On a Spring Morning in April
Hushhhh ... north winds speak ...
gently blowing through naked trees,
sweet cool air
wraps me ... face first,
mingling birdsong, brilliant eternal blue skies ...
hot sun penetrates my back.
Flowers ... few ... yellow ... forsythia ... popped open ...
rare bright spots ... mostly gray, brown and evergreen ...
many more soon to be.
Silent ... thinking ... last night ... the skies ...
bright with stars ... close ... reaching out in darkness.
Countless ... infinite, but so close ... and, how is it?
How can it be ... how can people ...
divided by countelss barriers,
feel so close?
Is it, like reaching for the stars?
No ... that is the power of love.
You are not alone.
Have a great day!
Life is Good and Life is Short, so make it as sweet as it can be, and don't hurt anybody.
Life is Love™© & StepWisely®™©
Dr. Mike
Michael F. Mascia, MD, MPH
Saturday, April 14, 2012
Tuesday, April 10, 2012
The Business of Medicine: Runaway Greed is Outrageous and Fatal
Runaway Greed: Beyond Bad Behavior, greedy criminals are now entering the Business of Medicine, with impunity?
There is a spectrum of greedy behaviors, all of which are destructive. All should be considered outrageous, targeted and eliminated by forced transparency, boycots, non profit cooperatives and legislation. Because, people are people and crooks are crooks ... the nature of the beast will allways be with us around the globe. Obviously, cutting corners for the sake of Profit over People is bad and unacceptable, even if it is "legal". While this practice is common, destructive, and bad enough, greedy psychopaths don't stop with legal crookery. Some push the matter to the edge and fall out of "bad practice" zone and into the clearly defined "illegal" zone. Some of these crooks don't get caught, or if they do, most proclaim "I have done nothing wrong", and the some slip through court scrutiny. But the ultimate of GREEDY is the group of psychopaths who, without conscience, demostrate behavior that is destructive and fatal. This obscenity is now being seen in many arenas, but the latest scam is counterfeit chemotherapeutic drugs. Must be easy pickings out there.
I have seen production pressure, generic drug substitutes, drug shortages, cuts to patient services, outrageous third party profits and other stupidity as a result of greed inside the Business of Medicine. But this latest scam is way over the line and, if fatalities occur, as a consequence of this behavior, execution of the perpetrators would not be out of line. What is it? Criminals are now entering the Business of Medicine and killing people with counterfeit drugs ... click on the link to see what the FDA has discovered.
http://blogs.fda.gov/fdavoice/index.php/2012/04/improving-the-integrity-of-the-drug-supply-in-a-global-marketplace/?source=govdelivery
Join me to BOYCOTT GREED, and encourage transparency inside the Business of Medicine. An easy start is the global food and drug industry. Require labeling that shows location of manufacture ... including the exact manufacturer on all drugs ... prescription, and over the counter.
Avoid ... AKA ... DO NOT USE any drugs, manufactured foods and supplements, unless properly labeled with all the details as to sources of all ingredients and manufacturers.
Sorry, guys ... but the good guys will have no problem with this. This will protect them and their businesses from garbage "low cost" substitutes.
Please comment, and thanks for your help.
Have a great day!
Dr. Mike
There is a spectrum of greedy behaviors, all of which are destructive. All should be considered outrageous, targeted and eliminated by forced transparency, boycots, non profit cooperatives and legislation. Because, people are people and crooks are crooks ... the nature of the beast will allways be with us around the globe. Obviously, cutting corners for the sake of Profit over People is bad and unacceptable, even if it is "legal". While this practice is common, destructive, and bad enough, greedy psychopaths don't stop with legal crookery. Some push the matter to the edge and fall out of "bad practice" zone and into the clearly defined "illegal" zone. Some of these crooks don't get caught, or if they do, most proclaim "I have done nothing wrong", and the some slip through court scrutiny. But the ultimate of GREEDY is the group of psychopaths who, without conscience, demostrate behavior that is destructive and fatal. This obscenity is now being seen in many arenas, but the latest scam is counterfeit chemotherapeutic drugs. Must be easy pickings out there.
I have seen production pressure, generic drug substitutes, drug shortages, cuts to patient services, outrageous third party profits and other stupidity as a result of greed inside the Business of Medicine. But this latest scam is way over the line and, if fatalities occur, as a consequence of this behavior, execution of the perpetrators would not be out of line. What is it? Criminals are now entering the Business of Medicine and killing people with counterfeit drugs ... click on the link to see what the FDA has discovered.
http://blogs.fda.gov/fdavoice/index.php/2012/04/improving-the-integrity-of-the-drug-supply-in-a-global-marketplace/?source=govdelivery
Join me to BOYCOTT GREED, and encourage transparency inside the Business of Medicine. An easy start is the global food and drug industry. Require labeling that shows location of manufacture ... including the exact manufacturer on all drugs ... prescription, and over the counter.
Avoid ... AKA ... DO NOT USE any drugs, manufactured foods and supplements, unless properly labeled with all the details as to sources of all ingredients and manufacturers.
Sorry, guys ... but the good guys will have no problem with this. This will protect them and their businesses from garbage "low cost" substitutes.
Please comment, and thanks for your help.
Have a great day!
Dr. Mike
Saturday, April 7, 2012
The Art of Medicine
April 7, 2012
PGY 39, Day 282
Some Preliminary and Recurrent Thoughts on The Art of Medicine
To MASTER the Art of Medicine, the Physician must learn to combine the best available science with love of People, Humanity, Life and each Patient in such a way as to do what is best for each and every patient at all times. To protect these most vulnerable of our population in time of need is to “do no harm” and to “do the right thing” at all times, as a matter of professional obligation. These fundamental operating principles are based upon long standing Medical traditions, embodied in the ancient “Oath of Hippocrates” and cemented in our minds upon graduation from medical school, at which time most, if not all of us had “taken” that Oath, in one form or another. These fundamental rules have been passed down from generation to generation, because they work for our Profession, the Doctor and the Patient. I take that Oath seriously.
It is said that it takes 10,000 hours to become a MASTER craftsman, and it certainly takes years of experience beyond medical school and post graduate training, to gain Mastery in Medicine. After this, the MASTER PHYSICIAN should be well prepared to put his or her talents to work for the OPTIMAL benefit of EACH PATIENT BEING SERVED. Easily said, but not so easily done … and as time goes on, it is harder and harder to SERVE PATIENTS as we are trained and obliged to do. Why? Third party interference and the Business of Medicine make it increasingly difficult and sometimes impossible for Physicians to meet Professional Obligations. In other words, to put it bluntly, The Profession of Medicine, The Art of Medicine, The Practice of Medicine and The Doctor Patient Relationship have all been hijacked by the Business of Medicine to increase profits and/or “cut costs”. Thus, each Physician’s professional obligation to carry out the Oath is often in conflict with the third party driving forces in the American Medicine Marketplace we know today. To be continued ...
Have a great day!
Dr. Mike
Friday, March 23, 2012
Reiteration and Update of "Open Letter to President Obama: The Business of Medicine is Killing the Doctor Patient Relationship
The Business of Medicine: For profit and non profit corporations (third parties) hijack the Doctor Patient Relationship and take 30 - 60 % of Health Care Money Out of the Patient Care Pot
The Information is slowly making it out to the general public.
A Recent Wall Street Journal Publication
Why America's Doctors Are Struggling to Make Ends Meet - WSJ.com
and Letters to the Editor that followed
Private-Practice Medicine Is a Threatened Occupation — Letters to the Editor - WSJ.com
are consistent with my previously published views.
But it is now time to reiterate for purposes of reinforcement. Below are the letters as they had originally been posted in 2009.
>>
Open Letters to President Obama
“Such a pessimist … you are,” I said to my college friend and fellow physician in a recent email. The email continued as follows.
Here are the facts:
1. We … physicians have chosen to apply and lock to our wrists, the golden handcuffs created by third parties … not the least of which is the federal government.
2. When NON PHYSICIANS and PHYSICIA N EXECUTIVES (not frontline boots on the ground guys and gals) dictate the care we provide and TAKE MONEY away from the frontlines of patient care … on our backs, nurses’ backs and patients’ backs … they take the money, put it in their pockets and into shareholders’ pockets … and when that happens everybody suffers, especially the patients.
3. When physicians bicker, everyone loses … including, but not limited to … Patients, Doctors, Nurses, Hospitals, and the larger community.
4. Physicians have more power than any group in the nation, but many are COWARDS, and they do not know how to work together toward their primary mission … which is … or should be … provision of optimal patient care.
5. I say, change the paradigm and get all the middle men out of the picture … the ones who have hijacked medicine for the sake of greed … the ones who steal about 30% of the healthcare dollars away from the frontlines of patient care. I say … let’s unite with the patients and create a new paradigm that works … for all of us. After all, we are all patients, too. I am thinking of a cooperative model.
6. If we can get 10% of the population to join a cooperative/joint venture with 10% of the docs and nurses, we should be able to reduce healthcare costs for the group by about … at least … 30% and that should easily be self-sustaining.
The hijackers … with our help … and with the help of bribes … have created the categorical “Dysintegrated and Disintegrated Healthcare” that we now know so well. These third parties have stolen millions of dollars away from frontline patient care, and they want to dictate the way physicians provide care. We, physicians and patients, need to take the power and the money back, but that can only be done when we ALWAY S PUT PATI ENTS FIRST.
Bottom line is this … Priorities are Patients, Patients and Patients. Cooperation among docs, and among Doctors, Patients and Nurses; then, after cooperation comes definition of minimum performance standards for patient care and PUSHING THE THIRD PARTI ES OUT OF THE BUSINESS OF HEALTHCARE . That should free up a minimum of 30% of every healthcare dollar … and, if it is put back into the frontline care of patients, we should realize costs savings in the 50-75% range.
Interested in helping to solve the problem? Click on the link [GJC1]to join me and others in the process of taking back the healthcare business from the hijackers.
Ciao for now,
MFM
President
Infinity Health Solutions
www.ihealsolutions.com
Here are the facts:
1. We … physicians have chosen to apply and lock to our wrists, the golden handcuffs created by third parties … not the least of which is the federal government.
2. When NON PHYSICIANS and PHYSI
3. When physicians bicker, everyone loses … including, but not limited to … Patients, Doctors, Nurses, Hospitals, and the larger community.
4. Physicians have more power than any group in the nation, but many are COWARDS, and they do not know how to work together toward their primary mission … which is … or should be … provision of optimal patient care.
5. I say, change the paradigm and get all the middle men out of the picture … the ones who have hijacked medicine for the sake of greed … the ones who steal about 30% of the healthcare dollars away from the frontlines of patient care. I say … let’s unite with the patients and create a new paradigm that works … for all of us. After all, we are all patients, too. I am thinking of a cooperative model.
6. If we can get 10% of the population to join a cooperative/joint venture with 10% of the docs and nurses, we should be able to reduce healthcare costs for the group by about … at least … 30% and that should easily be self-sustaining.
The hijackers … with our help … and with the help of bribes … have created the categorical “Dysintegrated and Disintegrated Healthcare” that we now know so well. These third parties have stolen millions of dollars away from frontline patient care, and they want to dictate the way physicians provide care. We, physicians and patients, need to take the power and the money back, but that can only be done when we A
Bottom line is this … Priorities are Patients, Patients and Patients. Cooperation among docs, and among Doctors, Patients and Nurses; then, after cooperation comes definition of minimum performance standards for patient care and PUSHING THE THIRD P
Interested in helping to solve the problem? Click on the link [GJC1]to join me and others in the process of taking back the healthcare business from the hijackers.
Ciao for now,
MFM
President
Infinity Health Solutions
www.ihealsolutions.com
Another in a Series of Open Letters from Dr. Mike to President Obama
Hearings to address impact of medical helicopter industry’s business structure on air safety, medical care.The New York Times (2/3, B1, Meier) reports that “the National Transportation Safety Board on Tuesday will begin four days of hearings,” during which “safety advocates are expected to demand a crackdown on the medical helicopter industry, a fast-growing and loosely regulated business with annual revenues estimated at more than $2.5 billion.” Instead of “focusing solely on the causes of accidents, the hearing will also consider the impact of the industry’s business structure on both air safety and medical care.” Some “safety advocates say necessary changes include tighter federal and state regulation.” Meanwhile, “industry officials say that they recognize a need for some safety mandates, including rules governing flights at nighttime,” but say “that companies should be free to choose the technologies best suited to their operations.” The Times notes that during “the last decade, the industry has doubled in size while undergoing a business transformation.” Although “hospitals used to be the primary operators of such helicopters, they now largely outsource that work to commercial operators.”
The above helicopter issue is another example of a great opportunity for Federal, State and Local Governments to spend federal money well … to COOPERATE in efforts to promote Public Health and Safety. Government monitors and operators under the military, coast guard, and Public Health Service should be cooperating with the private sector to GUARANTEE that transportation for critically ill and injured patients meets minimum performance standards, equivalent to, or better than the tightest of military and commercial airline standards. This is a no brainer … and again, when talking about salaries and profits, put a CAP on both SALARIES and BENEFITS! They (the Feds) are talking about caps for bankers, now, and they are talking about billions to be dumped into the healthcare sector. So, to prevent similar and ongoing greed and robbery in the healthcare sector, now, while talking about spending additional billions on healthcare, put the caps on healthcare executives’ salaries and corporate profits … otherwise the money will go down the drain … or should I say into the executive and shareholder pockets. They have already joined the rip off bandwagon, and when the Government starts to unload money into the healthcare sector, you can be certain they will be there shoveling as much as possible into their pockets.
Also, while talking about infrastructure projects for the nation as a part of the economic recovery plan, think about this: development of a secure health information network … to be used exclusively by registered healthcare providers and their patients … for the exchange of privileged information … not storage … exchange ONLY.
And, while thinking of delivering casualties safely, why not think of an integrated system?… And don’t forget the need for a real Disaster Preparedness Network that will be composed of frontline providers … the Doctors and Nurses who now take care of the casualties.
Tune in for more ideas and opinions and ciao for now,
Dr. Mike
Proposed legislation prohibits Medicare payments to new physician-owned hospitals
The Wall Street Journal (1/22, Martinez) reports, “A bill making its way through Congress to provide more low-income children with health-insurance coverage could spell financial trouble for scores of hospitals owned by physicians.” The proposal would “prohibit ‘the unethical kickbacks that physicians receive from ownership hospitals,’” Rep. Pete Stark, chairman of the House Ways and Means health subcommittee, said. The children’s health insurance bill “was passed by the House last week” and included a provision that “would effectively put a halt to the construction of any new doctor-owned hospitals.” Brett Gosney, president of Physician Hospitals ofEditorial Comment: My take on the above is this. LEGISLATORS think it is OK for non-physicians to make money from a hospital, but it is not OK for physicians to make money from a hospital. Why not BAN for-profit hospitals and for-profit insurance companies, or put a cap on salaries and profits? Level the playing field. In my opinion, nobody should be allowed to make excess profits on the backs of the sick. Right now, for-profit hospitals and insurance companies allow executives, and shareholders to walk away with excess “profits” by restricting the care provided to the sick patients for whom they are supposed to provide coverage.
Have you ever had trouble when trying to file or get reimbursement for a healthcare claim? Let us know.
Dr. Mike
Open Letters to President Obama About Health and Healthcare
President Obama:Congratulations! … and let the work begin.
Before Bill Clinton was first elected, I wrote to him and gave him a few ideas that might help with funding for patient care related to behaviors that cause health problems. I suggested that adding “healthcare” taxes to tobacco, alcohol, motor cycle licensing, auto licensing, road use, “unhealthy” foods and other high risk products and behaviors might provide a disincentive for some maladaptive behaviors associated with the health problems we see so often and the funds generated could help pay for the healthcare of the casualties. But, that was long ago, and although some of that work was done by Clinton and others, much more of it needs to be done, and, of course, there is the larger healthcare arena. The letters that follow will reflect my opinion(s) on the subject: Reforms needed to improve the quality of healthcare … to which I have dedicated my career since graduation from medical school more than 30 years ago.
Thanks and ciao for now,
Dr. Mike
Michael F. Mascia, MD, MPH
President, Infinity Health Solutions
COMMENTS:
The letters will focus on the following subjects, and more.
1. Compassion without knowledge is dangerous! Encourage Comprehensive Smart Card Development and use. Get Advanced Directives Done and be careful about who you pick as a healthcare proxy. DO NOT PUT PATIENT DATA IN CENTRAL DATA BANKS. Put the data on the smart cards that the patients hold and in patients’ computers and in provider (doctor and hospital) computers. Government should make the “health net” for secure transfer of the information. Do not leave it to the private sector …
2. Restore the Doctor-Patient Relationship: Government Should Encourage Moves toward Doctor-Patient Cooperatives in which responsibility for healthcare is appropriately shared by, rather than imposed, upon the patients.
3. Eliminate the MIDDLE MEN: More than 30% of the healthcare dollars are wasted in profit to shareholders, executives and other non-providers who know nothing about providing quality care and take money out of the process of providing quality care.
4. The for-profit system is incompatible with quality healthcare: Greed and the beancounters will take the money out of the business of providing quality care.
5. Insurance is for the insurance companies … not patients: Another example of profit over quality because these people working in insurance companies are there to do everything in their power to keep every dime they collect. They know nothing about quality healthcare, and do not intend to pay for your healthcare services, despite the fact that you give them your hard earned cash. Get them out of the picture!
More to come!
Ciao for now,
Dr. Mike
Raise the bar on Quality and Performance improvement
Quality and Performance Improvement can be combined with Cost Containment. In other words, the best care is the most cost effective care and cost containment can be achieved while simultaneously improving quality. Past efforts have separated these goals and cost containment has always been an obtuse way to increase short-term hospital profits … or limit losses. However, these shortsighted “for-profit” goals have always sacrificed quality and service … and to what end? … lower quality of care.
Of course, these moves are always based upon the advice of the same “business oriented” consultants who have gone through the industry like a wave since 1985 … the year that insurers started to squeeze reimbursement to hospitals.
You can see that the results of their disastrous recommendations are ubiquitous in the healthcare arena … they took the care out of the healthcare industry and now is the time to put it back and here are the fundamental principles.
1. All quality improvement (QI) activities should have a simple goal: improved patient outcome.
2. All quality improvement activities should be designed with scientific rigor.
3. Cost containment should never be isolated from quality and performance improvement strategies.
If you want to see an example of one QI-PI-Cost Containment project, see my article in Critical Care Medicine, July 2000:
Pharmacoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care.
Clinical Investigations
Critical Care Medicine. 28(7):2300-2306, July 2000.
Mascia, Michael F. MD, MPH; Koch, Manfred MD; Medicis, Joseph J. PharmD, BCPS
Abstract:
Objective: To determine the cost-effectiveness and safety of a set of rational use guidelines for analgesia, sedation, and neuromuscular blockade in critically ill ventilated patients when compared with similar factors in standard prescribing.
Ciao for now,
Dr. Mike
United Healthcare/Health Insurance Scams
This is a letter I sent to United Healthcare when they denied coverage for my lab tests last year. They still refuse to pay … even though I had paid them thousands of dollars over the many years of coverage, and I had NEVER previously made a claim for coverage.
Here is my letter to United Healthcare. I will see if I can find their response, and, if I can find it, I will include it in a future blog.
Michael F. Mascia, MD, MPH
Infinity Health Solutions
United Healthcare Insurance Company
United Healthcare Appeals
Ladies and Gentlemen:
It is my understanding that you have denied the claim for medical services rendered to me on September 20, 2007 , as shown on the attached “Explanation of Benefits” sheet. I was told that this is a penalty for not using an HCA facility. These services were right and necessary services provided by Bridgton Hospital Maine Bridgton Hospital
If, for some reason, you are still unwilling to pay for the services rendered, please contact me @ — — —-. I will also need written confirmation as soon as possible, so that I can be sure to get the proper word out on United Healthcare Insurance Company. And, if, in the future, you would like me to travel to Portsmouth , New Hampshire
Have a nice day.
Dr. Mike
Top 10 for Healthcare Reform
Back to Basics in Healthcare: Put the care back in and take the bureaucracy back out … put the money back into the care of patients and take it away from the executives, bureaucrats and corporate shareholders.
1. Restore the Doctor-Patient Relationship
2. Eliminate the middlemen in the reimbursement rip off.
3. Eliminate non providers from leadership positions in healthcare (use boots on the ground providers only for all health services administration).
4. Eliminate the for-profit option from healthcare institutions.
5. Eliminate the for-profit option from health insurance carriers.
6. Enable and facilitate Doctor-Patient cooperatives as an alternative to traditional insurance.
7. Establish government sponsored “catastrophic” health insurance.
8. Facilitate health savings plans as coverage for routine healthcare.
9. Government coverage for basic care via health savings plans.
10. Run pilot programs on all new government sponsored and government enabled programs so as to avoid massive and expensive programs that do not work. Small programs can be fine tuned and “perfected” before they are disseminated.
11. Fund healthcare for maladaptive behaviors with proper taxes.
True … It Is Bad and My Comments on NY Times Article
This is a copy of a piece of a NY Times article … outlining at least a part of the problem caused by categorical programs designed by beancounters to get money from third party payers, rather than focusing on providing care to patients. This has caused what I call the “disintegrated healthcare system” which is not a healthcare system at all. It is, rather, a collection of small factories designed to “process people and diseases” in an effort to make money for lay executives and shareholders. Put the money back into the hands of the caregivers and back into the care of the patients. Healthcare reform is another term for moving more money away from the care of the patients. Here ya go …
The NY Times calls overall US healthcare performance “abysmal.” In an editorial, the New York Times (11/18, A26) highlights the problems chronically ill Americans face in comparison with seven other industrial nations as detailed by the Commonwealth Fund report, calling it “the latest telling evidence that the dysfunctional American healthcare system badly needs reform.” The Times argues the study shows high quality healthcare is available “at a handful of pre-eminent medical centers, but is unavailable “to a huge portion of the population.” The US
How to Put CARE back into the HEALTHCARE system
By Dr. Mike. Nov. 18, 2008 at (Updated Nov. 18, 2008 at )
I have several things on a “to do list,” but the fundamental principle is very simple. All hospital and healthcare administration needs to be done by the frontline, boots-on-the-ground patient care providers. Yes … that’s correct, I did say ALL and this is why. Non-providers (be they doctors, nurses, or lay administrators) are disconnected from the problems they create in their efforts to MAKE AND SAVE MONE Y TO PUT INTO THEIR POCKETS AND THE POCKETS OF SHAREHOLDERS. They do not understand, or they have lost the capacity to understand, the problems they cause in these efforts. In essence, they lose sight of or DON ’T CARE ABOUT the needs of the patients, and this problem can be eliminated by requiring a minimum of 20% frontline patient care time from all members of any hospital administration. For example, all nurse administrators would be required to provide bedside care of patients at least one day per week and all physician administrators would be required to provide bedside care of patients at least one day per week, and all non-provider administrators would be asked to leave.
All non-providers should be removed from executive positions in hospitals and other healthcare institutions … take the crooks, money grubbers and other greedy folks out of healthcare systems administration and put a cap on greed as a motivator. Unfortunately, it was the government under Clinton
Ciao for now,
Dr. Mike
Information Technology is not the solution.
By Dr. Mike Nov. 22, 2008 at (Updated Nov 22, 2008 at )
Regarding the report Joint Commission statement below … the Joint Commission and their “panel of experts” is just plain wrong. The solution is boots on the ground and back to basics … at the bedside patient care … more experienced nurses and doctors who care … more care at the bedside and LESS technologic interference with bedside care. Technology does not provide patient care, and, in fact, it gets in the way of good patient care. Information is useful and necessary, but most of the essential information needed comes from patient and/or family. This IT phase is another example of noise that creates more and more barriers … barriers that interfere with proper bedside care that is delivered by dedicated doctors and nurses. Hospitals and Governments want to lower the costs of healthcare … get rid of “panels of experts” and get experts who actually provide the care on the frontlines.
More to come on the deterioration of the Doctor-Patient relationship noted over the last 35 years.
MFM
Medicine by the Numbers is Painting an Unacceptable Picture
By Dr. Mike Nov. 26, 2008 at (Updated Nov. 26, 2008 at )
Do you remember those “Paint by the Numbers” kits we used when we were kids? Have you ever used one? Have you seen the results? Sure, on the cover they show a masterpiece partly completed to perfection by the numbers.
Then, you or your child eagerly rips the kit open in anticipation and rushes to create your own copy of the masterpiece. You paint away by dutifully dipping your brush into each little container and carefully applying each color in the proper spot … yes, “according to the numbers.” After hours of careful work you have finished … ah … and you hold your finished product up to stare in admiration … only to find that you have created something that, at best, only grossly resembles the masterpiece. The finished product is most likely gross; a very disappointing and poor representation of the real masterpiece upon which the kit is based.
When I stand back and look at the products we deliver in American medicine today, it is only rarely that I see a true masterpiece … the work of a master craftsman. Frankly, I am often grossed out by what I see. Why? Currently, American Medicine is done “by the numbers.”
What do I mean? Modern American medicine is driven by reimbursement and not by patient needs, so many patients fall through the cracks. Hospitals and other care systems have clearly been forming their organizational structures and operational strategies based upon the “return on investment” and other production principles … the same business systems that drive factories, assembly lines and factory workers. Nothing against return on investment, production principles, business systems, factories, assembly lines and factory workers, but the model simply does not work in healthcare.
When I started working as a Critical Care Anesthesiologist at Tulane University Hospital
(CONTINUED(C) MFM@IHS)
Sunday, March 11, 2012
Messing with my clock again: SPRING AHEAD??? What?
PGY 39, Day #254
MESSING WITH MY (BIOLOGICAL) CLOCK AGAIN:
Part 2 Spring ahead?
One hundred and twenty-five days ago, they told us to move the clock back one hour, and now they are telling us to move it forward one hour? Makes no sense to me. To whom does it make sense? Is it a business decision? Why do we do this to ourselves, and what should we do to adjust when they "Mess with our BIOLOGICAL CLOCK?
It takes weeks to recover from/adjust to the clock change, and the loss of an hour's sleep. My recommendation is that you go to sleep "early" for several days to weeks, till you notice that your biological clock has synchronized with the change in the mechanical clock. My November 7, blog post (below) explains the fundamentals of circadian rhythm and the references will give you ALL the details.
Have a great day and StepWisely(R).
Dr. Mike
>>Monday, November 7, 2011
Mission: Healing November 7, 2011 Messing With The Clock
PGY 39, Day 129
THEY ARE MESSING WITH MY (BIOLOGICAL) CLOCK AGAIN:
AKA, I am Falling Behind Again
There is a natural rhythm to life and the universe, and that rhythm is synchronized. As a part of that system, animals (yes, including humans) have day-night cycles called circadian rhythm. This rhythim dictates many fundamental physiologic functions ... most notable of which are the day-night/sleep wake cycle.
(Reference link: http://www.nigms.nih.gov/Education/Factsheet_CircadianRhythms.htm)
(For Detailed Scientific Evidence see:The Clocks That Time Us by Moore-Ede, Sulzman and Fuller)
In other words, our natural rhythm, or biological clock is dictated by day and night, light and dark, or, in other words, SUNSHINE! Every time we arbitrarily "change the clock", we are "messing with" COUNTLESS HUMAN BIOLOGICAL CLOCKS, because our CLOCK TIME is NOT SYNCHRONIZED with SUN TiME. That is CRAZY! Why ON EARTH (:-)) would we not synchronize our MECHANICAL CLOCKS with the SUN? Stupid!(?) We have always done it that way? NO ... that is not at all true.
Disregard of facts about our circadian rhythm and the sun might have been excusable 100 years ago, but today, it is absolute nonsense. What effort would it take to keep the clocks all around the world synchronized with the sun? Very little extra effort. What would the cost be? I have no idea, but the benefit, I am certain, would be enormous with regard to human well being and performance.
Who benefits by maintaining the status quo? Frankly, I don't know. It seems as if this clock changing nonsense is just one of those "we have always done it that way" sort of things. Isn't it TIME for us to be SMART about Clocks, Sun rhythm and circadian rhythm? Let's start a move to synchronize mechanical clocks with the sun ... it would be good for our natural rhythm. I think the music would sound better, and, besides, what do we have to loose?
StepWisely(R) and have a good day.
Dr. Mike
PS. IF, there is some reason why machine time MUST be different from SUN TIME, or EARTH ROTATION TIME, then, at least give us both times on every clock.
PPS. And, for the advocates of this clock change nonsense, explain yourself, please!
Posted by Dr_Mike_IHS at 9:25 AM
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Dr_Mike_IHS
Michael F. Mascia, MD, MPH President: Infinity Health Solutions (C)All Material is protected by copyright law
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MESSING WITH MY (BIOLOGICAL) CLOCK AGAIN:
Part 2 Spring ahead?
One hundred and twenty-five days ago, they told us to move the clock back one hour, and now they are telling us to move it forward one hour? Makes no sense to me. To whom does it make sense? Is it a business decision? Why do we do this to ourselves, and what should we do to adjust when they "Mess with our BIOLOGICAL CLOCK?
It takes weeks to recover from/adjust to the clock change, and the loss of an hour's sleep. My recommendation is that you go to sleep "early" for several days to weeks, till you notice that your biological clock has synchronized with the change in the mechanical clock. My November 7, blog post (below) explains the fundamentals of circadian rhythm and the references will give you ALL the details.
Have a great day and StepWisely(R).
Dr. Mike
>>Monday, November 7, 2011
Mission: Healing November 7, 2011 Messing With The Clock
PGY 39, Day 129
THEY ARE MESSING WITH MY (BIOLOGICAL) CLOCK AGAIN:
AKA, I am Falling Behind Again
There is a natural rhythm to life and the universe, and that rhythm is synchronized. As a part of that system, animals (yes, including humans) have day-night cycles called circadian rhythm. This rhythim dictates many fundamental physiologic functions ... most notable of which are the day-night/sleep wake cycle.
(Reference link: http://www.nigms.nih.gov/Education/Factsheet_CircadianRhythms.htm)
(For Detailed Scientific Evidence see:The Clocks That Time Us by Moore-Ede, Sulzman and Fuller)
In other words, our natural rhythm, or biological clock is dictated by day and night, light and dark, or, in other words, SUNSHINE! Every time we arbitrarily "change the clock", we are "messing with" COUNTLESS HUMAN BIOLOGICAL CLOCKS, because our CLOCK TIME is NOT SYNCHRONIZED with SUN TiME. That is CRAZY! Why ON EARTH (:-)) would we not synchronize our MECHANICAL CLOCKS with the SUN? Stupid!(?) We have always done it that way? NO ... that is not at all true.
Disregard of facts about our circadian rhythm and the sun might have been excusable 100 years ago, but today, it is absolute nonsense. What effort would it take to keep the clocks all around the world synchronized with the sun? Very little extra effort. What would the cost be? I have no idea, but the benefit, I am certain, would be enormous with regard to human well being and performance.
Who benefits by maintaining the status quo? Frankly, I don't know. It seems as if this clock changing nonsense is just one of those "we have always done it that way" sort of things. Isn't it TIME for us to be SMART about Clocks, Sun rhythm and circadian rhythm? Let's start a move to synchronize mechanical clocks with the sun ... it would be good for our natural rhythm. I think the music would sound better, and, besides, what do we have to loose?
StepWisely(R) and have a good day.
Dr. Mike
PS. IF, there is some reason why machine time MUST be different from SUN TIME, or EARTH ROTATION TIME, then, at least give us both times on every clock.
PPS. And, for the advocates of this clock change nonsense, explain yourself, please!
Posted by Dr_Mike_IHS at 9:25 AM
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About Me
Dr_Mike_IHS
Michael F. Mascia, MD, MPH President: Infinity Health Solutions (C)All Material is protected by copyright law
View my complete profile
Thursday, January 26, 2012
Mission: Healing January 25, 2012
PGY 39, Day 208
Take home message: Never ... that's right, NEVER cut corners in health care. The only exception to this rule would be triage in a disaster situation. In that case, resources are allocated to those who are likely to "make it". Surge capacity and disaster preparedness should be a routine part of hospital structure and function, but it generally given lip service and window dressing to save on costs.
Doing the Right Thing: The Right to Do VS the RIght Thing to Do
How many times have you heard or seen the words "I have done nothing wrong" flowing repeatedly from the mouths of those accused of wrong doing? Well, they seem to be fairly common words from my perspective. A Google search today came up with many pages reflecting the frequency of the phrase. Check it out ...
http://www.google.com/search?q=%22I+have+done+nothing+wrong%22&ie=UTF-8&oe=UTF-8&hl=en&client=safari
What are the jokers who spew these words actually saying? My translation is this: "I really don't care what you think, I have no guilt or remorse (I have no conscience), and have not been proven guilty of breaking any law." While it may be a fact that many of these speakers of innocence are not (yet) proven guilty of misbehavior after further scrutiny, or in a court of law, and some may truly be innocent. And, what are they thinking? These folks rarely talk about the thought process that enables them to do things that they have the right to do, or can do, even though they are not doing the right thing. Why the disconnect? No conscience? This common statement of innocence, "I have done nothing wrong", belies the shady behavior that is absolutely wrong, but may be easy to get away with in the dark, or when in a powerful position. If you don't catch them and prove it in the light of day, or in court, they can and do get away with it ... and they will continue their misbehavior till forced by law or others to quit. Hence the need for transparency. I see transparency as a (perhaps poor) substitute for honesty (including intellectual honesty) and integrity, because the later two are so uncommon. In any case, what are these self proclaimed "inocent" people thinking? What kind of examples do these people (in leadership positions) set for the rest of us and for our children? My observations, based upon personal experience, reading and formal training, lead me to several conclusions ... which are simply the start of a long, ongoing conversation on Doing the Right Thing: honesty, integrity and transparency.
To do The Right Thing, or not to do The Right Thing? That is the question. Or, What is the price of your Integrity?
Why is it that so many seem to have difficulty recognizing the difference between right and wrong? Why is this line so blurry? Is it really blurry? Is that a matter of convenience? Is it greed? Why is it that so many seem to think it is OK to do whatever they want, as long as you don't get caught? These are questions that used to perplex me, but not so much any more. The disconnect between word and deed is very common. In fact, this disconnect is so common as to be ordinary, not extraordinary. What is it about? What can be done about it? Let's look a little deeper.
Generally, it is about a lack of personal integrity, and a willingness to cut corners on "the right thing" (ethics, morality and sometimes legality) for personal gain. This is, regrettably, very common. What is the price of your integrity? Will you cut corners to keep your job? When your boss pushes you to do something that you know is not right, are you going to do what he/she says, or risk loosing your job? I have seen this sort of stuff regularly during my years of life and work. Let's look at some examples that I have seen over the years during my medical career.
There is always an "excuse" for the bad behavior!
Example A: Hospital Excuses for Bad and Self Destructive Behavior
Around 1985 there was a malpractice "crisis". In other words, around this time, it became difficult for some physicians to get malpractice insurance. So, when some doctors went "bare", some hospitals went nuts. Driven by fear (self protection) that their own personal assets would be at risk, some hospital administrations and boards refused to change their policies to allow uninsured docs to keep working in their hospitals (wrong) while other hospitals "did the right thing", and changed their policies so that the doctors could continue to care for patients. In this example, "Doing the right thing" benefits the patients and the hospital by allowing patients to be cared for in their own community, and by keeping hospital revenue up to par. So, what is behind the flawed thinking in this case? Fear of personal financial risk originated in the administration and spread to the board of trustees of the "wrong" hospital. So, fear trumped reason and drove the hospital to do the WRONG THING. What else could these "WRONG" hospitals have done? StepWisley(R) and come up with a rational strategic plan for dealing with the problem in cooperation with the physicians.
Example B: Hospital Plunges into Mediocrity to Keep Control; AKA Blowing a Hole in the Bottom of Your Boat to Save the Ship
This is a beauty! Following the malpractice crisis talked about above, the following misbehavior was noted. A hospital administration and Board of Trustees recruited a marginally competent young surgeon from a nearby residency program to lessen the power of the competent, well respected surgeon who routinely filled the hospital with patients. Guess what happened? Young New surgeon (who was an operative from a competing hospital) torpedoed the ship! Ultimately, his efforts failed and he torpedoed himself, but for several months, hospital occupancy was at an all time low. What had been a very busy and well run Non Profit organization was failing, because the Administration and Board of Trustees was unable to work properly, could not support its medical staff and could not accept the proper authority of the medical staff. From that point on, the hospital slipped and ultimately needed a bailout from/merger with a larger hospital about 40 miles away. So, the the local community lost control and quality driven by the local community.
Example C: Department Chairman "cuts corners" and gets away with it
In this example, a Department Chairman walked away from his supervisory role with residents and actually left the hospital while he was supposed to be supervising. This behavior was so outrageous, that it came to the attention of proper authorities. During the investigation that followed, he admitted to "cutting corners" but he was able to slip out of any disciplinary action. How he got out of it, I don't know, but I don't think he ever made that mistake again. The real question is this: How could justify the behavior ... how could he conjure up a thought process that would twist such blatant misbehavior in such a way as to think it was acceptable?
Example D: Hospital Stupified by Y2K ... a prolific excuse for bad behavior among hospital administrators.
This situation was noted when I arrived to take a new position in the Summer of 1999. The preoccupation with Y2K nonsense by hospital administration was so outrageous as to be comical, but it consumed all their energy, and the consequences were not funny. The situation was so bad that we could not get attention for any real front line problems, and that repeatedly put patients at risk. We could not get proper equipment and we could not get the hospital to address any problems. To combat this stupidity, we were forced to take pictures of faulty equipment and we threatened to supply videos to the local TV stations, if they did not take proper action. When the hospital safety officer was presented with our documentation "book" that was prepared for the next JCAH visit, he flipped through it with a stone face and, at the end he said, "Can you loose the pictures?"
Example E: Department Chairman Refuses to Acceopt a Solution to His Problem
Perplexing at best, this guy asked me to help solve a problem that threatened to destroy the integrity of and quality of care in HIS Department. I did the job over several days by working with the entire faculty, came up with a solution acceptable to all and handed it to him in a nice neat package. He then said, "We are not going to do this." Shortly thereafter, he was replaced, and OUR solution has worked smoothly for more than 10 years. What was he thinking?
Example F: Katrina Stories (before, during and after Katrina)
Example G: The "Financial Crisis" Bad behavior today that use the the current financial situation as an excuse
Example H: Department Chairman Doing things "because he can" (get away with it?)
To be continued ...
Take home message: Never ... that's right, NEVER cut corners in health care. The only exception to this rule would be triage in a disaster situation. In that case, resources are allocated to those who are likely to "make it". Surge capacity and disaster preparedness should be a routine part of hospital structure and function, but it generally given lip service and window dressing to save on costs.
Doing the Right Thing: The Right to Do VS the RIght Thing to Do
How many times have you heard or seen the words "I have done nothing wrong" flowing repeatedly from the mouths of those accused of wrong doing? Well, they seem to be fairly common words from my perspective. A Google search today came up with many pages reflecting the frequency of the phrase. Check it out ...
http://www.google.com/search?q=%22I+have+done+nothing+wrong%22&ie=UTF-8&oe=UTF-8&hl=en&client=safari
What are the jokers who spew these words actually saying? My translation is this: "I really don't care what you think, I have no guilt or remorse (I have no conscience), and have not been proven guilty of breaking any law." While it may be a fact that many of these speakers of innocence are not (yet) proven guilty of misbehavior after further scrutiny, or in a court of law, and some may truly be innocent. And, what are they thinking? These folks rarely talk about the thought process that enables them to do things that they have the right to do, or can do, even though they are not doing the right thing. Why the disconnect? No conscience? This common statement of innocence, "I have done nothing wrong", belies the shady behavior that is absolutely wrong, but may be easy to get away with in the dark, or when in a powerful position. If you don't catch them and prove it in the light of day, or in court, they can and do get away with it ... and they will continue their misbehavior till forced by law or others to quit. Hence the need for transparency. I see transparency as a (perhaps poor) substitute for honesty (including intellectual honesty) and integrity, because the later two are so uncommon. In any case, what are these self proclaimed "inocent" people thinking? What kind of examples do these people (in leadership positions) set for the rest of us and for our children? My observations, based upon personal experience, reading and formal training, lead me to several conclusions ... which are simply the start of a long, ongoing conversation on Doing the Right Thing: honesty, integrity and transparency.
To do The Right Thing, or not to do The Right Thing? That is the question. Or, What is the price of your Integrity?
Why is it that so many seem to have difficulty recognizing the difference between right and wrong? Why is this line so blurry? Is it really blurry? Is that a matter of convenience? Is it greed? Why is it that so many seem to think it is OK to do whatever they want, as long as you don't get caught? These are questions that used to perplex me, but not so much any more. The disconnect between word and deed is very common. In fact, this disconnect is so common as to be ordinary, not extraordinary. What is it about? What can be done about it? Let's look a little deeper.
Generally, it is about a lack of personal integrity, and a willingness to cut corners on "the right thing" (ethics, morality and sometimes legality) for personal gain. This is, regrettably, very common. What is the price of your integrity? Will you cut corners to keep your job? When your boss pushes you to do something that you know is not right, are you going to do what he/she says, or risk loosing your job? I have seen this sort of stuff regularly during my years of life and work. Let's look at some examples that I have seen over the years during my medical career.
There is always an "excuse" for the bad behavior!
Example A: Hospital Excuses for Bad and Self Destructive Behavior
Around 1985 there was a malpractice "crisis". In other words, around this time, it became difficult for some physicians to get malpractice insurance. So, when some doctors went "bare", some hospitals went nuts. Driven by fear (self protection) that their own personal assets would be at risk, some hospital administrations and boards refused to change their policies to allow uninsured docs to keep working in their hospitals (wrong) while other hospitals "did the right thing", and changed their policies so that the doctors could continue to care for patients. In this example, "Doing the right thing" benefits the patients and the hospital by allowing patients to be cared for in their own community, and by keeping hospital revenue up to par. So, what is behind the flawed thinking in this case? Fear of personal financial risk originated in the administration and spread to the board of trustees of the "wrong" hospital. So, fear trumped reason and drove the hospital to do the WRONG THING. What else could these "WRONG" hospitals have done? StepWisley(R) and come up with a rational strategic plan for dealing with the problem in cooperation with the physicians.
Example B: Hospital Plunges into Mediocrity to Keep Control; AKA Blowing a Hole in the Bottom of Your Boat to Save the Ship
This is a beauty! Following the malpractice crisis talked about above, the following misbehavior was noted. A hospital administration and Board of Trustees recruited a marginally competent young surgeon from a nearby residency program to lessen the power of the competent, well respected surgeon who routinely filled the hospital with patients. Guess what happened? Young New surgeon (who was an operative from a competing hospital) torpedoed the ship! Ultimately, his efforts failed and he torpedoed himself, but for several months, hospital occupancy was at an all time low. What had been a very busy and well run Non Profit organization was failing, because the Administration and Board of Trustees was unable to work properly, could not support its medical staff and could not accept the proper authority of the medical staff. From that point on, the hospital slipped and ultimately needed a bailout from/merger with a larger hospital about 40 miles away. So, the the local community lost control and quality driven by the local community.
Example C: Department Chairman "cuts corners" and gets away with it
In this example, a Department Chairman walked away from his supervisory role with residents and actually left the hospital while he was supposed to be supervising. This behavior was so outrageous, that it came to the attention of proper authorities. During the investigation that followed, he admitted to "cutting corners" but he was able to slip out of any disciplinary action. How he got out of it, I don't know, but I don't think he ever made that mistake again. The real question is this: How could justify the behavior ... how could he conjure up a thought process that would twist such blatant misbehavior in such a way as to think it was acceptable?
Example D: Hospital Stupified by Y2K ... a prolific excuse for bad behavior among hospital administrators.
This situation was noted when I arrived to take a new position in the Summer of 1999. The preoccupation with Y2K nonsense by hospital administration was so outrageous as to be comical, but it consumed all their energy, and the consequences were not funny. The situation was so bad that we could not get attention for any real front line problems, and that repeatedly put patients at risk. We could not get proper equipment and we could not get the hospital to address any problems. To combat this stupidity, we were forced to take pictures of faulty equipment and we threatened to supply videos to the local TV stations, if they did not take proper action. When the hospital safety officer was presented with our documentation "book" that was prepared for the next JCAH visit, he flipped through it with a stone face and, at the end he said, "Can you loose the pictures?"
Example E: Department Chairman Refuses to Acceopt a Solution to His Problem
Perplexing at best, this guy asked me to help solve a problem that threatened to destroy the integrity of and quality of care in HIS Department. I did the job over several days by working with the entire faculty, came up with a solution acceptable to all and handed it to him in a nice neat package. He then said, "We are not going to do this." Shortly thereafter, he was replaced, and OUR solution has worked smoothly for more than 10 years. What was he thinking?
Example F: Katrina Stories (before, during and after Katrina)
Example G: The "Financial Crisis" Bad behavior today that use the the current financial situation as an excuse
Example H: Department Chairman Doing things "because he can" (get away with it?)
To be continued ...
Friday, January 6, 2012
Mission: Healing January 6, 2012
PGY 39, Day #189
White Dawning
This morning dawns cold and white,
light snow falling.
Flakes float gently through windless gray skies,
forest's green and brown,
landing gently ...
a thin blanket on frozen ground.
Peering through glass, safely warmed ...
wood stove and hot coffee bring children's laughter,
as they play on my mind ...
catching memories of cool flakes,
melting on my face and tongue.
Have a great day!
Dr. Mike
White Dawning
This morning dawns cold and white,
light snow falling.
Flakes float gently through windless gray skies,
forest's green and brown,
landing gently ...
a thin blanket on frozen ground.
Peering through glass, safely warmed ...
wood stove and hot coffee bring children's laughter,
as they play on my mind ...
catching memories of cool flakes,
melting on my face and tongue.
Have a great day!
Dr. Mike
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