Utilization management is medicine’s great conspiracy theory

Physician
June 20, 2022

So-called “evidence-based guidelines” are slowly destroying the practice of medicine, and companies that develop these proprietary guidelines are guilty of conspiring with payers to deny individuals necessary medical treatment.

Guideline developers, health plans, and their benefit managers contend that utilization management (UM) programs based on medically proven guidelines will reduce unwarranted clinical practice variation and improve care quality and cost. But real-world evidence paints an entirely different picture. A recent Read more…

Why is there a formula shortage? 

Policy
June 20, 2022

This is a complicated answer with a complex history.

The most recent factor contributing to the formula shortage is COVID-19 and the pandemic’s effect on supply chains. With the start of the pandemic, people began stockpiling supplies from toilet paper, bottled water, to formula. Concurrently, birth rates decreased due to fear of the virus and its unknown effects on pregnant patients, fetuses, and newborns. Formula consumption was low, decreasing …

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Art as a tool to manage pain [PODCAST]

Podcast
June 19, 2022
YouTube video

“I had also used arts and crafts previously in my own experience to help with healing. Including the previous year when I had a breast cancer recurrence did many crochet projects and took classes in mosaics making as I navigated from victim to survivor. However, following my catastrophic accident, I didn’t …

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A difficult conversation with my mother’s oncologist

Physician
June 19, 2022

The silence felt heavy on the other end of the phone line. I waited a few seconds, and it dawned on me: He wasn’t ready. This moment, each in our own worlds was a defining point in our journey.

Twenty seconds earlier, I had just shared the following with him, “We are ready for hospice.” But he clearly wasn’t. Or maybe he was and just couldn’t verbalize it. He paused after …

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5 reasons physicians are afraid to leave medicine

Physician
June 19, 2022

At age 33, I got my first job as an outpatient pediatric attending. With great pay, nice coworkers, and exceedingly better hours than in training, to everyone around me, I had finally “landed.” Soon after I began working, however, I woke up with trepidation every morning, forcing myself to get out of bed.

Why wasn’t I relishing the fruits of my labors? After all this time, I no longer trailed the …

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Supporting a new mom: my experience and some helpful tips

Physician
June 19, 2022

I recently came across a number for the National Maternal Mental Health Hotline. It took me back to my first pregnancy and postpartum experience.

I belong to a traditional family where there is an expectation of bearing a child after a year of marriage. No one prepares the couple for it. No one talks about any challenges during pregnancy and after the child is born.

It was no different …

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A bad death: the importance of truth-telling at end-of-life [PODCAST]

Podcast
June 18, 2022
YouTube video

“In their hearts, her daughters just wanted their mother to make the most of the time she had left. She never made it to the beach or hugged her grandchildren. From diagnosis to death, it was two short months. During those weeks, she waited for test results, went back and forth …

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Chronicles of my COVID isolation 

Physician
June 18, 2022

Day 1. I spent Thursday, my day off, golfing. Friday, I was scheduled to see patients and do surgery on the non-English-speaking mother of a patient I delivered a long time ago (who I didn’t really remember). She remembered me, though, and brought her mother from an hour away to see me. But as I coughed and felt slightly feverish, I realized that I had not felt well …

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Delivering unpalatable truths in medicine

Education
June 18, 2022

Many providers enter medicine to comfort patients and their loved ones. However, much of what I do doesn’t live up to that intention. In the past few months and particularly the past few weeks, I’ve spent most of my afternoons making little difference in the course of my patients’ hospital stays, and instead of having multiple conversations with the loved ones of these ill patients, providing daily updates, reiterating expectations …

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It’s time to flip the script on peer evaluations [PODCAST]

Podcast
June 17, 2022
YouTube video

“It’s time to flip the script on evaluations. How can we shine a light upon the strengths of the wonderful peers we are blessed to work with? How can we amplify their greatness, help them work in their own zone of genius? How can we recognize that we all have different, …

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The epidemic of work dread

Physician
June 17, 2022

Work dread.  Even if you didn’t know it had a name, you know the feeling.  It is that sensation in the pit of your stomach when you realize that the start of your workday or workweek is fast approaching, and you don’t want it to come.  Sometimes it begins on Sunday afternoon when you want to be enjoying time with your family.  Other times, you might find yourself sitting in …

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10 steps to create your direct specialty care clinic

Physician
June 17, 2022

Three years ago, I was a physician in the “traditional” medical system seeing 25 to 28 patients every day. I spent hours writing notes to provide proper documentation for the correct billing code. Often, my time was spent calling insurance companies to justify the appropriateness of my medical care. More and more hours were spent on completing tasks for insurance companies rather than patient care. Like many of my colleagues, …

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Burnout is a spiritual crisis [PODCAST]

Podcast
June 16, 2022
YouTube video

“It is a time to ponder on those essential questions: What is your purpose in life, and how can you follow it? What talents can you share with the world, and what are you grateful for? When we deviate from this true calling, when we deviate from love, from creativity, our …

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Is there more to patient safety than preventing medical error?

Conditions
June 16, 2022

I cry often enough that my kids almost gleefully expect it, checking me for tears during movies or shows, shaking their heads in mock dismay when they see that their prediction is correct. I’ve cried many times at home, watching screens, reading books, talking on the phone, and at work, where I am a doctor who cannot always suppress my emotions. And I’ve cried in front of health care providers …

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Allow patients to continue their opioid of choice while starting microdoses of buprenorphine

Meds
June 16, 2022

Twenty-six hours into the shakes, sweats, crawling anxiety, and gripping nausea of opioid withdrawal, Faye caves in and takes a couple of fentanyl tabs. She knows that she must tough out a couple of days without fentanyl to start Suboxone (buprenorphine/naloxone) through a medication-assisted treatment program, but the sickness gets the better of her. Those couple of tablets reset the clock on her withdrawal.

Starting buprenorphine – an evidence-based …

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Virtual care is convenient, but is it better for everyone? [PODCAST]

Podcast
June 15, 2022
YouTube video

“2022 is well underway, and we are still unclear about exactly where this virus is headed and what the lasting impact it will have had on all of us. We have self-driving cars, drones delivering food, and most of us spend our entire day on video calls, and the rest on …

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