Choosing (Un)Wisely

Watch Medical Groups Call on Doctors to Perform Fewer Tests on PBS. See more from PBS NewsHour.

"You see, Dr. Oz was right, you're ordering way too many tests for me," a patient told me today after seeing news reports of today's press conference in Washington DC by the Choosing Wisely campaign. This campaign, according to news reports (WSJ, PBS, ABC, NBC, NPR, AAFP, and others), points the finger directly at doctors for ordering "worthless" and unnecessary tests (that's why the press, like patient advocates, love this story, because another opportunity to blame doctors). While I believe this is a noble cause, here are some of the issues that I have with it...

Where's the Patient Responsibility?: So, if I get this right, there is also going to be educational campaigns directed toward patients with slogans like, "Don't expect that routine antibiotic for that cold," or "Don't expect routine testing if you're asymtomatic." There have been announced partnerships with consumer organizations like Consumer Reports Health, AARP, SEIU, and Wikipedia. Do you really think these groups will discourage patients from demanding unnecessary testing/treatments? Time will tell...

Thanks For Making My Job Is More Difficult: With these reports today, patients are challenging me even harder about the testing and treatments that I am recommending. I don't have a problem with this. However, I do have a problem how this story has been framed in that "I" am the reason why unnecessary tests are done, and my patients are more than happy to remind me of that.

Insurance Companies Must Love This: Sometimes I really wonder if all these physician organizations really know how medicine is practiced at the grassroots by physicians like me. Every day, our office have staff members sit "on hold" for hours at at time trying to walk through the maze of preauthorizations for tests and medications. I really think this announcement will further embolden insurance companies (including Medicare/Medicaid) to raise the bar and make testing and treatment more difficult for me to adequately treat my patients.

Where's the Tort Reform?: Does anyone see that pink elephant in the room? Every time unnecessary tests are mentioned, physicians usually respond by saying things like "defensive medicine" and "fear of malpractice." There have been many studies, arguably conflcting, asking the question about whether today's medicolegal climate causes physicians to order tests that they maybe shouldn't. I was disappointed that all these physician organizations had nothing to say about malpractice attorneys and the need for liabiility (meaning malpractice or tort) reform in this country. Everyone knows that it's needed, but physician organizations are taking (in my opinion) the easy way out in blaming themselves and trying self reform first.

Here's the Dirty Little Secret: I'm a amateur pundit, but here's what I think is really going on. All these physician organizations are afraid of the government (whether it's Obamacare or other plan) ultimately deciding what tests should be done or not done. Private insurance companies are somewhat doing this now. So, if physicians can show that we can "police" ourselves, physician groups are hoping to score political points with those in Washington (that's why the press conference was in DC today). 

Now, don't get me wrong. I agree with everything that happened today. 30 billion dollars annually of unnecessary tests are a real problem. However, will this effort really change the behavior of physicians? Probably not. Will this effort really try to educate patients not to ask for unnecessary tests? Probably not. Will this campaign hope to score political points with Congress and the White House? Some believe yes....

Science Roll Interview

Thanks to my friend Dr. Berci Mesko for the opportunity to be interviewed on the very popular blog Science Roll. I invite you to check out the post entitled, "Social Media in Primary Care: Interview." If I remember right, he and I came on the blogging scene right around the same time in 2006, I believe when he was still a medical student.

Now, he runs one of the most popular worldwide blog, and the medical resource called Webicina which is a search engine for internet medical resources. There is even content specific for specialties like Family Medicine. Something that is very exciting is the introduction of a global social media course for medical professionals called "Social MEDia Course: Revolution in Medical Education NOW." Check out the video below...

AAFP President Tonight 9pET

Glen Stream, MD will be appearing tonight on Family Medicine Rocks Episode 248. Dr. Stream is the President of the American Academy of Family Physicians. One topic will be the recent announcement that the AAFP will be remaining in the RUC. Another topic will be the AAFP Primary Care Valuation Task Force.

On last night's show (Show 247), I shared some background information to help you get ready for tonight's show. This includes an article entitled, "What Every Physician Should Know About the RUC," which gives you a basic idea of what the RUC is and why it's important.

For a long time, the AAFP has stated that the RUC does not see the value of Family Physicians because Medicare payments are lower than subspecialists. Last summer, the AAFP sent an aggressive letter to the RUC asking for changes in the RUC's structure. RUC responded a couple of months ago and made only small changes.

In a post from Health Affairs blog, they encouraged AAFP to leave the RUC and many wondered if that would happen.  On March 13, 2012, AAFP announced that it would remain in the RUC which made some people very upset (check out the comment section of their press release)

On March 16, Dr. Stream wrote "We're Changing Our Approach To The RUC." The Academy then reached out to me to see if I was interested to talking with Dr. Stream about the Board's decision. And, that's how this interview was set up. In the video segment above, I share some of the comments that people have communicated with me in the past week leading up to this show. (Download the entire audio podcast for Ep247 here and below)

So, I hope you can join us on Tuesday, March 27, 2012 at 9pm Eastern Time/6pm Pacific Time for Family Medicine Rocks Episode 248 with my guest Glen Stream, MD who is President of the American Academy of Family Physicians. See you for the show!

Download Ep 247 (mp3)

AAFP President On FamMedRocks Podcast

On Tuesday, March 27, 2012 at 9pm Eastern Time, the President of the American Academy of Family Physicians, Glen Stream, MD, will be appearing on the Family Medicine Rocks podcast. The topic will be AAFP's recent decision regarding the RUC. 

According to an article on the AAFP website from March 13, 2012: "After much debate, the AAFP Board of Directors has decided that the Academy will continue to participate in the AMA/Specialty Society Relative Value Scale Update Committee (RUC) for now, while continuing to advocate that changes be made to the RUC from within."

For my readers who may not be familiar with this story (especially those who do not work in medicine), the RUC is a panel of experts who make recommendations to Medicare with regard to payment of certain services. Family Physicians, like those in the AAFP, have expressed concern that the RUC is biased toward specialists and non primary care physicians. Many believe this is one of the many reasons why specialists are paid more than primary care physicians.

Last summer, the AAFP sent a letter to RUC to make changes in the composition of the committee to try to lessen the bias toward specialists. Following the release of this letter, many AAFP members were urging the Academy to walk away from the RUC - especially if the requested changes were not met. Last month, the RUC did make some changes, but certainly not all the changes that were requested.

Some have called the RUC changes "Slight of Hand" and urged the AAFP to walk away from the RUC. On March 13, 2012, the AAFP announced that they were remaining in the RUC. I encourage you to check out the comment section of this article, of course, some favoring AAFP's decision and some questioning AAFP's decision. I imagine that this type of dialogue is taking place across the country.

Last week, I was contacted by AAFP to ask whether I would be interested in talking with Dr. Stream regarding AAFP's decision to remain in the RUC. Our schedules could not match this week, but we were able to agree upon March 27, 2012 at 9pm Eastern Time. You will be able to listen to our chat live at this link which is my podcast site.

I encourage readers of this blog post to submit questions and to leave feedback in the comment section below with regard to AAFP's decision to remain in the RUC and Dr. Stream's recent commentary called "We're Changing Our Approach to the RUC." I will choose the best questions and ask them on the air. I will not be taking any call in questions the night of the podcast.

I think this is a HUGE step for the American Academy of Family Physicians to utilize social media in a way that they have never done before. I'm honored that Dr. Stream, whom I have never met in real life (yet), and the AAFP, reached out to me for this opportunity to chat about a knowingly controversial Academy topic. Please submit questions and feedback below so, at least, I can get a sense of what people are thinking out there on this important health policy issue....

Why #FMRevolution Matters

Had a great show last night with Dr. Michelle Quiogue who talked about saving the Family Medicine Residency program in Bakersfield, California. I encourage you to download the entire audio podcast and listen more about Family Medicine Rocks Episode 246.

At the end of the show, I had the closing monologue in the video above. We need more positive stories like this one in the Family Medicine community. This #FMRevolution that you see out there on twitter is not only about a twitter hashtag.

To me, #FMRevolution is about spreading the word about Family Medicine. Social media has the power to bring together people from across this nation and around the world. Family Medicine has the data that we give high quality patient care at a lower cost. The Patient Centered Medical Home is the model by which we have this data.

For too long, Family Medicine has let other people tell our story. If Family Docs cannot be advocates for themselves, then who will? Ever since I started in social media (almost) 6 years ago, it has always been my goal to help spread the message of Family Medicine. If you are a Family Doc and have a story to tell that impacts your patients and your community, I'd love to hear about it. Have a great week everybody!

FamMedRocks Ep 246: Dr. Michelle Quiogue

Thanks again to Dr. Michelle Quiogue (follow her on twitter) for coming on the show last night. She shared her story about the saving of the Family Medicine Residency program in Bakersfield, California. She is not directly connected with the program, but through a Facebook update, she learned the news and then sprung into action.

Through her advocacy training from the California Academy of Family Physicians, she contacted the local politicians through letters and phone calls. She also helped coordinate the efforts of the Family Medicine community to help get the word out.

In the video above, she described the scene at the meeting where many people gave testimony to keep the program open. She stated that there was three hours of testimony given my many individuals. At the end of the meeting, the board ordered the hospital CEO to hire a new intern class for the program.

In the second portion of the video above, I asked her what she tells people who say they are too busy for Family Medicine advocacy efforts. I encourage you to download the entire audio podcast of Family Medicine Rocks Episode 246. Can download from the mp3 file from the link below, or here. I also encouage you to "Like" the facebook page for this site and to follow me on twitter. Thanks so much!

Listen to internet radio with DrMikeSevilla on Blog Talk Radio

Download Ep246

Family Medicine Saves Residency Program

On Sunday, March 18th, 2012 at 10pm Eastern Time/7pm Pacific Time, I'll be interviewing Dr. Michelle Quiogue who was part of the effort to keep the Family Medicne Residency Program open at Kern Medical Center in Bakersfield, California. This interview will take place on the Family Medicine Rocks Podcast Episode 246. (don't worry if you cannot listen live, you'll be able to download the podcast and listen anytime)

This story begins at the end of February 2012 when Kern Medical Center in Bakersfield, California announced that they would be closing their Family Medicine Residency Program. This story even made the local TV news cast. In the video above, you'll see my commentary on the subject.

This is where the story gets good. The community, lead by Family Medicine (in my opinion), came together to spead the word about the potential complications of such a closure which included the question, "Who will take care of all these patients? Where will they go?" The local news paper even wrote, not one, but two editorials favoring keeping the residency program open.

Just this week, Family Medicine advocacy (otherwise known as #FMRevolution) helped to turn the tide. Dr. Quiogue tweeted out the meeting where testimony was heard supporting the residency program. The county supervisors sided with the program and ordered the hospital to hire new Family Medicine residents. Yay! Also check out the local TV news report and the follow-up editorial by the newspaper. I hope you can join us for the rest of the story! (I encourage my Family Medicine friends to spread the word about the show!)

Colon Cancer Awareness

March is Colon Cancer Awareness month. According to the prevent cancer foundation website, 143,360 people will be diagnosed with colorectal cancer and an estimated 51,690 people will die of the disease. In the video above is my interview on local TV news talking about colon cancer and screening.

If you find this interview helpful, I invite you to check out my other television interviews on local TV news at MikeSevilla.TV. Also check out the facebook page for this site, and, as always, follow me on twitter. Enjoy!

Chardon HS: It Will Happen Again

Kind of interesting monitoring twitter and the news through the day. It's kind of nice to see a student say "Wear something red tomorrow to support Chardon and this terrible time." Other tweets are continuing to play the blame game. As I reflect back on my own blog, I reviewed "From Columbine To Virginia Tech To Tuscon," written January 10, 2011.

Also I re-read my posts from the 2007 Virginia Tech shootings including, "Mental Health Care Delivery In The US," "Depression=Murder?", "Privacy Laws Need Scrutinized," In looking at the news and twitter through the day, the same questions come up again, with still no resolution. Here are some buzz words that are always thrown around:

• Bullying (ie - blame the bully): Since this is an election year, I predict the politicians will pass more bullying laws this year. Will they work? Probably not...
• How was his home life? Did he play video games? (ie - blame the parents): Some have said that his parents should also serve jail time.
• How safe are public schools (ie - blame the school district): Metal detectors in public schools has already come up in the discussion today. The home school people have also been talking today
• There are too many guns out there (ie - blame guns): The gun control people are out again advocating for passing more laws that may or may not be enforced
• Was the child mentally ill (ie - blame the doctor): I haven't read anything on this yet, but I predict that news stories will start covering this in the next few days
• Did you see his Facebook page? (ie - blame social media): I see a knee jerk reaction to prohibit and/or heavily monitor students social media use. Could that have prevented this? It's debatable.

Unfortunately, what usually happens is that the small community of Chardon will be in the spotlight for a few days. The usual pundits will debate the above issues. Again, no resolution will occur. And, then, again, another school shooting will take place. But, I will again post a quote from my 2007 post named, "Can The Cycle Be Broken?" All I can hope is that something will happen to change...

Of course, people are outraged by this situation. I'm outraged by what happened. But, I've seen this too many times. We are shocked by what happened, we mourn the victims, we blame whomever we need to blame for what happened, then we go back to our apathy until the next tragedy happens.

 Well, I'm sick and tired of this useless cycle. Instead of outrage turning into apathy, let's turn outrage into action. And, I'm not talking about knee-jerk reactions like firing some university official somewhere or a more strict student visa process or permanent resident visa process - like what's being talked about now.

Um, uh, wait a minute. As I think about things now (a couple of hours after starting to write this post), I'm thinking about what realistically can happen? Would it mean a radical change in American culture? A culture that celebrates violence? A culture that makes celebrities out of people like Eric Harris, Dylan Klebold, and Cho Seung-Hui [and now TJ Lane]

Chardon HS: Remember the forgotten

Chardon, Ohio is only 60 miles away from where I live. And, this morning, while monitoring facebook and twitter, I learned that there was a shooting at the high school there. Over the next few hours, I saw that national press picked up the story, and for me, memories of Columbine and Virginia Tech started to go through my mind.

Of course, throughout the day, the press was focusing on the one fatality and the others who were injured in the shooting. Then, they would talk about the shooter. And, then the blame game stories would begin. Could this have been prevented? Are public schools safe enough? Do we need more gun control laws? How can we better prevent bullying in the schools?

Only seldom were there stories about the counseling that is needed for the kids, parents, and the community. I'm glad that they announced that they were having counselors at the school today, tomorrow, and for the rest of the week. The governor's statement is in the video above.

I refreshed my memory about the condition called "Post Traumatic Stress Disorder." Especially in the pediatric age group, these memories will linger for a long time - long past when the TV cameras are gone, and long past when this community drops out of the national news. There are many great sources of information, but according to this WebMD article, here are key symptoms to look out for:

• Flashbacks: Often times, people will re-live the events of today again and again.
• Emotional Detachment: People may tend to avoid activities, friends, and places - especially associated with the traumatic event
• Jumpiness: A sudden noise may startle someone. Or someone may overreact to a seemingly simple situation. Or people may start to have trouble sleeping

Key to treatment, especially of children, is to give them the opportunity to express what their feeling, whether it be through talking or drawing pictures or writing. Anything to get those confused emotions out and not have them bottled up.

So, as the press is trying to get their ratings, sell their newspapers, and get hits on their website, they will probably forget about those students, those parents, and the community who has been emotionally scarred by this tragedy. Don't forget about them, because they will be the ones to bring Chardon, Ohio back...