July 8, 2020

"Chief Justice John G. Roberts Jr. suffered a fall at a Maryland country club last month that required an overnight stay in the hospital..."

"... a Supreme Court spokeswoman confirmed Tuesday night," after an inquiry from The Washington Post. The incident had not been disclosed voluntary, but The Washington Post had heard a tip.
The 65-year-old chief justice was taken by ambulance to a hospital after the June 21 incident at the Chevy Chase Club.... Roberts has twice experienced seizures, in 1993 and in 2007, but Supreme Court spokeswoman Kathleen Arberg said doctors ruled out that possibility in the latest incident. Doctors believe he was dehydrated, she said.... The scene was apparently witnessed by some at the club.... The person who told The Post about the incident said Roberts’s head was covered in blood....
The bloody scene was witnessed and it still took more than 2 weeks to get in the newspaper. Makes you wonder what else goes on.

I hope he's okay. It is possible to be walking along, doing nothing particularly challenging, and simply to fall. I've done it. I've tripped over an irregularity in the sidewalk. I've had a shoe malfunctiontwice, in recent years. When you're older, a standard question from your doctor is whether you've fallen in the last year. I try to keep my record clean, but then there's that one fall, and you've got to say yes, and the doctor is marking you down as an old person who falls.

Somebody asked at Quora why the doctor asks if you've fallen, and a doctor of internal medicine gives this answer (which surprised me):
No matter how ridiculous it may seem, there is a “QM” quality metric that will determine your doctors “P4P” or “pay for performance.” Checking off how many people 65 or older have fallen within the last 6 months will set off the “fall risk” QM metric on which we are mandated to do or not get paid.
In our medical system, we have to take your blood pressure over and over and over again in the same visit trying to get a reading that is below 140/90. Why? So our QMs will show “blood pressure under control.” So literally I could be adjusting your blood pressure medication and teaching you how to adjust your diet and helping you quit smoking and I could be “low quality” but someone who fudges the numbers several times until your pressure appears to be lower on the chart but does NOTHING ABOUT IT will be “high quality.” Then the insurer will call me a low quality doctor.

Some dumb ass bean counter thinks they can create quality metrics to determine who the good doctors are, and then the “system gaming doctors” spend the entire visit clicking a bunch of pure bullshit into your chart so every useless QM is clicked, checked, buffed, and appearing to look good but then they did not listen to you or deal with the problem that you came in for. This is what enraged me so much when I went in to see my personal PCP and it was click click click and a lot of pressure to fill out what I knew to be QM bullshit and I said that I “came here to discuss problem x and I don’t really care about your QM” and then my physician told me “YOU NEED A PSYCHIATRIST I CAN’T WORK WITH YOU.” Okay. She was having a bad day and I was not playing. I thought I had the right to choose the care that I wanted and to refuse the care that I didn’t want, but she was having none of that. So we parted ways in a non friendly manner. (I know, this makes me sound horrible but I was polite and not behaving badly at all, the only bad thing I said was, “I don’t care about that I just want to talk about problem x.” And I did not say it with a raised voice at all. I thought that since she knew I was an MD she would be cool with cutting the crap. She wasn’t. I stood corrected.) Now I do not have a doctor. Oh well, haha.

51 comments:

Sydney said...

That doctor is absolutely right. And it is why I plan to stop taking insurance in my practice by the end of the year.

gilbar said...

thank GOD he is alive, but let's not kid ourselves:
This was (nearly) another Covid-19 related death!

Let's face the facts!
This Happened
It Happened, during Covid-19

Therefore, BY DEFINITION! it Covid-19 related
Covid-19 is The Worst Thing, EVER to strike our world; Any (and ALL) restrictions are fully justified

rehajm said...

The 65-year-old chief justice was taken by ambulance to a hospital after the June 21 incident at the Chevy Chase Club...

...where he the immediately leapt to his feet and proclaimed Live! from New York, it's Saturday Night!!!

Rory said...

"It is possible to be walking along, doing nothing particularly challenging, and simply to fall. I've done it."

Seven years with my German Shepherd, and I estimate that I've averaged a fall a month. He flat out knocked me down several times, but he also trips me, I fall off curbs, step in holes, stumble on roots, and of course slip on ice, snow, and mud. Every time, he walks back and puts his face in mine as if saying, "You should stop doing that - you could hurt yourself."

gilbar said...

still took more than 2 weeks to get in the newspaper. Makes you wonder what else goes on.

That's Nothing! Ruth Ginsburg has been DEAD for more than 2 years; and STILL hasn't made the papers

rehajm said...

I thought that since she knew I was an MD she would be cool with cutting the crap. She wasn’t. I stood corrected.) Now I do not have a doctor.

As someone who has floated from doctor to doctor trying to avoid this shit, I can say it will be difficult to fond one that doesn't conform to the 'bean counters' and their metrics.

I would disagree however with the doctor patient that doctors are frustrated by the QM bullshit. On the contrary I've tried doctors -plural- in more than a few prestigious hospitals who seem to believe the obsessive conformity to QM metrics is the superior practice of medicine.

As a patient it is creepy and disturbing...

Mike Petrik said...

Yes, this is just another example of consultants engineering a system that makes sense on paper but which will always be gamed in reality.

Darrell said...

What sets off "a gun in the house" QM metric?

Michael K said...

I'll tell you one question to never answer with a "Yes."

My brother-in-law, who is coping with cancer of the bladder and had a major stroke 20 years ago that left him severely disabled, was at the hospital having some tests done last fall when a nurse asked him if he had ever thought of suicide. "Yeah, at times," He said. Alarm bells erupted. A security guard appeared. He was escorted to the nut ward and confined there for 48 hours. MY sister had a hard time getting him sprung.

It's like pediatricians asking if there is a gun in the house. Never give an honest answer. Medicine is far less interested in your health these days.

rhhardin said...

If you don't go to the doctor you miss all that.

Tom T. said...

65-year-old guy out socializing at his club two weeks ago AND burdening the hospital system, and the Post had nothing to say about virus safety? And yet the rest of us peons are supposed to stay at home?

traditionalguy said...

Dehydration at the Country Club? Sounds more like he drank too many martinis.

I Callahan said...

Checking off how many people 65 or older have fallen within the last 6 months will set off the “fall risk” QM metric on which we are mandated to do or not get paid.

I work in the health insurance field, and this is only one of many quality measures. That said, it was Medicare (the government) who put these in place, which no one should be surprised about.

That aside - people who considered fall risks are prone to broken hips, shoulders, backs, etc. So it is a valid measure of one's general overall health.

Michael K said...

Sounds more like he drank too many martinis.<

Yeah, I wonder what his BAC was ?

Michael K said...

And it is why I plan to stop taking insurance in my practice by the end of the year.

I know quite a few colleagues who are going to all cash. Overhead down 60% and a quiet life. Most are of an age where kids are educated and debts paid off. The busiest total hip surgeon in Newport Beach went to all cash a few years ago. I know some other orthopedists doing the same.

Churchy LaFemme: said...

No "Well that explains those votes!" jokes?

Danno said...

Hasn't all of this QM bullshit been a result of Obamacare mandates?

Sebastian said...

Methinks God read the abortion opinion.

wendybar said...

I wonder which Progressive pushed him down, and said if you don't vote our way....you will be Epsteined???

Howard said...

This explains his leftard shift

Fritz said...

Yep; get the question every year now that I'm on Medicare.

A few years ago, I stepped off the front porch at night while walking the dog and did a pratfall so I had to answer yes.

Last year I didn't tell them about time I was running after the dog (she's an escape artist), and jumped off a jetty and went face down in the sand.

However, falls contributed to both of my parent's deaths (both in their 90s), most directly to my mother's, so I'm starting to get a little more careful. I realize my balance isn't quite what it was once.

TreeJoe said...

A fall is not a fall is not a fall. A fall requiring a trip via ambulance to a hospital and an overnight stay and a head covered by blood sounds alot like a likely concussion.

On QM in medicine: Like ANYTHING ELSE IN LIFE, centralized control and oversight and assessment is a recipe for disaster. De-centralized oversight and decision-making at a local level leads to far better outcomes.

Here's an AMAZING example from 18 months ago:

My wife is 36 years old mother of 3, including a 4 month old baby who she is breastfeeding. She develops a stuck kidney stone requiring surgical removal - which btw is arguable but I walked through it with the Urologist and understood why he said it was required or at least strongly recommended.

The day of the scheduled surgery she is told the classic don't eat/don't drink for 12 hours beforehand. While breastfeeding. And against actual anesthiology best practice and modern recommendations anyway. Sigh. She's at a local top hospital (Paoli hospital). She's scheduled for ~8am IIRC.

Her surgery gets pushed, and pushed, and pushed, until they start at 3-4pm. All because of other surgeries, nothing to do with her. She remains under-nourished and under hydrated. During that time she receives an initial assessment by THREE DIFFERENT anesthesiologists none of which have any real experience with breastfeeding mothers and just take the stance of "Stop breastfeeding and do a bottle for 2 days"....which, to be clear, isn't something that just happens no problem for a baby who has only ever been breastfed and isn't something that you do without significant potential to interfere with your quality of life by messing with the baby's way of sucking. But alas, their recommendations. So based upon that, she says "Don't administer IV/oral opioids to me post surgery, please allow me to choose whether the pain warrants it."

Surgery occurs and is done in an hour. She's then coming out of being put under for at least another hour during which time supposedly the Urologist talks with her (without me present) and she supposedly declines opioids. Again, while still under the effects of anesthesia.

He GOES HOME. The surgery center shuts down except for 2 nurses. Again, my wife is literally post-op and still coming out of being under. As the anesthesia wears off, she develops "worst pain of her life" and asks for opioids. Nurses can't give it. Doctors can't phone it in because of DEA laws. There are no doctors available except a general hospital physician who "could take 3-4 hours to come by if we call on him."

Again, we are in a surgical center in post-op recovery. Their LITERAL recommendation: "If you are in that much pain, check yourself in to the ER. Alternatively, go home and contact your urologist in the morning."

She is in dry-heaving pain at times during this.

So, to re-cap, because of their on rules and administrative practices:

- 3 different "pain management" docs (anesthesiologists) involved pre-op, all with recommendations or requirements more restrictive or even contrary to national recommendations
- A surgery pushed to the point my wife went 24 hours without food while breastfeeding
- A surgical center closed down while a patient was in immediate pre-op to the point they recommended she leave and go into the same hospital's ER to receive follow-up care
- Basic pain management protocols were not followed and blamed on the patient
- The patient was supposedly consulted and declined pain management while she was probably legally unable to make her own decisions under the care of the surgery center due to still being under the influence of anesthesia, and physicians departed before she was lucid.

All of that and they hit all of their quality metrics and probably felt they did everything right.



mikee said...

QM metrics are bullshit, because they use standard deviations on a Bell Curve to determine success or failure in meeting the quality metric. That way, some doctors will always fail, despite the difference between success and failure having zero impact on patient care.

Ask a mathematician to explain this to you if it has been a long time since you set up a process control chart for factory equipment or checked your raw data for outliers in a lab. Basically, some data points will be on the tails of the curve, ALWAYS, and outside the "good v bad"limits chosen, ALWAYS, when the Quality Metric is set up this way.

This math has been brought to you by a 30+ year doctor who recognizes BS when she sees it.

mockturtle said...

No "Well that explains those votes!" jokes?.

Actually, that was the first thing that came to mind.

mockturtle said...

Gilbar is right. RBG won't officially 'die' until after the election. Because hope springs eternal in the Progressive breast.

Bob Boyd said...

Reminds me of the British magistrate who had a few too many at his club one night. As he was staggering home he became a bit nauseated, steadied himself against a lamp post and vomited all down the front of his suit and onto his shoes.
Eventually he made it back to his front door, opened it as quietly as possible and was tip-toeing toward the stairs, hoping his rather stern wife would be sound asleep, when he heard the familiar shrill and grating cry, "Oh my God! What on earth...?"

Thinking quickly, the magistrate said, "My dear, I've just had the most appalling experience. I was making my way home from the club, you see, when I ran smack into the most dastardly fellow, he was drunk as a man could be still on his feet. He stumbled into me, almost knocked me down, then he spewed his innards all over my frontage!"
"Good heavens!" shrilled his wife. "That's disgusting! I certainly hope you gave that dastardly fellow what for!"
"I certainly did!", said the magistrate. I summoned the constable and had him arrested. He awaits my wrath, the first case on my docket tomorrow morning. Now if you will excuse me, I've had a most trying evening and I want nothing more than a bath and to bed."
So he went to his room and passed out.

Next morning, as he was nursing a thunderous hangover, his wife came into the kitchen from the laundry room.
She said, "Don't forget to give that dastardly fellow what for when you get to your court this morning."
The magistrate replied, "My dear, I shall throw the book at him."
His wife said. "I hope so, because the dastardly fellow not only spewed his innards all over your frontage, he also shit your pants."

narciso said...


unrelated,

https://dailycaller.com/2020/07/08/christopher-steele-alfa-dossier-lawsuit-aven-fridman/

Dust Bunny Queen said...

The Doctors offices ask all sorts of "mental health" questions occasionally. They have to in order to continue to get some Federal funding.

I usually answer with yes or no. Do I feel depressed??....no.

Sometimes I write in an answer.

Do I like being around people??...."Well...that depends on who they are."
Do you often get annoyed?..."Only when having to fill in these stupid questionnaires."

Magson said...

"[A] nurse asked him if he had ever thought of suicide. "Yeah, at times," He said. Alarm bells erupted. A security guard appeared. He was escorted to the nut ward and confined there for 48 hours. My sister had a hard time getting him sprung."

Similar thing with my wife. She's formally diagnosed with treatment-resistant bi-polar depression. She's been under a psychiatrist's care for about 8 years now. Last year she was having some severe pain in here jaw that we thought might be an abscessed tooth, which is life-threatening, so we went to the ER. That wasn't the issue -- they actually couldn't find anything wrong with her, so they gave her pain meds was all -- but in the course of their questioning she answered "sometimes" to the suicidal thoughts question.

Which meant they wouldn't release her until they called in a psychiatrist to talk with her more extensively. In spite of the fact we told them that she's already under a psychiatrist's care and listed off the mental illness meds she was taking and so forth.

Seemed a scam to allow them to bill us more for being in the room longer and also let their psych bill us to boot.

Achilles said...

Welcome to government health care.

RobinGoodfellow said...

I “came here to discuss problem x and I don’t really care about your QM” and then my physician told me “YOU NEED A PSYCHIATRIST I CAN’T WORK WITH YOU.”

I think that was an episode of Seinfeld.

Michael K said...

Seemed a scam to allow them to bill us more for being in the room longer and also let their psych bill us to boot.

I'm sure you are right. My mother lived to age 103. When she was in her 90s, she helped a fat women stand up from her couch and crunched a vertebrae in her back. She ended up in the hospital for a couple of days for the first time since my sister was born in 1941. I called her every night and she sounded like she was getting confused. This is very common in the elderly and I called her Pakistani doctor to suggest he send her home. He told me he was about to request a psychiatrist to consult (No doubt a cousin). I told him no, send her home. He started to argue and I said I didn't want to fly back there but I would if he did not send her home.

He sent her home and she was back to normal the next day. I have a chapter in my book on this. "Sundowning" it's called.

rcocean said...

Fall from being "dehydrated" sounds like Hillary Clinton syndrome. Guess it sounds better than "drunk".

walter said...

"Makes you wonder what else goes on."
Yeah...RBG's various absences. I guess it's just her stretches of pumping iron.

TreeJoe said...A fall is not a fall is not a fall.
--
See Scarborough's intern.

BTW Tree Joe, couldn't the doc have arranged a standing rx for as needed/requested?




mockturtle said...

DBQ @ 9:19, LOL! Love it. I write in similar retorts or often just leave them blank. Just say no to insidious prying and to polls, as well!

tommyesq said...

Did Roberts trip over Harry Reid's treadmill?

Jupiter said...

"Now I do not have a doctor. Oh well, haha."

I haven't had a doctor since my Father died. Once you are past about 55, they are not happy until you are taking at least one medication regularly.

MadisonMan said...

My sister (who is althouse's age) shattered her kneecap when she fell while walking on a flat sidewalk. At some point, one foot dragged, and a trip ensued. I think it's much harder to trip if the terrain you're on is forcing your brain to stay engaged, rather than a flat surface where you expect no impediments. (Sister is fine now)
Dad fell multiple times in his 90s but never broke anything. He claimed his wrestling coach in High School taught him how to fall so nothing broke, and the training stuck.

cacimbo said...

For over a decade I had a fantastic nurse practitioner as my gp.She really took her time to go over all aspects of health and recommendations for treatment.Every specialist she referred me to was excellent.I felt like crying when she told me she was taking early retirement due to the onerous computer/paperwork requirements of Obamacare.It just became too burdensome.To avoid short changing her patients she was spending hours at home filling out required paperwork.

cubanbob said...

Althouse unfortunately the only practical way out of your conundrum is to get a concierge GP doctor. You pay him or her an annual fee and you have them on call when you need them and the government mandated BS is cut to a minimum. Tests, procedures and drugs coverage is still on whatever insurance plan you have or on a cash basis. Yes it's like paying for both a private school while paying taxes for public schools but for those who can afford it and are over sixty it's worth it. No rush in and out, they take their time to go though your problem and you don't have to wait for days to get an appointment. Another benefit is that if you have conditions that require specialists, the concierge doctor finds them for you and makes sure he or she has all of the information from your other doctors and can stay on top of things and follow up with them if he or she have questions.

Earnest Prole said...

The long, strange saga of Harry Reid and the exercise band

TreeJoe said...

Walter said, "BTW Tree Joe, couldn't the doc have arranged a standing rx for as needed/requested?"

Yes, and he told me to my face "She declined when I checked on her post-op" to which I looked him in the eye and said, "My wife was in 10/10 pain dry heaving all night because you went home and no one was in the post-op center to manage her pain when the anesthesia actually wore off."

To which he told me we should have checked in the ER.

Think about that for a second.

So in a bizarre turn of events about 6 months later I had a urological procedure scheduled. And there was an emergency switch of the urologist....and who does it instead but my wife's urologist. And, well, went just fine for me.

Joan said...

Why are we just accepting the narrative that Roberts did NOT have a seizure? There are reports of at least 2 in the past.

From my admittedly scanty knowledge, multiple seizures means you have some form of epilepsy, yet Roberts denied having any major health issues when he was confirmed.

I don’t trust him to be honest about what actually happened. The fact that this story is 2 weeks old strongly suggests it’s curated. IOW, it stinks.

It would be so awesome if we had media that did it’s job and actually investigated things like this.

Unknown said...

We'd hate to lose another liberal justice

Churchy LaFemme: said...

Well, it's not like he's an airline pilot. I don't see epilepsy as disqualifying for a justice.

Kirk Parker said...

"A fall is not a fall is not a fall.
--
See Scarborough's intern.
"

Or Robert Maxwell.

Kirk Parker said...

mockturtle,

You need to up your cynicism. The first thing that came to my mind was, Somebody is sending the CJ a warning.

Joe Smith said...

"I've fallen and I can't reach my beer!"

But seriously, I am sick and tired of the secrecy that's maintained around SC justices, presidents, and anyone who takes a salary from the government.

We are their employers...don't we have the right to know whether or not they are physically and mentally (in Biden's case) able to do their jobs?

I'm tired of hearing elected officials in DC referred to as 'our leaders in Washington.' They are our goddamn servants.

Mark said...

Um, were Maryland country clubs allowed to be open last month?

Or did Roberts break the law?

Joe Smith said...

"Um, were Maryland country clubs allowed to be open last month?"

And are there any black members?

Paul Doty said...

Probably nothing more than a mild case of demonic possession.