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Severe Paperwork Burden Tempts Physicians To Quit Medicine

For physicians, and especially those in primary care, it seems like there is a form for every purpose imaginable—often for purposes that are hard to imagine.

An ACP member in Rhode Island recently gave this example:

“I was just asked by my Medicare Advantage plan to sign a form for [a well-known pharmacy benefit manager]. This form is to be faxed to them in order for them to send me a prior authorization form for a med. So in other words, I had to complete a form in order to get another form. This is nuts!”

Or how about this, from another ACP member in a private internal medicine practice:

“The documentation that is getting to me, is that documentation that the ‘durable medical equipment people want including repetitive- recurrent documentation, whenever we see a patient to document “continued need”. The list of things we have to document, sign, approve or prior authorize, I believe is what makes most physicians think they chose the wrong field. A PBM letter to me about my prescribing practices today nearly did me in! Luckily I just shredded it. If I am kicked out of this business, I am so close to retirement it would be a blessing!”

Or this: Read more »

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

Doctors Are “Sponges?”

I am a doctor. Go ahead, call me what you may. Group me into a neatly, prejudged category: “All you doctors.” Just don’t label me a sponge.

That’s right. Recently in the Wall Street Journal, Mr. Andy Kessler, famous author and former hedge fund manager smart enough to turn $100 million into $1 billion, grouped doctors into a sub-category of the service economy which he labeled as “sponges.” We could have done worse: His other categories included “sloppers” (DMV workers), “slimers” (financial planners), and “thieves” (cable companies).

It seems that doctors — along with cosmetologists, lawyers, and real estate brokers — offend him because of the tests and licenses that we deem necessary:

Sponges are those who earned their jobs by passing a test meant to limit supply. According to this newspaper, 23% of U.S. workers now need a state license. The Series 7 exam is required for stock brokers. Cosmetologists, real estate brokers, doctors and lawyers all need government certification. All this does is legally bar others from doing the same job, so existing workers can charge more and sponge off the rest of us.

His essay goes on to argue the tired notion that technology endangers jobs in the service sector — the toll booth operator argument, again. He likes the creators of stuff: Apple and Google. (Duh.) But in my mind, doctoring is about creating something: We create better and longer lives for our patients. Ask the patient cured of cancer how happy they are that some doctor created his or her treatment plan. Read more »

*This blog post was originally published at Dr John M*

Christmas Gifts For My Medical Colleagues

This is my column in December’s Emergency Medicine News:

I like to think back on favorite Christmas gifts I have received down the years. I don’t think I can do any better than the children of mine who were born around Christmas. Three of the four came within one month of Christmas day. One came on December 23rd. What wonderful presents!

Going farther back, I recall sitting by the Christmas tree at my childhood home, or the homes of my grandparents. I found toy soldiers, toy horses, Matchbox cars, pocket knives and many other little-boy wonders. I remember the beautiful wooden stock and golden trigger of my first shotgun, and how it pulled me irresistably into a sense of impending manhood to know that my father and mother trusted me enough to give such a gift.

I have been thrilled to give gifts to my wife and children down the years. I smile when I consider stuffed animals, American Girl dolls, Polly Pockets, toy knights, castles, iPods, bicycles, books, a small harp, and a shiny sword. I admit that I love putting their packages under the tree.

I enjoy hearing about the things my loved ones love. It is my delight to know their hearts and to go and find the perfect thing that, when opened, will make their eyes light up and give them delight.

But there are people other than my family, and there are many kinds of gifts. I can’t help but think that if I were giving the perfect gift to my patients, some would love to open a gold-embossed Oxycontin prescription with the “infinity” emblem under “number of refills.” And others would be speechless to dump out their stocking and find their disability paperwork completed. The tears of joy would flow! Read more »

*This blog post was originally published at edwinleap.com*

Some Things About Medicine Will Never Change

I just can’t imagine life today as a medical student. Every medical publication in the palm of your hand. The capacity to create an audience and publish at your own will.  Real-time dialog between students, faculty, anyone. Global reach from your phone. It’s mind-boggling really.

This is in stark contrast to my experience. My world was centered on index cards, textbooks and pens with different colors. We communicated via Post-it notes on the door of the student lounge. There were no apps and our only game was foozball. As a first year I scheduled time to compose H&Ps on the library’s only Macintosh II computer. This was plugged into the new Apple LaserWriter with WYSIWYG. Hi tech we were. We thought.

Being distractible and restless, I’m going to guess that if I had access to the communication platforms and tools available to today’s students, I might not have made it through. The inputs must be staggering and I imagine that discipline with personal bandwidth has become a critical key to survival. Read more »

*This blog post was originally published at 33 Charts*

Why Doctors Should Be Less Like Chuck Yeager And More Like Captain Sullenberger

A recent medical error of a wrong-site surgery that occurred in one of the country’s best hospitals, Massachusetts General, reminded me why doctors need to be less like Chuck Yeager and more like Captain Sullenberger.

Growing up, I always wanted to be a fighter pilot, years before the movie “Top Gun” became a part of the American lexicon. My hero was World War II pilot Chuck Yeager, who later became one of the country’s premier test pilots flying experimental jet and rocket propelled planes in a time when they were dangerous, unpredictable, and unreliable.

Much like the astronauts in the movie “The Right Stuff,” Yeager and his colleagues literally flew by the seat of their pants, made it up as they went along, and never really knew if their maiden flight in a new aircraft might be their last. They were cowboys in the sky wrangling and taming the heavens.

Fast forward to January 2009, when shortly after takeoff, a one-in-a-million chance, a double-bird strike completely disabled a US Airways jetliner. Captain Chesley Sullenberger, with the help of his co-pilot Jeff Skiles, ditches the aircraft in the Hudson River in under four minutes even as the nation surely expected a tragedy. But not on that day. Not with that pilot. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

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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