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What Is Patient-Centered Healthcare?

Stanley Feld M.D.,FACP, MACE

Patient-Centered Healthcare is a new buzz phrase. It has become popular among Republicans in the last few years.

I have a feeling most people do not know what physicians mean by patient-centered healthcare.

The true definition is that patients are in the center of the medical care interaction. Patients determine their needs and their physicians. Patients drive the medical encounter. Neither the government nor the insurance industries drive the medical encounter.

A fatal floor in Obamacare was that President Obama wanted the federal government to control the healthcare system.

President Trump’s goal is to have patients in control of their own health and healthcare dollars. It is not a problem if the government or employers provide those healthcare dollars.

I believe Tom Price M.D. understands that the only system that will work is a system in which the consumers (patients) are responsible for their own health and healthcare dollars.

The government’s job is to provide incentives in the healthcare system for consumers to become responsible for their health and healthcare dollars.

I am not at all sure the Republican congressional leadership understands the definition or value of patient- centered care.

Obamacare provided just the opposite. Obamacare provided incentives for consumers/patients to be dependent of government.

This fundamental tenet of patient-centered care was tested by Stewart, et.al. in 2000. 

 Experts studied audio taped doctor-patient interactions while patients also rated these same interactions. 

 Expert opinion could not be correlated with positive results, but patient-perceived patient-centered care correlated with “better recovery from their discomfort and concern, better emotional health.

 A Wikipedia definition of “Patient centered healthcare” does not exist. There are many consumer-driven healthcare definitions.

Most of the Republicans are talking about patient centered healthcare. However, they start and end with Health Savings Accounts and Consumer Driven Healthcare.

The American Association of Clinical Endocrinologist defined patient-centered healthcare in its diabetes guidelines of 1996 and 2002. (on request)

The guidelines were a System of Intensive Self-Management of Type 2 Diabetes Mellitus.

The Type 2 Diabetic was taught to become a “professor of his/her diabetes.”

The goal was to get the diabetic blood sugar as close to normal as possible. It was shown that normalizing the blood sugar helped avoided the vascular complication of diabetes. The treatment of the vascular complications of diabetes absorbed 80% of the money spent on diabetes.

Patients live with their disease 24/7. Blood sugars are very variable. Patients need to learn how to adjust to these variables by managing their medications and lifestyle.

Patients taking a pill or a shot will not control their blood sugar unless they understand the medication and how to adjust it to have the greatest affect on the blood sugar.

The only way a patient can understand how to control their blood sugar is for them to understand how their blood sugar affects the effectiveness of the medication and how their medications and lifestyle affects their blood sugar.

This same phenomenon applies to most chronic diseases.

The only way to decrease the complications of chronic diseases is for patient to drive the treatment of their disease.

This in turn will be the only way to control healthcare costs. This is what I mean when I say patients should be in control of their health.

As an added incentive to control costs, patients should be in control of their healthcare dollars so they figure out how to use medication most affectively.

In the February 2017 Endocrine News published by the Endocrine Society there was an article interviewing four endocrinologists for their definition of patient centered care.

“In 2001, The Institute of Medicine published a book called Crossing the Quality Chasm: A New Health System for the 21st Century.”

“In it, the institute identified six aims for improvement of healthcare delivery, one of which was “patient-centered care,” defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”

The Institute of Medicine’s definition moves patients’ needs and attitudes toward patients being in the center of care. It does not place them as responsible for the management of their care. It does not include patients’ responsibility for their care.

All four of the endocrinologists got close to the definition of patient centered care. Only Carol Greenlee, MD, FACE, FACP, of Western Slope Endocrinology in Grand Junction, Colorado nailed the definition. Dr. Greenlee is the only physician in private practice.

She said:

“One of the most important things is partnership with the patient and what is called “contextualized” care, which means taking into account a patient’s needs and circumstances, goals and values.

It is also called developing a physician/patient relationship.

Another aspect is moving from the physician being at the center of the care model, with staff working to help the physician (doing tasks for the physician or other clinician such as “rooming” the patient or “scheduling” the patient for the clinician) to the staff also “taking care of the patient” as their job, with different roles on the patient-centered care team (getting the patient in for a needed appointment).

It is doing what is best for the patient (not giving the patient what they want, e.g. pain meds, MRI, antibiotics) or ask for (those things are not often best for the patient, but takes time to discuss through).

It’s taking our best science and knowledge and technology and then adapting it to meet the patient’s unique needs, circumstances, values, and goals.

It requires clearing up misconceptions (such as asking what the patient currently understands about a condition or a test or treatment), helping discuss risks and benefits in the context of that individual patient.

It requires asking not just telling, but it is not dumping everything back on to the patient.

It is taking into account the “work” (the job) of care (self-care that the patient or family need to do) on top of the illness and the rest of life that the patient and their family have to deal with and do (i.e. consideration)

Most clinicians think that they are already patient-centered because they care about their patients.

But that does not mean they provide patient-centered care or practice in a patient-centered approach.

I thought I was patient-centered because I cared but then I had to uproot my mental model to really become patient-centered.”

Republicans and their advisors do not understand the meaning of the concept of patient centered care.

Tom Price M.D. understands the concept of patient centered care.

Without the patient being in the center of the management of his/her care, the healthcare system can never be repaired and will never be financially sustainable.

I hope President Trump gets the concept in spite of the advice from congressional Republican and Democrats. Congress is trying to satisfy all the secondary vested interests. Healthcare is a big business with many secondary stakeholders. They do not want to lose this important profit center.

These stakeholders are better organized than patients or physicians to influence healthcare policy makers.

The primary stakeholders are patients with their head coaches and assistant coaches being physicians and their healthcare team.

Patients must be in the center of the healthcare team because they are the only ones that can influences the cost of medical care.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Listen Up: It Is All About Personal Responsibility

Stanley Feld M.D.,FACP,MACE

In my last blog I continued my War on Obesity. I started this war in 2007.

There has been little progress in this war because of cultural conditioning and a lack of emphasis on personal responsibility.

Every New Year’s Day millions of Americans make New Year resolutions to lose weight. They are initially successful. They then regain the weight they have lost.

If America is going to solve the healthcare systems unsustainable cost, it is going to have to solve the increasing Obesity problem.

The National Institute of Diabetes (niddk.nih} recently published Overweight and Obesity statistics:

  “More than two-thirds (68.8 percent) of adults are considered to be overweight or obese.”

 “ More than one-third (35.7 percent) of adults are considered to be obese.”

 “ More than 1 in 20 (6.3 percent) have extreme obesity.”

 “ Almost 3 in 4 men (74 percent) are considered to be overweight or obese.”

Each year the obesity problem gets worse. Companies have sprung up selling weight loss formulas. These companies advertise their great success.

However, most of the iconic personalities used in their advertising have regained their weight after experiencing mild or significant weight loss.

This study was conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention.

NHANES III was designed to provide nationally representative data to estimate the prevalence of major diseases, nutritional disorders, and potential risk factors.

  • Sixty-three percent of men and 55% of women had a body mass index of 25 kg/m2 or greater.

 

  • A graded increase in the prevalence ratio (PR) was observed with increasing severity of overweight and obesity for all of the health outcomes except for coronary heart disease in men and high blood cholesterol level in both men and women.

 

  • With normal-weight individuals as the reference, for individuals with BMIs of at least 40 kg/m2 and who were younger than 55 years, PRs were highest for type 2 diabetes for men (PR, 18.1; 95% confidence interval [CI], 6.7-46.8)

 

  • Women (PR, 12.9; 95% CI, 5.7-28.1]

 

  •  Gallbladder disease for men (PR, 21.1; 95% CI, 4.1-84.2) and women (PR, 5.2; 95% CI, 2.9-8.9).

 

  • Prevalence ratios generally were greater in younger than in older adults.

 

  • The prevalence of having 2 or more health conditions increased with weight status category across all racial and ethnic subgroups.

 

The Prevalence Ratio of Obesity and Type 2 Diabetes is 18.1 for men and 12.9 for women.

Therefore Type 2 Diabetes is very prevalent in both Obese and Overweight men and women.

 

  • Up to 75% of adults with diabetes also have hypertension, and patients with hypertension alone often show evidence of insulin resistance.
  • Hypertension and diabetes are common, intertwined conditions that share a significant overlap in underlying risk factors (including ethnicity, familial, dyslipidemia, and lifestyle determinants) and complications.
  • These complications include microvascular and macrovascular disorders. The macrovascular complications, which are well recognized in patients with longstanding diabetes or hypertension, include coronary artery disease, myocardial infarction, stroke, congestive heart failure, and peripheral vascular disease.
  • Although microvascular complications (retinopathy, nephropathy, and neuropathy) are conventionally linked to hyperglycemia, studies have shown that hypertension constitutes an important risk factor, especially for nephropathy.

Eighty percent of the treatment costs for diabetes and hypertension to the healthcare system is the result of the treatment of the complications of hypertension and diabetes.

In order for a healthcare system to be sustainable diabetes and hypertension must be cured. It is essential that each must be recognized early and treated aggressively.

Patients must be taught to be “the professor of their disease” so they can self-manage the control of their disease. Blood pressures and blood sugar are changing continuously. Patients live with their disease 24/7.

This takes a lot of personal responsibility and personal discipline.

Equally important is the morbidity resulting from the complications of diabetes and hypertension, two diseases that result from obesity.

Complications from the onset of both hypertension and diabetes take about eight years to develop. This is the reason to diagnose and discover Pre-Diabetes at the onset.

  • The shared lifestyle factors in the etiology of hypertension and diabetes provide ample opportunity for non-pharmacological intervention.
  • Thus, the initial approach to the management of both diabetes and hypertension must emphasize weight control, physical activity, and dietary modification.

Lifestyle intervention is remarkably effective in the primary prevention of diabetes and hypertension. These principles also are pertinent to the prevention of downstream macrovascular complications of the two disorders.

This is the where my story of the importance of personal responsibility comes in.

A restaurateur, in his early 50’s, who runs a large restaurant in Dallas, that I frequent, was slowly gaining weight. At 269 lbs. he had difficulty standing on his feet all day long. He was being treated for hypertension and hyperlipidemia (high cholesterol).

His physician told him he must lose weight. He informed him of his risk factors for the complications of these diseases.

This was all he needed hear. The thought of having to quit the job he loved and the possibility of dying from the complications of his diseases was enough to make him decide to loss the weight.

He was told he would be fine if he lost the weight.

He has lost 70 lbs.so far without assistence. He has decided to be personally responsible for his weight loss.

He now gets up at 5 am each morning and exercises for one hour each day before work.

He has stopped eating his wonderful pasta dishes. He eats nothing that is white.

Every time I meet a friend at the restaurant, the restaurateur sits down at our table for a chat. We usually talk about how great he is doing in the weight loss department.

I had initiated an obesity program at Endocrine Associates of Dallas P.A. in the mid 1980s. A California clinical endocrinologist, with whom I did my endocrine fellowship with, had a very successful obesity program. He convinced me to start one at EAD.

Patients on large doses of insulin were totally off insulin after two weeks. It was successful until the patients graduated from the program.

Unfortunately the recidivism rate (regaining weight) was around 80%. This rate was not dissimilar to the national overage at the time.

EAD stopped the program.

In my view there were not enough patients who turned the corner and stuck to the program.

I believe the restaurateur has turned the corner. This fellow has turned the personal responsibility corner to control his food intake and exercise output. I do not believe he will regain his weight.

He has exhibited personal responsibility for his health and well-being.

If only physicians could solve the obesity problem so easily, the cost of healthcare would plummet to sustainable levels.

The development of Type 2 Diabetes Mellitus would also plummet and the cost of the treatment of its complications would vanish.

Social change is necessary in restaurants and fast food chains.

People have to be taught to eat wisely in restaurants and at home.

People have to be provided with education about the perils of obesity.

People have to understand the natural history of obesity.

People have to be motivated to not only maintain their health. They have to be given financial incentives to control their health.

This can only be achieved with a consumer driven healthcare system in which people are provided with incentives to control their healthcare dollars.

My ideal medical savings account will provide all the appropriate incentives for all people of all economic levels.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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War on Obesity: Pre Diabetes Part 20

 Stanley Feld M.D.,FACP, MACE

This is a continuation of my War on Obesity.

The New York Times has criticized Donald Trump’s healthcare plan without even knowing what is in it.

I hope all the features of a healthcare plan missing from President Obama’s healthcare plan are included in President Trump’s healthcare plan. I believe Dr. Tom Price knows most of what needs to be included. He also knows that Obamacare is a disaster. It must be repealed.

I have written a series of articles outlining what should be included President Trump’s replacement healthcare plan after he repeals Obamacare.

I believe the critical element necessary for Repairing the Healthcare System is the development of a healthcare system in which consumers are responsible for their health and healthcare dollars.

This is the main reason Obamacare needs to be repealed. Obamacare makes consumers of healthcare dependent on the government and less responsible for their own healthcare.

Joan Colgin R.N. was Endocrine Associates of Dallas P.A.’s first fulltime Diabetes Educator. I nominated her for Diabetes Educator of the year some years back. She came out second to a woman who was trying to provide diabetes education to an indigent population. Endocrine Associates of Dallas P.A. was providing effective Diabetes Education on a one on one basis to consumers of all socioeconomic groups.

Joan provided Diabetes education to all people who were interested in learning to be responsible for the self-management of their Diabetes Mellitus. Patients live with their disease 24 hours a day and must learn how to manage it.

Endocrine Associates of Dallas P.A. was extremely successful in motivating people to be responsible for their own care.

Joan is presently the nurse member of the Texas Diabetes Council. Recently she asked me to publicize the CDC’s new position statement on Pre-Diabetes.

The National Institute of Diabetes (niddk.nih} published Overweight and Obesity statistics:

  “More than two-thirds (68.8 percent) of adults are considered to be overweight or obese.”

 “ More than one-third (35.7 percent) of adults are considered to be obese.”

 “ More than 1 in 20 (6.3 percent) have extreme obesity.”

 “ Almost 3 in 4 men (74 percent) are considered to be overweight or obese.”

 

My personal observation has been that 80% of patients in the Cardiac ICU have Type 2 Diabetes. Almost all have Type 2 Diabetes that was just discovered on this admission to the hospital.

We know the complications of Type 2 Diabetes Mellitus take at least 8 years after the onset of the disease to occur.

The Cardiac ICU patients either had Pre Diabetes (asymptomatic) or undiscovered Type 2 Diabetes Mellitus (also asymptomatic) for at least 8 years prior to their heart attacks.

The CDC position paper can be extremely helpful in reducing the cost of medical care to our healthcare system if it is rolled out effectively.

Eighty percent of our healthcare dollars are spent on the complications of all chronic diseases. Type 2 Diabetes Mellitus is the most prevalent.

The summary of the position paper is as follows:

“What Prediabetes is Trying to Tell You”

Did you know that people can have prediabetes for years without any clear symptoms?

It often goes unnoticed until serious health problems show up, like type 2 diabetes or heart disease.

But if you find out you have prediabetes early, you could make lifestyle changes proven to help safeguard your health.

Knowing your risk is the first step. If you have any of these risk factors for prediabetes, don’t wait—talk to your doctor about getting your blood sugar tested:

  • Being overweight
  • Being 45 years or older
  • Having a parent or sibling with type 2 diabetes
  • Being physically active less than 3 times a week
  • Ever having gestational diabetes (diabetes while pregnant) or giving birth to a baby who weighed more than 9 pounds
  • Being African American, Hispanic/Latino American, American Indian, Pacific Islander, or Asian American 
  • Want to find out your risk right now? Take the 1-minute quiz at organd be sure to share the results with your doctor.

 The summary is all you have to know.  DoIHavePrediabetes.org is an excellent questionnaire that takes two minutes to complete to determine if you are at risk for Type 2 Diabetes.

The CDC division of Diabetes Prevention includes a detailed position statement entitled:

The Surprising Truth About Prediabetes

The first sentence says it all!

It’s real. It’s common.

And most importantly, it’s reversible.

You can prevent or delay prediabetes from developing into type 2 diabetes with simple, proven lifestyle changes.

 The reason for the statement is simple to understand. We are all born with an inherited genetic make-up. About 33% of us have the genetic make-up that predisposes us to Type 2 Diabetes Mellitus.

Obesity will bring out the tendency to develop Type 2 Diabetes Mellitus by causing us to be resistant to our own insulin.

Our body in response to exposure to sugar secretes our insulin. If we are resistant to our own insulin our sugar level will increase to the point of officially having Type 2 Diabetic Mellitus.

America has an Obesity Epidemic.

“More than two-thirds (68.8 percent) of adults are considered to be overweight or obese.”

Americans are constantly exposed to too many calories. The only way to gain weight is to eat more than you burn. The only way to lose weight is to eat less and burn more.

One third of those 68.8 percent of obese people will get Type 2 Diabetes unless they lose weight to prevent its onset.

Unless those people lose weight they will be destined to suffer the morbidity and mortality resulting from Type 2 Diabetes Mellitus.

The only one in control of a person’s weight is that person. This is the reason that individuals must be responsible for their own care.

The government cannot provide weight loss. The government can provide education and incentives for individuals to be responsible for their own care.

Preventing the onset of Type 2 Diabetes will precipitously decrease the cost of medical care.

This is the reason a consumer driven healthcare system with consumers being responsible for their care is vital to a successful healthcare system.

I hope President Trump and all of congress is listening.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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The Republican Health Care Con By THE NYTimes EDITORIAL BOARD JAN. 21, 2017

Stanley Feld M.D., FACP, MACE

The New York Times editorial “The Republican Healthcare Con” should really be entitled “The New York Times Con of The Republican Health Care Con”

In my opinion The New York Times has become a biased newspaper. Instead of publishing “all the news fit to print”, it is printing articles and editorials that are biased opinions with incomplete facts.

The Republicans have not introduced their replacement of Obamacare yet this editorial is critiquing the replacements effect on the healthcare system..

Everyone is entitled to his or her own opinion. No one is entitled to his or her made up facts.

Republicans say the Affordable Care Act provides health insurance that manages to be both lousy and expensive.”

This is true. Most of the population seems to agree with this statement.

The only people buying insurance from the health insurance exchanges are people with pre-existing illnesses. These people have no other insurance available.

“Whatever the flaws of these policies (Obamacare), the new Trump administration is trying to pull off a con by offering Americans coverage that is likely to be so much worse that it would barely deserve the name insurance.

It would also leave many millions without the medical care they need.”

How does the New York Times editorial board know this when the Trump administration’s healthcare plan has not been introduced?

The liberal media keeps saying the Republicans have no plan. If Republicans do not have a plan how can the NYT criticize it?

How can a non-existent healthcare plan leave many millions without the medical care they need”?

There is no evidence for the statement above.

This reality became increasingly clear when President Trump’s choice to run the Department of Health and Human Services, Tom Price, testified before a Senate committee last week.

He looked pained as he described the terrible predicament of people who earned around $30,000 to $50,000 a year and had to deny “themselves the kind of care that they need” because they had Obamacare policies with deductibles of $6,000 to $12,000.

Tom Price M.D. is correct in saying the Obamacare deductibles are $6,000-$12,000. The NYT left out that the Obamacare networks available are restrictive and the access to proper healthcare is difficult.

The NYT editorial board also left out the fact that 85% of people buying healthcare insurance from the health insurance exchanges are subsidized by the government and have a pre-existing illness.

“ Yet, earlier in the same hearing, Mr. Price extolled the virtues of policies that would be woefully inadequate — policies that cover medical treatment only in catastrophic cases.”

This is a misrepresentation of Dr. Price’s testimony.

Perhaps the NYT editorial Board does not understand Health Savings Accounts?

If you want to understand a potential Trump administration proposal read my blog “Medical Savings Accounts Are Democratic.”

Dr. Price was talking about the virtues of health saving accounts without being specific.

The goal of health savings accounts are to put consumers in control of their medical care and healthcare dollars while providing them with financial incentives to save retirement dollars and not waste medical care dollars.

Consumers could have control of what they spend for their own healthcare.

The employer or government would pay for the deductible and the reinsurance above the deductible.

The money would be put in a healthcare trust. The money in the trust would pay for medical care.

If consumers did not spend the money on medical care that year, it would go into a personal saving trust for those consumers retirement.

“ Such policies often have deductibles of around $14,000 for family coverage.”

FALSE! One can get excellent coverage with a $6,000 deductible and first dollar coverage after spending $6,000 at a reasonable price.

Health Savings Accounts are the fastest growing healthcare insurance vehicle.

The government has put so many restrictions on health savings account that employees are hesitant to offer it. The government must remove these restrictions. www.unitedheath.com

“ This is simple hypocrisy. Condemn the policy you don’t like, propose something far worse as a replacement and claim that it is much better”

This paragraph is written to condemn Dr. Price and rile up the anti-Trump forces with false information.

The editorial completely disregards the fact that a proposal has not yet been announced by the Trump administration.

There were 2000 plus pages published about President Obama’s Obamacare proposal. There were glaring defects in he proposal.

The NYT did not comment on these defects at the time. Others did. I turned out that the defects were the source of Obamacare’s failure.

In reality the NYT has no idea of what the Trump administration’s proposal will be.

The NYT editorial also ignores the fact that Obamacare is unsustainable, unaffordable and is restricting access to care while rationing care for the very citizens that need the care.

“Mr. Price and Mr. Trump have recently said that their goal is to offer health care to many more people than are covered by the current health care law, which has driven the uninsured rate to historic lows.”

I believe historic lows are a counting error just as the unemployment rate and the inflation rate are counting errors in order to provide the Obama administration acceptable numbers.

Average people know exactly what is happening.

Mr. Price’s testimony and the legislation he introduced in the House (a few years ago), where until recently he was the Budget Committee chairman, show that the new administration will make decent health care less affordable and less accessible for most people.

The underlined portion is a NYT editorial opinion. It is an opinion without facts or evidence. It could also be a lack of understanding of the bill Dr. Price’s introduced.

The Trump administration’s upcoming proposal might be completely different.

How would the NYT know the Trump administration’s healthcare plan would make decent health care less affordable and less accessible for most people?

This is an unsubstantiated bias that would qualify as fake news.

“Those Health Savings Accounts would not help families earning the median household income of $56,000 a year because these families would never be able to sock away enough money.”

The NYT editorial either missed the concept of Health Savings Account totally or is reporting the concept to fit its bias.

The best description of what Mr. Price stands for can be found in a bill he introduced in 2015, the Empowering Patients First Act. It would “empower” Americans by eliminating the health care law’s expansion of Medicaid that has helped more than 10.7 million newly eligible people enroll in that government-run insurance program.

Many of these Medicaid patients cannot find a physician or hospital that accepts Medicaid.

Therefore they have very limited access to care.

A potential proposal could expand Medicaid patients’ access to care using health savings accounts.

It would also drastically cut subsidies that have helped 11.5 million people purchase private insurance on federal and state health exchanges.

There is no evidence for this wild statement.

Under his bill, people buying insurance for themselves would get between $1,200 and $3,000 a year in subsidies, down from an average of $4,600 that people get now on HealthCare.gov.

The amount of tax benefits or tax credits for Health Savings Accounts have been restricted by Obamacare in order to discourage its use.

The Obama administration wanted to control medical care and eliminate consumer choice and power.

President Obama wanted healthcare decisions to be in the hands of the central government.

The Trump administration plans to modify these restrictions. President Trump has stated he wants to put healthcare decision making back into consumers’ hands and not the government’s hands.

The bill would even get rid of the requirement that allows young people to stay on their parents’ insurance policy until age 26, a provision that is widely popular.

This is totally false and once again fake news.

And it would hurt people who get insurance through their employers by setting a cap on how much of that expense businesses can claim as a deduction on their taxes. Experts say that over time this would encourage companies to stop offering health benefits to workers.

The independent insurance market has not had tax deduction. It should be on a level playing field with group insurance. There is no evidence that the group market will lose its tax deduction.

“When it comes to health care, Mr. Price and other Republicans say their goal is to give people more choices. It is hard to argue against choice. But in the ideological world inhabited by Mr. Price, House Speaker Paul Ryan and many other Republicans, choice is often a euphemism for scrapping sensible regulations that protect people.”

This claim also has no basis in fact. It is pure opinion by the NYT editorial board.

“Some Americans might well be tempted by this far-right approach. They would have to pay less up front for these skeletal policies than they do now for comprehensive coverage.”

Has Obamacare provided comprehensive care? It is unaffordable and inaccessible to all.

But over time, when people need health care to recover from accidents, treat diabetes, have a baby or battle addiction, they will be hit by overwhelming bills.

Where did this come from? It came from a negative bias toward Donald Trump and his administration without facts or evidence.

The Trump administration seems perfectly willing to sell those people down the river with false promises.

People are not stupid. They do not need government to rule their life and make healthcare decisions for them.

People need incentive to control their health and healthcare dollars.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Come On Guys, Give Them A Chance!

Stanley Feld M.D.,FACP, MACE

It is clear that Donald Trump won the presidential election.

The U.S. economy is in bad shape despite what President Obama has been telling us. Economic growth has been stagnant with growth at less than 2%.

People are feeling the loss of jobs as factories are closing.

Corporations are moving factories overseas for cheaper labor.

The many unemployed gave up looking of jobs. Full time jobs have been switched to part-time jobs so corporations can avoid the Obamacare mandate. People need to have at least two jobs to make ends meet.

Price inflation continues but is not measured because food and fuel are left out of the inflation calculation.

Inner city unemployment is worse despite President Obama’s saying it is getting better. Neighborhood security has declined. National security is threatened. People do not feel safe.

Obamacare, which was supposed to provide universal healthcare that was affordable to all, was a outright failure both in terms of affordability for individuals and to the national economy.

Yet, the Obama administration, through the mainstream media, keeps telling the people everything is going as planned.

The people could easily see that the administration was tell them a lie. The unemployment rate was reported as being less than 5%.

Americans realized that much of the money for food stamps was being abused. It was discovered that many people were not using the money for food.

Hard working Americans found out that one could collect at least $49,000 non-taxed dollars from the government for not working.

Our foreign policy was in a shambles.

Americans were being told by President Obama that we winning the war. Yet we were losing territory to ISSI and experiencing terrorism both at home and abroad.

Ordinary hard working people were beginning to realize that the tax and spend Democratic Party were ripping them off even if the details of these rip offs were unclear.

Many state governorships and state legislatures were lost to Republicans. Many seats in the U.S. Senate and house were lost to Republicans.

It was clear that the people wanted a change even though they felt the Republican establishment had deceived them previously.

They understood that government was too large. The government bureaucracy consisted of people who could not be fired. These people can obstruct change.

As government grows it employs more people and it becomes more stagnant and less functional.

Along comes Hillary Clinton.

Hillary Clinton was a non-charismatic presidential candidate who received millions of dollars from rich people to buy uninspiring advertising on television.

Her message was that she was going to continue President Obama’s legacy. She missed the point completely.

Donald J. Trump comes along and tells the people they are being ripped off by our own government and by other governments. Our trade deals stink. Other countries are living off our tax dollars because of our government’s stupidity. He promises to fix it.

He says America has to be run like a business. He will bring back jobs, decrease waste, increase the status of our military all around the world and uncover the great energy and potential of America, especially in the decaying inner cities.

It is a great message. Few know how he is going to do it. He is not telling anyone. He says he is going to hire great people to help him. He is going to hire successful people to help him.

He is going to create opportunities for everyone using a free market based economy.

America as been sliding toward a central government controlled economy for many years.

It should be clear to everyone that Keynesan based central controlled economy does not work.

Fredrick Hayek taught us that in 1937. However, few listened.

I think it is because the central government fears a loss of control over the economy and the people. It fears that very smart people can take advantage of an economy if they have the ability initiative and become innovative without government restraints. The government does not want to believe that the free market works.

Steve Jobs believed it. Jeff Bezos believed it. All the start-ups believe it.

At the Consumer Electronic Show I saw many companies tying to succeed without government interference.

Why? People want to have the freedom to be innovative and creative.

Maybe the American people believe that Donald Trump is going to give them that opportunity without as many government restraints.

The establishment’s fear is warranted.

My view is the government’s job is to legislate the rules that put everyone on a level playing field. The government should step aside and make sure everyone plays by the rules.

This brings me back to my title, “Come On Guys. Give Them A Chance!”

Donald Trump might just know how to navigate through the swamp of the dysfunctional government bureaucracy.

He doesn’t have to tell us how he is going to do it yet. He just has to do it. He might know how to navigate around America’s bad trade deals.

He might just know how to pick a Secretary of Health and Human Services in the name of Tom Price M.D.. Tom Price M.D. might be the person who can navigate across the failed Obamacare healthcare system.

Tom Price M.D. is a smart and decent man. The Democrats and the media might want to indulge in his character assassination out of fear that he might have a workable plan to repair the healthcare system.

The American people are wise to the Democrats’ tactics.

These tactics will hurt them and not Tom Price M.D..

Maybe he knows how to create a system where if you like your doctor you can keep your doctor. If you like your insurance you can keep your insurance. If you like your freedom to choose you can keep that also.

The Democrats, the main stream media and the government bureaucrats should not criticize Donald Trump when the Democrats have failed so miserably. They do not know what the Republicans will propose.

We know what doesn’t work. That is Obamacare!!

Give the new guys a chance!

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Our Consumer Electronics Show (CES) “Weekend”

Stanley Feld M.D.,FACP,MACE

As my readers know every year each of my sons and I go away, separately, for weekend. We love to hang out, catch up with each other and eat plenty of chocolate ice cream.

Brad, my older son, is venture capitalist involved in startup technology companies. I am a retired endocrinologist who is a nerd. I love computer technology.

My wife, Cecelia, insists that I would have gone into compute science rather than medicine if I understood its potential when I was in college.

In my day the computer was a pencil, pencil sharpener and eraser.

Image1

My goal has always been to understand how everything works. I love to figure out trends and what will develop in the future.

This was the fifth year that Brad and I went to CES for 5 plus year. We walk the floor together and get a good feel for what is happening.

 Badge ces

Brad made a mistake thinking that the exhibition started January 4,2017. The only flight I could get on when I got my ticket to get in to La Vegas at a reasonable time from Dallas was a 7 am flight. It got me to Las Vegas at 8 am. However, he exhibition started at 10 am January 5th not January 4th.

It was no problem for me. I walked the entire Venetian Hotel and the Paris Hotel. My lunch was chocolate gelato.

Brad got to the Venetian with his partners Lindel Eakman and Ryan McIntyre at 2.30 pm.

Brad then negotiated a 3,000 square foot suite for the both of us. He gave up our two rooms for one.

We were happy and the hotel was happy because they were out of rooms. Now the Venetian Hotel had an extra room to sell.

We then walked from the Venetian to the Sands to get Brad’s registration badge.

On the way back to the Venetian for our afternoon nap stopped for my second chocolate ice cream of the day,

Ces brad 2 ice cream1

Brad, Ryan, Lindel, Morris Wheeler (a venture capitalist friend of Brad’s) and I had great dinner at the Lake Side in the Wynn Hotel.

My problem was that no one would share a salad or entrée with me. I am a clean plate guy and had much too much food.

I became sleepy after the large dinner that ended at 9 pm Las Vegas time since I had been up since 4.30 am Dallas time.

However, walking back to the hotel I was ready for another chocolate ice cream.

Ces brad 3rd icecream copy

At 8.45 am Thursday we were on the bus to get to LVCC from the Venetian. Las Vegas transportation authority did not create a bus lane. The one and one quarter mile drive took one hour.

I was starving at 9.45 am. I had no breakfast. I found a Nathan’s Hot Dog stand. I bought a hot dog and a coffee. All I needed was the coffee. The hot dog was great. The coffee was undrinkable. I threw it away.

Ces brad 5 nathans copy

CES seems to grow each year. This year it covered 2.5 million square feet of showroom space. It is a formidable challenge to walk 2.5 million square feet and see all the products of all the vendors.

I covered 9 miles a day for 3 days according to my Fit Bit.

The largest venue is the (LVCC) Las Vegas Convention Center. The Sands Convention Center was the second largest venue.

LVCC was where the big guys hang out. This year the automated automobile dominated.

For the first three hours we went from exhibit to exhibit quickly.

Brad was forever looking for patterns of innovation. Every few feet someone stopped Brad to ask him a question.

Many wanted to take a picture of Brad with them. Many wanted to take a picture of Brad and me.

Brad and stan randomn pic

The autos in the exhibits were phenomenal. Some of the sensor technology was otherworldly.

I was most impressed with the 3 D printed motorcycle.

Image1

A splendid exhibit at LVCC was a small exhibit by Sphero the creator of DB 8 and other Spheros one can control with a smart phone.

Brad is a major investor in Sphero, which originated as a TechStars start-up company.

We were led into the inner sanctum exhibit by Paul Berberian`, the CEO, to see the new products coming out in 2017.

There will be several new products that I believe will be big hits for both kids and adults in the next nine months.

The Sands Convention Center was the exhibit hall for all the start-ups and near start-ups exhibiting.

Eureka Park was where all the action and excitement was for me at CES.

Eureka park

Eureka Park was start-up heaven. This year CES outsourced Eureka Park’s development to TechStars. There were bout 600 vendors this year. Next year TechStars anticipates doubling the exhibitors in Eureka Park.

Brad was scheduled to interview James Park co-founder of Fit Bit at 1 p.m. After the interview I had my lunch in the TechStars green room. It was strawberry yogurt with a bunch of green and white TechStars M&M in the yogurt.

Brad ces yoguart 9

So far it has been a terrible eating day.

After lunch we continued in Eureka Park until 4 pm.

Was anyone tired yet?

Anyone tired yet

We were scheduled to go to the YPO meeting in the LYNKS Hotel after Eureka Park.

Brad met a couple of people as a favor to YPO’s CEO.

The hotel was advertised as being only 1 hotel away from the Venetian. The problem was it was over a mile away from the Sands in the bitter cold. I was done when we got there.

The next get together was a Foundry Group get together in a Mexican restaurant at the Venetian. It was a lot of fun. I spoke to lots of people and met lots of new people.

I was on running on empty. The wonderful people at TechStars begged me to come to their dinner that I was invited to. I tried but had to bale out for a good night’s sleep.

After a great night’s sleep I was determined to have a mellow day. It just did not happen. There were too many things to see and absorb.

I went to Brad’s panel on Diversity.

Brad diversity

I spent a lot of time in the area of micro-sensors and their use. We have not seen anything yet folks.

The use in clothing and exercise clothing made my head spin

I also spent a lot of time in the Smart Home and Smart Lighting area.

The night before I left Dallas Cecelia and I watched a Netflix movie entitled IT with Peirce Brosnan. https://dvd.netflix.com/RoleDisplay/Pierce-Brosnan/11699.

It is about the building of a Smart Home and its consequences.

My wife will never let us have a Smart Home after that movie.

I have news for everyone. Singularity is here. We do not have to wait for an Artificial Intelligent world.

It is here and we are living it.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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President-elect Trump Part 9

Stanley Feld M.D., FACP, MACE

I am extending my discussion on the importance of malpractice reform because politicians ignore the potential costs and decreased access of care resulting from the present system.

In 2003, Texas Governor Rick Perry and the Texas legislature unenthusiastically changed tort reform laws in Texas.

I thought it was inadequate tort reform. It turned out that the meager reform has had great results.

Rick Perry and the Texas legislature ended plaintiff attorneys’ practice of venue shopping for friendly judges.

They also put a cap of $250,000 on noneconomic damages like pain and suffering.

These reforms have changed the malpractice climate in Texas. The reforms limited plaintiff’s attorneys’ profitability on frivolous liability claims.

Texans believe that because of these reforms and the lack of a state income tax, Texas has become the country’s best state for economic growth and job creation.

A Perryman group report concluded,

“Perhaps the most visible economic impact of lawsuit reforms is the benefits experienced by Texans who have better access to high-quality healthcare.”

 

“Doctors and hospitals are using their liability insurance savings to expand services and initiate innovative programs; those savings have allowed Texas hospitals to expand charity care by 24%.”

The medical malpractice business for plaintiff’’s attorneys has dried up in Texas. plaintiff’s attorneys are moving to other states.

Physicians are applying for licenses to move to Texas from other states.

“In 2001, according to the American Medical Association, Texas’ ranking in physicians per capita was a dismal 48th out of 50.”

“Beginning in 2003, physicians started returning to Texas. The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years.”

 “Dr. Perryman, subsequent to the issuance of his Report, informed TLR Foundation that at least 1,887 of those physicians are specifically the result of lawsuit reform.”

 The Texas Hospital Association reported a 70% reduction in the number of lawsuits filed against the state’s hospitals.

Medical liability insurance rates declined. Many doctors saw average rates drop 20% to 50%.

The American Medical Association removed Texas from its list of states experiencing a liability crisis; marking the first time it has removed any state from the list.

A survey by the Texas Medical Association also found a dramatic increase in physicians’ willingness to resume certain procedures they had stopped performing, including obstetrics, neurosurgical, radiation and oncological procedures during the Texas malpractice crisis.

Two simple changes in the tort laws made malpractice suits unprofitable for plaintiff attorneys.

Rick Perry has been so impressed with the results of his tort reforms that he wanted to extend his state’s impressive tort reform record.

Mr. Perry is proposing a British-style “loser pays” rule, which would require plaintiffs to pick up the legal costs of their targets if they lose their suits.

The Wall Street Journal showed that Ezekiel Emanuel malpractice cost estimate was wrong. It is not $25 billion year.

According to the Pacific Research Institutes estimate it is at least $242 billion dollars a year. I think the cost is closer to $750 billion dollars.

 

President-elect Trump, there are other consequences of the present malpractice liability system in the U.S. that cannot be measured in dollars.

One is alawsuits emotional wear and tear on both patients and physicians,

In order to avoid potential lawsuits physicians are avoiding high-risk patients and high-risk patient procedures. The result is a decrease in patient access to necessary care.

The details of the Massachusetts Medical Society Defensive Medicine 2008 survey is profoundly important in explaining trends in the healthcare costs due to the lack of malpractice reform.

Unfortunately, the mainstream media has published only meaningless sound bites about malpractice reform significance.

The survey’s significance has not had the impact on policy it should.

The authors state that the dollar estimates do not include the diagnostic procedures, hospital admissions, specialty referrals and consultations, or unnecessary prescriptions by physicians in specialties not included in the study.

The eight specialties surveyed represent only 46% of the physicians in the Massachusetts. The real costs to the healthcare system from the practice defensive medicine in the state of Massachusetts are much higher.

I believe the costs of defensive medicine in many other states are also much higher because in many states malpractice awards are higher. This encourages litigation.

President-elect Trump, defensive medicine is a huge burden nationally to the healthcare system. Its costs will undermine any attempt at healthcare reform. You must take medical malpractice liability reform seriously. There has to be a fundamental change in the structure of adjudication.

The survey’s findings must be studied carefully. The physicians surveyed estimated their percentages for defensive medicine testing to avoid lawsuits.

The real percentages can be studied objectively using big data. . Nonetheless the current estimates reveal unsustainable waste in our dysfunctional healthcare system.

Radiological imaging is one tool overused by physicians defensively to avoid litigation. Physicians feel they must test everything even if the probability of a positive result is insignificant.

“Plain Film X-Rays: An average of 22% of X-rays were ordered for defensive reasons.”

“CT Scans: An average of 28% of CT scans were motivated by liability concerns, with major differences among specialties.”

About 33% of scans ordered by obstetricians/ gynecologists, emergency physicians, and family practitioners were done for defensive reasons.

The total number of unnecessary CT scans needs to be calculated along with its costs in order to understand the significance of the percentage presented.

The health policy solution should not be to lower the reimbursement for CT scans. The solution is to fix the medical malpractice liability system.

MRI Studies: An average of 27% of MRIs were ordered for defensive reasons, with significant differences by specialty.

Obstetricians/ gynecologists, general surgeons, and family practitioners reported the highest rates, with the lowest rates by neurosurgeons and emergency physicians.

Ultrasound Studies: An average of 24% of Ultrasounds were ordered for defensive reasons. Orthopedic surgeons (33%) and obstetricians/gynecologists (28%) reported the highest rates, with neurosurgeons (6%) and anesthesiologists (9%) the lowest.

I believe neurosurgeons are underestimating their use of radiologic procedures in order to look good. Neurosurgery is one of the specialties with the highest malpractice rates.

Please note that obstetricians/gynecologists take no chances and order the most procedures for defensive purposes.

Laboratory Testing:

An average of 18% of laboratory tests were ordered for defensive reasons, with emergency physicians (25%) reporting the highest rates and neurosurgeons (7%) the lowest.

Specialty referrals, consultations and hospitalizations are overused the most for defensive reasons. No one wants to take a chance and send the patient home even if the indication for hospitalization is small.

Specialty Referrals and Consultations:

“An average of 28% of specialty referrals and consultations were motivated by liability concerns, with significant differences by specialty.

 Obstetricians/gynecologists reported that 40% of their referrals and consultations were done for defensive reasons, and anesthesiologists and family practitioners said that 33% of their referrals and consultations were done for the same reasons.”

Hospital Admissions:

An average of 13% of hospital admissions were motivated by liability concerns, with surgical specialties reporting lower rates than the other specialties.

The cost of defensive medicine is very high and extremely wasteful.

The repair of the dysfunctional malpractice system is simple. The system must decrease financial incentives for plaintiff’s attorneys to file frivolous lawsuits.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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President-elect Trump: Part 6

Stanley Feld M.D.FACP, MACE

There has been no mention of the importance of tort reform in your proposal to replace Obamacare. President Obama made no mention of tort reform either.

Without medical malpractice reform your administration will not be able to reduce the cost of healthcare and increase the quality of medical care.

It is very difficult to institute malpractice reform. It is in direct opposition to the vested interest of plaintiffs’ malpractice attorneys and malpractice insurance companies. These two group have very powerful lobbies.

I have estimated that there is at least one trillion dollars of waste in our healthcare system because of over-testing, over-treating and over diagnosing as a result of the threat of malpractice lawsuits.

Malpractice insurance and the time and money spent in litigation has to be include in the one trillion dollar estimate. Ezekiel Emanual M.D., Obamacare architect, proposed an artificial threshold of significant cost savings in order to form a policy.

“ A useful threshold for savings is 1 percent of costs of healthcare, which comes to $26 billion a year. Anything less is simply not meaningful.”

One percent is arbitrary. It permits Dr. Emanuel to dismiss problems that cost the healthcare system less than $26 billion a year.

The validity of the data collection is of no concern to Dr. Emanuel. He says only $1.3 billion results in malpractice costs. He ignores over testing, and lawsuit costs.

He said,

“Health care spending in the United States typically increases by about $100 billion per year. Cutting a billion here or there from something that large is undetectable and meaningless.

 In health care, you have to be talking about tens of billions of dollars before you are talking about real money.

Dr. Emanuel has no difficulty in producing fake data to make his point to the unknowing.

 A study, closer to truth than just an opinion, disclosed:

The truth is a full accounting reveals that more than 10 percent of America’s health expenditures per year are spend on tort liability and defensive medicine.

This study concludes that $242 billion a year extra is spent because of the lack of tort reform.

The $242 billion is well above Dr. Emanuel’s fictitious threshold.

“Much of this waste is generated or justified by the fear of legal consequences that infects almost every health care encounter. The legal system terrorizes doctors. Fear of possible claims leads medical professionals to squander billions in unnecessary tests and procedures.

Physicians and nurses are afraid to speak candidly to patients about errors. They try to explain the risk reward ratio of treatments for fear of assuming legal liability. The result is the practice of defensive medicine and over testing to cover every possible contingency.

This legal anxiety is also corrosive to the therapeutic magic of the physician patient relationship.

It would be relatively easy to create new rules that would provide a reliable system of justice for patients harmed by medical treatments and procedures without encouraging costly litigation.

A new and effective tort reform system would decrease the costs of defensive medicine significantly. It would encourage physicians to use of clinical judgment rather than expensive tests. It would improve physician/patient relationships.

“ The good news is that it would be relatively easy to create a new system of reliable justice, one that could support broader reforms to contain costs.”

Everyone makes mistakes in every walk of life. The medical legal liability threat could result in further unnecessary errors. Physicians, nurses and hospitals are advised not to offer explanations about mistakes. Sometimes errors are concealed to avoid a legal ordeal. The hidden error could be compounded by additional mistakes.

“Even in ordinary daily encounters, an invisible wall separates doctors from their patients. As one pediatrician told me, “You wouldn’t want to say something off the cuff that might be used against you.”

There are cost multipliers created as mistrust accelerates between the patients and physicians. You would like physicians to adopt electronic medical records. Some physicians avoid using EMRs because the information could be misinterpreted and used against them.

The Electronic Medical Record available through hospitals systems or standalone physician practices is used by the government and the insurance industry to verify the treatment in order to guarantee treatment is best practice treatment.

Physicians are producing cut and paste reports to cover best practice observation by a third party rather than the actual encounter with the patient in order to avoid reimbursement penalty or possible liability.

There is an increasing use of second opinions. Every medical problem is requiring multiple unnecessary laboratory tests to rule out something that might have been missed in the evaluation of patients in order to avoid malpractice suits.

An example is a CAT scan done in Emergency Rooms for the slightest head trauma.

“Medical cases are now decided jury by jury, without consistent application of medical standards.

 According to a 2006 study in the New England Journal of Medicine, around 25 percent of cases where there was no identifiable error resulted in malpractice payments.

 The malpractice insurance companies want to settle the malpractice claims before the court charges mount.

“Nor is the system effective for injured patients — according to the same studies, 54 cents of every dollar paid in malpractice cases goes to administrative expenses like lawyers, experts and courts.”

These are some of the major tort reform issues that must be addressed in effectively.

They must be addressed to decrease wasteful expenditures in the healthcare system.

Malpractice lawsuits have been a growth industry for defense attorneys. The malpractice suits have also been a tremendous psychological and economic burden for physicians who have to defend themselves.

Politically is has been a tremendous economical burden to the healthcare system. In the past politicians have refused to acknowledge the economic burden to the healthcare system.

Malpractice reform is a threat to the vested interests of the defense attorneys and malpractice insurance companies.

Malpractice reform is essential to any meaningful healthcare reform.

President-elect Trump the big question is.

“Do you have the will and the courage to take on the plaintiff attorneys and the malpractice insurance industry in order to correct the medical tort reform system?”

 Effective Malpractice reform must treat both injured patients and physicians fairly.

 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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  • Naina Katyal

    It’s a great pleasure reading your post. It’s full of information I am looking for and I love to post a comment that “The content of your post is awesome” Great work!
    Desi chhokri kurtis

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Dear President-elect Trump: Part 5

Stanley Feld M.D. FACP,MACE

Dear President-elect Trump,

A blog from a medical student appeared in www.KevinMD.com

The medical student, Jacob Chevlen, got it right.

Don’t call me a provider.”

President-elect Trump, if you really want to repair the healthcare system and I believe you do, you must listen to this medical student carefully.

You must realized that patients are not commodities. They are living human beings with emotions as well as concrete illnesses.

Many illnesses and their complications can be avoided if the way to maintain good health is understood by consumers. Cultural changes must occur to decrease the external stimuli that lead to these illnesses including obesity and drug abuse.

It must be recognized that the most important stakeholders in the healthcare system are patients (consumers). A viable healthcare system must be built around patients who have incentives to remain healthy.

Consumers of healthcare depend on physicians. Physicians are the second most important stakeholders in the healthcare system.

Patients depend on physicians to use their expertise and judgment to help them maintain health and to fix them when they get sick. This skill is developed over 6 to 10 years of post-graduate education.

The government, the healthcare insurance companies, the hospital systems, and the pharmaceutical companies are all secondary stakeholders.

Both patients (consumers) and physicians have been devalued by the government’s desire to simply reduce healthcare costs.

Government bureaucracies believe that they can reduce costs by regulating physicians’ “decision making” and “second guess” their clinical judgment.

The federal government is trying to control the healthcare system. The harder the government tries to control the healthcare system the more dysfunctional it becomes.

Some day the federal government is going to realize it costs more in the long run to try to control the two most important stakeholders. (consumers and physicians) than it is to provide financial incentives to consumers to maintain their health.

Society has been programed by government and other secondary stakeholders to consider physicians as healthcare providers.

We are not healthcare providers. We are physicians! Medical student Jacob Chevlen expresses this sentiment perfectly.

“I am a medical school student. Like many of you reading this, my life is spent between the walls of the library and the walls of the clinic.”

I remember being told as a first year medical student that I would have to learn a new language and live a different life than my college friends not going into medicine.

“I was told at the beginning of this journey that it was fair; that it was an “equivalent exchange.”

“You want to relieve suffering — great — you’re going to suffer.”

“You want to extend lives — fantastic — you’ll trade years of your own.”

“You want to lead your patients to healthier relationships — beautiful — I promise you’ll be distanced from your family, friends, and other loved ones.”

One of these statements with its consequences has been true for many physicians I have known through the years.

“We accepted this trade because we are driven to be physicians.”

“Ultimately, it’s a small price to pay to join that sacred society of men and women who devote their lives to healing.”

It is truly a fulfilling emotional experience to have practiced clinical endocrinology for 30 years. I have developed so many wonderful physicians/patient relationships. I know these relationships that I had added to my therapy. These relationships had immensely improved my patients’ treatment outcomes and well-being.

“However, none of us made these sacrifices to be a “provider,” and this is the culture we must fight.”

As President of AACE and subsequent author of Repairing the Healthcare System, I have tried to fight for a cultural change.

Obamacare has devalued physicians and downgraded the physician/patient relationship.

Some of these sick human beings have no interest in listening to a provider when the government or the health insurance company will take care of them when they get sicker.

Consumers who desire to develop a patient/physician relationship are finding they have access. So many physicians have given up on developing physician/patient relationships.

Consumers are now gravitating to concierge physicians in their quest to find a physician that cares and will develop a physician /patient relationship with them.

“Recently, the director of the Governor’s Office of Health Transformation spoke at my medical school.”

It sounds like an agency in Atlas Shrugged to me. The “GOHT” is a mind programing agency whose goal is to manipulate physicians’ minds.

“To enroll in that will give them enhanced reimbursement for reducing costs to Medicaid.”

“Not once during his entire lecture did he use the word “doctor”, when referring to physicians, or advanced practice nurses; he only referred to them as “healthcare providers.”

The “experts” believe that social engineering works. President-elect, you surprised the government, the media and the experts and showed them social engineering does not work. You won the election, didn’t you?

Jacob Chevlan goes on to say;

“Stop.

Have you ever considered what a “provider” is or does?”

“Well, that’s obvious: A provider provides! A provider is the source of a good or service. They disseminate it freely and happily, expecting nothing in return.”

Unimportant is the many years of schooling to develop an understanding of the subtleties of disease, its presentation and treatments.

Physicians’ judgment and patient physician relationships should not be discounted.

“That is how government, insurance companies, and hospitals look at physicians. We are obliging tools, conduits along the path of the flow of money from patients to insurance companies, and insurance companies to hospital systems.”

Medical Student Jacob Chevlan has nailed it President-elect Trump. If you have any chance of Repairing the Healthcare System you should listen to this medical student who has not been involved in the present disillusionment of the practice of medicine.

I have outline simple fixes that can cure this dysfunction rapidly.

“Our feelings, and our goal of providing top-level care, are fundamentally irrelevant.”

“ Why else would prior-authorizations exist?”

The government and the healthcare insurance industry’s data supersede physicians’judgment.

“Or electronic health records whose only real function is to facilitate billing?”

EMR’s as crafted can easily provide irrelevant false “big data.” EMR’s should be used as a continuing education tool to enhance physicians’ judgment rather than a punishment tool for physicians’ reimbursement.

“ Or the fact that it is illegal to provide pro-bono care to Medicaid or Medicare patients?”

“These and other “innovations” burden physicians and patients, slowing or even completely halting the delivery of care.”

This medical student goes on to say;

I do not know when physicians allowed themselves to be called “providers,” but I do know that no positive change will happen to our toxic and unsustainable health care system until we stop accepting it.

I can only hope Mr. President-elect that you take heed and listen to this medical student as your surrogates formulate your replacement for the disaster called Obamacare.

“I am not a “provider school” student. When I graduate, my diploma will not say “provider” on it. It will say “doctor,” and we should accept nothing less.”

Bravo Jacob Chevlan !!!

 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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  • Naina Katyal

    Such a very useful article. Very interesting to read this article.I would like to thank you for the efforts you had made for writing this awesome article.
    Desi chhokri

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