BAD MEDICINE:
This is one of the underlying issues to our excess healthcare spending. Our country is afraid of death. It is morbidly afraid of death. Take a stroll through a nursing home. Walk through a long term care facility. Step back and look around at an ICU. There are many cases where we are trying to build a sand castle wall to keep the tide away.
Your existence is reduced to tubes.
-A tube in your throat to breath for you.
-A tube in your stomach or vein to feed you.
-A tube in your vein to drug you.
-A tube in your artery to check your blood gases.
-A tube in your rectum to drain your stool.
-A tube in your urethra to drain your urine.
-A tube to a wound vacuum to suction out the puss from your ulcer on your bottom as you aren't rolled or moved enough to prevent your skin from breaking down.
-A tube in your coronary artery to keep it open.
-A tube for every bodily function and even possibly for every artery and gastrointestinal lumen in your body.
You will be sent to these places because either you or your family asked for it. Your daily stimulus will consist of a myriad of people in an array of scrubs coming in to poke you, drain you, bath you, feed you, roll you, auscultate you, and many other invasive things. You will be imprisoned to a room to stair at the ceiling or mid day TV. Constantly you will be haunted by the beeping sounds of all the machines managing your tubes.
This is what medicine does to people and this is what America has said they wanted. For what? Why? Because we don't talk about death. We don't talk about how we want to die. We don't talk about things we don't want done to us. We all believe that it won't happen. It will be tomorrow. It will be 20 years from now. This all costs a tremendous amount of money. Does more time on earth trump quality of life?
GOOD SOLUTION:
1) We should create another ideological war. We have one against drugs, which we aren't and won't ever win. We have one against terrorism, which is merely a classification of violence and recognizing the inability to stop violence we won't win that one either. So if we are in the habit of declaring unwinnable ideological wars, why not add another? Let's declare war on the fear of death.
7/12/09
Reducing Costs II
BAD MEDICINE:
It is commonly recognized amongst physicians that there is a purveyant over ordering of tests. It is so out of control it has shifted the bar of what should be the standard of care to one that is much higher because more tests are needed to be ordered. Beyond all doubt this has raised the costs of health care dollars and contributed to the hastening demise of CMS, and unobtainable insurance premiums.
Yet, there is also something more insidious that we can't ignore. Even if we were able to remove the impetus behind physician orders (i.e. decrease liability, make the patient pay directly for more of their health care costs to lower entitlement attitude) there would still be the supplies and facilities.
Hospitals would still have high liability costs because they are concentrating some of the most accident prone members of society into one building. Falls. Smoking outside with your oxygen tank. Choking on food. Nosocomial infections.
Then there are the myriad of supplies. Oxygen. Tubing. Masks. Ventilators. Central line kits. Ambu bags. Tracheostomy tubes. Foley catheters. Each one of these products has to meet certain standards to be able to be used on humans. This costs more. Each of these manufactures can be targeted for product malfunctions. And who do you think they pass their liability insurance costs on to? Now multiply this across the whole spectrum of medical supplies.
This is why the fear of lawsuits forcing the necessity of insurance is so rampant in our society it is infused into every thing. Reducing physician liability insurance will only go so far.
GOOD SOLUTION:
1) Eliminate the ability for any healthcare worker or supplier or facility from being sued. Make it an all or non-license granted by the state medical board. If your products are defective and cause harm, you will lose your license to manufacture medical supplies. If your facility is too dangerous, you will lose your license to operate in that capacity. If you harm your patients you will lose your license to practice. Imagine the cost savings in healthcare without the infusion of liability insurance premiums at every level of delivery and product.
It is commonly recognized amongst physicians that there is a purveyant over ordering of tests. It is so out of control it has shifted the bar of what should be the standard of care to one that is much higher because more tests are needed to be ordered. Beyond all doubt this has raised the costs of health care dollars and contributed to the hastening demise of CMS, and unobtainable insurance premiums.
Yet, there is also something more insidious that we can't ignore. Even if we were able to remove the impetus behind physician orders (i.e. decrease liability, make the patient pay directly for more of their health care costs to lower entitlement attitude) there would still be the supplies and facilities.
Hospitals would still have high liability costs because they are concentrating some of the most accident prone members of society into one building. Falls. Smoking outside with your oxygen tank. Choking on food. Nosocomial infections.
Then there are the myriad of supplies. Oxygen. Tubing. Masks. Ventilators. Central line kits. Ambu bags. Tracheostomy tubes. Foley catheters. Each one of these products has to meet certain standards to be able to be used on humans. This costs more. Each of these manufactures can be targeted for product malfunctions. And who do you think they pass their liability insurance costs on to? Now multiply this across the whole spectrum of medical supplies.
This is why the fear of lawsuits forcing the necessity of insurance is so rampant in our society it is infused into every thing. Reducing physician liability insurance will only go so far.
GOOD SOLUTION:
1) Eliminate the ability for any healthcare worker or supplier or facility from being sued. Make it an all or non-license granted by the state medical board. If your products are defective and cause harm, you will lose your license to manufacture medical supplies. If your facility is too dangerous, you will lose your license to operate in that capacity. If you harm your patients you will lose your license to practice. Imagine the cost savings in healthcare without the infusion of liability insurance premiums at every level of delivery and product.
2/20/09
10,000 Hours
BAD MEDICINE:
…believing the path to becoming a physician can be circumvented. It is quite egregious some believe responsibility entrusted to physicians can be purchased with lobbyists for advancement of their own profession. It is audacious to believe that scraping by with the minimum can lead to physician equality. Being an expert requires hard work. Politicians at the beckoning of insurance companies and nursing lobbies have made it quite clear one need not be an expert in medicine to practice autonomously anymore.
For instance the Washington State University Psychiatry Nurse Practitioner Program requires only 405 hours of clinical training. Another sample on the opposite coast shows that the Medical University of South Carolina Family Nurse Practitioner Program only has about 540 hours of clinical training. The Doctor Nurse Practitioner program at the University of Tennessee Health Science Center is a mere three years after a Bachelor of Science in Nursing, can be completed online, and only requires at most 28 days on campus per year.
GOOD SOLUTION:
One Psychologist's research scratches the surface of how much time it takes to become an expert, a true master in one's field. 10,000 hours is what a person should aim for. Here is an excerpt from that link:
A physician without residency training has already accumulated 5280 hours (60hrs per week x 4 weeks of a rotation x 22 rotations = 5280 hours) of clinical training just from their third and fourth years of medical school. This doesn't even include the 80 hours a week of studying for two solid years as a first and second year student. This is done on campus and there is no time to work a full time job on the side. Residency is a solid 80 hours of clinical training hell for a bare minimum of three years. That comes out to 11,760 hours of clinical training at the very least (80 hours x 49 weeks x 3 years = 11,760 hours).
It seems to me a Physician who has completed their residency has put in the hours to become an expert, a true master at the art of medicine.
Also, in recognition of the excerpt's other point, who do you think is going to have the academic drive and acumen to seek out further experiences to continue their progression? We all know the answer to that.
1) Seek out the true experts when you are sick.
…believing the path to becoming a physician can be circumvented. It is quite egregious some believe responsibility entrusted to physicians can be purchased with lobbyists for advancement of their own profession. It is audacious to believe that scraping by with the minimum can lead to physician equality. Being an expert requires hard work. Politicians at the beckoning of insurance companies and nursing lobbies have made it quite clear one need not be an expert in medicine to practice autonomously anymore.
For instance the Washington State University Psychiatry Nurse Practitioner Program requires only 405 hours of clinical training. Another sample on the opposite coast shows that the Medical University of South Carolina Family Nurse Practitioner Program only has about 540 hours of clinical training. The Doctor Nurse Practitioner program at the University of Tennessee Health Science Center is a mere three years after a Bachelor of Science in Nursing, can be completed online, and only requires at most 28 days on campus per year.
GOOD SOLUTION:
One Psychologist's research scratches the surface of how much time it takes to become an expert, a true master in one's field. 10,000 hours is what a person should aim for. Here is an excerpt from that link:
Most individuals who start as active professionals or as beginners in a domain change their behavior and increase their performance for a limited time until they reach an acceptable level. Beyond this point, however, further improvements appear to be unpredictable and the number of years of work and leisure experience in a domain is a poor predictor of attained performance (Ericsson & Lehmann, 1996). Hence, continued improvements (changes) in achievement are not automatic consequences of more experience and in those domains where performance consistently increases aspiring experts seek out particular kinds of experience, that is deliberate practice (Ericsson, Krampe & Tesch-Römer, 1993)--activities designed, typically by a teacher, for the sole purpose of effectively improving specific aspects of an individual's performance. For example, the critical difference between expert musicians differing in the level of attained solo performance concerned the amounts of time they had spent in solitary practice during their music development, which totaled around 10,000 hours by age 20 for the best experts, around 5,000 hours for the least accomplished expert musicians and only 2,000 hours for serious amateur pianists. More generally, the accumulated amount of deliberate practice is closely related to the attained level of performance of many types of experts, such as musicians (Ericsson et al., 1993; Sloboda, et al., 1996), chessplayers (Charness, Krampe & Mayr, 1996) and athletes (Starkes et al., 1996).
A physician without residency training has already accumulated 5280 hours (60hrs per week x 4 weeks of a rotation x 22 rotations = 5280 hours) of clinical training just from their third and fourth years of medical school. This doesn't even include the 80 hours a week of studying for two solid years as a first and second year student. This is done on campus and there is no time to work a full time job on the side. Residency is a solid 80 hours of clinical training hell for a bare minimum of three years. That comes out to 11,760 hours of clinical training at the very least (80 hours x 49 weeks x 3 years = 11,760 hours).
It seems to me a Physician who has completed their residency has put in the hours to become an expert, a true master at the art of medicine.
Also, in recognition of the excerpt's other point, who do you think is going to have the academic drive and acumen to seek out further experiences to continue their progression? We all know the answer to that.
1) Seek out the true experts when you are sick.
2/8/09
The Minimum
BAD MEDICINE:
The field of medicine has regressed and let the intrusion of lesser trained practitioners impede upon the health and safety of our families. A medical degree (MD, DO, MBBS, MBCh, etc.) with a year of internship and a medical license used to be the bare minimum to practice medicine (some states require two years of training now). Now, we have lowered the bar for the practice of medicine to diagnose, treat, and manage to a measly two years. Our society has taken a step back in an era when there are more medications, newly defined diseases, increased procedures, and more complex patients as a whole.
Have we as a species become more intelligent? Did I miss the memo? It makes no sense no matter how you cut the cheese to water down something that is become more complex.
GOOD SOLUTION:
1) Begin the process to phase back into a physician only medical force. The limiting factor of physicians in this country is not the medical schools. It is the number of residency slots. There are more law schools than medical schools in this country (Am I the only one that sees that as peculiar?). I advocate that we continue to have Osteopathic schools increase in number, and allopathic schools to raise their class sizes. We can flood the U.S. graduate medical education system with our graduates until there are left overs.
Yes, I am advocating for a physician surplus. These unmatched grads will be able to match into intern years (these are far easier to create and open then a complete FP or IM residency, plus hospitals will love the cheap labor) for the bare minimum training to become the traditional General Practitioner. They can still pursue their own practice, but realistically they will be employed in the function of existing PAs and NPs.
The bare minimum would once again be raised. The competition in medical school, which is already high enough to cause depression, has the prospect of yielding better physicians for the specialty roles (this includes IM, and FP as a specialty).
The field of medicine has regressed and let the intrusion of lesser trained practitioners impede upon the health and safety of our families. A medical degree (MD, DO, MBBS, MBCh, etc.) with a year of internship and a medical license used to be the bare minimum to practice medicine (some states require two years of training now). Now, we have lowered the bar for the practice of medicine to diagnose, treat, and manage to a measly two years. Our society has taken a step back in an era when there are more medications, newly defined diseases, increased procedures, and more complex patients as a whole.
Have we as a species become more intelligent? Did I miss the memo? It makes no sense no matter how you cut the cheese to water down something that is become more complex.
GOOD SOLUTION:
1) Begin the process to phase back into a physician only medical force. The limiting factor of physicians in this country is not the medical schools. It is the number of residency slots. There are more law schools than medical schools in this country (Am I the only one that sees that as peculiar?). I advocate that we continue to have Osteopathic schools increase in number, and allopathic schools to raise their class sizes. We can flood the U.S. graduate medical education system with our graduates until there are left overs.
Yes, I am advocating for a physician surplus. These unmatched grads will be able to match into intern years (these are far easier to create and open then a complete FP or IM residency, plus hospitals will love the cheap labor) for the bare minimum training to become the traditional General Practitioner. They can still pursue their own practice, but realistically they will be employed in the function of existing PAs and NPs.
The bare minimum would once again be raised. The competition in medical school, which is already high enough to cause depression, has the prospect of yielding better physicians for the specialty roles (this includes IM, and FP as a specialty).
1/24/09
3rd Year Medical Students for Everyone
BAD MEDICINE:
The formal medical training of a Physician Assisstant is 2 years. One year of condensed book knowledge and one year of clinical rotations. A Nurse Practioner also has two years of formal medical training.
They cease their training at the level of a third year medical student. We are unleashing upon our country year after year 'third year medical students'. However, their level of formal training doesn't equate to that of a third year medical student. It lacks the depth and span of basic science fundamentals, physical diagnosis, pathology, physiology, etc.
I cringe at the thought of my own family trusting their care with such a level of medical training. You should too.
GOOD SOLUTIONS:
1) Seek the treatment of a physician and not the mid-level
2) If you are a physician don't hire them
3) If you do hire them choose the PA
4) Write your legislatures about this atrocity and watering down of medical training
The formal medical training of a Physician Assisstant is 2 years. One year of condensed book knowledge and one year of clinical rotations. A Nurse Practioner also has two years of formal medical training.
They cease their training at the level of a third year medical student. We are unleashing upon our country year after year 'third year medical students'. However, their level of formal training doesn't equate to that of a third year medical student. It lacks the depth and span of basic science fundamentals, physical diagnosis, pathology, physiology, etc.
I cringe at the thought of my own family trusting their care with such a level of medical training. You should too.
GOOD SOLUTIONS:
1) Seek the treatment of a physician and not the mid-level
2) If you are a physician don't hire them
3) If you do hire them choose the PA
4) Write your legislatures about this atrocity and watering down of medical training
1/20/09
Reducing Costs I
BAD MEDICINE:
Patients will frequently ask to stay longer or simply want to be in the hospital. There are a lot of reasons why. It happens. Regardless of why, it is a waste of money and a waste of a lot of people's time.
GOOD SOLUTION:
1) I advocate the crappy hospital food not improve. Keep it awful. It is an excellent way to gauge a person's health. If your medical issues aren't more imposing then the slop in front of you, then maybe the hospital isn't the place for you. The bad food might just be enough of a reason to keep people away if the thought of infections, needles, and invasive procedures just isn't enough. Who knows how much this saves American hospitals already?
Patients will frequently ask to stay longer or simply want to be in the hospital. There are a lot of reasons why. It happens. Regardless of why, it is a waste of money and a waste of a lot of people's time.
GOOD SOLUTION:
1) I advocate the crappy hospital food not improve. Keep it awful. It is an excellent way to gauge a person's health. If your medical issues aren't more imposing then the slop in front of you, then maybe the hospital isn't the place for you. The bad food might just be enough of a reason to keep people away if the thought of infections, needles, and invasive procedures just isn't enough. Who knows how much this saves American hospitals already?
Kindness
BAD MEDICINE:
You know the generalization... nurses have all the heart that physicians lost. Well recently I had a shiny moment amidst my usual day. An old foreign non-English speaking patient who is also hard of hearing in the ICU has questionable abilities to swallow. When the patient's family is around the patient perks up, swallows without difficulties and is pleasant as can be. Without the family around a nurse went to give the patient their medications and simply poured the pills in their mouth, gave a few pokes, and started to wash it down with some liquid and English encouragement. The patient was going to have none of this. The patient chewed their pills, spit some out, and smacked the liquid all over the place. I took the liquid, put it in the patients hand, said their name kindly and gestured to swallow. The patient obliged.
GOOD SOLUTIONS:
1) Hospitals, especially ICUs are power vacuums. Patients lose it. Medical folk gain it. Doing the little things to put the power, or illusion of it, back in the hands of the patient goes a long way.
2) Kindness isn't monopolized by any profession. Don't reinforce the stereotypes. I've witnessed an elderly, highly respected physician with full academic entourage in tow, slow his rounds down without hesitation to feed a hungry elderly demented woman her breakfast.
You know the generalization... nurses have all the heart that physicians lost. Well recently I had a shiny moment amidst my usual day. An old foreign non-English speaking patient who is also hard of hearing in the ICU has questionable abilities to swallow. When the patient's family is around the patient perks up, swallows without difficulties and is pleasant as can be. Without the family around a nurse went to give the patient their medications and simply poured the pills in their mouth, gave a few pokes, and started to wash it down with some liquid and English encouragement. The patient was going to have none of this. The patient chewed their pills, spit some out, and smacked the liquid all over the place. I took the liquid, put it in the patients hand, said their name kindly and gestured to swallow. The patient obliged.
GOOD SOLUTIONS:
1) Hospitals, especially ICUs are power vacuums. Patients lose it. Medical folk gain it. Doing the little things to put the power, or illusion of it, back in the hands of the patient goes a long way.
2) Kindness isn't monopolized by any profession. Don't reinforce the stereotypes. I've witnessed an elderly, highly respected physician with full academic entourage in tow, slow his rounds down without hesitation to feed a hungry elderly demented woman her breakfast.
Call
BAD MEDICINE:
Being on call really isn't fun.
GOOD SOLUTION:
1) Shift work? Heck, I have no solution for this one. I just don't like it.
Being on call really isn't fun.
GOOD SOLUTION:
1) Shift work? Heck, I have no solution for this one. I just don't like it.
1/7/09
Bad Influences
BAD MEDICINE: In our nation's crusade against physicians there have been some interesting developments. Big Pharma as of this year has reduced their trinkets they hand out to physicians. This was done for PR and to do it on their own terms to avoid a government mandate.
Here and there news blurbs pop up about some academic physicians and their ties to industry. Their brow raising exploits are being questioned.
For right or wrong we are making it out to be that any dealings with businesses are a shameful action for physicians.
GOOD SOLUTIONS:
If we are going down the path of making physicians declare their ties with businesses and how much they are receiving, why stop there? Isn't an insurance company also compensating a physician? Aren't they influencing the diagnosis, treatment, and management ofpatients customers far more than a speaking gig or free lunch ever could?
If we as a nation are going to start demonizing such dealings we better not half ass it. We should go to the heart of the beast.
1) Physicians are not allowed to directly bill to medicare or private insurance. Thepatient customer must seek reimbursement on their own.
2) Physicans may have no contractual agreements with insurance companies, medicare, or HMOs
3) Physicians cannot be burdened with pre-authorizations. This might skew their treatment plans (or lack of mentioning them). Thepatient customer must now argue on their own behalf.
4) Physicians may no longer be employees to hospitals or HMOs. You know darn well they put selective pressure to alter their practice of medicine.
These are the changes that are needed to have a truly unbiased physician. One who is responsible only to you. Until this is done, everything else is a joke.
Here and there news blurbs pop up about some academic physicians and their ties to industry. Their brow raising exploits are being questioned.
For right or wrong we are making it out to be that any dealings with businesses are a shameful action for physicians.
GOOD SOLUTIONS:
If we are going down the path of making physicians declare their ties with businesses and how much they are receiving, why stop there? Isn't an insurance company also compensating a physician? Aren't they influencing the diagnosis, treatment, and management of
If we as a nation are going to start demonizing such dealings we better not half ass it. We should go to the heart of the beast.
1) Physicians are not allowed to directly bill to medicare or private insurance. The
2) Physicans may have no contractual agreements with insurance companies, medicare, or HMOs
3) Physicians cannot be burdened with pre-authorizations. This might skew their treatment plans (or lack of mentioning them). The
4) Physicians may no longer be employees to hospitals or HMOs. You know darn well they put selective pressure to alter their practice of medicine.
These are the changes that are needed to have a truly unbiased physician. One who is responsible only to you. Until this is done, everything else is a joke.
1/5/09
Self Intubation Part II
BAD MEDICINE:
Same story, but this guy actually inflated the cuff and didn't use a camera.
GOOD SOLUTION:
1) Don't do it.
Same story, but this guy actually inflated the cuff and didn't use a camera.
GOOD SOLUTION:
1) Don't do it.
1/4/09
Future of Medicine: One Possibility
BAD MEDICINE:
Ever wonder what universal, single payer, socialized, mandatory insurance, or any of the other euphemisms might look like in the future? Here is one possibility.
GOOD SOLUTIONS:
1) Avoid anything that says universal, socialized, single payer, mandated insurance, as though it were a plague
2) Write your representatives
3) Educate people when they speak of its benefits as the end all solution
4) If you are in healthcare don't support medicare/CMS
Ever wonder what universal, single payer, socialized, mandatory insurance, or any of the other euphemisms might look like in the future? Here is one possibility.
GOOD SOLUTIONS:
1) Avoid anything that says universal, socialized, single payer, mandated insurance, as though it were a plague
2) Write your representatives
3) Educate people when they speak of its benefits as the end all solution
4) If you are in healthcare don't support medicare/CMS
1/2/09
Right to Healthcare: A Paradox
BAD MEDICINE: I'm still savoring the dulcet meal and dessert DrRich served up. The first bite of meat was awash with traditional brine. This set the tone for a foregone era of complex simplicity, of courtly love. Still, somehow, avoiding the cruel realities of that time he focused on hope with a pint of mead to die for. Pickled cabbage that slapped my tongue, but hugged it at the same time. With closed eyes the soft springy dry sensation let me know I had experienced warm fresh Rhine River Rye. But, oh! This experience didn't stop there. The dessert, more than merely palatable, it massaged my taste buds. They thought they couldn't handle any more after that meal, but they rallied. Indeed, the soft rumbling whisper of my stomach is correct. That was ambrosia.
Lucky for you I took a few pictures!
Now, slumped against an oak, Pan plots his mischief and these dreamy thoughts arise... Healthcare is not a right, nor should it be.
As it is now, when healthcare is not a right, we have the greatest access to treatment compared to any country. We can get the new medication to grow our lashes longer. We can get dialysis after the age of 65. We can perform an aortic repair on an 85 year old who is dissecting. Have our status be full code when we are 90. By not having the regulation that comes with universal healthcare, we all can ride on the coat tails of those who are paying their way for these great services via moral charity care.
But giving the go ahead for universal healthcare may give us some 'free' treatment, but we lose out on the harder to reach, more expensive, not always effective treatments. What we may gain in title we will lose when knocking at the clinic door. Universal healthcare brings the unlimited, untouchable starry sky down to being a drab white, office plaster tile ceiling within jumping range. Anything beyond this ceiling is no longer moral charity care, it is a privilege. You must pay cold hard cash to obtain that which was once 'free'. The paradox emerges, where a right is merely but a dream.
GOOD SOLUTIONS:
1) Avoid anything that says universal, socialized, single payer, mandated insurance, as though it were a plague
2) Write your representatives
3) Educate people when they speak of its benefits
4) Reduce the increasing influences of government in healthcare (future blog topics) and overlaps some with #2
Lucky for you I took a few pictures!
Prohibition did not work for alcohol, is not working for drugs, and will certainly not work for healthcare.That meal was so good! And over here you can see the dessert in much of its glory.
So the real question we should be asking those who are going to reform our healthcare system is: How are you planning to ration?
There are ways to devise a system of open healthcare rationing that would result in fair, effective, efficient healthcare, and that would actually minimize the number of effective healthcare services that will end up being withheld. But to accomplish this, we would have to openly agree to ration.
DrRich has not heard anyone in a position of authority, not even anyone from Mr. Obama’s team, a team that promises to set new standards of openness and transparency, mention that healthcare needs to be rationed. Thus, as much as DrRich would like to feel all new-era-y, he suspects that the rationing will continue to be done covertly.
Now, slumped against an oak, Pan plots his mischief and these dreamy thoughts arise... Healthcare is not a right, nor should it be.
As it is now, when healthcare is not a right, we have the greatest access to treatment compared to any country. We can get the new medication to grow our lashes longer. We can get dialysis after the age of 65. We can perform an aortic repair on an 85 year old who is dissecting. Have our status be full code when we are 90. By not having the regulation that comes with universal healthcare, we all can ride on the coat tails of those who are paying their way for these great services via moral charity care.
But giving the go ahead for universal healthcare may give us some 'free' treatment, but we lose out on the harder to reach, more expensive, not always effective treatments. What we may gain in title we will lose when knocking at the clinic door. Universal healthcare brings the unlimited, untouchable starry sky down to being a drab white, office plaster tile ceiling within jumping range. Anything beyond this ceiling is no longer moral charity care, it is a privilege. You must pay cold hard cash to obtain that which was once 'free'. The paradox emerges, where a right is merely but a dream.
GOOD SOLUTIONS:
1) Avoid anything that says universal, socialized, single payer, mandated insurance, as though it were a plague
2) Write your representatives
3) Educate people when they speak of its benefits
4) Reduce the increasing influences of government in healthcare (future blog topics) and overlaps some with #2
Kick 'em When Their Down!
BAD MEDICINE: We are starting to see more symptoms of the generalist inquisition. Plain and simple general surgery is far worse off than primary care in this coutry.
1) Too little pay.
2) Too much insurance, medicare, and administration bureucratic BS.
3) Global fees
4) Large overhead that can't be reduced. Even though you are operating, you still need office staff.
5) Dumping ground for EM physicians who triage to them rather than practice medicine first (as a result of defensive medicine).
6) Their services inflict a great deal of pain and potential morbidity on a country that expects perfect outcomes. That is never a good combo.
7) This list doesn't end...
GOOD SOLUTIONS:
1) Abolish global fees
2) Permit balance billing on medicare
3) No medical liability for those who don't, won't, or can't pay
4) Pass a generalist empowerment act, where any sort of committee or position dealing with surgery department rules in the hospital is filled only by general surgeons - no specialists.
5) Temporary fix until the surgeons come back: Relaxation of the surgical numbers for privileging so Family Medicine physicians are back in the OR for appendectomies, cholecystectomies, colonoscopies, hemmorhoids, etc.
6) Give them better speaker systems in the OR. Surgeons need to rock out more. Music works wonders for moral.
1) Too little pay.
2) Too much insurance, medicare, and administration bureucratic BS.
3) Global fees
4) Large overhead that can't be reduced. Even though you are operating, you still need office staff.
5) Dumping ground for EM physicians who triage to them rather than practice medicine first (as a result of defensive medicine).
6) Their services inflict a great deal of pain and potential morbidity on a country that expects perfect outcomes. That is never a good combo.
7) This list doesn't end...
GOOD SOLUTIONS:
1) Abolish global fees
2) Permit balance billing on medicare
3) No medical liability for those who don't, won't, or can't pay
4) Pass a generalist empowerment act, where any sort of committee or position dealing with surgery department rules in the hospital is filled only by general surgeons - no specialists.
5) Temporary fix until the surgeons come back: Relaxation of the surgical numbers for privileging so Family Medicine physicians are back in the OR for appendectomies, cholecystectomies, colonoscopies, hemmorhoids, etc.
6) Give them better speaker systems in the OR. Surgeons need to rock out more. Music works wonders for moral.
1/1/09
No More Scary Stairs
BAD MEDICINE: Hospitals carry with them an assortment of images. You hear the word hospital you think of a medical bed, a kind nurse, an old physician, a bunch of babies behind a glass window, beeping ICU rooms, etc. But hospitals aren't often thought of as forerunners to health. They are medical centers but not health centers. This is fine, but it couldn't hurt to inject a little health into the medicine stronghold.
My beef is with the scary unwelcoming hard to recognize stairs. How many have you seen that have those standard metal doors with a single vertical glass window guarding their entrance like a solitary prison cell. They are quite innocuous and easy to miss, especially with their drab colors. I fly right by them all the time.
These stair wells are also pretty darn scary. I'm good sized male so I really don't have any concerns, but those concrete floors, concrete cynder block walls, lack of features distinguishing which floor you're on, all make it uninviting. Especially one stair well in a certain corner of the hospital I recently showed others who didn't know it existed. They actually stopped and asked me where I was taking them. That's what scary stairs can do.
GOOD SOLUTIONS:
1) In this sad era of obesity I think we need to draw more attention to the stairs. Especially in a hospital! We should have those yellow wet floor signs altered to be a painful neon color with a big fat arrow. STAIRS--> When Christmas comes, only put lights up around the stairwell doors and trailing the hand rails within them.
2) Paint each corresponding floor level in the stair wells. Now you know by color that you are on the 3rd floor. On a surgery rotation I was often so tired that I would go to the wrong floor and wouldn't notice until I got to the nursing station. Had the stair wells been painted, my autopilot that kicks in when I'm tired would function a lot better.
3) Make them less scary. Put up some murals. Hire some teenagers or university art students to build their portfolios. Paint some local sceneries. Paint some happy-multicultural-working-together-diversity-propaganda sort-of-thing. Anything!
4) Let the world know the stairs are a fun place. You know what elevator music is right? We now have the opportunity to make a new stereotype. Imagine stair music. Picture up beat latino music. *boom* *cha* *cha* *boom* That's the place I want to be. That's the place I want to burn a few extra calories.
My beef is with the scary unwelcoming hard to recognize stairs. How many have you seen that have those standard metal doors with a single vertical glass window guarding their entrance like a solitary prison cell. They are quite innocuous and easy to miss, especially with their drab colors. I fly right by them all the time.
These stair wells are also pretty darn scary. I'm good sized male so I really don't have any concerns, but those concrete floors, concrete cynder block walls, lack of features distinguishing which floor you're on, all make it uninviting. Especially one stair well in a certain corner of the hospital I recently showed others who didn't know it existed. They actually stopped and asked me where I was taking them. That's what scary stairs can do.
GOOD SOLUTIONS:
1) In this sad era of obesity I think we need to draw more attention to the stairs. Especially in a hospital! We should have those yellow wet floor signs altered to be a painful neon color with a big fat arrow. STAIRS--> When Christmas comes, only put lights up around the stairwell doors and trailing the hand rails within them.
2) Paint each corresponding floor level in the stair wells. Now you know by color that you are on the 3rd floor. On a surgery rotation I was often so tired that I would go to the wrong floor and wouldn't notice until I got to the nursing station. Had the stair wells been painted, my autopilot that kicks in when I'm tired would function a lot better.
3) Make them less scary. Put up some murals. Hire some teenagers or university art students to build their portfolios. Paint some local sceneries. Paint some happy-multicultural-working-together-diversity-propaganda sort-of-thing. Anything!
4) Let the world know the stairs are a fun place. You know what elevator music is right? We now have the opportunity to make a new stereotype. Imagine stair music. Picture up beat latino music. *boom* *cha* *cha* *boom* That's the place I want to be. That's the place I want to burn a few extra calories.
More valueable than 15 minutes?
BAD MEDICINE: I have heard several times primary care physicians lamenting the affects of retail clinics on their practices. These clinics, because of their ease of access, allow for drive through like service. This is a wonderful advancement for patients consumers, but the implications of inadequately trained providers and the further fragmentation of a patients consumer’s medical record is bad medicine. This will be a topic for another day. The animosity is quite understandable when the pay you receive doesn’t vary much from seeing a young person with a slam dunk case of sinusitis compared to your elderly woman on 14 drugs with a complaint of dizziness. Yet, the rate at which you earn this pay does matter (how fast you see the patient).
These clinics are siphoning of what are often times the ‘easy’ cases (but still can be something far worse to the untrained mid-level eye) and accelerating the financial collapse of your local doctor. They cannot keep the lights on with the amount of time it takes to treat thesepatients consumers for the amount they are paid. These clinics are removing this overlooked subsidy that helps keep grandpa and grandma with Dr. Local.
Taking another step backwards and looking at the bigger picture it beckons the question, why? Why would someone take the health risk of being seen in one of these clinics rather than with Dr. Local? The answer is the quickness in being seen and getting an answer to their problem. Sickness begets pain and fear, which are excellent motivators for action.
Some have responded that primary care physicians should improve the quickness that patients can be seen in the offices and their hours of operation. And that these offices need to compete with these clinics as though they are equals. This is a solution, but not the best.
Primary care physicians fail to recognize the real value of their services. They are worth more than just a single office visit. They are more than just the means to a prescription for antibiotics. Fee for service medical practices set this precedent that thepatient consumer-physician relationship is only as long as the visit. As long as primary care physicians operate under this model they are giving their blessing to these clinics and hastening their demise.
GOOD SOLUTION:
1) Adoption of Retainer medical practices, like many of those found here at www.simpd.org. The retainer model commits apatient consumer-physician relationship to more than a 15 minute visit, but instead, a whole year (depending on the contract). If a patient is sick you can bet they will utilize their investment and won't go to these clinics. This improves the documentation of a patient's consumer's medical history allowing the physician to best do thier job (aka quality). This model also eliminates concerns of needing to subsidize elderly care as they may have a minimally higher retainer fee to account for this.
These clinics are siphoning of what are often times the ‘easy’ cases (but still can be something far worse to the untrained mid-level eye) and accelerating the financial collapse of your local doctor. They cannot keep the lights on with the amount of time it takes to treat these
Taking another step backwards and looking at the bigger picture it beckons the question, why? Why would someone take the health risk of being seen in one of these clinics rather than with Dr. Local? The answer is the quickness in being seen and getting an answer to their problem. Sickness begets pain and fear, which are excellent motivators for action.
Some have responded that primary care physicians should improve the quickness that patients can be seen in the offices and their hours of operation. And that these offices need to compete with these clinics as though they are equals. This is a solution, but not the best.
Primary care physicians fail to recognize the real value of their services. They are worth more than just a single office visit. They are more than just the means to a prescription for antibiotics. Fee for service medical practices set this precedent that the
GOOD SOLUTION:
1) Adoption of Retainer medical practices, like many of those found here at www.simpd.org. The retainer model commits a
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