American College of Physicians: Internal Medicine — Doctors for Adults ®

Tuesday, January 22, 2013

The great and powerful

Well, I did it. It wasn't easy, but I did it. But that comes later.

Yesterday, Forbes sponsored a Health Care Summit. It was a fascinating day-long conference featuring some of the most innovative minds in health care, policy, and technology, especially in the private sector. And me.

The tech stuff was very, very cool, but probably doesn't actually address the immediate needs of the health care system--delivery of better, more cost-effective care to more people. But it was an interesting glimpse into the future.

I got to ask Gov. Rick Perry of Texas a question during Q&A. Steve Forbes interviewed him about a health care boom in his state. Gov. Perry is a pretty impressive guy. He's tall and thin and folded himself into his chair a bit like a mantis, all angles and articulations. And I could see why a presidential run might not have suited him. Aside from the fact that I disagree with nearly all his policy ideas, he sat very much like a person with chronic back pain, one hand bracing him on the arm of the chair. I'd imagine Jack Kennedy looked similar, a mixture of pain, intelligence and charm.

But Perry is no Jack Kennedy. He emphasized his state's ability to attract doctors and researchers through tax cuts, tort reform, and other classically Republican economic ideas (not that I'm gonna complain about tort reform).

So I asked him, "Governor, what percentage of all of these doctors coming to Texas are primary care docs? Because we have a shortage. Only 4% of American medical grads choose primary care, mostly for economic reasons. How will you get PCPs down there?"

He admitted he didn't know much about the numbers, but that he was considering incentives including paying for education in exchange for service. This has always been a good idea, but our system doesn't make it worthwhile. Almost any specialist can make enough in a short period of time to pay off their loans, so unless you are drawn to primary care strongly enough, the economics don't work out.

Still, the dude answered the question directly. Maybe his policies help the Texas economy, but they aren't going to scratch the real health care problems. Like most policy makers, he doesn't seem to understand where the real problems lie.

I had a great conversation, which I hope to continue, with the President of the Joint Commission, Mark Chassin. I learned a ton about the Commission I hadn't known. For the non-medical peeps, the Joint Commission is a private entity that accredits U.S. hospitals, assessing them for safety, quality, etc. A failure to pass a JACHO inspection is a very, very big deal, and when they're in the house, entire hospital staffs tend to lose their shit.

To those of us on the ground, many of the JCAHO policies seem insane (and many of them probably are). Hospitals will prepare docs by giving them copies of the institution's "mission statement" so it can be dutifully recited to inspectors.

What concerns me more than mission statements is quality. We had a little chat about initiatives that JACHO has offered hospitals to, for example, make transitions from hospitals to home or nursing homes safer. Right now, when a patient of mine leaves the hospital, they, and I, get a many-page discharge document that no normal person could ever understand (and I include myself in that category).

Much of the reason for this sort of thing is hospital efforts to meet JCAHO and Medicare standards, standards that are often confounded with each other, an effort that is usually ham-fisted and non-sensical. It's not supposed to be that way.

As I gather my thoughts, I hope to share with you more from the conference, but first …

The night before, Steve Forbes hosted a reception at his offices. The surprise of the evening was an appearance by Dr. Mehmet Oz, one of the most disruptive forces in medicine, and someone who in my opinion, confounds sideshow barker nonsense with real medical science. He gave what was supposed to be an inspirational talk, but really, he just rambled from topic to topic, often contradicting himself. And everyone was starstruck.

It seems famous people like other famous people for being famous. I cannot think of a thing Dr. Oz has to offer American health care, other than his retirement from public life. But they flocked to him in the low-ceilinged gallery, jostling each other in the close space as if fighting for a New York cab, the kind that's never around when you need it.

I blame David Kroll for egging me on. I nudged slowly through the crowd of admirers and introduced myself, as a "fan and a critic." I told him I was a fan of his ability to communicate, but that my patients don't bring to me the message he thinks he's delivering. They would rather find some raspberry ketone than exercise and eat better.

"I don't sell any products. People use my image. Blah blah."

I thanked him for his time and nudged my way back out of the crowd.

The telling moment for me was during his speech. He closed with a joke, about a patient who had made use of a ton of "complementary medicine" during her hospital stay. When confronted with the bill, she replied, "but it's complementary!

That's not funny. Health care is expensive, people struggle to pay their bills and are terrified for their lives. To joke about billing them for services that are worse than useless, like reiki and acupuncture, is cruel and shows a lack of compassion.

But I got my say. As my dad says, "I don't think he'll lose any sleep over it."

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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