The Paradocs Podcast

Who is that man or woman in the white coat? What is he/she thinking as you are being examined or operated on? Is that physician burned out? Suicidal? Feeling optimistic about his/her profession? The future? There is a lot going on between the ears of that physician that isn't devoted to healing people. Today, I take a deep dive solo-style into the results of the comprehensive 2018 Survey of American Physicians by the Physician's Foundation.

The opioid crisis has been in the news for a few years now and those to blame for it are many. Is it pharmaceutical companies who made easy to prescribe formulations of powerful pain killers? Is it physicians for over prescribing pain medicine for simple aches and pains? How about federal guidelines that encouraged the over treatment of pain? Or the creation of the fifth vital sign in the late 90's that treated pain as important as heart rate.

Social media is ubiquitous in our lives and doctors have a less than average presence within that sphere. The reasons are many but probably partly related to concerns about medical liability, their employers, and reputations as physicians. Dr. Dana Corriel set out to change that. She created the #SoMeDocs which encourages physicians to engage the world more and bring their unique perspectives to patients and the public through the use of social media.

Our discussion hopefully offers some insight into grief while being sincere with brief moments of humor. What to expect, what is comforting, what is not helpful, and how it has changed our lives. Specifically, we discuss the process of forgiveness, grace, and practical things you can do to help your family members or friends in dealing with the grief. My hope is that this episode will be a comfort or helpful for those in the grieving process or those helping a loved one go through the process.

Sometimes, the best way to understand your present is to view it through the lens of the past. HMOs (Health Maintenance Organizations) were a product of the 70's and exploded onto the scene in the early 80s. Specifically, he recounts the 'industrialization' of health care delivery where a cottage business of caring for the sick transformed into the business it is today run by large corporations.

HIPAA (or the Health Information Portability and Accountability Act) passed in 1996 and has been touted by legislators, physicians, patients, and health industry leaders as a law that protects patient medical data privacy. It turns out, as with the names of many laws that pass in Congress, the act does the exact opposite as what you might guess. The act allows for over 2.2 million entities in the US to trade, disperse, and sell your personal medical data without your consent.

Did you know that most hospitals (or hospital systems) enjoy a non-profit tax status? Despite revenues in the billions of dollars these entities operate within your city or community with a tax exempt status including all the medical offices, laboratories, imaging centers, and billing offices that they build and purchase. Does this give them an unfair competitive advantage over for profit imaging centers, laboratories, or physician private practices?

Few are aware of the practice of public reporting for health care and on its face, it seems to be an obvious goal for policymakers. However, comparing health care systems, hospitals, or individual physicians is incredibly complex and probably impossible to do in any sort of meaningful way. Traditionally, patients relied upon local knowledge with their primary care physician to refer to the best few specialists.

Maintenance of Certification (MOC) continues to weigh down physicians encouraging early retirement, burnout, and financial strains leading to all sorts of other personal and professional problems. The private specialty boards (ABIM, ABA, ABP, etc) are under the auspices of the ABMS which sets many of the rules that are ruining physicians' lives.

Certificate of Need (CON) laws are commonplace in the United States and affect every patient and physician who lives in one of the 36 states which have them in place. The laws stipulate that you need permission from one a government regulatory board proving a need in your community to open a competitive health care service like ORs, laboratories, imaging centers, or hospitals.

Everyone knows that one of your most important assets is your identity. Without that you will have difficulty getting anything accomplished. Most importantly, whoever holds the key to your identity will wield the ultimate power. Thankfully, today's digitized world and the emergence of block chains for public accounting and private security is bringing us to a place where you can store this information in a decentralized space allowing the individual to have the power.

If you knew that millions of people were being murdered by government in the world what would you do? If you found out these people were being murdered for 'spare parts' to be sold to the highest bidder - what would you do? These are the questions we have to ask ourselves as we look at the practice of involuntary organ harvesting occurring in China to this day.

One of the most overlooked aspects of medical training is what to do after you finish your training. Especially any guidance for how you introduce new products to market as a physician. Doctors are coming up with products all the time that keep us healthier, make our life easier, or doctor's lives easier but there is usually not a lot known by those launching new products about how to do it. And what the pitfalls are. Today, I will discuss just those things with two physician entrepreneurs.

It's easy to forget that physicians are people. Certainly when we discuss doctors in our national political debates we forget that there is a critical relationship ignored - the patient-physician relationship. As that relationship is strained with the introduction of electronic medical records, production pressures, administrator rules changes, and malpractice physician burnout is almost inevitable.

One of the biggest obstacles faced by patients and doctors in health care is the exchange of payment for services as this is now accomplished through intermediaries like insurance companies, Medicare, etc. What would happen if we used a cryptocurrency with verifiable records on a blockchain with miniscule transaction fees? Or if you could earn credits as a patient by performing healthy acts?