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Location: The place where the road & the sky collide
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Quote:
Originally Posted by Hoagie58
First, I can assure you that the person you saw first was probably either a CMA or an RMA. Certainly no excuse for rudeness, but all too common.
Second, I am willing to bet dollars to donuts that somewhere on your chart or in conversation it came out that you are (were) an RN. Having been in the profession for 15 years, I learned long ago to never disclose my profession. First, it creates tension with those who are your peers- feeling they are being judged in the performance of their job, and more importantly, because of what happened to you. While I certainly cant defend it, I suspect this is why the physician engaged you in healthcare reform discussion, rather than answering questions- he simply assumed you'd know what to expect.
Third, in regards to anesthesia- the standard for sedation for colonoscopies used to be versed and demerol. The standard seems to be shifting to diprivan. Having given both in the ED, the propofol would certainly be my first choice, either as the nurse, or the receiver.
Finally, in case you (collectively) have not noticed, nearly all of the physician practices in this area have been bought out by either the CMC or Presby systems. Subsequently, the leadership of these practices set productivity goals. Typically, across the family practice spectrum, a physician is alloted 15 minutes for a normal office visit, and 30 minutes for a physical. This does not take in to account the typical pt who (a) shows up at exactly their appointment time, knowing they need to be wighed, have vitals taken, review meds, etc (b) the pt who shows up 10-15 minutes AFTER their appointed time, and still expects to be seen, and (c) the pt who tells the scheduler they're coming in for a routine follow up, and then presents a laundry list of problems for the physician to address.
It is not at all uncommon for the physician I work for to be 30+ minutes behind. It's also not uncommon for our pts to not say a word about it because they know if they require an additional 5,10,15 minutes of his time, he'll gladly give it to them. I cannot tell you how many times my 8:30-5:30 work day has extended to 7:00 or later, as he and I handle messages, refills, and other pt needs accrued throughout the day. I also know that Ive come to work, and found messages from my doctor that he sent to me at midnight or later-meaning he's up that late meeting pt needs.
All things considered, I think that the typical billing done by a physician is generally very reasonable. When you factor in that (a) most insurance companies do not pay anywhere near what is billed, (b) the amount billed has to cover all of the overhead of an office- lights, rent, employee compensation, malpractice insurance, and something for the doctor, (c) pt's who pay cash, on the day of service, are generally given a generous discount (ours is 20%), Im sure we can all agree that pricing really isnt that outrageous.
hoagie, just to add something to your information, & ask my own question.
Both the ob/gyn & onocologist who were dealing with me were surprised that I was aware of certain procedures, etc. with cancer diagnosis & treatment. I explained my mother's situation with colorectal cancer (not what I had) & both were shocked because they had studied the case in medical school & were unaware of any information about the patient, but did know who the surgeon was, as well as the date (1968).
My mother's surgeon was involved with the development of the original equipment used for colonoscopies. These are 2 links to verify what I just wrote. Marks Colorectal Surgical Associates || PHYSICIAN PROFILES (http://www.markscolorectal.com/site/MCSA%20Gerald.htm - broken link) Marks Colorectal Surgical Associates || Gerald Marks CV (http://www.markscolorectal.com/site/GMCV1.htm - broken link)
My mother had colonoscopies from the time that they were allowable. She was never knocked out. When the practice of knocking people out started, they asked her & she told them that since she had always had the proceedure done with a local, she saw no purpose. Yes, they did snip polyps from time to time, with a local.
I'm being sent to a specialist for genetic testing & may be looking at being given a colonoscopy, depending on the results. Based on the information in this thread, I'm wondering do they give the test with a local in this area? (If the genetic testing indicates what I will be tested for, the test would be given within the CMC system.)
Last edited by southbound_295; 03-26-2010 at 04:27 PM..
hoagie, just to add something to your information, & ask my own question.
Both the ob/gyn & onocologist who were dealing with me were surprised that I was aware of certain proceedures, etc. with cancer diagnosis & treatment. I explained my mother's situation with colorectal cancer (not what I had) & both were shocked because they had studied the case in medical school & were unaware of any information about the patient, but did know who the surgeon was, as well as the date (1968).
My mother's surgeon was involved with the development of the original equipment used for colonoscopies. These are 2 links to verify what I just wrote. Marks Colorectal Surgical Associates || PHYSICIAN PROFILES (http://www.markscolorectal.com/site/MCSA%20Gerald.htm - broken link) Marks Colorectal Surgical Associates || Gerald Marks CV (http://www.markscolorectal.com/site/GMCV1.htm - broken link)
My mother had colonoscopies from the time that they were allowable. She was never knocked out. When the practice of knocking people out started, they asked her & she told them that since she had always had the proceedure done with a local, she saw no purpose. Yes, they did snip polyps from time to time, with a local.
I'm being sent to a specialist for genetic testing & may be looking at being given a colonoscopy, depending on the results. Based on the information in this thread, I'm wondering do they give the test with a local in this area? (If the genetic testing indicates what I will be tested for, the test would be given within the CMC system.)
I am most familiar with demerol and versed combination. This is known as "conscious sedation", as you will be awake, and the doc able to speak to you, but the versed will also generally leave you with little or no memory of the actual procedure. My use of diprivan was as a sedative for pt's on vents. It too will provide a similiar effect, but IMHO, versed would be the better choice. I would certainly discuss both with whomever does your procedure- they may have data which suggests better results or outcomes with one vs the other.
Location: The place where the road & the sky collide
23,813 posts, read 34,657,307 times
Reputation: 10256
Quote:
Originally Posted by Hoagie58
I am most familiar with demerol and versed combination. This is known as "conscious sedation", as you will be awake, and the doc able to speak to you, but the versed will also generally leave you with little or no memory of the actual procedure. My use of diprivan was as a sedative for pt's on vents. It too will provide a similiar effect, but IMHO, versed would be the better choice. I would certainly discuss both with whomever does your procedure- they may have data which suggests better results or outcomes with one vs the other.
OK, Thanks. I know that my mother was given a shot, but I never asked her what it was. She used to enjoy watching the camera go up & would tell about it. I'm guessing that whatever they gave her is no longer used.
I am most familiar with demerol and versed combination. This is known as "conscious sedation", as you will be awake, and the doc able to speak to you, but the versed will also generally leave you with little or no memory of the actual procedure. My use of diprivan was as a sedative for pt's on vents. It too will provide a similiar effect, but IMHO, versed would be the better choice. I would certainly discuss both with whomever does your procedure- they may have data which suggests better results or outcomes with one vs the other.
Diprivan (propofol) was developed as a short acting anesthetic agent for procedures like bronchoscopy etc where deep short acting anesthesia was required.
Initially it wasn't licensed for sedation in ICU, because the clinical trials that lead to it being approved weren't for sedation.
So in the case of ICU it's used as a sedative, but usually for patients who are ventilated, often so that they will not breathe over the top of the ventilator.
As a an ICU nurse for 10 years it was the drug of choice for sedation, unless large amounts were required and then we would change to Midazolam ( trade name versed) which is longer acting .
Now this is completely different from using propofol to induce full anesthesia
for surgery!
I am trying to get my head around what is different with colonoscopies here rather than the UK that means they have moved from sedation with midazolam to giving full anesthesia which requires (I hope!) an anesthesiologist present.
MDs words were "we knock you out, it's MAC "(monitored anesthesia care)
So my question is not why they use a certain drug for sedation, but why they are giving a full aneshetic rather than conscious sedation?
The fact that I was an RN was on my form , yes.
If the MD felt threatened by that then that's his problem, and I have come across this in the UK. Sometimes I think it's a control thing, ie I don't want you to know as much as I do.
I doubt that he would have spent so little time with another MD!
susan, I gotta say, my limited experiences with the NHS were far better than the care that I have received here (and paid $$$$ for). Especially the care that I received in casualty (ER in America) and X-ray. I could go on, but, honestly, I think that the healthcare here is too $$$ driven and far less people-driven. You should read some of the posts by another regular, superk. It would break your heart and yet, it is indicative of the overall care that we have in this country. I could also tell you stories that would curl your hair regarding the lack of care that myself & sons have received over the years because we did not have insurance. My oldest son & myself are still dealing with the after-affects and this was years ago.
You are wise to question, wise to look for another MD, wise to keep your nose in everything. Too many people simply trust their doctors and the common thread in that is that they just throw medication at people, not cures, not trying to find out WHY. In the end, the people are far too dependent on the drugs and they die anyway. It is a very convoluted system.
Oh yes, am doing so, and not having colonoscopy either (not through them anyway).
I'm a nurse and being used to the UK NHS I was a little "shocked" to say the least. Atually made me quite anxious about the system here as a whole, being my first experience.
Give me a break. In the U.K. doctors say that the colonoscopy is an "American" thing. Like everything else, England is a few decades behind. Trust me, you are much, much safer in the U.S. for medical treatment and far less likely to die from infection. I remember in England when all Pab smears, colonscopys, prostrate checks, Mamograms, and other exploratory exams were halted because the national health system ran out of money. That is what we have to look forward to with you know who at the helm.
Give me a break. In the U.K. doctors say that the colonoscopy is an "American" thing. Like everything else, England is a few decades behind. Trust me, you are much, much safer in the U.S. for medical treatment and far less likely to die from infection. I remember in England when all Pab smears, colonscopys, prostrate checks, Mamograms, and other exploratory exams were halted because the national health system ran out of money. That is what we have to look forward to with you know who at the helm.
I was comparing the difference between the US and the UK systems regarding the process of care. In the UK we seem to place more emphasis on using clinical judgement ,which can only be made by taking a good history, followed by physical examination and then appropriate investigations.
The history and physical examination part IMO was inadequate.
A good history is vital . Google "importance of history taking in medicine" and it will become clear.
It is usual to do a per rectum examination if abdominal or pelvic pathology is suspected and also maybe to send a specimen of faeces to the laboratory for testing for blood.(FOB)
Expensive invasive investigations (that may also carry a higher risk to the patient eg anesthesia in this case) should never be a substitute for history taking and physical exam and should only be performed if appropriate once the physician has a good idea of the diagnosis.
The art of medicine isn't about throwing money and numerous investigations at a problem. If that was the case we could do without a lot of MDs, and actually I believe a NP could easily have done a better job than the specialist I saw. I certainly would have done.
Yes, in the UK there are more limited resources, but only because less people have private health insurance and govt funding for heathcare accounts for around 85% of total heathcare expenditure compared to arouund 40% in the USA.
The USA has huge geographical, racial and economic disparities in heathcare provision, cancer survival rates etc.
You have to remember that in the US those with private health insurance maybe getting a different service from those with none.
I remember in England when all Pab smears, colonscopys, prostrate checks, Mamograms, and other exploratory exams were halted because the national health system ran out of money.
Do you mean screening (ie in people with no symptoms) or examinations in those with symptoms? Huge difference.
Would be interested to know when this was.
England is a few decades behind.
More technology doesn't neccesarily mean improved healthcare.
If you looked at the evidence (or lack of) for some treatments that are carried out in the US but not in UK you might be shocked.
A good example was the Merci retriever which was approved in 2004 , despite evidence of mortality rate of 53% (from the MERCI study) and only 28% of patients (so less than 20% of those treated) being able to live independently with some disability at 3 months.
UK is more "fussy" about which drugs and treatments are licensed. Yes that has to do with cost effectiveness, but it also has to do with quality of life during and after the treatment. Being alive is one thing, quality of life is quite another.
I had my first colonoscopy 2016 at Carolina Digestive on Billingsley road. My husband had his colonoscopy on 2016 at the Carolina Digestive Endoscopy Center in Monroe, NC. My husband's experience was far superior to mine and with the same Doctor. He had a private room, was given IV fluids and he had an anesthesiologist that administered lidocaine prior to the propofol injection.
I had an IV line, no fluids, a curtain, and a CRNA that did not bother using lidocaine. I experienced the most horrific burning sensation of my life in the 20 seconds prior to the propofol taking effect.
My insurance BCBS of NC for retired teachers has an agreement with the Billingsley road location only. It would cost me $700.00( deductible)for any other location, $70.00 copay at Billingsley.
The Doctor, nurses and staff were very nice and professional. My procedure went well other than my hand "burning off", and I was able to leave 30 minutes after procedure. Honestly, I think the IV fluids would have been beneficial for me. I was dehydrated from the prep and my extreme fatigue afterwards, I believe can be attributed to not getting fluids.
Do your homework! I am having a difficult time dealing with my reaction to my hand and arm burning. Having birthed 2 babies and broken my ankle in three places- I have never been as frightened or in such pain. I know I was fighting and trying to get to the IV while yelling IT HURTS! I am a little embarrassed and traumatized. Insurance should not be able to dictate quality of care.
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