Saturday, July 22, 2017

“No one should stand between you and your doctor!”


Really! let me see!

Politicians
Administrators
Insurance companies
Medical Boards
Malpractice lawyers
Economists
Efficiency experts
Rating agencies
Third party payers
Speciality Associations
Guidelines committees.
Utilization review  nurses
preauthorization  personnel
Receptionists
Nurses
nursing assistants
The janitor
The Parking attendant/Robot
Beers Criteria

"My small examination room, designed for quiet personal consultation,
is already crammed with unobserved “third parties” intruding on an ostensibly
very private relationship. Pharmaceutical representatives, those
well-dressed young men and women carrying pill samples and wearing
corporate logos, are there to persuade me to prescribe their newest
and most expensive products. Midlevel managers of health insurance
firms and HMOs are also “in the room,” containing costs by restricting
and rationing care through the ploy of prior approval. Medicare bureaucrats
are there as well, codifying care of the elderly, translating the art
of medicine into volumes of digitized diagnostic reference numbers and procedure codes. Soon the bureaucrats will also be scoring the clinical outcomes
of care in an arcane formula for physician reimbursement. Last, the
plaintiff’s medical malpractice attorney lurks in the corner, never out of
my mind for a moment, as I defend myself daily through ever-escalating
diagnostics and unceasing documentation, always producing a well buffed
chart, but not necessarily a healthier, happier patient. Seating is
indeed limited in the exam room; patients should be advised that there
may be standing room only.procedure codes. Soon the bureaucrats will also be scoring the clinical outcomes of care in an arcane formula for physician reimbursement. Last, the
plaintiff’s medical malpractice attorney lurks in the corner, never out of
my mind for a moment, as I defend myself daily through ever-escalating
diagnostics and unceasing documentation, always producing a well buffed
chart, but not necessarily a healthier, happier patient. Seating is
indeed limited in the exam room; patients should be advised that there
may be standing room only.

It is not sufficient, however, merely to offer a paean to primary care,
singing its praises without appreciating what it is or how it works. As with
the modern laptop computer, the iPhone, or the GPS direction finder, we
depend on good primary medical care without knowing what’s inside. We
stand to gain from a look under the hood.

Compassionate, high-quality primary care medicine

Compassionate, high-quality primary care medicine, both affordable and
accessible, is fundamental to all health care. It is the right of every American,
and it is a national moral imperative. It is the cornerstone of care
and our best defense against the human misery of disease, dysfunction,
and frailty. Elections, geopolitical crises, and economic upheavals may
come and go, but the essential need for a good primary care doctor is here
to stay.

Health care an ice cream treat/challenge of a senescent society. Primary care, in particular,is inherently inefficient.


"Peter Orszag, the initial director of the Office of Management and Budget
under President Obama, admonishes Americans that we are in financial
trouble today because each of us consumes too much health care, as
though it were an ice cream treat. We gorge on a large or extra-large measure
of medical care, rather than show some restraint and order a small or
medium portion. This tasty dessert analogy superficially seems plausible,
given that morbid obesity has recast the shape of modern man."

 our society is in "greater need of ready access to good primary care than ever
before. The notion that health care for a sick and aging nation somehow
can be streamlined and economized (faster, better, and cheaper) is quite
naive"
Primary care, in particular,is inherently inefficient. Because it is relational, good primary care takes
time. Complex matters, convoluted family dynamics, and critical health
decisions must be addressed in the context of a continuous, supportive,
and trusting physician-patient relationship that is the polar opposite of
fast food.

"A physician-patient relationship thrives in a socially rich environment;
it withers when market-style interactions supplant the social and care
devolves into a pure business transaction metered by the minute (Hartzband
and Groopman 2009)."

Physician frustration, alienation, and chronic suppressed anger


"the near-future world of 78 million aged Baby Boomers, many
suffering some degree of cognitive impairment, demanding high-quality
and personal attention from a scant number of primary care physicians.
Imagine the frustration of trying to provide effective medical care to an
elderly patient who lacks the support and sympathy of a functional, loving,
and close-knit family. This is primary care in twenty-first-century
America, and we have a very big problem on our hands."

A new Model of Medicine Death by Disruption !



"a model of medicine in which the functions of a physician are teased out, stratifi ed, and supplied in bulk by technically optimized deliverers of narrow and specific services. (For example, a hernia is repaired in a hernia center.) Care is commoditized. The wholesale liquidation of traditional holistic primary care, however, recapitulates the creative packaging and repackaging of mortgage “products,” credit default swaps, and the clever “stripping” of securities into tranches (peeled-off profitable portions), which contributed ultimately to the massive financial market meltdown of 2007. As a physician, that is a path I choose not to take"

"Primary care, as I knew and enjoyed it, is principal care, relational in
its very nature. It is delivered in a continuum, sometimes over decades,
often across generations of family members. It is not merely a series of
short, staccato transactions, technically correct but emotionally empty and
dispensed like fast food. The practice of primary care fundamentally does
not lend itself to fractionation or focused factories. Primary care is different;
it is a unique health resource and a national asset, but its survival is in
serious doubt. I am neither the first nor the last to close up shop. By leaving
practice, I lost many delicate, slowly cultivated, and sustained relationships
with my patients; such relationships are remarkable phenomena
that lie beyond the purview of any conventional business model. Yet, it is
I who am now out of business, not the economists at the Harvard Business
School. The postmortem on primary care in the United States may well
read: “Death by Disruption.”
*

Out of practice : fighting for primary care medicine in America

Barken, Frederick M. (Frederick Mitchell), 1955-

Ithaca [N.Y.] : ILR Press, 2011. (Culture and politics of health care work.)

Vaidyo Narayano Harihi'? VS ""The physicians' loss is society's gain "


What is the meaning of 'Aushadhi Jahnavi Toyam Vaidyo Narayano Harihi'? Why doctor should be seen as a form of Lord Narayana? Sri Sri Ravishankar
Guruji is explaining the meaning of this in own words during a Satsang of Art of Living...
This means that when we take a medicine, we should consider it sacred, like the water from the river Ganga. When you drink water from the river Ganga (Ganga jal), how do you feel? You drink it with a feeling of purity, and with faith. That is the difference between regular water and Ganga jal. When you drink with faith, then the water becomes teerth (sacred water). A medicine should be taken with this same feeling, then it will work effectively. It is not just popping a pill into your mouth and drinking water.
'Vaidyo Narayano Harihi', means that a doctor should be seen as a form of Lord Narayana. There are two meanings for this verse. One is that the true doctor (healer) is Lord Narayana and the true medicine is the water from the river Ganga. The other is that a medicine should be considered as sacred as the water from the river Ganga, and a doctor should be seen as a form of Lord Narayana.

For protecting your health, good habits are needed. The mind also plays a very big role here. If we want to be free
from bad habits, our mind should be pleasant and we should have faith.

Vaid

hakim

Doctor

Physician

provider
" The kindly family doctor was diminished, downgraded, and deprofessionalized to the status of a “provider,” a bland descriptor on a clerk’s requisition form"

vendor
"Even worse, New York state’s Medicaid, which insured the indigent, classified me as a “vendor,” a term that sent me into orbit then and that still rankles today"

gatekeeper
"a “gatekeeper,” the person at the turnstile of a veritable health care amusement park where those with a ticket (a valid health insurance card) could spend an afternoon with a specialist, take a ride in the magnetic resonance imaging (MRI) scanner, or visit the X-ray funhouse."


"What’s in a name? Whether I was termed a gatekeeper, a provider, or even a vendor, I was where I wanted to be, still practicing primary care medicine in a very traditional way. I cultivated satisfying relationships with several thousand patients and their families, each unique, and I felt rewarded in providing an essential service for my community. Although the bureaucracy and banditry of the health insurance industry was a slowly constricting circle that annoyed as it encroached, in the mid-1990s and even early in the fi rst decade of the twenty-first century, I still could ply my craft."

" my practice increasingly was composed of the fragile, chronically ill sufferers of multiple degenerative diseases, all laden with the psychosocial complexities of the fi rst superannuated add-on generation in human history. It seemed they were all there, sitting in my waiting room. Medicare apparatchiks and federal “budgeteers,” the bill payers, probably thought so as well."

"Enter the Harvard Business School. Their mission: to apply their analytic powers to a challenging market problem, examine a service or product and its users, and tweak a business to achieve greater efficiency and productivity, thereby greasing the wheels of commerce. The practice of medicine, in theory, should be no less amenable to analysis than any other business. Harvard’s Clayton Christensen offers The Innovator’s Prescription: A Disruptive Solution for Health Care, his vision of a brave new world of doctoring in the twenty-first century (Christensen 2009). He sees my office as a “solution shop,” a quaint but outmoded and anachronistic storefront akin to a small Main Street hardware store or the premises of a butcher, baker, or candlestick maker. According to Christensen, mine is the last great cottage industry in the United States."

the following was a review by an Indian origin Physician I surmise this on the basis of his name .
let me see how many congressmen and senators will choose lower-cost caregivers

 "create conditions that allow disruptive innovations — such as the use of lower-cost caregivers — to take root and thrive."
"patients often walk in knowing what they need."
YA! "I need an MRI to prove i am disabled from  my work and not from my Morbid Obesity,or the Twelve pack of beer I consume daily or the 2 packs of cigarettes I smoke daily"

"The physicians' loss is society's gain — in the form of convenient and affordable care for patients."
 Dream on Clayton M. Christensen,

The main wrong notion everyone is having is that Healthcare can be in a free marketplace and that there is a free market.
Can a patient  having crushing chest pain and calls 911 can choose where he wants to go for treatment / can he choose to go to "minute clinic"

The Innovator's Prescription: A Disruptive Solution for Health Care

N Engl J Med 2009; 360:2038-2039May 7, 2009DOI: 10.1056/NEJMbkrev0810803
Article
Citing Articles (1)
The Innovator's Prescription: A Disruptive Solution for Health Care
By Clayton M. Christensen, Jerome H. Grossman, and Jason Hwang. 441 pp., illustrated. New York, McGraw-Hill, 2009. $32.95. ISBN: 978-0-07-159208-6
In Aravind Adiga's novel The White Tiger (New York: Free Press, 2008), the narrator describes his weekly visits to the liquor store. On the wall, in dripping red paint, were the names of hundreds of liquor brands and their prices. But he knew what he wanted. He was there to buy whiskey for his master, who drank only one kind. He had to jostle with dozens of other customers who milled around the counter, yelling to get the store clerk's attention.
MinuteClinic promises a better experience. Founded in Minnesota in 2000, the company has clinics in about 525 retail stores in 24 states and offers to treat medical problems that range from athlete's foot to strep throat in 15 minutes. The company's slogan is “You're sick. We're quick.” It lists a handful of common illnesses, tests, and vaccines along with the associated charges, which are under $100 for most services. Nurse practitioners provide care to patients, and like Adiga's liquor store customers, the patients often walk in knowing what they need.
According to Clayton Christensen and his coauthors, MinuteClinic is disrupting traditional business models by bringing services closer to users at lower cost. Nurse practitioners are delivering care that was formerly the bailiwick of family physicians. The physicians' loss is society's gain — in the form of convenient and affordable care for patients.
Underpinning such innovations are advances in technology that convert “intuitive medicine” to “rules-based care.” Problems that once needed intensive diagnostic work by highly trained physicians can now be handled by assistants who use algorithms that incorporate the expertise of physicians. Patients with diabetes can check their own glucose levels and manage their condition with insulin. Quick tests for strep throat allow nurses to provide care. Primary care physicians, meanwhile, are taking on tasks that previously were performed by specialists. And specialists are encroaching on each other's turf — angioplasty, for example, has enabled cardiologists to displace cardiac surgeons.
Christensen first studied disruptive innovation in the disk-drive industry, a field he selected because a friend described disk-drive companies as the “closest things to fruit flies that the business world will ever see.” Geneticists like to study flies because of their short life span. The rapid rise and decline of waves of disk-drive technology helped Christensen formulate his theory of innovation, which he has applied to fields as diverse as education and telecommunications. Along with his coauthors, Jerome Grossman and Jason Hwang, he intends The Innovator's Prescription to be a road map for health care reformers as they tackle the problems of rising health care costs and poor access to services in the United States.
Physicians often denounce the commercialization of health care. Arnold Relman, former editor-in-chief of the Journal, has said that the U.S. health care system is failing because “we in America have allowed ourselves to believe that healthcare is just another industry, that the provision of medical care is a business, and that medical services are an economic commodity that is best distributed by market forces.”
Christensen and his colleagues believe that such arguments are self-serving — an attempt by physicians to preserve incomes and dysfunctional service models. Their prescription: let people choose the health care they need and use health savings accounts, coupled with high-deductible insurance, to pay for it. They foresee further fragmentation of service delivery and hope that electronic health records will be “the connective tissue that draws and holds together the individual elements of our care.” They urge integrated, fixed-fee providers such as Kaiser Permanente to expand nationwide, to act as orchestrators of health care reform, and to create conditions that allow disruptive innovations — such as the use of lower-cost caregivers — to take root and thrive.
The Innovator's Prescription will delight supporters of consumer-directed health care, will alarm physician associations and proponents of nationalized health care, and will enlighten all.
Karunesh Tuli, M.D., Ph.D.
310 Mockingbird Ln., South Pasadena, CA 91030

Perfection In PowerPoint

Kleinke, J DHealth Affairs; Chevy Chase28.4 (Jul/Aug 2009): 1223-1224.
Clayton Christensen first applied the term "disruptive" to health care in the 1990s, when he apparently discovered that angioplasty was cheaper and easier than bypass surgery, and he has been applying it ever since, most recently in the form of The Innovator's Prescription The book is 441 pages of postmodern business jargon, bubble charts, and marketplace anecdote, swirled into a menacing-sounding methodology and ladled across the entire U.S. health care system. Although the book excavates several fascinating nuggets about wrenching changes in other industries, it attempts to force each into Christensen's franchise-inprogress, "disruption theory." A bewildering amalgamation of high business concept, market evangelism, and wishful thinking, the book lacks disciplined data on what patients actually demand and health care actually supplies. It is also willfully at odds with what occurs every day in the actual corporate marketplace. To wit, the same day I was reading the authors' argument for the inevitable integration of health care business functions, thanks to die pressure of today's market disconnections (p. xxxi), WellPoint was announcing the spinoff of its pharmacy benefits management company to ExpressScripts. The authors may believe they are lighting the way to a brave new world of corporate health care, but much of their analysis is oddly nostalgic - a reminder of the good old days (circa 1995) when every health care merger, no matter how big, made perfect sense - at least to those who papered it."

\"The Innovator's Prescription offers up a vocabulary for a Utopian health care system in perfect alignment with a magically functional marketplace. Sick patients go to retail clinics for primary care; primary care physicians are doing much of the work of specialists, in practices now called "solution shops," aided by telemedicine and clinical decision-support software; specialists collaborate through Web communities and are paid for outcomes, not procedures; hospitals have deconstructed themselves into "solution shops" or "value-added processors," depending on what the authors need them to be; the chronically ill are managed by call centers and each other through "facilitated networks"; the uninsured get health savings accounts (seri- ously); and the whole thing works because every American has control of his or her own portable electronic medical record. Poof! A bunch of market-driven miracles, all rendered flawlessly in, well, PowerPoint."

"the authors claim that consumers will happily compile and circulate their health risk assessment scores in search of a good health insurance deal, adjusting their risk behavior in real time to changes in their premiums in an unfettered marketplace where payers reward full disclosure and everyone assembles and shares their online personal health record with their employer (pp. 142, 175)."

"Perhaps it is the self-aggrandizement the authors seem to share with the ballooning employer-fix-it crowd, but when I encountered this perennial theory in The Innovator's Prescription, I finally realized that everything I learned as a bartender at HBS was true: things do work out perfectly when we all nod in agreement, sketch it out on cocktail napkins, and congratulate each other for being in each other's presence.
"This idea is so powerful that it shows up on the pundit circuit at least every three years, best tracked by the terms "direct contracting," "re-engineering," "benchmarking," "six sigma," "Bridges to Excellence," "Leapfrog Group," and "pay-for-performance." The idea actually dates back to the 1980s"