Dispensary

Paying doctors for better care

There is an NY Times article about how Congress in the US is trying to pass legislation to pay doctors for better care, rather than just for seeing larger numbers of patients.

This is being implemented in areas, where such issues can be addressed and quantified.

Very interesting this and a long-time coming. This is something that should have been implemented by the medical associations themselves many many years ago, setting standards and outcome criteria - we never did it ourselves and now others are foisting them on us and making sure we start complying.

Discrimination of diabetics in the workplace

People getting fired for the diabetes related issues in the US - this is the subject of an NY Times feature.

As the problem of diabetes goes out of control, this is going to be a larger and larger issue and for businesses and corporations to take the easy way out, by firing people who are diabetic, does amount to discrimination.

If the diabetes is under control and all steps are being taken to make sure that the sugar levels remain low and that there are no complications, there should be no discrimination as well.

Doctors making super-money outside medicine

The NY Times has this interesting article about how doctors are making mega-bucks on Wall Street, by not practicing medicine. The profile is on one particular doctor, who joined a consultancy firm and eventually landed up in Merill Lynch and now makes 10 times his fellow colleagues, which they figured out during a reunion.

This is not necessarily a new phenomenon, but as medicine gets corporatized, more and more doctors are getting this opportunity. In insurance, in management and in the financial services.

The issue is that you do cease to be a doctor when you stop practicing medicine. And if the loss of that satisfaction and special standing is acceptable, then that's fine. But the relationship between mainstream doctors and those who have opted out will always be a mixed one. Admiration and envy for being able to make so much money, but a bit of condescension that he/she had to move out of medicine to do so. All doctors believe that if they were to move out of medicine, they would be able to do the same...and a lot of the doctor ego comes from the fact that a doctor can still take to most other professions, but other professionals and workers can never ever become doctors.

Lung transplantation

The NY Times has a story on how lung transplantation rates and results have improved. Two things have happened
1. The waiting lists are now geared towards providing transplants to those with the most need and not to those who have been waiting the most - this ensures that those who need transplants earlier get them and do not die while waiting
2. The ability to harvest lungs successfully has improved considerably

This is one more example of how success in many areas in medicine are not necessarily skill-based, but are sometimes a result of tweaking procedural or logistical issues.

In India, we still don't do lung transplants, predominantly due to the high prevalence and incidence of tuberculosis. There is however, a large number of patients, that needs this procedure and it may not be a bad idea for someone to at least start lung transplants, in this country.

Teleradiology - legal and financial issues

This article from Health Affairs, explores the two models of teleradiology that currently exist - the Nighthawk (US trained, board-certified radiologists) vs the "Indian" model (non board-certified, lowly paid).

Obviously the majority of the article is devoted to the legal minefields associated with the Indian model, especially since the erring Indian radiologists cannot be brought to book. Having said this, I know for sure that there are very examples of the Indian model - most of this is hype related to the old Saini Saini controversy.

The Nighthawk model is followed by Arjun Kalyanpur of Teleradiology Solutions. The Indian model...show me even one company that you can find.

MSK imaging and MRI

This article from Imaging Economics talks about the upsurgence of musculoskeletal (MSK) MRI and the lack of trained MSK radiologists. It quotes the usual cast of characters with pithy comments, but eventually the article ends with the same turf warnings that all such articles eventually end with - that orthopedists are now putting up their own MRI scanners and radiologists are wondering what to do.

I guess in India, this is not really going to be an issue, considering that even in cardiac imaging, there isn't a turf battle. Except for gynecology and interventional procedures, there really isn't any kind of ongoing turf battle. To think that orthopedic surgeons will try and put up their own CT scans and MRIs is really unimaginable - this is probably due to a combination of lack of stomach for the kind of monies involved and more importantly the fact that everyone is busy doing their own thing and there would be very little time to manage an additional multi-crore MRI. And since an MRI facility would never be able to break-even with just the orthopedist's patient load, it would involve marketing to outside referrers, etc, which would only add on to his headache.

Insuring adultescence

The NY Times has an article on how children upto the age of 30 are piggy-backing on their parents' insurance plans.

Though this doesn't really concern us in India, it is an interest comment on a trend that is occuring in a country, whose systems we are currently trying to emulate.

Diabetes

NY Times has done a large feature on diabetes in India, following up on their continuing features on this subject.

If 35 million people today have diabetes with a projected 75 million by 2020, that is a lot of work for a new generation of diabetologists. Each patient with diabetes does not just have to be looked after with respect to sugar control and advise, but also needs to be evaluated for possible neurologic, cardiac, renal, and peripheral vascular disease complications.

Being a diabetologist is not a bad thing in this scenario, especially since these patients are also usually affluent and can pay.

Most certainly, the insurance companies are going to shy away from reimbursing diabetes related disease, except possibly for the first episode.

Health monitoring remotely

One trend that will eventually catch on everywhere is patient monitoring from the house. The NY Times has a feature on this issue, this week and talks about monitoring of pacemakers, blood sugar levels, etc.

In our part of the world, where access to family physicians is so easy, this may not work, but it would still help to have a system such as this for a large number of people living alone or with multiple chronic disabilities.

This is an idea whose time has come and needs to be worked upon.