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Keeping The “Primary” In Care

He came in for his regular blood pressure and cholesterol check. On the review of systems sheet he circled “depression.”

“I see you circled depression,” I said after dealing with his routine problems. “What’s up?”

“I don’t think I am actually clinically depressed, but I’ve just been finding it harder to get going recently,” he responded. “I can force myself to do things, but I’ve never have had to force myself.”

“I noticed that you retired recently. Do you think that has something to do with your depression?” I asked.

“I’m not really sure. I don’t feel like it makes me depressed. I was definitely happy to stop going to work.”

I have taken care of him for many years, and know him to be a solid guy. “I have seen this in a lot in men who retire. They think it’s going to be good to rest, and it is for the first few months. But after a while, the novelty wears off and they feel directionless. They don’t want to spend the rest of their lives entertaining themselves or completing the ‘honey do’ list, but they don’t want to go back to work either.”

He looked up and me, “Yeah, I guess that sounds like me.” Read more »

*This blog post was originally published at ACP Internist*

No Go On A Doc Fix

The Senate has rejected the so-called “doc fix.” This means that doctors taking Medicare patients will now get 21 percent less pay for their work.

How’s that getting involved in politics working out for you guys? Not so good.

But there’s a larger issue here. Why do we keep trying to control healthcare costs by just mandating that less money be spent?

It’s failed for decades. But like a losing gambler convinced that if he just keeps doubling down he’ll finally come out ahead, people keep trying. For example, the New York Times reported on a study of the impact of pay cuts to doctors for Medicare patients with lung cancer. Read more »

*This blog post was originally published at See First Blog*

Primary Care Doctors And The Medicare Boycott

I saw this interesting article linked to from a blog about angry doctors dropping out of Medicare in Texas. As one who shares the universal annoyance at congress’ failure to fix the SGR for more than 30 days at a time, I was kind of cheered by this. That’s what it will take to get the system fixed – a grassroots, full-scale rejection of the system! Good for them. And the opening lines of the article were encouraging:

Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable.

An “alarming” rate. Wow. Cool. So how many is that, anyway?

More than 300 doctors have dropped the program in the last two years, including 50 in the first three months of 2010, according to data compiled by the Houston Chronicle. Texas Medical Association officials, who conducted the 2008 survey, said the numbers far exceeded their assumptions.

That’s 300, right? Hmm, not too shabby. Not exactly going to topple the state with that, but it’s a start.

Hey, I wonder how many doctors there are in Texas, anyway? I hear it’s a pretty big state, though I seem to recall it consists mostly of scrubland and swamp. Maybe there are only like 500 doctors in the state to start with. Something is tickling my head about Texas, though, I vaguely remember that they had some nice tort reform law a few years ago that I was pretty envious of. Read more »

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

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Latest Book Reviews

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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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