First of all, a wonderfully happy and blissful 2009 to one and all!!
So I know that mum's the word around here, lately, and I do hope to get up and running again, soon.
In the meantime, it seems mighty big that peanut butter is getting recalled left and right, so I thought I would let everyone of you [3 or so people that check in here :)] know.
So, here are the facts: Peanut Corporation of America (and here) is doing a recall of peanut butter for fear of Salmonella contamination. Likewise, Kellogg (yes, THAT Kellogg) is recalling--preemptively--all peanut butter-containing products. There was also a recall of peanut butter by King Nut 2 days ago for the same reason.
Since peanut butter is a major indulgence for many, I thought I would post about this. As always, stay safe and healthy!
14 January 2009
26 October 2008
Time for an FDA recall alert
Well, I suppose that with this sort of thing, you just have to try it out for a few years, and see what happens.
There has been a worldwide (of course) recall on the HeartMate II Left Ventricular Assist System, which have been in use since November of 2003. The failure rate has been deemed unacceptable. Apparently the leads that connect the pump to the controller wear down significantly enough to affect pump function. "The estimated probability of the need for pump replacement due to percutaneous lead damage is 1.3% at 12 months, 6.5% at 24 months and 11.4% at 36 months." (as per the FDA site) THAT is significant!!
Left ventricular assist devices are essentially used to buy time for "CHFers" (Congestive Heart Failure patients) who are awaiting transplant, or they may even be used indefinitely in patients who are not candidates for transplant.
There has been a worldwide (of course) recall on the HeartMate II Left Ventricular Assist System, which have been in use since November of 2003. The failure rate has been deemed unacceptable. Apparently the leads that connect the pump to the controller wear down significantly enough to affect pump function. "The estimated probability of the need for pump replacement due to percutaneous lead damage is 1.3% at 12 months, 6.5% at 24 months and 11.4% at 36 months." (as per the FDA site) THAT is significant!!
Left ventricular assist devices are essentially used to buy time for "CHFers" (Congestive Heart Failure patients) who are awaiting transplant, or they may even be used indefinitely in patients who are not candidates for transplant.
11 October 2008
(Not So) French Toast
Those of you that have looked at the recipes here before have probably realized: I am not much of a sweets person. I am much more of a savory eater, and therefore, a savory cook. So, I guess it should not come as too much of a surprise that this morning's breakfast was what is commonly known as a sweet food, turned not-so-sweet.
Best served with some grilled sausages (you can use veggie sausages, if you prefer), this makes for a really quick, simple breakfast. By the way, the way I prepared the sausages:
slice up an onion and let the slices cook in a pan over a low flame for a good 10 minutes or so in a small amount of olive oil
add a healthy splash of balsamic vinegar
add the sausages in slices and let that cook over a (really) low flame until the sausages are browned
On to the bread...
You need:
3 eggs
1C milk (I used 2%, but anything, including soy, would be fine)
bread (4-5 large slices or 9-10 small)
healthy pinch of salt
1t marjoram
1t sweet savory
(I used dried herbs, as my Aerogarden has not yet produced its crop. By all means, if you have fresh, use them... and feel free to play around with other herbs.)
You do:
1. In a rather shallow bowl, beat together eggs and milk. Add salt and herbs; beat some more.
2. Start heating up a skillet over a low-medium flame. I used a le Crueset grill, to make everything pretty, but any skillet will do. Don't forget to coat with olive oil or non-stick spray. Alternatively, you can bake these--see below.*
3. Throw the slices of bread into the mixture and let soak--at least 1 minute/side.
4. Once the bread is saturated, and the grill is hot, place the slices on the grill so that they do not touch one-another. Cook until browned on both sides.
5. If you have more than one batch, they will keep warm in an oven at 250F.
Voila--not so French, but very nice.
*Now, for baking:
1. Preheat an oven to 425F.
perform steps 1 and 3 above
2. Prepare a baking sheet with non-stick spray.
3. Place the bread slices on the sheet so that they do not touch one another, and place into the preheated oven for 6 minutes or so.
4. Flip the slices and place back into the oven for an additional 5-6 minutes.
That is all. Very simple, quick, and tasty.
Enjoy!
Best served with some grilled sausages (you can use veggie sausages, if you prefer), this makes for a really quick, simple breakfast. By the way, the way I prepared the sausages:
slice up an onion and let the slices cook in a pan over a low flame for a good 10 minutes or so in a small amount of olive oil
add a healthy splash of balsamic vinegar
add the sausages in slices and let that cook over a (really) low flame until the sausages are browned
On to the bread...
You need:
3 eggs
1C milk (I used 2%, but anything, including soy, would be fine)
bread (4-5 large slices or 9-10 small)
healthy pinch of salt
1t marjoram
1t sweet savory
(I used dried herbs, as my Aerogarden has not yet produced its crop. By all means, if you have fresh, use them... and feel free to play around with other herbs.)
You do:
1. In a rather shallow bowl, beat together eggs and milk. Add salt and herbs; beat some more.
2. Start heating up a skillet over a low-medium flame. I used a le Crueset grill, to make everything pretty, but any skillet will do. Don't forget to coat with olive oil or non-stick spray. Alternatively, you can bake these--see below.*
3. Throw the slices of bread into the mixture and let soak--at least 1 minute/side.
4. Once the bread is saturated, and the grill is hot, place the slices on the grill so that they do not touch one-another. Cook until browned on both sides.
5. If you have more than one batch, they will keep warm in an oven at 250F.
Voila--not so French, but very nice.
*Now, for baking:
1. Preheat an oven to 425F.
perform steps 1 and 3 above
2. Prepare a baking sheet with non-stick spray.
3. Place the bread slices on the sheet so that they do not touch one another, and place into the preheated oven for 6 minutes or so.
4. Flip the slices and place back into the oven for an additional 5-6 minutes.
That is all. Very simple, quick, and tasty.
Enjoy!
08 October 2008
Never, not once. until yesteday
I am not proud. I am, in fact, rather ashamed. But the other emotions I feel are anger, distaste, and, quite frankly, dread.
I took the gentleman from this post to the OR last week... last Monday, to be exact. He was a mess. I have never seen anything like it. A grown man, mid-40s, strong (as far as looks--very muscular, fit), handsome, even... quivering uncontrollably at the sight of an IV needle. No joke. It took 5 of us to hold him down, after a lot of begging and bargaining, that is, to sssslide that little 20 into one of the hoses on his arm.
The surgery itself? I was so happy. I took off the distal phalanx routinely, looked at the middle phalanx--SOLID. No signs of infection. Surrounding skin? Healthy. Beautiful. The closure? I gotta tell you, I was so conscious of this man wanting to get back to work, I did not even allow a little dog ear. The whole surgery (minus starting the IV) went so smoothly, I was thrilled that he was coming for his first post op visit yesterday.
By the way, he called the day after surgery about some papers he needed to get filled out for work, but that was it. Smooth sailing. No calls about pain, nothing.
I explicitly ask all of my patients to leave their surgical dressing on until they see me at the first post-op visit. I tell them, reinforce it with their loved ones and write it in capital letters on the discharge papers. It is really, really rare that these orders are not followed. Seriously, my patients know I mean business.
So, I was almost confused when my friend came in with no dressing. Not even something he threw on at home, which some people try to fool me with. (Trust me, a surgeon ALWAYS knows their own dressing.) When I asked him what happened and when? He answered that the night of the surgery (!!!) the finger was itching him, so he took off the dressing so he could bite it (!). Then, over the past week, he remained with no dressing, going about his business (although he assured me he stayed in the house) changing his baby's diapers and the such, but NEVER ONCE WASHING HIS HAND!!!!
He complained (now, in my office, as he waved the swollen digit around) that the pain was tremendous. I asked him why he never called. I was calm, at first, when I reminded him that he called about his papers, but never mentioned any of this. My eyes were met with a blank stare.
I asked him to wash his hands now, in the office, with soap and water. As soon as he finished, he turned to me, "Why is there pus coming out?"
I looked in disbelief, at the same time realizing that it was the only explanation: he had a wound infection, which explained the tremendous pain and swelling. When he washed his hands, he dislodged some dirt and blood that was covering the wound, and now the pus was pouring out.
I told him that I would need to take out at least a few sutures and open the wound to let the pus drain. It was the only way to get rid of the pus and the pain. He started moaning and crying (crying, with tears streaming down his face). This is when the fiasco started. I called my medical assistant into the room. We are both small women. He is a tall, muscular, fit man. After wrestling with him for about 20 minutes, I asked my MA to call our administrator in. A man, pretty much the peace keeper, but not much larger than us. The amazing thing is that the whole problem was that this patient was truly, magnificently AFRAID. He was not aggressive to me or anyone else; he just would not allow me to do what I needed to. The whole procedure, on a cooperative patient, would take less than 1 minute. Really. Start to finish.
With this man, it took an hour and a half. Every five seconds, he was ready, and then he would freak out again. Taking out 3 sutures took 45 minutes. (I left the rest for another day.) He had on 5 layers of shirts, which he started taking off one by one. (I really kept thinking that he was going to be sitting in front of me nude.) He had on two hats (I am not joking). Once he finally let me do what I needed to do, it really did take exactly 2 seconds (scissors into wound, spread, done).
The thing that I find worst of all is my reaction. After the first 30 minutes of begging and cajoling, trying to mesmerize him into cooperating... I lost it. I really did. I was screaming at him. I have never done that. I feel awful. I was cursing, too. Not pretty, not professional. Really, really awful. I cannot stop thinking about it, replaying it in my brain. I cannot justify it. All I can say is that I really just wanted to do right for this man, and he would not let me. On top of that, I had patients piling up outside, so I felt pressured to get a move on. I even told him (and this I truly meant with all my heart) that if I had known that this was how things would go, I would have come in on my day off so I could spend as much time as necessary with him--even the whole day, if I had to. Unfortunately, that was not the case here.
The only good thing, well 2 good things: 1. When all was said and done and the dust settled, he thanked me. I mean, the man knows I really was trying to do good for him, NOT to hurt him. He understands he brought this on himself. 2. We called him today, and he said he is feeling much better with less pain. He is doing the wound care that I instructed him on.
No matter, I am seeing him again on Friday. He is one of the patients that I would move in with, if I could.
I took the gentleman from this post to the OR last week... last Monday, to be exact. He was a mess. I have never seen anything like it. A grown man, mid-40s, strong (as far as looks--very muscular, fit), handsome, even... quivering uncontrollably at the sight of an IV needle. No joke. It took 5 of us to hold him down, after a lot of begging and bargaining, that is, to sssslide that little 20 into one of the hoses on his arm.
The surgery itself? I was so happy. I took off the distal phalanx routinely, looked at the middle phalanx--SOLID. No signs of infection. Surrounding skin? Healthy. Beautiful. The closure? I gotta tell you, I was so conscious of this man wanting to get back to work, I did not even allow a little dog ear. The whole surgery (minus starting the IV) went so smoothly, I was thrilled that he was coming for his first post op visit yesterday.
By the way, he called the day after surgery about some papers he needed to get filled out for work, but that was it. Smooth sailing. No calls about pain, nothing.
I explicitly ask all of my patients to leave their surgical dressing on until they see me at the first post-op visit. I tell them, reinforce it with their loved ones and write it in capital letters on the discharge papers. It is really, really rare that these orders are not followed. Seriously, my patients know I mean business.
So, I was almost confused when my friend came in with no dressing. Not even something he threw on at home, which some people try to fool me with. (Trust me, a surgeon ALWAYS knows their own dressing.) When I asked him what happened and when? He answered that the night of the surgery (!!!) the finger was itching him, so he took off the dressing so he could bite it (!). Then, over the past week, he remained with no dressing, going about his business (although he assured me he stayed in the house) changing his baby's diapers and the such, but NEVER ONCE WASHING HIS HAND!!!!
He complained (now, in my office, as he waved the swollen digit around) that the pain was tremendous. I asked him why he never called. I was calm, at first, when I reminded him that he called about his papers, but never mentioned any of this. My eyes were met with a blank stare.
I asked him to wash his hands now, in the office, with soap and water. As soon as he finished, he turned to me, "Why is there pus coming out?"
I looked in disbelief, at the same time realizing that it was the only explanation: he had a wound infection, which explained the tremendous pain and swelling. When he washed his hands, he dislodged some dirt and blood that was covering the wound, and now the pus was pouring out.
I told him that I would need to take out at least a few sutures and open the wound to let the pus drain. It was the only way to get rid of the pus and the pain. He started moaning and crying (crying, with tears streaming down his face). This is when the fiasco started. I called my medical assistant into the room. We are both small women. He is a tall, muscular, fit man. After wrestling with him for about 20 minutes, I asked my MA to call our administrator in. A man, pretty much the peace keeper, but not much larger than us. The amazing thing is that the whole problem was that this patient was truly, magnificently AFRAID. He was not aggressive to me or anyone else; he just would not allow me to do what I needed to. The whole procedure, on a cooperative patient, would take less than 1 minute. Really. Start to finish.
With this man, it took an hour and a half. Every five seconds, he was ready, and then he would freak out again. Taking out 3 sutures took 45 minutes. (I left the rest for another day.) He had on 5 layers of shirts, which he started taking off one by one. (I really kept thinking that he was going to be sitting in front of me nude.) He had on two hats (I am not joking). Once he finally let me do what I needed to do, it really did take exactly 2 seconds (scissors into wound, spread, done).
The thing that I find worst of all is my reaction. After the first 30 minutes of begging and cajoling, trying to mesmerize him into cooperating... I lost it. I really did. I was screaming at him. I have never done that. I feel awful. I was cursing, too. Not pretty, not professional. Really, really awful. I cannot stop thinking about it, replaying it in my brain. I cannot justify it. All I can say is that I really just wanted to do right for this man, and he would not let me. On top of that, I had patients piling up outside, so I felt pressured to get a move on. I even told him (and this I truly meant with all my heart) that if I had known that this was how things would go, I would have come in on my day off so I could spend as much time as necessary with him--even the whole day, if I had to. Unfortunately, that was not the case here.
The only good thing, well 2 good things: 1. When all was said and done and the dust settled, he thanked me. I mean, the man knows I really was trying to do good for him, NOT to hurt him. He understands he brought this on himself. 2. We called him today, and he said he is feeling much better with less pain. He is doing the wound care that I instructed him on.
No matter, I am seeing him again on Friday. He is one of the patients that I would move in with, if I could.
27 September 2008
Really?
So, I went in to the office an hour early yesterday, thinking that that way, I could get some of the pile of paperwork done. As soon as I walked in, I noticed an X-ray hanging on the view box.
"Um, P, what's this?" I asked my medical assistant as I flipped on the switch and let the buzz of the old machine warm up. "Oh, Dr C dropped that off yesterday, for whenever you had a chance to look at it," she said nonchalantly.
The machine suddenly sprang to life, and I did a... more than a double-take, that's for sure, with my mouth agape, stammering. There, on the X-ray was an innocent little finger with more than 90% dorsal and 75% lateral dislocation at the proximal interphalangeal joint. I started firing questions at my innocent medical assistant. "When did this happen? Was anything done about it? Where's the kid, now?"
She knows me well. She knows that I was not angry, just very concerned about the patient. So, she quickly produced Dr C's extension and got her on the phone, so I could fire the same questions at her.
Dr C's answers were not comforting: "It happened yesterday, and the child came right to the office. Yes, of course I did something. I took an X-ray and wrapped it with an ACE."
"Did you reduce it?!"
"Reduce...? It looked less swollen and better, so I sent him home."
You've GOT to be kidding me. That is what I wanted to scream into the phone, but I kept my composure. I said, instead, "Did you get another film before sending him home to make SURE it was better?"
"No." Of course.
"OK, I'll take it from here. Thank you."
P called the child and mother, and they swiftly got into the office. We got another X-ray, and, as expected, still dislocated. So, I explained to them that since it was now more than 24 hours since the original injury, I was not sure if a reduction would be successful. I would attempt it, however, after a digital block. I told them all of the risks and warnings, including that if this did not work, then this fourteen year old boy was looking at surgery! (In my mind, I was thinking, "Damn, all because your stupid PCP wouldn't pull on your finger!!")
So, I numbed his finger and (with a little difficulty) reduced it (YAY!). I buddy taped him securely, and got another X-ray--still reduced (YAY). And, for good measure (he IS a 14 year old boy who likes to play sports), I put him in an ulnar gutter splint. (phew)
Here's the deal: Finger dislocations are REALLY easy to reduce, if they are gotten to in time. And they do really well, if they are gotten to in time and managed appropriately. Often, especially in kids, all you have to do is anesthetize the digit, give a pull and it pops back into place. (You always hear stories of people doing this on their own without anesthesia, but we are doctors. We have the goods. So, be nice, and numb them up.) Yes, sometimes you have to maneuver a little, but just look at the X-ray, and use common sense (AFTER distracting the joint). And always, always treat dislocations like fractures--meaning immobilization for the appropriate amount of time (buddy tape or splint, NOT just an ACE). Because they WILL dislocate again otherwise.
The problem comes when the dislocation is not treated, or treated and not immobilized. That's when things can result in a chronic dislocation. That can cause volar plate laxity, ligament laxity and disruption, and finally a hyperextension (Swan neck) deformity. That necessitates surgery. NOT pretty for a simple dislocation.
Needless to say, the pile of paperwork still awaits me.
Oh, and the man from the prior post (Lucky) is scheduled for amputation on Monday. Yes, there is osteomyelitis present. And, as expected, his first reaction was, "I need a drink," quickly followed by, "I need a cigaret," when I told him he cannot have a drink. I took my time explaining to him that both alcohol and cigarets slow healing. Since his primary goal is getting back to work ASAP, it is in his best interest that the post-operative healing takes place in the best environment possible. While he was in my office, he understood, but I hope he remembers when at home, too.
"Um, P, what's this?" I asked my medical assistant as I flipped on the switch and let the buzz of the old machine warm up. "Oh, Dr C dropped that off yesterday, for whenever you had a chance to look at it," she said nonchalantly.
The machine suddenly sprang to life, and I did a... more than a double-take, that's for sure, with my mouth agape, stammering. There, on the X-ray was an innocent little finger with more than 90% dorsal and 75% lateral dislocation at the proximal interphalangeal joint. I started firing questions at my innocent medical assistant. "When did this happen? Was anything done about it? Where's the kid, now?"
She knows me well. She knows that I was not angry, just very concerned about the patient. So, she quickly produced Dr C's extension and got her on the phone, so I could fire the same questions at her.
Dr C's answers were not comforting: "It happened yesterday, and the child came right to the office. Yes, of course I did something. I took an X-ray and wrapped it with an ACE."
"Did you reduce it?!"
"Reduce...? It looked less swollen and better, so I sent him home."
You've GOT to be kidding me. That is what I wanted to scream into the phone, but I kept my composure. I said, instead, "Did you get another film before sending him home to make SURE it was better?"
"No." Of course.
"OK, I'll take it from here. Thank you."
P called the child and mother, and they swiftly got into the office. We got another X-ray, and, as expected, still dislocated. So, I explained to them that since it was now more than 24 hours since the original injury, I was not sure if a reduction would be successful. I would attempt it, however, after a digital block. I told them all of the risks and warnings, including that if this did not work, then this fourteen year old boy was looking at surgery! (In my mind, I was thinking, "Damn, all because your stupid PCP wouldn't pull on your finger!!")
So, I numbed his finger and (with a little difficulty) reduced it (YAY!). I buddy taped him securely, and got another X-ray--still reduced (YAY). And, for good measure (he IS a 14 year old boy who likes to play sports), I put him in an ulnar gutter splint. (phew)
Here's the deal: Finger dislocations are REALLY easy to reduce, if they are gotten to in time. And they do really well, if they are gotten to in time and managed appropriately. Often, especially in kids, all you have to do is anesthetize the digit, give a pull and it pops back into place. (You always hear stories of people doing this on their own without anesthesia, but we are doctors. We have the goods. So, be nice, and numb them up.) Yes, sometimes you have to maneuver a little, but just look at the X-ray, and use common sense (AFTER distracting the joint). And always, always treat dislocations like fractures--meaning immobilization for the appropriate amount of time (buddy tape or splint, NOT just an ACE). Because they WILL dislocate again otherwise.
The problem comes when the dislocation is not treated, or treated and not immobilized. That's when things can result in a chronic dislocation. That can cause volar plate laxity, ligament laxity and disruption, and finally a hyperextension (Swan neck) deformity. That necessitates surgery. NOT pretty for a simple dislocation.
Needless to say, the pile of paperwork still awaits me.
Oh, and the man from the prior post (Lucky) is scheduled for amputation on Monday. Yes, there is osteomyelitis present. And, as expected, his first reaction was, "I need a drink," quickly followed by, "I need a cigaret," when I told him he cannot have a drink. I took my time explaining to him that both alcohol and cigarets slow healing. Since his primary goal is getting back to work ASAP, it is in his best interest that the post-operative healing takes place in the best environment possible. While he was in my office, he understood, but I hope he remembers when at home, too.
20 September 2008
Lucky
We really are... many of us, at any rate. Here I am, complaining about my difficulties with starting a private practice, and yet... I am lucky. quite lucky, very lucky, I'd even venture. happy, healthy, with a tiny, but solid, family, a man who loves me, my cats (2), and a job... and both of my hands with all ten functional healthy fingers. That's it, really. Hands are so amazing, and so important. As a hand surgeon, you see it all. Most days, hands astound me, in surgery, in the office, on the street... and yet, sometimes, I just run on automatic. I think we all do, sometimes. Until it just hits you from time to time.
Yesterday, I saw a gentleman, mid-forties, completely candid recovering alcoholic, "I don't want to drink, doc, but it hurts so bad sometimes. I know a drink would make it better. But I can't. I gotta do better for my new baby."
"How old is your baby?"
"A month and a half--my first. I guess there was a reason I had to wait this long, and my wife, she's so good to me... So, when can I go back to work, doc? Because my wife, she's on maternity leave, and there's no one else..."
You see, this guy has a terrible, I mean really awful, poorly diagnosed and mistreated open wound of the right index finger (yes, he's right handed). Weeping, purulent, probably osteomyelitic, ongoing for more than a year. Did I mention that he was my last patient yesterday evening? Oh, and he works in dietary... in a hospital... and desperately wants to return to work.
Amongst the malingerers and bad attitudes, I just felt so much grief for this man.
And yes, we are lucky.
Yesterday, I saw a gentleman, mid-forties, completely candid recovering alcoholic, "I don't want to drink, doc, but it hurts so bad sometimes. I know a drink would make it better. But I can't. I gotta do better for my new baby."
"How old is your baby?"
"A month and a half--my first. I guess there was a reason I had to wait this long, and my wife, she's so good to me... So, when can I go back to work, doc? Because my wife, she's on maternity leave, and there's no one else..."
You see, this guy has a terrible, I mean really awful, poorly diagnosed and mistreated open wound of the right index finger (yes, he's right handed). Weeping, purulent, probably osteomyelitic, ongoing for more than a year. Did I mention that he was my last patient yesterday evening? Oh, and he works in dietary... in a hospital... and desperately wants to return to work.
Amongst the malingerers and bad attitudes, I just felt so much grief for this man.
And yes, we are lucky.
10 September 2008
Silence...
I don't really know where to start. Is anyone still out there? Any of the five of you? I have been silent for so long. I thought that, by now, I would be up and running in my little 'enterprise.' ;) FAAAAAR from it.
Opening a private practice must be one of the most frustrating things in the world. Especially in this economic climate.
In order to get a business loan, you must be in business for at least two years. What if you need money to start that business? What if, like me, you are not independently wealthy? You can try lines of credit or business credit cards. Even those, with most banks, you have to already be in business to get. You can try "angel investors." However, most of these guys are currently interested in web-based, tech-y stuff. (Angel investors, by the way, got their name from the early 1900s, when wealthy businessmen would invest in Broadway shows. Now, most angels are far from multi-millionaires. They just find a company that they believe in and want to help. These people are very business-savvy and more often than not want to be on the board of directors or a partner of the company they support.) There are also physician funding companies on the internet. I will have more to say about these in the next few weeks, as I delve more deeply into them.
The whole setting up a corporation thing is another story entirely. Word to the wise: make sure the person that does this for you knows what they are doing!! The first guy I talked to was a business lawyer, who had never heard of a D.O. And he touted himself as a 'specialist' in professional corporations. "So, we don't have to set you up as a doctor, we could just do a regular corporation." This was after my explanation of, "I am a surgeon, a physician..." Which was then followed by, "OK, doooctooor." (very long, drawn out, not nice.) The next one is a family friend of a very close friend. Not good. This is the one that is actually working on my papers, but extremely slowly (molasses slow), and often with mistakes that I have to clean up. I have already paid him, and he is (finally) about two-thirds done, but it has been painful... and I have no idea when the other third will get finished.
These are major hold-ups. Hence, my silence.
And, I am in the meantime, keeping my "day job." Very busy. That was a joy, by the way, telling Mr. Big-Shot President of the company that I am opening a private practice. There I was, excited, like a little puppy, as what I do in my spare time does not affect Mr. BS Pres in any way, shape, or form. But, to be nice, I thought it only right that I put my plans "out there, in the open," so nothing has to be a secret. (Also, so if--rather when--insurance companies make mistakes and send checks to the wrong place, it won't be as big of an ordeal to retrieve the money.) The meeting ended in the most uncomfortable way: Mr. BS just repeating over and over again that I could not steal the group's patients, and me reassuring him that that was not my intention. He was so bothered, in fact, that he came to my office the next day to interrupt my patient hours and again reitterate that I was not to steal patients. This went on for another fifteen minutes.
Joyful.
Opening a private practice must be one of the most frustrating things in the world. Especially in this economic climate.
In order to get a business loan, you must be in business for at least two years. What if you need money to start that business? What if, like me, you are not independently wealthy? You can try lines of credit or business credit cards. Even those, with most banks, you have to already be in business to get. You can try "angel investors." However, most of these guys are currently interested in web-based, tech-y stuff. (Angel investors, by the way, got their name from the early 1900s, when wealthy businessmen would invest in Broadway shows. Now, most angels are far from multi-millionaires. They just find a company that they believe in and want to help. These people are very business-savvy and more often than not want to be on the board of directors or a partner of the company they support.) There are also physician funding companies on the internet. I will have more to say about these in the next few weeks, as I delve more deeply into them.
The whole setting up a corporation thing is another story entirely. Word to the wise: make sure the person that does this for you knows what they are doing!! The first guy I talked to was a business lawyer, who had never heard of a D.O. And he touted himself as a 'specialist' in professional corporations. "So, we don't have to set you up as a doctor, we could just do a regular corporation." This was after my explanation of, "I am a surgeon, a physician..." Which was then followed by, "OK, doooctooor." (very long, drawn out, not nice.) The next one is a family friend of a very close friend. Not good. This is the one that is actually working on my papers, but extremely slowly (molasses slow), and often with mistakes that I have to clean up. I have already paid him, and he is (finally) about two-thirds done, but it has been painful... and I have no idea when the other third will get finished.
These are major hold-ups. Hence, my silence.
And, I am in the meantime, keeping my "day job." Very busy. That was a joy, by the way, telling Mr. Big-Shot President of the company that I am opening a private practice. There I was, excited, like a little puppy, as what I do in my spare time does not affect Mr. BS Pres in any way, shape, or form. But, to be nice, I thought it only right that I put my plans "out there, in the open," so nothing has to be a secret. (Also, so if--rather when--insurance companies make mistakes and send checks to the wrong place, it won't be as big of an ordeal to retrieve the money.) The meeting ended in the most uncomfortable way: Mr. BS just repeating over and over again that I could not steal the group's patients, and me reassuring him that that was not my intention. He was so bothered, in fact, that he came to my office the next day to interrupt my patient hours and again reitterate that I was not to steal patients. This went on for another fifteen minutes.
Joyful.
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