policy

Cleaning the Graffiti in Healthcare

I just left the most unusual conference I have ever attended. First, it was small – 25 people. Second, it was all women. Third, it was all senior healthcare leaders who have done amazing things…make that trail-blazing things. Moreover, I found myself surrounded by women who were journalists at major news outlets, retired military officers from the highest ranks, senior leaders (in some cases the senior most leader!) at major federal and state healthcare agencies, Fortune 500 companies, large health systems, healthcare foundations, national advocacy organizations. It’s no surprise the name “Amazon warrior” resonated with this group! Finally, the conference was all about identifying our “living legacy”. Legacy seems like a strange word when you are living…it’s even stranger when you feel like you haven’t done anything yet! So, how did I get invited you (and I) are wondering? After all, I was the youngest person in the room, which as an aside, is a very unusual context when you work with students and residents for big chunks of the day. So, believe it or not, I was invited by in large part due to my… social media presence! After reviewing the list of participants, the organizers realized something was missing, and that something was someone younger who also had a social media presence. And whoever said tweeting is a waste of time? While there is much I could say,...

‘Medicine’s Top Earners Are Not the M.D.s’…Yeah, And?

​I recently took a new position in the healthcare system where I work–a big change that would place me right at the heart of a nationwide initiative toward patient-centered care. My first day at the new, larger, sparklier hospital, all the new hires were taken down the long hallway of the administrative building and encouraged to gaze upon the Wall of CEOs, pictures stretching back, down the hall, to the beginning of the hospital’s history. All men. All middle-aged. All white. I made the decision a few years ago to switch medical tracks and head toward a degree in hospital administration, hopefully getting a master’s in public health and, eventually, a PhD. When I first started working in healthcare in ernest, I realized right away that the medical professionals themselves had a frustratingly small effect on change when it came to hospital system politics. Each year it seemed they spent more times with their hands tied than on patients they were treating. I want, perhaps naively, to be an agent of change, a force in healthcare reform, and I realized that I couldn’t do that and practice as a physician – if I really wanted to devote myself to reform, I had to be an administrator. The trouble is up at the top and trickling down, negatively affecting the way physicians and nurses practice, the health of patients and...

Are You Binge Drinking?

When the doctor asks you, “how many drinking do you have per week?” do you just guesstimate? Do you consider binge drinking only 7 shots or more? There may be a lot you don’t know about binge drinking. The CDC explains that this information is important for anyone, but especially aspiring physicians, to...

How the Solution to Physician Shortages May Be Right on Your Screen

With more and more Americans receiving healthcare coverage, it remains to be seen how this will affect the shortage of primary care physicians. But is there a more efficient, modern solution to this imminent problem? An article in The New Yorker delves into the world of telemedicine, which allows patients from anywhere and at anytime to connect and correspond with doctors via video chat. It holds the potential to vastly improve the quality of medical care and reduce cost and wait times. The article notes the particular usefulness of telemedicine in fields such as emergency care, “which deals with issues that need prompt attention but can be diagnosed and treated without an in-person exam—respiratory illnesses or urinary tract infections, for example.” A Health Affairs study found that off-hour, two-way video conferencing between physicians and residents in nursing homes culminated in Medicare costs savings that far exceeded the cost of the telemedicine service. It remains to be seen whether healthcare providers will adopt the approach. Many of the situations in which telemedicine could be particularly effective would not have applicable Medicare reimbursements to justify using the technology. However, the outlook may be changing, especially for large health organizations that receive bonus reimbursements from the government for meeting quality and efficiency standards: Bundled payment schemes pay providers a fixed amount to manage a given medical condition, in contrast to the traditional model that reimbursed a la...

When Children Ask to Die

“Parliament in Belgium has passed a bill allowing euthanasia for terminally ill children without any age limit, by 86 votes to 44, with 12 abstentions.” via the BBC. Most of us do not enjoy seeing people suffer; especially kids. Over the years, sensationalized images of sick children have appeared in program brochures, marketing ploys and donation campaigns of children’s hospitals and foundations that aim to offer some comfort to kids with incurable diseases. Cancer ridden kiddos, bald and ghostly white, strapped to beds with tubes in their noses and dark circles shadowing their eyes have become so consistently heartbreaking that it’s a go-to for dramatic, award winning film and television. But the reality is much less dramatic and more frighteningly human. Children are, after all, just tiny humans. And those who have experienced the pain and anguish of chronic illness, cancer or other terminal conditions have developed an adult-like awareness of humanity that some people decades ahead of them may never know. Lawmakers in Belgium have realized this and the country has become the first in the world to remove age restrictions from euthanasia. Euthanasia, sometimes referred to as “physician assisted suicide” is when someone terminally ill, with no hope of survival, is relieved of their suffering with the humane intervention of medicine as opposed to the prolonged suffering involved in “waiting to die.” Many European countries have comparatively...

What We Do When Not on the Wards

So I’ve explained about all of the various crises facing us (SGR, GME cuts, student debt), but I haven’t really talked about how medical students and physicians have organized to prevent this from happening, so I thought I’d use this post as a little intro and then bring you, O Constant Reader, up to speed with what happened at our last conference.  Here goes. I acknowledge that there are specialty societies that exist at multiple levels, as well as other interest groups, but for the sake of this being a primer, I’m sticking with the gestalt of organized medicine. The Basics of Geography: The smallest level of organized medicine that I’ve encountered is the local medical society.  Be it representative of a city, county, or region (it varies all across the country), this group is composed of, you guessed it, local physicians.  Often there isn’t a set political agenda, but it provides a means for physicians working in close proximity to interface with each other at monthly (give or take a few weeks) meetings. The next level is the state medical society.  These bodies mainly concern themselves with the goings-on at the state legislative level and accordingly direct much of their resources to state policies.  In general, the societies break their state up into districts (or equivalent word) that are represented by one or more of the aforementioned local...

Would You Pay $1,000 Per Day For a Medication?

Sovaldi, the newest FDA approved antiviral for treating Hepatitis C, has been shown to cure patients in as little as three months. That’s right: not prevent, cure. Touted as a miracle drug, Sovaldi has been on the market since December and patients have been scrambling to get their hands on it. That is, until they get a look at the price tag: $1,000 per day for a three-month course. Who are the patients? By and large, Veterans, prisoners and those who are uninsured or insured by Medicare. The lowest income patients are the ones with the greatest need, and such, the taxpayers are the ones who are picking up the tab. The tab, in this case, is almost as much as the United States spends on all prescription drug coverage annually: for one year of funding for every one Hepatitis C patient in the United States, the tab is $227 billion dollars. Spending for all prescription drug coverage in a single year? $260 billion. Even so, the company that manufactures the cure, Gilead, is not unsympathetic to the cost of the drug: in worldwide distribution they have begun offering the drug to countries based on their per capita income. So, when Gilead offered the drug at a 99% discount to Egypt, the United States couldn’t understand why patients here were still paying $1,000 per day. The answer is simple: Gilead’s...