Tuesday, March 9, 2010
What if Other Parts of Life Were Like Healthcare?
Health care is bizarre. Anyone who spends significant time in its ranks will attest to the many quirky and downright ludicrous things that go on all the time. But I am not sure people realize just how strange our system is. Perhaps it would be interesting to see what it would be like if other parts of our lives were like health care.
1. Get up in the morning
The first thing that happens in your day is that your alarm fails to go off. Although you have major things happening, nobody ever has explained to you exactly what you are supposed to do and when. You watch the morning TV show and it seems that some experts say you should go to school while others say you should avoid school at all cost. You call a friend who says that she knows someone who went to school and it destroyed their liver. Another friend goes to school every day and is just fine.
Confused, you turn to the Internet and go to a Web site that explains that you should base your schedule on the pattern of tea leaves in a cup. This site claims that your normal schedule is actually fraught with secret appointments that will, unbeknown to you, make you have cancer. It states that those people in power are making you go through this dangerous schedule so they can make money off of you. They don't care for you like the people who made this web page (and for $400 you can have six months of magic tea leaves).
Finally, you decide that you are going to go with the majority opinion and go to school.
2. School
You go to your bus stop and wait. You keep waiting. You know that the bus was supposed to come at 8 a.m., but after an hour you begin to wonder if you missed it. Calling the bus service, you find out that the bus got caught up doing some extra routes. There is a shortage of buses, and so the ones that remain have to do twice as many routes as is feasible. After a two-hour wait, the bus finally arrives to take you to school.
The first teacher comes into the classroom and looks very distracted. She teaches general studies and is staring at a curriculum that contains a huge amount of subjects. As she is doing her lessons, she furiously takes notes on her own teaching so that she can submit documentation to the school board and prove that she taught you. This is the only way she gets paid.
In total, she teaches for about 15 minutes and documents her teaching for 45 minutes. You want to ask questions, but the bell rings and you have to move on to your next class before any can be answered.
The next teacher only teaches a small specialized subject. This teacher is paid four times more than the first teacher. Instead of teaching and answering questions, however, he is constantly making you take tests. Apparently, the school system pays a huge amount for making you take tests, but very little for teaching lessons that would make you do well on those tests in the first place.
School is finally over, but you don't feel like you got much out of it (except for taking a lot of tests and getting more confused). You decide that a trip to the store would perhaps make you feel better.
3. The grocery
Upon entering the grocery store, you notice something odd. There are very few different brands of items stocked on the shelves. Your choice is limited to only the brands that have struck the best deal with the grocery chain. These brands have to send the grocery store a large "rebate" check because they are carried exclusively in this store.
When you go to the meat counter and ask for some steak, the butcher asks you if you have first tried the ground beef. You may not purchase steak unless you have first tried and disliked the ground beef. The ground beef, of course, is actually ground turkey, but the butcher says that these two are basically interchangeable and so the substitution is permitted.
The grocer can't post prices because all customers have different negotiated prices. Posting prices, in fact, would be considered collusion since other grocers could find out exactly what this grocer is charging. Some congressman in California decided that grocers are all crooks and should not be allowed to share what they charge for things.
You go to the cash register to pay. The total is $380, but the cashier informs you that your negotiated price is only $150. A poor person behind you has not had the chance to negotiate a price and so must pay full price for everything.
There are a few people in the store who don't have to pay anything. They have had the price negotiated for them by the government, and so will come to the store very often. They sometimes come for real food, but are often coming for candy and cigarettes--all paid for by the government.
This experience leaves you more tired and confused, and so you decide to go home.
4. Home
Coming home, you notice that your house is under construction. There is a new wing being built that contains all sorts of the newest and fanciest gadgets, such as flat-screen TVs, the fastest computers, and wonderful new kitchen appliances. Going into the house, you notice that there is no running water or heat. Apparently, there are all sorts of grants and low-interest loans to pay for the fancy gadgets, and so contractors find it much more profitable to do that instead of fixing water or heating.
Your mother is in the kitchen trying to make dinner, but instead of cooking she is staring into a cookbook and at the ingredients you brought from the grocery store. You assume she can make do with what you brought, but she just sighs helplessly. Despite the fact that your mother is incredible at improvising meals, she is required to follow a cookbook that doesn't fit the ingredients that are available. This makes dinner taste pretty bad. Your mother, obviously angry about this, gives you a weak smile and tells you to finish what is on your plate.
After dinner, you settle down to watch some television. As you are finally starting to relax, a knock on the front door breaks your peace. At the front door stands a police officer. "You are only authorized to be in the house for two hours today, so I am going to have to ask you to leave."
You try to explain that two hours is not enough to get the rest you need, but the officer threatens a stiff fine and forces you to leave. Before you can get your necessary things, you are forced to leave without an explanation of how you are supposed to survive on the streets.
If it doesn't make sense in real life, how can it make sense in medical practice?
Rob Lamberts, ACP Member, writes the blog Musings of a Distractible Mind and is on Twitter. His podcast, House Call Doctor, is available online and on iTunes). He is board certified in Internal Medicine and Pediatrics and was an early adopter of electronic medical records.
Labels: health care delivery, humor, medicare, primary care shortage, reimbursement, Rob Lamberts
posted by Dr. Rob at
1:41 PM
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Monday, March 1, 2010
Once Upon A Time
AUTHOR'S NOTE: I am very frustrated with a system that increases cost dramatically and yet reduces what I get paid. The rest of the money is going somewhere, and since it is not improving the overall quality of care, it is mostly waste. We are enamored with MRI scans, stents, and expensive cancer treatments, with little to show for them except increased expenses and a lot of third parties getting rich off of this waste: drug and device manufacturers, medical imaging companies and other para-healthcare industries. This story, which originally appeared at Musings of Distractible Mind, is prompted by my frustration with waste and how it spurs unneeded health care delivery.
Once upon a time there was a land on the ocean. The people lived off of the food from the ocean and were very happy. But as they grew bigger, they had a problem: They made a lot of waste! Yuk! Nobody likes waste. What could they do about all of this that stuff that nobody needed?
Some said that they should find a way to make less waste. They said that the people of the land were not smart and should be making less waste. But most of the people in the land didn't like to change what they were doing. It's hard to change. So they built a large pipe that pumped the waste into the ocean.
The land was clean again and the people were happy!
As time went on, they had to build more and more pipes to handle their waste. Nobody ever tried to make less waste because they could just make more pipes and pump it into the ocean. This even built a very successful industry of pipe-workers. This helped the economy.
But then one day something terrible happened. The pipes pumping waste killed off several species of sea life. This made the environmentalists in the land cry out in protest. But as it stood, the number of species in the ocean were so vast that the killing off of a few of them was felt to be no harm. So the pipes kept pumping. The people still could be happy with a few less species.
And then came a day when something magical happened. New species of sea creatures formed around the pipes. These creatures fed off of the waste and thrived around these pipes. These new creatures became very big and very fancy, and this made the people of the land very happy. What were the environmentalists all worried about? So what if a few species had died off; there were new exciting species being formed! The people were so excited that they made even more waste and more pipes so they could make more new species of sea creatures.
What fun!
Now, these fancy new creatures were hungry. They ate all of the waste and wanted more. They ate most of the other sea animals and wanted still more. They couldn't get enough food. So they sent lobbyists to the government of the land to get them to build more pipes and send more waste. The creature lobby was very rich, and so poured lots of money at the government of the land. This made the politicians very happy. So the happy politicians told the companies of the land to make more pipes and send more waste out to the sea. And the sea creatures were happy.
And so it went for many years: more pipes sending more waste making more fancy sea creatures eating more waste sending more lobbyists to make politicians get more companies in the land to build more pipes. Everyone seemed to benefit from this nice arrangement! Maybe they'd be happy forever!
But one day, some of the people of the land got tired of putting all of their money into building pipes to send waste. They thought their land should stop making so much waste and start putting those resources into schools, food and fighting crime. The government was raising taxes more and more so that they could afford to make more pipes. This made these people mad because some people couldn't afford any more taxes. Paying for all of this waste was too much.
But the lobbyists from the sea creatures put commercials on television saying how good the waste was. In fact, having so much waste made the land one of the best lands anywhere. They pointed out how many new sea creatures came to be because of this waste and how other lands couldn't do this. The pipe manufacturers also made commercials telling about all of the jobs these pipes were creating. They all made so much sense!
They also sent more money to the politicians so they would ignore the people who couldn't afford paying for the waste.
But then some of the people of the land ran out of money and stopped paying taxes. This made the government mad, and so it left these bad people to live in their own waste. Many of these people became sick in their waste, and some of them died. Finally, the cry of the people was loud enough that the politicians in the land took notice. They decided that all of this waste was a real problem. No other land had so many pipes sending so much waste. True, there were lots of fancy new sea creatures, but the people in the land were getting angry, and some were dying.
But the politicians started fighting. One group of the politicians decided that the pipe-making companies were the problem. They thought that the government should take over the pipe-making job and guarantee waste pipes for every home. Others thought that the government could never do as good of a job as the companies did. They said that those people who couldn't afford pipes were dead-beats and probably deserved to die.
They held town hall meetings to talk about who should be making pipes, and people got very angry.
Finally, someone who wrote a waste-pipe blog suggested that perhaps the problem wasn't the pipes, but instead it was the waste. He said that the people should find a way to cut back on the waste, and so need fewer pipes. The blogger was criticized sternly, because his suggestion would have very bad consequences. The new fancy sea creatures that made everyone so proud would die off if they cut back on waste, and the pipe-workers would lose their jobs and be very sad. Plus, people didn't want the government telling them how much waste they could make. It's a free country, and people should be able to make waste without the government rationing it.
But as the people of the land thought about what this blogger said, they saw the sense in it. Yes, the sea creatures and the pipe manufacturing companies put very moving commercials on TV about dying sea creatures and unemployed pipe workers. They were very sad commercials and they made a lot of people weep. But the people of the land realized that this land was for people to live in, not for pipe companies or fancy sea creatures. Yes, it would be sad to not have those fancy creatures, and they'd have to get new jobs for the pipe company workers, but it was the only way.
Oh, it was hard to cut back on waste and kill off the fancy sea creatures. People got very mad and lobbyist groups tried to change laws or pay off politicians. But this was a good and smart kingdom, and they didn't listen to the creatures any more. And finally the day came when the sea was clean again.
And everyone was happy.Rob Lamberts, ACP Member, writes the blog Musings of a Distractible Mind and is on Twitter. His podcast, House Call Doctor, is available online and on iTunes). He is board certified in Internal Medicine and Pediatrics and was an early adopter of electronic medical records.
Labels: cardiology, climate change, drug companies, environment, health care delivery, humor, Rob Lamberts
posted by Dr. Rob at
2:00 PM
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Friday, February 5, 2010
Airplane Medicine: What Happens When You Answer The Flight Attendant's Call For A Doctor
This post by Liam Yore, MD, originally appeared at Better Health.
Rounding at 37,000 Feet
Anyone who has flown long-distance flights has heard the call: "If there is a doctor on board, please identify yourself to a flight attendant." But it's impossible to understand how that call induces the urge to flee to the lavatory and hide unless you are one of those unfortunate few who are on the hook, which is to say that you are qualified to respond, but you really really don't want to.
But gee, I can hear you think, Aren't you an ER doctor? Isn't this sort of thing second nature to you? Don't you revel in the adrenaline and glory? Well, yes. But, first of all, there is the performance anxiety thing. I'm used to working with a very small audience. In economy class, there may be 300 people watching me try to do my thing, and I'm just not used to that many people being in the exam room--and I know they are very interested in what's going on.
Also, being an ER doc, I am terminally paranoid, and over the Atlantic Ocean there's just no easy way to differentiate the Very Bad Things[tm] from the more common complaints which occasionally represent Very Bad Things[tm]. So that also is anxiety-provoking. And then there's the potential that things might turn bad, and then it's a flog to run a code in the limited space available.
Click on the "More" link to read the full post.
So, on Olympic Air, somewhere over the mid-Atlantic, the dreaded call goes out. I cringe and try to sink deeper into my seat, hiding my face behind my magazine. Finally, seeing that nobody else responded, I gave a deep sigh and pushed the call light. It was a 60-70ish guy in First Class with abdominal pain which radiated through to his back.
Great, I thought to myself, It's an aortic aneurysm. (See? I told you I was paranoid.) But his belly was soft with no pulsatile mass, good femoral pulses, and clinically, I thought the pain was much more suggestive of a kidney stone. I gave him some ibuprofen and said I'd check on him later.
I tried to sleep, but maybe an hour later, the attendant approached me again ... there's another patient for you. Sheesh. This is an older fellow with a history of heart disease who has epigastric pain and nausea. How the hell am I supposed to tell heartburn from angina over the Atlantic? I asked the attendant if there was a defibrillator on board, thinking maybe I could at least look at the ST segments, but the Greek-speaking attendant seemed to not understand the question. I mimed shocking someone with paddles, and his eyes got very big, but then said, no, they didn't have anything like that.
The patient said he has had typical chest pain with his heart attacks and this felt much more like his stomach. Then he threw up and felt a little better. I rooted through the medical kit and found something which looked like Greek meclizine and gave it to him. I checked on the first guy and he said he felt a lot better.
A couple of hours later, they roused me from a deep sleep (this was an overnight flight), to apologetically tell me that there was a third passenger in need of attention. Oh. My. God. This elderly lady was having trouble breathing and they had gotten an oxygen mask on her. Well, her lungs were clear and her pulse was normal and she seemed really panicky and her traveling companion said she had been under a lot of stress and hated to fly. So probably a panic attack. I told the flight attendant to keep her on oxygen for another half an hour (purely for placebo value) and told the patient in my most authoritatively reassuring tone that she would be feeling better by then. I then checked on the kidney stone (sleeping) and the nauseated fellow (much better, thank you). I went back to the galley and hung out with the crew, drinking coffee for half an hour, then went back to the panicky lady who had in fact experienced a miraculous recovery.
The flight crew was very nice and gave me a free bottle of champagne as a gift. And I swore I would never again admit that I was a doctor on an airplane flight.
The time in Greece was lovely. We started off on the island of Kos, Hippocrates' birthplace, and I got a cool T-shirt with the Hippocratic Oath on it, in Greek. As it happened, that was the only clean garment I had for the flight home (this time on Delta). This time we made it most of the way across the Atlantic before the call came for a doctor. I waited and waited and nobody else responded. Finally I decided that I couldn't very well walk around with the fricking Hippocratic Oath on my chest and not help out, so I gave in and rang the bell. As I stood up, I saw an elderly man about 10 rows in front of me, standing in the aisle in the tripod position, labored breathing, gray and sweating. That must be my patient, I thought. He doesn't look good. He couldn't tell me anything (too short of breath), but his traveling companion cheerfully informed me that he had had a heart attack only two weeks ago, and just got out of the hospital with congestive heart failure and had a pacemaker put in.
Oh, is that all? His pulse was about 150, way too fast, and his blood pressure was also very high. When I asked, he nodded "yes" that he was having chest pain. I figured that most likely he had gone into an irregular heart rhythm as a consequence of his heart failure and the low oxygen pressure in the cabin. I got out the defibrillator and moved him to an empty seat in business class because I figured that if he was going to code, I wanted room to work it. He looked that bad. I rooted through his med bag (a cornucopia of heart meds) and gave him aspirin, nitro, lasix, and metoprolol. And oxygen, of course. Then I went to talk to the pilot. We were two hours out from JFK, he said, but we could get down just a bit sooner by landing at Halifax, Nova Scotia. I tried really hard not to let the knowledge that I had a connecting flight affect my decision-making. Tough decision. Finally, I said that I thought he could make JFK but we should expedite it. I heard the engines spool up as the pilot accelerated the plane. So I sat up in first class with him to keep an eye on him (The wife eventually joined me when I didn't return to our seats in coach), and he progressively improved. His pulse came back towards normal with a second dose of metoprolol, and by the time we landed (almost 40 minutes early) his color was much better and his breathing was a lot easier. I wrote up a little report for the paramedics/ER, and after the fastest landing and shortest taxi I have ever had, the medics bustled him off the plane.
Again, the flight crew was really nice (and almost pathetically grateful, which was appropriate, since an unscheduled landing would be just about the end of the world to them). They took my business card and promised me a "nice little something." Lord knows what that'll be--probably a fruit basket. It was rather a pain in the butt, but at least the guy really needed me, and it was gratifying to see him get so much better. And I have resolved that from now on, I will fly with an iPod in my ears, cranked up so loud I cannot hear a single overhead announcement ever again.
This post originally appeared on Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
Labels: humor, travel medicine
posted by the Better Health network at
2:20 PM
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Friday, January 29, 2010
...and I Feel Fine
This post by Rob Lamberts, ACP Member, originally appeared at Musings of a Distractible Mind.
Primary care is dead. Long live primary care.
Wait a minute, I am in primary care. I am not dead. Not yet, at least.
Which reminds me of this Monty Python skit:
CART MASTER:
Bring out your dead!
[clang]
Bring out your dead!
[clang]
Bring out your dead!
[clang]
CUSTOMER:
Here's one.
CART MASTER:
Ninepence.
DEAD PERSON:
I'm not dead!
CART MASTER:
What?
CUSTOMER:
Nothing. Here's your ninepence.
DEAD PERSON:
I'm not dead!
CART MASTER:
'Ere. He says he's not dead!
CUSTOMER:
Yes, he is.
DEAD PERSON:
I'm not!
CART MASTER:
He isn't?
CUSTOMER:
Well, he will be soon. He's very ill.
DEAD PERSON:
I'm getting better!
CUSTOMER:
No, you're not. You'll be stone dead in a moment.
CART MASTER:
Oh, I can't take him like that. It's against regulations.
DEAD PERSON:
I don't want to go on the cart!
CUSTOMER:
Oh, don't be such a baby.
CART MASTER:
I can't take him.
DEAD PERSON:
I feel fine!
CUSTOMER:
Well, do us a favour.
CART MASTER:
I can't.
CUSTOMER:
Well, can you hang around a couple of minutes? He won't be long.
CART MASTER:
No, I've got to go to the Robinsons'. They've lost nine today.
CUSTOMER:
Well, when's your next round?
CART MASTER:
Thursday.
DEAD PERSON:
I think I'll go for a walk.
CUSTOMER:
You're not fooling anyone, you know. Look. Isn't there something you can do?
DEAD PERSON: [singing]
I feel happy. I feel happy.
[whop]
CUSTOMER:
Ah, thanks very much.
CART MASTER:
Not at all. See you on Thursday.
Now I would never suggest that the cart master who clubs the dead person represents, say, Medicare. It would not be in my nature to make such a suggestion.
But that is not the point of this post. While many complain of the death of primary care and declining reimbursement, some practices are experiencing quite the reverse: growth in income. I should know, because I am in such a practice.
We are not business geniuses in any stretch of the imagination, but we have been quite successful and raising our incomes substantially. Since I started 13 years ago, my income has doubled, and most of that increase has happened over the past five years, just the time that the death of primary care has been announced.
Our practice is almost totally outpatient (we still see inpatient pediatrics), and we earn very little at this point from labs and procedures. The vast majority of our income comes from regular office visits.
Here are some of the ways we have accomplished this:
We have focused on process. Using our electonic medical record, we try and find the most efficient ways to perform tasks in the office, involving the lowest possible number of staff. This has been a passion (see also: obsession) of mine.
We have focused on our patients. Our patients are our business, and so trying meet their needs (instead of the needs of the doctors) has resulted in a booming business. Here are some ways we have done this:
1. We have extended office hours. with a walk-in clinic (for acute problems only) every morning from 7:30-9:00 a.m. and every evening from 5:30-7:00 p.m. People don't get sick on a schedule and so we allow them to come in when they are sick. To do this, we had to drop most of our inpatient care (or have no life). This accounts for about 25% of our revenue that we would have otherwise lost to prompt cares or ERs.
2. We allow work-in visits. The patient likes to be able to see their doctor when they are sick (they get whoever is in clinic if they use our walk-in clinic). So even with a full schedule, I allow one "quick sick" visit every hour.
3. We do not tolerate patients being treated poorly. Doing so is considered a fireable offense. If a physician does so, they talk to the senior partner (which is me, but this really has not happened).
4. We strive for timeliness. Although we can never guarantee being on-time, we have done our best to have patients out the door within an hour of their arrival. This goal was modest enough to be possible, while allowing for the obvious emergencies.
5. We have a modified "open access" schedule. While I have too many chronic disease patients and scheduled follow-up visits to want to go completely open access, we do leave an hour of each afternoon open until the day of, so even complex patients can possibly be seen on the day they call.
We understand what is most important. While many practices focus on the complex higher-priced visits, we have understood from the start that the money we can earn per hour is much higher for ear infections and urinary infections. Plus, the majority of our patients are only going to use us episodically, so we want our office to cater to the larger population rather than the minority who are sick all of the time.
We are growing. My income went up when my share of the overhead went down. While our system worked fine for three physicians, it requires very few additional staff and space to run it with six. Adding new physicians and/or mid-levels has cut our overall overhead per provider dramatically.
We are planning. We know that pay-for-performance (P4P) and the "medical home" concept are probably going to happen. We have tried hard to keep our data good enough to be able to pounce on this once it is offered. So far, I have personally collected over $5,000 from P4P programs already, and their penetration is minimal. We know that once that wave starts, we will be in the front of it.
Quality is not compromised. We have done what we can to run the business well, but have tried not to forget that we are offering healthcare. The physicians in our practice agree to certain care standards and common practices. If we can all agree to what good quality care is, then we are far more likely to achieve it and we can engineer our process to accomplish it. For example, when National Committee on Quality Assurance certification became a means to increasing income, we were already exceeding the standards to become certified in diabetes care within a matter of weeks.
Admittedly, it has not been a smooth road to where we are now, and we are not without our problems (there is always a crisis somewhere), but from what I can tell, we have remained one of the less dysfunctional practices around. Given the unstable ground of U.S. health care, we certainly have no guarantees that this trend will continue, but I am doing my best to anticipate any trends in the system and set us up for capitalizing on this, rather than being caught off-guard.
Hopefully we are not facing any bridge of death in the near future. If we are, then perhaps we can start collecting shrubbery. I already have my electronic medical record programmed to say "Ni!"
Bonus points if you know the significance of the title. The answer is here.Rob Lamberts, ACP Member, writes the blog Musings of a Distractible Mind and is on Twitter. His podcast, House Call Doctor, is available online and on iTunes). He is board certified in Internal Medicine and Pediatrics and was an early adopter of electronic medical records.
Labels: electronic medical records, humor, medicare, patient communication, patient-centered medical home, primary care, quality reporting, Rob Lamberts
posted by Dr. Rob at
1:00 PM
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Friday, January 22, 2010
Facing the Future
This post by Rob Lamberts, ACP Member, originally appeared at Musings of a Distractible Mind.
The following is an actual fictional conversation that took place in the doctor's lounge at a local hospital.
Internist: Dang, these Medicare cuts are coming and I doubt that Congress has the wits to avoid them. I am not sure I can go on practicing if they cut them anymore.
Family Physician: Yeah, we already get paid so little by Medicaid and the private insurers, we have had to start to look for other sources of revenue.
Internist: Really? We have been looking into that as well. What are you thinking about doing?
Family Physician: We thought about doing cosmetic procedures, but we have an especially good-looking population, so we really can't make it work.
Internist: Bummer.
Family Physician: Yep. Instead, we have decided to open a kiosk for Krispy Kreme donuts. We figure we can make money off of the donuts, plus we can get more of our patients obese. Then we can treat worse diseases and code a higher level for each visit.
Internist: Genius. Plus, you can get all of the kids hyperactive on the sugar and treat their ADHD.
Family Physician: And the "Hot Donuts Now" sign along with the scent of fresh-baked donuts will really draw in new customers ... I mean patients.
[Click on the More link below to read the full post.)
Internist: One of the GI doctors in town is doing the same sort of thing, opening a Starbucks in his office. He figures he gets walk-ins, gets people with worse dyspepsia, and gets free WiFi to boot.
Family Physician: Brilliant. What have you been thinking of?
Internist: We have noticed the interest our patients have in holistic medicine, and thought we should capitalize on that.
Family Physician: So you are hiring a homeopath?
Internist: No, they wouldn't set foot in our office because of the "evil" immunizations we use. We tried to get all sorts of alternative providers, but they would always sneer at our practices. And so we finally opted for two things: First, we are doing aromatherapy, which has our staff so relaxed that they don't seem to have noticed that we cut their pay by 50%.
Family Physician: Great.
Internist: Second, we have a psychic who goes around in our lobby doing palm reading and tea leaves on our patients as they wait. There are two positive outcomes from this: the patients who get bad fortunes told are so anxious that their blood pressure is up and they are ripe for anxiety treatment; the ones with good fortunes are happy enough that we can order all sorts of tests on them and they don't seem to care. There is a downside, however.
Family Physician: What's that?
Internist: My partner now thinks that we should take our entire budget for next month and invest it in Power Ball lottery tickets. He says it is a "sure thing."
Hospitalist: Hey guys, what's up?
Family Physician: We're just discussing what we are going to do to offset the impending Medicare cuts. Do you have plans?
Hospitalist: Oh yes. I don't like the idea of increasing the load to 70 admissions per day. Fifty is plenty. Instead, we are capitalizing on the fact that our patients are a "captive audience."
Internist: This I've gotta hear.
Hospitalist: We figured that we have enough turnover that some sort of direct marketing scheme to our patients could be quite lucrative. We are now certified Amway sales representatives.
Family Physician: I love it!
Hospitalist: Yep. We have these patients in a position where they can't move, and we sell them cleaning solvents, vitamins, and skin care products. Instead of taking cash, we just add it on to their hospital bill, so they usually buy a bunch.
Internist: As an added bonus, the families of your patients will be so scared that you will try to sell them Amway products, that they steer completely clear of the hospital.
Hospitalist: Bingo! It works like a charm. We got this idea from the intensivists who were holding Tupperware parties in the ICU. The patients were sedated "just enough" so that they left the hospital with all sorts of cups, jugs, and bowls.
Family Physician: Any complaints?
Hospitalist: Not yet. You figure, what we charge for the solvents is 1/4 of what the hospital charges for an aspirin. The patients really don't notice a little more charge. We have even had some insurances mistakenly pay for some of our Amway products!
Internist: You know, maybe this Medicare cut may just be a good thing. Look at how it has pushed us to open new frontiers in medicine. Our children will look back on this time as being one of the real turning-points in American healthcare.
Family Physician: Yeah, today Amway ... tomorrow ...
Hospitalist: Healthcare reform? Higher reimbursement? A fair payment model?
Family Physician: Used cars.
Internist: I am so glad I went into medicine.Rob Lamberts, ACP Member, writes the blog Musings of a Distractible Mind and is on Twitter. His podcast, House Call Doctor, is available online and on iTunes). He is board certified in Internal Medicine and Pediatrics and was an early adopter of electronic medical records.
Labels: health care reform, health insurance, humor, Rob Lamberts
posted by Dr. Rob at
8:00 AM
1 Comments
Tuesday, January 12, 2010
Blogging gives voice to doctors in the trenches
My name is Dr. Rob, and I am the newest contributor to the ACP Internist blog. (That sounds a lot like a 12-step meeting, doesn't it?) Perhaps that's appropriate, as many of us internists feel powerless at this point in time, and we could certainly use help from a higher power (or at least from Washington, D.C.)
Since I will be a regular contributor, I thought a little bit of background information is appropriate:
--My full name is Rob Lamberts, ACP Member, and I am part of a private practice in suburban Augusta, Ga. I grew up in New York and went to medical school at Jefferson Medical College in Philadelphia. Read between the lines: I get called "Yankee" a lot.
--I did a combined internal medicine/pediatric residency at Indiana University and my practice is a mix of both. Read between the lines: I have a masochistic streak.
--Our office has been on electronic medical records since 1996, and was recognized by Health Information and Management Systems Society for our excellent implementation, receiving the Davies Award for 2003. Read between the lines: I am a geek.
--Since 2006, I have authored the blog Musings of a Distractible Mind, which is a mix of personal musings about life as a doctor, an insider's view of our ridiculous system, and humor (with the inexplicable appearance of llamas in an inordinate number of posts). Read between the lines: I write whatever strikes me at the time.
--Since July of 2009, I have hosted The House Call Doctor podcast, part of the Quick and Dirty Tips family of podcasts. My goal is to give concise and accurate medical information that the general public can understand. Read between the lines: the apocalypse may already be upon us.
One of my main passions--and what I will concentrate on in this blog--is to give a voice to the practicing internist. The health care debate rages in Washington, lobbyists vie for influence, and bills are passed; yet, the people who are at the center of the whole debate have very little voice. Doctors do have their advocacy groups (ACP is among the best), but even those representatives don't truly understand our situation.
I make my living off of seeing patients in my office. I have to meet payroll, pay rent, and cover my other expenses before I can get paid at all. This means that I don't have time to spend in Washington giving my very important perspective. I only get paid for days I am at work.
Blogging has given the doctors "in the trenches" a voice. I have been honored to be able to actually have some influence on the debate through my blog. I have been cited by the New York Times and Los Angeles Times, and have appeared on NPR. I contribute to the website MedPage Today. It boggles my mind that a practicing doctor in the deep south could actually have the opportunities to voice my views before such a large audience; but, the reason I have gotten this opportunity is that I voice a very important perspective that is rarely heard.
So I hope you enjoy my contributions to this fine blog. I am going to start out re-posting some of my more popular posts. Read between the lines: I am being a little lazy but will cover hot topics when they come up. I am truly honored to be part of ACP, and relish the opportunity to contribute on this blog. I doubt llamas will come up much. Read between the lines: It's irony.Rob Lamberts, ACP Member, writes the blog Musings of a Distractible Mind and is on Twitter. He is board certified in Internal Medicine and Pediatrics and was an early adopter of electronic medical records.
Labels: advocacy, health care reform, health information technology, humor, Rob Lamberts, social media
posted by Dr. Rob at
8:00 AM
1 Comments
Friday, December 18, 2009
Santa's reindeer quarantined over Lyme disease fears
North Pole reindeer have been quarantined following the discovery of ticks carrying Lyme diseases, bringing into question their availability on Dec. 24 and the possibility of causing a global Lyme disease pandemic should they cross international borders.
Elves first found reindeer ticks on Rudolph, which they reported to Santa. Responses to the question, "Who will guide my sleigh?" were greeted mostly by much tugging on beards and shuffling of pointy slippers.
"Normally, culling the herd is the best response," said one epidemiologist specializing in animal-human disease vectors, who declined to be named due to fears of being labeled a Grinch. "But I don't want to be the one to have to explain that my kids."
The issue has created considerable response, though, for fears of widespread Lyme disease infection. The North American Aerospace Defense Command (NORAD) is now tracking Santa's sleigh and mulling possible responses.
"We'll track Santa," NORAD's commander emphasized. "But I have no authorization from the President to engage him under any circumstances. Besides, how would he explain that to Congress?"
Global pandemic experts remain concerned, however. "What if reindeer ticks can fly, too," asked one epidemiologist at the Centers for Disease Control and Prevention, who declined to be named for fear of nothing in his stocking this year. "Frankly, I don't want to be the one to have to explain that. I can't explain that."
Labels: epidemiology, humor, infectious disease, Lyme disease, superbugs
posted by Ryan DuBosar at
8:00 AM
0 Comments
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
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