Dot Richardson, olympic athlete turned ortho surgeon. nm

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when a patient is ready to be discharged, he always says "____ is peeing and pooping normally." Slays me every time! I just find myself giggling like a little kid whenever I hear it! Peeing and pooping are such a great words...embrace them!

I want to get my finances ready before I schedule the surgery. My previous experience with surgeons and disability is "go back whenever you feel ready"...they don't seem to want to comit to a timeline. The last time I had surgery I went back way too soon and had complications, so would like to avoid that this time around.

Thanks to everyone who has replied, this is all good advice and info. I think I will plan for the worst at 6 weeks or so and hope for best at just a week or two. It certaily won't hurt to have some extra money saved.

I had a similar situation a few years ago. I paid and the ins. co. paid, dentist kept both payments. After 3 phone calls to the office, no money. So, I wrote a letter to the dentist, put PERSONAL AND CONFIDENTIAL on the envelope, put a cc to the state dept of insurance at the bottom of the letter (dept of ins. scares them more than the AMA (if dealing with MDs) or American Dental Association).

my son to have his wisdom teeth removed. Charged us $75.00 for the consult. I didn't like the oral surgeon and his office staff were very standoffish can I did not make an appointment with him for surgery, but with another oral surgeon. I had to pay the $75.00 up front - no problem, but they filed the insurance with the money coming to them. It has been 5 weeks now since they received payment and I have called twice asking for a refund. They told me the insurance company had 90 days to come back and ask for the money, but I PAID upfront so what difference does that make, they aren't out anything and they have $52.00 of MY money on top of the $75.00. They said they would issue a check next week, but is what they told me 2 weeks ago. It isn't a lot of money, it is the principle of the thing.

Went to another oral surgeon and they didn't charge me anything for the consult and the amount I have to pay upfront is $300.00 less than what the other office quoted me.

who says what he REALLY thinks about the JCAHO. Funny, I found it on Google when I typed in JCAHO and q.i.d. since I wasn't sure what to do about q.i.d. ........

The Death Star of American Medicine

I wish I had written this (JCAHO Unplugged; registration required), because it gives voice to the feelings that I (and probably 99% of the physicians in this country) have about the Death Star of American medicine -- JCAHO. A few excerpts (emphasis is mine):

That is why it really upsets me to watch the JCAHO people walk through my hospital like they were navigating a toxic waste dump. What upsets me even more is the utter paralysis of normal activity that occurs months before their visit and the huge sums of money spent on mock drills and consultants to prepare for the JCAHO invasion. JCAHO (the Joint Commission on Accreditation of Healthcare Organization) arouses more fear in hospitals than MRSA gone wild, and their "visit" has a greater institutional paralytic effect than circulating a neuromuscular depolarizing agent through the ventilation system.

A few unsigned verbal orders, or an anesthesiologist carrying a syringe of Anectine in his or her scrubs, or not locking up I.V. bottles of normal saline will result in conditional or provisional approval, and failure to take remedial action within 30 days may result in the death penalty, which for the hospital means bad PR, and more significantly, loss of all federal money. That's right, you can get the chair for parking tickets in the JCAHO world.

It doesn't matter that the hospital admits 50,000 patients a year, saves countless lives and performs daily miracles. Write q.i.d. twice and you can get your liver transplant someplace else.

A response by Russell Massaro, MD, FACP, Executive Vice President Accreditation and Certification Operations, JCAHO, follows Dr. Cossman's screed. The only thing I can say about it is that he makes clear that unannounced surveys will be forthcoming in 2006. Oh, joy!

A lot of the press in the past few days has been discussing issues such as oversight, accountability, and clearly expressed legal authority. JCAHO operates without any real semblence of these niceties, and does so with all the subtlety of a bureaucracy run by Darth Vader. Watching hospital administrators lose bowel and bladder control the minute a JCAHO inspection is brought up has always reminded me of Vader's underlings wilting in his presence --- and for good reason. Without the JCAHO seal of approval, they cannot operate an otherwise well-run, caring facility. The organization, as it was originally intended, was designed to ensure a basic level of safety for all hospitals. It has now become yet another "certifying" agency which must come up with new "critical" problems to fix in order to ensure its ongoing existence (those of you who have gone through the most recent mental masturbatory experience of banning QD and QID in orders know what I mean). What is most galling to me, however, is that hospitals must fork over a hefty sum for these frequent torture sessions, and the inspections are done not by practicing physicians or nurses, but by folks who long ago gave up the difficulties of actually caring for patients for the safety of a clipboard to hide behind.

Maybe I have my metaphors mixed up --- JCAHO comes in like the Death Star, but leaves no room for different institutions to solve problems in their own way. The JCAHO mantra can really be translated as "Resistance is futile. You will be assimilated!" As a result, I suppose JCAHO is really The Borg.

I do have Instant Text and several Stedmans such as phrases but no specific specialty books.

I previously did multispcialty for many years which mostly consisted of family practice with an occational specialty thrown in to break the monotomy.

I would not say I am nervous about 100% ortho but I am "cautiously optimistic". Since it seems likeall I would be doing in the immediate future I was wondering if I should invest in the books etc.

I'm working on an ortho eval for a patient with a PIP fracture. Doctor has dictated an unfamiliar term (there's always that ONE WORD) for me. He dictates, "X-ray examination today shows impaction at the base of the middle phalanx with approximately 70% joint surface involvement." Here's the word I don't know (spelled phonetically--Sorry": "A syphiant(??) portion of the joint surface is translated dorsally."

If someone could point me in the right direction for finding this word, I would really appreciate it!