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Healthcare Reform, Direct Patient Care, And The Period Of Discovery

As the period of debate over the Healthcare Reform Bill ends with President Obama penning his signature, one moment from the “debate” at Blair House stands out in my mind. A Republican Congressman sitting behind a copy of the then-current reform bill –- a pile higher than 2,000 pages –- was mocked for using such a prop. It’s complicated to fix healthcare with the laconic response to his theatrics.

Things don’t appear to have grown any simpler as we settle in for a period of discovery to determine exactly what this new law spells out for us in terms of reform. There is no consensus on whether this law will help or hinder, and I’m worried.

I cannot read 2,600 pages written in legalese. I juggle my time now to keep up with the medical literature necessary to adequately do my job and I suspect other physicians struggle similarly. All doctors fight a daily battle with time, trying to care for each patient in the best way possible (this is why many of us walk so fast through hospitals and clinics.) I hope that healthcare reform doesn’t result in less time for direct patient care. Read more »

Until Patient Behaviors Change, “I Do The Damn Test”

Congress controls the nation’s purse strings. It can tell the Executive Branch how to spend money. It can regulate all commerce, and by the way, to Congress everything is “commerce.”

Congressional legislation can incent economic behavior–pay for this, but not for that–but it can’t change personal decisions. A case in point is Dr. Robert Cantor, ACP Member, of Boca Raton, Fla., who says he authorizes the tests that his patients demand. His opinion? “I do the damn test.”

He says there’s little incentive not to order tests and little in healthcare reform to make him and others change their habits. More likely is the idea that, once new medical technology is invented, it will find a use.

Another article compiles a wide spectrum of ideas on how to reduce healthcare spending. Tort reform was one, sure, but many doctors focused on changing patient behavior first.

*This blog post was originally published at ACP Internist*

Perverted Economics: Eating Healthy Is Too Expensive

I watched a good documentary called “Food, Inc.” It was nominated for an Academy Award. The promo says “you’ll never look at dinner the same way” and they’re right. Since I’m a fan of Michael Pollan and have read “Fast Food Nation,” I was already a healthy-food fan, but seeing how agriculture and farming has changed over the last 40 years was still a shocker.

There’s no doubt that high-calorie, sugar-laden processed foods are contributing to serious health issues in America. And 10 billion animals are raised on factory farms under inhumane conditions.

So when I went to the grocery store today, I made a conscious choice to ask if Safeway had any grass-fed beef for a healthy stir fry I was making for dinner. The answer was “No,” so I journeyed over to Whole Foods where I bought a pound of grass-fed sirloin. The cost was a whopping $16.43.

I have to ask myself why grass-fed beef should be so much more expensive than corn-fed beef. There’s no way the average family could afford to eat the way we should. The impact on our environment and our health is suffering terribly because of these perverted economics.

*This blog post was originally published at EverythingHealth*

The “No Viagra For Sex Offenders” Amendment

There’s been some buzz on Twitter that the Democrats in the Senate have killed an amendment which would have prohibited federal funding for erectile dysfunction (ED) medications for sex offenders, which means in the upside-down logic of Washington D.C. that the Democrats favor giving Viagra to pedophiles. Right? Well, not exactly.

First, just a point of procedure: Remember, healthcare reform (HCR) is now a law, on the books, signed by the President. But there was this reconciliation sidecar bill which was meant to fix the HCR law as originally passed—it was passed in the House pretty much as soon as the Senate bill was passed. But it had to pass the Senate in the identical form, word for word, in order to go directly to Obama’s desk for signing. If the Senate mucked things up by tacking on amendments, it would have to go back to the House for approval, and given the razor-thin margin in the House, Democrats very much wanted to avoid that. Read more »

*This blog post was originally published at Movin' Meat*

Blame Game: The Census Bureau vs. The Postal Service

The U.S. is ramping up its decennial census, and a few days ago I received my census form in the mail. Or, perhaps I should say, a census form. It wasn’t really mine at all, because it wasn’t addressed to me. It was addressed to a nearby house that doesn’t get mail delivery.

You see, our street—just two blocks long—has a “north” and “south” portion. My, northern, portion was developed about a decade and a half ago, and for some reason they decided to use the same house numbers as they had on the homes down the street, just with a “north” added to the street name. So there are two homes on the street with the same number—mine and another one about 50 yards away. Read more »

*This blog post was originally published at The Daily Monthly*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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