Category: Future of Healthcare

Nurses Strike!!! Why Not Doctors???

Trigger alert. The URL you are about to be sent to contains an article written by a resident physician and published in Left Voice. If you are ready to chow that down, click here.

Key points that you will read. The American medical system is broken. Yup! WHO ranks it 37thin the world, despite our huge per capita spend on healthcare. Wow! Etc.  

So, what does this budding young physician think doctors should do about this? Organize! Strike! Not for better pay or better hours, but for the kinds of patient care improvements that nurses in NYC and other locales have been striking for.

Bottom Line. I buy the author’s premise that physicians should be far more vocal than they have been about healthcare issues. And I buy the notion that they need to get more “organized” to get their voices heard. But frankly, the image of doctors walking picket lines doesn’t thrill me.  

Has it really come to that?

More Blurred Lines!!!

We have often discussed how large sections of health care, that used to be the clear domain of a particular specialty or provider type, are now being redirected into other hands. Typically, the flow is downward in the food chain. Primary care sliding from physicians to NP’s and PA’s, in private practices or in pharmacy clinics. Fitting of hearing aids moving from ENT’s offices and audiologists to patient do-it-yourself. Etc.

Here’s another one. Smileclubdirect is partnering with Walgreens and CVS to provide “teeth-straightening” in their pharmacies. Patients are provided with a free scan of their teeth. This scan, it should be noted, isnotcarried out by a dentist. Those customers who decide to proceed with therapy then have their cases passed electronically through licensed dentists and orthodontists who “approve” and “manage” their cases. The invisible aligners are then shipped direct to the patients.  

Bottom Line. Lots of consequences here. Probably the most obvious positive outcome is that patients who otherwise wouldn’t have convenient access to orthodontia wind up being treated, doubtless to their benefit.  

However. The shifting of revenues and profits away from dentists and orthodontists, who fit “Invisalign” appliances for a living, may substantially alter the economics of those professions.

Look for more shifts of this nature to come in the future!

What Family Practice Should Look Like

Check this out. Usually when I do a riff on Pamela Wible, M.D., it focuses on her work in understanding and preventing physician burnout and suicide. This article is the flip side of Pamela. The side that, following her own near suicide, focused on developing an ideal family practice setting. Based on ideas contributed by her patients. No outside funding was necessary. $280 per month rent, $1,200 per year malpractice insurance and NO staff! Read the description of the practice carefully. Picture, with me, the smile on Dr. Wible’s face as she bicycles to and from the office. She works part time, but on a schedule that doesn’t require patients to miss work.

Bottom Line. Yup, the see-a-patient-every-ten-minutes model of Family Practice almost killed this caring doc. What you are looking at here is the “after” picture. After she decided to take control of her practice. And her life.

Heart-warming stuff! Can other physicians be helped to see the light? Dr. Wible is trying to help them do just that, by providing a template for creating a practice like hers.  

Should we help her to help?

What Doctors Can Learn From Taxi Drivers

Today, I have for you a one-two punch. I am going to send you to two URL’s. No extra charge.

Here is the first one. An important little vignette about a physician who hopped into a cab for the first time in several years. Once ensconced, she got to thinking about how much the cabbies’ lives have changed in a world where Uber and Lift hold sway. What are their lives like now, she wondered, when compared with the way things used to be? What does the balance sheet of a taxi company look like in 2019? And then she realized. Just as taxi cabs have become largely obsolete, physician practices too are in jeopardy of becoming dinosaurs. What will cause this? Who knows. Telemedicine, do-it-yourself medicine, Amazon medicine? All possible, as are a bunch of other potential paradigm shifters.  

Here is the second one. The  Web presence of the Pediatrician who wrote the article I sent you to, above. Look at it for a few moments. Here is a doctor who is following her own advice for doctors to develop business savvy, and  to use it in their practices. Note the “Ivy League” name. Check her background. With all due respect, I don’t see any “ivy” there.  

Then there are the sales of earrings for “medical ear-piercing patients,” video testimonials, etc.

Bottom Line. Here is my question. If it is really time for physician practices to go the way of the dinosaur, will any of these “business” interventions save the bacon? I’m going with No. If there is anything that doctors can learn from cabbies, it is that when the end comes, it will be merciless and unavoidable.  

What do you think?

gofundme for Medical Bills

Check this out. What you will see is a piece that notes that, with increasing frequency, people are turning to crowd sourcing to help cover their medical bills.  In the 8 years since its inception, GFM has collected more than $5 BILLION in donated funds. At the present time, 1 in 3 requests is medically related.

Why? Patients without medical insurance. Rising deductibles. Costs like hotel bills, gas and lost salaries that insurance doesn’t cover.

As usual, I am of two minds on this one. One part of me thinks just how wonderful it is that the money raised by GFM has come from over 50 million donations, large and small. You can read a few of the heart-warming stories of patients who benefitted from this assistance.

The other part of me ponders the desperation and hopelessness that drive patients to this source of funding, and the comment that all of this makes on the state of health insurance in the U.S.  

OH. And then there is the cynic in me that ponders such cases as the high profile GFM started by a couple purportedly to collect money for a homeless man that  gave no money to the nominal beneficiary. Instead, the couple bought luxury cars and vacations for themselves.  

Bottom Line. Whatever the underlying social issues and opportunities for abuse, I thank God that for the generous people who are willing to step forward to help people with their medical bills.  

Need medical $ yourself or know someone who does? Go here to learn how to go about getting it through GFM. 

A Bioethics Writing Contest???

Yup! Check this out. What you will see are the results of an annual contest which has students write essays on selected ethical issues. This year there were three. My favorite among them was the question as to whether candidates to be transplant recipients should move higher on the list if they and/or their relatives have agreed to donate.  

The winner of the contest opined that potential recipients should not be moved up the list based on their/their relatives’ agreement to donate. His argument?  

 “the intersection of market and moral values is a dangerous line.”

Bottom Line. Actually, I have two related bottom lines today. First, I think that it is really laudable to get students to immerse themselves so actively in bioethics. So many opinions on these important topics are formed rather slap dash, and having the entrants actually go out and conduct research to come up with their arguments has got to be a good thing for them, and for society at large, in the long run.

Second, I would like you to pick one of these three issues and craft in your head, or maybe even on your computer screen, your position on the issue and your reasoning behind it. At the end of the day, there are not a lot of philosophical areas more important than bioethics. Getting us, like these students, to take a rigorous approach to thinking them through has got to be a good thing.

JNJ CEO Sees Big Opportunities For His Company In Working With Amazon

Check this out. What you will see is an interview with Johnson & Johnson’s CEO Alex Gorsky. Gorsky sees a number of different ways in which Amazon could disrupt healthcare, including new models of drug distribution and reimbursement. But this is not just conjecture. Gorsky reports that JNJ and Amazon are already well along in conversations on a number of different topics at multiple organizational levels. AND. Of course it should not be ignored that JNJ already relies on Amazon as a major distributor of its consumer products.

Bottom Line. Throughout 2018, I have been gushing about how fascinated I am by the healthcare impacts possible with Amazon, let alone with the Amazon/BH/JPM troika. Throw some more heavy hitters like JNJ into the mix and things might really get interesting in 2019. 

 I’m looking forward to it!

Human Inconvenience

Check this out. What you will see is a brief and insightful post about how little tolerance people have for inconvenience. When it comes to healthcare, patients want the latest in technology to take care of them definitively and immediately. Conveniently.

BUT. This blogging physician believes that at some point in time, patients will learn that physicians will, in the process of automating healthcare, “regress to the means of consistency and quality.” In the process, the warmth of interaction that used to be a hallmark of medical practice will disappear.

Bottom Line. SO. Do patients want “high tech” or “high touch” in the delivery of their healthcare? This doctor thinks that the average patient would say “both!” 

Now what?

SEVEN OUT OF TEN DOCTORS . . .

. . . wouldn’t recommend that their kids become doctors! Check this out. What you will learn is that in a national survey of over 3,000 physicians, 70% of them would tell their kids to avoid their own chosen profession. AND. The next story says that 54% of U.S. physicians plan to retire in the next five years. Yikes!

Bottom Line. I may not be the brightest bulb in the hardware store, but I am guessing that these two statements combine to augur a rapid and significant increase in the “doctor shortage.” AND. I am guessing this is not just a numbers game. What happens to the quality of U.S. medical care if the “best and the brightest” head off down other career paths? 

This is sort of like global warming. You can only ignore this for just so long before the ecosystem becomes irrevocably broken. Somebody better start figuring out some clever ways to reverse what is happening here. And soon!

Disappearing Medical History

Check this out. What you will find is a strange story of what has recently happened at Brigham and Women’s hospital in Boston. Seems that a number of portraits of professors from long ago, that had hung in a busy lecture hall forever, were taken down and dispersed to locations of far less prominence. Inquiring minds wanted to know why. Here’s the answer. All of the portraits were of old, white men. Yup, that was the demographic profile of physicians at the time. So why were they taken down? It seems that the venerable institution decided that they wanted to be more “inclusive,” and thus the message of these portraits (?) was not the one that they wanted to send.

Let’s think about that for a second. Living in the South, I have witnessed firsthand the fierce debate about the removal of Civil War statues from public parks. I must confess that I understand both sides of that debate, though certainly lean toward their removal. I have also read about statues of historical physicians being removed for cause, and/or having their names stripped from buildings and prestigious awards because of their scurrilous misdeeds. I see little ground for debate as to the appropriateness of taking these actions.

But somehow, this Brigham and Women’s story, that has made it into the Boston Globe and is being hotly discussed by physicians in the social media, seems a little different. While reasonable minds can disagree on this one, and seem to be doing so, the blogging physician opines in this post that we are dealing here with a “slippery slope” of erasing history. As the Globe article rightly reports, the student body, faculty and administration of this hospital, like most, is extremely diverse in 2018. There is no denying that. And it wasn’t always so. There is no denying that either.

Bottom LineSo what better serves the psyches of today’s Brigham and Women’s physicians? Proudly seeing the addition of new and diverse professors’ portraits changing the makeup of the walls in front of their eyes, letting them view with pride the metamorphosis, or removing the historical portraits and pretending that things weren’t much more homogeneous in days gone by?

 You decide!