Health Train Overload

ALL ABOARD THE HEALTH TRAIN

Health Train Engineer Ratings

e-Patients.net today had an interesting topic about the value of doctor rating sites on the internet.  John Grohel and Ruth Given elaborate on the worth, value, and the economics of these web sites as sources of valid and credible information for patients.

Some of these sites should have their title "Buy  your Grades"...These sites are not even secure...what is to stop hacking in to the 'teacher's"  grading books??  The whole issue seems a bit sophomoric.

1. It is not unbiased

2. Who reviews and rates the comments

3. Is there any credibility and accountability for ratings and/or comments.

4. Do the rated physicians have the ability to offer answers to criticisms??

1.true

2 ??

3.no

3.no

'nuff said?

Health Train Reports

Pay for Performance:  It's a no way street, since medicare has failed to live up to it 's promise.  Providers are struggling to determine what went wrong...Not a win-win situation, and a loser for both sides.  The experiment to improve outcomes by requiring coding for certain behavior on the part of providers and rewarding them for the same is flawed fundamentally by a rigid set of parameters to measure, which in the long run will most likely evolve with time.  It's going to be the dog chasing it's own tail.   Most providers do not have the time or resources for this unless it is a substantial size group.  2 percent  incentives for hiring administrators and software to perform this function is offset by increased overhead.  This amounts to negative reinforcement if payers and CMS decide to penalize those who do not conform to a very questionable mandate.

The effects of medical group practice and physician payment methods on costs of care.

AMA survey results:This study indicates that payment methods at both the medical group practice and physician levels influence the cost of care.  However, the methods by which that influence is manifest is not clear.

Many doctors are still trying to figure out what went wrong with the 2007 PQRI.

Confidential physician feedback reports from last year's initiative, which for the first time offered Medicare bonuses for successfully reporting quality measures, became available to participating practices starting in August. Since then, many participants have been struggling to make sense of the information that they received -- if they were able to access it at all.  Only about 20% of 408 physicians surveyed in September by the American Medical Association were able to download their 2007 feedback reports, which told each doctor whether he or she reported enough measures to qualify for a bonus. Nearly 60% of those who sought assistance from the Centers for Medicare & Medicaid Services in accessing the confidential reports said they received little to no help from the agency.

In the interest of efficiency CMS has contracted with new companies to process payments.

Never you mind that the new companies are unable to perform.

How will CMS deal with increasing complexity of coding, transition to ICD 10, and vendors who are ill prepared to assume the responsibility for payments to providers?

And how will CMS deal with audits and repayments by providers?

HEALTH TRAIN CONTRIBUTES TO THE ECONOMY

A long time ago in a distant past my parents told me that if I became a physician I would always have work to do. They also told me I would probably never be a rich man.  I did not pursue medicine as a 'job'  My very worth is embedded in being a physician and surgeon... Like most physicians I wonder what I could do if I    could no longer care for patients. 

At times while it is exhausting and saddled with many 'duties' such as becoming a secretary filling out forms, entering data and patient histories into an electronic health record.  While most clerical personell earn about 10-15 dollars/ hour my pay grade is far above that figure.  For me it is a good deal. The downside for providers is less ability to see an increasing number of patients..For payors and medicare it is  poor economics to pay the physician  to do secretarial work.  As medicare and payors increase the bureaucracy and regulatory requirements there reaches a rate of diminishing return.

An analogy to this is what Hubbert calls "Peak  Oil".  named after Dr. M. King Hubbert, Geophysicist.

This eponym describes the phenomenon where it takes more energy to pump oil out of the earth than  what it yields in energy.  This is due to the necessity of pumping water into the well to force crude oil to the surface, drilling deeper, and drilling further offshore and in remote locations (cost of transportation)

Add to that, the political, ecologic, and economic aspects of legislative hurdles, environmental protection, and building infrastructure.

We are now entering the era of "Peak Medicine".

Dr. Phil Roth, unknown to me has already described this phenomenon in his blog, Peak Oil Medicine.

Peak Oil is well described in this video.

I think there are many parallels between Peak Oil and what is occuring in medicine and health care.

The emphasis has been to control costs by ratcheting down reimbursements, increasing bureaucracy and regulation, while at the same time ,demand is increasing due to aging, and increasing;y expensive  technology.

Health care employment is one area of the economy that continues to enjoy steady growth. Health finance experts tell us that medical care is increasingly a larger percent of the GDP. Is this because the remainder of the GDP is contracting due to outsourcing, an automobile industry in shambles, exporting production of telecommunications, electronics, and NAFTA.  Are the statistics skewed?

 

del.icio.us Tags: peak oil,peak oil medicine,hubbert,physician making a living,medicare,payers,regulation,GDP,NAFTA

Health Train Motorcycle Detour

 

David Kibbe MD a family practice physician joins us here courtesy of Matthew Holt of The Health Care Blog....Dave is a well known writer on the subject of health IT.  In this particular episode he takes us on a cross country tour produced by Scribe media.org   I think  you will like the music as well. Enjoy!

And now Heeeeere's Dave !!

Health Train Transfer

GREAT QUOTES

The overriding theme of the recent campaign season was and is “CHANGE”. The sea of jubilant Americans, young, older, all races, and backgrounds celebrating this victory of Obama for America demonstrates the power of democracy. Yes, democracy is more powerful than capitalism (run amok) and socialism.

We tend to think of black and white. Either left or right. During the campaign at times it was difficult to analyze the real deep meaning of either candidates proposals. There were many who feared this outcome, however the majority has ruled. It is obvious many of us have been left behind.

The outcome is not the death of capitalism, nor the onset of socialism, it is however the demonstration that capitalism and free markets have exceeded their inherent ability to balance the equation. One can argue that creeping entitlements have led us into this “dead end”. The normal market pressures have become dysfunctional.

George Bush’s policies and decisions ended when we invaded Iraq. We were caught up in a perfect storm of global events and economic turmoil.. and terrorism was the overriding theme for us.

Americans had never been attacked in the underbelly, or the heart of the nation’s highest peak (the World Trade Center). The events of 911 symbolized and unknowingly foreshadowed the events of the past several months. In reality these events were ongoing for considerable time. Our recent financial collapse has been blamed on the supreme mortgage meltdown. This is a smokescreen for what has been ongoing for the past ten or twenty years in real estate, credit markets, the consolidations of enterprises, the greed of the stockmarket, insurance industry, technology whether it was for the good, or for mindless entertainment among increasingly idle Americans, who had lost their direction.

We should have learned that actions should not always be based upon fear. We should also remember not to depend upon one person to lead us and/or save us from ourselves.

At the onset of the crisis I said “look in the mirror, there is the culprit”. Even those of you who are relatively successful depend upon inequality, and greed. How big a house, and how many do you need? How big a vehicle do you want? Is it based upon your life’s needs, or some other motivation. Some families with 2-4 children do need a larger vehicle. Why has the foreign car market exploded? Why have we had to export and/or outsource many of our vital functions?

I am not going to give answers here. I don’t know all of them, But we all, patients, payers, providers, and yes government need to assess what we have done. It has not been done to us. Look in the mirror.

While we have been counting the casualties, worrying about health care financing, the gradual and relentess increases in the cost of energy, and the innumerable eco- disasters the perfect storm arose and devastated capitalism as we knew it.

Our new leader is largely unknown, however he is extremely bright, a brilliant orator and politician. This inexperienced man defeated a powerful political machine, overturning the democratic party, just like a boat in the perfect storm. We must all row the boat together as a team to insure our success. We don’t expect a miracle, but more people now have hope.

No capitalism is not dead, nor is socialism taking over. It is not black and white.

President Obama is the perfect combination for our country, a man of color and white, an immigrant, a man who came out of nowhere, from a very modest background, raised by a single parent and grandparent. How familiar does that sound to you? It is not the American dream, but it is the American Reality.

Hope must come before prosperity. There is no prosperity without hope.

As I drive to work through endless homes

I always wonder, what is going on in each of those homes. Are they healthy? Do they have jobs? How many are living from paycheck to paycheck, unable to save or follow the advice of financial wizards? How many are sad?   How many have dysfunctional families? How many alcoholics and drug dependent people are in those homes? How many don’t have insurance? How many live in fear of losing their homes and/or their transportation. How many have latchkey children?

There are many more questions than answers. Statistics don’t tell the real story. They indicate the enormity of our problems, however as I drive through the neighborhood I feel the pain.

We as providers face these situations on a daily basis, unable to respond effectively for our patients, unable to commit sufficient time to analyze problems of poor health based on economics, family structure, anxiety and/or depression, limited income in a country with supposedly unlimited financial resources. In truth it has not been this way for many years.

Democracy gives us Hope

 

del.icio.us Tags: election,obama,capitalism,socialism,health financing,free market,hope,prosperity

Health Train Transfer

GREAT QUOTES

The overriding theme of the recent campaign season was and is “CHANGE”. The sea of jubilant Americans, young, older, all races, and backgrounds celebrating this victory of Obama for America demonstrates the power of democracy. Yes, democracy is more powerful than capitalism (run amok) and socialism.

We tend to think of black and white. Either left or right. During the campaign at times it was difficult to analyze the real deep meaning of either candidates proposals. There were many who feared this outcome, however the majority has ruled. It is obvious many of us have been left behind.

The outcome is not the death of capitalism, nor the onset of socialism, it is however the demonstration that capitalism and free markets have exceeded their inherent ability to balance the equation. One can argue that creeping entitlements have led us into this “dead end”. The normal market pressures have become dysfunctional.

George Bush’s policies and decisions ended when we invaded Iraq. We were caught up in a perfect storm of global events and economic turmoil.. and terrorism was the overriding theme for us.

Americans had never been attacked in the underbelly, or the heart of the nation’s highest peak (the World Trade Center). The events of 911 symbolized and unknowingly foreshadowed the events of the past several months. In reality these events were ongoing for considerable time. Our recent financial collapse has been blamed on the supreme mortgage meltdown. This is a smokescreen for what has been ongoing for the past ten or twenty years in real estate, credit markets, the consolidations of enterprises, the greed of the stockmarket, insurance industry, technology whether it was for the good, or for mindless entertainment among increasingly idle Americans, who had lost their direction.

We should have learned that actions should not always be based upon fear. We should also remember not to depend upon one person to lead us and/or save us from ourselves.

At the onset of the crisis I said “look in the mirror, there is the culprit”. Even those of you who are relatively successful depend upon inequality, and greed. How big a house, and how many do you need? How big a vehicle do you want? Is it based upon your life’s needs, or some other motivation. Some families with 2-4 children do need a larger vehicle. Why has the foreign car market exploded? Why have we had to export and/or outsource many of our vital functions?

I am not going to give answers here. I don’t know all of them, But we all, patients, payers, providers, and yes government need to assess what we have done. It has not been done to us. Look in the mirror.

While we have been counting the casualties, worrying about health care financing, the gradual and relentess increases in the cost of energy, and the innumerable eco- disasters the perfect storm arose and devastated capitalism as we knew it.

Our new leader is largely unknown, however he is extremely bright, a brilliant orator and politician. This inexperienced man defeated a powerful political machine, overturning the democratic party, just like a boat in the perfect storm. We must all row the boat together as a team to insure our success. We don’t expect a miracle, but more people now have hope.

No capitalism is not dead, nor is socialism taking over. It is not black and white.

President Obama is the perfect combination for our country, a man of color and white, an immigrant, a man who came out of nowhere, from a very modest background, raised by a single parent and grandparent. How familiar does that sound to you? It is not the American dream, but it is the American Reality.

Hope must come before prosperity. There is no prosperity without hope.

As I drive to work through endless homes

I always wonder, what is going on in each of those homes. Are they healthy? Do they have jobs? How many are living from paycheck to paycheck, unable to save or follow the advice of financial wizards? How many are sad?   How many have dysfunctional families? How many alcoholics and drug dependent people are in those homes? How many don’t have insurance? How many live in fear of losing their homes and/or their transportation. How many have latchkey children?

There are many more questions than answers. Statistics don’t tell the real story. They indicate the enormity of our problems, however as I drive through the neighborhood I feel the pain.

We as providers face these situations on a daily basis, unable to respond effectively for our patients, unable to commit sufficient time to analyze problems of poor health based on economics, family structure, anxiety and/or depression, limited income in a country with supposedly unlimited financial resources. In truth it has not been this way for many years.

Democracy gives us Hope

Health Train Express stops at the Voting Booth

I have to give Barak Obama and John McCain a great deal of credit for their ceaseless energy in campaigning.  Whether you agree or disagree with either of them, admit that they have 'charged' the electoral process.  For the first time in my memory we have a real choice.

This column does not pretend to be unbiased, either in my pronouncements or opinions. It is the culmination of 65 years on the third rock from the sun, and as a physician for 40 years. There are many of you out there that are older, younger, but few wiser than me.  I admire Barak Obama for energizing his "base"

I did not like the  way Obama at the last minute decided to  waive campaign financing in lieu of fund raising.  He obviated the careful thinking about removing finances from the equation. Most of us pay one dollar to fund campaigns.  So  much for Obama being the voice of the  people  HYPOCRISY

I admire John McCain for his life and experience.  Young politicians can be gifted and wise beyond their years. Obama's lie story is compelling and appeals emotionally to many,  but his real world experiences are limited....He is much like the academic who is smart, but has limited real world experience and speaks from two polar opposites....academia and the poor of Chicago. I am suspicious of his origins in Chicago, his affiliations, his glib statements, and his denial of being a very left politician. 

He cannot extract a list of accomplishments compared to McCain. He is not even a proven academic. Where is his list of papers. What happened during his college years?  Being head of the Harvard Yale Law does not prove much unless he practice law and perhaps it allow him to be in a certain circle of elite friend in the law.

It has been said he will govern from an oligarchy of four associates.

John McCain did not have the 'handlers' nor the organization of Obama...He also started too late. Obama was at this fully committed for two years.  McCain all but dropped out a year ago.

Political handlers do not run our country, they stage Roman festivals, go door to door (paid to do that).  Tell the candidate where and where not  to go.  Obama  has kept his handlers well hidden. I don't see him as having any original thought...great oratory in a hypnotic manner of delivery.

Yes, I have a bad feeling.  There is a great deal of emotion and anger in Obama and his wife.  His wife and friends harbor these feelings, which may be justified. He is supported by millions of disenfranchised citizens.

Anyone who would use the phrase, "my program will allow you to buy more of those 'iTune' songs says it all. 

For a presidential candidate what cultural and sociologic or even true inspirational aspects are present??

 

My vote does not depend upon either candidate's proposals for healthcare reform...There are much bigger issues to consider.

I have a MCCAIN-PALIN bumper sticker on my car in a heavily OBAMA neighborhood.  My son, age 22 told me I should take it off if I don't want my windows smashed.  The fact that he felt some intimidation surprise me.  He however is much more in touch with young people.  I took it off....he is a very good judge of character.

SO I WILL VOTE FOR JOHN MCCAIN, AND IF YOU HAVE SOME LOGIC AND REASON YOU WILL SEE THAT OBAMA PLAYS TO OUR EMOTIONAL NEEDS....IF YOU VOTE FOR OBAMA TODAY YOU WILL GET WHAT YOU DESERVE...LOSS OF FREEDOMS,much higer taxes, more entitlement programs and further movement of businesses to foreign countries.A SLAVE TO THE 'PEOPLE'....SOUNDS LIKE MARXISM, SOCIALISM AND THE DREAD WORD WE HATE TO SAY "COMMUNISM"

YOUR VOTE HAS BEEN BOUGHT BY MILLIONS OF DOLLARS, AVERAGED OUT TO 18.75 DOLLARS PER VOTE.

 

SORRY SID, YOU ARE BEING PLAYED BY SOMETHING THAT SOUNDS WONDERFUL  BE CAUSE YOU ARE SUCH A GREAT GUY, PHYSICIAN AND CARE SO MUCH FOR PEOPLE.

Forty eight hours and counting....VOTE, VOTE VOTE

Here is how the last minute polls show the Presidential Race::::How will America go??

Obama McCain Health Train Comparisons

All commentary is taken from The Heritage Foundation

 

Obama: 

 

McCain:

It's been some time since we have had such a clear choice in our selection for our President and the leader of what we call the free world.

Obama---black, young,liberal,inexperienced,

McCain--white, old,conservative, experienced

Both men tempered by their life's stories, both credible, neither with a good plan for our present crises, which are ECONOMIC, NOT POLITICAL.  The same pertains to HEALTHCARE.

Get your hot ICD codes on the Health Train

Medicare and other payors are mandating a conversion to the new coding standard, ICD-10 from ICD-9.  Now what's in a number?  Well, the new standard will allow for over 155,000 unique identifiers for diagnostic coding, whereas the current standard only allows for something over 9,000 diagnoses.

Converting from one to the other is a big deal since current fields in computer programs do not allow for the added field size.

What's more important to most providers is that the 'unfunded mandate" will cost a three man physician group 80,000 dollars to convert.  KevinMD and DrVal point out this conundrum in the face of decreasing reimbursement, the push for EMR and the present economic meltdown.

The Dr. House podcast fan club also has as medical consultant extraordinaire, Dr Anonymous, whose weekly show can be seen on Thursday evenings at 6PM PDT or 9PM EDT on blog talk radio.

HealthTrain Arriving from Germany

I participate in SERMO quite a bit (a physician only blog) and I came across an enlightening story about a german OB/GYN who immigrated to the U.S. after falling in love with a woman he met in N.Y. while visiting.  He tells this story on Sermo (ABC1530). Fragments are quoted here, and although his writing crosses much territory not directly related to medicine and health care, here are some of his observations and experience.....comparing, contrasting and teaching what is the difference about U.S. healthcare.................

 

"Flashback a few years, I am 18 and graduating from high school. I am considering architecture, because I would like to "produce something that I can touch, that I can show", but I end up choosing medicine. I trust my ability to study and memorize more than my artistic talent. And the promise of a good life and social standing help to change my mind. At the time admissions to medical school in Germany were strictly by grades and you needed something between A/B or A-. In Germany you have to decide on your career when you graduate from high school, typically at 18 or 19."

In the meantime the admission criteria for medical school have been expanded to include a lottery (based on the thought that performance in school may not be such a great criterion), a personal interview, a waiting list (the longer you wait and the older you are, the more likely are you to be admitted, and finally the good old grade average. They also reserve 2 % for foreigners - e.g Americans and 1-2% for "social cases" where you can be admitted after providing proof that your grades were unfairly diminished or you were impaired by circumstances beyond your control.
There is nothing comparable to the American "college" years where you look around and decide what you want to do in life. Medical school takes 6 years and The first two years are "preclinical", meaning you study medical terminology, chemistry, physics, biology, genetics, physiology, biochemistry and anatomy and histology. You take an exam after the first two years, passing is required for continuation. The following year is "introduction to clinical medicine" and includes pathophysiology, pathology, pharmacology, medical statistics, clinical examination and history taking and some introductory course in internal medicine and surgery. Again exam.
Then two years of clinical courses, which include "bedside teaching" and demonstration of actual live patients. course include all fields of medicine - internal medicine, surgery, obgyn, dermatology, neurology, urology, radiology etc. Another exam. The German exams pretty much resemble the USMLE 1, 2 and 3 in style and difficulty.
Courses usually have a "practical part", small group teaching, where attendance is checked and lectures in large lecture halls, where attendance is not controlled.
Overall there is much less control, supervision and guidance. You are free to do and not to do whatever you want. as long as you show up in the courses, pass the course exams and the USMLE equivalents, you are fine. There is no grading, ranking, no recommendation letters from faculty or from deans. You get out of medical school what you put in in terms of activity, participation, commitment and desire to learn.
You can start in fall and in spring. Medical school is...free.
Suvarov asked me about the expectations when you start?
Could you clarify the question? Expectations of the medical students, the parents, society?
I expected to learn a lot, have a challenging career, work quite a bit later in life and be rewarded with good social status and a stable income which is at least average, if not better.

 

The expectations when entering medical school are certainly not as high as here, at least not now. After a continuous decline in income and consequently status and power physicians are just another group of white collar workers. Much like physicians in America if the present trend continues (and, guys, here we go into the "conservative" issues you correctly expected).
Physicians in Germany were making excellent income with fee for service payments by the quasi government Allgemeine Ortskrankenkasse (General Local Sickness Fund), which was established almost immediately after the "Iron Chancellor" Bismarck

passed a law in 1883 to establish such funds and make health coverage mandatory for every German. Some speculate that it was a political move to ward off the socialistic tendencies at the time. The general health insurance worked very very well for almost one hundred years - and then the money ran out. The money ran out due to a combination of rapidly increasing health care costs across the board and the doubling of the number of physicians within a short time - thanks to our friends the lawyers. In the 70s it was one of the main ways to get into medical school. Peoples checked at the bottleneck places in medical school - usually the anatomy courses - and claimed that there were still unused spots. Meaning if there was a group around a cadaver of only 7 students, an additional student immediately sued and got in.

With those tricks the number of medical school students doubled within a few years - with disastrous consequences as you might expect. Within a few years there were unemployed physicians driving cabs and everybody was earning less - the pie, the pot of money available through the AOK obviously never increased, never changed. The pot of money is strictly limited by those 12% health taxes!
Consequently there was less money for everybody.....
The physicians representing the other physicians returned every year from the contract negotiations with a helpless shrug and the comment "we achieved to increase reimbursements for blablabla, in exchange for some cuts at blablabla. The cuts always were much bigger than the small pieces of candy the docs were thrown.

Pretty much the same as the negotiations with HMOs and Medicare (if there are any negotiations with Medicare!).
Those representing physicians were the same breed as the AMA people:

politicos who do not care about those whom they represent, and just enjoying their feeling of "importance", the travel, the cocktails etc.

 

Residents are picked by personal connections. Medical students that are interested in one particular specialty volunteer in that specialty, get to know the attendings, the chief etc.(PANDERING) They might help out on the floor, volunteer for overnight shifts etc. Then they might do a research project in that field, preferably in the hospital they would like to work and train in. (that works very well in university hospitals). Having good grades in the final test, the USMLE equivalent helps as well. Adn the rest is just timing, meaning you apply at the right time and you get in.
There is a significant difference to the US: While here all residents start on July 1st, in Germany you may enter medical school in Spring and fall and therefore people graduate in Spring and Fall and may apply all around the year. There is no such time as the July 1st. People start and graduate the whole year. So you never know when a position is going to be available.
Residences are not as scheduled, they are not as predictable as here. A residency may take you more time than the minimum. Your Department chief pretty much has the power to keep you and to delay your graduation for quite some time.
You can graduate when you have fulfilled your "numbers". For example in ObGyn you have to document 100 deliveries, 35 cesareans, 30 hysterectomies, 20 laparoscopies etc. Yes, these nunmbers are a guess, but they are about right. I do not remember them exactly, but they are VERY LOW compared to American standards.

 

AZdrydoc  Family Medicine

Posted Oct 25, 2008 at 4:28 PM

<The pot of money is strictly limited by those 12% health taxes! > 12% of what? Income? Sales? When you said "medical school is --free" I immediately thought, well, yeah, but who is paying for the "free"?

 

AZdrydoc, it actually is (now in 2008) between 13 and 15% of your income - of the gross (!) income! The employer and employee each pay about half of this. Yet,

this is total coverage, eyes and dental included. You have complete choice of doctors and hospitals.

I obviously have thought quite a bit about the differences between my German and my American residency. Conclusion: you guys are very lucky to have trained here. While Germans tour "academic freedom" - nowadays or at least for me just another label for "laissez faire", the Americans are much more regimented in their training, it is more scheduled, more supervised, more controlled, more defined.
Just one very important point: In Germany you have to fight for your desirable times in residency - in obgyn it is the operative floor. You try to cut your time short in places where you do not learn much, e.g "postpartum". In Germany I actually had a few months where I was responsible only for the postpartum floor. This seems utterly ridiculous for an American obgyn resident, who is used to taking care of the postpartum floor between 5 AM and 7 AM before going to labor and delivery - where, by the way, he or she also takes care of the "emergent Ob Clinic" or triage etc.
German physicians have to draw blood and start iv s in the morning! I can hardly believe it now that I am used to iv teams and respiratory that comes and draws blood gases etc. What a waste of physician time in Germany.
But then, my German Department chief said he did not want to upset the nurse by having them draw blood, because "you can get a doctor any time, but good nurses are hard to find"
The nurses really got on my nerve in Germany. I heard by far too often "You have to do that yourself Mr. (!) Abc1530,

I do not have time". Brought my blood to a boil every time. They would draw blood for the attending though....
When I left in 95, they were just introducing the ordering in the chart.....
Here in the US I write the order and bam, it get's done. If it does not get done, I am not blamed, but the nurse. If I really want, I can write her up. I have never done that though. Nurses are very good here.
Much better system here

 

Level of talent entering the door in medical school.
I am not sure if it differs. There is a study that medical students have an average IQ of 125 in Germany. I am not aware of a similar study here.

But I am absolutely sure there is a gigantic difference in ambition. American physicians are DRIVEN. Holy cow! I could not believe the push, the umpf, the stamina, the energy Americans put into their training.
Sorry, my liberal colleagues, but I believe that this is the result of two things: you have to pay for medical school! It is expensive, so it is dear to you, it is hard to get in, so you have to and you want to make the very best of it.
And, there is the promise of the big reward at the end, a reward to big that it is worth staying up late, going the extra mile, doing the whole 9 yards....
No such thing in Germany. Hey , medical school is free, yes, you heard it, free. So, it can't be worth THAT much, right? At least that's how you feel. And you do not earn that much afterwards, so why struggle! Let's live now, let's go out tonight, let's have a party..residency takes so long anyway, and hours are controlled, so youa re never exhausted, so why work your behind off?
I have seen so many slackers in my German residency, it was disgusting. I was very satisfied (sorry to say that, I aoplogize) to see that a resident who exhibited the typical slacker behavior of too many of my German colleagues in one of the American residency programs - was fired.

You either want good doctors or you don;t.

 

Yes, German physicians are more relaxed and pretty trusting, especially when they hear that someone has trained in the US. American medicine has a great great reputation almost all over the world. Americans and Sermoans may not fully realize the extent of this. You guys are the top, the best, the cream of the crop, welcome and admired all over the world. Not surprising at all that the anesthesiologist handed over the patient to you!
You grew up here, you trained here, you take the American efficiency, quality for granted!
You are the best! Become aware of it!
If I would return to Germany, my future would be secured just by spreading the word that I am board certified in the US and have actually trained and worked there.
Don't underestimate how good American medicine is! How respected it is...

In Germany we say "the prophet is ignored at home".....OUr colleagues are so used to the high quality of medicine here that they take it for granted and consider it "normal". Yes, thank God it is normal, but..... only for the US.
And , thank you for pointing out the probloem with "fixing" health care just to make it resemble the system in those countries that admire us.

On EMRx

Hi Mohican! Guten Tag!
I am using General Electric's "Centricity", formerly know as "Logician". Was programmed 20 years ago, and you feel it. I started using it 1.5 years ago. The part that is most useful is the ability to fax prescriptions directly to the pharmacy

Click-e-ti-clack and the Rx is on it's way, pt does not have to carry a piece of paper around, drop it off, wait, come back, pick it up. Now they drive by the pharmacy on the way home and it is ready.
Besides that it is a big drain on productivity. Everything takes longer, many things are hard to accomplish, such as sending a letter to the PCP that referred the patient to me.
The good side is that all docs in our health care "system" are using it and this actually saves duplicate entries and less things fall through the cracks. I can see the lab reports, the path, the radiology, the ER visit notes on my computer - and - nice too - in the office, at the hospital or at home, with equal ease. Just click and ...wonder...

But the damn thing does not even have a spell-checker! )(&!@^(%#()!

So, it has good and bad sides, overall it takes more time to work with it, but it wil surely get better over the years. When I retire the system will be just as I imagined it to be the first day when they told me about it---- ;-)

 

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Technorati Tags: german medicine,american medicine,medical students,high standards

Health Train Blogging

Only I can change my life. No one can do it for me.

Carol Burnett
US actress & comedienne (1936 - )

What blog subjects are the most popular? My recent review of the Blog Catalog, in order are:

1. Blogging

2. Arts & Entertainment

3. Technology

4. Humor

5. Health

So health is in the top five, but just barely. It is tied with Politics, and ahead of all the rest, law, business,financial,beliefs, social, and believe it or not social media.

At this time Health and Politics go together, entrenched in the economy as top talking points in the presidential campaign for the world's most powerful office.

An interesting observation from the Wall Street Journal by Robert Carroll points out the tax realities of each candidates. It gives a clear endorsement to John McCain's health policy proposals.  Would I put it in the arena of Health Care Reform?

NO.  This is merely a poorly conceived financial manipulation to have more people in the 'insured category'.  Both Obama's and McCain's Health Reform amount to a wallet biopsy.

Other issues, such as propositions in Arizona would ban programs such as universal payor or universal health plans.  Would Federal  law pre-empt  state law??

Technorati Tags: health refrom,universal payer,tax breaks,blogging,state law