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.
A friend recently asked me, “Where do we go from here?” The friend was referring to our impasse with health care in America. The Democrats have failed to repair the Affordable Care Act, and the Republicans have failed to repeal or replace it.
With the status quo, I can understand our health care system providing lower quality care compared to its counterpart industrialized nations. I can even tolerate lack of access to …
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3 steps to a better health care system
The Sunshine Act is part of the Patient Protection and Affordable Care Act passed in 2010. This act went into effect in August of 2013 and requires the full disclosure of any payments (or transfers of value, i.e., lunches and dinners) made to physicians from pharmaceutical and medical device manufacturers.
The spirit of the act is to have more transparency with regards to potential conflicts of interest created when physicians receive …
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Have you been reported under the Sunshine Act?
As physicians, our patients generally look up to us as people who make a great impact on their lives and sometimes even save them. But over the last year, I’d have to say that it’s my patients who have repeatedly saved me, starting with a four-month-old baby girl on November 9th, 2016.
The morning after election day, I walked into my first patient’s room at 9 a.m. Like most of the …
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In today’s political era, my patients save me. Here’s how.
Years ago, our government had a problem with health care. Medicare and other health care costs were spiraling out of control. It was clear that the problem was rapidly advancing technology and pressure to provide that technology to everyone who was demanding it. But the government, as usual, choose a politically motivated solution.
They went after the one group involved who was the most disorganized, least clear on its desires and …
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Does the medical profession need their version of the NRA?
The United States of America is home to the free and land of the great. So many have died attempting to flee from war, dictatorships, and poverty to gain access. Once a country with such strong influence, it’s now divided by bipartisan views and gridlocked actions. As a nation, we struggle to find solutions for our poor outcomes. Why does such a great country rank so poorly in education and …
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Registered nurse for president!
When I found out my patient was in the hospital again for the third time in six months, I wondered why her asthma had flared. Was the cold weather bothering her? Was her treatment regimen inadequate? When I spoke with her, I discovered the heartbreaking truth: she had been limiting her albuterol inhaler use because she simply could not afford to take it as much as she needed.
For many of …
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Drug price hikes sometimes have catastrophic effects on patients
I love my doctors.
I have an undiagnosable autoimmune disease. It’s mostly manageable, my lab work is perfect, and I rarely get sick. I get allergy shots and take blood pressure medication. I always have at least low level, mostly familiar, physical symptoms. Occasionally a new one appears. Sometimes it is scary.
I could have sued any or all of my doctors over the last decade-plus. I could be “livin’ large.” They …
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No one cares about the doctors
It may be hard to believe, but there is a bigger problem than repealing or saving the Affordable Care Act. And that problem is: Why are we so sick to need it in the first place?
Health insurance has become the sine qua non for life in America. Without it, the Fates sever the thread of life with ease. For those escaping the scissors of death, you might be beleaguered with …
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President Trump: Stop focusing on insurance and focus on health
Every patient eventually asks the same question: “How can I find the best hospitals and doctors?”
The solution might seem easy, since we live in a world where information is readily available on the Internet. In a few clicks we can shop for goods, review consumer products, market ourselves on social media, and complete financial transactions instantly. You would think that health care, which accounts for 17 percent of the GDP, …
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Why quality reports for hospitals and doctors are interesting but flawed
A friend of mine recently underwent a total knee replacement. Although he did well and was pain-free, he did say that he felt he was on an assembly line. I asked him what he meant. As he was talking, I flashed back 30 years, back to a time when by today’s standards I would be considered a “good old country orthopedist.”
Thirty years ago, I moved to a small community to …
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Is assembly line surgery better for the patient?
During a 15-minute recess, the elementary school students trooped from the playground toward nurse Catherin Crofton’s office — one with a bloody nose, a second with a scraped knee and a third with a headache.
Kids quickly filled a row of chairs. Staffers brought paper towels for the bleeders and tried to comfort the crying.
“We’re here for first aid, emergency, counseling,” said Crofton of the Mount Diablo Unified School District. “There …
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One nurse for 4,000 pupils isn’t the healthiest arrangement
It’s a tale of two health systems: the VA and Kaiser Permanente.
The U.S. Department of Veterans Affairs, Veterans Health Administration (VA) is a mission-driven health organization, serving our nation’s veterans. A patient population of 8.9 million, led by David Shulkin, MD. An early leader in health technology adoption. The VA has faced serious issues; however: long patient wait times (deadly long in some cases) and high physician turnover rates.
Kaiser Permanente …
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Better paid, better utilized physicians can transform the VA
I’ve discovered a new condition called “Cadillac Health Care Syndrome.” Those afflicted are relatively healthy people who have numerous diagnoses, take multiple medications and have frequent surgical procedures because they have excellent health insurance with little to no out-of-pocket expenses. Risk factors include early retirement, lack of hobbies, jobs with paid sick days, excessive television watching and overuse of the Internet to investigate symptoms.
It has been widely assumed that better …
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Is too much insurance a problem?
Since the birth of our nation, labor unions have existed in one form or another in the United States. Unions are a force to protect the “working population” from inequality, gaps in wages and a political system failing to represent specific industry groups. Historically, unions organize skilled workers in a specific corporation, such as a railroad or production plant. However, unions can organize numerous workers within a particular industry. Known …
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It’s time to speak with a collective voice: Why doctors should unionize
I was a chubby kid, but my parents still introduced me to lots of sports. Soccer, swimming, tennis, basketball; so many sports, when all I wanted to do was read and eat Doritos. I wasn’t particularly good at any of them, but some of my teams were better than good. We were champs. My swim team won the Cape Cod Summer League, my soccer team won its division one year, …
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The key to health care is to have a great team
The statistics are staggering.
The high maternal mortality rate in the U.S. has been a matter of great interest and debate, spurring a reflective look into our health care system to determine why our country is on the wrong end of this statistic. The reasons and numbers vary across the country and notably in the state of Maryland, which has had a higher than average maternal mortality rate, the number of …
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Is rising maternal mortality just hype? Nope, here’s why.
It’s no secret that the United States is in the midst of an opiate epidemic. Almost 60,000 people died last year from overdoses, and overdose deaths are now the most common killer of Americans under the age of 50. Physicians and our patients have finally started the difficult conversation about what it will take to stop the suffering. But what’s been missing from this conversation is that this is not …
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The opioid epidemic: What we can learn from history
Over the past seven seasons, Game of Thrones fans have demonstrated the ability to spot an emerging threat early on — a quality more leaders in health care need to possess.
If you’ve tuned into the popular HBO series from the beginning, you likely recall Ned Stark (Lord of Winterfell) forecasting doom and gloom in the show’s opening episode, appropriately titled “Winter Is Coming.” Right then, you knew something bad was …
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What health care can learn from Game of Thrones
If we listen to the president, fixing the American health care system is too complicated. It is not actually that complicated. The number one issue is cost. Even with many millions of people unable to access care, we already spend close to twenty percent of every dollar in the U.S. on health care. If we hope to include everyone in the health care system, then we need to lower health …
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Fixing the American health care system is simple. Here’s how to do it.
