Why health care delivery is an exceptionally different industry: Why does it matter?

Policy
December 27, 2021

Third in a series. Please read part 1 and part 2.

We expect that most readers have noticed the differences in health care delivery compared to other industries that we discussed in part 1 and part 2. Those differences relate to board governance, health care leadership, infrastructure, and operations. Readers probably also noticed that these differences …

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Why health care delivery is an exceptionally different industry: Why does it matter?

Attack COVID like the terrorist it is

Conditions
December 27, 2021

More than 1,100 in the U.S. are still dying every day from COVID-19. Every three days, we are losing more Americans than the number that died on 9/11. Just because we don’t see it sneaking up on our families does not mean the COVID terrorist is defeated. While deaths are mainly in 12 northern states, it is highly likely we will again experience a similar problem in Texas and across …

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Attack COVID like the terrorist it is

Groomers at PetSmart have more autonomy than physicians

Physician
December 26, 2021

“You do not rise to the level of your goals.  You fall to the level of your systems.”
– James Clear, Atomic Habits

I had a bit of a revelation recently when I brought my dog in for grooming. Some background: My dog is ten years old and has a double coat from hell (although very pretty). She also had a spinal cord injury in November 2019 and has residual weakness in …

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Groomers at PetSmart have more autonomy than physicians

There is no other body part that has filled me with such a roller coaster of emotion

Physician
December 26, 2021

Their absence makes me feel sad,
I look around at my peers, envious and curious,
Obsessing over when they will show up.
When they do, they never seem to live up to expectations,
Too small, too uneven, but what’s sure is it’s a sign I’m no longer a child.

It adds to my wardrobe in a hushed way,
I don’t know whether to be proud or embarrassed that they’re finally here.
I look at magazines; should I …

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There is no other body part that has filled me with such a roller coaster of emotion

Sustaining mental health during the holidays and starting strong in 2022

Conditions
December 26, 2021

The holiday season was notorious for causing loneliness, sadness, anxiety, and a sense of loss even before adding the COVID-19 pandemic to the mix. The pandemic has only served to magnify many of these feelings, as gatherings with loved ones are postponed or canceled. The stress of getting everything done on time and navigating family dynamics can lead to struggles that can benefit from support and self-care. In 2021, support …

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Sustaining mental health during the holidays and starting strong in 2022

A reflection on stomach surgery

Physician
December 25, 2021

One of the most dramatic changes from my training to the present is the nearly complete disappearance of elective ulcer surgery. (Reminder: as I’ve said before, “elective” means non-emergent, as opposed to unnecessary.) The revolution began with the advent of drugs that effectively reduce gastric acid production and settled in for real when the relationship between ulcer formation and the bacterium known as H. pylori was worked out. I have to …

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A reflection on stomach surgery

Leaving academic medicine was a matter of self-respect

Physician
December 25, 2021

“Mom, every time I look in the mirror, I see something different. Sometimes it’s good, and I feel good about myself. But, sometimes it’s not.”

It was well after dinner, and my nine-year-old daughter was perched on the kitchen counter, nibbling on apple slices while I made tea. Her eyes were fixed on her reflection in the mirror across the room, her expression critical.

I leaned forward. “Let me share something with …

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Leaving academic medicine was a matter of self-respect

High deductible health insurance is bankrupting Americans

Policy
December 24, 2021

Two decades ago, high deductible health plans barely existed. Today, more than half of the U.S. workforce is on one, which are plans with deductibles greater than $1300 per individual or $2,600 for a family.

It’s a growing, undiscussed problem for public health. Most doctors have had patients refuse treatment due to out-of-pocket costs caused by their high deductible health plan. All the while medical debt continues to …

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High deductible health insurance is bankrupting Americans

A holiday greeting card from the land of primary care

Physician
December 24, 2021

I wish you and your family a safe, healthy, and happy holiday season. I hope your new year is bright and better. And in the campy spirit of the family newsletter some folks send out each year (which I love to read), here is one from me to you.

This year as a family doc was challenging. Again.

At times it was inspiring, frightening, and exhausting. I started the year with a …

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A holiday greeting card from the land of primary care

Let’s not become a nation of physician-robots

Physician
December 24, 2021

My 5-year-old proudly told me during lunch, “Did you know animals don’t cry?” When she told me this, I had to think about it and then immediately Google this. Having small kids teaches you many random facts, including that sharks don’t blink because they don’t have eyelids.

So, when she told me her new fact, I was intrigued.

Animals, unlike humans, do not have a prefrontal cortex.

This is an area of the …

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Let’s not become a nation of physician-robots

Think again: Get a second opinion

Physician
December 24, 2021

Most patients believe and trust a diagnosis and treatment plan their physician provides them. So why is a second opinion in medicine so important? The “practice of medicine” is a term used to imply a variety of diagnoses and treatments. Yes, there is a standard of care in every medical discipline, but there are also many physician-driven distinctions in getting to a definitive diagnosis with a treatment plan. These decisions …

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Think again: Get a second opinion

Tobacco is a painful addiction

Conditions
December 23, 2021

Smoking cigarettes is well known to cause heart disease, lung cancer, and premature death. In the face of these risks of death, quality of life issues that affect smokers are often overlooked. Although some quality of life issues such as cost, cravings, inconvenience, illness, and stigma are well known, some important effects are largely unknown to the public. For one, smoking is connected with a surprisingly large variety of pains.

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Tobacco is a painful addiction

The goal of health care is in peril

Policy
December 23, 2021

Introduction and background

As an emergency department medical director and physician, a busy emergency department can be a thing of beauty to me. We work hard to set up systems that will provide the care our patients need. Despite our best efforts, almost daily, variables occur that throw the system into chaos and lead to inefficiency. The COVID-19 pandemic unveiled and exacerbated many challenges that affect our ability to provide the …

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The goal of health care is in peril

The 12 days of COVID: year 2

Physician
December 23, 2021

Please also see the original 12 days of COVID.

On the first day of COVID, the ongoing pandemic gave to me,

An insurrection in Washington, DC.

On the second day of COVID, the never-ending pandemic gave to me,

Two backordered gloves.
And an insurrection in Washington, DC.

On the third day of COVID, the society diving pandemic gave to me,

Three anti-vax Karens.
Two backordered gloves.
And an insurrection in Washington, DC.

On the fourth day of …

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The 12 days of COVID: year 2

Life along the railway lines in Bangladesh during Bishwa Ijtema: a physician’s photojournal

Physician
December 23, 2021

The Bishwa Ijtema meaning “global congregation” is an annual gathering of millions of Muslims in Tongi, by the banks of the Turag river, just north of Dhaka, in Bangladesh. Bangladesh is predominantly a Muslim nation. This yearly “BI” is one of the largest peaceful gatherings in the world. The Ijtema is a prayer meeting spread over three days, usually in January during which attending devotees perform daily prayers while listening …

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Life along the railway lines in Bangladesh during Bishwa Ijtema: a physician’s photojournal

Disrupt health care with blockchain

Tech
December 22, 2021

Health care requires forward progression in the chase for quality, safety, and sustainability. When considering how far we have come collectively, success is often celebrated. Be it a new vaccine to curb a pandemic, an advanced diagnostic tool to expedite diagnoses or process alteration to achieve sustained quality, advancement is paramount in both length and quality of life and care delivery. Retrospectively, one can look with ease on the way …

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Disrupt health care with blockchain

Osler and the doctor-patient relationship

Education
December 22, 2021

I first heard about Sir William Osler (1849-1919) through my primary care physician. His biography stated: “I practice family medicine because every day I get to meet new people from all over the world. I get to hear their stories, meet their families, and help them heal. In some cases, I get to see them again and again, building trust and respect while forming meaningful relationships. To me, there is …

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Osler and the doctor-patient relationship

Why health care delivery is an exceptionally different industry: health system infrastructure and health system operations and execution

Policy
December 22, 2021

Second in a series. Please read part 1.

The business of health care delivery differs markedly from other consumer and service industries in many ways. First and foremost, the economics differ. Specifically, the payers of medical care are often different from the customers, the government and third-party insurers are the primary payers, demand is inelastic, quality metrics are typically unavailable, and the industry consists largely …

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Why health care delivery is an exceptionally different industry: health system infrastructure and health system operations and execution

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