Misc Useful Information


 It seems Congress is still struggling with Obamacare. 

The cost of a citizen buying Obamacare insurance is rising. This insurance products are sold by different insurance companies to the public. These are relatively inexpensive products for the consumer. My understanding is that the insurance premium that the insurance company receives are subsidized by your tax money. However even with the subsidy, most insurance companies are raising the premiums by 30%. Actually the subsidies are another reason for this agreement. One of the benefits of Obamacare has been that people can buy insurance without regard of preexisting conditions. People who have had a serious condition before were denied insurance by the insurance companies. This is another point of this agreement amongst the different members of Congress. 

Interestingly, nobody seems to mention the rising costs of healthcare. In my opinion, unless this is addressed, universal healthcare is the real eventuality. 

Drug Addiction


Drug addiction is so common now in Oklahoma that drastic measures are being taken. Of course, that can be treated as a disease or as a crime, especially for people who are dealing with drugs. It is not unusual that I hear from people that a Lortab tablet can bring $25 on the street so you can see that between legitimate patients, drug addicts, the facilitators and the drug dealers, Lortabs have become a huge problem. Not only in Oklahoma, but also in the nation. So now, how are we as a society to treat this affliction? Of course the easiest way is not to probably find the criminals, or treat the addicts, the easiest way would be to curtail the ease with which they can get this medication. This then turns back on the poor physician, who now is encumbered by having to check the background of every patient he writes a prescription for Lortab. The other difficulty also is that we now cannot give Lortabs to a patient without a written prescription. This means we cannot call it into a pharmacy, which we were doing up until 6 months ago. What happens is if there is a problem, like one doctor had, there was something missing from the prescription he wrote, the patient went home first, and then went to the pharmacist, and the pharmacist would not fill out the prescription. The patient is in pain, the doctor gets a phone call in the middle of the night from the patient, telling him they cannot fill their pain medication prescription, so the physician had to get up in the middle of the night, get dressed, and go meet the patient somewhere on the hospital grounds to give them another prescription. How can we fix these things? That will be left to our state and the bodies who take care of this problem.


Prescription Medication Prices

The prices for prescription medications keep rising. 
One patient was complaining to a doctor that another doctor had put her on this new medication for a leaky bladder. That would cost her about $600 a month. One medication called Ditropan, which does about the same thing. Now, this is the same family of medications that are used for this condition. It would cost $10 a month. It is unfortunate that most physicians do not get involved with how much a drug that they are prescribing costs. It looks like physicians need a disincentive for prescribing expensive medications. A lot of times, they recommend medications that are new, but not necessarily more effective. 
One can save a lot of money as a patient to have a frank discussion with the physician concerning this issue. A patient can save a lot of money by not being bashful. 
Healthcare Co-ops

One of the newer organizations that the new healthcare law started are the healthcare co-ops. These are organizations to take care of some patients with the help of government grants. These organizations are mostly managed by family physicians. 
Recently, a review has been done as far as how these set ups are working. It was discovered that a large percentage have already stopped functioning. It appears that no matter how hard one tries to improve healthcare reform, unless the individual physician has both incentives and disincentives (financial), most set ups will not be able to deal with overhead. The insurance bought through the exchanges have not done very well. The premiums have gone up. Of the ten million people who have signed up during the last year, 90% of the enrollees signed up for Medicaid. 

Exchange Insurance

As more and more products of exchange insurance are purchased, some realities were discovered. One cannot buy exchange insurance anytime. Normally the months of the year that these exchanges are open for enrollment would be in November and December. What happens when somebody gets sick and he has no insurance yet? 
One patient tried to buy insurance from an agent who sold him a product which would be good for four months. This would tie him over until exchange enrollment time. However, the agent did not tell him that this would not cover his pre-existing condition. I have had a patient who was in this situation but was able to enroll in the exchange even before the date by declaring his condition as urgent. It will take some work and patience, but with exchange products, we'll make exceptions if pursued. 

What is a Colonoscopy?

This is a scope test to check on the large bowel. This is done to check on polyps and cancer. Normally, this is done in a clinic or an outpatient setting. The patient receives intravenous sedation as well as a narcotic. Some patients have had this without IV sedation. Recently, it was decided by the physicians and institutions to give the patient Propofol. This is an IV medication that will put the patient to sleep momentarily. It is short-acting and it should be given repeatedly to cover the 45 minutes that a colonoscopy may take. The problem with this is that the patient is not fully anesthetized with a mask or a tube, so he may end up by aspirating his stomach contents into his lungs. This can lead to severe complications. For that reason, the presence of an anesthesiologist is required. Physicians and outpatient healthcare facilities started doing this specially so they could charge the patient and the patient could leave the recovery room and the facility much faster, saving time and expenses for the facility. Well, at this time it appears that Medicare has decided not to pay the extra fees to the anesthesiologist and to the healthcare facility for the Propofol starting in January of 2016. I am predicting that the use of Propofol for colonoscopies will drop dramatically if the patient is asked to pay for all of that. By the way, it was Propofol that caused Michael Jackson's death. 


As we all aware, this disease is due to a virus amd is a deadly one, with about 50-90% of patients dying.
The transmission is mostly by contact of body fluids of infected patients with symptoms like cough, bloody diarrhea, and blood in the urine. After inoculation with the virus, the incubation period, which means the start of the symptoms, is 2-21 days. So usually if somebody is quarantined for 21 days and has not developed symptoms, he is most likely not infectious anymore. There is no practical treatment at this time except for IV or PO fluids and supportive treatment until the patient gets over it. The question one is asked if a patient has coughed on a surface or some body fluids get on that surface which is touched by another person, can this cause infection? The answer is obviously yes. So it becomes important to wash our hands and keep good hygiene. Maybe we should restrain from traveling for leisure and avoid crowded places. Some of us will panic. I will not blame them if they are proven wrong later. I will keep you posted on future developments as they unfold. 

Does having a vasectomy cause prostate cancer?

A large study completed recently has shown that patients who have had vasectomies may be more prone to develop aggressive prostate cancers in the future. A similar study in the early 80's tried to show that patients who have had vasectomies are more prone to prostate cancer. It took a few years and many studies, the conclusion was that it was not significant. 
At this time, this is informational. For patients who have had prostate cancer in the family, it may be that they should postpone the procedure. It may be that they should have it, and then be very particular about getting their prostates and PSAs checked later in life. 

One Network for Healthcare Providers

Patient's History, Physicals and Encounters with different physicians and providers, as well as admissions to different health care facilities, present the provider with chaotic and sporadic facts that some patients even forget. 
To fix this, the government decided a master plan, whereby all healthcare providers will be on one network or several large networks where they can talk to each other by computers. The government even offers about $40,000 per physician to buy the computers and the software to facilitate this. As the rule of unforeseen consequences unfolded, things got worse than improved. Actually, a simple paper chart became a multipage cut and paste document that may enhance payment from the government and insurance companies. This, however, became very impractical for the treating physician as he/she tried to go through pages and pages of jargon, trying to look for maybe one sentence that makes sense. I had talked about this problem for a long time and finally, I came up with an idea of the Patient Journal. This is a booklet that contains almost all the major topics of the patient's health care. It includes patient information, names of physicians, facilities, medications, allergies, procedures, lab tests ordered, questions to ask the doctor, the last pages are blank pages for the patient to fill out the lines with notes from his/her encounter of the day.The patient is to fill the booklet out at home, before and after his/her visit. Then bring the booklet to every health care encounter. The booklet is made such that it can be copied and scanned into electronic medical records. One can simply divide a spiral notebook with these topics and start keeping track. This may be cumbersome for a lot of people. Instead you can let us know and, for the cost of $13.00, we can provide you with one which is ready to go. To order one you can email us at hrairkurk@gmail.com
ObamaCare Exchanges

These are healthcare entities that offer healthcare to different people with different income levels. These exchanges are healthcare products just like other products like HMOs and PPOs. So, the same insurance company may have 3 different products: an HMO, a PPO, and an Exchange. For instance, Blue Cross Blue Shield has an exchange program called Advantage. This is not to be confused with Advantage Medicare programs that are basically Medicare HMOs that are offered by private insurance companies like Aetna and United Healthcare and others. To apply, for instance, for Blue Cross Blue Shield Advantage exchange program, one would go to www.healthcare.gov, look for it, and follow the instructions. This may take a while in some instances, but in others, the number of questions was reasonable, and the whole process was successful. The time it took was reasonable. 

Relationship between Testosterone and Heart Disease

Recently some articles have been published about testosterone and heart disease. It appears that some patients are at increased risk of having heart attacks when on testosterone. It is not clear if this is due to the injections or the creams. At this time we are withholding testosterone from patients who have not been proven by blood tests that they have low testosterone. Even then, this seems to be serious enough that one should not prescribe or receive this hormone without thorough consultation and blood tests. 

Is PSA necessary?

The government task force has decided that, in most men, PSA measurement is not necessary. In the early 90's, when there was no PSA, 70% of patients who presented to the office, and eventually got diagnosed with cancer of the prostate, already had prostate cancer spread in the bones. For a whole nation, maybe what the task force has decided is beneficial, however, for the individual person dying a painful death from cancer in the bones may be something different. It is well known that excessive testing and biopsying the prostate could be financially driven and may hurt some patients. It becomes important then to find a physician that you know would not take that path.

Boutique Medicine

A rather new invention in the health care delivery system. Some primary care physicians have opted to charge individual patients about $2,000 a year for special consideration. The way this works is that this special patient will get 24 hour cell phone access to this physician. He will have a long and thorough physical exam once a year, sometimes lasting for 2 hours. Furthermore, he is promised to be seen same day or the next day, anytime he needs an appointment. This is not covered by any insurance or medicare. Some companies help doctors set up these arrangements. Of course people have a lot of questions about how this really works. Will the Doctors continue to see his other patients? Will the company that sets this up and recruits the patients be selective?
I can see from the business aspect, a patient who has multiple diagnoses and takes multiple  medications, may not have access to this program. Time will tell.


It looks like Obamacare has withstood the test of the Supreme Court for now. It is interesting that almost half the country and half the Supreme Court are against it. I wonder if all the supreme court justices had time to read all the 2,300 pages of the law. I wonder, with all my respect, if they understood every sentence with its medical implications. I wonder, sometimes, if in situations like this, the justices should  be given a chance to read the whole document and then take a test which consists of 100 multiple choice questions. Then whoever passes the test should be able to vote. But then, I wonder, if you, as a patient, would like to be treated by a physician who scored 51% on his licensure board exams.

Health Care Reform

The supreme court has met about health care reform. The crucial question that is on the minds of most Americans is: Can we enforce an American citizen to buy health insurance? 
If the supreme court decides that the answer is no, then the health care reform law will have to be drastically changed. What to do then? One of the simplest solutions for the uninsured would be to accept all into the Medicaid program.
The funding will be left to the creativity of the American people.
One suggestion would be to tax people on the money they spend on entertainment. For example, and I know this is going to upset some people, how about taxing football tickets at 10%? The health care system is broken. The fix is not going to be painless.

Contraception and Catholic Institutions
It appears that the new health care reform bill includes the rule that if any institution accepts federal funds, then it cannot deny payment for contraception. This has produced a lot of turmoil and discussion. It is well known that catholic women do not abide by the dictums of the church as far as contraceptives are involved. What then should the average American citizen think about this issu

HMO's Run by Private Companies

There are HMO's run by private companies, which are designed 

specifically for Medicare patients Their premiums, copays an

deductibles may be attractively much less expensive or even non-

existentAs I understand it, the company is paid a certain fixed amount of money every year to take care of  all the healthcare needs of th

individual enrollee. If one becomes ill, unlike traditional Medicare 

plans, the company may deny some tests and treatments. It is obvious that besides efficiency scales, which have a definite endpoint and limit, denying interventions and diagnostic tests would be an avenue to generate revenue. The cruciaquestion then arises regarding what 

constitutenonessential tests and treatments. How is this decided on by one insurance company?


Accountable Care Organization


This week’s health care news is mostly focused on ACO’s. ACO 

stands for accountable care organization. This is basically an HM

that is owned by a hospital, insurance company, or a group of 

physiciansThe principle is to cut down on costs by rendering more 

efficient servicesThe pit fall would be that which did in the HMO’s, namely denial of careAnother hot topic this week is what is essential healthcare? In other words what is basic healthcare that will be the goal of universal healthcare for all Americans.

To read more about ACO's you can start by looking the word up in Wikipedia.