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.
As a family physician in the trenches, I routinely see blatantly poor medical care in the history of my new patients. Far too many people get unwarranted medications and tests, while important things go unrecognized or unaddressed. This paradox is maddening.
We must do better.
To this end, policymakers have developed programs to promote “quality” and “performance” among clinicians. The main approach has been altering payments to serve as financial incentives and …
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Policymakers: Put down your carrots and sticks. They will not work.
A young male patient checks into the emergency department (ED) and is brought back to a room for an ankle injury he suffered the day before. He states that he twisted it while doing some indoor rock climbing and tells the triage nurse that it is swollen and tender, but that he can walk on it. His vital signs are registered, and he is brought back to a room where …
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Patient satisfaction should not be driven by poorly-designed surveys
On a daily basis, patients of mine come in for office visits complaining of wear and tear injuries, as well as aches and pains, and their methods of dealing with chronic pain. As we all know, aging is a part of the normal life process.
For instance, as we approach 70 years old, we typically lose three-quarters of our functioning kidney cells (nephrons) but do well with our limited reserve as …
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Many questions remain about medical marijuana
Superhero movies have long been my favorite. When I used to have a hobbies section of my resume, action adventure, thriller, and superhero movies were always listed. During one of my interviews for a medical residency position, the female interviewer asked me about that hobby.
“Why have you listed action adventure and superhero movies as a hobby, and why do you enjoy them?”
“Because they help me see that the impossible can …
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Superhero movies: a perspective from a woman in medicine
Last month on February 3, 2019, we celebrated National Women Physician’s Day (NWPD). Created in 2016 by the Physician Mom Group (PMG) in collaboration with Physicians Working Together (PWT) and Medelita, NWPD honors the first female physician in the U.S., Dr. Elizabeth Blackwell and highlights gender inequality in medicine. The day is a social media “holiday” of sorts, with timelines flooded with inspirational posts of women in white coats declaring …
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Celebrating Dr. Rebecca Lee Crumpler, the first African American female physician in the United States
I started sharing my journey through medicine on Instagram about four years ago after I failed the musculoskeletal block during my first year of medical school. I felt alone in my struggles and didn’t want anyone else to feel that way. So I started talking about it openly. It quickly became a place to nurture my creative self and build community. And even though a lot …
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8 reasons why Instagram is important in medicine
With the 2020 election cycle already moving into high gear, we are hearing a lot about Medicare for all. But is it a serious campaign promise, a catchy bumper sticker or a viable national program?
Supporters suggest it will be a panacea for our nation’s health insurance needs. Others are less sure. And some are downright opposed. So where do we go? As a starting point, there are things we can …
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Medicare for all: a campaign promise, catchy bumper sticker, or viable program?
One of the most popular topics in health care is the idea of universal health care coverage. You know the soundbites: “Medicare for all.” “Single-payer system.”
While universal coverage sounds desirable to many, some factors must be considered. In this post, I’m going to provide an aerial view of this complicated topic. My goal is to translate this issue into patient-friendly language that all of us can understand. This topic isn’t …
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A framework to understand universal health care
I often wonder what it was like before patient-centered care became a mainstream catchphrase. Was there a poor relationship between the patient and physician in the outpatient setting? Were hospitalized patients’ feelings, desires, goals, and therapy options ignored? It amazes me that we were able to care for patients more than ten years ago without using a “patient-centered” approach.
According to NEJM Catalyst, “Patient-and family-centered care encourages the …
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The fallacy of patient-centered care
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
More than two-thirds of Americans use social media, and 90 percent of adults in the U.S. have a cell phone. With these tools surrounding us, we must be more connected with one another than ever before. Right?
It doesn’t feel like we are. At least, the people who engage with the health care system don’t feel connected to the rest of us. They feel lonely. It feels like we send them …
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Social isolation is a health risk
The evolving politics of single-payer health care conflate the concepts of universal coverage, health care on demand and free health care. To the indiscriminate progressive mind, all three are part of the holy grail. The fly in the ointment is that highly attractive and altruistic politics runs into the brick wall of reality. As Thomas Sowell — a noted Stanford economist — wrote: “The first lesson of economics is scarcity: …
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Medicare for all and the problem of health care on demand
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
Medicare for all is one of the leading campaign issues among the Democratic presidential candidates.
Michigan Rep. John Conyers first introduced the idea in Congress in 2003. It went nowhere, but as the one-time party of JFK morphed into something much further left, Medicare for all rose from the dead.
Medicare for all promises universal coverage, so that no one is without insurance. Unfortunately, it is cost prohibitive, costing as much as …
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Instead of Medicare for all, how about Medicare for more?
There has been a disturbing shift in how medical professionals feel about their career. I almost cringe every time I’m at a party or social gathering now and tell people I retired early from my medical practice. I try not to bring it up.
I don’t cringe out of fear for how they will perceive me or whether they will look down upon me with condescending scorn about how I left …
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The reason so many physicians are retiring early
Let’s talk about that infamous transition to third year. This is a precarious time in your medical school career when your resolve faces its greatest challenge yet. After weeks of self-imposed exile to prepare for Step 1, you finally take that dreaded exam. Before you even know whether or not you’ve passed, you and your colleagues scattered to the far corners of the earth to begin clinical rotations.
But hey — …
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Millennials: This is our time in medicine
At some point in my career, I had the crazy idea that if I could scale the patient-centric work I was doing in my community at a small rural hospital — then I could make more of an impact. This is why, when a technology company came calling, dangling a carrot in front of my nose to “disrupt” health care, it seemed like a no brainer to make the leap …
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A new health care dawn is coming
Since the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, it has been said that health tech would dramatically revolutionize health care and the patient experience. Advocates have claimed time and time again that it would advance disease diagnosis capabilities, improve patient outcomes, and increase patient satisfaction. Belief in this narrative can be seen in the sharp increase in health tech investments, with …
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What physicians can learn from anthropologists
