I know, I know, I spend way too much time ranting about work in the emergency department. But after some recent shifts, my box of rants is full once more. And what I want to point out is the enormous struggle of the mid-sized emergency departments in America today.
I know this is a problem; I work in them, and I know and talk with people who work in them. It’s …
The plight of mid-sized emergency departments
On a particularly sultry day in a hospital of the Peruvian Amazon, I found myself with the task of telling a group of parents that their babies, who had been waiting in the hallways for days without eating in preparation for surgery, would not be able to have their cleft lip and palate fixed. We, a group of American doctors and medical staff offering this procedure free of charge to …
The fine line between do no harm and do nothing
I took a great continuing education course recently, and had an opportunity to review some useful skills and fascinating cases. Because health care knowledge areas expand more quickly than most and keeping current is an integral part of doing these jobs well, it was easily worth the time.
The cost seemed unreasonable, but I was only superficially interested in that anyway; like most, I’m fortunate that my employer offers a generous …
The moral hazard of health insurance
One day a man decided to open a pizza shop. The first week he sold pizzas and collected money from his customers; the happy customers ate hot pizza, and the man made some money.
The next week many of his customers who came in had pizza insurance, and had already paid Blue Wall Insurance for their pizzas. Since so many of his customers had purchased pizza insurance, the man signed a …
An excerpt from the CEO’s Guide to Restoring the American Dream: How to deliver world class healthcare to your employees at half the cost.
I often think about a question that should make us all step back a bit. Why are millennials—the largest American generation in history—the first generation to think life won’t be better for them than their …
Health care stole the American dream. But it’s absolutely possible to take it back.
To the patients concerned about the future of health care:
We need one another now more than ever.
In April last year, I started this blog to help patients and physicians connect in an increasingly disconnected health care system. Both patients and physicians feel bound and invaded from multiple directions, all interfering with the doctor-patient relationship. We all suffer for it.
It occurs to me that many of you may …
Patients and doctors need one another now more than ever
Despite assurances over the course of his presidency that undocumented immigrants brought to the United States by their parents would be protected by this administration, President Trump has announced recently that he is considering ending the deferred action for childhood arrivals (DACA) program.
DACA was announced by former President Obama in August 2012 as an initiative providing individuals who came to the United States as children and who meet certain other …
The effect of rescinding DACA on immigrant communities
When health officials learned that the 2015 measles outbreak was caused by clusters of unvaccinated children, Americans once more wanted to understand why some parents do not vaccinate their children. In our highly polarized culture, media commentators and even academics began to connect opposition to vaccination to either the left or right of politics.
So a question arises: Who is more likely to be opposed to vaccination, liberals or conservatives? As …
Anti-vaccination beliefs don’t follow the usual conservative and liberal lines
Last week a physician friend recommended watching the movie the Big Short. The description given to me was that it was a great movie that was all about a bunch of guys who saw the 2008 financial crisis coming. Sure enough, that very weekend, I planned a night in to get take out and watch it on Netflix.
And it sure didn’t disappoint. Starring Ryan Gosling, Steve Carrell, Christian Bale, and …
The Big Short in health care: What happens after the bubble bursts
To listen to all those desperate to reform health care, you get the impression that physicians are pretty horrible people. We are all sexist, greedy, money grubbing tyrants who will perform unnecessary tests and procedures just to make money. We don’t care about quality or cost. We are killing off 250,000 patients every year with our ignored “errors.” We purposely keep our patients in pain, or we addict them to …
9 reasons the “golden age of medicine” was golden
I swiped this editorial cartoon by Steve Sack from the redoubtable Dr. David Gorski’s blog, who goes by the nom-de-web of Orac. Recent epidemiology shows reducing the fraction of vaccinated children in the population rather promptly leads to a resurgence of the diseases vaccines protect against. This is the concept of community or herd immunity.
Epidemiologists debate the concept around …
The mythical unicorn of vaccine denialists
Recently, there have been many times when you may have gotten a news alert on your phone or checked the latest Twitter hashtag and wanted to scream. Or you were too busy to even check until later that day and did not know what to say other than to lurk and watch a train wreck in progress. You may have thought about saying something, but paused and wondered, “Is this …
Physicians: Use your voice to make the difference
Reformers have expended considerable effort to change the way Medicare buys health care for millions of Americans, finding a wide range of support across the political spectrum. But Medicare’s current structure may doom these reforms. Some primary care doctors fear that the skewed incentives in Medicare’s pricing system will get built into any new system, whether it is “accountable,” “affordable,” or “value-based.” This fear is well-founded. If special interests buy …
Fix the pay imbalance between specialists and primary care physicians
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I was browsing the latest issue of the Journal of the American Medical Association, as I often do, and an article by one Andy Slavitt, MBA, and Gail Wilensky, PhD, titled “Reforming Medicaid,” caught my eye. From 2015 to 2017, Mr. Slavitt served as the Acting Administrator for the Centers for Medicare & Medicaid Services (CMS). In that role, he oversaw the government’s awful Meaningful Use EHR program, and helped …
Administrators who don’t see patients often make the most important decisions
Obamacare repeal and replace is going nowhere, despite seven years of promises by Republican members of Congress. For the foreseeable future, it will remain the law of the land, along with rising insurance premiums and deductibles and fewer plans to choose from. It’s worth remembering the next time someone asks you for money to support Republican incumbents.
What if the airline industry could light the runway toward fixing one of the …
What health reform can learn from United Airlines
White nationalists and neo-Nazis marched through Charlottesville, President Trump addressed the nation in what should have been a straightforward call for unity against racism and bigotry. Instead, he left us perplexed, wondering if he had just insinuated anti-racist counter-demonstrators were to blame for the violence that ensued. Trump then made explicit his intentions by attempting to spin an argument of moral equivalence between white supremacists and racial justice advocates. He …
After Charlottesville: What are physicians responsible for?
Health care reform continues to make national headlines as Republican senators have failed to pass a bill in the Senate with enough support to repeal and replace the Affordable Care Act (ACA). How did we get here, and why do so many Republicans want to make the ACA go away badly? To answer this question, you have to first understand the history of health care reform in the United States …
A history of health care reform
Yesterday, we had a meeting about leakage.
No, it was not about urinary or fecal incontinence, but it was about care that could have been provided within our institution that ended up, for a multitude of reasons, happening with providers beyond the walls of our institution.
Representatives from our accountable care organization had requested a meeting to go over some issues they’ve been having with our practice, including low levels of usage …
Stop the patient leakage in primary care practices
A guest column by the American College of Physicians, exclusive to KevinMD.com.
In April, the American College of Physicians (ACP) released a position paper titled Putting Patients First by Reducing Administrative Tasks in Health Care, published in the Annals of Internal Medicine. The paper, part of ACP’s Patients Before …
Improving physician satisfaction by eliminating unnecessary practice burdens
Last November, we wrote an op-ed for STAT, as medical students, lamenting how politicized our future profession has become in recent years. In the aftermath of a divisive election that we argued may well have been a “referendum on the Affordable Care Act,” we implored policymakers and other stakeholders to take politics out of health care before attempting to reform it. We believe that partisanship has infected …
The vision forward for health care should be bipartisan
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