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.
If you get health insurance through your job, beware: you might be picking up more of the cost of your medical care than you realize. With increasing frequency, employers are directing their workers to the kind of high deductible, high out-of-pocket insurance plans that leave workers financially responsible for a surprising portion of their health care expenses.
Not long ago, having insurance coverage meant your costs were largely …
Read more…
How high-deductible plans are a bait and switch
Single payer health care is enjoying a boomlet in public opinion.
A Pew Research Center poll released in June 2017 found that, “Overall, 33 percent of the public now favors such a ‘single payer’ approach to health insurance, up 5 percentage points since January and 12 points since 2014.” 58 percent of those surveyed by Pew said that the government has a responsibility to ensure health for all, with a third …
Read more…
Are physicians ready for single-payer health care?
We live in an era of demonization. Political adversaries are not opponents; they are villains. Commentary that contrasts with our views is labeled”fake news.” Presumption of innocence? R.I.P. Civil discourse has become a quaint memory. Why would one debate respectfully when today’s tactic is to talk over and demean your adversary?
On the morning that I prepared this post, I read an article reporting that one of Ohio’s largest insurance companies, Anthem, is denying payment for non-emergency …
Read more…
Denying payment for emergency care: a physician defends insurers
For more than 100 years, Americans have searched for a cure for health care inequality. Instead, we’ve been prescribed placebos: watered-down poverty programs and party politics.
Despite attempts to ease the pain with reforms like Medicaid and the Affordable Care Act (ACA), we continue to rely on a market-driven health care system. After stitching together the remnants of various poverty programs, we are left with a system so dysfunctional and freakish …
Read more…
A case for national health insurance
During my third year of medical school, I received a harrowing phone call, “Can you please go over to Steve’s place? I am worried about him. He might want to hurt himself.” The person requesting this was the mother of one of my best friends in medical school. I was a third-year medical student on my surgical rotation. Steve’s mom was concerned he might commit suicide. Sleep deprived as I …
Read more…
Physician, know thyself
I am an emergency medicine physician. I started my career in an ER that saw a significant amount of walk-in trauma. Eventually, I left that department and moved on and now primarily see medical emergencies. For a while, I truly missed being involved in treating trauma patients. I missed the adrenaline, excitement, and fervor that ensues after a penetrating trauma is dropped off in the ER driveway.
But I just don’t …
Read more…
What can physicians do about mass shootings?
It has been well publicized that premiums for Obamacare insurance plans have been rising at a disturbing rate. Local news is filled with reports of 21.5%, 36.3% and even higher price hikes. President Trump complained in February that Obamacare premiums “have increased by double and triple digits,” even remarking that premiums in Arizona “went up 116% last year alone.”
If the cost of buying insurance were really …
Read more…
Obamacare prices are rising. But not for the reasons you think.
Public health and poverty go hand in hand, the latter oftentimes affecting the former. While the root of poverty is complicated, political, and rarely based on an individual’s capacity to succeed, it has more profound, long term effects that go beyond the bank account.
Consider a reality where wage theft — that is, nonpayment of wages to which workers are entitled — greatly contributes to low income. But it goes beyond …
Read more…
Low income is a neglected public health issue
A confounding and deadly disconnect teems throughout hospitals. Professionals whose careers are devoted to improving health outcomes consistently put their patients at risk of infection. Less than half of nurses and other caregivers consistently wash their hands before interacting with a patient, despite decades of studies and guidelines heralding the positive impact this simple — but not easy — action can have.
The Centers for Disease Control estimate that …
Read more…
Solving health care’s hand-washing puzzle
“Philadelphia is a sanctuary where we can live in peace,” said Mrs. Lopez, a patient at a local clinic caring for the undocumented. “It wasn’t always this way, and we lived in constant fear,” she added, referring to Philadelphia’s recent adoption of “sanctuary city” policies, adopted also by dozens of other cities and counties across the country. What exactly are these “sanctuaries”? Whom do they protect? And why should physicians …
Read more…
What physicians should know about sanctuary cities
As I sit here today, I think about the future and how life will be ten years from now. There seems to be an illusion that when you finish your residency and you start to be an attending that your life magically becomes better and that you have a lot higher quality of living. However, what I have found going through this process is that the dream may not be …
Read more…
We need to be happy with what we have now, and not rely on delayed gratification
The last few days have been rough. The emergency department is overcrowded, and patients have been very sick. Treatments were labor-intensive, and patients holding in the ED took up valuable resources at the cost of others. I could see the frustration on the faces of physicians, nurses and other staff. A physician and a nurse separately pulled me aside to have conversations about what the ED has become and why …
Read more…
Running an emergency department is like a battle: It takes an army
There is an accepted storyline in American health care that is so ingrained in our culture that it is almost beyond question. It goes like this. The chief culprit underlying the high-cost, low-quality American health care system is the traditional fee-for-service payment model, which rewards physicians for the volume of services they provide with no consideration for the quality of care being delivered.
The answer, the story goes on to say, …
Read more…
The bureaucratic myth harming American health care
As part of the interview for my book, I asked about the role that mental health plays in healthcare. Responses were unequivocal: It plays a vital role. All of these doctors have patients who are depressed, anxious, traumatized, or otherwise in need of mental health services. My doctor interviewees frequently added comments about lack of access to mental health services and insurance interference.
Refusal to pay is a big problem, according …
Read more…
A consistent and clear picture of significant barriers to mental health care
When my classmates and I returned to Boston to continue our first year of medical school early last month, we returned to a very different type, of course, called “Essentials of the Profession.” In it, we explored health policy, social medicine, ethics, and other topics outside the realm of traditional physiology and disease but just as important to our roles as physicians. In the health policy class, we learned about …
Read more…
This is what’s missing from medical education today
Despite loving my patients, I burned out. I chose my own quality of life over continuing to work with the chronically mentally ill population that I adored. This patient population is frequently shortchanged with their quality of care, and I have joined the ranks of people failing them.
This is my experience working in one mental health clinic in the United States. Every clinic runs differently, and there are fantastic systems …
Read more…
Patients lose when physicians burn out
He’s a young guy: polite, well-dressed, easy to talk to. He works construction and is here because he’s been getting allergies to dust and pollen. He’s never had insurance, but it doesn’t really matter because he’s always been healthy. He’s the easy slot in my schedule; I ask him a few questions, look in his nose, we chat about the new Avengers movie, and I’m about to send him home …
Read more…
Teaching Health Centers: when there’s nowhere else to go
Lately, I have been seeing a lot of writing from Pamela Wible, MD. And today, I re-read her article about doctor suicides. As I read and reflected on how medicine has changed during my lifetime, I am struck by the degree to which the humanity scrubbed out of the system. I think about the times when I thought, “You know, it is not worth …
Read more…
A physician thinks about his future
