Employers, health insurance coverage and PSA testing

Help me with this please.

A 56-year-old man just got a new job. As part of the pre-employment process and in order to be covered by his new company's health insurance, he had to undergo a physical examination and some blood tests. A digital rectal exam was not done.

He has no risk factors for prostate cancer or urinary symptoms and by most guidelines is not a candidate for PSA screening.

He was not told of the possible harms of the test, nor was he told to abstain from ejaculation within 48 hours of the blood being drawn.

Of course, his PSA is 5.9 ng/mL.

The cost of the repeat PSA test will be borne by the patient. There is already talk of biopsies.

Not only will the patient have to deal with the anxiety generated by the test, he is being pro-rated by his health insurance carrier. He will be paying $200 per month extra for his coverage.

Does anyone have any thoughts about this?

More baffling stuff about ICD-10 codes

The ICD-10 list may be inadequate.

ABC News reports an actor was hospitalized after his foot became caught in an elevator raising the stage during a performance of the Broadway show "Spider-Man: Turn Off The Dark."

As a connoisseur of ICD-10 codes, I decided to see if I could classify this injury correctly.

To my surprise, I could not.

The only codes having to do with elevators are the W303XXs Contact with grain storage elevator.

Since I had once read that the codes were originally developed in Europe, I even searched for "lift." But all I got were Y93F2 Activity, caregiving, lifting and W240XXs Contact with lifting devices, not elsewhere classified.

Contact with lifting devices, not elsewhere classified hardly seems appropriate for elevators, which are so common. People are frequently hurt on them or by falling down their shafts. All you get when you search "shaft" are hundreds of codes dealing with bones.

We know that ICD-10 has given us such gems as

V9027XA Drowning/submersion due to falling or jumping from burning water-skis, 

V982XXA Accident to, on or involving ice yacht,

W5609XA Other contact with dolphin,

V9542XA Forced landing of spacecraft injuring occupant and

V9733XD Sucked into jet engine subsequent encounter.

[Click on the links to read my comments about those codes.]

So how is it that there's no code for contact with an elevator? For that matter, what about injury during a Broadway show? Surely both elevator and Broadway show injuries are much more common than say V8022XA Occupant of animal-drawn vehicle injured in collision with pedal cycle.

Filippe Vasconcellos ‏(@fvguima), a Twitter follower, suggested W230XXA Caught, crushed, jammed, or pinched between moving objects, initial encounter, but it is not clear that there was more than one moving object. And the stated aim of ICD-10 is to introduce much more specificity into the codes for better tracking of things like injuries.

What we need is even more codes. Maybe we need to get going on ICD-11 sooner than we thought.

What is the purpose of research?

There a number of excellent answers to this question. Here are a few—exploration, description, and explanation; to learn something; to gather evidence; documentation, discovery, and interpretation; the advancement of human knowledge

Here’s a nice one from TheLancet about why medical research is done: "to advance knowledge for the good of society; to improve the health of people worldwide; or to find better ways to treat and prevent disease."

I’m sure you could come up with a few responses to the question yourself.

But I don’t think you would get it, nor do I think the lofty answers I listed above are correct either.

What's the real reason to do research?

To get published.

How to overcome a low USMLE Step I score and become a surgeon

On my companion blog "Ask Skeptical Scalpel," a medical student asks how he can overcome a low USMLE Step I score and obtain a residency position in general surgery. Click here to view that post.

Why send letters containing ricin to public figures?

You probably heard about the Texas woman who was indicted for sending letters containing the deadly poison ricin to President Obama and New York's Mayor Bloomberg.

What goes through the mind of someone who would try to send the president ricin? Did this individual really think that presidents open their own mail?

She might have thought it was something like this.

Barack Obama: "Michelle, did you get the mail today?"

Michelle Obama: "No, I didn't, honey. Would you mind doing it?

BO: "OK. I'll be right back." [Goes out the front door of the White House, goes to the end of the driveway, greets tourists through the fence, opens mailbox, grabs mail and walks back.]

MO: "Anything important in the mail?"

BO: "Not much. A bill for the healthcare of everyone in the United States, a coupon for 20% off from Bed, Bath and Beyond, some credit card offers … wait, here's something interesting. It's a letter. Hmmm, no return address, but it's postmarked 'Boston, Texas,' so it might be worth reading. I'll open it and see what it says."

Not likely. In fact, inconceivable.

Why on earth would someone in their wildest dreams think that poison sent to any prominent person would reach them?

If you think that was bad, how about the two Upstate New York men who were charged with conspiracy to support terrorism? Using an x-ray machine, they constructed a "death ray" for targeting certain groups and possibly the president.

ABC News reported the story uncritically, but the Huffington Post quoted a radiologist as saying the device was unlikely to have been effective because it would have required a large amount of electricity, would not have been very portable and any potential victim would have had to remain stationary for a long time.

One of the plotters was an industrial mechanic for General Electric, a company that makes x-ray machines.

Despite that background, he and his henchman apparently didn't consider all the details.

Neither did the ricin lady. There wasn't enough ricin in the envelopes to harm anyone.

Ricin? Death ray? What were they thinking?

In my next life, I want to be a management consultant

I once blogged that in my next life, I wanted to be reincarnated as a weatherman. You get to make predictions and have no accountability when they are wrong (except for one Washington, DC weatherman who was given a "time out" after an erroneous forecast).

I know it can be stressful when you have to stand on the beach in front of a TV camera and try to keep your cap on during a hurricane.

But even so, it seems a bit easier than being a surgeon, a job which is very stressful and carries strong penalties for errors—especially for the patients.

Another occupation that is similar in circumstances and results to meteorology is that of management consultant. They advise, and they leave. They don't see the aftermath of their actions nor do they suffer the consequences. They also make a lot of money.

The ultimate hospital rating system

Finding out which hospitals are best is like "a riddle, wrapped in a mystery, inside an enigma."

Are you tired of seeing conflicting ratings from such once respected sources as Leapfrog, Medicare Compare, HealthGrades and Yelp?

Does it confuse you when a hospital is ranked in the top 10 by US News and World Report, but is "god-awful" according to Consumer Reports?

The Skeptical Scalpel Institute for Advanced Outcomes Research is proud to unveil a new rating system for hospitals.

Advanced metrics and creative statistics are linked with secret Bayesian methodologies, patient surveys and publically available databases to yield the most powerful and accurate hospital ratings ever imagined.

Just kidding.

Based on word of mouth, innuendo and rumors that have come to our attention through the back channels of the Internets, Skeptical Scalpel Ratings Plus offers unparalleled accuracy in hospital ratings.

For the low, low price of only $29.99, you will receive the Skeptical Scalpel Hospital Ratings Guide.

But wait, there's more. Here's the plus. At no extra charge, we will send you information about a weird trick that will enable you to undergo open heart surgery for just $8.00. Insurance companies are furious.

That's not all. The first 127 people to buy the guide will get a set of the sharpest kitchen knives known to mankind as our gift.

Are you a hospital administrator? Be advised of some special features of our ratings just for you.

If your hospital's ranking is not what you think it deserves, don't do what all the others do and waste time with in-house task forces or ad hoc committees. And don't claim we used bad data. Since we don't use data, that won't work.

Instead, try an on-site consultation from the Skeptical Scalpel Institute. We can show you ways to improve your standing without the need for expensive new patient safety programs.

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