I’m a cardiologist. But if you believe the news, you will assume my entire medical specialty is shady and full of morally suspect physicians. Let me tell you why.
Recently, two articles surfaced in the lay press, one published by the New York Times and the other by U.S. News & World Report. Like the majority …
Targeting physician salaries: I speak for the ten-percenters
Regular readers here are well-versed on the controversy surrounding maintenance of certification (MOC) and the American Board of Internal Medicine (ABIM).
The story recently made mainstream news, with a comprehensive recap by Newsweek senior writer Kurt Eichenwald: The Ugly Civil War in American Medicine. Go read it.
The ABIM subsequently released a strongly-worded statement. They are clearly not happy with the mainstream media spread …
The ABIM response to Newsweek determines how far anti-MOC sentiment will spread
In a recent article posted in JAMA, authors presented a viewpoint about the phenomenon of the flipped patient when describing the increasing reliance that millennial trainees place on getting to know the electronic health record (EHR) of patients rather than the patients themselves. As I read through the text, I found myself agreeing with the points made by the contributing writers that EHRs are increasingly used as the first line of …
The phenomenon of the flipped patient
One of the obligations of a medical or surgical specialist is to communicate with the referring primary care provider. This can take many forms: a phone call, texting via smartphone, email, messages sent via EMR, and dictated letters. The format is pretty standard no matter what medium is chosen. You thank the referring doc for the consult request, you give some brief background info about the patient in question, and …
How corrosive cynicism is destroying professional relationships in medicine
“I’ve been getting winded lately.”
He’s a middle-aged man with diabetes. This kind of thing is a “red flag” on certain patients. He’s one of those patients.
“When does it happen?” I ask.
“Just when I do things. If I rest for a few minutes, I feel better.”
Now the red flag is waving vigorously. It sounds like it could be exertional angina. In a diabetic, the symptoms of ischemia (the heart not getting …
Waiting for problems to become emergencies is terribly expensive
As a physician, you have endured many years of schooling, and you have received many A’s on your report cards. You have passed exams with flying colors, and you have pleased your higher-ups in the food chain. You have come so far, and you now find yourself in a rarefied position that most people only dream about.
So what’s standing …
Doctors: Is it time to love the F word?
When I speak with colleagues about ways to provide primary care to the poor, they generally fall into one of two camps. The first camp, generally supporters of the Affordable Care Act, contends that the ACA’s originally mandatory (but later ruled optional) expansion of Medicaid insurance eligibility and a temporary federally-funded increase in Medicaid fee-for-service rates to Medicare levels provided enough incentives to attract family physicians to patient-centered medical homes that …
Providing health care to the poor: It’s time to get creative
Whether you like it or not health care financing is transitioning from payment for discrete services to global payment for value. Whether you agree with this trend, or comprehend its meaning, if it has one, is largely irrelevant in the short term. The government of the United States, the Chamber of Commerce, both political parties, all health care stakeholders, and even your own medical associations are fervently supporting, and actively …
The transition to value-based care: Think Starbucks
Many of the patients that I treat have brain injuries. Whether caused by a stroke, car accident, fall, or drug overdose, their rehab course has taught me one thing: nobody likes to be forced to do things against their will. Even the most devastated brains seem to remain dimly aware of their loss of independence and buck against it. Sadly, the hospital environment is designed for staff convenience, not patient …
It’s time to think about how we’re affecting patient morale
The ink hadn’t yet dried on the report of the 2015 Dietary Guidelines Advisory Committee before the assaults began. I guess in this day and age, that’s not much of a big, fat surprise.
Despite all the over-heated rhetoric I’ve seen about not trusting this report because the “government” can’t be trusted, this report is not from the government. While we may, indeed, need to worry about what the political authorities will …
No, it’s not the broccoli: What to make of the new dietary guidelines
I remember one day a few years ago when I was talking with one of my friends about the challenges of being a doctor after a tough day at work. I had seen a large number of patients within the span of a few hours, and in addition to many of them being sick, I dealt with family members who had so many questions and who wanted to provide me …
Medicine: A profession of sacred trust
Dr. Wes has written passionately against MOC: ABIM Pleads for Mercy.
But perhaps we should ask first: Why MOC at all?
Contrary to years of propaganda promoted through pseudo-science and journal article citations on the ABIM’s website, might MOC have really been created because the ABIM’s consolidated fund balance dropped 43.2% from $54,009,086 on June 30. 2001 to $30,691,329 by June 30, 2013 while the Standard and Poors 500 index increased 37.7% …
In order to interpret the world, we tell ourselves stories. All day long. About everything. That guy in the grocery store who clipped your heels with his cart? A jerk. The car that cut you off at that intersection? A jerk. A little old lady stopping in the middle of the aisle at the grocery store? Senile.
It is automatic, it takes no effort, and it is completely egocentric. It is …
It’s important that we get our stories right
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Have you ever tied your shoes and found that the bow unraveled and you almost tripped over your own laces? Learning to tie your shoes is a life skills task that you learned as a toddler unless you were trained on Velcro straps! You performed the task of tying your shoes nearly every day of your life believing that you were …
What physicians can learn from tying their shoes
I went to the retired firefighters dinner last week and had a great time, probably because I happened to land on a table full of contemporaries: men who worked at pretty much the same time I did.
Inevitably, conversation turned to our memories of some of the older firefighters we had to deal with as we worked our way up the seniority ladder; “getting time on” is what it was called. …
What a retired firefighter has to do with health care today
On Valentine’s Day weekend last year I found myself at Paddles, the local dungeon in New York City’s Chelsea neighborhood, for the first time. I was perched at the alcohol-free bar when a man politely introduced himself as a human carpet. He asked that I tread on him and lay on the floor to demonstrate. A professional dominatrix-in-training stepped onto his …
Doctors should pay more attention to their kinky patients. Here’s why.
Incentive structures in health care have to change. Right now, we pay for services, or have a so-called, fee-for-service system. The idea is that the more patients doctors see, the more expensive tests doctors order and the more patients doctors hospitalize, the more money clinics and hospitals make. This incentive structure has transformed our health care into sick care.
The reality is, in America, we are adept at caring for complicated medical problems that require …
3 ways to change the way we pay for care
Come, let us build ourselves a city, with a tower that reaches to the heavens, so that we may make a name for ourselves.
– Genesis 11:4
With these words, so begins the biblical story of The Tower of Babel. The tale was written, at least in part, to explain the origin of different languages. Essentially, a group of earth’s early inhabitants started to build a tower to the sky in order …
The two towers of medicine. Which one will you choose?
A physician in Texas posts this photo on Facebook. Caption: “My schedule one morning in January 2014. Never again …”
Yay! Another physician breaks free from assembly-line medicine.
High-overhead, high-volume offices sacrifice the sacred physicians-patient relationship and perpetuate a disease-billing management system. This is not health care. It’s abuse.
Patients: Avoid clinics with 10-minute slots. Go for docs who offer 30 to 60-minute appointments. Physicians: …
Health care or abuse: Which are you receiving?
The other day I ordered a CT scan with contrast on a patient with an apparent mass on his neck. I explained about the need to get a blood test to make sure his kidneys could handle the iodine contrast. Because our lab was closed, I had to print a requisition for him to bring to the hospital lab.
Printing a requisition from our EMR is a multi-step process that involves …
Today’s EMRs: Extra work with uncertain benefits
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