Monthly Archives: August 2011

American Physicians versus American Medicine

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It is a common misconception that when the American Medical Association speaks it is the voice of America’s doctors. While this may have been true a few decades ago, today fewer than 20% of America’s physicians are actually members of the AMA. Over the years many practicing doctors have left the ranks of the AMA over a variety of political and social stances taken by its leadership. As has been widely reported, there was a significant increase in this gradual exodus following the AMA’s support of the highly controversial Patient Protection and Affordable Care Act of 2010, commonly known as Obamacare. http://blog.heritage.org/2011/06/23/doctors-medical-students-abandon-ama-in-search-of-alternatives/

A major element of the healthcare reform act is a government mandate that all citizens must purchase health insurance, which meets or exceeds specific standards set by the Secretary of Health and Human Services. This feature of the law has been widely criticized by various advocacy groups nationally and it was the subject of intense debate during the latest AMA House of Delegates meeting in Chicago. The majority of the House voted to continue AMA’s policy supporting this insurance purchase requirement. It must be pointed out that the House currently has a disproportionate representation of liberal academic physicians and medical students since most conservatives abandoned the AMA long ago.

Proponents of the policy argue that without a mandate with significant penalties, many people will simply not purchase insurance until they are actually facing a major healthcare expense. Since another feature of the reform law is the highly popular “guaranteed issue” provision, insurers would be compelled to issue their policies even to those facing imminent surgery, costly chemotherapy or any new diagnosis. These so-called “free-riders” would drive the cost of health insurance through the roof for everyone and force more and more people into a single payer system controlled by the government.

A second reason used for supporting the mandate is the idea that when people don’t have health insurance they tend to delay seeking healthcare for treatable problems until late in their course and will avoid routine screening for potentially preventable diseases. Proponents use various studies and statistics in an attempt to demonstrate that people with insurance get better care and are healthier than those who don’t. What they don’t say is many poor “uninsured” Americans qualify for the Medicaid program but fail to avail themselves of this existing benefit. These same people certainly cannot afford to buy private insurance, but under the mandate would be forced to do so or enroll in Medicaid. Essentially, this amounts to forcing such individuals to accept a government handout or face a fine.

Opponents of the mandate, which includes the majority of practicing physicians in America, believe this is a very slippery slope. They argue that if the government can force its citizens to buy health insurance that they don’t want or can’t afford, then there is nothing beyond the scope of their control. It is also pointed out that having health insurance is no guarantee of access to quality healthcare services. It is also clear that many people with insurance don’t get routine check-ups or screening for things like colon cancer, breast cancer, hypertension, etc. What’s next? Is the government going to force everyone to get a colonoscopy according to its guidelines? That would give a whole new meaning to “up yours.”

Perhaps the most important reason why many physicians oppose the mandate is that it is simply un-American. The word mandate is defined as an “authoritative command.” Who is it that has given our government the authority to issue such a command? This country was founded on the principle of individual freedom and personal responsibility with government playing the limited role of defender of those freedoms, not forcing responsibility. As a physician I took an oath to put my patient’s interests above my own; a system that has served society well for 2,500 years. But under the mandated system that the AMA endorses, the government will soon require physicians provide only those treatments that a panel of “government experts” has deemed appropriate. Your physician will have become a government functionary, an employee of the state. Is that what you want, even if it appears to be free?

 

 

Check out my web site at www.robertsewellmd.com

Leading by Example

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There is one word that if embraced could fundamentally change the course of our country. One word that if aptly applied has the power to return us to a course of prosperity with virtue. One word that is universally revered but at the same time consistently ignored. You’re probably expecting me to say “Jesus” or “God,” or perhaps the “Bible,” but our deities and even the “Good Book” consistently refer all of us, directly or indirectly, back to this same word as part of our humanity. Based on the title of this post you might expect the word to be “leadership” and you’d be close. Actually, the word I’m referring to is a character attribute commonly displayed by true leaders. Its a quality that most people would agree is laudable, but in recent years has become difficult to find in our leaders. So, what’s the word? In our house the kids just refer to it as the “r” word. Responsibility!

One of the first things most of us learned about the father of our country was a lesson in responsibility. Perhaps its more fable than fact, but legend has it that one day George Washington’s father discovered that a cherry tree in the family orchard had been cut down. When confronted, young George admitted, “I cannot tell a lie, I chopped down the cherry tree.” Whether this is exactly what happened we will never know, but his honesty and willingness to accept responsibility are in large part what endeared Washington not only to his generation, but to all those that have followed.

How incredibly different things seem to be today. Watching Mr. Obama speak to a crowd in Iowa during his recent bus tour across America’s heartland, I couldn’t help but draw a stark comparison. Our economic troubles may or may not be caused by his policies; that’s a topic for another post, but for him to stand up as the leader of our nation and blame the previous administration, the Congress, the TEA Party and “bad luck”, demonstrates his unwillingness, or perhaps his inability, to accept responsibility. This character flaw has been revealed repeatedly over the last two and a half years, and is at the root of his declining popularity. People want leaders they can trust. “The dog ate my homework” is a pretty lame excuse, and so is the earthquake and tsunami in Japan.

In an earlier post “Mr. Obama, the High-Center of Attention” (May 24, 2011) http://www.spiritofhealthcare.com/?p=38 I pointed out how disingenuous this President was in taking personal credit for finding and killing Osama bin Laden. The way he handled the triumph of that military action was an obvious political maneuver designed to get a bump in the polls. Now, with the numbers going against him once again, he either is too self-absorbed to recognize his inability to lead, or he simply lacks the character to accept any responsibility for our fallen economic “cherry tree.”

The latest example of this “its not my fault” phenomenon involves the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF), a division of the Department of the Treasury along with the Department of Homeland Security and the Department of Justice. All these government entities appear to have been involved in operation “Fast and Furious,” which was part of “Project Gunrunner.” As this story continues to unfold it is clear that Federal officials allowed and perhaps even encourage thousands of weapons to be sold within the United States to operatives of Mexican drug cartels. Instead of leading to the heads of these organizations, as government officials are now saying was their plan, these weapons quickly crossed the border into Mexico and into the hands of ruthless gangsters. Operatives of these drug lords used these same guns to wreak havoc on both sides of the border, including the slaying of Brian Terry, an American Border Patrol Agent on US soil. The fact that this story has not been widely reported by the liberal media shows just how far they too have fallen in fulfilling their responsibility to the American public compared to the era of Watergate and Richard Nixon 40 years ago.

There is an old saying, “the fish rots from the head,” and I fear that is precisely what is happening to America. It is a well known fact that if a man abuses his wife his sons are far more likely to abuse their wives. When people see their leader shirking his responsibilities they too will follow suit, using any and all available excuses to justify their own failures. Unfortunately this is exactly what we are seeing play out throughout our society. Whether its our Congressmen, like Barney Frank, failing to own up to the part they played in the sub-prime mortgage scheme, which brought down the housing market, or the flash mobs who are conducting “Smash and Grab” raids, the trend is for every misdeed to be followed by an excuse. Typically, the media spends more energy convincing the public of the validity of the excuses than they do condemning the acts of corruption and lawlessness. Thus public accountability is lost and justice delayed is indeed justice denied.

There are however, examples of everyday people taking responsibility and they should be applauded for doing so. Earlier this month identical twins Nate and Nick Smith of Faribult, Minnesota, along with their dad, Pat, attended the “Shattuck vs. the World” annual charity hockey game to raise money for the local youth hockey league. As is common during such events, someone is selected from the audience to take a shot from center ice, trying to put a three-inch wide puck through a three and one half inch opening 89 feet away. Impossible, right? Nick’s dad had signed him up for the drawing to take the shot, but just before the selection was announced Nick left the seating area. Before leaving he told his brother to take the shot in the unlikely event his ticket was selected.  As fate would have it Nick’s ticket was selected and Nate took the $50,000.00 shot; miraculously he made it. The following day their dad went to the event organizers and explained the situation knowing full well that they would likely not get the money. Never the less he felt he needed to do the right thing. At last report the promotions company decided they would not award the prize to Nate, but instead gave a $25,000 donation to the hockey league.

Fifty Thousand dollars is a lot of money, and I’m certain the Smith’s could have used it, but the lesson those boys learned through the example of their father (leader) will in the long run be far more valuable. He didn’t just talk about honesty and responsibility, he demonstrated it, and actions speak much louder than words. Perhaps we should start a new campaign that would result in a new version of “Mr. Smith Goes to Washington.”

 

 

 

I invite you to check out my web site at www.robertsewellmd.com

 

 

Digital Medicine

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The other day my 20 year-old son ask me, “What has been the greatest invention in your lifetime?” I thought for a few moments and then said with confidence, the Internet. Certainly there have been countless other technical and scientific advances over the last 60 years, but I would argue that none have had the impact on everyone that we’ve seen with the invention of the World Wide Web. It has revolutionized communication and empowered everyone with a wealth of information, available at the click of a mouse. One unfortunate side effect is that we now have a bunch of unemployed encyclopedia salesmen.

The digital revolution has certainly infiltrated the medical community and has begun to change the way many physicians practice. Now we routinely communicate with each other and with patients via e-mail. We can access hospital records and keep up with the latest advances in medicine from around the world, all from a laptop, iPad or even a smart phone with a high speed Internet connection.

Patients are also well connected, using the Internet for everything from learning about a diagnosis or treatment to investigating the credentials of their doctor. It is rare that I see a patient who hasn’t done both, and I applaud that effort. Taking personal responsibility empowers individuals to act on their own behalf, and better informed patients are more likely to understand and process all the information they need to make appropriate decisions about their health.

However, the Internet should come with a “user-beware” warning label. Anybody can write anything they want and publish it on the web. Most sites, like most people, are legitimate and offer accurate and honest information. Some are more biased, while others go well beyond bias, offering advice that usually starts with a phrase like “things your doctor doesn’t want you to know.” You can bet they are just trying to sell you a 3 months supply of vitamins or some exotic juice that “promises” to improve your health regardless of your problem.

Despite these potential pitfalls, the Internet promises to continue to revolutionize healthcare. In the near future “virtual doctor visits” will become common, employing video conferencing software like Skype. Technology already exists that allows a physician to check your pulse rate and listen to your heart online. Its not yet clear exactly how we’ll be able to do a virtual abdominal exam, but hey, I certainly wouldn’t rule it out.

Perhaps the most valuable use of the Internet in healthcare will be the creation of individual health records. Most of us have a difficult time recalling the specifics of previous tests or procedures we’ve had, as well as the list of medications we take. For any physician, anywhere, to have immediate access to all your current health information will be a huge step forward in improving the overall quality of care and reducing the cost. Having access to your data could all but eliminate redundant testing, shorten the time to appropriate treatment, and help avoid adverse drug interactions; all without you having to recall exactly when you got your last tetanus shot.

But before online health records can become a reality they must first be made absolutely secure to prevent anyone not directly involved in your care from accessing sensitive, personal information. This is the easy part. The hard part is finding a way for all the various electronic record systems that already exist to share information. Managing data across different platforms presents a logistical nightmare. And, since hospitals and physicians have already invested billions of dollars in various proprietary systems it will be a while before we have one that allows us to simply “plug and play” your health information wherever you happen to seek care.

While all this sounds very exciting and holds great promise in the coming years, it is important to recognize that healthcare is still the most personal of all services. Healing involves more than just an accurate diagnosis and the right prescription. The key word is still “care” which includes a human touch, compassion, empathy, kindness and other emotions that neither a computer nor a robot can provide. So for the foreseeable future the best medicine is still practiced face to face, one doctor, and one patient at a time.

 

This piece appeared in the August 2011 edition of Society Life Magazine

Visit my web site at www.robertsewellmd.com

The Lost Art of Personal Service

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Do you remember your first paying job? Mine was as a gas station attendant in Kansas City, Missouri. Back in those days they called them “service” stations. Cars would drive in off the street and that familiar “double ding” would announce their arrival. I’d run out to greet the driver and ask the standard questions: “Fill ‘er up sir?” “Regular or Ethyl?” (Ethyl was what we called premium back in the day.) “Can I check under the hood?” “Do you want me to check your tire pressures?” I’d then pump the gas and do whatever else the customer asked, and the job wasn’t complete until all the windows were washed. By the way, gasoline was 19 cents a gallon and motor oil was 50 cents a quart.

In the late ‘60s customer service was not extra, it was expected. At $1.15 an hour it was simply part of the job, even in the rather seedy part of town where I was working. Inside the station we had a couple of vending machines where customers would occasionally come in and buy a candy bar for a nickel or a coke for a dime. But the big sellers were cigarettes because back then it seemed almost everybody smoked.

Today it is pretty hard to find a “service station.” I can’t remember the last time someone actually came out to my car to pump the gas or check the oil. Obviously there’s no money in personal service at the pump. Instead, the gas station has actually become a front for the more lucrative convenience store. I’m sure most storeowners wish they’d never offered the “pay at the pump” option. They’d much rather you would come inside to pay so you’d also buy a lottery ticket and a three-dollar energy drink. Times have certainly changed, but not just in the retail business.

The other day I was reflecting on just how much change there has been in the practice of medicine over the 32 years since I first hung up my shingle. I was talking with one of the emergency physicians at our hospital about the fact that more and more of our colleagues have become shift-workers. This started with the specialty of emergency medicine, but it has grown to encompass nearly all areas of medical practice. Today nearly every hospital employs what are referred to as hospitalists. These docs typically work 12-hour shifts entirely in the hospital, caring for patients with whom they have no prior relationship. Likewise they are not likely to have any further contact with the patient once they leave the hospital.

One of the chief responsibilities of hospitalists is to admit and provide inpatient care for patients who come in through the emergency department. Notice I didn’t say emergency “room.” That area of the hospital has become the major portal of entry and hardly qualifies as a “room” any more. Most hospitals also employ various specialists to provide additional services such as radiology, pathology and anesthesia on a contracted basis. Recently, even surgical specialists have been lured into being employees of hospitals rather than maintaining independent practices. As a surgeon myself I find that pill a little hard to swallow.

The idea of performing major surgery on someone and never seeing them again is completely foreign to me. However, that seems to be a growing trend, as personal service gives way to an ever-increasing “drive through” culture. The unfortunate net effect is the gradual erosion of compassion and care. In fact I think it is safe to say that health “care” has morphed into what can only be referred to as health “acts.” I would say health “services” but that would imply that the patient is actually being treated as a customer. Unfortunately, the one paying the bill, and therefore deserving of the label “customer,” is the third party payer. Insurance companies and the Federal government appear to be detached from the actual delivery of health “acts” but, since they are writing the checks, they make most of the rules. Over the years the impact of third party payer rules on the practice of medicine has been enormous. To the point where many of those who entered the medical profession as a calling have become so frustrated with the over regulated environment they have chosen to pursue alternate careers. Others have decided just to go along to get along and the result is the development of a shift-worker mentality.

The tragedy of these changes is not measured in early physician retirements or even a loss of practice satisfaction. Rather, it is the loss of personal care, the basic hallmark of the healing arts. Care is a verb defined as: to be concerned or interested; to provide needed assistance or watchful supervision. These are not the actions of a corporate or governmental entity. Only individual human beings are capable of truly caring for another human being. This is the essence of the Hippocratic Oath, which is clearly under attack by a variety of faceless entities that endeavor to benefit from health “acts” without regard to the basic welfare of those who are in need of health care. It is that very oath that traditionally separates being a physician from virtually every other occupation. But once that personal pledge is not kept the practice of medicine goes from being an honored profession to just another job where service has become a lost art.

 

Visit my website at www.robertsewellmd.com