In The Trenches at ABC

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1. Yeferson
   

   DocThank you. I've seen similar saiuttions. One of my favorite babies from our maternal fetal medicine practice was a little girl who was born with a giant oomphalocele, dislocated hip, and cardiac defect. There were no structural brain defects noted on ultrasound, but there had been the usual concerns that multiple identified anomalies might be accompanied by further problems. She sailed through the multiple corrective surgeries and did well. The last time I saw her, she was a bright, interactive 2 y/o with a good vocabulary and considered ahead of the curve developmentally.Unrelated to that tale, there was a medical director at one of the managed care plans who would allow medical exceptions and order payments for new and often expensive treatments that were not on the fee schedule. Of course, a fee schedule always lags behind medical innovation so the authorizations are booted to the medical director. The story goes that this particular medical director had been counseled that he needed to quit approving payment for such treatments. Since he was a doctor who was supposed to use his best medical judgment, he continued to approve what he considered reasonable or necessary treatments. He was fired and replaced.I have no interest in returning to a job in nursing or managed care. A comfortable paycheck would be nice, but the frustration is no longer worth it.Hint: some land, a tractor, a greenhouse, and some seeds can make for a relaxed time.

   June 29, 2012 at 12:27 pm | Reply