1) Dartmouth Medical School is leading the “slow medicine” movement, where the elderly are given the decision whether to pursue more intensive medical therapies.
My take: Bravo. This trend needs to be publicized and spread nationwide. Much of Medicare’s spiraling costs can be attributed to unnecessary end-of-life care.
We need to communicate the acceptability of saying “no”, and give patients more of a say in the treatments they undergo.
2) The RUC is responsible for coming up with a payment mechanism for the medical home.
My take: Specialists continue to hold primary care by the balls.
The RUC is dominated by specialists and sub-specialists. Until this committee is completely disbanded and reformed with a generalist majority, primary care will continue to get the payment shaft.
Go and read The Happy Hospitalist’s detailed analysis for how the RUC is sinking the proposed medical home.
3) A reader writes: “Have you seen any hospitals that are able to avoid the bantering and animosity between the ED docs and the admitting docs over admissions?”
My take: I’ve seen both. There are cases where hospitalists are happy to take every admission, and others where there is considerable resistance.
It comes down to the degree and acceptance of defensive medicine practiced within the hospitals. Just as hospitalists occasionally order questionable tests defensively, emergency physicians admit borderline cases on cya basis.
Physicians with an understanding and acceptance of what’s really going on generally avoid the animosity that is associated with questionable admissions.
4) A reader writes: “Curious as to where physicians see the dividing line between ‘patient relations’ and ‘risk management’. At what point does a patient who has a legitimate concern he’d like to discuss stop deserving communication and start having to be treated as a potential lawsuit — never mind that the patient has shown no sign of being interested in suing?”
My take: Patient relations and risk management go hand in hand. Studies have shown that better communication can reduce the risk of malpractice lawsuits.
Unless the patient actually sues, there should be no barrier obstructing patient communication with the physician. Sadly, this is rarely the case, as I wrote in a recent op-ed.
Related posts:
- Medical home
- Emergency physicians and the medical home
- How not to sell the patient centered medical home
- Poll: What are the obstacles to the patient centered medical home?
- Why doctors skip medical interpreters, and how that damages physician-patient communication
- Encouraging news on the medical home
- Continuity of care
{ 8 comments }
If there was a PCP majority on the the RVU board and the shoe was on the other foot, can you imagine how hard it would be to fill the specilities.
Not only are specialities that are high paying usually longer training in terms of years, but they are more intense in terms of hours worked and the immensely physical nature of the job.
I’m sorry, but if you want to see a real crisis then you should lower payment to specialty medicine because those are going to be the spots that will NEVER be filled if the money isn’t there. At least internal medicine and family practice is only 3 years of residency.
Good luck filling jobs like Urology (5-6 years training, dealing with the unglamorous penis), orthopedics (horrible work hours, physically demanding), cardiology (horrible work hours, must be willing to miss every kids birthday), etc.
Kevin, I’ve said it before and I’ll say it again… your coverage of this specific area is biased and you are being motivated by self interest.
The shortages are just beginning, with primary care only being the most obvious.
In the coming years, almost every frontline field will be affected, if not already:
1)general surgery: why take out an appendix at 3 am when you can do elective carotids in vascular surgery, and make more money?
2) general ob-gyn: why do a c-section at 3 am if you can become an infertilfity specialist?
3) cardiothoracic surgery: although high paying, is it really worth the risk if one can go into derm? or plastics?
4) neurosurgery: ditto above
5) general orthopedics: why repair 85 year old hip fractures when you can do “hand”?
6) nephrology: why be dependant on low paying dialysis patients when you can go into GI?
The list goes on.
Every physician should be worrying about the fate of primary care. Once we’re gone, they’re going to come for you next.
If I were a primary care doc I would step out of the system.
Regarding #3 — ED vs admitting our hospital has come full circle and it related to the ED docs to a large degree. When we had a team of community docs (those that lived locally) in the ED and they where a full time team they never called in the dead of night unless they really needed you and in turn no one gave them a hard time when they did call. Move in a contract dispute and new locum docs and the mutual respect evaporated and the animosity developed. Now 3-4 years later we have mostly full time docs back and things have greatly improved.
“Slow medicine” is not a movement that needs to be spread. It is the historical usual way of taking care of those dying of “old age” that I was taught was normative to offer to the elderly back in the “old days” of the 80’s in the avant garde state of Arkansas.
The RVS system is set to pit specialty against specialty and reforming it will not change that. Rather what PCP’s need to do is write and float their own CPT system with distinct code and lobby for it’s implementation for primary care services by CMS. There is absolutely no reason not to do that.
You are comparing apples and oranges and their downgrading of your services compared to other specialities is as groundless as your constant sniping about it is useless. They need not and should not be compared at all.
Urology is actually rather popular at the moment. Unglamorous as the penis and prostate may be, it’s a laid-back specialty with decent call and lots of reimbursement for procedures.
But yes, as one surgeon told me:
“Don’t go into surgery if you can see yourself doing anything else in medicine.”
It simply isn’t worth it unless you know you really want it, because the lifestyle can be so tough.
hi, first time here..would like to continue reading ur blog…would you mind we exchange link?
hav a nice day ahead!
When Australian patients are allowed to be given accurate reports on radiology scans and appropriate medical treatment when it involves injuries from car accidents, workcover and other insurance claims then you can have something comment about.
Who will take responsibility?
Is it corrupt Government or Health system?
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