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Is the new professionalism and ACP's new ethics really just about following guidelines?

The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of ...

Tuesday, July 19, 2016

Grief Counseling-who benefits? hint- who get paid for it?

Bringing in grief counselors seems to be a fairly common occurrence. We hear about it when a tragedy, such a shooting at a school, occurs. We are told that such specialists are being brought in to do whatever they do to help the students cope with their loss.

There is even an organization through which one can be certified in grief counseling,the American Institute of Health Care Professionals. They also offer other certifications including "Health Care Life Coach".

Apparently the basis of grief counseling has been undermined in recent years by some published data. To add a veneer of fairness I mention this article which critically reviews articles that have claimed actual harm from the process focusing on two papers which they believe are flawed and have unduly damaged the reputation of grief counseling.

A 2007 Newsweek article quotes some research that demonstrated actual harm ( mainly prolonging of the symptoms for which they were treated) from grief counseling and claimed that solid proof on its efficacy is lacking.

Monday, July 11, 2016

Is the new professionalism and ACP's new ethics really just about following guidelines?

The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of the physician and the patients but presumed to define what the relationship of the physician  should be to society. The physician was to strive for social justice and was to act as the "steward of society's " finite medical resources.

Implicit in the stewardship of resources notion is the egalitarian concept of the collectivization of  privately owned resources i.e all of the assets and individual skills that constitute the medical resources. This is the view that resources as a whole should be considered as the common asset of everyone with each to have a right to their share or that the resources are "owned" by everyone.  This notion is antithetical of the notion of private property and seemingly ignoring the key role of  private property concepts as the basis for civilization, At least that is what David Hume,Adam Smith, John Locke and founding fathers thought about the importance of private property.

Owned is in scare quotes because the concept of ownership in a free society with rule of law entails the right of the owner to use his property,to exclude others from use of his property and the right to dispose of the property.If everyone owns the resource then no one owns it and no one could be excluded from use of the property.

All of the  medical resources of the United States cannot in any real sense or legal sense be owned by everyone. So the common ownership rhetoric must be metaphorical and physicians as stewards of the resources must be rhetorical as well. It is a poetic way of saying the physicians should rein in the ever increasing cost of medical care. Further they can do that  by ordering fewer tests and procedures and treatments,that they should abide by recommendations based on studies of cost effectiveness of various medical options, that they should not let their concern and duty to the individual patient override the collective good which will be brought about by doing what is best for the group and what will be best will be determined by the progressive medical elite.Just follow the guidelines,Doc.

Tuesday, July 05, 2016

The 4th of July, Pride and "How Can I help you/"

This blog is for the most part about medicine and the practice of medicine so quoting extensively from a economist's blog might seem off track and one may wonder what if any is the link to medicine. This recent posting by George Mason University's professor, Don Boudreaux is so congruent with my core beliefs and he expresses them so well  that I have to quote him.

Broudreaux's topic is why, on the 240 th anniversary of the United States, we should be proud to be an American. See here for the entire essay.

Quoting from his blog, Cafe Hayek:

"...I’m proud of the peaceful manner in which most Americans conduct their private affairs.  I’m proud of the widespread respect for private property that continues to govern people’s personal, private relations.  I’m proud of the entrepreneurial spirit that continues to exist among many of my fellow denizens of these United States.  I’m proud of – and deeply grateful for – the innovativeness and entrepreneurial creativity of many of my fellow Americans.  I’m proud that America continues to be a destination for people seeking better, freer lives.  I’m proud that many Americans continue to believe that the most ethical course in life is for each individual to be self-responsible, self-supporting, hard-working, honest, and upright.

I’m proud, in short, of America’s bourgeoisness.  It’s this bourgeoisness that has made America great.  This greatness comes not from bellowing politicians, not from well-weaponed armies, not from arrogant judges, not from meddling bureaucrats, not from pompous Washington and New York and San Francisco pundits; it comes not from anything but the hundreds of millions of ordinary Americans who daily work hard, honor their contracts and other people’s property, cherish their families, friends, and neighbors, and think it perfectly natural to ask strangers in commercial settings “How can I help you?” "

 It has always seemed natural for a physician to ask that same question upon seeing a patient. In fact I recently saw an orthopedics for pain in my calf who asked that exact question.

As I read commentaries about the MACRA proposal and the nearly 1000 pages it takes to describe the process I wonder how long as the bureaucratic interference levels continues to increase and impede medical practice  will it be before that question will be merely perfunctory as more and more time and effort will be drained  away in an effort to go by the rules of " quality care" and properly document them so the reimbursement  will be 3 or 4 % more or less ( see here) and less available to do what is needed to help the patient.

Addendum; For an excellent  review of how MACRO will change just the "Meaningful Use" program (and there is much more to it than that) see here.

 h/t to Margalit Gur-Arie on her blog "On Heath Care Technology"