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Here We Go Again

I don’t know if I can do it this time.  A month ago, when it appeared that Congress had backed out of passing Health Care Reform legislation, I felt neither happy nor sad.  I didn’t know how I felt but this past Monday, after the following triad of events had unfolded, it became clear to me that I feel weary towards the whole healthcare reform process:

  • First, several states temporarily halted a rapacious rise in health insurance premiums from companies with quarterly profits last year in the billions of dollars.  Seriously, don’t these companies have PR firms?
  • Second, the Senate Finance Committee actually issued a drug warning and in this one act illuminated either a glaring problem with Congress or – far more concerning and unfortunately for us, more likely in this instance–some type of bias at the FDA.
  • Thirdly, the President called for a televised debate on health care between ‘both sides.’ Then, within days, he posted his own plan on the White House website.  It is a ten page summary I found hard to follow that left me with a troubling sense of déjà-vu.

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Snowmaggedon And Physician Responsibility

I practice medicine in the suburbs west of Washington, DC, and everywhere I look I see 30 or more inches of snow.  I keep reminding myself of where I am –not unlike a man pinching himself to ascertain wakefulness–because the view my window affords me is tailor made for the usual snow typical to Buffalo, NY.  Two days after the snow stopped falling, schools are cancelled indefinitely, most side streets have yet to see a plow, and tens of thousands are without electricity including my partner’s family huddled together like in a dark basement enjoying the extra two or three degrees of warmth to be found there.

It is hard, but not impossible, to practice medicine when the pace of modern society grinds to a halt. Yet at least we, here, enjoy the benefits of living in a country with a well developed infrastructure prepared to rebound instead of recoiling from nature.  To compare our “snowmageddon” (a term used on the news here) and the earthquake in Haiti would be both inappropriate and naïve; yet, our daily lives have distinctly altered and in that an understanding of the fragility of society and the responsibility of a physician is possible.  Still, there are many differences.  We ask when our power will be returned, not if; snow will melt,  but buildings don’t un-crumble; and while my neighbors shiver together in their homes, many Haitians seek their loved ones with a shovel.
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What Role Should A 21st Century Physician Play?

Some patients in the 21st century approach “modern” healthcare with the same expectations I bring into a deli for lunch:  “I’d like the sinus infection with antibiotics and a note for work, please.” I confess, when seeing such a patient I have occasionally acted on the impulse to ask if they would like fries with their order.  Yet, these patients do have something to teach us about how to be a 21st century physician.

Eighteen years ago while a fourth year medical student I registered for an elective class on the future of computer science in medicine.  This was my first time to see the Internet and I was awed by the vision my instructors had for the future.  They had no idea. Read more »

‘Twas The Night Before Healthcare Reform

‘Twas the night before Christmas, and following the House
The Senators were blending their bill while some groused

The amendments were stuck to the bill without care
In hopes that Obama soon would be cheered

The Doctors and Patients were trying not to dread
The visions of full waiting rooms that flashed through their heads

All watched the TV, hoping to avoid new Red Tape
But confusing reports lead to a hypnotic state

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PECOS: A Back Door Way To Force All Physicians To Accept Medicare?

This upcoming January 4, 2010 will prove an important date for any physician who prescribes durable medical equipment for their patients to use in the home.  The Centers for Medicare and Medicaid Services (CMS) have implemented an internet-based enrollment process for Medicare termed PECOS, another progeny of the 1996 HIPAA legislation.  PECOS stands for Provider Enrollment, Chain and Ownership System and was created in large part to prevent fraud.  Yet when I called the PECOS helpline, fraud was not a concern, and it was explained to me that PECOS is an internet version of my Medicare Application.

Since my practice makes house calls, we treat a variety of home-bound patients unable to make it to a doctor’s office without great effort.  We care for stroke patients, quadriplegics, those with end-stage pulmonary disease, and many simply weakened by the effects of advanced age.  Most need equipment like mattresses to prevent recurrent pressure sores, wheelchairs, nebulizer machines, or oxygen.  A patient depends on their physician’s ability to order anything necessary, and it is imperative this be done without creating an exorbitant financial burden or by denying them a Medicare benefit already paid for. But, according to our Home Supplier, if we haven’t enrolled by January 4 then our Medicare & Medicaid patients will have to pay 100% of the cost for any equipment prescribed. Read more »

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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