VOLUME 2 | 2021 2021: THE YEAR WE OVERCOME
WWW.PHYSICIANOUTLOOK.COM PUBLICATION DEDICATED SOLELY TO PHYSICIANS AND THEIR PATIENTS
Cover Art by Physician Artist Susie Sharpe, M.D.
F R O M T H E P U B LIS H ER
Springing Forward
LOOKING BACK
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Wri t t en by Ma r l e n e Wu st- S mi t h, M . D.
pring has finally arrived, and not a minute too soon. I dread daylight savings time every year because I lose an hour of precious, increasingly evasive sleep. The only saving grace of that lost hour of restful slumber is the promise that a sunny renewing Spring is around the corner. I was in quite a funk when March 14th rolled around in this post-pandemic year. Like many others, I felt derailed and unsettled as we approached the oneyear anniversary of the “day the world shut down.” I was woefully behind in getting 2021’s second issue of the Physician Outlook Magazine completed and to the printer. I had been distracted. I had been anxious. I had been too busy to stop and practice gratitude. I had been eating too much. I had not been delegating and leading effectively. I had allowed myself to put too much on my plate. I had not been exercising. I had been “canceled” by colleagues that I highly respected, and I 2 | 2 0 2 1 VO LU M E 2
was letting their ignorance get to me. I had been having trouble sleeping, and not surprisingly, I was tired all of the time. I was apathetic. I was self-sabotaging. I was not using my organizational skills. I had been prioritizing the wrong tasks on my list. Worst of all, I had been letting this negative self-chatter occupy valuable real estate in my brain. Why? I took a hard, long look inside of myself and realized that a big part of my “funk” was that I was mourning the loss of a man who I had barely met “in real life,” but who had become emblematic of the horrible nightmare that COVID-19 had wreaked across the globe. This man was my boss. It turns out that the life and death of Dr. Dennis DePerro, the president of Saint Bonaventure University (where I serve as the Medical Director for the
Center for Student Wellness), was in large part the root cause of my mental paralysis. He was diagnosed with COVID-19 on Christmas Eve, admitted to the hospital 4 days later, put on life support by mid-January, and pronounced dead by March 1st. Dr. DePerro was just a few years older than I am. His two sons are not much older than my own daughter. Like me, a little overweight, but otherwise healthy. Like me, somewhat of a “doubting Thomas” throughout the different stages of the pandemic. He was villainized for traveling out of state for a donor’s meeting in November of 2020, days before we made the difficult decision to send all of our students home due to rising COVID cases. I, too, had traveled out of state for “non-essential” travel. Dr. DePerro aptly dubbed COVID-19 relentless. His untimely passing is an ironic tragic reminder of this fact.
IMAGE C RE DIT BY IN GRA M IM AGE S IMAGE CREDIT BY DEPERRO FAMILY
My boss was a jovial, visionary, charismatic bold martyr who looked COVID in the eye and didn’t let it stop him or his university. Enrollment and retention actually INCREASED during the pandemic as it had during the preceding 3 years of his tenure. He made a commitment to ensure our students would have as normal a college experience as possible despite being in the midst of a global health emergency. He was SO proud that Saint Bonaventure had fared much better than most U.S. colleges in the fall of 2020, maintaining in-person instruction and our Division 1 and NCAA athletes practicing. He lamented that we didn’t make it all the way to Thanksgiving. It was Dr. DePerro’s aplomb and leadership style that brought us through last semester and continues to let us thrive when many other institutions of higher learning are struggling or failing. At Saint Bonaventure, the fact that I am a physician who has founded a
magazine is met with admiration and respect. It is welcomed that I provide internship opportunities to students and that I encourage them to write, edit and contribute content. I am surrounded by brilliant young minds who are pursuing degrees in health, marketing, journalism and who are learning how to become independent autonomous young adults. Like Dr. DePerro had likely experienced a few years prior when he finally achieved his life’s goal of becoming a university president, I felt that I had arrived in Utopia. A Utopia that got turned on its head in early 2020 when the global pandemic reached our tiny academic community, that turned my “easy job” into a 24/7 nightmare of a rollercoaster ride. A Utopia that ultimately sacrificed the very life of Dr. DePerro, who made the conscious decision to put others before self by leading in person, not hiding in his basement nor behind a computer screen. His last words (penned in the BonaVenture Magazine in the Winter 2020-21 issue) are eerily beautiful and simultaneously haunting: “For so many reasons, I’m sure we all wish 2020 could be erased from our memories. However, like so many other years of historical significance, it will change our world in ways we can’t conceive of now. Let’s hope that 2021 will cast far more sunshine upon us.” As Spring has sprung, I have come to realize that I am blessed to still be standing, to still be breathing and living, creating and sharing. I have much to be grateful for, and I have much that I need to say and do through this magazine. It is my life’s mission to restore the sanctity of the physician-patient relationship, and it is high time to reset my clock and my mindset and enjoy the life and love that surrounds me. 1
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Al-Agba and Bernard tell a frightening story that insiders know all too well. As mega corporations push for efficiency and tout consumer focused retail services, American healthcare is being dumbed down to the point of no return. It’s a story that many media outlets are missing and one that puts you and your family’s health at real risk. JOHN IRVINE, DEDUCTIBLE MEDIA
Laced with actual patient cases, the book’s data and patterns of large corporations replacing physicians with non-physician practitioners, despite the vast difference in training is enlightening and astounding. The authors’ extensively researched book methodically lays out the problems of our changing medical care landscape and solutions to ensure quality care. MARILYN M. SINGLETON, MD, JD
A must read for patients attempting to navigate today's healthcare marketplace. BRIAN WILHELMI MD, JD, FASA
This book is a warning of what is to come if we ignore training and education. Share this book or tell others to buy it. We cannot wait to act on this.” DOUGLAS FARRAGO MD AUTHENTICMEDICINE.COM
This book exposes one of the best kept secrets in our current healthcare jungle created through the corporatization of medicine. Filled with relevant examples and anecdotes to help the reader understand the issues being addressed, this book captivated and held my interest from beginning to end. AINEL SEWELL MD
Inspiring, inciteful, and eye-opening! An in-depth and thought-provoking examination of important decisions affecting modern healthcare in America. This work should be mandatory reading for all administrators and policymakers influencing the US healthcare industry. KEVIN LASAGNA, LTC, US ARMY
A masterful job of bringing to light a rapidly growing issue of what should be great concern to all of us: the proliferation of non-physician practitioners that work predominantly inside algorithms rather than applying years of training, clinical knowledge, and experience. Instead of a patient-first mentality, we are increasingly met with the sad statement of Profits Over Patients, echoed by hospitals and health insurance companies. JOHN M. CHAMBERLAIN, MHA, LFACHE, BOARD CHAIRMAN, CITIZEN HEALTH
Table Of Contents
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FROM THE PUBLISHER
Springing Forward, by Marlene Wust-Smith, MD/p.2 THE HUMANS IN MEDICINE
The Hidden World Of Anesthesia, by Marianna Seefeldt and Rachel Torregiano/p.6 Vaccine Misinformation, by Peter Valenzuela, MD/p.9 Vaccines: Olympics Without Medals, by Marta Illueca, MD/p.10 Maggie’s Musings - “D.O.”ing Medical School, by Margaret Hurley/p.12 THE DOCTOR’S BAG
Clubhouse Rules! by Nathan Eckel/p.14 American Health Care’s Staggering Administrative Overhead, by Marion Mass, MD/p.18 UBERDOC, by Paula Muto, MD/p.20 PLEASURES AND PASTIMES
SharpeR Image, by Marlene Wust-Smith, MD/p.22 Spring Arugula Salad Recipe, courtesy of HumanOS.me/p.24 THE LAST WORD
Dealing With My Insurance Company Is Making Me Sick, by Maryanna Barrett, MD/p.28
Cover Art by Physician Artist Susie Sharpe, M.D. WWW.PHYSICIANO U T LOOK . C OM | 5
T H E H U MAN S O F M ED IC IN E
The Hidden World of Anesthesia AN ANESTHESIOLOGY RESIDENT EXPLAINS ALL
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Wri t t en by Ma ri a nna S eefel dt a n d Rachel To rregi a no
r. Nabil Othman is a fourthyear anesthesiology resident at Cedars Sinai Medical Center in Los Angeles, C.A., who recently finished writing his first book, Vigilance: An Anesthesiologist’s Notes on Thriving in Uncertainty. He’ll be graduating from residency at the end of June before beginning a fellowship year in Houston, TX. Born in Chicago and raised in Michigan, a career in medicine piqued Dr. Nabil Othman’s interest at a young age. In middle school, Dr. Othman spent time helping his grandfather, who elected to manage his heart failure at home instead of pursuing invasive medical treatment. “He elected to have a 6 | 2 0 2 1 VO LU M E 2
nurse come to his house and help him during the day and I would help him out in the mornings, and I really enjoyed that,” said Othman. After finding joy and performing well in his science classes throughout school, Dr. Othman applied to medical programs and soon began to pursue his MD from Wayne State University School of Medicine in Detroit. He first began his career in medicine with an interest in trauma surgery, but realized his third year of medical school it was not what he was looking for. It wasn’t until his fourth year of medical school that everything clicked for Dr. Othman, when he spent a day with anesthesiologists. “I couldn’t do
a formal anesthesiology rotation until after the residency application deadline because I decided late,” said Othman. Although it was risky, he was confident in his backup plan to work in an Intensive Care Unit or critical care if he didn’t end up liking anesthesiology. “Critical care and anesthesia are so similar that the odds of liking both are very high,” said Othman. Now, in his last year of residency, anesthesiology has become both a career and passion for Dr. Othman. This is what drove him to write Vigilance: An Anesthesiologist’s Notes on Uncertainty. “In almost every other specialty, there’s tangible evidence of what they do, but with anesthesia, you don’t tan-
PH OTO CRED IT BY MARTIN SALGO
P HOTO C RE DIT BY M A RTIN SA LGO
gibly experience anything,” said Othman. Beginning to write the book was not an easy or simple process. Dr. Othman had to find both the time to write and words to express what he described as an abstract thinking process that patients will never see. “It’s hard to explain something conceptual that that they patients can never experience,” said Othman. He began the process by reading many books about cognitive psychology, behavioral economics, philosophy of perception, and decision-making and was able to use language from those books and apply it to his own knowledge to put his thoughts into words on paper.
rience in the operating room served as inspiration for the book and drove Dr. Othman’s goal to help others better understand both the processes and passion behind anesthesiology as a profession. The medical world continues to change and grow with the emergence of advancements in technology. Dr. Othman finds himself continuously impressed and excited about the evolving medical technology industry but does not see anesthesiology being an aspect of medicine that could rely 100 percent on it. ‘Black Swans’ is a term he uses in his book to describe the unpredictable events that occur in anesthesiology. This unpredictability is why Dr. Othman believes in the necessity of a doctor. “There’s so much that patients don’t know about their medical care. That’s why you have a doctor there – doctors guide the technology and have it do what you need it to do,” said Othman. “It’s changed medicine for the better but it’s not a panacea. You still need experts to understand the technology and know when to use it and when not to use it. You want an expert in your corner to navigate that and give you the best outcome.” 1
An Opportunity to Write Cancelled elective procedures as a result of the COVID-19 pandemic provided Dr. Othman with time to work on the book. His workdays were reduced, and Dr. Othman was doing anesthesia all day and writing all night, the pandemic gave him a solid head start. “It took me months of working on end,” said Othman. “I set out to write a book, and I wanted to do it well, writing 1,0002,000 words per day.” Dr. Othman wanted to explain the importance of anesthesiology in medicine. “The things we master in the operating room affects things outside of it too,” said Othman. The years he spent in medical school, as well as his expeWWW.PHYSICIANO U T LOOK . C OM | 7
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Microchipped Vaccine Dr. Lam educates her patient about vaccine disinformation
Bill Gates Portrait by Susie Sharpe, M.D.
T H E H U MAN S O F M ED IC IN E
Vaccines OLYMPICS WITHOUT MEDALS
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Wri t t en by T h e Re v. D r. M a rt a Il l u ec a
he global race to develop effective vaccines against Covid-19 has unraveled the extent of the scientific and technological capabilities of mankind. Like an Olympic competition seeking the coveted gold medal, new vaccines emerge on the horizon in a race towards a finish line that challenges the nature and spirit of human beings. That great scientific Olympiad began a couple of centuries ago, with the history of vaccination. I would like to remind you, if I may, of the devastating global scourges of diseases like smallpox and polio. And now, instead of gratitude for the triumph of science in elucidating the identity and weaknesses of the new coronavirus, what we see is a tsunami of misinformation that generates division and mistrust. 1 0 | 2 0 2 1 VO LU M E 2
Science Lessons In the history of medicine, science has taught us to battle the unfathomable mystery of viruses and it has accurately decoded the name and signature of those viruses that attack and endanger the health of humans. Shortly after the first cases of COVID-19, we figured out the identity of the villain, a new coronavirus called SARS-CoV-2. The latest member of the coronavirus family would bring great devastation to the world. This group of viruses began its attack on human health in 2002, and it was then that efforts were initiated to develop a vaccine which was “shelved” due to the eventual suppression of that outbreak. Now the new pandemic reminds us that we have no cure for the coronavirus.
I want to emphasize that one of the most intriguing and disturbing legacies of science is to make us understand that for viruses, there are practically no effective medicines. For example, available remedies for bacteria are antibiotics like penicillin. These compounds have the ability to control and cure diseases caused by this variety of microbes. Unfortunately, they are not useful to treat viruses. The same goes for antiparasitic drugs. The reason is simple: there are too many virus variants and having a specific treatment for one, will hardly work for many others. Those medications that can help control a virus do so by affecting the genetic material of the virus, which depends on access to human cells to express itself. Therefore, these antiviral drugs have the potential to be toxic and of limited use for us. In-
P HOTO C RE DIT BY IN GRA M IM AGE S
The author is a physician, researcher and ordained priest with the Episcopal Church in Delaware and Fellow of the Yale Program for Medicine, Spirituality and Religion
hibiting a virus “in vivo,” in the human body, entails causing “collateral damage” to the host tissues. Therefore, there is no government or pharmaceutical company in the world with the necessary means to design and pay for effective treatments against all existing viruses. Only through a safe and effective vaccine will we be able to cut the vicious cycle and the ravages of the coronavirus. The history of medicine has proven it. Smallpox caused three hundred million deaths and was only eradicated thanks to vaccination in 1977. Polio left thousands of children paralyzed and was only controlled with vaccines in the West in 1994. Congenital rubella, a devastating disease for newborns, was finally controlled in the Americas in 2009 with its vaccine. And it was only in 2020 that
an area of northeast Africa was liberated from Ebola, also thanks to a massive vaccination program. The same has been the case with diseases such as measles, mumps, tetanus, diphtheria, whooping cough, tuberculosis and rabies. Ironic Mentality The irony of the “anti-vaccine” mentality is precisely their forgetting about the ravages of the aforementioned diseases when left to run wild, but which thanks to vaccines, no longer exist or are hardly seen. Childhood vaccination protects children, and surprisingly many adults have no idea that they have been the beneficiaries of many efficient and safe vaccination practices, because words like polio and smallpox were never part of their vocabulary.
Vaccines, like all medicines, have possible side effects. That is why there are international regulatory authorities that, based on the laws of each country, monitor the pharmaceutical development and the safety data of new treatments, each one for a specific indication. In short, the development of vaccines has been the greatest science-based Olympiad in history and the athletes have been doctors, scientists, laboratories, governments and patients. There will be no gold, silver or bronze medals for the first vaccines against the coronavirus. And the final race isn’t over until all of the approved vaccines, together, contribute to the goal of herd immunity. Only then can we declare victory for COVID-19. 1 This article first appeared in La Prensa Newspaper, Panamá City, Republic of Panamá, January 24, 2021 WWW.PHYSICIANOU T LOOK . C OM | 11
T H E H U MAN S O F M ED IC IN E
PHOTO CREDIT BY ALICIA ROCELLI
Maggie’s Musings D.O.’ING MEDICAL SCHOOL Wri t t en by M a rga ret H u rl ey, S t u dent P hy si c i a n
Hello PO Readers! I just finished Term 2… onto the final term of first year! This term we start out with a quick unit in head and neck anatomy and then we move to our first systems based course in Heme/ Onc. Some reflections on Term 2. I really LOVE anatomy and physiology. I had the privilege to learn from dozens of cadavers this term, and every time I go into the lab, I am constantly reminded that I am working with someone’s mother or father, brother or sister, husband or wife. I walk in and see their brains carefully preserved in clear buckets - a window into their life - their every thought, memory and emotion. I am grateful to have had some wonderful “first patients.” As for physiology, it was definitely hard but fascinating to learn the normal workings of the 1 2 | 2 0 2 1 VO LU M E 2
body and it laid the foundation for the transition to pathology as we move on to systems. A piece of careful advice to myself and anyone who embarks on the journey to medical school. Stop comparing yourself. Just stop! I saw a really cool analogy today “flowers are pretty but so are sunsets and they look nothing alike.” In medical school, your colleagues are some of the most intelligent and dedicated people. We are go getters, grinding non stop, always looking for ways to improve ourselves and those around us. It is easy to compare yourself to others on this journey, but it’s also important to be mindful that this journey is uniquely yours. At the end of the day, everyone is going to carry the title of physician and everyone’s path to get there will look different. In college as pre-meds, we did a lot of “checking boxes” - clubs and ex-
tracurriculars, research, shadowing and volunteer work. These are all important experiences, but never feel less if you are not able to do some of these things. In undergrad, I couldn’t bring myself to do wet-lab research (it seemed that every lab worked with drosophila or mice and that just wasn’t for me haha). Instead, I did educational research to learn more about study strategies for college students. My point is that if you feel the pressure to do something just to make yourself more competitive, take a step back and make sure you are doing it for the right reasons - because you WANT to! We are already going through some of the hardest years of our lives, and it is absolutely vital that you take the time to prioritize your happiness, sanity and wellbeing. 1 Happy vibes until next time, Maggie
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T H E D O C TO R’ S B AG
Clubhouse Rules! ALL-TALK, NO GAMES
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Wri t t en by N a t ha n Ec k el
few weeks ago I was invited to participate in a Clubhouse discussion led by fellow Physician Outlook contributor, Dr. Marion Mass. Clubhouse is a new social media channel. Its ‘drop in’ audio-only format makes it a fast favorite for anyone who wants to connect video-free and relatively drama-free. There is only audio and the medium has a wonderfully humanizing effect, especially with a facilitator like Marion. One of the points that Marion eloquently made is that physicians are not in charge of the system of medicine anymore. Medicine has been taken away from the doctors, and Marion’s point is that medicine is not going to be restored 1 4 | 2 0 2 1 VO LU M E 2
without physicians stepping up and reclaiming medicine. Growing Up In Medicine As a non-physician, I had the unusual privilege of experiencing firsthand how special the physician-patient relationship could be - and how much has been lost. Growing up, my bedroom was a floor above my doctor father’s waiting room until I was 10. In my late 70s world, it was normal to have my 900 square foot basement serve not as a TV room but as a busy medical clinic. It was homey and the patients loved the close knit feel and enjoyed their doctor’s high level of personalized care and autonomy.
And while my father was human and subject to grogginess when patients called in labor at 3 AM, he always rallied and adjusted his mindset so that he could treat his patients as if they were family. It is easy to realize why he was so overwhelmingly loved and appreciated by his patients. In an odd technological twist, 40 years later, I am saddened when I read my childhood friends’ Facebook posts lamenting that they are having trouble finding a new family doctor or pediatrician for their own families. “I’m heartbroken. My family doctor just announced he was retiring.” they write. It was ironic to read and to feel their grief, on Facebook, as well as the shock of having to find someone who
P HOTO CR ED ITS BY WILLIAM K RAUSE O N U NSP L ASH
could provide the intimate knowledge of their health and level of care that they had become accustomed to. What does that story, have to do with you? And what does it have to do with Marion’s clubhouse call? It’s very simple. #TakingBackMedicine The individual physician has the power to do something about the way medicine has changed, to reverse what we have lost. You just don’t know it, or you just don’t believe it. It’s the mission of Physician Outlook to empower you to help take back medicine. As a designer the focus of my work and my collaborations is to assist physicians like you take
control over your time, focus, and your life in medicine. The way to empower the individual physician is to provide you with proactive tools that will give you back the time you need to help you stay in front of the next crisis. It is rumored that Marion Mass will be hosting future Clubhouse calls and we would love for Physician Outlook readers to join her. The Clubhouse app is open only to Apple iOS users at this time, and participants are allowed to join by private invitation only. Make sure you have downloaded the app and that you have the phone number(s) of people in your network saved to your contacts.
Clubhouse is another tool to help us #TakeBackMedicine If you have been patiently waiting for an “invite” and struggling with the Fear Of Missing Out (aka ‘FOMO’), wait no longer! On a first come, first serve basis I am offering physicians who send an email to retrospam@gmail.com an exclusive Clubhouse invitation. Mention Physician Outlook Clubhouse in the subject line and briefly tell me the top 3 things you wish you could change about your daily routine that would make you reclaim lost time in your day. 1 WWW.PHYSICIANOU T LOOK . C OM | 15
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Dr. Draghinas and Ryan are both podcasters. Desiree built their teams to help support them and others to consistently produce content. All three knew how challenging that was to do in the midst of busy schedules, competing priorities, unpredictable monetary compensation, and fluctuating motivation. Physician podcasters are there for the doctors and healthcare providers that make up their podcasting audience. But “this can be a tough and lonely journey for the podcast creator.” Doctor Podcast Network is there for the physician podcaster. It’s a place where they can come together, learn from, collaborate, and confide in one another, as well as facilitate the monetization of their shows. Having soft launched with 15 founding members in October 2020 and formally launching in January 2021 with 17 shows, the network has shown its capability of creating the community and environment that podcasters need to thrive.
Doctors Unbound is a podcast created for doctors who are busy with unique side passions outside of their normal schedule. Dr. David Draghinas shares their stories of triumph, learned lessons, and, ultimately, their humanity. Financial Residency is geared toward early-careered physicians looking for practical ways to manage their finances. Ryan Inman is usually found nerding out over phoned-in questions by his listeners asking about student debt, investing, insurance, and balancing budgets. The Physicians Guide to Doctoring is hosted by Dr. Bradley B. Block where he seeks to answer the question, "what should we have been learning while we were memorizing Kreb's cycle?" His podcast is a practical guide for practicing physicians and other healthcare practitioners looking to improve in any and all aspects of their lives and practices.
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T H E D O C TO R’ S B AG
American Health Care’s Staggering ADMINISTRATIVE OVERHEAD
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Wri t t en by Mari o n M a ss, M . D.
hen a group called Citizen Health recently crunched the government’s numbers for 2018 to find out where the money was going in American health care, the result was a pie chart — a picture worth a thousand words, some of which aren’t printable. That pie chart showed that 73 cents of every dollar of the $3.6 trillion national tab for health care that year went to people who have nothing to do with actually providing care to patients. Let that sink in. Almost three-fourths of your healthcare-related taxes, your insurance 1 8 | 2 0 2 1 VO LU M E 2
premiums, your out-of-pocket costs do not pay physicians, nurses, nurse practitioners, physician assistants, physical therapists, EMTs, testing labs, and health aides. So where does the money go? Doctors Outnumbered A 2013 study indicated that American health care’s administrative class outnumbered physicians by 10 to 1. Between 1975 and 2010, the number of health care administrators grew by 3,200%. From 1970 to 2018, spending on health care increased by a similar amount. Although much of the money is craftily hiiden, it would make sense that much of your money pays
these administrators (executives, bureacrats, clerks, assorted paper pushers, and bean-counters). That spending now constitutes over a sixth of the American economy. The “apex predators” of healthcare administration do extremely well. Almost $1.7 billion goes to the top 64 CEOs alone in healthcare-related industries — pharmacy benefit managers (PBMs); information technology companies producing healthcare-related software; healthcare-related data miners; insurance conglomerates; pharmaceutical manufacturers; regional health systems; and the list goes on. (And make no mistake about it — the lobbying dollar spent by these indus-
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We started small. In the 1940s, we started to anesthetize ourselves by giving employers who bore the cost of health insurance a special tax deduction. In the 1960s, Medicare and Medicaid were introduced. At the time, physicians wagged a finger at us, warning us of where this would take us. (And to be even more tiresome and annoying, those callous, heartless skinflints turned out to be right.) The original, official estimates of the cost of Medicare were not a little bit low, but wildly, stunningly low. Medicare’s trustees issue fresh reports from time to time on when insolvency can be expected. And yet there are some who call for “Medicare for All.” They argue that the simplicity of having the federal government manage the nation’s health care and be the “single payer” would lead to the reduction of all that costly administrative overhead. Uh-huh. Remember those original, official estimates of the 1960s? Here’s some more history. 1973: The HMO Act. 2003: MMA (Medicare, Part D; prescription drug benefits, etc.). 2009: The HITECH Act. 2010: The Affordable Care Act (ACA, aka Obamacare), 2015: The little-known MACRA bill.
tries in Washington and state capitals is impressive also.) How did we get here? Well, as newsman Ted Koppel once said, “Our society finds truth too strong a medicine to digest undiluted. In its purest form, truth is not a polite tap on the shoulder. It is a howling reproach.” Nonetheless, here it is — undiluted, impolite, and reproachful. We’ve voted, legislated, and regulated ourselves into this predicament. We looked elsewhere while the political class did this to us in the name of doing it “for” us. In short, we did it to ourselves.
2018 U.S. National Health Expenditure: $3.6 Trillion
You will be happy to know that there’s an academic who has crafted a justification for American lawmakers not reading the laws they pass and not understanding their consequences in the real world. All by itself, the ACA, in its early phase, added 11,000 pages of regulation that elaborated on the 2,300+ pages of the law. Death and taxes — you can count on them, right? You can count on this, too: More regulation = more administration. Did you know that physicians now spend at least half (and often more) of their time each day on “administrative” work? Call your lawmakers. Tell them: “Get smart about unwinding this mess. We need healthcare policy that puts patients first, not corporations, not lobbyists, not a bloated administrative class.” Remember Citizen Health, the number-crunching makers of that pie chart? Join ’em. Our topic next time? The appalling cost of not knowing the cost. 1 Marion Mass, M.D.; Bucks County pediatrician; co-founder, Practicing Physicians of America. This article is part of a series that was first published in the Bucks County Courier Times. The author is a member of this paper’s editorial board
•Everything Other Than Healthcare Providers
•Physicians •Registered Nurses •Home Health Aides and Personal Aides •Nursing Assistants and Orderlies •Pharmacists •Licensed Practical Nurses •Dentists •Nurse Practitioners, Nurse Midwives and Nurse Anesthetists
•Medical Assistants •Physical Therapists •Clinical Laboratory Technologists and Technicians
•Dental Hygienists •Radiologic and MRI Technologists •Pharmacy Technicians •Dental Assistants •Physician Assistants •Speech-Language Pathologists •Occupational Therapists •EMTs and Paramedics •Diagnostic Medical Sonographers and Cardiovascular Technologists and
•Respiratory Therapists •Physical Therapists Assistants and Aides 17 more
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P HOTO COU RTE SY OF U BE RDOC
T H E D O C TO R’ S B AG
UBERDOC TECHNOLOGY THAT RESTORES THE PHYSICIAN-PATIENT RELATIONSHIP
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Wri t t en by Pa u l a M u t o , M . D.
or the first time in many years physicians have a real opportunity to change the system. We have been relegated to the sidelines, as government regulators, insurers, and employers have been deciding what is best for us. Our patients as well, have been held hostage by their employer’s health plan, and have had to endure long delays in treatment and network restrictions while shouldering more and more of the bill through rising deductibles and copays. It’s not a model that is sustainable or even makes sense anymore. That is why we created UBERDOC, the first direct to consumer platform providing access only to the best and most experienced physicians for a transparent price. Founded by those on the front lines of care, UBERDOC has created a network of doctors from every specialty who set aside one or two appointments per week for a patient who wants the convenience 2 0 | 2 0 2 1 VO LU M E 2
of seeing a doctor without a phone call or insurance hassle. Doctors can even offer both in person and telemedicine appointments. Disruptive? Perhaps, but we need a way to restore the doctor-patient relationship and now we have the technology to do it. UBERDOC is open to board certified specialists, licensed in their state, and credentialed with a hospital or health system. There is no cost to become an UBERDOC and list an available appointment. However, subscriptions are available for telemedicine and other digital health services. Every UBERDOC has their own individual marketing page and a profile that can be linked to existing web sites and can be edited by the physician. Our goal is to provide physicians access to the tools they need to run a complete digital office including scheduling, reminders, billing, and collecting, so the doctor can
focus on what they do best, taking care of patients. And what about the patients? Do they want the convenience of seeing a doctor quickly and will they pay for it? You bet, and they have been doing it for years paying a minimum of $250 just to visit a walk-in. Now they can “walk-in” to their own doctor’s office or to a hard to schedule specialist without waiting. UBERDOC has seen over 1000 patients, with over 10,000 searching monthly for doctors nearby and available. Patients want affordable options and better access. UBERDOC provides both. So please join our mission. There are only 985,000 of us in practice, we need everyone happy and working to take care of the generation of patients who are living longer and healthier because of our efforts. For more info go to joinuberdoc.com. 1
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PL E ASU R E S A N D PA S TIM ES
Sharpe“r” Images A PHYSICIAN ARTIST SHARES BEAUTY, HARMONY AND HOPE THROUGH HER WORK
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Wri t t en by Ma r l e n e Wu st- S mi t h, M . D.
or probably the first time in history, the work of a practicing American physician artist has been accepted to the prestigious International Contemporary Art Fair in Paris. Dr. Sharpe’s artwork will also be showcased at the International Art Fair in Luxembourg (LuxExpo The Box: September 1719, 2021) and Brussels (Expo Center: November 26-28, 2021). This doctor is ON FIRE! Her creations were recently shown in Milan, Italy at the end of March (International Art Exhibition GAIA by the M.A.D.S Gallery) and will be included as part of the Market Art & Design Hamptons Show from August 12-15. Her art was accepted to the New York City Art Expo in November but Dr. Sharpe hasn’t definitively accepted that opportunity as of yet because she has 3 International Art
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Fairs in Europe later this year. She was recently featured in Arianna Huffington’s Thrive Global and Authority Magazine. Most amazing of all? Dr. Sharpe continues to see patients in her office. These events have typically each drawn 20,000+ visitors from all over the world in past years. Dr. Susie Sharpe is a respected physician with 25 years of medical practice who is also a celebrated artist. Her path has been anything but straightforward or smooth. Dr. Sharpe’s extraordinary journey is inspiring! Growing up in Korea, she always excelled in art and in academics. Her dream was to become an artist and to study abroad in Paris. When she was 16, her parents decided to emigrate to the United States. Without speaking any English, she faced a great deal of hardship including language, social barriers and poverty.
Choosing Medicine Over Art She gave up her dream of becoming an artist, and instead chose to pursue a medical career. She wanted the security of being able to support herself in a a career that would help people directly. For the next two decades she buried herself in books, graduating from Wesleyan University with a degree in Chemistry, and then graduating from Yale Medical School with her M.D., followed by a residency at Yale New Haven Hospital, all while learning English and working to pay for her education. During those twenty years, she became a very successful internal medicine physician in Seattle, Washington and then settled in Missouri where she remains, while raising two gifted children. While she felt fulfilled and loved her medical practice and family, she
P HOTO C REDIT BY DR. SUSIE SHA RP E PHOTO CREDIT BY DR. SUSIE SHARPE
P HOTO C RE DIT BY DR. SUSIE SH A RP E
never gave up her childhood dream of becoming an artist someday. Despite her demanding schedule as a physician and mom, she made it a priority to study art whenever the opportunity presented itself. The art Dr. Sharpe created became highly acclaimed, and before long she was being rewarded with many awards, and being asked to showcase her art in many exhibits, all while still enjoying her practice of medicine. She has also become recognized as an exceptional artist online and through that exposure, her art has been selected to participate in several international art fairs. Being chosen for the upcoming art fair in Paris is particularly meaningful for Dr. Sharpe, as it fulfills her childhood dream. One of her works to be featured in the upcoming art fairs is titled: “Follow Your Dream to the Stars”. It is
a culmination of what she could only dream of for decades — following her childhood aspirations to become an artist in Paris. Proving that age is irrelevant when one is in pursuit of goals, Dr. Sharpe’s journey as an artist has just begun. She has ambitious dreams of sharing her art all over the world, from coast to coast in the U.S. as well as abroad, spreading her message of optimism. As a physician, she witnesses a lot of human suffering. Yet, she sees life as a precious gift. Typically, she treats many patients with chronic conditions including diabetes, heart disease and cancers. Over the past year, she has been very busy with many patients afflicted by the COVID-19 pandemic. Her mission as a physician is to lessen human suffering, both physical and mental. Her mission as an artist
is to share beauty, harmony and hope through her art. There is much darkness in the world and this inspires her to show the positive, beautiful, brighter side of life. She is also a passionate musician; her love of music shows up in her art as well. “The Art of Medicine has its Roots in the Heart”-Paracelsus. Dr. Sharpe is a physician who has a deeply rooted love for her patients and for the beautiful art she creates. It is truly healing for the soul. 1 To see recent work by Dr. Susie Sharpe and to learn more about the artist, visit: https:// www.susiesharpe.net/ Instagram: https://www.instagram.com/ susie.sharpe/ Facebook: https://www.facebook.com/SusieSharpeArt Email: Susie.sharpe@gmail.com WWW.PHYSICIANOU T LOOK . C OM | 23
PL E ASU R E S A N D PA S TIM ES
Ingredients 1lb cooked chicken breast, shredded 4c arugula 1c green peas 2T olive oil mayonnaise 2 stems green onions, chopped 1/4c fresh italian parsley, chopped 1t garlic powder 1/2t sea salt and pepper to taste
Spring Arugula Salad Recipe
Preparation 1. Combine chicken with mayonnaise, green onions, parsley, garlic powder and salt & pepper in a mixing bowl. Mix gently and set
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Reci pe by S a ma ra Pa rdi
aside.
resh peas are usually only available in the Spring and can be eaten raw as well. If
you like the crunch on this salad, feel
2. Boil only a couple inches of water in a small saucepan that a steaming basket will fit into. Once boiling, lower steaming basket with peas into the pan and ensure water remains below the bottom of it. Steam for 2 minutes only, then drain thoroughly and set aside.
free to skip the steaming step. The dressing from the chicken salad is usually enough for the greens, but if you’d like to add more, drizzle arugula with 2 tbsp olive oil. 1 https://www.humanos.me/libraries/recipes/ simple-food-diet/spring-arugula-chicken-salad 2 4 | 2 0 2 1 VO LU M E 2
3. Arrange arugula in a large salad bowl. Sprinkle peas over it and scoop the chicken salad on top.
WWW.PHYSICIANOU T LOOK . C OM | 25 P HOTO C RE DIT BY IN GRA M IM AGE S
PADPCA is a non-profit organization of Independent Direct Primary Care physicians in Pennsylvania.
WE ARE GRATEFUL RECIPIENTS OF OUR STATE MEDICAL SOCIETY’S 1ST ANNUAL PRACTICE INNOVATION GRANT. Thank you PAMED Society! As the model grows rapidly across the country, PADPCA is informing and educating the public, medical schools, residencies, physicians, and employer groups in PA about our transformative model of healthcare delivery. DPC = Transparency + Affordability + Access + Attention + Patients + Physicians–the Middlemen
www.facebook.com/PADPCA/
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MEDICINE IS
OUR AND
T AK I NG
HOUSE, WE
I T
ARE
B ACK!
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T H E LA S T WO RD
Dealing With My Insurance Company IS MAKING ME SICK Wri t t en by Ma r ya nna B a rret t , M D
I
t was not exactly her chief complaint, but it was one of the concerns raised by my patient at a recent office visit. In fact, it has become increasingly more common in recent years for patients to raise concerns about their insurance directly to me, their doctor. Not only is dealing with insurance companies a time-sucking administrative burden for practices and an endless source of frustration and illness-inducing stress for patients, this nuisance has now found its way into the exam room. I have literally started a pen-and-paper list where I log the ridiculous anecdotes from my patients, details of how insurance carriers rejected claims and the alleged rationale. I have come to refer to these various tactics as “the bag of tricks.” They seem to occur in waves, then die down for yet another new trick to emerge while the old trick shows up from another carrier as its success ripples through the Interpol-like covert communication between the players of the oligopoly. 2 8 | 2 0 2 1 VO LU M E 2
I’ll share a few examples. A patient of mine needed an outpatient surgical procedure for a precancerous condition. Being a conscientious member, she called her health insurance carrier to verify outpatient surgical benefits. She confirmed that both myself and the outpatient surgical facility were in network, but the hospital’s lab and pathology department were not. Her in network pathology group was...in another state. Did they want her to drive her surgical specimen across state lines? That sounds cost effective. Let’s hope there is a nearby in-network hospital to treat her post-op dvt (blood clot) while she is there handing off her specimen. Another patient, also undergoing outpatient surgery for a non-emergent but very time-sensitive and potentially emergent condition, received notification from the anesthesia group after her surgery that they were not in network with her insurance, despite the fact that the
facility was approved, and were initiating the burdensome appeal process. Yet another patient was told by her insurance company that every time she goes for inpatient or outpatient procedure or evaluation she needs to call and verify the facility, the treating doctor, the lab, the anesthesia group, the pathology department, etc. And, then what? Hire her own anesthesiologist while she is on the way to the hospital just in case her emergency becomes surgical? How is she supposed to know or accomplish this? Which brings me to another example. I have not experienced this one directly, but have had colleagues who have seen claims denied by insurance companies based on place of service noting that for the diagnosis rendered, the patient should have been seen in the emergency department OR should not have gone to the emergency department. So now, not only do patients need to be hiring their own anesthesiologists and pathologists,
ORIGIN A L A RTWORK P RODU C E D BY OLIVIA BISH OP
they also need to know their diagnosis and its exact acuity before arriving. Isn’t that why they come to us? My most recent entry to the bag-oftricks log, so ridiculous as to be almost unbelievable, comes from a patient I was seeing for her annual well woman exam. She had elected to switch birth control methods at her previous visit, so I inquired how she was doing with the new method. She had never started it, because her carrier denied payment based on having her designated as “male” gender. Never mind that she is one of those rare patients who hasn’t changed her insurance plan in over 5 years, and that they covered the previous contraceptive. But, honest mistake, just a little clerical error when updating the plan year, maybe? She clarified her gender of choice and requested a correction. Apparently, this is an unreasonable request without her furnishing both her birth certificate and her marriage license, documents that she was never required to furnish
before. She asked them would they prefer to cover maternity claims? I suspect they would use the same clever trick to deny and/or delay payment of those claims as well. In the mean-time, with her money and the money of doctors/ pharmacists/facilities they’re refusing to pay, they continue to make themselves rich on the arbitrage. Screenings Covered but Not Diagnostic Work-Ups Even more upsetting to me than the bag-of-tricks practice is the evolution of full coverage for screening and full patient-responsibility for diagnostic work-up of any abnormal screens which has become ubiquitous across the typical plan offerings of the oligopoly. A patient has an abnormal pap smear, but does not want to come in for the requisite biopsy because it is subject to the astronomical deductible that she will never meet. Or a screening mammogram was suspicious and the patient declines the diagnostic
work-up and biopsy for the same reason. Many patients seem to feel that the diagnostic evaluation is not important and only want to continue with screening that their “insurance pays for” as they put it. Many struggle to understand that a screen is only as useful as its follow through, despite my best attempts to explain. They’ve become so accustomed to thinking that their insurance dictates their health care that the message they’ve received is that following up on abnormal screenings is not important, when in reality it can be life-threatening. Having this kind of insurance plan has become a deterrent to following through with appropriate care and a risk factor for advanced disease. It has also become yet another insurance-inducing administrative burden as physicians and their staff spend endless hours calling and sending letters to patients declining important diagnostic evaluations. I think it also bears mentioning here that I, as a self pay patient, paid less for my annual well woman exam, pap smear and screening mammogram combined than I would have spent for just one month’s premium with your typical oligopoly plan. So, what can we as doctors and patients do about this? I will share my strategy. I keep a sheet of paper on my desk with the name and address of my state Commissioner of Insurance and the name and email of the contact on his executive counsel. This information is readily available to anyone who looks for it — search your state, department of insurance. When a patient shares a grievance, or trick, with me, I have them take a screenshot of this piece of paper and I empower them not only to share every detail with this state department, but to let their insurance carrier know that they are doing so. It is amazing how quickly some of these insurmountable errors get corrected when the patients themselves employ this strategy. Looks like we have our own bag-of tricks! 1 Visit KevinMD.com to read more from Dr. Maryanna Barrett. WWW.PHYSICIANOU T LOOK . C OM | 29
St. Bonaventure has several avenues for students to pursue a
MEDICAL CAREER.
• FRANCISCAN HEALTH CARE PROFESSIONS www.sbu.edu/prehealth
• RN TO B.S. IN NURSING www.sbu.edu/nursing
PHYSICIANS NEED TO TELL THEIR STORIES
PHYSICIAN OUTLOOK TELLS IT. CENTERED AROUND THE LIVES OF THEIR PATIENTS. VISIT WWW.PHYSICIANOUTLOOK.COM TODAY
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Publisher: Marlene Wüst-Smith, MD Editor in Chief: Alicia Roselli Managing Editor: Alejandra Suarez VP of Advertising: Pamela Ferman Director of Art and Production: Ricardo Castillo Marketing/Social Media Intern: Allison Easton, Pennsylvania State University; Marianna Seefeldt, Saint Bonaventure University Contributing Authors: Maryanna Barrett, MD; Nathan Eckel;; Margaret Hurley, Student Physician; Marta Illueca, MD; Marion Mass, MD; Paula Muto, MD; Marianna Seefeldt, SBU’21; Peter Valenzuela, MD; Rachel Torregiano Cover Art: Susie Sharpe, MD (front & back); Other Art: Olivia Bishop Published By “Physician Outlook Publishing” Editorial Policy Physician Outlook Magazine is a national magazine dedicated to empowering physicians and their patients to improve the world of medicine together. Editorial decisions are based on the editor’s judgement of the quality of the writing, the timeliness of the content and the potential interest to the readers of The Physician Outlook Magazine. The magazine may publish articles dealing with controversial issues. The views expressed herein are those of the authors and/or those interviewed and might not reflect the official policy of the magazine. Physician Outlook neither agrees nor disagrees with those ideas expressed, and no endorsement of those views should be inferred unless specifically identified as officially endorsed by the magazine. Letters to the Editor Email: aroselli@physicianoutlook.com Information on Advertising, Subscriptions, Job Board Email: hello@ physicianoutlook.com “Physician Outlook is a registered trademark”
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