The New HMO Fiasco
There is no more perverse, more derailed concept in today’s health care environment than fee-for-service. Even Wikipedia knows true evil when it encounters it. Let’s read their definition:Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. Similarly, when patients are shielded from paying (cost-sharing) by health insurance coverage, they are incentivized to welcome any medical service that might do some good. FFS is ...
Source: In My Humble Opinion - February 17, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
When In The Course
As high school teachers go, he was an anomaly. A rare mix of humor and excitement, he was able to extract from his students the last ounce of concentration left at the end of a busy school day. He taught my United States history class. Long after I had collected acceptances from colleges my senior year, I sat engaged and learning a subject I frankly had little interest in.He was constant energy. He zoomed about the room, the tempo of his voice nearly as erratic as it's volume. The attention demanded by his motion was only second to the content of his lecture. He made history both intoxicating ...
Source: In My Humble Opinion - February 16, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Is Medicare Unnecessarily Complicated?
I had one crowning achievement during my college career. Freshman year, I took the most challenging course the university had to offer. I still wake up in the middle of the night in a cold sweat with differential equations flying through my brain. Advanced calculus not only had a difficult subject matter, it also had a professor known for challenging even his most avid students.I remember tackling the material with a voracity that I had never displayed in my course work before. I ate, slept, and inhaled the complex mathematical formulas. I couldn’t believe my eyes when I got the final grade back. A+.Over the years, ...
Source: In My Humble Opinion - February 11, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Losses and Gains
Loss is something all humans face in their everyday lives. As a physician, the effects are often magnified. People die, they move away, they graduate from your services, or occasionally they pursue care elsewhere. Parting can sometimes bring relief, and others a deep sense of failure. But with Clara, I'm not sure we actually parted. Mostly, I was left with confusion.Clara came to me by way of the nursing home. Her family had brought her to the hospital when she became too weak to rise out of the reclining chair in her living room. The hospital stay was short. Multiple diagnos...
Source: In My Humble Opinion - February 9, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
The Spoils Of War
There was once a kind and merciful General. His joy of the study of war could only be matched by his love for the soldiers who trained dutifully beneath him. Day in and day out, he could be seen in the barracks beside his men. He was both dogged and forgiving, relentless but affable. His mind was laser sharp, and his physical agility could match that of any of his much younger recruits.He was a nationalist. More willing to devote his life to the calling of country than to risk those of the young people who gathered around him. So his attention to detail was incessant, his expectations fo...
Source: In My Humble Opinion - February 2, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Is Doctoring Easier For Men?
She was everything one could ask for in a medical resident. During the few weeks she had been shadowing in my office, I found her fund of knowledge to be exceptional. Her intuition was right more times than not. And she negotiated the fine line between detached clinician and caring advocate. My patients loved her.Did I forget to mention that she was exceptionally attractive? I hope so. I really feel that such things have little relevance in medical training (or life in general). Sure, I could tell that she was careful about how she presented herself. She dressed over-conservatively in an attempt to deflect attention from h...
Source: In My Humble Opinion - February 2, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Mortally Wounded
Neither of the two most important people in Aaron's life could stand to be in the same room with each other. There was a long colorful history between his ex-wife and his brother, and as his disease began to accelerate, the feuding became quite intense. They argued over Aaron's advance directives. They both tried to coerce and manipulate themselves into commanding positions. The shouting became louder, the fury more fierce. Aaron, for his part, was fading under the colossus of his difficult to treat leukemia. Any bit of energy left after chemotherapy, was quickly snuffed out by his loved...
Source: In My Humble Opinion - January 26, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Health Care's Newest Dirty Word
As a child, I loved games of strategy. Whether it was Monopoly, Stratego, or Risk, certain themes pervaded. One had to learn how to think multiple maneuvers into the future and form beneficial partnerships to survive the onslaught. The goal, of course, was total world domination. The game was over when one side was economically or physically manipulated into full capitulation.I have carried these strategies with me on my long voyage through medical education and doctorhood. Disease, the great evil adversary, is wily and deft. The ability to foresee her courageous moves, plan and prepare for the future, and meet her o...
Source: In My Humble Opinion - January 23, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Doctor On Doctor Crime
Her heart was failing; her ejection fraction was unmeasurable. Her hip was broken, and she developed a pulmonary embolism post-operatively. She was painfully close to death. Yet at some point, the hospital finished, and spit her out at the nursing home. She was confused.I tried to take the best history that I could. Her answers where usually no more than a single word. Her physical exam revealed a desperately weak woman, swollen from head to toe. Fluid seeped out of the wounds and lacerations on her legs.I hopefully clung to the one positive portion of her assessment, it appeared that he...
Source: In My Humble Opinion - January 19, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Hands
My mother-in-law has a theory about our children, and it has to do with their hands.My son, the eldest, would sleep from his earliest infancy with his fingers balled tightly into tiny little fists. He was born with a herculean grasping reflex resistant to any sort of outside manipulation. Over the months, his fingers learned how to curl around a wide variety of colorful and textured devices. He would fixate on one toy or another, refusing to let go. Every attempt to remove the object of his affection would be met with squawks of displeasure. Eventually enthralled in a drunken fit of sleep or f...
Source: In My Humble Opinion - January 13, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Is Meaningful Use Killing Us?
It took days to unravel what happened.The patient first presented to her cardiologist a few weeks prior. We figured that she must have doubled her amlodipine dose that morning, because her blood pressure was uncharacteristically low. He dutifully documented the hypotension and discontinued the 5 mg of amlodipine, not realizing that she had accidentally taken too much.Seven days later, her systolic pressure reached the 200 mark. She, of course, didn’t know that. She only knew that her head started to hurt and that she was slurring her speech. By the time she arrived at the emergency room, she could barely move her right a...
Source: In My Humble Opinion - January 12, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
The Final Gift Of The Dying
I assumed many things that morning. For instance, I thought it was likely that Ronald's fatigue was from lung cancer that had metastasized to the liver. Or that he decided to stay in his room in the nursing facility because the decision to elect hospice had finally taken it's toll. I was sure that he was both physically and emotionally spent. I reasoned that I wouldn't want to get out of bed either. My visit, however, was much more optimistic than anticipated. Ronald was jovial and inviting. And he was spent.The holidays brought an onslaught of family and friends to his little corner of the skilled ...
Source: In My Humble Opinion - January 11, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Begin Again
It was a rather unlikely place to begin my clinical career. Shortly after starting medical school, I signed up to volunteer in the hospice unit of my academic medical center. The first few visits I relegated myself to fairly banal activities. I shredded old medical records, or I might do a load of laundry for a family member who had been waiting tentatively by their loved one's side and was unable to carry out such basic human necessities. Over time I became more familiar and would engage families, sit with the dying, and comfort the staff. I once helped a nurse prepare a newly deceased body, and a...
Source: In My Humble Opinion - January 6, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Sometimes Medical Care Requires More Than Just A Minute (Clinic)
The truth is, I know it's easy to go to the Minute Clinic. I know the enticement of not needing an appointment, of being able to shop while you wait, of having the prescription ready to pick up by the end of your appointment. Who doesn't like convenience and a friendly smile to add? Who doesn't like the customer service offered at CVS, Target, or your local pharmacy? I certainly do. And I know that the doctor's office can be a pain. I also loathe the annoying phone tree that leads to a tired nurse or secretary, and possibly the hours of waiting to have the physician call you back and tel...
Source: In My Humble Opinion - January 3, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
In My Humble Opinion; The Most Popular Posts of 2014
These were my most viewed posts of 2014. Enjoy!1.Let's Be Real Clear About This...Are doctors being overpaid and causing the catastrophic rise in American Healthcare costs?2.Doctors Behaving Badly...A dozen set of eyes stared upwards. The nurses ate their pizza and glanced back and forth between me and the dry erase board that I had recently filled with incomprehensible scrawl.3.Malcolm Gladwell Is Wrong, Tell Them That You Love Them...Malcolm Gladwell thinks we should tell people whats it's really like to be a doctor. And by God I have invested the last seven years in doing just that.4.Creative Dest...
Source: In My Humble Opinion - January 1, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
