Wednesday, March 8, 2017

"Thank You" Used to Mean Quality

This is a response I wrote to a Blogger Friend who was lamenting about her mother being ignored out of getting a referral which she needed in a part of the healthcare system out west.
When I read your Mom’s story, I know it’s totally true. And sad. I mourn for my profession which sold out to Wall Street, dressed as harmless hospital administrators and pharmaceutical representatives and faceless insurance companies with phony quality initiatives and empty terms that somehow appealed to good boy and girl scouts like physicians. 
Now, we have “Value” based care and drop down bonus-based EHR’s that prevent us from seeing the patient, who doesn’t get a drop down bonus of their own. The mutant brain of the physician, who amassed impressive SAT and/or ACT scores is dulled by the mechanistic drivel of the pile of prescription rejections at the start of every year and the ensuing Prior Authorization forms to get the patient out of tier 4 and back to tier 2 on their pharmaceutical co-pay. There’s little room in the physician’s brain for the challenge and fun of developing a complex differential diagnosis that get’s your mother aligned with the best opportunity for achieving her remaining dreams. They used to have fun and get great satisfaction our of the patient’s “Thank You, Doctor.” That was the bonus. That assured the quality. That relationship kept the thieves away. I mourn for my profession and the patients it has abandoned.
The NP’s and PA’s are used in places to keep physicians practicing at the “Top of their license”, meaning they don’t get to enjoy and deliver relationship-based care. The PA’s and NP’s have their own limitations in education and sometimes of licensure, depending on state laws, some of which you already mentioned.
(p.s., I don’t use an EHR, but own two. I have fun every day. Patients say “Thank You, Doctor.” I get to discuss personal (even complex nutrigenomic) strategies daily with patients, if indicated, with time to listen to their story- the most important part of the visit- and their values, goals and dreams. I am a fossil. Endangered fossil. I expect to drop all relationships with insurance companies at the end of this year to expand my Direct Family Medicine practice which enables patients to tell their story, unencumbered with the next massive wave of phony quality initiatives which will result in a 6 to 9% penalty ($) for Medicare patients and already is 12% with one commercial carrier.)
Oops, this is long enough to be a blog post- so I’ll post it on my blog, too.
Peace to you and yours.

Friday, March 3, 2017

Patient Centered Care and Other Lies

"Eating fat is bad for you.  Cholesterol is bad for you.  Drink low fat milk."

These are basically medical lies.  Your brain is mostly made of fat and cholesterol, by the way.
Wheat and sugars are the root of most obesity.

"Value driven, patient centered care will solve most of the problems in healthcare."

Translation:  These terms will sound good to people while we continue to maximize shareholder value for the pharmaceutical, insurance and hospital industry, aka the Medical- Industrial Complex (MIC).
We will maximize the use of the Electronic Health Record (EHR) to inflict maximal "quality sounding" billables on an unsuspecting public.
We will take advantage of the intense desire of physicians to pay off their medical school debts to induce them into specialties that can be used to maximize MIC profits.
We will use electronic prescribing to maximize the medications taken per capita by eliminating patient choice about filling prescriptions.
We will inflict guidelines on patients as if they are facts or legal standards of care and not let them know their actual probabilities, eliminating their ability to choose which medical risks they wish to take.
Metrics will drive bonuses and more inflicted care on patients.  Drop down menus will remind physicians of value based bonuses that they receive if they inflict a medication or procedure on the patient.
We will call it patient centered care.  (It is actually profit centered care)
It will look good.
It will be filled with more lies.

What do you think?

Wednesday, March 1, 2017

How Dangerous are Herbs, including Marijuana?

Herbal Medicine's Hidden Risks Pose Threat to Health
The title of this article highlighted on February 27, 2017 as Top News by this daily email, MDLinx, to thousands of physicians aligns with the party line about herbals and most health foods from the medical profession. The same people who are ignoring the risks of "Taxable" Marijuana by allowing members of our profession to "recommend" so-called "Medical" Marijuana (MM) still condemn herbal medicine. Marijuana is an herb. We physicians should soundly refuse to recommend the MM because of its risks, but read The German Commission E Report which scientifically analyzes other herbal medicines. It then identifies risks and benefits of the herbal medicines in medical and civilian terms, suitable for decision making about their use. No marijuana isn't included in their analysis.  It has too many cannabinoids to qualify as medical or understandable as a medicine.  As chemicals are extracted from cannabis, they are being individually studied for potential benefits and harms in FDA approved research processes.  Since the FDA still lists marijuana as a schedule I drug (same Schedule as heroin), it is illegal for a physician to prescribe it.  Asking physicians to "recommend" it, as many state legislatures have done, is dishonoring of the medical profession and demonstrating a poor understanding of a still worthy profession, if medical ethical standards are reaffirmed for the protection of society.