MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

Vol VI, No 10, Aug 28, 2007

 

In This Issue:


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

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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.  

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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.

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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

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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.

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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

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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 familiar—especially 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 demands–and 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.

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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

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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 ER—you 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.

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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.

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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.

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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:


 

                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?" go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.

                      PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website.

                      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. I also believe in an honest day's pay for an honest day's work. Please note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. 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.

                       Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis.

                      Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com. 

                      Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

                      David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.

                      Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.

                      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 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.

                      Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.

                      Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the recent topics. Don't miss last weeks pundits, Medicare: No Coverage for Preventable Errors.

                      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 scroll down on the left to departments and click on News of the Day in Perspective: Socialized medicine for children—and accompaniments or go directly to it at www.aapsonline.org/nod/newsofday457.php. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read SICK, SICKER, SICKEST. Scroll further to the 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 page of the current issue. Don't miss the extensive book review section which covers eight great books this month including America Alone and Pain in America.

Dr. Huntoon will be giving his "signature talk,"
The Dark Side of Peer Review, in Daytona Beach, Florida on Sept 11, 2007. The talk is sponsored by the Volusia County Medical Society.  Location: Indigo Lakes Golf Club, 312 Indigo Drive, Daytona Beach, FL 32114

To sign up, contact: Ms. Gloria Barkin, Executive Director Volusia County Medical Society, P.O. Box 9595, Daytona Beach, FL 32120-9595, (386) 255-3321or 254-4105.

Be sure to put the AAPS 64th Annual Meeting to be held on October 10-13, 2007, in Philadelphia/Cherry Hill, NJ, on your planning calendar and get 17 CME units credit.


 

PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website.

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. I also believe in an honest day's pay for an honest day's work. Please note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. 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.

Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."

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

Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com. 

Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.

Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.

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 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.

Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.

Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the recent topics. Don't miss last weeks pundits, Medicare: No Coverage for Preventable Errors.

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 scroll down on the left to departments and click on News of the Day in Perspective: Socialized medicine for children—and accompaniments or go directly to it at www.aapsonline.org/nod/newsofday457.php. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read SICK, SICKER, SICKEST. Scroll further to the 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 page of the current issue. Don't miss the extensive book review section which covers eight great books this month including America Alone and Pain in America.

Dr. Huntoon will be giving his "signature talk," The Dark Side of Peer Review, in Daytona Beach, Florida on Sept 11, 2007. The talk is sponsored by the Volusia County Medical Society.  Location: Indigo Lakes Golf Club, 312 Indigo Drive, Daytona Beach, FL 32114

To sign up, contact: Ms. Gloria Barkin, Executive Director Volusia County Medical Society, P.O. Box 9595, Daytona Beach, FL 32120-9595, (386) 255-3321or 254-4105.

Be sure to put the AAPS 64th Annual Meeting to be held on October 10-13, 2007, in Philadelphia/Cherry Hill, NJ, on your planning calendar and get 17 CME units credit.


 

* * * * *

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Words of Wisdom

Edward Langley, Artist 1928-1995: What this country needs are more unemployed politicians.

 

Some Relevant Postings

Why Health Care Reform is Failing - Again, By David J. Gibson, MD, www.ssvms.org/articles/0707gibson.asp  www.medicaltuesday.net/voicesofmedicine.asp#Previous%20Issue

Code Blue: Health Care in Crisis by Edward R. Annis, www.delmeyer.net/bkrev_CodeBlue.htm

In Memoriam

W.F. Deedes, In praise of a questing vole, modest, curious and experienced - a vanishing breed in journalism, Aug 23rd 2007, From The Economist print edition

"PLASHY" is not a word often used these days, not even in the London Daily Telegraph. It impressed the managing editor of The Beast, however, and that was (partly) how William Boot, countryman, came to be sent to cover the Ishmaelite crisis in Evelyn Waugh's "Scoop". Boot, it is said, was modelled on Bill Deedes, who died last week. Waugh met him in Abyssinia in 1935, where both were covering the war. Covering wars was something that Deedes was still doing almost to the last, sending his dispatches to the Daily Telegraph.

He fought in one, too, winning the Military Cross in the Netherlands. He also became a member of Parliament, served in the cabinet, was made a peer and played many rounds of golf with Denis Thatcher, Margaret's husband. This gave rise to further fiction-linked fame when letters purportedly written to him by the prime minister's husband were printed every fortnight in Private Eye, a satirical magazine.

Above all, though, Deedes was a journalist. Journalism is not a respectable activity in Britain; it has certainly never been considered a profession, for which qualifications and decent conduct are required. Some journalists have been forgiven their early calling and gone on to win public esteem in other activities—Winston Churchill, for instance. And, like Churchill, Deedes became a politician, if only for a while. But Deedes was unusual in that he earned respect as a journalist. This was partly no doubt because he lived so long: he was 94 when he died, and still hard at work. To read the entire obituary, go to www.economist.com/people/displaystory.cfm?story_id=9687386.

On This Date in History - August 28, 2007

On this date in 1922, the first radio commercial was born on a station then known as WEAF that was a pioneer radio station in New York.

On this date in 1966, Julie Marie Meyer, CEO and Founder of AriadneCapital, a Global Investment and Advisory Firm, was born. Happy Birthday, Julie!