April 2010
3 posts
“Institutions will try to preserve the problem to which they are the...”
– The Technium: The Shirky Principle
Symptom Checker - Check Your Symptoms - Check... →
Doctors Remove Ammunition From Soldier’s Head →
We shy away from live ammunition in our practice, though we’re happy to help with lacerations and other less dramatic events.
November 2009
3 posts
“universal health care will be doomed if there are not enough primary care...”
– Doctor and Patient - Primary Care’s Image Problem - NYTimes.com
So true, but not the whole story.
The JAMA study of medical students cited in the article describes medical students looking at the impossible pressures and manifest misery of the typical primary care physician. 98% of those medical...
Headed to the emergency room? Bring a book. →
Is it crowds of poor people using the ER as their source of primary care? No….
“The researchers conclude that poor, uninsured patients aren’t to blame.”
It turns out that while wait times have increased and the proportion of people going to the ER have increased over time, the proportion of poor folks going has remained the same.
So what’s behind this?
“…it...
The Rules of Cancer - Well Blog - NYTimes.com →
A wonderful example of someone who totally gets the power of a collaborative relationship in health care.
Health care is so much more than tests and diagnoses; it is about real and complex people. To honor the essence of our profession we must get off the hamster wheel.
October 2009
2 posts
Should insurance contracts come with black box...
A colleague wrote:
If your practice is what you want it to be, then do not spoil it by taking (hundreds of) Medicare patients in order to fulfill the criteria for the stimulus money. Doctors have been giving up autonomy for money for years and that is why 58% would quit medicine if given the chance. If you feel your practice is financially faltering and you need an infusion of more patients or...
WatchA peek at the tip of the iceberg of paperwork sinking the great Titanic of US healthcare.
September 2009
28 posts
“We really need a national conversation about how we measure quality. The...”
– Ideal Medical Practices: Clinical gist and what we measure
An interesting commentary from JAMA on verbatim and gist memory & implications on how we measure medical quality.
Why aren't teabaggers fired up about socialized...
A top White House economic adviser says the Obama administration’s proposed overhaul of financial rules preserves the policy of “too big to fail,” and could lead to future bailouts. Former Federal Reserve Chairman Paul Volcker said Thursday that by designating some companies as critical to the broader financial system, the plans create an expectation that those firms enjoy...
Protect Insurance Companies PSA from FOD Team,... →
“As a nation, we first need to answer the question as to whether health care is a right or a privilege before we jump into the details of fixing it. If health care is a privilege, then we need to decide unapologetically who should die unnecessarily (certainly letting the old, poor, and sick die would be the most financially advantageous) . If that seems a bit harsh and we can’t determine who...
“Are health insurance companies generally being fair and honest when they reject...”
– In Health Care, Number Of Claims Denied Remains A Mystery
Lemme take a crack at this. Um, I seem to recall some recent posts from colleagues that tell a pretty grim tale regarding rejections.
OK, not all claim rejections are such horror stories. I had claims rejected because I forgot to fill in...
“The signal to public policymakers is that to attain more health with less health...”
– Ideal Medical Practices (quote from Milstein & Gilbertson Health Affairs article)
The shocking depths to which some insurers will...
From a colleague :
I did see a rather ruthless preexisting condition denial today. A [bleeped] y/o male came to see me as a new pt. He had a plate and screws put in his jaw 9 years ago after a mugging and jaw fracture. He developed a non-healing fistula in the floor of his mouth from infected hardware. [Major Insurer], with whom he’s been insured for 5 years denied a removal...
“In an important victory for the insurance industry, Senator Max Baucus’s...”
– Guarded Optimism Among Insurers, but Some Health Sectors Remain Skeptical - NYTimes.com
Somethings about this makes me nervous for doctors, patients, the public, employers……
“Yes, we invent disease, we invent new therapies to treat invented disease…and...”
– Tumblr - Jay Parkinson
And a “mwah-hah-hah-hah-haaaa!” to all!
Just picture me standing over you with a big syringe: “Go ahead. Make my (pay)day!”
The incentives in health care are so freaking sick!
“I have no self-interest in this fight beyond wanting to wanting to see less...”
– Doctors for America - Bringing Doctors Voices to Health Care Reform
Dr. Alice Chen describes her motivation for health care reform. I share her motivation. I see a brighter future in which government plays its right and appropriate role regulating the excesses of the insurance industry:
People...
“Primary care clinicians routinely face unreasonable time pressures, a chaotic...”
– Why the doctor won’t see you now | KevinMD.com
So true, Kevin.
I used to think that I had to have payment reform before I could shift the practice paradigm and start really caring for my patients again, using the full scope of my training in comprehensive primary care.
It finally dawned on...
“While the U.S. health care bureaucracy frets and fumbles over what to do, one...”
– Innovative doctor: Anchorage Daily News | adn.com
Hooray Dan! Another doc not waiting for anyone’s permission or an act of Congress to take matters in his own hands and do what is right for his patients.
The tortured logic of medical tort reform
Being a doctor means my pulse races when I think of malpractice suits. The response seems to have become hard-wired to my nervous system and at the first mention of tort reform parts of my brain that I don’t even seem to control jump to the fore shouting “You lie!” (Oh, wait…. that was Wrong Way Wilson).
See what I mean? It’s like a knee-jerk emotional response. ...
GameChangers » Health Care, Already Reforming →
A shout out to Aaron Blackledge - a cutting edge doc with an incredibly cool looking practice, unbelievable energy for doing beautiful work, and not waiting around for anyone’s permission to do what’s right for his patients.
“Jens N. Olsgaard manned a community health center in Butte, Mont., where four of...”
– Summer of Work Exposes Medical Students to System’s Ills - NYTimes.com
Want a peek into the status quo of primary care? Ever wonder why US outcomes lag so far behind that of the developed world while we spend 1.5x more per person on health care?
This is just the tip of the iceberg, folks. The...
Primary care is so much more than treating disease. Treating disease is part of what we do but does not define what we do.
I’m fascinated by the studies that delve into what helps people do better with managing their conditions - be it diabetes or heart disease, exercise, or consistency in taking pills.
What fascinates me is what you find when you read studies that demonstrate an...
“I can log in to my bank, company accounting system, 401k, kids school but there...”
– I live in this schizophrenic world of medicine where on one hand I have the exact same experience as this business guy who emailed me above, and on the other I’m in this priesthood of physicians, wrapped in my white robes (no hood, thank you) and there’s no chance I’d ever open...
msnbc.com:Flat-rate health care a viable option? →
Nice piece on Qliance - providing great care by changing the paradigm.
Initiatives sponsored by multi-stakeholder groups and large medical associations focus more on tweaking the status quo. I’m betting that these ‘tweak’ initiatives will occasionally show some good results, but nothing as interesting and rewarding as a practice that has shed the rules and strictures that are...
“I am speaking out about how big for-profit insurers have hijacked our health...”
– Bill Moyers Journal Features CMD’s Wendell Potter | Center for Media and Democracy
“Catherine did everything she thought she was supposed to when it came to her...”
– Prescription for Change
The arcane and complex language in health insurance contracts make them extremely confusing. Former Cigna exec Wendell Potter described in his testimony to Congress the willful intent to mislead and confuse policy holders so that it would be easier to drop them when they...
“We know exactly what primary care is, we know exactly why systems organized...”
– Barbara Starfield, M.D., Focuses on Primary Care and Health Care Reform — AAFP News Now — American Academy of Family Physicians
“At this particular point in the health care debate, we’re finding that there’s...”
– RNC’s “Bill of Rights” | FactCheck.org
August 2009
29 posts
Armey Encourages Good Manners At Town Halls : NPR →
Fascinating to listen to a politician twist and turn while trying to sound reasonable and honest.
“All Americans should have access to affordable, dependable and quality health...”
– Consumers Union
Real Choice? It’s Off-Limits in Health Bills →
Click the title to read an article in the NYTimes about current limits to choice.
The public’s lack of awareness of the pernicious effect of insurance policies leads to complacency with a broken system.
Example - they fund ads that lie to the public about reform plans saying “your doctor’s decisions will be dictated by government.” The actual bills say the opposite.
In...
“we have the only health system in the world based on avoiding sick people.”
– Marcia Angell, M.D.: Health Reform: Throwing Good Money After the Bad
“RAM LA Results
The following totals are from patient records in hand and, due...”
– Remote Area Medical
Some of the grim statistics reflecting the status quo of health care
Planet Money Blog : NPR - patient experience as... →
Just listed to the 8/21 podcast describing a consumer web site measuring patient satisfaction with their doctors. This is a good move - consumers taking charge of measurement.
Patient satisfaction = ‘were you satisfied with….’
E.g. “were you treated with respect” or “do you like your doctor”
Patient experience = ‘has X happened to you’
...
Why 'adherence to guidlines' is the wrong way to...
Guidlines tell us how to maximize the treatment of a condition or organ system. They are incredibly helpful tools that guide us in optimal care of diabetes, hypertension, AHDH, etc.
As I noted in my last post, overall health and wellness is not necessarily the same thing as maximizing the treatment of an organ system. There are times when guideline adherence is the wrong thing for some...