Ratner EJ, Person P, Kleinman DJ.
Lancet. 1978 Jan 14;1(8055):106-7. No abstract available.
- PMID:
- 74557
- [PubMed - indexed for MEDLINE]
Ratner's work was known to
Vladimir K. Zworykin - Wikipedia, the free encyclopedia
en.wikipedia.org/wiki/Vladimir_K._Zworykin
Vladimir Kosmich Zworykin (Russian:
Влади́мир Козьми́ч Зворы́кин - Vladimir Koz'mich Zvorykin)
(July 29
[O.S. July 17] 1888 – July 29, 1982) was a ...
Biography - Second marriage and calling - Death - HonorsManfred von Ardenne - Wikipedia, the free encyclopedia
en.wikipedia.org/wiki/Manfred_von_Ardenne
Manfred von Ardenne (20 January
1907 – 26
May 1997) was a German ... In 1937, Ardenne
developed the
scanning transmission electron microscope.
During ...
I myself am not a MD but I can read, write and think a little bit. Not too much.
As a betting man, I know that autoimmune diseases may be treated and/or cured by BCG and am shooting same while I await the production of a documentary You Tube Video. See eg pubmed.org fasutman dl and pubmed.org ristori bcg. Healthcare in the US stinks in part because BCG is not widely available.
I don't have cancer but a little bit of reading and thinking shows or tends to show that if you do metformin and aspirin might well do the trick for you, safely and inexpensively. Because metformin and aspirin are inexpensive you will likely never see them widely studied. While you are waiting for your VA appointment you might find yourself with ample time to read and see what you think and then act accordingly.
Eugene J Ratner once told me a story of being ordered to go to Paris. Upon arriving in Paris he examined a Congressman. The Congressman had a toothache. God Bless America?
I will be glad to send via facsimile a letter from the crook, Senator Harrison Williams of NJ, to John J Shelly, saying that the US would love to fund Ratner's successful work, if only he could explain why it worked.
God Bless America.
Hiram Maxim was the greatest MD of all time as the automatic weapons have stood the medicinal test of time. They are cheap, easy to use, produce guaranteed results all the time, and are available all over the world.
It is appalling that the work done by Ratner for the US in NY has not been used to improve the quality of life of US Veterans and Civilians. The records and publications are there. Go get 'em.
3.
Ratner EJ, Person P, Kleinman DJ.
Lancet. 1978 Jan 14;1(8055):106-7. No abstract available.
- PMID:
- 74557
- [PubMed - indexed for MEDLINE]
Dr.
Phyllis Hollenbeck, a primary care physician, took a job at the
Veterans Affairs medical center in Jackson, Miss., in 2008 expecting
fulfilling work and a lighter patient load than she had had in private
practice.
What
she found was quite different: 13-hour workdays fueled by large patient
loads that kept growing as colleagues quit and were not replaced.
Appalled
by what she saw, Dr. Hollenbeck filed a whistle-blower complaint and
changed jobs. A subsequent investigation by the Department of Veterans
Affairs concluded last fall that indeed the Jackson hospital did not
have enough primary care doctors, resulting in nurse practitioners’
handling far too many complex cases and in numerous complaints from
veterans about delayed care. “It was unethical to put us in that
position,” Dr. Hollenbeck said of the overstressed primary care unit in
Jackson. “Your heart gets broken.”
Her complaint is resonating across the 150-hospital Veterans Affairs medical system after the department’s inspector general released findings on Wednesday that the Phoenix medical center falsified data about long waiting times for veterans seeking doctor appointments.
Graphic
Major Reports and Testimony on V.A. Patient Wait Times
Problems with waiting times for veterans seeking medical
care have been documented dozens of times by federal agencies over the
past 15 years.
In
Washington, the number of lawmakers in Congress calling for the
resignation of Eric Shinseki, the Veterans Affairs secretary, grew by
late Thursday to nearly 100 — including almost a dozen Democrats — as
President Obama prepared to receive an internal audit on Friday from Mr.
Shinseki assessing the breadth of misconduct at veterans hospitals.
White House aides declined to say whether Mr. Obama would ask Mr.
Shinseki to step down.
At
the heart of the falsified data in Phoenix, and possibly many other
veterans hospitals, is an acute shortage of doctors, particularly
primary care ones, to handle a patient population swelled both by aging
veterans from the Vietnam War and younger ones who served in Iraq and
Afghanistan, according to congressional officials, Veterans Affairs
doctors and medical industry experts.
The
department says it is trying to fill 400 vacancies to add to its roster
of primary care doctors, which last year numbered 5,100.
“The
doctors are good but they are overworked, and they feel inadequate in
the face of the inordinate demands made on them,” said Senator Richard
Blumenthal, Democrat of Connecticut and a member of the Senate Veterans
Affairs Committee. “The exploding workload is suffocating them.” The
inspector general’s report also pointed to another factor that may
explain why hospital officials in Phoenix and elsewhere might have
falsified wait-time data: pressures to excel in the annual performance
reviews used to determine raises, bonuses, promotions and other
benefits. Instituted widely 20 years ago to increase accountability for
weak employees as well as reward strong ones, those reviews and their
attendant benefits may have become perverse incentives for manipulating
wait-time data, some lawmakers and experts say.
Representative
Jeff Miller, a Florida Republican who is chairman of the House Veterans
Affairs Committee, said whistle-blowers at several veterans hospitals
had told his staff members that they would be threatened if they failed
to alter data to make patient-access numbers look good for their
supervisors, one reason he has called for a criminal investigation into
the Veterans Affairs hospital system.
“Fear
was instilled in lower-level employees by their superiors, and those
superiors did not want long wait times,” Mr. Miller said in an
interview. “Bonuses are tied directly to the waiting times of the
veterans, and anybody that showed long wait times was less likely to
receive a favorable review.”
The
precise role incentives and performance reviews might have played in
falsifying waiting-list data remains unclear. In Phoenix, the inspector
general’s office said, investigators plan to interview scheduling
supervisors and administrators to “identify management’s involvement in
manipulating wait times.”
But
documents suggest that using the data in annual performance reviews may
be commonplace. One review at a Pennsylvania veterans medical center
showed that a significant portion of the director’s job rating was tied
to “timely and appropriate access,” which would include waiting times
for doctor appointments. One of those goals would be met only if nearly
all patients were seen within 14 days of their desired appointment date —
a requirement not found in the private hospital industry.
Share Your Experience With Veterans Affairs Health Care
New York Times journalists would like to hear from
veterans about their experiences with health care at Department of
Veterans Affairs hospitals and clinics
Schemes
to disguise wait times generally followed a handful of approaches,
whistle-blowers and officials in Congress say. In Phoenix, where
administrators were overwhelmed by new patients, many veterans were not
logged into the official electronic waiting list, making it easier to
cloak delays in providing care.
Another
strategy, according to documents and interviews, was for Veterans
Affairs employees to record the first date a doctor was available as the
desired date requested by the veteran, even if they wanted an earlier
date.
“Yes,
it is gaming the system a bit,” one employee at the Veterans Affairs
medical center in Cheyenne, Wyo., explained in an email to colleagues.
“But you have to know the rules of the game you are playing, and when we
exceed the 14-day measure, the front office gets very upset.”
In
Jackson, Dr. Hollenbeck reported that hospital administrators created
“ghost clinics” in which veterans were assigned to nonexistent primary
care clinics to make it appear that they were receiving timely care.
And
in Albuquerque, an employee at the veterans center said some doctors
were shocked when they received a memo a few months ago stating that 20
percent of physician “performance pay” would be doled out only to
doctors who found a way to limit patient follow-up visits to an average
of two a year — a tactic to reduce waiting times by persuading veterans
to make fewer appointments.
“Clinic
staff were instructed to enter false information into veterans’ charts
because it would improve the data about clinic availability,” states a
whistle-blower complaint filed by the employee, who did not want to be
identified. “The reason anyone would care to do this is that clinic
availability is a performance measure, and there are incentives for
management to meet performance measures.”
Experts
point out that performance reviews and incentives were a crucial
element in transforming the Veterans Affairs medical system, considered a
medical backwater after the Vietnam War, into a national health care
system that, for all its problems, is generally well regarded.
Debra
A. Draper, the director of the Health Care Government Accountability
Office, said that performance-contract incentives were only one possible
explanation for inaccurate wait-list data, and that other factors
included lack of oversight and training.
Most
experts agree that soaring demand for veterans’ care has outpaced the
availability of doctors in many locations, and that high turnover is a
major problem. In the past three years, primary-care appointments have
leapt 50 percent while the department’s staff of primary care doctors
has grown by only 9 percent, according to department statistics.
Those
primary care doctors are supposed to be responsible for about 1,200
patients each, but many now treat upward of 2,000, said J. David Cox
Sr., national president of the American Federation of Government
Employees, which represents nurses and other support staff. He said the
department spent too much hiring midlevel administrators and not enough
on doctors and nurses, a complaint shared by some lawmakers and veterans
groups.
The
department said this week that it was reviewing the size of patient
panels at its hundreds of outpatient clinics and assessing whether more
could provide night and weekend hours. The department also said it would
increase the number of patients it referred to private medical care, to
reduce waiting times.
Critics
and supporters of the department agree that many facilities do not have
enough physicians. But they disagree about whether that is because the
department has poured too much of its hefty federal budget increases
into hiring midlevel managers instead of clinicians, or whether the
system simply does not have enough funding — or a large enough pool of
doctors to hire from — to keep up.
Supporters
of the department also note that hospitals everywhere are struggling to
find primary care doctors. But some experts say the department has
additional hurdles, including lower pay scales. Primary care doctors and
internists at veterans centers generally earn from about $98,000 to
$195,000, compared with private-sector primary care physicians whose
total median compensation was $221,000 in 2012, according to the Medical
Group Management Association, a trade group.
Many
veteran medical center directors tend to make $160,000 to $190,000;
according to 2012 data, those directors given performance awards
typically received $8,000 to $15,000 more.
Dr.
Atul Grover, chief public policy officer at the Association of American
Medical Colleges, said the department’s doctor shortage came down to a
simple fact: “It’s just harder to attract physicians to care for more
challenging patients while paying them less.”
There
are long delays for specialty care, too, veterans say. Kent Carson, a
former Marine with epilepsy, said he had tried to make an appointment
with his neurologist at the veterans hospital in Nashville after having
five seizures in four days in 2012. But Mr. Carson, 29, said he was told
he would have to wait more than two months — or go to the emergency
room. He has since switched to private insurance through his job as an
accountant in Lenexa, Kan. The Nashville hospital did not respond to a
request for comment.
“I
have seizures, but it’s not life-threatening,” Mr. Carson said. “But I
really do worry about vets who have more serious problems.”US ships Veterans to Italy for treatment of MS to save money and promote international commerce and the sound practice of common sense.
Ristori
G, Romano S, Cannoni S, Visconti A, Tinelli E, Mendozzi L, Cecconi P,
Lanzillo R, Quarantelli M, Buttinelli C, Gasperini C, Frontoni M,
Coarelli G, Caputo D, Bresciamorra V, Vanacore N, Pozzilli C, Salvetti
M.
Neurology. 2014 Jan 7;82(1):41-8. doi: 10.1212/01.wnl.0000438216.93319.ab. Epub 2013 Dec 4.
- PMID:
- 24306002
- [PubMed - indexed for MEDLINE]
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