Why I Love Vaccines…

In the fall of 2004, my last year of medical school, I spent nearly 3 months in South Asia.

India, the country where my parents were born and raised and where nearly all my relatives still live, had historically been a regular destination for me.  The fall of 2004 was an opportunity to visit my grandparents, uncles and aunts, and cousins, experience Diwali and a host of other festivals in India for the first time, explore the city of Mumbai independently, and travel through historic cities of Sri Lanka and Tamil Nadu state in Southern India.

Raven Effigy during Navratri

Demon King Raven Effigy during Navratri

Roaming the Streets of Surat

Roaming the Streets of Surat

 

New Years Pooja to Books

New Years Pooja to Books

Ganesh Festival 16

Ganesh Festival, Mumbai

 

The technical reason I was in India, however, was to complete two month-long elective rotations as part of my medical education.  I spent a month in Surat (Gujarat State’s second city, a few hours north of Mumbai) at a private pediatrics hospital seeing burgeoning services for the rising middle class, with some additional time at an aunt’s homeopathic clinic.  I also spent a month at KEM Hospital in Mumbai, a government hospital for Mumbai’s indigent population.

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The Scope of Practice Battle: Does it Do More than to Divide and Conquer Us?

Hanging Boxing Gloves

***  Primary Care Physicians vs. Nurse Practitioners  ***

It’s the marquis turf battle that’s sexy and exciting for journalists, politicians, and healthcare groups.  State-by-state changes have been giving nurse practitioners (NPs) more and more (sometimes less) ability to practice more medicine with less supervision.

In many states and federally, expansion of NP scope of practice has, by the viewpoint of many physicians and physician groups, become the Pandora’s Box that will reshape primary care for the worse, challenge the future of the profession of primary care physicians, increase healthcare costs, and cause great harm to patients and communities.  Full legal independent scope to practice medicine is the line in the sand that most states yet have not crossed, requiring NPs to have a “collaborative agreement” with a physician who “supervises” their care of patients.

I won’t go into the detailed arguments made by physician groups about education and training differences between primary care physicians, nurse practitioners, and physician assistants (“physician extenders”, or “mid-levels” providers).

What I question, however, is if this battle really matters and is the best use of resources.

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Five reasons why Primary Care Physicians might get replaced by computers

computer-doctor

Computers are getting smarter, better, and more personable, there’s no doubt about it.  Will there ever come a time, however, when computers get so good at human interaction that even the highest-skilled in the work force — primary care physicians (PCPs) — go the way of the travel agent?

I began wondering this a few months ago after listening to Dr. Martin Kohn, a physician who works at IBM Research and works on integrating the Watson supercomputer (of Jeopardy! fame) in healthcare.  He spoke about computer technology changes, their history, and their integration with healthcare.

Could computers be the biggest disruptors of healthcare delivery (and my career as primary care physician)?  Here are five reason why, one day, primary care physicians could possibly be replaced by computer…

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Are Primary Care and Public Health Already Integrated? My First-Hand Experience at Bridging the Two…

790

Last week I gave testimony to the Oak Park Village Board in support of a youth bicycle helmet ordinance (passed 5-2!). It was pure policy work for population-based health safety outcomes. Using my voice as a primary care physician (who just happens to bike to work regularly) was instrumental to the broader public health arguments made.

The “integration” of the two realms, primary care and public health, came up regularly throughout my year on the Board of Directors for the AAFP (American Academy of Family Physicians), especially through my Commission liaison role on the Health of the Public and Science.

I learned something new: public health and primary care aren’t integrated, and a number of groups are working to bridge the two.

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Primary Care Prevention and the Most Difficult Patients

vaccine
People say that doctors make the most difficult patients. They’re wrong. My parents make the most difficult patients.

My parents are great case studies for the challenges of primary care and prevention. Years upon years of my attempts reinforcing health education have seen more failures than successes. What can we do to win the primary care and public health battle of prevention?
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Unanswered Questions of ACA Implementation

bigstockphoto_health_care_reform_green_road__5632944
In just a week, I start my new position as Medical Director of Near North Health, a network of federally-qualified health centers (FQHCs) with a 40-plus-year track record of providing comprehensive primary care services to historically marginalized communities throughout Chicago.

I’m especially excited to be doing so now, just months before full Affordable Care Act (ACA) implementation, and just days after the third anniversary of its passage. Come January 2014, numerous changes will affect health delivery and payment; innovations in patient centered medical homes (PCMH) and graduate medical education (GME, aka residencies); regulations and quality mandates. A great time to be at the forefront of health care leadership!

Serving on the Board of Directors for one of the largest professional medical organizations in the nation (the American Academy of Family Physicians), in addition to my role with Doctors Council SEIU, I’ve had the privilege to meet with, listen to, and learn from the brightest and most engaged people in health care. And I’m always surprised: whether it’s physician leaders or those at the top of the federal health agencies, no one quite knows what things will look like next year.

Below are just two vital questions, amongst many others, that burn through my mind; that keep me awake at night when I think of the challenges ahead; the unanswered questions of ACA implementation that I don’t hear spoken of enough (or at all). If you have answers (or speculation), please feel free to comment!
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Why does health care cost so much? A response.

Supply-and-Demand-Graph
How much would a toaster cost if someone busted your kneecaps if you didn’t purchase it?

The March 4, 2013 edition of Time magazine focuses on the cost of health care (“Bitter Pill: Why Medical Bills are Killing Us” http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/). The special report looks at the cost of care for uninsured individuals after diagnoses ranging from lymphoma to indigestion, and wonders why costs are so high.

I thought that was a question with an obvious answer: because health care isn’t subject to supply and demand. It’s not a free marketplace; capitalism doesn’t apply.

Things got even more discouraging when I watched my DVR recording of This Week with George Stephanopoulos, which originally aired on ABC the morning of February 24. (Yes, I record the Sunday morning political talk shows. Don’t judge me.)
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