The Affordable Care Act comes with the promise of a dramatic overhaul in what many see as a broken health care system. It promotes the potential for “better all around” – better care, easier access to hospitals, and affordable treatment. It also comes with a price. For one reason or another, the turbulence within the American health care system is causing doctors to shut down, downsizing or sell their practices …
The 21st century challenge for the American health care delivery system is to deliver higher quality care for less money. Republican and Democratic experts agree that payment reform involving transitioning from fee-for-service to global, value-based systems is necessary for us to achieve that goal. Accountable care organizations (ACOs) are the new entities that will receive the new global payments and distribute them to the doctors, allied health professionals, hospitals, and …
It is increasingly becoming the year of the Thrifty Patient. People are paying for more medical care and are more responsible for the costs of getting that care via higher deductibles and co-pays. Patients don’t have a choice but to be involved in their care. Though the recent 2008 recession saw a decrease in overall medical and health care utilization as …
“Passed by corruption, aided and abetted by the purest man in America” is how anti-slavery Congressman Thaddeus Stevens described President Lincoln’s successful effort to enact the 13th amendment, banning slavery. This historically accurate quote, which runs counter to the public image of “Honest Abe” Lincoln, is among the many fascinating stories recounted in the Steven Spielberg’s masterpiece “Lincoln” playing …
Most of us would agree that doctors should not treat patients without their consent, except in special cases like emergency care for an unconscious patient. It’s not enough for doctors to ask “Is it OK with you if I do this?” They should get informed consent from patients who understand the facts, the odds of success, and the risk/benefit ratio of treatments. The ethical principle of autonomy requires that they …
Surprise! It turns out that if every woman in the US got a mammogram every year, almost exactly the same number of them would still die of breast cancer. Why? Watch this video. Read this by TBTAM. Bottom line: mammograms don’t find aggressive cancers soon enough (by definition, you can’t), while too many of the cancers they do find were never going to be fatal anyway. This is what “over-diagnosis” …
A buddy of mine sent along an interesting link by a physician named Ben Brown that makes an argument that doctors actually aren’t all that well off. Salaries are down. Education costs can exceed $300,000 over the course of college, medical school, and residency. By the time you take that first job, you’re on the wrong side of 30 and Wells Fargo is demanding $1800 a month for all your student loans. It’s a topic …
I have used the electronic medical record (specifically EPIC) since 2004. I have grown accustomed to its nuances, benefits and quirks. There are parts about it I really like. There are parts of it I’d like to do without but accept that they are necessary evils in our current health care climate. I know that there will always be parts of any modified …
I learned of a disturbing decision from the Court of Appeals for the Second Circuit. In an insane ruling, two of judges determined that a drug rep promoting “off-label” uses for a drug was exercising his freedom of speech. Let’s stroll to the back of a typical doctor’s office to see how this plays out.
Physicians are terrible patients. That fact is one of the few absolutes in medicine. I can remember developing an acute appendicitis as a medical student. I remember the fear, the uncertainty and the discomfort. I can remember wanting someone who was in charge to spend a little time in my room explaining things to me. I can remember the embarrassment I felt when a group of 6 student nurses paraded …
There is one aspect of our relentlessly rising healthcare costs that seems particularly out of control — administrative costs. An interesting recent editorial in the New England Journal of Medicine provides some sobering details.
Every physician confronts daily the burden of dealing with healthcare bureaucrats of various sorts. The average doctor personally spends 43 minutes each day at it, and behind every physician there is an army of coders. …
The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s already crowded waiting room and wondering how their care will be impacted when their doctor is responsible for even more patients. And doctors who even now are swamped and frustrated …
It seems both ironic and inevitable: I won’t be getting any more “meaningful use” checks. It’s not that I didn’t qualify for the money; I saw plenty of patients on Medicare and met all of the requirements. I was paid for my first year money without much hassle. The problem I am facing is this: I am probably going to be “opting out” of Medicare, and once I do that …
My elderly and infirm parents live 15 minutes south of my home in an assisted living facility. They moved there after it became apparent that they could not manage their affairs in their own home, have some degree of independence and socialization with friends and receive the care and supervision they needed to stay out of the hospital. Their cognitive impairment …
We know that physicians (and their pens/keyboards) are some of the main drivers in health care spending. But which ones are the biggest offenders?
A recent study from the nonprofit RAND Corporation asked this question and found that newer doctors tend to run up higher health care bills for their patients than their more seasoned colleagues. The study, published in Health Affairsearlier this month, looked at insurance …
I attended a talk by the Dean of Admissions of one of the most competitive medical schools nationwide. The topic was primary care and community health. He talked at length about how not enough medical students were entering primary care. He put up some graphs showing that the most lucrative specialties tend to be the most competitive ones, with primary care among the lowest-paying and least-competitive. He said that medical …
Your child has a rash and is acting a little sick. You reach for your phone–not to call the doctor, but to look up rashes on Google or your symptom checker app.
This, according to the latest report from the Pew Internet and American Life Project, is the direction we are moving. As a doctor, I think it’s great.
My veterinarian answers my phone calls. The other day I called her office to ask for a renewal of the pain medication for my little dog Jack. He has been blind and deaf for over a year, but now his rear end is going and he is falling a lot and having a hard time getting up. When I asked for …
A war is brewing in the House of Medicine. It’s a war of philosophy based on how we physicians approach our patients–the people who come to us to be cared for and to be cared about. The people who come as patients to the physician as healer, a healer who also has a wealth of scientific knowledge which can be used to stamp out disease and bring long, healthy lives …
