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Are Doctors the New Drug Dealers? Print E-mail
Written by Michael Kirsch, MD | KevinMD   
Thursday, 24 November 2016 00:00

I have written about pain medicine, previously on this blog, and it generated some spirited responses. Let me be clear that I am completely against all forms of pain, whether foreign or domestic, physical, spiritual, psychic or even phantom. The medical profession has superb tools to combat and relieve pain, and physicians should utilize them, within the boundaries of appropriate use. We now have an actual specialty - pain management and physicians with special training in the science and treatment of all varieties of pain. I utilize these specialists when necessary, and I am grateful for the help they provide to my patients.

There are two forms of drug abuse in our society - legal and illegal.

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JAMA Forum: How Would the Next President Ensure Competitiveness in the Health Care Marketplace? Print E-mail
Written by Ashish K. Jha, MD, MPH   
Thursday, 03 November 2016 00:00

Recently, 10 health care experts were asked to state 1 question they would ask the presidential candidates. Although they offered a variety of responses, 1 topic seemed dominant: what the next president would do to ensure competitiveness in the marketplace.

The next president must choose between dealing with the symptoms of an increasingly dysfunctional marketplace or dealing with one of the key underlying causes, namely, the market power of hospitals and health systems. If the Affordable Care Act (ACA) is to thrive under the next administration, the most important federal agency to ensure its success may not be the one that everyone focuses on, the Centers for Medicare & Medicaid Services (CMS). Instead, it may be the Federal Trade Commission (FTC), whose work to monitor and regulate the consolidation frenzy that has taken hold among physician practices, hospitals, and hospital systems that will likely have the biggest impact on the future viability of the ACA.

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How one patient's end-of-life care can affect us all Print E-mail
Written by James C. Salwitz, MD | KevinMD   
Monday, 24 October 2016 00:00

David was 42 when he died from stomach cancer. He spent the last year of his life receiving useless chemotherapy and debilitating radiation. David was in terrible pain all of the time. He stayed in bed for months as cancer destroyed his ribs, back and lungs.

Finally, David was rushed to a hospital, plugged into a breathing machine and pierced by countless IV drips. He died despite a battery of tests, drugs and several rounds of rib-cracking CPR.

His wife - previously positive, happy and successful - never recovered. She quit work, drank heavily and spun into a therapy-resistant depression. 12 months later, she used pills to take her life.

At the time of David's death, his son was 17. The teen found comfort in the kind of pharmaceutical intervention that comes from the bottle and needle.

He was high school dropout and in jail by 20. Although paroled at 23, David's son was back in prison by 26. His life had dissolved to rubble.

David's suffering, poorly controlled during that last year of life, was a direct result of a failure to plan for the inevitable and the inexcusable negligence of his caregivers to provide comfort. That misery transferred to those he loved. David's pain continued after death.

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Double booking the doctor is half-booking the patient Print E-mail
Written by A Country Doctor Writes   
Friday, 14 October 2016 00:00

Not only have we shortened medical appointments to 15 minutes. We also sometimes double book them.

I get the feeling that non-providers think of this as something fairly ordinary, and even reasonable. But it is often a very difficult and destructive thing to do.

The term "double booking" and the way it looks in an ordinary doctor's scheduling grid suggest that the physician might possibly be expected to be in two places at the same time. That is hardly ever the case for those of us who are mere mortals.

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Last Updated on Saturday, 15 October 2016 10:10
A Samurai Physician's Teachings Print E-mail
Written by FHI's Week in Review   
Monday, 03 October 2016 18:09

A Country Doctor Writes about the merits of Traditional Chinese Medicine (TCM) on 9/30/16. The author believes the value of TCM lies in "a certain enlightenment and pragmatism" and that the Chinese approach puts responsibility on the individual, rather than rely on the pharmacological effectiveness of traditional Chinese medicines. 
According to the author:

In the last hundred years, our <American> culture, with its tremendous scientific and technological advances, embraced the notion that our diseases come from invading bacteria, random gene mutations and other causes completely beyond our control. The promise of modern medicine has been that we can understand and counteract these forces through science, with more and more counteractive interventions. But as our treatments get more and more powerful, we have seen many of them cause ripple effects that cause other types of discomfort or disease.

Read more in the current issue of Week in Review>>

Last Updated on Monday, 03 October 2016 18:25
Fixing our EHR mess: What needs to be done Print E-mail
Written by Kevin Campbell, MD | KevinMD   
Thursday, 22 September 2016 00:00

In 2009 the Health Information Technology for Economic and Clinical Health Act (HITECH) was signed into law by President Obama and this law quickly changed the way medicine in the United Sates is practiced. The law was a first step in requiring all physicians to utilize electronic records. The president promised that creating and electronic record mandate for physicians would result in a national, universal electronic medical record system and improve care and communication. Ultimately, the legislation that required EMR implementation in 2009 began the process of penalizing physicians who do not use them and started a lucrative business for healthcare IT vendors such as Allscripts, EPIC, Cerner and many others. The requirements to implement EMR resulted in thousands of physician practices having to make harsh financially motivated decisions - either close the doors or sell out to larger healthcare systems.

Certainly, EMR systems do have their benefits - standardized documentation and portability all improve care. When a patient travels and has an illness care is improved when another hospital and provider can easily access long-term medical records. Communication between physicians of different specialties and organizations is significantly improved.

However, EMR vendors have not yet created exchangeable, universal systems as Mr. Obama promised they would.

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Last Updated on Saturday, 24 September 2016 10:22
Mylan Pharmaceuticals Made these Two Critical Mistakes Print E-mail
Written by Justin Reno, MD | KevinMD   
Thursday, 08 September 2016 00:00

Pharmaceutical companies are brilliant. They make profit off of chemicals that can be potentially life-saving. The list is quite impressive: antibiotics for somebody who would otherwise succumb to sepsis, insulin for someone whose pancreas loses the ability to function, antivirals for chronic viral suppression, antineoplastic agents for somebody whose cells have lost their regulatory mechanisms, just to name a few.

The recipe seems to be quite simple: Charge as much money as insurance companies are willing to pay. And do this as quietly as possible: Don't let the American public know how much a drug costs.

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