Featured Post

Is the new professionalism and ACP's new ethics really just about following guidelines?

The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of ...

Wednesday, February 01, 2023

Medicare Wellness Visit will not detect early disease but it is quick easy money for internist

 For the past five years I have taken part in a version of the Medicare Wellness Visit with the addition of a series of blood tests.During that time a thyroid cancer grew to the size of a very large egg ( 5.5 cmX 3.5X 3.5) before it was finally detected from a cervical spine CT. Medicare Wellness exam is reimbursed by Medicare reasonably well but Medicare does not pay for physical exams

My medical " care " during  a nine month period during which I was ostensibly  being evaluated for a mild anemia is notable for the following:

1.The entry of a number of errors in my medical chart ( which is recorded in a widely used electronic health record (EHR) My diagnosis included atrial fibrillation and diabetes neither of which do I have.The EHR continues  to admonish me that my diabetic eye exam  and diabetic foot exam are  overdue.

2.The ignorance of my primary care doctor and a GI specialist  in regard to the diagnosis and treatment of  the most common anemia in the world namely iron deficiency anemia was not reassuring. Both of their  knowledge gaps could have been quickly corrected  by spending a few minutes accessing Up T0 Date on their  electronic device.

3.The alarmingly long time lag between various elements of my diagnostic workup which took place in a nationally known and highly ranked medical care system AKA hospital system. For example from the time my  thyroid cancer was diagnosed by a fine needle aspiration (FNA) until the day of surgery was 43 days.

4.Entries in my record of several "phantom" medical exams. By phantom I mean description of exams that were in fact not done but still attested to by the physician's electronic signature. Why do some many physicians put their signature to a cut and paste exam that was not performed? Do they know what they will say if asked at a future deposition 'Doctor, did you actually do a exam on Mr.Jones on such and such date? Do you routinely lie on the medical record? .During a nine month period I was seen in the office by physicians 8 times and none of them apparently even looked at my neck let alone felt my thyroid gland  though on several occasions a normal thyroid exam was recorded in the chart  ( ie. the phantom exam).

5.My bone marrow aspiration and biopsy was done by a NP who told me she had been taught the procedure by a hematologist only some several  months earlier. A noteworthy thing about the BM exam was the price charged ($ 23,000 ) by the hospital.

6.The thyroid mass was detected by a CT of the cervical spine ordered by a neurologist who never did notify me of the abnormality. Fortunately I was able to access the report and read of the finding myself. An earlier chest CT report did not mention a thyroid mass although it was clearly visible. 

7.Astonishingy an ENT specialist who did a fiberoptic office exam of my throat for evaluation of a cricopharyngeal bar recorded a normal neck exam including the comment that the thyroid was free of nodules did not  perform an exam of the thyroid at all. One week later the cervical CT showed a thyroid mass 5.5 cm in its largest dimension. I had to wait 6 weeks for that ENT appointment.

8.The pathology report of the surgical specimen of the thyroid tumor has a number of syntactical and transcription errors,likely representing inconsequential errors but IMO reflecting an alarming lack of proofing and professionalism.

(9 The attending surgeon and the consulting endocrinologist both  either misread the pathology report or did not understand the significance of the reported findings and both told me that it was a very low risk variation but after the case was presented to the tumor board both amended their evaluation and recommendations accordingly based on the microscopic findings.

No comments: