procedures

[paindoctor2014]

Are people doing them? If so, what criteria is being used to determine a procedure "non-elective." Curious as to what people are doing around the country. Here in Georgia most have stopped, some are just not really even slowing down.

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[SommeRiver]

I'm doing epidurals. No ablations or MBB. No SIJ.

I did a hip recently that was utterly trashed, but I'm really doing epidurals only.

 

[unchockey21]

One competitor in town is still doing SCS and Vertiflex. Before anyone asks, yes it’s Florida.

 

[vadim1980]

Doing only for significant symptoms and after discussion of possible additional risks associated with coronavirus situation. Mostly epidurals, and occasional joints for severe pain. In Massachusetts

 

[SSdoc33]

I'm doing epidurals. No ablations or MBB. No SIJ.

I did a hip recently that was utterly trashed, but I'm really doing epidurals only.

Heyyyyy. There you go!!!! Knew you'd come around

 

[Laryngospasm]

At what point do we reopen? The whole purpose of this was just to blunt the peak of the curve.. we haven’t stopped the virus from circulating.

 

[Jcm800]

At what point do we reopen? The whole purpose of this was just to blunt the peak of the curve.. we haven’t stopped the virus from circulating.

It seems like most people are working towards May 1... It would be great if it was sooner, but I just don’t see it happening before then. unless you’re doing procedures in your own office, which I think you could probably get away with starting sooner...

 

[pmrmd]

I haven’t stopped office procedures but the volume is down. Lots of precautions.

No ASC procedures at all. Guidance from CMS “recommended” rescheduling elective procedures, i.e. Medicare won’t pay, but it did not mention office.

 

[wavygravy99]

Should report those still doing SCS and ASC procedure to the state medical board

 

[paindoctor2014]

all of our procedures are either done in an asc or hospital setting. 3 docs (myself included) have stopped doing procedures, one is continuing at at least 75% volume. Suits are acting like he's doing the right thing and we aren't. Talking salary decreases. moderate amount of Covid cases in our area, don't think we've hit our peak

 

[drusso]

Should report those still doing SCS and ASC procedure to the state medical board

Do you think it would be helpful?

 

[wavygravy99]

Do you think it would be helpful?

I think it depends on the state. My state, Texas, the medical board and the governor specifically stated prohibited from doing any elective non life sustaining medical procedure, surgeries. Those in violation can risk fine, jail time and or suspension of license.


I stopped doing including office procedures. As much as it sucked financially, my best buddies from med school, many are ER doc and hospitalist and they are working extra and risking their lives, also I don't want to risk losing licence or going to jail.

 

[unchockey21]

Why don't you report them then? In many states, Tx, FL, etc clinics are shut down if they continue business as usual.

It’s been submitted.

 

[unchockey21]

what's been submitted? sorry not following.

Medical board complaint.

 

[PAINISGOOD]

I think it depends on the state. My state, Texas, the medical board and the governor specifically stated prohibited from doing any elective non life sustaining medical procedure, surgeries. Those in violation can risk fine, jail time and or suspension of license.


I stopped doing including office procedures. As much as it sucked financially, my best buddies from med school, many are ER doc and hospitalist and they are working extra and risking their lives, also I don't want to risk losing licence or going to jail.

Im hoping to restart procedures on 4/22 right now per Texas Medical Board for elective procedures...

 

[pmrmd]

Medical board complaint.

That's going to get you quite far in your community...

So a guy or gal takes great precautions and treats people that show up at the door and you file a complaint? Did the doctor force them to come in or did they want to?

 

[bronchospasm]

No procedures from May 19th. Did an emergency Kyphoplasty last week. Only telemedicine consults on established patients. We have guidelines to stop elective procedures till April16 th. Plannin on reopening in 2 weeks.

 

[unchockey21]

That's going to get you quite far in your community...

So a guy or gal takes great precautions and treats people that show up at the door and you file a complaint? Did the doctor force them to come in or did they want to?

To be clear, I didn’t personally make the decision or submit anything. It’s a small community and word travels. I’m just relaying what’s going on in my neck of the woods in response to OP’s question.

But I wouldn’t waste a match lighting an Easter candle for this guy if on the slim chance something actually is done about it. This is the latest in a long line of ethically questionable happenings. I mean we’re not talking about a hot radic or an acute VCF. It’s SCS and Vertiflex for chronic pain using PPE in an ASC. It’s a ridiculous argument. Of course nobody forced the patients to show up but that’s the whole point of stay at home orders. If people were responsible enough to use logic, we wouldn’t need them. Just because a patient wants something, doesn’t mean we give it to them. People can go back to practicing Burger King medicine after the executive order expires.

 

[pmrmd]

To be clear, I didn’t personally make the decision or submit anything. It’s a small community and word travels. I’m just relaying what’s going on in my neck of the woods in response to OP’s question.

But I wouldn’t waste a match lighting an Easter candle for this guy if on the slim chance something actually is done about it. This is the latest in a long line of ethically questionable happenings. I mean we’re not talking about a hot radic or an acute VCF. It’s SCS and Vertiflex for chronic pain using PPE in an ASC. It’s a ridiculous argument.

Is it?
The entire directive to cancel elective procedures was to ensure PPE goes to the hospital. What about the PPE that the facility already has? Are they supposed to donate it? It's self-limiting. When the PPE runs out the procedures stop. It may take a while for them to get restocked even after the directive ends. I have plenty of PPE at my ASC and if I didn't have concerns about Medicare and other insurers paying I would proceed. The hospitals here don't give a rats ass if they put me out of business or not. They aren't "team players" by any stretch and if they have millions to buy out primary care and orthopedic groups and build their own pain service, I don't feel I have any duty to support them.

From the patient perspective, most wish they could get what they need, be it a knee arthroplasty, Vertiflex, or permanent SCS. They live the pain and would like to get it resolved if they could. Ask them.

 

[unchockey21]

Is it?
The entire directive to cancel elective procedures was to ensure PPE goes to the hospital. What about the PPE that the facility already has? Are they supposed to donate it? It's self-limiting. When the PPE runs out the procedures stop. It may take a while for them to get restocked even after the directive ends. I have plenty of PPE at my ASC and if I didn't have concerns about Medicare and other insurers paying I would proceed. The hospitals here don't give a rats ass if they put me out of business or not. They aren't "team players" by any stretch and if they have millions to buy out primary care and orthopedic groups and build their own pain service, I don't feel I have any duty to support them.

From the patient perspective, most wish they could get what they need, be it a knee arthroplasty, Vertiflex, or permanent SCS. They live the pain and would like to get it resolved if they could. Ask them.

Yes, it is. Your argument is getting worse and more tangential. I have no love for hospitals and we own our ASC too. It’s not about propping them up, the government will take care of that. It’s about taking care of the community you hold so dear if the circumstances became so dire that another executive order is issued asking for that PPE or to use the ASC as an ICU.

From a patient perspective, could you share your new patient intake form where it asks how many oxy 30s and Xanax they’d like per month? They live the pain after all. Of course our patients want their procedures. Just like these spring breakers wanted their vacations. Doesn’t make either a good idea or in compliance with executive orders.

 

[Painted]

That is not the “entire directive”. If a patient has a procedure complication and gets admitted...that uses a lot more resources than just PPE. A fresh implant that gets Covid could have a worse outcome.

 

[Ferrismonk]

I could be wrong, but I don't think the medical board has any enforcement actions with emergency orders from the Governor. That is more of a legal issue.

In my state ASC and Hospital elective procedures are shut down by the state, but office procedures are not part of that stop order. Legally speaking, an IM toradol injection is viewed the same as an RFA if done in the office. That being said, we're being more judicious about patient selection, limiting steroid injections of any type, and only doing procedures for those in severe pain after discussing the risks.

I've deferred my stims and would also defer Vertiflex and Pumps if I did them because what if something bad happened and the patient had to go to the hospital? A complication requiring neurosurgical help? Not worth the risk to the patient.

 

[pmrmd]

Yes, it is. Your argument is getting worse and more tangential. I have no love for hospitals and we own our ASC too. It’s not about propping them up, the government will take care of that. It’s about taking care of the community you hold so dear if the circumstances became so dire that another executive order is issued asking for that PPE or to use the ASC as an ICU.

From a patient perspective, could you share your new patient intake form where it asks how many oxy 30s and Xanax they’d like per month? They live the pain after all. Of course our patients want their procedures. Just like these spring breakers wanted their vacations. Doesn’t make either a good idea or in compliance with executive orders.

I find your argument vague and more emotionally charged than anything else. "Taking care of my community that I hold so dear" means helping those that come through my door given they meet criteria. You have to create hypotheticals to try to make a point which doesn't make your argument valid. Lol at an EO to command use of the ASC as an ICU.

 

[pmrmd]

That is not the “entire directive”. If a patient has a procedure complication and gets admitted...that uses a lot more resources than just PPE. A fresh implant that gets Covid could have a worse outcome.

Fair point, but a complication in this field requiring PPE means surgery. If anyone is having those kinds of complications that require surgery they may consider prolonging that hold on procedures forever.

 

[unchockey21]

I find your argument vague and more emotionally charged than anything else. "Taking care of my community that I hold so dear" means helping those that come through my door given they meet criteria. You have to create hypotheticals to try to make a point which doesn't make your argument valid. Lol at an EO to command use of the ASC as an ICU.

No emotions needed. It’s there in black and white, at least in our order. Your argument seems to be that if a patient wants a procedure, they get it. That’s clearly not how our order is written. But if you think SCS and Vertiflex are non-elective procedures, there’s no point discussing it further because anything is going appear vague with that haze of green clouding your judgment.

 

[Painted]

Well maybe you should remove those complications from your consent then since they are not a possibility.
Seriously, Obviously rare but why risk it?

 

[pmrmd]

No emotions needed. It’s there in black and white, at least in our order. Your argument seems to be that if a patient wants a procedure, they get it. That’s clearly not how our order is written. But if you think SCS and Vertiflex are non-elective procedures, there’s no point discussing it further because anything is going appear vague with that haze of green clouding your judgment.

Try to stick to the facts instead of the insinuations if you can. My argument is that procedures are cancelled to preserve PPE and that rationale on the face of it is nonsense. You could do procedures in your own ASC safely on the appropriate patients and not be a burden to your health system. From what I can tell your best argument to not proceed is that your governor may command you to put a vent patient in your OR.

 

[hyperalgesia]

It's looks like things are far better than they could have been. The argument would be different if local hospitals were flooded, out of PPE, and people were dying because of it.

 

[Agast]

Patients will beg you to be a pal and give them the procedure they want and then won’t hesitate to sue you (or their family sues you if they die) if they end up in the hospital with COVID. It’s not a favor if you’re getting paid.

 

[deleted131481]

Some very questionable justification here for elective procedures which clearly governor orders and medical boards have directed temporary stoppage for.

The majority here understand what that means.

Other$ will not.

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[lobelsteve]

Some very questionable justification here for elective procedures which clearly governor orders and medical boards have directed temporary stoppage for.

The majority here understand what that means.

Other$ will not.

Sent from my Pixel 3 using Tapatalk

It is state dependent.

 

[pmrmd]

Elective procedures are simply a metaphor for the broad economic damage caused by these state shutdowns. History won’t be kind.

 

[Ducttape]

you must be in a location with no problems with access to surgical equipment. some states, apparently especially Florida, were sent significant amounts of PPE that were not needed.

at present, locally, all healthcare workers are being told that masks are good for a week - ie 7 days - if not soiled, and all hospital personnel are being given face shields to keep the masks unsoiled. hand sanitizer is being donated from distilleries because lack of supplies.

I have been wearing the same surgical mask for 5 days. in the pain clinic, there is 1 box of procedure masks. 20 masks in that box, for patients who check in, and I last grabbed one last week when noone was not looking.

 

[lobelsteve]

Some very questionable justification here for elective procedures which clearly governor orders and medical boards have directed temporary stoppage for.

The majority here understand what that means.

Other$ will not.

Sent from my Pixel 3 using Tapatalk

WWE deemed an essential service, returns to live televised shows | CNN

Professional sports in Florida are getting the green light to resume production after the Florida Governor's Office deemed them "essential services."

www.cnn.com

Not an argument for or against procedures.

 

[SommeRiver]

Doesn’t make either a good idea or in compliance with executive orders.

Is the reporting of another physician bc of your belief in the medical risk or bc they're not "in compliance with executive orders?"

That is two separate things IMO.

WWE deemed an essential service, returns to live televised shows | CNN

Professional sports in Florida are getting the green light to resume production after the Florida Governor's Office deemed them "essential services."

www.cnn.com

Not an argument for or against procedures.

Ha!

 

[clubdeac]

WWE deemed an essential service, returns to live televised shows | CNN

Professional sports in Florida are getting the green light to resume production after the Florida Governor's Office deemed them "essential services."

www.cnn.com

Not an argument for or against procedures.

I saw that they were considered "essential". Is it not insane that they are essential while we are on here bickering back and forth about whether we should be. We are truly in a state of complete ridiculousness

 

[Ducttape]

I think if you looked at this Republican Governor's actions, you would understand that the ridiculousness lies with him.

same Governor who said he "just found out" that it could be transmitted by an asymptomatic carrier roughly 3 months after that news came out.
same Governor who decided to issue a "stay-at-home" order based on Trumps demeanor at his daily press conference.
same Governor that believed that college kids on Spring Break at the beaches, wearing nothing but bikinis and swim trunks, would maintain "social distancing".



otoh, when I was a that young, my definition of "social distancing" would be a lot different than it is now...

 

[SommeRiver]

We will look back at this one day and realize this was not worth shutting down the country and pushing millions and millions of individuals into unemployment.

 

[hyperalgesia]

We will look back at this one day and realize this was not worth shutting down the country and pushing millions and millions of individuals into unemployment.

What was the alternative - a watered down version? Working through it? Time will tell us more but the potential devastation of the outbreak without mitigation was dire. Maybe a more targeted "shut down" would have been better but I guess we're just still in the dark about the virus' lethality and transmission. But each governor did what they thought was right.

I think our biggest weakness in the US is health/personal privacy. South Korea mandates tracking of COVID pts by their cell phones.

 

[Sig123]

Colorado lost its ability to dictate closures when they closed recreational MJ dispensaries for 3 hours before re-opening them under the guise of "essential." Essential to their tax revenue.

 

[deleted131481]

WWE deemed an essential service, returns to live televised shows | CNN

Professional sports in Florida are getting the green light to resume production after the Florida Governor's Office deemed them "essential services."

www.cnn.com

Not an argument for or against procedures.

Wrestler in the pic will need emergent kypho shortly!

Agree it is state dependent. I suspect my state will lift restrictions by May 1, but in the meantime we're sitting tight.

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[ateria radicularis magna]

We will look back at this one day and realize this was not worth shutting down the country and pushing millions and millions of individuals into unemployment.

Correction—
Some people will look back and realize it was not worth shutting down the country.
Some people will look back and realize it was the shutting down of the country that saved the country.
These two sides will never agree.
Duality is a b***h

 

[Ducttape]

We will look back at this one day and realize this was not worth shutting down the country and pushing millions and millions of individuals into unemployment.

I'm willing to bet the families of the 28,000+ Americans who died would have wished more was done, sooner...

 

[pmrmd]

^ I’m sure they feel the same way the family does with deaths from all causes.

Seriously this China information coming to light is the first glimpse of the impending geopolitical denouement.

 

[SSdoc33]

^ I’m sure they feel the same way the family does with deaths from all causes.

Seriously this China information coming to light is the first glimpse of the impending geopolitical denouement.

No, its not. China will skate. They are too important to everyone's economy. Last thing we need is a worsening trade war on the heels of a global depression

 

[lobelsteve]

No, its not. China will skate. They are too important to everyone's economy. Last thing we need is a worsening trade war on the heels of a global depression

Orange man will not let China skate. Puff up his chest and take us to brink of WWIII.

 

[pmrmd]

No, its not. China will skate. They are too important to everyone's economy. Last thing we need is a worsening trade war on the heels of a global depression

After a short time the entire world is going to be pissed if they were playing in some lab and ended up causing this catastrophe. Wrongful death lawsuits galore and that’s just on an individual level. Moving the supply chains isn’t impossible and the CCP is going to be fighting to save face. It won’t just be the U.S. No way.

More apropos, looks like elective procedures resuming here very soon. Hospitals going broke.

 

[unchockey21]

Is the reporting of another physician bc of your belief in the medical risk or bc they're not "in compliance with executive orders?"

That is two separate things IMO.



Ha!

Like I said to pmrmd, I didn’t report anything. I was just told something had been filed when I was talking about it with some colleagues. I had assumed it was to the medical board but as Ferrismonk pointed out it may have been to the state. I’ve got enough to deal with as it is between tech support to the elderly while trying to do telemedicine, teaching my second grader fractions, and filming my Blinding Lights TikTok dance mix without getting involved in that.

In this specific case, this dude is a non fellowship trained doc with a history of shady activity. Between what he’s shown in the past and what I’ve been specifically told in regards to this instance from multiple people, I have zero doubt that financial considerations are the only thing at play here. Not the patient. Hence why I won’t waste a bit of time feeling sorry for the guy if something does happen. Now you can debate ad nauseam about whether these executive orders should have been put in place or what the true health risk is. The fact is people are being reported. I know of at least one ASC that got busted in FL and another doc in NM. Disgruntled employees and patients, family members and PCPs who think you put their loved one/patient at risk, etc. could all potentially pick up that whistle. If you’re conducting business as usual, you’re taking that risk.

 

[SSdoc33]

After a short time the entire world is going to be pissed if they were playing in some lab and ended up causing this catastrophe. Wrongful death lawsuits galore and that’s just on an individual level. Moving the supply chains isn’t impossible and the CCP is going to be fighting to save face. It won’t just be the U.S. No way.

More apropos, looks like elective procedures resuming here very soon. Hospitals going broke.

if it is indeed determined that someone in the Wuhan Virology lab forgot to wear their hazmat suit, then we'll talk. i think that is a pretty unlikely scenario, and i cant imagine we will ever really find out, but if it is proven, then china really effed up. however, most people (in and out of gvt) would rather work with china to build things back up quicker. there wont be much appetite for a $1500 iphone when there is a global depression.

 

[SSdoc33]

More apropos, looks like elective procedures resuming here very soon. Hospitals going broke.

so, im thinking that we will start doing our shots pretty soon. i can reasonably tell a patient that they need to wait several weeks for an ESI or RF. i cant reasonably tell them they need to wait months and months with no end in sight. at some point, these "maintenance injections" do become a medical necessity. i am in a pretty hard hit state, but i think that by early-ish May, the shots will start to resume in earnest.....