A Painful and Protected Disease Kept Isolated From the Cure



Anytime there is a really sick child or adolescent, regardless of whether or not you are specialty trained in pediatrics, there is a visceral pain and wanting to immediately remedy the condition.  For many of those faced with such circumstances, there is rarely an opportunity to completely eradicate the underlying disease or offending circumstances.  We look to bring more eyes and minds together to stop the disease process, to reduce the suffering and to help the patient, their parents and caregivers. Often entire communities come together to raise support for a child or a family dealing with cancer.  Dozens or more people put their personal needs aside and focus intently on those of a family hoping to stop the cancer that is ravaging their child’s physicality, devouring their emotional existence and impacting their lives forever.   This occurs despite a complete lack of knowledge about the disease.

Scared to Death

As a medical student during a surgical rotation in the 90s at the old Boston City Hospital, I started locking the resident’s call room door whenever I was attempting to catch a cat nap.  This came on the heels of the morning after the chief surgical resident was jumped and beaten while he was sleeping in the call room, by a completely random person wandering the floors of the hospital.  Over the years I have seen patients attack patients, nurses, caseworkers and physicians.  All completely random acts without provocation in the middle of emergency departments, hospital wards and out of the way sundry areas like stairwells or the hospital garage.  The incidence and severity of violence is on the rise in healthcare settings.  Dr. Michael Davidson, the 44-year-old Boston based cardiovascular surgeon who was murdered just weeks ago by a patient’s relative, is one recent tragedy.

Generically Expen$ive

It can be a self-rationalizing moment to reconcile prices at the pumps when filling up these days.  If you are not driving an economy car, it can break the bank.  No need to even go near the social conscientious swirl of how big your carbon footprint is, essentially a personal decision of indiscretion.  If you do a bit of research, a graduate degree in economics is not requisite to understand how prices from the wellhead to the pump are influenced by supply and demand through embargos and OPEC controls.  However, it is not as easily understood regarding the rapid rise in costs for several generic medications over the past few years.  For many this can lead to a personal healthcare and financial crisis that is not based upon personal indiscretions, while the drug companies’ explanations just don’t make sense.

You Don't Have to Be a Player to Be a Coach - You Have to Be Present

The disenchanted practice of medicine is often found to encompass those who have been at it for many years.  Then there are the newbies, not yet out of medical school, encountering the dynamics of clinical rotations, but eyes and ears wide open to get a clearer understanding of how to select a residency training program to best suit their lifelong careers in medicine.  Now, more than ever, the voices of mentors and far less senior clinicians are having greater impact on the future career decisions of medical school grads and early retirement of others.  There is mounting intolerance to corporate directives, second to the short-sighted corporate decisions made on their behalf by administrators.  It is far more challenging and uncertain as to how to plan for the future.  One cannot just go with what one’s heart and inherent talents lead one to, but rather how to hopefully align with the future state of health care.  

It Will Be a Lifesaver for Many

There have been convoluted discussions regarding the utility in providing educational awareness in how to reduce the risk in risky behavior. Needle exchange programs struggled to get off the ground for years.  Proponents supported disease prevention while increasing access to unused syringes without punitive legal ramifications.  Counterpoints have viewed such options as means to increase illicit substance abuse of those already exposed and to entice others in contemplation.  Data and the tincture of time have borne out the need for ongoing support with a multifaceted approach, incorporating strategies and stop gaps, not to derail well warranted public health initiatives.  “To effectively reduce the transmission of HIV and other blood-borne infections, programs must consider a comprehensive approach to working with IDUs. (IV Drug Users). Such an approach incorporates a range of pragmatic strategies that address both drug use and sexual risk behaviors.

NHMS Membership - Two More Please

Our practices are attached to the swinging pendulum of healthcare debt, reimbursement and corporate drivers.  This blog is not intended to highlight the potential trends of ACOs, hospital mergers and acquisitions, or the impact they will have on the quality of physicians’ professional practices and our patients.  After all, so many providers are well aware of the changes on the horizon.  Many more healthcare professionals are intimately aware of business practices and much more willing to partner with or be employed by healthcare organizations than to weather it alone.  This, too, is part of the swinging pendulum that physicians should be mindful of.  There can be some very positive outcomes for all, but it is important to remain at decision tables and as proactive stakeholders.  To do so, it is essential for physicians to grow more robust and cohesive groups in order to be proactive agents of change.

Right Sizing MOC Exams

Over the past decade and a half, there has been considerable attention given to the utility of Maintenance of Certification (MOC) examinations in order to remain board-certified for many specialties.  As a de novo approach, the impetus was to serve as a better means to keep physicians current with the rapidity of changes occurring in any given specialty.  Ongoing scrutiny regarding the correlation between the MOC, as well as other requisite lifelong learning curricula to support the 10-year re-examination cycle, remain under the magnifying glass as to how efficacious they really are. 

Can't always sort wheat from chaff

In follow up to last week’s blog, it may be considered somewhat reflexive to speak to a confounding circumstance in the recognition and treatment of multi-substance abuse and addiction.  Mental illness is intertwined in the management of substance abuse and addiction.  Neither one of these complex conditions are adequately addressed through episodic care, whether it is rendered in an emergency department, a primary care office or from a three-day stay in a psychiatric facility.  Rarely are any of the underpinnings addressed adequately, and quite often the process can be viewed as simply inhumane.

It Is In Your Backyard

It was 2 a.m., 22 years ago, when I answered the phone.  My friend’s brother, barely audible, asked if I wanted to buy his parents’ silverware or maybe a saltwater fish tank setup.  He would be over in less than an hour, and we could settle on the price then.  Another close friend was distraught, having just been informed that her daughter, a freshman in college 3,000 miles away, had been found unresponsive on the floor and taken to the emergency department.

MLPs – Current State vs. Future State: What to do with mid-level providers?

While I was recently speaking with a group of physicians, a comment was made regarding mid-level providers.  Somewhat succinctly and pointedly, it was mentioned that the direction of health care is such that patients are more frequently unable to see a physician in primary care settings, specialty clinics and emergency departments.  This is not a new circumstance, but a growing and developing integral transformation in health care occurring over several decades.  Interestingly, the same physician’s practice has MLPs as part of the staffing model, with a very large patient base and a well-regarded reputation.  What is paradoxical is that over the years many patients have commented that they have not seen their PCP at all within that practice, they are seen exclusively by a midlevel in the office who they have come to accept as the provider who knows them better than anyone else in the group, and they are quite satisfied with their PA-C/APRN relationships. 

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