Some of things I have learned about and written about in my blog over the past three years I would have never imagined three years ago let alone forty years ago when I was handed a MD diploma. Here are some of them.
1.Alternative medicine, AKA integrative medicine, AKA woo . This is many ways may be the most mind boggling. Whatever you want to call it, Dr RW called is quackademics, "it" has moved into the medical school curriculum, research activities and the accepting mind sets of many medical students. We see large numbers of government funded research grants and for many of the projects all you can say is "you've got to be kidding me".
2.The role of the AMA in damaging primary care through its development and continuing support of an advisory group that virtually sets fees from CMS and does so in such a way as to denigrate primary care and elevate procedure based medical specialists.Three years ago I had not even heard about the RUC ( Relative value scale update committee) and paid too little attention to the RBRVS (Resource Based Relative Value Scale ). With friends like the AMA...
3. Three years ago I had not heard of DrRich's thoughts regarding "covert rationing". Now that I have I cannot think of medical practice in the same way. His thoughts can be found at his web site and more completely in his book docs and I believe medical students and physicians alike should read what he is saying before they do anything else. On the insight scale this would be a ten.
4.The downward spiral of primary care. No. 2 above plays a role here but a major culprit is the price controls that are part of the Medicare system which I ranted about here.
5.Pay for performance (P4P) as absurd and wrong on so many levels as seems to be to me it continues to thrive and I believe make matters even worse in primary care. Physicians accepting bribes to do their job is just another example of the continuing loss of pride and ethical demise.
How to apply group data to individual patients, the potential pitfalls and traps and tricks of evidence based medicine (EBM) and how some can pervert the sound principles of EMB to their own ends are some of the thoughts that have recurred in my mind and in my blog. Thanks to those who have commented on my comments, some of which were laudatory and a few of which were not and the occasional one who missed the point or whose mind set is imbued with a different vision. I know I have learned more from other blogs than they have from mine but it has been and I hope will continue to be a blast.