The Gun Debate

Several factors in the gun debate border on medical and safety topics for the general public. To that end, I've given a fair amount of thought to the matter. If you'll indulge the borderline political debate, the following explains my take on the issue, from a health perspective.

In the past, I've spoken at length to a few of my European colleagues who deal with the health consequences of blunt force and knife injuries with much higher frequency than gunshot wounds. Most of them attribute this to the gun laws of most European nations which require a full blown proficiency test and background check for owning a firearm.  It's easy to obtain or create a bladed or blunt weapon, so violent crime still exists. Murder happens, but neglecting military and paramilitary activity, fewer large scale massacres occur with regularity. Gun crime also occurs in the small scale, but not as frequently as here in the states. In fact, one German coroner with whom I spoke as a medical student, visited Kentucky on exchange to learn more about gunshot wound pathology, since he saw fewer than 70 gun crimes a year on average. 

This illustrates a pertinent point. Fewer people owning guns can minimize but not completely eradicate gun crime. As the popular saying goes "if owning a gun is a crime, only criminals will own guns." While I understand the sentiment and see the need for defining sides in a debate, a middle ground does exist that would satisfy people on both sides of the debate. 

The European system still allows the average citizen to own a gun, protecting the right to bear arms, but anyone requesting the permit must demonstrate an ability to use the gun properly, safely and with restraint. If, as several of those I've heard and seen arguing state, any limits prevent ownership, I will again point to the driver's licensing system already in place. Do we simply hand keys to a 16 year old and let them have free reign over a 2 ton pile of metallic death? No, we first insure that they are able to appropriately comport themselves as a driver. Tests, both written and practical, to prove proficiency in operation of the vehicle and knowledge of the traffic laws, give some semblance of assurance of safety. The debate still rages over whether this is adequate. Many states require formal driver's instruction and a permit period lasting months or years to protect the citizens on the road. Why should a gun, which carries significantly more responsibility and has similar power to end life quickly, be any different.

The average citizen (or the child thereof) could easily obtain appropriate instruction in the safe use and care of firearms and obtain a permit to do so, satisfying the desire to uphold the second amendment. However, not everyone will pass the test and background check(just like the driver's test, which has a reported 20% failure rate GMAC), especially those with a history of violent crime. It would also be useful to field questions to evaluate the psychiatric fitness of the owner, which also exist to a certain extent on the driver's test. That level of evaluation prevents unskilled users and possibly violent persons from simply walking into a store and walking out with an arsenal. The common defense and well-maintained militia still have access to firearms with which to defend their possessions and the country at large. And those of us who don't like being shot have some sense that, just like the slim margin of safety on the highway, we are safe in our homes. Or in a movie theater. Or at church. Or at a football game. Or at school. 

Long Time, No Type

It's been a fairly long time (over 5 months) since I posted anything to the blog.  A whole host of factors conspired to make it lower on the priority scale. That being said, I've still been following the tech route.  I'm still involved in social media. More than ever before, I know that these things changed business fundamentally with their arrival. I understand that I have to participate to remain relevant.  What I don't want to do is sound like I'm complaining too much.  My first world problems pale in comparison to 90% of the rest of the world, and I feel no compunction to use the internet as a whining room.
I've been blessed with a great business opportunity, a great family and a chance to do something I love in a way that I want to do it. There's been adversity, which often spawns writing, but there hasn't been a great deal to promote the kind of writing I think matters.

Until now.

Over a year ago when we began planning this endeavor into Direct Medicine (Concierge, Flat Fee), we decided to accept Medicare for the first year, as a service to those patients who were unsure if they wanted to commit to a $75 monthly fee alongside their Medicare. Forms were filled out and submitted.  Phone calls were made. 5 Months Later, we still have no Medicare provider numbers for ourselves or the company.  The government bureaucracy, in its infinite wisdom, provided us with 6 different answers to the same question, none of which appears to be the correct one.

We no longer plan on accepting Medicare.

In an era when physicians can receive jail time for Medicare fraud, we agreed that the need to accept Medicare was far outweighed by our fear of making an ignorant mistake and winding up with fines or imprisoned. If this many errors occurred with only the application, how can we be sure that the same errors or worse won't happen with the claims process.

An interesting phenomenon has arisen from our decision. Our Medicare bearing patients have decided to stick with us and pay the fee. They seem to prefer it. It's simpler, more direct and they know exactly what their primary care costs.

It's a symptom of a system with big problems.  Insurance, meant to help those who couldn't afford the high costs of advanced medical procedures, has become the healthcare equivalent of the lottery.  You pay into it, hoping to never use it, and when you need it, the returns on investment don't cover the first 20% or more. As is true with the lottery, health insurance has become a tax on people bad at math.

Back to the Future

Two posts in one day! Whoda thunkit?

I've been holding it in. You may notice this gets random. The blog, not this post. Though now this post is taking a direction totally off topic.

Anyway, there's a huge group of people in Orlando, called the American Academy of Family Physicians (AAFP). The Scientific Assembly and the recently completed Congress of Delegates, give Family Physicians see and guide the organization that speaks for us at the highest levels of government and provides physicians with resources and networking opportunities. For many years I attended this meeting and actively participated in the Academy. For the last few years, I haven't.

There are several reasons I could cite. I got busy. I had other projects. But let's be honest. I got jaded. You ever hear the story of the puppy who got kicked too many times and eventually just quit coming back? I never got kicked, but I did get quieted. I know I'm loud. And opinionated. And difficult at times. What I'm not is a door mat. I wasn't the only voice pushing to bring the Academy into the 20th century (let alone the 21st), but I was a loud one. The Commissions and Committees on which I served listened to my ideas, but they never seemed to understand. Call it an age gap, call it a group too focused on their own agendas (which is ok, since that's how we all operate), but whatever you call it, it wasn't for me.

All that being said, this weeks CoD and SA meetings have shown that change does happen, albeit at a glacially slow pace. And it gives me hope that the Academy may one day return as my voice. The meeting organizers broadcast over Ustream. Tweeters were (and are) everywhere. And one of my good friends even gave a presentation on social medicine. There may be hope yet.

Location:Mt Zion Rd,Florence,United States

Return

So, I've been idle.  In more ways than one. 

Currently, my father and I are putting together a new practice based on the Direct Medicine model.  For those of you who have heard of the concierge concept or seen the show "Royal Pains," this should be familiar.  For everyone else, this model consists of a retainer fee for unlimited access.  In essence, you pay me (or us, though we'll get to that in a moment) to be available to you at any time of day for consultations.  Similar to the legal profession, this isn't just limited to face-to-face visits, but encompasses things like e-mail, phone and text messaging. There's also going to be an education and preventive medicine component that we're designing almost from the ground up.

While my father and I will be sharing space and staff (which are both streamlined and adapted to a much more personalized experience), we likely won't be seeing patients for each other. The whole point of Direct Medicine, the unlimited access, hinges on the fact that I will be Your doctor. We contract together that I will support and encourage your health, wherever that might be. In the hospital (no extra fee), in the office (no extra fee or "co-pay") or over the wires (STILL no extra fee!), I am your personal physician.  We may cross-cover if we get busy enough (extreme cases, vacations, etc.) but the goal is to re-personalize medicine.  In an age of hospitalists and laborists, we want to be there for our patients when they need us.  Like it used to be. "A new way of practicing old-fashioned medicine." Without the leeches.

All that being said, there have been many hours of waiting.  Waiting for my dad's non-compete clause to expire.  Waiting for a possible third partner.  Waiting for the bank to decide if we have enough possibility on which to take a chance.

I've been attempting to be a good house husband, though I sometimes think I'm not very good at it.... Now, though, as the practice comes together more, I realize that if the worst case scenario predictions occur, it may be years before I can sustain us on only this practice, especially since my student loans are about to come due. Therefore, I'm looking for a supplementary job, and in the meantime, I'm going to be posting on here more than in recent months, and I might even finish the three-part series I started

Either way, here's to your health.

My Review of Fleece 5.0

Originally submitted at SCOTTEVEST, Inc.

What do you get when you combine the warmth of fleece, a cutting-edge Personal Area Network from Technology Enabled Clothing and years of product development experience? The absolute best fleece ever produced by SCOTTEVEST! This dual-fabric, fifth-generation fleece is filled with 24 pockets... just...

Fleece 5.0

Physicians in Cooler Climates Take Note

By Gerry the Doctor from Greenwood, SC on 9/29/2010

 

4out of 5

Sizing: Feels true to size

Sleeve Length: Feels true to length

Pros: Attractive Design, Versatile, Warm, Massive Storage, Comfortable, Lightweight, Stylish, Fits a Stethoscope, IPad Pocket, Great Color

Cons: Zipper Catches

Best Uses: Travel, Daily Use, Work

Describe Yourself: Casual Dresser

I bought this jacket for multiple reasons, but in the first day alone I've found uses I never expected. I'm a family medicine doctor in a moderate climate, so I'm constantly looking for a lightweight/middleweight jacket to wear in the fall and winter that will also house all of my gear (stethoscope, iPhone, iPad, books, etc.) Fleece 5.0 fits the bill, and with the zip-off sleeves, it's even alright in the low summer heat/cooler nights. It also holds everything comfortably, with pockets to spare. I have all of the above items in the pockets and still don't feel weighed down or bulky.
Not a complaint, just an observation: I may lubricate the zippers with a bit of graphite, as they stick on occasion. Not bad, just annoying at times.
Overall, the best jacket I've ever owned!

So many pockets, so few gadgets...

Tags: Using Product, Picture of Product

(legalese)

AAFP NCRS

Reminder: Come visit the South Carolina Booth at the AAFP National Conference of Residents and Students and look for me roaming the floor to join the live Blogtalk Radio Podcast of the Doctor Anonymous Show (http://www.doctoranonymous.com)


- Posted from my iPhone

Location:Wyandotte St,Kansas City,United States

The Transformation

"Everything changes." "We start dying the moment we're born." "The only constant in life is change." "The more things change, the more they stay the same."

All very trite, but mostly all very true. The changes that become more evident to me daily involve the gentle paradigm shift in medicine. An institution that once held the health of its constituents as its utmost goal, now looking more at profitability than personal responsibility.
It started out insidiously. In the early 70's and into the 80's the quiet voices began to whisper to physicians. "You're here to practice medicine, but you're also a business." "You should be fairly compensated for the work you do." As in any industry, there have always been those who practiced medicine "for the money," but it wasn't until the slow rise of the for-profit hospital and the night in shining armor, the HMO, that things took a system-wide turn away from people and toward dollar signs. While campaigning for the managed care paradigm, a gatekeeper model where a primary care physician would coordinate care and refer to the specialists that were also owned by the HMO, hospitals and large multi-specialty groups began to recruit patients, touting a one-stop shop, a strategy clearly effective at turning a profit, ala Walmart. A good idea in theory, but in practice, the overwhelming number of patients in the system caused long wait times, and accusations of monopolizing and self-referral flew like mad.
I'll be honest. I don't have concrete data to back this up, and there's no specific person, place or time that you can pinpoint as the tipping point. There's simply a slow paradigm shift toward money-centric medicine.

There's nothing wrong with appropriate compensation. I do, however, take issue with abusing new technology as a way to make more money. Don't get me wrong, businesses incur great expense purchasing and innovating new technology. Once it's paid for, though, prices should summarily begin an inexorable decrease. Take the PC industry. Please... (sorry, it just sounded funny in my head, so it stays). Manufacturing processes (equating to, say a CT scanner in this analogy) are discovered to create a hard drive. That process is refined and perfected at great cost, which is transmitted to the initial consumer, the early adopters, but over time the process becomes so well refined and frequently used that income far surpasses production costs and even pays for the R&D.
If we assume that a CT scanner represents that manufacturing process, in this analogy, as the process is perfected, costs decrease exponentially, especially with frequent use. While the cost for your average CT has dropped significantly over the years, it still far surpasses the costs incurred by the hospital for staffing and power, especially after it's paid for.

You'll have to trust me on the math, and this is definitely an oversimplification, but if the average CT Scanner costs 3.5 million dollars, that means only 1000 scans at $3500 each would pay for the machine. There were ~7 million scans performed in the US in 2007 alone. Assuming a hospital large enough to have a scanner does at least a thousand a year, that means the machine could theoretically be paid off in one year. But wait, you object. What about the radiologist and the technician and the energy cost? Won't that put the cost much higher? Calculating average costs for reading fees and tech salaries and power costs (and assuming a random but educated yearly number for insurance on the machine) the numbers may be surprising, just not to me. You need only do an extra 25 CT scans a year to cover those extra costs. So after 1 year of $3500 scans, totaling just 1025 scans, the machine is paid for. Ongoing costs amount to a mere 100 scans per year thereafter to pay the radiologist and the incidentals. The rest keeps the hospital administration and the janitor paid. This is all an average, an educated guess, but it points to a fundamental problem with healthcare and hospital systems... like all other businesses, they're run by people, and people run businesses to make money.

This isn't bad, just problematic. I'm not against a free-market economy, as long as the flow of information is free, as well. Publish the cost. Let people make informed decisions and shop around if they so desire. Don't assume that because you *can* do something, you should. The system isn't broken because we charge $1800-3500 for an average CT scan. It's broken because free market value is no longer determined by the market...

To Be Concluded...


-- Post From My iPad

Location:Oak Ridge Dr,Greenwood,United States