May 12th, 2010 by AlanDappenMD in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays, True Stories
Tags: Adjustments In Care, Co-Pay, Cutting Healthcare Costs, Diagnosis, DocTalker, Doctor Office Delays, Dr. Alan Dappen, Erythrocyte Sedimentation Rate, ESR, Face-To-Face, Family Medicine, General Medicine, Good Medical Decision Making, Healthcare Economics, Healthcare System, Internal Medicine, Medicare, Office Visits, Phone Call, Physical Exam, Prednisone, Primary Care, TA, Telemedicine, Temporal Arteritis
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A common problem in healthcare is the number of times that small adjustments are needed in a person’s care. Often for these little changes, a physical exam and face-to-face time have nothing to do with good medical decision making.
Yet the patient and doctor are locked in a legacy-industrialized business model that requires the patient to pay a co-pay and waste at least half of their day driving to and from the office, logging time in a waiting room, and then visiting five minutes with their practitioner for the needed medical information or advice.
Today I’d like to visit the case of a patient I’ll call “DD,” who I easily diagnosed with temporal arteritis (TA) through a 15-minute phone call after she’d spent four weeks as the healthcare system fumbled her time with delays and misdirection via several doctors without establishing a firm diagnosis. Read more »
May 5th, 2010 by SteveSimmonsMD in Better Health Network, Health Policy, Humor, Opinion, Primary Care Wednesdays, True Stories
Tags: Continuous Restrictive And Punitive Paperwork, CRAPP, DocTalker Family Medicine, Dr. Steve Simmons, Healthcare Insurance Industry, Healthcare reform, Medical Acronym, Medical Paperwork, Patient-Doctor Relationship, Primary Care, Primary Care Practitioners, Primary Care Shortage, Quality of Care, Uncle Sam
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In medicine, hardly a week passes without the introduction of some new acronym, previously unspoken in the average practice, which then grows to prominence — take HIPAA, PECOS, CPT, ICD, etc. — the list goes on and on.
I believe that after 14 years of practice I’ve earned the right to introduce an acronym of my own: CRAPP. For the last several months, my partner and I have used this term to describe the volumes of denials, pre- and prior- authorizations (is there really a difference?), and faxes that seem to grow like weeds on the fertile planting grounds of our desks.
More specifically, in our office the acronym CRAPP stands for: Continuous Restrictive And Punitive Paperwork. To put it blithely, CRAPP could represent any document you wish someone had put on your partner’s desk instead of yours.
On a more emotional level, this acronym captures the visceral response I have whenever my attention is drawn away from my patients and redirected towards some nonsensical busywork — much like someone yelling at a golfer during their backswing.
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April 28th, 2010 by AlanDappenMD in Better Health Network, Health Tips, Opinion, Primary Care Wednesdays, True Stories
Tags: Direct Access to Care, Direct Delivery of Care, DocTalker Family Medicine, Dr. Alan Dappen, General Medicine, Immediate Access to Healthcare, Primary Care, Telemedicine
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At my front door stood my neighbor and his daughter making their annual Girl Scout cookie trek. “Should I make it a baker’s dozen?” the girl asked, knowing I wouldn’t refuse. Her father chimed in, “I was just at a wedding where I sat next to someone who said you saved her life. She said some very nice things about your medical practice.”
The name of the patient he was mentioning flashed me back. Mrs. BB (whose name has been altered to maintain privacy) was referred by a mutual acquaintance who already used our practice. This acquaintance felt that maybe I could solve Mrs. BB’s problem, specifically because all of our practitioners are paid for time, which means we can listen and communicate to determine how we can best help our patients.
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April 21st, 2010 by AlanDappenMD in Better Health Network, Opinion, Primary Care Wednesdays, Research
Tags: Comprehensive Healthcare, DocTalker Family Medicine, Dr. Alan Dappen, General Medicine, GPS, Health Monitoring, Nutrition, Primary Care, remote monitoring, Telehealth, Telemedicine, U.S. Healthcare System
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Today, in a bold and not too distant place, 300 individuals who are at high risk for multiple health problems predictive of high mortality rates, are participating in a visionary experimental project for telemedicine and health monitoring.
Every day these individuals are tracked through GPS location. Their movement patterns and whereabouts easily can be observed by trained technicians who ascertain that the individuals are getting up and going about their daily activities in a normal fashion. Deviations in movements for any expected individual can be the earliest indicator that something has gone seriously wrong and might warrant an investigatory call or visit to look into a developing heath problem.
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April 14th, 2010 by SteveSimmonsMD in Better Health Network, Health Policy, News, Opinion, Primary Care Wednesdays
Tags: DocTalker Family Medicine, Dr. Steve Simmons, Health Insurance Reform, Healthcare reform, Primary Care Wednesdays, Shortage of Primary Care Pracitioners
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This past Monday, I was drawn to an article in the Wall Street Journal: “Medical Schools Can’t Keep Up.” The article detailed the growing shortage of primary care doctors in our country and reminded me that we in the U.S. may have something called “insurance reform” now, but without physicians to translate insurance access into healthcare, the state of our healthcare system will continue to beg additional attention and reform.
Although new medical schools are opening and some schools have increased enrollment numbers, there are a limited number of residency positions in this country. The government has always funded these residency positions and our new reform law tries to address the primary care shortage with “slot redistribution,” whereby money from unused residency positions will be deferred to primary care or general surgery residency programs. Read more »
