Surgery Center of Oklahoma Blog

August 16, 2011

State Politics

Filed under: Uncategorized — surgerycenterok @ 1:13 am

I remember in a presidential debate one time when Robert Dole was asked if there was an issue over which he was willing to lose.  Dole could not answer the question, obviously because there was no issue he felt strongly enough about to lose.  Like the vast majority of legislators he had no principles.   Last week I met two state legislators that are principled.  The are not registered libertarians but they might as well be.  I hope that the foul political process doesn’t change their thinking.   I hope that when and if they see this blog they will know how much that principled leadership is appreciated and needed.  They are under constant pressure to bend and compromise but do not appear to be swayed.  I am not sure if I should feel hopefulness that individuals like this are involved in politics or to despise them for giving me that hope and optimism, as I have been let down many times before by the political trimmers.  Has the time come for people to follow principled leadership or are the vast majority of voters still willing to sell their vote for promises of government handouts? Time will tell.

G. Keith Smith, M.D

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August 15, 2011

Ron Paul

Filed under: Uncategorized — surgerycenterok @ 3:51 pm

Check out this highlight video from the recent republican presidential debate in Iowa. At about 4:19 into the video, Dr. Paul talks like no other, mentioning the government and corporate influence on medical practice and how it interferes with the doctor-patient relationship.  This is blockbuster stuff.  He is wielding a meat axe at those who would control our health care and making an extremely strong case for free markets in medicine.

G. Keith Smith, M.D.

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August 14, 2011

Government-Funded Research

Filed under: Uncategorized — surgerycenterok @ 10:18 pm

In June of 1995 the journal of the American Society of Anesthesiologists published this letter of mine.  I was beginning to understand that the political process contaminates everything it touches, including medical research.  A shocking article on shows how the CDC collaborated with the World Health Organization to create the phony swine flu pandemic.  Incredibly, the article linked at the end of this article reveals that experts advising the World Health Organization had conflicts of interest with companies manufacturing the recommended vaccines.

Medical research is too important to involve the corrupt influence of politics D.C. style.  The decisions for what diseases and drugs are investigated and the conclusions themselves have to be suspect if government money is involved at any point in the process.  As I have said in previous blogs, what are the chances that a cure for AIDS, for instance, will ever be found if this discovery puts all of the labs looking for it out of business?  What is the likelihood that money changes hands at the FDA so that the bribing company’s drug is the one found to be effective for treatment  and the only one getting approval by the FDA?

Don’t think this can happen?  Don’t think this has happened?  Federal funds for medical research should be eliminated for lots of reasons, not the least of which is the looming bankruptcy of the government.

G. Keith Smith, M.D.

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Indian Health Care

Filed under: Uncategorized — surgerycenterok @ 7:13 pm

Do free markets in medicine exist?  Barely.  The Surgery Center of Oklahoma is an example.  There are others.  Many physicians in private practice do not accept government money.  There are more and more that don’t accept payment from third parties, at all.  Most of the medical care delivered in this country is not free market, though.  Most of it is paid for by third parties and by the government.  The extent to which the market is absent is the extent to which the price tends to rise and the quality tends to fall.  The extent to which the market is absent is the extent to which fraudulent billing practices rear their ugly head.  But make no mistake.  The market-based practice of medicine even though battered and bruised and under constant attack  wields a power that no government thug or agency can match.  In fact, I would maintain that it is the small but powerful force of free market, private practice medicine that holds the entire mess of health care in this country together (otherwise why would Canadian politicians come to the U.S. for their care?!).  If every hospital were like the government VA hospitals or the Indian Health Service, there would be riots by angry patients.  Where is the drive for excellence and price fairness most acute?  In the private market where competition is intense.  If a private practice doctor is no good and charges too much, he is out of business…unemployed.  If a government doctor is no good he probably gets transferred to torture patients somewhere else  that likewise can’t do anything about it and have no alternatives.

An article in our local newspaper today mentions the need for more money for Indian health facilities and Indian doctors.  Seriously?  Why not close these abysmal facilities and make great care available to these folks?  Why not close the VA hospitals altogether and use local hospitals for the military and veteran care?  Why shouldn’t the vets and Indians have access to great care, not the trashy government provided type they have put up with for years?  Wow!  Better care for less money with the savings of closing these  government facilities?  Makes too much sense, doesn’t it?

The Surgery Center of Oklahoma has had arrangements and contracts with Oklahoma tribes over the years.  This has worked beautifully for the tribes with regard to the quality of services provided and the price charged.  I have often wondered why the tribes didn’t outsource all of their medical care rather than maintain their own facilities that are high priced and extremely inefficient.  The money that we have saved the tribes over the years is a great example of Bastiat’s “what is not seen.”  The complications that have not occurred due to the high standards at physician offices and facilities exposed to the discipline of the free market is another example of Bastiat’s “what is not seen.”    Less government medicine and more free market alternatives are what the Indian tribes should be working for as this will provide the quality and price combination that is otherwise unattainable.

G. Keith Smith, M.D.

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August 11, 2011

Electronic Medical Records Part 2

Filed under: Electronic Medical Records — surgerycenterok @ 6:55 pm

Imagine that you are a cardiologist.  You work at a large hospital in Oklahoma City.  You are about to perform a heart catheterization on a patient.  The “system goes down.”  What ?  You mean that a computer system might fail?  You have no medical records because they are digitalized on “the system.”   You have no idea what this patient’s history is or what it is they need or what you had planned to do for them.  You ask the patient,” you mind telling me what it is that I see you for?”

This would be crazy if it weren’t true.  This happened here in Oklahoma City.  There wasn’t a paper chart or handwritten notes to rely on.

Imagine that you are a surgeon that always prescribes the same thing for patients just prior to surgery.  Eye drops. Antibiotics. Ear drops.  Nose drops.  Everytime.  The system doesn’t post these “standing” orders for one reason or another.  In a world full of human beings the nurse would think, “Dr. X always gives his patients Afrin nose spray and antibiotics prior to their surgery.  I know that’s what he wants even though this order didn’t come through.”  He or she would then give the appropriate meds.  In a world full of robots, however, that have been told not to think, but just do what is on the order list, this medical error would result in the patient not getting what they needed.  This would be crazy if it weren’t true and happening every day at a large hospital here in town.

Imagine that you are  a patient and you have gone to see your doctor whose practice was destroyed by a hospital administrator and is now an employee of the hospital and his computer system is “integrated” with that of his employer.  Your (well…formerly your) doctor types your responses to questions that the computer is prompting him to ask you with his back to you the entire time.  One of your answers is not on the list of acceptable preconceived responses listed by the computer.  The doctor says,”your response is not on here.  I need for you to say that it is one of the three things that are listed here.”  This, too, would be crazy if it weren’t true.

Imagine that your child has had their tonsils removed and starts bleeding the next day (a legitimate medical emergency).  You go to the emergency room where with no code for “acute post-tonsillectomy bleeding” your child’s computer label is “wound drainage.”  This label fails to communicate the urgency of the situation and the staff at the emergency room wait far too long to address this.  This, also, would be crazy if it weren’t true.

Imagine that five years from now your physician has lost his license to practice medicine or has been blacklisted by your insurance company because the treatments he/she recommended (while perfectly suited for you) didn’t match up with the “best practices” paradigm designed by computer testing models.  If a recommended treatment doesn’t match up with the pattern of data in the electronic patient survey (most of us still call this the patient’s chart) that physician is in trouble.  This type of control is well on its way thanks to our wonderful public servants in D.C.

Are you ready for it?

G. Keith Smith, M.D.

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August 10, 2011


Filed under: Uncategorized — surgerycenterok @ 7:39 pm

The man in the White House is an idiot.  He has issued new fuel standards that vehicles (even existing ones) must meet.  Changes to these vehicles necessary to comply with the new fuel regulations will cost hundreds of dollars for some vehicles and thousands of dollars for others.  The idiot said that over the life of the vehicle this money will be saved many times over due to lower fuel consumption.

This above is true and is how I would have written it 15 years ago when I thought people in D.C. were stupid.  The political class in D.C. should not be given the benefit of the accusation of stupidity.  The political class in D.C. is no more than a criminal gang.  While most of the folks in the grim shake-down business of government didn’t start off as coercive advocates of the criminal activity they are involved in now, the vast majority quickly succumb to the various temptations D.C. offers.  There are exceptions.  Not many.  Probably not 10 men in the house/senate/white house in the last 25 years.

Here is how I would write it now:

The man in the White House has shown once again that he is bought and paid for.  The new fuel standards issued for new and existing vehicles will serve to direct money to the unions of the major car companies and the “green” groups that have no doubt geared up their aftermarket modifications in anticipation of this political pay off.  If indeed a company would save in fuel costs many times over what these mandatory new government standards will supposedly save, wouldn’t the business owner do this on their own without the coercion of the state?  Why would the state need to force businesses to do for themselves what was good for the businesses?  Answer:  if you answered because this is all lies and will not be good for these businesses you go to the head of the class.

The same holds for health care.  Remember how the thugs in D.C. told us that the  health care plan would save businesses and the country money?  Remember how we were all promised that this bill would reign in the deficit?  Read this.  The political class knows what they are doing.  All of the time and energy spent trying to educate our representatives so they will make an informed decision is wasted.  The decision made will be the one that makes them the most money and/or increases their power/position the most.  The criminal class in D.C. knows that national health care will be a disaster.  They know that there will be rationing.  They know that people will die in line.  They know that the care will be awful.  They knew that this bill would significantly contribute to unemployment.  They knew that more unemployed folks meant more folks dependent on Uncle Sam.  A larger constituency.  More votes.  More, secure power.  And don’t forget the countless opportunities for bribes.  Think folks will try to bribe their way to the front of the line so their child can have their heart surgery before they die waiting?  Extortion and bribery will be the rule all along the rationing lines.  The most sought after jobs will be those government positions where access to various government goodies can be sold and bribery is commonplace.  Think Mexico/Latin America type corruption where the bribery is open and assumed.  I maintain that this is what the political class wants for the rest of us.  They do not get to play stupid.  Don’t give them that.

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Electronic Medical Records

Filed under: Electronic Medical Records — surgerycenterok @ 1:51 am

This sounds like a great idea, doesn’t it?  Have all of your medical information on a disk or a chip so that if you are in car wreck you will receive better care.  Have all of your information digitalized so that if you go to see a specialist they can look at your complete medical history and not miss a beat.  What could be wrong with this?  Doesn’t the digitalization of medical information benefit the patient?

If you have been following this blog you are either laughing or cursing by now.  The federal government is requiring everyone that takes federal money (Medicare/Medicaid) to convert to EMR or accept the punishment of a lower payment.  Why does the federal government care?  What possible benefit could this be to them?  Control?  Do you think?  Duh! That they want this is reason enough to resist!

Once medical information is digitalized it can be analyzed and categorized and, poof!, you’re a statistic!  Once the feds realize that 20% of federal dollars are spent on cancer care for instance, poof!, there’s a great way to save 20%!  You get the idea?  And all for our benefit.

What about patient confidentiality?  POOF!  GONE!  Stories about the theft of laptop computers containing raw patient information have been reported lately.  These patients’ data could be used to deny them care later or used for identity theft…you get the idea. Once the data is on a disk the patient’s medical information is not as secure as it is on a paper chart.

Could end of life euthanasia decisions be made using statistical analysis of this data?  Surely not!  Think again.  All of the national health care schemes have run into bankruptcy scenarios.  You think that with the government’s back against the wall they won’t tell a citizen that it is their patriotic duty to “take one for the team?”

We don’t utilize EMR at the Surgery Center of Oklahoma.  Partly due to patient confidentiality concerns.  Partly because every operating room I’ve ever been in that has computer capability results in a nurse with her back to the surgeon and patient, typing constantly.  Not good patient care, in my humble opinion.

Some physician offices utilize EMR for efficiency reasons.  I have no problem with this if they take confidentiality concerns seriously.  Once the data goes to the hospital computer system, all bets are off, though, I’m afraid.  The worst scenario?  Hospitals networking with physician offices so that they are integrated. Now the patient is an afterthought.  Confidentiality means nothing.  You should ask your physician if their EMR is integrated with the hospital they are working with/for.  If so, I would find another doctor.  You information is not safe.

G. Keith Smith, M.D.

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August 9, 2011

Vichy Doctors

Filed under: Uncategorized — surgerycenterok @ 9:57 pm

It is one thing for a physician to surrender to a hospital administration bent on destroying private practice for as far as the eye can see.  Physicians typically have mortgages and bills to pay, kids in private school, etc.  Physicians are not great with money, typically being short-sighted with finances.  Fear takes over, and the next thing they know they are a hospital employee, a decision they will regret for the rest of their career in the vast majority of instances.

It is quite another thing for a physician to seek the job of the hatchet man.  These physicians have such fear that they don’t want to just participate as employees, they want to get on the inside and be decision makers over those with whom they previously could not compete.  They want power because they are consumed with fear….fear of what the free market would do to them if they were practicing on their own.  These individuals are universally hated by the medical community and are perceived as evil doers by many.  I think they are the wimp doctors…the sell-outs….the Vichy doctors, as I have called them for years…the collaborators.  They use strong-arm tactics to bully private practice physicians and legitimize the scheming of their bosses the wonderful hospital administrators that are, of course, not wanting to make a profit.

In the mid ’90′s these jerks led the way for hospital physician organizations (HPO’s, or PHO’s).  These organizations were  a disaster and didn’t last.  These fear-mongers along with the hospital administrators tried to capitalize on the fear that the Clinton health care plan if passed (and that was a certainty we were told) would destroy our private practices….. so why not surrender now while the getting is good?  Every one of the physicians I know that became Vichy doctors were vilified and their reputations destroyed as sell-outs when none of this came about.

Now we face Obamacare.  Once again, the fear mongers are at work.  Once again there are physicians out there all too willing to participate in wielding the hatchet at the private practice physician hold-outs.  Some of the Vichy doctors are small mousy men that kids used to beat up on the playground.  Some of them are poster children for narcissistic personality disorder.  They have abandoned their oath as physicians and have the morals and ethics of most congressmen.  They are all collaborators and will, like their predecessors,  find their reputations in the toilet, I predict, once the insanity of government medicine for all is outed as the denier and killer it is.

G. Keith Smith, M.D.

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Infection Rates

Filed under: Uncategorized — surgerycenterok @ 3:43 pm

Someone sent me this article. The gist of the article is that surgery centers are lax on infection control procedures.  A whole host of folks are quoted in the article saying that surgery centers need to be held to the same high standards that hospitals are.  If you have been following this blog you are laughing right now.

You should be asking yourself “why are state health departments cracking down on surgery centers with these infection control procedure violations now?”  If this has been an issue why the crackdown now?  Well it just so happens that our wonderful federal government that has more money that it knows how to spend gave state health departments funds to conduct this very activity in the last “stimulus package.”  I know this because when the Oklahoma State Department of Health came to our surgery center I asked them about this.

Why would the gangsters in Washington want to give money (that they don’t have) to state health departments to attempt to discredit surgery centers?  Notice two things:  hospitals were not included in this crackdown and they are reporting on departures from procedures, not infection rates.  Could politics be involved?  Think any money changed hands from the hospitals to our wonderful leaders in D.C.?  Or maybe there is a promise of future bribes like the American Hospital Association’s million dollar contract with former Oklahoma Senator Don Nickels who shortly after leaving the senate set up a lobbying company.  The AHA was his first customer and this contract was on the heels of his offering extremely anti-competitive surgery center crushing legislation.  Ahh…business the D.C. way!

What you will not see is a comparison of infection rates between surgery centers and hospitals.  This would be devastating information for the hospitals.  This type of press release just shows how desperate the hospitals are to avoid having to compete with surgery centers.

We have published our infection rates online.  I would encourage our hospital friends to be transparent not only about their pricing but also about their infection rates.  Focusing on breaches of procedure is a smoke screen meant to prevent folks from looking at results.

G. Keith Smith, M.D.

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August 8, 2011

Leonard Read

Filed under: Uncategorized — surgerycenterok @ 3:11 am

Check out the Foundation for Economic Education. This outfit was founded by the great libertarian Leonard Read.  There is absolutely no way to better acquaint oneself with the great political philosophy of non-aggression than familiarizing yourself with his works.  My favorites are “Anything That’s Peaceful,” “Elements of Libertarian Leadership,” and “I Pencil.” …you can read “I Pencil” here.

I thought of him this weekend while visiting with a friend who is going through the angry phase of the wake up to reality that I believe many libertarians go through on their philosophical journey.  This anger finds its way into the politics of medicine.  Forcing people to undergo drug tests.  Forcing sterilization or abortion.  These are the methods of the aggressive, non-peaceful men that are tired of being robbed.  The right approach was, according to Read, always a non-aggressive, loving approach.  He was an intensely Christian man and his political views were as consistent with his faith as any man that has written about political economy or political philosophy, in my humble opinion.  His writings had an intense impact on me, not only his philosophy but his faith.

His answer, by the way to the above scenario would be to characterize the event that led to the creation of the welfare check as an aggressive, violent act of robbery.  Why discuss how to dispense with the money?  What about the original crime and victim?  His writings always seem to bring peace in troubled times.

G. Keith Smith, M.D.

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