Sean Khozin, MD, MPH

Recently, while returning from a Yankees game, my friend had a serious car accident. She was in the passenger seat and her husband was driving. Unfortunately, her husband died almost instantly. My friend, badly injured, was intubated in the field and rushed to the hospital. She suffered broken limbs and intracranial hemorrhage (bleeding into the head). The first few days in the hospital were intense but miraculously she survived. She was in the Intensive Care Unit (ICU) for a month and is now recuperating in the rehabilitation unit of the hospital. The care she received in the ICU was topnotch. The care team did everything right and with absolute precision. Witnessing her recovery has urged me to remain proud of being a  physician and belonging to a cadre of professionals who are saving lives every day.

Our medical system is very well designed to respond to acute situations. We have the best hospitals and the best acute care facilities in the world. Physicians in these situations can function free of third party restrictions dictating what can and cannot be done. In acute medical situations, there is little time to deal with nonsense and the patient becomes the focal point and the doctor-patient interaction the essence of care.

This senario exposes the dichotomy in our healthcare system. On the one hand, we have amazing rapid response systems in place where care can be delivered without intrusion of special interests. On the other hand, we have a very lousy primary care and longitudinal care infrastructure, where the infridgement of third parties and other special interests has created a convuluted maze of ineffeciency leading to bad clinical outcomes. This shortcoming represents a great burden in terms of causing pain and suffering, lives lost, and economic strain, rapidly approaching the threshold of crisis.

Dr. Sandeep Jauhar, whose recent article in the New England Journal of Medicine didn’t sit too well with me, published a great article in the New York Times earlier this week on the pitfalls of pay for performance (P4P) schemes, where doctors are given financial incentives to practice cookbook medicine. Stating that “doctors have seldom been rewarded for excellence, at least not in any tangible way”, Dr. Jauhar outlines how P4P measures can actually compromise quality of care.

A new study published in JAMA shows that only 2% of medical students are considering being primary care physicians, citing the bad lifestyle as one of the main factors. I don’t blame them. Primary care physicians are overworked and underpaid. Why should any medical student with over $100,000 of debt settle such an under-appreciated job? Life is too short and self-sacrifice doesn’t pay the bills.

Politicians and policy experts should wake up. There is an impending crisis of great proportions in healthcare that will soon compromise our ability to care for our aging population and remain competitive in the global marketplace.

More info: USA Today

Two recent reports present differing views on the status of consumer-driven health plans, i.e. high deductible plans that are often paired with health savings accounts (HSAs). One report shows increased adoption of these plans by 43% over 2007 accounting for about 13% of all plans offered by employers. The opposing perspective is presented by a small study in Iowa, showing that about 17% of the 954 surveyed businesses offered consumer-driven health plans combined with HSAs, dropping from 26% in 2007. This may be due to the fact that many employers don’t see the value in high dedutible plans since it seems like insurance companies are raising the premiums to the same level of traditional managed care plans. This is a great strategy on the part of the health insurance industry to maintain control over healthcare transactions. Consumer-driven health plans put patients in the driver’s seat. Why should the insurance industry hand over decision-making to consumers? They obviously know better how to spend the patients’ money.