December 3rd, 2008 by Dr. Val Jones in Opinion, Primary Care Wednesdays
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By Alan W. Dappen, MD; Steve Simmons, MD; Valerie Tinley, FNP of Doctokr Family Medicine
We are a family doctor, an internist and a family nurse practitioner working on the front line of the American health care system. We share a moral and ethical duty to protect the health of our patients along with all our colleagues who labor daily doing the same.We as Americans are proud of what has long been considered a first-rate health care system. Sadly, this system is broken despite our best efforts. Americans spend much more per capita for care as any other country. The World Health Organization has graded our care as 37th “best” in the world. Even worse, American citizens were the least satisfied with their medical care compared to the next five leading socialized industrialized countries, including England, Germany, Canada, Australia and New Zealand. There are many things wrong. Let’s examine a few:
Primary care medicine in America is gasping for its last breath. Internists, family doctors, pediatricians (whom health experts consider essential to a robust and cost-effective delivery system) are leaving primary care in droves. The number of newly trained generalist doctors has plummeted so fast that extinction of the generalist doctor has been forecasted within 20 years by both the American Academy of Family Practice and the American College of Physicians.
Patients are angry and exasperated with long delays, poor service and confusing and redundant paperwork. To date 17% of us are uninsured and this number will quickly grow in a deepening recession.
Employers face a huge cost burden as health insurance prices go through the roof. CEOs consistently say the runaway costs in health care benefits (which double in price every seven to ten years) threaten the viability of their companies. Since 2000, the number of small businesses offering health insurance has dropped 8%.
Health insurance companies are making so much money that several states have motioned legislation compelling insurance companies to disclose the percentage of premiums spent on actual medical care. Not surprisingly, their lobbyists are resisting. It is not uncommon for insurance companies to keep 30-40% of every dollar for “administration” and profits. Many of these companies are on record reaffirming their commitment to shareholders and short-term profits.
Doctokr (“doc-talker”) Family Medicine is a medical practice that was created to respond to the conflicts and problems listed above. We have worked to resuscitate the soul of the Marcus Welby-style patient-focused physician while adding technology to deliver fast, responsive and informed care. All fees are transparent and time-based and are the responsibility of our patients to pay. All parties that interfere with the doctor patient relationship or increase our costs have been removed from the equation. The practice delivers “concierge level” services: 24/7 access, connectivity to the doctor no matter where our patients are located, same day office visits for those that need to be seen, even house calls for those unable to get to our office. By removing the hurdles and restoring transparency and trust, 75% of our clients get their entire primary care needs met for $300.00 a year.
This post is written by three medical professionals who stopped waiting for someone else to find a solution and are actively changing primary care in ways that dramatically improve quality, convenience and access, while drastically reducing costs. The US deserves excellent health care and it must be done right. To understand why we would bother to “walk the walk,” we ask your indulgence and participation while we “talk the talk.” We hope this format will educate and inform you in ways that move you to participate in your care. Health care is about you, just as much as it about us, because we are all patients. We all have a stake in shaping the inevitable need for reform.
The next upcoming topics:
- Where did the Marcus Welby, MD-style of primary care go and how can we get it back?
- How have you as a patient lost control of your body and health?
- Turning the primary care model upside down: What does primary care need to do to reinvent itself so that it serves its patients without other conflicting interests?
- Begin the exploration of the unexamined assumptions of health care….
Until next week, we remain yours in primary care.
– Alan, Steve, and Valerie
December 2nd, 2008 by Dr. Val Jones in Announcements, Primary Care Wednesdays
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I’m really proud to announce the addition of my very first, regular guest blogger team: the healthcare professionals of Doctokr Family Medicine. Each Wednesday they will bring us new insights from the frontier of primary care – their cash-based, high tech, low cost service meets the needs of thousands of local patients at an average yearly cost of only $300. These primary care providers are happy, unhurried, and unfettered by insurance paperwork. They provide 24/7 care by phone, email, office visits and house calls. They’ve negotiated affordable rates with local labs and radiology services and pass on those savings to their patients. Their prices are transparent, affordable, and membership fees are very low.
Sound too good to be true? Well, check back every Wednesday to see what the doctors and nurses of an American primary care revolution have to say.
Their first post will be featured live at 8am, Wednesday, December 3rd.
Left to right: Alan Dappen, M.D.; Steve Simmons, M.D.; Valerie Tinley, N.P.
December 2nd, 2008 by Dr. Val Jones in Book Reviews
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I just finished reading Dr. Ben Goldacre’s new book, Bad Science. It received a very favorable review by the British Medical Journal, and so I thought I’d take a look for myself. After all, I am passionate about patient empowerment and worry sincerely for their safety as healthcare is becoming more and more of a “do-it-yourself” proposition.
Ben is a talented writer – his style is straightforward, accessible, and witty. The premise of the book is to expose the underbelly of science – how it’s miscommunicated to the public (via media, PR, and representatives from the snake oil community) and how research is often poorly designed (by uneducated scientists and government agencies, for-profit pharmaceutical companies, and biased physicians).
The case studies presented in Bad Science are especially poignant. Ben has selected a few shining examples of self-promoting figures who have risen to the highest rank of “expert” in the eyes of the media – all the while referring to themselves as “doctor” and yet only having a Ph.D. from an online correspondence school. Their legal bully tactics, fabrication of data to support their proprietary health gimmick, and extreme narcicism – are excellent studies in poor character triumphing over common sense. It is painful to see how successful snake oil salesmen can be, even in these modern and “enlightened” times.
Bad Science carefully dismantles the pseudoscience that underlies many of the claims of alternative medicine. He clearly demonstrates how research can be manipulated to demonstrate a positive effect for any therapeutic intervention, and explains why cosmetic and nutrition research are particularly rife with false positive results.
Ben also explores the role of the human psyche in misunderstanding science. Our deep desire to find a 1:1 correlation between every cause and effect is difficult to overcome. We want 1) to bring artificial simplicity out of complexity, 2) a quick fix in a pill form, 3) to believe in “breakthrough therapies,”4) to read sensational or scintillating news headlines. Unfortunately, science is often coopted to pander to these wants, rather than illuminate the truth.
Finally, Bad Science explores the many ways that statistics can be manipulated to support any claim. In fact, human intuition about math in general is quite flawed, which works against us as we try to understand the data collected by researchers.
I finished the book feeling enlightened but somewhat despairing – yearning to read a sequel, “Good Science” if only to restore my hope in the idea that wise people will have the courage to seek truth over sensationalism, and value objectivity over subjectivity for the greater good of all.
What does Ben Goldacre think we can do to combat the tidal wave of bad science on the Internet? He suggests that people of sound mind blog about the subject as frequently as possible, so that those who are searching for a voice of reason may find one. I blog here and at sciencebasedmedicine.org for that very purpose.
In my next post, I’ll summarize some tips from Bad Science that will help you to recognize when a health message is likely to be inaccurate.
December 1st, 2008 by Dr. Val Jones in Opinion
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I’d like to point out an error I made during a more optimistic time in my online career. Last year on my blog I suggested that physician ratings were “here to stay” so physicians should “embrace the inevitable.” What I hadn’t thought through at the time was the fact that virtually no one would use the ratings tools. I had made a fairly narcissistic assumption: that everyone cared so much about their healthcare experience that they were dying to describe it online.
The truth is that any online tool, portal, social network, or health 2.0 application must deliver a compelling “value proposition” to the user, especially if participation requires any degree of effort. It is human nature to take part in activities that reward us for our time. For example, we may slave over a hot stove because we stand to gain a delicious, satisfying meal in the end; we continue to work at jobs that we dislike because the paycheck makes it worthwhile. But why would a patient fill out a lengthy survey about his or her doctor when there’s no obvious value to them in doing so?
A recent article in Slate (h/t to the ACP Internist) makes a compelling case for why physician-rating sites have such low participation rates as to be fairly useless. The return on investment (time spent filling out a long questionnaire) is extremely low, and is worthwhile to only the most irritated patients. And of course, there is no policing of contributions – physicians can rate themselves into the highest quality rankings by logging in as fictional patients.
So does this mean that there are no worthwhile physician rating tools online? The Slate author would have you believe that there are none. However, I would suggest that Castle Connolly’s America’s Top Doctors list is a reliable, if somewhat limited source. Why? Because teams of staff (who are paid by Castle Connolly) do the heavy-lifting, requiring no effort from patients or online raters. Castle Connolly reviewers first request nominations for physician excellence from within a given specialty and region. Peers nominate others for the honor and then the Castle Connolly staff seek corroborative data from surveys sent to physician peers, hospital administrators, and support staff to ensure that nominated physicians are indeed highly esteemed by many of those with whom they work. In the end, about 10% of physicians are fully vetted and included in the list – and I’d say that the selection process is quite sensitive but not specific. In other words, a physician listed in America’s Top Doctors is likely to be excellent, but many excellent physicians are not captured by the methods.
I spoke to John Connolly in a recent interview about how to find a good physician and you may listen to the podcast here. Locating a good doctor is not too difficult – but finding one that will take your insurance (or still has some slots available for new patients) is another story.
December 1st, 2008 by Dr. Val Jones in Announcements, Medblogger Shout Outs
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This is one awareness day where your coffee habit can make a difference. Starbucks is donating 5¢ to the Global Fund for every Starbucks beverage sold on December 1, 2008 at participating US and Canada locations.
h/t Emergiblog
And Dr. Anonymous has a nice post about World AIDS Day, citing this letter from a survivor:
(This is an excerpt from a letter to the editor from the Cleveland Plain Dealer from November 30, 2008):
I am a 20-year survivor living with AIDS, and another World AIDS Day (Monday) is fast approaching. Food trays once left at hospital room doors of those dying from AIDS are now being served. The preventative measure of “gown ing-up” has come and gone. However, the stigma of AIDS has stayed unchanged. Sadly, there are conflicting AIDS transmission fears and infection rates spiraling out of control.
I am blessed in that I am still here, with thinning hair, bifocals and my AARP card in hand. I am living proof of the incredible medical strides made in managing HIV/AIDS. I am blessed in living to see nieces and nephews come into my world and bring forth great-nieces and great-nephews. I am blessed in that I continue to continue. I still grieve for the many friends I’ve lost to AIDS.
This year, another 56,000-plus Americans will become needlessly infected with HIV/AIDS. We know how to prevent HIV infection. We need to wage a War on AIDS in America. We know how to win it.
Robert W. Toth — Cleveland, OH
