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Showing posts from July, 2019

Value Based Pricing in Medicine - A 'Stinging' Issue!

Some professionals and businesses get paid regardless of their outcome.   They are paid for their time and expertise.   For example, if you hire an attorney, unless you have a contingency fee arrangement, you will be billed regardless of the outcome.    If you sue a business because you allege a product you purchased is defective, but the business counters that you damaged it by using the wrong tools to assemble it, there is no guarantee that you will enjoy a legal victory.   However, if your lawyer has invested 20 hours of labor as your advocate, he or she will certainly enjoy a financial victory if an hourly rate is in place.   Similarly, if your financial advisor, who is paid on commission, advises that you invest in a certain product, and the investment declines 10%, only one of you will take a major hit.   Guess who? If you treat yourself to expensive theater tickets, but you find that the performance was dull and uninspiring, do you expect to be given vouchers for another

Walk a Mile in their Shoes - Lessons from a Backyard Rodent

“He ate my dahlia!” exclaimed the lady of the house.   Our backyard is a menagerie.   We are often perched at the window gazing at birds hovering over our feeders, raccoons climbing tall trees, ground hogs, possum, wild turkey, deer, a red tail hawk, a seemingly misplaced spring peeper, stray cats and scampering squirrels and chipmunks. And, the lady was correct.   A chipmunk, who seems to know our property as well as a trained surveyor, hopped into the newly created dahlia flower pot and enjoyed a colorful repast.   As of this writing, there is one remaining, lone dahlia, which might be on his menu later for dinner or a midnight snack. Where Have All the Flowers Gone? I will take issue, ever so gently, that the resourceful rodent ate ‘our’ dahlia.   I suspect that readers have uttered or heard similar phrases, such as 'the deer ate our flowers!'   Let’s consider the issue from the animal's points of view.    The land that we claim title to is th

Do Patients Like Electronic Medical Record Systems?

I have penned several posts on the pitfalls of the electronic medical record (EMR) system that we physicians must use.   Indeed, I challenge you to find a doctor who extols the EMR platform without qualification.   Sure, there are tremendous advantages, and the ease of use has improved substantially since it first came onto the scene.   But, keep in mind that these systems were not devised and implemented because physicians demanded them.   To the contrary, they were designed to simplify and automate billing and coding.   While this made their tasks considerably easier, it was at physicians' expense.   Features that helped billers and insurance companies didn’t help us take care of living and breathing human beings.    It made us focus on silly documentation requirements in order to be fairly reimbursed.   And, it offered very clumsy mechanisms to record a patient’s history – the story of your symptoms – which is our most valuable piece of medical data.   You simply can't cli

Is E Pluribus Unum 'Fake News'?

The colonists were not united in the mission to achieve independence from Great Britain. Indeed, there was tension between the Loyalists, who wanted to remain British, and the Patriots, who demanded separation.  Ultimately, the nation came together as the the great experiment in American democracy commenced.  This is embodied in the nation's original motto e pluribus unum , translated from Latin as 'out of many, one.  Have we remained true to this principle? Challenges and Choices Before Us in 2019 Divide or heal A cudgel or an olive branch Dialogue or lecture Accusation or apology Breaking or bending Sneering or smiling Entitlement or generosity Shouting or singing A polemic or poetry A fist or a handshake Saying no or saying yes 'You are wrong' or 'I am wrong In your view, dear readers, how are we doing?  Should we adopt a new motto, to unum de multis, out of one, many?