Don Buford, MD’s Post

Non-veterans and people associated with the VA medical system can’t understand why veteran suicides took an up tic last year. They can’t figure out why veteran’s don’t seek out VA care when they’re in crisis, or until their condition has advanced to a near-catastrophic state. It’s not the VA. It’s military medicine in general. Every veteran can tell you a story of being given “vitamin M” for whatever ails them. If you need something stronger, you’ll get Mobic or Flexeril. You might be seen by an actual physician eventually, when “taking a knee, drink some water, and rub a little a dirt on it” doesn’t work any longer. By that point, the injury has shifted from a nuisance to debilitating. And, even then, you’ll get routed to a back-logged physical therapy department where you MIGHT see the same therapist two visits in a row. You’ll get a certain number of visits, not based on your injury, but based on the backlog. When your last visit is up, you’ll get some printouts of stretches and exercises you should do on your own. Or maybe you’ll get a referral! And, you can wait a few days for it to activate. Then you can call and try and schedule outside care. But, that referral is only written for so many visits. If you need more, slide back to Space 1 on healthcare Chutes and Ladders to go through the eval and referral process all over! Meanwhile, servicemembers buy their own ankle braces, knee wraps, compression tape. Some of them use them correctly. All of them use them to get out there for their next run, or next field event, or next deployment, favoring the injury only to destabilize some other part of the “kinetic chain”. Some limp along, performing at suboptimal levels, carried on by prescriptions, or OTC painkillers, or both, or maybe even some of “grandpa’s cough medicine”. And, because they’re performing at a suboptimal level, there’s the stress of it affecting their promotability. Or, like meteors, they burn hot during peak events and grind themselves down further. And, when promoted, they take the attitude of, “I can seek the long road of help, or I can just do it on my own, because it worked before.” Some servicemembers’ mileage may vary. And, there are good people in the military medicine community. But, for the most part, that’s the experience when we’re IN service, when we’re the athlete the team is counting on to win the big game. Those good people are good because they’re doing their best to fight their own system FOR the member. And, they don’t stay there forever. When we’re out, do you REALLY think the experience gets better? And, given their experience with in-service treatment, do you REALLY think they want to go into a SLOWER, MORE bureaucratic process? Hard pass...

An important new study recently released by AMA affirms what had previously been established: a significant proportion of physicians may expect to face liability suits during their practice lifetime, especially in obstetric or other surgical specialties. Nearly half had been sued by mid-career. Women physicians are sued somewhat less often than men (but may be more likely to leave practice as a result). The fact that the majority of cases are resolved without payment does not lessen the impact of malpractice claims on the wellbeing of physicians. AMA has recently published a new version of Liability Reform Now ( https://lnkd.in/gM7eyZGB ) with more details and approaches to addressing this issue of significant and continuing concern to physicians continuing to practice. See related post: https://lnkd.in/gHBD46xQ #litigationstress #medicalmalpracticestress #liabilityreform

I was having a conversation with TMJ advocate when she said, “This is nobody’s joint.” I’ve heard patients with temporomandibular disorders describe themselves as orphans without a home, who get passed from one provider to another. The truth is, orthopedists don’t claim the TMJ, because they don’t treat it. There are a few oral surgeons who operate on it, but many do not. Most dentists don’t bother with it, either because it is a mystery to them or because the few approved treatments are billed under medical insurance rather than dental. So, whose joint is it? Well the answer might surprise you. It is the PATIENT’S joint. And as such, isn’t it about time we start treating the patient as the expert? They are the ones living with pain, insomnia, depression, anxiety, and other multi-system conditions that coexist with these disorders of the musculoskeletal system. The patient doesn’t have time nor energy to worry about artificial divisions in healthcare, structural and institutional norms, egos or any of the things that hinder our ability to provide care effectively. They just want relief. And that’s a reasonable ask. #tmj #patientexperience #integrativehealth

I love #personalinjury, and I cannot lie! The bread and butter of any personal injury case is the analysis of injuries, prognosis for the patient, and possible defenses...From a legal nurse standpoint. In every case I work up, I dig into the potential contributory and comparative negligence - Whether I am the plaintiff or the defense. #LegalNurses think and analyze like they are on both sides of the team. Nurses are trained to look for trends, statements, or assessments that are out of the norm. Triage nurses (like me) are trained to look at every complaint with some degree of skepticism. Legal nurse consulting is no different. Not every chest pain is a heart attack. Not every altered mental status is a stroke. Not every injury is what it seems. The weak spots are the weak spots. The things that don't add up are things that don't add up. My boss needs to know what I found, what I think, and what to do about it. Here are a couple of examples I recently went through for possible defenses: 1) "I have light sensitivity due to a concussion from a car accident." Defense: The patient has a known bilateral corneal abrasions. Light sensitivity is a known complication. 2) "I had to have revisionary surgery to correct my failed anterior cervical discectomy and fusion surgery. Defense: The patient has a history of uncontrolled diabetes type 2. Hemoglobin A1C's are consistently greater than 7 for the last year. Diabetes impairs the healing process, and this likely contributed to his failed ACDF surgery. 3) "The patient was inconsistent with their appointments and, therefore, is considered non-compliant." Defense: There is a recorded pattern in the medical record that the patient had difficulty paying their co-pays due to the strain of being unable to work from the accident. This may be why she decided not to return to physical therapy. 4) "I was hit by a car in the parking lot and suffered a broken tibia." Defense: Lab work shows the client was under the influence at the time of the accident. The alcohol level was >.12%. Nurses' assessments note that the client stated, "I was stumbling and didn't see the car coming." Personal Injury - My Preferred Bread and Butter.

The AMA analysis shows it is virtually a matter of time before a physician is sued. The longer a physician is in practice, the higher their exposure to risk. However, the analysis shows that in addition to age, a physician’s medical specialty and gender are prominent factors in the likelihood of being sued during a career in medicine. #medmal #riskmanagement #patientsafety #claims

If you were to sue your HMO for breach of contract and 1 day of pain - what is reasonable to ask for one day of pain in Civil Small Claims Court, Florida ? Remember there are limits to Small Claims Court. What would you ask for? I am thinking a thousand dollars a day for a wasted day and pain. Is that reasonable? Should I accept Mediation or take it directly to the Civil Courts in Florida? What would you ask for each day of pain after the first day until they solve the issues and meet their contracts? Legitimate Pain Like After Surgery After Heart Surgery Diabetes Post Surgery muscle and skeletal issues Pain level 5 to 6. At pain level 10 for a few days and my heart will stop. Ever walk out of a Doctors Office in more pain than when you started? Regards, Todd W. Byars Tallahassee Florida The weather report is for Lawsuits starting tomorrow and running into next week. I just downloaded the checklist for 2023 lawsuits in Leon County Courts. By Monday I will have 3 or more lawsuits written and ready to file - or if I pass away due to such horrible care my family will continue and expand on the lawsuits. You know if more people would stand up for their rights and if Florida was not such a corrupt State none of this would be happening. To those of you who think its funny - wait till you have a serious surgery after your are an adult and see how much pain you will have to deal with due to bad laws, apathy, and very poor medical and healthcare at any price here in Florida.