13. Restoring Accountability in Medicine, Government and Society

* * * * *

The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data The 16th Annual World Health Care Congress will be held April 30-May 3, 2017 --Washington D.C. For more information, visit www.worldcongress.com. The future is occurring NOW.

* * * * *

1. Featured Article: The key for patient satisfaction is physician satisfaction

DIKE DRUMMOND, MD | PHYSICIAN | MARCH 14, 2013

In these early days of pay for performance (P4P) reimbursement, as the size of your paycheck begins to reflect your patient satisfaction scores, let’s have a frank discussion about three important topics all healthcare providers and organizations must understand going forward.

1. How your performance will be measured

2. How to get the highest patient satisfaction scores and be a happier doctor at the same time

3. The first step to improving performance (in a healthy way) for you and your organization

How your performance will be measured

A large component of your performance ratings will be based on patient satisfaction surveys very much like the HCAHPS inpatient or Press Ganey out patient satisfaction surveys currently in use. Here is a link to the HCAHPS patient satisfaction questions where you can see the three doctor specific patient satisfaction measures that are already publicly reported on the Medicare Hospital Compare website.

It is important that we get granular here so that you understand exactly how your own personal patient satisfaction is both scored and reported.

The satisfaction surveys ask several questions the patient answers on a 4 or 5 point Lickert scale where the top score represents the word/phrase “always”, “strongly agree” or “outstanding”.

You may naturally assume that your personal physician rating is an average of the scores from individual patients. You would be completely wrong in that assumption.

Here’s how your satisfaction ratings are actually scored — it is not an average.

Your scores are reported as a “percentage of top”. This means the percentage of patients who gave you the top score. In other words, only the top scores count. Anything less than 5 out of 5 is thrown out. “Good” or “Above Average” is meaningless to these scoring systems.

Now that you understand how your performance will be rated and reported in the near future, I invite you to take just a moment to recall your last personal experience with a customer satisfaction survey of any kind.

§ Are you a person who gives a 5 out of 5 under any circumstances? (most doctors are not!)

§ When did you last give a retail transaction or online customer service top marks?

§ What did they have to do to earn that rating from you?

Imagine the experience your patients will expect and you will have to consistently provide to receive the all-important “5”. This is exactly how you will be rated by your patients more and more frequently in the years ahead. Soon these patient ratings will determine a portion of your pay as well.

How to get the highest patient satisfaction score and be a happier, healthier doctor at the same time

First you must understand what most healthcare administrators do not. Physician satisfaction is the only lasting foundation for patient satisfaction. It takes happy doctors and staff to have happy patients — in that order.

To understand this fundamental fact, let me ask you the following question.

How can we reasonably expect a patient to give a doctor a 5 out of 5 score on satisfaction when if we asked that doctor to rank their personal satisfaction with their workplace on that same day, they would score it a 3 out of 5?

Your administration might be able to goose patient satisfaction numbers temporarily by cracking the whip and teaching some communication tricks to you and your staff. It won’t last.

As P4P and the closely related “value based purchasing” become more common in your marketplace, organizations that create a healthier, happier, less stressful workplace environment for their staff and doctors will establish a strong competitive advantage.

§ Patients will want to be seen there.

§ Quality doctors will want to work there.

§ Your patient satisfaction scores will reflect the efforts to keep physicians and staff healthy and get systems out of the way of patient interactions.

Your first step to higher physician and patient satisfaction

Here is a question to get you and your leadership team going.

Start by looking back on the last 3 months in your own practice. What average score would you give your personal satisfaction level with your day-to-day practice experience on that same 5 point scale? Take a moment to actually give it a number.

1=very low | 2=low | 3=OK | 4=Good | 5=Excellent

What is your physician satisfaction number? Keeping your score in mind:

§ What is the first thing you would change at work to improve your personal satisfaction score? Even if you have given up on this change being possible, what is the one thing that would make all the difference for you?

§ What is the first step in making that change – the smallest step to making progress in the direction of a better work day?

Now grab your medical director (or your team if you are the medical director) and get on it.

This simple process identifies a piece of low hanging fruit for you and your organization to improve three things all at once:

§ Your personal satisfaction

§ Your patient satisfaction scores

§ Ultimately, the size of your paycheck down the road

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

TAGGED AS: PRIMARY CARE

http://www.kevinmd.com/blog/2013/03/key-patient-satisfaction-physician-satisfaction.html

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

* * * * *

2. In the News: Donald Trump enters the Presidential Race-who is Donald Trump?

DONALD J. TRUMP
Chairman and President, The Trump Organization

Donald J. Trump is the very definition of the American success story, continually setting the standards of excellence while expanding his interests in real estate, sports, and entertainment. He is the archetypal businessman –a deal maker without peer.

Mr. Trump started his business career in an office he shared with his father in Sheepshead Bay, Brooklyn, New York. He worked with his father for five years, where they were busy making deals together. Mr. Trump has been quoted as saying, "My father was my mentor, and I learned a tremendous amount about every aspect of the construction industry from him." Likewise, Fred C. Trump often stated that "some of my best deals were made by my son, Donald . . .everything he touches seems to turn to gold." Mr. Trump then entered the very different world of Manhattan real estate.

In New York City and around the world, the Trump signature is synonymous with the most prestigious of addresses. Among them are the world-renowned Fifth Avenue skyscraper, Trump Tower, and the luxury residential buildings, Trump Parc, Trump Palace, Trump Plaza, 610 Park Avenue, The Trump World Tower (the tallest building on the East Side of Manhattan), and Trump Park Avenue. Mr. Trump was also responsible for the designation and construction of the Jacob Javits Convention Center on land controlled by him, known as the West 34th Street Railroad Yards, and the total exterior restoration of the Grand Central Terminal as part of his conversion of the neighboring Commodore Hotel into the Grand Hyatt Hotel. The development is considered one of the most successful restorations in the City and earned Mr. Trump an award from Manhattan's Community Board Five for the "tasteful and creative recycling of a distinguished hotel." Over the years, Mr. Trump has owned and sold many great buildings in New York including the Plaza Hotel (which he renovated and brought back to its original grandeur, as heralded by the New York Times Magazine), the St. Moritz Hotel (three times and now called the Ritz Carlton on Central Park South) and until 2002, the land under the Empire State Building (which allowed the land and lease to be merged together for the first time in over 50 years)

Additionally, the Nike Town store is owned by Mr. Trump, on East 57th Street and adjacent to Tiffany's. In early 2008, Gucci opened their largest store in the world in Trump Tower.

In 1997, the Trump International Hotel & Tower opened its doors to the world. This 52 story mixed–use super luxury hotel and residential building is located on the crossroads of Manhattan's West Side, on Central Park West at Columbus Circle. It was designed by the world-famous architect, Philip Johnson, and has achieved some of the highest sales prices and rentals in the United States. As one of only three hotels in the nation to have received a double Forbes Five-Star rating for both the hotel and its restaurant, Jean-Georges, it has also received the Five Star Diamond Award from the American Academy of Hospitality Sciences, and was voted the number one business hotel in New York City by Travel + Leisure Magazine. Conde Nast Traveler Magazine has named it the number one hotel in the US and its innovative concept has been copied worldwide. It has won the Forbes Five-Star Hotel Award each year from 2009 to 2015 and ranked in the Conde Nast Traveler "Readers' Choice" awards every year since 2010. This year marks the eighteenth anniversary of this Trump Hotel Collection gem.

Mr. Trump was also the developer of the largest parcel of land in New York City, the former West Side Rail Yards which is now Trump Place. On this 100 acre property, fronting along the Hudson River from 59th Street to 72nd Street, is the largest development ever approved by the New York City Planning Commission. There are a total of 16 buildings on the site, with Mr. Trump building the first nine buildings and the other portion of land being sold for a substantial amount. Mr. Trump also donated a 25 acre waterfront park on Trump Place and a 700 foot sculptured pier to the city of New York.

Other acquisitions in New York City include The Trump Building at 40 Wall Street, the landmark 1.3 million square foot, 72-story building located in Manhattan's Financial District, directly across from the New York Stock Exchange and the tallest building in downtown Manhattan. This purchase, which took place at the depths of the New York City real estate market, is said to be one of the best real estate deals made in the last twenty-five years and is considered to have one of the most beautiful "Tops" of any building in the country. In addition, Mr. Trump built 610 Park Avenue (at 64th Street), formerly known as the Mayfair Regent Hotel, which was very successfully converted into super-luxury condominium apartments achieving, at that time, the highest prices on Park Avenue. Further east, adjacent to the United Nations, sits the spectacular Trump World Tower, a 90-story luxury residential building and one of the tallest residential towers in the world. The Trump World Tower has received rave reviews from the architectural critics, with Herbert Muschamp of the New York Times calling it "a handsome hunk of a glass tower." Likewise, Trump World Tower is considered one of the most successful condominium towers ever built in the United States. . .

An accomplished author, Mr. Trump's 1987 autobiography, The Art of the Deal, became one of the most successful business best-sellers of all time, having sold in excess of three million copies, and being a New York Times number one best-seller for many weeks. The sequel, Surviving at the Top, was on The New York Times best-seller list and was also a number one best-seller as was his third book, The Art of the Comeback. Mr. Trump's fourth book, The America We Deserve, was a departure from his past literary efforts. This book deals with issues most important to the American people today and focuses on the views regarding American political, economic and social problems. His fifth book, How To Get Rich: Big Deals from the Star of The Apprentice, became an immediate bestseller on all lists, as did Trump: The Way to the Top and Trump: Think Like a Billionaire which was released in October of 2004. Trump: The Best Golf Advice I Ever Received was published in April 2005, followed by Trump: The Best Real Estate Advice I Ever Received in 2006. He has also teamed up with Robert Kiyosaki to make publishing history with their book, Why We Want You To Be Rich: Two Men, One Message, which in October of 2006 made the #1 spot on the New York Times, The Wall Street Journal, and Amazon bestseller lists. Trump 101: The Way To Success debuted in late 2006. In October of 2007 Mr. Trump's book with Bill Zanker, Think Big was launched. In early 2008, Mr. Trump's Never Give Up was released, followed by Think Like a Champion in April of 2009. Midas Touch, another collaboration with Robert Kiyosaki, was released in October of 2011. Time To Get Tough: Making America #1 Again was released in early December of 2011, becoming a bestseller. . .

Read the entire biography . . .

Seeing the direction of his writings, it should be no surprise that Donald Trump enters the presidential race on the Republican side on June 15, 2015. He was a democrat who contributed to Clinton campaign, socialized with the Clintons, was at their daughter’s wedding. There was no future for him in the Democratic Party. The New York political scene seems rather fluid. Sometimes it is difficult to tell which party a New York Politician really endorses. What are the remaining trophies yet to be won? Would the Republican Party be a good stepping stone to the premier address in the world? One that would top all of Trump’s present prestigious addresses—the White House? And seeing how presidents seem to become super wealthy, wouldn’t that be the logical path to be the world’s first Trillionaire? Since he’s already written the book on how to think like a Billionaire, wouldn’t this then require him to write his final Book?

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

* * * * *

3. International Medicine: Canada still struggles to provide health care to all

Seeking relief outside Canada's borders

Nadeem Esmail and Bacchus Barua
The Fraser Institute

Appeared in Guelph Mercury and Waterloo Region Record posted December 20, 2013

One of the unfortunate realities of Canada's monopolistic health-care system is that some people feel they have no choice but to seek the care they need outside the country. And who can blame them?

Faced with waits for treatment that are often months long (sometimes stretching over a year), it should come as little surprise that many Canadians ultimately choose to be medical tourists. The question of course, is how many?

While data on exactly how many patients seek treatment abroad are not readily available, it is possible to estimate this number using data from the Fraser Institute's annual waiting list survey and from the Canadian Institute for Health Information.

The Fraser Institute's annual waiting list survey asks physicians in 12 major medical specialties what percentage of their patients received non-emergency medical treatment outside Canada in the past year. In 2013, averaged across all medical specialties, almost one per cent of patients in Canada were estimated to have done so, the same as in 2012.

Putting these numbers together with data on the number of procedures performed in Canada from the Canadian Institute for Health Information reveals that a conservatively estimated 41,838 Canadians received treatment outside the country in 2013.

Interestingly, this year's estimate is a slight decrease from the 2012 estimate of 42,173. At the same time, the wait time from specialist consultation to treatment in Canada increased from 9.3 weeks in 2012 to 9.6 weeks in 2013. . .

Among the 12 medical specialties, the largest numbers of patients receiving care outside Canada were estimated for urology (6,635), general surgery (5,537), and ophthalmology (3,083). Patients were less likely to be receiving cardiovascular surgeries (114), radiation treatment for cancer (127), and chemotherapy for cancer (249) in another country.

Those numbers are not insubstantial. They point to a sizable number of Canadians whose needs and health care demands could not be satisfied in Canada. They also point to a large market of patients that might choose to remain in Canada (and in their home province) if only they had that option. One can only wonder how many more would have liked to join them, but couldn't afford the travel on top of the privately funded care.

There are a number of possible reasons why Canadians ultimately received the care they required outside of the country. Some may have been sent abroad by the public health care system because of a lack of available resources or the fact that some procedures or equipment are not provided in their home jurisdiction. Others may have left in response to concerns about quality, seeking out more advanced health care facilities, higher tech medicine, or better outcomes. Others may have fled Canadian health care in order to avoid some of the consequences of waiting for care such as worsening of their condition, poorer outcomes following treatment, disability or death. And some may have done so simply to avoid delay and to make a quicker return to their life.

That a considerable number of Canadians traveled and paid to escape the well-known failings of the Canadian health-care system speaks volumes about how well the system is working for them. It leaves open the question of just how many more Canadians might choose medical tourism outside Canada if given the opportunity.

Nadeem Esmail is director of health policy studies at the Fraser Institute.
Bacchus Barua is a Fraser Institute senior economist.

See more at: https://www.fraserinstitute.org/article/seeking-relief-outside-canadas-borders#sthash.bu0qDR7x.dpuf

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

* * * * *

4. Medicare: Canadian Medicare

A Healthy Alternative: Opting Out of Federal Health-care Funding Could Save Money and Lead to Better Access

Nadeem Esmail Senior Fellow, Fraser Institute

Last week, Premier Klein suggested that Alberta might reform the health care system in ways that would conflict with the myriad rules and regulations enshrined in the Canada Health Act. The planned reforms--charging facility fees and fees for doctors’ services, and delisting procedures—were proposed as ways to control the spiraling costs of health services in Alberta. Though there is no question that the first two of those changes would result in a loss of federal health care funding, would they mean the end of universal access health care in Alberta?

First and foremost, a cost-sharing program for patients in Alberta would not mean abandoning the compassionate approach to health service delivery. Of the 28 OECD countries that share Canada’s goal of providing care on the basis of need and not ability to pay, 23 have some form of cost sharing program for patients covering hospital and physician services, and in many cases emergency room visits. All of these countries have realized what economic experiments and international evidence have shown for years: making patients responsible for some of the cost of their care leads to more informed decisions about when and where the health care system is accessed.

Two nations have, in fact, expanded their cost sharing programs over the last year in order to take better advantage of the benefits generated by such reforms. Beginning just last month, the German cost sharing program has been expanded to include physician services in addition to hospital services. The Slovak Republic has taken an even larger step and gone from no cost sharing for hospital and physician services, to a full range of co-payments. The Slovak reforms have been remarkably successful at controlling costs: just six months after the new Slovak program, the government witnessed a 30 percent reduction in the number of visits to general practitioners and a 25 percent reduction in the number of hospital stays.

Put another way, implementing a cost sharing policy as is done in France, Sweden, Japan, and Australia -- all of whom do better on health care outcomes than Canada while spending less than we do -- would have profound effects on the efficiency and cost of health care in Alberta. First, access to family physicians and clinics would be improved for those in need as some patients (25 to 30 percent in the case of Slovakia) will opt to save the charge and not seek medical attention. Second, remarkably long waiting times for emergency care would fall as patients requiring attention for non-critical conditions would seek care in more cost-effective settings. Third, resources freed up as a result of the first two effects could be used to treat the real health care problems that reside on the province’s waiting lists or allow for tax relief that would benefit the economy as a whole.

Of course, there will always be detractors who claim that these fees will only lead to increased health expenditures in the long run since patients will avoid accessing the health care system early on in the progression of their illness and will ultimately cost more to treat. These detractors would be wrong. The evidence on cost sharing has shown that only those with low incomes and particular pre-existing conditions experience worse outcomes without free access to care, suggesting that an appropriately designed program should allow these patients to access care without the necessary fees.

It is relatively obvious that fewer patients using the system would lead to a cost savings for the system as a whole. But what would the cost of such a program be in Alberta, where over 16 percent of provincial health care spending comes in the form of transfers from Ottawa? It turns out that, after accounting for the savings that would accrue from a cost-sharing program, Albertans would actually save money while experiencing better access to health services.

For 2004/05, the Alberta government plans to spend $7.8 billion, of which roughly $1.3 billion will come from the Canada Health Transfer, the Canada Health and Social Transfer supplement, and the Health Reform Fund. These transfers are the potential penalty that the federal government could impose if Alberta were to implement a cost-sharing program. On the other hand, research has shown that the savings from making patients responsible for 25 percent of health expenditures (up to reasonable annual limits) work out to about 19 percent of total expenditures, or roughly $1.5 billion. In other words, a cost sharing program for health services would actually save Albertan’s about $200 million, even after accounting for the lost transfers from Ottawa. . .

Alberta is uniquely positioned to take advantage of this win-win situation, as the benefits to be obtained from reform outweigh the penalties for contravening the federal health act. What Premier Klein needs to do now is ensure that this week’s summit in Vancouver does not result in more calls for increased federal funding – sourced from taxes that will be disproportionately borne by Alberta taxpayers. If such calls are made, and heard, patients in Alberta will not see the benefits of better access and Alberta’s taxpayers will still be stuck with the big bill.

- See more at: https://www.fraserinstitute.org/article/healthy-alternative-opting-out-federal-health-care-funding-could-save-money-and-lead-better#sthash.DZxLa9y5.dpuf

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Government is not the solution to our problems, government is the problem.

- Ronald Reagan

* * * * *

5. Medical Gluttony: Healthcare Gluttony

Healthcare's Medical Gluttony

Contributor Dan Munro

I write about the intersection of healthcare innovation and policy.

Seems to me we always have a few big breaking healthcare stories early in the year. I remember last year when Mary Meeker released her stunning report –USA, Inc. For the first time, it gave us a detailed view into the health of our country – as if it were a Corporation using balance sheet accounting. That report is truly outstanding. If you haven’t read it – I can’t recommend it highly enough. In some ways I think it’s “table stakes” for any intelligent discussion around the health (and healthcare) of our Country. In that report are two charts that graphically illustrate the size of our healthcare spending (as reported through 2009) – and then the results of our healthcare system. This was the first one:

1960 Total Health Care spending : $187 Billion

2009 Total Health Care Spending: $2.5 Trillion

From Mary Meeker's Report - USA, Inc.

Lot’s of takeaways from this. Including the sheer size ($2.5 trillion in 2009) – and at least one financial opinion that we don’t have a debt problem in this country – we have a healthcare problem. In this graph, Mary Meeker’s focus was more on the hyper-growth of Medicare/Medicaid – which basically went from 0% to 35% in about 45 years. It doesn’t take a proverbial Village to see this chart and that statistic as unsustainable. The companion chart was one that compared our healthcare results (as measured by Life Expectancy) to other countries using per capita cost per year. This too was eye-popping:

For those of us that have been tracking this over the years – no real surprises – these numbers don’t just arrive in a year. It takes a sustained effort to deliver this kind of appalling value – for this kind of money. Shocking? Clearly. Surprising? Not so much. No, the real, perhaps only question is – what’s causing this – and how do we really stop it? Of course this debate has raged for years – and is still ongoing. Lots of good politicking, teeth gnashing, jaw boning, turf protecting and food fighting. Hey – there’s lots of blame to pass around.

Finally, in March of 2010 – President Obama signed into law the Patient Protection and Affordable Care Act – or PPACA for short. We were told this was THE fix – or the best we could reasonably get. We were told that healthcare insurance was to blame. Profits were obscene and they had been denying coverage for “pre-existing” conditions. Insurance companies were inefficient accounting bureaucrats – that delivered no value. We were told that our system of “fee-for-service” was a system of sheer volume over value. We were told that 50 million uninsured was a major cause of higher insurance costs for everyone. All true – and all partially to blame. But were any of those really core, systemic issues – or were they, are they conveniently around the edges?

Now, for the first time, a leading healthcare clinician – the Chief Medical Officer of the American Cancer Society – Dr. Otis Webb Brawley is breaking ranks – literally and figuratively. His new book is squarely aimed at the Hippocratic oath and aptly titled – How We Do Harm: A Doctor Breaks Ranks About Being Sick In America. . . . the Editorial Reviews are noteworthy:

· “My friend and colleague Otis Brawley has written a raw and honest portrayal of our health care system. There are certain to be special interest organizations and medical groups that take issue with Dr. Brawley’s conclusions, but few can argue with the scientific rigor he has demonstrated in writing this book. Otis is the go-to oncologist I send so many patients to see, because he is not only a great doctor, but also a compassionate man. As we discuss the transformation of health care in this country, put Dr. Brawley’s book at the top of your list.” Sanjay Gupta, Associate Chief of Neurosurgery Grady Memorial Hospital, Chief Medical Correspondent, CNN

· “Otis Brawley is one of America’s truly outstanding physician scientists. In How We Do Harm, he challenges all of us– physicians, patients, and communities– to recommit ourselves to the pledge to ‘do no harm.’” David Satcher, Former Surgeon General of the United States, Director, Satcher Health Leadership Institute, Morehouse School of Medicine. . .

CNN provided coverage on the book’s release here – and had these direct quotes by Dr. Brawley:

· “There is often selective reading of the science, especially by those trained in a specialty wanting to advocate for it.”

· “Medical gluttony, the inappropriate use and overuse of medical treatment, is not just adding unnecessary cost to health care. It can actually be harmful to the individual.”

· “Health care providers and the public often overlook the emotional and financial conflicts of interest of health care professionals.”

The CNN article also recounted the story of a woman, Helen, who was diagnosed with early stage breast cancer. As was fairly common in the early 1990′s – surgery was followed by high doses of chemotherapy – and a bone marrow transplant. Quoting Dr. Brawley:

“The therapy Helen received was expensive and commonly given to women with breast cancer in the early 1990s. During this time, numerous women sued insurance companies who did not want to pay for the therapy and nearly a dozen states passed laws saying insurance companies had to pay for it.”

“There was one really good reason why the health insurers did not want to pay for high dose chemotherapy and bone marrow transplant for breast cancer: No study had ever been done to prove it beneficial.”

“Even without evidence, some patients and their doctors had faith that it worked. The procedure was common because some doctors taught that the transplant was beneficial to patients. Truth be told, it was very beneficial to the doctors and hospitals offering it.”

“By 1999, well after Helen had recovered, three well-designed clinical trials were completed. They showed that bone marrow transplant and high dose chemotherapy, a treatment now common for nearly a decade and a half, was not better than the standard therapy and there were indications it was more harmful.”

. . . All of this does suggest at least one more very large and systemic failing in our healthcare system. It also adds a new clinical term that I had not heard before. Medical gluttony.* Simply put, the healthcare system we have rewards expensive specialty care over primary preventative care. In order to reduce expensive specialty care – you have to add primary preventative care. I can’t help but agree with Dr. Brawley’s final prescription: “The cold hard reality is America does not need to reform health care, we need to transform health care.”

· Harriet A .Washington, author of Deadly Monopolies: The Shocking Corporate Takeover of Life Itself and the Consequences for Your Health and Our Medical Future and Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

MEDICALTUESDAY HAS USED THE TERM AND THE CONCEPT OF MEDICAL GLUTTONY FOR THE LAST 12 YEARS.

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Medical Gluttony thrives in Government and Health Insurance Programs.

It Disappears with Appropriate Deductibles and Co-payments on Every Service.

* * * * *

6. Medical Myths: Dying is painful.

This is something that is exploited by bureaucrats, politicians, and socialists. They act like patients are screaming in pain as they come to death’s door. It is better to euthanize them to avoid such pain. But I’ve never seen a patient in pain when he dies. They just quietly quit breathing and if you have your hand on their pulse, you can monitor the body shutting down as the pulse gets slower and slower until you can’t feel it any more. Then you can watch the hands and feet turn blue as well as their ears and mouth as the oxygen is used up. Then, if you are family or friend, you can give them a warm squeeze or earn a kiss.

I hear family members state that they thought their loved ones had just taken a nap and as they are leaving, they notice no breathing. It was all so quiet and peaceful. Just look at the obituary columns. There are fewer and fewer people dying in the hospitals, a terrible place to die. Sometimes there are so many wires, tubes and monitors that the loved ones can even get close to the patient in those precious final moments. What cruel way to leave this world with no one holding your hand. What a painful way to see your loved ones die when you cannot even touch them during their final hours or their final moments. And the guilt and grief you’ll experience for a long time when you realize that you didn’t even kiss them good-bye. This kind of guilt and grief may never go away—because there is no way to make amends as they lie in their graves returning to dust.

TAKE CARE OF YOUR DYING PARENT, SPOUSE OR LOVED ONES AT HOME WHENEVER YOU CAN.
IT’S THE ONLY KIND OF PARTING THAT IS NATURAL.
THIS TYPE OF GRIEF CAN FREQUENTLY TURN TO A JOYFUL MEMORY.

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Medical Myths originate in Hearsay.
Myths disappear when relatives spend time during those final days comforting their loved ones.

* * * * *

7. Overheard in the Medical Staff Lounge: Trump’s entry into a White House Run

Dr. Rosen: Donald Trump has entered the Presidential Race. Is he really a Republican?

Dr. Edwards: I don’t think he understands limitations in government.

Dr. Milton: He is for Single Payer Health Care. That would not be good for doctors, their patients, nor the current insurance companies.

Dr. Ruth: Wouldn’t he use the insurance companies to administer his program much like Medicare and CMS are doing now?

Dr. Michelle: It seems the insurance companies today are just implementing what CMS dictates.

Dr. Yancy: Insurance companies will become like paper tigers—no teeth, no moral restraints.

Dr. Sam: And physicians will become robots with the controls from Washington, D.C. via CMS.

Dr. Dave: And our patients will become brainless Pawns, to be manipulated in a cost-containment fashion, outmaneuvering the conservative watchdogs, without any moral turpitude.

Dr. Kaleb: Every country in the world is going through this same maize. As physicians we have to master these channels and navigate them better than politicians and their bureaucrats.

Dr. Patricia: But why should physicians have to play these games?

Dr. Rosen: Our colleagues from the UK at our meetings are quite open about their medical choices to circumvent political directives. On asking them, what’s new in Britain? They are very frank and say, their minister of the NHS this year has funded Asthma care, so we all get busy doing all the expensive allergy and pulmonary evaluation of our patients. The criteria become much looser in these situations with an open window to the Ministers favorite diseases since we know there is little review of their favorite diseases. Our colleagues think the NHS minister has asthmatics in his family.

Dr. Milton: A couple of years ago, emphysema was the favorite. He was on a cigarette rampage and so anything goes that is related to cigarette smoking.

Dr. Thomas: But that could go the opposite direction. If the Minister is so antismoking, he could just as easily state that it’s the patient’s fault. Why spend money on self-induced diseases?

Dr. Harold: With all this emphasis on aid in Dying, we could all just give these folks in lung failure some extra valium and in a few days they would be so sleepy that they couldn’t breathe. Wouldn’t that be a painless death?

Dr. Milton: And that would also make the undertakers happy and wealthy. Congress is less averse to making undertakers millionaires that they are to making doctors rich. They hate us.

Dr. Sam: Maybe we shouldn’t take all this so seriously. Why don’t we just play their game their way and beat them at it. I’m sure we are all smart enough to overspend on all the loopholes and bring the CMS to their knees as they go belly up. Actually, I think that would be fun.

Dr. Richard: It would also be tragic to destroy our healthcare system.

Dr. Harold: The politicians would just blame the doctors and the AMA would agree with them.

Dr. Sam: Didn’t Romney already do it by introducing Obamacare Light in Massachusetts? That made it a piece of cake for Obama.

Dr. Yancy: Don’t forget Gov. Christie of New Jersey closing the George Washington Bridge twice tainting his administration and his party. He’s clearly a RINO.

Dr. Edwards: Now we have a third RINO Donald Trump, former Democrat and large contributor to the Democratic Party. What will he do? What can he do?

Dr. Yancy: Well, he has promised to bring Hillary to justice. He’s the only Republican, even though he may be a RINO, who has the capability to do so.

Dr. Edwards: So what is a Democrat to do?

Dr. Yancy: Support Bernie, of course.

Dr. Sam: Good idea. I think Bernie would be easier to defeat than Hilary.

Dr. Yancy: At least that would eliminate the female prejudice. What do you think Ruth?

Dr. Ruth: I’m sorry to agree. Many women would vote to eliminate what they feel is the glass ceiling.

Dr. Patricia: I’ve always felt we were fortunate in Medicine. Our salaries are not gender based unless we women make it so by wanting less hours for what only women can do.

Dr. Michelle: If we are in private practice as most of us in the Doctor’s Lounge are, our income is based on the volume of work we do. I think that’s fair.

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

The Staff Lounge Is Where Unfiltered Opinions Are Heard.

* * * * *

8. Voices of Medicine: THE CATRASTROPHE

A Neurologist’s Notebook: THE CATASTROPHE

Spalding Gray’s brain injury

By Oliver Sacks, MD

THE NEW YORKER | April 27, 2015

In July of 2003, my neurological colleague Orrin Devinsky and I were consulted by Spalding Gray, the actor and writer who was famous for his brilliant autobiographical monologues, an art form he had virtually invented. He and his wife, Kathie Russo, had contacted us in regard to a complex situation that had developed after Spalding suffered a head injury, two summers earlier.

In June of 2001, they had been vacationing in Ireland to celebrate Spalding’s sixtieth birthday. One night, while they were driving on a country road, their car was hit head on by a veterinarian’s van. Kathie was at the wheel; Spalding was in the back seat, with another passenger. He was not wearing a seat belt, and his head crashed against the back of Kathie’s head. Both were knocked unconscious. (Kathie suffered some burns and bruises but no permanent harm.) When Spalding recovered consciousness, he was lying on the ground beside their wrecked car, in great pain from a broken right hip. He was taken to the local rural hospital and then, several days later, to a larger hospital, where his hip was pinned.

His face was bruised and swollen, but the doctors focused on his hip fracture. It was not until another week went by and the swelling subsided that Kathie noticed a “dent” just above Spalding’s right eye. At this point, X-rays showed a compound fracture of the eye socket and the skull, and surgery was recommended.

Spalding and Kathie returned to New York for the surgery, and MRIs showed bone fragments pressed against his right frontal lobe, though his surgeons did not see any gross damage to this area. They removed the fragments, replaced part of his skull with titanium plates, and inserted a shunt to drain away excess fluid.

He was still in some pain from his hip fracture, and could no longer walk normally, even with a braced foot (his sciatic nerve had been injured in the accident). Yet, strangely enough, during these terrible months of surgery, immobility, and pain, Spalding seemed in surprisingly good spirits—indeed, his wife thought he was “incredibly well” and upbeat.

Over Labor Day weekend of 2001, five weeks after his brain surgery, and still on crutches, Spalding gave two performances to huge audiences in Seattle. He was in excellent form.

Then, a week later, there was a sudden, profound change in his mental state, and Spalding fell into a deep, even psychotic, depression.

Now, two years after the accident, on his first visit to us, Spalding entered the consulting room slowly, carefully lifting his braced right foot. Once he was seated, I was struck by his lack of spontaneous movement or speech, his immobility and lack of facial expression. He did not initiate any conversation, and responded to my questions with very brief, often single-word, answers. My first thought, and Orrin’s, was that this was not simply depression, or even a reaction to the stress and the surgeries of the past two years—to my eye, it clearly looked as if Spalding had neurological problems as well.

When I encouraged him to tell me his story in his own way, he began—rather strangely, I thought—by telling me how, a few months before the accident, he had had a sudden “compulsion” to sell his house in Sag Harbor, which he loved and in which he and his family had lived for five years. He and Kathie agreed that the family needed more room, so they bought a house nearby, with more bedrooms and a bigger yard. Nonetheless, Spalding had resisted selling the old house, and they were still living in it when they left for Ireland.

It was while he was in the hospital in Ireland following his hip surgery, he told me, that he finalized a deal to sell the old house. He later came to feel that he was “not himself” at the time, that “witches, ghosts, and voodoo” had “commanded” him to do it.

Even so, despite the accident and the surgeries, Spalding remained in high spirits during the summer of 2001. He felt full of new ideas for his work—the accident, even the surgeries, would be wonderful material—and he could present them in a new performance piece, entitled “Life Interrupted.”

I was struck, and perhaps disquieted a little, by the readiness with which Spalding was prepared to turn the horrifying events of the summer to creative use. Yet I could also understand it, because I had not hesitated, in the past, to use some of my own crises as material in my books.

Indeed, using one’s own life (and sometimes others’ lives) as material is common among artists—and Spalding was a very special sort of artist. . . He wondered sometimes if he did not create crises just for material—an ambiguity that worried him. Had he sold his house as “material”?

One of the special features of Spalding’s monologues was that, onstage at least, he rarely repeated himself; the stories always came out in slightly different ways, with different emphases. He was a gifted inventor of the truth, of whatever seemed true to him at the moment. . .

Ever since, Kathie told me, Spalding had been sunk in depressive, obsessive, angry, guilty rumination about selling the house. Nothing could distract him from it. Scenes and conversations about the house replayed incessantly in his mind. All other matters seemed to him peripheral and insignificant. Previously a voracious reader and a prolific writer, he now felt unable to read or write.

Spalding had had occasional depressions, he said, for more than twenty years, and some of his physicians thought that he had a bipolar disorder. But these depressions, though severe, had yielded to talk therapy, or, sometimes, to treatment with lithium. His current state, he felt, was different. It had unprecedented depth and tenacity. He had to make a supreme effort of will to do things like ride his bicycle, which he had previously done spontaneously and with pleasure. He tried to converse with others, especially his children, but found it difficult. His ten-year-old son and his sixteen-year-old stepdaughter were distressed, feeling that their father had been “transformed” and was “no longer himself.”. . .

In September of 2002, Spalding jumped off his sailboat into the harbor, planning to drown himself (he lost his nerve and clung to the boat). A few days later, he was found pacing on the Sag Harbor bridge, eying the water, until the police intervened and Kathie took him home.

Soon after this, Spalding was admitted to the Payne Whitney Psychiatric Clinic, on the Upper East Side. He spent four months there, and was given more than twenty shock treatments and drugs of all kinds. He responded to none of them, and, indeed, seemed to be getting worse by the day. When he emerged from Payne Whitney, his friends felt that something terrible and perhaps irreversible had happened. Kathie thought that he was “a broken man.”. . .

In July, when Spalding first came to see Orrin and me, I asked him if there were any other themes besides the sale of his house that he ruminated about. He said yes: he often thought about his mother and the first twenty-six years of his life. It was when he was twenty-six that his mother, who had been intermittently psychotic since he was ten, fell into a self-torturing, remorseful state, focused on the selling of her family house. Unable to endure her torment, she had committed suicide.

In an uncanny way, he said, he felt that he was recapitulating what had happened with his mother. He felt the attraction of suicide and thought of it constantly. He said he regretted not having committed suicide at the U.C.L.A. hospital. Why there? I inquired. Because one day, he replied, someone had left a large plastic bag in his room—and it would have been “easy.” But he was pulled back by the thought of his wife and his children. Nevertheless, he said, the idea of suicide rose “like a black sun” every day. He said the past two years had been “gruesome,” and added, “I haven’t smiled since that day.” . . .

There was a brief, dramatic break in Spalding’s rumination just a week before he came to see us, when he had to have surgery because one of the titanium plates in his skull had shifted. The operation took four hours, under general anesthesia. Coming to from the anesthesia and for about twelve hours afterward, Spalding was his old self, talkative and full of ideas. His rumination and hopelessness had vanished—or, rather, he now saw how he could use the events of the past two years creatively in one of his monologues. But by the next day this brief excitement or release had passed. . .

But the frontal lobes also exert an inhibiting or constraining influence on what Pavlov called “the blind force of the subcortex”—the urges and passions that might overwhelm us if left unchecked. (Apes and monkeys, like children, though clearly intelligent and capable of forethought and planning, are relatively lacking in frontal lobes, and tend to do the first thing that occurs to them, rather than pausing to reflect. Such impulsivity can be striking in patients with frontal-lobe damage.) There is normally a beautiful balance, a delicate mutuality, between the frontal lobes and the subcortical parts of the brain that mediate perception and feeling, and this allows a consciousness that is free-ranging, playful, and creative. The loss of this balance through frontal-lobe damage can “release” impulsive behaviors, obsessive ideas, and overwhelming feelings and compulsions. Were Spalding’s symptoms a result of frontal-lobe damage or severe depression, or a malignant coupling of the two?

Frontal-lobe damage can lead to difficulties with attention and problem-solving, and impoverishment of creativity and intellectual activity. Although Spalding felt that he had not had any intellectual deterioration since the accident, Kathie wondered whether his unceasing rumination might not, in part, be a “cover” or “disguise” for an intellectual loss that he did not want to admit. Whatever the case, Spalding felt that he could no longer achieve the high creative level, the playfulness and mastery, of his pre-accident performances—and others felt this, too. . .

January 10, 2004, Spalding took his children to a movie. It was Tim Burton’s “Big Fish,” in which a dying father passes his fantastical stories on to his son before returning to the river, where he dies—and perhaps is reincarnated as his true self, a fish, making one of his tall tales come true.

That evening, Spalding left home, saying he was going to meet a friend. He did not leave a suicide note, as he had so often before. When inquiries were made, one man said he had seen him board the Staten Island Ferry.

Two months later, Spalding’s body was washed up by the East River. He had always wanted his suicide to be high drama, but in the end he said nothing to anyone; he simply disappeared from sight and silently returned to the sea, his mother. ♦

Read Dr. Oliver Sacks’ entire medical narrative of Spalding Gray’s frontal lobe injury in The New Yorker, April 27, 2015. . .

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about

* * * * *

9. Book Review: Being Mortal

“Being Mortal: Medicine and What Matters in the End.”

By Atul Gawande, MD, Brigham and Women’s Hospital

Professor of Surgery, Harvard School of Public Health

Reviewed By SHERI FINK | NYT | NOV. 6, 2014

It began with a tingle in the surgeon’s fingers and a pain in his neck. A couple of years later, he learned he had a tumor inside his spinal cord. That was when the difficult choices began. Should he have it removed right away in a risky operation, as his doctor recommended? Or should he take time to consider this question: At what point would the expanding tumor cause debility bad enough to justify the risk of greater debility or even death in trying to fight it?

The surgeon in the story is the father of Atul Gawande, who is also a surgeon as well as a writer for The New Yorker. His new book, “Being Mortal,” is a personal meditation on how we can better live with age-related frailty, serious illness and approaching death.

It is also a call for a change in the philosophy of health care. Gawande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is “to enable well-being.”

If that sounds vague, Gawande has plenty of engaging and nuanced stories to leave the reader with a good sense of what he means. In a society that values independence, what happens when that is no longer possible? We need to reckon with the reality of the body’s eventual decline, he argues, think about what matters most to us, and adapt our society and medical profession to help people achieve that.

Gawande writes: “For many, such talk, however carefully framed, raises the specter of a society readying itself to sacrifice its sick and aged. But what if the sick and aged are already being sacrificed — victims of our refusal to accept the inexorability of our life cycle?”

Medical professionals are the ones who are largely in control of how we spend our “waning days,” he writes, yet they are focused on disease, not on living. “Medicine has been slow to confront the very changes that it has been responsible for — or to apply the knowledge we have about how to make old age better.” The experts quoted here argue that doctors should not only treat disease but also concern themselves with people’s functional abilities, and that most medical trainees should learn about geriatrics.

In the first part of the book, Gawande explores different models of senior living — from multigenerational households to newfangled nursing homes. In the latter part, which is shorter, he shifts somewhat abruptly to end-of-life medicine, promoting hospice as a model of care. . .

“Being Mortal” is a valuable contribution to the growing literature on aging, death and dying. It contains unsparing descriptions of bodily aging and the way it often takes us by surprise. Gawande is a gifted storyteller, and there are some stirring, even tear-inducing passages here. . .

The stories give a dignified voice to older people in the process of losing their independence. We see the world from their perspective, not just those of their physicians and worried family members.

One of his most provocative arguments is that hard-won health and safety reporting requirements for elder care facilities might satisfy family members, but ignore what really matters to the residents in question. Despite the popularity of the term assisted living, “we have no good metrics for a place’s success in assisting people to live,” Gawande argues. A life of safety isn’t the life most people really want for themselves. . .

In the last part of the book, Gawande argues against the treatment-at-all-costs model that once prevailed in medicine. “People with serious illness have priorities besides simply prolonging their lives,” he writes. “If your problem is fixable, we know just what to do. But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity and extraordinary suffering.” . . .

Gawande offers a succinct discussion of euthanasia at the end of the book. “The debate is about what mistakes we fear most — the mistake of prolonging suffering or the mistake of shortening valued life.” He critiques end-of-life policy in the Netherlands, calling the fact that so many Dutch people seek assisted suicide “a measure of failure. Our ultimate goal, after all, is not a good death but a good life to the very end.” He questions whether the Dutch have been slow to develop palliative care programs because “their system of assisted death may have reinforced beliefs that reducing suffering and improving lives through other means is not feasible when one becomes debilitated or seriously ill.” . . .

Sheri Fink, the author of “Five Days at Memorial,” is a reporter at The Times.

Read the entire book review . . .

Also reviewed in The New Yorker, May 11, 2015

To read more book reviews . . .

To read book reviews topically . . .

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

The Book Review Section Is an Insider’s View of What Doctors are Reading and Writing about.

* * * * *

10. Hippocrates & His Kin: The IRS Bounce

Many Americans call the IRS to verify if a cost is deductible. The IRS hung up on 8 million citizens this tax season. Did this prevent many citizens from making a legitimate deduction to reduce their taxes and IRS found a new revenue source? Or did many citizens then take the deduction anyway and gamble on a reduction of their taxes hoping not to be audited?

What a crap shoot for our federal budget!

The MediCal Bounce

In California, you quality for MediCal if you make up to 138% of the Federal Poverty Level or about $16,200 for an individual. If you make between 138% and 400% of the FPL, you qualify for Covered California, a subsidized health insurance plan from Obama’s Health Insurance Exchange. California has about 12 million in MediCal and 14 million in Covered California. One recurring complaint is “Falling Off of MediCal” and having to start all over again.

But many are finding that they can’t bounce high enough to regain entry.

To read more HHK . . .

To read more HMC . . .

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

* * * * *

11. Words of Wisdom, Recent Postings, Today in History . . .

Words of Wisdom

Welcome to managed care: What the Public Health Doctor fails to prevent, the Private Doctor tries to cure; what the Private Doctors fails to cure, the Specialist tries to improve; what the Specialist fails to improve, the Mortician beautifies.

Welcome to Managed Care: Healthcare managed by business school Ph. D.’s to save bucks and fill their coffers, rather than by medical school M.D.’s to save lives and heal their coughers.

We’re all going to die. Getting there, of course, is half the fun. It should be all the fun, but life, especially in this century, has become a killjoy. Until recent years, American Medicine had greatly enhanced our ability to reach three score years and ten in reasonably good shape and in pretty good humor. Then came Managed Care, the prospect of an untimely death suddenly became, if not attractive, certainly more cost-effective.

Some Recent Postings

In the April issue:

1. Featured Article: Doctors and nurses vs. administrators on patient satisfaction.

2. In the News: 1.5 Million Missing Black Men

3. International Medicine: Canadian Medicare isn’t really free.

4. Medicare: One-third of Doctors Reject Medicaid

5. Medical Gluttony: Health Insurance without Copayments

6. Medical Myths: Healthcare is expensive

7. Overheard in the Medical Staff Lounge: Gender Dysphoria

8. Voices of Medicine: Sham Peer Review—Infusing Staph in a patient to get rid of the Dr.

9. The Theater: Let There be Love

10. Hippocrates & His Kin: Uncle Willy’s Willy

11. Restoring Accountability in Medical Practice, Healthcare, Government and Society

12. Words of Wisdom, Recent Postings, Today in History

* * * * *

12. In Memoriam: Dr. James Jude, Who Helped Develop Use of CPR, Dies at 87

Dr. James Jude, a thoracic surgeon whose recognition that external manual pressure could revive a stalled heart, and who used that insight to help develop the lifesaving technique now known as cardiopulmonary resuscitation, or CPR, died on Tuesday at his home in Coral Gables, Fla. He was 87.

In the late 1950s, Dr. Jude was a resident at the Johns Hopkins University School of Medicine in Baltimore, experimenting with induced hypothermia as a way to stop blood flow to the heart by cooling it down and allowing surgical procedures to be performed without fatal loss of blood.

In experiments with rats, he found that hypothermia often caused cardiac arrest, a problem that two electrical engineers down the hall were addressing in experimental work on dogs, using a defibrillator to send electrical shocks to the heart. William Kouwenhoven, the inventor of a portable defibrillator, and G. Guy Knickerbocker, a doctoral student, had seen that the mere weight of the defibrillator paddles stimulated cardiac activity when pressed against a dog’s chest.

Dr. Jude immediately saw the potential for human medicine and began working with the two men.

In July 1959, when a 35-year-old woman being anesthetized for a gall bladder operation went into cardiac arrest, Dr. Jude, instead of using the standard technique of opening the chest and massaging the heart directly, applied rhythmic, manual pressure.

“Her blood pressure came back at once,” he recalled. “We didn’t have to open up her chest. They went ahead and did the operation on her, and she recovered completely.”

In 1960, the three partners published an article in The Journal of the American Medical Association, “Closed-Chest Cardiac Massage,” reporting that when the technique was used on 20 patients, ranging in age from 20 months to 80 years, 14 of them resumed normal heart function.

“Anyone, anywhere, can now initiate cardiac resuscitative procedures,” the authors concluded. “All that is needed is two hands.”

Cardiac massage evolved into CPR when Dr. Jude and his team collaborated with doctors at Baltimore City Hospital (now Johns Hopkins Bayview Medical Center) who had been working on pulmonary resuscitation, a noninvasive method of restoring lung function. Neither team had known what the other was up to, but when the two were brought together, their techniques were combined to create what they called “heart-lung resuscitation.”

The American Heart Association, which formally accepted the technique in 1963, renamed it cardiopulmonary resuscitation, believing that term to sound more professional.

Dr. Jude became a missionary for CPR, appearing before medical groups around the country to explain the benefits of the technique, which was gradually adopted by fire departments, police departments, paramedical services and hospitals around the world. . .

After helping develop CPR and serving as an attending surgeon and professor of medicine at Johns Hopkins, Dr. Jude was a professor of surgery and chief of thoracic and cardiovascular surgery at the University of Miami School of Medicine and Jackson Memorial Hospital in Miami. There, he and several colleagues outfitted some of the first mobile cardiac units and trained paramedics in CPR. In 1971, he went into private practice, from which he retired in 2000.

He was the author of “Closed Chest Cardiac Resuscitation: Methods, Indications, Limitations,” published by the American Heart Association in 1966, and the co-author, with James O. Elam, of “Fundamentals of Cardiopulmonary Resuscitation” (1967). He was also a co-author of “Coping with Heart Surgery and Bypassing Depression” (1991). . .

“It was just serendipity — being in the right place at the right time and working on something for which there was an obvious need,” he told the alumni newsletter of the University of St. Thomas in 1984. “Things like that happen in medicine all the time.”

Read the entire obituary in The New York Times . . .

13. Restoring Accountability in Medical Practice, HealthCare, Government and Society:

• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports.

• Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog.

• The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government.

• To read the rest of this column, please go to www.medicaltuesday.net/org.asp.

• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis.

• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section.

• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter 75 years ago. Be sure to read the current lesson on Economic Education.

• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today.

• CATO. The Cato Institute (www.cato.org) was founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio, articles and books at www.cato.org/people/cannon.html.

• The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business.

• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels.

• Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.

• The Heartland Institute, www.heartland.org, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?

• The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse."

• The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter.

• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission was to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, and was used by some as a justification for the Obama plan, they have lost sight of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions.

• The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, wartime allows the federal government to grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St. Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in wartime, we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com.

• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17^th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. Choose recent issues. The last ten years of Imprimis are archived.

• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

• FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser’s view on today’s health care problem: In today’s proposals for sweeping changes in the field of medicine, the term “socialized medicine” is never used. Instead we hear demands for “universal,” “mandatory,” “singlepayer,” and/or “comprehensive” systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this “nationalized financing” or “nationalized health insurance.” In a more honest day, it was called socialized medicine.

• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD. To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.

• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.

• The AAPS California Chapter is an unincorporated association made up of members. The Goal of the AAPS California Chapter is to carry on the activities of the Association of American Physicians and Surgeons (AAPS) on a statewide basis. This is accomplished by having meetings and providing communications that support the medical professional needs and interests of independent physicians in private practice. To join the AAPS California Chapter, all you need to do is join national AAPS and be a physician licensed to practice in the State of California. There is no additional cost or fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .

Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"

• PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.

Our motto, "omnia pro aegroto" means "all for the patient."

On This Month in History – July

July 1, is Freedom Day. Many nations—including our own—gained their freedom during this particular month of the year. Canada became a self-governing British dominion on this day in 1867. France had its first revolution on July 14. Nations such as Algeria, Argentina, Colombia, Belgium, Peru, Liberia and Venezuela also gained self-government and freedom during this month.

On July 4, 1776, the men who signed the Declaration of Independence said and meant it literally, that “we mutually pledge to each other our lives, our fortunes, and our sacred honor.” Two of men who signed the Declaration of Independence died years later on exactly the same day in 1826. President Thomas Jefferson and President John Adams—whose lives were so closely intertwined in both destiny and friendship—died fifty years to the day after they signed the Declaration of Independence. And five years later, President James Monroe—author of the Monroe Doctrine—passed away in 1831. In 1872, future president Calvin Coolidge was born in Plymouth, Vermont.

July 1, is the anniversary of the three-day Battle of Gettysburg, a confrontation that took place in 1863. President Lincoln said we must remember this battle so that from its honored dead “we take increased devotion to that cause for which they gave the last full measure of devotion.” In the larger sense, their cause was to fight for what Lincoln described as a “government of the people, by the people, for the people [that] shall not perish from the earth.”

After Leonard and Thelma Spinrad

Thank you for joining the MedicalTuesday.Network and Have Your Friends Do the Same. If you receive this as an invitation, please go to www.medicaltuesday.net/Newsletter.asp, enter you email address and join the 10,000 members who receive this newsletter. If you are one of the 80,000 guests that surf our web sites, we thank you and invite you to join the email network on a regular basis by subscribing at the website above. To subscribe to our companion publication concerning health plans and our pending national challenges, please go to www.healthplanusa.net/newsletter.asp and enter your email address. Then go to the archives to scan the last several important HPUSA newsletters and current issues in healthcare.

Please note that sections 1,2,4,& 8 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. We respect copyright as exemplified by George Helprin who is the author, most recently, of “Digital Barbarism,” just published by HarperCollins. We hope our highlighting articles leads to greater exposure of their work and brings more viewers to their page. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.

ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.

Spammator Note: MedicalTuesday uses many standard medical terms considered forbidden by many spammators. We are not always able to avoid appropriate medical terminology in the abbreviated edition sent by e-newsletter. (The Web Edition is always complete.) As readers use new spammators with an increasing rejection rate, we are not always able to navigate around these palace guards. If you miss some editions of MedicalTuesday, you may want to check your spammator settings and make appropriate adjustments. To assure uninterrupted delivery, subscribe directly from the website rather than personal communication: www.medicaltuesday.net/newsletter.asp. Also subscribe to our companion newsletter concerning current and future health care plans: www.healthplanusa.net/newsletter.asp

Del Meyer

Del Meyer, MD, Editor & Founder

DelMeyer@MedicalTuesday.net

www.MedicalTuesday.net

6945 Fair Oaks Blvd, Ste 2, Carmichael, CA 95608

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, any single payer initiative, Social Security was born for the benefit of the state and of a contemptuous disregard for people’s welfare.

We must also remember that ObamaCare has nothing to do with appropriate healthcare; it was similarly projected to gain loyalty by making American citizens dependent on the government and eliminating their choice and chance in improving their welfare or quality of healthcare. Socialists know that once people are enslaved, freedom seems too risky to pursue.

MEDICAL TUESDAY. NET	NEWSLETTER
Community For Better Health Care	Vol XIV, No 7, July, 2015