Medical Malpractice

I confess that I am a big fan of the humorous and satirical TV series "The Simpson's."
In a recent episode, Homer, Marge and the kids hop on an airplane to visit their northern neighbors in Canada. The 1st thing Homer does in the city of Toronto is quite baffling. (Well, maybe not for Homer.) He runs out in the middle of the street in front of a speeding car and gets run over. Marge screams to Homer, "Why did you do that, Homer?" Homer responds quite flippantly, "Health care is free in Canada!"

Matt Groening's writers have satirically portrayed Canadians as a nation with a wonderful and free health care system. However, is health care in Canada really free? Would Homer Simpson actually want to leave his well being to the care of our Canadian health care system?

In the newly released book "Squandering Billions," Don Nixdorf and Gary Bannerman examine the mismanagement and inefficiency of the Canadian Health Care system. The Canadian definition of free universal health care only applies to those services provided by medical doctors and hospitals. If patients choose to get treatment from any other health care provider in Canada, they are asked to pay fully or partially out of their own pocket. " Despite all of the obstacles placed by the system to divert patients from chiropractors, optometrists, naturopaths, podiatrists, acupuncturists, physiotherapists, for whom the patient or insurer must pay some or all of the fees--as opposed to the "free" medical doctor competition -these professionals demonstrate every day that people will pay for value received. It is high time medical doctors earned the same respect for their "free" medical services to patients. Canada is the only universal access nation in the world that does not have a user fee to encourage responsible behavior by patients and service providers.

This book also demonstrates that the absolute power of medical doctors, pharmaceutical companies, health bureaucrats and hospital administrators enshrines mediocrity at the expense of patients. We have many dedicated and skilled doctors and nurses, but mistakes, inefficiency and malpractice in the Canadian health system may be causing 10 times more unnecessary death a year than the toll from traffic accidents and crime. Despite dramatic television footage and newspaper headlines reporting highway tragedies, driving is a much safer activity than hospitalization. A study by the Canadian Institutes of Health Research and the Canadian Institute of Health Information released in 2004 concluded that 185,000 patients out of 2.5 million admitted to acute care hospitals suffer death, disability, or extended hospitalization as a result of adverse effects of treatment. Between, 9,250 and 23,750 of these people die because of preventable errors.

Homer would find out in a hurry that our "free" health care system is nothing to write home about. And should we always be relying on the system to keep us healthy or rather should we as a nation and society start taking more responsibility ourselves?

Teaching reading intervention is qualitatively different from teaching beginning reading. By definition, the initial reading instruction did not "take" to a sufficient degree, so things must be done differently this time around to improve chances for success. According to reading research, these chances are not good betting odds. Only one out of six middle schoolers who are below grade level in reading will ever catch up to grade level.

Much has been written about the characteristics of remedial readers. Sufficed to say, knowing their developmental characteristics is just as important as knowing their specific reading deficiencies. Effective reading intervention instruction depends on addressing both components.

But, knowing the specific reading deficiencies is crucial. Using prescriptive diagnostic assessments that will produce the data needed to inform instruction is the one non-negotiable prerequisite. Teachers need to know exactly where their students are to take them to where they want them to be. Once administered, the reading intervention teacher is confronted with the "snowflake phenomena." No two remedial readers are exactly alike. One has no phonemic awareness; one does not know phonics; one does not know how to blend; one lacks fluency; one is vocabulary deficient; one has poor reading comprehension; and one has poor reading retention.

Of necessity, an effective reading intervention program must be based upon differentiated instruction. A cookie-cutter program starting all students at the same level or having all students use the same workbooks or receive the same direct instruction will address some needs of some students, but not all the needs of all students. Anything less than the latter is nothing less than professional malpractice. Would a medical patient who sets a doctor's appointment to treat a variety of maladies be satisfied with receiving the same course of treatment as every patient-ignoring some issues and being treated for issues that do not require treatment? Even the staunchest advocates of the current health care system would find this brand of medical practice unacceptable.

Regarding student placement in reading intervention, a number of factors must be considered. Chief of these must be the reductive consideration. First, if the student is placed in a special intervention class, what class is replaced? Removing a child from a literature class seems much like "robbing Peter to pay Paul." Poor readers require compensatory instruction, not just different instruction. Second, multiple measures are needed to ensure that a student needs reading intervention and that the student has a reasonable chance of success in the reading intervention class. Standardized tests can provide an initial sort; however, the student history in the cumulative records and the diagnostic assessments detailed above must be analyzed to refine the sort. Behavioral considerations are legitimate concerns; many students who read poorly tend to compensate with inattentive and disruptive behavior. These students need an intervention with a behavioral specialist that will also teach to their reading deficiencies. These students do not need another platform in a typical reading intervention class to prevent the learning of their peers.

The greatest variable that will determine the success of a reading intervention class is the teacher. A well-trained teacher with superior management skills, sufficient reading training, and a commitment to diagnostic and formative assessments to inform differentiated instruction are the keys to success. The teacher must be the "best and brightest" on campus, not the new teacher fresh out of the teacher credential program. Reading intervention is the hardest subject to teach and requires a special teacher. The students for whom our educational system has most failed deserve no less.

So, what to teach? The task is daunting. Remedial reading is not just skills instruction or extra reading practice. Effective reading intervention involves both content and process. Reading is both the what and the how. The short answer is that the students themselves determine the what via their diagnostic assessments. The teacher decides the how through differentiated instruction. Beyond this cryptic, albeit accurate, response, certain components will no doubt require attention in a reading intervention class for any age student. Following is an instructional template that will provide a proper balance between the what and how with a brief description of the instructional component and a percentage of the class that the component will necessitate:

• Small ability group fluency practice (emphasizing repeated readings within the group's zone of proximal development (15%)
• Small ability group phonemic awareness practice (10%)
• Small ability group phonics practice (10%)
• Individual sight word and syllabication practice (10%)
• Guided reading, using self-questioning comprehension strategies (15%)
• Direct instruction and whole group vocabulary development (10%)
• Small ability group spelling practice (10%)
• Small ability group blending practice (10%)
• Independent reading at the individual student's instructional reading level (10%) and for homework

Every component described above is needed to ensure a successful reading intervention program for students of all ages. All of these instructional components with support resources can be found in these two comprehensive curricula:

1. Find multiple-choice assessments on two CDs, blending and syllabication activities, phonemic awareness and phonics workshops, comprehension worksheets, multi-level fluency passages on eight CDs, 390 flashcards, posters, games, and more to differentiate reading instruction in the comprehensive Teaching Reading Strategies

2. For individual sound-spelling worksheets that correspond with the comprehensive spelling assessment, spelling rules with memorable raps and songs on CD, spelling tests, Greek and Latin vocabulary worksheets, syllable practice, spelling games, vocabulary games, and more to differentiate spelling and vocabulary instruction, please check out Teaching Spelling and Vocabulary.

Have you ever wondered why health care costs are so much higher in the US than in Canada? I was recently astounded upon finding out that a 60 day supply of a certain new anti-Parkinson's drug being challenged by my insurer because it cost 800 US dollars, was being sold in Canada for a mere 128 dollars. Why would that be? In the interest of writing about it, I conducted some informal but solid research into the problem. Though many contributing factors can be named, like for instance, the fact that televised drug commercials directed at the public are discouraged by the Canadian government, I discovered another deeper and allegedly more malignant cause sitting at its roots.

The solution did not appear to me when I interviewed 2 pharmacists and a hospital administrator. Nor did I receive adequate answers when I queried several social news websites. Then I happened to meet for other reasons, an attorney friend who had served as a legislator. He boiled it down for me with one single word: "lobbyists." Let me explain. Well-funded legislative third party negotiators aka. lobbyists, represent various collective self-interested groups of generally non-voter-represented competing interests, and with minimal central oversight.

Think of it this way. Let's say you have a fixed number of healthcare dollars to spend on a cardiac coronary-artery bypass surgical procedure including professional fees, hospital stay, drugs and other charges. For example let's imagine we're in the US and Medicare will pay 30,000 dollars for total costs. That same 30,000 if used in Canada would be carefully distributed and negotiated principally by the central government within one organization, and then further aided by another oversight bureau in each province, keeping their eyes on the pie at all times, and perhaps even trying to get the total costs down to 20,000 dollars.

On the other hand, lobbying groups work the US system from the inside. For example, doctors represent one lobbying group. The hospitals represent another. Pharmaceuticals comprise a third big lobby (and we'll throw in medical supplies and technical equipment there). Of course we cannot forget the lawyers' lobby groups railing against any attempts at tort reform which might otherwise place limits on the malpractice liability system. And then there are the payer groups: private insurance and HMO's.

Everyone is throwing money at legislators who deal on a very personal level with these lobbyists. Money gets dispensed through all kinds of "grey" channels. Then the lobbyists sit in the senate and house chambers keeping a close eye on how their purchased political interests vote on key issues. Meanwhile American adults, the average of whom cannot name the Vice President, eschew CSPAN for "JLo." Instead of attending, observing or even following the House or Senate voting by their elected officials, millions express more concern over why star-candidate Pia Toscano was voted off of "American Idol."

Nobody watches the legislative till in the US more than the lobbyists. The result? Using our cardiac surgery example, that original 30,000 US dollar allotment can quickly balloon to 40,000 as the well-heeled lobby-lubricated legislators aim to please all their special-interest lobbyists. For without those needed donations and other grayer perks, their slick TV campaign ads could barely compete with consumer-directed pharmaceutical ads and I daresay, American Idol itself.

In order to work in an actuarial job, you must need deep analytical skills, as well as an understanding of behavior and control risk programs. Actuarial jobs in the insurance industry include many disciplines and sectors of insurance including: pension, life, property, casualty, liability, health and general insurance. Actuarial jobs for life, health and pension insurance deal with the risk of death, medical services risks and investment risks.

Actuarial jobs for general insurance are known as casualty actuaries and deal with non-life risks that occur to property and people. They commonly work with companies specializing in auto insurance, home insurance, commercial insurance, malpractice, product insurance and other types of liability insurance.

Insurance is required in nearly every aspect of our lives, and big insurance companies have to calculate the risks associated with each insurance policy in order to properly bill for the service. This risk assessment, done by an actuary, is what helps the insurance companies decide whether the risk of the particular policy is worth it and how much to charge for the policy in order to minimize financial loss of the company.

Actuaries specialize in probability and statistics, and use the foundations of mathematics, finance, business and economics to determine risk of events and to create policies that minimize the financial loss of the risk.

In the UK, actuarial jobs are common, especially in the Government Actuary's Department to analyze data and statistics to estimate the likelihood of events and their impact on the country and residents. The actuaries also design pension plans and financial strategies for the government to maintain finances and stability in the country.

The general employment of actuaries in both life and casualty is to determine premiums and reserves for insurance policies that cover a wide variety of risks. The premiums (payments made by the policy holder to the insurance company) are based on the amount of money the insurance company needs to collect in the event of expected loss and expenses (such as vehicle replacement due to collision). In the life end of actuarial jobs, the actuary does the same job but analyzes the frequency of loss and size of loss in severity.

In the UK, actuaries must qualify for the job though a series of courses and exams provided by the Institute of Actuaries and the Faculty of Actuaries--which are separate bodies but coincide with each other, although training schemes run by employers to exist. The exams are taken after joining the body although if courses are taken at university, some of the courses and exams may be exempted. It is required that a candidate of these bodies have three years of experience in actuarial work under the supervision of a recognized actuary in order to be eligible as a "Fellow of the Institute/Faculty of Actuaries.

Laser hair removal is done when a laser is directed to the skin wherein the hair would absorb the light causing it to stop the growth. The procedure may be permanent but it may need for maintenance every six months or every year. For a treatment session, the skin will be red and inflamed; to decrease the swelling and redness, one must apply cold packs and avoid heat exposure as well.

So as mentioned, laser hair removal is permanent but needs to have maintenance every six months to one year. The temporary side effects of laser hair removal would be pain during and after the procedure, swelling, redness, blistering, hyperpigmentation which makes the skin darker. All of these are just temporary so no need to worry about this, the dermatologist will give solutions to these side effects as well.

On the other hand, the permanent side effects of laser hair removal would be epidermal damage, skin discoloration which is the lightening of the skin, scaring which only happens if the procedure was not done right so as with burns. The alarming side effects such as burn, scaring and epidermal damage only happens when the technician is not well trained about the treatment procedure.

Here is some information for you to know regarding on how you may minimize the risk of having any kind of side effects. First thing's first, you will be informing your dermatologist if you have a family history of hormonal conditions. You need to know as well that the lighter the skin is, the lesser the side effects. The dermatologist usually prescribes bleaching before the procedure. One should avoid waxing and plucking for weeks before the procedure for the results to be much effective. If you are given with antibiotic or antiviral medications you must follow it as prescribed. The area to be treated must be clean prior to the procedure. All these information are done by a dermatologist as standard operating procedure for they are trained to be clean, sterile and have a safe operation.

Since laser hair removal is permanent and has maintenance of six months to one year, as an individual you would know first the risk and complications of the procedure and you could ask your practitioner for the medication if complications happen. The best way for you to make sure that laser hair removal is safe; you would better go for the practitioner who is highly qualified and does not have any history of any malpractice or any history of having a patient with severe side effects.

Personal disability insurance protects a physician's ability to earn income, but what protects his or her medical practice? Business overhead expenses are just as relentless for those who suffer a disability. A practice 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 ("BOE") disability policy will cover the ongoing operating expenses of your practice. 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 BOE insurance:

- 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

Some policies even cover the salary of a temporary employee hired to do the duties of the disabled. Income taxes, the cost of inventory, and the cost of furniture are a few expenses that are not covered.

There are several key areas in which BOE insurance differs from personal disability insurance.

Benefit Periods - Usually, BOE insurance policies have short benefit periods that do not exceed two years. Remember that BOE insurance is not protecting your ability to generate income--that is what a personal disability policy does. Instead, BOE insurance allows you to keep your practice open, or at least pay for its expenses until you recover. In the case of a long-term disability, it offers you up to two years to make a business decision, such as whether to shut down or liquidate your practice, without worrying about accruing debt from business expenses.

Maximum Benefits - Personal disability insurance pays a monthly benefit as defined in the policy. BOE insurance policies offer a maximum monthly benefit, but only pay the actual overhead expenses if they are less than the maximum benefit. For example, if the maximum monthly benefit is $1,000 but actual business overhead expenses are only $600, the benefit paid is $600. With some insurers, that unused $400 benefit can be applied to increase future monthly maximums or to extend the benefit period.

Taxation - As long as premiums for personal disability insurance are paid with after-tax dollars, the benefits are tax free. DOE insurance benefits are subject to income tax, but the premiums are tax deductible as a business expense.

One similarity that BOE insurance and personal disability insurance policies share is that the sooner you purchase a policy, the better. Not only will you get lower rates when you are younger and generally in better health, but additional coverage can be purchased later without providing further evidence of medical insurability.

BOE insurance is a great idea for small practices with several physicians. If one physician is disabled, their portion of business overhead expenses will be covered by the policy so the other physicians are still able to practice without an extra financial burden.

Your practice should allow you to earn income, not be a financial parasite if you become disabled. BOE insurance doesn't just protect your practice... it protects you.

The word cholesterol has become synonymous with poor health. Indeed, one does not typically hear the word used, or see it printed, unless it points to yet another distressing fact -- that high cholesterol is the number one factor for coronary heart disease, and the number one cause of heart attacks[i].

However, cholesterol is, in itself, not a negative thing. On the contrary, cholesterol plays a vital role in forming cell membranes, regulating hormones, insulating nerves, and more. The problem with cholesterol therefore lays not in cholesterol itself, but the amount of cholesterol present in the bloodstream. For most Americans who talk and read about this subject, the scenario almost always involves too much cholesterol, or the condition known as hypercholesterolemia.

When there is too much cholesterol in the blood, it cannot easily dissolve, and thus cannot effectively be transported to cells by the carrier called low-density lipoprotein (LDL). This can create a build-up of LDL cholesterol (a.k.a. “bad cholesterol”), and start to interfere with arteries that transport blood to the heart and brain. Both a stroke and a heart attack are the most severe manifestations of LDL cholesterol build-up, and the main reason why so many people are seeking ways to reduce the LDL build-up in their bloodstream[ii].

However, reducing cholesterol has been fraught with challenges. Though reducing or eliminating certain foods from diet is a necessary first step for most individuals, some who suffer from hypercholesterolemia require medical interventions to immediately begin lowering their risk of heart attack or stroke. As such, dozens of cholesterol-lowering statin drugs are currently on the market, and while some people have experienced relief due to their use, there are side effects that cause concern, including nausea, diarrhea, muscle tenderness, and increased liver enzymes[iii]. The out-of-pocket costs of these statin drugs can also be cost prohibitive for those not covered by a comprehensive drug plan.

However, a natural product called policosinol is generating an unusual amount of attention – both positive and negative – from the medical community in light of its purported cholesterol lowering capacity. Derived from the wax of sugarcanes and honeybees, policosinol is said by some to reduce cholesterol, offer no known side effects, be safe in high doses, increase blood flow, reduce platelet clumps, and prevent atherosclerosis (plaque buildup on the artery walls)[iv].

Studies have been conducted on policosinol efficacy, and there is some empirical research evidence that supports it as a high LDL cholesterol remedy. A 2002 study by researchers at the University of Bonn reviewed 60 clinical trials involving 3000 patients, and concluded with cautious optimism that policosinol is a promising alternative to cholesterol lowering stain drugs, and thus warrants further study[v].

However, those poised to buy policosinol and lower their cholesterol should approach with caution; and this is the message voiced by those who are less than enthusiastic about the policosinol’s emergence as something of a wonder cure.

Though a natural remedy and thus far not causing the side effects associated with statin drugs, those skeptical about policosinol quickly point out that it is not an FDA approved drug. As such, it has not been subjected to the rigorous testing that comes with approving a new drug, including supervised preclinical trials and standardized testing in successively larger population of people. The fact that the FDA approves 1 out of 5000, or .0002 of the applications that it receives for new drug approval, is an indication of how highly valued – and rare – this approval is.

However, this instigates another debate – whether the FDA approval process is the most appropriate way to accept drugs into drug plans, and whether doctors should be permitted to prescribe non-FDA-approved drugs without undue concerns for malpractice lawsuits. Indeed, an MD may have personally benefited from a natural remedy like policosinol, but to prescribe that to a patient requires more support than personal preference, or even personal testimony.

And it is the intersection of these two separate debates -- whether policosinol works or not, and whether the FDA approval process is fair or not – that the situation, and verdict on policosinol, currently lies. This debate is frustrating to all sides; including patients themselves, who simply want a real solution.

However, despite these frustrations, the fact that efforts are being undertaken to develop – or verify – a remedy that is safe, complete, and free of side-effects – is a step in the right direction. Additional research on policosinol will further clarify whether that step should be towards FDA approval, or towards a warning label.

ABOUT PROTICA

Founded in 2001, Protica, Inc. is a nutritional research firm with offices in Lafayette Hill and Conshohocken, Pennsylvania. Protica manufactures capsulized foods, including Profect, a compact, hypoallergenic, ready-to-drink protein beverage containing zero carbohydrates and zero fat. Information on Protica is available at http://www.protica.com

You can also learn about Profect at http://www.profect.com

REFERENCES

[i] Source: “Heart Mender”. CNN.Com.
[http://www.cnn.com/SPECIALS/2001/americasbest/science.medicine/pro.pridker.html]

[ii] Source: “Cholesterol”. American Heart Association.
http://www.americanheart.org/presenter.jhtml?identifier=4488

[iii] Source: “Statin Medications: What are the Side Effects?”. Mayoclinic.com
[http://www.mayoclinic.com/invoke.cfm?id=AN00587]

[iv] Source: “Policosinol ”. Wholehealthmd.com.
[http://www.wholehealthmd.com/refshelf/substances_view/1],1525,10127,00.html

[v] Source: “Policosinol : clinical pharmacology and therapeutic significance of a new lipid-lowering agent”. Gouni-Berthold I, Berthold HK. Am Heart J. 2002 Feb;143(2):356-65.