1.
Featured Article:
An Unfortunate Blight on American Medicine
2.
In the News:
Jailing of Tuberculosis Patient Sparks Debate
3.
International
Medicine: NHS May Be Restricted to Core Services
4.
Medicare: What Does
"Medicare for All" Really Mean?
5.
Medical Insurance
Gluttony: Blue Cross Cancellations Called Illegal
6.
Medical Myths: ICD9
Codes Are Necessary to Deliver Appropriate Health Care
7.
Overheard in the
Medical Staff Lounge: Physician-Assisted Suicide - A Worldwide Tragedy
8.
Voices of Medicine:
The Cost of
Medicine and Reimbursement
9.
From the Physician
Patient Bookshelf: Is the White
Plague Coming Back?
10.
Hippocrates &
His Kin: In God We Trust. All Others We Scan for Viruses.
11.
Related
Organizations: Restoring Accountability in Medical Practice and Society
MOVIE EXPLAINING
SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE
Logan Clements,
a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the
truth about socialized medicine. Clements' strategy is to release the
documentary this summer on the same day that Michael Moore's pro-socialized
medicine movie "Sicko" is released. This movie can only be made
in time if Clements finds 200 doctors willing to make a tax-deductible donation
of $5K each. Clements is also seeking American doctors willing to perform
operations for Canadians on wait lists. Clements is the former publisher
of "American Venture" magazine who made news in 2005 for a property
rights project against eminent domain called the "Lost Liberty
Hotel."
For more
information visit www.sickandsickermovie.com or email logan@freestarmovie.com.
* * * * *
1.
Featured Article:
The Psychology of Sham Peer Review, JPS Editorial by Lawrence R. Huntoon, MD, PhD
As sham peer
review has spread across the nation, it has left behind a trail of broken and
ruined lives and careers of good physicians. Although each case is unique,
there are certain common features underlying the psychology of sham peer
review.
Psychology of the Sham Peer Review Process
Sham peer
review is a premeditated process that begins long before the actual sham peer
review hearings and formal proceedings. It begins in the minds of those who set
out to destroy a targeted physician. Improper motives, having nothing to do
with furthering quality care, drive the process.
The process
of sham peer review frequently involves a progressive series of small attacks
leading up to a final formal proceeding designed to end the targeted
physician's medical career. Sometimes
these trial runs may go unnoticed or seem insignificant to the targeted
physician. Meanwhile, the hospital often secretly collects, compiles, and even
solicits documentation to be used in the final attack at a later date.
The final
attack (formal sham peer review proceeding) is often well planned and well
choreographed so as to give the appearance of a legitimate, good-faith peer
review action. The appearance of due process and fundamental fairness is given
top priority, although substantive due process and fundamental fairness are
always lacking in sham peer review. To read more,
please go to www.medicaltuesday.net/index.asp.
Psychology of the Attackers
Although
there are some cases in which one or a few participants in the sham peer review
proceedings are lazy and negligent and simply defer to the leaders of the
attack in casting their vote against the targeted physician, in most instances
those who participate in the sham proceedings know exactly what is going on.
The
psychology of the attackers is a combination of the psychology of bullies and
that of the lynch mob. The attacks are typically led by one or a few bullies
who have gained positions of power over others and who enjoy exercising and
abusing that power to attack and harm the vulnerable. Although there is always
some improper motive that precipitates the attack, the attack itself often
serves to distract attention from the bully's own underlying shortcomings,
deficiencies, insecurities, and cowardice.
Sham peer
review is by nature a group effort involving collaboration between unethical
hospital administrators and unethical physician attackers. The psychodynamics
involve both the excitement of the hunt and the raw power of the lynch mob that
often develops a life of its own, leading to actions that individuals would
likely not take if acting alone. It is the psychology of predators versus prey.
Others are drawn into the group hunt via the same type of macabre attraction
that often compels people to turn their heads and gawk as they drive slowly by
the car wreck, looking for any sign of mangled or dead bodies.
The power to
snuff out the career and livelihood of a fellow physician in the blink of an
eye provides a certain pathological satisfaction and excitement for some
attackers. To share in the "group hunt" is to share in some of the
power and excitement. And the nearly absolute immunity the attackers enjoy
under the Health Care Quality Improvement Act (HCQIA) and the doctrine of
judicial nonintervention further emboldens and enhances the power of the
attackers.
Psychology of the
Physician Victim
Facing
superior power and numbers, the targeted physician soon understands that he is
the prey and the hunt is on. The final attack is often unleashed quite suddenly
and with great fury. The resultant shock and awe often causes a sudden loss of
energy and a mental numbness that impairs the physician victim's ability to
defend himself effectively. This often further excites the predators as the
deer stands motionless, caught in the headlights.
Shock and
awe is followed quickly by denial and disbelief. This is frequently accompanied
by a strong belief that the truth will save the victim and set him free.
Meanwhile, the stigma attached to mere allegations of wrongdoing produces an
intended isolation of the targeted physician. As a result, the physician victim
often shuns contact with colleagues, further assisting the predators in cutting
the prey out from the herd in preparation for the kill.
At this
stage, alone and isolated, facing almost certain demise, extreme fear sets in.
How will the physician provide for his spouse and children? How will he cope
with the bills that are mounting up now that the attack has stopped cash flow?
How will he survive?
Constantly
living in an adrenaline-soaked fight-or-flight state further depletes the
victim's energy and is often accompanied by significant depression, complete
with severe sleep disturbance (too much or too little), weight loss, and a
pervasive feeling of helplessness and hopelessness. The risk of "death by
stress" or suicide is very real at this stage.
Anger
emerges as the physician victim comes to recognize that the truth and the facts
do not matter at all in sham peer review since the proceedings are rigged and
the outcome predetermined. The procedural presumption is that the physician is
"guilty" and the burden is shifted to the physician to prove his
innocence—a burden that the attackers will never allow him to meet. Anger is
often accompanied by a consuming desire to hold the attackers accountable for
their evil deeds. This not infrequently leads to many years of litigation,
further depleting the victim's energy and resources, and consuming the lives of
the ruined physician and his family.
Chronic fear
and anger often take a heavy toll on the physician's physical and mental
well-being, and on his relationship with family and others. The resulting
downward spiral often leaves the physician devastated, still alive physically,
but invisible or "dead" to former colleagues and to the profession of
medicine. It is a cold and lonely pit that no one could have envisioned upon
entering the profession of medicine.
Psychology of the Enablers
Enablers are
those physician bystanders who are aware that the sham peer review attack is
taking place, but who stand by and do nothing to object or to stop it. It is
the psychology of the herd that stands placidly by while one of its own is cut
out from the herd and killed. Enablers are like the timid sheep who huddle
close together, keeping their heads down, in the hope and belief that the
predator's appetite will be satisfied with the "kill," leaving the
rest of the herd to graze in peace.
In many
instances, a few vocal physician bystanders may be all that it would take to
stop the bully's attack. Expressing objections to individual physicians could
also destroy the psychodynamics that impel a lynch mob.
Although bullies
who launch vicious attacks against physician colleagues may be beyond
redemption, renewal of professional ethics through education, and urging of the
physician bystanders to get involved, may help to stop the spread of sham peer
review. It may be the only hope.
Unless
ethical physicians stand up and object, and hold the unethical physicians
accountable for their actions, the spreading moral malignancy of sham peer
review will irreparably harm patient safety, medical excellence, and the
integrity of the medical profession.
Lawrence R.
Huntoon, M.D., Ph.D., is a neurologist practicing in New York and serves
as Chairman of the AAPS Sham Peer Review Committee. www.jpands.org/jpands1201.htm
To read a press report, go to www.louisianamedicalnews.com/news.php?viewStoryPrinter=934.
For more reading on this important topic, please click
on the following:
Hippocrates Modern Colleagues, www.delmeyer.net/HMCPeerRev.htm.
Center Peer Review Justice Inc, www.peerreview.org, Dr Richard B Willner, President.
Semmelweis Society International Annual Meeting, May 13-15, 2007, Washington D.C. The agenda can be
found at www.semmelweis.org/. Also, see the Semmelweis Society for extensive Peer
Review and Whistleblower retaliation at www.Semmelweissociety.net.
* * * * *
2. In The News: Jailing of Tuberculosis Patient Sparks
Debate
A 27-year-old man in Phoenix is locked in a jail cell
with negative-pressure ventilation, perhaps for life, because he failed to heed
doctors' instructions to wear a mask in public. He is infected with an
extensively drug resistant strain of tuberculosis, XDR-TB, which is considered
virtually untreatable.
He told the Associated Press he was treated worse than
a jail inmate, kept all alone inside four walls. He said he had not even seen
his own reflection in months.
Only one other person has been detained in Phoenix in
the past year. Texas has placed 17 patients in the past year in an involuntary
detention facility in San Antonio.
XDR-TB is apparently a new strain that is found
throughout the world, including pockets in the former Soviet Union and Asia.
In the U.S., there were a total of 13,767 cases of
tuberculosis reported in 2006 (Arizona Daily Star 4/3/07). To read more, please go to www.medicaltuesday.net/news.asp.
According to a report from the Pima County Health
Department to the Public Health Committee of the Pima County Medical Society,
the case rate in Arizona, which ranks 11th in tuberculosis morbidity
nationwide, rose to 5.0 per 100,000 in 2006, a 9% increase, after declining
from 7.2/100,000 in 1995 to 4.6/100,000 in 2005. Foreign-born individuals
accounted for 57% of the 2006 cases, and 67% of the infected foreign-born
individuals were from Mexico.
Legal immigrants are screened in their country of
origin as long as 2 years before entry. The proportion of the problem
attributable to illegal aliens is not known.
Arizona has the highest percentage of tuberculosis
cases diagnosed in correctional facilities. Forty percent of all inmates in
Arizona detention centers are Mexican nationals who entered illegally (Newsmax.com 3/15/07).
A pilot project by the Arizona Department of Health
Services found the Arizona Department of Corrections to be mostly in compliance
with the pertinent recently revised rules.
www.cdc.gov/mmwr/preview/mmwrhtml/mm5511a2.htm
http://jama.ama-assn.org/cgi/content/full/296/23/2792
www.who.int/tb/xdr/faqs/en/print.html
Additional information:
·
"Illegal
Aliens and American Medicine," by
Madeleine Pelner Cosman, J Amer Phys Surg, Spring 2005.
·
Before the antibiotic
age, radiation therapy was used for many infectious diseases, including
"glandular tuberculosis," with the most impressive results seen in
gas gangrene. When antibiotics became available, this treatment fell completely
out of favor. In a patient who otherwise faces life imprisonment and early
death, cautious consideration might be given to older modes of therapy. See:
Kelly JF, Dowell DA. Roentgen Treatment of Infections. Chicago, Ill.:
Year Book Publishers; 1942. Also Berk LB, Hodes PJ. Roentgen therapy for
infections: an historical review. Yale J Biol Med 1991;64:155-165.
* * * * *
3.
International
Medicine: NHS May Be
Restricted to Core Services by Nicholas Timmins, www.FT.Com, March 20, 2007
The prospect that the National Health Service might provide
only core 198 services, with patients forced to pay for any other treatment or
meet it from private insurance, was raised by the government yesterday.
News that ministers were examining the possibility of
defining the services that the NHS is obliged to provide free to everyone was
disclosed in the small print of the public services policy review launched
yesterday by Tony Blair, the prime minister, and Gordon Brown, the chancellor.
It says the government should "look at the
possibility of drawing up a package of services that all users are entitled
to". NICE, the National Institute for Health and Clinical Excellence,
could be asked to do that.
The health
department confirmed it was "looking at the possibility in the normal
process of policy development" and agreed that deciding what everyone was
entitled to would also involve deciding "what they are not entitled to.". . . To
read more, please go to www.medicaltuesday.net/intlnews.asp.
Anna Dixon, deputy director of policy at the King's
Fund think-tank, and a specialist on international health systems, said:
"It sounds like establishing a core package of benefits that the NHS will
fund – and that is something that has long been debated in academic circles.
But politicians. . . have always shied
away from being more explicit about entitlements."
Social insurance systems tended to be much more
explicit about what was and was not covered, with private insurance markets
developing to cover excluded treatments, she said.
Tub she warned that when lists of exclusions were
drawn up, "they often do not feel right to the public". It was
"a very difficult exercise" and one that, if undertaken, "is
going to be very controversial".
To read more as well as other Nicholas Timmons
articles, (subscription required) please go to http://search.ft.com/search?queryText=Nicholas+Timmins&aje=true&dse=&dsz=&x=15&y=6.
The NHS does not give timely
access to healthcare, it only gives access to a waiting list.
After 60 years of reworking
the NHS, the entitlement is getting smaller.
Can governments ever admit
to making a mistake in the original plan?
* * * * *
4. Medicare: What Does "Medicare for All" Really Mean?
John Edwards
Will Give You Free Health Care, By William F.
Buckley Jr., NR Editor-at-Large.
The word among professional Democrats is that John Edwards
has set the stakes on the matter of health care, and no one who wants to be
president can offer less than he is offering, which is — of course — guaranteed
health. That is to say, guaranteed free health care.
Mr. Edwards's primary complaint is that 47 million
Americans do not have health insurance. In a free society, one scans this datum
in search of its component parts.
If health insurance were without cost, one assumes
that everyone would have health insurance. A corollary of this is that everyone,
in a society of allegedly free health care, would actually be paying the
collective costs of health care. The political challenge lies in disguising the
cost. To read more, please go www.medicaltuesday.net/medicare.asp.
When a commodity is quantifiably measurable, yet
universally available, like air, one can talk about its being "free."
Only people in submarines need to measure air, and to pay the cost of supplying
it. Health care, unlike air, can't be free, because doctors and nurses and
drugs are not in infinite supply. So can we generate what amounts to a public
subsidy by reducing the costs of
health care?
To look that problem in the face, we search out
relevant figures. One set of these reveals that the cost of health care for an
American is twice what it is for a Western European. If in Germany it costs
$100 per day per patient at a hospital, while a comparable hospital stay in the
United States costs $200, one reaches for an explanation. Is it that American
health care is twice as expensive because it is twice as comprehensive, twice
as resourceful? Or is it simply that, for other reasons, doctors and nurses and
drugs cost twice as much in the United States?
In any case, how do we go about reducing these costs?
Either you pass a law that doctors and nurses and drug companies have to slash
the cost of their services and products by one-half — a proposal nowhere hinted
at by Mr. Edwards — or else we need to reduce the number of people entitled to
receive that health service. How do you do that?
Not by going in the direction proposed by Candidate
Edwards, but by going in the opposite direction. His proposal is that more
people should be covered. But if more people are insured, they will increase their
consumption of health care, and therefore increase the total U.S. expenditure
on health care.
But John Edwards calls for something different — a
fiscal frumpery by which the cost of health care is somehow dissipated. This is
done by obscuring the agent by which health care is provided. It has frequently
been noticed by social philosophers that from about 1943, when income taxes
were first collected so to speak at the source, via withholding, the average
worker does not think of himself as being taxed — because the instrument by
which the money is taken is so automatic as to be more or less invisible. . .
Mr. Edwards speaks grandly about health coverage for
47 million people who do not now have it. But unless there is a diminution in
the cost of health services, they will be paid for by somebody. If it is so
that the 47 million without insurance are the identical 47 million who are the
nation's poorest, then it might be said that all we are really engaging in is
more redistribution. There is a case to be made for this, and indeed,
redistribution has been accepted for years. The wealthiest 5 percent of
Americans pay 54 percent of all taxes, which means they are paying taxes that
would otherwise be paid by the 95 percent of Americans whose tax rates are lower.
. . To read the entire column, please
go to
http://article.nationalreview.com/?q=MDdhYTI5ZmI5YjFmNWVmNDZmNmYxMjk4NTBhODAxZWQ.
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Insurance
Gluttony: Blue Cross Cancellations Called Illegal
The health
insurer 'routinely' dropped the policies of pregnant or ill clients, an agency
finds. The company disputes the charge. By Lisa Girion. Los
Angeles Times Staff Writer, March 23, 2007
Blue Cross of
California "routinely" violated state law when it canceled individual
health insurance coverage after policyholders got pregnant or sick, making no
attempt to determine whether they did anything to merit such "harsh"
treatment, according to a state investigation of practices that appear to be
industrywide.
State
regulators plan similar investigations of other health plans in California, and
the findings against Blue Cross ratchet up the risk of liability for other
insurers, many of whom face lawsuits from consumers who claim they were
illegally dumped and subjected to substantial hardships.
As a result
of its unprecedented investigation, the Department of Managed Health Care on
Thursday said that it had fined Blue Cross $1 million — an amount immediately
criticized by canceled policyholders and consumer advocates as too small to
matter to an insurer whose parent company, WellPoint Inc., earned $3.1 billion
in profit last year on revenue of $57 billion. . . To read
more please go to www.medicaltuesday.net/gluttony.asp.
The state
investigation found that Blue Cross used computer programs and a dedicated
department to systematically investigate and cancel the policies of pregnant
women and the chronically ill regardless of whether they intentionally lied on
their applications to cover up preexisting medical conditions — a standard
required by state law for canceling individual policies.
Regulators
examined 90 randomly selected cases of policy cancellations — out of about
1,000 a year in California — and found violations in each one. . .
The state
report said the legal standard for cancellation was high because it put plan
members at great risk — financially and medically — and because it left
physicians and hospitals holding the bag for services rendered in good faith
and often with prior authorization from the insurer.
"Rescission
is the harshest possible punishment," Department of Managed Health Care
Director Cindy Ehnes said. "It leaves providers unpaid and it leaves the
enrollee uninsurable." .. . .
To read the entire
article, go to
www.latimes.com/business/la-fi-health23mar23,1,6559553,print.story, lisa.girion@latimes.com.
* * * * *
6.
Medical Myths:
ICD-9 Codes are Necessary to Deliver Appropriate Health Care
The AMA's Physician ICD-9-CM 2007 Volumes 1 & 2 are here! With significant changes made yearly, you'll want to order your copy now to stay up-to-date with the most recent ICD-9-CM code changes.
My inbox is peppered with ads from the AMA trying to
sell me books on coding, how to code appropriately, how to code your bills to
get reimbursed (a lot of the codes change every year), and how to code for
maximum reimbursement (or how to soak your insurance carrier and Medicare for
more money). The hidden message is that if we help the AMA make more money from
their publications, we will also get more money (with which to pay AMA dues.
Some sources say that the publications bring in more revenue than the
diminishing number of dues-paying members). Forcing payment for billing codes
to bill Medicare and MediCal is an interesting twist since a private concern
exists between the government and the provider of services in order to bill the
government CMS programs. Usually such items are provided at cost by the
government printing office. But to change the codes to totally different
meanings suggests an ulterior motive if it requires doctors and billing
services to purchase code books from this private concern in order to provide
services. To read more,
please go to www.medicaltuesday.net/myths.asp.
All providers of services have to use the codes. The
laboratories frequently decline to do lab tests if the code is not detailed
enough, sometimes to the fifth digit or two digits to the right of the decimal
point. Patients get a statement of charges due from the laboratory if their
doctors don't provide a detailed enough code. What difference could it possibly
make to obtain a glycohemoglobin on a 250.00 diabetic vs a 250.01 diabetic? Or
what possible difference could it make in how much to pay for an office call if
it is a 250.00 vs a 250.01 diabetic? Office calls within a specialty are about
the same as office calls by most doctors in that specialty, and to split hairs
just adds to the cost of healthcare. But the 30 minutes to an hour a day a
physician spends looking up detail codes is never figured into the healthcare
cost equation.
Now with pharmacy reimbursement plans, the rules have
again changed. For diabetes type 2 or 250.00, all the digits to the hundredth
place no longer matter. Reimbursement only matters if there is one of four
complications; whether there is DM with renal disease, with peripheral vascular
disease, with peripheral neuropathy, or with retinopathy. This seems to confirm
that the previous five digit coding was totally irrelevant. These new codes for
2007 will only
be valid until the government buys enough physicians to come up with more
detailed policing mechanisms, further mandates and increasing regimentation.
The hidden message is that the government needs
unnecessary information in order to control us—to make us fall into line. In
other spheres, this would simply be called harassment. When will it have the
same impact as these other forms of harassment by individuals? When a patient
comes to see a doctor for an office call, it doesn't make any difference what
the reason is. It is his or her prerogative to see the doctor and no insurance
company or even Medicare will prevent that. Can we give the patient the full 20
minutes and not reduce it by the three or five or seven minutes needed for
harassment management, which adds nothing to the quality of care?
Fact: ICD-9 codes have nothing to do with quality of
care, only with bureaucratic control of care.
If it does affect quality, it will only be to diminish it.
* * * * *
7. Overheard in the Medical Staff Lounge:
Physician-Assisted Suicide – A Worldwide Tragedy
Dr. Rosen: There
is sure a lot of news about Physician-Assisted Suicide in the papers and now
even in the medical press. How can a healing profession even consider being the
messengers of death?
Dr. Sam: The
party of death is now in power and they feel they have superior wisdom and
understanding, including the ability to make decisions of life and death?
Dr. Milton: Yes,
we are always involved in those decisions, but it is usually in the context of
when to turn life support off, when to discourage heroic measures, and when to
tell the family that a number of vital organs are failing and saving a failing
heart will not save the failing kidney or failing liver.
Dr. Michelle: There
are so many areas in which we can shed light on the issues of life and death
that it would jeopardize all trust our patients have in us to even recommend
hastening or causing a death.
Dr. Milton: How
can a patient ever be comfortable with trusting us as the healers in white when
we might be the executioners in black? To read more,
please go to www.medicaltuesday.net/lounge.asp.
Dr. Del: Even
some of the regional medical journals have articles this month not only on
whether or not it's OK to be involved in Physician-Assisted Suicide but even
supporting it. I've eliminated all of them from consideration for my
"Voices of Medicine" column in Sacramento Medicine. I wouldn't
want to be caught highlighting such a travesty on our profession.
Dr. Patricia: But
the public is getting confused on these mixed messages from our profession. How
do we regain their trust?
Dr. Sam: I'm
not optimistic with the current crowd in DC. They are putting a very populist
twist on this as a humanitarian effort. Maybe rephrasing their sentences: The
kindest thing you can do for your Aunt Liz with cancer is to kill her?
Dr. Patricia: We
have to continue to point out that with modern pain therapy, no one has to
suffer.
Dr. Milton:
Sometimes it's the family that is suffering more than the patient. I've seen
family members of cancer patients squirm in pain while the patient is lying
very comfortably and free of pain.
Dr. Rosen: I've
even seen a nurse suffer more than the patient. I once made a home visit on a
patient with cancer of the pancreas and went over his pain management plan. He
clearly stated that the patches were very effective in keeping him relatively
free of pain. A few hours later, I received a call from the visiting nurse
wanting to double the size of the pain patches. I told her that I was just out
there and he wasn't complaining of any significant pain. She responded,
"Doctor, don't you know his diagnosis?" That nurse was experiencing
more pain than the patient for whatever reason, which went beyond the empathy
we expect from our nurses.
Dr. Sam: We have
a very assertive legislature out here in California. They passed a law that
makes us take pain management courses and demands that all pain will be
relieved. They are unable to understand that much of human pain is not the kind
that is delivered by pain fibers to the brain. There is so much variation in
pain thresholds that it's difficult to compare one patient with the next. How
do we keep the medical incompetent lawmakers from practicing medicine?
Dr. Rosen: Looks
like our profession has challenges on all fronts. And our best and brightest
better get busy with astute dialogue on all fronts before it's too late.
Dr. Del: In
reviewing the
local and regional small medical society journals, I find it to be a it's really a
tragedy that only a small number have articles written by physicians. Most
articles are written by administrative staff that hasve very little comprehension of the
real issues, which are usually unrelated to the issues that the administrators
running the societies keep before the public.
Dr. Rosen: And
to make matters worse, many medical societies do not allow the public to read
their articles on the web. They only allow their members to read them. We need
the widest dissemination of information from the captains of the health-care
team.
* * * * *
8. Voices of Medicine: A Review of Local and Regional
Medical Journals
MOHAMMED ARAIN,
MD, writes about
the cost of medicine and reimbursement in the President's Message February
2007 issue of Vital Signs, the Official Publication of the
Fresno-Madera Medical Society.
The costs of practicing medicine are on the rise.
Decreased reimbursements for the services provided by doctors of all
specialties by Medicare and other insurers combined with higher liability
insurance costs mean more hours that we have to work just to stay afloat. Health care issues are among America's
biggest national concerns. Thirty-two percent of Americans feel that the U.S.
health care system is not meeting the needs of them and their families, 68
percent feel the current system does not meet the needs of most Americans.
Ninety percent feel Congress must address the changes needed in the health care
system, and 95 percent said national health care reform is needed.
I want to tell our patients and politicians that all
we want to do is take care of our patients, and we can't do that if we're being
undermined and cut. You can't diminish reimbursement and expect access to care
to increase. Medicine is, in essence, a moral enterprise, and physicians are
expected to promote the interests of those they serve. This, sadly, has not
always been the case when economic, commercial, and political agendas so often
take precedence over ethical obligations. History reflects a constant tension
between self-interest and ethical ideals that has never been resolved. Today
this problem is greater than ever. This conflict is eroding the moral
foundations of all professionals, not only in medicine, but in law, education,
and even the ministry. To read
more, please go to www.medicaltuesday.net/voicesofmedicine.asp.
Physicians are facing an ever increasing cost to stay
in practice. The license fee used to be $65 about 25 years ago and now
it is $985. With emergence of HMO's even the PPO insurance have reduced
the payments to near Medicare level. Reimbursements for services have become
about 25 percent of what they used to be. In this medico-legal environment,
paperwork has tremendously increased, and it takes five to six people to do the
same work which used to be done by two. Malpractice insurance, workman's comp
insurance, employees overhead expenses, increased cost of utilities compounded
with reduced reimbursements have forced physicians to work 12-14 hour
days.
There is no other profession in which physicians are
nearly 40 years old by the time they get into practice and pay back their
loans. The average work life of physicians is 20 years.
Governor Schwarzenegger's health reform plan is
promising to provide insurance for all. This may make it easy for the emergency
rooms across the state to get better coverage from the physicians. His program
is to please the public sector by providing guaranteed health benefits,
increasing hourly wages and workers' compensation. This should not be done at
the cost of further asking sacrifices from physicians and hospitals.
The maximum temporary total disability (TTD) rate will
increase to $881.66/week as of January 1, 2007. This marks the first
year the TTD rate will be affected by a change in the state average weekly wage
(SAWW) – which increased 4.96% from the previous year Also increasing is the
rate that insurance carriers and employers must pay for mileage. The mileage rate for medical and
medical-legal travel expenses will increase to 48.5 cents per mile effective
January 1, 2007. This rate must be paid for travel on or after this
effective date, regardless of the date of injury.
There is no other profession in which one is forced to
provide services without any return. There are laws such as EMTALA to punish
physicians. We find no appreciation,
recognition or sympathy for us from the power pillars of the state. Everyone
takes advantage of physicians. The least which the physicians could get for
emergency services for the uninsured is to get tax benefits for our services.
For this we need to work with CMA and AMA. To achieve anything we need to have
a larger membership and a strong voice. While fighting for our rights, we must
continue the good patient care and our pledge for service to humanity.
The entire article can be found by clicking on
Newsletter at http://www.fmms.org/.
To read other VOM, please go to www.healthcarecom.net/voicemed.htm.
To read HMC, please go to www.delmeyer.net/HMC.htm.
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The University of Pennsylvania Press is publishing a series
with the general topic of Studies in
Health, Illness, and Caregiving in America under the general editorship of
Joan E. Lynaugh. Dr. Bates' book is the
seventh in that series.
Bates introduces tuberculosis as the most common cause
of death in the United States and in Western Europe throughout the nineteenth
century. During the last decade of the
nineteenth century, there emerged a new optimism about the disease and more
aggressive attempts to deal with it. In
1882, Robert Koch discovered the tubercle bacillus, and as physicians and
social leaders recognized that consumption was infectious, they promulgated new
laws, educational programs, and institutions with which to combat it. In 1885, Edward L. Trudeau opened the first
successful sanatorium in the United States.
It was thought that, if TB was infectious, controlling the patients'
behavior and separating the afflicted from their families and from the rest of
society could stop the spread of the disease. To read more,
please go to www.medicaltuesday.net/bookreviews.asp.
Bates notes that historians have traditionally focused
on either the medical knowledge of tuberculosis or on the social movement to
control the disease. The protagonists
are usually physicians or social reformers who led the campaign against
tuberculosis. The story of the
experiences of the patients, their families, and those who took care of the
sick has been told in part. A
collection of letters preserved by Dr. Lawrence F. Flick, a tubercular himself,
and his family helps to correct this deficiency.
Bates shows how anti-tuberculosis activities convinced
both physicians and the public to support tuberculosis institutions through
such methods as the Christmas Seal Campaign and films like The White Terror. She also
points out with graphs that the campaigns to control TB had little impact on
the disease. Henry P. Phipps, a steel
industrialist, funded an institute in Philadelphia in 1903 that included a
dispensary. Dr. Flick, who had a
life-long commitment to provide care for poor patients with TB, was its medical
director and was able to serve a broader city community. In 1910, Phipps became convinced that his
institute could be properly run only by an elite research-oriented
university. When he transferred it to
the University of Pennsylvania, Flick lost his position as director, and the
institute gradually lost its commitment to patient care.
Dr. Bates, an internist and historian at the
University of Pennsylvania, examines the development of scientific medicine,
the growth of health-related institutions and voluntary organizations, the
development of trained nursing, the calls upon government to provide medical
care, and a highly competitive society in which opportunity was stratified by
class, race and gender. In this
microcosm, she develops the interplay among individual experiences, family
relationships, professional behaviors and interests, values, politics and
social structure.
In a TB sanatorium, the patients always put on a mask
when a doctor or nurse entered the room without a mask. This stops the spread of TB in that room and
is less intimidating to the patient who can see the faces of all visitors. In this community, some hospitals require
gown, gloves and boots in examining a tubercular patient. It takes a long time to change behavior, as
Dr Bates points out. Let's hope this
excellent, well-researched book with nearly 100 pages of endnotes and
bibliography will help dispel some of the witchcraft around TB.
[In view of the current increase in tuberculosis even
in our prisons, we bring you this review from our archives at www.delmeyer.net/bkrev_BargainingForLife.htm.]
To read other reviews, please go to www.delmeyer.net/PhysicianPatientBookshelf.htm. To search topically, please go to www.healthcarecom.net/bookrevs.htm.
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10. Hippocrates & His Kin: In God We Trust: All Others
We Scan for Viruses.
If the AMA is making as much money from their
publication division as they are from their membership, maybe before too long the
AMA won't need doctor members.
If Blue Cross can eliminate
rate payers with a computer program, that certainly takes the wind out of the
sails of Robin Cook, MD, Michael Crichton, MD, and others who made fortunes out
of a more direct approach to eliminate the high-risk insured. www.healthcarecom.net/bkrev_MedThrillers.htm
To read more,
please go to www.medicaltuesday.net/hhk.asp.
Maybe this
physician-assisted suicide is not entirely bad. What if we had Michael Moore as
a patient? Would we have the courage to improve society?
My Dear Wormwood: Our work as Temptress of the world
is getting easier all the time. The plan devised by Our Father Below, is
working so well that before long we won't have to lift our fingers to get
people on the wide path to spend eternity with us. The lawmakers are working so
well with us that not only is killing the pre-born legal, soon it will be legal
to kill the defective born, the disabled, the cancer patients, the pain
patients, all those that suffer, those wanting to die, and before long, those
that don't want to die but society has determined that they should die. Your
loving uncle, Screwtape. (After CS
Lewis)
To read more vignettes, please go to www.healthcarecom.net/hhkintro.htm.
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11. Physicians Restoring Accountability in Medical Practice,
Government and Society:
1.
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Physicians Restoring Accountability in Medical
Practice, Government and Society: