It is pretty easy to be against Obamacare these days.
The federal government can’t come up with a working website to help people buy health insurance. The president misled people about whether they could hold onto their old insurance plans. And come next tax day, the least popular provision of the Affordable Care Act — the individual mandate — will be implemented for the first time.
Lost amidst all this controversy is …
Is it racist to oppose Obamacare?
As an advocate of patient-centered care, I have to recognize that some varieties of patient-centrism make me more comfortable than others. If I really want the patient to do X, and the patient doesn’t want to, I generally feel okay about that. Frustrated, sure, and often times convinced that my way is the right way and the patient’s way is some sort of detour.
Most often, though, I am able to …
A solution for patients who request unnecessary care
It’s once more cold season, bringing up the question parents commonly face. Should they buy one of those rows and rows of cough, sneeze, and runny nose medicines one finds in every drug store and supermarket?
In a nutshell, no — none of the preparations sold over-the-counter to treat upper respiratory infections in children work, and all could be dangerous. That’s the conclusion of a report some years ago by the Food and Drug Administration, …
Cough medicines shouldn’t be used in small children
The conversation parents dread even more than the one about the birds and the bees? It’s the one about their kids’ weight.
Sure, the facts-of-life talk is awkward and needs to be age-appropriate and you want your facts straight, but it’s different when you’re talking to your kids about what they weigh. Your children never view such talks as positive, only as being about what’s “wrong” with them. But you can have this …
How to talk to your child about obesity
If we in the U.S. ever hope to get a grip on Medicare costs, our society will first have to navigate a steep learning curve. That’s the lesson to take from three recent publications.
Despite the fact that Medicare is expected to represent 18% of the federal budget in 2020 (up from 15% in 2010), and that the Medicare Part A trust fund is projected to have insufficient funds to cover …
3 ways Medicare can reduce overtreatment
As I was watching CNN news recently, I noted in the headlines different ways Obamacare is failing. Current problems discussed were the customers’ sticker shock of high deductible plans (up to $12,700 for families), the president blaming the insurance companies for having substandard plans, and the people blaming the president for losing their current insurance.
One patient even complained, “My new health care plan tripled in price, and now, it is …
Dear lawmakers: Why aren’t doctors involved in health care reform?
In 1996, visiting a mall during an out-of-town trip, I suddenly felt dizzy while descending on the escalator. The sensation rapidly resolved, but to be on the safe side, I went to a local emergency room. My evaluation included a CT scan of my head; the results, I was told, were “normal.”
Shortly after returning home I received another call. The CT results were not normal, and I should see a …
Lessons learned from far exceeding the expected prognosis
A version of column was published in USA Today on November 20, 2013.
I once diagnosed a patient with high cholesterol, and prescribed him a medicine commonly known as a statin. When I saw him months later for follow-up, he admitted that he didn’t fill the prescription.
“I took red yeast rice capsules instead,” he said.
When I asked him why, he told me that he was wary of statins’ long list of side effects …
Herbal supplements may be natural, but that doesn’t mean they’re safe
Over the years that I’ve worked in acute inpatient rehab centers, I have been truly vexed by a particular type of patient. Namely, the stubborn patient (usually an elderly gentleman with a military or armed forces background). I know that it’s not completely fair to generalize about personality types, but it seems that the very nature of their work has either developed in them a steely resolve, or they were …
The downward spiral of the stubborn patient
To err is human. To really screw things up, you need government.
One half of my patient population and one fourth of my receipts are from Medicaid patients. My state has a mandatory balanced budget, which means in this age of perpetual recession Medicaid runs out of money every year.
Last year, my state capped the monthly brand name prescriptions to 1 for the summer. Apparently the information that asthma inhalers and …
There is only one reason why I still accept Medicaid
The culture of medicine has changed and a new generation of medical students has noticed this insidious path to disgruntlement. Reimbursement rates dominate conversations among health care professionals. Physicians are slowly burning out while younger faces are tempted away from humanitarianism by lucrative lifestyle specialties. Bureaucrats, technology, and increasing health-care costs have transformed the doctor-patient relationship, and students pick up on the increasing frustration in the profession.
The few oases of …
Student-run free clinics: A pure form of medicine
As we’ve gone through the process of building our patient-centered medical home, we have brought along a little bit of the scientific method.
As part of the medical home rollout, we developed an expanded quality improvement curriculum for our internal medicine residents. A series of talks on key topics of the patient-centered medical home has been developed, and several faculty experts have been delivering these to the residents. As a part …
How the medical home can spur academic research
If you haven’t already, you will someday see a primary care physician (PCP).
It’s practically unavoidable.
The reason for this self-declared truth is that PCPs are the shape shifters of medicine, assuming various roles at different stages of an adult’s life and wellbeing.
These responsibilities range from treating various health conditions, ushering patients in and out of hospitals, coordinating long-term medical decisions, and consulting with other specialists to better optimize patient care.
Given that …
What you should know about your primary care physician
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It’s been very interesting to read the range of responses to the recent FDA recent crackdown on the personal genetic service company 23andMe. Some have decried the FDA as too paternalistic while others have said the FDA is rightfully protecting the health of the public.
The evidence, I believe, shows the FDA is correct: 23andMe should not be doing genetic tests that have serious medical implications. Let’s look at …
The problems with the BRCA test from 23andMe
“What is the one best test?”
A test-taker’s frustration boils over as they read this prompt and think, “in real life we would do all of the above.” And for the most part, they are correct. In the United States, medical trainees are taught for exam purposes to answer the one best test for diagnosis or the one best procedure for management.
However, in practice the same trainees watch our role-models take …
Medical trainees have access to far too many resources
The catchy title of a recent Harvard Business Review Blog post, The Big Barrier To High Value Health Care: Destructive Self-Interest, suggested that the Institute for Healthcare Improvement (IHI) is forging arrangements that can overcome fee-for-service reimbursement’s propensity to drive excess. As the honest broker, IHI could advocate for arrangements of mutual self-interest based on the right care, better outcomes and less money. Employers and unions would get lower costs, with …
Will fee for service ever go away?
New guidelines from the American College of Cardiology and the American Heart Association on the assessment of cardiovascular risk and the manipulation of cholesterol levels to mitigate that risk have certainly been in the news. The guidelines appropriately use high quality evidence to abandon old untested or unproven paradigms such as treatment to LDL targets and manipulation of non-HDL cholesterol as a secondary goal. In many ways, the new guidelines …
Cholesterol management with patients requires shared decisions
Recently, after a fairly long day of surgery where everything was going well, I was finishing my fourth case. It was about 2pm on a Friday, and we were running on schedule, which made me happy.
As I walked out to the waiting area in search of the family of the elderly woman on whom I had performed an elective procedure, I noticed her husband sitting in the corner. He stood …
It’s scary when our loved ones have surgery
Retirement is an intensely personal decision. I have done virtually nothing but medicine for the last 35 years. Oh sure, I have made some money from writing, or giving lectures and expert case reviews, but most of these are tied to medicine as well. Having just turned 65, my financial advisor says from his analysis, I can retire any time now. I have a contract with my cardiology group, which …
How can a physician retire gracefully?
I practiced surgery for many years in a very large hospital. In the 1980s, the marketing department launched a campaign with the tagline, “A Leader in World Medicine.” About the same time, two of my colleagues created the Hernia Institute, sensing gold in them groins. They placed ads in the sports pages of our local newspaper, right next to those of the topless clubs.
These initiatives had two things in common:
It’s time to support performance measurement in health care
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