Category: Uncategorized

Are Physical Exams Obsolete?

Sometimes! Check this out. What you will see is a post by our friend, The Country Doctor, who argues that such examinations are often conducted without a good reason.  and perfunctory. As evidence, he offers the successful journey that most physicians made into telemedicine during the COVID-19 pandemic, successfully treating patients without laying eyes or hands on them. 

BUT. The conversations I have been having with physicians for my ongoing On Doctors’ MindsSM project have clearly indicated to me that many of them feel otherwise. For them, telemedicine was a necessary, temporary adaptation to permit their practices to go on rather than being put under, in terms of both patient care and finances, by the coronavirus.  Now that offices have reopened to personal visits, telemedicine is being relegated to extremely limited use, if any. Doctors report that they need to observe their patients to get the full picture of what is going on. Specialists in fields from cardiology to neurology have specific evaluations that they want to make, and they have to be done in person.

But is the same thing true for PCPs in a “routine” office visit? A brief story. When my wife and I moved to Hilton Head Island almost a decade ago, we promptly joined the concierge practice of what we were told (and it is true!) was the best Internist in Beaufort County. On my wife’s first visit, the physician laid her hands on my wife’s throat and “felt something.” Scroll forward and her cancerous thyroid was summarily removed. A good “routine” physical exam? Damn straight!

Bottom Line. I get the Country Doctor’s point.  Sometimes physical exams look a lot like “going through the motions” for no reason whatsoever.  BUT. To catch the unanticipated, as well as to build patient relationships, they are probably about as far from obsolete as they could possibly be!!!

Segmenting the Non-Vaxxers

Non-vaxxers are not necessarily anti-vaxxers. Nope. They are just people who haven’t received the COVID vaccine.  Yet. For various reasons. And the variety of reasons is actually the theme of this NYT article.  

As I pondered each of the segments described here, my main thought was to question which of the reasons offered by these four behavioral segments makes the least sense. The largest segment, amazingly, hasn’t gotten the vaccine because its members deny that COVID presents a significant health risk. What? With over 500,000 Americans dead from the coronavirus???

And look at the other segments. Nine percentreport that they couldn’t afford the vaccine. Last I looked, “free” was the going price at most injection sites. 

Eight percent are in wait-and-see mode. Almost a year and a half into this, one wonders what they are waiting for.

And then there is the final segment. The 4% who believe that the health care system has not been fair to them.  Quite possible, but of questionable relevance. 

And there you have it. Several different “personas” that all wind up inhibiting the overall population from reaching herd immunity. As is pointed out in the article, the “psychobehavioral” segmentation approach being  used here permits better targeting and tailoring of pro-vaccine motivational messages than does an approach based on demographics. 

Bottom Line. But hold on a second. All of this leaves me wondering just how different these personas really are from one another. I’m thinking that all of the reasons offered here for vaccine avoidance might simply be different ways of saying “I don’t want to” or “I’m scared to.”

How do we drill down to find out what is really going on here?

Who Can Make A Ventilator Quickly?

I must confess that the nightly news has had me scratching my head a couple of times lately. As the COVID-19 pandemic continues its impact worldwide, there is no doubt that ventilators, the last ditch mechanical effort to keep a patient hospitalized with the virus breathing, are in extremely short supply. That’s not the part that got me scratching my head. The part that got to me was the picture of an automobile assembly line, and President Trump’s report that Ford Motor Company had called him to offer to make ventilators. Last I looked, manufacturing complicated medical equipment was a tad different than building Explorers, so while applauding their spirit, I scratched my head trying to figure out how they might pull that off. I have yet to hear the answer to that question.  

But now this. Dyson, of vacuum cleaner and hair dryer fame, has actually figured out, in record time, how to design and build a ventilator AND is busily manufacturing 15,000 of them to help in the fight against the pandemic. I guess that having experience in making devices that move air around can provide a significant leg up here.

Bottom Line. Extraordinary times call for extraordinary measures. It will be fascinating to see what other innovations will be crafted in response to the pandemic, and to figure out what are the learnings we can glean from them.

Why Is This Resident Smiling???

Check this out. What you will learn is that he is the “Chief Resident of Wellness” at Stanford University. Interesting in and of itself. But the plot thickens. Continuing on the theme of my most recent blog, wherein I referred you to Dr.  Pamela Wible’s presentation on practical things that can be done to reduce physician burnout, Dr. Orlovich recounts a study that found that simply granting Resident physicians a handful of “wellness days” every year can actually reduce their burnout rate.  

Could it be that we could significantly reduce physician burnout by chipping away, one by one, at the laundry list of “little things” that cause it? Note the comment made to Dr. Orlovich by a physician coming to Stanford from another residency program. “Do you know how much they charged us to park there every month?” Overcharging in the cafeteria, no call room, other little things about her previous program just, well, made her nuts!

Bottom Line. There is no question that training to be a physician is inherently hard. BUT. What happens if we reduce the nonsense that has nothing to do with the training process?

Dr. Wible told us in the previous post that such improvements can reduce burnout rate for practicing physicians. Seems that the same thing might be true for Residents.  

Is there a learning here???

WOW!!!

I don’t know what else to say about this case. Check this out. What you will see is an article describing the legal travails of Dr. Diana Blum, the Neurologist pictured here. Blum joined a medical group in CA, and over time became horrified by their optimization of profit at the expense of patients. Mandated use of generic drugs, refusal to distribute drug samples, unwillingness to refer out of network.  

To her credit, she spoke up about her concerns to her colleagues. Heatedly. Repeatedly. Eventually, she was asked to stifle her comments or leave the practice. Her contract was terminated. And she sued the group. For $10 Million!!! 

Eventually, a jury awarded her all of $28,415. But the story doesn’t end there. The medical group is suing her for $1.4 Million in legal fees!!!

Bottom Line. Good grief. I frequently express my concerns about physician well-being in terms of burnout, suicide, etc. But I hadn’t really thought much about the stress that this kind of acrimony could cause on the physicians involved, and on the practice of medicine in general.  

Sad!!!

What Marie Kondo Can Teach Us About Physician Burnout

Check this out. What you will see is a piece that is interesting at two different levels. First, it is interesting because it is written by a doctor who specializes in consulting with other physicians on how to build a happy/non-burned out life. We have seen this kind of consultancy offered before. There is probably meaning to be found in the fact that these kinds of side gigs seem to be increasing in number.

Second, I find it interesting because Dr. Bayley draws a parallel between his own area of interest and the work of Marie Kondo, a noted “tidiness” expert. How? Marie tells us that we can take a significant step toward happiness by controlling our “stuff,” rather than letting our “stuff” control us. More specifically, she tells us to jettison our possessions that don’t bring us joy, and to organize what is left so that we will be able to enjoy those items optimally. Bayley tells physicians that they should do the same things with the activities in their lives.

Bottom Line. While at first blush all of this makes sense, I am guessing that for the average physician, jettisoning the activities that don’t provide them with joy is easier said than done. Most of what physicians tell me they don’t like about their practice of medicine are activities that they just flat out need to do. Demanded by their patients, required by their employers and insurance companies, etc.

What then???

Individual States and The Federal Government vs. Pharmaceutical Company Pricing???

Check this out. What you will see is that many individual States are writing laws aimed at controlling drug prices. Medicaid programs, which are funded at the State level, obviously have a vested interest in avoiding drug price increases. BUT. Drug companies are not taking this lying down. Nope! They are suing States, claiming that the laws being written infringe on their constitutional rights. Bottom Line. I’m not a lawyer, nor do I play one on TV. BUT. As a layperson, this looks a lot like Double Jeopardy to me. And I don’t mean the TV show! While Trump and the Federal Government attempt to get drug prices “under control (?),” should States also be allowed to play in the drug pricing law game? I’m going with a big “NO” on that one!

Physician Startup CEO’s

How do these words fit together, and why is their confluence so important? Check this out. What you will see is an article written by a physician who adamantly believes that we need more physicians as CEO’s of startup companies. Atul Gawande, the CEO of the Amazon/Berkshire Hathaway/J.P. Morgan joint venture pictured above, is a prime example of the right doctor in the right place at the right time to deliver on this vision. There are several key points made in this article. First and most important, the author opines that healthcare in the United States will never get fixed from within. It is going to need entrepreneurial upstarts from outside to right the ship. BUT. Such startups don’t need an MBA as a CEO. Rather, they need experienced clinicians who can “get real” about what fixes are required and how to bring them off. As Dr. Nazem points out, there is nothing new about the concept of a MD/CEO. Doctors have been heading medical centers and other traditional medical organizations for a long time. BUT. The “fire in the belly” that entrepreneurial physician CEO’s can bring to the party is key to making truly disruptive changes. Bottom Line. Note that the author of this article is also the founder of an online organization, https://nomadhealth.com/, that can help to find such important “jobs” for physicians.  He isn’t just writing about an opportunity to make MD’s into CEO’s of entrepreneurial organizations aimed at changing healthcare. He is pursuing this vision. Right on!

This Pediatrician Supports A Student Walkout

Check this out. What you will see is a piece penned by a Pediatrician who was on the ground to treat the victims of the Columbine massacre. Twenty years ago. Yup, twenty years! She is understandably wondering why so little has changed over those two decades. Why a situation still exists that allows dozens of people, students and teachers alike, to be massacred in the ensuing years. Now she sees what she believes are signs of change for the better. Walmart raising the required age for gun purchase to 21. Dicks’ Sporting Goods halting sales of AR’s. Airlines retracting discounts formerly offered to NRA members. AND. School walkouts by students demanding better gun control. Bottom Line. I get it. Physicians who have seen the horror of student carnage up close have a special interest in changing things so that this doesn’t happen again. But is declaring their support for a student walk out enough?  Which brings us to the main question here. Actualy, it is a double barreled one (Sorry!). First, do physicians have a special responsibility/opportunity to make a difference here? Second, if so, what changes in “gun control” do they actually believe/can actually demonstrate will make that difference? I will be anxiously awaiting answers!

Hispanic Oral Health-Or Not!!!

Check this out. What you will find is that over half of Hispanics in the U.S. report significant quality of life problems resulting from oral health issues. 57% is an important and daunting number. But it is not a final answer. Next steps in this ongoing research must gain an understanding of Why this percentage is so dreadfully high, and what can be done to improve this picture. Bottom Line. While I often make fun of “awareness” as a road to nowhere, there are many cases where it is the first step in an important journey. This is one such case. Here we have a high incidence problem in a large percentage of our population. Getting something done to fix this, NOW, would seem to be a very high priority!