October 3rd, 2010 by DrRob in Better Health Network, Health Policy, Opinion
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“It will never happen.”
“They know better than to do it.”
“They realize the disaster it would be if they let it pass.”
That’s what I hear. I hear that the upcoming SGR adjustment, the one that will cut Medicare reimbursement by 23 percent, won’t go through.
In case you missed it, the SGR is a formula coming from the Balanced Budget Act of 1997 that does automatic cuts to Medicare reimbursement. This year we witnessed a legislative game of chicken in congress, with both sides agreeing that it was a bad idea to screw physicians in a time that they are trying to fix healthcare. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
September 26th, 2010 by DrRob in Better Health Network, Health Policy, Opinion, True Stories
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The “empowered patient” movement (which I think is a good thing) strives to take the doctor out of the center of care and put the patient at its focus. The role of doctor is not to be the star of the show, the quarterback, the superhero, but the advocate and helper for the patient to accomplish their goal: Health.
Many rightly attack doctor prima donnas who want the exam/operating room to be about them instead of the patient. This is health care, not health performance. They want doctors who care more about the people they treat than they do about money, praise, or status.
I get it. I get the message that doctors have to adjust to this new age of patient empowerment and patient-centeredness. I get the fact that making patients wait is a bad thing, and that communication is as essential of a skill as is medical knowledge — remove either one of them and you don’t have care. I hear the message: Doctors should care about patients more than they care about themselves. That is what we are paid to do, and that is what we have neglected at our own peril. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
September 22nd, 2010 by DrRob in Better Health Network, Health Policy, News, Opinion, Research, True Stories
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The man who twirled with rose in teeth
Has his tongue tied up in thorns
His once expanded sense of time and
Space all shot and torn
See him wander hat in hand –
“Look at me, I’m so forlorn –
Ask anyone who can recall
It’s horrible to be born!
– Bruce Cockburn, from song “Shipwrecked at the Stable Door”
I found the discussion around my recent post about treating colds very interesting. Sick people come to the office to find out how sick they are. Most people don’t want to be sick, and when they are sick they want doctors to make them better.
Most people.
Some people want to be sick, and some doctors want to make people sick. I am not talking about hypochondriacs — people who worry that they may have disease and become fixated on being sick. I am not talking about malingerers — people who pretend to be sick so they can get medications. I am talking about the slippery slope of defining disease. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
September 10th, 2010 by DrRob in Better Health Network, Health Tips, Opinion, True Stories
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She looked down toward her feet at the end of her visit. “I’ve got one more question, doctor,” she said, hesitating. I turned toward her and waited for her, letting her ask on her own time. Clearly this was something difficult for her to ask.
“When will I get over the death of my husband? It’s been ten years, and I still wake up each morning thinking he’s there. I still come home wanting him to be there. Am I crazy?”
Her face showed the shame that was so clear in her words. I had been along with her during the death of her husband, and she handled that period with much grace and strength. Now the silence at home is deafening. People around her, on the other hand, are far too quick to tell her how to grieve. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
September 1st, 2010 by DrRob in Better Health Network, Opinion, True Stories
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Dear Student:
Thank you for your consideration of my profession for your career. I am a primary care physician (PCP) and have practiced for the past 16 years in a privately-owned practice. (At some point I intend to stop practicing and start doing the real thing. It amazes me at how many patients let me practice on them.)
Anyhow, I thought I’d give you some advice as you go through what is perhaps your biggest decision regarding your career. Like me, you probably once thought that choosing to become a doctor was the biggest decision, but within medicine there are many options, giving a very wide range of career choices. It is the final choice that is, well, final. What are you going to do with your life? ”Being a doctor” covers so much range, that it really has little meaning. Dr. Oz is a doctor, and he has a very different life from mine (for one, he’s not the target of Oprah’s contempt like I am -– but that’s a whole other story).
Here are the things to consider when thinking about primary care:
1. Do you like talking to people who are not like you?
Primary care doctors spend time with humans -– normal humans. This is both good and bad, as you see all sides of people, the good, bad , crazy, annoying, funny, and vulnerable sides. If you see mental challenge as the main reason to do something, and would simply put up with the human interaction in primary care, don’t do it. The single most important thing I have with my patients that most non-PCPs don’t have is relationship. I see people over their lifetime, and that gives me a unique perspective.
2. Do you prefer variety over predictability?
Every room I walk into is different –- often vastly different -– from the last. I could be walking in on a crisis or a stable recheck. The person could be elated or crying. They could be 90 years old or two days old. They could have something wrong with any system, and it could range from mild to life-threatening. I’d go nuts doing the same thing every day, be it looking just at skin or just dealing with the kidney. But some folks do better with routine and a lack of surprise, they don’t want their days to be unpredictable. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
