Health Policy and Public Health

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.

What health care can learn from the Boeing 737 Max tragedies

Cesar Padilla, MD

Physician

July 25, 2019

The recent Boeing 737 airline crashes have left a scar on the American (and worldwide) psyche regarding air travel. Boeing, an iconic brand, prestigious in history and talent, neglected to update and formally educate pilots regarding an essential software update which ultimately contributed to two fatal crashes, killing 346 people in total.

Recent audio between an American Airlines pilot and Boeing’s leadership offers some insight — and lessons — into this …

Scope of practice expansion: Patient safety is sacrificed for greater access

Suzanne M. Everhart, DO

Health Policy

July 24, 2019

When a patient seeks the care of a professional, they expect that person to be well trained, experienced, and constantly continuing their education. As an ophthalmologist, I completed a 4-year undergraduate program at Virginia Commonwealth University, 4 years of medical school training at The University of North Texas Health Science Center, a year of a rotating internship, and a 3-year residency program in ophthalmology at Tulsa Regional Medical …

Street medicine: You don’t know about it, but you don’t care to

Ti Hoang

Medical Education

July 24, 2019

Street medicine is a small niche, but it’s not new. Dr. Jim Withers and Dr. James O’Connell began the pioneering in the United States in the 1980s, and it’s not just a local practice; the Street Medicine Institute is a global organization made up of fifteen countries across five continents. When preceptors or other physicians ask me what field I want to go into, I tell them “street medicine.” Almost …

Remembering the lives lost — and lives saved — in Normandy 75 years ago

John Biemer, MD

Physician

July 23, 2019

Nothing quite prepares you for the American cemetery in Normandy, the final resting place for 9,380 lives cut short in World War II. Even if you’ve seen “Saving Private Ryan,” you can’t help feeling an emotional gut punch, a combination of awe, sadness and respect when you see those simple white marble gravestones on the gently curving hills of Colleville-sur-Mer, stretching as far as you can see.

This June marked the …

Reduce health care’s carbon footprint to save our patients

Aditi Gadre

Health Policy

July 22, 2019

I would like to explore a typical American health care experience through a different lens: energy.

Upon entering a hospital, I would see bright lighting and hear the gentle hum from ventilation. If I were to get an MRI, this requires significant energy often supported by fossil fuels. For blood work, there would be medical waste generated from my stick. While grabbing a quick bite to eat in the hospital cafeteria, …

What Ocasio-Cortez and Cruz get right about birth control

Kyle Varner, MD

Health Policy

July 18, 2019

I think we can all agree that women have a lot more hoops to jump through when it comes to contraception. If a woman wants to go on the pill, she has to go through the bureaucratic process of seeing a doctor and getting a prescription.

This is why I am so happy to see Alexandria Ocasio-Cortez and Ted Cruz agreeing to support a bill …

Should physicians stay in their lane on abortion?

Nina Shapiro, MD

Physician

July 17, 2019

Now more than ever, it seems that medicine, politics, social justice, and societal mores have become intertwined. There are so many “lanes” that the 405 to the 10 freeway splits seem like country roads in comparison. Perhaps we have social media to thank for this multitude of lanes. Or maybe it’s to blame.

When doctors were publicly berated (on social media, primarily) soon after we became outspoken about the issue of …

How technology ruined, and can save, the doctor-patient relationship

Robert Pearl, MD

Health Technology

July 16, 2019

Each year, Medical Economics surveys physician readers to find out what irks them most. Topping the latest list: insurance paperwork, followed closely by electronic health records (EHRs).

The reason is the same for both. Insurers and EHRs get between doctors and their patients.

When it comes to medicine’s computer problem, the obstacle is literal. Doctors sit behind a screen, focused on the EHR and not the patient. …

Does medical school train students to become managers or leaders?

Maria Yang, MD

Medical Education

July 14, 2019

I worked with someone (not a physician, but that doesn’t really matter here) whose title was “assistant director.” He and I quickly recognized that we worked well together: His head brimmed with big visions and ideas, whereas my head brimmed with plans as to how to make those ideas manifest in the actual world.

“He’s like a bunch of balloons,” I quipped to a colleague. “He’s got a ton of ideas …

An American physician in Sweden. Here’s what he thought about its health care.

Richard Young, MD

Health Policy

July 14, 2019

I had the distinct pleasure working with family physician colleagues in Sweden recently. It was a similar experience to a trip I made to Britain about five years ago that I also wrote about. I got to spend some time watching one of my colleagues care for her patients in her surgery (they use the same description of a clinic as the British).

I got to spend some time watching …

Are hospitalists to blame for the fragmentation of medical care?

Skeptical Scalpel, MD

Physician

July 14, 2019

“What About Recovery” is a provocative essay by Yale professor Lenore Buckley, MD, in JAMA.

She writes in detail about the death of her 68-year-old brother in a hospital. She felt his doctors did not do enough to help him recover because his nutritional and physical therapy needs were not met.

However, there’s more to it. She calls out the system existing in every hospital I’m aware of writing, …

Why you’re an unhappy physician

Suneel Dhand, MD

Physician

July 13, 2019

Health care is a tough job to work in — whether you are a doctor, nurse or any other professional. We are dealing with matters of life and death, our patients expect (and deserve) the best from us, and we always have a hundred-and-one things to do at the frontlines of medicine. I remember reading somewhere when I was a teenager that a career in medicine would be a “mentally, …

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Why you’re an unhappy physician

Understanding the distinction between universal health care and a single-payer system is critical

Niran S. Al-Agba, MD

Health Policy

July 4, 2019

The World Health Organization describes universal health coverage — a system coupling health care access with financial protection for all residents — as the “single most powerful concept that public health has to offer.” The goal of universal care is to give all people the equal opportunity to enjoy the best health possible.

I wholeheartedly endorse universal health care, though not a single-payer system like “Medicare for all” because there is …

Technology is corrupting the culture of medicine

Robert Pearl, MD

Health Technology

July 2, 2019

To help then-candidate Bill Clinton remain focused on the No. 1 voter issue ahead of the 1992 presidential elections, political strategist James Carville coined an unforgettable mantra, which he posted inside Clinton campaign headquarters.

It read, “The economy, stupid.”

The quote became famous both for its edginess and wisdom, reminding us to separate the big picture from everything else.

In health care, it can be hard to define the “big picture” issue when …

Physicians: Do not be intimidated by administrators

Suneel Dhand, MD

Physician

June 28, 2019

A piece of advice I would give to any younger physician, especially one who is just graduating residency, would be to expect a whirlwind ride into the realities of frontline medical practice. It’s something that you are totally not prepared for in the controlled environment of education and residency training. A steep learning curve awaits you once you start practicing medicine. And one of the biggest things you will have …

How climate change affects your skin

Sultan H. Qiblawi and David Fivenson, MD

Conditions and Diseases

June 27, 2019

Global climate change is reaching a critical mass.

Since the advent of the industrial revolution, we have seen the global mean temperatures increase by 1°C (1.8°F), and significant steps must be taken by 2030 to mitigate an even larger global temperature increase of 1.5 to 3C as predicted by 2030. In other words, we are in dire need of change.

This change is not only reliant on governmental policy change but is …

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How climate change affects your skin

A physician volunteers with migrants. Here’s what she saw.

Sheryl Recinos, MD

Physician

June 26, 2019

“At least seven children are known to have died in immigration custody since last year,” according to a NBC News report last month.

I recently spent a Saturday working with amnesty-seekers that had been detained at California detention centers in the desert. They were dropped off at bus and train stations in the desert in Southern California, most with no money and no ability to …

Can the states fix our national health care disaster?

Elisabeth Rosenthal, MD

Health Policy

June 26, 2019

Earlier this year, California’s new governor, Gavin Newsom, promised to pursue a smörgåsbord of changes to his state’s health care system: state negotiation of drug prices, a requirement that every Californian have health insurance, more assistance to help middle-class Californians afford it and health care for undocumented immigrants up to age 26.

The proposals fell short of the sweeping government-run single-payer plan Newsom had supported during his …

Cancer care costs everyone too much. What can we do about it?

Andrew Hertler, MD

Health Policy

June 24, 2019

Today’s fee-for-service oncology business model misaligns incentives by rewarding practices for keeping margins and service volumes high — even when it’s wasteful — rather than for optimizing patient outcomes.

While discussions of drug pricing dominate the cost control conversation, we, as practitioners, have been abdicating responsibility and missing the opportunity to address cancer’s financial toxicity. We can do better. The practice-level assumption of financial risk for patient care — or the …

Physicians have been reduced to overpaid dairy farm labor

Kyle Varner, MD

Physician

June 24, 2019

I can tell you why there is a high burnout rate in the medical profession, but to do so, I have to explain why there isn’t one for small private practices.

When I was finishing up medical school, I went to see a general practitioner. Now, this doctor had an unbelievably high level of charisma. To say he was engaged in his patient’s health care would be an understatement. Not only would …

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