Thank God For Big Brother…

The tears welled up in my eyes. A passing waiter noticed that my glass was empty and came back with the gin bottle.

I took up my glass and sniffed at it. The stuff grew not less but more horrible with every mouthful I drank. But it had become the element I swam in. It was my life, my death, and my resurrection. It was gin that sank me into stupor every night, and gin that revived me every morning. When I woke, seldom before eleven, with gummed-up eyelids and fiery mouth and a back that seemed to be broken, it would have been impossible even to rise from the horizontal if it had not been for the bottle and teacup placed beside the bed overnight. Through the midday hours I sat with glazed face, the bottle handy, listening to the television. From 3 to closing-time I was a fixture in the bar. No one cared what I did any longer, no alarm woke me, no television admonished me. Occasionally, perhaps twice a week, I went to a dusty, forgotten-looking office in the hospital and did a little work, or what was called work. I had been appointed to a sub-committee of a sub-committee which had sprouted from one of the innumerable IT committees dealing with minor difficulties that arose in determining Meaningful Use within the Affordable Care Act. We were engaged in producing something called an Interim Report, but what it was that they were reporting on I had never definitely found out. It was something to do with the question of whether commas should be placed inside brackets, or outside. There were four others on the committee, all of them persons similar to myself. There were days when we assembled and then promptly dispersed again, frankly admitting to one another that there was not really anything to be done. But there were other days when we settled down to our work almost eagerly, making a tremendous show of entering up our minutes and drafting long memoranda which were never finished – when the argument as to what we were supposedly arguing about grew extraordinarily involved and abstruse, with subtle haggling over definitions, enormous digressions, quarrels – threats, even, to appeal to higher authority. And then suddenly the life would go out of us and we would sit round the table looking at one another with extinct eyes, like ghosts fading at cock-crow.

The television was silent for a moment. I raised my head again. The bulletin! But no, they were merely changing the music. I pictured vote tallies behind my eyelids. The trends were a diagram: a red arrow tearing vertically southward, and a blue arrow rising rapidly. As though for reassurance I looked up at the imperturbable face in the portrait. Was it conceivable that the red arrow did not even exist ?

My interest flagged again. I drank another mouthful of gin. A shrill trumpet-call had pierced the air. It was the bulletin! Victory! It always meant victory when a trumpet-call preceded the news. A sort of electric drill ran through the bar. Even the waiters had started and pricked up their ears.

The trumpet-call had let loose an enormous volume of noise. Already an excited voice was gabbling from the television, but even as it started it was almost drowned by a roar of cheering from outside. The news had run round the streets like magic. I could hear just enough of what was issuing from the television to realize that it had all happened, as I had foreseen; a vast electoral surge, the blue arrow tearing across the tail of the red. Fragments of triumphant phrases pushed themselves through the din: “Vast strategic manoeuvre – perfect co-ordination – utter rout – half a million counties reporting – complete demoralization – control of the whole of the Electoral College – greatest victory in human history – victory, victory, victory!”

Under the table my feet made convulsive movements, and I felt a thrill going up my leg. I had not stirred from my seat, but in my mind I was running, swiftly running, I was with the crowds outside, cheering myself deaf. I looked up again at the portrait of Big Brother. The colossus that bestrode the world! The rock against which the hordes of Republicans dashed themselves in vain! I thought how ten minutes ago – yes, only ten minutes – there had still been equivocation in my heart as I wondered whether the news would be of victory or defeat. Ah, it was more than a right-wing party that had perished! Much had changed in me since those first days of the Administration, but the final, indispensable, healing change had never happened, until this moment.

The voice from the television was still pouring forth its tale of electoral booty and slaughter, but the shouting outside had died down a little. The waiters were turning back to their work. One of them approached with the gin bottle. I, sitting in my blissful dream, paid no attention as my glass was filled up. I was not running or cheering any longer. I was back in the hospital, with everything forgiven, my soul white as snow. I was walking down the white-tiled corridor, with the feeling of walking in sunlight, and an armed guard at my back. The long hoped-for bullet was entering my brain.

I gazed up at the enormous face. Four years it had taken me to learn the smirk of a smile. O cruel, needless misunderstanding ! O stubborn, self-willed exile from the loving breast ! Two gin-scented tears trickled down the sides of my nose. But it was all right, everything was all right, the struggle was finished. I had won the victory over myself. I loved Big Brother. Thank God for Big Brother.

But only for today…
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Big Scanner In The Big Apple

Following our recent visit to Ann Arbor, we went to New York to see a Philips Precedence SPECT/CT in action. We had a long look at the scanner and the computer, and spent an incredible time with Dr. S., whose Nuclear Medicine knowledge I could only hope to faintly imitate. I’m thinking of submitting the time as CME; that’s how much I learned.  
The Precedence itself is HUGE, although it would probably fit the room where it needs to be placed. The SPECT part of the machine consists of two heads on articulating arms, as you can see above, basically a stationary version of the SKYLight, of which we already have two. The CT is a nice 16 slice unit. The computer system is the Extended Brilliance Workspace (EBW), which is unified across the Philips line, more or less, anyway, and it is fairly powerful. We will probably mostly use our Segami Oasis and TeraRecon (if it ever arrives) for most of the processing, though.
Now, if all decisions were made by how much fun one has on the site visit, well, it’s hard to top The Big Apple. (Elscint once took me and a former partner to Israel and Germany, after the company was bought by GE, and the stuff we went to see was never put into production.) 
Having a few hours to kill before our flight back to the boonies, we went down to Ground Zero to see the new Freedom Tower:

Then it was off to Times Square, where we encountered the Naked Cowboy:
He was not really naked, as he was wearing a pair of Fruit of the Loom’s, but a guitar hides a multitude. I texted the photo to Mrs. Dalai, who, miffed that I was having fun in NYC, responded, “Looks like you’re working hard.” I responded, “So is ….” ummm…never mind.
Here is Kathi, our Department Director, and Gerald, the Philips rep, enjoying the sites of Times Square. Notice that the camera is pointed up, and not at Naked Cowboy. 

Kathi was quite traumatized by our various cab rides. After my trip to Peru, nothing they can do bothers me, although had one of the drivers actually struck the two pedestrians he was aiming for, that might have reached my threshold of attention.

When you have only a few hours in New York, you have to make them count. We had a great lunch at the Atlantic Grill, but for me the absolute highlight of a trip to Manhattan is a stop at the Carnegie Deli:

You won’t find these matzoh balls in a jar!

Despite the cabbies’ best efforts, we did make it back home safely. Time to make some decisions…

Medicine And Capitalism

In response to my last post, Anonymous (he sure does get around!) eructated forth the following:

You, my dear sir, are a hypocrite,

As you admit yourself, and what anyone who have come across your blog before knows, you are a staunch defender of the free market and capitalism. The most basic part of *that* is a well-functioning market where the price of goods and services are determined by supply and demand.

As my old friend and foil “eradicator” once posted on AuntMinnie, much of what we see happening in health care today is anything BUT capitalistic, and bypasses any semblance of a “well-functioning market”. Prices of goods and services are NOT determined, at least not properly, by supply and demand.

Let me explain.

In healthcare, at least in our particular, peculiar version of it, the consumer has few choices. Basically, one goes to a physician on an approved list, has tests at facilities that have negotiated contracts with the third party payer, Medicare, or whatever, and has little knowledge overall of what he or she has bought. Or rather, what has been bought on the patient’s behalf. The only decision the patient can make is which insurance to buy and how much, and usually even that is out of their hands, having been preordained by their employer anyway.

My socialist friend Anonymous (why else would he get so snarky, unless perhaps he wallows in this unsavory stuff?) makes a fundamental mistake in his (get over it, pronoun-pc’ers) analysis. What BadRay is doing is NOT offering the consumer the opportunity to CHOOSE for themselves to pay less for ummm, an unknown level of care (yes, for the lawyers I shall say unknown). Rather, it targets institutions interested in skimming profit, and this is very clear from the teaser on the website. Said institutions are choosing on behalf of the consumer, and the patients haven’t a clue that their child’s scans are being read by  the lowest bidder for the job. Like Enron, BadRay does nothing at all to promote choice, nor does it add any particular real value to the system. If anything, it restricts choice, deciding more or less by itself who should read, and pocketing a middle-man fee for insinuating itself where it doesn’t belong.  This is not capitalism, it is manipulation, pure and simple.

Can health care operate on a purely free-market basis? I’m not sure, frankly. The only example I can see on first blush is that of patients going to other countries to have expensive procedures done at a lower price. Those who do so, those who are able to do so, that is, do indeed exercise choice in an international free-market. I don’t have the figures, but I suppose most do OK, assuming their surgeons are well-trained, and the facilities are up to snuff. But with the lower price tag comes some strings, mainly the lack of recourse should something go wrong. It’s sort of like buying something on eBay, but maybe not even as secure. Caveat Emptor.

Here’s my own humble opinion: The whole mess needs to be scrapped. Every last facet. Medicare and Medicaid must go. They are bloated, corrupt bureaucracies, and for the most part have created the tangled quagmire that now drags us down. Overpayments and underpayments are the rule, not the exception. A lot of docs have made a lot of money off of both by gaming the system, and that is not acceptable.

I’m not going to go into much detail, because I don’t have time or energy or intelligence enough to do it, but I think my friend Bart was on the right track with his idea that I published years ago. Basically, let the government buy the most basic of catastrophic insurance for everyone, and then the individual fills in the gaps. Remove interstate restrictions, etc. This is not the insurance exchange envisioned by Obamacare, by the way. I’ll add to Bart’s plan the thought of removing Medicare and Medicaid from the equation, or at the very least, revamping them from top to bottom.

But I digress…

I have no problem with profit. I think profit is a better and more benign motivation than power. I DO have a problem with cheating, with gaming the system, with manipulating people’s lives and health to make a buck. But that sort of garbage isn’t really capitalistic anyway.

The Future Of Radiology? Seriously??

As you know, I do occasionally follow the internet trails that lead my readers to this information sink called DoctorDalai.com. It sends a thrill up my leg to know that anyone actually reads this drivel, and I just have to know how you may have stumbled upon this particular intellectual wasteland.

Someone from Rome (Italy, not Georgia) found me by Googling the phrase, “when radiology pacs don’t work.”  We can only wonder which system they might be using…anyone have a GEneric Answer I can Give For thAt?

Anyway, coming before this blog on the search was an entry for RadBay, The American Radiology Exchange, LLC, “The Future of Radiology” or so they say. Now, I think this company has been discussed on AuntMinnie, but I can’t find the thread, so we’ll pursue this as a new topic.

What is BadRay, I mean RadBay, and what did they do to earn my sarcastic derision? Simply put, they reduce the radiology business to an auction:

RadBay is an internet based auction site that matches up hospitals, imaging centers, and physician offices (including other radiology groups in the case of night reads) with radiologists through an online bidding process.

After a radiologist has signed up and installed our PACS partner’s viewer, his/her account is activated on RadBay. Imaging centers send studies to the RadBay PACS which sends the study info to RadBay to be auctioned to qualified radiologists for competitive bidding. You can bid on single or multiple studies at once. Once a study is auctioned, the radiologist will interpret it and sign off on the report in a specified time. The time is different based on the priority (stat, ASAP, routine) of each study. Once you interpret a study, it will be transcribed by the imaging center’s transcriptionist. After you sign your report on the PACS, RadBay bills the imaging center for the interpretation. RadBay then pays you after receiving payment from the imaging center.

As for the imaging center…

After you have signed up and been connected by our PACS partner, completed studies are auctioned to qualified radiologists for competitive bidding. When you sign up, you have the option of setting a maximum price for each type of study to ensure costs are controlled. The auction process allows qualified radiologists to bid competitively to drive down the price you’ll have to pay to have your study interpreted. You can allow any qualified radiologist in your state to bid on a study or restrict bidding to your preferred or sub-specialized radiologists. RadBay only lets radiologist that are caught up on their work to bid. Once a study is auctioned, the radiologist is required to interpret it and sign off on the report in a pre-specified time. The time is different based on the priority (stat, ASAP, routine) of each study. You may use your own transcriptionist or allow us to connect you to a preferred transcription service. You are then billed by RadBay and the radiologist is paid by RadBay, thus completing the transaction. With a vast pool of radiologists and the ability to add and remove radiologist with ease, quality can be maintained to the highest standard and the fastest report turnaround can be achieved. In addition, radiologist have the opportunity to give technologist feedback on every study. You can get reports from this feedback, allowing you to see how you can improve the quality of your studies.

Why a radiologist would want to work as the low-bidder is beyond me, although I guess you gotta do what you gotta do, right? For the imaging center, the attraction is clearly spelled out by our friends at BadRay RadBay (and this is on their website, mind you…I’m not making this up!):

Summary Of RadBay Benefits

Profit
The auction process allows the hospital or imaging center to pay the lowest rate for interpretations on each study, keeping more of the global charge.

Quality

Imaging centers and hospitals can pick from a list of all licenced radiologist in their state, regardless of geographic location. If they experience problems with the reports of a radiologist, they just remove him/her from their list. There is no longstanding contract with a radiologist, politics, or privilege issues to prevent removal from the list.
Every study can be read by a radiology sub-specialist, giving even the smallest communities the level of radiology care previously only achievable at large academic centers.
Radiologists can easily give electronic feedback on every study, so radiology directors can get hard data on what can be improved in their department.
With or without a local PACS, our cloud PACS can act as a backup PACS for your facility (without additional charge).

Rapid Delivery Of Care

RadBay monitors the workload of each radiologist and does not let them bid on new work until they are caught up, insuring rapid report turnaround.

Credentialing/ Governmental

You can do your own credentialing from the information that we collect from radiologist when they sign up, or pick from a list of radiologists that are credentialed through a Joint Commission Certified process. With patient studies archived in the cloud PACS, if a patient goes to a different center or even a different state, their images are readily available, moving toward the federal government’s goal of easy access to electronic medical records.

Community

The American Radiology Exchange, LLC believes in supporting local communities and seeks to donate a portion of every dollar earned on RadBay to support local nonprofits. Imaging centers are encouraged to recommend a local non-profit for RadBay to support.

The first entry is of course the most important, of course. And why deny it?

Somehow, it isn’t surprising that BadRay RadBay uses Viztek PACS, which is certainly adequate to the job, but definitely not the most expensive product out there.

This is how low we’ve sunk, folks. Medicine by low-bid. Would you want your scan read on this basis? Not to denigrate those fine radiologists who find themselves in need of employment by these means, but come on, folks. This is ridiculous.  I’m a capitalist, and proud of it, but I have to think that medicine is somehow different than making widgets. So, what’s next? Surgery by the lowest bidder?

Excuse me, but I’ve got to go bid on some widgets on eBay.

It’s Here…

In case you missed it, the NEW iPad (that’s its name, not iPad 3 or iPad HD, or the SJM (Steve Jobs Memorial) iPad) has arrived. Debuted by Tim Cook, Apple CEO, the New iPad does indeed have a 3MP display with 2048 by 1536 pixel resolution. That’s Barco territory, folks. It also boasts a new A5x quad-core processor, and the same price points as its predecessor, the iPad 2.

OK, PACS vendors. It’s your turn. Go out and write the killer PACS iPad app for this thing. I’ll be the first to volunteer to test it out for you. Well, as long as someone supplies me with a NEW iPad. The 64 Gb version with 4G would be just fine, thank you.