Archive for May, 2014

A Doctor’s Declaration of Independence

Sunday, May 4, 2014 // Uncategorized

Physicians are increasingly be told by their professional societies to remember that they have obligations to society as well as their patients.  The American College of Physicians has called on it’s members to be parsimonious in their care of patients.  We do not have unlimited resources and we should try to eliminate waste and low quality care.  Still it feels like these are pressures that erode the doctor-patient relationship.  Particularly chafing are those dictates that come from the government that have increased the hassle factor of providing care without an improvement in quality of care. In  the following opinion piece from the Wall street Journal an orthopedic surgeon vents his frustration at this trend.


A Doctor’s Declaration of Independence

It’s time to defy health-care mandates issued by bureaucrats not in the healing profession.



Daniel F. Craviotto Jr.

Updated April 28, 2014 7:34 p.m. ET
In my 23 years as a practicing physician, I’ve learned that the only thing that matters is the doctor-patient relationship. How we interact and treat our patients is the practice of medicine. I acknowledge that there is a problem with the rising cost of health care, but there is also a problem when the individual physician in the trenches does not have a voice in the debate and is being told what to do and how to do it.

As a group, the nearly 880,000 licensed physicians in the U.S. are, for the most part, well-intentioned. We strive to do our best even while we sometimes contend with unrealistic expectations. The demands are great, and many of our families pay a huge price for our not being around. We do the things we do because it is right and our patients expect us to.

So when do we say damn the mandates and requirements from bureaucrats who are not in the healing profession? When do we stand up and say we are not going to take it any more?

The Centers for Medicare and Medicaid Services dictates that we must use an electronic health record (EHR) or be penalized with lower reimbursements in the future. There are “meaningful use” criteria whereby the Centers for Medicare and Medicaid Services tells us as physicians what we need to include in the electronic health record or we will not be subsidized the cost of converting to the electronic system and we will be penalized by lower reimbursements. Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist?

This is not a unique complaint. A study commissioned by the American Medical Association last year and conducted by the RAND Corp. found that “Poor EHR usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information between EHR products, and degradation of clinical documentation were prominent sources of professional dissatisfaction.”

In addition to the burden of mandated electronic-record entry, doctors also face board recertification in the various medical specialties that has become time-consuming, expensive, imposing and a convenient method for our specialty societies and boards to make money.

Meanwhile, our Medicare and Medicaid reimbursements have significantly declined, let alone kept up with inflation. In orthopedic surgery, for example, Medicare reimbursement for a total knee replacement decreased by about 68% between 1992 and 2010, based on the value of 1992 dollars. How can this be? Don’t doctors have control over what they charge for their services? For the most part, no. Our medical documentation is pored over and insurers and government then determine the appropriate level of reimbursement.

I don’t know about other physicians but I am tired—tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine. No other profession would put up with this kind of scrutiny and coercion from outside forces. The legal profession would not. The labor unions would not. We as physicians continue to plod along and take care of our patients while those on the outside continue to intrude and interfere with the practice of medicine.

We could change the paradigm. We could as a group elect not to take any insurance, not to accept Medicare—many doctors are already taking these steps—and not to roll over time and time again. We have let nearly everyone trespass on the practice of medicine. Are we better for it? Has it improved quality? Do we have more of a voice at the table or less? Are we as physicians happier or more disgruntled then two years ago? Five years ago? Ten years ago?

At 58, I’ll likely be retired in 10 years along with most physicians of my generation. Once we’re gone, who will speak up for our profession and the individual physician in the trenches? The politicians? Our medical societies? Our hospital administrators? I think not. Now is the time for physicians to say enough is enough.

Dr. Craviotto is an orthopedic surgeon in Santa Barbara, Calif., and a fellow of the American Academy of Orthopedic Surgeons.

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Thursday, May 1, 2014 // Uncategorized

So you have just finished building your dream house in the Hamptons and you suddenly realize that your are at ground zero for Lyme disease.  How do you dress to avoid tick bites.  This is an informative article from the Wall Street Journal.

Wearing Clothing Pretreated with Insect Repellent Significantly Reduced Bite

Ann Lukits

April 28, 2014 6:55 p.m. ET


Wearing clothing pretreated with the insect repellent permethrin significantly reduced tick bites in outdoor workers compared with taking routine tick-prevention measures, according to a study in the May issue of the American Journal of Preventive Medicine.

Common recommendations for avoiding tick bites include wearing long-sleeve shirts, tucking pants into socks and applying insect repellent, but they aren’t always followed, even by people at high risk of tick bites, researchers said.

An estimated 34,000 cases of tick-borne illnesses, including Lyme disease, are reported to the Centers for Disease Control and Prevention every year.

Researchers at the University of North Carolina recruited 133 state-employed outdoor workers during tick season in 2011 and 2012. The workers were 39 years old, on average, and more than a third had reported previous tick bites.

From mid-March to the end of September, one group of 67 workers wore uniforms, including hats and socks, treated with permethrin, a nontoxic chemical used in insect repellents. The treated clothing was expected to retain its tick-repellent properties for at least 70 washes, researchers said. A control group of 66 workers wore untreated uniforms. (Workers were unaware of their uniform type.)

All of the subjects recorded tick bites in log books, including the time, place and location on the body. Tick removal kits were provided so the ticks could be collected and identified.

During the first tick season, 84 tick bites were reported by 64 subjects in the permethrin-treated clothing group. This compares with 493 bites reported by 63 people in the control group.

In the second season, 181 bites were reported by 53 permethrin subjects and 287 bites by 48 in the control group. Of 867 ticks submitted for analysis, 286 were from the permethrin group and 581 from the control group.

Chigger and mosquito bites were significantly reduced in the permethrin group, but not in the control group. Tick-related illnesses were diagnosed in two subjects in the control group.

Permethrin-treated clothing is used by the U.S. military and is available for consumers, according to the Environmental Protection Agency.

Caveat: As socks tend to wear out more quickly than other clothing, it was likely that subjects in the permethrin group wore untreated socks at times, researchers said. The National Pesticide Information Center cautions that permethrin shouldn’t be sprayed on skin and should be applied to clothing when it isn’t being worn


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