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Showing posts from September, 2019

Value-based Pricing and Reimbursement in Health Care

I am a conservative practitioner in my specialty of gastroenterology.   Compared to peers, I order fewer scope examinations, prescriptions and CAT scans.   I’ve always believed that a more parsimonious practice of medicine would protect my patients better than would a more aggressive approach.   Sure, this also means that I spend fewer health care dollars on my patients, but this is not my primary motivator.   I practice in this manner because I am convinced that in the medical profession, less is more. I am somewhat of an iconoclast as many of my colleagues for various reasons practice differently.   They might feel that my medical nihilism is depriving my patients of necessary testing and treatment. Patients over time tend to find physicians who share their philosophy.    Patients who believe that more testing and more medication is the pathway to better health will not be comfortable with a doctor like me. But, change is afoot!   I predict that within the next several year

Do I Have Diverticulitis?

I have been treating diverticulitis for 30 years the same way.   When I suspect that a patient has this diagnosis, I prescribe antibiotics.   This has been the standard treatment for this disorder for decades. I have found that diverticulitis is a slippery entity that has two trap doors waiting for physicians to fall through.   It is an easy task to miss the diagnosis.   Every physician has done this. The diagnosis can be erroneously assigned to a patient.   Every physician has done this. Recognize that the phrase ‘every physician has done this’ includes me. The diagnosis can be elusive as there is no diagnostic test that secures the diagnosis.   The technology tsunami has covered the medical landscape, as it has run over so many other spheres in our society.   Doctors and patients increasingly rely upon ‘the numbers’.    Want proof?   Do you think there are many physicians today who can actually plug a stethoscope into their ears and hear, let aloneunderstand all of

Should High Blood Pressure be Treated?

In last week's post, I promised an explanation why many screening and medical treatments offer so little benefit to individual patients.    If you invest the time to digest last week's post and the post before you now, then you will be equipped with new understanding that will enable you to make much better medical decisions.  In accordance with this blog's mission, this is truly a 'peek behind the curtain'.  I grant you that these 2 posts are a little wonky, but try to stay focused.   Here is the main reason that ordinary people – and even some medical personnel – become confused on this issue.   Studies that assess screening tests and medical treatments are often performed on very large groups of patients.   The reason for this is that smaller studies, for reasons I cannot fully explain here, are simply not felt to be sufficiently reliable.    This is why the Food and Drug Administration would never grant approval of a new medicine based on favorable resu

Does Mammography Save Lives?

I find that the public often exaggerates the benefits of many preventive health measures.   I don’t blame the public for this.   There are several forces conspiring to deceive the average patient into accepting exaggerated claims of various medical tests and strategies.    Of course, the Medical Industrial Complex is a gluttonous beast that must be fed massive quantities of medical testing and treatment if it is to survive. Most of the public thinks that medical interventions, including mammography, lowering cholesterol levels, blood pressure reduction and even colonoscopy are downright lifesaving. Recognize that I am in favor of all of these measures, but that the actual benefit to the individual is much smaller than most folks believe.   In the case of mammography, there is uncertainty as to whether it saves lives at all, a view readers can easily find with a rudimentary internet search.   Mammography experts all agree that any benefit of this screening test to the individu

Labor Day 2019

All work is honorable. Honor everyone's work. Work with honor.   The Whistleblower wishes all of you a meaningful Labor Day.