Charles Dinerstein, MD, MBA
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Latest articles
Physician voices
In a world where experts are our go-to for solving everything, the COVID-19 pandemic exposed just how fallible these specialists can be. Despite impressive titles and years of experience, many experts were just as clueless as the rest of us,…
In a world where experts are our go-to for solving everything, the COVID-19 pandemic exposed just how fallible these specialists can be. Despite impressive titles and years of experience, many experts were just as clueless as the rest of us, often with unwarranted confidence. A recent study delves into the uncomfortable truth: the more knowledge you think you have, the less aware you might be of your actual ignorance.
We rely …
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Trust me, I’m an expert: the pandemic parade of pompous professionals
Physician voices
You'd think surgeons would be the first to know when to hang up their scalpel, but alas, they're as stubborn as a rusted bolt. When should a surgeon put down the knife and stop pretending they're not going blind? It's…
You’d think surgeons would be the first to know when to hang up their scalpel, but alas, they’re as stubborn as a rusted bolt. When should a surgeon put down the knife and stop pretending they’re not going blind? It’s a question of cognitive decline, ego, and knowing when to pass the baton—or in this case, the scalpel.
Unlike our colleagues in internal medicine, surgeons wield sharp objects, making the temporal …
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Cognitive decline and surgery: the silent struggle doctors don’t talk about
Physician voices
For decades, the medical community has wrestled with the role of race in research and practice, a tug-of-war steeped in historical, social, and political entanglements. While some argue for discarding race, in doing so, we overlook the nuanced interplay between…
For decades, the medical community has wrestled with the role of race in research and practice, a tug-of-war steeped in historical, social, and political entanglements. While some argue for discarding race, in doing so, we overlook the nuanced interplay between genetics and lived experiences. Does race carry explanatory power, or are there better alternatives to this surrogate?
Race presents a complex interplay of benefits and challenges as a variable in health …
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Medicine’s struggle with genetic and social realities
Conditions and diseases
In 2013, the American Heart Association (AHA) and the American College of Cardiology (ACC) created a "risk calculator" to estimate the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) and guide patient-centered medical therapy for prevention strategies, like starting statins. However,…
In 2013, the American Heart Association (AHA) and the American College of Cardiology (ACC) created a “risk calculator” to estimate the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) and guide patient-centered medical therapy for prevention strategies, like starting statins. However, concerns arose that the pooled cohort equations (PCEs) overestimate risk and do not reflect the current diverse U.S. population, particularly underrepresenting Asian and Hispanic adults.
In 2023, AHA’s Cardiovascular-Kidney-Metabolic Scientific Advisory …
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Diverse data redefines heart disease prevention strategies
Health policy
My friend and colleague, Alex Berezow, wrote a piece titled "Is the U.S. doctor shortage intentional?" The writers at ACSH share their work before publication to get feedback, and in the case of Alex's latest, we disagreed. While much of…
My friend and colleague, Alex Berezow, wrote a piece titled “Is the U.S. doctor shortage intentional?” The writers at ACSH share their work before publication to get feedback, and in the case of Alex’s latest, we disagreed. While much of what he wrote is factual, without the nuance of the setting, it fails to tell the entire story. So here is not so much my rebuttal but the rest of …
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The truth behind the U.S. doctor shortage: Is it intentional or not?
Physician voices
When demand exceeds supply, a resource is limited. Allocating those resources "involves a tension between efficiency and equity." The market has several ways to allot those limited resources, beginning with cost. For example, frequent flyer miles, a form of resource…
When demand exceeds supply, a resource is limited. Allocating those resources “involves a tension between efficiency and equity.” The market has several ways to allot those limited resources, beginning with cost. For example, frequent flyer miles, a form of resource allocation, may not seem controversial, except to those getting on last, where there is no room for their carry-on. Health care is a limited resource for many reasons, and equity …
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Concierge medicine: exclusive access or equity dilemma?
Drugs and prescribing
They are the foundation of the CDC's 2016 opioid guidelines, resulting in legislation limiting opioid prescribing in 36 states. Morphine milligram equivalents, or MMEs, are used to set arbitrary prescribing limits for opioids by physicians since many state legislators fail…
They are the foundation of the CDC’s 2016 opioid guidelines, resulting in legislation limiting opioid prescribing in 36 states. Morphine milligram equivalents, or MMEs, are used to set arbitrary prescribing limits for opioids by physicians since many state legislators fail to understand — and translate into policy and law — the ’16 guidelines. If we had all known the history of MMEs, perhaps we would not have been so eager …
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The true story of morphine milligram equivalents
Health policy
With the announcement of CVS Health HUBs, the synergy of data and business is rapidly coming to the health sector; health systems will become havens only for the severely acutely ill, the more complex, the expensive. In the same way…
With the announcement of CVS Health HUBs, the synergy of data and business is rapidly coming to the health sector; health systems will become havens only for the severely acutely ill, the more complex, the expensive. In the same way that urgent care centers catered to low acuity, high financial margin problems that both financially supported and congested emergency departments, HealthHUBs will take similar problems away from primary …
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How pharmacy-based primary care takes the low-hanging fruit
Health policy
Jimmy McMillan might have been right. Mr. McMillan ran for mayor of New York City as the founder and candidate of the “Rent Is Too Damn High” Party. And while he was talking about real estate rent, he might have…
Jimmy McMillan might have been right. Mr. McMillan ran for mayor of New York City as the founder and candidate of the “Rent Is Too Damn High” Party. And while he was talking about real estate rent, he might have made a similar complaint about health care’s rent — payments made for costs over what is needed to produce a good or product.
Rent is not …
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The rent is too high in health care
Health policy
Pay for performance (P4P) is all the rage in health care. Big Pharma led the way, and the popular press would have you believe that one can “incentivize” physicians and their clinical colleagues with as little as a sandwich and…
Pay for performance (P4P) is all the rage in health care. Big Pharma led the way, and the popular press would have you believe that one can “incentivize” physicians and their clinical colleagues with as little as a sandwich and a bag of chips. Corporations have used bonuses, stock options, and commissions for years as motivators. And the government and insurance companies, although late to the party, are all in …
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Physicians are now lab rats
Health technology
When we all lived in villages, knowing individual merchants allowed you to identify and avoid the cheats. As we urbanized, brand names became the reputational marker. But when you are dealing on the internet, where no one “knows you’re a…
When we all lived in villages, knowing individual merchants allowed you to identify and avoid the cheats. As we urbanized, brand names became the reputational marker. But when you are dealing on the internet, where no one “knows you’re a dog,” what guarantee do you have? A case involving a Dutch physician who argued that her licensure suspension should be forgotten, highlight health care’s growing dilemma of privacy and reputation.
The …
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Do physicians have a right to be forgotten?
Health technology
Among the many recurring topics, this year has been the impact of machine learning in our lives, especially the implications for our future work life. Prophecies range from ubiquitous utopian machine servants to a dystopian ravaging, hollowing out the work…
Among the many recurring topics, this year has been the impact of machine learning in our lives, especially the implications for our future work life. Prophecies range from ubiquitous utopian machine servants to a dystopian ravaging, hollowing out the work and economic standing of the middle and lower classes. “What can machine learning do? Workforce implications” by Erik Brynjolfsson and Tom Mitchell in Science provides some perspective on machine learning …
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Will robots replace doctors?
Medical education
Recently, there has been a number of articles on reducing the length of medical training to help ease the physician shortage. And our medical curriculum is due for a major overhaul. Its foundational document, the Flexner report, was released over…
Recently, there has been a number of articles on reducing the length of medical training to help ease the physician shortage. And our medical curriculum is due for a major overhaul. Its foundational document, the Flexner report, was released over 100 years ago, and our medical needs and knowledge have changed. Shortening medical education may provide a “bonus” in easing the anticipated shortage of physicians …
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Shortening time in medical school is a bad idea. Or is it?
Physician voices
Take a moment to ask yourself the following: 1. Did I come to practice medicine because it was a calling, rather than a possibly lucrative career path? 2. Do I consider the practice of medicine primarily an art, a craft…
Take a moment to ask yourself the following:
1. Did I come to practice medicine because it was a calling, rather than a possibly lucrative career path?
2. Do I consider the practice of medicine primarily an art, a craft and the consistent application of evidence-based care?
3. Do I respond to inner measures of prideful work more than the appeal of external motivators?
4. Are there lines that cannot be crossed, even if …
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