The Healthcare Problem

Ask Your Doctor if this Blog is Right for You

You’ve seen the commercials: the ones with the attractive, happy and healthy looking people whose lives have been changed by the latest and greatest new drug. The commercial always ends with the laundry list of warnings about what the wonder drug can do to you, like:

– Don’t take this drug if you are allergic to this drug (duh!).

Please tell your doctor if you have any of the following symptoms
– Severe abdominal pain
– Blood pressure elevation
– Excessive bleeding
– Erections lasting more than 5 hours
– Pregnancy resulting from prolonged erections
– Stool or urine glowing in the dark
– Head explosions
– Unusual obsessive thoughts about llamas
– Corrosive flatulence
Death.

I promise! I won’t.

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Patient Centered Care

The real question I am asking here is not if this care is good or bad (the answer to that is, yes, it is good and bad), but whether it is patient-centered.  

This should be a silly question, like asking if car-repair is car-centered.  But it is clear that much of the high cost of care in our country is due to the huge number of unnecessary procedures, medications, hospitalizations, and services given to/done on people.  Unnecessary care is, almost always, not patient-centered.  

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Patient Centered (Part 1)

Rather than dwelling on the malfunction of the system, however, I want to turn my eyes toward what most people don\’t see: what real patient-centered care could and should be. It\’s not that I am suddenly wiser than my colleagues in the sick-care system.  Despite 18 years in practice, I was not able to see what true patient-centered care looked like until I left the system. 

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ICD-10 and Inflation of Codes

For those still unaware (perhaps looking through catalogs for gigantic inflatables for president\’s day), ICD-10 is the 10th iteration of the coding taxonomy used for diagnosis in our lovely health care system.  This system replaces ICD-9, which one would expect from a numerological standpoint (although the folks at Microsoft jumped from Windows 8 to Windows 10, so anything is possible).  This change should be cause for great celebration, as  ICD-9 was miserably inconsistent and idiosyncratic, having no codes describing weakness of the arms, while having several for being in a horse-drawn vehicle that was struck by a streetcar.  Really.

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The Impending Revolution

Like my practice, membership medicine is still in its early phases.  Like my practice, the future of membership medicine depends on a lot of things beyond our control.  But the excitement I hear regularly from physicians, residents, medical students, patients, business owners, and even politicians about its potential is quite remarkable.  Both of these conferences were full of something that I once thought no longer existed: doctors who were excited about medicine and cautiously optimistic about the future.

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Washington, We Have a Problem

“Daddy?” “Yes, Jonathan?” “Sometimes my leg hurts.” “Yes?” “Why does it hurt?” “Uh, that’s a tough question.  Does it hurt a lot?” “No, just every once in a while.” “OK, and where does it hurt.” He gives an expression of disbelief at the stupidity of the question.  ”My leg!” “Where on your leg?” “I don’t

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