Tuesday, September 27, 2011

Drug War plus Obamacare destroy efficient, effective medicine

Because with all of the laws today, you can convict a ham sandwich of a crime.

The Cure For Doctors Who Think Outside The Box
It seems it's other doctors reporting them. Jay Parkinson had a bright idea about how to incorporate technology and house calls into a medical career:
Upon finishing my second residency at Hopkins in Baltimore in September of 2007, I moved back to Williamsburg to start a new kind of practice:
1. Patients would visit my website
2. See my Google calendar
3. Choose a time and input their symptoms
4. My iphone would alert me
5. I would make a house call
6. They'd pay me via paypal
7. We'd follow up by email, IM, videochat, or in person
It was simple, elegant, and affordable for me to start. But most importantly, it just made sense given how we all communicate and do business today.
...I didn't need an office or staff. Everything was run by me, my iPhone, and my MacBook Pro. My overhead was about 10%, compared to a regular doctor who spends about 65-70% of their practice revenue on overhead. I was profitable after just a few days. The 7 million hits on my website in the first month obviously helped get the word out about my new practice (thank you internet!).
Then, about six months later I got an official letter from the New York State Office of Professional Conduct. Obviously, that was unsettling. It essentially said that someone had made a complaint about my practice and my use of the internet. They wanted all of my records about the eight patients I prescribed narcotics for in my practice-- I prescribed one time prescriptions for Tylenol #3 for eight patients treating their acute pain for various conditions. The state wanted a serious offense they could charge me with, hence why they singled out the narcotics. I pulled up my records on my MacBook for all eight patients and made them into a pdf and sent them off to the state proving that I'd seen the patients in person, established a doctor-patient relationship, followed standard medical treatment guidelines, and kept the records to prove it.
... You see, anyone, anywhere, can call the state anonymously and report any doctor they want. The state then takes action by sending a startling letter to that doctor asking for records. You are then asked to produce those records and appear in front of their board with or without your lawyer at your expense (lawyer's fees and lost revenue from time not practicing...thousands of dollars).
The state was looking to see if I was prescribing narcotics to strangers I've never met using the internet to do so.
Obviously, I wasn't. That surely wasn't what my practice was about. My practice was about being an old-fashioned neighborhood doctor using today's technology to provide care to the uninsured in my neighborhood who lived close enough to me to walk or ride my bike. I looked at internet communication as augmenting the real-life relationship I had with my patients. That was my dream, and that was my reality.
He ended up shutting his practice down. I wish he'd given all the reasons why. What he went through after being reported is one reason he said he closed up shop, but to me, this seems to be a smart and innovative way to practice medicine, and one more doctors should consider, especially in the wake of governmentcare in 2014

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