New Docs on the Block

it has become a huge problem for persons coming down with illenss during summer months, as this is holiday time. doctors and nurses are off for the yearly vacations, leaving the hosp and patients in the hands of interns and newbies. when they are not gone vacationing, they sit around making phone calls and talking to fellow workers about the trips, cost, destinations, others experiences and suggestions. and the rest of the year they are caught up with trying to cash in on their "sick" days. if they are not used they do not carry over. so it is difficult to keep the same doctors or people who are familiar with your case around, leaving you to have to go thru expensive unnecessary proceedures because the new people are lost. it would be so much better if hosp staff could stagger their vactions so someone is running the store so to speak.l it frightens me, and has caused me extreme discomfort and fear. and sick days????? people can't get their medical bills paid for while the workers are off using up their deserved days off. what a shame.

Did you know that if McCain is elected you will have to pay income tax on the value of the medical insurance that your employer gives you? Worse still, he is offering a tax break for people who pay their own insurance, BUT only $2,500 for individuals and $5,000 for families.

Let's say you have a family of four. Your insurance policy costs would be at least $1,500-2,500 per month under a self-pay plan, which cost more than employer group plans. So, you pay $18,000 -$30,000 per year for insurance, and you get to deduct only $5,000 of that. If you paid $25,000 for you insurance, you would be out of pocket $20,000 per year. This is FAR WORSE than the current system, where if you are self employed you can deduct 100% of you medical insurance costs.

So, if you're not self employed, you would stick with your Employer's plan. Employer plans for a family of four have a value of $900-$1,500 per month totaling 10,800-$18,000 per year. Surprise! On April 15th, you owe tax on all of that as INCOME to you. Say your bracket is 25%, and the value of your Employer medical plan is $14,000. You will OWE THE IRS an additional $3,500, and that's ON TOP of whatever monthly premium you already pay to your employer for your insurance.

Many analysts say that McCain's new rules would encourage employers to stop offering health benefits. If that happened, then far fewer Americans would be insured than are insured today, because what family of four can afford $18,000-$30,000 out of pocket per year for self-pay health insurance?

Furthermore, McCain's plan does not require insurance companies to cover pre-existing conditions of people who self-pay their insurance. People under employer group plans have all of their pre-existing conditions covered. This is a hugely unfair aspect of the current system. Insurance companies can afford to cover the pre-existing conditions of the much larger pool of people with group insurance, but they refuse to pay the pre-existing conditions on the smaller pool of self-pay customers. They have been allowed to price gouge the self-pay customers, which is a form of market manipulation that should be illegal.

So let's say one of your kids had diabetes and you have high blood pressure, then your employer stops offering insurance. You now have to buy your own, but you and your child are INELIGIBLE due to pre-existing conditions. Oh, yeah, they will let you buy the insurance, but you can't use it for any pre-existing condition until you have paid on time every month for two years. And you know what happens at one year and 11 months? You get a letter saying your policy has been cancelled. I have many patients this has happened to.

McCain's plan SUCKS.

It does nothing to help middle class working Americans afford or obtain medical insurance. In fact, it makes the current system WORSE.

Maybe there are checks and balances in place during the day, during the week, in the ICU and on the high-profile surgical floors, but as a former night shift nurse with many years' experience, I can tell you that in the middle of the night and on weekends on many medical floors, it is the first year resident, period. And in July, it is an inexperienced first year resident.

Yes, they can always wake up their chief resident, but few do. The smart ones rely on the nursing staff, as the article points out. The ones that don't have a clear idea of their limitations make mistakes, sometimes dangerous mistakes - there is no 'system of checks and balances' until the morning, and over the weekend, sometimes not until Monday morning.

The article also fails to point out that in July, most new graduate nurses are just coming off their orientation, so the nursing staff in a big teaching hospital, particularly on the night shift, may also be new.

Regardles of what this article claims, I personally advise my friends and family members to avoid admission to teaching hospitals in July. In fact, I generally advise the people I care about to avoid big teaching hospitals in favor of smaller community hospitals any time of the year. My rule of thumb is: only go to a big teaching hospital if you have a rare condition, or have severe trauma; you'll get the physician specialists you can't get any where else. For more routine surgeries, chemo therapy, and medical management, go to a smaller community hospital, it is the superior nursing care that will pull you through.

This article is totally wrong and misleading in it's description of the advancement process for medical trainees. For starters, medical students do not replace interns. Rather, students who have graduated medical school... the last time I checked, we called them "doctors" or "physicians"... replace interns. The interns, who are physicians in their first year of training, replace residents after their training period is up. Most importantly, resident physicians who finish training (or residency) don't become full doctors, since they are full doctors already. Rather, they become board certified doctors, or they go onto fellowship training and attain board certification thereafter.

Furthermore, whatever the initial marginal costs are to medical training, care provided by a resident team supervised by an attending physician (or licensed doctor) has always been proven to be superior to private care, administered by private doctors without residents, because the interns and residents (who in the US are pretty well supervised) provide a system of checks and balances that ensures optimal care for patients.

It would be interesting to read a column by Ms. Ellison that suggests otherwise. However, for that article, I recommend that the author actually speak with a physician before writing about one.

This article is totally wrong and misleading in it's description of the advancement process for medical trainees. For starters, medical students do not replace interns. Rather, students who have graduated medical school... the last time I checked, we called them "doctors" or "physicians"... replace interns. The interns, who are physicians in their first year of training, replace residents after their training period is up. Most importantly, resident physicians who finish training (or residency) don't become full doctors, since they are full doctors already. Rather, they become board certified doctors, or they go onto fellowship training and attain board certification thereafter.

Furthermore, whatever the initial marginal costs are to medical training, care provided by a resident team supervised by an attending physician (or licensed doctor) has always been proven to be superior to private care, administered by private doctors without residents, because the interns and residents (who in the US are pretty well supervised) provide a system of checks and balances that ensures optimal care for patients.

It would be interesting to read a column by Ms. Ellison that suggests otherwise. However, for that article, I recommend that the author actually speak with a physician before writing about one.

Doctors being embarrased to ask a nurse or take advice from a nurse is hardly a new thing! 25 years ago in July while working on a pediatrics unit I asked a new intern to please recheck a medication order. I asked him again after he bit my head off...........he had ordered ten times the correct dose of a medication on a 2 month old with cardiac problems. Most nurses I have worked with in my 32 years in the field are willing to help new doctors. The ones who accept it learn and grow. The ones who ask "And where did you go to medical school" don't get nearly as much help nor do they learn as much or become as good of doctors. For the patients' sake it has to be a team effort.