America Out Loud PULSE: What People Want from Their Patient-Physician Relationship

From my America Out Loud Pulse podcast with Travis Morell, MD – https://www.americaoutloud.news/what-people-want-from-their-patient-physician-relationship/

Works on the scientific and ethical practice of medicine called the Corpus Hippocraticum are attributed to Hippocrates (450 – 375 BC), considered the father of medicine. The quote “do no harm” is not in the Oath of Hippocrates, but rather in another volume, Of the Epidemics. Additionally, the writings were written in Greek and the Latin phrase primum non nocere comes from a 17th Century English physician, Thomas Syndenham. Irrespective of the authorship’s history, for centuries the medical profession adopted the Oath as a guide of professional conduct.

Patients likely don’t know the instructions in the Oath, nonetheless, patients trust doctors with their health. The Oath advises physicians, among other things, to do everything for the benefit of the sick, to keep private whatever physicians see or hear in the lives of their patients, or as some translations say, treated as “holy secrets.” These duties attached whether the patients were “free or slaves.”

Multiple surveys (here, here, here, here) have asked patients what they really want from their patient-physician relationship. Just as with any close relationship, undistracted listening tops the list. Another constant is that patient prefer the total experience with the doctor and his or her office over price. If one wish could be granted for patients it would be for more time with their doctor.

What makes are some of the other factors that make a good experience? In todays’ era of electronic medical records and computer screens, eye contact is more important than ever. If a doctor is open and honest about his knowledge base, gives truly informed consent to proposed treatments with risks and benefits, patients will develop trust. We need to have patients feel comfortable telling us everything that is going on in our lives. And doctors mustn’t be reluctant to form an emotional bond when making a connection with their patients. Patients want to know their doctor is not doing procedures for financial gain. Patients also want access to their physician. This is one of many reasons that direct primary care practices are growing increasingly popular.

Patients, like all of us want to be treated with respect. That means having their time and needs respected. Simple apology from the front desk if the doctor is running late goes a long way to letting patients know you care. Another thing patients need is clear communication, not ‘medicalese.’ Finally, patients want a partnership and giving then the opportunity to express their opinion about the proposed treatment.

My guest today is one of those physicians who is working to keep skill, compassion, and honesty in medicine – despite the roadblocks put up by current political winds and corporate takeovers.

Bio

Travis Morrell, MD, MPH, is a husband, father and physician leader. A lifelong learner to a fault, his medical training in five specialty departments gives him a broad perspective. He is a Board Certified dermatologist and dermatopathologist in private practice in Western Colorado. Dr. Morrell is also Chair of Colorado Principled Physicians, a truly grassroots organization defending non-partisan physician values such as free speech and evidence-based medicine.

Website:

Colorado Principled Physicians – https://www.coloradodocs.org

America Out Loud PULSE: Are Medical Boards Helping or Hurting Patients?

From my America Out Loud Pulse podcast with Kelly Sutton, MD – https://www.americaoutloud.news/are-medical-boards-helping-or-hurting-patients/

The patient-physician relationship is supposed to be sacred, as Hippocrates explained thousands of years ago. Medicine has entered a brave new world of third parties (insurers) telling us what to do. Various laws, particularly in California, are squelching choice for patients and free speech for physicians even with threats of loss of their licenses. Consequently, patients are losing their choice in medical treatment.

In June 2015, California passed a law, SB277 that removed the personal and religious belief exemption from mandated vaccines. Without the 15 to16 vaccines,, a child cannot not attend public schools or day care facilities. In September 2019, California went a step farther to squelch medical vaccine exemptions with SB 276. This applied to private as well as public schools.

Prior to the enactment of SB 276, state law permitted physicians to issue medical exemptions based on their independent medical judgment. Now a State Public Health Officer is the final arbiter. The state will review all medical exemptions at schools where fewer than 95 percent of students are vaccinated, from doctors who submit five or more exemptions in one year and from schools that haven’t shared vaccination rates. The state will cancel waivers written by doctors who are under investigation by the medical board.

The State has the power to revoke the exemption if it decides the exemption is “inappropriate.” Talk about inserting a third party smack dab in the middle between physicians and their patients. If the state determines a physician is “contributing to a public health risk,” it will report the physician to California’s medical board.

The laws are designed to crack down on physicians “practicing outside the accepted standard of care.” But they also target the parents who believe it is their right to make medical decisions for their children. The term “anti-vaxxer” is a pejorative description of concerned parents and physicians who question the “science.” I think Covid-19 taught us more than we want to know about the perversion of science.

Mandates rely on coercion rather than informed consent. Clearly, a parent is left in an untenable position: Vaccines or pull their child out of school. Most parents – if both are working – do not have the ability to homeschool their children. Moreover, this could only be the beginning of the erosion of individual patient rights. We have a major controversy over the appropriate treatment of minors who have decided they want to be the opposite sex. In some states schools have the right to withhold gender issues from the child’s parents. Parents have lost custody of their child over treatment choices that could have life-altering consequences. In some states, schools do not have to inform parents about an abortion of a child over 12 years old.

The silver lining? Medical tyranny has gone so far that more and more patients and physicians are becoming activists.

Bio

Kelly Sutton M.D. completed residency in Internal Medicine and some Pediatrics, and practiced family medicine for almost fifty years, using knowledge from conventional and integrative medicine. She practiced until her medical license was revoked for writing eight vaccine medical exemptions by the state of California in 2022, and by Massachusetts and New York in 2023 based only on reciprocal discipline. There were no patient complaints in any state, and no patient injury. Dr. Sutton is challenging this revocation in court.

See  www.reclaimingmed.org/drsutton for this story, its relation to other doctors’ experience with regulators, and their legal cases.

Healthcare Redefined: Finding the Right Doctor Once They’ve Retired

Guest Column by Virginia Cooper.

Embarking on the journey to find a new primary care physician (PCP) can be challenging, particularly when your long-trusted doctor decides to retire. For many, this transition is not just about finding a new healthcare provider, but also about ensuring that their specific health needs, especially as minorities, are understood and respected.

The importance of finding a physician who not only has the skills but also the cultural competence to manage your health is paramount. This guide aims to streamline your transition to a new PCP, ensuring your healthcare needs continue to be comprehensively addressed, respecting both your health and cultural background.

Leverage Referrals from Your Retiring Doctor

When your trusted healthcare provider decides to retire, it’s an opportunity to benefit from their professional network. Your retiring doctor, familiar with your health history and needs, can provide targeted referrals to other healthcare professionals who share a similar commitment to patient care.

These referrals are often more than just names; they come with the retiring physician’s endorsement, providing you with a vetted starting point in your search. It’s an approach that not only saves time but also offers a sense of continuity in your healthcare journey.

Assess Online Patient Reviews

In today’s interconnected world, online reviews have become a crucial tool in evaluating potential healthcare providers. Platforms like Google, Healthgrades, and specialized healthcare forums are treasure troves of patient experiences and feedback. When sifting through these reviews, pay attention to comments about the doctor’s approach to patient care, their ability to listen, and their effectiveness in treatment. This insight is invaluable in gauging whether a potential PCP is not just competent but also the right fit for your unique healthcare needs. Be aware that some reviews may not be accurate or based on actual patient experiences.

Digitize Your Medical Records

In a world increasingly moving towards digital solutions, having your medical records in digital format is a significant advantage, especially to help with searching for documents. Saving documents as PDFs not only makes your personal health information readily accessible to you but also eases the process of sharing these details with a new healthcare provider.

Digital records allow your new primary care physician to quickly search and review your health history, allergies, past treatments, and medications, ensuring they can provide informed and personalized care from the start. Plus, you can change a file back to its original format easily if needed.

Opt for an In-Network Physician

Navigating the complexities of health insurance can be daunting. One practical step to ensure affordability in your healthcare is to select a PCP who is in-network with your insurance provider. This choice not only helps in maximizing the benefits you receive under your plan but also plays a crucial role in managing out-of-pocket costs. It’s a decision that balances financial prudence with access to quality healthcare.

Connect with Culturally Competent Physicians

For minority patients, the importance of finding a culturally competent physician cannot be overstated. Such physicians bring an understanding of the nuances of different cultures and how these can impact health and healthcare experiences. They are better equipped to provide care that is respectful of and tailored to your cultural background, leading to more effective and personalized healthcare outcomes.

Evaluate the Physician’s Location and Accessibility

When choosing a new PCP, practical considerations such as the location of their clinic, office hours, and the ease of scheduling appointments are important. A conveniently located clinic reduces the stress and time involved in accessing healthcare. Additionally, the AMA Ed Hub notes that flexible office hours that match your schedule can make a significant difference in maintaining regular health check-ups and treatments.

Explore Healthcare Coverage Options

For those who are freelancers or self-employed, traditional employer-based health insurance may not be an option. In such scenarios, Policygenius points out that exploring healthcare coverage through the Affordable Care Act (ACA) becomes essential. The ACA offers a range of plans that can provide comprehensive coverage, ensuring that you have access to quality healthcare regardless of your employment status. You can also consider Direct Primary Care and other cash-based practices.

The transition to a new primary care physician post the retirement of your current doctor can be seamless with the right approach. By seeking referrals, researching thoroughly, maintaining digital medical records, choosing in-network physicians, valuing cultural competence, considering logistical aspects, and exploring coverage options, you ensure a smooth transition. This proactive approach guarantees continuity in your healthcare journey, with your unique needs as a minority patient being met with empathy and expertise.

Read more informative articles on the Marilyn Singleton, MD JD blog today!

Bio

Virginia Cooper is a retired community college instructor. She always encouraged her students to see the real-world value in their education, and now, she wants to spread that message as wide as possible. Her hope is that Learn a Living (learnaliving.co) will be a go-to resource for adult learners embarking on starting, continuing, or finishing their education.

Image: Freepik

America Out Loud PULSE: Do We Really Need to Take So Many Pharmaceuticals?

From my America Out Loud Pulse podcast with Richard Amerling, MD – https://www.americaoutloud.news/do-we-really-need-to-take-so-many-pharmaceuticals-richard-amerling-md/#

The second opinion is—or should be—a staple of medicine. Second opinions can help you make better decisions about your health. In one large national survey, one-fifth of patients who saw a doctor in the past year sought a second opinion. According to one study, a second opinion affected treatment plans for 37 percent of patients and changed diagnoses for almost 15 percent.

And why should you get as second opinion? Sometimes your insurer requires one, especially for surgery or expensive treatments. I doubt they are looking out for you. They are likely making sure they can save a few bucks. If you have an unclear diagnosis or want an expert on your condition, you should definitely talk to another physician. It may turn out that the recommendations are the same. If you are still uncomfortable, get a third opinion.

One very important reason for getting a second opinion is that your current treatment is not working, is risky, and/or you have major side effects. You may wonder if such drastic treatment is actually necessary. On the flip side, always get a second opinion if your doctor tells you that you have no options. And remember to ask if waiting is an option.

I have a few personal rules about treatment. The doctor is not always right. In a trusting relationship, your doctor will welcome your questions and offer that you get another opinion. He or she will not be insulted if you ask whether the treatment is really necessary. Never feel rushed unless a real emergency. It’s your body; the final choice is up to you.

One of the things I can thank Covid for is that it exposed the flaws in the “follow the science” mantra. It got many doctors asking, whose science? Does anybody really have the last word in how to treat patients? Remember statins, low fat diets and countless other differing and changing opinions in medicine?

Unfortunately, during Covid, many doctors were whipped into submission by fear and intimidation. But standing your ground works. Physicians filed lawsuits against California’s AB 2098 (Sec. 2270 of Business and Professions Code). This was the “misinformation” law that threatened physicians with the loss of their licenses if they disagreed with the official “scientific consensus” on Covid-19. Then magically, this Covid misinformation law was quietly repealed by a late amendment provision (sec. 19) to Senate Bill 815.

In today’s episode, my guest and I will talk about medical opinions, medical consensus, and your overall health.

Bio

Dr. Richard Amerling is a board-certified internist/nephrologist with over 35 years of clinical experience, mostly in New York City.  In 2016, he took a position at St. George’s University and taught there until July 2021, when he refused the Covid vaccine. Dr. Amerling is Past-President of the Association of American Physicians and Surgeons. 

Navigating the Medical Maze: Strategies for Avoiding Burnout

Guest column by Virginia Cooper.

In the relentless and demanding field of healthcare, it’s all too easy to fall into the trap of burnout. As a medical professional, you are familiar with the high-stress environment and the toll it takes. Yet, there’s hope. By adopting specific strategies, you can preserve your well-being and continue to provide the best care to your patients.

Embrace Wellness Rituals

Your health is as critical as that of your patients. Integrating wellness rituals into your daily routine is not a luxury but a necessity. Think about activities that bring you joy and relaxation. Maybe it’s a morning jog, an evening of painting, or simply reading a book. Exercise not only keeps you physically fit but also serves as a mental escape from the pressures of work. Regularly engaging in hobbies can rejuvenate your spirit, making you more resilient in your professional role.

Be Conscious About Alcohol Intake

In the high-pressure world of medicine, turning to alcohol might seem like a quick fix for stress. However, moderation is key. Excessive drinking can lead to health issues and impact your ability to perform at work. If you find yourself struggling, consider seeking help. There are various treatment options in the area, with many rehab centers accepting major health insurance providers. Research facilities focusing on factors like treatment methods, location, and patient reviews to find the best fit for your needs.

Improve Decision-Making Under Stress

High-stress situations are part and parcel of medical work. Developing a strategy for making sound decisions under pressure is crucial. Before reacting, take a moment to assess the situation mindfully. This pause allows you to respond thoughtfully rather than reactively. Envision the broader implications of your decisions and trust your well-honed instincts, using the information at hand.

Building a Support Network

The path of a healthcare professional need not be a solitary journey. Building connections with peers can offer a much-needed sense of understanding and support. These relationships provide a safe space to share experiences, challenges, and advice. Engaging in conversations with colleagues who understand the unique pressures of the medical field can be both comforting and enlightening.

Consider Taking a Sabbatical

Sometimes, the best way to recharge is to step away temporarily. A sabbatical, or an extended break from work, can be a transformative experience. It offers an opportunity to rest, pursue personal interests, or engage in professional development activities without the daily pressures of patient care. This time away can provide a fresh perspective and renewed energy, ultimately benefiting both you and your patients.

Reflecting on Your Career Path

In the dynamic world of healthcare, it’s important to periodically reassess your career goals. Are you where you want to be? Is your current role fulfilling? Sometimes, a change within the medical field can reignite your passion for healthcare. Whether it’s specializing in a new area, shifting to a different facility, or even transitioning to a teaching role, these changes can provide new challenges and renewed motivation.

Mastering the Art of Saying “No”

One of the hardest but most essential skills to learn in any demanding career is the ability to say “no.” Setting boundaries is crucial for maintaining your mental and physical health. It’s okay to decline extra shifts or additional responsibilities when you’re already stretched thin. Remember, taking on too much can compromise the quality of care you provide to your patients.

Prioritizing Your Mental Health

The psychological toll of working in medicine can be significant. Regularly check in with yourself. Are you feeling overwhelmed, anxious, or depressed? Seeking professional help through counseling or therapy is a sign of strength, not weakness. Mental health professionals can provide coping strategies and support, helping you navigate the complexities of your role with resilience and clarity.

In the fast-paced, high-stakes field of healthcare, taking care of yourself is not just a personal priority—it is a professional necessity. From managing stress to seeking treatment for an alcohol issue and evaluating your career path, each step is crucial in avoiding burnout. Remember, making good decisions under stress is a skill that can be honed with practice and mindfulness. By prioritizing your well-being, you ensure that you can continue to provide the best care for your patients, day in and day out.

Virginia Cooper is a retired community college instructor. She always encouraged her students to see the real-world value in their education, and now, she wants to spread that message as wide as possible. Her hope is that Learn a Living (learnaliving.co) will be a go-to resource for adult learners embarking on starting, continuing, or finishing their education.

Image: Freepick

America Out Loud PULSE: Exploring Direct Primary Care with Dr. Kimberly Corba

From my America Out Loud Pulse podcast with Kimberly Corba, DO – https://www.americaoutloud.news/exploring-direct-primary-care-with-dr-kimberly-corba/

Going to the doctor is a necessary inconvenience, or to some, a real pain in the neck, when we are sick. Waiting sometimes weeks for an appointment adds to the irritation.

Seeing a doctor can also be a pain in the wallet. Despite employers’ sponsoring most working Americans’ health insurance, in 2023 workers this year contributed $6,575 annually toward the cost of family premium – that’s $500 more than in 2022, with employers paying the rest.

Many large employers try to save on costs by having on-site clinics where employees can get blood tests, and basic primary care needs. These clinics have reduced the use of the emergency room and improved the overall health of the workers.  This tool is now being adopted by smaller employers. Workers can be seen at a primary care clinic located near the workplaces for free versus an outside visit that is subject to a co-pay.

A troubling issue with standard health insurance is the allegedly free annual “wellness visit.” Patients are often charged for any discussion that veers from a yes or no answer to the screening questions. Real medicine is not a check-the-box endeavor.

Here is what a survey of patients who prefer independent doctors think:

  • 78% appreciate the more personal relationship with their provider
  • 60% trust these providers more
  • 58% prefer to support locally owned businesses
  • 57% say quality of care is higher

Unfortunately, it is getting more difficult to find and independent doctor. Over the last several years many physicians have either closed their private practice and started working for a health care system.

Some physicians have taken their independent practice a step farther. They have ditched insurance and are cash-based. One such model is called Direct Primary Care. The key word is “care”. The physician’s office is dedicated to patients, not health insurers. And where the patient is not a bean counter’s data point. Under the Direct Primary Care model, physicians can maintain a small, independent practice with less time on paper (computer) work and more time with their patients. In addition to time and individual attention, patients can rest assured that their private medical information stays within the walls of the doctor’s office.

My guest tonight will discuss her Direct Primary Care practice. And we will delve into the particular relevance of a strong, private patient-physician relationship as the world devolves into more turmoil.

To find a direct primary care physician:

DPC Frontier

https://aapsonline.org/direct-payment-cash-friendly-practices/

 Bio

Dr. Kimberly Corba earned her medical degree from The Philadelphia College of Osteopathic Medicine. She completed her Rotating Internship at Allentown Osteopathic Medical Center in 1994. After completing a year of Physical Medicine and Rehabilitation Residency at Temple University Hospital, Dr. Corba and then decided to pursue Family Practice and completed her Residency in 1997 at the Philadelphia College of Osteopathic Medicine. After practicing in the Lehigh Valley for 15 years, Dr. Corba opened the first Direct Primary Care office in the Lehigh Valley in 2016. She still finds time to mentor medical students and volunteer in many community activities for school, youth sports, and church.

America Out Loud PULSE: Doctors Preparing for Disasters

From my America Out Loud Pulse podcast with Jane M. Orient, MD –https://www.americaoutloud.news/doctors-preparing-for-disasters-with-jane-m-orient-md/

Natural or man-made disasters are always on the horizon. Throngs of people begging for help from government entities is a lasting memory of Hurricane Katrina. The stranded folks soon learned the local, state, and federal responses were inadequate. Over as dozen train derailments have occurred so far in 2023, some with the release of toxic cargo.  Wildfires in Maui brought sudden destruction and death.

Covid-19 and the response that had patients needlessly die, children needlessly deprived of 2 years’ worth of schooling, and economic hardship for many, while others were overworked to the point of suicide in some cases. This led a large number of our fellow Americans wonder about the competence and efficacy of government public health planning.

Of course, the other issue that Covid brings to mind is the use of biowarfare. China (who hardly can be considered our friend) is linked to a secret lab with at least 20 infectious pathogens, including bacteria that cause tuberculosis and meningitis, and viruses that cause Covid and hepatitis. Right out of a spy movie, investigators found dead mice genetically engineered to catch and carry Covid. Bioweapons do not discriminate among its victims. As we experienced with Covid, a virus can spread around the world in weeks.  This is particularly worrisome given the current drug shortage and the demonstrated ineffectiveness for preventing transmission of the Covid shots.

For a while nuclear disaster was on our minds with talk of the potential for terrorists’ “dirty bombs”. Now the war in Ukraine and increasing aggression with the U.S. now supplying cluster bombs and the deployment of troops to the region have brought back the conversation of the real threat of nuclear war. It seems we have little control over our foreign policy but we do have control over ourselves.

The most important thing to remember with disasters is that you are your own best emergency manager. No one cares more about you and your family than you.

My guest will discuss some of these issues and how to prepare for disasters.

Some resources:

 Bio

Dr. Jane Orient, MD is the Executive Director of Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943. She is also the president of Doctors for Disaster Preparedness. Dr. Orient received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. Dr. Orient’s op-eds have been published in hundreds of local and national newspapers, magazines. She has written several novels and non-fiction books, including Sapira’s Art and Science of Bedside Diagnosis in its fifth printing.

America Out Loud PULSE: Save Money on Your Medical Bills

From my America Out Loud Pulse podcast with Marshall Allen –https://www.americaoutloud.news/how-to-take-charge-of-your-medical-bills/

According to the Congressional Research Service (CRS), health spending represents 18.3 percent of our gross domestic product (GDP). Americans whether individually, through insurance, or through the government spent $4.3 trillion ($4,255.1 billion) or $12,914 per person in 2021. Out of pocket spending was 10.2 percent or $433.2 billion. Out of pocket expenses are coinsurance, deductibles, and services not covered by insurance but does not include insurance premiums.

As health expenditures grow year after year, politicians relish using costs and access as a campaign issue but only in the last few years have pushed for price transparency – that’s the buzzword of the day. Only in health care do we routinely make use of a product or service without knowing the cost beforehand. According to one study, employees who used a price transparency tool paid between 10 percent and 17 percent less than employees who did not have access to the service.

For the last few years, hospitals have been required to post online, in a consumer-friendly format, the rates they’ve negotiated with insurers for 300 common medical services. Unfortunately, these prices are written in billing jargon and hard to understand. Moreover, the prices differ within the same institution depending on whether the bill is paid by Medicare, private insurer or self-pay.

One thing we’ve learned so far with this data is that physician-owned hospitals both commercial negotiated prices and cash prices in physician-owned hospitals were about one-third lower than their competitors across eight common services and have higher quality care.

Recently, Congress has put forth a few transparency bills designed to let the consumer know the inner workings of their insurance contract. The Hidden Fee Disclosure Act (HR 4508) requires disclosure of the details of contracts of pharmacy benefit manager and third party administration services for group health plans contracts. The Health Data Access, Transparency, and Affordability Act or Healthcare DATA Act (HR 4527) would ensure that a group health plan’s fiduciaries may access de-identified information from providers, third party administrators, and pharmacy benefit mangers relating to health claims. The Transparency in Coverage Act (HR 4507) would  convert a 2019 rule into a law requiring health insurance plans to publicly share negotiated rates and cost-sharing estimates, and the number of claims that are denied, among other things.

But it could be that insurance is the root of cost evils. Even with the inappropriately named Affordable Care Act, the premiums have gotten higher every year. The average person in America pays $456 per month for marketplace health insurance.  According to the Kaiser Family Foundation (KFF), in 2021, the average cost of employee health insurance premiums for family coverage was $22,221. The average annual premium for a self-only plan was $7,739. Employers paid about 80 percent of those premiums.

Surveys published by the American Hospital Association in July 2023 looked at the effects of the practices of commercial insurers. The surveys found that some 80 percent of patients, nurses and physicians say insurer policies and practices are reducing access to medical care, driving up health care costs and increasing clinician burden and burnout.

So, what is the immediate answer for you to pay less for your medical care? My guest will discuss some tools for fighting a system that is not looking out for you.

Key websites to visit:

https://www.marshallallen.com

Newsletter – https://marshallallen.substack.com

Allen Health Academy (videos) https://www.allenhealthacademy.com

Medical Care Prices – https://www.fairhealthconsumer.org;
https://www.healthcarebluebook.com/explore-home/;
https://turquoise.health;
https://healthcostlabs.com.

Bio

Marshall Allen is a journalist who has spent more than fifteen years investigating the health care industry, exposing the insidious ways the system preys on vulnerable Americans: price gouging, sloppy billing, fraud, insurance denials, unnecessary treatment and more. He is also the founder of Allen Health Academy, which produces a curriculum of short on-demand videos to equip and empower employees to navigate the health care system. He is the author of “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.” Mr. Allen’s work has been honored with several journalism awards, including the Harvard Kennedy School’s 2011 Goldsmith Prize for Investigative Reporting and coming in as a finalist for the Pulitzer Prize for local reporting. He also has a master’s degree in Theology. Before he was in journalism, Mr. Allen spent five years in full-time ministry, including three years in Nairobi, Kenya.

America Out Loud PULSE: Freedom, Not Government Control, Is Key to Receiving Good Medical Care

From my America Out Loud Pulse podcast with Dr. Elaina George – https://www.americaoutloud.com/freedom-not-government-control-is-key-to-good-medical-care/

Our medical care is too important to leave to the politicians. Over the years, doctors and patients have been squeezed out of the policymaking process. This has resulted in the powerful driving health policy toward government control of our medical care.

Germany’s Chancellor Otto von Bismarck created the model for socialized medicine in 1883. In the face of the rising Socialist Movement, he granted the nascent socialists free medical care to mollify them. One of the first acts of the Lenin’s new Bolshevik government was to institute national health insurance. It was clear: national health insurance gave control over the population and, importantly, over physicians. Doctors are a calculated target – they tend to be free thinkers and they must be reined in.

The 1930s Great Depression gave a window of opportunity for President Franklin Roosevelt to rally Americans to support government intervention on a massive scale. Thirty-seven new government agencies and reams of regulations were born. The creation of the Old Age, Survivors and Disability Insurance, better known as Social Security was the mother of government-sponsored medicine. Roosevelt wanted national health insurance as part of his Social Security legislation but political opposition led him to drop the idea in order to get the legislation passed. On Aug. 14, 1935, the 29-page Social Security Act became law and the role of the federal government was changed forever. The Social Security Act (which includes Medicare and Medicaid) is now over 3,400 pages.

Starting in World War II, the government became more and more involved in managing our medical care. It started in 1965 with Medicare and Medicaid. Through the years more regulations, prior authorizations, and patient databases became commonplace. The stake into the heart of physician autonomy and our medical privacy was slipped into the Stimulus Bill in 2009 (The Health Information Technology for Economic and Clinical Health Care (HITECH) of 2009). In order to get full payment for physician services we had to use of electronic medical records linked to the government Office of the National Coordinator for Health Information Technology.

My guest and I will discuss what we can do to decrease costs and increase access to care while maintaining the principles of good, individualized medicine.

To find an independent physician go to the Association of American Physicians and Surgeons website, https://aapsonline.org/direct-payment-cash-friendly-practices/ and Join the Wedge (of Freedom) – https://jointhewedge.com.

To find Direct Primary Care practices: https://www.dpcfrontier.com

Bio

Dr Elaina George is a Board Certified Otolaryngologist (Ear, Nose, and Throat physician). She graduated from Princeton University with a degree in Biology and received her Master’s degree in Medical Microbiology from Long Island University. She earned her medical degree from Mount Sinai School of Medicine in New York. Dr George completed her residency at Manhattan, Eye Ear & Throat Hospital. She is the author of Big Medicine: The Cost of Corporate Control and How Doctors and Patients Working Together Can Rebuild a Better System, a book which explores how the U.S. healthcare system has evolved and explains how patients and doctors can create a healthcare system that is based on the principles of price transparency with the power of the doctor patient relationship. She currently also has a radio show, Living in the Solution.

America Out Loud PULSE: The ABCs of Drug Addiction and Treatment

From my America Out Loud Pulse podcast with Dr. Molly Rutherford –https://www.americaoutloud.com/fentanyl-is-now-the-top-cause-of-death-among-u-s-adults-drug-addiction-treatment/

Fentanyl ushered in a new era of anesthesia making outpatient surgery safe and ultimately, commonplace. In contrast to morphine or meperidine (Demerol®), fentanyl is very short-acting, allowing patients to emerge from anesthesia faster. The downside for the safety profile is that fentanyl is 100 times more powerful than morphine. Of course, anesthesiologists (unlike the vast majority of drug users) are trained professionals and are constantly monitoring a patient’s oxygen, breathing, pulse, and blood pressure.

Now that fentanyl has become a street drug, it has become a quick path to death. According to the U.S. Centers for Disease Control and Prevention (CDC), fentanyl is now the top cause of death among U.S. adults (ages 18-45)—more than COVID-19, suicide and car accidents. Out of 2022’s 105,452 drug overdose deaths, 19 percent were due to fentanyl. According to the Drug Enforcement Administration (DEA), in 2021 fentanyl killed more Americans than guns and traffic crashes combined.

How did it become so popular? Seventy-five percent of overdose deaths are due to opioids. The legal prescriptions for hydrocodone, oxycodone, oxymorphone had been the main cause of overdose deaths. But after these medications came under scrutiny and became the subjects of multiple lawsuits, fentanyl hit the streets. Fentanyl is 50 times stronger than heroin. A lethal dose fits on the tip of a pencil. And fentanyl is synthetic—meaning it can be made in a lab from chemicals. (Heroin is made from poppies). But because fentanyl is so cheap, it is slipped into other illicitly-obtained prescription pills unbeknownst to the buyer of the drug.

Fentanyl and its ingredients are mainly smuggled into the U.S. from Mexico by drug cartels and is much cheaper ($4 or $5 per pill) than other opioids ($30 per pill). Fentanyl is a very versatile drug: it can be injected, snorted/sniffed, smoked, taken orally by pill or tablet, and spiked onto blotter paper. Teens have become a large portion of its victims as fentanyl has been sold via some social media outlets. Fentanyl was identified in more than 77 percent of fatal overdoses among adolescents in the first half of 2021.

I’m disturbed that all I am hearing about is naloxone, better known as Narcan®. This drug immediately reverses the effects of narcotics. An over-the-counter version of Narcan®, a nasal spray, was approved for purchase without a prescription by the FDA in March 2023. While this may save a life in the short term, it doesn’t stop drug use. I wonder whether it will make it worse if the user knows there is a reversal. Anecdotally, what I’ve seen after working in the ER, experiencing an overdose does not scare off an addict from using drugs again.

What’s wrong with Americans that’s they consume so many mind-altering drugs? Hopefully the $50 billion in settlements by drugmakers will go to prevention of addiction in the first place.

For information on newer trends in pain management: The Pain Management Best Practices Inter-Agency Task Force Report

https://www.hhs.gov/opioids/prevention/pain-management-options/index.html

Dr. Molly Rutherford is the founder, medical director, and physician at Bluegrass Family Wellness—a direct primary care clinic in Kentucky. She is board certified in Family Medicine and Addiction Medicine, and employs a holistic approach to her patients’ physical health. She has more than a decade of experience treating opioid addiction. She was chosen to be part of the federal Pain Management Best Practices Inter-Agency Task Force.

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