Direct Family Medicine: Let Patients Do Their Own Charting/ Coding in EHR

OK, let's allow patients to do their own charting.  We can agree on a format to facilitate mutual understanding and sharing of information on the process of care including the differential diagnosis of the physician.  Physicians will enter information about their clinical processes, including the development and evaluation of their differential diagnosis.  Weighing of information should be shared.  Goals, dreams and values of patients would be important aspects of their charting.  Likewise, physician values would enter into the decision making process.

HIPAA:  Let patients opt in or out according to their desire, encounter by encounter.

Licensure:  Physicians will maintain a moral, ethical and legal context of their practice and relationships with patients.

EHR:  Patient has a portal for an agreed to level of access, but not for alteration of information.

How do you think such an approach would work?

Family Medicine: Coding and Billing Versus Caring

Have you noticed that health care has taken a back seat to billing?  Coding medical services using the appropriate number from the code book must be done to bill.  The possible codes expand from around the current 13,000 to over 110,000 next year.  Guess who has the time to look up the codes?

NO ONE! 

Unless resources are diverted away from clinical care and personal energies are diverted away from patients.  If you've been in a hospital, you've felt it.  When the nurse wants to hold your hand for comfort, she/he can't because they have to hold onto the bar-code reader.  Yes, folks, the nurses are now billers, too.

WHY?     

MONEY!

One way to redirect some of these misguided energies:  Family Medicine should secede from the money-sucking, misguided insurance driven non-system of health care and endorse/practice Direct Family Medicine or a similar Direct Primary Care strategy.

Get the bar-code readers out of the hands of health care professionals.  Caring is more important than billing.

Yes, business is important, billing is important, coding is important, AFTER patient care and the patient-physician relationship are addressed.

What do you think?

Is the Medical Profession in Need of a Defibrilator/Pacemaker or a Hospice Consult?

Ciampi Family Practice in Maine

Somewhere between the IRS, the NSA and the ACA, the practice of medicine is on life support.  My profession, if it still is a profession, is powerless to effect the transformation needed to realign with the actual health care needs of our nation.  We failed.

The cardiologists may say we just need a consult with an electrophysiologist to get us an implantable defibrillator to get the profession out of a dangerous arrhythmia, not wanting to remind us that 1/3 of the recipients get significant cognitive dysfunction as a result.  Just check our cholesterol and take a statin?  Sorry, there are no last minute saves of medical practice.  (AND statins are way over-rated and massively over-prescribed, anyway).

Radical suggestion: Click on the link above to read about Ciampi Family Practice in Maine.  Let's get all the family doctors and go "back to the future".  Drop all the insurance relationships.  Get away from the pollution of the phony quality initiatives and the Medicare audits.  (Not to mention non-payment from time to time).  Can Family Medicine avoid the Hospice consult that's been called for the practice of medicine?

Direct Primary Care is waiting in the wings (in over 500 medical offices already).  See www.dpcare.org for more information.  It's one way to get refreshed and potentially "reboot" one part of medical practice.

More later, including a strategy to care for the poor.

Family Medicine: Tension Matters

A creative tension should develop in relationships over time.  So it should be in the relationship between Patient and Family Physician.  As we develop the creative tension in the Patient-Physician dyad, we can make better decisions and feel more protective of each other.

How to develop the tension?  RECOGNIZE the uniqueness in each other.  HONOR each other and the scarce, valuable resources at your disposal.  ASK open ended questions that include words like how, what and why.  RESPOND to each other.  DISAGREE politely.  AGREE honestly.  RESPECT the relationship, and each other and the context of engagement.  REFLECT on the relationship and decisions made in the context of the relationship.  RETURN.

More later, unique readers.

More From "The Wall": He's Gone

OK, Folks, In my mind's eye, I'm back at "The Wall"
As I reflect on my blog post last week after my Class of 1968 Memorial Ceremony at the Vietnam Veteran's Memorial, I know I flinched by withholding five words.  Granite Truth: Message from The Wall

Here is the "Updated" version of that section:

"Look.  Come closer.  Allow my presence to teach you about me," the Wall seems to whisper reverently.  "Find the panel where your friend's name is located.  Read it.  Read it.  Read it again.  He's gone.  Notice your thoughts and feelings.  He's really gone.  OK, Stop and take a deep breath."

"Now step back and view all of me.  Notice the wholeness of my message.  Allow it to be within you."

"Notice now that your name isn't carved on me.  It's OK to feel relieved.  And obligated."

The Wall gives the firm, final message, "He's gone." But, knowing we still can't or won't believe it, it repeats with emphasis, "He's really gone."

Our grief filters block those words for a while.  The Wall seems to know that we need more time and visits to allow the grief to reconcile us to the loss.

"He's gone.  He's really gone."

"Look.  Come closer.  Allow my presence to teach you about me," the Wall seems to whisper reverently.  "Find the panel where your friend's name is located.  Read it.  Read it.  Read it again.  Notice your thoughts and feelings.  OK, Stop and take a deep breath."

"Now step back and view all of me.  Notice the wholeness of my message.  Allow it to be within you."

"Notice now that your name isn't carved on me.  It's OK to feel relieved.  And obligated."

"There.  Your heart is grasping some of the meaning of my "Granite Truth".  Not too fast.  Not too much at once."

"Come back when you're ready.  Peace to you, too."
- See more at: http://drsynonymous.blogspot.com/2013/06/granite-truth-message-from-wall.html#sthash.j9j8mxrF.dpuf

"Look.  Come closer.  Allow my presence to teach you about me," the Wall seems to whisper reverently.  "Find the panel where your friend's name is located.  Read it.  Read it.  Read it again.  Notice your thoughts and feelings.  OK, Stop and take a deep breath."

"Now step back and view all of me.  Notice the wholeness of my message.  Allow it to be within you."

"Notice now that your name isn't carved on me.  It's OK to feel relieved.  And obligated."

"There.  Your heart is grasping some of the meaning of my "Granite Truth".  Not too fast.  Not too much at once."

"Come back when you're ready.  Peace to you, too."
- See more at: http://drsynonymous.blogspot.com/2013/06/granite-truth-message-from-wall.html#sthash.j9j8mxrF.dpuf

"Look.  Come closer.  Allow my presence to teach you about me," the Wall seems to whisper reverently.  "Find the panel where your friend's name is located.  Read it.  Read it.  Read it again.  Notice your thoughts and feelings.  OK, Stop and take a deep breath."

"Now step back and view all of me.  Notice the wholeness of my message.  Allow it to be within you."

"Notice now that your name isn't carved on me.  It's OK to feel relieved.  And obligated."

"There.  Your heart is grasping some of the meaning of my "Granite Truth".  Not too fast.  Not too much at once."

"Come back when you're ready.  Peace to you, too."
- See more at: http://drsynonymous.blogspot.com/2013/06/granite-truth-message-from-wall.html#sthash.j9j8mxrF.dpuf

"Granite Truth": Message from "The Wall"

"Speak to me, Wall.  I'm listening," I thought as I regarded the Vietnam Veterans Memorial from afar during our Class of 1968 Memorial Ceremony on June 9th.  "I don't need to say anything," it seemed to respond.

Taps sounded from the tree line as Dick McClelland, another member of the West Point Class of 1968, used his trumpet playing skills to add to the moment.  Tears started.  Taps softens hearts to accept reality.

We've lost twenty members of our class to the Vietnam Conflict.  The non-war that seemed like war.  Their names are carved into the wall.  All were honored today.  Many had relatives or friends here to accept our sentiments and share their grief with us.

"Look.  Come closer.  Allow my presence to teach you about me," the Wall seems to whisper reverently.  "Find the panel where your friend's name is located.  Read it.  Read it.  Read it again.  Notice your thoughts and feelings.  OK, Stop and take a deep breath."

"Now step back and view all of me.  Notice the wholeness of my message.  Allow it to be within you."

"Notice now that your name isn't carved on me.  It's OK to feel relieved.  And obligated."

"There.  Your heart is grasping some of the meaning of my "Granite Truth".  Not too fast.  Not too much at once."

"Come back when you're ready.  Peace to you, too."

Family Medicine: Drug Samples May Be Costly to Patients

Drug samples are often offered to physicians by pharmaceutical companies, either by a pharmaceutical rep in person or via sign up online or mail in form.  The cheapest new drug starts at about $150 per month, with more of them being over $200 per month.  The combination inhalers may go for $350 per month.  So how free do the samples look if they set you up for a high monthly expense.  "But I have great insurance which will pay for the drug" you might add.

Your insurance generally won't let you have access to the new drug unless they know you've taken  a generic drug and the "covered" brand names first with documented failure or intolerable side effects.  Then your physician must submit a document to the insurance company stating your side effects or reactions to the medication.  THEN they may cover the medication.

So, watch out for samples.  Nothing is free.

More later

Health Care Heats Up: Will Direct Primary Care be a Useful Alternative?

I notice slowly increasing intensity in all aspects of health care recently.  Obamacare hits October 1st with the Medicare offerings and state "insurance" exchanges.  January 1st, 2014 is all or none day for America.  We don't yet know what that means, but physicians caring for any federally subsidized patients will have to align with "quality" initiatives and "meaningful use" criteria for electronic Medical Records.  I'm cringing.

Massachusetts passed a law that physicians can't be licensed in 2015 unless they have competence in the use of EMR's, online prescribing and "meaningful use" plus a couple of lesser skills.  That could be a disaster as many physicians may not like the tightening noose around their professional necks that traps them as a coder instead of a carer.  We love to help patients.  Let us do it!

The Direct Primary Care (www.DPCare.org) subscription practice movement is picking up steam as more frustrations mount for Family Physicians and we look for a better connection point with our patients.  Going through an insurance company or the government is polluting the practice of medicine and watering down patient care, while significantly adding to the bankrupting of America by the medical - industrial complex.  More physicians face burn out as administrivia piles up to extend the work day, detract from the patient-physician relationship and irritate their home lives.

Direct Primary Care offers a business model that decompresses the stress for many physicians and patients.  It's generally cheaper than cable TV and less traumatizing. The patient pays an enrollment fee, then a monthly membership fee and, in many practices, a copay.  Most include basic family medical care in those fees, while many practices have other fees, such as labs that are sent out of the practice and x-rays.  The hard part for patients is that each DPC practice is different, due to varying practice styles and business strategies for each physician.  Web sites and the confusion of ObamaCare (and RomneyCare in MA) will help many people to get motivation to learn more about Direct Primary Care.

What do you think?

More later.