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Why Doctors Should Participate In The Debt Ceiling Debate

Joe Scarborough reminds us that the divisions in American government are hardly new, paraphrasing Benjamin Franklin’s observation that “When you assemble a number of men, to have the advantage of their joint wisdom, you inevitably assemble . . . all their prejudices, their passions, their errors of opinion, their local interests, and their selfish views. From such an assembly can a perfect production be expected?” (This comes from a September 17, 1787 speech by Mr. Franklin to urge ratification of the U.S. Constitution, read on his behalf because he was too ill to deliver it in person. The Constitution was ratified the same day.)

I suppose we should be encouraged that Congress’s prejudices, passions, errors of opinion, local interests and selfish views are as American as apple pie, and the Republic has somehow survived nonetheless. Still, I find it deeply troubling that today’s politicians can’t find their way to agree on the debt ceiling.

No one should expect a “perfect production” to come out of this Congress and this administration, given how far apart they are on the need for tax increases and entitlement reforms. But they need to agree to something, and they need to do it soon.

I will leave it to others, who know a lot more about global economics than me, to explain what likely will happen to the economy if the debt ceiling isn’t increased by August 2. Let’s talk about the impact on health care, something I know quite a bit about—and why physicians especially should be concerned: Read more »

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

Who Is Responsible For The Hospital Bills Of Prisoners?

Are government entities required to pay the hospital bills of incarcerated prisoners?  This is a scenario that happens quite often.  Jailed patients are admitted onto the hospitalist service through the ER for anything from patients faking seizures in the ER to chest pain to drug overdoses.  When patients are under the custody of the city, state or federal system, those entities are required to pay for necessary acute health care services.  I don’t know, maybe it has something to do with a prisoner’s constitutional right.  You lose your right to vote, but not to get a liver transplant.
So what happens? Jailed patients get admitted and guards, sometimes, one, two or three at a time, are required to be at the patient’s bedside 24 hours a day.  If the patient needs to transport to the radiology department, sometimes this must be arranged with the guards ahead of time to allow extra staffing for the transport.
As you can tell, having a jailed patient is expensive, not only for the cost of the incurred hospital expenses but also the extra labor costs of having additional guards in the patient’s room 24 hours a day.  So what’s a city to do? Read more »

*This blog post was originally published at The Happy Hospitalist*

The Right To Bear Salt: Is Sodium Restriction Warranted For The General Population?

Q. What is the difference between a public health expert and Il Duce?
A. Mussolini was not nearly as arrogant as a public health expert.

In prior posts, DrRich related how two major publc health efforts over the past few decades – the effort to put all of us on low-fat diets, and the effort to reduce everyone’s cholesterol levels – have amounted to massive experiments, based upon insufficiently-tested assumptions and surmises and hypotheses which the experts arrogantly (and incorrectly) determined to be fact, and which were conducted upon the entire American population without its knowledge or consent.

These public health experiments cost billions of dollars, needlessly transformed large swatches of American industry, and (at least in the case of low-fat diets) likely produced significant harm to the citizenry. Furthermore, despite such results, these misbegotten public health efforts have inured Americans to the notion that it is right and proper for government experts to determine for each of us what we must and must not eat.

DrRich now feels obligated to call his readers’ attention to yet another experiment which these same public health experts have launched, an experiment under which each of us – once again – is to become an unwitting research subject, an experiment whose results are unpredictable, but which has a realistic chance of producing harm to many of us. DrRich speaks, of course, of the new US dietary guidelines, published earlier this year, regarding sodium. Read more »

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

The Next Generation Of Physicians Won’t Be Frustrated By Losing The Autonomy They Never Had

At this writing, I am in Atlanta visiting our daughter at Emory University. This may be the only college campus in the nation where you can’t buy Pepsi. Coke is King here. If you don’t know this, do some due diligence before you or someone you love interviews here.

I remember a few decades interviewing at the medical school here. There are only 2 medical school interviews that I recall after all these years. At N.Y.U. School of Medicine, the canny interviewer asked me what the death rate of Americans is. I correctly responded, “100%”. I suppose that untangling enigmatic questions was an N.Y.U. admission requirement, since they did accept me, and I did attend. The other medical school interview I still recall was at Emory, although it’s not the questions I remember. Their unique interview format made the experience memorable. Three medical school applicants were interviewed simultaneously as we faced a bank of questioners. This was reminiscent of the ancient and popular TV show, The Dating Game, where 3 bachelors or bachelorettes heard their competitors’ responses and often had to respond to the same questions. Read more »

*This blog post was originally published at MD Whistleblower*

Healthcare Regulations Gone Wild

We certainly have seen regulations upon regulations appear for health care over the past several years, and this letter to the editor of the Wall Street Journal (1 June 2011) from the Commissioner of the Consumer Product Safety Commission, Nancy A. Nord, should cause us all to pause:

As a commissioner at the U.S. Consumer Product Safety Commission (CPSC), I can attest that no such (regulatory reform) activity is happening at this agency. We certainly have not combed through our regulations to eliminate those that are “out-of-date, unnecessary, [or] excessively burdensome,” as he suggests is being done across the government. Instead, we are regulating at an unprecedented pace and have pretty much abandoned any efforts to weigh societal benefits from regulations with the costs imposed on the public.

In health care, we have seen an unprecedented rise in regulations for in-hospital MRSA screening while little data have been forthcoming about its patient benefits. Doctors are under increased administrative burdens to complete Pay for Performance questionnaires without any evidence of their benefit to patients. Read more »

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

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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