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.
When Amazon, Berkshire Hathaway, and JP Morgan (AmBerGan) announced their health care partnership, Berkshire CEO Warren Buffett declared “the ballooning costs of health care act as a hungry tapeworm on the American economy.” He is right. Our broken system is infested with tapeworms. Tapeworms are parasites; they exploit their hosts, drain resources, and suck the life out of their prey. Unfortunately, Buffet failed to call attention to the tapeworms specifically; …
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Can direct primary care save us from the tapeworms of insurance?
“I love what I do. I hate what I have to do.”
It’s a quote that doctors attribute to their profession behind closed doors. As patients, we are so overwhelmed with our own problems. We fail to notice that our doctor may be battling her own problems with a complicated system.
But what do we care? Our meeting with the doctor is a paid transaction. We are owed our money’s due. Empathy …
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Remember that your doctor is also human
American physicians dole out lots of unnecessary medical care to their patients. They prescribe things like antibiotics for people with viral infections, order expensive CT scans for patients with transitory back pain, and obtain screening EKGs for people with no signs or symptoms of heart disease. Some critics even accuse physicians of ordering such services to bolster their revenue.
So what happens when uninsured patients make it to the doctor’s office …
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Do uninsured patients receive more unnecessary care?
I am a terrible coder. I think I am a pretty good doctor, but when it comes to coding, the process of figuring out which billing code to pick to assign to a bill for an office visit, I am hopeless. No matter how many times I have had the rules explained to me, or how much feedback I have been given about specific visits, or which “pocket guide” to …
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A physician contemplates Medicare blended rates
“Better patient care” is the reason hospital and health systems usually give when they merge or acquire one another. Our research suggests that mergers and affiliations might, paradoxically, increase the risk of harm to patients in the short run. Improving the safety of patient care is possible during mergers and affiliations, but requires intentional efforts.
What happens after …
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Hospital mergers and the risk to patient safety
It’s easy to get excited about technological advances such as nanobots that swim in blood to deliver drugs or 3-D printers that print human tissues. However, in our enthusiasm to find the next fix, we are failing to notice the ground slipping underneath the health care industry.
Here are four trends that are changing health care but on the surface are too unsexy for us to care about.
Trend 1: The doctor-patient …
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4 disturbing trends in health care
The health care system has never been so complex as it is today. As doctors, we’ve seen the struggles that happen just trying to help patients get the medical care they need. Patients are now ladened with high deductibles and often are the victims of baseless denied coverage for diagnostic tests and medication.
Insurance companies insist that they are not practicing medicine, merely making coverage determinations and that the patient is …
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How our health care system traumatizes patients
As more doctor pay is being tied to patient satisfaction and “outcomes,” a recent Forbes article argues that “It’s only a matter of time before physicians will see the bulk of their compensation tied to quality measures.” To prepare for this pay-for-performance apocalypse, the article cites Medical Group Management Association (MGMA) CEO Haylee Fischer-Wright, MD, who urges physicians to “build data analyses” and take …
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Stop treating doctors like school children
I remember visiting my pediatrician as a child, and even at a young age I was in awe of his degrees hanging on the wall. Looking back, I think I may have looked like the kid in Norman Rockwell’s Doctor with my behind in the air waiting to get a vaccination while staring in fascination at my pediatrician’s diplomas. Even at that young age, I could appreciate that these placards …
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Our medical degrees are in boxes
In the recent weeks we’ve seen frequent headlines alerting people around the country to dangerous heat waves. Physicians and nurses see these headlines and the human results of the heatwaves in the form of heat illness, people burdened with lung ailments and suffering from deteriorating air quality, and a range of individual harms brought on by wildfires and torrential downpours. Current trends in extreme temperatures are alarming and clearly linked …
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Doctors need to lead the way on divestment from fossil fuels
Medical school was a difficult adjustment for me. Coming from a blue-collar background and lacking a medical pedigree, I did not relate to most of my classmates, and I made very few friends.
That changed when I met J., a second-generation physician-to-be without the competitive guile or sense of entitlement implicit in most of the medical students I had met. With a generous personality undoubtedly sculpted by the experience of motherhood, …
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Serving the underserved: a win-win situation
A recent stir was created regarding a California pediatrician Dr. Bob Sears. Dr. Sears is sympathetic to parents who do not want their children vaccinated. Apparently, Dr. Sears got in trouble with the California State Medical Board for not producing medical records to support a parent’s claim that their son could not take vaccines because of adverse reactions, including “loss of urinary function and going limp,” and instead, just taking …
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The consequences of taking patients at their word
The face of a 2-year-old Honduran girl, dwarfed by the adults who only appear as legs in the photo, communicates undeniable anguish. Used to represent the horror of children separated from their parents at the U.S.-Mexico border, the photo became a lightning rod for controversy when it turned out that this particular child was not actually separated from her mother. In an interview for CBS News the border patrol officer involved …
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When family separations become a threat to existence
Engaging in an economic conversation about the conventional compensation of a physician leads one to believe that doctors are well-to-do. In the minds of most citizens, school-tuition board members and even local neighbors, if you’re a physician the presumption is that you are economically prosperous, maybe even rich. This sociological assumption probably sounds false to most whom honorably don the white coat. Perhaps a decade or two ago, when medical …
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A case for paying doctors more
Today’s news is full of commentary about work requirements for Medicaid. Is work a prerequisite for health care or is health a prerequisite for work?
Not to complicate things, but can we even agree on what health care is? I don’t think we can, and it largely falls back on what we want to share in paying for.
A patient with an ugly skin lesion can have it removed if it might …
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Balancing stewardship and entitlement in health care
The word “historic” is often used by PR professionals to hype something that is, well, pretty run-of-the-mill. They figure that no one is going to read a news release that announces “[Name of organization] proposes small change that really won’t make much of a difference.” The problem is that when something is done that really measures up to being historic, the recipient is less likely to believe it, kind of …
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Medicare’s historic proposal to change how it pays physicians
Author’s note: My personal reflection about the Sutherland Springs mass shooting was written before the horrific events at Stoneman Douglas High School and Santa Fe High School. The chorus of voices has only increased in amplitude regarding the calls to responsible action on firearm safety. While a larger debate continues in Washington, DC, I ask myself again: What can I do now as a medical provider to make a difference? …
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Make a commitment to ask patients about firearms
Poverty is known to be an important determinant of a person’s health and longevity. A person’s zip code is more relevant than genetic code. Does a physician’s zip code – that is where they were born and raised – have an effect on where they practice? Specifically, do rural born and raised physicians return to their rural roots? The story of Prashant, a physician raised in rural Bihar, India, is …
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The social determinants of a physician’s path
