General Medical issues thread

[Quickstatus]

Interesting offer:



For bookings up until 31 Jan 17 for flights up to 11 months in advance

 

[drron]

What about us Queenslanders!

 

[Quickstatus]

You got the State of Origin Cup

 

[QF WP]

Renal cyst? - can wait. Renal physician. But its not important.

As noted in the MRCP. Agreed, that's for another day as hopefully fluid filled and benign.

The wait and see approach is sometimes the best. "Tincture of time". Over time things declare itself. I don't think you would get to the end any quicker with the story you have presented.

In the end if the cause was found to be a gallstone then the treatment is supportive. Low fat diet. No alcohol, eat small amounts. Remove gallbladder when everything settled down in a FEW months. If PSC - then more serious and ultimately difficult to treat and progressive. May need immunosupressants, steroi_s eventually liver transplantation. Lets aim for a gallstone story.

Pity that you weren't the doctor Quickstatus, because nothing like this was explained to the patient. I could work with that explanation and I'm sure if explained to the patient they would be the same. For a Doctor in such a senior position, I find that poor (let's say I'm thinking of other words but this is a swear free zone). Yes, have researched PSC (as noted in MRCP) and I hope that is a low possibility, so like where you're aiming . Low fat diet already in place, nil alcohol won't be an issue for them and they already eat small amounts (but now will be smaller and more often). Still think ECRP needs to be done first, thus my request for them to see this specialist.

Thank you, most enlightening explanation as I have come to expect. I trust that you like a drink, as I owe you and drron

 

[Quickstatus]

Can see parallels when aircraft delayed. Patients and for that matter, airline passengers are better off being informed contemporaneously.

No test should be undertaken without serious thoughts about risks to patient especially this one. I sense they were trying to sort it out without going to a more invasive diagnostic route. ERCP can be risky: Anaesthetic in a semiprone position in a darkened xray room (so actually anaesthetists dont like "gassing" for this") , risk of bile duct infection and pancreatitis.

Number one question if contemplating a test: Is it going to change my management of the patient - slightly different to "will it give me an answer". If it gives an answer but does not change the management then reconsider especially if an invasive test.
Number two question: is it going to make the patient worse?


Good luck with the Specialist.

 

[blackcat20]

Had my pre-surgery appointment today. I'm expected to pay the full amount upfront now and claim it back from my health insurance after. They seem to assume that everyone can find multiple thousands at the drop of a hat

 

[Quickstatus]

Someone gotta pay for upcoming holiday.

 

[Pushka]

Had my pre-surgery appointment today. I'm expected to pay the full amount upfront now and claim it back from my health insurance after. They seem to assume that everyone can find multiple thousands at the drop of a hat

Ouch. Surely you could just pay the gap? They can check on the spot if you are covered. Although Urologist did exactly the same recently but just over $500.

 

[legroom]

Ouch. Surely you could just pay the gap? They can check on the spot if you are covered. Although Urologist did exactly the same recently but just over $500.

Legally you are not allowed to charge a gap followed by Medicare / Fund billing. Supposed to be the other way around.

The system is 'rigged' to encourage no-gap fees.

 

[QF WP]

I can directly relate to the word "contemporaneous" and "client risk" in my industry, so great choice of words.

Patient has had issues in past with anaesthetics, including 24hr halter monitor to try and diagnose cause of "ectopic" heartbeat during previous surgical procedure. NAD. I'd love gassing (nitrous oxide was my friend during much dental work)

Can see parallels when aircraft delayed. Patients and for that matter, airline passengers are better off being informed contemporaneously.

No test should be undertaken without serious thoughts about risks to patient especially this one. I sense they were trying to sort it out without going to a more invasive diagnostic route. ERCP can be risky: Anaesthetic in a semiprone position in a darkened xray room (so actually anaesthetists dont like "gassing" for this") , risk of bile duct infection and pancreatitis.

Number one question if contemplating a test: Is it going to change my management of the patient - slightly different to "will it give me an answer". If it gives an answer but does not change the management then reconsider especially if an invasive test.
Number two question: is it going to make the patient worse?


Good luck with the Specialist.

 

[Pushka]

Legally you are not allowed to charge a gap followed by Medicare / Fund billing. Supposed to be the other way around.

The system is 'rigged' to encourage no-gap fees.

To which specialists have never agreed to.

I don't have any issues with great specialists charging a gap. My rheumatologist has a large one for consults but didn't charge for two cortisone shots. And she is fabulous. The first rheumy whom I will report to his professional body in the new year - I should do a charge back on my credit card.

Blood test results tomorrow. Am betting cholesterol still high. I only lasted on porridge 2 days and as I dont eat bread (it disagrees with me) then I haven't used the 'reducing' spread much either. My main concern is rising creatinine and lowering egfr - kidney issues that most with APS get especially with other symptoms. Also reckon low potassium - haven't been eating bananas.

 

[blackcat20]

Ouch. Surely you could just pay the gap? They can check on the spot if you are covered. Although Urologist did exactly the same recently but just over $500.

Nope, they insist on payment in full one week prior, receipt provided on the day of surgery after which I can claim with health insurance and medicare.

 

[Pushka]

Nope, they insist on payment in full one week prior, receipt provided on the day of surgery after which I can claim with health insurance and medicare.

Worse than going to the Vet!

 

[penegal]

It is becoming more common for those performing elective procedures to request partial payment upfront (or full pre-payment in your case blackcat20).

Apparently a surprising number of patients default on payments, and doctors don't like debt collectors.

 

[blackcat20]

It is becoming more common for those performing elective procedures to request partial payment upfront (or full pre-payment in your case blackcat20).

Apparently a surprising number of patients default on payments, and doctors don't like debt collectors.

This isn't elective.

 

[penegal]

This isn't elective.

Sorry for the assumption.

In any case, the advice above is quite common for elective procedures based on my discussions with numerous specialists over several years.

 

[Quickstatus]

Legally you are not allowed to charge a gap followed by Medicare / Fund billing. Supposed to be the other way around.

The system is 'rigged' to encourage no-gap fees.

As in Dr can't charge a gap and then send a bulk billing invoice to Medicare

 

[Quickstatus]

It is becoming more common for those performing elective procedures to request partial payment upfront (or full pre-payment in your case blackcat20).

Apparently a surprising number of patients default on payments, and doctors don't like debt collectors.

There have always been patients who game the system. Get private Dr to treat then disappear.
Wrecks it for everyone.
Sort of like lounge or airline unpublished benefits

 

[Pushka]

This isn't elective.

I think these days anything but life and death is considered 'elective' and sometimes even cancer surgery if it isn't for immediate life/death situations.

 

[blackcat20]

I think these days anything but life and death is considered 'elective' and sometimes even cancer surgery if it isn't for immediate life/death situations.

That is true. I guess I consider it non-elective as I would like to regain full use of my nose. I only have one functional nostril currently. In medicare terms, its considered "medically necessary" which doenst really sound elective to me.