1.
Featured Article:
The Failures of North American Health Care Systems
2.
In the News: Costly
'Affordable' Health Care
3.
International Medicine: Sicko
Europe By DANIELE CAPEZZONE, WSJ
4.
Medicare:
Socialized Medicine Doesn't Work by David Gratzer
5.
Medical Gluttony:
Emergency Departments
6.
Medical Myths:
Health Insurance Is the Answer to Our Health Care Problem
7.
Overheard in the
Staff Lounge: Why Can't Appointment Clerks Make Appointments?
8.
Voices of Medicine:
Charged $20
Per Phone Refill and the Problem Went Away
9.
From the Physician
Patient Bookshelf: The Business of Medicine by J K Silver, MD
10.
Hippocrates &
His Kin: Why Impose Problems Related to
Health Care on Doctors?
11.
Related
Organizations: Restoring Accountability in Medical Practice and Society
MOVIE EXPLAINING SOCIALIZED
MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
Logan Clements, a pro-liberty
filmmaker in Los Angeles, seeks funding for a movie exposing the truth about
socialized medicine. Clements is seeking 200 doctors willing to make a
tax-deductible donation of $5K. 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 or to review a trailer, visit www.sickandsickermovie.com or email logan@freestarmovie.com.
SICK AND SICKER is a feature-length movie in currently in
post-production that explores the ethics and realities of a government take
over of the medical profession.
SICK AND SICKER will investigate whether government intervention in
the U.S. medical system is the cause of, or the solution to, our problems and
whether Canada is really the health care utopia that politicians tell us it
is.
* * * * *
1.
Featured Article:
The Failures of North American Health Care Systems
The Prisoner's Dilemma: Economic Lessons from the
Failures of North American Health Care Systems by Gerry Smedinghoff, SAS Conference, 03-Aug-2007
The title of my speech today is "The Prisoner's
Dilemma: Economic Lessons from the Failures of North American Health Care
Systems." What I will show is how health care in North America fits the
economic definition of the negative sum game known as the Prisoner's Dilemma,
why health care is the only product or service in our economy that has grown
progressively worse and more expensive over the past half century, and how
Singapore and other Asian nations can avoid our mistakes.
The Prisoner's Dilemma
Let me illustrate the absurd process of procuring
health care in the United States, where the average working adult knows nothing
about the cost of health care, because she does not purchase it. Instead, she
allows her employer, who knows nothing about her health, to purchase it for
her, deciding which doctor she can see, often forcing her to visit two doctors,
when she only needs to see one. And worst of all, neither the patient, nor her
doctor, will decide how she will be treated. That decision will be made by a
nurse - employed by the insurer - who has never met either of them, and who may
be several hundred kilometers away. This is what is known in the United States
as "managed care." To read more,
please go to www.medicaltuesday.net/index.asp.
The common saying, "It's as simple as
A-B-C," does not apply to health care in North America, where A, buys health
care from B, but which is paid for by C. The common saying, "Two's
company, but three's a crowd," more accurately describes our health care
system. The simple health care transaction between the patient (A) and doctor
(B) is complicated by a third party (C), the employer. The interference by a
third party, C, creates tension between the A and C, and between B and C, which
results in a prisoner's dilemma.
The Prisoner's Dilemma is a subset of the economic
discipline of choice theory, which was the creation of James Buchanan, and for
which he was awarded the Nobel Prize in Economics in 1986. Buchanan defined
private choices, such as the food you eat, clothes you wear, or car you drive.
You get exactly what you want based on your personal preferences. And your
choices - whether good or bad - do not affect anyone else.
Then there are public choices, such as the politicians
we elect, the MRT subway schedule, and the temperature in this room. These
decisions are based, not on your personal preferences, but on the aggregate
preference of the group. These choices are forced on you, and you have
virtually no chance of changing them, regardless of how hard you try.
One would think that health care, which is personal,
private, and delivered one patient at a time, would be a private choice. But in
North America, it's a public choice. And the Prisoner's Dilemma represents a
scenario where your preferences are ignored, your actions are futile, and your
fate is decided by someone else.
To read the entire address by Gerry Smedinghoff to the
South-East Asia Health Insurance Conference, held in Singapore, please go to
his website at www.gerrysmedinghoff.com/articles/South-EastAsiaHealthInsuranceConference2007.pdf.
* * * * *
2.
In the News:
Costly 'affordable' health care By Paul Belien, Washington
Times, August 15, 2007
John Stossel is right. Last week he wrote that the
"Healthy Wisconsin" scheme, passed in that state's Senate and
offering supposedly "free" socialized health care, is good for
America because people apparently need bad examples. As Mr. Stossel says,
"We need laboratories of failure to demonstrate what socialism is like.
All we have now is Cuba, Venezuela, North Korea, the U.S. Post Office, and
state motor-vehicle departments. It's not enough. Wisconsin can show the other
49 states what 'universal' [health] coverage is like. I feel bad for the people
in Wisconsin . . . but it's better to experiment with one state than all of
America."
More bad examples can be found in Europe. When the topic of health care crops
up I always think of my grandfather. He was very old - 91 - when he died. In
his family, longevity was not uncommon. My grandfather had never been ill. He
had never needed medical treatment. Upon reaching his 90s, however, he began to
have a prostate problem and had to go to the hospital for surgery. Like all
Belgians, throughout his professional life my grandfather had paid wage-related
contributions to cover health insurance. As he had never needed much health
care, he had been a net contributor to the system. Now was the very first time
he was going to claim something back. To read more,
please go to www.medicaltuesday.net/news.asp.
My grandfather had his operation in May. In November he was dead. The prostate
operation had gone well, but the hospital administered an antibiotic drug that
caused complete deafness. Though there were other, but costlier, treatments
possible, the hospital gave this drug to the old man. Hospital staff knew about
the possible side effect, but it did not strike them as an unreasonable and
unjust thing to do. A man who has already had 90 healthy years of his life
surely has no right to complain about deafness when some people get more
seriously ill or die at far younger ages.
When my grandfather left the hospital, he was completely deaf. But his prostate
problem had been cured. According to the clinic, the prostate operation had
been highly successful. As far as the Belgian health-care statistics were
concerned, my grandfather's treatment raised the quality average. It also had
been cheap. Statistics show that Belgium has a high quality of health care that
is relatively cheap, available to all the country's inhabitants, and virtually
free of charge for the patients. It is the kind of health care that Americans,
looking for comparative statistics, would envy. My deaf grandfather, however, lost
his will to live. Six months after the operation, he was dead.
His predicament is not unique. Certain medical treatments or drugs are no
longer available to Europeans above a certain age. Studies of kidney dialysis,
for example, show that more than a fifth of dialysis centers in Europe and
almost half of those in England have refused to treat patients over 65 years of
age.
My grandfather's deafness was the side effect of an antibiotic that was given
to him because of budgetary constraints in a system providing "free"
health care. More expensive drugs and treatments with fewer side effects are
set aside for younger patients. Political authorities, claiming to be the
guardians of solidarity in society, deem it less desirable for a young person
to be deaf than for an old one. Hence my grandfather, after having paid heavy
wage-related contributions as a young man to fulfill his solidarity with the
sick and elderly, had to pay the price of deafness to fulfill his solidarity
with the young.
In Europe, old people increasingly receive less care than young people do. In
the United States, ironically, the situation is the reverse. Elderly Americans
are entitled to universal health coverage via the Medicare program. In America,
the bulk of government health-care expenditure goes to those over 65 years old,
while in Europe most of the government money is spent on those under 65. If
European governments continue this policy, soon euthanasia will be the price
that the solidarity principle of the European welfare states imposes on the
very old and the very sick. European doctors have already warned about
"economic euthanasia."
If Americans need bad examples in order to know what to avoid, then Europe is a
good place to learn from. America has now lost one of its states to socialism.
In Wisconsin there will soon be grandfathers sharing the fate of my granddad.
Paul Belien is editor of the Brussels Journal and an adjunct fellow of the
Hudson Institute.
www.washingtontimes.com/article/20070815/EDITORIAL/108150007/0/RSS_EDITORIAL
* * * * *
3.
International
Medicine: Sicko Europe By DANIELE CAPEZZONE, WSJ, August 3, 2007, Rome
We live in an age of unprecedented medical innovation.
Unfortunately, most of today's cutting-edge research is conducted outside
Europe, which was once a pioneer in this field. About 78% of global
biotechnology research funds are spent in the U.S., compared to just 16% in
Europe. Americans therefore have better access to modern drugs. One result is
that in the U.S., the annual death rate from cancer is 196 per 100,000 people,
compared to 235 in Britain, 244 in France, 270 in Italy and 273 in Germany.
It is both a tragedy and an embarrassment that Europe
hasn't kept up with the U.S. in saving and improving lives. What's to blame?
The Continent's misguided policies and state-run health-care systems. The
reasons vary from country to country, but broadly speaking, the custodians of
public health budgets aren't devoting the necessary resources to get patients
the most modern and advanced medicines, and are happier with the status quo. We
often see news headlines about promising new cures and vaccines next to
headlines about patients who can't get life-saving drugs as politicians impose
ever stricter prescription controls on doctors. To read
more, please go to www.medicaltuesday.net/intlnews.asp.
The human toll can be measured in deaths and
unnecessary suffering. It also costs us a lot of money. Prevention is cheaper
than treatment. Modern medicine can prevent many medical complications that
would otherwise require hospitalization and other expensive care. For every
euro spent on new medicine, national health-care systems could save as much as
3.65 in later treatments, according to a National Bureau of Economic Research
study.
This situation is especially dire in Italy. The
government has capped spending on pharmaceuticals at 13% of total health-care
expenditures while letting expenses for infrastructure and staff skyrocket.
From 2001 to 2005, general health expenses in Italy grew by 31% while
expenditure on medicines increased a mere 1.7%. Italian patients might well
have been better off if the reverse was the case, but the state bureaucrats who
make these decisions refuse to acknowledge the benefits of advanced drugs.
Also as a result, pharmaceutical research in Italy is
falling behind even faster than in the rest of Europe. In 2004, pharmaceutical
R&D spending was 3.9 billion in Germany, 3.95 billion in France and 4.78
billion in Britain, compared to only 1.01 billion in Italy.
It is time for politicians and regulators to confront
our backward health-care systems and unleash the powers of medical research.
Besides expanding drug budgets, European countries should work together to
deregulate the pharmaceutical industry -- for instance, by speeding up the
approval process for new drugs. The EU can better ensure that drug patents are
adequately protected both in Europe and around the world against compulsory
licensing and other infringements. Finally, we should give medical researchers
tax incentives to slow the brain drain to the U.S. -- much like Ireland is
attracting artists with favorable tax laws. We Europeans are getting older; we
should be getting wiser, healthier and happier, too.
To read the entire article, please go to (subscription
required) http://online.wsj.com/article_print/SB118610945461187080.html.
Mr. Capezzone is the president of the productivity
committee of the Italian Chamber of Deputies.
Government Medicine does not
give timely access to healthcare, it only gives access to a waiting list.
* * * * *
4.
Medicare:
SOCIALIZED MEDICINE DOESN'T WORK by David Gratzer
Government researchers now note that more than 1.5
million Ontarians can't find family physicians. These problems are not unique
to Canada -- they characterize all government-run health care systems, says
David Gratzer, a physician and senior fellow at the Manhattan Institute.
For example:
·
More than 1 million
Britons must wait for some type of care, with 200,000 in line for longer than
six months; one cancer patient tried to get an appointment with a specialist,
only to have it canceled -- 48 times.
·
In France, the supply of
doctors is so limited that during an August 2003 heat wave -- when many doctors
were on vacation and hospitals were stretched beyond capacity -- 15,000 elderly
citizens died.
Despite this situation, a growing number of prominent
Americans are arguing that socialized health care still provides better results
for less money. One often-heard argument is that America lags behind
other countries in crude health outcomes, namely life expectancy. But
this statistic can be misleading, says Gratzer. To read
more, please go to www.medicaltuesday.net/medicare.asp.
·
Americans live 75.3
years on average, fewer years than Canadians (77.3) or the French (76.6) or the
citizens of any Western European nation save Portugal.
·
Health care influences
life expectancy, of course, but a life can end because of a murder, a fall or a
car accident.
·
Such factors aren't
academic -- homicide rates in the United States are much higher than in other
countries.
[In The Business of Health, Robert Ohsfeldt and John
Schneider factor out intentional and unintentional injuries from
life-expectancy statistics and find that Americans who don't die in car crashes
or homicides outlive people in any other Western country.]
And if we measure a health care system by how well it
serves its sick citizens, American medicine excels. Consider the five-year
cancer survival rates:
·
For leukemia, the
American survival rate is almost 50 percent; the European rate is just 35
percent.
·
For esophageal
carcinoma, the American survival rate is 12 percent; the European rate is just 6
percent.
·
For prostate cancer, the
American survival rate is 81.2 percent; in France, it is 61.7 percent; and in
England, it is down to just 44.3 percent -- a striking variation.
Source: David Gratzer, "A Canadian Doctor
Describes How Socialized Medicine Doesn't Work," Investor's Business
Daily, July 27, 2007.
Gratzer, a physician, is a senior fellow at the
Manhattan Institute.
For text: www.ibdeditorials.com/IBDArticles.aspx?id=270338135202343
For above reference: www.ncpa.org/sub/dpd/index.php?Article_ID=14825
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Emergency Departments
Joshua Weil, MD, Chief of Emergency Medicine at Kaiser
Santa Rosa, California, reports in Sonoma Medicine on the problems in the
Emergency Departments.
Over the past few years, we have experienced a steady
climb of non-Kaiser members presenting to our ED, most of them uninsured or
underinsured . . .
The Emergency Medical Treatment and Active Labor Act
(EMTALA) requires that any person presenting to an ED receive a medical
screening exam to ensure that no life- or limb-threatening emergency exists.
What constitutes a medical screening exam is open to some interpretation; but
as the Department of Health Services has both the final say and the ability to
levy large fines, the vast majority of patients will be seen and evaluated in
the ED.
The implications of caring for the uninsured in EDs
are multiple. For starters, the charges incurred in the ED are much higher than
for most office-based evaluations. . . To read more,
please go to www.medicaltuesday.net/gluttony.asp.
What is clear is that the standard of care in the ED
is different than in the office. While the office-based physician focuses on
what is most likely to be the problem, my job is to exclude what is most likely
to be the lethal diagnosis. "Heartburn" can be readily addressed as
GERD in the clinic, whereas I am obliged to perform more rigorous evaluations
to exclude coronary ischemia in that same patient. These procedural differences
are even more pronounced for patients with little or no history in our system
and with whom we are not familiarespecially if timely follow-up cannot be
assured. In some cases, this lack of knowledge may even necessitate hospital
admission, which is surely more costly. . .
What may be less obvious are the hidden costs of
meeting regulatory and compliance requirements, such as nurse staffing ratios
and timelines for cardiac, stroke, and pneumonia patients. EDs must staff to
meet these demandsand staff isn't free. Meanwhile, hospitals and EDs across
California are closing even as populations are growing (e.g., Santa Rosa),
placing stress on the remaining delivery systems. Patients in ED waiting rooms
are often at the highest risk: they are undiagnosed, off monitors, and yet to
be evaluated. The last thing EDs need is patients who shouldn't be there,
delaying care for those who should.
To read the entire report, go to www.scma.org/magazine/scp/sm07/weil.html.
[Government regulations are once again the cause of
excessive health care costs. One emergency physician told me that the risk of
missing a possible lethal diagnosis in
a patient without readily available medical records, is a risk too great to
bear because it may result in a fine that would destroy his medical career.
Hence, he felt obligated to do $5,000 worth of unnecessary testing on 1,000
emergency patients that he thinks would not be normally needed in a private
office environment, to make sure that there is nothing the state could take
issue with or fine him for. After all, the extra $5,000 on 1,000 patients or $5
million dollars of unnecessary testing is mandated by the state and is paid by
"someone else." And if he became an advocate, the next government
mandate would only make his life worse and even more hazardous. So why make an
issue out of the subterfuge?]
I understand Congress and
Legislatures are lying awake at night trying to figure out how to decrease
health care costs. Have they every thought of just repealing all mandates? That
would cut costs at least 30 percent.
* * * * *
6.
Medical Myths:
Health Insurance Is the Answer to Our Health Care Problem
A Trip
to The Hospital Shouldn't Leave The Patient With 'Bill-Itis' By Dr. Michael Wilkes - Inside Medicine, Sacramento Bee,
August 4, 2007
One Friday afternoon, a young teacher developed
unusual and concerning stomach pain. At first, the pain was just annoying, but
throughout the day it grew in intensity to the point where she got scared. She
called her doctor, who by then had already left the office for the weekend, but
his answering service reached him by phone, and after listening to her story,
he thought she might have appendicitis. He told her to go to the hospital
emergency room to be evaluated. To read more,
please go to www.medicaltuesday.net/myths.asp.
Given that she had full insurance, that advice sounded
reasonable, so she and her father drove to the hospital. Once there, she was
examined by a doctor and then spent the next six hours on a gurney waiting for
blood and urine test results to come back from the lab. A nurse placed an IV in
her arm to provide small amounts of sugar water, and occasionally the nurse
stopped by to make sure the patient was OK.
After six hours the pain had lessened but had not
disappeared entirely. A doctor came in and told her an aide would soon take her
to get a CT scan.
A CT scan? She asked several questions about the scan,
and the doctor answered but seemed frustrated. Did she not come to the hospital
to get evaluated? The woman explained that she didn't really want a CT scan --
she didn't want the X-ray exposure and the pain seemed to be getting better.
Couldn't she just go home and return if the severe pain returned?
Begrudgingly, the doctor agreed, but not without first
telling her what could go wrong. He had her sign several forms releasing the
doctor and hospital from liability should her condition worsen at home.
She went home and got better. However, two weeks later
she became quite ill again, but this time with "bill-itis."
Bill-itis is a common condition found almost
exclusively among Americans. Symptoms include nausea, headache and a pounding
or racing heart. Onset is sudden and it usually follows the arrival, either in
person or through the mail, of health care charges.
The teacher's bill -- $11,000, and that did not
include the doctor's fee. The bill, which I have seen, includes $1,956 in
laboratory charges including a pregnancy test ($234), a complete blood count
($354), and a urine test ($179). By the way, none of these tests should cost
more than $25 to complete. The hospital charged a "definitive care room charge"
($4,096) and an emergency room utilization charge ($3,220). On top of
everything, her insurance refused to pay the $11,000.
She called the hospital and after several angry
encounters with a billing representative, the hospital reduced her bill from
$11,000 to $5,800. Of this, she had to pay $1,200 out of her own pocket -- this
despite the fact that she has good health insurance coverage. So, after six
hours, no diagnosis, and no treatment she was left with a whopping bill. The
next time she gets sick she says she'll need to be on death's door before she
even considers going to the emergency room. What made her so angry, she
reports, is that no one ever told her the cost nor did they give her the option
to forgo certain elective procedures like an IV ($600). Furthermore, when she
did begin to ask questions about the need for the CT, the staff seemed annoyed.
This story has three morals.
To read the entire article,
please go to www.sacbee.com/107/v-print/story/306296.html.
Michael Wilkes, M.D., is a professor of medicine at the University of
California, Davis. Identifying characteristics of patients mentioned in his
column are changed to protect their confidentiality. Reach him at drwilkes@sacbee.com.
Health Insurance Is the Cause of Our Health Care
Problem
The Patient Has Been Removed From the Decision-Making
Equation
Hospitals and Insurance Companies Working Alone
Together Is an Expensive Proposition
* * * * *
7.
Overheard in the
Medical Staff Lounge: Why Can't Appointment Clerks make Appointments?
Dr. Rosen: I had
a 40-year-old man in the office yesterday who had a blood pressure of 240/120.
He had a pacemaker and defibrillator implanted, saw a cardiologist to manage
his BP, but looked to me to get his BP under control.
Dr. Dave: I
guess you slapped some nitroglycerin paste on him in a hurry.
Dr. Rosen:
Certainly. But he was on larger doses of an ACE inhibitor, an ARB,
beta-blockers, and diuretics than I had every used. But since he had an
appointment with his cardiologist today, I let him go home wearing the
nitropaste and doubled the beta-blocker.
Dr. Ruth: Let
me guess. You overtreated him and he crashed and had to go to the hospital in
shock?
To read more,
please go to www.medicaltuesday.net/lounge.asp.
Dr. Rosen: I
received a call from his wife this afternoon saying they were unable to get in
touch with his cardiologist having started calling the office at 9 AM. The
office staff said they would try to get in touch with him.
Dr. Michelle: That
should have been a straight-forward remedy.
Dr. Rosen: Well,
no. His wife called me about 4:30 desperate since his BP, although going down
yesterday from the paste to 180/90, was back up to 220/115, and they were
wondering if they should go to the ER.
Dr. Sam: Well,
I hope you said "yes." Go immediately. Do not stop.
Dr. Dave: But
you have to be careful Sam. A couple of hours of stress in the ER might be just
enough to elevate his BP even more, causing him to stroke out.
Dr. Patricia: I've
never heard of anything so stupid, Dave. I send all my emergencies to the ER.
At least it's no longer my problem.
Dr. Dave: But
we have to think primarily of the patient and make sure no harm comes to him.
At least I'd feel badly if I sent him to the ER and he had a stroke which
paralyzed him on one side for the rest of his life.
Dr. Edwards: That
can be a tricky situation. Your decision process may be valid, but there is some
bureaucrat that may have established a guideline that requires a BP over a
certain level to be evaluated in the ERyou know, a populist comment that it's
not safe to treat at home. And it's your medical license and practice at stake.
I agree resting at home with an extra beta-blocker may be more beneficial than
lying on a gurney in the hospital corridors with other patients heaving next to
you or even dying in the next bed.
Dr. Rosen: Let
me get back to my patient whose doctor's office could not give him an
appointment without checking with the doctor first. Isn't that what a medical
assistant or appointment clerk does? Shouldn't a doctor have hours in which he
sees patients that have appointments? I get the same run-around when I try to
call a doctor for a consult. I may finally get through to the consultant's
nurse who should have the ability to make the appointment, but she also says
she has to check with the doctor. These delays are the standard fare in the UK,
Canada, or all countries with government medicine. Why are we destroying our
system with costly delays? It shouldn't take longer than an office call to
obtain a referral or get an appointment. That reflects on all of us.
Dr. Edwards: I agree.
We doctors best get our own house in order, or the government, under the
illusion they can get it in order, will cause thorough chaos. So, what is
happening to your patient, Rosen?
Dr. Rosen: I'll
see him tomorrow morning. He's already on double maximum doses of three groups
of antihypertensive medications, I will add a calcium channel blocker and see
if I can get him hooked up with a cardiologist. He is beyond internal medicine
fare. But, I won't abandon him. I'll remain in the background since patients
seem to have so much trouble hooking up with the right doctors.
* * * * *
8. Voices of Medicine: What Doctors Write in the Local
Medical Journals and Letters
Responding to the article in the last issue on the
problem of phone prescription refills, Dr. Kurt Belgard offers some insight.
About 4 years ago, I was overwhelmed with Rx refill
requests. As I always wrote Rx to last to the next recommended
appointment, they should have been rare, but were taking 1-2 hours additional
time at the end of every clinic day. As it was a psych practice, I had to
review each chart, being careful not to authorize excessive quantities.
Often the numbers didn't match up and I had to call patients and pharmacies.
I began charging $20 a refill and the problem went away. Down to 1-2 Rx
per day only. It wasn't the money, I hardly ever actually posted a charge
as the problem went away. It was what the charge communicated and how it
focused attention on the fact that phone refill requests are not the norm, and
signal something is wrong. It removed the incentive to avoid office
visits to avoid a co-payment. It helped focus my attention on my
prescription practices as well to be extra careful to make sure people leave
the office with adequate Rx. To read the
source of the problem, please go to www.medicaltuesday.net/voicesofmedicine.asp.
I found that one source of the problem all along was that the chain pharmacies
were automatically generating a faxed refill request when the patients called
in for refills on their automated service line. This was generating
refill requests even when adequate refills were authorized already. In
other words, an automated system had evolved that generated hours of extra work
for me everyday without any consideration given to that--until I decided to
charge for that work. It gave patients and incentive
to take charge of the process and not let the pharmacy be the middle man.
It was one of my patients who studied the process in the pharmacies and
reported back to me why the problem had escalated so markedly.
Almost all the private psychiatrists in the area do this now. I don't
know if any other physicians are. We have more incentive as we usually
operate on lower gross receipts and earn by keeping overhead down doing more
ourselves.
Kurt Belgard, MD
Baton Rouge, LA
If doctors would put the kibosh on phone refills, we
would all have more family time.
* * * * *
9.
Book Review: THE
BUSINESS OF MEDICINE by J K Silver, MD, Hanley & Belfus,
Inc., Philadelphia, 1998, xi + 376 pages + index, ISBN 1-56053254-8, Review by Del Meyer, MD
J K Silver, MD, from Carmichael, California, UC Davis
graduate, (as is her sister who practices at Permanente and is a member of our society)
instructor in Physical Medicine and Rehabilitation at Harvard, has assembled 31
authors who deliver 21 chapters on the business aspects of medicine ranging
from solo practice to finding a job to physician executives. Many of these
authors are non-MDs and of the authors who are MDs, many hold additional
degrees such as MBA, MHA, MPH, DPH, and JD. Each author represents their own
point of view.
Gail Bender, MD, MS, author of the chapter, "Solo
Practice," feels that solo practice is the best way to deliver high
quality, personable and personalized care, be a patient advocate, be more
available and accessible, and, because of better continuity of care, be the
most cost-effective for both outpatient and hospital care. She feels if quality
of patient outcomes and cost-effectiveness could be analyzed comprehensively
and objectively, they probably would demonstrate that the medical outcomes in
the solo independent practice setting are at least as good and probably more
cost-effective than in many fully integrated group settings. To read more, please go to www.medicaltuesday.net/bookreviews.asp.
Four persons--a health educator, a social worker, a
naturopath, and a physician--contribute to the chapter, "Practicing the
Art of Medicine." Although one cannot fathom an Art of Medicine that is
not grounded to the scientific method and good clinical judgment, close
attention to the points about communication, an open attitude, being fully present,
intuition, and respecting the imbalance of power, will make any of us more
effective in our practice.
The book contains a wealth of data on numerous areas
of practice from physician compensation to physician errors, their types and
importance. Practical help on running the office with help for your office
manager followed by a chapter on checking the vital signs of your practice is
worth reviewing from time to time.
Since each chapter is relatively autonomous, one can
review a chapter or two without the compunction of reading the entire book.
To order, please go to www.delmeyer.net/bkrev_BusinessofMedicine.htm.
To proceed to the Physician/Patient Bookshelf, go to www.delmeyer.net/bkrev_BusinessofMedicine.htm.
To browse Book Reviews topically, go to www.healthcarecom.net/bookrevs.htm.
* * * * *
10. Hippocrates & His Kin: Why Impose Problems Related
to Health Care on Doctors?
The Foundation Health Plan (FHP) met with the hospital
administrator who had the medical director there. He seemed surprised and took
issue with his presence. "Surely we don't have to impose on this busy
doctor. We all know what doctors do."
Sure Tom, Everybody Except Insurance Carriers and
HMOs.
To read more,
please go to www.medicaltuesday.net/hhk.asp.
Electronic Medical Records
Aren't As Interchangeable As the President and Congress Think.
We had the X-ray group
install the Stentor program on our office computers, which allows us to pull up
the x-rays as well as the report. We no longer need to wait for the x-ray film.
As the IT expert moved effortlessly about the screen instructing us, he pointed
out how they have bypassed the several electronic medical records (EMR) used in
our community. Why? Because the EMRs from the three hospitals don't talk to
each other and "we can't be limited by these EMRs."
Why are the president,
members of Congress, Newt Gingrich, and other uninformed, unknowledgeable
non-experts in health care extolling the EMR as the answer to our health care
problems?
Unfortunately, these medical illiterates are the ones
who will be making the decisions that will enslave medicine for decades to
come.
Any Ideas on How This Stampede Can Be Stopped?
Physician-assisted
"Suicide?" or ". . . Homicide?" or ". . . Just Plain
Execution?"
Yesterday's Headlines: The rapid transit [a local
government monopoly] is eliminating all non-remunerative bus lines. A partial
list includes the following routes . . .
Tomorrow's Headlines: Medicare for all [a federal
government monopoly] is eliminating all non-essential procedures for members
over 70. A partial list includes coronary bypass, hip replacements, and organ
transplants . . . [for a more complete list, check the Canadian Medicare or the
NHS exclusions.]
Next Year's Headlines: All Medicare members [a federal controlled fiefdom]
who have exceeded five times the average healthcare costs during the past three
years, will be subjected to physician-assisted suicide. If the member objects,
the member will be subjected to physician-assisted homicide.
Isn't this really execution? Perhaps we should use the
more euphemistic term we use with our dogs and cats that are too sick to keep -
put then to sleep, permanently? Or the Nazi Program: Eliminate those with lives
not worth living. Have we really come to the same status in a free society?
To read more vignettes,
please go to the archives at www.healthcarecom.net/hhk1993.htm.
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11. Physicians Restoring Accountability in Medical
Practice, Government and Society: