Dr. Brenner's Thoughts on Healthcare

Supreme Decision

2012-06-29T13:49:00.000-07:00

Sorry this is a day late, but I was working nights...

As a doctor and writer on Health Care issues, I will simply state re: today's supreme court decision, the health care reform bill passed by congress and upheld today, while not perfect and definitely in need of tweeking and likely further legislation, has already led to health care coverage for my ER patients, including some last night who were sweating the decision for fear they would go back to the ranks of the uninsured.

Nothing in this world is more frightening than the indignity of being sick and being unable to obtain proper care. Nothing is more frustrating to me than telling a person with a non emergent but potentially deadly illness that there is nothing I can do for you. Any steps that give people back some of their dignity, and relieve an uncertain and morbid future is a step forward in the right direction.

A Medical Malpractic Book Update

2011-07-17T18:06:00.000-07:00

Hello all,

I just wanted to update those who are technologically inclined that my book "How to Surivive a Medical Malpractice Lawsuit" is now available on Kindle. Which means it is also available for the ipad via the Kindle app, but since you are technologically inclined, you already know that.

Thank you all for your support.

Schizo is a Finalist Again!

2011-07-09T08:20:00.000-07:00

Hi all, it's been an exciting Spring with Schizo. Two festivals named me a finalist, and even though I did not win, I consider this quite an achievement! The film quality at the Los Angeles United Film Festival was top notch, and attending made me realize how fortunate I was for getting so far in the screenwriting competition.

Well, I have news about another contest: The Peachtree Village International Film Festival Screenwriting Competition has named me a finalist! It is being held in Atlanta this August, in Midtown - W Hotel and the Woodruff Arts Center. Crossing my fingers for a win this time.

Sunscreen blog update

2011-05-25T06:15:00.001-07:00

To see the 2011 recommendations for sunscreens based on effectiveness and harmful chemicals, check out this link to the Environmental Work Group.

How to get published...

2011-05-19T19:22:00.000-07:00

I've written a blog on this topic, but if you are interested in publishing a non-fiction book, I have much advice to give. Here's a new article that goes through the 10 steps to getting your non-fiction book published.

If you have any questions, I'm happy to answer at my email irbrennermd at gmail.

Brief Schizo update

2011-04-28T00:24:00.000-07:00

By Schizo I mean my screenplay adaptation, not a patient.

I wanted to let you know I've updated my Schizo page with a pdf link to the first 10 pages of my screenplay.

Update - I'm a finalist!

2011-04-26T14:00:00.000-07:00

Here is the link for the film festival finalists (see me? Ilene Benator...my married name). Thanks for all the good wishes! Well, the planets have aligned and I've made the decision to fly to LA for the ceremony.

I have a 33% of winning, so please keep me in your thoughts. Good vibes, this is California after all.

I'm a finalist!

2011-04-21T15:55:00.000-07:00

April 21st Update!

I was just named a Finalist in the Los Angeles United Film Festival Screenwriting Contest in the Horror/Thriller category. Winners are announced at the festival on May 5th. It's last minute notice, and I'm trying to attend. We'll see.

I will update on any further developments. Hopefully soon!

Defensive Medicine Article

2011-04-19T23:52:00.000-07:00

Hi all, I've just published another article with Medscape. This one titled, "Why Defensive Medicine Won't Go Away...And Might Become Worse."

New Developments

2011-03-30T18:02:00.000-07:00

I've recently added a new page to my blog. Eventually it will become another website, but for now, I'm adding a heading "Schizo the novel," about my new book.

Under my new married name, Ilene B. Benator, I have finished a novel entitled Schizo that is inspired by a true story (of me in medical school):

An ambitious future surgeon on his psychiatric rotation is assigned a schizoaffective patient who reveals to him specific patient information about an organized plot to control the population. His innate curiosity leads him to verify that these delusions are part of her psychosis, but when he discovers instead that these patients indeed exist, he investigates their connection, and his pursuit of the truth leads him to become a psychiatric patient in the same facility.

My agent has submitted this for publication, and while I have been playing the waiting game, I wrote the screenplay adaptation of the book. There's a lot of action and intrigue that plays well on the big screen. I have submitted this screenplay to a number of film festivals, and recently won an award!

Thanks so much to the Los Angeles Cinema Festival of Hollywood for this honor!

I will update on any further developments via this new link above "Schizo the novel." Hopefully soon!

Trauma care for all!

2011-01-19T12:16:00.000-08:00

In Georgia, a referendum to have drivers pay $10 extra to pay for an improved Trauma system, did not get enough votes to pass. Oddly, the most votes for the fee were in the Atlanta area, where there is already great trauma care (Grady, AMC). In the rural areas, where there are few if any Level 1 trauma facilities, $10 was too much money.

Read this excellent article on why a Level 1 trauma facility is so very important, and how what we take for granted is liable to go away soon if we don't protect the facilities we have now.

Medscape article #2

2011-01-18T19:30:00.001-08:00

I've got another Medscape article out. This one is all about tips for the Trial. Hope you like it. http://www.medscape.com/viewarticle/734257

The genius of magazines and books on the ipad and why publishers are ruining it

2011-01-03T07:54:00.000-08:00

I know, this is NOT a medical article. But I feel compelled to write this because I fear that the publishers without a clue will destroy a burgeoning sales model before it even gets started.

First, let me state that the statistics of an initial peak of electronic magazine sales on the ipad, then recent decrease, is not surprising. This is because early adopters wanted to see really cool content on their really cool device. And they were willing to pay for it. At least initially.

However, it is insane to pay more for an electronic document than the written version. For paper content you pay for the content, editing, distribution, and capital cost (cost of the paper and printing of the document). For the ipad, you pay for the first two, but the last two are minimal. The distribution is through apple. Advertising the existence of the app is probably a necessary expense. But what capital cost is there in electrons? None.

Therefore, the magazine subscription model could be applied by taking the current list price for the paper mag, and decreasing it by the capital costs, and giving large discounts for prepaid subscription buyers. A $2.00 mag could cost $1.50 on the pad.

But this is not what's occuring. For instance two full years of "Wired" magazine paper version is $20, but one electronic version is $3.99 an issue. That's too much money for the coolness factor. So sure a bunch of early adopters coughed up the money for one issue, but that is not sustainable.

What do I want out of an electronic newspaper/magazine?
These Ten things:
1) Good quality content consistent with the paper version
2) Added value with multiple spots to click for extra content (photos, video, website links...)
3) A vibrant design
4) Sound I can control, and video I can control: NO AUTOPLAY VIDEO and EASY DISABLING OF SOUND
5) Price consistent with paper version, perhaps even discounted off paper version
6) Ability to buy a reasonable subscription in advance for a discount like with paper versions
7) Easy links for sharing to social media portals like FB and Twitter
8) No popup advertising
9) More functional advertising - for instance, have ads like in paper version, but where you can click for a coupon, sweepstakes, catchy video ad, etc...
10) Allow paper version subscribers to get the app at a significantly discounted rate so subscribers aren't double charged.

My concern is that newspaper/magazine publishers will see the lower sales and say that the model of electronic media has failed. It hasn't. THEIR model is what is failing: which is to say, the model whereby you gouge the early adopters and then drop the price when it becomes clear nobody will buy your product, and then drop the format when it "fails."

The problem is not in having a shortage of consumers, or reaching those consumers. Ipad users want great content. And are willing to pay a fair price for them. But what is occurring now is going to ruin the industry before it even starts.

Hopefully, the "moguls" will realize this cash cow for what it is. Look at the apple app store. Look at how much money is made on these apps. Millions of apps. Give a good product at a fair price and you will make money on the volume. And as an added bonus, you'll kill less trees in the process.

For book publishers, it is a similar idea. If you are going to charge me $20 for an electronic book, I want added value. I want video interviews of the author. I want interpretations by critics. I want photos of the setting (a la Dan Brown "extra content" books). I want to be able to click on any word in the book and get a link to it's definition, thesaurus, and relevant google search. I want to be able to personalize the book with notes, and print those out.

If you won't give me added value, then I want a lower cost. And I mean REALLY lower. I think no electronic book that is merely a pdf of the print copy is worth more than $4.00 a copy.

Publishers need to think quality, cost and volume. Good quality + Low Cost = High Volume of Sales and $$$$$ to publishers.

Maybe book publishers could even go with a subscription service for popular authors like Dan Brown, Michael Palmer, Nora Roberts where readers pay a lower price per copy than anyone else, but commit to three books at a time. And get discounted access to the "backlist" of older books. If they had that for Dean R. Koontz I'd do it in a heartbeat.

I just hope that while publishers run in fear from new media, then gouge the ones who lead the way, they don't kill the cash cow before it is old enough to produce milk.

Deposition Article

2010-10-28T11:41:00.000-07:00

I've written another article, this time for WebMD's Medscape: Eight Things to Never Do at Your Deposition http://www.medscape.com/viewarticle/730950

It is the first in a series. I hope you don't need the advice, but if you do, I hope it helps!

Help With The Heat

2010-07-12T17:04:00.000-07:00

I've been seeing a lot of patients lately who have tried to be out in the heat, and tried to do the right thing, but have come up short. Sometimes you have jobs that make you go outside. Or you play sports. Or garden. Whatever keeps you outside in 90+ degree heat, you need to take a few precautions. Sunblock, of course, see my blog on the dangers of certain types of sunscreens for more information on which ones to buy.

Most importantly, you need to be hydrated. And water doesn't cut it.

Are you shocked that I'm telling you that drinking water is bad for you for the heat? Here's why:

Your body tries to regulate your temperature to prevent overheating by sweating and evaporation. Have you noticed your sweat is salty? That means you don't have pure water coming out--you have electrolytes too. If you sweat electrolytes, but replace with water, you will dilute your electrolytes and lead to imblances that can cause cramping, or worse, heart abnormalities and altered mental status.

The outside temperature for which your body can maintain a normal body temperature is 84 degrees. Higher temps and/or humidity can increase your body temp.

You are at higher risk if:

Physical activity in hot/humid weather
Extremes of age
Excessive clothing
Dehydration
Cardiovascular disease
Skin disorders (i.e. schleroderma or severe burns)
Obesity
Medicines

What are heat cramps?
Cramps tend to occur later in the day when relaxing or taking a cool shower after having been in the heat. Normal body temperature. Involve calves, thighs and shoulders most commonly.
-Prevent by injesting salt and water (electrolyte solutions like gatorade work well)
-Treatment: Rest in cool environment, Salt replacement (electrolyte solutions or IV saline)

Heat exhaustion:
Extreme fatigue, profuse sweating, dizzy, nausea/vomiting, even diarhea. Dull headache. Body temperature normal or slightly elevated. Most common heat illness that usually occurs during heat waves. Lots of sweating.

Heat stroke:
Least common, most serious. Suspect if altered mental status and elevated body temp after having been in hot/humid environment. Alcoholics and elderly particularly vulnerable. Hot DRY skin.
-Treat with COOLING not fluids. Too many fluids can lead to congestive heart failure. (of course call 911 and get the patient to an ER ASAP)
---Remove clothes. Spray water onto skin, don't apply ice directly to skin. Fan patient. Ice packs to underarms and groin. Some oral electrolyte solutions if able, but don't overdo.

You need to drink electrolyte solutions such as gatorade, propel, powerade, etc... or drink water, eat crackers (salt) and bananas (potassium).

How much should you be drinking to prevent illness?

As much as you can, as often as you can, as long as you are exposed to heat. As long as you are making large amounts of dilute urine, you are drinking enough. If you aren't urinating or are urinating dark urine, you need to drink more.

New Experience

2010-07-01T07:27:00.000-07:00

While I have written many things: books and scores of articles, I have never acted as a journalist before. I usually write based on my own knowledge. But recently I had an opportunity to step out of my comfort zone and interviewed some architects to produce my latest effort: "Building a Better ED: An Architects Perspective."

You can view it here: http://www.epmonthly.com/features/current-features/building-a-better-emergency-department-an-architects-perspective/

It was a wonderful challenge. Hope you like it.

2010-06-11T22:51:00.000-07:00

Thanks to everyone who came to support me at my launch party for "How to Survive a Medical Malpractice Lawsuit."

I signed lots of books. Drank lots of Sangria. And had lots of great conversation. Thank you again for all of your support!

Mobilize the troops!

2010-05-25T20:24:00.000-07:00

Hello all, just a quick note to announce that my book has officially launched! Spread the word. If you are a doctor or know one, buy a book. Or three. It makes great July 4th presents. Father's day. Yom Kippur. Whatever.

I do need a favor. Though I have a better deal than amazon on my site, and I'd like you to buy through me, I need reviewers for amazon.com.

In order to be a reviewer, you must buy the book through amazon. See link:

I ask a few of you to buy through amazon, read the book, and write a review. Please. Thank you. I will answer any and all questions you have through my blog and my email irbrennermd@gmail.com

Thanks!
Dr B

How to get published (Part 1)

2010-05-05T19:31:00.000-07:00

First, there are different ways to go about it depending on what type of book you are writing. There's fiction vs nonfiction, and in nonfiction there's trade vs. academic.

For fiction, your book needs to be finished and edited before you can solicit publication.

Nonfiction is different. While having a finished book can help, it isn't necessary. All you need is a proposal which has at most three sample chapters in it; though usually has one or two. A great resource is, "How to Sell, Then Write Your Nonfiction Book." Though that seems counterintuitive, for nonfiction, publishers often like to influence the final product.

I know a lot of people who say, "I'd really like to write a book." The only way to be a writer is to write. The only way to get good at it is to keep writing. But if you have a nonfiction book, write a few chapters, then focus all your efforts on the proposal. You still need to have a detailed outline of your book, but you waste a lot of time if you write the book before trying to sell it. The publishing process is slow. Very very very painfully slow (if you are an ER doc like me). So write a few chapters, write the proposal, try to sell the book, then continue writing the book.

A common question is, "Can I go straight to the publisher to sell my book or do I need an agent?"

Fiction: While there are certainly exceptions, most authors must get an agent to solicit a publisher to buy your book. Harlequin is an example of a publisher that will take direct submissions. Not sure? Go to their website. It will tell you if they read unsolicited manuscripts.

Nonfiction Trade (books that sell to the general public): If this book can be sold to a large number of people, you'll need an agent. If it is for a niche market, you often can do a direct submission. Again, use the websites for information. Sending manuscripts to places that don't want them will be a waste of time, and a poor use for the trees that valiantly gave their lives in vain.

Nonfiction Academic: Usually is direct to publisher-no agent required. Look on your bookshelf for textbooks. There has been a lot of corporate consolidation, so there are not that many independent players. You'll find that different labels are often supplied by the same editors. Make sure you pay attention to this-it would be a mistake to send your query to the same editor more than once.

Another major question aspiring authors ask, "Why should I get an agent when they take 10% of what I earn? Won't I do better going straight to the publisher?"

Answer: Agents earn their money. Publishers will negotiate with an agent items that you'll never even know to ask for, and how to ask for it. It is likely that you will get a better contract working with an agent, even accounting for the lost 10%. Now if you do a direct submission to a publisher and get a contract, I recommend spending the $300-$400 an hour for a literary attorney to negotiate your contract. It sounds like a lot of money, and it is, but you'll get that back and more because of a more favorable contract. I recommend Paul S. Levine because he is an attorney and agent, so you kinda get a two for one special.

To be continued...

In my shameful act of self promotion: if you are a health care provider or know one, please buy my book, "How to Survive a Medical Malpractice Lawsuit." Link to buy is on the upper right of my blog http://drbrenner.blogspot.com

How to Survive a Medical Malprace Lawsuit Part 2

2010-05-04T01:02:00.000-07:00

It feels really good to hold the books in my hands. It will feel even better handing them off to people who want and need the advice within.

It has come to my attention that a lot of people subscribe by email to my blog, and therefore the links to buy don't function.

If you want to buy my book, go to my website http://drbrenner.blogspot.com and all the information to buy will be there: Reviews, Book Excerpt, Pretty Cover, etc...In the upper right corner of the main page, you will see a "Buy Now" button. In the space above that enter in any information you want in your autograph. Then buy through paypal.

If for some reason you hate the idea of buying through paypal, click on one of my tabs and there will be a link to amazon on those pages where you can buy through them.

Thank you all for your support.

I'm thinking of having a series of articles on the blog, "How to get your book published." Anybody interested? Let me know.

-Dr. Brenner

How to Survive a Medical Malpractice Lawsuit

2010-04-17T22:49:00.000-07:00

Today is a special day. I held my newly published book for the first time. Since the book doesn't officially come out until May 24th, 2010, you can't get one yourself for several weeks. However, you can order an autographed copy from me for $31 plus $4 shipping (see website link below or to the right). Or you can do the amazon.com pre-order now (see below).

I've added a new page that tells you why you should buy my book. And another page that has a book excerpt, not found on amazon.com's site, that will show you why you should buy this.

Or I can tell you now - If you are a healthcare provider that hasn't been sued yet there are things you don't know about your medical malpractice policy that could become a problem later on if not resolved now. There are preventative tips that could decrease the likelihood of your getting sued. And if you are unlucky enough to be involved in a lawsuit now or in the future, this book will tell you things that most physicians never realize. And what you don't know can hurt you.

In a few weeks I will have a free iphone app that you can download that will summarize some very important parts of the book. It is a quick fire guide to surviving a suit. I will update the blog when this is ready for launch. And if you don't need this app, but have an iphone, ipad, or ipod touch, please download it anyway. It will help my rankings.

Press-Ganey Hell Revisited

2009-12-09T08:50:00.000-08:00

For those of you that follow @movinmeat's blog, as well as my own (and see me on twitter @irb123), you know about my "issues" with the unfairness of the Press-Ganey system of customer service, and how I feel it is actually undermining good patient care.

Well, irony of ironies, over the last 2 months, I am...wait for it (drumroll)...#1 in my group and in the 97.5% of all (doctors in atlanta? the US? a hypothetical sample size from the imaginings of the P-G folks?) on the list.

And guess what folks? I didn't do anything different. I told that to my medical director today when he congratulated me on a job well done, bringing up my scores. His response: pretend like you did something different if someone asks.

In other words, for the P-G to be legit, one set of behavior leads to one set of scores, but another set of behavior leads to a different set of scores. But in my world, there is one type of ER practice that leads to a rollercoaster of scores from the very bottom to the very top.

Once again, the P-G fails to indicate anything meaningful for me and for my patients. Only now, I am not in the doghouse with the CEO. Maybe this is the right time to ask for that iphone I've been wanting...

Some of my fav photos

2009-11-10T01:08:00.000-08:00

A colleague (@DrRemy on twitter) was kind enough to set some of my fav photos to music. It is about time we take a break from all the stresses going on with healthcare reform. Even now, it is hard to say what reform will look like, though I feel confident something will happen.

Enjoy your respite:

By popular request here are the photo descriptions:

Alaska Mendenhall Glacier, in B&W, film, titled "Three Waters"
North Carolina Mountains, the smokies
Mendoza, Argentina
Does this need a description? "Purple"
Amazing Sulfur formation on the road between Chile and Mendoza
Machu Picchu, Peru
Town of Macca Church, Peru
Prague in Winter
Convent doorway, Arequipa, Peru
Westglow Spa, N.C., Sunset (early)
Westglow Spa, N.C., Sunset (late)
Smokies, rays of light through the clouds
Colca Canyon, Peru "Lavender Sunset"
Tallulah Falls, Georgia
Jewish museum, sculpture, Berlin
New York City from top of Museum
Holocaust Memorial, Berlin
Photo by Dr.Remy

Dr.Remy linked to my video on her blog and added my poem "Dreams" below it. The poem is actually excerpted in the video at the very end. If you want to see the whole poem here is the link to her blog:

Video Interview of Me

2009-11-05T11:25:00.000-08:00

Just a quick note and link to a video of me talking about the medical malpractice issues that come up in my upcoming book "How To Survive a Medical Malpractice Lawsuit." Please let me know what you think.

Link to epmonthly.com

Are ERs wasteful or the epitome of healthcare efficiency?

2009-10-28T13:57:00.000-07:00

I have seen a lot of criticism of ERs lately. The new House Bill for healthcare reform introduces ways to reduce crowding and boarding in the ERs, and better prepare them for disasters like pandemics and Katrina-type travesties. But they also put the focus on reducing ER use, as if overuse of ERs is responsible for the exhorbitant waste and cost of Healthcare.

There is waste in healthcare, and some of the patients who come to ERs are inappropriately abusing the system. But those statistics state that 10% of patients are responsible for 90% of the visits. So the waste in the ERs is largely out of control of those who run them.

This site debunks some of the myths surrounding the ER and healthcare.

I go a step further, and challenge the criticisms that the ERs are unnecessarily over testing patients:

Why do ER docs do a lot of tests?
1) Patients expect and demand it and we are at the whim of Press-Ganey for job security.

2) Consultants demand it. I cannot get a surgeon to even LOOK at my patient without a CT (cat) scan. I would get laughed at-more accurately-yelled at for diagnosing appendicitis without a CT scan at 3am and waking up the surgeon to inform them of this.

Hospitalists and attendings routinely ask for a complete workup before they will admit a patient. That means not just labs, but followups on labs. CT scans to rule out PE (pulmonary embolism) or surgical entities.

I have found that Admitting docs expect more from us than a simple Admit or Discharge. They want a diagnosis and treatment plan. This is partly because Medicare won't pay for certain diagnoses, so hospitals want to make sure that those who come in will be "paying" patients. That requires full workups to prevent admissions that don't need to be in the hospital. In the past you could admit a patient with minimal workup, and let the attendings figure out what was going on. That's not good enough for the government because Medicare will reject payment for patients if they think it is not necessary. Unfortunately, care has already occurred and money has already been spent. No "social" admits for patients who have nowhere else to go and are too sick to be home alone. No observation admits to see if something shows up. Now the patient is worked up in the ER, gets a diagnosis, and the hospital's job is to figure out how to discharge them as soon as humanly possible.

3) Pts in the ER self select as Emergencies. Therefore an Emergency must be ruled out. I can’t always rule stuff out without further testing. Abdominal pain in an office setting and abdominal pain in the ER are not the same animal. You can't just send someone home; you need to rule out deadly reasons for this pain. Nobody comes to the ER because they want to be there (okay, there are a few, but those people aren't typical). If patients thought their problem could wait until they were scheduled to see their doctor, given a bunch of tests that take a few weeks to come back, get the outpatient study they need in a month, and see the specialist when THEY can fit the patient in, then they would have done so. Instead patients who come to ERs want relief of their symptoms. They want answers and often need immediate action.

4) Sometimes patients have ambiguous symptoms that affect areas that require different types of tests. For example, A patient with abdominal pain in RUQ (right upper quadrant) needs an U/S (ultrasound) because that is more effective for picking up GB (gallbladder) disease. However, if I think the problems is in the intestines, a CT is the best choice. CTs do not do well ruling out GB disease, so on occasion you need to do both tests if the first one is negative.

5) Lots of patients without insurance come to the ER. These patients will not get tests unless done in the ER. They will fall through the cracks. If I don’t do the CT scan, nobody will. If they had insurance, sure, they could see their doctor and get an outpatient scan. But in reality, the majority of my patients are uninsured or underinsured and can’t get these tests unless they come to the ER.

For the arrogant doctors who judge the care of the ER docs, don’t throw stones when you live in a glass house. I deal with your complications everyday. I deal with the patients who can’t reach you on the phone and come in with a preventable ER visit. I deal with the undesirables you don’t want to see. And I don’t cast aspersions upon you and question your training.

ER docs now are better trained for emergencies than internists, family practioners and surgeons. We know the emergency aspects of every specialty. We see the overall picture. Do you know how many times I am the first doctor to give them nutrition and prevention advice? Why wasn’t their primary doc doing that? Why didn’t their surgeon explain to them that their surgery will drive up the patient’s blood sugar and they’ll need more insulin?

Perhaps you shouldn’t be asking what should ER docs do to change things. Perhaps you should be looking at why ERs need to be doing what they must to be the safety net that keeps the strands of healthcare from dissolving into complete chaos.