I had a conversation with a family practice physician today, a man who is far closer to the end of his career than the beginning. He is part of a private practice group that recently was sold to one of the larger hospital groups in the area, which put him on a salary, but also allowed him to work only three days per week. He stated that the decrease in …
The physicians of today have given up their unique soul
Doctors at Memorial Sloan-Kettering Cancer Center recently declared they would not use Zaltrap (Sanofi), for advanced colorectal cancer. In a New York Times editorial, they suggested the extraordinary cost for incremental benefit could not justify its use. Sanofi appeared to cave to the pressure and announced a 50% discount – which only made things worse.
This August, Zaltrap received FDA approval for the treatment of advanced colorectal cancer. In …
Dramatically influence drug prices by positive action
When the marketing of ObamaCare began in 2009, I always believed that the end game was for a federal single payer system. Since the present Affordable Care Act, (ACA), was passed in 2010, there has been nothing to convince me otherwise. The only reason single-payer wasn’t passed two years ago was because it was hard enough to arm-twist and bribe even …
ObamaCare: All roads lead to single payer
As millions of Americans gain health care coverage under the Affordable Care Act, we have an unprecedented opportunity to work on eliminating health disparities based on race, income and insurance status. Several states, including California, soon will begin marketing their Health Benefits Exchanges (in our state it’s called “Covered California”). Through these exchanges, millions will enroll in health plans and expanded Medicaid programs for coverage that takes effect in January …
How health reform can eliminate health disparities
The Affordable Care Act comes with the promise of a dramatic overhaul in what many see as a broken health care system. It promotes the potential for “better all around” – better care, easier access to hospitals, and affordable treatment. It also comes with a price. For one reason or another, the turbulence within the American health care system is causing doctors to shut down, downsizing or sell their practices …
Your doctor has sold his practice: 6 tips for patients
Recently there was a news story about Dr. Russell Dohner, of Illinois. He charges all patients a flat fee of $5 per visit. He doesn’t take insurance.
This led to several online threads featuring comments such as “Finally! A doctor who cares!”
Apparently, this means that doctors like me, who charge more than practically nothing, are evil and don’t care.
I respect …
Charging $5 per visit is easy if you’re independently wealthy
The 21st century challenge for the American health care delivery system is to deliver higher quality care for less money. Republican and Democratic experts agree that payment reform involving transitioning from fee-for-service to global, value-based systems is necessary for us to achieve that goal. Accountable care organizations (ACOs) are the new entities that will receive the new global payments and distribute them to the doctors, allied health professionals, hospitals, and …
What is the ideal payment system for health care delivery?
Prior to heading out West for my postgraduate medical training, I spent four amazing years in Chicago absorbing everything I could about becoming a doctor. Throughout this time in medical school, I was taught everything from the smallest components of atoms to the largest organs of the human body. Academic physicians spent countless hours teaching me the art of bedside patient care and the scientific evidence behind clinical decision-making.
Despite this …
Doctors cannot escape quality improvement
I first met her when I consulted on her hospitalized son, who’d been in and out several times with transient abdominal pain. He’d already been through various tests and consultations, each time improving before a diagnosis was established. When I was asked to see him he was once again on the mend, but I concluded that he likely had the uncommon …
The role of faith in a patient beating long odds
It is increasingly becoming the year of the Thrifty Patient. People are paying for more medical care and are more responsible for the costs of getting that care via higher deductibles and co-pays. Patients don’t have a choice but to be involved in their care. Though the recent 2008 recession saw a decrease in overall medical and health care utilization as …
Are you a thrifty patient? How to get the care you need and save money
My heart began pounding as I listened to the sound of the dial tone in my ear. After three rings a woman answered groggily and uncertainly, “H-hello?”
“Mrs. Peterson?” I asked. My voice trembled slightly. It was 2 a.m., and I’d awakened her from what I imagined had been a troubled sleep.
“Yes?”
“This is Dr. Lickerman. I’m calling from the hospital.” I paused. “I’m calling about your husband.”
There was silence. Then a breathless, “Yes?”
“Mrs. Peterson, …
How to deliver bad news to patients: 9 tips to do it better
Hospitals are busy places to work. The work is fast paced, and never seems to stop. For most physicians, the work ends when the work is done, or until you fall over, whichever comes first. So as a consultant, when I am seeing a patient wherein there is no longer anything that I am contributing to a patient’s care it’s routine that a physician would “sign off” the case, meaning …
Offer hospice patients a smile
Recently, I spent some time answering the questions on one of those CAHPS surveys for doctors. CAHPS stands for Consumer Assessment of Healthcare Providers and Systems, and these days hospitals ask patients to use them to review not only their hospital experience but their experience with their doctors as well.
Many public hospital ratings use data collected from CAHPS hospital experience surveys, but patients rarely have much access to …
What patients can learn from public hospital ratings
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“Passed by corruption, aided and abetted by the purest man in America” is how anti-slavery Congressman Thaddeus Stevens described President Lincoln’s successful effort to enact the 13th amendment, banning slavery. This historically accurate quote, which runs counter to the public image of “Honest Abe” Lincoln, is among the many fascinating stories recounted in the Steven Spielberg’s masterpiece “Lincoln” playing …
What Lincoln can teach us about health reform
Most of us would agree that doctors should not treat patients without their consent, except in special cases like emergency care for an unconscious patient. It’s not enough for doctors to ask “Is it OK with you if I do this?” They should get informed consent from patients who understand the facts, the odds of success, and the risk/benefit ratio of treatments. The ethical principle of autonomy requires that they …
Patients have trouble giving true informed consent
Surprise! It turns out that if every woman in the US got a mammogram every year, almost exactly the same number of them would still die of breast cancer. Why? Watch this video. Read this by TBTAM. Bottom line: mammograms don’t find aggressive cancers soon enough (by definition, you can’t), while too many of the cancers they do find were never going to be fatal anyway. This is what “over-diagnosis” …
How often should I screen for disease?
A buddy of mine sent along an interesting link by a physician named Ben Brown that makes an argument that doctors actually aren’t all that well off. Salaries are down. Education costs can exceed $300,000 over the course of college, medical school, and residency. By the time you take that first job, you’re on the wrong side of 30 and Wells Fargo is demanding $1800 a month for all your student loans. It’s a topic …
Don’t devalue physicians to mere employees
The debate over pay for performance in healthcare gets progressively more interesting, and confusing. And, with Medicare’s recent launch of its value-based purchasing and readmission penalty programs, the debate is no longer theoretical.
Just in the past several months, we’ve seen studies showing that pay for performance works, and others showing that it doesn’t. …
P4P: Should physicians be treated as purely economic animals?
I have used the electronic medical record (specifically EPIC) since 2004. I have grown accustomed to its nuances, benefits and quirks. There are parts about it I really like. There are parts of it I’d like to do without but accept that they are necessary evils in our current health care climate. I know that there will always be parts of any modified …
Information overload for doctors increases malpractice risk
We are on a search for truth, but will we ever find it? That summarizes how I feel after reading an article in the New England Journal of Medicine, which once again raises the question of how much screening mammography contributes to the progress we have made in reducing deaths from breast cancer in …
ACS: Finding the truth about mammogram screenings
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