amoung the provider members. A truely jaded

way to

> see it would be to say they kept her in a wheelchair so that they

could

> pocket extra money at the end of the year: but I am not so

jaded. I think

> the accidental end point of any health care system that uses

profit as its

> primary measurement is bound to give poor care at high cost.

>

>

>

> Joanne Holland DVM/MD

>

>

>

> _____

>

> Fussy? Opinionated? Impossible to please? Perfect. Join

>

<http://us.rd.yahoo.com/evt=48516/*http:/surveylink.yahoo.com/gmrs/ya

hoo_pan

> el_invite.asp?a=7%20> Yahoo!'s user panel and lay it on us.

>

[Guest guest]

Joanne, You and your patient are awesome! Lonnajoanne holland wrote: From Dr Joanne, the Old MD in Drain, Oregon, This last Thursday I had a patient walk into my office, using a cane. She had not walked in the last seven years, being wheelchair bound from pain and instability. She had a diagnosis of MS, and had been labled a "non-compliant" patient, because she kept insisting on

getting her pain treated, and getting her muscle spasms treated, and on getting...Oh, the last group of illness included referrals to 6 different specialists. One can see why she irritated providers, since she has a psych problem and was loud about it. She was fired from a number of offices. In one case they called the police and had her taken out in handcuffs, rolling her wheelchair to the car for her because she could not manipulate it in her cuffs. What did we do different? Well, I established a weekly visit, whether she needed it or not. I took her pain seriously and treated her with methadone. I took each of her complaints in order, and in the last year we had visits with about 8 different specialists. The most serious problem: We did find a neck spondylosis and a narrowing of her canal that was causing pain and is going to be surgically treated this

coming week: the surgeon wanted to wait until the other things were stable. We fixed her feet with shoe inserts, her ingrowing toenails were treated, I treated her GERD and treated her infected teeth. At last we treated her swollen feet and legs (lymphedema and intermittent cellulitis) we cultured, treated with antibiotics. We found a latex allergy and changed her clothes: no elastic waist bands on her skirts or under ware, no stretchy cheap socks, no flipflops, no stretchy throws on the chairs and beds, no stretchy wrist bands, and all cotton or linen clothing. In the end she totally cleaned her house up with a full house vacuum that took two days. During that time we treated her with a two week prednisone taper. Four days later she got up out of the wheelchair, and was walking with only her neck and arm pain from the cervical problem. It has taken us a

year. I am quite surprised that she has gone as far as she has. From this, admittedly difficult, patient I have been again confirmed in my belief that we have to listen to the patient. It is good to have some standard management systems, but there is no reason to just follow some standard system that does not work in the patients best interest. By the by, she once was assigned to an HMO, DCIPA, which did not include easy referrals to some of those specialists including the neurologist for her MS and the neurosurgeon. This group takes the OHP money to manage these medicaid patients, and then at the end of the year, they split any extra money amoung the provider members. A truely jaded way to see it would be to say they kept her in a wheelchair so that they could pocket extra money at the end of the

year: but I am not so jaded. I think the accidental end point of any health care system that uses profit as its primary measurement is bound to give poor care at high cost. Joanne Holland DVM/MD Fussy? Opinionated? Impossible to please? Perfect. Join Yahoo!'s user panel and lay it on us.

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[Guest guest]

Me too! What a wonderful story! Myrialynn ho wrote: JoanneWhen I grow up, I want to be a doctor like you.Lynn Ho To: From: joandvmmdDate: Mon, 17 Sep 2007 10:59:07 -0700Subject: Patient Triumphs in Drain, Oregon From Dr Joanne, the Old MD in Drain, Oregon, This last Thursday I had a patient walk into my office, using a cane. She had not walked in the last seven years, being wheelchair bound from pain and instability. She had a diagnosis of MS, and had been labled a "non-compliant" patient, because she kept insisting on getting her pain treated, and getting her muscle spasms treated, and on getting...Oh, the last group of illness included referrals to 6 different specialists. One can see why she irritated providers, since she has a psych problem and was loud about it. She was fired from a number of offices. In one case they called the police and had her taken out in handcuffs, rolling her wheelchair to the car for her because she could not manipulate it in her cuffs. What did we do different? Well, I established a weekly

visit, whether she needed it or not. I took her pain seriously and treated her with methadone. I took each of her complaints in order, and in the last year we had visits with about 8 different specialists. The most serious problem: We did find a neck spondylosis and a narrowing of her canal that was causing pain and is going to be surgically treated this coming week: the surgeon wanted to wait until the other things were stable. We fixed her feet with shoe inserts, her ingrowing toenails were treated, I treated her GERD and treated her infected teeth. At last we treated her swollen feet and legs (lymphedema and intermittent cellulitis) we cultured, treated with antibiotics. We found a latex allergy and changed her clothes: no elastic waist bands on her skirts or under ware, no stretchy cheap socks, no flipflops, no stretchy throws on the chairs and beds, no stretchy wrist bands,

and all cotton or linen clothing. In the end she totally cleaned her house up with a full house vacuum that took two days. During that time we treated her with a two week prednisone taper. Four days later she got up out of the wheelchair, and was walking with only her neck and arm pain from the cervical problem. It has taken us a year. I am quite surprised that she has gone as far as she has. From this, admittedly difficult, patient I have been again confirmed in my belief that we have to listen to the patient. It is good to have some standard management systems, but there is no reason to just follow some standard system that does not work in the patients best interest. By the by, she once was assigned to an HMO, DCIPA, which did not include easy referrals to some of those

specialists including the neurologist for her MS and the neurosurgeon. This group takes the OHP money to manage these medicaid patients, and then at the end of the year, they split any extra money amoung the provider members. A truely jaded way to see it would be to say they kept her in a wheelchair so that they could pocket extra money at the end of the year: but I am not so jaded. I think the accidental end point of any health care system that uses profit as its primary measurement is bound to give poor care at high cost. Joanne Holland DVM/MD Fussy? Opinionated? Impossible to please? Perfect. Join Yahoo!'s user panel and lay it on us. Make your little one a shining star! Shine on!

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