I’ve been hearing a lot about these quick-stop clinics staffed by nurse practitioners. I hear about them in the news or read about them online. They seem to be on the east coast or midwest. Or maybe I’m just not paying any attention to them here locally.

As someone going into a medical career, this is somewhat discouraging. I don’t see how a family physician can compete against an NP based solely on costs. It seems like the scope of nursing just keeps getting expanded more and more. I’m sure the nurses are elated about this. And their paychecks continue to rise as they get more specialized.

I don’t think we need to go back to the days were the doctors were kings of their wards and nurses stood whenever one came in the room. But I do think that scope of practice of nurses and doctors cannot overlap too much. Because let’s face it, the nurses will always be able to offer their services at lower costs. And, more often than not, they (nurses) have less debt coming out of school.

Amy from RNCentral.com sent me this post titled 20 Surprising Ways Wal-Mart Clinics Will Affect US Healthcare. It’s a good read discussing the pros and cons of Wal-Mart entering the health service industry by opening up clinics at their stores.

Courtesy of MichaelMoore.com

I guess I’m slow. I’ve heard that before. But I finally got to see Michael Moore’s documentary on the American Healthcare System. This was my very first Michael Moore documentary. I didn’t watch bowling for Columbine or Fahrenheit 9/11.

Prior to watching this film I thought that Michael Moore was pretty obnoxious. Not that I’ve ever met the guy. He just came across that way to me. He seemed confrontational. But maybe you need to be that way to produce an effective documentary.

Throughout the film, Michael Moore introduces the audience to various Americans. We get to meet them and find out about their difficulties in the system of medicine that Americans seem to have accepted.

As a documentary about the atrocities of the American healthcare system, one would expect to see the negatives. And Mr. Moore does not fail to deliver. He presents one tear-jerking story after another and with his sarcasm points out how broken our system really is.

At one point he brings a group of Americans who have health problems resulting from their work at Ground Zero of on 9/11. These rescue workers had many problems that they just could not afford to deal with back home. Moore took them to Cuba where they were treated free of charge.

I consider this film to be an argument for Universal Healthcare. As an argument, I didn’t expect an unbiased view. Even so, Michael Moore did point out some of his critics. And one can easily find the opposing viewpoints with a quick Google search.

Without getting into a debate about the merits or pitfalls of universal medicine, I previously wrote that there are two entities that keep America from going the route of universal healthcare. Those two are (1) doctors and (2) Big Pharma. (see my post: Reforming the U.S. Healthcare System for more).

Overall, I think it was an excellent film for anyone interested in healthcare in America. Is it a good generalization of the state of things in this country? I don’t know. My mother had cancer a couple years ago and was very well taken care of by her insurance (not going to name them, but the founder is briefly mentioned in the film). Maybe my mom was the exception and not the norm? I just haven’t been in and around the hospital system to know. Nevertheless, the film does offer one viewpoint and its probably that we should take a look at.

I recently saw an episode of The Daily Show with Jon Stewart. It’s always an interesting way to get my news. But he did one segment which I’ve included below. Check it out.

I was gonna write about how surprised I am to hear that increased gambling was listed as a side-effect. But I figured that any way I found to convey my disbelief in such absurdity would kind of be overshadowed by Jon Stewart.

If anything, just remember to know what the side-effects are of any medication you take.

In a previous post (Physician Salaries on the Decline) I wrote about declining physician salaries and how that is bad for healthcare.

I recently found a post from a medical student in the U.K. The system is kind of different there. He talks about the salary a newly graduated doctor would make out of medical school. Here in the States, I’ve found some residency brochures that advertise paying their residents somewhere between $45,000 and $50,000 USD.

Anyways, the post talks about how the financial benefits of a career in medicine might not be enough to entice the “cream of the crop” into medicine. And, the author points out, wouldn’t you want the best and the brightest to be the ones taking care of you when you’re sick?

From the post:

Where would you want the brightest people in the country to work? Would you have them making you money as stockbrokers; defending you in court as lawyers; writing your next headline as journalists; or would you have them saving lives as doctors? Most people would rank their health as one of the most important aspects of their lives, but is medicine financially attractive enough to entice the cream of the crop? I am not sure. In financial terms medicine might not be the best choice for the bright young future of tomorrow.

The post is at sBMJ - Viewpoint: Deterred by the doctor’s salary?

Related Posts: Britney Spears Now In Doctors’ Hands

Copyright 2008 Brad Barket / Robyn Beck / Getty Images

News on the street, and by street I mean Internet, is that Dr. Phil paid a little visit to a certain celebrity (whom I’ll refer to as Ms. S) on Saturday (January 5) at Cedars-Sinai Hospital. She had been there since Thursday after her standoff with police.

Well after his meeting with Ms. S, Dr. Phil released this statement to Entertainment Tonight:

My meeting with Britney and some of her family members this morning in her room at Cedars leaves me convinced more than ever that she is in dire need of both medical and psychological intervention. She was released moments before my arrival and was packing when I entered the room. We visited for about an hour before I walked with her to her car. I am very concerned for her.

I am neither a doctor, nor a HIPAA expert, but I did sign the form and take a little class about it. Isn’t this situation a breach of doctor-patient confidentiality? Dr. Phil, shame on you!

I suppose he might claim that he is not her doctor and she isn’t his patient. So in that case, he is not bound by doctor-patient confidentiality.

According to one article by TMZ, Ms. S was totally “blindsided” by the visit:

People on the 7th floor at Cedars-Sinai Medical Center say the doctor arrived about 7:30 AM Saturday. We’re told [she] did not invite him in; she didn’t even know he was coming. Sources say it was [her] parents who told Dr. Phil to go to the hospital. When he walked into her room, we’re told, a blindsided Britney walked out — and eventually came back.

Maybe Dr. Phil’s defense can be that he was an invited family guest? I don’t think so. Further reading of that article reveals that Dr. Phil would like to do a television intervention of the pop-star anonymous celebrity patient.

Hmm.. so Dr. Phil comes in at the request of the patient’s parent. And then he decides to use this opportunity to generate some publicity for his television show?!? Who in the world got him on the air?? Oh, wait.. Oprah! Oprah needs to pull him in for a little sit-down.

I’m glad to see that I’m not the only one thinking that this was inappropriate. Another article at TMZ reports that many psychiatrists have criticized both Dr. Phil and Cedars-Sinai.

the hospital should not allow any doctor who does not have in-patient privileges into a patient’s room, unless that patient has given prior consent. TMZ has learned Britney had no idea Dr. Phil was coming to her room and indeed when he walked in she became agitated and walked out.

The psychiatrists were pretty much unified in their opinions. One claimed to be “outraged and disgusted” about the whole situation. Another called Dr. Phil’s actions “intrusive and inappropriate.” Yet another criticized the Cedars for allowing Dr. Phil, who doesn’t have practicing privileges there, to see one of their patients without her knowledge or consent.

Out of line. The whole situation was absurd from a patient confidentiality standpoint. When dealing with any patient, their privacy is so important. Which is why every single medical blog (at least that I know of) has a very clear privacy statement. No patient identities are to be compromised. Doctors, in order to do their job well, must be able to get the complete story from their patients. And patients, in order to open up, must feel confident that what they share to their doctor will stay between them. Its a simple ethical issue, and a legal one as well.

*****

Update (January 7, 2008): Today (January 7) MSNBC.com is reporting that Dr. Phil has decided to pull his special on Ms. S. He said that the situation is “too intense” for him proceed.

Dr. Phil’s statements and actions have sparked a lot of criticism in the media. He defends his actions by saying he was not acting in a professional capacity when visiting Ms. S. You can check out the article at E! Online - Dr. Phil Defends Britney Visit, Calls Off Special.

Update (January 12, 2008): A complaint against Dr. Phil has been filed with the California Board of Psychology. The complaint, filed by another psychologist, claims that in going to counsel the pop-star, Dr. Phil was practicing psychology without a license. This is a serious charge, and one the board might hand over to the District Attorney for review because practicing psychology without a licenses in California is a felony.

Dr. Phil has never been licensed to practice psychology in California and retired his Texas license in 2006.

The complaint also says that a petition to remove Dr. Phil from the air is going around.

More can be found at TMZ.com: Psychology Board Investigates Dr. Phil.

Update (January 18, 2008): USA Today is reporting that Dr Phil still believes his meeting with Ms. Spears was appropriate. However, Dr. Phil says, that he regrets making a statement about it afterwords. Quoting from the article:

“Was it helpful to the situation? Regrettably, no. It was not, and I have to acknowledge that and I do,” the talk show host told his audience Thursday during taping of a Dr. Phil episode that will run Monday.

“I definitely think if I had it to do over again, I probably wouldn’t make any statement at all. Period.”

More can be found at USA Today - Dr. Phil says he regrets statement on Britney.

Sources: TMZ.com: Brit Blindsided by Phil — Hospital Acts Curiously, TMZ.com: Psychiatrists Slam Phil, Cedars, Entertainment Tonight, E! Online - Dr. Phil Defends Britney Visit, Calls Off Special, TMZ.com: Psychology Board Investigates Dr. Phil, USA Today - Dr. Phil says he regrets statement on Britney.

Source: MSNBC.com - Doctors often dole out placebos to patients

In a recent MSNBC.com article, I discovered that many physicians prescribe placebos. The researchers claim that half of the doctors surveyed admitted to prescribing a placebo to a patient at one point.

One of the authors of the study, Rachel Sherman (a medical student), said that this “illustrates that doctors believe expectation and belief have therapeutic potential.”

One part of the article made me wonder… It said that some doctors tell their patients that they are prescribing a placebo (4 percent of doctors surveyed). Doesn’t that defeat the purpose of prescribing a placebo? Maybe these doctors missed that lecture in medical school. Wait, no.. we learn about placebos as early as high school! Why in the world would you tell your patient, “It’s a placebo”?!?

I just find it amusing that doctors prescribe placebo. I suspect that a number of these cases would be for patients, or their parents, who insist on getting some sort of medication even though their physician says they have nothing to worry about.

It makes me wonder if I’ve ever been prescribed a placebo. Although I’ve never insisted on taking something. I don’t think my mom has ever insisted to the doctor that I be prescribed something either.

Personally, I think that the only time I’d be tempted to prescribe a placebo is for an insistent patient. I realize that there are ethical objections to the practice, though.

In a perfect world, maybe there would be no need for informed consent. The patient would have complete trust in the doctor and the doctor would be perfectly competent. Of course, in a perfect world, there would be no need for doctors…

The holiday season is here. Are you trying to think of what to get that special someone? Well in the spirit of giving, I shall give a suggestion. For that special scientist in your life, or maybe just science nerd, you can give the gift of knowledge. Knowledge of his or her personal genome, that is.

A company now offers to sequence DNA commercially. Just collect some saliva and mail ship it to them. Oh, and don’t forget your $999 check.

Yup, for less than a grand, a DNA sequence can be bought!

Brave new world.

Oh, I almost forgot. You’ll want the link to the company’s website, right?

It’s 23andMe.com

Sources: New York Times

Related Posts: Doctor Salaries, A Problem Overseas Too

Sources: American Medical Association, American Medical Student Association, Center for Studying Health System Change, New York Times

Last year (2006) a story published in the New York Times reported something troubling. Physician salaries are on the decline.

the average physician’s net income declined 7 percent from 1995 to 2003, after adjusting for inflation, while incomes of lawyers and other professionals rose by 7 percent during the period.

Some people do not think that this decline is a problem at all. Even with the decline, physicians are still making a decent salary. They aren’t going hungry. Maybe they have to forego a brand new S-class, but doctors don’t live off of welfare. And with the ever-increasing costs of healthcare, physician salaries just don’t seem as important.

It is very important. This country is headed towards a severe physician shortage. New medical schools are opening up and existing schools are expanding their freshman class sizes in response. Producing more physicians each year is not enough. Physician salaries must increase as well.

The shortage we are expected to go through is in the primary care segment. As it is, the current state of healthcare encourages doctors to enter high-paying specialties. New graduates are not flocking to Pediatrics, Internal Medicine, and Family Practice. Take a survey of any freshman medical class in the country. Many will share their desire to go into radiology, surgery, orthopedics, plastics, or dermatology.

Why? Frankly, for most, it’s because that is where the money is. Those specialties are the quickest way to get out of the enormous debt incurred during medical training. According to the American Medical Student Association (AMSA), the median debt for students at a public medical school is over $119,000 while those that go to a private medical school will carry a median debt of nearly $150,000. On top of debt, physicians make approximately $48,000 during their years during residency — which lasts at least 3 years. It could take up to 8 years for a thoracic surgeon to complete his/her training.

The stereotype of a lawyer is someone whose focus is on the number of billable hours. On the other hand, the stereotype of a doctor is one of compassion for a patient. While stereotypes can be dangerous, it is possible that in some ways they may give us a glimmer of reality.

The kind of people that go into medicine are usually people who truly care about the health of their patients. It is not a career chosen solely based on financial reasons. Today’s medical students are aware of the huge costs of training and the low reimbursements from insurance, medicare, and medicaid.

But there are many people who would make excellent doctors. They have all the right qualities but choose to go into other fields. They are discouraged from pursuing a medical career by working doctors tired of rising costs of malpractice insurance, declining salaries, bureaucratic hassles, and long workweeks. A career in medicine just does not seem “worth” the time and effort (see AMA Response to declining physician salaries).

Declining physician salaries are a big problem. It’s a big problem for the medical community and a big problem for the patient. If they continue to fall more and more prospective medical students will decide not to go into medicine because it is not “worth” it. Medical school graduates will continue to avoid primary care for higher paying specialties. And doctors will continue to order diagnostic procedures that bring in more revenue.

December 1, 2007 is World AIDS Day. Last year I wrote a short post summarizing an MSNBC article about how AIDS has changed America and you can find that post here.

Over the past two and a half decades AIDS has transformed from a strange and unknown disease associated with gay men into a global pandemic whose effects have reached into all levels of society.

The problem is that we still don’t know how to fight it. We can’t stop HIV. Sure, we seem to have had success in delaying the onset of AIDS in HIV Positive patients (i.e. Magic Johnson), but that requires a very expensive cocktail of anti-viral medication. We know that HIV is not a death sentence, but the majority of people who test positive do not have the resources to get this sort of treatment.

At this point, the most effective weapon in the fight against AIDS is information. That’s what World AIDS Day is all about — raising awareness about the disease and its prevention. Through another medical blog, I found a post at The Unofficial Stanford Blog (TUSB) titled HIV/AIDS Awareness Ads You’ll Remember in the Bedroom.

Below are a couple of Ads I found. All four were made by the same organization. The last three can be found at TUSB:

According to TUSB, the Ads were created by

a French NGO called AIDES (”aide” means “support” or “help” in French), which was founded by Daniel Defert in 1984 following the death of his partner, philosopher (and former Berkeley professor) Michel Foucault. AIDES now operates in over 70 small towns and villages within France, and is recognized as one of the most important European HIV/AIDS NGOs.

I’m not too sure how to describe the Ads. It definitely has its “shock value,” which is usually a good thing when it comes to grabbing an audience’s attention. Maybe I’d use the word “disturbing.” I suppose it makes its point, though..

Finally, to finish up this post, I’d like to provide a link to an excellent, well-written post titled HIV, AIDS, safe sex, & fornication: Personal, religious, medical and social viewpoints. It’s written by another Jeffrey. He is a medical student at Monash University in Australia working on a 5-year MBBS degree.

Related Posts: Physician Salaries on the Decline

This quarter I’m taking a course called “Medicine and Ethics.” The class is taught by Dr. X. (name withheld). There are a number of topics that was scheduled to be discussed and each topic was presented by a group of 3 or 4 students. I ended up in a group of four. Our topic, as you can probably guess by the title of this post was “Reforming the American Medical System.”  

I wanted no part of this topic. I felt that the American Healthcare System is a mess but there’s not much we can do about it. I really wanted to be in the group that would present on physicians and war. But as Dr. X went down the list and waited for volunteers for each topic, it became clear that Reforming the U.S. Healthcare was not the popular one. No hands jumped up at the opportunity to tackle this problem… So I reluctantly raised my hand and said I’d join the group.

I had already heard that the United States spends more money than any other industrialized nation on healthcare. I had heard people complain that the Healthcare system in America is broken. But these were only things I heard. I, personally, had never had any problems accessing healthcare. And so when I actually looked at the stats, well, it was a bit surprising.

Some of the things I discovered in my casual research:

• The United States is the only industrialized nation that does not have a form of Universal Healthcare.
• The United States spends at least 40% more per capita than any other industrialized nation on healthcare.
• The United States spends more than 3 times more per capita than Canada on Health Administration costs alone.
• Almost 47 million Americans (approx. 16%) are without healthcare insurance.
• Eight out of 10 uninsured Americans come from working families.

Those are some incredible numbers. And while only about 16% of Americans are uninsured, the majority of Americans with insurance are only one major medical emergency away from bankruptcy. Many are well-aware of how much is available to them under their health insurance policy. And, while it may be enough for your routine physical check-up or the occasional prescription medication, it is nowhere near enough to cover $40,000 that might be billed for cancer treatment.

Why is it that every other industrialized nation can provide healthcare to their citizens at a far lower cost than what Americans spend? Its a shame that the country that won the race to the moon cannot figure out how to ensure that every citizen has access to basic healthcare.

In my mind, there are two major roadblocks preventing the United States from transitioning to a Universal Healthcare system.

1. Doctors
2. Big Business

Physicians are afraid of the idea of Universal Healthcare and a single payer system. Why? Because they fear losing control. I believe that many physicians are afraid that a single payer system would negatively affect physician salaries. While it may be possible for the government to force down physician salaries in a single payer system, it is not in the best interest of the government or the nation to do so. If there was not financial benefit to being a physician, most countries would have a huge shortage of physicians. But, under the universal systems in other industrialized nations, physicians do make a decent, comfortable living.

The bloated health care system of the United States benefits big business more than any other party involved. It benefits big business more than physicians. But most concerning, it benefits big business more than the patient. As health insurance premiums continue to rise, insurance companies continue to pull in a profit while more and more Americans find out that can no longer afford coverage.

Greed drives the industry. The sole purpose of a corporation is not to look out for the interests of its customers and ensure customer satisfaction. The goal of a corporation is to make money for its shareholders.

And that is the problem with privatized healthcare. If a corporation begins to lose money, its shareholders get antsy. But when healthcare is federally funded, the government can take a loss for the good of its citizens.

Reforming the healthcare system will probably mean that the big corporations in the healthcare system won’t be making as much money. But America needs to decide, as a whole and through our leaders in congress, that the health of a nation is more important than the pocketbooks of corporations. Hopefully, we decide soon.

Sources: