Communicating

My malpractice is through SVMIC.  They periodically sent out a newsletter with upcoming seminars and an article or two on ways to improve your practice/ decrease your risk of getting sued.  The current issue’s article is “Communicating with Patients Who Are Deaf.”

The article reminds us in health care of the Americans with Disabilities Act (ADA) which prohibits all physician's offices (except those operated by religious entities but notes the similar Rehabilitation Act of 1973 covers physician’s offices operated by religious entities) from discriminating against people with disabilities, including those who are deaf.

Key Points:

1.  The physician’s office must provide effective communication which meet the patient’s individual needs.

2.  The physician’s office must pay for the cost – qualified interpreter, video interpreting service, etc.

3.  If there are two equally effective methods or sources, the physician has the right to chose the most cost effective.  The caveat here is equally effective for the individual patient. 

4.  The physician’s office is prohibited from passing along the cost of providing the auxiliary aids/services to the the patient.

5.   The ADA does allow physicians to refuse to provide a specific auxiliary aid/service if doing so will create an undue financial burden (significant difficulty or expense).  This is hard to prove, as it isn’t as simple as weighing the cost of the service against the payment for the appointment.

Examples of auxillary aids and service include 1) qualified interpreter, 2) note takers, 3) open or closed captioning, 4) video interpreting services, and 5) exchange of written notes.

REFERENCES

1.  Deaf Patients, Doctors, and the Law:  Compelling a Conversation about Communication (pdf file); 2008, Florida State Law Review, Vol 35:947

2.  Communication with Deaf and Hard-of-hearing People: A Guide for Medical Education; Barnett, Steven MD; Academic Medicine: July 2002 - Volume 77 - Issue 7 - p 694-700

3. Department of Justice ADA Enforcement page 〈http://www.usdoj.gov/crt/ada/enforce.htm〉. Accessed 2/26/12. United States Department of Justice, Washington, DC, 2001.

A Day in My Life

Inspired by @GregSmithMD’s post:  A Day In The Life

Reviewing disability cases, here are the allegations from a recent day.  Each bullet represents one individual and their allegations of medical determinable impair (MDI):

• Hx surgery knee, reflex sympathetic dystrophy
• Sickle Cell Anemia
• Hypertension, Arthritis, and depression
• Buttock and elbow contusion
• Seizures
• Broken Ankles
• Stage II breast cancer, FM, chronic pain, asthma, sleep apnea, emergent rhinitis, urinary incontinence, migraines, eczema, adenomyosis, nephrolithiasis, RLS, HTN, GERD, lymphedema, plantar fasciitis, and mental
• Frozen RT ankle
• HIV/AIDS complicated by CMV

Stephen Hawking, ALS, and Disability

Updated 3/2017--all links removed as many no longer active. 

Stephen Hawking turns 70 today.  He was diagnosed with ALS almost 50 years ago when he was only 21.  It’s very unusual for someone with ALS to survive more than 5 years after being diagnosed.  It is because of this dire prognosis that SSI gives a person who meets the listing (11.10) for ALS begins benefits without having to endure the normal waiting period (pdf file).

………individuals with disabilities must wait five-months before receiving SSDI benefits. Finally, after receiving their SSDI benefits, individuals must wait an additional 24 months before they receive Medicare coverage. (Exceptions to the waiting period have been
made for individuals with ALS, and for those with end-stage renal disease.)

Scientific America has a very nice article by Katherine Harmon:  How Has Stephen Hawking Lived to 70 with ALS?

Stephen Hawking turns 70 on Sunday, beating the odds of a daunting diagnosis by nearly half a century.

The famous theoretical physicist has helped to bring his ideas about black holes and quantum gravity to a broad public audience. For much of his time in the public eye, though, he has been confined to a wheelchair by a form of the motor-neuron disease amyotrophic lateral sclerosis (ALS). And since 1985 he has had to speak through his trademark computer system—which he operates with his cheek—and have around-the-clock care.

But his disease seems hardly to have slowed him down. Hawking spent 30 years as a full professor of mathematics at the University of Cambridge. And he is currently the director of research at the school's Center for Theoretical Cosmology.  …….

Shout Outs

Updated 3/2017 -- photos and all links removed (except to my own posts) as many no longer active.


Amy Tenderich, Diabetes Mine blog, is the host for this week’s Grand Rounds. You can read this week’s edition here.

Welcome to Grand Rounds, Vol. 8, No. 9, the 2011 Thanksgiving edition of the weekly summary of the best health and medical blog posts on the web. Many thanks to the organizers at Get Better Health for inviting us to host!

In a world where major economies are imploding and a climate catastrophe seems impending, there is still much to be thankful for — especially in the arena of health and medicine, where technology is empowering a revolution of sorts in hospitals, clinics and doctors’ offices, and in patients’ everyday lives.

What We’re Collectively Thankful for, from all around the med-blogosphere:

Last week’s host, Alvaro Fernandez at Sharp Brains, is thankful that everyone contributing to and reading Grand Rounds has a human brain (no bots, we hope!), and thankful that the human brain is not fully pre-wired.  .….

…………………….…

H/T to @gastromom  for the link to this Huffington Post article by Dr. Rebecca Palacios:  Learning to Cook and Cooking to Learn

The holidays offer wonderful opportunities to create learning experiences for children that center around cooking. These experiences are especially powerful because they involve all of the senses: smelling, tasting, touching, hearing, and seeing -- which is one reason that memories created in the kitchen can last a lifetime! With a little thought and preparation, you can use this time to build important understandings and skills in literacy, mathematics, science, health, and even art. ……….

………………………………….

H/T to @doctorwes for alerting me to this WSJ article: Doctor Revolt Shakes Disability Program.  His link required a subscription for full access, but @MDBuyline sent me a tweet with a link to full article.  I’m still thinking about it (as this is the work I am now doing), but my initial reaction is that the article is selectively biased.  The graphics with the article are impress though – take this one for example (check out the interactive map here)

See how the percentage of residents ages 18 to 64 receiving disability benefits has changed in each state since 2001.

…………………………………

H/T to @sandnsurf for this tweet with link:  “Cool... Free e-book: Oh Doctor, The Places You Will Go... Precious Bodily Fluids t.co/FomfzD2r” 

  …….a parody of Dr Seuss' classic Oh, the Places You'll Go! It is a candid look at the journey people make in order to become doctors. I found it charming. Go download it. .…….

……………………………….

How about a book review by @medicallessons:  ‘Cutting For Stone,’ and Considering the Experience of Practicing Medicine

A short note on Cutting for Stone, a novel I’ve just read by Dr. Abraham Verghese. He’s an expert clin­ician and pro­fessor at Stanford. The author uses rich lan­guage to detail aspects of Ethiopian history, med­icine and quirks of human nature. The book’s a bit long but a page-​​turner, like some lives, taking a strange and some­times unex­pected course.

For today I thought I’d mention one passage that haunts me. …….…….

…………………………………

The Alliance for American Quilts received 119 quilts for it’s 2011 "Alliances: People, Patterns, Passion" contest.   You can see all the quilts here. My entry was “Redwork Quilt” and is included in this week’s (Week Two --Mon, Nov. 21- Mon, Nov. 28) quilts being auctioned off on eBay.

All contest quilts will be auctioned via eBay starting on Monday, November 14, 2011 and ending December 12, 2011. All proceeds will support the AAQ and its projects. ….

Week TWO auction guide: Monday, November 21 - Monday, November 28 ……
New this year: "Alliances" contest artist's were offered the chance to record their artist's statements thanks to the generous services of AAQ Business member, VoiceQuilt, visit them at www.voicequilt.com.

Learning, Part Two

Updated 3/2017 -- photos and all links removed as many no longer active. 

I have now completed three weeks at my new job with the Disability Determination Services office.  I sort of knew there were two types of disability payments under SSI:  Title II and Title XVI.  Now I understand the differences much clearer.

I would urge everyone who can afford it to purchase disability insurance.  As the person training me put it, “If you are disabled, you are still ‘costing’ your family in addition to not contributing to the family income.”

The big difference between the two (II and XVI) is that anyone who has worked and paid taxes has in effect purchased disability insurance (Title II – DIB).  Title II is not based on your I & R (income and resources) as you are insured.  Title XVI individuals are the truly poor who must meet an I& R test. 

Both Title II and Title XVI must the SSI definition of a disability to be eligible:  The individual must not be able to perform substantial gainful activity (SGA) due to a medically determinable impair (MDI) which can be substantiated by a medical consultant backed up by significant signs, symptoms, and laboratory data.  The MDI had to be one which is expected to result in death or which has lasted or will last 12 months.

The person training me is blind (due to RP).  Note he does not meet the able definition as he is working.  He is an amazing person who was a pediatrician prior to taking a job with DDS as his sight began to go.  He uses a program called JAWS to read to him at work, but types faster than I do.  He has the listings memorized.