She tells me that she sees them at night when she is lying in her bunk bed — eight to a room. Grotesque forms with masks over their heads and guns across their chests. She hears panicked shrieks, but is never certain if they are coming from the next trailer, or if they are inside her head. They cannot be nightmares, because she never sleeps. She reminds herself that haunting …
What being held at the Mexican border is really like
Have you ever been the only customer in your local supermarket? Although the experience can be a bit unnerving, at first, you soon start to notice the advantages: No line at the deli, no pushy shoppers, no carts jamming up the produce section. As you breeze through checkout, you think to yourself, “Gee, I could get used to this.”
Now, imagine walking into an empty waiting area at your local emergency …
3 ways to decrease emergency department wait times
From 2009 to 2012, I directed the graduate course “Fundamentals of Clinical Preventive Medicine” at Johns Hopkins University’s Bloomberg School of Public Health. It was a required course for Hopkins preventive medicine residents, and also usually attracted other master’s level public health students and undergraduates with a strong interest in medicine. The class size was 15 to 25 students. In that setting, with a small group who generally believed that …
Why this physician teaches health policy in medical school
A store cashier sees dozens of customers during a shift. A car tire shop mechanic may work on 20 cars. Workdays can be hard across professions.
Medicine surely does not escape this. We just don’t deal with customers or goods, despite efforts to make it look like that. A simple runny nose visit may be the closest thing to a customer who is …
Chasing numbers contributes to physician burnout
So let’s get down to it. Everyone is tired of shooting sprees. If you’re a gun owner, you’re tired of seeing weapons abused and misused to harm the innocent. If you’re a gun opponent, you feel the same way but can’t imagine why anyone has these weapons in the first place. I get it. I hope both sides get it.
I’ve thought about this a lot. I’m a gun owner. I …
A physician gun owner’s suggestion
When Amazon, Berkshire Hathaway, and JP Morgan (AmBerGan) announced their health care partnership, Berkshire CEO Warren Buffett declared “the ballooning costs of health care act as a hungry tapeworm on the American economy.” He is right. Our broken system is infested with tapeworms. Tapeworms are parasites; they exploit their hosts, drain resources, and suck the life out of their prey. Unfortunately, Buffet failed to call attention to the tapeworms specifically; …
Can direct primary care save us from the tapeworms of insurance?
American physicians dole out lots of unnecessary medical care to their patients. They prescribe things like antibiotics for people with viral infections, order expensive CT scans for patients with transitory back pain, and obtain screening EKGs for people with no signs or symptoms of heart disease. Some critics even accuse physicians of ordering such services to bolster their revenue.
So what happens when uninsured patients make it to the doctor’s office …
Do uninsured patients receive more unnecessary care?
I am a terrible coder. I think I am a pretty good doctor, but when it comes to coding, the process of figuring out which billing code to pick to assign to a bill for an office visit, I am hopeless. No matter how many times I have had the rules explained to me, or how much feedback I have been given about specific visits, or which “pocket guide” to …
A physician contemplates Medicare blended rates
“Better patient care” is the reason hospital and health systems usually give when they merge or acquire one another. Our research suggests that mergers and affiliations might, paradoxically, increase the risk of harm to patients in the short run. Improving the safety of patient care is possible during mergers and affiliations, but requires intentional efforts.
What happens after …
Hospital mergers and the risk to patient safety
It’s easy to get excited about technological advances such as nanobots that swim in blood to deliver drugs or 3-D printers that print human tissues. However, in our enthusiasm to find the next fix, we are failing to notice the ground slipping underneath the health care industry.
Here are four trends that are changing health care but on the surface are too unsexy for us to care about.
Trend 1: The doctor-patient …
4 disturbing trends in health care
Health care is buzzing as Atul Gawande has been selected as CEO of the Berkshire-Hathaway/Amazon/JP Morgan strategic venture. I was thrilled they picked a physician, like myself, in the trenches to run their gig. After hearing the news, I remembered Gawande’s TED Talk from 2012 and decided to catch up on it during my flight to the Healthcare Finance Management Association Annual Meeting and Innovation Lab.
After watching the …
Atul Gawande’s prescient 2012 TED talk
By now, everyone has heard that the Centers for Medicare and Medicaid Services (CMS) has proposed to dramatically change how physicians get paid for evaluation and management (E&M) services in the office as part of the proposed 2019 Physician Fee Schedule Rule. In fact, as of the end of July, CMS has received over 600 comments on the proposed rule, with virtually all of them criticizing the proposal. I suspect …
Don’t throw the E&M baby out with the bath water: the proposed CMS changes
The health care system has never been so complex as it is today. As doctors, we’ve seen the struggles that happen just trying to help patients get the medical care they need. Patients are now ladened with high deductibles and often are the victims of baseless denied coverage for diagnostic tests and medication.
Insurance companies insist that they are not practicing medicine, merely making coverage determinations and that the patient is …
How our health care system traumatizes patients
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As more doctor pay is being tied to patient satisfaction and “outcomes,” a recent Forbes article argues that “It’s only a matter of time before physicians will see the bulk of their compensation tied to quality measures.” To prepare for this pay-for-performance apocalypse, the article cites Medical Group Management Association (MGMA) CEO Haylee Fischer-Wright, MD, who urges physicians to “build data analyses” and take …
Stop treating doctors like school children
In the recent weeks we’ve seen frequent headlines alerting people around the country to dangerous heat waves. Physicians and nurses see these headlines and the human results of the heatwaves in the form of heat illness, people burdened with lung ailments and suffering from deteriorating air quality, and a range of individual harms brought on by wildfires and torrential downpours. Current trends in extreme temperatures are alarming and clearly linked …
Doctors need to lead the way on divestment from fossil fuels
A guest column by the American College of Emergency Physicians, exclusive to KevinMD.com.
Emergency medical care in the United States is a unique success story. Born from military tactics, emergency medicine has grown exponentially in size and sophistication from its early days. What was once a patchwork of inspired professionals cobbled together at a moment’s notice is now a highly esteemed medical specialty; singularly trained and expertly equipped …
Emergency care coverage denial policies put lives at risk
If Atul Gawande’s first week as CEO of a health care startup was anything like mine, I hope he is able to get away from it all and enjoy a completely relaxing weekend. He will have earned it.
After Gawande was named to head the joint venture between Amazon, Berkshire Hathaway, and JPMorgan, some critics said that choosing …
Health care needs more physician CEOs
Engaging in an economic conversation about the conventional compensation of a physician leads one to believe that doctors are well-to-do. In the minds of most citizens, school-tuition board members and even local neighbors, if you’re a physician the presumption is that you are economically prosperous, maybe even rich. This sociological assumption probably sounds false to most whom honorably don the white coat. Perhaps a decade or two ago, when medical …
A case for paying doctors more
Today’s news is full of commentary about work requirements for Medicaid. Is work a prerequisite for health care or is health a prerequisite for work?
Not to complicate things, but can we even agree on what health care is? I don’t think we can, and it largely falls back on what we want to share in paying for.
A patient with an ugly skin lesion can have it removed if it might …
Balancing stewardship and entitlement in health care
The word “historic” is often used by PR professionals to hype something that is, well, pretty run-of-the-mill. They figure that no one is going to read a news release that announces “[Name of organization] proposes small change that really won’t make much of a difference.” The problem is that when something is done that really measures up to being historic, the recipient is less likely to believe it, kind of …
Medicare’s historic proposal to change how it pays physicians
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