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.
Now that the children have shouldered their muskets and taken aim — figuratively speaking, of course — against the gun lobby, maybe we can interest them in another partisan conflict that’s even more sweepingly about their survival: climate change. Not to minimize the horrific consequences of school shootings, but there are many more lives at stake from climate calamities. Threats from sea level rise, flooding, wildfires, and storms are multiplying …
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A case for climate activism: but where are the medical students?
I need your help.
I’m trying to figure out how to get rid of something that’s terribly broken in our process of taking care of patients, and I can’t do it alone.
It’s time to kill the referrals process, get rid of them altogether.
Every day, a huge proportion of the messages we receive through the electronic health record are requests for us to “put in a referral.”
Patient has low back pain, has …
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The referral system to specialists: It’s a nightmare
A hundred years ago, the practice of medicine was just that: the practice of professionals specially trained to alleviate suffering and heal the sick. Doctors had a fiduciary responsibility to put the needs of their patients before their own. A small town doctor might be paid for his efforts in chickens — living or cooked.
Flash forward.
Medicine is big business. Trillions of dollars are spent every year in the health care …
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Medicine could use more common sense
By their nature, fee-for-service reimbursement schemes incentivize procedures over prevention. This creates a serious moral hazard: If you keep your patient panel healthy through early interventions and exhaustive lifestyle counseling, then there are fewer profitable procedures to do. On the other hand, if you let your patients become critically ill, then you will be rewarded handsomely for all of the (now) medically necessary procedures and tests that you can perform …
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A reimbursement structure that can benefit primary care
A casual reader scanning the headlines would rightly infer a direct cause-and-effect relationship between pharmaceutical company payments and the number of opioid prescriptions written based on this headline displayed prominently on the CNN homepage. What follows is nothing short of a character assassination of the medical profession, portrayed as complicit drug pushers in bed with the pharmaceutical industry. Rather than a reasoned look at the history of causes of the …
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To those who think doctors make money on opioids
The short white coat, breast pocket full of colorful pens, side pockets bulging with gauze pads and suture kits, a simultaneous look of bewilderment, excitement and fear. Pathognomonic signs of the third-year medical student on wards. Third year of medical school is a period of learning how to diagnose disease, treat patients and understand what it means to be a doctor in this health care landscape. There is not enough …
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Learning the health care ecosystem is an uphill battle
March 30th is National Doctors’ Day, a day set aside to recognize physicians, their work, and their contributions to society and the community. Though we are used to thinking of the profession of physician as something many parents hope their children aspire to, the reality is that fewer and fewer students are choosing that path.
According to a March 2017 report by the Association of American Medical Colleges, the U.S. will …
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This National Doctors’ Day, conquer the physician shortage one mentor at a time
You go to your doctor because you are suffering pain, fatigue, or some equally debilitating ailment. Your doctor examines you and is worried there may be a serious underlying medical reason for your symptoms and orders a test. But, before you can have that test done to determine the cause of your symptoms, the insurance company must agree that you need it in order for them to cover the cost …
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The health insurance industry is like a house of cards
It is wildly popular to say that the chief culprit in the U.S. health care system is the traditional fee-for-service payment system, which rewards physicians for volume but not quality, leading to high-cost, low-quality health care. It supposedly follows that the fix is a system of “value-based” payments.
Despite the popularity of these arguments, both aspects have been shown to be wrong. Studies show that the rising cost of American health …
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What is the perfect fee-for-service system?
Our health care system in the United States is notorious for providing a lot of unnecessary medical care — something we’ve written about extensively.
Doctors may provide that unnecessary care because they perceive that patients are expecting or requesting it.
If health care professionals don’t provide the aggressive care that patients believe they require, the thinking goes, patients won’t be satisfied, and the doctor-patient relationship will suffer. Plus, the patient will just go …
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Too much testing: Are patients to blame?
Drug costs in the U.S. are higher than in in any other industrialized country in the world. Our cost for an insulin glargine (long-acting insulin) pen is $76.80 and in Canada, so very few miles away, it costs $19.60. The latter price is reasonable. The former price can make the difference between being able to afford a life-saving drug and dying. It is illegal, however, for a U.S. citizen to …
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Crippling drug costs: the role of insurers
I was behind schedule (again). My next patient was Helen, a non-compliant diabetic that hadn’t been into my office in over two years. Her blood sugars weren’t controlled at her last visit when I’d tried to impress on her the serious health problems that could develop if she didn’t take better care of herself.
Clearly, I’d failed. Maybe I’d even chased her away? No pill I prescribed would help her diabetes …
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The real cost of not having health insurance
Behind that computer in your doctor’s office, there is a war going on. As a patient, it affects your care. Your doctor is pushing back on the forces eroding your quality of care, but they are being torn apart by legislation, bureaucracy, and big business. Unlike, 30 years ago when doctors controlled patient care, your doctor is being outflanked by powerful people that did not go to medical school or swear an oath to protect.
Your doctor gave up …
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Behind that computer in your doctor’s office, there is a war going on
There has been a nauseating amount of discussion about physician burnout lately. An equal number of remedies, from mindfulness to exercise, to inpatient psychiatric treatment for doctors experiencing unmanageable stress and burnout. And then I read this report of a survey from the world-famous Cleveland Clinic, which describes 35 percent of nearly 1100 physicians employed the Cleveland Clinic have signs of overt burnout. More importantly, those physicians who cared more about their …
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Political leaders are oblivious to the true causes of physician burnout
I’ve got a confession to make. I own stock in a firearms maker.
Seems ironic that someone like myself — a physician has cared for countless victims of gun violence and someone who advocates for evidence-based policies to avert gun deaths — would not only own guns himself but also be a stockholder of a company that manufactures them.
Let me explain how this happened. When I first got out of residency, …
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Why this physician divested from a firearms maker
The NHS is robust. And part of that is due to the passion of its workforce. Since its beginning in 1948, the service has met each new challenge with vigor. But never before has it’s existence been under such threat. And with it, the safety of a nation. And there is no one more qualified to save it than those who fight on the frontline. I sat …
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Why nurses must help lead the NHS
“I’ve done this thousands of times. If you do not intubate him, he will die quickly. I’m a pro, but I don’t have all night: either decide to let me do my job, or he dies. But remember, he could die while I do the procedure as well.”
These were the words that echoed around a group of five siblings, a spouse and ten grandchildren, all lost in the chaos of …
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What Frederick Douglass can teach us about health care
First, a history lesson. Back in the mid-2000 oughts, the AAFP launched a wholly owned subsidiary called TransforMed. It was originally started to help practices implement the “new model of care” from the Future of Family Medicine Report. Soon after it was launched, the joint principles of the patient-centered medical home (PCMH) were announced, so TransforMed pivoted to help practices implement the PCMH model of care.
In …
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The tiny gains of patient-centered medical homes. Are they worth it?
All eyes are on interest rates as investors look for more signs of trouble ahead.
If their concerns over higher-than-expected inflation prove accurate, many players in the U.S. economy will suffer the burden of higher costs. But perhaps no sector would feel the strain more than health care. Higher costs would be just the start of many problems to come for providers, insurers and, eventually, patients.
Surging inflation would create a vicious …
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How inflation will affect our health system
