Dr. Emily's Blog

Doctors have been bemoaning changes in the practice of medicine for years, and with good reason.  It’s harder and harder to make a go of it in private practice.  In recent years our area has lost several small practices -- Hal Grotke’s Redwood Family Practice closed*, Dr. Garcia retired, Teresa Marshall’s solo office shut its doors, Eureka Internal Medicine transitioned to Humboldt Medical Specialists (which then became St. Joseph Hospital Medical Group), and  Beverly Copeland relocated to Ashland.  As I was writing this, Dr. Windham announced that he is ceasing the provision of primary care at his small office.  Unfortunately, young, freshly trained physicians are not arriving here to take their places.  Most recent graduates take positions with large organizations that can offer loan repayment funds, regular hours and steady salary. It’s no wonder new physicians want to be employees with reasonable pay and limited hours.  If you are not working for...

QUALITY IMPROVEMENT (QI): or Is It?* Who says the quality of medicine needs improvement?  According to some, we have the best health care in the world.  What could we possibly do better?  Do you suppose that during the 11 years of medical training I received, the focus was on giving substandard care?  And besides, how do the health care wonks know that what they suggest will improve upon what we are already doing?  Did anyone think to ask those of us providing primary care if we want to do this, or have time to participate in these protracted projects?  No!  However, let’s give the policy makers the benefit of the doubt, and suppose that primary care does need quality improvement.  Common sense would dictate that no one does anything perfectly and that we all can find ways to improve.   The world of QI is not a pretty picture.  First off, it seems as though everyone and their grandmother has some QI program that physicians ar...

May 2016 editorial PHYSICIAN BURNOUT--updated version Medicine:  “Oh, Physician, How do I stress you?  Let me count the ways:” 11-13 years of intense training under immersion in the “Superman” medical culture Sleep deprivation/interruption Emotional impact of treating serious illness, death, or chronic disability Pressure to work while pregnant/sick/chronically ill Malpractice lawsuits Financial debt EHR/ data entry Federal mandates Insurance hassles Isolation Pay for Performance programs and surveys Repetitive work Pressure to see large volumes of patients Loss of autonomy due to protocols/insurance restrictions/formularies/provider network restrictions etc.. Can you think of more?  I would love to get responses to share. (eurekapedsemily@gmail.com) Physician burnout is characterised by 3 features:  exhaustion not relieved by rest, depersonalization (cynicism), and a sense of worthlessness of one’s...

A father stands anxiously at the window to our reception desk, shifting his weight from side to side, clutching at a piece of paper.  “ My son can’t play football unless this form is signed, and practice starts this afternoon.  Can’t you help me?”   “Unfortunately,” explains my receptionist, “We are booking out 6 to 8 weeks for a well check up.  Our same day appointments are set aside for patients with serious, acute illnesses, and besides, sport physicals are not covered by insurances.”   “What am I supposed to do?”  asks the distraught parent.  The receptionist gives him a sympathetic look and hurries to answer the persistently ringing phone.  Some desperate families actually go to the emergency room to get their sport physical forms filled out.  Thus the insanity of the sport physical season plays out. Typically, the required paperwork is handed out to families in late July, and the school system expects physician offices to to s...

We are coming to the end of the first year of the Affordable Care Act (ACA).  Although the ACA ushered in an era of improvements, we still have a long way to go.   Devin Miller, Washington correspondent for the American Academy of Pediatrics, optimistically reports that more children that ever are currently insured, thanks to the ACA, Medicaid, and the Children’s Health Insurance Program. 1 He reports a 25% reduction in the number of uninsured Americans, which should be great news.    My question is, what does “being insured” mean?  In my experience, the new Covered California plans generally have a large deductibles, sizable co-pays, restrictive formularies accompanied by many exclusions.  If you can still go bankrupt from medical bills while insured, how much good has this done?   We are happy that many more people have insurance now, but that needs to translate into good medical care for policy-holders.  If the insurance indu...

Hi.  My name is Emily Dalton. I am a local pediatrician and  I have had the misfortune of dealing with the health insurance system from 3 different perspectives:   that of a patient who uses an insurance plan, that of a small business owner who purchases insurance for a group of employees, and that of a physician who contracts with and gets paid by various insurance companies.  Our system is profoundly dysfunctional, and we need to completely rethink how we deliver healthcare to the nation’s population.  Previously I spoke about my experiences as a patient and an employer.  Today I will share my opinion as a physician.   I have had no end of problems dealing with the 9 different insurance companies with which our office contracts.  After one of our doctors has seen a patient, we submit a claim to that patient’s insurance plan requesting payment.  Three full time employees work to make sure the claims we submit get paid correctly....

Hi.  my name is Emily Dalton, and I am a local pediatrician.  I have had the misfortune of dealing with the health insurance system from 3 different perspectives:  that of a patient who uses an insurance plan, that of a small business owner who purchases insurance for a group of employees, and that of a physician who contracts and gets paid by various insurance companies.  I am here to tell you that the system is broken, and that what is going on today in medicine is so dysfunctional that we need to completely rethink health care in our country.   Previously I spoke about some of my experiences as a patient, struggling to get medical expenses covered by my insurer.   Today I am going to talk about what I deal with as a small business owner who provides insurance for the 30-odd employees of my medical practice.   Over the past decade, our medical office dreads the arrival of each new year because the insurance plans offered previously are c...