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Showing posts from February, 2016

Protecting Human Subjects in Medical Research

There was a tragedy in France recently that did not involve offensive cartoons, radicalized jihadists or terrorists masquerading as refugees.  Innocent French citizens were taken down by a profession whose mission is to heal and comfort.  A medical clinical trial careened off the rails and crashed.  Were these volunteer study patients properly informed?  Are medical study patients here in the U.S. truly making a free choice? From time to time, friends, patients and relatives ask my advice if they should participate in a medical experiment.  While I am a doctor, I usually say no.  And, once I explain to them the realities of medical research, they usually say no also. While my colleagues may chastise me for not encouraging my patients to join clinical trials, my primary obligation is to advocate for the patient before me, not for society.  If physicians contemplate changing this ethical construct to consider the greater good when we advise patients, then we need to engage the

Concierge Medicine - Is it Ethical or Elitist?

Massachusetts General Hospital (MGH), perhaps the most prestigious hospital in the United States, has just announced that it is joining the concierge medical universe.  Concierge medicine offers patients Rolls Royce care for an extra fee.  This model has gained popularity across the country and is attracting both patients and physicians.  Patients receive white glove treatment on demand and physicians have more time with each patient as they no longer are pressured to increase patient volume to pay bills.  I’m sure that some of these physicians have increased their incomes, but others may be paid the same, but enjoy seeing 6 patients per day instead of 20.  I was struck by $6,000 annual feel that MGH was charging concierge patients, the highest I had ever seen before.  The typical fee I had seen was in the $1,500 per year range.  Six grand per year will get Bay Staters personalized care whenever they want.  They will never wait for an appointment.  I imagine that the waiting rooms

Emergency On-Call Physician Policy - A Doctor Dissents

I am known by my patients and friends for my calm, imperturbable manner.  Yes, I am equipped with the full range of human emotions, but few folks have ever seen me raise my voice or demonstrate bulging next veins.  I am not suggesting this is a virtue or a character flaw, but is just the way I am wired. Sure, I get irritated and frustrated with the absurdities of life, as we all do.   For those who cannot relate here, may I suggest calling any airline carrier to discuss changing your ticket reservation.  If that fails,  then have a go at reaching out for tech support when your home internet goes ‘poof’! Last week, I did become irritated when I was notified one evening about a patient’s abnormal blood test result.  I was on-call for our gastroenterology group, so I would be the designated physician to notify with concerning test results.  Why, then, was I miffed? Our community hospital uses a ‘new and improved’ system for notifying physicians after hours of significantly abn

Are High-deductible Health Plans Working?

May I whine for a few sentences please?  My staff and I have a high-deductible medical insurance plan.  As the costs of coverage increased each year, we had to find a product that we could afford for our small private practice.  As any small business owner knows, margins are tight, revenue is declining and expenses inexorably rise.  And physicians, unlike other retailers, cannot raise our fees.  Would you want to invest in a company with this business model?  If so, then contact me directly. High-deductibles health plans are painful for consumers.  The first several thousand dollars are borne by the individual.  While we have an HSA (Health Savings Account), which confers a tax advantage, it is still painful to fork over wads of one's wages to cover medical expenses.  Isn’t that what medical insurance is supposed to do? Would we expect fire insurance to cover only part of our house if it burned down? Will fire insurance cover a fire? But, I recognize that high-de