Medical Malpractice

The healthcare field is the subject of a host of federal statutes, regulations, guidelines, interpretive information, and model guidance. There are a considerable number of statutes and regulations that have an impact on the delivery of healthcare services. A statute is legislative enactment that has been signed into law. A statute either directs someone to take action, grants authority to act in certain situations, or to refrain from doing so. Statutes are not self-enforcing. Someone must be authorized to do so to take action. A statute may authorize the Department of Health and Human Services to take action, and it is up to the department to implement the law. Regulations, or rules, are made by administrative personnel to whom legislatures have delegated such responsibilities. It is a tool for developing policies, procedures, and practice routines that track the expectations of regulatory agencies and departments. The statutory and regulatory requirements are subject to judicial interpretation.

A very important element of healthcare management is to understand the key regulatory environment. One government statute that effects patient healthcare is the Anti-Kickback Statute. The Medicare and Medicaid Patient Protection Act of 1987 (the "Anti-Kickback Statute"), has been enacted to prevent healthcare providers from inappropriately profiting from referrals. The government regards any type of incentive for a referral as a potential violation of this law because the opportunity to reap financial benefits may tempt providers to make referrals that are not medically necessary, thereby driving up healthcare costs and potentially putting patient's health at risk. The Anti-Kickback statute is a criminal statute. Originally enacted almost 30 years ago, the statute prohibits any knowing or willful solicitation or acceptance of any type of remuneration to induce referrals for health services that are reimbursable by the Federal government. For example, a provider may not routinely waive a patient's co-payment or deductible. The government would view this as an inducement for the patient to choose the provider for reasons other than medical benefit. While these prohibitions originally were limited to services reimbursed by the Medicare or Medicaid programs, recent legislation expanded the statute's reach to any Federal healthcare program. Because the Anti-Kickback statute is a criminal statute, violations of it are considered felonies, with criminal penalties of up to $25,000 in fines and five years in prison. Routinely waiving copayments and deductibles violates the statute and ordinarily results in a sanction. However, a safe harbor has been created wherein a provider granting such a waiver based on a patient's financial need would not be sanctioned. The enactment of the 1996 Health Insurance Portability and Accountability Act (HIPAA) added another level of complexity to the Anti-Kickback statute and its accompanying safe harbors. HIPAA mandated that the OIG (Office of Inspector General) furnish advisory opinions to requesting providers that are either in an arrangement or contemplating an arrangement that may not fit squarely within the law. For a fee, the OIG would analyze the arrangement and determine whether it could violate the law and whether the OIG would impose sanctions on the arrangement. In many of its advisory opinions published over the past few years, the OIG has stated that it would not impose sanctions, even though it found that the arrangement in question could violate the statute. A common reason the OIG has given for not imposing sanctions has been that the arrangement provides an overall benefit to the community. Healthcare finance professionals need to ensure that all business transactions comply with the Anti-Kickback statute.

The Anti-Kickback statute effects the patient. The main aim of this statute is to improve patient safety, provide satisfaction and avoid risk. The result of the acquisition of a physician's practice would serve to interfere with the physician's subsequent judgment of what is the most appropriate care for a patient. It would also interfere with a beneficiary's freedom of choice of providers.

Physicians have direct patient care responsibilities. Any incentive payments to such physicians that are either tied to overall costs of patient treatment or based on a patient's length of stay could reduce patient services. Also, the profits generated by cost savings may induce investor-physicians to reduce services to patients. Health care programs operate on the good faith and honesty of health care providers. It is important to ensure that quality services are provided at the hospital. The Anti-Kickback statute helps the government not to tolerate misuse of the reimbursement systems for financial gain and hold the responsible parties accountable for their conduct. Such conducts can also prompt patient complaints. The hospitals and physicians who are interested in structuring gainsharing arrangements might adversely affect patient care.

The Anti-Kickback statute creates a protective umbrella, a zone in which patients are protected so that the best health care is provided. This statute helps to improve efficiency, improve quality of care, and provide better information for patients and physicians. The Anti-Kickback statute is not only a criminal prohibition against payments made purposefully to induce or reward the referral or generation of Federal health care business, it also addresses the offer or payment of anything of value in return for purchasing, leasing, ordering of any item or service reimbursable in whole or part by a Federal health care program. It helps to promote quality and efficient delivery of health care transparency regarding health care quality and price.

There are millions of uninsured patients who are unable to pay their hospital bills. Giving a discount on hospital charges to an uninsured patient does not implicate the Federal Anti-Kickback statute. Most need-based discounting policies are aimed at making health care more affordable for the millions of uninsured citizens who are not referral sources for the hospital. For discounts offered to these uninsured patients, the Anti-Kickback statute simply does not apply. It is fully supported that a patient's financial need is not a barrier to health care. Furthermore, OIG legal authorities permit hospitals and others to offer bonafide discounts to uninsured patients and to Medicare or Medicaid beneficiaries who cannot afford their health care bills. The Anti-Kickback statute is concerned about improper financial incentives that often lead to abuses, such as overutilization, increased program costs, corruption of medical-decision making, and unfair competition.

There are risk management implications of this statute. There are risks associated with the Anti-Kickback statute and its good to prevent them. Rather than be an imposing and daunting challenge to understand, the outcome can be development of risk management systems to guide the delivery of health care. This fact is recognized that such statutes are an important attribute of the risk management professional. For example there are potential risks under the Anti-Kickback statute arising from hospital relationships. In case of joint ventures there has been a long-standing concern about arrangements between those in a position to refer or generate Federal health care program business and those providing items or services reimbursable by Federal health care programs. In the context of joint ventures, the chief concern is that remuneration from a joint venture might be a disguised payment for past or future referrals to the venture or to one or more of its participants. The risk management should be done by having a knowledge of the manner in which joint venture participants are selected and retained, the manner in which the joint venture is structured and the manner in which the investments are financed and profits are distributed. Another area of risk is the hospital's compensation arrangements with physicians. Although many compensation arrangements are legitimate business arrangements, but may violate the Anti-Kickback statute if one purpose of the arrangement is to compensate physicians for past or future referrals. Risk management is to follow the general rule of thumb that any remuneration flowing between hospitals and physicians should be at fair market value for actual and necessary items furnished or services.

Risk management is also needed in entities such as in cases where a hospital is the referral source for other providers or suppliers. It would be prudent for the hospital to scrutinize carefully any remuneration flowing to the hospital from the provider or supplier to ensure compliance with the Anti-Kickback statute. Also, many hospitals provide incentives to recruit a physician or other health care professional to join the hospital's medical staff and provide medical services to the surrounding community. When used to bring needed physicians to an underserved community, these arrangements can benefit patients. However, recruitment arrangements pose substantial fraud and abuse risk. This can be prevented by having knowledge of the size and value of the recruitment benefit, the duration of payout of the recruitment benefit, the practice of the existing physician and the need for the recruitment. Another area where risk management is to be applied is when the discounts are given. The Anti-Kickback statute contains an exception for discounts offered to customers that submit claims to the Federal health care programs. The discounts should be properly disclosed and accurately reported. The regulation provides that the discount must be given at the time of sale or, in certain cases, it should be set at the time of sale. This will help in risk management. It is also needed in medical staff credentialing and malpractice insurance subsidies.

The key areas of potential risk under the Federal Anti-Kickback statute also arise from pharmaceutical manufacturer relationships with 3 groups: purchasers, physicians or other health care professionals, and sales agents. Activities that pose potential risk include discounts and other terms of sale offered to purchasers, product conversion, consulting and advisory payments. The pharmaceutical manufacturers and their employees and agents should be aware of the constraints the Anti-Kickback statute places on the marketing and promoting of products paid for by federal and state health care programs. To that end, the draft guidance recommends pharmaceutical manufacturers ensure that such activities fit squarely within one of the safe harbors under the Anti-Kickback statute. The Department of Health and Human Services has promulgated safe harbor regulations that protect certain specified arrangements from prosecution under the Anti-Kickback Statute.

Healthcare being one the most regulated of all sectors of commerce, it is important that all facts and circumstances with respect to the statutes and regulations are evaluated.

A birth defect is generally referred to as a complication occurring at birth which causes an infant to come out deformed, or otherwise impaired. Many people just assume that these birth defects are the result of a natural birth, and there is no way to help it. You might be surprised to find out that isn't actually the case. As a matter of fact, a number of factors can cause birth defects, such as, fetal distress, improper positioning at birth, a delayed c-section, or many, many other factors. These factors can lead to even more serious afflictions such as Cerebral Palsy, Autism, Epilepsy, and Erbs Palsy, topamax birth defect, and pesticide birth defects to name a few.

A prime example of an induced birth effect, was the introduction of thalidomide to pregnant women in 1967 as a sleep aid, and a way to ward off morning sickness. It was only discovered later, that this drug caused the children to be born with horrific birth defects, ranging from having no arms, missing toes, and bring horrible misshapen. Recently it has been discovered that thalidomide was created by the Nazi's in World War II in order to combat the effect of sarin gas. Fortunately, an FDA inspector named Frances Oldham Kelsey managed to discover the negative effects of the drug, and block it from being used in the United States, though recently it was legalized to treat other types of diseases.

The above is just one example of malpractice and negligence in the medical community, so how can we be sure similar things aren't happening now? Isn't it entirely possible that drugs worse than this exist today, and we just don't know it? Yes, it is possible, and with careful observation, and a willingness to pay attention, we can certainly notice these things, and even say no to certain medical procedures, however what if you find out too late that your son or daughter has come out deformed? What then? Maybe it's just something simple, like a missing finger, but even so, that is your child, your flesh and blood, and the doctors treated him or her like they were nothing. But that's not all, it could even be the result of other types of neglect. Maybe you were exposed to some sort of pesticide, or even the epilepsy prevention drug Topamax, which has been known to cause genital birth defects in infants.

Sad but true, harmful drugs are prescribed every single day, and we sheepishly accept them. Though if you've been a victim of such a drug, you won't be very quick to accept it again. If you find yourself to be affected by any sort of neglect, you need to contact a specialized lawyer immediately, and work with him or her to resolve this. They know the deal, they've dealt with this before, and they will go after those responsible to help you get every penny that's coming to you, and maybe more. This isn't something to be taken lightly, it's the future of you and your children, and you must do everything in your power to secure those futures.

Locum Tenens is a term used in many industries. Essentially, it literally means "place-holder" and it is a way of describing a worker who temporarily performs the duties of another worker. Such is the case in the medical profession. There are times when doctors need to take time off for maternity leave or other reasons, or doctors retire and leave the profession entirely. Medical facilities then need a replacement physician to fill the empty spot. Physician staffing services are available online to make finding your next physician a much easier process for all involved.

The Benefits of Locum Tenens

There are many benefits for both physicians and medical facilities for hiring temporary staff for physician jobs. For facilities, it means that you do not lose the revenue each day a physician is absent from a regularly filled position, which can be a considerable amount over the usual months it takes to fill physician jobs. You also have the unique opportunity to watch your new doctor in action and see how he or she performs in the actual day-to-day practice typical at your facility. This is a benefit that is often impossible to duplicate in a physician jobs hiring scenario. If you like the way things have worked out with the physician and the contract comes to an end, you have the choice of offering the doctor full-time employment or not at your discretion, with no hard feelings from the doctor either way.

Physicians also have much to gain by temporary employment physician jobs. They as well will be able to use their time at the facility to see if the facility offers a good fit for them. This is especially beneficial to new physicians, who often experience unhappiness over their initial jobs once out of medical school. Seasoned physicians enjoy the opportunity to break out of a rut and experience new work situations. It gives them a chance to check out the town where the hospital or medical office is located to see if they feel comfortable there. Just as the medical facility is under no obligation to extend an offer of employment beyond the initial contract, so too the physician is under no obligation to accept an offer if he or she so chooses, with no repercussions to the doctor.

How To Get Started With Temporary Physician Jobs

Job seekers and medical facilities can find or fill physician jobs by working with a physician recruiter. A physician recruiter working through a staffing agency will have access to hundreds of candidate CVs and will do all of the initial background checks and screenings. Better agencies will help the physician obtain malpractice insurance, any necessary state licensing and will also arrange for transportation and accommodations. A physician recruiter is available online to answer all your questions about this simple process, making both finding a job as well as hiring staff easier.

It's an important question... because most of the sexual malpractice by ministers has been violating boundaries with teens. And... The clinical record shows that most ministers who violated sexual boundaries with adolescents... thought they were doing ministry! Astonishing... isn't it?

But thought is exactly what was missing in every one of those cases... because there is a certain anti-intellectualism that permeates virtually all ministries.

Ministry puts little emphasis on the mind but great emphasis on feelings ... loving God... loving one's neighbor. But the latter too often becomes making love to one's neighbor... and sadly... to their children.

A Google search for "youth ministry" brings back nearly four million pages... all referring to youth ministry. But few pages... if any... can be found that actually define it.

Using the word to define itself by saying that youth ministry is ministering to youths is just an example of a lack of the presence of intelligent... knowing... mind in ministry.

The word ministry itself is perhaps the most overused... undefined... word in Christendom. Though there are millions of examples of ministries. By defining ministry itself... we automatically exclude everything that isn't ministry... everything that does not fit that definition.

Some say "Everything is ministry!"... but the Gospel (Matt. 7:21) disagrees and says there are apparent ministries where one does evil under the guise of doing ministry...

Not everyone who says to me Lord, Lord will enter the kingdom of heaven...
Many will say to me on that day... "Lord, Lord, did we not prophesy in your name?
Did we not drive out demons in your name? Did we not do mighty deeds in your name?"
Then I will declare to them solemnly... "I never knew you. Depart from me you evildoers.

So here's a definition of ministry... and all examples must meet its requirements... or be excluded.

Ministry is...

Religious activity... that brings both minister and people closer to God.

Now with that definition no one... in their right mind... could claim that violating sexual boundaries with children and adolescents was ministry. Such activity is not religious and does not bring both minister and people closer to God.

So the youth minister/coach who... with no medical training... helps prevent testicular cancer in teenage boys by checking them for it... cannot assert... as he did... that he was doing health ministry.

Unable to hide behind 'ministry' as defined here... he would need to confront the real reasons for his predatory sexual behavior. So his treatment had to begin with a rational definition of ministry.

Because of the false belief that predatory ministers are helping youths by violating sexual boundaries... there is genuine abuse with lasting residual non-sexual effects. You can read more about those at the URL below if you want to know how pervasive they can be.

Now...

What's a youth?

Typically we make a vague separation between children and youths by the onset of puberty. I say vague because girls generally enter puberty sooner than boys... and puberty can be early or late in both boys and girls.

It's probably more useful to define a youth by their present social context... and the rites of passage that take place in that context. So... a 13 year old eighth grader is not the same 'youth' as a 15 year old sophomore who is about to get a driver's permit... or an 18 year old senior who is thinking of getting engaged... or planning to leave the family nest... and its influence... and go to college.

So... a youth is

A minor... at a specified stage of development.

And "youth ministry" has to bring both these minors... and their ministers... closer to God through religious activity.

An emphasis of youth ministry then would be to help young people cope with their present stage of development... such as the onset of puberty and its meaning in Christian life... and to prepare them for the next stage of development.

For example... driving creates more mobility for the teenager... more opportunities to get into various kinds of danger... some of which may be serious risks to life... to health... and to morals.

So youth ministry can be understood as integrating religious values with specific increasing freedoms and independence.

How this is done is a major task of definition... of putting the intelligent mind into ministry... and not just hanging out with... being with... being there for... or serving... youths.

Many senior citizens across the country are facing a terrifying outlook on the availability of quality healthcare. Already the lowest reimbursing health insurance carrier, Medicare is cutting physician fee schedules by more than 20% across the board. The end result may be catastrophic for those that have no other option.

In an effort to rein in costs, congress has approved this measure without giving much consideration to the end result. Physicians in all specialties are faced with the task of absorbing these cuts in order to continue to treat patients desperately in need of quality care. Meanwhile, seniors are facing the reality that their doctors may no longer offer treatment to Medicare patients.

Many people believe that doctors sit on the golf course while earning millions of dollars per year. Although this may have once been a reality, I can assure you that this is no longer the case. Physicians and healthcare professionals in most specialties have been facing the reality of shrinking profit margins year after year. The constantly evolving insurance reimbursement process has made it more and more difficult for physicians to receive payments for services they've already performed. With the growing cost of malpractice insurance, overhead, and billing expenses one can see how difficult it has become to run a profitable medical practice.

With costs rising and reimbursements declining, how can we expect healthcare providers to handle a 20% reduction in reimbursement? Many specialties rely entirely on Medicare patients to keep their practice afloat. These certainly are not the highest grossing doctors in the nation. If physicians can no longer afford to treat Medicare patients, where will seniors go for the treatments they need? How will they manage to stay healthy without regular visits to the doctor? These issues must be addressed in a timely fashion or seniors and healthcare providers will be hung out to dry! Although there certainly is a need to control the spiraling cost of healthcare, squeezing physicians and seniors can't be the only option. How could we let this happen while insurance companies are profiting billions per year?

The president of the American Medical Association, Dr. Cecil Wilson has recently spoken out against these cuts. He's calling for a thirteen month reprieve to allow for the opportunity to come up with different alternatives. Hospitals, physicians, and pharmaceutical companies all oppose cuts to the fee schedule. We will have to wait and see if the powers that be will allow this atrocity to take place.

When it comes to protecting personal wealth and business assets, the first thing that comes to many people's minds is insurance. There is no question that insurance can play an important role in asset protection. Not only is it often required by law, by your lender or by your landlord, insurance can be an effective first line of defense against liability lawsuits. However, to fully protect your assets, it is critical to understand what insurance is and what it does and does not do for asset protection.

Included within most typical insurance policies such as automobile, homeowner, landlord and business insurance are three main general categories of coverage:

1. Liability coverage - this is the coverage to compensate the other party for bodily injury or property damage caused by you. For example, if you cause an automobile accident and the other car is damaged and the driver is injured, your liability coverage will pay for the injury of the other driver and the repair of the other car.
2. Property protection coverage - this is the coverage to replace or repair your property for any sudden and accidental loss or damage caused by a covered peril. For example, if your car is also damaged in the above accident, your property protection coverage will pay to repair or replace your car after you pay your deductible.
3. Other additional protection - this is a broad category of coverages designed to help you get by during the period when your property is being repaired like a rental car when your car is in the shop as well as other miscellaneous coverages like towing and medical expenses for you and your passengers.

Liability insurance gives you a layer of protection against lawsuit and lost of assets. However, it has a number of limitations:

• There are always limits on how much the insurance policy will pay for losses for which you are liable. If the court awards the person you've injured a judgment of $350,000 but your liability limit is just $100,000, the most the insurance policy will pay is $100,000. Guess who will have to come up with the remaining $250,000? That's right: you! You will have to come up with the cash or face the real possibility of losing your home and/or other assets.
• There are many exclusions in your insurance policies. For example, any liability from an intentional or criminal act is excluded. Sexual harassment, employment discrimination or wrongful termination is typically excluded as well. Discharge of waste and other toxic materials is generally excluded. Liabilities arising from breach of contracts or agreements are typically not covered. Professional liabilities such as malpractice, errors and omissions are usually excluded unless a separate professional liability policy is in force. In other words, for a LARGE liability claim, the insurance company will try to find ways to avoid paying. So unless it is specifically and explicitly covered by the insurance policy, you are most likely on your own. In addition, any failure to disclose material facts in your application or failure to report any material changes after the policy is in force gives the insurance company a way out of paying a claim even if it is covered.
• Most insurance policies do not cover many more ways you can be sued. For example, you might be sued for misappropriation of other's funds, fraud or allegation of fraud, breach of contract, slander, libel, copyright, trademark or patent infringement, divorce, accidents from a motorized speed race, a hostile working environment, a liability arising from a willful violation of an ordinance or a statute, suits from local, state or federal government agencies, just to name a few. You can't even buy liability insurance for these risks in most cases. And if you can find insurance for these risks, they will likely cost a great deal.

There is no question that we should all carry the insurance required by law, the lender or landlord as the first line of defense against lawsuits and loss of assets. However, since there are limits on what insurance will pay and there are too many situations where insurance will not provide the coverage, you cannot rely solely on insurance to protect your assets.

Oftentimes, just having all your assets visible to an aggressive injury attorney invites lawsuits that might otherwise not be filed. There is no better way to stop a potential lawsuit from starting than to lead the injury attorney to think that there won't be any money or assets for him to collect after spending all the time and money to go to trial even if he wins.

Is your healthcare facility falling behind in the technology department? Do you walk into other hospitals or nursing homes and see minuscule, but notable upgrades in the equipment these places use that your facility doesn't? There is a common issue among healthcare facilities around the country where the most up-to-date equipment has not yet been implemented. And in the fast paced progression of the healthcare industry, you don't want to be left behind in the dust.

So what kind of technology are we talking about here? Many could not name off the top of their head all of the different devices and machines that are used in a healthcare facility on a day-to-day basis. Amidst the large number of devices a facility may choose to upgrade, there are a few simple upgrades that might be the first step a hospital, nursing home, or doctor's office may want to take, and among these is an upgrade to a synchronized hospital clock-the most technologically advanced product of its kind.

The synchronized hospital clock has many beneficial features to offer any healthcare facility, all within the confines of a quick and cost effective upgrade. Using synchronized time in hospitals has been proven to increase the efficiency of operations in multiple ways. For instance, with consistently accurate time displays that synchronized hospital clocks provide, doctors and nurses no longer experience the confusion of inconsistent time displays from room to room. Additionally, patient's time in and out of the operating room occurs on schedule with the use of synchronized time displays. With every clock in the system displaying the identical time throughout the healthcare facility, personnel is able to perform tasks more efficiently.

Not only will a synchronized hospital clock improve the efficiency of the facility, but it will also protect the organization from possible legal risks. How is this possible? One of the most important tasks that nurses and doctors must perform accurately for their patients is administering medication. Diligent records must be kept and scheduled delivery cannot be a minute off when it comes to giving a patient their medicine. Therefore, the hospital clocks that nurses and doctors receive their time from to make these records and administer the scheduled medication cannot waver one minute from the accurate time. If they are inaccurate, patients can fall ill from not receiving medication on time, and inaccurate record-keeping can validate malpractice in a lawsuit. When healthcare facilities use synchronized hospital clocks, the staff can rely on an accurate display when it's time to record and administer scheduled medication.

If it seems that your healthcare facility is falling behind with the outdated technology used in your hospital or nursing home, and your head spins when you think of where to start with an upgrade, look into implementing synchronized hospital clocks into the building. For a moderate price and a quick install, staff within the facility will see the resulting benefits immediately upon set up of the system. Synchronized hospital clocks are the beginning step in the process of updating the technology of your healthcare facility's devices and machinery.

There are a number of diverse factors to consider when you are choosing a plastic surgeon and surgery facility. Naturally, surgical experience and training are the most important considerations as far as the doctor is concerned, while the facility would be graded on how up to date the equipment is, the cleanliness and orderliness of the operation, and so forth.

Of course, you have a of help in making these assessments, although you should do as much personal investigating as possible, including doctor consultations and visits to the outpatient surgery centers you are considering. Although there are numerous factors to consider, the following five criteria will help make your decision a bit easier, and steer you in the right direction for other information.

1. As previously stated, when choosing a plastic surgeon there are a number of factors to be considered, but medical training and surgical experience are still the first qualifications you want to establish. The first step is to interview the surgeons. Don't be afraid to ask questions about where they went to school, where they did their internships and residencies, etc. If you want to look into a doctor's credentials a bit further, and find out about any past or pending malpractice judgments and/or disciplinary actions, just call, visit or log on to the Web site of your state's medical association.

2. Although there is no one factor that can guarantee your getting the best doctor for the procedure you want, board certification is usually an indication that surgeons are involved in ongoing education in their specialties. Not all societies or boards are the same, so you will need to research these as well. There are three major boards related to plastic surgery:

a. The American Board of Plastic Surgery (ABPS) certifies doctors in plastic surgery on the entire body. These surgeons have the highest levels of training, as well as the highest standards of certification for plastic surgery done anywhere on the body, including breast augmentation, reconstructive surgery and facelifts.

b. The American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) restricts its certification to doctors performing facial plastic/reconstructive and cosmetic surgery. The board certifies that the doctors are expert in procedures specifically involving the head, face and neck.

c. The American Board of Otolaryngology (ABO) provides certification to surgeons specializing in otolaryngology, meaning conditions and diseases of the eyes, ears, nose, throat, head and neck.

For any questions about a doctor's board certification, you should visit the Web site of the American Board of Medical Specialties at http://www.abms.org. This group has 24 different boards as members, which offer doctors certification in almost 90 different special practices.

3. Each doctor's individual practice should be looked at carefully. You should ask to speak with former patients, ask about any recent negative outcomes, talk to the medical staff and check out the doctor's business ethics record with the Chamber of Commerce or Better Business Bureau. Also keep the doctor's actual patient pool in mind. If you discover that the doctor performs primarily cosmetic procedures or laser hair removal, you may wish to extend your search if you are contemplating eye surgery or a complex reconstruction of some kind.

4. Some plastic surgeries are performed in a hospital, but more and more often they are performed in a surgeon's office, surgical center or other facility. Any facility other than a hospital at which surgery takes place has to maintain quality standards set by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). You can confirm that a particular facility is accredited with a quick visit to the Surgery Facilities section of the AAAAS Web page.

5. Because hospital privileges require that a physician's ability be reviewed by his peers, it is essential that you ask the doctor about his standing at local and regional hospitals. You can also contact these hospitals directly, and ask about the doctor's privileges, as well as what procedures those privileges cover.

Lawsuit Loans. No Risk Loans

A relatively new source of financing is now available for both individuals
and business owners. It is called lawsuit financing, often referred to as lawsuit loans or lawsuit funding. But these are not loans because the money does not have to be paid back unless the case is won.

Lawsuit financing (loans) help clients who are having financial difficulties. Lawsuit funders do not require credit checks, monthly payments, notes, or any other security.

Frequently, claimants have missed work or lost their job and can no longer meet their rent or automobile payments. In the past, these claimants have needed to accept lesser settlement amounts due to pressing financial difficulties. Now, clients can sustain their personal lives and give the attorney the necessary time to achieve the full value of the case.

Often times, individual claimants and commercial litigants require financial loan assistance prior to settlement or judgment. Types of cases that qualify are:

- Personal Injury: Automobile Accidents, Any Type

- Malpractice: Medical-Legal, Accounting, Construction,

- Wrongful Termination

- Discrimination

- Harassment: Sexual/Rape, Any Type

-And much more

There are a handful of companies that provide lawsuit funding. For more information on these lawsuit
loan companies please visit http://www.fredcoutts.com/indexlawsuit.htm. Each company provides funding that is specific to their criteria. All lawsuit funding companies will provide funding
for personal injury lawsuits. But there are only a couple that will fund commercial and other non- personal injury lawsuit cases.

Rates will vary depending upon the risk. Lawsuit funding companies will generally finance up to 10-15% of the potential settlement value. For example, if the case has a potential value of $100,000, you can expect a funding offer of $10,000 to $15,000. Lawsuit funding companies carefully analyze the cases they choose to fund. They must like the lawyer as well as the potential settlement value.

Lawsuit funding is available in most states and can be a very beneficial source of funds.

For more information please contact the author Fred Coutts
at http://www.fredcoutts.com/indexlawsuit.htm or phone at 888-942-6639.

Trusting just anyone these days without properly knowing the person well can be risky these days. Criminals can be anyone from any walk of life where they can even mask themselves as professionals. Just like the many cases of physicians victimizing their patients. This is the reason why a certain patient has the right to perform background check on the physician that they are going to visit. You'll never someone as professional as these doctors can have past crimes.

By studying the public records of a physician, you will be able to discover certain aspects that can affect their credibility. The background check result of a physician may contain information such as the medical school he went; some legal actions for Medicare or medical fraud involvement; any sort of malpractice committed; status of license; review of the person's internship; organizations; present and past residences; specialty experiences; academic performance; all the contact details of the doctor; the doctor's publications; and the overall rating of the physician. By careful evaluation of the records, you can discover things you never knew about the doctor. Just hope that there are no bad records or else, find another doctor.

You can find reliable background check services on the Internet which will give you complete information about any physician like the details mentioned above. Use the service of the background check company with a reputable database that is large enough to contain complete information. You can search these sites by using the search engines but make sure that you choose the most reliable service.

A recent article in the USA Today stated that there was a 47% rise in deaths in the Gulf Coast states within the impact area of Hurricane Katrina as a result of the loss of healthcare professionals in those areas. Healthcare professionals displaced by Hurricane Katrina, many laboring under the burden of student loan repayments and the daily financial needs of life assimilated themselves into their new home community as they landed in cities and towns across the United States.

Now that the cities of the Gulf Coast are rebuilding they are discovering that these healthcare professionals are not rushing home to the Gulf Coast.

Startup cost for a private medical practice vary between $100,000 and $200,000 for rent, business insurance, malpractice insurance, equipment, supplies, information systems, computers and simple office decorations. Most of the healthcare providers in the Gulf Coast region lost well-established practices and if they were insured at all they used the funds from those insurance payments to begin again in their new communities. Unfortunately, healthcare practices in 2007 have little resale value; particularly, when only one or two years old. Even if these professionals were inclined to move back to the Gulf Coast region, they face significant financial hardship in accomplishing that feat.

Add to this the lack of meaningful business recovery and a decline in the number of insured patients in many of these regions. The sad facts are that employment statistics and new business starts in the areas most affected by Hurricane Katrina are well below national averages. Healthcare providers, now comfortable in their new homes, find little inducement to assume the responsibilities, liabilities and hardships of returning to their former practices and even when they do often find that their former patients have yet to return as well.

Physicians are not the only individuals affected in this fashion. Hospitals that have already reopened in the Gulf Coast region are finding it more difficult to recruit nurses in a nation where there are already nursing shortages. Even when temporary staffing agencies provide nurses, known as travelers in the industry, to the Gulf Coast region to fulfill short-term contracts, most of these nurses decline the opportunity to extend their stay, take full-time positions, or return at a future date.

Much of the problem is that as healthcare has moved from the individual private doctor and the small community hospital to large corporate enterprise, it severed its relationships with its healthcare professionals seeing them more as expendable drones and less as a necessary and valued part of the healthcare delivery system.

Healthcare professionals regularly find themselves mandated to choose between maximizing patient flow and maximizing patient safety. They are often forced to forego important family events under threat of suspension, retaliation or termination. When the healthcare professional finds a home where they can achieve a level of work/life balance, it is difficult if not impossible to dislodge them again. It took a hurricane to dislodge these professionals from the Gulf Coast and nothing short of another force of nature, perhaps this one favorable, will move them back.

2000 years ago, the baby Jesus was born in a manger in Bethlehem. When seen from a medical perspective, this blessed event appears quite differently. Let's examine it with so-called "modern" thinking.

Consider the big risk our Heavenly Father took when he sent his son to us the way he did. First of all, the Virgin Mary was much too young to bear such an important child. No tests were performed to see if she was capable of carrying a child full term. Also, Mary was not adequately prepared. She attended no birthing classes, did not practice her breathing, nor did she read up on the birth process.

It should also be noted that some safety procedures were ignored during this pregnancy. I mean, no blood tests were done, no obstetric examinations, no ultra sound, or even the listening and monitoring of the child's heartbeat. Surely for such an important baby, an amniocentesis should have been done! The mother wasn't even prescribed the proper regime of vitamins for her nutrition. When you think about it, we're taking a major risk here.

Just think about the terrible conditions for the birth itself. Certainly that stable was not sterile. With all the animals in the same room, it's a wonder there wasn't a major infection. Not even simple clean sheets or surgical masks for the 3 Wise Men were used. I'm quite sure that Mary was not on the proper delivery table with her feet in the stirrups. If that's not bad enough, common medical practice was also lacking from this point on. Certainly an important woman like Mary should have been given some pain relievers or a spinal block to help ease her discomfort. Of course an episiotomy would have been called for to help out. I'll bet that a set of head clamps weren't available in case of need. There wasn't even a fetal monitor available should an emergency cesarean be required. This whole situation sounds like a nightmare.

It gets worse. No sterile surgical instruments to cut the cord, no silver nitrate for the baby's eyes, no fetal intensive care unit, alcohol rub, temperature control cubicle or suction of the child's nose or throat. None of the safety precautions our modern medical system deems necessary were carried out.

The more I think about it, I'm convinced this entire procedure was a menace to the mother and child. In a case like this, someone should be liable for malpractice. With things as they were, I'll bet the baby jesus never even got his required vaccinations!

If it were up to modern medicine, this birth would have been handled very differently. God sure took a big chance...or maybe we need to rethink the things we think are necessary and stop interfering with normal God-given miracles.

Every week, the national health care debate seems to change direction. However, in this seemingly never-ending battle raging on Capitol Hill there is one topic, despite the course, which comes up again and again: Reform.

Regulations, protocol, and policy, while all of these may need amending reform itself can be a tricky word (changing the rules, not changing the system). One of the hot reform topics being discussed right now happens to be Tort Reform. This particular debate seems to be flying under the radar lately and I am pretty sure that if asked the question today, not many of us would actually know a tort from a tart, so let me give you a real-world definition: Tort Reform = Reducing Lawsuits.

Here's the issue, serious lawsuit reform would reduce healthcare expenditures by an estimated $200 billion dollars every year! This savings is based on a variety of reliable studies and would go a long way in saving the government both in time and resources. A billion here, a billion there, and pretty soon you're talking real savings! Now, not to get too political, but it would be simple to say (not to mention true) the reason that no one in the Democratic Party is recommending any serious lawsuit regulation is because trial lawyers are a HUGE contributor to the party. I am not in any form being partisan on this issue; I am just simply paraphrasing Dr. Howard Dean, the past Chairman of the Democratic Party. Believe me, it was a rare, but refreshing moment of candor.

Let's take a look at the issue without partisan politics for a moment. I want to start by sharing my thoughts on an episode of a medical drama that I watched recently, as it really is so often, that art imitates life. On the episode, a major car crash takes place and a little boy is hit in the neck by flying shrapnel from an exploding fuel truck. He is airlifted by helicopter to a hospital and en route, his breathing stops, as his airway has become blocked. The EMT suggests a tracheotomy using the boy's mother to help, as she is the only other person in the back of the helicopter, but the hospital's ER doctor forbids him saying, "That's just a lawsuit waiting to happen".

In other words, let the boy die as opposed to risking a lawsuit. Not to ruin the story, but the EMT ignores the order and saves the boy's life. The point here is that this plot line is so believable to many of us because we all know stories similar to it - in real life!

So, what if the EMT's maneuver had gone wrong? What recourse would both parties take? Would they sue? Should they retain council on the grounds of insubordination, even though it was in an effort to save someone's life? The answer unfortunately is not that simple. I have many friends who happen to be trial lawyers and the defense they and their association give against Tort Reform is that trial lawyers are the defender of the wronged and without them there would be no recourse at all. They point out that there are 98,000 deaths each year in the US caused by poor or ill advised medical practice and who would look out for the victims if not for them? Fair point I would say.

So here's the problem; how many medical deaths are caused by unnecessary delays and procedures being done - defensively to prevent lawsuits - or, not done at all, as in the above fictional example? Not to worry, no one is suggesting that there be no recourse for the wronged, just a more reasonable system. In fact, in Mississippi they have instituted broad reforms on arbitrary lawsuits and in turn, they have plummeted!

Meanwhile, no one in Mississippi is complaining of violated rights and as for my lawyer friends and their title as "defenders of the oppressed", it ignores that over half of the proceeds from malpractice settlements go to the combination of lawyer's fees and the costs incurred in order to prepare the case (i.e. medical experts and research).

It remains to be said that there are a number of good proposals on the table ranging from those in Mississippi, to plain old "Loser Pays", where if you bring forth a lawsuit and you lose, the cost of the defense is paid by the plaintiff (the person bringing the suit). Trial lawyers suggest that this might work to suppress the many people who never intend to win (only settle) from even bringing suit, especially if they are just looking for a payday. The answer to this one is simple - I suggest giving a judge the discretion to modify the loss suffered by the plaintiff, should he see financial hardship unduly created. End of story.

The point is simple. Why are we not including one of the biggest pieces of the puzzle in the mainstream discussion of so-called health care reform? Or, is this just another exercise in paying off special interests by one of the political parties that will help no one but those very same special interests? It's certainly something to think about.

Aetna collier county anxiety psychologist provide comfort to patients who suffer from anxiety and depression. Many people does not believe that patient comfort is medically necessary anymore. Although plenty of information available regarding etna collier county anxiety psychologist, board certification and malpractice suits, the search for a nonspecialist that can diagnose, treat and handle anxiety still can be frustrating.

During the previous years, people used to have physicians for life who will provide them proper and satisfying care. But things have become more complicated. There are fewer primary care physicians, family practice physicians and internal medicine doctors who are in selection pool due to a physician shortage. Hospitals are now having a hard time finding primary care doctors including psychologists who will handle problems on anxiety and other related illnesses. The number of doctors to be internists has dropped to smaller percentage. The biggest reason is that, specialists make more money. Patients and doctors become more mobile these days. And so is the insurance, with employers often switching to more cost-effective plans, forcing patients to find new doctors who handle minor illnesses and practice preventive medicine. At the same time, more and more individuals are being forced to pay.

Aetna collier county anxiety psychologist has faster walk-in options. Of course, some folks desire a psychologist that can keep an eye during the times of their attacks including anxiety and panic attacks. Aetna collier county assure an effective anxiety psychologist and can offer a traditional health maintenance. Aetna is also expanding with a health savings account and its HealthFund consumer-driven option. Premiums have also been reduced to all eligible federal enrollees. Aetna members get preventive care for medical, dental and vision. Their plan allows members to visit physicians and psychologists without a referral. Moreover, Aetna is the first and only carrier who have federal workers doctor-specific price information, and in some markets, clinical quality and efficiency data to help evaluate a physician's overall value before a service is performed.

Today, young people are equipped with the skills and habits needed to live a healthy, happy and productive lives. But Aetna needs to develop the systems to deliver effective prevention programs to a far wider group of children and adolescents. As anxiety had been a big issue for many years, successful records in preventing such conditions as depression anxiety behavioral issues and substance abuse should be improved. Aetna collier county anxiety psychologist teaches at-risk adolescents how to handle stress and helps prevent major depression.

Finding a LASIK M.D. to perform your LASIK eye surgery is not a task which you should take likely. You should be able to go into your surgery confident that your doctor has both the knowledge and skills necessary to complete your procedure quickly, painlessly, and correctly. You'll want a LASIK M.D. with as much experience as possible, so there's track record you can use to deduce your chances of having an optical disaster. But how can you find a qualified LASIK M.D?

You won't learn anything from advertisements for LASIK eye surgery; they are designed to appeal to your pocketbook, and will not tell you nothing about the surgical qualifications of the LASIK M.D. who will be performing your procedure. You'll have to do better than that!

If you have any acquaintances who have experienced LASIK eye surgery, don't hesitate to ask them for their opinions of their LASIK M.D.s . It's one of the best ways to get an objective review of an eye surgeon's competence and approach to his or her patients.

Professional Organizations

You can also get information on a prospective LASIK M.D. form the American College of Surgeons, which will give you a much fuller picture of a surgeon's credentials and background. The ACS is extremely demanding in its credential issuing process.

The American Academy of Ophthalmology, whose website is http://www.aao.com, will help you find a LASIK M.D. thought their "Find an eye MD" section. The site will give you an idea of what qualities you should look for in Your LASIK M.D. And the Council for Refractive Surgery has a list of questions for you to print out and present to the surgeons you are interviewing before you select one of them as your LASIK M.D.

Questions To Ask A LASIK M.D.

The questions will cover the amount of experience your LASIK M.D. has; the more the better. You should ask the surgeon specifically about how many times she or she has performed the procedure you'll be undergoing, with the same kind of laser which will be used on you.

Ask the doctors how high a percentage of their patients have had their vision improve to at least 20/40 following their surgeries. But if you receive an answer greater than 90%, be cautious; the industry average is 90%. And the average for patients gaining 20/20 vision following LASIK surgery is only 50%. Any LASIK M.D. who indicates he or she has a better record should be willing to back it up with some sort of documentation.

Ask your potential LASIK M.D.s to provide you with a list of their patients who have been treated for the same visual defect which you have by undergoing the same procedure you will be undergoing. If you really want to press the point, inquire as to the state of the LASIK M.D.'s malpractice [http://www.2020lasikeyesurgery.com/Articles/Lasik_Vision_Institute.php] insurance. Is it still in force, or has it been denied? The same applies for the surgeon's medical license--has it ever been suspended for any reason?

You may even, if you are really determined to uncover everything about your LASIK M.D. inquire whether he or she has ever been charged with a felony. If your questions get you tossed out of an office, fine. You have the right to ask anything you want about a doctor's experience and professional background, if knowing the answer will make you comfortable with the LASIK M.D. you choose.

Lt. Costello (name and place changed, but the story is true) sat behind a large, conspicuously clean desk at the Tarrytown Police Station in N.Y. He was cool, composed, and seemed as uncluttered mentally as he was physically. The awards on his book cases and certificates on the wall attested to a long, successful career.

"I paid my dues,"he said and smiled as he scanned the room and the work it all represented. As he saw it, however, his career really started in Vietnam when he was only a teenager serving in the U.S. Army. It was there, assigned to an armored car division sent deep into the jungle, that he learned what it took to survive physically, mentally, and emotionally.

He was on a mission in the Delta, it was summer and the temperature outside had reached upwards of 115 degrees Fahrenheit before noon. Inside the tank it was at best unbearable under normal conditions. On one particular day he still remembers with stunning clarity, it was life-threatening.

"It must have been 130 or more inside. It was hot in a way I had never experienced before. I couldn't stop sweating, couldn't drink enough, couldn't just get up and go to the bathroom. I was burning up. I don't mean that metaphorically. I was literally burning up and I had to lower my body temperature somehow or I was going to die. Funny how it didn't scare me. It was just as clear to me as the coffee in front of me now. It was a fact. I had no air conditioning. I couldn't get out of the tank. There was nowhere to go except a POW camp, if I was lucky enough to get caught and not killed right away. I remember thinking that I should have been panicking. Instead, I was utterly, crystal clear. It was in the space of such a small moment that I realized it was completely up to me. Whether I survived or not was between me and my own mind."

The lieutenant sat forward, his body compressed with the intensity of the experience, still vivid in him.

"For some reason, I thought about something I'd heard about some monks in the Himalayas, how they went outside in sub-zero temperatures and howling winds to meditate and never suffered any ill effects. They raised their own thermostats. And I figured if they could do it that way, I could lower it. To this day I don't know exactly what I did or how I did it, but I imagined cool water inside me and around me, like I was dunking myself into a cooler filled with ice or skinny dipping in the lake back home. And hell if it didn't work. I'm here. I never forgot that," he sat back.

"This," he pointed to his head," was my greatest weapon of all. And it has served me ever since, no matter what or where the battle."

Post-9/11 Sensibilities

Since 9/11 the two ratings-building spin words are survival and emergency. Today, Americans are fed a regular diet of security alerts, color-coded for those who need the visual aids, preparedness strategies, complete with thousands of products one can buy for only $49.95 plus shipping and handling, and countless medications courtesy of the pharmaceutical industry to help us all manage the resulting anxiety, depression, and despair. This is not all that different from the build-a-bunker-mentality of the anti-communist frenzy during the cold war and the subsequent pill-popping that ensued. We had to protect ourselves then no matter what it took.

And we feel the same urgency now. But most of the people who are building bunkers today, anxiously watching the colors flip back and forth from orange to red alert status, packing enormous first aid kits when they go hiking on local trails, or getting into armored tanks that can put holes through mountains are prepared in almost every way except what scientists are now coming to believe is the most important way. And that is the way of the mind.

The images we hold in our minds seem to be held in our bodies as well. What we think is what we are. What we feel determines how we heal. Dr. Larry Dossey, best-selling author and one of the foremost proponents of mind/body medicine, has written, "Images create bodily changes just as if the experience were really happening. For example, if you imagine yourself lying on a beach in the sun, you become relaxed, your peripheral blood vessels dilate, and your hands become warm, as in the real thing."  

If this is even partially true, it is an astonishing statement. The case to definitively establish the link between mind and body was opened almost 1,500 years ago when Hippocrates wrote that a person might yet recover from his or her belief in the goodness of the physician. Belief, image, thought--these were all clinical givens long before the advent of modern technology.

In 1912 one doctor reported that tuberculosis patients who had previously been on the mend, when given bad news (e.g., that a relative had passed away) took sudden turns for the worse and died. It was not called stress medicine or psychoneuroimmunology at that time, but the concepts were the same. And today the data supporting the connection between thoughts and health, indeed between mental images and survival, are mounting.

Images and Immunity

"We now can measure changes in immune cells and the brain in ways that give us objective scientific proof of the connection between them," says Mary Jo Kreitzer, director of the Center for Spirituality & Healing at the University of Minnesota. In psychotherapy circles, it is now considered common knowledge that people under hypnosis can be given suggestions and make them manifest in their bodies immediately. For example, a person who is given the suggestion that he is being touched by a burning cigarette will produce a burn blister even though the object that was actually touching him was neither hot nor cold.

People known to suffer from multiple personality disorders have even been documented with allergic responses when presenting in one personality but not in the others. Muscle movement is no different and, according to researchers, anyone who's ever watched a movie has personally experienced the physiologic power of thought or imagery. In one study, movie-goers were monitored (via machines which record galvanic skin responses) and found to unconsciously mimic what was occurring on screen with micro-muscle movements. When someone in the movie jumped, the muscles ordinarily responsible for jumping in the person watching the movie made similar movements.

Brain scans have similarly shown that when we imagine an event, our thoughts light up the areas of the brain that are triggered during the actual event. Sports psychologists have been responsible for extensive work in this area. In one study, skiers were wired to EMG machines and monitored in a manner similar to the movie-goers except that they were being monitored for electrical impulses sent to the muscles as they mentally rehearsed their downhill runs. The skiers' brains sent the same instructions to their bodies whether they were doing a jump or just thinking about it.

What does this mean for a person out in the mountains who suddenly finds himself stuck in a downpour and unable to get out before dark when the temperature is expected to fall nearly 40 degrees? How does this help someone with an asthma attack in the middle of a lake or a person with a broken leg one hour from the nearest ranger station? How does this help a rock scrambler or skier have the performance of a lifetime and keep themselves calm and healthy? What some people claim is that it can mean the difference between life and death.

The simple notion is that the words we say (to ourselves and to one another) do matter, that they affect us both physically and mentally, there are ways to speak that make those words healing no matter what the situation. By saying the right words in the right way we are able to speak directly to the body, reduce an inflammatory response, help to slow down or stop bleeding, change the way an event is interpreted so that it is experienced differently IN the body.

Thinking Past Illness

The scientific community seems to be coming to this conclusion. "There is ample evidence that negative thoughts and feelings can be harmful to the body," says Lorenzo Cohen, director of the Integrative Medicine Program at the M.D. Anderson Cancer Center in Houston. Stress is known to be a factor in heart disease, headaches, asthma and many other illnesses.

Studies by Janice Kiecolt-Glaser and Ronald Glaser at Ohio State University show once again how even relatively minor stressors--a job interview or a speaking engagement, for example--can sufficiently compromise the immune system so as to predispose one to illness. The researchers found that a marital spat delays wound-healing and that the stress of caring for an Alzheimer's patient leaves the caregiver more vulnerable to illness even years later. 

What Can We Do, What Can We Say: Verbal First Aid in Real Life

Deepak Chopra begins to answer that last question when he uses the metaphor of two people in a roller coaster. The following example is an adaptation and elaboration of his story:

Two people are getting into a roller coaster. One is a young cowboy-hardly moving off the platform yet, but his arms are already in the air and he's hootin' and hollerin' with anticipation. His heart is pounding. He's smiling. The woman next to him has her hands clamped down onto the metal rod in front of her. Her heart is pounding but she is not smiling. Both are in the same seat, on the same ride, but they are clearly not experiencing the same thing. The difference? Their thoughts.

The young cowboy in the roller coaster sees that the woman next to him is nervous. He turns to her. She looks to him, her eyes wide. She says, "How can you be so relaxed?" He smiles, points to his hat, "It's my magic hat." He takes it off his head and hands it to her. "You hold on to it while we ride, okay? It's easier to enjoy the ride when you know you've got magic with you." Her hands loosen their grip. She takes the hat. Tentatively, she smiles.

According to medical experts, anxiety (or fear) and pain are inextricably woven together for the vast majority of people. A great deal of human discomfort comes from our anticipation of it and our perception of it. Unfortunately, there is nothing marketed as vigorously in this country as is fear. If we're not scared to death by a headline, it's a radio report, a movie, a video game, or a television show. We're literally bombarded by images and ideas

that promote fear. We are propelled by it and sold by it.

If the science is correct, the good news is that we can change it on every level-from the conscious to the autonomic. When we alter our thoughts, are soothed by a kind authority, or are assured that we are in good hands, we can begin to feel the changes in our bodies-the softening of muscle fiber, the opening of bronchial tubes, the quieting of pain, the start of healing. This is why so much of  Verbal First Aid in the field is directed to the alleviation of anxiety through the development and utilization of rapport. In rapport, a person will feel, "She understands me." "He is going to help me." "I'm safe, now."

When we feel understood, our anxiety is reduced. And when anxiety is reduced, pain is relieved. Even if we are entirely alone, clinicians and scientists agree that what we say to ourselves matters and we can direct our thoughts so that our chances for survival are enhanced.

Whether you're speaking to yourself or to someone else on the trail, how you approach someone mentally and emotionally is at least as important as the medical expertise you have, according to Winnie Maggiore, former Asst. Chief of Placitas Volunteer Fire Brigade, paramedic, former Asst. D.A., and now a malpractice defense attorney.

"We saw the same things in the wilderness that we saw locally-snake bites, mountain bike wrecks, breaks, falls, cardiac conditions-but the injuries in the wilderness feel worse to the patient in that he's away from familiar surroundings. Most of what we had to do in rescues was anxiety management. The first step is to let the person know you have the expertise to help. This conviction allowed us to say 'do this' in a way that motivated compliance."

The other major ingredient in dealing with crises on the trail, according to Maggiore, is giving people some sort of control over what is happening to them. "When we were just learning emergency medicine, we were given a course in hypnosis so it could be used in pain control, because it could be all we'd have to work with out there. The worst part for patients was being out of control so put them back in control as much as we could, gave them something positive to focus on. Panic is a patient's worst enemy."

People normally want to reassure with blanket statements, e.g., "you're fine." When this is obviously untrue, it's the sort of statement that breaks rapport. It's better to say, according to the experts, that the worst is over and you're there to help. Your caring presence is the cornerstone of the healing process. If you don't know what to say, say nothing and listen as you wait for help or do standard first aid. Your care can do more than you might imagine.

The following are just two examples of ways we can talk to someone in distress so that they are calmed, their pain is reduced, and they are moved steadily towards healing.

Asthma in the Sandias.

Sam and his son, Jared, went for a hike up the Tunnel Springs trail. Sam was sure Jared had packed his inhaler. Jared was sure his dad had packed it. When they got up to the first crest, Jared was straining for breath. When they realized they'd forgotten it, Sam was smart enough to take a deep breath himself so that when he turned to his son he was calm, focused, and sure-footed.

Sam: Jared, I can see you're breathing but that it's a little tight?

Jared: (Nods, but can't speak.)

Sam: Sit with me here and lean forward like this. Put your head forward like this so your bronchial tubes can open and smooth out. [At this point, Sam's voice drops in pitch and slows down so that it's soothing and controlled. He "paces" his son's breath with his own, carefully so as not to hyperventilate, just enough so that there is a joint rhythm. As he speaks to his son, his breathing slows down just a little bit at a time, "leading" his son back to normal breathing.) And as you do, you can remember very clearly how your inhaler feels when you take a puff on it, a little cool, a little tingly and how it opens you up pretty quickly, you can remember how it feels when it's working...a little more open now...a little more open, a little cooler, until you can get a really good deep, slow, even breath...

A Tumble Along the Trail

The La Luz trail in New Mexico, full of crumbled granite that feels like a trot on a field of ball bearings, has brought more than one person to his or her knees. Cuts, abrasions, bites are exceedingly common crises. For that reason, while it's always smart to pack along a first aid kit, it's even smarter to know what to say to stop the bleeding and initiate a healthy immune response.

Sandra skids down the trail and slides into a sharp rock. When she gathers herself up, blood is pouring

down her leg from a 3-inch laceration along the side of her calf. Her friend Kim, well-prepared for a full day

hike, pulls out some Betadine, cleans the wound, applies sterile gauze on top of it and wraps it with a

clean, cotton bandana. As she does, she speaks to her friend so that the bleeding stops and healing begins.

Sandra: Damn it! It's really bleeding.

Kim: It is and that's actually a really good thing so that it cleans outthe wound. As soon as you've washed it through enough, you can stop [Kim emphasizes "stop"] the bleeding.

Sandra: Damn it. That was so stupid.

Kim: It happens to everyone. I know you've gotten cut before and you've stopped the bleeding before just like you're stopping it right now. You can hold it tight like this. Y'know even as we're sitting here, it's already starting to heal and the bleeding has slowed to a stop so we can walk down the rest of the trail.

Points to Remember

1. What we think, we feel. What we feel determines how we heal.

2. In shock or stressful situations, we are more suggestible. What you say to others and to yourself is translated quickly into physiological reality.

3. No "nots."  Keep your thoughts and your words simple, positive and concrete. If you want a person to survive, tell him to "stay with you." Telling someone not to die leaves them with only one image in his mind: dying. Even in ordinary circumstances, no one can imagine a "not."  We only see what you are telling us to not see.

4. Be authoritative. When a person is scared, they are looking for a pack leader, an authority to help and reassure them. If you're with someone who's hurt (even if that someone is yourself), you have to assume that role if you want to be of help. It requires a calm, centered, and confident approach.

5. If you don't know what to say, use a calming presence and say nothing. A touch of your hand, your presence can do a great deal to help a person when she's hurt or ill. 

Mental survival-regardless of where a person is, whether that's in the extremes of battle or a backpacking expedition-is often a matter of recalling or being made aware of the resources one already has. As Lt. Costello learned the hard way, the mind is the greatest weapon of all.

c. Judith Acosta, 2009. All rights reserved. 

In most respects, Sara Taylor was like any other ten-year-old girl; however there was one very big difference: she had a severe health condition that, despite multiple visits to the doctor, had not been resolved.

Sara had several disturbing symptoms, the most noticeable of which was a persistent cough. She also suffered from recurring ear infections, intermittent stomach pain, and eczema. Her very concerned mother told me that despite being treated with multiple rounds of antibiotics, Sara had not gotten any relief. She simply could not stop coughing.

On November 7, 2012, her parents brought her into my office, hoping that conservative chiropractic care could help boost her immune system. With each office visit, I evaluated Sara's spine for alignment; then I would make gentle adjustments to restore the circuitry of the nervous system, including the autonomic nervous system. The adjustments were not done by hand, as with most patients, but with a spring-loaded instrument that essentially feels like someone is tapping the patient on the shoulder.

After just three office visits, Sara began showing improvement. By the sixth office visit, her cough was gone, she was sleeping better and her stomach pains had decreased in intensity and frequency. At that point I estimated that she would need a few more sessions to ensure her nervous system was functioning optimally, but she was certainly on the road to full recovery.

Imagine my surprise when I learned that Sara's neighbor, a two-year-old named Claire, was also suffering from a persistent cough. I was even more surprised-astounded, actually-to find that Claire had been prescribed ten consecutive rounds of antibiotics, which had not done her a bit of good.

It is well-established that taking too many antibiotics can have long-lasting and harmful side-effects, including a compromised intestinal tract and a resistance to medication. How could any physician, particularly a pediatrician, prescribe so many such meds to a two-year-old child? To me, this was a clear case of malpractice.

After my initial evaluation of Claire's condition, it was immediately apparent that she would need a different course of treatment than Sara. Claire was suffering from allergies; therefore, I decided upon the natural allergy elimination technique. Instead of spinal manipulation, this treatment involves a type of acupressure. It is designed to eliminate allergies by gently reprogramming the body to not react to the usual triggers; namely, eggs, milk, wheat and yeast, sugar, and mold.

The real beauty of this treatment plan was that there was no placebo effect. It is well-known that medications have a thirty percent placebo effect; however, this does not apply to young children such as Claire, as they are not old enough to equate medicine with wellness. The same is true with hypnosis: I cannot hypnotize a two-year-old because they do not have that sort of focus; certainly not when his/her parents are there.

Usually, parents bring their children to holistic healthcare providers only after traditional medicine has been unsuccessful. Much of this has to do with public perception: while we are bombarded with commercials for pharmaceuticals, complete with testimonials by qualified physicians, we rarely see holistic doctors on TV. As with many aspects of medicine, the key to changing this perception is education. People must understand that just because holistic healers don't have billions in advertising dollars, it does not mean their work is not rooted in science.

Within seven weeks, Claire was feeling like a normal toddler, and I was thrilled to have been able to help these two families. It is yet another example of why it is important to question all healing procedures, even those prescribed by traditional doctors. Many times, the best course of action is a combination of conventional medicine and evidence-based holistic treatments.

Stress has become a part of our modern day society and is showing its toll on the younger generation or the elderly alike. It is here that mental health professionals help in providing their services to such beings. In a recent report by National Institute of Health has found out that one in every four adult nowadays suffer from mental disorder of one form or other. This should sound as alarming considering the fact that this study did not include stress that children and adolescents face. It is thus not difficult to understand the necessity and importance of mental health practitioners who can extend their services to people suffering from such mental ailments. It should be noted that such mental health professionals can setup their private practice in the comforts of their own clinics or home as such a practice gives the freedom of flexible hours and salary for such practitioners. However, one should note that there are lots of decisions to be made before setting up a practice as a mental therapist. There are various tips and pointers which mental health experts can extend to establish their own practices.

# Licensing requirements: One of the first requirements for mental health professionals before they can start their own private practice is to meet the state licensing and education requirements. Most states require that one has to have a minimum of a master's degree in counselling, psychology or social work before starting the practice. So make sure one completes the state recognised exams and other requirements before one can obtain the license.

# Setting up a clinic: Make sure to think about a legal business name and get it registered with the state. This might require paying up the fees for registration as is required. A proper research of the laws and registration rules for the regions where setting up of clinic is decided should be studied properly. Staying in contact with experienced colleagues for guidance and assistance might sometimes serve as a boon in disguise. Get a professional hired to create a brand presence such as logo and banners might help in creating a conducive environment. Such professionals also help in selection of right furniture which promotes a comfortable and soothing atmosphere for patients. One might think of investing in a computer and a desk so that electronic data might be stored for patients who might be coming to the clinic.

# Purchasing Malpractice insurance: Such liability insurance is of utmost importance for practitioners who opt for practicing on their own and might be very important at times when a client files a lawsuit and decides to sue. Proper thought and talks with experienced practitioners in this field about the choice and insurance companies goes a long way.

# Place for clinic: Prior research and time should be devoted in finding out areas and locations which might serve beneficial from a business standpoint. Proper thought should be given before setting up a clinic in an area. Choosing an office space that has easy accessibility to individuals especially those with disabilities, might serve as a step or move in the right direction.

# Proper Management: Such practitioners should always keep in mind that a flourishing and profitable private practice might dwindle into the red if small minor events are not checked due to mismanagement. It is a common practice for health professionals to start working in larger clinics which are owned by others. Such professionals may then decide to setup their own clinics and may think of retaining the clients from their previous work. It is important to note that such a practice is not unethical, but one should always strive to properly manage his new practice as it is very easy to get one's reputation destroyed if practices are mismanaged.

# Advertising: Now that the clinic is setup and the office stationery is in proper place, one can concentrate in drawing patients to your practice clinic. Giving advertisement in local newspapers and distributing business cards might serve as a great start in this direction. One may also benefit by widening his network of practitioners in the same field because there is no denying of the fact that word of mouth serves as the best medium of advertising for health professionals. Such medical practitioners may refer their patients that may need mental diagnosis to your business which may serve as quite beneficial. One may also opt for advertising through internet and campaigns such as pay per clicks. Such campaigns help in targeting specific audience who really need the services of mental health professionals belonging to a specific geographical location. The effect of yellow page advertising needs no justification as many traditional businesses have risen to success through advertising on yellow pages. One should not forget to send a letter of appreciation, once a referral is received from another medical practitioner.

Dental care is one of the important things in the general hygiene of an individual. Visiting a dentist can be a very daunting task that can cause anxiety and frustration. Dentists are of many types depending with their specialty of training.

Pediatric dentists are trained to cater for the oral care for children and adolescents. They focus on growth and development, disease cause and prevention as well as management of adolescent and pediatric dental care with high level restorative techniques. To be a pediatric dentist, an additional two years is required after attaining a dental degree and acquisition of a license is required before one practices or presents themselves as a pediatric dentist.

Special care dentists, also called special needs dentists, are concerned with the oral care of people with special emotional, physical, social or medical needs. It requires extra three years of post graduate training after getting the dental degree and focuses mainly on the people whose oral care has been affected by their disability, medical history or surrounding conditions.

Forensic dentists apply their knowledge of dental care in legal proceedings. Forensic Dentistry involves the examination, evaluation and presentation of dental evidence. They study the dental structure before death or by use of dental records to obtain information such as identification of the victim, age and bite marks that may be useful in court cases. These evidences can also be used in establishment of malpractices especially in civil cases.

Other types of dentists include cosmetic dentists who are concerned with the aesthetic, form and shape of teeth and use different methods such as veneers, teeth bridging, teeth bleaching or whitening or general restructuring of the dental structure. Geriatric dentists are concerned with the oral care of older adults and are involved in the diagnosis, prevention and treatment of dental problems associated with old age. Veterinary dentists are concerned with the dental care of animals including diagnosis prevention and treatment of disorders of the oral cavity of animals.

The Drawbacks and Benefits of Implementation

When it comes to EHR implementation, many people wonder why it hasn't yet taken off. The technology is there, but awareness still isn't where it should be.

EHR offers physicians some incredible benefits, especially when it comes to coordinating patient care. Think about this for a moment: today, many patients have a complex team of doctors. There might be a primary care physician, a cardiologist, an oncologist, a nephrologist, and a rheumatologist all treating the same person.

Chances are, this patient's medical records are scattered in half a dozen offices. These doctors and hospitals rarely communicate with each other about the patient, which increases the likelihood of errors like duplicate testing and unnecessary or conflicting prescriptions.

Implementing EHR eliminates this risk to the patient as well as offering a wide array of other benefits. Yes, implementation can be challenging, but the final result is worth it.

Let's take a look at the challenges and opportunities with EHR implementation.

Challenges

By far the biggest hurdle to EHR implementation is cost. At the American Health Information Management Association conference in October, 2006, the panelists estimated that the average cost of purchasing and installing an EHR system would cost over $32,000 per physician. Maintaining the system would cost $1,500 per physician, per year. That's a hefty price tag for any facility, much less the smaller clinics.

Other studies have put the cost much lower, at $10,000 to $15,000 per physician.

The good news here is that thanks to the Health Information Technology (HIT) Extension Program in the American Recovery and Reinvestment Act, over $19 billion has been set aside for incentives and investment into EHR implementation.

Another drawback is the learning curve with EHR. Most physicians see a drop in productivity the first six months after full implementation, and NY E-Health estimates that this productivity drop will cost around $11,000 per physician during the first year. There are several reasons for the drop in productivity.

First, physicians and support staff have to learn the system. This takes training and time. If the new EHR system isn't user-friendly and doesn't take into account the needs of clinicians, and the data they need on a daily basis to make decisions, then the learning curve is going to be even higher.

There's also a good chance that, at first, the system might not function correctly 100% of the time. Errors in implementation or use can result in a frozen or delayed system, which can cost minutes or hours in patient care.

Another major drawback to EHR implementation is the lack of privacy for patients. According to some experts, 150 or more people might have access to one patient's records.  This accessibility could lead to vital information like family statistics and billing information leaking out, or errors due to the sheer number of staff involved in entering information.

Benefits

The good news here is that EHR implementation will offer patients, physicians, clinics and hospitals several benefits.

One major benefit to EHR is that it can reduce operating costs and increase revenue for clinics in several ways:

• EHR reduces transcription costs, saving an estimated $2,700 per physician, per year
• EHR reduces billing errors
• EHR lowers malpractice insurance costs
• EHR lowers pharmacy costs
• EHR eliminates unnecessary chart pulls, which can save $3,000 per physician, per year
• EHR drastically reduces copying and paper costs
• EHR can help increase number of patient visits per day, due to efficiency
• EHR helps reduce the number of full-time employees needed compared to a paper-based office

Another major benefit is coordination of patient care. With an EHR system hospitals, clinics and physicians will be able to effectively communicate and share information about patients. There will be no more issues with scattered or lost records, unreadable handwriting, or duplicate treatments.

EHR also checks for drug to drug and drug to allergy interactions. This double-checking will drastically reduce errors and risk for patients. The system also allows physicians to see a complete picture of a patient's medical history. This allows for a more in-depth diagnosis of a patient's problem.

Final Word...

As you can see, there are just as many challenges as there are benefits to EHR implementation. Yes, the costs are high, but the potential for long-term savings will help offset these costs once the system is up and running. And, with the incentives put out by the American Recovery and Reinvestment Act, hospitals and clinics can expect to see some help financially for implementing a qualified EHR system.

What happens if:

The main physician (and owner) of a medical practice becomes disabled
A successful and growing business owner suddenly dies

Can the medical practice sustain enough income to pay all of the business overhead expenses? Would the physician have enough in personal savings to cover their expenses and provide for themselves and their family? If one of the owners dies, will the business die with it? What about all of the associated estate taxes, ownership, and business disruption issues?

These are certainly some challenging issues. However, with some diligent planning and thought you can manage these risks.

There are policy and procedures designed exclusively to mitigate some of the risks mentioned above. These include:

Buy-Sell Agreements
Key Person Life Insurance and Key Person Disability Insurance
Business Overhead Expense Insurance

Buy-Sell Agreement:
This is an agreement between partners (or potential owners) on the terms and procedures of a change-in-ownership. It includes a transaction valuation (current and ongoing), names all involved parties, and enactment triggers (which typically include the death or disability of one or more of the partners). This agreement is a binding contract. In most scenarios, specialized life insurance and disability insurance policies are used to fund the agreement.

Key-Person Insurance (Life & Disability):

Key Person Insurance plans protect your business from the untimely death or disability of one of your key employees, owners, or doctors. In most scenarios, the business will own these key-person policies and receive the cash benefit.

Each individual doctor or owner should have key person life insurance and key person disability plans to protect their personal income and family.

Business Overhead Expense Insurance (BOE):

A practice or business that relies on a small number of people (or one person) to produce revenue is economically vulnerable if one of those individuals becomes disabled. A Business Overhead Expense disability policy will cover the ongoing operating expenses of your practice or business. It ensures that you do not have to use personal assets to pay for business expenses if you become disabled.

If the insured does become disabled, a BOE policy pays a monthly benefit based on business expenses, not anticipated profits. The following are some business overhead expenses that are covered by a BOE policy:

Rent or Mortgage Payments
Employee Salaries and Benefits
Utility Bills
Property Taxes
Accounting Fees, Legal Fees, and Professional Dues
Malpractice and Other Business Insurance Premiums
Maintenance and Janitorial Services
Depreciation
Interest on Business Debts
Office Supplies
Other Fixed Expenses that are Ordinary, Necessary, and Tax Deductible

Every business is uniquely different in some form. However, managing risks certainly should be a consideration of any business especially if the business heavily relies on the efforts of few people.

Protect your business and you'll protect yourself.

Listed in the top 34 jobs in America, by CNN.com, Pharmacists are one of the leaders in the scientific job market. How does an average starting salary of $90,000 a year sound to you?

Do you have what it takes to make this long scholastic journey? Here's what you must know before choosing this career field:

• Plan on six years of college, and on the job training.
• You will also need an additional 30 units of continuing education classes before you have to renew your license every two years.
• You must LOVE & be skilled in math and science.

The benefits of the job:

1. Most states recognize your license from state to state. Therefore, if you get licensed in one state, you can pretty much live and work anywhere.
2. The pay is good and the industry is stable and growing.
3. You do not have to prescribe drugs for the patient, and the worry of malpractice that goes with it. Instead, you only need to dispense exactly what the medical practitioner has prescribed.

According to Internet Drug News, they recommend that prospective pharmacists take science every year in high school. Every year! Biology, earth science, chemistry, physics - take them all. And if you can handle AP science, so much the better. You'd better love chemistry because if you're fortunate enough to be admitted to pharmacy school, you'll be taking tons of chemistry and labs. They also recommend taking a foreign language as it gives prospective universities insight into your memorization and shows you to have well-rounded capabilities.

When considering a career in the pharmaceutical industry ask yourself whether you have a strong interest and understanding of anatomy, biology, chemistry, physics, calculus, statistics and especially pharmacology. Because you will also be a clinician, you will need strong people skills. If you decide to work in retail, you will be counseling patients and answering medical questions. Should you choose to work as a hospital pharmacist, you must be able to clearly explain the medication's indications, side effect and contraindications to patients, doctors and nurses.

To be a fully licensed pharmacist in the United States, you need a doctor of pharmacy, or Pharm.D., degree. There are nearly 100 U.S. universities with the necessary programs to complete your course work. In the United Kingdom, your degree will consist of a 4-year undergraduate degree, with an additional one year on the job training before taking your licensing exam.

Upon graduation, about 60% of graduates will go straight into jobs at community pharmacies. Others will find work at hospitals, clinics, mail-order pharmacies and the federal government. Some specialize by discipline: such as cardiology, pediatrics, or oncology. Other niches, according to Science Careers, include academic pharmacy (teaching) pharmaceutical research, drug regulation and clinical research.

If you love science and math, want to make a good living in a stable industry, the pharmaceutical industry may well have the position you're looking for. Here's to the career of your dreams!

Alternative medicine is a term to describe healing practice that is beyond conventional medicine. A few popular form of highly commercialized alternative medicine are Naturopathy, traditional Chinese medicine, Ayurveda, meditation, homeopathy and diet-based therapies. Frequently grouped with complementary medicine, alternative medicine comes from different foundations and practices.

The basis of the practice could originate from traditional medicine, folk knowledge, spiritual belief, or newly found approached towards healing. As more people turn towards alternative medicine, governmental and scientific bodies are setting a benchmark to regulate those practices and perform research to prove their claim of effectiveness. Regulation by health and scientific bodies will help in preventing malpractice which can in some cases cause negative effects to patients. More and more medical colleges are offering courses in alternative medicine. Future doctors and health practitioners were trained to open their mind towards the possibility of coupling conventional medicine with alternative medicine.

Ayurvedic medicine is one of the oldest forms of alternative medicine practiced by Hindus. In India, Sri Lanka and Pakistan, conventional medical practitioners work together with Ayurvedic physicians to treat patients. Based on complete heathcare system through detoxification, diet, exercise, herbal medicine and techniques to improve mental and emotional health, Ayurvedic medicine is practiced to maintain health and prevent illnesses. Revolving around keeping the three vital energies balanced, Ayurveda considers good digestion and positive emotions as keys to good health. Infants to elderly persons can benefit from Ayurvedic medicine which can cure many modern conditions or diseases. Most localities will have at least a shop where you can buy Ayuvedic medicine after seeking advice from a certified practitioner.

Buy Ayurvedic medicine if you are thinking of quitting smoking or if you want to cure your indigestion. Ayurvedic herbal clinic offers herbal cigarettes which provides alternative to tobacco and is claimed to be effective in breaking addiction. Smokers are promised clarity of mind, throat, chest and even the five senses when smoking the herbal cigarettes. It contains no chemicals and shows amazing results as testified by many users. Other than getting off cigarette, it can also strengthen your immune system. Herbal cigarettes can help with preventing depression, anxiety, and weight gain normally associated with quitting. You will have reduced nicotine craving and a more control appetite at the same time. Indigestion is another problem busy modern people suffer in silence. Himalaya Ayurvedic Herbal Tea for digestion will help in regulating digestive system and provide relief from abdominal discomfort. You can say goodbye to indigestion, belching, hyperacidity and flatulence just by taking a cup of tea two times a day after meals.

Herbal medicine prepared for Ayurvedic treatments are prepared by government licensed producers in India. The preparation of the herbal medicine requires long processes but it is currently aided with modern technologies. You can buy Ayurvedic Medicine in the form of liquid, tablets, powder or paste. There are absolutely no chemicals in ayurvedic medications. Exercise, Yoga and meditation might also be advised for people seeking this alternative treatment. Ayurvedic herbal medicines can treat problems on digestions, circulation, metabolic disorders, disorder of nervous system and symptoms such as insomnia, headache, tension, anxiety, high blood pressure, blood sugar problems, injuries and others.