Ribbons Shmibbons

We All Have Our Own

In my office, no one who works there - from the front desk to the doctors is allowed to wear disease ribbons. You know those ribbons - pink for Breast Cancer, Red for AIDS , and so on. While there is a real medical/practice reason why I feel medical personnel should not wear ribbons in general I have had enough of these ribbons and the LiveStrong wrist bands and the hundreds of other meaningless, nonsensical pseuodoshows of compassion by most people who would kill any person who cut them off on the checkout line at Filene's Basement or Walmart.

Here it goes.

Doctors, as a matter of basic ethics, should feel compassion for any and all patients who come through the door. For a surgeon to wear a Breast Cancer ribbon on a day you go to that surgeon for a hernia, that surgeon is saying: I really support and care about Breast disease, I don't really give a crap about freakin' hernias but to pay the bills I will do your hernia but don't get emotional on me because hernias don't have a ribbon yet, buddy.

The average person chooses medical causes based on media culture hype and not the real medical problems of the day. According to an article in JAMA (Journal of the American Medical Association) in March 2004 by a group of researchers at the Centers for Disease Control the top three causes of death in the United States in the year 2000 were as follows:

1. Tobacco (435,000 deaths; 18.1% of total US deaths a little less than half from lung cancer)
2. Poor diet and physical inactivity (365,000 deaths; 15.2%)
3. Alcohol consumption (85,000 deaths; 3.5%)

Uh, hum...I don't really see any ribbonesque items in the top three now do I? So when someone comes into the doctor's office with emphysema, malnutrition, liver disease, infections, etc. we don't NEED to wear a ribbon because they will probably die anyway - is that it? Or is it really that the Hollywood and Media (all the Today Show and Good Morning America Hosts and Hostesses combined) feel that these problems that make up the highest proportion of medical deaths are just not sexy enough to get air time.

Concerning cancers specifically - according to the American Cancer Society more people die of lung cancer than of colon, breast, and prostate cancers combined. Breast cancer sees about 43,000 deaths a year. This is, of course, extremely sad. It is also just one of MANY diseases that require our attention, care, and awareness.

For a doctor there is no such thing as Breast Cancer Awareness Month. Every day, every week, and every month is Breast Cancer Awareness Month. It is also Diabetes Awareness Month, Liver Disease Awareness Month, Arthritis Awareness Month, Drug Addiction Awareness Month, Colon Cancer Awareness Month, and the list goes on.

Let's take the hype out of disease and be aware that we live in complex times of global warming, war, disease and unlimited opportunities for all of us to get involved in helping in all these areas and not just the one a pretty face on TV tells us to help.

Dr. K.

Related Topics: Lung Cancer Q&A, Inactivity, Obesity Killing Americans

Tags: health and wellness,ribbon,healthcare,media hype

The Last of the American Samurais

....in the Killing Fields of Corporate-Controlled Medicine

Lester Greenberg was my pediatrician.

People often ask me why I went into medicine. They say "Dr. K, why did you go into medicine?" People are so literal sometimes. For me the answer is easy. The role of Jerry McGuire opposite Renee Zellwegger was taken by Tom Cruise so I had no other choice. I figured that being a doctor was my only chance of meeting Ms. Z since she would eventually sprain an ankle or break a bone. I thought it was a good plan at the time. Who knew?


Sometimes the question is not why anyone becomes a doctor but why anyone remains a doctor. What is at the soul of the decision to be a doctor? Actually the decision to become a doctor in certain cultures is preordained. For example, I suspect that the decision for me to become a doctor was made while I was still in the womb. In fact, it is well known and documented in the Old Testament (special edition) that in my religion the issue of abortion is easily determined. The fetus does not become a life until he gets into medical school. Note the "he" component of that.

What was so special about Dr. Greenberg? For one, he seemed to do nearly everything. It is interesting the memories I have of him. In a sense they were probably just glimpses of his life but in my mind they put together a mosaic of a remarkable man. Squeezing all the years of going to him into a single day he did the following:

• Gave polio vaccines
• Reduced a wrist fracture, rolled his own plaster and put the cast on
• Cleaned wax out of a kids ear with a contraption that looked like a cross between a cyclotron and a bazooka
• Made sure everyone got a lollipop when they left
• Listened to all the questions from my mom. She had a lot of questions. He had a lot of answers.

To top it all off, he lived in a house on my block. My dad owned a small grocery store on the beach in Rockaway and my mom at that time did not work. Our doctor lived on our block. A regular house. A regular guy. A regular car.

Long before corporations started "managing care" Dr. Greenberg managed my care. He managed the care of a quadrillion kids without the help of care coordinators, clinical pathways, precertification specialists, and insurance on-call nurses. Amazing concept.

I miss Dr. Greenberg. I miss all the Dr. Greenbergs of the world.

What happened? I wish I knew. Maybe it was money. Maybe when doctors started making "easy" money from insurance companies in the 70's and 80's they lost touch with the people they cared for. In the quest for the dollars I think doctors of that era gave up some serious substantive rights to insurance companies. It reminds me of the movie the Last Samurai. The honor of the individual and the recognition of the force of individual spirit has been traded in for commodities and corporate decisions. The insurance companies have gattling guns with lawyers, contracts, and the government on their side and a solo practitioner doctor caring for the patient has the firepower of a Twinkie to combat them.

I'd take the Twinkie any day of the week and at the end of the day I will stand alone with my pride and honor intact.

I know I can down it with some Lipitor at least.

Dr. K.

Related Topics: Making Provider Choices in Managed Care, Battling the HMO Formulary

Tags: HMO, healthcare, managedcare, generalpractice

Bake Sales and Death

I recall a number of years ago seeing a bumper sticker that read "Why are there no bake sales for the Defense Department to buy weapons?"

One obvious reason is that a Tomahawk missile will cost 6.02 X 10/23 chocolate cupcakes with sprinkles. Two times that without the sprinkles.

I thought of this while I saw a recent sign-up locally for a fundraiser for a nurse and her family. She is getting financially decimated by the treatments for her leukemia.

The first thing I wondered was the following: The nurse has medical insurance. Why is it that she is having any bills related to her medical care?

Here is what I learned: Specifically in the area of cancer treatment, the insurance companies and the Darth Vaders who run them have found an interesting loophole. They like to categorize a lot of cancer treatments as "experimental." Speaking to my colleagues who are oncologists I discovered the reason for this. Cancer treatment - an ever evolving field - always needs to have various trials and experimentations of combinations of acceptable cancer drugs. This is why we are always seeing great advances in cancer. The problem is that the insurance companies call any treatment that is in a study or combining approved drugs in new ways- "experimental" and they do not pay for experimental treatments. Now if this does not make you mad as hell then what does?

If you go to the Mayo Clinic, MD Anderson, or Sloan-Kettering - three top cancer centers in the country and get the latest treatments from the greatest cancer research minds in the country some pinhead bean counter like the CEOs of major health insurance carriers will send down an edict that this is not to be paid.

Enough of this already. We need the following law:

"The Any Available Treatment Law"

"If a physician offers a treatment of any FDA approved drug, whether this is approved as a publicly available drug or approved for a study, this is to be defined as acceptable treatment and must be paid within the same policy parameters of ANY standard treatment that the insurance company pays for."

As an example- if they pay for Naprosyn (prescription Alleve) with a ten dollar co-pay then they must pay for Avastin with 7 other new cancer cocktails with the same ten dollar co-pay. If there is an available treatment with methods that have been approved for any type of use by the FDA or Internal Review Boards then it is called treatment and NOT experimental treatment.

Just as a kicker, any insurance company that does not follow the law should undergo the mandatory punishment: a public flogging following by a public stoning of all the insurance executives and Board of Directors of the guilty company. I chose this form of punishment because there is a law in this country forbidding cruel and unusual punishment. Since these idiots are so consumed by the almighty dollar - a financial fine of say 500 Billion dollars (the minimum worth of a single life give or a take a few dollars) could be perceived as cruel and unusual, but flogging and stoning are well described in the history of mankind and seem appropriate for the crime at hand.

Bake sales should be for after-school activities and not to maintain the life of a human being.


Dr. K.


Related Topics: Make Your Health Benefits Work for You, Experimental Treatments? Unapproved But Not Always Unavailable

Tags: healthcare,cancer,Avastin,fundraiser

iPods and American Medicine

The Best of the Best

I love music. All music. Well almost all music - all music minus Captain and Tenille. If you love music you gotta love your iPod. In the palm of your hand you can hold 23 different versions of All Along the Watchtower - from Dylan to Hendrix and beyond. If you don't like a song - get rid of it. If the iPod is too heavy - get a Mini. If that is too heavy - get a Nano. The thing rarely breaks (except your heart if you listen to Billie Holiday...) and even older versions are useful.

iPods are the music technology equivalent of American medicine. First of all we have a gazillion doctors to choose from (more than can fit on a 60GB iPod probably). You can mix and match all your doctors like a play list. If you don't like one, don't go to him. If you like one - go to him all you want. There are more than 23 different versions of Internists from those named Dylan to probably a few named Hendrix (although they probably spell it Hendricks). If the surgery is too large for you- get mini surgery. If that is too large- get microsurgery. I bet the next advance will be nanosurgery. Even your old family doctor is useful. iPods and American medicine- like apple pie.

Why do I bring this up? Because I can. I want to make it clear who the good guys and who the bad guys are in medicine. The bad guys we'll talk about in upcoming posts. The good guys- Doctors, Nurses, Hospital Workers, Medical Office Workers, Allied health Professionals and all the rest on the front line. Every one who opens a heart and every one who cleans the blood off the wall at the end of the case. The person who says hello to you in the maternity ward at the first breath of life and the person who is there in the intensive care unit at your last. The person who draws your blood and the person who donates your blood.

So in a way, you can say I really am "mad about medicine." It is a great thing. There are things that make us mad about medicine but it doesn't change the fact that we are mad about medicine.

I thought about this recently when a friend told me that many people in her family trash medicine. They say this thing or that thing negative about doctors. Essentially they seemed to hate doctors. I was glad I was not invited to Thanksgiving dinner to this home. It is better to be the carver vs. the carvee.

After hearing this, though, it got me thinking. (People who know me consider thinking to be a dangerous state for me to be in. That's why I am a surgeon.)

What I thought was that it was funny that everyone hates doctors but everyone loves their own doctor. Think about it. When someone says "I hate doctors" the first thing you should ask is "Do you like your own doctor?" Invariably they say- "Of course, my doctor is the best. I love MY doctor." Mathematically how can everyone hate doctors and everyone love their own doctor? It is impossible. Unless of course everyone hates doctors and everyone goes to the same one doctor that is universally loved. Don't think so.

I think it is like the iPod. You were wondering when I was going to go back to that. Our own health experience with doctors is like carrying our own iDoctor around with us. We put the doctors we like in our own iDoctor and walk around with it. If all of music was the music we chose NOT to put in our iPod I guess we would say we hate all music. Except, of course, our own music. But then again that would be as silly as saying we hate all doctors. Except our own doctor. Who would say such a silly thing? Probably everyone.

As an aside I do think we hate all lawyers including our own lawyer. That discussion, though, is for another day.

iRa

Related Topics: Work in Partnership with your Doctor, Choosing a Doctor

Tags: iPod,doctors,medicine,choice

Tags: iPod,doctor-patient

Welcome to Mad About Medicine

Welcome.

Into my second decade in the practice of medicine I feel that I have gone through a whirlwind of Orthopaedic and Medical Progeria. When I started my training in 1985, American Medicine was in its heyday. Then someone decided something was wrong. Something needed to be fixed so we all screwed with it. Well, as Peter Finch so eloquently said in the movie NETWORK- "I am mad as hell and I'm not going to take it anymore."

When I went into practice in 1991 here is what happened to me:

1991 to 1991: Joined a joint replacement only private practice. Problem- one month before I got there, the major surgeon of the three decided to leave suddenly, destroying the practice. I left 4 months later after seeing three reasonable surgeons yell at each other, spend more money in legal fees than the gross national product of the Congo, and even have pushing fights in the operating room. Needless to say- I moved on.

1991: Consulted to US Healthcare on Orthopaedic Utilization issues- Little did I know at the time that they were the company from hell.

1991-1995: I joint Kaiser Permanente in NY. Eventually I was the Chief of Adult Reconstructive Orthopaedic Surgery (a dubious, small title) and the Director of Resource Management in the Northeast region. Due to a mass lobotomy of the entire health plan I won the 1995 Vohs Award for Quality. This is the most prestigious award at Kaiser Permanente.

I say that line about the mass lobotomy because in the history of the award only Pediatrics, Cardiology, Cancer, and Epidemiology have ever won. Chalk one up for the Orthopods! I actually liked Kaiser a ton. To this day I still feel it is a strong a persuasive medical model. The problem is that all the imitators calling themselves HMO's have totally bastardized Kaiser's version of a good idea. More on this in later posts.

1995-2000: I rolled the Orthopaedic Department at Kaiser into a large Orthopaedic subspecialty group. Good idea. poorly executed. Never counted on 2 things. Kaiser would eventually leave NY. Disagreements among partners. In 2000-2001, 3 of us left the group, for different but exactly the same reasons. I then decided to really do something totally radical. I went into a solo Orthopaedic practice in the most competitive suburb, overlooking the most competitive city, in the most competitive country in the history of mankind. As George Burns would have said- If I woke up in the morning and saw that my name was not in the obituaries I knew it would be a good day. I saw 4 patients on my first day with 3 staff members and debt from a loan from the bank.

Fast Forward.........

Five years later, possibly due to the fact that I love medicine and surgery- (I really am "mad about medicine") and partially due to factors beyond the major capabilities of my active brainstem - here are the facts:

• Last year I took an associate in the practice
• The year prior to bringing him on I personally saw over 5,500 office visits and performed nearly 300 major Orthopaedic cases
• My office became totally paperless and digital (in 2000) and I lecture around the world about this. (Along the way I was involved in the development of medical multimedia and Medscape- starting a web site called Bone Home that was bought out by Medscape and became Medscape Orthopaedics with me as the Executive Medical Director- another dubious title...)
• I am a minimally invasive surgery evangelist, do more joint replacements than anyone in my hospital- and my hospital does the #1 in the county
• I open my office for any kid with any injury 24/7, I don't mind seeing back pain. I do house calls some times.
• My patients get my cell phone number
• No one is wishy-washy about what I do- hate or love- black and white- no one in the gray.

Here is how I feel about all this:

• I hate insurance companies with a passion- they produce no products, but they print money on our fear
• I like drug companies- they actually produce products that help us. So they make a lot of money- welcome to America...
• Stem cell research needs to be done aggressively- I actually don't like chronic destructive diseases.
• I voted for Bill Clinton twice, Al Gore once, and George W. Bush the last time. Edwards was a medical malpractice attorney and they are the lowest form of life. Couldn't pull that switch.
• Everyone should have healthcare. Everyone needs to pay something.
• Everyone thinks it's the poor that are the problem. That's a lot of medical crap. They have problems, they are not the problem. The problem is that insurance companies are pulling so much profit out of medicine there is nothing left for anyone even to get a thermometer up where the sun don't shine.
• Also, when did the government start to suddenly care about people and healthcare? Your Senator and Congressman have no interest in the state of healthcare. They pander to insurance and other lobbyists and people that give thm large amounts of money. In the end, all they do is vote on how much less money to give hospitals and doctors in Medicaid and Medicare. I thought that $7.00 for an office visit for Medicaid was a bit low but Congress voted on it. No wonder no one wants to accept that program. How about some meaningful insurance regulation?
• Despite all this- if you have doctor that cares for you- you are gold- and that is why American Medicine is the jewel of the last century. Dedicated doctors, nurses, and others are contributing to making us healthy every day.

That's enough for now.

Over the course of this Diary I would like to hear from you about the reasons why you are "Mad About Medicine"-- the good and the bad.

It's only life and death. It isn't business.

-- Dr. K

Related Topics: Medicare, More than 1 in 10 in US Lack Health Insurance, Joint Replacement

Tags: healthcare,medicare,medicaid,health insurance