Basic Health Access

Pessimists include politicians, micromanagers, insurance payers - those that devalue those who deliver the health care or any that try to hold them accountable. Optimists sit at home optimizing care on spreadsheets and have difficulty separating assumption from reality but that does not stop their abusive policies and regulations. Realists are those out there delivering care, constantly adjusting in one on one interactions with patients as always, but they must now adjust to the resource deficits from the pessimists and to the innovative regulatory distractions of the optimists. For us realists, health care is our life. And we are tired of the abuses of the pessimists and the optimists. Let our people and our patients go.   Via Timeline Photos   Triple Threat is the enemy of health access.  Pessimistic revenue kept too low.  Optimistic tinkering accelerating costs of delivery.  Challenging patient complexity made worse b...

Eric Levi outlines the Dark Side of Doctoring in one of the most important health care topics of our time. He was led to this blog post after another physician took his own life. The words of the widow of the physician to trace the final steps leading to this tragic loss. These words have the power to help others to understand the process that leads to death for those pledged to life. The following represent a number of resources for physicians and their families as they struggle with the Dark Side. Advice comes from the blog, the widow, 5 Regrets at the End of Life, The Antidotes of Stress, and what we should do as physicians and as a nation. The formula is not difficult to understand - Too little sleep, too many life interruptions, too little time left for family or self, feeling too important, finances too complicated, feeling too inadequate, and eventually leaving too few indications of the final act to come.  Exhaustion, interruption, marginalization, superhuman e...

Bandwagon movements have been very common in primary care. They have been very distracting. The failure of Primary Care Medical Home for many reasons now leads to the need to have another bandwagon. Lean Primary Care may lead the charge to become the next bandwagon. The rosy reviews have been seen in the usual media sources. These indicate a 5% increase in productivity, guaranteed to attract attention . Whether this was Lean or the movement of physicians into the action is impossible to address - except in the media and in the article. Which would you read Scaling Lean in Primary Care Impacts on System Performance or Moving Physicians from Back to Front Offices Improves Performance Lean Primary Care Meets Many of the Criteria of Primary Care Medical Home The usual suspects are present such as inflated claims for results despite short term data collection. The problems also persist: Lean is too vague - a similar problem with Primary Care Medical Home. There is no way...

Cries of victory may ring out today after the apparent defeat of the misguided Republican Replacement Plan, but the sand people will be back and in greater deception. The designs over past decades will continue to be shaped by those with their own agendas - agendas that are a poor fit with the needs of most Americans or true improvements in health outcomes. The first realization that must be made is that the designers will be back with plans that work for them, but not for most Americans. The second realization is that good intentions taken to excess have consequences as seen in austerity focus and in runaway health care costs. Austerity Focus Runaway Health Costs Cuts or prevents or diverts investments in areas that shape local determinants of outcomes Increase so rapidly that federal and state dollars are diverted to health care and away from the determinants of outcomes The Determinants of Health, Education, Economic and Other Outc...

During this time of "value" focus, we have apparently replaced the temporary focus upon reflective practice. Recent patient care experiences confirm the value of reflection as there are so many dimensions of learning available, especially compared to the few via biomedical focus. Well being is about restorative time. Across residency training and primary care practice, there is an assault on this time and the value of such efforts. A major theme for practice or for patients or for those in training is the value of rest and reflection time. The most important learning requires rest and reflection - and these require time. Well-being is compromised when rest, reflection, and sleep are compromised. Too often it is easier to just work toward the end of the day. It is easier to speak too soon, listen too little, or jump to treatment as seen in too much medication. It is harder to insure best communication or to go the extra mile to impact the care experience of a child or a ne...

Unprecedented decreases in morale and productivity have been seen across primary care in recent years. It is very clear that team members have faced rapid changes and increasing care demands along with declining support while patients and situations have increased in complexity. Health care leaders are not paying attention. There has been no progress to improve support or to decrease the challenges. Even worse, primary care leaders get poor ratings as they spend their time and effort and scarce resources on areas that will not reverse marginalization, burnout, turnover, and productivity problems. A recent RAND study was very relevant and indicated increasing concerns regarding the ability to best care for patients and have been sent through formal family medicine channels. Studies document the proliferation of additional work hours before and after patient care. Numerous studies indicate the higher costs from HITECH to MACRA and for primary care medical home. These are designs that...