An excerpt from Prescription for Bankruptcy: A doctor’s perspective on America’s failing health care system and how we can fix it.
Many years ago, while I was involved in developing the pre-hospital emergency medical care system in Massachusetts, I went with a group to meet with the then-president of Blue …
How health insurance contributes to our failing system
For my students in 2018, it’s difficult to imagine an era when there was no such thing as evidence-based medicine (EBM). When I started medical school in 1997, though, the term had only been in use for six years, having been introduced by Dr. Gordon Guyatt at McMaster University (though EBM’s intellectual origins can be traced to several key individuals). When I tell trainees how recently EBM …
Considering the recent setbacks of evidence-based medicine
I remember when I started nursing school about a decade ago, that there was a near militant attitude describing the nursing shortage. School administrators, politicians, and journalists hopped on this easy bandwagon and talking point. Research and polls of dubious quality rode the tidal wave of popular opinion. Unsurprisingly, their genesis in an echo chamber yielded predictably confirmatory responses. As graduation time was fast approaching, the class began to job …
The nursing shortage: then and now
The stories are disturbing. A pregnant emergency physician assaulted in a hallway. A patient leaping from the bed, wielding medical equipment as a weapon against the care team. A security guard intervening in a tense waiting room confrontation late at night. Most people find the violence hard to fathom, but for emergency physicians, these threats are part of life on the job every day.
A new poll by the American College …
Violence in the emergency department puts patients and physicians at risk
When I talk to medical practices about hierarchical condition category (HCC) and risk-adjusted diagnosis coding, I receive a lot of questions that point to the existence of persistent urban legends!
Let’s separate fact from fiction.
Urban legend #1: CPT fee-for-service coding will be a distant memory when we switch from volume to value
Not anytime soon. Medicare’s newer payment models starting with Medicare Shared Savings Programs (MSSP) and Accountable Care Organizations (ACOs) are …
5 urban legends about risk-adjusted diagnosis coding
The beverage industry derailed the movement for soda taxes in California by convincing state elected officials to pre-empt local taxing authority in exchange for cancelling a ballot initiative that would have made all new taxes difficult to pass. But taxes are not the only way to reduce sugary beverage consumption in California or the U.S. as a whole.
The beverage industry has come up with several ideas on how to …
A new way to reduce sugary beverage consumption
In country after country, I witness the same sad situation: caring, often-brilliant men and women toil in the health care industry to care for others, but to do so they must battle the system itself. That system has lost sight of what matters, which is humans caring for other human beings.
To simplify things a bit, every health care system on earth has three main stakeholders:
Yes …
Simplicity is the cure for our complex health system
There are now more than 700 million obese people worldwide, 108 million of them children, reported the New York Times in 2017. In Brazil, food giant Nestle sends vendors door-to-door hawking its high-calorie junk food and giving customers a full month to pay for their purchases. Nestle calls the junk food hawkers, who are themselves obese, “micro-entrepreneurs.”
Big Food is increasingly targeting poor countries as “emerging markets” to …
Why do we think obesity is caused by lack of exercise and not junk food?
Being self-aware sometimes to the point of turning self-critical — I, as a constituent of an anesthesiologist’s society, am writing this freestanding letter to bring forth our ethical questions and concerns regarding a shortage of not only medications but also skills, funds and time.
Scenario 1: Patient requests for spinal anesthesia for cesarean section, but a shortage of hyperbaric spinal anesthetics warrants epidural anesthesia as its replacement. What must be done? …
Patient autonomy in times of shortage
So many moving parts.
Just last week, a patient I’ve cared for over 20 years came to see me, and she was despondent over a number of issues.
First and foremost was that her partner of over 60 years has had progressive dementia, and finally things got so bad that he had to be transferred to a long-term care facility, no longer safely able to be cared for at home despite all …
Health care has too many moving parts
As I explained to my medical student this morning that I was ordering an ultrasound on a patient first because the insurance company wouldn’t authorize a CT scan without it, it occurred to me that medicine derailed from its true purpose. Shortly later, I found myself again pointing out why I was prescribing a certain medicine rather than the one I wanted because it was not on the formulary of …
Unhealthy behaviors such as smoking, overeating, or lack of exercise lead to chronic health conditions, and many patients wanting to make positive changes to their health may seek the advice of their doctor to do so. But our insurance payment system works against supporting people when they want to act in a healthy way, and some of these payment decisions seem rooted in prejudices against those suffering from certain conditions.
Smoking …
Our health system is a sick system
A guest column by the American Medical Association, exclusive to KevinMD.com.
Since the 1970s, women have been carving out an increasingly large role in medicine, and the profession is becoming more representative of our society. September is Women in Medicine Month, a great time to acknowledge the changing face of medicine, but also to note that female physicians are not immune from the …
Challenging gender bias in the house of medicine
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Well, cement trucks and health care used to have a lot in common. Now all of that has changed.
Cement plants have a market that is determined by the time it takes for special trucks to transport wet cement and get it in place before it sets. We see those cement trucks out on the roads with their spinning cargo bins — and all of them are bound to a local, …
What do cement trucks and health care have in common?
Many of us have moms and dads or older friends and relatives in nursing home facilities and care very much about their well-being and the supports they receive. But who’s caring for the care aides who do the bulk of the frontline work in nursing homes? Their welfare is almost entirely overlooked in the health system. And it turns out, the health of the care aide affects the Read more…
Who is caring for the care workers?
I have two hours until I’m due to breastfeed my seventh-month-old baby again, so I’ll make this quick: Breastfeeding is really hard for many and our environment and current policy context makes it even harder.
The month of August has been declared “National Breastfeeding Month” by the United States Breastfeeding Committee — an organization committed to “creating a landscape of breastfeeding support” by advocating for policy changes …
3 ways we’ve failed woman who breastfeed
To me, my white coat symbolizes a willingness to care for my fellow man, and every day I strive to fulfill that challenge. But even the brightest white coat has a few stains. Growing up in a small Midwestern town, I just didn’t “get” the homeless community. They were completely isolated from my day to day life. Surrounded by my local community, I just assumed that the homeless were either …
The paths to homelessness are more complicated than we think
American medicine is in trouble, and the men and women who run our country’s medical societies are just the ones to save it.
Think about the trouble, the confusion, the upheaval. Some call it reform. Some call it progress. Some call it just more damn, unnecessary change. Health care is such a politically volatile phrase that it’s tough to have a civil conversation about what’s working and what isn’t. In Texas, …
How medical societies can save American medicine
Will physicians go extinct? Artificial intelligence, legislation, profit motives in the health care industry, and clever lobbying by non-physician providers may all contribute to our demise. However, I believe the existential threat to our profession stems from the ranks of physicians themselves.
1. Unwillingness to embrace activism
Pathologist and writer Rudolph Virchow once said: “The physician is the natural attorney of the poor.” Like most physicians, my goal is to provide evidence-based …
4 reasons why physicians will become extinct
While hundreds of doctors have submitted (mostly unfavorable) comments to CMS on the proposed evaluation and management changes, other issues seem to be receiving much less attention than they deserve. And one of those may hit physicians who perform procedures in the wallet.
In 2015, Congress asked CMS to analyze the global period data to ensure procedure weighting accurately reflected the actual work done by physicians. Of course, when Congress asks …
Are Medicare procedure payments in jeopardy?
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