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Getting Doctors And Patients On The Same Team: A Basketball Metaphor For Health Care

It is tough playing man-to-man when coaches on the sideline keep insisting your team plays zone.

Such is it with health care.

For doctors, the man-to-man defense never ends. Stay with them. Glue to them. Move with them. Run with them. Defend against the bounce pass, or the dribble to avoid the admission. Hands up! Watch their waist, ignore the head fake. You shift your coverage to accommodate their needs. One on one, mana-a-mano.

But for the business of medicine, it’s all about the zone. Defend the admission basket against as many people as possible with the least number of defenders. Stay in your position. Work it 2-1-2, 2-3, or if you’re really adventurous: 1-2-2. Stick to Read more »

*This blog post was originally published at Dr. Wes*

Diabetes: An Expensive Disease

Back when I was a young bird with type 1 diabetes, insulin cost about $70 dollars per bottle.  (And I had to walk uphill both ways to the endocrinologist’s office.)  I had no concept of this cost, or how it played into my family’s finances, at the time.  I would just open the fridge door, grab the bottle, uncap the orange top to a 1cc syringe, and take the units my mom would yell to me from the kitchen sink.

“Two. Two of Regular should do it.  Rotate to your right arm this time, okay?”

“Okay!”  (And then I’d proceed to jab it into my left arm because I’m right-handed and also stubborn.)

Now, twenty-five years later, insulin has taken a bit of a price hike.  I just ordered a three month supply of Humalog from Medco and the total for the insulin came to six hundred and ninety-seven dollars.  For six bottles of Humalog that will be all gobbled up by early March.  (And thanks to a high, but manageable-on-paper deductible, we’re responsible for the full cost this round.)  Almost seven hundred dollars worth of insulin.

We’re lucky that we’re able to pay for that cost without panicking, but knowing what these bottles cost without the assistance of insurance makes me look at everything through a diabetes lens.  When three days are up on my insulin pump site, I am very aware of Read more »

*This blog post was originally published at Six Until Me.*

Money For Nothing: Capitation Medicine

My dad’s wife called to ask if I could see a friend of my brother’s. This 30 year old woman had been “put through the ringer” by her HMO dermatologist. He looked at her nose diagnosed a “pre cancer” and treated her with freezing. Then he put her on a cream. The “wart” is still there and she can’t get in to see the doctor (actually a physician’s assistant) for 2 months.

Welcome to capitation medicine.

This evil creation of your local managed care plan pays a doctor Read more »

*This blog post was originally published at Truth in Cosmetic Surgery*

How Has The Mayo Clinic Fared Since It Dropped Medicare?

Update: this happened 2 years ago. So, I wrote this thinking it was a new development, but it isn’t. Anyone know how this experiment has played out?

I’ve wondered for years if hospital organizations (and big organized clinics) had done the math on whether they could do without Medicare, and apparently Mayo has. More after the quote

President Obama last year praised the Mayo Clinic as a “classic example” of how a health-care provider can offer “better outcomes” at lower cost. Then what should Americans think about the famous Minnesota medical center’s decision to take fewer Medicare patients?

Specifically, Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.

Mayo says it lost Read more »

*This blog post was originally published at GruntDoc*

Current System Of Medical Malpractice Targets The Wrong People

When lawyers talk, I listen. Two attorneys penned a piece on medical malpractice reform in the April 21st issue of The New England Journal of Medicine, the most prestigious medical journal on the planet. Here is an excerpt from their article, New Directions in Medical Liability Reform.

The best estimates are that only 2 to 3% of patients injured by negligence file claims, only about half of claimants recover money, and litigation is resolved discordantly with the merit of the claim (i.e., money is awarded in nonmeritorious cases or no money is awarded in meritorious cases) about a quarter of the time.

This is not self-serving drivel spewed forth by greedy, bitter doctors, but a view offered by attorneys, esteemed officers of the court. Apply the statistics in their quote to your profession. Would you be satisfied if your efforts were benefiting 2-3% of your customers or clients? Would this performance level give me bragging rights as a gastroenterologist? Perhaps, I should attach a new slogan to my business card.

Michael Kirsch, MD
Gastroenterologist
Correct Diagnosis and Treatment in 2-3% of Cases
We would have to Read more »

*This blog post was originally published at MD Whistleblower*

Latest Interviews

The Surprising Economic Burden Of ADHD (Attention-Deficit Hyperactivity Disorder)

If you can read this you need to download a more recent browser It is estimated that as many as million U.S. adults have ADHD Attention-Deficit Hyperactivity Disorder A recent research study publication-pending suggests that the economic burden of ADHD on America could be as high as billion annually. I…

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Is The Adderall Shortage A Harbinger Of Future Drug Supply Problems?

If you can read this you need to download a more recent browser Today most- if not all- Doctor’s offices are strained by the shortage of some prescription medication or vaccine. A month ago President Obama signed his executive order directing the FDA to take steps to reduce drug shortages…

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Latest Book Reviews

Book Review: The First Step To Improve Health Care Is A Close Examination Of How It’s Delivered

My friend and former Chair of the CFAH Board of Trustees Doug Kamerow has written a book that I think you will like. Besides being a mensch and witty as heck Doug is a family doctor and a preventive medicine specialist. In his new book Dissecting American Health Care Commentaries…

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“Your Medical Mind” Explores Factors That Influence A Patient’s Medical Decisions

Recently I had a conversation with Shannon Brownlee the widely respected science journalist and acting director of the Health Policy Program at the New America Foundation about whether men should continue to have access to the PSA test for prostate cancer screening despite the overwhelming evidence that it extends few…

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Book Review: Food Truths, Food Lies

Food Truths Food Lies written by family physician Eric Marcotte M.D. may be the most refreshingly evidence-based diet book of the decade. You will not find a single mention of super-foods magical berries or supplement must-haves in the entire book. What you will find is the cold hard truth about…

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