Physicians writing on KevinMD about the rules they practice under: prior authorization and the algorithms now deciding it, gold card laws, scope of practice and who may practice without supervision, Medicare and Medicaid, the Affordable Care Act, drug pricing, rationing that is done and not named, and the policies that decide which patients get care. Four maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words, Race and medicine: what physicians say, in their own words, and Medical ethics: what physicians say, in their own words.
Five years ago, if you asked oncologists at my practice to name the list price of a given chemotherapy agent, most wouldn’t have known–unless they were executives, maybe. Pharmaceutical reps rarely talk about costs. The EMRs don’t give list prices. And when we input drug orders back then, no cost analyses were offered.
These days, those same oncologists can quote efficacy and cost data chapter and verse for a variety of …
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Driving culture change in the pursuit of oncology value
As a medical student, I have discussed with classmates and faculty how to handle a potential patient interaction on vaccinations. Learning how to handle a patient who may be misinformed may be best through experience rather than lectures. During the COVID-19 pandemic, this experience may come sooner and be more commonplace than I previously expected.
While anti-vaxxers currently make up a small percentage of the United States, their Read more…
COVID-19 misinformation is a public health crisis
As we all grapple with what it means to live in society battling a global pandemic that is so fundamentally altering the way we interact with one another, we are faced with several questions we haven’t faced before in our lifetime: how are we going to move forward from this? What does a post-COVID-19 world look like? When will we be able to go back to “normal”?
While all of these …
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COVID-19: Here’s how to gain the public’s trust
As protests broke out on the streets of downtown Cleveland and the National Guard camped outside the hospital, I delivered a beautiful, Black baby boy. In some ways, that night was like any other night. Another vaginal delivery, another moment filled with love and joy that I had the privilege of sharing with a family. But this delivery felt different.
Medically, the patient was fine. My checklist of assessments after the …
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An OB/GYN resident’s perspective on Black Lives Matter
Concern
There is no debate on the insurmountable value of kids needing to be in schools. CDC data shows that children account for 6% of COVID-19 cases and 0.2% of all deaths. Yet, the system can miserably fail if bullied into opening. Children could turn into potential super-spreaders or develop multi-system inflammation, Kawasaki, or toxic-shock syndrome. And once that domino falls, we …
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Opening schools? The devil is in the details.
The United States government has resumed capital punishment after a 17-year hiatus. Even setting aside questions of whether the death penalty is legal, ethical, or humane, the renewal of the practice of lethal injection poses some grave concerns, particularly in the context of the global pandemic. According to Department of Justice documents, the government is using the drug pentobarbital to carry out the executions. The government’s …
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Unethical policy: Resuming federal lethal injections during a global pandemic
Nursing has always been my passion. The idea of spending hours at a patient’s bedside, putting in blood, sweat, and tears to save a life. Now that is living! I was made to be a nurse. I’m not afraid of hard work. I have worked 13 consecutive hours without as much as a bathroom break; more often in my career, this is the case than not. I’m not afraid of …
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Our health system is stealing a free ride on the broken backs of the nurses
“I often heard as a child that Mexicans were lazy and dirty. As a Mexican-American, I did not wear shorts for years despite the heat because I thought my knees looked dirty. Now I fully embrace my identity. However, as a medical student, I still feel the pressure to disprove these stereotypes.”
– Camila Hurtado
“Growing up in the barrio, my white classmates would tease and bully the brown Latino kids constantly. …
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Declaring racism as a public health crisis from the lens of two Latinx student doctors
During clinical training, medical students worry about caring for patients, learning how to do procedures, memorizing drug interactions, and documenting their work in the electronic medical record —they shouldn’t be worried about paying medical bills at the same time. Shortages of personal protective equipment and the subsequent dangers of working in health care permeate the news and threaten our ability to overcome the COVID pandemic. However, there is another often-neglected …
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Uninsured medical students are at risk
A quarter of the physician workforce in the United States consists of international medical graduates (IMGs). This year 4,222 non-U.S. citizens matched in first-year residency positions. I am an IMG from Guatemala, where I completed medical school. In March of 2014, I matched to an internal medicine residency in the United States. The road has been both satisfying and challenging, with all kinds of uncertainties. I have always been attracted to …
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The uncertainty of an international medical graduate during the COVID-19 pandemic
Born in the United States of America to Nigerian parents, I was raised in Nigeria and returned to the U.S. after medical school for residency training. I have practiced medicine in Chicago, IL for 25 years, and like many others, have had to deal with microaggressions and racism within and outside the workplace. However, this article is not aheabout outlining my personal experiences. This is a call to action to …
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Immigrant physicians: Acknowledge our privilege and move to action
In a market economy, business leaders take every opportunity to shrink the cost line of labor on the balance sheet to boost profits and shareholder/investor value. It’s the metric on which they are evaluated, and left unopposed; they will do it more and more.
The core strategy for shrinking labor costs (along with automation and offshoring) is to drive increased “efficiencies” by demanding more and more work from the same number …
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3 reasons why doctors don’t unionize
I look out at the world through bright blue eyes. Blonde hair. A skinny but shapely 19-year-old’s body. I know six languages. I am educated. I can prescribe medicine that saves lives. I am in love. I am a person.
I look down at the tattoo on my arm. A number— like cattle. My family is gone. My home destroyed. I am living in a small room— …
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I always hope that a sense of humanity will supersede the status quo
The daily email update on COVID-19 affecting our hospital system is a glaring reflection of the health disparities amongst those in marginalized groups. The farther south you go, generally in San Diego, the higher the number of socioeconomically disadvantaged persons, and that tends to include a disproportionate number of persons of color. These populations may be unable to physically distance due to living conditions and job conditions. Perhaps there is …
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COVID-19 becomes a magnifying glass for health disparities
Public health has never been more important. As the coronavirus waxes and wanes, it is crucial that our evolving understanding of COVID-19 translate into our everyday lives. Our collective response to the virus will be much improved with an acknowledgment that our scientific knowledge is dynamic, and that we may have to alter our behaviors as scientists unearth more information about the virus’s transmissibility and lethality.
Nowhere is this evolving understanding …
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Our public health efforts depend on flexibility and trust
We dealt with the death, uncertainty, and fear of COVID-19 with a stiff upper lip. But our hearts broke when George Floyd was murdered by the police on May 25. George is a symbol of an immense problem. A study reported that one in every thousand Black men can expect to be killed by the police. One in every thousand! Racially directed violence by the police is a public health …
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White Coats for Black Lives: How to transform anger into action
In the United States, there is clear evidence that minority populations continue to be underrepresented in clinical research related to new therapies for common and serious long-term medical conditions such as type 2 diabetes (T2D). This is despite these same populations facing a continuing and disproportionate burden of T2D, which shows no signs of abating.
Black people have one of the highest rates of T2D (13.2 percent), a rate almost twice …
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Minorities and medical research: Who is still excluded?
Primary care is on life support. COVID-19’s toll on American health care extends beyond the hospitals and medical workers besieged by infection. An equally insidious but less-visible crisis is engulfing primary care, the long-neglected foundation of our health care system. Given the role of America’s largest corporations in providing health care benefits, the C-suite should be on high alert.
As growing numbers of patients postpone appointments over concerns about …
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Primary care is dying: Why that should scare every large employer
