Youtube:Private Pain Practice Response to COVID-19 w. Dr. Timothy Deer

[drusso]

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[lonelobo]

 

[hyperalgesia]

Dr. Deer is basically leaving it up to pts to decide what is "elective", other than his exclusions of SCS, pumps, etc.

I don't necessarily think he and many others have bad intentions. So much of your approach depends on your personal assessment of COVID in your area.

I guess, like many other issues, it's really about a person's intentions and motivations.

 

[Agast]

That makes sense. Who knows better than a patient how bad their pain really is? That’s why I always ask them how much oxycodone they want and what strength it should be. It’s essential to take this pain seriously!

 

[hyperalgesia]

That makes sense. Who knows better than a patient how bad their pain really is? That’s why I always ask them how much oxycodone they want and what strength it should be. It’s essential to take this pain seriously!

I have to believe the guidance/orders left this wiggle room on purpose. Governors could have said all medical is cancelled except "threat to loss of life or limb". They did not. They used the term "elective", which has one meaning for physicians and a totally different meaning for everyone else.

I'm doing 100% telehealth because I truly fear the letting this thing into my clinic. How can we say something is "urgent" and not be available on weekends? But time will tell. If there's an outbreak at a clinic/office, it will be an ugly exposure.

 

[Agast]

I think the purpose of the wiggle room is to acknowledge that the state doesn’t know what every single surgery is for and so hopes the doctors will use their best judgement. Sort of like hoping people will sit their asses at home and not throw backyard BBQs.

A reasonable question to ask yourself would be, if your patient died 11 days later from coronavirus and people started looking into what you did, would you still be firmly convinced that your procedure was truly urgent and could not have waited? A beloved patient of mine had cardiac clearance to hold his plavix and he really, really wanted the epidural. 3 days later he died in his sleep and forever I will wonder what part I played in it. I’d rather have him back than the $150 that’s for sure. It’s too easy to be cavalier because what we do is so quick with almost immediate pay off. I hate not working and I hate not making money, but not causing harm is priceless.

 

[hyperalgesia]

The term "elective" includes medical procedures that are not immediately medically necessary to preserve the patient's life or long-term health, except that procedures that cannot be postponed without compromising the patient's long- term health, procedures that cannot be performed consistent with other law at a later date, or procedures that are religiously mandated shall not be considered "elective" under this Order.

https://governor.wv.gov/Documents/EO%2016-20electiveprocedures.pdf

My interpretation from this is that ALL pain procedures are deemed "elective" by the state of WV. It's a stretch to say you are compromising a patient's "long-term health" by postponing a pain procedure. So Dr. Deer is on thin ice here imo.

 

[bedrock]

Deer is definitely not the guy I look toward for ethical guidance in any part of pain medicine, before COVID, during, or after COVID.

 

[paindoc007]

Deer is definitely not the guy I look toward for ethical guidance in any part of pain medicine, before COVID, during, or after COVID.

why all the hate

 

[lobelsteve]

I think the purpose of the wiggle room is to acknowledge that the state doesn’t know what every single surgery is for and so hopes the doctors will use their best judgement. Sort of like hoping people will sit their asses at home and not throw backyard BBQs.

A reasonable question to ask yourself would be, if your patient died 11 days later from coronavirus and people started looking into what you did, would you still be firmly convinced that your procedure was truly urgent and could not have waited? A beloved patient of mine had cardiac clearance to hold his plavix and he really, really wanted the epidural. 3 days later he died in his sleep and forever I will wonder what part I played in it. I’d rather have him back than the $150 that’s for sure. It’s too easy to be cavalier because what we do is so quick with almost immediate pay off. I hate not working and I hate not making money, but not causing harm is priceless.

Thats why we are moving away from holding antiplatelet and anticoagulant therapy for epidurals.

 

[SSdoc33]

Thats why we are moving away from holding antiplatelet and anticoagulant therapy for epidurals.

That is not the conclusion you should have drawn from her post. Well stated, agast....

 

[bedrock]

Thats why we are moving away from holding antiplatelet and anticoagulant therapy for epidurals.

I agree there is a current debate on this regarding TFESI, particularly with small needles, but I don’t ever see myself not holding thinners for ILESI.

 

[ateria radicularis magna]

That is not the conclusion you should have drawn from her post. Well stated, agast....

I’m pretty sure it’s possible to conclude an infinite number of things from any presentation of ideas, none of which is invalid in any sense but an arbitrary one.

 

[ateria radicularis magna]

why all the hate

Dollars for Docs

ProPublica has compiled the disclosed payments from pharma companies to doctors and other health care providers. Search for your doctor in our interactive database.

projects.propublica.org

 

[paindoc007]

Dollars for Docs

ProPublica has compiled the disclosed payments from pharma companies to doctors and other health care providers. Search for your doctor in our interactive database.

projects.propublica.org

Dollars for Docs

ProPublica has compiled the disclosed payments from pharma companies to doctors and other health care providers. Search for your doctor in our interactive database.

projects.propublica.org

The highest earning on the website. I knew I recognized the name. This was the PD for Dr Death. Go figure

 

[Ducttape]

why all the hate

Anyone who cleared, in a single year, $881,000 from device reps may be a little biased...

 

[unchockey21]

Anyone who cleared, in a single year, $881,000 from device reps may be a little biased...

Couldn’t disagree more. You cannot possibly be biased if you’re accepting money from every company. They all cancel each other out!

 

[drusso]

Anyone who cleared, in a single year, $881,000 from device reps may be a little biased...

Maybe he's just more evolved.

 

[Ducttape]

Well without debate he is a lot richer than I.

 

[deleted993114]

Deer is definitely not the guy I look toward for ethical guidance in any part of pain medicine, before COVID, during, or after COVID.

I agree- his name should never appear in a discussion of ethics.

 

[metadr]

On a lighter topic

 

[lonelobo]

LMFAO

 

[deleted993114]

why all the hate

I contrast Deer with Ken Follett. Follett (now retired) was one of the kindest, most ethical neurosurgeons in the field of neuromodulation and was not purchased by the equipment companies (God knows they tried). You could trust what he said, as it was not influenced by money. I can't say the same about MANY of the speakers who appear at the neuromodulation meetings.

Everybody likes money; however, there are some things that are not worth the money.

 

[cowboydoc]

I contrast Deer with Ken Follett. Follett (now retired) was one of the kindest, most ethical neurosurgeons in the field of neuromodulation and was not purchased by the equipment companies (God knows they tried). You could trust what he said, as it was not influenced by money. I can't say the same about MANY of the speakers who appear at the neuromodulation meetings.

Everybody likes money; however, there are some things that are not worth the money.

He timed that impeccably. Now to find competent DBS performing physician between Denver and Chicago...