As our nation struggles with the mind-boggling algebraic-like task of reigning in on health care expenditures while increasing provider access and high-quality medical care, provider payment structures are in flux between traditional payment methods and relatively new financial structures. While I am no means an expert of health policy nor medical business and financing, I think it's important for medical trainees and enthusiasts alike to understand the very general basics of ...

Read more...

I chose to leave clinical medicine in 1996 after just three years as a general internist. At the time, I was certain that it was the right decision and necessary for my overall health, but could not have articulated all the reasons why I needed to leave. I loved both the intellectual challenge and the art of medicine. I thoroughly enjoyed my connections with patients. I regarded my professional life ...

Read more...

We’re living in a world or ratings. Books get rated on Amazon, dry cleaners get rated on Yelp. Doctors are getting rated, too -- not only on web sites, but also in ways that end up dictating how much money we can make, or whether we can keep our ability to work in a hospital. Is this a good way to improve medical care or medical outcomes? Is it ...

Read more...

Prestige in medicine often follows research. Physician-scientists who do basic science research have often been considered among the giants of medicine. As the field of medicine advanced, the gap between what we knew from basic science and how we practiced grew. This created a need for more translational researchers: physicians who could bring what they knew from the laboratory bench to the bedside through large clinical trials. Now, the next great gap ...

Read more...

Are insurance companies making more decisions about the health care you receive? While a decade or two ago utilization nurses working for insurance companies had some power to approve or reject certain treatments, the reach of insurers into the patient-physician relationship is lengthening. In March, I reported that insurers were sending questionnaires to policyholders newly insured under Obamacare asking about their health conditions and medical needs. And some people were filling them ...

Read more...

This is often proposed, but I have trouble understanding it. Real outcomes are not blood pressure or blood sugar numbers; they are deaths, strokes, heart attacks, amputations, hospital-acquired infections and the like. In today’s medicine-as-manufacturing paradigm, such events are seen as preventable and punishable. Ironically, the U.S. insurance industry has no trouble recognizing “Acts of God” or “force majeure” as events beyond human control in spheres other than health care. There is ...

Read more...

He was rather tall.  Or at least he appeared so with his long erect back jutting from the bicycle seat. The cringe worthiness of his helmet-less head was assuaged by the gigantic headphones covering his ears.  I figured they would provide minimal protection during a crash, but at least he would be listening to groovy tunes. He weaved in an out of traffic on a busy two lane road.  He peddled ...

Read more...

Next in a series. The art of healing is very important in medicine. There is a difference between being a modern day physician and being a healer. All societies have healers -- wise men and women, shamans, medicine men and people of other names. The “old time practitioner” was almost always a healer but many physicians today are not. It is an issue of interest, training, time and prioritization. Most ...

Read more...

House call on a hundred foot cliff Johnny’s disabled. He can’t get to my office anymore. So I drive 100 miles up the Oregon coast to check in on him. I get lost, but finally discover his little white house on the edge of a cliff overlooking the Pacific Ocean. House call on a hundred foot cliff House call on a hundred foot cliff “Last ...

Read more...

In his book The Art of Loving, Eric Fromm wrote that “the deepest need of man is to overcome his separateness, to leave the prison of his aloneness.” In the Bible, after forming Adam from the dust of the ground and breathing into his nostrils the breath of life, God declares that something is missing: “It is not good for the man to be alone.” A number of scientific studies verify that a ...

Read more...