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Baltimore Health Examiner
Showing entries for Category: medical-trends
Showing entries for Category: medical-trends
Patient Frustration: the case of the impenetrable paperwork.
 My friend's daughter got hurt at a picnic today. Trampoline. Smashed knee. Tears. You get the picture. The little girl needed an Xray and I thought I could grease the wheels and save my friend from hours of waiting in the ER. I had my radiologist husband with me and my prescription pad in my purse, so we concocted the brilliant idea of accompanying her to the radiology department at our local hospital. We would use our magic doctor powers to get her in and out in record time. This little girl had a medical doctor and a radiologist by her side. How much better could it get? You might be surprised. We called the hospital to be sure they accepted her insurance. No one knew. While I was on hold hell waiting for a person who never came back, my friend tried to get answers from her insurance company. Surely they would know. They didn’t. We finally hung up, questions unanswered, as we pulled up to the hospital doors. The sole check-in person was with another patient but there was no one else ahead of us. We thought we’d be in and out in 20 minutes. Thirty-five minutes later we were still waiting to see the admissions lady. Sixty minutes later my friend was answering countless questions and the kids were getting antsy. Ninety minutes later we had yet to make it past the paper work and onto the medical part of this adventure. When we finally made it to the back, the Xray itself took 5 minutes, and it took my husband another 5 minutes to determine that the knee wasn’t broken. Perhaps you aren’t sympathetic that we, doctors, had no more influence over the frustrating process of seeking medical care than you would have. I understand. This experience gave me insight into the insane medical landscape that we all navigate. My husband and I, both doctors on staff at the very hospital that we were visiting, couldn’t get past the paperwork. We were stymied by it. We had the patient. We had the doctor’s order. We had the radiology technicians waiting expectantly for us. We had the radiologist ready to interpret the films. Yet we couldn’t get past the intake lady. Does this make sense? Shouldn’t we be more concerned with medical care than paperwork? The healthcare system has lost its mind. We get so invested in insurance ID numbers and pre-authorizations and computer data entry that actual medical care almost seems irrelevant. The patient may have collapsed from exhaustion waiting for someone to attend to his health… but at least the HIPAA forms have been filled out. |
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Medical Information: tainted or pure?
 Here’s a secret: the medical information that you hear, whether on the radio, on TV or straight from your doctor’s mouth, may not be as pure as you think. You might imagine that those medical experts on the morning news or big-shot specialists at Johns Hopkins are simply sharing straight-up facts. Think again. As much as we, physicians, like to imagine that we are unbiased, there are many forces influencing us. Drug companies dangling generous consulting fees, the desire to please media sponsors, and the need to recruit patients for our research studies just to name a few. I had a surprising experience recently that opened my eyes to how easy it is for bias to creep into medicine. A drug company representative contacted me after I had been quoted in the Wall Street Journal. First she flattered me “we are looking for distinguished physicians who are thought leaders in the community, and we wondered if you could spare a few minutes. We would like to offer you media exposure, first local, then possibly national.” It sounded tempting. Then she offered me money. I was feeling the pinch of starting a new patient advocacy practice and my bank account was precariously low. A little easy money would have been welcome. But once I understood what she was suggesting, it was clear to me that I couldn’t accept her offer. To be honest, I felt a little sleazy just for considering it. This was the deal: the drug company would get me appearances on TV and radio programs where I would function as a medical expert on the topic of their choice. I would share some medical nuggets and answer the host’s questions, and by doing so I would educate the public. So far so good. But here is the catch. Since I would really be the drug company’s undercover representative, I would need to mention their drug, casually and without drawing attention to it, and be sure to bathe it in a positive light. This got me thinking of all the times I had seen a medical expert on a morning news show, talking about migraines or allergies or ulcers. Were they all being paid by a drug manufacturer? Check out an informative article in Slate on this topic. There is nothing wrong with advertising, of course. But advertising masquerading as news is sneaky and manipulative. Not only is it dishonest, it also reflects poorly on the ethical purity of my profession. How could I not decline their offer? I hope that most of my colleagues would have done the same. (photo courtesy of ABC news) |
Chronic Diseases: Rethinking our rusty magic bullets
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After the days of leeches had passed, doctors became virtual miracle workers. No need to die from scarlet fever anymore – we have penicillin! Our vaccines prevent Polio. Our sterile surgical technique can make a broken man whole again. Those were the good old days. Medicine was complex yet simple: attack disease and restore the body to health. We wielded our tools mightily: scans, medications, radiation and surgery. We knew that there was more to learn, but at least the map was clear. Things have changed. We have all survived, or been vaccinated against, the childhood infections that attacked previous generations. We have survived childbirth and prevented our genetically programmed heart attacks. Yet we suffer decades of stress, which takes a poorly defined, but clearly significant, toll on our bodies. We have different problems now and we need different solutions – our magic bullets have rusted. Ask people who suffer from vexing illnesses such as chronic pain, multiple sclerosis, post traumatic stress disorder, and chronic fatigue syndrome about our ‘miracle cures.’ I doubt they will sing our praises. Our ‘shoot to kill’ methods simply don’t work for most chronic diseases. Dr. David Reilly, a well-respected integrative medicine physician (who recently gave an inspiring talk at the University of Maryland), asks doctors to think of ourselves as gardeners. As ‘gardeners’ we support the body’s natural healing abilities, using gentle and safe therapies whenever possible and saving the aggressive methods for when they are clearly needed. We can help our patients identify their innate healing strengths and encourage their capacity for health and wellness. Caring for those with chronic illnesses takes an entirely different mind-set. Doctors and patients must both accept that there is no magic medicine around the corner that will eliminate all the suffering. The road to wellness will likely be circuitous and require commitment. There will be lifestyle issues to consider such as sleep and exercise and nutrition. The doctor and the patient must enter into a partnership of mutual respect, and they must take the time to trust each other. They must listen – truly listen – to each other and include the patient’s beliefs and values in their treatment decisions. We need a new game plan for the future of medicine. One that includes patients with chronic illnesses or symptoms for which there is no magic pill. I believe that we will get there, and when we do both patients and physicians will be happier. Yes, we will get there, but first we need to stop trying to smash the chronic disease peg into the magic bullet hole. |
Mystery Diagnosis - what doctors do for fun
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Do you have a secret TV show obsession? American Idol, maybe? Or daytime soaps? I have one. I'm obsessed with Mystery Diagnosis on the Discovery Health channel. This fascinating show dramatically tells the story of some poor soul who has baffling symptoms that stump doctor after doctor. The real patients re-enact the months or years of ER trips, pain, weird rashes, GI problems, fuzzy vision, colored urine and other wacky symptoms. We hear of the bumbling doctors who missed the real diagnosis and then see the heroic diagnostician who finally solves the mystery. I compulsively watch long after I ought to be asleep. I check myself against the clueless doctors that are blowing off the patient's secretly serious symptoms. Would I have missed that? Wouldn't I have taken the patient more seriously? Sometimes I compare favorably but, then there are those other times. Today I figured out two of the cases! In my home office, at midnight, I strutted proudly (figuratively, that is, since I was sitting on the couch). But I missed the one where the guy had tapeworm eggs in his spleen that caused his face and ears to turn purple. I don't need to feel guilty, right? I'm not wasting time watching mindless TV. I'm studying. I'm improving my medical knowledge. I'm becoming a better doctor. Right? Check it out: http://health.discovery.com/fansites/mystery-diagnosis/mystery-diagnosis.html |
Is your nurse a doctor? How physician assistants and nurse practitioners are changing primary care
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Change is coming. The world as we, primary care doctors, know it is turning upside down and I don’t think we’re ready. When I was in college the student health doctor was a doctor. There were no health clinics in discount stores and your primary care doctor had gone to medical school. Things have changed. Physician Assistants and Nurse Practitioners have made a place for themselves in the medical arena and doctors have had to move over to make room. This new model has plenty of benefits. It allows physicians to accommodate larger practices and provides medical care, particularly in rural areas, for people who wouldn’t otherwise have any. In some practices the PA or NP spends more time with patients than the doctor, making them the “primary care doctor” of choice. Some doctors bash ‘midlevels’ – as PAs and NPs are often called. I don’t. I have worked with many great PAs and NPs, and I’ve both taught them and learned from them. Plenty of midlevels are smart and dedicated and some, particularly those with experience, have excellent medical knowledge. OK, do you get it? I’m not one of those doctors who stands on my high horse and blindly dismisses what PAs and NPs have to offer. I see the value. But still… Midlevels can augment the offerings of the physician and offer the patient a quicker, richer or more focused experience. This is a good thing. But can they really replace the doctor entirely? Does 2 years of PA school really create the same depth and breadth of knowledge as 4 years of medical school and 3+ years of residency? More and more people seem to be answering “yes.” Doctors were blindsided by the rapid rise of midlevels. There are rarely student health, STD clinic, or minute clinic positions available to physicians anymore. PAs and NPs fill those jobs and doctors simply aren’t welcome. The business men and women in charge seem to believe that the MD simply isn’t worth the extra money. As this trend continues, some are wondering where it will end. Will the primary care of the future be delivered by midlevels? Will primary care physicians perish like the dinosaurs? This is not just idle paranoia. Midlevels are cheaper and our healthcare system is bleeding money. But I’m concerned. In primary care, patients arrive without a diagnosis. Often their problems are minor. Often, but not always. It doesn’t take that much experience to treat a cold, but it takes significantly more to evaluate dizzy spells in an older person or recognize a pheochromocytoma. It is difficult to recognize what you have not seen, and this is why I am worried. In those 7+ years of training, including countless nights on call, doctors in training see a lot. They learn to recognize subtle signs of serious illness and they see the results when they are missed. PAs and NPs are helpful and valuable. They are less expensive for a practice to support and patients often love them. Yes, they are all these things. But do you know what they aren’t? They aren’t doctors. |
Dr. Delia Chiaramonte
Dr. Delia Chiaramonte is the founder and president of Insight Medical Consultants, a private medical advising and patient advocacy company. She is board certified in family medicine and is Medical Director for Hospice of Baltimore.
Dr. Delia Chiaramonte is the founder and president of Insight Medical Consultants, a private medical advising and patient advocacy company. She is board certified in family medicine and is Medical Director for Hospice of Baltimore.
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