Thursday, May 19, 2011

Patients Rating Doctors: Let's Pay Popular People More!

Doc Gurley's Urban Health Beat, Reporting on Health, patient satisfaction, doctor reimbursement

Patients Rating Doctors: Let's Pay Popular People More!

Obligatory conflict-of-interest announcement: I am paid an hourly salary by a local government. My patients may fill out satisfaction surveys for other physicians in other settings, but they don't for me.

Part One of Three: My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in the double digits. Sam (not his real name) was the classic public inebriate - he woke on sidewalks with the shakes, vomited blood on a regular basis, had lost most of his teeth, and was such a frequent victim of head trauma that depressions and scars ridged his balding skull. 

Over the last week, our substance abuse counselor had daisy-chained together an impressive series of phone calls, blood tests, and clearance forms to line him up for one of our rarely-available detox beds. 

Only 20 minutes to go.

But it was 20 minutes too long for him.

Sam wanted pills to help his shakes, and he wanted them now. When I told Sam the nurses would bring them as soon as they could and that I needed to examine him before the van arrived, his head turned away, and his arm-crossed rocking picked up speed.

With a sideways look at me, he pulled from his jacket pocket his trump card - a crumpled prescription. He showed me how, just that morning, an emergency room doctor had already given him a prescription for Librium (a long-acting withdrawal drug, with high street re-sale value).

He was telling me that he didn't need all this hassle.

Librium is, by any measure, a dangerous drug, with a narrow gap between helpful and lethal. If you shake out one or two extra pills to try to quell the violence of your withdrawal symptoms, or you take a dose, feel better, and then succumb to the lure of a readily available bottle, you can die. (Or, perhaps worse, go into a coma and endure prolonged, intensive, and expensive suffering.)

Librium is extremely dangerous to a serious inebriate and is a big cause of the markedly short lifespan of people like Sam. But Librium is also a really quick and easy way to get someone to leave your ER happily.

Despite Sam's shakes, coughing, and symptoms that indicated he might be vomiting blood again, he had spent less than an hour from check-in to discharge in his Librium-producing ER visit.

Sam saw me looking at his ER client satisfaction survey and discharge instructions, and he said, "I want my prescription back. I'm not waiting any more."


Disclaimer: Identifiable patients mentioned in this post were not served by R. Jan Gurley in her capacity as a physician at the San Francisco Department of Public Health, nor were they encountered through her position there. The views and opinions expressed by R. Jan Gurley are her own and do not necessarily reflect the official policies of the City and County of San Francisco; nor does mention of the San Francisco Department of Public Health imply its endorsement.

Lakeside Park at Lake Merritt in Oakland
Lakeside Park at Lake Merritt in Oakland

Dick Ebersol, XFL Creator, Leaving NBC Sports

According to ESPN, Dick Ebersol, forgotten as the creator, with the then-called World Wrestling Federation, of the Extreme Football League, or XFL, has resigned in a contract dispute with Comcast.

The first thought that comes to this blogger's mind is apparently Comcast's not into paying what talented people are worth. Dick Ebersol, who not only formed the XFL, but developed and produced Sunday Night Football, now called Football Night In America, and many successful Olympics telecasts, and with Lorne Michaels, Saturday Night Live, is worth a king's ransom.

But Ebersol, who also lost one of his two boys in a plane crash in Colorado in 2004, also said he was just plain tired from all of the plane travel from event to event.

He deserves a break, but also that's a lot of talent just sitting around on a couch. Maybe too much talent.

Stay tuned.

Zazzle Bay To Breakers - Carol And Candy Want The Floats Back

Now that the 100th Bay to Breakers, and the first to be called "Zazzle Bay To Breakers," is over, it's time to consider improvements for the future. On that note, this blogger had the pleasure of meeting two runners (who were also participants and party goers, given the nature of things B2B) at the Park Chalet Restaurant after the race.

They were happy, talkative, and wonderfully opinionated.

Carol And Candy Want The Floats Back in the Bay To Breakers:

The sisters and San Francisco natives both said this year's event was "sparse" as Carol said "it's just the ambiance of everyone on their having such a good time. It seemed kind of sparse without the floats."

The Floats were disallowed for 2011 because they were seen as "rolling bars" distributing alcohol, leading to problems with falling down drunk people. In 2010, the party activity was so intense in the heat of the day that the Crossover Drive underpass was essentially blocked for emergency traffic, as this video from 2010 shows at the 4:42 mark:

This year, as upcoming videos will show, it was a lot tamer at the Crossover Drive underpass. In all, observers said the 2011 Bay To Breakers had fewer mishaps and problems than the year before.

The logical conclusion is that the new rules helped, but I still contend all of these problems would be almost totally eliminated if a big name group like The Rolling Stones or The Black Eyed Peas, or Lady Gaga took the stage at The Polo Grounds. Then, the action would be in that area, rather than all over the streets in Golden Gate Park.

Would it be perfect? No. But the crowd direction would be predictable; everyone would want to be in or close to the Polo Grounds. And the concert would go on until near dusk, insuring that people didn't have time to wander around because the Bay To Breakers was over and the Footstock was closed.

But we can toss around many different ideas for Bay To Breakers 2012. After all, we've got a year to go.

Well, unless Harold Camping gets his way!

End Of The World Not May 21st - Harold Camping Wrong

As this blog post is written, today is Thursday, May 19th, 2011. If Christian Radio Broadcaster Harold Camping has his way, Saturday May 21st will be The End Of The World. It's not necessary to go into a lot of detail to explain that Mr. Harold Camping is wrong.

Rather than immediately point to any Biblical scripture that reads "The World Will End On May 21st 2011," Camping points to a self-created math that leads him to that conclusion. But, really, it's a conclusion Camping would have come to an asserted without numbers.

It's just like Google using an algorithm to express what really is a set of opinions about how Internet search, and the placement of news, should work. Google execs are fond of pointing to this 'black box' that produces a result, but the fact is, if that black box comes up with a search outcome that's not in favor with their views, it will be altered.

Mr. Camping, originally a Berkeley-trained Civil Engineer long before creating the ministry of Family Stations, Inc., used a mathematical system of his own design to generate his result, which has really nothing directly to do with the Bible. In fact, in an interview in New York Magazine, Camping says...

— but there’s nothing in the Bible that holds a candle to the amount of information to this tremendous truth of the end of the world. I would be absolutely in rebellion against God if I thought anything other than it is absolutely going to happen without any question.

In other words, forget the Bible, the end of the World is nigh!

In this way, Camping is very much like another "expert" on what God is, does, and intends who was attacked in this space: Steven Hawking. Hawking is as certain that Heaven's a "fairy tale," much as Camping is sure that the World will end this Saturday, and both hide behind math and science to prove their points.

And the media gives them a ton of attention.

Yikes, man. Yikes.

Camping's backers are every bit as self-righteous as Hawkings's and just as annoying. Both are wrong, but in Camping's case, all it take is for us to wake up and see Sunday, May 22nd, 2011 to know it.

For Hawking, we have to pass away. Or talk to Don Piper:

Stay tuned.

Dominique Strauss-Kahn IMF Salary vs. Bay Citizen CEO Salary

In the wake of the arrest of IMF Manager Dominique Strauss-Kahn for sexual assault, CNN asked if the World leader's $440,000 salary was too much, given his responsibilities.

The Cable News Network compared the IMF with The World Bank, and came away with the point that observers say it's the right amount, considering that Strauss-Kahn had oversite for the loans to those of its 187 member countries who need them.

Well, let's compare Dominique Strauss-Kahn's salary with that of Bay Citizen CEO Lisa Frazier, who makes $400,000.

Is the Bay Citizen salary justified, given CNN's questions about Dominique Strauss-Kahn's salary? The answer's no. $100,000 salary? Yes.

But for Frazier to make as much as the Dominique Strauss-Kahn or President Obama, and yet be in charge of a regional news website, and not even a World news website, is outrageous.

It's not personal, only business.

And the business fact is that The Bay Citizen can't justify paying that high a salary given the small size and Internet traffic footprint of the SF Bay Area news website.

But will that change anything over at the Bay Citizen? No. It still has the outdoor ads that are more debate challenges on the future of journalism than a message to type "," as I talked about in this recent video:

Stay tuned.