TOP

DJP Update 3-13-2017:  1- PPACA (ACA etc.) Repeal and Replace?  2- LAGNIAPPE: The Clock House and Bose QC 35, and don’t forget DJP News Enhanced Podcasts!

DJP Update 3-13-2017:  1- PPACA (ACA etc.) Repeal and Replace?  2- LAGNIAPPE: The Clock House and Bose QC 35, and don’t forget DJP News Enhanced Podcasts!

1.  Unless you have been cut off from communications since the November 2016 elections, you know there is a surprising change in the office of the President and in the Senate and House.  Pundits and polls for the most part got a failing grade.

 Regardless of your political views and your possible excitement or despair, one can be certain that health system reform is on the agenda in the immediate future.  It will be a test of leadership in Washington to see if reason and facts will prevail in the debate or if political rigidity and obstructionism continues based on political party lines.  This also is a chance for medical organizations to stand up and advocate long-standing policy rather than acting like the opportunists in the Vestibule of Hell in Dante’s Inferno (First part of Divine Comedy).

 I won’t dwell on this topic but it is an IMPORTANT issue for our patients and the profession of Medicine.  Time to enter the arena.

 Finally, I list two articles I mentioned in a November 9, 2016 @DJPNews Tweet:  the first is one I co-authored with 2 PhD economists at AMA in 2004 when I was AMA president entitled:

 Expanding Insurance Coverage Through

Tax Credits, Consumer Choice, and Market Enhancements

The American Medical Association Proposal

for Health Insurance Reform

Donald J. Palmisano, MD, JD

David W. Emmons, PhD

Gregory D. Wozniak, PhD

 It is at:  JAMA, May 12, 2004—Vol 291, No. 18, pages 2237-2242 and is based on long-standing AMA policy as of 2004.

The second article is an editorial I wrote entitled The 2010 “Patient Protection and Affordable Care Act”: A Failing Grade.  The citation for it: J La State Med Soc VOL 162 September/October 2010, pages 243-244

It can be found at:

 http://intrepidresources.com/html/PEJLSMS2010.pdf

 Now for LAGNIAPPE!

 LAGNIAPPE: 

 1- THE CLOCK HOUSE

New Orleans is a fun place to visit because of the history, the people, food, and exciting traditions like MARDI GRAS and JAZZ FEST.  For those who like to stay in a private home rather than a hotel, Robin and I have a friend who has a place listed in AirBnB.  We visited the place. It is in Metairie and wonderful.  More details below:

 https://www.airbnb.com/rooms  

 Go there, search for “The Clock House” or 1010 Metairie Road, Metairie LA 70005

 A brief summary:

“The Clock House” is a 1943 4-bedroom 2.5 bath home built in the “Grand Cottage” architectural style.  The main floor features a screened-in front porch, a gourmet kitchen, a breakfast area with a built-in banquette, and coved ceilings in the living and dining rooms.  Connecting bathrooms between the two bedrooms are on each side of the center hall on top floor. An arbor with a swing, table and bench grace the backyard where you can enjoy a garden view and bird watching at the feeder.  The home is one block from grocery, coffee shops, banks, and restaurants.  It is 5 miles to the French Quarter, 1.8 miles from the Streetcar line, and 1.6 miles to I-10 access.  The host lives in separate quarters on property.  Cereal, coffee, tea, snacks provided.  $275/night, (+ $150/reservation for housekeeping) for up to 8 guests  (babies & children count as guests.)  Fee is higher on special event weekends such as Mardi Gras, Jazz Fest and New Years.

 2- GADGETS:  Bose QC 35

 A) For trips to do keynote addresses and to attend board meetings, I try to protect my hearing in planes and block out the loud noise.  In the past, I used ear mufflers that are used on noisy construction sites.  But they are bulky.  I now have an ideal solution with additional benefits.  I recently purchased the new Bose QC 35.  The noise canceling is outstanding, the Bluetooth works well, and there is the added advantage of making phone calls with the two built-in microphones. 

 Here is part of my research:

 http://www.theverge.com/2016/6/21/11975496/bose-qc-35-bluetooth-wireless-headphones-quietcomfort-flawed

 “What’s odd to me is that the reviews have been mostly glowing — CNET, Gizmodo, The Next Web, Tom’s Guide, buyers in the Head-Fi forums all agree.”

—-

http://www.imore.com/i-am-never-taking-boses-qc-35-noise-cancelling-wireless-headphones

 “I can sleep with the QC35 on inside a plane. The headphones are that comfy.”

 “I am never taking off Bose’s QC 35 noise-cancelling wireless headphones.”

—–

http://www.pocket-lint.com/review/139017-bose-quietcomfort-35-review-the-perfect-travel-companion

 “The QuietComfort 35 ‘phones are certainly not everyone’s cup of tea, considering they aren’t particularly fashion-conscious or able to playback grime with the growly thump of bass focused peers, but they are perfectly suited to the travelling lifestyle of their target audience.”

 “A plane journey will never feel quite the same without them.”

 Finally, here is the official Bose Website with more info on these headphones:

https://www.bose.com/en_us/products/headphones/over_ear_headphones/quietcomfort-35-wireless.html?mc=25_PS_BD_BO_00_GO_&gclid=CKCr3Kbz09ICFci2wAodsy4PAA&gclsrc=aw.ds

—–

 Finally, one note of caution.  Popular items are sometimes copied by others and sold as Bose.  Here is some info to protect against that problem:

 How to spot fake: BOSE Headphones – 6 Steps

 http://www.detectafake.com/viewProduct/?269580

 Also call Bose and read serial # to Bose and they will tell you if genuine or fake.

Call 800-367-4008 and ask customer service to confirm. 

I did that when I purchased my Bose QC 35 from Best Buy after problems getting through with order at Bose Website. They confirmed mine were genuine. Customer Service later told me I could order in future by phone.

3- Don’t forget DJPNEWS Enhanced Podcasts if you missed them on publication.  More to come!

Go to:  http://djpupdate.com/

4- I continue to teach my leadership seminar to 3rd and 4th year medical students at Tulane Medical School:  Leadership – How to give a 2-minute memorable speech.

 Stay well!

 Donald

 Donald J. Palmisano, MD, JD, FACS


Intrepid Resources® 

Donald J Palmisano Consulting

 5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

DJP@intrepidresources.com

http://www.intrepidresources.com/

http://onleadership.us/

(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)

DJP Updates: 

Twitter:  https://twitter.com/DJPNEWS

YouTube: https://www.youtube.com/user/IntrepidResources/videos Check out the videos.  

This DJP Update started out going to leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends; and now around the globe via Twitter followers.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

 

 

 

Read More
TOP

DJP Update 6-12-2016: Unable to attend AMA Annual Meeting; this video contains the message I would have shared to anyone interested in my views.

DJP Update 6-12-2016: Unable to attend AMA Annual Meeting; this video contains the message I would have shared to anyone interested in my views.

For multiple reasons, including my recent neck injury secondary to being in a car accident when our car was stopped and another car crashed into the rear of our car, I am not at AMA Annual Meeting.

This 24 minute speech captures what I try to teach medical students, doctors, and lawmakers in addition to the importance of medical liability reform.

Leadership in Medicine: Tales from The Little Red Book of Leadership Lessons – YouTube from Donald Palmisano’s Tweet

Alternative link:
https://t.co/ZuKEu8S7ip

DJPNEWS
Unable attend @AmerMedicalAssn ann. mt; 1st time in 33 yrs. My message: Med Ethics key. ⬇️Gov in Med; more: https://t.co/ZuKEu8S7ip #AMAmtg
6/11/16, 9:32 AM

Thanks to AAPS for posting video in a tweet on Memorial Day to honor Bud Lomell and other heroes.
AAPSonline
This D-Day rewatch Leadership in Medicine talk by @DJPNEWS. Includes lessons learned from Normandy hero Bud Lomell. https://t.co/9D3oXDbx13
6/6/16, 11:57 PM

————
Tired of PPACA (ACA)? Frustrated by MACRA? Wish you could spend more time with patients rather than electronic medical records designed by regulators for other purposes? ADVOCATE for the right to balance bill what the patient and doctor agree regardless of the payor of insurance (long-standing AMA policy). Stop going along to get along. Withdraw support for failed government policies distorting the practice of Medicine. Review my 6 Commandments of Medicine.

Stay well and be safe. Unfortunately the world is becoming more dangerous as obvious by terror attacks. Increase your vigilance and protect your loved ones.

We have been the land of the free only because of the brave. Never forget that.

Donald

AMA President 2003-2004

Donald J. Palmisano, MD, JD, FACS
DJP@intrepidresources.com
504-455-5895
www.intrepidresources.com
www.onleadership.us

DJP Updates: www.DJPupdate.com
Twitter: @DJPNEWS
YouTube: http://www.youtube.com/user/IntrepidResources/videos

Read More
TOP

DJP Update 12-8-2014 Tomorrow on C-SPAN 3 Hearing on PPACA; 2- Some Weblinks; LAGNIAPPE: Movies and Louisiana U.S. Senate runoff election

DJP Update 12-8-2014 Tomorrow on C-SPAN 3 Hearing on PPACA; 2- Some Weblinks; LAGNIAPPE: Movies and Louisiana U.S. Senate runoff election

Airing LIVE Tuesday, Dec 09 9:30am EST on C-SPAN 3 re PPACA, the healthcare law.

http://www.c-span.org/video/?323115-1/hearing-jonathan-gruber-marilyn-tavenner-health-care-enrollment

Jonathan Gruber and Marilyn Tavenner on Health Care Law Enrollment
Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner and MIT economist Jonathan Gruber testify before the House Oversight and Government Reform Committee about enrollment issues with the Affordable Care Act.
If you are caring for patients during that time, set your recorder.  It is my view the hearing will not be limited just to enrollment.  Professor Gruber’s comments regarding how the law was designed and what he thinks of the public no doubt will be explored.

2- Some Weblinks to Professor Gruber’s comments and an interesting article in WSJ today about PPACA threat to private practice:
DJPNEWS
“Will Jonathan Gruber Topple Obamacare?” @politico Pro: http://t.co/BsvjJmkgJJ #CSPAN tomorrow = Testimony #Congress . #ACA #tcot
12/8/14, 10:20 AM
Alternative link:  http://www.politico.com/magazine/story/2014/12/will-jonathan-gruber-topple-obamacare-113369.html?hp=t3_r#.VIZVLIer9XZ

DJPNEWS
“ObamaCare’s Threat to Private Practice” @WSJopinion @AEI http://t.co/zvBtuPqWOb #PPACA #ACA #tcot @AAPSonline @AmerMedicalAssn @sonodoc99
12/8/14, 11:21 AM
Alternative link:  http://www.wsj.com/articles/scott-gottlieb-obamacares-threat-to-private-practice-1417990367  (Requires log in)

—————

LAGNIAPPE:  Two movies and one YOUTUBE that we saw recently and enjoyed.  1- Big Hero 6.  We saw this with our grandkids in movie theatre.  Story of a robotics prodigy. A story of genius, tragedy, and triumph.  Stresses education.  2- The Hundred-Foot Journey (based on book of same name)  A tale of a family who suffers a tragedy in India and moves to France.  One son is a gifted chef.  Heart-warming story of family, love, and cooking.  Available ON DEMAND from TV services.  Info about the author, Richard C. Morais, is at:  http://www.richardcmorais.com/

YOUTUBE:  Work of art video;  It shows the design of a Beretta shotgun by Apple designer and the craftsmanship of the folks at Beretta.

http://www.thefield.co.uk/news/beretta-486-apple-designer-marc-newson-26297
TheFieldmag
Is this the most fantastic collaboration ever? @BerettaItalia with Apple designer Marc Newson http://t.co/TofGpD5vLZ http://t.co/Azlu6BGsEj
11/17/14, 5:26 AM

————

Must not forget the La. U.S. Senate runoff election that took place Saturday December 6.

DJPNEWS
RT @BillCassidy: Louisiana, you voted for change. It’s an honor and a privilege to be your next senator. Thank you! http://t.co/Gj7oKa6EKy
12/6/14, 10:21 PM

DJPNEWS
Election results not close in Rep. Bill Cassidy win over Sen. Mary Landrieu for La. U.S. Senate seat. #tcot #GOP http://t.co/OtldoH4DOi
12/6/14, 9:14 PM

The final tally was 56 percent for Dr. Bill Cassidy and 44 percent for Senator Mary Landrieu.

And the Louisiana State Medical Society (LSMS) sends out this message today:

4 LSMS Members in the United States Senate and House of Representatives

“Congratulations to Drs. Cassidy, Boustany, Fleming, and Abraham

“LSMS Member in the U.S. Senate
Dr. William “Bill” Cassidy was elected to the US Senate on December 6, 2014.

“LSMS Members in the U.S. House of Representatives
District 3 reelected Dr. Charles W. Boustany, Jr. on November 4, 2014.
District 4 reelected Dr. John Fleming on November 4, 2014.
District 5 elected Dr. Ralph Lee Abraham on December 6, 2014.”
——-
Stay well,

Donald

Donald J. Palmisano, MD, JD, FACS

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

DJP@intrepidresources.com

www.intrepidresources.com

www.onleadership.us

(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)

DJP Updates:  www.DJPupdate.com

Twitter:  www.twitter.com/DJPNEWS

YouTube: http://www.youtube.com/user/IntrepidResources/videos  Check out the videos.

This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

 

Read More
TOP

DJP Update 11-25-2014 OP-ED on Alternative to PPACA by Dr. Healy and DJP; Also Dr. Tenery article; Lagniappe: Some tweets not about health system reform

DJP Update 11-25-2014 OP-ED on Alternative to PPACA; Also Dr. Tenery article; Lagniappe: Some tweets not about health system reform
(Sent yesterday but server problem so sending again today after server fixed. Also added links.)

Here is the link at The Daily Caller with the OP-ED written by a former president of the American College of Surgeons, Dr. Gerry Healy, and me. Published 11-24-2014.

(Copy and paste links into your browser if it doesn’t show up as a hot link here.)

http://dailycaller.com/2014/11/24/we-need-healthcare-reform-but-obamacare-is-not-it/

The OP-ED is on two pages so click page 2 at bottom of first page.

Of course, I did a tweet about it too:

DJPNEWS
OP-ED @DailyCaller Dr. Healy + @DJPNEWS #PPACA + better way http://t.co/bRlEOidgIs #tcot @AAPSonline @AmCollSurgeons @LaMedSoc @BretBaier
11/24/14, 5:06 PM

By the way, if you want your own copy of The Patient Protection and Affordable Care Act (PPACA, ACA, etc.) for review during a discussion, here is a government link that gives you entire law.

The sequence of events and dates of PPACA passage can be found in my 2010 OP-ED: http://www.intrepidresources.com/html/PEJLSMS2010.pdf

https://www.govtrack.us/congress/bills/111/hr3590/text

A retweet involving PPACA and the man who found Professor Gruber videos.

This introduces the world to the person who found all of the Jonathan Gruber videos. I find it fascinating that this man is not a reporter but a guy who did his own research in his space time and scooped all of the press and those in Washington, DC. This man doesn’t want any publicity. He merely wanted to document the record regarding PPACA. He deserves a Pulitzer Prize.

DJPNEWS
Tell folks follow! @phillyrich1 RT @Heritage: Meet..Man Who Found the Jonathan Gruber Videos – http://t.co/aCHLvZnFle http://t.co/CuXl23U2tk
11/20/14, 2:44 PM

Try this link if above link doesn’t work: http://dailysignal.com/2014/11/20/meet-man-found-jonathan-gruber-videos/?utm_source=twitter&utm_medium=social

plus the image at: https://twitter.com/Heritage/status/535529301882327040/photo/1

BONUS: Here is a blog posting by Dr. Rob Tenery, a former Chair of CEJA that deals with PPACA. It is entitled: Boondoggle?

Worth reading: http://www.robtenerymd.com/blog/?p=367

LAGNIAPPE: Some of my Tweets/retweets you may find of interest not dealing with health system reform:

Watch the excellent video of a Beretta shotgun designed by Apple designer Marc Newson:

DJPNEWS
Work of #Art – incl video RT @TheFieldmag: … @BerettaItalia with Apple designer Marc Newson http://t.co/xL2J2XJkz4 http://t.co/uYkb1r0IbD
11/22/14, 9:31 AM
If link does’t work, use this instead: http://www.thefield.co.uk/news/beretta-486-apple-designer-marc-newson-26297 and then this one: https://twitter.com/TheFieldmag/status/534306606708953088/photo/1

Here is KitKat the day after the Saints lost on Monday Night Football:

DJPNEWS
Our outside #cat – #KitKat – with inside visitation privileges appears sad after loss #NOLA #Saints last night. #NFL http://t.co/NealmIvZp3
11/25/14, 2:50 PM
Try this link if link in tweet doesn’t work: https://twitter.com/DJPNEWS/status/537347570318594049/photo/1

Here is one of my Double Knockout roses. My daughter Mary Ellen recommends KnockOut Roses because they are so easy to grow and are resistant to disease.
DJPNEWS
Today’s #DoubleKnockoutRose from our garden. #Flowers #Roses #photography http://t.co/9xKweYy30x
11/25/14, 2:43 PM
Try this link for rose: https://twitter.com/DJPNEWS/status/537345797751603201/photo/1

That photo was take with iPhone 6+.
—————

Have a wonderful Thanksgiving!

Donald

Donald J. Palmisano, MD, JD, FACS

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

DJP@intrepidresources.com

www.intrepidresources.com

www.onleadership.us

(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)

DJP Updates: www.DJPupdate.com

Twitter: www.twitter.com/DJPNEWS

YouTube: http://www.youtube.com/user/IntrepidResources/videos Check out the videos.

This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

Read More
TOP

DJP Update 10-5-2014 Gadgets and Lagniappe (articles)

DJP Update 10-5-2014 Gadgets and Lagniappe (articles)

If you are not into tech stuff and do it yourself projects, you can skip this item and go directly to Lagniappe.  The Gadget section is about modifying old computers so you can use longer plus info re new iPhones.

 GADGETS A) Computer upgrade B) iPhones

A) Upgrading your old computer with larger hard drive (SSD) and more RAM

I decided to upgrade my Apple mid-2009 MacBook Pro with 4 GB RAM and 250 SSD (Solid State Drive rather than a spinning hard drive) GB hard drive that I use as my desktop computer for writing. The 250 GB hard drive was full despite moving most data off.  Lots of programs!

With the availability of excellent YouTube videos online free for viewing via Internet for viewing options and techniques for changes the insides of my computer, I ordered 8 GB of RAM and the new Samsung SSD 850 Pro SATA III (512 GB) from Amazon.

I also bought special screwdrivers (T6 Torx and Phillips PH00) made by Boxer to remove back of computer and the internal screws.  In addition I got an anti-static wristband with clip to attach to computer at the advice of my younger brother who knows much more than I do about computer insides.

I cloned my original 256 GB SSD to the new 512 GB SSD (solid state drive) before removing using “Carbon Copy Cloner” program and connecting new SSD to USB port before the swap.

No problems at all with transplant or data transfer including clone of operating system. Computer worked immediately when I turned it back on.  All items were bought from Amazon. As a PRIME member, I received items in 2 days at no extra mailing costs.  The Carbon Copy Cloner was free for 30 days and worked smoothly.  It was downloaded from the maker of the program:

https://www.bombich.com/

I then purchased the Carbon Copy Cloner program ($39.99) to encourage the developer of the program plus the program is a good way to back up frequently so that you have a bootable external hard drive if the internal drive crashes. The advantage of this is if the computer hard drive crashes and remains broke, you can put in new hard drive or take it to a computer store to remove broken drive and add new one. Then the new internal hard drive with everything you saved on external drive is cloned using Carbon Copy Cloner.  In other words, no need to reinstall the Operating System from original discs that came with your computer.  Remember, ALWAYS back up!  (Some people use the “Cloud” to store data but I don’t as I worry about security at those sites.  I believe it best to control your own backups and keep one backup at another location in a waterproof container such as a Pelican 1200 case made by Pelican Products in Torrance, California. Light enough to carry with you in an evacuation. Those who suffered through Hurricane Katrina know the value of backup and alternative safe locations to store one additional backup!)

This Carbon Copy program copies booting files, all programs, and all data. I have two external hard drives for back up.  One backs up with Apple’s TIME MACHINE, the other with CARBON COPY CLONER. Both external hard drives are Lacie 500 GB 7200 RPM with option for Firewire 800 or USB 3.0.  I have Firewire 800 on my old mid-2009 as well as the slower USB 2.0. Using Firewire 800 with the 7200 RPM makes the back up very fast.  Most external hard drives at stores are 5000 RPM.  7200 RPM drives are faster and give better result with transferring and modifying video.

I am impressed with educational info on YouTube!  The swap reminded me of my first short wave radio I built from a Heath Kit when I was a teenager.  Lots of fun.

Here is some info re the revolutionary Samsung 850 Pro 512 GB SSD that I inserted into computer:

http://www.samsung.com/global/business/semiconductor/minisite/SSD/global/html/ssd850pro/overview.html

This adventure give me a functional writing computer for some additional years rather that spending thousands on a new computer.  The speed increase in the computer is noticeable!

Here are examples of the YouTube educational videos reviewed before attempting this transplant and more specs on my Mac:

Larger Samsung SSD into MacBook Pro and also cloning in this YouTube video:

——–
Cloning hard drive to swap hard drives in MacBook Pro (to back up all programs, data, etc.)

———
Upgrade RAM in MacBook Pro – YouTube



————–
Specs on my mid-2009 MacBook Pro

Core 2 Duo 3.06 15″ Model Identifier 1066 PX3-8500 with 4 GB RAM.

(After addition of new RAM, I now have 8 GB RAM.)

 Conclusion:  For most purposes, one doesn’t have to upgrade to a new computer when you run out of space on hard drive or need more RAM for running multiple programs at once.  Simple transplants can keep the computer sufficient for most needs, especially writing.  Educational info on YouTube makes the swaps easy and instills confidence.

B) iPhones: Robin and have used iPhone 4S for several years.  But there are problems with these phones in our hands with the updated software that brings new features for iPhone 6.  Freezing of program, inability to use some of apps, etc.  We decided to get the new iPhone 6.  We chose different versions:  Robin iPhone 6 and DJP iPhone 6+.  Her phone arrived in a few days.  Mine won’t get to me until the end of this month.  Her phone works well!  Great detail.  We also switched carriers to Verizon as we get good Verizon signal at our home but a poor signal with ATT on old iPhones.  We have had the Verizon Jetpack for portable hotspot for computers and we have used these Verizon portable devices with great success.  Good signal strength where we travel in USA.

Good YouTube video showing how to transfer all data and apps from old iPhone to new iPhone.  This is method I used and it works well.

LAGNIAPPE:

A) Dr. Stormy Johnson forwarded this link for me to share re health system reform.  It is an article by James C. Capretta in National Review Online:

http://www.nationalreview.com/article/388386/replacing-obamacare-saves-lot-money-james-c-capretta

B) Mark B. Constantian, MD, FACS and co-author Chee Paul Lin, M.A. have new articles re unhappy patients and plastic surgery in Plastic and Reconstructive Surgery, The Journal of the American Society of Plastic Surgeons.

Journal cite: Plastic & Reconstructive Surgery. 134(4):823-835, October 2014.

Why Some Patients Are Unhappy: Part 1.

Relationship of Preoperative Nasal Deformity toNumber of Operations and a History of Abuse or Neglect

Why Some Patients Are Unhappy: Part 2.

Relationship of Nasal Shape and Trauma History to Surgical Success

Journal cite: Plastic & Reconstructive Surgery. 134(4):836-851, October 2014.

Both can be found in medical library or at: http://journals.lww.com/plasreconsurg/pages/results.aspx?txtKeywords=constantian

Summaries can be seen at link:  e.g. Part 1:

Background: Trauma (neglect or abuse) can create body shame (different from body dissatisfaction), driving some patients to seek aesthetic surgery. We hypothesized that a trauma history would be related to the severity of the original deformity and the drive to undergo repeated operations.

Methods: Descriptive statistics were computed for 100 secondary rhinoplasty patients, 50 of whom originally had dorsal humps, 21 of whom had straight, functional noses, and 29 of whom had subjectively normal noses but underwent multiple rhinoplasties. This latter group fulfills criteria for body dysmorphic disorder.

Results: Compared with patients with hump noses, patients with normal primary noses were 2.9 times more likely to be demanding 2.5 times more likely to be depressed, had undergone 3.0 times more rhinoplasties and other aesthetic operations, and were 3.8 times more likely to have confirmed trauma histories. Patients who had undergone more than three operations were 92.7 percent women; 85 percent originally had straight noses and had undergone an average of 7.56 rhinoplasties and 5.78 aesthetic operations; 85.4 percent had histories of abuse or neglect.

Conclusions: Secondary rhinoplasty patients with normal preoperative noses, who fulfill the criteria for body dysmorphic disorder, had significantly higher prevalences of depression, demanding conduct, previous rhinoplasties and other aesthetic operations, and confirmed trauma histories than patients who originally had dorsal deformities or straight noses with functional symptoms. To the authors’ knowledge, this is the first report of such associations. A history of childhood trauma may impact adult patient behavior and therefore the surgical experience.

Mark also has an editorial in Plastic & Reconstructive Surgery (December 2013)

The New Criteria for Body Dysmorphic Disorder: Who Makes the Diagnosis?

These articles and the editorial are very interesting.  Risk managers and medical liability companies especially may find the information of value.

Stay well.
Donald

Donald J. Palmisano, MD, JD, FACS

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

DJP@intrepidresources.com

www.intrepidresources.com

www.onleadership.us

(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)

DJP Updates:  www.DJPupdate.com

Twitter:  www.twitter.com/DJPNEWS

YouTube: http://www.youtube.com/user/IntrepidResources/videos  Check out the videos.

This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

Read More
TOP

DJP Update 9-28-2014 1- AMA Ethics Award Recipient Dr. Ezekiel Emanuel’s article “WHY I HOPE TO DIE AT 75”. 2- DJP Updates

DJP Update 9-28-2014 1- AMA Ethics Award Recipient Dr. Ezekiel Emanuel’s article “WHY I HOPE TO DIE AT 75”. 2- DJP Updates

The article by Dr. Ezekiel Emanuel is published in THE ATLANTIC September 17, 2014 with the title:

 Why I Hope to Die at 75

H/T to Dr. Art Fougner for the alert about article in the listserv he moderates “Speaking As An Individual” and via his Twitter account: @sonodoc99

Dr. Emanuel’s article is at: http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/

You have to read his entire article to get his message.  Here is one excerpt re his approach to treatment as one gets older:

“This means colonoscopies and other cancer-screening tests are out—and before 75. If I were diagnosed with cancer now, at 57, I would probably be treated, unless the prognosis was very poor. But 65 will be my last colonoscopy. No screening for prostate cancer at any age. (When a urologist gave me a PSA test even after I said I wasn’t interested and called me with the results, I hung up before he could tell me. He ordered the test for himself, I told him, not for me.) After 75, if I develop cancer, I will refuse treatment. Similarly, no cardiac stress test. No pacemaker and certainly no implantable defibrillator. No heart-valve replacement or bypass surgery. If I develop emphysema or some similar disease that involves frequent exacerbations that would, normally, land me in the hospital, I will accept treatment to ameliorate the discomfort caused by the feeling of suffocation, but will refuse to be hauled off.

“What about simple stuff? Flu shots are out. Certainly if there were to be a flu pandemic, a younger person who has yet to live a complete life ought to get the vaccine or any antiviral drugs. A big challenge is antibiotics for pneumonia or skin and urinary infections.”
————

Bio from article:

Ezekiel Emanuel is director of the Clinical Bioethics Department at the U.S. National Institutes of Health and heads the Department of Medical Ethics & Health Policy at the University of Pennsylvania.

——

Of course, AMA Delegates and the AMA Board know Dr. Emanuel well as he received the AMA Foundation’s “2013 Isaac Hays, M.D. and John Bell M.D. Award for Leadership in Medical Ethics and Professionalism” at the June 2013 Annual AMA House of Delegates.

See: http://www.ama-assn.org/ama/pub/news/news/2013/2013-11-18-ama-foundation-honors-physician-for-ethics-leadership.page

Comments by others on Dr. Ezekiel Emanuael’s article:

sonodoc99
@AmerMedicalAssn @DJPNEWS Dr. Emanuel stands Primum non nocere on its ear. http://t.co/4iO51DLCra
9/21/14, 8:16 AM

http://nypost.com/2014/09/24/a-pathetic-case-for-stopping-life-at-75/

http://pjmedia.com/ronradosh/2014/09/19/dr-ezekiel-emanuel-to-me-and-others-dont-live-past-75/?singlepage=true
…….

DJP editorial comment:  I disagree with Dr. Emanuel.

Dr. Emanuel’s article is his opinion.  But if the government adopts such an approach though the IPAB (Independent Payment Advisory Board) of PPACA or some other scheme yet to be devised, then we have a problem!  Dr. Emanuel is a chief architect of PPACA/ACA and you already know my views on that law: http://www.intrepidresources.com/html/PEJLSMS2010.pdf

My answer to Dr. Emanuel’s view is in my 6 Commandments of Medicine: S-E-C-C + 2.

Science – Ethics — Compassion – Courage and the +2 =

Is this in the patient’s best interest?

Do I have my patient’s informed consent?

I included the 6 Commandments in my commencement speeches to graduating medical students and other medical professionals at Tulane University Health Sciences Center (May 22, 2004), LSU Health Sciences Center New Orleans (May 18, 2002), LSU Health Sciences Center Shreveport (May 29, 2004), and Oklahoma University College of Medicine (May 27, 2006).

See one of my speeches containing the 6 Commandments at:

http://www.intrepidresources.com/html/commencement_address.pdf

May 18, 2002 LSU Health Sciences Center Commencement Address

Also published in Vital Speeches of the Day; 9/15/2002, Vol. 68 Issue 23, p764

These speeches were delivered during my time on the AMA Board 1996-2005 and as AMA president 2003-2004 and after.

I am 75 years old and I tell the medical students I teach at Tulane if some future government edict states people my age should be ignored and put on a gurney in the corner of the emergency department if they are in an auto accident, don’t follow the rule.  Show courage and leadership and follow the 6 Commandments.  I remind them it is the least they can do for a clinical professor who teaches them for free and it is the ethical act to do what is in the patient’s best interest, not the government or insurance company!

Throughout history there are people who seek to control, command, and remove liberty from others or use their view of ethics to justify their actions. America’s response has been to fight for freedom and individual self-determination.  Visit Arlington National Cemetery, the National Cemetery of the Pacific in Hawaii, or the Normandy American Cemetery and Memorial for powerful reminders of the price we paid for Liberty..  Remember, LIBERTY is the absence of coercion.

As for various views of ethics and how different results can be obtained using different ethical models, see my 1998 speech:  Hippocratic Oath:  Discarded Relic Or Living Soul of Medicine:

http://haciendapublishing.com/medicalsentinel/hippocratic-oath-discarded-relic-or-living-soul-medicine

Read the entire speech.  Here is an excerpt about the ethical models:

———-Excerpt——–
Let us not go quietly into this abyss, this new Dark Age, a Dark Age of medicine. Let us stand on principle. A revival of the Hippocratic Oath with reasoned discussion of what it means is a step away from the abyss.

We must understand what ethics mean. Never accept blindly a statement that something is ethical without reviewing the analysis that led to that conclusion.

For example, consider the following different ethical models:

• Deontological: rightness is not defined in terms of their consequences; violate no rights.

• Teleological: goal or consequence oriented.

• Social utility: greatest good for the greatness number.

After selecting one of these reasoning models, was an analysis done that considered the following? Autonomy, Nonmaleficence, Beneficence, Justice.

Each of these analyses has additional choices to make in order to complete the analysis. For example, to do the justice analysis, one must decide which of the following theories one will use: Egalitarian, Communitarian, Libertarian, Utilitarian.

Thus it is obvious that it is possible to reach different conclusions as to what is ethical and what is not depending on the ethical model used.

—————- End of Excerpt———–

If Dr. Emanuel is serious about the statements in his article, it would be a good idea for him to do a legal document, an “Advance Directive” (sometimes called a “Living Will”).  This gives instructions regarding medical treatment in the event an individual becomes incapacitated and is unable to instruct the doctors on treatment choices (or no treatment).  Others who wish to have relatives or a trusted friend make medical decisions also execute a “Durable Power of Attorney for Healthcare”.  Such a document turns comments in an article into reality.

2- DJP UPDATES:

Some doctors have contacted me and asked if they fell off my DJP Update blog because they have not received a DJP Update since July 7, 2014.  I informed them that I have not sent any since July 7.  I have been very busy and my spare time writing is on my novel plus Twitter postings, now up to 12,144 tweets as of September 26, 2014.  See @DJPNEWS

Remember, you always can view previous DJP Updates at http://djpupdate.com/

Another reason some individuals don’t receive the DJP Updates is because emails that have thousands of recipients frequently go to junk mail.  That can be avoided by selecting my DJP@intrepidresources.com email as a favorite and thus one not destined for junk mail.  Of course, if you want to get off of my DJP Updates, just put REMOVE in reply subject line.

—————
Stay well.

Donald

Donald J. Palmisano, MD, JD, FACS

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

DJP@intrepidresources.com

www.intrepidresources.com

www.onleadership.us

(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)

DJP Updates:  www.DJPupdate.com

Twitter:  www.twitter.com/DJPNEWS

YouTube: http://www.youtube.com/user/IntrepidResources/videos  Check out the videos.

This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

Read More
TOP

DJP Update 7-2-2014 Have a wonderful 4th of July! – Twitter as a source of news – AMA Board and AMA position on SCOTUS Hobby Lobby case

DJP Update 7-2-2014 Have a wonderful 4th of July! – Twitter as a source of news – AMA Board and AMA position on SCOTUS Hobby Lobby case

1- Happy 4th of July!  Hope you have a wonderful and safe celebration and reflect on the courage of those who gave us this land of liberty.

2- TWITTER:  Once again, I repeat myself about the advantage of Twitter as a news source.  You don’t have to tweet.  Just download the app.  I use Twitter app plus Echofon.  Both do the same basics but each has advantages over the other.  You can follow news organizations and get breaking news long before you see it on TV or Websites.

Example, follow Twitter accounts of news from TV stations, news organizations such AP, Reuters, NYTimes, Washington Post, Washington Examiner, Wall Street Journal and your favorite investigative reporters plus medical sources.  By the way I own no stock in Twitter and I am not an employee of Twitter.  I find the book (previously described via DJP Update) that explains Twitter best is “The Twitter Book” by Tim O’Reilly and Sarah Milstein.  Easy to read and understand and has all of the essentials.

Here is one example below of news about AMA that is not on AMA Website yet ( http://www.ama-assn.org/ama/pub/news/newsroom-index-2014.page?&linkid=subnav-1 ) as of 1:28 PM Central.

AMA position on decision by Supreme Court of the United States (SCOTUS) re Hobby Lobby case is noted in Modern Healthcare tweet below.  As you may recall, the Court, as summarized by Modern Healthcare, said closely held private companies should not have to provide insurance coverage for four types of contraceptives to which company owners have religious objections.  As other news sources have pointed out, Hobby Lobby has no objection to covering the insurance costs of 16 of the 20 ACA/HHS forms of contraceptives.  http://www.minnpost.com/dc-dispatches/2014/07/post-hobby-lobby-how-will-affected-women-get-contraception-coverage

http://www.modernhealthcare.com/article/20140701/NEWS/307019939/doctors-nurses-urge-action-following-hobby-lobby-decision

Use this link if link in tweet below doesn’t work.  When copying tweets, the link sometimes changes!
You also may have to sign in.

This info was noted in a tweet by Modern Healthcare:

modrnhealthcr
#Hobbylobby decision “intrudes on the patient-physician relationship,” says @robertwahmd: http://t.co/S4rx5aNC9X @AmerMedicalAssn
7/2/14, 6:45 AM
——————

Obviously, my views on PPACA and HHS regulations are well known and I have stated repeatedly that specific law and the regulations related to it are the greatest intrusions on the patient-physician relationship.
I have shared those views with you in past including this Op-Ed:  http://www.intrepidresources.com/html/PEJLSMS2010.pdf

Rather than read only the comments of others about the decision, be sure to read the entire decision yourself.  It can be found at the U.S. Supreme Court site:

http://www.supremecourt.gov/opinions/13pdf/13-354_olp1.pdf

Other Supreme Court decisions can be found at:  http://www.supremecourt.gov/opinions/slipopinions.aspx?Term=13

3- AMA Board 2014-2015 as of June 2014 elections by HoD and Board itself for intra-board positions
The link below gives all board members and their titles.

http://www.ama-assn.org/ama/pub/news/news/2014/2014-06-12-ama-announces-2014-board-trustees.page

If you wish to write anyone on board, the email is firstname.lastname@ama-assn.org
Thus first name followed by period and then last name followed by @ama-assn.org

Example AMA President:
Robert.Wah@ama-assn.org

Communication with elected board members is critical to understand positions board takes and to share how the practice of medicine is going in your community.  Failure to communicate increases risk of membership loss.  The best way to enhance communication, in my opinion, is to have the equivalent of C-Span viewing of AMA board meetings available only to AMA members.  That way one can see the debate on controversial issues and see how the board members vote.  This allows one to see if the rhetoric of the candidate matches the actions of the same person if elected to Board.  But then I repeat myself.

Have a great 4th of July and give thanks to the veterans and those still in our military.  Those in uniform protect our liberty with their lives at risk.

Stay well,

Donald

P.S. If the link did not work re Melinda and Bill Gates Stanford 2014 Commencement Speech mentioned in last DJP Update, here is another link with the speech on YouTube:
Go to one hour and one minute in YouTube posting to get to the speech as noted below.

Intro and speech begin at 1:01:00. ( just slide your pointer slowly to the right once it begins to play; if you slide it over too fast, the beginning audio background continues to play while they are speaking).

Also, Robin and I just returned from trip with granddaughter Alexis.  Great fun.  Activities included helicopter landing in Grand Canyon.  See @DJPNEW tweets for more details and photos.

Donald J. Palmisano, MD, JD, FACS
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, LA 70006
USA
504-455-5895 office
504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us
(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)
DJP Updates:  www.DJPupdate.com
Twitter:  www.twitter.com/DJPNEWS
YouTube: http://www.youtube.com/user/IntrepidResources/videos  Check out the videos.
This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an  email stating “Join DJP Update”
To get off the list, state ” Remove DJP Update” in subject line.

Read More
TOP

DJP Update 6-17-2014 Travel, Tweets, AMA, ABA, ON LEADERSHIP now an audiobook, Stanford Commencement Address by Bill and Melinda Gates; Gadgets

DJP Update 6-17-2014 Travel, Tweets, AMA, ABA, ON LEADERSHIP now an audiobook, Stanford Commencement Address by Bill and Melinda Gates; Gadgets

1- My DJP Updates have decreased in number because of the lure of Twitter.  I tweet daily at @DJPNEWS and it is a good way to learn how to be concise as the total number of characters cannot exceed 140.  Plus by following reporters and news channels one can get the breaking news immediately.  The TV news almost becomes unnecessary.

2- Lots of travel so far this year to board meetings plus PIAA in Ontario, AMA Annual Meeting, and presentation with son Donald Jr. at American Bar Association just after AMA meeting in Chicago.  Next week we go on the 2nd of the planned grandchildren adventures!  We are taking Alexis, our granddaughter to Paris, not in France but the Las Vegas Paris Hotel.  She picked Paris as the destination but she will have to wait until high school graduation for her parents to take her.  These trips are great for one-on-one time with the grandkids.  I highly recommend it.  Just about finished designing the new course I will teach at Tulane Medical, how to make a powerful 2 minute presentation.  The goal is to encourage the students to be comfortable using rhetorical devices plus understanding the importance of C.O.D., namely Content, Organization, and Delivery.  With the large number of students in the USA not getting a residency spot such a course should make them better able to convince the residency to select them.

3- My book ON LEADERSHIP has been selected by Audible.com as an audio book!  In addition to the print version, having the book in digital reading format and digital audio means it always will be available.  That is nice.

Reviews of the print version can be found at:  http://onleadership.us/pages/reviews.php

4-  I won’t depress you with my views about the continued problems with PPACA, SGR, ICD-10, etc.  There are too many depressing stories on other topics in the news today.  Perhaps we will get to the truth of the current controversies soon.  But courage and leadership will be required.  It will require truth to trump politics.

5- Stories are a powerful way to get a message to the audience.  People in the audience remember stories years later, long after they forgot the rest of the speech.  Watch and listen to the 2014 Stanford Commencement speech delivered by Bill and Melinda Gates.  Bill and Melinda both share stories that are powerful.

Here are my comments about the speech:

Bill’s first story about the lack of reliable power source for computer in Africa  points out the importance of what I call “walking the halls”.  One has to go to the site of action to see what is really happening.  I tell that to hospital administrators all the time.  Can’t run a hospital from the fancy office on the 12th floor.  Go visit the wards, the O.R., and the Emergency Dept. and learn what the real problems are.  Talk to the surgeons in the surgery lounge at 7 A.M. and hear their frustrations.

My favorite story was Melinda’s account where she personally carried a dying woman with AIDS to the roof of the “Home for the Dying”. “The stigma of AIDS is vicious and the punishment is abandonment.” Powerful.  Melinda is a natural storyteller and she does it without notes.  I can picture the woman holding Melinda’s hand on the roof top as woman watches the setting sun just before dying.

Here is my @DJPNEWS tweet with the link and location in the timeline of the commencement address.  BTW, H/T to Raymond French, father of Melinda, for the alert about the speech.

I strongly recommend you listen to this commencement address.

DJPNEWS
Stanford 2014 Commencement Address: Bill/Melinda Gates. 1:01:42 of Webcast and ends at 1:31. Powerful esp. 1:19:17 https://t.co/ttLxbFvcfk
6/16/14 5:40 PM
Melinda and Bill Gates are shining examples of leadership and they work through their foundation to try and solve horrific ills in the world.  Think Malaria, Polio, HIV, and more!  Read more about their work at:

http://www.gatesfoundation.org/

Some specific programs:
http://www.gatesfoundation.org/What-We-Do/Global-Health/Malaria
and
http://www.gatesfoundation.org/What-We-Do/Global-Development/Polio
and
http://www.gatesfoundation.org/What-We-Do/Global-Health/HIV

6- GADGETS:  Tomorrow, June 18, Amazon is announcing the Amazon smart phone.  Amazon Prime customers now have over one million songs available to hear as a bonus in addition to the free movies with the Prime service.  The new gadgets, software, high-speed streaming via Internet are akin to magic.  Great adventures for techies.

One last thing.  I have a new camera for the trips with the grandkids.  It had to be a camera with a long zoom but small enough to fit in my jacket pocket.  After testing many cameras, I settled on the Olympus Stylus 1.  It has an adequate sensor and the zoom goes to 300 mm equivalent.  The sensor is large enough for 11 X 14 enlargements with excellent quality.  It has an easy to use Wi-Fi and photos can be sent to a smart phone immediately for sharing.  Nice!  The first one I bought had a software problem with freezing up but my favorite camera store, Bennett’s Camera in Metairie, immediately exchanged it for another new one.  A big stimulus for this camera was the safari at “The Wilds” in Columbus Ohio at the Columbus Zoo where we ride in the back of a pickup truck going by the animals on the plains.  Didn’t want to carry the large Nikon and the Canon 110 did not have enough zoom.  The Columbus adventure is in July with two more of the grandkids, Diego and Pablo.  They wanted to travel to Ohio to see where “Nana” Robin was born!

P.S.  To all the folks I photographed on the trips, I will send the photos by email but it will take a while to get to it.  Some of you saw your photos on Twitter at the AMA meeting with the hashtag #AMAmtg

Some examples:

DJPNEWS
#AMAmtg : Also = renewal of friendships. Robin and I visit 2 wonderful bright ladies after the day’s work. @PeggyMP http://t.co/35iqmX5UsY
6/9/14 2:22 PM

DJPNEWS
Standing ovation #AMAmtg for Dr Monica Wehby, fmr AMA Board member candidate for U.S. Senate Oregon. Go Regency D 5PM http://t.co/JsNKq4A4gt
6/7/14 4:49 PM

And one taken by moderator at ABA panel!
DJPNEWS
Thx! @doctorscompany RT @CountrymanClay: First time Donald Palmisano Jr and Sr presented on same panel #PHYLAW14 http://t.co/oensKgRuZx
6/12/14 4:16 PM
Stay well,

Donald

Donald J. Palmisano, MD, JD, FACS
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, LA 70006
USA
504-455-5895 office
504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us
(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)
DJP Updates:  www.DJPupdate.com
Twitter:  www.twitter.com/DJPNEWS
YouTube: http://www.youtube.com/user/IntrepidResources/videos  Check out the videos.
This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an  email stating “Join DJP Update”
To get off the list, state ” Remove DJP Update” in subject line.

Read More
TOP

DJP Update 2-5-2014 The SGR mess and the solution.

DJP Update 2-5-2014  The SGR mess and the solution.

The Medicare Sustainable Growth Rate (SGR) is a price-fixing law in Medicare.  There are three committees of jurisdiction in Congress:  the Senate Finance Committee, the House Committee on Energy and Commerce, and the House Committee on Ways and Means.

There is movement to get rid of the SGR because of the ticking clock of looming dramatic cuts.  But a critical question is whether physicians will be able negotiate a fee with patients regardless of what the government pays.  An example of that method is what Australia does in its Medicare system.  Unfortunately, I believe Congress will not give up control of the price-fixing of the total fee but instead will deliver a new law that may remove the term SGR and give a very small increase in payment in exchange for additional chains on the physician, including “quality” determined by bureaucrats.  Combine this approach with the unfolding disaster of PPACA and it is easy to see why physicians are discouraged and why there will be a crisis in access to care for patients.  I believe many physicians who are able will get out of all government programs and do direct contracting with patients. This is hard to do if you are a specialist such as a cardiac surgeon or a neurosurgeon requiring hospital facilities!  Other physicians will become employees of large entities.  The current system allows folks in Congress to ask for donations each year to get the system fixed but the system never gets fixed and the fund raising continues.

Here is an article published today that is worth reading.  As mentioned in the article, this is what is needed:

EXCERPT:

While Medicare has issued subsequent regulations, this insulting provision is still on the books. As Drs. Donald Palmisano, Daniel Johnson, and William Plested—three former presidents of the American Medical Association—have written, “The right of patients to privately contract with physicians to ensure they have the medical care they want, without penalty—regardless of what the government pays—must be recognized and protected.”
————–
End of excerpt.

Comment:  Until national medical and specialty societies insist on that provision as the sine qua non, the mess will continue.  Don’t negotiate the length of the chains.  Choose liberty.  After all, we are Americans and not serfs.
And don’t forget the years of meetings and policies passed at AMA advocating that right to privately contract with patients.  Here are just a few examples:

NOTE: Balance-billing in Medicare and the right to privately contract has been AMA policy since the 1980s & 1990s.  And, pay attention to this policy in 2009

EXCERPT from policy passed at Annual 2009:  H-383.991 Right to Privately Contract

Our AMA includes in its top advocacy priorities: (1) the enactment of federal legislation that ensures and protects the fundamental right of patients to privately contract with physicians, without penalties for doing so and regardless of payer within the framework of free market principles with the goal of accomplishing this by 2010

Also see policies H-380.994, H-380.989, H-165.916, etc.

Does no good to pass policies if they never get enacted by Congress.  Time for a new game plan.

And never forget Section 1801 of the original Medicare law:  “Prohibition Against Any Federal Interference…or control over the practice of medicine…or compensation…of any…person providing health service… (More details on pages 255-259 in Notes section of my book, ON LEADERSHIP. 1st edition 2008)  Keep that in mind with promises made in Congress.

————

Now on to the full article Published in THE FOUNDRY of THE HERITAGE FOUNDATION by Robert Moffit.  He is Director of The Heritage Foundation’s Center for Health Policy Studies.

http://blog.heritage.org/2014/02/05/replacing-medicare-sgr-congress-expand-options-doctors-patients/

Replacing the Medicare SGR: Why Congress Should Expand Options for Doctors and Patients

Robert Moffit
February 5, 2014 at 1:54 pm

Currently three major congressional committees are working feverishly to finalize language to repeal and replace the Medicare Sustainable Growth Rate (SGR). Whether they will succeed in protecting the practice of medicine from intrusive government interference remains to be seen.

The Balanced Budget Act (BBA) of 1997 created the SGR physician payment update formula, an epic failure in health policy. But the BBA also imposed an unprecedented statutory restriction on the right of doctors and patients to enter into private agreements outside the Medicare program to deliver services covered by Medicare.

The BBA allowed Medicare patients to enter into private agreements with doctors and pay them directly for any medical services covered under Medicare—but only if the doctor signed an affidavit of the contract, submitted that affidavit to the Department of Health and Human Services within 10 days of the agreement, and refrained from billing Medicare for the treatment of any other Medicare beneficiary for a period of two years.

So, under the terms of the statute, if a patient did not want to submit a claim to Medicare and pay a doctor directly—for any reason—she would not be able to do it unless the doctor could afford to give up his Medicare practice for two years. The unspoken assumption was that seniors might be gouged by predatory physicians, a class of professionals who bear special supervision—unlike, say, lawyers.

In 1997, the Clinton Administration claimed that the BBA “liberalized” private agreements between doctors and patients. Not true. No Medicare law specifically forbade private agreements between doctors and patients. And in previous federal case law, a federal judge (in Stewart v. Sullivan, 1992) also found that no law or federal policy forbade any such private agreements.

While Medicare has issued subsequent regulations, this insulting provision is still on the books. As Drs. Donald Palmisano, Daniel Johnson, and William Plested—three former presidents of the American Medical Association—have written, “The right of patients to privately contract with physicians to ensure they have the medical care they want, without penalty—regardless of what the government pays—must be recognized and protected.”

Another provision (enacted in 1989) forbids doctors to charge patients any amount above Medicare’s payment, i.e. a price control. A much better policy would allow doctors and patients to negotiate any difference between what the government pays and the doctors’ fees. Under such a policy, Medicare physicians would be allowed to accept the base Medicare payment and forgo any government bonus payment, but they would be required to disclose the prices of their services beforehand. This would create real price competition among physicians and drive innovation and quality in health care delivery.
——————–

Stay well,

Donald

Donald J. Palmisano, MD, JD, FACS
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, LA 70006
USA
504-455-5895 office
504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us
(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)
DJP Updates:  www.DJPupdate.com
Twitter:  www.twitter.com/DJPNEWS
YouTube: http://www.youtube.com/user/IntrepidResources/videos  Check out the videos.
This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an  email stating “Join DJP Update”
To get off the list, state ” Remove DJP Update” in subject line.

Read More
TOP

DJP Update 10-24-2013 1- NPSF Board Meeting Boston; 2- More on PPACA Tribulations; 3- DJP Remarks at TMAA Award; 4- LAGNIAPPE: Gadgets!

DJP Update 10-24-2013 1- NPSF Board Meeting Boston; 2- More on PPACA Tribulations; 3- DJP Remarks at TMAA Award; 4- LAGNIAPPE: Gadgets!

1- NPSF:  Joint Meeting 10-23-2013 of Board of Directors and Board of Governors of National Patient Safety Foundation.  Meeting held in Boston.  This organization is dedicated to advancing patient safety and preventing harm to patients.

AMA was a key mover in starting this organization in 1996 and was a major donor founder.  Time for AMA to partner again with NPSF.  (Full disclosure:  I was on the founding board of directors of NPSF.  NPSF now has 2 boards:  a fiduciary board of directors and an advisory board of governors.  I now am on the advisory board.)

Visit http://www.npsf.org/  Here is the posting at the Website on Home Page:

NPSF gratefully acknowledges the support of its founding sponsors:
American Medical Association
CNA/HealthPro
3M
and major benefactor Schering-Plough Corporation
NPSF has a new CEO, a delightful and talented doctor.

Tejal K. Gandhi, MD, MPH, CPPS
President
tgandhi@npsf.org
617.391.9900

Also:  CONGRATS to Dr. Jeff Copper, another board of governors member of NPSF:  ASA Distinguished Service Award.  Read about his research at:

https://www.asahq.org/For-the-Public-and-Media/Press-Room/ASA-News/DS-Award.aspx

P.S. A nice person and deserving of this award!
San Francisco — (October 14, 2013)

“The American Society of Anesthesiologists (ASA) today presented Jeffrey B. Cooper, Ph.D., with its 2012 Distinguished Service Award in recognition of his contributions to dramatically advance the safety of anesthesia. The award is the highest honor ASA bestows and is presented annually to a member who has transformed the specialty of anesthesiology.”

2- PPACA is in the news again, this time because of the disaster (freezing, crashing, inability to complete registration, etc.) with the government Website:  https://www.healthcare.gov/

My negative view on the new health care law has not changed.  See http://www.intrepidresources.com/html/PEJLSMS2010.pdf

Here are some tweets I did recently.

Read this pediatric cardiac surgeon’s assessment of the future of The Patient Protection and Affordable Care Act (PPACA).  See if you agree.

DJPNEWS
Read! Accurate assessment of future with #PPACA #ACA = @WSJopinion Dr Bradley Allen. “Obamacare 2016: Happy Yet?” http://t.co/JOlYKRIy9W
10/23/13 7:22 AM
Here is the link for the article if the hash marks are confusing to anyone:  http://t.co/JOlYKRIy9W

————
This is a very important issue!  Patient privacy is important in the patient-physician relationship.  Without that assurance, patients won’t tell physicians all necessary information to aid in diagnosis.  Sometimes important information can be embarrassing and patients won’t tell the doctor the info without assurance of confidentiality.  A Website that has patient info that is not secure puts the patient at risk for embarrassment,  identity theft, etc.  I hope AMA will discuss this critical issue of the EHR and the Portal Website at the Interim Meeting in November.  Without proof of patient privacy and medical record confidentiality, I believe the AMA is obligated to remove its support of PPACA.  AMA policy is opposed to the use of a unique patient identifier and now with the gov Website the patient’s social security number is listed!  Certainly that is a unique identifier.  Three other identifiers, without a single unique identifier, solves the correct identification without the unreasonable risk on a unique identifier such as Social Security Number via Web.

  DJPNEWS
AMA = strong patient #privacy + med record #confidentiality 2 yr comm. I co-chaired 1999-2000; passed HoD #AMAmtg ; Speak up! Risks #ACA
10/22/13 9:06 AM
————

  DJPNEWS
FANTASY: fixing gov Website will show wonders of #ACA . REALITY: fixed Website will unleash the disaster: ⬆Cost ⬇access ⬇privacy ⬇DrChoice
10/21/13 9:15 PM
————

3- My remarks October 4, 2013 when receiving Tulane Medical Alumni Association Outstanding Alumnus 2013 award.

Our new Dean of Tulane Medical School, Dr. Lee Hamm (Congrats!), make remarks and presented the award.  I greatly appreciate his kind remarks and the TMAA for the selection. Here are my remarks of thanks:

http://www.intrepidresources.com/html/tmaa_remarks.pdf

4- LAGNIAPPE:  Gadgets!

A bike that is awesome.  I brought my bike in for a repair and the bike show owner showed me the new Specialized Turbo and let me take it out for a ride.  It is as though a rocket is propelling the bike!  Read the article in Forbes in link below.  At the link you will find 2 videos.  Watch both.  They are short.  25+ miles per hour!  No, I did not buy one!

    DJPNEWS
I rode it. Awesome. RT @Forbes: “It’s a bicycle. … battery and a motor that turn your efforts into Superman’s.” http://t.co/AOVny0ShjE
9/21/13 10:27 PM

———-

New Apple gadgets and new Macintosh operating system (Mavericks)

_______
Long article with lots of info re Mavericks!
DJPNEWS
Lots detailed info new OS! RT @dsilverman: It’s epic: OS X 10.9 Mavericks: The Ars Technica Review | Ars Technica – http://t.co/sJ7RjeLIhu
10/22/13 10:20 PM

———-
New iPad, “iPad Air” (faster and thinner) and new iPad Mini high-resolution screen (Retina) and faster.

DJPNEWS
#gadgets iPad Air vs iPad Mini Retina ! RT @CNET: Technically, this..true RT @bendreyfuss Today, Apple killed ..iPad http://t.co/VhUZz1Cx7F
10/22/13 3:11 PM

DJPNEWS
And faster engine. #gadgets RT @WIRED: The iPad Mini Finally Gets a Retina Display http://t.co/Ubd98sIYkR
10/22/13 3:06 PM
——–
Stay well.
Donald

Donald J. Palmisano, MD, JD, FACS
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, LA 70006
USA
504-455-5895 office
504-455-9392 fax
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us
(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)
DJP Updates:  www.DJPupdate.com
Twitter:  www.twitter.com/DJPNEWS
YouTube: http://www.youtube.com/user/IntrepidResources  Check out the videos.  You can post your views on your own YouTube site.
This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an  email stating “Join DJP Update”
To get off the list, state ” Remove DJP Update” in subject line.

Read More