Health Care Foibles – A Personal Tale

An example of the stupid things even doctors do when it comes to health care. 

In March of 2013 I wrote Healing the Health Care Cost Conundrum. Four years later, in March of 2017, I have retired from the US Army and am practicing medicine in Memphis, TN. My practice is in the inner city, and our focus is serving the Medicaid population. Our patients are impoverished and often very sick, with chronic diseases frequently showing up 20 years earlier than in their more affluent counterparts. Many live in dangerous communities, have no reliable transportation, and have unhealthy food. Obesity is the norm, violence is taken for granted, and serious mental illness is widespread. It comes as no surprise that many patients abuse drugs, citing chronic pain that may or may not be real. Some come to the clinic for no other reason than to feed their drug habit, and try to get narcotics to generate a little extra income. It is the toughest medical environment I have encountered since my combat tour in Iraq.

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Discovery and Innovation in the Business of Health Care

How can you do something that you have never done, or discover something that no one has ever known? Read below for some help. 

Discovering things previously unknown is one of the most important, and most enjoyable, things that anyone can do. Most people do it every day, whether as simple as finding a new restaurant they love or discovering a new comet in the heavens. Fundamentally, new discoveries come from observation, analysis, and experimentation. A husband looking for a new restaurant to try with his wife might observe something that in his experience resembles a restaurant on a street corner. He then analyzes the available information to decide if he wants to try it; what kind of food they, the opening hours, and whether it is clean and inviting. Finally he and his wife try it out, completing the process of discovery.

New discoveries are often far more difficult than finding a great new place to eat. Identifying a new comet can require expensive equipment and uncommon expertise, while sequencing the human genome, learning about subatomic particles or curing cancer are some of the slowest and most resource intensive discoveries of all. The discovery that smoking causes lung cancer followed the same observation-analysis-experimentation sequence. In the 1930s a few surgeons noticed that they seemed to be performing lung cancer surgeries on a lot of smokers. Some published their observations and that induced others to analyze the existing information and hypothesize that smoking is associated with lung cancer. Researchers then developed experiments to test the hypothesis and in 1956 the British Doctors Study provided the first convincing evidence that smoking increased the risk of lung cancer.

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Healing the Health Care Cost Conundrum

A prescription for making US health care better quality, more accessible, and less expensive for all of us. 

The military health care system is different in many ways from the civilian system, but a primary difference is the income incentive. Simply put, health care providers and other medical professionals are not paid based on the number of patients that they see or the number of procedures that they do. Instead they receive a fixed salary with few if any bonuses for productivity or quality. The budgets for military health care institutions, and many others in the Federal government, are based on Congressional appropriations, not on productivity. This has been changing in the past decade but remains largely true today.

Civilian medicine is not so. They are paid for what they did, patients seen and procedures done, and everyone on staff is usually highly motivated to do more. Some have described such fee-for-service reimbursement arrangements as “you eat what you kill.” In some practices, that can equate to more visits and more procedures, even if some are not medically required.

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