Physicians writing on KevinMD about policy as it reaches the exam room: prior authorization and the state and federal rules now written for it, scope of practice laws state by state, the CDC opioid guideline and what forced tapers did to patients, and public health from vaccination to the pandemic. Four maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words, Opioids: what physicians and pain patients say, in their own words, and Vaccines: what physicians say, in their own words.
Earlier this summer, the Trump administration announced new rules that would eliminate asylum eligibility for people arriving from countries where COVID-19 is “prevalent,” even if they are fleeing for their lives. This is the latest in a string of anti-immigrant policies being pushed forward during the pandemic under the guise of public health. As physicians who care for migrants within and outside of the United States, …
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Stop using false public health claims to attack immigrants
Spoiler alert: If you are looking for the “right” answer as to whether or not your school should reopen for in-person teaching or if you should send your kid to school (versus virtual learning), you will not find that answer below. But you will find some factors to consider in making a decision for your family.
Given that I am in multiple Facebook physician groups and parenting/community groups, my Facebook feed …
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A physician-parent’s thoughts on reopening schools
My friend, the hospitalist, was livid as he came from meeting the administration. “They said doctors cost too much!” he sputtered. “We’re an expense. An expense the hospital can no longer support. We are an expense!”
He turned purple. Nice color. Like a good Bordeaux. I worried about his blood pressure. He can’t have a healthy lifestyle! None of us do. Seven twelves in a string will do a number on your workout routine, …
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Something’s rotten in America’s health care
The murder of George Floyd at the hands of police officers in Minnesota has awakened a country out of hibernation and put Black Lives Matter on the national platform. Practicing primary care in Springfield, Massachusetts, I have known for a long time that Black lives do matter. It is important to understand that Black health matters and blank education matters as well. The Black on Black violence needs attention as …
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Black lives will not start to matter until Black health matters
With the news that nearly 6 million Americans have lost their employer-sponsored health due to COVID, it is finally time to ask ourselves: is the “American Model” of health care working?
The “American Model” is a system of fragmentation: one in which changing jobs can mean lapses in insurance, moving to a new state can mean losing Medicaid eligibility, and getting a raise can mean financial ruin …
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Is now the time for single payer?
As protests broke out on the streets of downtown Cleveland and the National Guard camped outside the hospital, I delivered a beautiful, Black baby boy. In some ways, that night was like any other night. Another vaginal delivery, another moment filled with love and joy that I had the privilege of sharing with a family. But this delivery felt different.
Medically, the patient was fine. My checklist of assessments after the …
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An OB/GYN resident’s perspective on Black Lives Matter
“I absolutely insist that you accept this 5-dollar bill,” said the slightly hunched, distinguished-looking Caucasian man in khaki shorts and a T-shirt. He held my big brown hand firmly open with the fingers of one hand while placing a five-dollar bill in it with the other. He looked into my eyes gently but firmly.
I looked down at Abraham Lincoln on the currency bill and instantly felt devalued. My brain went …
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This physician decided not to get offended and started a healing interaction
The United States government has resumed capital punishment after a 17-year hiatus. Even setting aside questions of whether the death penalty is legal, ethical, or humane, the renewal of the practice of lethal injection poses some grave concerns, particularly in the context of the global pandemic. According to Department of Justice documents, the government is using the drug pentobarbital to carry out the executions. The government’s …
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Unethical policy: Resuming federal lethal injections during a global pandemic
An African American female had been to the hospital three times in the last week for severe abdominal pain. Yelling for pain medication, she returned with the same complaint. The abdominal imaging two weeks ago was normal, and doctors had labeled her a “drug seeker.” Now, after a few hours, the physician reluctantly ordered another abdominal scan that showed ischemic colitis, a serious illness. She was taken for emergency surgery …
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Discrimination kills: What to do about implicit bias training
Some images stick in the mind as unreal and incandescent things, despite their lived experience. My mind holds onto the gray-haired woman, stooped from age and wearing the hospital-issue facemask, standing alone with her hands clasped tightly behind her back. She was peering through the window of the door to her husband’s ICU room where he had just died. I joined a small group of nurses to hold a distant …
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The unseen debt of the pandemic
“I often heard as a child that Mexicans were lazy and dirty. As a Mexican-American, I did not wear shorts for years despite the heat because I thought my knees looked dirty. Now I fully embrace my identity. However, as a medical student, I still feel the pressure to disprove these stereotypes.”
– Camila Hurtado
“Growing up in the barrio, my white classmates would tease and bully the brown Latino kids constantly. …
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Declaring racism as a public health crisis from the lens of two Latinx student doctors
On March 20th, as the chaos of the unfolding pandemic enveloped New York City, Governor Cuomo issued Executive Order 202.10, which, among other directives, suspended work hour restrictions for residents in New York. These regulations, which had been enacted 30 years prior, were the consequence of the journalist Sidney Zion’s well-publicized crusade to investigate the death of his daughter Libby at New York Hospital in 1984, …
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Empower residents: It’s important now more than ever
During clinical training, medical students worry about caring for patients, learning how to do procedures, memorizing drug interactions, and documenting their work in the electronic medical record —they shouldn’t be worried about paying medical bills at the same time. Shortages of personal protective equipment and the subsequent dangers of working in health care permeate the news and threaten our ability to overcome the COVID pandemic. However, there is another often-neglected …
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Uninsured medical students are at risk
As of October 2019, the small country of Lebanon began its descent into its worst economic collapse in modern history. Exacerbated by the COVID-19 pandemic, the Lebanese currency has lost nearly 85 percent of its value on the black market, and the inflation rate within the country has surpassed even that of Syria, with the worst still to come. As a result, unemployment rates have been climbing, countless businesses, both …
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Physicians in a failing state set an example
A quarter of the physician workforce in the United States consists of international medical graduates (IMGs). This year 4,222 non-U.S. citizens matched in first-year residency positions. I am an IMG from Guatemala, where I completed medical school. In March of 2014, I matched to an internal medicine residency in the United States. The road has been both satisfying and challenging, with all kinds of uncertainties. I have always been attracted to …
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The uncertainty of an international medical graduate during the COVID-19 pandemic
Born in the United States of America to Nigerian parents, I was raised in Nigeria and returned to the U.S. after medical school for residency training. I have practiced medicine in Chicago, IL for 25 years, and like many others, have had to deal with microaggressions and racism within and outside the workplace. However, this article is not aheabout outlining my personal experiences. This is a call to action to …
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Immigrant physicians: Acknowledge our privilege and move to action
In a market economy, business leaders take every opportunity to shrink the cost line of labor on the balance sheet to boost profits and shareholder/investor value. It’s the metric on which they are evaluated, and left unopposed; they will do it more and more.
The core strategy for shrinking labor costs (along with automation and offshoring) is to drive increased “efficiencies” by demanding more and more work from the same number …
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3 reasons why doctors don’t unionize
I look out at the world through bright blue eyes. Blonde hair. A skinny but shapely 19-year-old’s body. I know six languages. I am educated. I can prescribe medicine that saves lives. I am in love. I am a person.
I look down at the tattoo on my arm. A number— like cattle. My family is gone. My home destroyed. I am living in a small room— …
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I always hope that a sense of humanity will supersede the status quo
The daily email update on COVID-19 affecting our hospital system is a glaring reflection of the health disparities amongst those in marginalized groups. The farther south you go, generally in San Diego, the higher the number of socioeconomically disadvantaged persons, and that tends to include a disproportionate number of persons of color. These populations may be unable to physically distance due to living conditions and job conditions. Perhaps there is …
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COVID-19 becomes a magnifying glass for health disparities
