Authentic Medicine Gazette

Enjoy our most current issue of the most popular medical e-newsletter on the internet.

Blogs and Thoughts for October 12th to October 18th, 2017

Here is what we had this past week:

  1. Sexuality Please, We’re British! by Pat Conrad MD
  2. Medical Schools and their New Training Emphasis
  3. 4 in 10 Now Obese
  4. ABMS Reevaluating MOC?
  5. Making Medicine Authentic
  6. What’s Not to Love?? by Pat Conrad MD
  7. Friday Funny: Patient Education
  8. Quote of the Day: Joe Walsh

 

1. Sexuality Please, We’re British! by Pat Conrad MD

October 18, 2017

This is really getting tiresome.  Every minor celebrity from chefs to actresses to has-been athletes has to go skipping to the microphones to announce their gender-identity-sexuality-cis-trans-WTF or whatever else will make their hearts and assorted giblets sing to the breathless virtual masses.  And.  I.  Don’t.  Care.  I really don’t.  In medical school, we all got the lectures about asking about a patient’s sexual orientation as part of a complete history, and if you really think it matters then be my guest.  When treating the usual various ailments in primary care, and later when dealing with typical ER zaniness, it, for the most part, has just never mattered.  Like you, I have had all sorts of non-traditional patients traveling in non-traditional directions, and it has not affected my choice of anti-hypertensive, how I dealt with their hyponatremia, or where I chose to attempt the central line.

Across the pond, our increasingly demented cultural progenitors continue to push back the frontiers of irrelevance.  The British NHS Service “users over the age of 16 visiting their local GP or hospital may be asked to confirm whether they are straight, gay, bisexual or other,” answers to which the providers are now expected to record.  “The health service said the move was to keep in line with equality legislation to ensure those who do not identify as heterosexual are treated fairly.”

Nurse:  I have a few questions.

Patient:  I have a sore throat.

Nurse:  Ok, but first, when was your last tetanus?

Patient:  It really hurts to talk.

Nurse:  I’m sure it does.

Patient:  (coughs)

Nurse:  Do you identify as straight, bisexual, gay or lesbian, or other?

Patient:  (hoarse) huh?

Nurse:  You are allowed to change your answer on subsequent visits.

There are certainly times and settings where it is appropriate to discuss patient sexuality, but making it a mandatory reporting event is as stupid as it is insulting to both parties.  A good clinician will deal with this subset of concerns when appropriate and doesn’t need to feel obligated to turn every encounter into a Rocky Horror Picture Show introspective.  And what if a patient would rather not say?  Should they be encouraged to then lie, or choose “other”?  I’d love to see real studies that show that patients are actually treated inadequately based on their sexuality.  I’m sure any number of concerned groups would claim to have said studies, but that would surely contradict my own observations in the medical field over the last quarter century.  This is the kind of idiocy I can completely expect to see here.  It is tiresomely going to be another case where the medical field is used to push special interest politics and to make their respective advocates feel better about themselves, but it will not be about rendering equitable care.  We already do that.

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2. Medical Schools and their New Training Emphasis

Oct. 17, 2017

The AMA Rounds points out that:

Modern Healthcare provided an update on the progress at the NYU School of Medicine at NYU Langone Health and other medical schools “that received $1 million grants in 2013 through the AMA’s Accelerating Change in Medical Education Consortium.” That effort “advocates teaching students about health system science, which emphasizes the role of human factors in value-based care delivery, collaboration throughout systems, leadership and patient improvement strategies.” Susan Skochelak, MD, group vice president of medical education at the AMA, said, “We think about teaching the science of medicine, but we have some students leaving medical school who don’t know the difference between Medicaid and Medicare – and that’s not on them, it’s on us.” AMA President David O. Barbe, MD, said. “Once upon a time, the physician could get away with focusing on patient care and letting someone else worry about insurance and the economics of it.” Dr. Barbe added, “Those times are way past.”

How does that sit in your belly?

  • Teaching value-based care, which is unproven
  • Patient improvement strategies, which is unproven
  • Learning the difference between Medicaid and Medicare, which takes 3 seconds and who gives a crap
  • Learning about insurance, which is a broken model

The rest of the Modern Healthcare article is a treasure trove of nausea so take some Zofran before you read it. See how students are studying:

  • EHR platforms
  • How to be patient navigators
  • How to work in teams and with social workers, nurses and other non-clinicians to grasp how the system is interconnected and to best use community resources to keep patients healthy

In a perfect world, we could teach students EVERYTHING but I have seen students who don’t know how to do physical exams, do a SOAP note, or actually communicate with another human.  They are lacking the basic power of observation (“How did you not see the tobacco stains on his fingers” or “Did you not notice she was demented and confabulating?”).  But at least we are teaching them EHR platforms and insurance models.

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3. 4 in 10 Now Obese

Oct. 16, 2017

Look around and you will find the following:

  • In 2015 and 2016, just short of 4 in 10 American adults had a body mass index that put them in obese territory.
  • In addition, just under 2 in 10 American children — those between 2 and 19 years of age — are now considered obese as well.
  • The new measure of the nation’s weight problem, released early Friday by statisticians from the Centers for Disease Control and Prevention, chronicles dramatic increases in obesity levels since the start of the 21st century.

Yeah, a few tweaks in our healthcare system should fix this.  Obviously, I say this with tongue-in-cheek.  Buy, hey, let’s grade doctors on patient outcomes because we all know it is their fault patients are obese.  Okay, that was said tongue-in-cheek as well.  Bad me.

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4. ABMS Reevaluating MOC?

Oct 15, 2017

Are you ready for another smokescreen?  The head of the ABIM, Richard Baron MD, said:

“We’re figuring out what is the best way to recognize and reward and acknowledge special expertise that doctors have, do it in a way that it results in a credible credential that adds value to their professional ability to do what they do.”

What he is really saying is that “we’re figuring out what is the best way to make money off doctors without them bitching about it”.

Here is more from the article:

The ABMS and those member boards, which represent various specialties, last week announced it will establish a commission that will include multiple partners to reevaluate the MOC system. The goal is to create a system of continuing board certification that “is meaningful, relevant and of value,” while meeting the demand of patients, hospitals and others who expect physicians to maintain their knowledge and skills to provide quality care, the group said.

Who gave them that goal?  No one!  It’s like me saying that I have a goal to create a system where you give me all your life savings.  I feel that goal is best for me.  What’s that?  You don’t like that?  Well, too bad because your board certification depends on it.

Also, they did not create CME.  We get CME from other areas. No other profession is held to such unreasonable standards.  This is a money grab, plain and simple, and they hold your board certification hostage if you don’t do what they say.

Lastly, Baron goes on to say:

However, Baron told MedPage Today that the cost of just under $2,000 to maintain certification covers a 10-year period and breaks down to less than $200 a year. And there’s evidence that board-certified physicians earn more money than those not certified, he said. Furthermore, he said, the ABMI finances are posted on the organization website in full transparency.

This dude is a joke.  Dr. Wes, he was obviously responding to you on this.  Any thoughts?

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5. Making Medicine Authentic

Oct. 14, 2017

I want to thank Hallie Smith over at Doximity for writing this article about me:

The blog, aptly named Authentic Medicine, focuses on “hard-hitting discussion of topics that no one else really wants to call to stage” — topics like the role of hospital administrators, how bureaucratic drag leads to doctor burnout, and how much insurance interacts with healthcare.

She really did a nice job and I am honored to the be the subject of her piece.  I would really appreciate if you would leave a comment on the Doximity link to give her some feedback.

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6. What’s Not to Love?? by Pat Conrad MD

Oct 13, 2017

Under the category of “shocker!” Medscape reports that doctors aren’t rushing the gates to become buprenorphine treatment providers.  The prevalence of opioid addiction is driving headlines, and doctors are being browbeaten to be the solution.  Okay fine, so stop writing Norco 10 mg #120 for the 39-year-old with shoulder pain.

But as we all know, buprenorphine is not an opioid, but kinda is; that it helps addicts to wean off of opioids even though buprenorphine can be used for a high, and has even killed people due to overdose and respiratory depression.  When it first came out, buprenorphine treatment required a special DEA registration as a Narcotic Treatment Program.  In 2000, Congress passed the Drug Addiction Treatment Act that opened a lot of this up, with further waiving and loosening of restrictions in 2002.  Now you need to do an additional 8 hours of training and you can apply.

This article quotes researchers who surveyed 558 U.S. physicians in 2016, 80% of whom had gotten a waiver.  “However, more than half with a waiver said they were not currently prescribing to capacity. SAMHSA (Substance Abuse and Mental Health Services Administration) rules at the time of the survey allowed physicians to prescribe buprenorphine to only 100 patients; this year, the cap was increased to 275.”

Buprenorphine treatment records should include a log identifying prescriptions/recipients.  “Practitioners can decide if they want to keep these records within standard patient charts or if they want to keep separate buprenorphine treatment records. When the physician keeps separate records then only these records would be subject to review during a DEA audit. The DEA does recommend keeping buprenorphine records separate, but it is not required.”  (Authors note:  I could not verify how old this directive is, and whether it even takes EHR’s into account, so consider with discretion.)

A lot of waived docs are not seeing their full capacity of Bupo-users, citing time constraints and inadequate reimbursement.  But then the study authors state:  “Nearly 55 percent of waivered doctors not prescribing to capacity indicated that nothing would increase their willingness to take as many buprenorphine patients as they can.”  Unwaivered docs stated they didn’t want their lobbies full of Bupo-seekers, and feared reselling/diversion.

There are a lot of chronic opioid users, addicts, seekers, and related deaths, over 50,000 per year in the U.S. by some tallies.  And yes, physicians should be very judicious in prescribing narcotics, lest it becomes handing out the candy.  But stories are starting to be written that not enough docs want to become active narc weaners.  Extra CME, more time with a needy patient subset, the need for extra levels of record keeping, the increased exposure to DEA audits, the legal potential of drug diversion, and lousy reimbursement … what’s not to love?

And no, it probably won’t come to this, but just imagine:  what if increased media handwringing led to increased political pressure for docs to take, shall we say, a more active interest?  In my state, every time we renew our license, we have to take extra CME on HIV and domestic violence.  Both of these categories were instituted as requiring extra attention not for demonstrable medical or public health reasons, but due to political pressure from special interest groups.  So the precedent is there for the next concerned group to hit a state capital near you and suggest mandatory buprenorphine awareness training, for starters.  What’s not to love?

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7. Friday Funny: Patient Education

A very gifted cartoonist.  Find him here.

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Quote of the Day: Joe Walsh

Oct 12, 2017

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UNTIL NEXT TIME, KEEP SMILING, KEEP LAUGHING AND KEEP OUT OF THE SAMPLE CLOSET!

Douglas Farrago MD

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  75 comments for “Authentic Medicine Gazette

  1. Dennis Kabasan
    April 27, 2017 at 10:23 am

    Doug,
    I ordered the Cryohelmet for my sixteen year old daughter, who sustained a concussion, with brief loc, after being struck in the forehead by a soccer ball, in a school match, two weeks ago. She’s been wearing the helmet, as recommended, one hour at a time, since it arrived three days ago. Her pediatrician is following her. She only tolerates a few classes each day, d/t frontal and temporal headaches and extreme tiredness. Sleep helps her. Is there any benefit to longer wear-time? Thanks.

    0
    • Doug Farrago
      April 27, 2017 at 10:31 am

      See my email to you

      0
  2. April 12, 2017 at 2:52 pm

    For some reason, my version of Authentic Medicine is delivered with comments from 2011 and 2012.

    Any notion of what may be going on?

    Thanks.

    1+
    • Doug Farrago
      April 12, 2017 at 3:55 pm

      none

      0
  3. John Comis, DO
    May 30, 2012 at 11:34 am

    Please encourage the KOM to join his friends at QC13.

    7
    (…of the lemons)
    PS the healthcare system is so terrible it is beyond any further comment.
    Peace,
    John

    1+
    • Doug Farrago
      May 30, 2012 at 12:27 pm

      I will try.

      1+
    • au-digit
      January 26, 2017 at 3:33 pm

      The Bush you quote was #41.

      1+
  4. Gary Gaddis
    May 20, 2012 at 7:43 pm

    Regarding our Federal government, Centers for Medicare and Medicaid Services (CMS), Secretary of Health and Human Services Kathleen Sebelius, and the growing gap between CMS perceptions and reality, here is my sarcastic “Sound Bite” suitable for the brief attention span of our electronic news media:

    “Since the Department of Justice is headed by an attorney, and the leader of the Federal Reserve is an economist, then how is it logical that the Secretary of Health and Human Services is also headed by an attorney?”

    Does anyone else agree with me?

    5+
    • Kristina Berger MD
      May 21, 2012 at 7:31 am

      There are too few physicians in politics. Is it because we dont have the stomach for it, or another reason? I know if there were more of us as policy makers, the healthcare system in this country would improve greatly.

      1+
      • Simon Cummings
        May 23, 2012 at 8:59 am

        My vote is for Doug and not the type of physician represented by the Cardiologist who told me that he wasn’t interested in cardiac rehabilitation cos there’s no money in it!

        2+
    • Judy
      May 24, 2012 at 8:58 pm

      No, I think that it is correct for a lawyer to head the Department of Health & Human Services. Only a lawyer can read the volumes of crap they put out as regulations and find a loophole way to still make a living; only a lawyer can repeatedly find a way to let someone die and it be due to no fault attachable to him; only a lawyer can write voluminous policies that effectively help only a select few of his supporters and require the rest of the populace to pay for it except himself; and only a lawyer can sit passively by and provide no useful assistance to a group of sick, needy people but still require them to pay for his service. If you will think on these comments for a few minutes, you may change your opinion.

      2+
      • Bill
        June 4, 2012 at 9:22 pm

        Hey Doug ! I am a lawyer. never made more than $85K /year and spent my entire career in trenches helping people, most who did not have much money, with problems, many of them caused by their own bad decisions and choices. and I love your journal.
        Given the wide range of attitudes, opinions and incomes among doctors do you really want a politically-connected MD in charge ? maybe an orthopedist ? xoxo

        2+
        • Doug Farrago
          June 4, 2012 at 10:43 pm

          The description “politically-connected” should remove that person from contention immediately.

          3+
        • Dr Bonz
          June 21, 2017 at 8:29 am

          Dear Bill.

          F*** You.

          Signed,

          An orthopedist.

          0
    • Jeff
      February 22, 2017 at 3:14 pm

      I agree, absolutely, that HHS should be headed by a physician.

      What about having an advanced practice nurse in that role?

      But (God help us) not an attorney, a chiropractor, a homeopath, a naturopath, a shaman, or a faith healer!

      On second thought, a shaman would be better than a lawyer any day.

      1+
    • Jeff Palmer
      February 22, 2017 at 3:16 pm

      I agree, absolutely, that HHS should be headed by a physician.

      What about having an advanced practice nurse in that role?

      But (God help us) not an attorney, a chiropractor, a homeopath, a naturopath, a shaman, or a faith healer!

      On second thought, a shaman would be better than a lawyer any day.

      0
    • John A Goldman, mD
      March 4, 2017 at 3:10 pm

      thank goodness in 2017 it is a physician

      1+
  5. Alan Levine
    May 9, 2012 at 9:03 am

    You have bemoaned our lowly position in hospitals, commenting how few recognized our contributions on Physician Recognition DAY. In what I feel is a further diminution of what we do, my hospital is now celebrating Nurse Recognition WEEK!!!! How far we have fallen………….

    1+
    • Doug Farrago
      May 9, 2012 at 2:53 pm

      I agree

      0
      • Jack Forbush
        May 23, 2012 at 12:10 pm

        Ditto

        0
    • Common Sense
      May 30, 2012 at 4:54 pm

      So you’re denigrating nurses in an attempt to rally support for your plight? It is just as easy to argue that since nurses spent 7 times more time with patients, theyre deserving of their week.

      Or, you know, we could all just stop getting butthurt over who has the longest display of solely symbolic “appreciation” and get back to working as the team we were intended to be.

      We’re your knights and you’re our Earls. There is nothing to be gained by making besouring diatribe. Be good to your staff and your patients and you’ll have more appreciation and recognition than your little heart can handle.

      0
      • Doug Farrago
        May 30, 2012 at 5:11 pm

        You really need to have read the thread completely before making that comment. Please check out the blogs on how Doctor’s Day has been totally dismissed. Maybe then you will understand how we feel. This is NOT about doctors against nurses. It really is about administrators.

        1+
      • Doug Farrago
        May 30, 2012 at 5:12 pm

        You missed the point on this. It is about Doctor’s Day being totally dismissed by administrators. Please read those blogs.

        0
        • Alan Levine
          May 31, 2012 at 8:56 am

          That was exactly my point. In recognition of out efforts several years ago my hospital–a level 3 teaching hospital–gave chocolate bars (small ones) to the docs. Nurses this year received flowers and other shows of appreciation.

          0
          • JoAnne Fox
            June 8, 2012 at 7:23 pm

            Acknowledgement of a job well done would have been nice. I got a scoop of hot cocoa mix, repackaged in a baggie, with a little note attached telling me how wonderful nurses are.

            0
  6. Doug Given
    April 25, 2012 at 5:29 pm

    What a screw job from the lovely IRS on the Mandate.

    1+
  7. Judy
    April 18, 2012 at 10:05 am

    think you should run for President, as long as you will continue to keep up this site after you win!

    1+
  8. Dave Hoffman
    February 29, 2012 at 11:20 am

    Great thoughts as always, Doug!

    Is there a way to start new comment threads each time you post a new entry?

    0
    • Doug Farrago
      February 29, 2012 at 12:31 pm

      Each entry is a blog and has their own comment section

      0
      • t mcglone
        April 4, 2012 at 8:25 pm

        Having “served” for 15 years, those are finely edited comments fit for civilian consumption .

        0
  9. February 29, 2012 at 8:53 am

    today’s (feb 28, 2012) gazette was one of your best. some might say that your gazette is merely entertainment. i however, enjoy the articles with their kernel of truth/fact at the center and your encouragement for us to critically examine the field of medicine that we are a part of. the top ten signs that a hospital stay isn’t going well is what we see all our careers. uphoric for gout patients who like beer and ujerky for cardiac patients and the statin report were particularly good reading. i don’t know how you find the time or energy to do this. i was usually totally exhausted by the middle to end of my workday. thanks again.

    0
    • Doug Farrago
      February 29, 2012 at 9:06 am

      thanks, dennis! I appreciate the feedback and I am truly flattered.

      0
  10. Angi Wall DO
    February 9, 2012 at 9:18 pm

    I’m with Doug on the dietary/diabetes. It’s not often you catch those guys looking good in a bikini and munching on carrots.

    0
  11. Dr. Veronica Friel
    January 25, 2012 at 4:20 pm

    More! More!! Doug, keep it coming!!!

    0
  12. Robert Bosl, MD
    January 25, 2012 at 1:27 pm

    Regarding relationship of AD & DM, and comment that DM is dietary–too simplistic and likely wrong. We know about dysmetabolic syndrome & PCOS etc. which is genetic, DMS causes weight gain and subsequent DM. Consider whether strong relationship of DM to increased risk of AD is also genetic predisposition to both rather than one causing the other.

    0
    • Doug Farrago
      January 25, 2012 at 2:06 pm

      100% disagree. Predisposition is not a certainty. How can you NOT think DM is dietary related?

      0
      • Robert Bosl, MD
        February 1, 2012 at 4:12 pm

        My earlier comment may have been oversimplified–just tried to point out that some legit. MD’s believe in insulin resistance as a cause of some obesity issues than the result thereof, and it is conceivable that the “insulin resistance gene” may also play a role in development of Alzheimer’s.

        0
    • Bridget Reidy
      March 8, 2012 at 6:49 am

      Ever consider the relationship between Alzheimer’s and diabetes might be iatrogenic brain damage from hypoglycemia? I’m always shocked at how lightly my patients consider the risk of it.

      0
      • March 16, 2012 at 12:13 am

        May I suggest that the dementia with chronic diabetes isn’t Alzheimer’s, it is more likely to be due to the vasculopathy that accompanies non-well controlled diabetes or elderly age + diabetes. So the relationship is between DEMENTIA and diabetes, not Alzheimer’s Disease and diabetes. The fact that most elderly diabetics are vasculopaths, and the recurring theme in medicine that the brain depends on a constant supply of glucose and oxygen to function well, and that vasculopathy impairs oxygen and glucose delivery, is much more plausible than recurrent hypoglycemia.

        0
  13. Scott Miller, MD
    January 25, 2012 at 12:34 pm

    I work in urgent care and when I get home at night I am too tired to exercise. I find that the exercise I get from going back and forth in order to finish the articles in your journal gives me the physical exercise I need to stay healthy and sane. Thanks, Doug! Could you get me a beer when you go to the kitchen?

    0
    • Doug Farrago
      January 25, 2012 at 2:08 pm

      You got it!

      0
  14. Allyagottadois
    January 18, 2012 at 8:55 am

    If I can print it out in its’ entirety, I can leave it casually around the hospital. Mailroom, Medical floors, ICU, ER, surgical suites, administrative offices, JACHO. Because All I’ve got to do is: everything everybody tells me to do.

    0
  15. Dr. Bill Ameen
    January 1, 2012 at 11:31 am

    Hey Dr. Doug,
    To start the new year right, this ticks me off! I was belatedly reading the 11/4/11 issue of THE WEEK, an article about the Top 1% wage-earners. It takes annual earnings of $516,000 to qualify. Guess what? One out of six of the Top 1% is “in medicine”…I suppose some could be CEO’s of Big Pharma, but I suspect a large number are like the pediatric surgeon who heads the AMA and lives overlooking Central Park, and probably every orthopedist. Sorry, but I believe that anybody who makes that kind of dough either 1) inherited it, 2) stole it, or, as with most surgeons, sports figures and actors, 3) was grossly overpaid (as by insurance companies).

    0
    • Doug Farrago
      January 1, 2012 at 12:32 pm

      agreed

      0
  16. bill lorentz
    December 28, 2011 at 11:25 am

    I am a recent professor emeritus from a well known university medical school. For a number of years I worked with administration as an associate chief of staff. We spent considerable time and effort reviewing patient satisfaction scores using a well known national company and were quite excited that ours were consistently higher than most othere and certainly higher than I thought was reasonable.
    Bottom line-we discovered that the administrator in charge of managing the satisfaction suvery was “doctoring” our results. When we changed over to a more honest effort our scores dropped significantly. However, no one in administration was happy with our new lower scores and the subsequent need to address the outcomes.

    0
  17. David Devonis
    December 16, 2011 at 11:17 am

    Impressed that a lot of teachers are reading this material. Your site is the Writing on the Wall. Keep it coming!

    0
    • Doug Farrago
      December 16, 2011 at 1:35 pm

      Thanks!
      Doug

      0
  18. Dr. Bill Ameen
    December 15, 2011 at 10:46 pm

    Hey Dr. Doug, Heard that due to droughts affecting the peanut crop the price of peanut butter will go up. There’s a worsening shortage of PCP’s, so guess what? They’re paying us less..and less…and less. Also, latest Medical Economics has lead article about MOC. I was gritting my teeth reading remembering when you published the ABIM chief’s salary at $600,000. I’m sure ABFP CEO’s isn’t far behind. Where are the studies showing MOC (or even boards) make any difference in our performance? Finally, get “The Parking Lot Movie” on DVD. It’s a hysterically funny documentary about the parking lot behind The Corner at U.Va that will remind you of your days there!

    0
    • Doug Farrago
      December 16, 2011 at 5:04 am

      Thanks for the great points, Bill! Will need to get that DVD, as well. On one of my first dates with my future wife she remembers me checking all over the ground for parking lot tickets that were cheaper than the one I had in my hand. I was a class act.

      0
    • Dr. Veronica Friel
      January 25, 2012 at 4:16 pm

      Peanut butter prices going up? At COSTCO, the price of the large-size Jiffy Peanut Butter remains the SAME – the large-size is simply 8 oz. smaller.

      0
    • Connie Severin
      February 8, 2012 at 1:06 pm

      Thanks so much for adding that bit about the movie. I just ordered it off Amazon. I worked at UVa Med Cen from 1980-1985 and remember the strip and the parking behind it (apparently pre-Farina days). I remember some sort of parking honor system and some lot Nazis from back then too, but obviously predating when this documentary is set. It was about the only parking within a mile of campus too, so finding any spot at all was a miracle. I’m looking forward to the video. Thanks for the heads up.

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  19. Mary K Freel
    December 9, 2011 at 7:08 am

    RE: Grading Dr. on patient performance. Can you grade me if I work in a factory stamping out parts? Absolutely!! If the part doesn’t meet specifications then I’ve failed. Can you grade me on my patient’s health performance? Absolutely not!! I can only control a small part of what goes into a patient’s health and as studies have shown patients often pay for the dr. advice and then do nothing or the opposite. What a wonderful world it would be if when the dr. told his patient to lose weight and quit smoking they went right out and did those things. I was a nurse for 22 years and a teacher for 10 and in both professions I was the one who got blamed for whatever didn’t go right–whether it was poor scores on tests and the patient not getting better faster. Until people take ownership in their own health and realize that they are the number one reason that their health doesn’t improve the overall health of this nation will not improve and so our health care costs will continue to rise.

    0
  20. Bridget Reidy MD
    December 8, 2011 at 10:44 pm

    I agree with the teacher and have always been suspicious of both of our “quality” grading.

    The recent issue of AMA News gave opinions of practicing docs on lots of little issues but NONE on their main article on why small practices (aren’t they usually run by docs?) aren’t getting EMR’s. Gee 15% more pay for 50% more work – why wouldn’t we bite? I wonder if it’s a censored rag. Thank you Doug for validating our voices.

    0
    • JoAnne Fox
      June 8, 2012 at 7:32 pm

      Where do you find doctor owned small practices?? Most everyone around here is owned by one of the two hospital systems, and one has the gall to proclaim itself “not for profit” – I guess if you don’t mention the wholly owned subsidiaries they don’t count.

      0
      • Doug Farrago
        June 8, 2012 at 8:27 pm

        Hopefully you will find them in the future

        0
  21. Pat Nagle
    December 7, 2011 at 11:45 am

    I enjoy your site. I appreciate your heartfelt concern for patients and your irritation at the “solutions” suggested/mandated by outsiders (e.g. politicians). What strikes me most of all are the similarities between the world of medicine and the world of education, in which I spent 40+ years, working from K-graduate schools.

    Although the history, dynamics, and focuses are different,
    healthcare and education get pushed around by folks who don’t know what the hell they’re talking about, from Presidents, Congresspeople, media, on up, and the bottom line is always the bottom line, not the needs of patients and students.

    Your tirades against administrators parallel my feelings about the “consultants” and “foundations” who infest educational policymaking at every level. The last ones consulted are the frontline teachers and docs. And of course, the politicians and business moguls take no responsibility for the culture and economy they’ve helped create which lead to the problems in both areas.

    I don’t always agree with you (I’m adamantly for universal/single payer healthcare), but I appreciate your struggle. Keep up the good work.

    1+
    • Doug Farrago
      December 7, 2011 at 12:39 pm

      Thanks for some great feedback! And the similarities are eery.

      Doug

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    • Frank J. Rubino MD
      December 14, 2011 at 6:55 pm

      We do have much in common. “No child left behind” where the teacher is held responsible for the sucess of each and every child no mater how functional or dysfunctional is the child’s family.

      “Pay for performance” reguardless of how cooperative a patient is with diet & exercise and with their medication regimine for hypertension, diabetes etc.

      If one wants to make a lot of money in a short period of time, one should become a “consultant” to to school districts or to health care organizations. Expensive advice with out the responsibility. Charge a lot and then get out of town.

      1+
    • pat nagle
      December 21, 2011 at 12:50 pm

      Pardon me for doubledipping, but I forgot to mention that no legislator/congressperson has ever begged to be put on merit pay/pay for performance. Obviously, legislating doesn’t lend itself to factory models of evaluation. So why do medicine and education? The things that count aren’t measurable, and the measurable things don’t count.

      1+
      • Judy
        January 4, 2012 at 9:26 am

        hey, Pat, hope you don’t have a patent on your last line! that is about to become my ‘signature statement’ on my sign-offs!

        2+
        • Richard W. Mondak
          March 28, 2012 at 1:56 pm

          I think several of us are going to “borrow” that line (of course we’ll give credit to whomever coined that phrase — whoever that is)

          1+
  22. John Chase
    December 7, 2011 at 9:11 am

    I would prefer your stories to run in their entirety rather than “read more”. Very irritating to have to go back and forth

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    • Doug Farrago
      December 7, 2011 at 10:08 am

      Ok, will work on it.
      Doug

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      • Greg Salard
        December 8, 2011 at 2:35 am

        I have to agree. Not only is it irritating, it can be confusing when you have to …

        Read More >>>

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        • Doug Farrago
          December 8, 2011 at 3:31 am

          LOL. Will work on it

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          • thea
            December 14, 2011 at 8:00 am

            Would like more written stories/blogs etc, do not have sound card on computer so can’t hear any of these videos..they kinda lose their punch without sound?

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          • Doug Farrago
            December 14, 2011 at 8:14 am

            Understandable. I had some videos done already and needed to get out a few extra this week. Won’t always be like that.

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          • Chris
            December 15, 2011 at 11:20 am

            Dear Doug,

            Not only do I want full articles on the page and written articles instead of videos, but I also want to have $100 deposited into my bank account each time I click onto your sight. And world peace.

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          • Doug Farrago
            December 15, 2011 at 11:25 am

            Done and done.

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          • tom walsh
            January 11, 2012 at 7:52 am

            These same people who can’t fathom going “back and forth” to read an article are the same ones who had difficulty with ‘butterfly” ballots in the 2000 elections in Florida.
            I have been enjoying your articles for quite a while and have no problems with the layout. Keep up the great work!! And, thanks.

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          • Doug Farrago
            January 11, 2012 at 7:54 am

            Thank you, Tom!

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          • Connie Severin
            February 8, 2012 at 1:09 pm

            Thanks for the new format! Jumping between responses and articles was a nuisance. I like being able to read everything in only one, maybe two spots at one read. It also makes it easier to check on new entries to the comments all at once, rather than having to check for each separate article.

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        • Richard W. Mondak
          February 22, 2012 at 12:21 pm

          I have a short attention span, so reading part of the article and assuming I know what is being stated is par for the course for me. I often shoot par – 36 on the first 5 or 6 holes – so why play more?

          I don’t mind procrastining to READ MORE>> later

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      • Ariel
        December 8, 2011 at 8:58 pm

        Agree with Mr. Chase. Thanks for looking into it!

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        • Sharon
          December 28, 2011 at 10:10 am

          I totally agree with Chris!

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