I recently described the loathsome “relative value unit” (RVU) and its role in the decline in prestige and pay in primary care.  The RVU is maintained and updated by a small panel of 31 physicians called the Specialty Society Relative Value Scale Update Committee (RUC).  Twenty-seven of the 31 physicians are specialists, which is not at all representative of the physician workforce, given that primary care doctors comprise over one third of ...

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When I first met Ralph, he was 82-years-old.  He suffered from shortness of breath which started when his wife of 56 years was diagnosed with a rare bone cancer.  Upon further investigation, I diagnosed him with a weak heart and a very tight aortic valve which required immediate surgery.  Ralph made it; his wife died.  Today, twelve years later, he brings me treasures from his metal detecting hobby on the ...

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My 87-year-old father broke his hip this past weekend.  He was in Michigan for a party for his 101-year-old sister, and fell as he tried to put away her wheelchair.  The good news is that he’s otherwise pretty healthy, so he should do fine. Still, getting old sucks. During the whole situation around his injury, surgery, and upcoming recovery, one thing became very clear: Technology can really make things much easier:

If you read my articles, then you likely know about the scam known as pay-for-performance (P4P).  This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it. In short, P4P pays physicians (or hospitals) more if certain benchmarks are met.  More accurately, those who do not achieve these benchmarks are penalized financially. I do not object to this concept.  Folks who perform ...

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It is time for American physicians to rise up It's time for the American physician to stand up. We will no longer bend to the tyranny of bureaucracy, the venom of litigation, or the naivete of legislation.  For we have spent many a night sweating on the phone as our dear administrators slept comfortably in their beds stuffed with hundred dollar bills.  Our experience standing in the line of fire dwarfs ...

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A physician I have known for many years recently told me about his decision to enter the world of concierge medicine. His reasoning was telling, saying that it came down to a very simple decision on staying independent or becoming a hospital employee. He liked being an independent solo practitioner, and that was his primary motivation: to maintain independence in a time of consolidation. Richard Gunderman, writing for the Atlantic, tackled ...

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After I left my position as a staffer for the U.S. Preventive Services Task Force in November 2010, it was three years before I was tapped for another guideline post, this time at the American Academy of Family Physicians. Recently I joined the AAFP's Commission on Health of the Public and Science, which formulates guidance for family physicians on a variety of topics, including clinical preventive services. My appointment coincided ...

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Next in a series. Years ago while in oncology training, I was on night duty when a patient of one of my colleagues was having severe penile pain. He had received a new investigational chemotherapy and it turned out to have an unexpected property of damaging the lining of the bladder and urethra. It gave him a strong uncontrollable urge to urinate yet each time the burning was excruciating. Oral ...

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As a child, I often watched science fiction movies and television shows wondering how much would become reality in my lifetime.  From space travel in Buck Rogers and Star Trek to time travel in Back to the Future, I often imagined growing up in a world where the impossible became probable.  Bionics and the repair of human tissues was captivating and the Six Million Dollar Man became a hit series. Now, much of what was thought to be ...

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I’m not sure if you’ve heard the parable of the tall man and the cat. Maybe not, since I had to make it up in light of health care’s unending cost increase. In this allegorical village, there was a group of citizens who were very upset with a man who lived there. This man was very, very tall, and he made all the villagers feel uneasy (they were insecure about the crowns of their heads, ...

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