Friday, September 23, 2016

“Mama Don’t Let Your Babies Grow Up To Be Doctors”

This is Waylon Jennings' and Willie Nelson's 1978 cover of "Mamas, don't let your babies grow up to be cowboys". The song, originally performed by Ed Bruce, was number 1 on the charts for four weeks in the spring of 1978 and was released on the classic duet album "Waylon & Willie".
In the famous song by Willie Nelson and Waylon Jennings, they opine about the hardships of the “cowboy life”.

This song was Waylon Jennings' and Willie Nelson's 1978 cover of "Mamas, don't let your babies grow up to be cowboys". The song, originally performed by Ed Bruce, was number 1 on the charts for four weeks in the spring of 1978 and was released on the classic duet album "Waylon & Willie".
When asked the question of whether you would want your children or relatives to become physicians in the modern era, the answer is always “YES… but….”
Motivations for becoming a physician are multiple with multiple answers. They are generational in scope and multi-factorial. These include

1. Saving the world
2. Helping mankind
3. A means to an end.
4. Avoiding the draft and the Vietnam War
5. Family tradition
6. Economically motivated
7. Opening doors
8. Raising your social statue
9. Good at “School”
10. etc.
The modern day physician is caught in the trap of the “fantasy” of the good old days and ever-changing landscape. The physician is no longer the perceived expert of their domain but a valued cog in the big picture.
Patients still love their personal physician but want input in all aspects of their care. The paternal system of “I’m The Doctor” no longer works.
The physician is also trapped in the electronic world of endless data capture that is rarely relevant to the individual patient in front of them. Click 18 more boxes and you might get paid. 17 boxes and you get a 50% reduction. Did the patient get better? Who knows?
The modern day physician has become a corporate employee with little autonomy unless you are a dinosaur from the past and cling to your “perceived” freedom. Once you accept Medicare and Medicaid payments, you are indirectly/directly an employee of the government.
Getting back to whether you would recommend it as a career. I would do it over again because of the positives definitely outweigh the negative. Every 10-15 years medicine has been shaken up for financial reasons and everyone survived. The burdens are different but with the proper understanding that early acceptors of change are always the winners.

Friday, September 16, 2016

Where Does Telemedicine Fit In??

The authors of Telehealth Poised to Revolutionize Health-care review the present and potential trends in telemedicine.  ” Three trends, all linked, are currently shaping telehealth. The first is the transformation of the application of telehealth from increasing access to health care to providing convenience and eventually reducing cost. The second is the expansion of telehealth from addressing acute conditions to also addressing episodic and chronic conditions. The third is the migration of telehealth from hospitals and satellite clinics to the home and mobile devices.”
The article does an excellent job of delineating the present and potential benefit of telemedicine.
These include:
1.    Availability for underserved areas
2.    Reduction in costs
3.    24 hour service
4.    Providing specialty support in real-time
5.    Real-time ICU coverage
6.    Real-time diagnostic imaging
7.    Clinical consultation on time sensitive dilemmas like acute stroke and emergency treatment
8.    Etc.
These services will continue to expand but eventually spread to ongoing chronic care. A good example is Diabetes Treatment. It has become so complicated with multiple new medications that the average provider may not have the ability or time to coordinate the care.
Another service will be online support groups for various conditions where the endless questions and concerns of patients can be addressed and supported.
The modern generation will want easy access to health care without the delay and time spent directly visiting a Emergency Department, Urgent Care, and or Primary Care.
Some downsides include:
1.    Over-consumption of care.
2.    Most illnesses or problems are solved with tincture of time.
3.    Not knowing when it is important to go right to the Emergency Department because of the potential seriousness of the condition.
4.    Getting care from numerous sources without coordination
5.    Almost totally giving up on the regular Family Provider who “knows you”.
There are also legal issues (future malpractice issues), credentialing issues, lack of access to high-speed internet, and the reality that the computer cannot perfor  m life-saving measures or surgery.
Where telehealth fits in with the primary care provider, urgent care, Walmart/CVS, Dr. Google (being your own provider) and the ultimate safety net –The Emergency Department –will have to be figured out.  

Friday, September 9, 2016

Should Physicians Join the Union???

With the Brexit vote in the United Kingdom, endless global conflicts, and the 50-50 political dichotomy in the USA, it may be time for providers (physicians, Nurse Practitioners, and Physician Assistants to organize into an effective voting force.
In the interesting blog Physicians must unionize.  Here’s why, the author recommends that physicians create a union to protect their interests from governments, health systems, and the endless prevailing forces that the individual has no control over.
I would suggest reading the article as maybe the time has come for physicians to get organized and protect their substantial interests.
These interests include autonomy, financial security, work conditions, and protecting the greatest guild ever created. Physicians have reaped the benefits since the 1960’s thanks to a fee for service model and Medicare guaranteeing a financial floor to generate exceptional incomes for 30-40 year careers. Along with social status and respect, it is a great job.
However, practice and personal satisfaction has significantly decreased in the last decade. More government mandates (usually unfunded), hospitals employing physicians, and the destruction of the personal doctor-patient relationship has been steadily on the rise.
Physicians are generally organized if at all by specialty societies with varied interests. This diminishes the overall power and clout of all physicians. Critics would argue that doctors are overpaid compared to the world market and are chief offenders at driving up costs.
A similar argument can made against the National Football League Players Association (NFLPA). It has been called a joke because it represents rich football players. The football players do make great sums of money but their careers last 3-5 years with lifetime physical disabilities to follow.  Physicians can earn significant amounts of money over 30-35 years without similar threat to life or limb.
The union could  represent the physician body in the ongoing financial negotiations with CMS, insurance companies and hospitals, work rules, malpractice, contracts, Electronic Health Record implementations, ICD -10 implementation, and etc.
The individual has lost any clout to fight these forces or influence the decision making. A physicians’ union would put the “players” back in the discussion. And yet, there may be ethical and practical considerations that might keep some from wanting to join a union.  For example, would you cross a picket line to help the bleeding patient on the sidewalk?  Most would say yes, despite getting roughed up or jettisoned from the union.  And then, how many times have you seen a hundred or more physicians in a meeting (think union meeting) that agree on anything?  Younger physicians steer clear of medical entities, such as the AMA, which has a pre-union character to it.  Perhaps they realize that the results of joining could include an early retirement a la Jimmy Hoffa.  Lots to think about before unionizing.

Friday, September 2, 2016

Tai Chi for Health-care Practitioners

I recently started taking TAI CHI lessons to improve my balance, flexibility, and coordination.
It looks pretty easy on movies but does take a fair amount of training. People like myself, who cannot dance or suffer from right to left confusion will need to practice to gain muscle and brain memory.

The article Tai Chi for Health-care Practitioners emphasizes the value for health care practitioners helping their patients. The programs includes  “applications for balance, geriatrics, stress and pain management, oncolcogy, PTSD,TBI, polytrauma, autoimmune diseases, women’s health. orthopedic, neurological, cardiovascular and respiratory rehabilitation".
Wikipedia states that “Tai Chi generally provides health benefits. In all the forms of Tai Chi there are movements that involve briefly standing on one leg, which may improve balance; circular movements of the shoulders and wrists which improve suppleness and circulation; learning the sequence of the set movements may improve cognitive function such as concentration; the social atmosphere can sometimes forge friendships and alleviate loneliness and anxiety; and the exercise itself can boost a person's mood and alleviate depression.[3][4]”
My wife figured out at the first lesson that all the hand and feet movement should be considered preparations for striking and/or blocking an opponent. She’s right to have intuited the relationship between this originally Chinese practice, and the martial arts.  Many in the far east are skilled in both.  Not having 2 left feet will help with the movements. The individual motions are easy but the linkage and flow take practice, practice, and practice.
In general, TAI CHI is another worthwhile avenue to explore as we have a tendency to live longer and become quite immobile. You may learn how to dance. And if not, you may be able to defend yourself better.