As I explained to my medical student this morning that I was ordering an ultrasound on a patient first because the insurance company wouldn’t authorize a CT scan without it, it occurred to me that medicine derailed from its true purpose. Shortly later, I found myself again pointing out why I was prescribing a certain medicine rather than the one I wanted because it was not on the formulary of …
Unhealthy behaviors such as smoking, overeating, or lack of exercise lead to chronic health conditions, and many patients wanting to make positive changes to their health may seek the advice of their doctor to do so. But our insurance payment system works against supporting people when they want to act in a healthy way, and some of these payment decisions seem rooted in prejudices against those suffering from certain conditions.
Smoking …
Our health system is a sick system
A guest column by the American Medical Association, exclusive to KevinMD.com.
Since the 1970s, women have been carving out an increasingly large role in medicine, and the profession is becoming more representative of our society. September is Women in Medicine Month, a great time to acknowledge the changing face of medicine, but also to note that female physicians are not immune from the …
Challenging gender bias in the house of medicine
The Hippocratic Oath, as presumably most of us know, is the oath taken by physicians promising to uphold ethical standards in treating their patients. The four pillars of medical ethics primarily stem for this oath: autonomy, beneficence, non-maleficence, and justice. The world we see now is socially different compared to what it was when Hippocrates was alive. Physicians and policymakers in health care now face new ethical challenges that they …
Looking for the silver lining at supervised injection facilities
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 …
Shortening time in medical school is a bad idea. Or is it?
In 2016, dispatchers in my hometown of Mansfield — a Rust Belt city in rural North Central Ohio — fielded over 363 overdose-related police calls. The community organized an opiate response team, created to help individuals following an overdose, which could only respond to those experiencing their second overdose. Around the country, small towns and rural communities are making heroic efforts to prevent opioid-related overdose deaths. But matching action by …
It’s time to change how we regulate methadone
Many of us have moms and dads or older friends and relatives in nursing home facilities and care very much about their well-being and the supports they receive. But who’s caring for the care aides who do the bulk of the frontline work in nursing homes? Their welfare is almost entirely overlooked in the health system. And it turns out, the health of the care aide affects the Read more…
Who is caring for the care workers?
To me, my white coat symbolizes a willingness to care for my fellow man, and every day I strive to fulfill that challenge. But even the brightest white coat has a few stains. Growing up in a small Midwestern town, I just didn’t “get” the homeless community. They were completely isolated from my day to day life. Surrounded by my local community, I just assumed that the homeless were either …
The paths to homelessness are more complicated than we think
Purdue Pharma recently ran a full-page advertisement in the Wall Street Journal and the Washington Post asserting that the company, which manufactures prescription opioids, wants to limit the use of prescription opioids. While this ad may have left some readers confused, one point rang true: “we believe the country needs a new approach to prescribing opioids.”
In its approach to addressing the opioid crisis, Purdue Pharma is encouraging limiting patient access …
Pain care must be patient-centered, integrated, and individualized
Jerry and his wife, Pam, were not “medical people” and wouldn’t be considered high achievers. They seemed to be taking life in stride with a “mom and pop” disposition. Jerry had Alzheimer’s disease and was returned to his care facility after having a pacemaker inserted. The staff noticed Jerry slumped in his chair and called 911. Jerry’s blood pressure was low, and EMS transported him to the nearest hospital. He …
The lost art of reassurance medicine
The pay gap between men and women has been a subject of interest recently, particularly in 2018 reports by Doximity and Medscape.
Notably, the gap favors men, is not explained by obvious factors such as hours worked or choice of specialty, and does not seem to be improving. In-depth studies published in the medical literature have examined the relationship between gender …
The antiquated conversations on the gender pay gap
Will physicians go extinct? Artificial intelligence, legislation, profit motives in the health care industry, and clever lobbying by non-physician providers may all contribute to our demise. However, I believe the existential threat to our profession stems from the ranks of physicians themselves.
1. Unwillingness to embrace activism
Pathologist and writer Rudolph Virchow once said: “The physician is the natural attorney of the poor.” Like most physicians, my goal is to provide evidence-based …
4 reasons why physicians will become extinct
Physicians are overwhelmed by patient loads, 10-minute visits, the wealth of documentation dictated by health insurance requirements and the overwhelming overtaking of medicine by non-physician personnel.
Wellness programs abound, which addresses the symptoms of a problem.
As medicine changed from patient to profit-centered, it marked the beginning of the end. We see articles on physicians fired or coerced into resignation for speaking up about non-physicians overstepping boundaries putting patients at risk. Physicians …
The demise of medicine: A neurologist advocates for patients and is silenced
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While hundreds of doctors have submitted (mostly unfavorable) comments to CMS on the proposed evaluation and management changes, other issues seem to be receiving much less attention than they deserve. And one of those may hit physicians who perform procedures in the wallet.
In 2015, Congress asked CMS to analyze the global period data to ensure procedure weighting accurately reflected the actual work done by physicians. Of course, when Congress asks …
Are Medicare procedure payments in jeopardy?
She tells me that she sees them at night when she is lying in her bunk bed — eight to a room. Grotesque forms with masks over their heads and guns across their chests. She hears panicked shrieks, but is never certain if they are coming from the next trailer, or if they are inside her head. They cannot be nightmares, because she never sleeps. She reminds herself that haunting …
What being held at the Mexican border is really like
Can the health system survive?
It comes down to the people. It is not about their work, but how they feel: feeling valued, feeling their work is valuable to those they serve, and feeling valuable doing the work. It is work as an extension of what you believe, what you love and how you want the world to be reflected back to you.
For 22 years, I have watched systems work to …
Want to change the health system? Find your why.
Have you ever been the only customer in your local supermarket? Although the experience can be a bit unnerving, at first, you soon start to notice the advantages: No line at the deli, no pushy shoppers, no carts jamming up the produce section. As you breeze through checkout, you think to yourself, “Gee, I could get used to this.”
Now, imagine walking into an empty waiting area at your local emergency …
3 ways to decrease emergency department wait times
A colleague recently sent me a link to the American College of Cathopathic Physicians a new organization whose mission “is to protect the professional autonomy and advocate for a full, broad scope of practice for DNPs as a ‘cathopathic physician’ completely equal in every way to our MD and DO counterparts.”
I was, I admit, so stunned by the statement that I thought the whole thing might be an elaborate joke. It was only …
Not all doctors are physicians
From 2009 to 2012, I directed the graduate course “Fundamentals of Clinical Preventive Medicine” at Johns Hopkins University’s Bloomberg School of Public Health. It was a required course for Hopkins preventive medicine residents, and also usually attracted other master’s level public health students and undergraduates with a strong interest in medicine. The class size was 15 to 25 students. In that setting, with a small group who generally believed that …
Why this physician teaches health policy in medical school
So let’s get down to it. Everyone is tired of shooting sprees. If you’re a gun owner, you’re tired of seeing weapons abused and misused to harm the innocent. If you’re a gun opponent, you feel the same way but can’t imagine why anyone has these weapons in the first place. I get it. I hope both sides get it.
I’ve thought about this a lot. I’m a gun owner. I …
A physician gun owner’s suggestion
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