Sunday, September 28, 2014

HIDING IN PLAIN SIGHT: THE DETERIORATION OF MEDICINE-a disgusted physician tells the real story

 
HIDING IN PLAIN SIGHT:
THE DETERIORATION OF MEDICINE

by John Tedeschi, MD

(Robbinsville, NJ) – It’s happening so gradually you hardly notice it at first.  It’s a slow and deliberate erosion, targeting your family doctor, someone who will soon become a thing of the past. 

Thanks to politics, insurance companies, special interest groups and other organizations, medicine is changing:  the way it’s provided; who it’s provided to; exactly who the providers are and their qualifications; how much it costs and, literally, “who lives and who dies.”  The old saying “follow the money” has never been truer than today. 

On the surface, the bureaucrats are pretending to have the best interest of the patient in mind when it comes to medical coverage and healthcare.  One wonders, though, when the architect of the Affordable Care Act questions the quest for life after 75.


In reality, Ezekiel Emanuel says it’s a matter of saving money – and where the money IS ultimately spent, it’s directed to special interest, profit-making organizations.  Benefit to the patient is secondary.

It’s all carefully choreographed -- better than a Broadway musical.

As a result, physicians around the country are up in arms over unsafe and unethical insurance and federal regulating policies.  These policies remove the trusted, precious and irreplaceable ‘doctor/patient relationship’ in favor of healthcare “rationing’ that is based on previously established Third World standards.  And physicians have nowhere to turn for help.  The AMA (the American Medical Association), long the advocate for the nation’s doctors, abandoned the needs of the physician years ago and has its own agenda.  Today, only 14% of the nearly 400,000 licensed physicians are still members.

Doctoring just isn’t the same.  The practice of medicine, its costs and medical policies, are now dictated and controlled by groups that don’t know the first thing about medicine, nor the people it serves.  At one time, the practice of medicine in America was the envy of the world.  Unfortunately, it has now been radically segmented.

The individual human rights and patient care needs are completely eroded and purposefully ignored.  And more and more great doctors and educators, whose hands are tied, are simply giving up or leaving the country altogether.

It’s a national disgrace. 
  
Getting a flu shot at Wal-Mart or CVS, for instance.  Do these walk-in-off-the-street retail stores even know -- or care -- about the history of the patient and whether or not it’s safe to administer medicine of any kind?  Flu shots are not for everyone, but they have no way of knowing.  You find yourself in the hands of pharmacists who’ve just recently received a ‘crash course’ in how to immunize, a process mandated by the companies for which they work.

And even TV producers are realizing it’s a joke.  In a recent episode of one sitcom, a son asks his father, “Hey, where have you been?”  The father replies, “I got a flu shot at the pharmacy, because who better to administer medical care than the guy who puts price tags on flip-flops?”

Did I already use the words “national disgrace?”  

Then, there are the rapidly emerging, drive-thru urgent care centers.  Do you see a real doctor, or are you treated by a nurse practitioner or physician assistant who ‘looks and acts’ like a doctor?  Plus, it’s an uncontrolled data collection center of your personal information.

Regardless of issue, doctors are now told how much time we can spend with each patient; 
what tests we can and cannot request.  We are now forced to re-certify more frequently and answer questions, in many cases, unethically, just to serve their financial needs. 

We are told what kind of treatment can be provided to older patients, a type of  “too old to treat” approach because of the life expectancy of the patient and the cost to the federal government.  Even prescription medications that will effectively help the patient are routinely rejected by insurance companies and Medicare in favor of less expensive, ‘generic’ drugs that are archaic and simply don’t do the job. And we are aware, of course, of the conflict of interest of insurance companies having stock in the drugs that they do approve.  It’s really sad.

The entire emphasis is not just based on saving money, but also ‘making money’ at the expense of human life and quality care.

We saw what happened to the VA under government control.  Now the government wants to administer and control all of healthcare, nationwide? 

The Affordable Care Act, neither ‘affordable’ nor ‘caring.’  Not a political statement; a fact.  Ask any ‘real’ doctor.

The so-called “watchdogs” are not watching.  The government agencies established to “protect American citizens” from these abuses are not doing their job.  Where are our protectors?  Where is today’s Paul Revere who can set out to “warn us.”

Why does society accept this?  Are we ignorant, na├»ve, apathetic?  Probably.  One thing’s for sure:  We’re on our own.

Think about that.  But not for too long; you’ll give yourself a headache.”

-0-

Doctor John Tedeschi is a primary care-family doctor in Robbinsville, New Jersey, who has been practicing medicine for more than 30 years. He lives in Morrisville, Pennsylvania.

Monday, September 22, 2014

How To Discourage a Doctor from doing the right thing

This is one of the most informative pieces I have read in years as to how the medical profession is being tied by the ankles:
“Though physician compensation accounts for only about 8% of healthcare spending, decisions that physicians strongly influence or make directly – such as what medication to prescribe, whether to perform surgery, and when to admit and discharge a patient from the hospital – have been estimated to account for as much as 80% of the nation’s healthcare budget. To maintain a favorable balance sheet, hospital executives need to gain control of their physicians. Most hospitals have already taken an important step in this direction by employing a growing proportion of their medical staff..............

Tuesday, September 16, 2014

NBCRNA IRS 990s and the exponential growth of profits in this non-profit!

Gross receipts $3,292,415

Gross receipts $8,001,719

Gross receipts $16,570,001
So you see an exponential growth in income at this NBCRNA and there is certainly NOT an exponential growth in that profession in these 3 years! ALl information is on file at Guidestar.com, or as a NON-profit they  are REQUIRED to provide this information on request-and I wonder what they will charge you for that!

Tuesday, August 12, 2014

MOC the Pablum for the masses of the ABMS

MOC is all just Pablum for the masses and there is no better analogy: see: 
http://www.babypost.com/babies/infant-developme... 
ANother invention that SEEMED a good idea which is NOT!

Is Pablum Necessary? New recommendations on what baby's first foods should be (hint: it doesn't include infant cereal) 
by Teresa Pitman 
In the 1920s, many babies were being fed with homemade formulas that consisted primarily of sweetened cow’s milk and water. Doctors at Toronto’s Hospital for Sick Children wanted to find a baby food that could supplement this formula, as many babies of the time showed signs of vitamin deficiencies and malnourishment. 
In 1931, they invented Pablum, a powder that could be mixed with water or milk and spoon-fed to even quite young babies. The original ingredients included: ground wheat, oatmeal, cornmeal, wheat germ, bone meal, brewer’s yeast and alfalfa plus added vitamins and minerals. It was the first infant cereal, and it quickly became the standard first food for babies. 
Over time, many companies began producing their own variations. Because of concerns about allergic reactions, most now use just a single grain (such as oats or rice). 
But times have changed. As more babies are once again being breastfed, and the quality of formulas available to parents has improved, recommendations about adding complementary foods have also changed. The Canadian Pediatric Society and the World Health Organization now both recommend that babies be exclusively breastfed for six months, and then continue breastfeeding with added solid foods for two years and beyond. 
When a baby starts on solid foods at six months or later, there’s no need for a highly processed, semi-liquid food like Pablum or another infant cereal. These babies are ready for REAL food! In fact, the World Health Organization recommends that babies be offered the foods that are part of the family’s usual healthy diet. 
- See more at: http://www.babypost.com/babies/infant-developme...

Saturday, August 9, 2014

Putting Quality on the Global Health Agenda-NEJM & IOM crap



I read the article praising Institute of medicine political statements from the NEJM and wrote the following (naturally not accepted for publication). I used real definitions to define the problem, not politically motivated ones:
Placing the “mea culpa” in real terms regarding "quality healthcare".
The recent perspective on quality in healthcare continues to miss many essential realities. Quality is also defined as:”A measure of excellence or a state of being free from defects, deficiencies and significant variations.”
Rehashing the Institute in Medicine’s particular brand of definition, emphasizing: “it is safe, effective, patient-centered, efficient, timely, and equitable” simply does NOT describe modern medical care:
Safe: The very nature of healthcare (surgery, drug administration, anesthesia and procedures) is extremely dangerous, while this fact is typically minimized in expectations and when obtaining informed consent.
Effective: Typically the patient’s ability for self-healing is only promoted by treatment, typically introducing drugs and procedure related specific known dangers in the process-often as dangerous as the disease itself.
Patient centered: Increasingly emphasis decries utility of preventive care including PSA, mammograms, pelvic and even routine yearly physical exams-emphasizing cost effectiveness over patient centricity.
Efficient and timely: would require maintenance and preventive care-currently not emphasized-see above.
Equitable: you cannot purchase health, only health care. Poverty and lifestyle remains after healthcare, as a causative factor.

By failing to recognize that quality healthcare starts with having health and maintenance, whereby the patient is the primary source of health, we will never get past placing blame on physicians and health care systems for inadequate quality. Physicians cannot consistently replace that, which is already lost. The continued emphasis on “adverse outcomes” blaming heathcare systems, ignores the many patient centered causes of sickness including poverty, handguns, rampant drug, tobacco and alcohol abuse, obesity and multiple other life style choices including “extreme” and professional sports-which are not typically terminated by the patient, even after problems are treated and causality confronted. Adverse outcome continues to be defined as anything less than an optimal desired (advertised) outcome typically=restitutio ad integrum! This “failure” is not equal to malpractice, deficient or even inadequate care. Patients come to hospitals, when problems become severe and baseline health is marginal, increasing the risks from receiving care.
The example of the inability to decrease maternal mortality by financing all deliveries in hospitals is not surprising, as provision of care introduces specific risks (a la Semmelwiess or modern expected risks): I.e. failure to provide adequate pre and postpartum care, C/section rate risks are certainly as, or even more important, than delivery in a hospital vs home . We need to quite blindly accepting corporate definitions from the IOM or elsewhere and accepting all blame for complications.

As an anesthesiologist and for example, where the expectation is to provide general anesthesia (versus no anesthesia needed) for a MRI scan, in the most extremely hostile physical environment known, to merely “take a picture”, expected complications will always prevail and provide “adverse outcomes”. It is time to capture all inherent/statistical/expected risks and start tabulating adverse outcomes based in the real world.

This is the article available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1402157
Putting Quality on the Global Health Agenda
Kirstin W. Scott, M.Phil., and Ashish K. Jha, M.D., M.P.H.
n engl j med 371;1 nejm.org july 3, 2014
PERSPECTIVE
3
Thoughts?

Thursday, August 7, 2014

Public Health & Policy MOC: Dissecting the Issues MedpageToday

Public Health & Policy

MOC: Dissecting the Issues

Published: Aug 6, 2014
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Paul Kempen, MD, PhD, has been actively investigating the certification industry and background, introducing the term "regulatory capture," which he defines as the use of laws to create compliance with corporate self- serving programs. Kempen is an anesthesiologist now in private community practice after decades of academic practice. He regularly posts atwww.Changeboardrecert.com and his blog.

SEE: http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/47085?xid=nl_mpt_DHE_2014-08-07&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=ST&eun=g821443d0r&userid=821443&email=daraparvez%40gmail.com&mu_id=6133776&utm_term=Daily 

Sunday, July 27, 2014

FLorida Joins list of states resolving to Oppose MOC-the best set of resollutions yet and serve as example to any state without!

Today, the Florida Medical association House of Delegates passed the following resolution without a single vote of dissent among the 300 delegates in attendance: .

RESOLVED, That the FMA acknowledges that the certification requirements within the MOC process are costly, time-sensitive, and result in significant disruptions for the availability of physicians for patient care, and therefore, the current MOC programs should be modified; and be it .

RESOLVED, That the FMA opposes any efforts to require Maintenance of Certification (MOC) program as a condition of medical licensure, or as a pre- requisite for hospital/staff privileges, employment in State of Florida/county medical facilities, reimbursement from 3rd parties, or issuance of malpractice insurance; and be it further .

RESOLVED, That the FMA advocates that the lack of specialty board recertification should not restrict the ability of the physician to practice medicine in Florida. .

RESOLVED, That the FMA monitor the American Health Legal Foundation who is seeking legislation to prevent hospital staffs and insurance companies from refusing to credential physicians who do not participate in the MOC program. .

RESOLVED, That a copy of this resolution be transmitted to the AMA House of Delegates.

The number of states openly opposing this regulatory Capture= Extortion is on the rise and this set of resolutions should serve as template for EVERY state on MOC