The mission of this blog is to connect us back to the roots of medicine. It is about fighting back against those things that are taking us away from the direct care of patients while still pointing out the lunacy and hypocrisy of this job.
I will soon be moving this blog and a lot of my other works to www.authenticmedicine.com. I am in the process of building this site now and hope to get it launched for the new year. I also will be doing some videos that talk about and mock some of the lunacy in our healthcare system. That will go on there as well. I would be honored if you can check out the site and tell me what you like or dislike so far. Also, any recommendations for adding stuff would be great. For example:
Here is some reassuring news. Contractors paid by the government to detect fraudulent Medicare claims used inaccurate data. The Department of Health and Human Services cited repeated problems and systemic failures by federal health officials to supervise these contractors who were paid tens of millions of dollars. In summary, the fraud finders were actually defrauding the public as well. What's next? The government will hire some contractors to examine the contractors who were hired to examine the Medicare data? It could keep going like an M.C. Escher painting.
Once again the common theme is "inaccurate data" and yet we move full speed ahead with quality initiatives that are unproven and quite possibly fraudulent. These same contractors will be in charge of interpreting other data used to see which doctors are supposedly good or bad. Still not buying it.
One of the ways it was thought medical care costs could be decreased was by cutting the cost of hospitalization. The simplest way this could be accomplished was felt to be by limiting hospitalization. If less people were hospitalized it should cost less. This it was felt could be accomplished by getting patients out of the hospital sooner, thus lessening the cost of hospitalization. To accomplish this hospitals began to employ “discharge coordinators”. The “discharge coordinator” was charged with making rounds daily on all hospitalized patients and if they did not require monitoring or i.v.’s they should be discharged. Another way to limit hospitalization was to set a predetermined number of days for certain diagnoses. If the hospital could get the patient discharged even sooner than the allowed number of days they could reap better financial benefits.
The result of these measures has not shown to be significant judging by the rapidly increased costs of hospitalization nor the increased overall cost of medical care. The simple solution that when you buy less of something it should cost less has not been true in this instance. Why??
Medicare has allowed a certain number of days for patients having a hip replacement, regardless of age, other medical problems or complications. On a trip to India I was surprised to learn that for a hip replacement a 10 day stay was mandatory to observe for possible post operative infections and to be sure that starting physical therapy is started promptly.
Less days of hospitalization should result in less cost. This has not occurred as the cost of hospitalization has risen as the cost per day of hospitalization has increased rapidly. If the severity of the illness and the requirements for increased care increase the cost of hospitalization will rise rapidly. More nurses, more care all cost more. The savings expected have not occurred and may well have resulted in unexpected results. Patients discharged early may well have unanticipated infections as well as other complications. Re-hospitalizations increase and occasionally outcomes are less favorable.
The cost for hospitalizations depends on the medical and nursing facilities required by the patients being taken care of, and the number of individuals being needed to provide for their care.
Reasonable care should be determined by the physician. Hospitals and insurance companies should not determine length of hospitalization.
How sad is it that there is a real food fight going on between Congress and the Obama administration on what to feed our kids in school. The debate is around the free lunch program and what counts as a vegetable. It seems Congress has sided with ConAgra foods in deeming pizza sauce a vegetable. OMG! This is how bad it is getting. Our politicians are so bought out that they have to agree that tomato paste should count as a vegetable. One of their arguments (which is sadly valid) is that kids just throw away the other vegetables so pizza is all they will eat. What chance does this country really have to fight the diabetes and obesity epidemic when we are down to one food group and that is crappy pizza? And last I remember the tomato was actually a fruit!!!
I like to point out other industries as comparisons to the healthcare system. It is important to realize that you can learn from them. Heck, hospital administrators and managed care executives do it a all the time as they try to tinker with (read: f%ck up) our industry and justify their exorbitant salaries. Here is an article in the USA Today talking about the banking industry. One can argue that no one really needs a brick-and-mortar structure with bank tellers anymore but it isn't true. As the article states, customers value the human touch. If that is true in such industries in banking then it is exponentially true in healthcare. Virtual medicine is just not going to happen.
The National Heart, Lung and Blood Institute and the American Academy of Pediatrics have come out with the recommendations that the first cholesterol check should occur between ages 9 and 11 and the test should be repeated between ages 17 and 21. Wow. That is what it has come to? We are unable to hold back the tide of obesity and now we are going to get kids on statins. I see a massive controversy coming and I see a lot more money being spent on testing. I am sure the labs around the country are salivating over this. Instead of figuring out why our kids are so fat with high cholesterol and more diabetes we are instead doing more testing.
The "guidelines seek to address lifestyle factors from birth with a recommendation that babies be breastfed, adding that after age 1, children can be given low-fat milk and after age 2 can be given fat-free milk". Is that so? I thought kids need fat for their brains. In fact, there is more and more evidence that the appropriate fat (even saturated fat) is not the issue causing obesity. Read this article about skim milk versus whole milk.
It seems to me that our whole grain and low fat recommendation has been an utter failure. I have a 1% success rate in getting patients healthier on this diet. Maybe, just maybe, carbs are the issue. We may want to delve into that before we have every kid in this country on a statin.
It is a well known fact that patients often don't fill their prescriptions or even take the medicine if they do fill them. That is what makes it so insane to "grade" doctors depending on their patients' cholesterol, blood pressure, blood sugar average, etc. In a study involving patients who had a recent heart attack, only half of them took the statin, beta blocker and aspirin recommended. Even better, the medications were given to the pateints for......FREE!!!!!!! Maybe this is a problem with communication? I doubt it as this was a study and they have more time to explain things and educate the participants. Maybe this is a cultural issue? Who knows but to give "quality" grades to doctors that depend on patients' compliance is like basing an educational system where teachers are paid depending on what tests scores the students achieve. Who is crazy enough to do that?
We are heading towards "No Patient Left Behind" which will fail miserably.
I have fired patients before in my career. The main reasons are:
Abusive to the doctor or the staff
Narc seeking or selling
This article in the USA Today talks about how more and more pediatricians are firing patients (parent and kids) who refuse to get their kids vaccinated. As brutal as this may seem, there is now MORE than enough evidence showing that there isn't any link between vaccines and autism. Pediatricians, as this article states, are just fatiguing on this issue and are willing to let families find healthcare in other places if mom or dad disagree on this issue. I believe these docs have a valid point but firing them seems kind of harsh. Maybe pediatricians just don't have enough patients who are:
Abusive to the doctor or the staff
Narc seeking or selling
If they did they may get a better perspective on who they should keep or not.
About ten years ago an important committee recommendation from the American Heart Association came out to endorse the switch to automated defibrillators in hospitals taking out the "human" variability. It was done on a hunch that these new devices would make their use speedier. The problem is that evidence now shows that they save fewer lives. It seems the decision by the brilliant experts was made without clinical research answering a crucial question: Did the new devices, when used in hospitals, produce better results than the old equipment? Huh, seems like a valid question. Now, a 1000 more patients die every year. Interestingly enough, a quarter of the members of the heart association committee that recommended the automated defibrillators had business ties with manufacturers of the devices. Pathetic.
In my humble opinion, there are too many chiefs wanting to make the big decisions to justify their salaries. Regardless of whether these members were paid off, it bothers me that any new technology is just assumed to be better than what humans can do. Isn't this really the trend we are seeing in all of medicine? Idiotic and overpaid administrators, which are multiplying as we speak, want to get rid of the doctors and bring in the computers. This AED example is just the kind of thing that happens when you do that.
In a recent JAMA study on 17,847 patients who had cardiac bypass surgery or coronary angioplasty, it was found that doctors prescribed nuclear stress tests and/or echocardiograms later than 90 days after discharge more often if they had financial interests in the tests. For stress tests, it was 12.6 percent of docs who prescribed the test versus 5 percent of those who were not paid for testing. For echos, it was 2.8 percent versus 0.4 percent. This sucks. It makes us look bad. Doctors are human and if they are on the fence in any way about doing a test then it seems they will lean towards ordering what pays them better. That being said, there are some outliers in any occupation who just don't care and abuse the system. Also, some teaching programs don't follow the same rules. Heck, I remember in medical school the hot shot cardiologist ordering an "echo, Holtor, MUGA" test on EVERY patient. And he was the chief editor of Circulation, a prestigious journal! Yes, I am well aware that mentioning the MUGA test does give away my age.
A job search portal called CareerCast.com has a list with the twelve jobs that are "traditionally believed to be great occupations but that actually look a lot better on paper than they might be in reality". Looks like being a physician made the list. Sadly, I am not convinced they are wrong.