Kidney Stones

A middle aged asian man came in today complaining of pain in his right flank.

The patient experienced sudden onset of pain on his right flank in the morning. The pain never subsided. He woke up in the middle of the night at 2 AM with same quality of pain. When he urinated, he felt a burning pain in his lower abdomen. He experienced frequent urination and nausea. There was no vomiting, blood in urine, or chills. 

Upon examination, he had a clear case of right flank tenderness. Urine showed a tiny blood spec, and a clearly positive microscopic hematuria. 

Dr. concluded that he may have had some sort of kidney stone. Dr. ordered a CT along with extra hydration and some exercise. Patient needed to ensure that he filtered his urine to make sure he could find the stone. The patient was also prescribed percocet for th epain. Dr. explained to the patient that it would be extremely painful for the stone to pass. If it was larger than 4mm large it would most likely not pass and would need to be referred to a specialist.

The patient did not look comfortable.

And I hope I never get a kidney stone.

The Troubles of Billing in a Medical Office Part I

It is very difficult to collect claims in a medical office.

The basic premise consists of the following:

Step 1

The patient comes to see the Dr. who examines the patient and fills out a superbill that looks very similar to this:

Step 2

After Dr. completes the superbill, she hands the bill to the billing staff. We input the claim according by adding in each CPT code(or procedural code) along with the appropriate ICD codes(diagnosis codes, whatever the patient was diagnosed with.)

Step 3

That claim is then sent to the clearing house. The clearing house will run a set of checks on the claim and send it back to us if there is anything wrong.

Step 4

Once I fix the claim, the claim is sent back to the clearing house who then sends it to the insurance company. The insurance company will then go through the claim and send us the remittance.

Then you pray you get paid.  Next post:  a million ways your claim can get denied.

Heartburn

A male patient middle aged came in today complaining of left upper chest pain. He woke up with an uneasy chest pain that lasted for about a minute. He had shortness of breath. It went away and he went back to sleep. And when he woke up around 10 AM he experienced another similar pain. So After the second instance of pain, he came in to see Dr. He kept insisting that he had lung disease and he kept asking Dr. what was wrong with his lungs.

I could see how challenging it is to deal with patients who keep insisting or arguing that there is something else wrong or different than the doctors real diagnosis. Once Dr. was certain that it had to be a heart attack, she quickly did an EKG. Even the daughter kept continually asking why she was doing an EKG when it was a problem with his lungs.

Once she saw the EKG results and saw that the patient had an unstable angina from the clear acute EKG changes(An unstable angina is a condition when your heart doesn't get enough blood flow and oxygen.) he was immediately given aspirin and cholesterol lowering medication (Lipitor).

Sent to ER.

Don't let the bed bugs bite

Dr. brought in a young boy and a girl aged 7 and 5 years old respectively for rashes. The rashes had been going on for several months, but the family did not have insurance, thus, they took their time to see a physician.

The girl had rashes all over the body and scratch marks all over the body except her face. The boy has the same symptoms.

When I was looking at this, I was thinking to myself, "what the hell kind of disease is this?"

Upon further discussion and examination, it was determined that the kids had to have had bed bugs. Dr., asked very specific questions:

Where do the kids sleep? Do they have their own beds? Has she ever gotten better?

So whenever, the little girl slept by herself, she consistently got better. However, when she played with little brother and fell asleep in his bed, she would get the rashes again.

Therefore, it was determined that there were bed bugs in the boy's bed. After prescribing some anti-itch medication and instructions of how to clean the mattress the kids were discharged.

I hate bugs.

Why Should I go to Medical School?

It's a legitimate question, especially when the architect of Obamacare, the former health czar Nancy-Ann DeParle, said that private small medical practices like my mom's would need to accept "Big Medicine."  See this: http://www.medscape.com/viewarticle/790689.                    

                                                  

We have many representatives coming in from larger "big medicine" industries like the George Washington Medical Associates group, etc. It looks as if every doctor to be involved with ACO(accountable care organizations) or large hospital groups. I wonder if that will decrease the quality of care for patients instead of increasing it. Will it decrease costs? I would worry that it would force these organizations to really only care about profits instead of the patients.

Stress Sucks

Wow, I did not think stress could affect you that badly.

I was wrong.

Middle aged patient complained of headaches and pain in his ear. After a short interview, the patient described he was extremely stressed out and working 80 hours a week, Dr. noticed that he had a severe case of herpes around his mouth. She then looked at the patient's ear. He had vesicles in his tympanic membrane. (inside his eardrum!)

I also learned some useful terms.

Macules are flat
Paupule(pimples) are elevated
Patch is a bigger macule
Plaque is a bigger papule
Vesicle small water contianed papule
bulla(e) bigger water pcoket

pustule pus contained (white head with an infection)
but whiteheads without an infection comedone
black comedone(black heads)

If I am working that hard and I start to get that stressed out, I'll know to take a small vacation.