Insurance for Routine Care: An Idea Whose Time Has Passed

Patients paying doctors directly for their care is best for patients, best for doctors, and best for the country.  Most of my patients know that this simple idea has been my obsession for the last few years.  Initially, I thought this idea was just a good way to reorganize my practice.  But now, with Medicare within a decade of insolvency, with decreasing numbers of medical students choosing primary care as a career, with increasing numbers of patients finding good primary care either unavailabl...
More

Laparoscopic Gastric Banding Can Cure Diabetes in Obese Patients

The scientific evidence for treatment of obesity is trending in a very interesting direction.  For years a safe and effective medication for weight loss has been sought, with only modest results.  (I wrote about orlistat, the medication in Xenical and Alli, a year ago.)  Surprisingly, for obese patients evidence is increasingly mounting in favor of surgery for weight loss, rather than medications or even diet and exercise. In 2006 ...
More

Does Your Doctor Use an Electronic Health Record?

This week's New England Journal of Medicine publishes a health policy report about electronic health records (EHRs).  The article reviews the potential benefits of EHRs to patients and to physicians and laments that as of 2005 only about 23% of physicians used them. The reasons for the slow adoption of EHRs provide an instructive illustration of deep problems in our healthcare marketplace.  EHRs are exp...
More

Concierge Medicine Gets Some Local Attention

Yesterday's L.A. Daily News business section featured an interesting story about concierge medicine.  I was delighted to be one of the physicians interviewed for the story.  I'm grateful to Barbara Correa for shining some light on a practice model that has received very little attention -- a model that I'm convinced is better for patients, better for doctors, and better for the healthcare system.  I'm also grateful to my ...
More

Garlic Doesn’t Lower Cholesterol

Garlic is frequently touted as a natural treatment for high cholesterol, and many garlic extracts are sold with the suggestion that they improve cholesterol levels.  The current issue of the Archives of Internal Medicine has an article reporting the most definitive study yet looking at the effects of garlic on cholesterol.  Volunteers were randomized into four groups:  raw garlic, powdered garlic suppl...
More

Will Primary Care Survive?

Last week's New England Journal of Medicine features an important article by Dr. Thomas Bodenheimer, Primary Care -- Will it Survive?  I encourage all of you to read it. Dr. Bodenheimer starkly presents the looming crisis in primary care.  Patients are waiting increasingly long for shorter appointments, frequently do not understand their doctor's instructions, and are increasingly dissatisfied.  Primary ca...
More

What Do You Call This Kind of Medical Practice?

About a month ago I attended the annual conference of the Society for Innovative Medical Practice Design (SIMPD), a national organization of physicians like me who have decided to stop working for insurance companies, and start working for our patients. The conference was very inspirational. We heard distinguished speakers including Tommy Thompson, former Secretary of the Department of Health and Human Services, Regina Herzlinger, Professor of Business Administration at the Harvard Business Scho...
More