Advanced Directives

Today a Hungarian doctor came from Headquarters to teach us about Advanced Directives. Usually the state overreacts to any error in medical judgment by any provider statewide with some gigantic, costly program that involves retraining everyone but the offending clinician who is usually suspended or let go.

A few months back a patient with an Advanced Directive for Do Not Resuscitate committed intentional suicide. The patient was found and potentially could have been brought back but the nursing and medical staff followed his wishes. Well, lo and behold, the court judged that a suicidal patient cannot have his Advanced Directive honored. So the state was in error. Therefore the state is implementing a giant education program for all medical staff to learn how to complete an advanced directive and then when NOT to honor it.

A beautiful program including powerpoint, Q&A and draft forms for us to practice. (Yes, we were required to complete out own advanced directives in order to show we understood how to complete the forms.) Of note, the forms we were given are not the actual forms we will use as those were not approved or ready for distribution by the time of the scheduled class. So we all evidenced we are capable of completing the forms we will NOT be using with patients. Pure genius!

I spent the meeting reading Standard & Poors "Movies & Entertainment" industry report. Basically, CDs are dying, mail-order is alive and online streaming/downloading is the growth engine of tomorrow. I purchased 300 shares of VTI and VEU today on limit orders that purchased at the bottom drop. I was just lucky that the market went back up at the end of the day. Though it matters little. The market will likely drop more in the next week but I am aiming for a holding period of around 12 months as I get my asset allocation set. I have been increasing my foreign equities. After the global equity balance is correct, I will liquidate some ETF holdings and purchase individual stocks.

The MAR committee went well. This committee reviews selected specialty care referrals by having the ordering provider defend why they want the requested service. Usually their is a selection bias where an Utilization Management nurse has preselected the weakest Requests For Service and then attempts to facilitate us publicly humiliating ourselves to our peers. Unfortunately for her, the medical staff find this meeting comical and sarcastically deny our own specialty requests and then write the denial is per MAR committee. This usually results in the Administrators reviewing it themselves and approving the requests as they are fearful the client's attorneys will attribute MAR committee decisions to the bosses.

I found out today that the inmates in the kitchen have been recently fired for putting feces in the chili, spitting in the soup and urinating in the cheese sauce. The kitchen inmates recently had their unit searched for contraband which results in their catharting pent up aggression on the unfortunate customers of the PK (Prison Kitchen.)

I'm watching South Carolina make Ole Miss look weak. Before this game I would have said Steve Spurrier is done, retired in less than 3 years. Maybe all he needed was a quarterback with an arm and some eyes.

Over and out.