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Should Primary Care Be Abandoned?

In his last post, DrRich pointed out to his PCP friends that their chosen profession of primary care medicine is dead and buried – with an official obituary and everything – and that it is pointless for PCPs to waste their time worrying about “secret shoppers” and other petty annoyances.

It is time for you PCPs to abandon “primary care” altogether. It is time to move on.

Walking away from primary care should not be a loss, because actually, primary care has long since abandoned you. Whatever “primary care” may have once been, it has now been reduced to strict adherence to “guidelines,” 7.5 minutes per patient “encounter,” placing chits on various “Pay for Performance” checklists, striving to induce high-and-mighty healthcare bureaucrats (who wouldn’t know a sphygmomanometer from a sphincter) to smile benignly at your humble compliance with their dictates, and most recently, competing for business with nurses.

This is not really primary care medicine. It’s not medicine at all. It’s something else. But whatever it is, it’s what has now been designated by law as “primary care,” and anyone the government unleashes to do it (whether doctors, nurses, or high-school graduates with a checklist of questions) now are all officially Primary Care Practitioners.

What generalist physicians (heretofore known as primary care physicians) need to realize is that “primary care” has been dumbed-down to the point where abandoning it is no loss; indeed, it ought to be liberating to walk away from it.

The beauty is that Read more »

*This blog post was originally published at The Covert Rationing Blog*

Healthcare Cybersecurity: An Internet ID For All Americans?

From CBS News:

President Obama is planning to hand the U.S. Commerce Department authority over a forthcoming cybersecurity effort to create an Internet ID for Americans, a White House official said here today.

It’s “the absolute perfect spot in the U.S. government” to centralize efforts toward creating an “identity ecosystem” for the Internet, White House Cybersecurity Coordinator Howard Schmidt said.

That news, first reported by CNET, effectively pushes the department to the forefront of the issue, beating out other potential candidates including the National Security Agency and the Department of Homeland Security. The move also is likely to please privacy and civil liberties groups that have raised concerns in the past over the dual roles of police and intelligence agencies.

No, they’re not talking about a national ID card, just an international internet ID. The announcement came at an event today at the Stanford Institute for Economic Policy Research, where U.S. Commerce Secretary Gary Locke and Schmidt spoke. The Obama administration is currently drafting what it’s calling the National Strategy for Trusted Identities in Cyberspace, which Locke said will be released by the president in the next few months. (An early version was publicly released last summer.)

“We are not talking about a national ID card,” Locke said at the Stanford event. “We are not talking about a government-controlled system. What we are talking about is enhancing online security and privacy and reducing and perhaps even eliminating the need to memorize a dozen passwords, through creation and use of more trusted digital identities.”

Imagine: Anyone registered with such a cyber-ID who conferences with their doctor via a “secure server” can also be tracked by the government with such a mechanism. And the issue of not needing more than one password? While convenient, the ramifications of multiple accounts being compromised if a data leak were to occur remains with such a mechanism. Read more »

*This blog post was originally published at Dr. Wes*

Big Tobacco: A Government Scapegoat Favorite

Smokers of the world unite! It’s strange for a physician to be sympathizing with the tobacco companies, purveyors of the opium of the people. Am I a stealth nicotine addict, an apologist for Big Tobacco who supplies me with my daily fix? This scurrilous allegation can be vaporized in a one-question quiz:

Q: Identify which two of the three individuals listed below are cigarette smokers:

- John Boehner, newly elected Speaker of the House , 3rd in line to the presidency

- Barack Obama, Commander-in-Chief and leader of the free world

- Michael Kirsch, Hemorrhoid Examiner

I’ve never smoked and I detest the habit. It kills people and separates lower income Americans from money that could likely be devoted to more worthwhile endeavors. I remember caring for folks with end-stage emphysema as a medical resident and thinking that this disease was worse than cancer. I haven’t changed my mind.

Yet I have felt for years that Big Tobacco is demonized by the press and the government as Big Scapegoat, and this blame shift has always troubled me. I am well aware that the tobacco companies are guilty of many offenses. They have lied about their corporate practices, advertising strategies and manipulation of nicotine content. These companies — like any individual or business — should be held accountable with available legal remedies. If crimes were committed, then I’m sure this nation has a few idle and altruistic attorneys who can fight them in the courts. Read more »

*This blog post was originally published at MD Whistleblower*

The Government’s Involvement In New Primary Care Models

Government healthcare reform efforts are picking up the pace to roll out new reimbursement and practice models for primary care.

Medicare is giving out $10 billion for pilot projects encouraging new models of primary care, including the patient-centered medical home. New Jersey just passed legislation to explore the patient-centered medical home. Now, Massachusetts, the early adopter of mandatory health insurance, is now ambitiously planning how to take on the fee-for-service reimbursement system and moving toward accountable care organizations. Under discussion are the scope of power for state regulators, what rules will apply to accountable care organizations, and how to get rid of the existing fee-for-service system.

Blogger and pediatrician Jay Parkinson, MD, MPH, comments about the “bureaucrats in Washington” that, “they’ve decided for doctors that we’ll get paid for strictly office visits and procedures when, in fact, being a good doctor is much, much more about good communication and solid relationships than the maximum volume of patients you can see in a given day.”

Now, it’s those same bureaucrats who are changing the system, trying to find a model that will accomplish just those goals. (CMS Web site, NJ Today, Boston Globe, KevinMD)

*This blog post was originally published at ACP Internist*

Patient Bill Of Rights: What Ever Happened To It?

One of the more surprising twists and turns in the continuing debate over healthcare reform is that many physicians who now object to the Affordable Care Act (ACA) were just a few years back advocates for more federal regulation. In fact, in the early 2000s, more than 200 “provider” and consumer groups — including many state medical and national medical specialty societies that now oppose the ACA because of concerns about “excessive regulation” — were among the fiercest champions of federal legislation to mandate that health insurers comply with a Patient Bill of Rights.

A bipartisan bill introduced by Senator John McCain (R-AZ) and the late Senator Ted Kennedy (D-MA) would have ensured that patients have the “right” to appeal insurance company denials to independent reviewers, to choose a specialist of their choice, and to access emergency room services when needed. This effort to enact a federal Patient Bill of Rights failed, because of opposition from the insurance industry and President George W. Bush.

I bring up this history lesson because most of the key provisions in the McCain-Kennedy bill are now the law of the land, thanks to the ACA. Yet instead of applauding the new protections, many of the same physician organizations who called for a federal patient bill of rights now want to “repeal” the same consumer protections established by the ACA. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

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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