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Who’s Feeding At The Healthcare Trough?

I went to my physical therapist yesterday for knee treatment and we talked about the fact that Blue Cross is cutting their reimbursement to the point that the cost of providing care will not even be covered. All I could do was lament with him and listen. One insurer even told him (the owner of the business) to just “make the sessions shorter and don’t give as much care.” As if that is how it works…”You get little money..so just do a little”.

Clearly the insurance intermediaries, who never actually see a patient or deliver any care, haven’t got a clue how this whole health thing works. They are happy with mediocre doctors that cut time and care. Those doctors (and physical therapists) run mills, but the insurance companies are happy with them. Quality and quantity of time are not rewarded, and in fact are punished in the health care environment we have. Read more »

*This blog post was originally published at EverythingHealth*

The US Is Number One…

… in national health care expenditures, that is. This, of course, is nothing new: spending on health care in the U.S. has long out-paced any other industrialized country. What is noteworthy is “the largest one-year increase in [health care’s] GDP share since the federal government began keeping track in 1960” blogs Chris Fleming, of Health Affairs. He writes that a new study shows that health care spending increased by an estimated 5.7 percent since 2008 despite a projected decline in the gross domestic product (GDP) in the same period.

The recession is having a big impact on respective roles of the public and private sectors. “Health spending by public payers is expected to have grown much faster in 2009 (8.7 percent growth, to $1.2 trillion) than that of private payers (3.0 percent growth, to $1.3 trillion)” Fleming writes, which is attributable to an increase in “projected growth in Medicaid enrollment (6.5 percent) and spending (9.9 percent) as a result of increasing unemployment related to the recession. Conversely, enrollment in private insurance is expected to have declined 1.2 percent in 2009, despite federal subsidies for Americans who have lost their jobs to extend their private insurance coverage via the Consolidated Omnibus Budget Reconciliation Act (COBRA) that increased participation in these plans.” Read more »

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

Nurses Stand Up For Science And Patient Safety, Then Face Jail Time?

balanceYou may have heard about the whistleblower case in Texas where 2 nurses reported a physician (Dr. Rolando G. Arafiles, Jr.) to the State Medical Board for unethical medical practices. Even though the American Nurses Association’s Code of Ethics requires nurses to report physicians who may be of harm to patients, these two were punished for doing the right thing. (Apparently, the local sheriff was a friend of Dr. Arafiles’ and took it upon himself to charge the nurses with misuse of official information, a third-degree felony in Texas, because patient medical record numbers were included in the letter to the Texas Medical Board). The criminal prosecution charges were dropped against Vicki Galle, but the case against Anne Mitchell is ongoing.

But the real story – what was Dr. Arafiles doing that was so egregious? – has yet to be made public by the nurses. And thanks to bloggers Mike Dunford, and Orac over at ScienceBlogs.com, the truth is being revealed. Video footage of Dr. Arafiles’ bizarre medical beliefs and practices are available here. Apparently, he prescribed colloidal silver to treat H1N1 flu, promoted the false idea that vaccines contain a wild array of toxins (everything from MSG to fetal tissue), and was diagnosing patients with “Morgellons disease” which he describes as a parasitic infection that produces fibers that turn host cells into plastic. Read more »

What Is A Medical Archeologist?


I’m becoming an amateur archeologist. The hilltop where we live is strewn with arrowheads and bits of Native American pottery shards. I have slowly, surely, trained my eye to find them. There is little flint here; so most of the pieces I find were made of quartz. (Hard to work with, but remarkably beautiful and almost always a brilliant white.)

My kids and I walk the red-clay paths and look down for bits of stone protruding up, especially after a good, soaking rain. Elijah, my youngest boy, was the first to find one. ‘Is that an arrowhead, Papa?’ ‘Yep, good eye son!’ He had found what was probably the point of an atlatl (a kind of mix between arrow and spear).

We look for rocks that seem shaped by human hands. That’s the ticket; look for something that seems to suggest a purpose or a history. Things with no shape, no marks from being worked, are probably not worth our time. Read more »

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

Medicaid Requires Pre-Approval For Vitamins

So know I hear that Medicaid preauthorization is required to administer vitamins in an outpatient setting.  One of the greatest things about hospitalist medicine is I can give just about any medication I think is clinically justified to my patients in the hospital.  I don’t have any doctor, Dr Nurse, or other third party insurance bureaucrat telling me I have to get preauthorization before my patient can receive care.  I have at my disposal a 24 hour all you can eat pharmacy.  Sometimes they don’t know what I’m ordering, and my Green Goddess doesn’t get filled.  But generally speaking, I get what I ask for.

That’s not the way it works in the frustrating outpatient world of clinical medicine. Read more »

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

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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