Just think about it for a second. This means now we actually practice medicine based on bona fide evidence? What the hell have I been doing for the past 25 years? Making it all up? And who wrote those thousands of articles I’ve read? Dr. Seuss?
Evidence based medicine, or EBM, may be just another way to remove a physician’s autonomy. This trend has marched on for years, …
Evidence based medicine removes a physician’s autonomy
An alarming article in Politico.com looks at what could happen if the Supreme Court determines that the Affordable Care Act’s individual mandate provision is unconstitutional—something that the current conservative leaning of the Court seems to indicate is somewhat more likely than not.
Assuming that such a possible decision by the Court follows that of the Eleventh Circuit Court of Appeals in ruling that the mandate is unconstitutional but …
What if the individual mandate was unconstitutional?
Public health has often focused on prevention tools that impact an entire community or population. Before Henry Bigelow MD described the use of Ether in 1846 to mitigate pain during surgery or Joseph Lister MD discovered the value of sterile technique, surgical candidates were few. Even if one were convinced tolerate the pain of surgery, more than half would die from the risk of infection. For most of surgical …
Why haven’t surgeons been on the front line of public health?
The art of practicing medicine is dying, soon to be replaced by the art of template medicine.
Modern medicine is based on laudable terms: “quality,” “outcomes,” “cost effective,” and “evidence based medicine,” which all sound good when sold in infomercials to the medical world and public. When examined closely, all are vague and open to abuse.
Each of these terms is intent on taking the human factor out of medicine. Each …
The art of practicing template medicine
Here are my next two principles of affordable healthcare reform.
First, healthcare reform cannot occur without tort reform. Anything less is akin to a drunk leaning up against a lamppost for support but insisting it is for illumination.
It is well known that fear of malpractice suits accounts for defensive medicine; e.g., performing tests and procedures and making unnecessary referrals to assure staying out of the court room. We are all …
Tort reform and integrated systems in health reform
It’s become one of those trendy phrases, “unnecessary care.” When you hear it on television or talkshow radio it’s usually said with a sneer. Indeed, the speakers almost spit the phrase out — “unnecessary care” — like it tastes bad. It’s almost always accompanied by “fraud and abuse,” or a not so subtle accusation that some doctor is profiting off this unnecessary care at the expense of some poor …
What exactly is unnecessary care?
As Occupy Wall Street has gone from an obscure protest covered only on blogs and social media to a national phenomenon, the apparent parallels between the issues it is raising and the issues we have been raising in health care grows.
A growing number of protesters are calling themselves the “99 Percenters,” referring to those who are not in the top 1% of earners. The top 1% of income is clearly greater than $250,000 per year, and likely …
Why 99 percent of health care should be angry
I recently had some physical therapy for a minor injury. Since the office forgot to charge my co-pay the first time I went in I received a so-called Explanation of Benefits (EOB) from my insurance carrier, BlueCross BlueShield of Massachusetts. EOBs are a holdover from the mainframe era: arcane, inflexible reports that are hard to interpret. They may have done their job in the day when their only purpose was …
What does the Explanation of Benefits really mean?
Ask most patients, and they say their doctor has a good reason for ordering tests and prescribing treatments. Turns out their doctor may secretly disagree. That’s the conclusion of a new study. The implications are more than a bit disturbing.
Researchers from the Dartmouth Institute for Health Policy conducted a survey of more than six hundred physicians. Forty-two percent of family doctors admitted that patients in their own practice receive too much care – meaning …
The impact of unnecessary testing and treatment on patients
With all the debate about cost control, it’s clear that we doctors will have to police ourselves – or else politicians and insurance companies will exert even more influence over our practices than they already do. The main question is:
Are we willing to let our physician colleagues exert influence on our care decisions?
Taking a case from my field: at a conference this past week I met a radiology resident …
Our easy access to imaging has led to overutilization
Doctors are in the cross-hairs of the nation’s politics more than ever. We’re all being asked to achieve more with less. We must cope with nightmare scenarios precipitated by cracks in the social and healthcare infrastructure so often these days that medical schools insist students become effective patient advocates as well as healers. Practicing good medicine necessitates navigating a minefield of competing interests. Doctors are increasingly tempted to just walk …
Doctors who cross the line by protesting too much
Why does health care cost so much more in the United States than in other countries? The answer is exceedingly complex; pharmaceuticals, hospitals, and physician services (among others) comprise the multiple slices of the health care pie that in the United States is about twice the size of the next largest spender for health care services.
A new study from one of President Obama’s appointees (note: this study was written prior …
Are physician services to blame for high health costs?
The relationship between doctors and their patients has changed dramatically over the past few years. Medical beneficence became paternalism and is now near obsolete. Shared decision making is the new lofty ideal we should all be striving for. It is guiding new health policy both in the UK, with the new mantra “nothing about me without me,” and in the US.
We are at the start of the Century of the …
Shared decision making is impossible in a government run health system
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Data from the Dartmouth Atlas show patients with chronic illness in their last two years of life account for about 32 percent of total Medicare spending, with much of that expense going toward physician and hospital fees associated with repeated hospitalizations.
Opportunities to reduce medical expenditures during the last 2 years of life are often looked upon as a way to reduce the cost of healthcare while actually improving the …
Palliative care physicians can enhance patient decision making
Doctors order too many tests.
That’s not a surprise for regular readers of this site, but even the physicians themselves think so.
A recent survey reported that, “42% of the 627 respondents believed the patients in their own practice were getting too much care. Just 6% of doctors believed their patients were getting too little care … And 28% of the …
Progressive health reformers need doctors to change the health system
At every turn, we in health care are being told we must fundamentally change the way we deliver care to the patients who come to us for assistance, advice, and decisions as to how they can, if not maintain health, at least survive in an increasingly burdensome world. Whether referenced as medical home, health care home, advanced primary care, patient-centered approaches, or accountable care organizations, it all sounds the same …
Physicians lack harmony in this age of health reform
I once asked a man in his 30’s why he was on disability. He had fallen attempting to ford a swift stream while fishing. He replied: “Well, the judge said I have a bad attitude, I don’t like people and I can’t hold a job.” Shocking as it sounds, it wasn’t very different from other reasons I’ve heard. “I don’t remember, my Dad put me on it.” “I have anxiety.” …
America’s broken disability system
Hospital systems and physician groups are faced with unprecedented change demanding decreased per-capita cost and increased quality in American health care. Boards of directors are underutilized resources that must be tapped more effectively in order for such organizations to survive in a time of industry consolidation. Generative thinking is a tool that can help organizations innovate in order to improve patient care and the financial bottom line.
Generative thinking is …
A hospital board needs to understand generative thinking
After nearing the brink of political collapse, Congress and the President reached agreement on a plan for deficit reduction. Part of the agreement is that a “super committee”will cut an additional $1.5 trillion from the federal budget. Cuts are being considered for a range of programs, including Medicare. As director of a wellness program for retirees, however, I remain acutely concerned about the impact Medicare cuts will have on …
Physicians need to be part of the overall wellness process
I would like to share a story about my son’s recent surgery that, while only one simple case, reveals the foundational problem with the U.S. health care system.
I write this story as a father of a 12 year old boy who has cerebral palsy. Jack is fortunate to be healthy and active with minor medical needs. As he has grown he experienced some issues with contractures in his right lower …
It is not easy being a patient-consumer, but it can be done
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