Archive for the ‘Pediatrics’ category

They Know

April 2, 2011

Again, I have confirmation that they, of the CMS (the conventional medical system) know.  The head of Cedars-Sinai Orthopedic Spine Surgery is a DO.  The head of Harvard’s Spinal Orthopedic and Rehabilitation is…a DO.  In 2007, they, Harvard, an allopathic MD school hosted a continuing education course for MDs, with full cooperation from New England DOs, to teach basic OMM (osteopathic manipulative medicine) 101 to MDs.  Ha-ha, joke’s on them, it will take about another 7 years of daily exposure to get even somewhat good.  For the course alone, they charged $1500.  Do the math.  They see the value and they are co-opting us, it, osteopathy.

There are MD neurologists, neuroradiologists, orthopedic surgeons, pain management, phys med and rehab doctors who know that surgery is not, most of the time, an answer, that PT fail frequently, that chiros injure and that traditional DOs are effective, so much more effective that they, of the CMS, would…lose patients…they dare not refer patients to us.  The gravy train of sick people needing help would…slow, if not stop.

Please continue to read through the prior posts so that you understand this medical system.  It is important for you to understand how you, your health, your family and friends fit into this system, that there is a far more cost effective (in the long run) alternate system out there.  Stay tuned for my next post in a couple of weeks.  Please forward this blog to friends and family read as, it will not be the same.   I fear very soon, I will be forced to reign in my voice, be more politically correct and censor myself.

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Aspirations II

March 15, 2011

Supposing that on our road to greatness, we discover that we are not as skilled and we do not get the results that we expect.  What happens then?  Do we turn our backs on this osteopathic stuff that we love so much?  Probably not, it would be too costly.  In addition, it would be an admission of failure.  In any profession,  most people end up compromising. 

In my pediatric practice, I am pleased to say that I have not had to do this.  I do not accept Medi-Cal so that you don’t have to sit in a crowded waiting room, your child exposed to other sick children (sorry, I’ve done my time, mission trips, volunteering in free clinics -this was before children, when i was still young and idealistic).  I have not compromised on my stance regarding informed consent as the basis for a reasonable vaccine schedule (i.e., i have not succumbed to the HMO incentives for vaccination along the CDC schedule; yes, there is one financial incentive – this is another post for another day).

So the lesson of this post is Aspiration is inversely proportional to Compromise; in non-mathematical terms, they are diametrically opposed, they are antithetical to each other.  As you give up aspiring, you end up compromising.  As you compromise (your standards), you have really stomped on any spark that was once aspiration.  What is happening with “healthcare insurance?”  This is an oxymoron.

Insurance, in any other business arena, is just that.  They take your money and you don’t want to have to collect; life insurance is really death insurance and you don’t want to have to collect.  Health insurance, is no longer insurance.  I would call it medical contracts cards, that is what we are buying monthly with our premiums.  People use and consume.   Healthcare is no longer healthcare, it is disease maintenance.  It then, in effect, our premiums purchase a “disease maintenance medical discount contracts card.”  What a mouthful.  Believe it or not, most doctors, we are stuck in this cycle as well and we usually choose not to consume and we ourselves purchase super high deductibles so that we don’t not use.  When we do use, the cost to us at the discounted contract rate is considered a reasonable expenditure for information.

What happens then is that the increased cost of medical insurance comes from usuage.  When usuage increases, the insurance companies squeeze profits from employers, the insured, and the doctors.  So usuage leads to cuts, which leads to decreased quality, increased volume in waiting rooms, less time with patients.

So as you can well guess, insurance and the standard, biochemical, biostatistical model of medicine is not is not compatible with osteopathy.  For those of us who are traditional osteopathic physicians aspiring to greatness, we merely tolerate insurance for a short time…

Again, it is very important for you to share this blog with your friends, co-workers and families…more in the next few posts…

Aspirations

March 5, 2011

Hello all.  It has been a couple of weeks sinces I have posted.  I want to share with you the aspirations of us traditional osteopathic physicians.  By now you have a sense of how special this traditional osteopathic hands on stuff is to me, to us.  We love this work.  It takes so long to be this good.  It costs so much in terms of time, dedication, work, and yes, in dollar terms as well.  We do it because it has meaning.  It is profound beautiful work.  For our patients, we want them to understand their body, connect with the health that resides within, do the best that can be done, naturally and avoiding drugs, needles, scaples as much as possible.  The OMT work serves to guide the patient back towards the roadmap of health.  Once that memory is rejiggered, you no longer need us nor any other doctor or ancillary health care provider (including, podiatrist for arch supports, dentists and bite guards, massage therapists and deep tissue, yes, even, theoretically, glasses and optometrists/ophthamologists).  In what other medical field is the ultimate goal…you leaving us…to go out on your own…to be healthy?  Remember, I have said this before and I will say it again.  The mechanically unstrained body does not need anything or anyone. 

In doing this work we learn from our patients how to be better physicians. Most normal physicians want to spend time with our patients and to be compensated for the investment we have made in our knowledge, skill and experience.  Ultimately, what we want for ourselves is to be able to solve a case in as few visits (for the patient) as possible.  Patients are thrilled!  After wasting their time and money on multiple specialists who charge them, but then don’t get them any tangible results, the $500-$1,000 is the best cash they ever spent.  The trust is that philosophically, we want what you want, which is to not come back because you are better.  While we ambitiously strive for this goal, we continue to develop our treatment skills…we aspire…to greatness…

I will continue this thought in the next post.  In the meanwhile, it is very important that you share some of your favorite past blogs with friend, co-workers and family…

HMO Plagiocephaly Helmet

February 18, 2011

I wanted to share with you a recent email exchange I had with a pediatrician executive at an HMO.  As most of you know, I have been doing cranial osteopathic treatments for infants in my office for the last 7 years.  I have not been terribly aggressive about “marketing” this work.  People who search, parents who are concerned will find their way to OMT and us osteopaths.  Recently, I found out that the helmet people have been sending out droves of salespeople to ‘educate’ pediatricians about their services.  Because of this, I printed out a flyer to educate my colleagues about the mechanics of plagiocephaly.  I also had cards made and did a separate website, www.plagiocephalytreatment.com.   I showed my work and talked to several pediatricians.  I even spoke to a pediatric neurologist and he was not a fan of the helmet and quite supportive of me.  He and a few other pediatricians said to me, ” You should talk to Dr. So-So.”  I wasn’t keen on it and did not think much of it.  Several months later, I eventually dropped it off to Dr. So-so.  The response was, “No thanks, we have a cheaper helmet.”  That says it all doesn’t it?

Unfortunately, medicine is a business and is very much like anything else in life.  You get what you pay for.

Vaccines, Part II

February 11, 2011

This week a skeptical parent wanted the low down on whether doctors (we pediatricians) made money on “pushing vaccines.”  The short answer would be ‘no.’  He was thinking in terms of kickbacks, which are illegal.  He thought that doctors got some money, in the form of a check, directly from pharmaceutical companies fo giving vaccines.   Trust me, the lawyers and the gov’ment are all over our case, breathing down our necks; that never happens.  Here is how it really works…

First, lets talk about govment interference, i.e., mandates.  Federal law requires that all children in the US get vaccines regardless of economic or legal status.  The reccommended vaccines are determined by an “Advisory Committee” made up of pediatricians and vaccine researchers (who researches vaccines? people who are paid to research).  Is there true independence?   What is the governments’ financial interest?  No, pharmaceutical companies do not cut checks out to government entities (not that I know of, it’s just not how it works); they do cut checks to spokespeople, people who represent them.  It is the other way around…the federal government is the largest purchaser with deep pockets (and its own press to print paper money) that pharmaceuticals try to sell to the government at a premium when it is “proven” safe and efficacious.  The federal governements interest is not to protect you the individual;  The government looks out for the large populations of immigrants that are at risk, poor to no prenatal care, living in crowded conditions that can potential spread an outbreak.

Lets  talk about the compensation source, who pays whom for what when your child gets one vaccine.  Say you have a PPO insurance.  You take your child in and get 1 vaccine.  You pay a $20 copay.  Maybe you don’t pay anything at all, upfront.  But, where did that vaccine come from?  Poof, out of thin air?  No.  The pediatrician (me) has to stock it in my refrigerator.  Where did I get it?  I had to purchase from a vaccine manufacturer at any price which they choose to set.  Then they don’t send it one at a time.  I have to buy it in bulk, between $200 to $600 for a box of 10 of one type of vaccine.  Look at the vaccine schedule, I have to stock one of every possible vaccine at the appropriate recommended vaccination period.  Before I even see your kid, I have to outlay, out of my own pocket, to stock the refrigerator a couple thousand.  So, your $20 copay, does that really help me offset my upfront costs?  I did not give the vaccine yet, so I can not even get you or the insurance company to prepay.  When your child gets the vaccine and you leave, then we can bill the insurance company.  If the office is pretty streamlined with electronic billing and the biller posts that charges that day (which usually never happens), theoretically we might get a payment in 2 wks.  In the real world, even with inhouse billing, it usually doesn’t go out for a week or two.  Also, based on contracts and payment, legally, the payer is allowed 90 days to pay.  In any sector of society, where does a professional providing a service have to wait to get reimbursed for costs related to providing that service?  Now, that is the supposed to be the good insurance. 

Suppose you have an HMO.  Same scenario, kind of.  With volume buying power within the network/HMO, sometimes the pharmaceuticals will cut a deal for volume purchases and they are not allowed to gouge us doctors (should we be thankful?).  As in any business (construction, interior design, landscaping), when we buy a wholesale item legally (and even ethically) we cannot and should not mark it up exorbitantly.  Most decent reputable people do not do mark ups of more than 10% and insurances don’t reimburse for more than that.  In fact a trend is for them to pay even less than the cost price.  [ Aside: do you know why chain pharmacies are popping up around every corner; they are flush with cash to buy real estate because…you guessed it…their markups are astronomical; think Walmart…if they can make a profit, selling people without insurance generics for $4, that means that their cost for that generic is…probably…under $2-3.  Not huge profit per unit, but in terms of volume, fairly decent.  Think of credit card companies right now.  They borrow money from the government pretty much for free, in this horrible economic environment.  They turn it around and your interest rate has now skyrocketed to 20-25%; that is called loansharking, but it is perfectly legal].

Let’s now talk about the poor who have no insurance.  They can go to a community health center and get all the vaccines without paying a copay, no questions asked.   I don’t begrudge this for the poor at all.  I just think that it is so sad, is the government really looking out for them?  With insidious marketing campaigns for formula, the uninformed think that formula is great, and it is free, from WIC.  And the women who work for the state government programs, they can’t educate other women about the benefits of breastfeeding?  The assumption is that the at risk population does not breastfeed.  Community health centers get their shipments of vaccines for free.  They are charged with vaccinating and protecting the public.  So if you want free vaccines, take your kid in, but you will be subjected to the vaccination rules/schedule.   If you go to a private office that accepts Medi-Cal, then that pediatrician did not have to buy those vaccines out of pocket.  Unfortunately, again, once you accept government monies, you have to follow govmt rules.  Any office that offers free vaccines, free physicals (for the poor) must abide by that vaccine schedule; they are regularly audited.  To make things much simpler, any office that takes a mix of payors, PPOs, HMOs and Medi-Cal all mingled together are more likely to uniformly apply the vaccination schedule rigorously.  There is no time to figure out those at risk to need vaccination and quite frankly, most offices are too busy to care to cater to anyone.

I hope this sheds some light for those of you who are skeptical of the motivations for pediatricians who “push” vaccines.  In my office, my feeling is that I lose when I give a vaccine and I also lose when I don’t.  Its a wash.  What happens in those other offices?  Wait for upcoming posts…

Osteopathic, What is It?

January 30, 2011

So many people do not know what this is.  Even worse, my most successful patients still have difficulty describing it to others.  I used to be at a loss for how to explain it.  I now can get the message across after a lengthy exposition of its origins, relationship to other types of manual therapies, relative to chiropractic, deep tissue, acupuncture, etc.  I have never been able to succinctly describe in a few sentences.

All of you out there who have been initiated, i.e., have had a treatment, might agree with this description.  Osteopathic is the sensing and reading of the mechanically strained body.  The work is precise hands on reduction of vectors through strained tissues, muscles and bones.   I like this, don’t you.  It is very fitting.  It is appropriately descriptive for everything I do from malformed infant heads to migraines to neck pain, back pain, herniated discs and I love, love, absolutely love, car accidents.

Controversial

January 24, 2011

I wanted to share with you some of the things my patients shared with me.  This is one of my most favorite compliments.  One of my patients was trying to explain this work to friends and coworkers.  Those of you who have experienced it, you know that it is difficult to comprehend, even more difficult to explain to the uninitiated.  It is perplexing how such light, precise, direct touch can accomplish so much.  Herein lies the mystery, the beauty (and if you heard me whisper some of my personal experiences, the profundity, is that a word?) and ultimately/unfortunately how others are able to perpetrate a fraud upon the unknowing and unsuspecting public.  She was at a loss for words and she summarized it this way, “Dr. Hoang…knows things that other doctors don’t.”  I just thought that was so cool.  Another new patient referred 2 friends and he said, “She could tell me,just by touching me where something happened, which way it was going…”  Neat.  Thanks guys.  There are a bunch of Armenians in Glendale who think I am a “miracle worker.”  And for them I can understand how they think that.  I can only thank them for taking care of themselves (and not altering their strains) that I am able to help their bodies return to closer to normal within one visit.  Awesome.  Before you guys start rolling your eyeballs, thinking, “Her head is getting fatter by the minute,” I will reassure you that that will never happen.  Do you know why?

I have to eat humble pie quite frequently, almost everyday.  I do get it from every direction mind you.   In fact, I’m starting to not like pie at all.  The MDs who don’t know anything of osteopathic work think that I am a second class doctor.  The skeptics who will go to chiropractors, massage therapists, reiki, reflexology 1. have so altered their strains that it is more work for me, 2. they give me fewer chances to get results, 3. they are more skeptical of me even though I am way more educated then all the other people they have already seen (combined), 4. they don’t realize that skeptics and certain personality types can resist treatment.

I also have a few patients who have experienced results and know of others who have benefited despite the fact that these cases are so different.  These women work in the healthcare setting and they know the system.  They see people hurting and suffering within that system.  They tell me that they want to say something to those suffering but feel that they cannot for fear of reprisals.  In the MD/CMS setting they want to say something about OMT (and me) but cannot.  I reassure them that I understand completely.  I do not expect that they risk anything to tell others about this important work.  I do fine.  I have a solid reputation.  All my referrals are word of mouth, now even 2-3 degrees of separation.

Many of you ask, how come I have not heard of this before? or How come no one ever told me about you?  The reasons above explain part of our difficulties.  I do have to explain the other reasons for why others do not broadly discuss osteopathic work; this is an unwritten conspiracy of silence.  Because it is so subtle, other less skilled, less educated, intellectually dishonest people will keep quiet and let others suffer.  It is primarily an issue of…economics and secondarily, aspiration.  Within the San Gabriel Valley, people know of us traditional osteopathic physicians, myself and several other colleagues.  I know and hear of physical therapists, massage therapists, chiropractors who know our work and yet I have never had a single referral.  (I know because these patients eventually come to me still strained and still suffering and they tell me they’ve seen this person or that person, doing this or that and charging them a certain amount; invariably, they got jack for their money).  If these practitioners admit that they are less skilled even though they have taken osteopathic weekend courses that have been significantly “watered down”  for their consumption, then their business would be completely decimated.  It might have blogged of this before.  When their clients leave them for lack of results, they keep mum, and do not discuss osteopathic as an option.  Someday, I might blog about the secondary issue of Aspiration, maybe not at all…

Those of you out there who are my most stalwart and staunch supporters, rest assured, I will continue to fight the good fight.  Please share these blogs with your friends and family, pass it along.  I hope to shed light on some of the inner workings of the medical system so that you may educate yourself and others.  Most of all be skeptical of what is first offered to you, seek second opinions and always expect and demand results.