Business of Medicine

Numerous articles, books, and newspaper editorials have been written about the “crisis” in mental health care in our country from various perspectives, and the phrase is often used that the mental health system is “broken.” It seems that lately, this topic is often brought up after the most recent mass shooting.¹

Philip T. Yanos, PhD, correctly asked recently whether we should be talking about a “broken” system, because implicit in the phrase is the assumption that the mental health system was once “whole,” and he has pointed out² chronic deficiencies, such as the absence of affordable housing, and the availability of services to those with chronic mental illness.

In addition, many authors have asserted that, with deinstitutionalization – which occurred starting with the Community Mental Health Act of 1963 – homelessness also became a big problem for people in our prisons and jails, which became the default treatment providers for many of those with serious mental illness.Once authors make this point, they often offer up ways to start addressing various parts of the system, and it usually comes down to asking for more funding for more outpatient treatment and services as well as more inpatient beds. Some authors make the point³ that people with mental illness often lack insight into their illness and the need for treatment. Thus, we have the quandary of people with severe mental illness not believing that they need help, and thus not even trying to access services, which can lead to homelessness and jail time.

But what of those individuals with serious mental health problems who aren’t facing those obstacles and complications? What about individuals who aren’t facing homelessness, who haven’t gotten embroiled in the legal system, who do have insurance coverage, who live in areas with sufficient numbers of outpatient mental health centers to choose from, and who have no problems finding an inpatient bed when needed? Let’s suppose that we have an individual who does have insight into his mental illness and need for treatment, and is motivated to seek treatment. How responsive is the system to such individuals? That will be the focus on my article.

In a recent report,⁴ the author quotes American Psychiatric Association President Bruce J. Schwartz, MD, appealing to members of the U.S. Congress to step in. According to the author, Dr. Schwartz’s position is that the crisis in American mental health begins specifically with a drastic, and growing, shortage of psychiatric beds, especially in publicly funded state and county hospital beds. From there, the crisis spreads to the nation’s city streets, and its jails and prisons, where the largest number of people with serious mental illness now reside. He also talks about a shortage of psychiatrists and child psychiatrists, and says the shortage is likely to worsen. The proposed solution to this problem, of course, is more funding from Congress to open more psychiatric beds, as well as providing more funding for mental health in general and funding to residency programs to increase the numbers of psychiatrists.

I respect the opinions of Dr. Schwartz and that of the other authors who want to talk about lack of adequate beds, outpatient clinics and services, insufficient numbers of psychiatrists, and a lack of funding by Congress. However, I would like to provide further information, from a personal perspective, which causes me to believe that the problem is even more complex than that, and that the failures of the system are compounded by a dysfunctional culture within the ranks of professional caregivers. In other words, once the pieces are in place and assembled, the mental health system still seems to be “broken” but from within. I worry about apathy and an absence of motivation to provide good or even adequate services by the very people who are or should be aware of the problems and what it takes to help our vulnerable patients lead better lives.

I have practiced psychiatry for many years in various settings. I have spent many years working as an inpatient psychiatrist in a large state hospital. I have worked in community mental health outpatient settings. I have also worked in a private practice doing both inpatient and outpatient patient care as well as significant forensic work. At the hospitals, I have witnessed and prepared internal reports about patients who are “revolving doors.” Such patients often had more than 50 psychiatric hospitalizations and no apparent solution to keep them stable enough in the community.

But mental illness is not just a career for me. In addition to being psychiatrist, I am the father of a son with severe and persistent mental illness. I have watched him struggle to find stability. He, too, has been in and out of hospitals. My wife is also in the mental health field. She and I have endlessly tried to work with our son’s local community mental health center to provide them with feedback and to get them to respond to his needs – often with great frustration. It has been our impression that clinicians have difficulty listening to us and understanding the difficulties our son is having, from my son’s case manager to the treating psychiatrist, to the director of the agency. We have tried shifting him to other programs in a neighboring county, including one known to be a “model” program, but had the same issues.

Psychiatry is more of an art than science. Our other medical colleagues can try to resolve a clinical problem, no matter their rank, by ordering the right blood test or getting certain imaging. Psychiatry has no such biomarkers, or validated tests, to rely on to resolve disputes. We have only our training and experience and, unfortunately, our biases. If we don’t agree with a colleague, we often resort to rank and argument.

It is hard to hear, but psychiatrists sometimes resort to name-calling, often behind their colleagues’ backs, and to acting superior. There seems to be a certain attitude. Psychiatrists (just as can colleagues in other specialties) can be insufferably arrogant.

My personal experience has been that the hospital and the community often don’t communicate well. This seems to be a systems problem, as is the case for many complex unsolvable problems. I have been to discharge meetings involving hospital staff and the receiving community system. The attitude of the inpatient psychiatrist is often: “If you guys only did your job better, this patient wouldn’t keep having to be admitted. It’s your job to keep him out of the hospital.”

Alternatively, the community rejects this attitude and points to the absence of resources that prevents them from seeing patients in a timely manner and from adequately monitoring them. They say they are shackled by their resource constraints and that the endless admissions are inevitable. Further, the outpatient psychiatrists complain bitterly that all the inpatient doctors do is make a bunch of useless medication changes and then don’t keep patients in long enough to make sure the patient stays well. And on and on the arguments go with no resolution.

Sadly, and confirmed by my personal experience, when well-meaning and knowledgeable family members try to communicate with the community mental health system about their son’s mental disintegration, the community agency often doesn’t welcome the feedback. They resort to “confidentiality” concerns, often ill advised. Their opinion seems to be that the patient, (i.e. the patient who is falling apart and is becoming psychotic), should be the one calling the agency, waiting on hold forever, and not getting a call back. When my son has been in this situation, he has hung up his telephone out of frustration, then headed off to the emergency room, where he knew he would be seen.

The other area of frustration is that of the ideal of recovery. Mental health programs love to tout that their mission is “recovery,” and they list it as one of their primary areas of vision and goals. Yet, when we tried to communicate with community clinicians, they usually ignored our request to assist our son with supported employment and to help him achieve independence and a social life. When we tried to convey our recovery concerns to the psychiatrist, the usual response was also to ignore it and focus on “meds, meds, meds,” which most psychiatrists seem to view as their mission and area of expertise. Many psychiatrists have embraced the “bio-bio-bio” model of evaluation and treatment⁵ with only lip service paid to the “biopsychosocial” theory they like to say they advocate. When we reached out to our son’s psychiatrists and could get through, we found that they mostly failed to display much interest in paying attention to broader areas of functioning, instead focusing on symptoms, which they could observe in person.

So, I add to the chorus complaining that our mental health system is broken. Broken not only in terms of adequate funding, but also broken from within. It would require much wisdom and self-examination to even begin to address the problem. Without a better plan, throwing money at this broken system won’t improve the lives of our seriously ill and vulnerable psychiatric patients.
 

Dr. Kausch is a clinical and forensic psychiatrist who is on the faculty at Case Western Reserve University in Cleveland as an assistant clinical professor. He spends most of his time seeing patients through the Akron General/Cleveland Clinic health system. He has published in the area of forensic psychiatry, addictions, pathological gambling, and suicide. He has recently taken an interest in conducting marital therapy and is now publishing in that area as well.

References

1. Doroshow D. “We need to stop focusing on the mental health of mass shooters.” Washington Post. 2019 May 20.

2. Yanos P. “Is the mental health system ‘broken’?” Psychology Today. 2018 Oct 11.

3. Orenstein N. “How to fix a broken mental health system.” The Atlantic. 2016 Jun 8.

4. Moran M. APA rings alarm in nation’s capitol about crisis in mental health care. Psychiatr News. 2020 Jan 1.

5. Paris J. “Psychotherapy in an Age of Neuroscience.” New York: Oxford University Press, 2017.

Numerous articles, books, and newspaper editorials have been written about the “crisis” in mental health care in our country from various perspectives, and the phrase is often used that the mental health system is “broken.” It seems that lately, this topic is often brought up after the most recent mass shooting.¹

Philip T. Yanos, PhD, correctly asked recently whether we should be talking about a “broken” system, because implicit in the phrase is the assumption that the mental health system was once “whole,” and he has pointed out² chronic deficiencies, such as the absence of affordable housing, and the availability of services to those with chronic mental illness.

In addition, many authors have asserted that, with deinstitutionalization – which occurred starting with the Community Mental Health Act of 1963 – homelessness also became a big problem for people in our prisons and jails, which became the default treatment providers for many of those with serious mental illness.Once authors make this point, they often offer up ways to start addressing various parts of the system, and it usually comes down to asking for more funding for more outpatient treatment and services as well as more inpatient beds. Some authors make the point³ that people with mental illness often lack insight into their illness and the need for treatment. Thus, we have the quandary of people with severe mental illness not believing that they need help, and thus not even trying to access services, which can lead to homelessness and jail time.

But what of those individuals with serious mental health problems who aren’t facing those obstacles and complications? What about individuals who aren’t facing homelessness, who haven’t gotten embroiled in the legal system, who do have insurance coverage, who live in areas with sufficient numbers of outpatient mental health centers to choose from, and who have no problems finding an inpatient bed when needed? Let’s suppose that we have an individual who does have insight into his mental illness and need for treatment, and is motivated to seek treatment. How responsive is the system to such individuals? That will be the focus on my article.

In a recent report,⁴ the author quotes American Psychiatric Association President Bruce J. Schwartz, MD, appealing to members of the U.S. Congress to step in. According to the author, Dr. Schwartz’s position is that the crisis in American mental health begins specifically with a drastic, and growing, shortage of psychiatric beds, especially in publicly funded state and county hospital beds. From there, the crisis spreads to the nation’s city streets, and its jails and prisons, where the largest number of people with serious mental illness now reside. He also talks about a shortage of psychiatrists and child psychiatrists, and says the shortage is likely to worsen. The proposed solution to this problem, of course, is more funding from Congress to open more psychiatric beds, as well as providing more funding for mental health in general and funding to residency programs to increase the numbers of psychiatrists.

I respect the opinions of Dr. Schwartz and that of the other authors who want to talk about lack of adequate beds, outpatient clinics and services, insufficient numbers of psychiatrists, and a lack of funding by Congress. However, I would like to provide further information, from a personal perspective, which causes me to believe that the problem is even more complex than that, and that the failures of the system are compounded by a dysfunctional culture within the ranks of professional caregivers. In other words, once the pieces are in place and assembled, the mental health system still seems to be “broken” but from within. I worry about apathy and an absence of motivation to provide good or even adequate services by the very people who are or should be aware of the problems and what it takes to help our vulnerable patients lead better lives.

I have practiced psychiatry for many years in various settings. I have spent many years working as an inpatient psychiatrist in a large state hospital. I have worked in community mental health outpatient settings. I have also worked in a private practice doing both inpatient and outpatient patient care as well as significant forensic work. At the hospitals, I have witnessed and prepared internal reports about patients who are “revolving doors.” Such patients often had more than 50 psychiatric hospitalizations and no apparent solution to keep them stable enough in the community.

But mental illness is not just a career for me. In addition to being psychiatrist, I am the father of a son with severe and persistent mental illness. I have watched him struggle to find stability. He, too, has been in and out of hospitals. My wife is also in the mental health field. She and I have endlessly tried to work with our son’s local community mental health center to provide them with feedback and to get them to respond to his needs – often with great frustration. It has been our impression that clinicians have difficulty listening to us and understanding the difficulties our son is having, from my son’s case manager to the treating psychiatrist, to the director of the agency. We have tried shifting him to other programs in a neighboring county, including one known to be a “model” program, but had the same issues.

Psychiatry is more of an art than science. Our other medical colleagues can try to resolve a clinical problem, no matter their rank, by ordering the right blood test or getting certain imaging. Psychiatry has no such biomarkers, or validated tests, to rely on to resolve disputes. We have only our training and experience and, unfortunately, our biases. If we don’t agree with a colleague, we often resort to rank and argument.

It is hard to hear, but psychiatrists sometimes resort to name-calling, often behind their colleagues’ backs, and to acting superior. There seems to be a certain attitude. Psychiatrists (just as can colleagues in other specialties) can be insufferably arrogant.

My personal experience has been that the hospital and the community often don’t communicate well. This seems to be a systems problem, as is the case for many complex unsolvable problems. I have been to discharge meetings involving hospital staff and the receiving community system. The attitude of the inpatient psychiatrist is often: “If you guys only did your job better, this patient wouldn’t keep having to be admitted. It’s your job to keep him out of the hospital.”

Alternatively, the community rejects this attitude and points to the absence of resources that prevents them from seeing patients in a timely manner and from adequately monitoring them. They say they are shackled by their resource constraints and that the endless admissions are inevitable. Further, the outpatient psychiatrists complain bitterly that all the inpatient doctors do is make a bunch of useless medication changes and then don’t keep patients in long enough to make sure the patient stays well. And on and on the arguments go with no resolution.

Sadly, and confirmed by my personal experience, when well-meaning and knowledgeable family members try to communicate with the community mental health system about their son’s mental disintegration, the community agency often doesn’t welcome the feedback. They resort to “confidentiality” concerns, often ill advised. Their opinion seems to be that the patient, (i.e. the patient who is falling apart and is becoming psychotic), should be the one calling the agency, waiting on hold forever, and not getting a call back. When my son has been in this situation, he has hung up his telephone out of frustration, then headed off to the emergency room, where he knew he would be seen.

The other area of frustration is that of the ideal of recovery. Mental health programs love to tout that their mission is “recovery,” and they list it as one of their primary areas of vision and goals. Yet, when we tried to communicate with community clinicians, they usually ignored our request to assist our son with supported employment and to help him achieve independence and a social life. When we tried to convey our recovery concerns to the psychiatrist, the usual response was also to ignore it and focus on “meds, meds, meds,” which most psychiatrists seem to view as their mission and area of expertise. Many psychiatrists have embraced the “bio-bio-bio” model of evaluation and treatment⁵ with only lip service paid to the “biopsychosocial” theory they like to say they advocate. When we reached out to our son’s psychiatrists and could get through, we found that they mostly failed to display much interest in paying attention to broader areas of functioning, instead focusing on symptoms, which they could observe in person.

So, I add to the chorus complaining that our mental health system is broken. Broken not only in terms of adequate funding, but also broken from within. It would require much wisdom and self-examination to even begin to address the problem. Without a better plan, throwing money at this broken system won’t improve the lives of our seriously ill and vulnerable psychiatric patients.
 

Dr. Kausch is a clinical and forensic psychiatrist who is on the faculty at Case Western Reserve University in Cleveland as an assistant clinical professor. He spends most of his time seeing patients through the Akron General/Cleveland Clinic health system. He has published in the area of forensic psychiatry, addictions, pathological gambling, and suicide. He has recently taken an interest in conducting marital therapy and is now publishing in that area as well.

References

1. Doroshow D. “We need to stop focusing on the mental health of mass shooters.” Washington Post. 2019 May 20.

2. Yanos P. “Is the mental health system ‘broken’?” Psychology Today. 2018 Oct 11.

3. Orenstein N. “How to fix a broken mental health system.” The Atlantic. 2016 Jun 8.

4. Moran M. APA rings alarm in nation’s capitol about crisis in mental health care. Psychiatr News. 2020 Jan 1.

5. Paris J. “Psychotherapy in an Age of Neuroscience.” New York: Oxford University Press, 2017.

Numerous articles, books, and newspaper editorials have been written about the “crisis” in mental health care in our country from various perspectives, and the phrase is often used that the mental health system is “broken.” It seems that lately, this topic is often brought up after the most recent mass shooting.¹

Philip T. Yanos, PhD, correctly asked recently whether we should be talking about a “broken” system, because implicit in the phrase is the assumption that the mental health system was once “whole,” and he has pointed out² chronic deficiencies, such as the absence of affordable housing, and the availability of services to those with chronic mental illness.

In addition, many authors have asserted that, with deinstitutionalization – which occurred starting with the Community Mental Health Act of 1963 – homelessness also became a big problem for people in our prisons and jails, which became the default treatment providers for many of those with serious mental illness.Once authors make this point, they often offer up ways to start addressing various parts of the system, and it usually comes down to asking for more funding for more outpatient treatment and services as well as more inpatient beds. Some authors make the point³ that people with mental illness often lack insight into their illness and the need for treatment. Thus, we have the quandary of people with severe mental illness not believing that they need help, and thus not even trying to access services, which can lead to homelessness and jail time.

But what of those individuals with serious mental health problems who aren’t facing those obstacles and complications? What about individuals who aren’t facing homelessness, who haven’t gotten embroiled in the legal system, who do have insurance coverage, who live in areas with sufficient numbers of outpatient mental health centers to choose from, and who have no problems finding an inpatient bed when needed? Let’s suppose that we have an individual who does have insight into his mental illness and need for treatment, and is motivated to seek treatment. How responsive is the system to such individuals? That will be the focus on my article.

In a recent report,⁴ the author quotes American Psychiatric Association President Bruce J. Schwartz, MD, appealing to members of the U.S. Congress to step in. According to the author, Dr. Schwartz’s position is that the crisis in American mental health begins specifically with a drastic, and growing, shortage of psychiatric beds, especially in publicly funded state and county hospital beds. From there, the crisis spreads to the nation’s city streets, and its jails and prisons, where the largest number of people with serious mental illness now reside. He also talks about a shortage of psychiatrists and child psychiatrists, and says the shortage is likely to worsen. The proposed solution to this problem, of course, is more funding from Congress to open more psychiatric beds, as well as providing more funding for mental health in general and funding to residency programs to increase the numbers of psychiatrists.

I respect the opinions of Dr. Schwartz and that of the other authors who want to talk about lack of adequate beds, outpatient clinics and services, insufficient numbers of psychiatrists, and a lack of funding by Congress. However, I would like to provide further information, from a personal perspective, which causes me to believe that the problem is even more complex than that, and that the failures of the system are compounded by a dysfunctional culture within the ranks of professional caregivers. In other words, once the pieces are in place and assembled, the mental health system still seems to be “broken” but from within. I worry about apathy and an absence of motivation to provide good or even adequate services by the very people who are or should be aware of the problems and what it takes to help our vulnerable patients lead better lives.

I have practiced psychiatry for many years in various settings. I have spent many years working as an inpatient psychiatrist in a large state hospital. I have worked in community mental health outpatient settings. I have also worked in a private practice doing both inpatient and outpatient patient care as well as significant forensic work. At the hospitals, I have witnessed and prepared internal reports about patients who are “revolving doors.” Such patients often had more than 50 psychiatric hospitalizations and no apparent solution to keep them stable enough in the community.

But mental illness is not just a career for me. In addition to being psychiatrist, I am the father of a son with severe and persistent mental illness. I have watched him struggle to find stability. He, too, has been in and out of hospitals. My wife is also in the mental health field. She and I have endlessly tried to work with our son’s local community mental health center to provide them with feedback and to get them to respond to his needs – often with great frustration. It has been our impression that clinicians have difficulty listening to us and understanding the difficulties our son is having, from my son’s case manager to the treating psychiatrist, to the director of the agency. We have tried shifting him to other programs in a neighboring county, including one known to be a “model” program, but had the same issues.

Psychiatry is more of an art than science. Our other medical colleagues can try to resolve a clinical problem, no matter their rank, by ordering the right blood test or getting certain imaging. Psychiatry has no such biomarkers, or validated tests, to rely on to resolve disputes. We have only our training and experience and, unfortunately, our biases. If we don’t agree with a colleague, we often resort to rank and argument.

It is hard to hear, but psychiatrists sometimes resort to name-calling, often behind their colleagues’ backs, and to acting superior. There seems to be a certain attitude. Psychiatrists (just as can colleagues in other specialties) can be insufferably arrogant.

My personal experience has been that the hospital and the community often don’t communicate well. This seems to be a systems problem, as is the case for many complex unsolvable problems. I have been to discharge meetings involving hospital staff and the receiving community system. The attitude of the inpatient psychiatrist is often: “If you guys only did your job better, this patient wouldn’t keep having to be admitted. It’s your job to keep him out of the hospital.”

Alternatively, the community rejects this attitude and points to the absence of resources that prevents them from seeing patients in a timely manner and from adequately monitoring them. They say they are shackled by their resource constraints and that the endless admissions are inevitable. Further, the outpatient psychiatrists complain bitterly that all the inpatient doctors do is make a bunch of useless medication changes and then don’t keep patients in long enough to make sure the patient stays well. And on and on the arguments go with no resolution.

Sadly, and confirmed by my personal experience, when well-meaning and knowledgeable family members try to communicate with the community mental health system about their son’s mental disintegration, the community agency often doesn’t welcome the feedback. They resort to “confidentiality” concerns, often ill advised. Their opinion seems to be that the patient, (i.e. the patient who is falling apart and is becoming psychotic), should be the one calling the agency, waiting on hold forever, and not getting a call back. When my son has been in this situation, he has hung up his telephone out of frustration, then headed off to the emergency room, where he knew he would be seen.

The other area of frustration is that of the ideal of recovery. Mental health programs love to tout that their mission is “recovery,” and they list it as one of their primary areas of vision and goals. Yet, when we tried to communicate with community clinicians, they usually ignored our request to assist our son with supported employment and to help him achieve independence and a social life. When we tried to convey our recovery concerns to the psychiatrist, the usual response was also to ignore it and focus on “meds, meds, meds,” which most psychiatrists seem to view as their mission and area of expertise. Many psychiatrists have embraced the “bio-bio-bio” model of evaluation and treatment⁵ with only lip service paid to the “biopsychosocial” theory they like to say they advocate. When we reached out to our son’s psychiatrists and could get through, we found that they mostly failed to display much interest in paying attention to broader areas of functioning, instead focusing on symptoms, which they could observe in person.

So, I add to the chorus complaining that our mental health system is broken. Broken not only in terms of adequate funding, but also broken from within. It would require much wisdom and self-examination to even begin to address the problem. Without a better plan, throwing money at this broken system won’t improve the lives of our seriously ill and vulnerable psychiatric patients.
 

Dr. Kausch is a clinical and forensic psychiatrist who is on the faculty at Case Western Reserve University in Cleveland as an assistant clinical professor. He spends most of his time seeing patients through the Akron General/Cleveland Clinic health system. He has published in the area of forensic psychiatry, addictions, pathological gambling, and suicide. He has recently taken an interest in conducting marital therapy and is now publishing in that area as well.

References

1. Doroshow D. “We need to stop focusing on the mental health of mass shooters.” Washington Post. 2019 May 20.

2. Yanos P. “Is the mental health system ‘broken’?” Psychology Today. 2018 Oct 11.

3. Orenstein N. “How to fix a broken mental health system.” The Atlantic. 2016 Jun 8.

4. Moran M. APA rings alarm in nation’s capitol about crisis in mental health care. Psychiatr News. 2020 Jan 1.

5. Paris J. “Psychotherapy in an Age of Neuroscience.” New York: Oxford University Press, 2017.

An ob.gyn. accused of being under the influence while on the job has prevailed in her defamation and fraud lawsuit against an Indiana hospital.

Jurors awarded Carmel, Ind.–based ob.gyn. Rebecca Denman, MD, $4.75 million in damages against St. Vincent Carmel Hospital and St. Vincent Carmel Medical Group on Jan. 16, 2020, after a 4-day trial in Indiana Commercial Court. Dr. Denman sued after the hospital and medical group took a series of actions in response to a nurse practitioner’s claim that Dr. Denman smelled of alcohol while on duty. The doctor’s lawsuit alleged the NP’s claim was unproven; that administrators failed to conduct a proper peer-review investigation; and that repercussions from the false allegation resulted in lost compensation, out-of-pocket expenses, emotional distress, and damage to her professional reputation.

Indianapolis attorney Kathleen DeLaney, who represented Dr. Denman in the case, said that her client was pleased with the verdict.

“Dr. Denman feels vindicated that a group of jurors spent 4 days listening to all the evidence and gave her a resounding victory,” she said in an interview.

Dr. Denman declined to comment for this story through her attorney.

In a statement, a spokesman for Ascension, the hospital’s parent company, said the hospital was disappointed by the verdict and that it was “exploring all options available to us, including appeal.” The spokesman declined to answer further questions about the case or its peer-review process.

The case stems from an NP’s claim that Dr. Denman’s breath smelled of alcohol during an evening shift on Dec. 11, 2017. Dr. Denman was not informed of the allegation on Dec. 11 and was not tested for alcohol at the time, according to Dr. Denman’s lawsuit. Under hospital policy, if a physician is suspected of being under the influence of alcohol at work, the employer must immediately assess the doctor, relieve the doctor of duty, and request the physician submit to immediate blood testing at an external facility.

The NP reported the allegation to her supervisor through an email on Dec. 12, 2017. The supervisor relayed the information to the hospital’s chief medical officer who met with other administrators and physicians to discuss the claim. During the discussions, a previous concern about Dr. Denman’s drinking was raised, according to deposition information included in court documents. In 2015, two physicians had suggested Dr. Denman consider an assistance program after expressing concerns that she was arriving late to work and missing partner meetings. At the time, Dr. Denman did not enter an assistance program, but she changed her drinking habits, began seeing a therapist, and started arriving on-time to work and to partner meetings, according to court documents. No other criticism or complaints regarding her drinking or workplace behavior had been reported since, according to court documents.

When confronted with the NP’s claim on Dec. 13, 2017, Dr. Denman denied consuming alcohol on Dec. 11, 2017, and questioned why the hospital’s substance abuse protocol was not followed.

St. Vincent Carmel Hospital conducted a preliminary review of the allegation through its peer-review process and turned the matter over to St. Vincent Medical Group for further review, according to court documents. St. Vincent Medical Group later informed Dr. Denman they had reviewed the allegation through its peer-review process and that she was suspended with partial pay until she underwent an evaluation for alcohol abuse through the Indiana State Medical Association, according to the lawsuit.

“They falsely misrepresented to her that peer review had been done,” Ms. DeLaney said in an interview. “In spite of that statement, they never offered her a hearing before a peer-review committee, they never shared with her the substance of any evidence they had against her, they never gave her an opportunity to respond to the allegations. In fact, she wasn’t interviewed at all until the deposition in the lawsuit.”

According to the Indiana Peer Review law, a health care provider under investigation is permitted to see any records accumulated by a peer-review committee pertaining to the provider’s personal practice, and the provider shall be offered the opportunity to appear before the peer-review committee with adequate representation to hear all charges and findings concerning the provider and to offer rebuttal information. The rebuttal shall be part of the record before any disclosure of the charges and before any findings can be made, according to the statute.

Dr. Denman was referred by the medical association to an addiction treatment center that evaluated Dr. Denman and diagnosed her with alcohol use disorder, according to the lawsuit. As a result of the report and as a condition of retaining her medical license, the medical association and St. Vincent Medical Group required Dr. Denman to enter a treatment program at the same addiction treatment center. Dr. Denman was also required to sign a 5-year monitoring contract with the Indiana State Medical Association as a condition of her employment, according to the lawsuit.

“The actions had life-changing consequences,” Ms. DeLaney said. “As a result, she was required to sign a contract that mandates she do a breathalyzer test four times a day for the first year and then three times a day for 4 more years. She has to go for random drug screenings. For the first year, she had to go to four [Alcoholics Anonymous] meetings a week. Now that number has been reduced, but she’s on a 5-year monitoring contract because of all of this.”

Dr. Denman sued the hospital, the medical group, and the NP in July 2018 alleging fraud, defamation, tortuous interference with an employment relationship, and negligent misrepresentation. The NP was dismissed from the case shortly before trial.

In its response to the lawsuit, attorneys for St. Vincent wrote that Dr. Denman’s action was frivolous, vexatious, and executed in bad faith. The defendants requested that a judge dismiss the lawsuit, noting that they were entitled to immunity pursuant to Indiana state and federal laws, including protection by Indiana’s Peer Review statute. In October 2019, a judge denied the hospital’s request to dismiss the lawsuit and allowed the case to proceed.

In their verdict, jurors awarded Dr. Denman $2 million for her defamation claims, $2 million for her claims of fraud and constructive fraud, $500,000 for her claim of tortious interference with an employment relationship, and $250,000 for her claim of negligent misrepresentation.

Dr. Denman remains employed by the medical group and must continue the conditions of her 5-year monitoring contract, Ms. DeLaney said. She hopes Dr. Denman’s case raises awareness about physicians’ due process rights.

“We hope that Dr. Denman’s case emboldens physicians to stand up for themselves in the face of false accusations and rushes to judgment,” she said. “We hope the verdict leads to fair, prompt, and unbiased investigations by hospital and medical practice administrators, which include due process for accused physicians.”

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An ob.gyn. accused of being under the influence while on the job has prevailed in her defamation and fraud lawsuit against an Indiana hospital.

Jurors awarded Carmel, Ind.–based ob.gyn. Rebecca Denman, MD, $4.75 million in damages against St. Vincent Carmel Hospital and St. Vincent Carmel Medical Group on Jan. 16, 2020, after a 4-day trial in Indiana Commercial Court. Dr. Denman sued after the hospital and medical group took a series of actions in response to a nurse practitioner’s claim that Dr. Denman smelled of alcohol while on duty. The doctor’s lawsuit alleged the NP’s claim was unproven; that administrators failed to conduct a proper peer-review investigation; and that repercussions from the false allegation resulted in lost compensation, out-of-pocket expenses, emotional distress, and damage to her professional reputation.

Indianapolis attorney Kathleen DeLaney, who represented Dr. Denman in the case, said that her client was pleased with the verdict.

“Dr. Denman feels vindicated that a group of jurors spent 4 days listening to all the evidence and gave her a resounding victory,” she said in an interview.

Dr. Denman declined to comment for this story through her attorney.

In a statement, a spokesman for Ascension, the hospital’s parent company, said the hospital was disappointed by the verdict and that it was “exploring all options available to us, including appeal.” The spokesman declined to answer further questions about the case or its peer-review process.

The case stems from an NP’s claim that Dr. Denman’s breath smelled of alcohol during an evening shift on Dec. 11, 2017. Dr. Denman was not informed of the allegation on Dec. 11 and was not tested for alcohol at the time, according to Dr. Denman’s lawsuit. Under hospital policy, if a physician is suspected of being under the influence of alcohol at work, the employer must immediately assess the doctor, relieve the doctor of duty, and request the physician submit to immediate blood testing at an external facility.

The NP reported the allegation to her supervisor through an email on Dec. 12, 2017. The supervisor relayed the information to the hospital’s chief medical officer who met with other administrators and physicians to discuss the claim. During the discussions, a previous concern about Dr. Denman’s drinking was raised, according to deposition information included in court documents. In 2015, two physicians had suggested Dr. Denman consider an assistance program after expressing concerns that she was arriving late to work and missing partner meetings. At the time, Dr. Denman did not enter an assistance program, but she changed her drinking habits, began seeing a therapist, and started arriving on-time to work and to partner meetings, according to court documents. No other criticism or complaints regarding her drinking or workplace behavior had been reported since, according to court documents.

When confronted with the NP’s claim on Dec. 13, 2017, Dr. Denman denied consuming alcohol on Dec. 11, 2017, and questioned why the hospital’s substance abuse protocol was not followed.

St. Vincent Carmel Hospital conducted a preliminary review of the allegation through its peer-review process and turned the matter over to St. Vincent Medical Group for further review, according to court documents. St. Vincent Medical Group later informed Dr. Denman they had reviewed the allegation through its peer-review process and that she was suspended with partial pay until she underwent an evaluation for alcohol abuse through the Indiana State Medical Association, according to the lawsuit.

“They falsely misrepresented to her that peer review had been done,” Ms. DeLaney said in an interview. “In spite of that statement, they never offered her a hearing before a peer-review committee, they never shared with her the substance of any evidence they had against her, they never gave her an opportunity to respond to the allegations. In fact, she wasn’t interviewed at all until the deposition in the lawsuit.”

According to the Indiana Peer Review law, a health care provider under investigation is permitted to see any records accumulated by a peer-review committee pertaining to the provider’s personal practice, and the provider shall be offered the opportunity to appear before the peer-review committee with adequate representation to hear all charges and findings concerning the provider and to offer rebuttal information. The rebuttal shall be part of the record before any disclosure of the charges and before any findings can be made, according to the statute.

Dr. Denman was referred by the medical association to an addiction treatment center that evaluated Dr. Denman and diagnosed her with alcohol use disorder, according to the lawsuit. As a result of the report and as a condition of retaining her medical license, the medical association and St. Vincent Medical Group required Dr. Denman to enter a treatment program at the same addiction treatment center. Dr. Denman was also required to sign a 5-year monitoring contract with the Indiana State Medical Association as a condition of her employment, according to the lawsuit.

“The actions had life-changing consequences,” Ms. DeLaney said. “As a result, she was required to sign a contract that mandates she do a breathalyzer test four times a day for the first year and then three times a day for 4 more years. She has to go for random drug screenings. For the first year, she had to go to four [Alcoholics Anonymous] meetings a week. Now that number has been reduced, but she’s on a 5-year monitoring contract because of all of this.”

Dr. Denman sued the hospital, the medical group, and the NP in July 2018 alleging fraud, defamation, tortuous interference with an employment relationship, and negligent misrepresentation. The NP was dismissed from the case shortly before trial.

In its response to the lawsuit, attorneys for St. Vincent wrote that Dr. Denman’s action was frivolous, vexatious, and executed in bad faith. The defendants requested that a judge dismiss the lawsuit, noting that they were entitled to immunity pursuant to Indiana state and federal laws, including protection by Indiana’s Peer Review statute. In October 2019, a judge denied the hospital’s request to dismiss the lawsuit and allowed the case to proceed.

In their verdict, jurors awarded Dr. Denman $2 million for her defamation claims, $2 million for her claims of fraud and constructive fraud, $500,000 for her claim of tortious interference with an employment relationship, and $250,000 for her claim of negligent misrepresentation.

Dr. Denman remains employed by the medical group and must continue the conditions of her 5-year monitoring contract, Ms. DeLaney said. She hopes Dr. Denman’s case raises awareness about physicians’ due process rights.

“We hope that Dr. Denman’s case emboldens physicians to stand up for themselves in the face of false accusations and rushes to judgment,” she said. “We hope the verdict leads to fair, prompt, and unbiased investigations by hospital and medical practice administrators, which include due process for accused physicians.”

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An ob.gyn. accused of being under the influence while on the job has prevailed in her defamation and fraud lawsuit against an Indiana hospital.

Jurors awarded Carmel, Ind.–based ob.gyn. Rebecca Denman, MD, $4.75 million in damages against St. Vincent Carmel Hospital and St. Vincent Carmel Medical Group on Jan. 16, 2020, after a 4-day trial in Indiana Commercial Court. Dr. Denman sued after the hospital and medical group took a series of actions in response to a nurse practitioner’s claim that Dr. Denman smelled of alcohol while on duty. The doctor’s lawsuit alleged the NP’s claim was unproven; that administrators failed to conduct a proper peer-review investigation; and that repercussions from the false allegation resulted in lost compensation, out-of-pocket expenses, emotional distress, and damage to her professional reputation.

Indianapolis attorney Kathleen DeLaney, who represented Dr. Denman in the case, said that her client was pleased with the verdict.

“Dr. Denman feels vindicated that a group of jurors spent 4 days listening to all the evidence and gave her a resounding victory,” she said in an interview.

Dr. Denman declined to comment for this story through her attorney.

In a statement, a spokesman for Ascension, the hospital’s parent company, said the hospital was disappointed by the verdict and that it was “exploring all options available to us, including appeal.” The spokesman declined to answer further questions about the case or its peer-review process.

The case stems from an NP’s claim that Dr. Denman’s breath smelled of alcohol during an evening shift on Dec. 11, 2017. Dr. Denman was not informed of the allegation on Dec. 11 and was not tested for alcohol at the time, according to Dr. Denman’s lawsuit. Under hospital policy, if a physician is suspected of being under the influence of alcohol at work, the employer must immediately assess the doctor, relieve the doctor of duty, and request the physician submit to immediate blood testing at an external facility.

The NP reported the allegation to her supervisor through an email on Dec. 12, 2017. The supervisor relayed the information to the hospital’s chief medical officer who met with other administrators and physicians to discuss the claim. During the discussions, a previous concern about Dr. Denman’s drinking was raised, according to deposition information included in court documents. In 2015, two physicians had suggested Dr. Denman consider an assistance program after expressing concerns that she was arriving late to work and missing partner meetings. At the time, Dr. Denman did not enter an assistance program, but she changed her drinking habits, began seeing a therapist, and started arriving on-time to work and to partner meetings, according to court documents. No other criticism or complaints regarding her drinking or workplace behavior had been reported since, according to court documents.

When confronted with the NP’s claim on Dec. 13, 2017, Dr. Denman denied consuming alcohol on Dec. 11, 2017, and questioned why the hospital’s substance abuse protocol was not followed.

St. Vincent Carmel Hospital conducted a preliminary review of the allegation through its peer-review process and turned the matter over to St. Vincent Medical Group for further review, according to court documents. St. Vincent Medical Group later informed Dr. Denman they had reviewed the allegation through its peer-review process and that she was suspended with partial pay until she underwent an evaluation for alcohol abuse through the Indiana State Medical Association, according to the lawsuit.

“They falsely misrepresented to her that peer review had been done,” Ms. DeLaney said in an interview. “In spite of that statement, they never offered her a hearing before a peer-review committee, they never shared with her the substance of any evidence they had against her, they never gave her an opportunity to respond to the allegations. In fact, she wasn’t interviewed at all until the deposition in the lawsuit.”

According to the Indiana Peer Review law, a health care provider under investigation is permitted to see any records accumulated by a peer-review committee pertaining to the provider’s personal practice, and the provider shall be offered the opportunity to appear before the peer-review committee with adequate representation to hear all charges and findings concerning the provider and to offer rebuttal information. The rebuttal shall be part of the record before any disclosure of the charges and before any findings can be made, according to the statute.

Dr. Denman was referred by the medical association to an addiction treatment center that evaluated Dr. Denman and diagnosed her with alcohol use disorder, according to the lawsuit. As a result of the report and as a condition of retaining her medical license, the medical association and St. Vincent Medical Group required Dr. Denman to enter a treatment program at the same addiction treatment center. Dr. Denman was also required to sign a 5-year monitoring contract with the Indiana State Medical Association as a condition of her employment, according to the lawsuit.

“The actions had life-changing consequences,” Ms. DeLaney said. “As a result, she was required to sign a contract that mandates she do a breathalyzer test four times a day for the first year and then three times a day for 4 more years. She has to go for random drug screenings. For the first year, she had to go to four [Alcoholics Anonymous] meetings a week. Now that number has been reduced, but she’s on a 5-year monitoring contract because of all of this.”

Dr. Denman sued the hospital, the medical group, and the NP in July 2018 alleging fraud, defamation, tortuous interference with an employment relationship, and negligent misrepresentation. The NP was dismissed from the case shortly before trial.

In its response to the lawsuit, attorneys for St. Vincent wrote that Dr. Denman’s action was frivolous, vexatious, and executed in bad faith. The defendants requested that a judge dismiss the lawsuit, noting that they were entitled to immunity pursuant to Indiana state and federal laws, including protection by Indiana’s Peer Review statute. In October 2019, a judge denied the hospital’s request to dismiss the lawsuit and allowed the case to proceed.

In their verdict, jurors awarded Dr. Denman $2 million for her defamation claims, $2 million for her claims of fraud and constructive fraud, $500,000 for her claim of tortious interference with an employment relationship, and $250,000 for her claim of negligent misrepresentation.

Dr. Denman remains employed by the medical group and must continue the conditions of her 5-year monitoring contract, Ms. DeLaney said. She hopes Dr. Denman’s case raises awareness about physicians’ due process rights.

“We hope that Dr. Denman’s case emboldens physicians to stand up for themselves in the face of false accusations and rushes to judgment,” she said. “We hope the verdict leads to fair, prompt, and unbiased investigations by hospital and medical practice administrators, which include due process for accused physicians.”

[email protected]

Clinical Psychiatry News is pleased to welcome Alice W. Lee, MD, to its editorial advisory board.

Dr. Lee, who works with children, adolescents and adults, specializes in integrative and holistic psychiatry. In her private practice in Gaithersburg, Md., she integrates functional/orthomolecular medicine and mind–body/energy medicine in her work with patients.

She also writes and publishes weekly newsletters, and produces YouTube videos to an audience of more than 3,000 subscribers, followers, and website visitors per month. In addition, Dr. Lee is a Reiki master who integrates the biochemistry of chemistry with the quantum physics of healing. One of her specialties is helping patients withdraw from their psychiatric medications safely.

Dr. Lee is a member of the Academy of Integrative Health & Medicine, the Association for Comprehensive Energy Psychology, the Integrative Healthcare Symposium, and the Physicians Committee for Responsible Medicine.

Clinical Psychiatry News is pleased to welcome Alice W. Lee, MD, to its editorial advisory board.

Dr. Lee, who works with children, adolescents and adults, specializes in integrative and holistic psychiatry. In her private practice in Gaithersburg, Md., she integrates functional/orthomolecular medicine and mind–body/energy medicine in her work with patients.

She also writes and publishes weekly newsletters, and produces YouTube videos to an audience of more than 3,000 subscribers, followers, and website visitors per month. In addition, Dr. Lee is a Reiki master who integrates the biochemistry of chemistry with the quantum physics of healing. One of her specialties is helping patients withdraw from their psychiatric medications safely.

Dr. Lee is a member of the Academy of Integrative Health & Medicine, the Association for Comprehensive Energy Psychology, the Integrative Healthcare Symposium, and the Physicians Committee for Responsible Medicine.

Clinical Psychiatry News is pleased to welcome Alice W. Lee, MD, to its editorial advisory board.

Dr. Lee, who works with children, adolescents and adults, specializes in integrative and holistic psychiatry. In her private practice in Gaithersburg, Md., she integrates functional/orthomolecular medicine and mind–body/energy medicine in her work with patients.

She also writes and publishes weekly newsletters, and produces YouTube videos to an audience of more than 3,000 subscribers, followers, and website visitors per month. In addition, Dr. Lee is a Reiki master who integrates the biochemistry of chemistry with the quantum physics of healing. One of her specialties is helping patients withdraw from their psychiatric medications safely.

Dr. Lee is a member of the Academy of Integrative Health & Medicine, the Association for Comprehensive Energy Psychology, the Integrative Healthcare Symposium, and the Physicians Committee for Responsible Medicine.

Melissa Walt, PsyD, a clinical psychologist, recently joined the Taussig Cancer Institute at Cleveland Clinic. In this role, Dr. Walt focuses on the psychological treatment of cancer patients, helping them adjust to their diagnosis and navigate life with cancer.

Dr. Walt was previously a staff psychologist at the outpatient behavioral health/mental health clinic at the VA Southern Nevada Healthcare System in North Las Vegas. She obtained her doctorate degree from Adler University in Chicago, completed a residency at the VA Southern Nevada Healthcare System, and completed a fellowship at Memphis VA Medical Center.

Sheela Ahmed, MD, has joined Fox Chase Cancer Center in Philadelphia and works in the department of medicine as an associate clinical professor in the division of pulmonary, sleep, and critical care medicine. She is board certified in internal, pulmonary, critical care, and sleep medicine.

[email protected]

Melissa Walt, PsyD, a clinical psychologist, recently joined the Taussig Cancer Institute at Cleveland Clinic. In this role, Dr. Walt focuses on the psychological treatment of cancer patients, helping them adjust to their diagnosis and navigate life with cancer.

Dr. Walt was previously a staff psychologist at the outpatient behavioral health/mental health clinic at the VA Southern Nevada Healthcare System in North Las Vegas. She obtained her doctorate degree from Adler University in Chicago, completed a residency at the VA Southern Nevada Healthcare System, and completed a fellowship at Memphis VA Medical Center.

Sheela Ahmed, MD, has joined Fox Chase Cancer Center in Philadelphia and works in the department of medicine as an associate clinical professor in the division of pulmonary, sleep, and critical care medicine. She is board certified in internal, pulmonary, critical care, and sleep medicine.

[email protected]

Melissa Walt, PsyD, a clinical psychologist, recently joined the Taussig Cancer Institute at Cleveland Clinic. In this role, Dr. Walt focuses on the psychological treatment of cancer patients, helping them adjust to their diagnosis and navigate life with cancer.

Dr. Walt was previously a staff psychologist at the outpatient behavioral health/mental health clinic at the VA Southern Nevada Healthcare System in North Las Vegas. She obtained her doctorate degree from Adler University in Chicago, completed a residency at the VA Southern Nevada Healthcare System, and completed a fellowship at Memphis VA Medical Center.

Sheela Ahmed, MD, has joined Fox Chase Cancer Center in Philadelphia and works in the department of medicine as an associate clinical professor in the division of pulmonary, sleep, and critical care medicine. She is board certified in internal, pulmonary, critical care, and sleep medicine.

[email protected]

In 1982, I went to my first concert. It was Rush, on their “Signals” tour, and I loved it. In fact, I went back and saw them again about a year later. I bought a concert T-shirt at the first one. I still have it somewhere, though I am pretty sure it hasn’t fit me in years.

Weatherman90/Wikimedia Commons/CC BY 3.0

I loved their music before the concert, enjoyed it even more afterwards, and still do. Their albums are all on my computer and phone, and part of the daily soundtrack of my life when working at my desk, driving, and walking (I’m trying to fit back in the shirt).

On Jan. 7, 2020, Neil Peart, the trio’s remarkably gifted drummer, died of a neurologic disease.

According to the news, he had a glioblastoma multiforme, a tumor terrifying for its aggressiveness, difficulty of treatment, and lack of preventable risk factors.

The cost of neurologic disease is terrible. Glioblastoma multiforme, unfortunately, is far from rare, nor is it the only one. In recent times, entertainers afflicted with neurologic disease have included Neil Diamond, Linda Ronstadt, Peter Falk, Glen Campbell, Charlton Heston, Gene Siskel, Michael J. Fox, Stephen Hillenburg, Teri Garr, Annette Funicello, Robin Williams, Dudley Moore, and most recently Ozzy Osbourne.

That’s a pretty short list, too, far from all-encompassing. The majority of people with these disorders won’t be in the news. Their everyday struggles, stories, and losses are known only to family, friends, and the medical team doing its best to help.

Medical technology advances every year. In the 22 years since I began practicing, we’ve made remarkable strides in some areas – multiple sclerosis, for example. But our work in so many other areas is nowhere close. The increasing knowledge as to the mechanisms and causes of Alzheimer’s disease have, to date, failed to translate into treatment success.

That’s not to say we should give up. Far from it. Our species has gotten where we are by always wanting to get over the next hill. Initial failures will always outnumber successes. But when you’re a doctor dealing with the very real human cost of neurologic disease, that’s not much consolation. And it’s far less so for the patients and families affected who come to us for help.

We use terms like “burden” or “cost” to discuss the financial aspects of illness, but they often don’t seem adequate to describe the real effects. The emotional damages. The gifted musicians and loved family members lost. Family members struggling with the difficult role of being care givers.

Neurologic disease doesn’t discriminate against anyone, regardless of age, fame, or talent. I’ll stay here and do my best for all of them who come to me. I’m certainly not on the front line of research. That’s incredibly important, but I’ll leave it to others. My work is where the patients are every day.

Thank you for the music, Neil.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

In 1982, I went to my first concert. It was Rush, on their “Signals” tour, and I loved it. In fact, I went back and saw them again about a year later. I bought a concert T-shirt at the first one. I still have it somewhere, though I am pretty sure it hasn’t fit me in years.

Weatherman90/Wikimedia Commons/CC BY 3.0

I loved their music before the concert, enjoyed it even more afterwards, and still do. Their albums are all on my computer and phone, and part of the daily soundtrack of my life when working at my desk, driving, and walking (I’m trying to fit back in the shirt).

On Jan. 7, 2020, Neil Peart, the trio’s remarkably gifted drummer, died of a neurologic disease.

According to the news, he had a glioblastoma multiforme, a tumor terrifying for its aggressiveness, difficulty of treatment, and lack of preventable risk factors.

The cost of neurologic disease is terrible. Glioblastoma multiforme, unfortunately, is far from rare, nor is it the only one. In recent times, entertainers afflicted with neurologic disease have included Neil Diamond, Linda Ronstadt, Peter Falk, Glen Campbell, Charlton Heston, Gene Siskel, Michael J. Fox, Stephen Hillenburg, Teri Garr, Annette Funicello, Robin Williams, Dudley Moore, and most recently Ozzy Osbourne.

That’s a pretty short list, too, far from all-encompassing. The majority of people with these disorders won’t be in the news. Their everyday struggles, stories, and losses are known only to family, friends, and the medical team doing its best to help.

Medical technology advances every year. In the 22 years since I began practicing, we’ve made remarkable strides in some areas – multiple sclerosis, for example. But our work in so many other areas is nowhere close. The increasing knowledge as to the mechanisms and causes of Alzheimer’s disease have, to date, failed to translate into treatment success.

That’s not to say we should give up. Far from it. Our species has gotten where we are by always wanting to get over the next hill. Initial failures will always outnumber successes. But when you’re a doctor dealing with the very real human cost of neurologic disease, that’s not much consolation. And it’s far less so for the patients and families affected who come to us for help.

We use terms like “burden” or “cost” to discuss the financial aspects of illness, but they often don’t seem adequate to describe the real effects. The emotional damages. The gifted musicians and loved family members lost. Family members struggling with the difficult role of being care givers.

Neurologic disease doesn’t discriminate against anyone, regardless of age, fame, or talent. I’ll stay here and do my best for all of them who come to me. I’m certainly not on the front line of research. That’s incredibly important, but I’ll leave it to others. My work is where the patients are every day.

Thank you for the music, Neil.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

In 1982, I went to my first concert. It was Rush, on their “Signals” tour, and I loved it. In fact, I went back and saw them again about a year later. I bought a concert T-shirt at the first one. I still have it somewhere, though I am pretty sure it hasn’t fit me in years.

Weatherman90/Wikimedia Commons/CC BY 3.0

I loved their music before the concert, enjoyed it even more afterwards, and still do. Their albums are all on my computer and phone, and part of the daily soundtrack of my life when working at my desk, driving, and walking (I’m trying to fit back in the shirt).

On Jan. 7, 2020, Neil Peart, the trio’s remarkably gifted drummer, died of a neurologic disease.

According to the news, he had a glioblastoma multiforme, a tumor terrifying for its aggressiveness, difficulty of treatment, and lack of preventable risk factors.

The cost of neurologic disease is terrible. Glioblastoma multiforme, unfortunately, is far from rare, nor is it the only one. In recent times, entertainers afflicted with neurologic disease have included Neil Diamond, Linda Ronstadt, Peter Falk, Glen Campbell, Charlton Heston, Gene Siskel, Michael J. Fox, Stephen Hillenburg, Teri Garr, Annette Funicello, Robin Williams, Dudley Moore, and most recently Ozzy Osbourne.

That’s a pretty short list, too, far from all-encompassing. The majority of people with these disorders won’t be in the news. Their everyday struggles, stories, and losses are known only to family, friends, and the medical team doing its best to help.

Medical technology advances every year. In the 22 years since I began practicing, we’ve made remarkable strides in some areas – multiple sclerosis, for example. But our work in so many other areas is nowhere close. The increasing knowledge as to the mechanisms and causes of Alzheimer’s disease have, to date, failed to translate into treatment success.

That’s not to say we should give up. Far from it. Our species has gotten where we are by always wanting to get over the next hill. Initial failures will always outnumber successes. But when you’re a doctor dealing with the very real human cost of neurologic disease, that’s not much consolation. And it’s far less so for the patients and families affected who come to us for help.

We use terms like “burden” or “cost” to discuss the financial aspects of illness, but they often don’t seem adequate to describe the real effects. The emotional damages. The gifted musicians and loved family members lost. Family members struggling with the difficult role of being care givers.

Neurologic disease doesn’t discriminate against anyone, regardless of age, fame, or talent. I’ll stay here and do my best for all of them who come to me. I’m certainly not on the front line of research. That’s incredibly important, but I’ll leave it to others. My work is where the patients are every day.

Thank you for the music, Neil.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

The suicide rate for women who provide health care is higher than that of all women of working age, while male health care practitioners are less likely to end their lives than working-age men as a whole, according to the Centers for Disease Control and Prevention.

In 2016, the suicide rate for women classified as “healthcare practitioners and technical” – a category that includes physicians and surgeons, as well as chiropractors, physician assistants, and nurse practitioners – was 8.5 per 100,000 population, compared with 7.7 per 100,000 for all working women aged 16-64 years. That difference, however, was not statistically significant, Cora Peterson, PhD, and associates at the CDC said in the Morbidity and Mortality Weekly Report.

For females classified as “healthcare support” – medical assistants and transcriptionists, phlebotomists, and pharmacy aides – the suicide rate of 10.6 per 100,000 was significantly higher than that of all working women, the investigators noted.

The suicide rate for males in each of the two occupation categories was 23.6 per 100,000 population in 2016, lower than the rate of 27.4 per 100,000 for males of all occupations, they said, based on data from 32 states that participated in the 2016 National Violent Death Reporting System.

For males, the highest suicide rates in occupations meeting criteria for sample size were “construction and extraction” (49.4 per 100,000); “installation, maintenance, and repair” (36.9); and “arts, design, entertainment, sports, and media” (32.0). Among females, the highest rates were seen in “construction and extraction” (25.5 per 100,000), “protective service” (14.0), and “transportation and material moving” (12.5), with healthcare support next, Dr. Peterson and associates reported.

“Although relative comparisons of suicide rates in this manner are useful for prevention purposes, these results should not overshadow the essential fact that the suicide rate in the U.S. working-age population overall has increased by 40% in less than 2 decades. Therefore, all industry sectors and occupational groups can contribute to reducing suicide incidence,” they wrote.

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SOURCE: Peterson C et al. MMWR. 2020 Jan 24;69(3):57-62.

The suicide rate for women who provide health care is higher than that of all women of working age, while male health care practitioners are less likely to end their lives than working-age men as a whole, according to the Centers for Disease Control and Prevention.

In 2016, the suicide rate for women classified as “healthcare practitioners and technical” – a category that includes physicians and surgeons, as well as chiropractors, physician assistants, and nurse practitioners – was 8.5 per 100,000 population, compared with 7.7 per 100,000 for all working women aged 16-64 years. That difference, however, was not statistically significant, Cora Peterson, PhD, and associates at the CDC said in the Morbidity and Mortality Weekly Report.

For females classified as “healthcare support” – medical assistants and transcriptionists, phlebotomists, and pharmacy aides – the suicide rate of 10.6 per 100,000 was significantly higher than that of all working women, the investigators noted.

The suicide rate for males in each of the two occupation categories was 23.6 per 100,000 population in 2016, lower than the rate of 27.4 per 100,000 for males of all occupations, they said, based on data from 32 states that participated in the 2016 National Violent Death Reporting System.

For males, the highest suicide rates in occupations meeting criteria for sample size were “construction and extraction” (49.4 per 100,000); “installation, maintenance, and repair” (36.9); and “arts, design, entertainment, sports, and media” (32.0). Among females, the highest rates were seen in “construction and extraction” (25.5 per 100,000), “protective service” (14.0), and “transportation and material moving” (12.5), with healthcare support next, Dr. Peterson and associates reported.

“Although relative comparisons of suicide rates in this manner are useful for prevention purposes, these results should not overshadow the essential fact that the suicide rate in the U.S. working-age population overall has increased by 40% in less than 2 decades. Therefore, all industry sectors and occupational groups can contribute to reducing suicide incidence,” they wrote.

[email protected]

SOURCE: Peterson C et al. MMWR. 2020 Jan 24;69(3):57-62.

The suicide rate for women who provide health care is higher than that of all women of working age, while male health care practitioners are less likely to end their lives than working-age men as a whole, according to the Centers for Disease Control and Prevention.

In 2016, the suicide rate for women classified as “healthcare practitioners and technical” – a category that includes physicians and surgeons, as well as chiropractors, physician assistants, and nurse practitioners – was 8.5 per 100,000 population, compared with 7.7 per 100,000 for all working women aged 16-64 years. That difference, however, was not statistically significant, Cora Peterson, PhD, and associates at the CDC said in the Morbidity and Mortality Weekly Report.

For females classified as “healthcare support” – medical assistants and transcriptionists, phlebotomists, and pharmacy aides – the suicide rate of 10.6 per 100,000 was significantly higher than that of all working women, the investigators noted.

The suicide rate for males in each of the two occupation categories was 23.6 per 100,000 population in 2016, lower than the rate of 27.4 per 100,000 for males of all occupations, they said, based on data from 32 states that participated in the 2016 National Violent Death Reporting System.

For males, the highest suicide rates in occupations meeting criteria for sample size were “construction and extraction” (49.4 per 100,000); “installation, maintenance, and repair” (36.9); and “arts, design, entertainment, sports, and media” (32.0). Among females, the highest rates were seen in “construction and extraction” (25.5 per 100,000), “protective service” (14.0), and “transportation and material moving” (12.5), with healthcare support next, Dr. Peterson and associates reported.

“Although relative comparisons of suicide rates in this manner are useful for prevention purposes, these results should not overshadow the essential fact that the suicide rate in the U.S. working-age population overall has increased by 40% in less than 2 decades. Therefore, all industry sectors and occupational groups can contribute to reducing suicide incidence,” they wrote.

[email protected]

SOURCE: Peterson C et al. MMWR. 2020 Jan 24;69(3):57-62.

LA JOLLA, CALIF. – Physicians and other medical professionals who routinely foster empathic connections with patients may be helping themselves steer clear of burnout.

That’s what iconic actor Alan Alda suggested during a media briefing at Scripps Research on Jan. 16, 2020.

Vidyard Video

“There’s a tremendous pressure on doctors now to have shorter and shorter visits with their patients,” said the 83-year-old Mr. Alda, who received the Public Welfare Medal from the National Academy of Sciences in 2016 for his work as a champion of science. “A lot of that time is taken up with recording on a computer, which can only put pressure on the doctor.”

Practicing empathy, he continued, “kind of opens people up to one another, which inspirits them.”

Mr. Alda appeared on the research campus to announce that Scripps Research will serve as the new West Coast home of Alda Communication Training, which will work in tandem with the Alan Alda Center for Communicating Science at Stony Brook (N.Y.) University, a nonprofit organization that Mr. Alda helped found in 2009.

“This will be a center where people can come to get training in effective communication,” Mr. Alda, who is the winner of six Emmy Awards and six Golden Globe awards, told an audience of scientists and medical professionals prior to the media briefing.

“It’s an experiential kind of training,” he explained. “We don’t give tips. We don’t give lectures. We put you through exercises that are fun and actually make you laugh, but turn you into a better communicator, so you’re better able to connect to the people you’re talking to.”

During a question-and-answer session, Mr. Alda opened up about his Parkinson’s disease, which he said was diagnosed about 5 years ago. In 2018, he decided to speak publicly about his diagnosis for the first time.

“The reason was that I wanted to communicate to people who had recently been diagnosed not to believe or give into the stereotype that, when you get a diagnosis, your life is over,” said Mr. Alda, who played army surgeon “Hawkeye” Pierce on the TV series “M*A*S*H.”

“Under the burden of that belief, some people won’t tell their family or workplace colleagues,” he said. “There are exercises you can do and medications you can take to prolong the time it takes before Parkinson’s gets much more serious. It’s not to diminish the fact that it can get really bad; but to think that your life is over as soon as you get a diagnosis is wrong.”

The first 2-day training session at Scripps Research will be held in June 2020. Additional sessions are scheduled to take place in October and December. Registration is available at aldacommunicationtraining.com/workshops.

[email protected]

LA JOLLA, CALIF. – Physicians and other medical professionals who routinely foster empathic connections with patients may be helping themselves steer clear of burnout.

That’s what iconic actor Alan Alda suggested during a media briefing at Scripps Research on Jan. 16, 2020.

Vidyard Video

“There’s a tremendous pressure on doctors now to have shorter and shorter visits with their patients,” said the 83-year-old Mr. Alda, who received the Public Welfare Medal from the National Academy of Sciences in 2016 for his work as a champion of science. “A lot of that time is taken up with recording on a computer, which can only put pressure on the doctor.”

Practicing empathy, he continued, “kind of opens people up to one another, which inspirits them.”

Mr. Alda appeared on the research campus to announce that Scripps Research will serve as the new West Coast home of Alda Communication Training, which will work in tandem with the Alan Alda Center for Communicating Science at Stony Brook (N.Y.) University, a nonprofit organization that Mr. Alda helped found in 2009.

“This will be a center where people can come to get training in effective communication,” Mr. Alda, who is the winner of six Emmy Awards and six Golden Globe awards, told an audience of scientists and medical professionals prior to the media briefing.

“It’s an experiential kind of training,” he explained. “We don’t give tips. We don’t give lectures. We put you through exercises that are fun and actually make you laugh, but turn you into a better communicator, so you’re better able to connect to the people you’re talking to.”

During a question-and-answer session, Mr. Alda opened up about his Parkinson’s disease, which he said was diagnosed about 5 years ago. In 2018, he decided to speak publicly about his diagnosis for the first time.

“The reason was that I wanted to communicate to people who had recently been diagnosed not to believe or give into the stereotype that, when you get a diagnosis, your life is over,” said Mr. Alda, who played army surgeon “Hawkeye” Pierce on the TV series “M*A*S*H.”

“Under the burden of that belief, some people won’t tell their family or workplace colleagues,” he said. “There are exercises you can do and medications you can take to prolong the time it takes before Parkinson’s gets much more serious. It’s not to diminish the fact that it can get really bad; but to think that your life is over as soon as you get a diagnosis is wrong.”

The first 2-day training session at Scripps Research will be held in June 2020. Additional sessions are scheduled to take place in October and December. Registration is available at aldacommunicationtraining.com/workshops.

[email protected]

LA JOLLA, CALIF. – Physicians and other medical professionals who routinely foster empathic connections with patients may be helping themselves steer clear of burnout.

That’s what iconic actor Alan Alda suggested during a media briefing at Scripps Research on Jan. 16, 2020.

Vidyard Video

“There’s a tremendous pressure on doctors now to have shorter and shorter visits with their patients,” said the 83-year-old Mr. Alda, who received the Public Welfare Medal from the National Academy of Sciences in 2016 for his work as a champion of science. “A lot of that time is taken up with recording on a computer, which can only put pressure on the doctor.”

Practicing empathy, he continued, “kind of opens people up to one another, which inspirits them.”

Mr. Alda appeared on the research campus to announce that Scripps Research will serve as the new West Coast home of Alda Communication Training, which will work in tandem with the Alan Alda Center for Communicating Science at Stony Brook (N.Y.) University, a nonprofit organization that Mr. Alda helped found in 2009.

“This will be a center where people can come to get training in effective communication,” Mr. Alda, who is the winner of six Emmy Awards and six Golden Globe awards, told an audience of scientists and medical professionals prior to the media briefing.

“It’s an experiential kind of training,” he explained. “We don’t give tips. We don’t give lectures. We put you through exercises that are fun and actually make you laugh, but turn you into a better communicator, so you’re better able to connect to the people you’re talking to.”

During a question-and-answer session, Mr. Alda opened up about his Parkinson’s disease, which he said was diagnosed about 5 years ago. In 2018, he decided to speak publicly about his diagnosis for the first time.

“The reason was that I wanted to communicate to people who had recently been diagnosed not to believe or give into the stereotype that, when you get a diagnosis, your life is over,” said Mr. Alda, who played army surgeon “Hawkeye” Pierce on the TV series “M*A*S*H.”

“Under the burden of that belief, some people won’t tell their family or workplace colleagues,” he said. “There are exercises you can do and medications you can take to prolong the time it takes before Parkinson’s gets much more serious. It’s not to diminish the fact that it can get really bad; but to think that your life is over as soon as you get a diagnosis is wrong.”

The first 2-day training session at Scripps Research will be held in June 2020. Additional sessions are scheduled to take place in October and December. Registration is available at aldacommunicationtraining.com/workshops.

[email protected]

This column should arrive just in time. By now, you may have already failed some or all of your New Year’s resolutions. By this time in February, eighty percent of us will abort what we resolved to do this year. If this was you, it could be considered a catastrophic failure because not only is it a new year, it is a new decade. That’s right, the opportunity to fix the 10-year-imperfect you won’t come again until 2030!

marekuliasz/iStock/Getty Images

I’m among you. I intended to read fiction daily (starting with “The Great Gatsby,” not “Moby Dick” – I thought I would give myself a fighting chance, but alas ...), to workout at least 5 days every week (I tore my left triangular fibrocartilage complex, so there’s that), to write at least 500 words daily (I’m typing this one-handed: I’m lucky to get 500 letters a day). So I’m out.

If you resolved to do something this year, chances are it was to make a better you: a self-improvement goal such as losing weight, saving more money, or exercising more. According to a Marist Poll, these were the most popular resolutions for 2020. At the bottom of the most-likely-resolutions list were things like “worry less” or “be kinder to others.” These are important goals we’d agree, but we don’t deem them resolution-worthy. Why?

And why do we have New Year’s resolutions in the first place? When I looked into this further, I was surprised by some of the history I discovered.

As far back as the Babylonians, once a year, we’ve tried our best to get better. At the feast of Akitu, the Babylonian new year festival (about March on our modern calendar), people resolved to do a better job of paying debts and returning favors – spin had not been invented, and yoga hadn’t caught on in the Middle East yet. This fundamental desire to be a better human seems hardwired, and long before Bullet Journals we seem to have loved “fresh start” days on the calendar. Yet, we’re doomed to fail, over and over, at least for the last 5,000 or so attempts.

We know so much more now. Put your Nike Renue Fusion shoes next to your bed so you get up and run first thing. Set SMART goals. Sign up for automatic retirement contribution and for automatic, plant-based meal delivery from Blue Apron. (I’ve no conflict of interest in these products).

Good ideas all, but I’m suggesting a different approach: Resolve to do something else this year.

Rather than try the same things we’ve attempted, how about selecting something from the bottom of the Marist Poll list – such as resolving to be more humble. Admit when you don’t know something or don’t understand what’s being discussed. Recognize and acknowledge when you’ve screwed up. Or resolve to be more selfless. Add on someone else’s patient, an extra call without expecting a favor in return, or do what you can to help a curbside consult, even if there is no reward or even a small risk to you. Repay the debt you owe your friends, family, colleagues, staff, and patients.

These things are a little trickier to track, but you can find a way to keep yourself accountable. Add a box to your weekly planner that says “Be humble and kind” and check it off for the next 42 weeks. Good news, March 1 falls on a Sunday this year – let’s call it the feast of Akitu.

Happy New Year! And good luck!
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at [email protected].

This column should arrive just in time. By now, you may have already failed some or all of your New Year’s resolutions. By this time in February, eighty percent of us will abort what we resolved to do this year. If this was you, it could be considered a catastrophic failure because not only is it a new year, it is a new decade. That’s right, the opportunity to fix the 10-year-imperfect you won’t come again until 2030!

marekuliasz/iStock/Getty Images

I’m among you. I intended to read fiction daily (starting with “The Great Gatsby,” not “Moby Dick” – I thought I would give myself a fighting chance, but alas ...), to workout at least 5 days every week (I tore my left triangular fibrocartilage complex, so there’s that), to write at least 500 words daily (I’m typing this one-handed: I’m lucky to get 500 letters a day). So I’m out.

If you resolved to do something this year, chances are it was to make a better you: a self-improvement goal such as losing weight, saving more money, or exercising more. According to a Marist Poll, these were the most popular resolutions for 2020. At the bottom of the most-likely-resolutions list were things like “worry less” or “be kinder to others.” These are important goals we’d agree, but we don’t deem them resolution-worthy. Why?

And why do we have New Year’s resolutions in the first place? When I looked into this further, I was surprised by some of the history I discovered.

As far back as the Babylonians, once a year, we’ve tried our best to get better. At the feast of Akitu, the Babylonian new year festival (about March on our modern calendar), people resolved to do a better job of paying debts and returning favors – spin had not been invented, and yoga hadn’t caught on in the Middle East yet. This fundamental desire to be a better human seems hardwired, and long before Bullet Journals we seem to have loved “fresh start” days on the calendar. Yet, we’re doomed to fail, over and over, at least for the last 5,000 or so attempts.

We know so much more now. Put your Nike Renue Fusion shoes next to your bed so you get up and run first thing. Set SMART goals. Sign up for automatic retirement contribution and for automatic, plant-based meal delivery from Blue Apron. (I’ve no conflict of interest in these products).

Good ideas all, but I’m suggesting a different approach: Resolve to do something else this year.

Rather than try the same things we’ve attempted, how about selecting something from the bottom of the Marist Poll list – such as resolving to be more humble. Admit when you don’t know something or don’t understand what’s being discussed. Recognize and acknowledge when you’ve screwed up. Or resolve to be more selfless. Add on someone else’s patient, an extra call without expecting a favor in return, or do what you can to help a curbside consult, even if there is no reward or even a small risk to you. Repay the debt you owe your friends, family, colleagues, staff, and patients.

These things are a little trickier to track, but you can find a way to keep yourself accountable. Add a box to your weekly planner that says “Be humble and kind” and check it off for the next 42 weeks. Good news, March 1 falls on a Sunday this year – let’s call it the feast of Akitu.

Happy New Year! And good luck!
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at [email protected].

This column should arrive just in time. By now, you may have already failed some or all of your New Year’s resolutions. By this time in February, eighty percent of us will abort what we resolved to do this year. If this was you, it could be considered a catastrophic failure because not only is it a new year, it is a new decade. That’s right, the opportunity to fix the 10-year-imperfect you won’t come again until 2030!

marekuliasz/iStock/Getty Images

I’m among you. I intended to read fiction daily (starting with “The Great Gatsby,” not “Moby Dick” – I thought I would give myself a fighting chance, but alas ...), to workout at least 5 days every week (I tore my left triangular fibrocartilage complex, so there’s that), to write at least 500 words daily (I’m typing this one-handed: I’m lucky to get 500 letters a day). So I’m out.

If you resolved to do something this year, chances are it was to make a better you: a self-improvement goal such as losing weight, saving more money, or exercising more. According to a Marist Poll, these were the most popular resolutions for 2020. At the bottom of the most-likely-resolutions list were things like “worry less” or “be kinder to others.” These are important goals we’d agree, but we don’t deem them resolution-worthy. Why?

And why do we have New Year’s resolutions in the first place? When I looked into this further, I was surprised by some of the history I discovered.

As far back as the Babylonians, once a year, we’ve tried our best to get better. At the feast of Akitu, the Babylonian new year festival (about March on our modern calendar), people resolved to do a better job of paying debts and returning favors – spin had not been invented, and yoga hadn’t caught on in the Middle East yet. This fundamental desire to be a better human seems hardwired, and long before Bullet Journals we seem to have loved “fresh start” days on the calendar. Yet, we’re doomed to fail, over and over, at least for the last 5,000 or so attempts.

We know so much more now. Put your Nike Renue Fusion shoes next to your bed so you get up and run first thing. Set SMART goals. Sign up for automatic retirement contribution and for automatic, plant-based meal delivery from Blue Apron. (I’ve no conflict of interest in these products).

Good ideas all, but I’m suggesting a different approach: Resolve to do something else this year.

Rather than try the same things we’ve attempted, how about selecting something from the bottom of the Marist Poll list – such as resolving to be more humble. Admit when you don’t know something or don’t understand what’s being discussed. Recognize and acknowledge when you’ve screwed up. Or resolve to be more selfless. Add on someone else’s patient, an extra call without expecting a favor in return, or do what you can to help a curbside consult, even if there is no reward or even a small risk to you. Repay the debt you owe your friends, family, colleagues, staff, and patients.

These things are a little trickier to track, but you can find a way to keep yourself accountable. Add a box to your weekly planner that says “Be humble and kind” and check it off for the next 42 weeks. Good news, March 1 falls on a Sunday this year – let’s call it the feast of Akitu.

Happy New Year! And good luck!
 

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at [email protected].

The first issue of Skin & Allergy News, now Dermatology News, was published in January 1970. One front-page story highlighted the "continued improvement and more widespread use of steroids" as the most important development of the 1960s in dermatology. Another covered the launch of a national program for dermatology "to design a pattern for its future instead of simply drifting and letting its fate be determined by others."

Throughout 2020, look for articles and features marking the publication's golden anniversary. And read the first ever issue in the PDF above.

The first issue of Skin & Allergy News, now Dermatology News, was published in January 1970. One front-page story highlighted the "continued improvement and more widespread use of steroids" as the most important development of the 1960s in dermatology. Another covered the launch of a national program for dermatology "to design a pattern for its future instead of simply drifting and letting its fate be determined by others."

Throughout 2020, look for articles and features marking the publication's golden anniversary. And read the first ever issue in the PDF above.

The first issue of Skin & Allergy News, now Dermatology News, was published in January 1970. One front-page story highlighted the "continued improvement and more widespread use of steroids" as the most important development of the 1960s in dermatology. Another covered the launch of a national program for dermatology "to design a pattern for its future instead of simply drifting and letting its fate be determined by others."

Throughout 2020, look for articles and features marking the publication's golden anniversary. And read the first ever issue in the PDF above.

The American College of Physicians is recommending either a single-payer system or a public option within a regulated private insurance system to help deliver universal and affordable access to health care for all Americans.

“We came to the conclusion that two directions or approaches could get us to where we need to be,” ACP President Robert McLean, MD, said in an interview. “We need ... a system that provides universal, affordable access to care.”

After examining the evidence, ACP discarded one option: a direct market-based approach.

“Direct market-based approaches won’t work,” Dr. McLean explained. “If you look at where direct marketplace approaches ... have been implemented, they just will not get you to a place where you are going to get universal coverage, portability, essential benefits, and preexisting condition protection and administrative simplification.”

Dr. McLean highlighted two paths that could achieve universal coverage and better access to health care: a single-payer–financed system, or a publicly financed coverage option within a system of regulated private insurance.

It’s the first time ACP has endorsed a single-payer approach. The college supported the public option that wasn’t included as part of the Affordable Care Act. But ACP’s latest publicly financed proposal offers a deeper level of detail on how to make that option work in the context of a private insurance system.

While the health reform conversation may be a political, ACP doesn’t want to make it a partisan one. ACP’s policy recommendations represent a carefully researched series of ideas backed by evidence-based research, Dr. McLean said.

“There is a lot of nuance behind” the two recommendations, he noted, and those nuances are explored in a series of articles and editorials published Jan. 21 in Annals of Internal Medicine.

Sizing up single payer

The ACP acknowledges that for its single-payer system, the transition could be “politically difficult and strain the federal budget,” according to Ryan A. Crowley, senior analyst at ACP, and colleagues in an article outlining the organization’s vision. “Taxes would probably replace premiums, and private insurance would have a reduced role or be eliminated altogether.”

However, the authors note that a single-payer system could be designed to address concerns from a generally skeptical public, such as providing bulk funding or setting minimum standards to guide state operations. It also could include private insurance to provide supplemental coverage.

Even so, “adopting a single-payer system would be highly disruptive and could lead to price controls that would perpetuate flaws in the current Medicare payment system, including the undervaluation of primary care,” Mr. Crowley and colleagues wrote. “If prices are set too low, it could lead to shortages and longer wait times for services. Without sufficient cost controls, however, the cost of a single-payer system could be too high to be feasible.”

Pondering the public option

Given a single-payer plan’s potential challenges, ACP also is endorsing a public option model, which provides the choice of a government-sponsored health insurance plan to compete with existing private insurance options.

“Depending on its structure and implementation, a public choice (or public option) model available to all could help to achieve universal coverage, better access, and improved outcomes without the disruption of a single-payer approach,” the ACP authors noted.

The public option has its own drawbacks, they acknowledge. Those include an inability to achieve better savings on prescription drugs, compared with a single-payer system. The public option approach also doesn’t do away with the current administrative burden, and access issues related to narrow provider networks would persist.

Dr. McLean noted that a more highly regulated insurance market would be needed to help make the public option model work.

“Insurance companies don’t have regulation in a lot of things that they do,” Dr. McLean said. “We see that as quite problematic. They are kind of running amok at this point.”

Expanding the role of primary care

In either reform scenario, primary care would play a much greater role.

“We need to promote primary care,” Dr. McLean said. That includes better incentives to draw physicians to it. “We have to pay them enough,” he added.

The health care models will need to move away from higher pay to specialties for high-cost, high-volume procedural reimbursement. And they’ll need to recognize the need for placing a higher value on the cognitive services provided at the primary care level.

Also in need of change: physicians’ administrative burdens. Reforms need to address the burden created by value-based care and the poor application and misapplication of quality measures.

Migration to a single-payer environment could would make reducing the administrative burden a lot easier, Dr. McLean said. But it also could be done with a public option approach.

That’s where regulators can play a big role in working with insurers to help address administrative burden – streamlining prior authorization of procedures, the types of forms used, and other policies, Dr. McLean explained.

“The number of insurers and their ability to have their own rules and regulations [make it] incredibly complex for patients as well as physicians trying to figure out how to deliver the care that they need,” he noted.

Dr. McLean hopes that the ACP’s papers will spark conversation, particularly among legislators and regulators.

“The bottom line is we cannot afford to not do something bold,” he cautioned. “It is just not working. Our patients deserve better, and we can do better.”

[email protected]

The American College of Physicians is recommending either a single-payer system or a public option within a regulated private insurance system to help deliver universal and affordable access to health care for all Americans.

“We came to the conclusion that two directions or approaches could get us to where we need to be,” ACP President Robert McLean, MD, said in an interview. “We need ... a system that provides universal, affordable access to care.”

After examining the evidence, ACP discarded one option: a direct market-based approach.

“Direct market-based approaches won’t work,” Dr. McLean explained. “If you look at where direct marketplace approaches ... have been implemented, they just will not get you to a place where you are going to get universal coverage, portability, essential benefits, and preexisting condition protection and administrative simplification.”

Dr. McLean highlighted two paths that could achieve universal coverage and better access to health care: a single-payer–financed system, or a publicly financed coverage option within a system of regulated private insurance.

It’s the first time ACP has endorsed a single-payer approach. The college supported the public option that wasn’t included as part of the Affordable Care Act. But ACP’s latest publicly financed proposal offers a deeper level of detail on how to make that option work in the context of a private insurance system.

While the health reform conversation may be a political, ACP doesn’t want to make it a partisan one. ACP’s policy recommendations represent a carefully researched series of ideas backed by evidence-based research, Dr. McLean said.

“There is a lot of nuance behind” the two recommendations, he noted, and those nuances are explored in a series of articles and editorials published Jan. 21 in Annals of Internal Medicine.

Sizing up single payer

The ACP acknowledges that for its single-payer system, the transition could be “politically difficult and strain the federal budget,” according to Ryan A. Crowley, senior analyst at ACP, and colleagues in an article outlining the organization’s vision. “Taxes would probably replace premiums, and private insurance would have a reduced role or be eliminated altogether.”

However, the authors note that a single-payer system could be designed to address concerns from a generally skeptical public, such as providing bulk funding or setting minimum standards to guide state operations. It also could include private insurance to provide supplemental coverage.

Even so, “adopting a single-payer system would be highly disruptive and could lead to price controls that would perpetuate flaws in the current Medicare payment system, including the undervaluation of primary care,” Mr. Crowley and colleagues wrote. “If prices are set too low, it could lead to shortages and longer wait times for services. Without sufficient cost controls, however, the cost of a single-payer system could be too high to be feasible.”

Pondering the public option

Given a single-payer plan’s potential challenges, ACP also is endorsing a public option model, which provides the choice of a government-sponsored health insurance plan to compete with existing private insurance options.

“Depending on its structure and implementation, a public choice (or public option) model available to all could help to achieve universal coverage, better access, and improved outcomes without the disruption of a single-payer approach,” the ACP authors noted.

The public option has its own drawbacks, they acknowledge. Those include an inability to achieve better savings on prescription drugs, compared with a single-payer system. The public option approach also doesn’t do away with the current administrative burden, and access issues related to narrow provider networks would persist.

Dr. McLean noted that a more highly regulated insurance market would be needed to help make the public option model work.

“Insurance companies don’t have regulation in a lot of things that they do,” Dr. McLean said. “We see that as quite problematic. They are kind of running amok at this point.”

Expanding the role of primary care

In either reform scenario, primary care would play a much greater role.

“We need to promote primary care,” Dr. McLean said. That includes better incentives to draw physicians to it. “We have to pay them enough,” he added.

The health care models will need to move away from higher pay to specialties for high-cost, high-volume procedural reimbursement. And they’ll need to recognize the need for placing a higher value on the cognitive services provided at the primary care level.

Also in need of change: physicians’ administrative burdens. Reforms need to address the burden created by value-based care and the poor application and misapplication of quality measures.

Migration to a single-payer environment could would make reducing the administrative burden a lot easier, Dr. McLean said. But it also could be done with a public option approach.

That’s where regulators can play a big role in working with insurers to help address administrative burden – streamlining prior authorization of procedures, the types of forms used, and other policies, Dr. McLean explained.

“The number of insurers and their ability to have their own rules and regulations [make it] incredibly complex for patients as well as physicians trying to figure out how to deliver the care that they need,” he noted.

Dr. McLean hopes that the ACP’s papers will spark conversation, particularly among legislators and regulators.

“The bottom line is we cannot afford to not do something bold,” he cautioned. “It is just not working. Our patients deserve better, and we can do better.”

[email protected]

The American College of Physicians is recommending either a single-payer system or a public option within a regulated private insurance system to help deliver universal and affordable access to health care for all Americans.

“We came to the conclusion that two directions or approaches could get us to where we need to be,” ACP President Robert McLean, MD, said in an interview. “We need ... a system that provides universal, affordable access to care.”

After examining the evidence, ACP discarded one option: a direct market-based approach.

“Direct market-based approaches won’t work,” Dr. McLean explained. “If you look at where direct marketplace approaches ... have been implemented, they just will not get you to a place where you are going to get universal coverage, portability, essential benefits, and preexisting condition protection and administrative simplification.”

Dr. McLean highlighted two paths that could achieve universal coverage and better access to health care: a single-payer–financed system, or a publicly financed coverage option within a system of regulated private insurance.

It’s the first time ACP has endorsed a single-payer approach. The college supported the public option that wasn’t included as part of the Affordable Care Act. But ACP’s latest publicly financed proposal offers a deeper level of detail on how to make that option work in the context of a private insurance system.

While the health reform conversation may be a political, ACP doesn’t want to make it a partisan one. ACP’s policy recommendations represent a carefully researched series of ideas backed by evidence-based research, Dr. McLean said.

“There is a lot of nuance behind” the two recommendations, he noted, and those nuances are explored in a series of articles and editorials published Jan. 21 in Annals of Internal Medicine.

Sizing up single payer

The ACP acknowledges that for its single-payer system, the transition could be “politically difficult and strain the federal budget,” according to Ryan A. Crowley, senior analyst at ACP, and colleagues in an article outlining the organization’s vision. “Taxes would probably replace premiums, and private insurance would have a reduced role or be eliminated altogether.”

However, the authors note that a single-payer system could be designed to address concerns from a generally skeptical public, such as providing bulk funding or setting minimum standards to guide state operations. It also could include private insurance to provide supplemental coverage.

Even so, “adopting a single-payer system would be highly disruptive and could lead to price controls that would perpetuate flaws in the current Medicare payment system, including the undervaluation of primary care,” Mr. Crowley and colleagues wrote. “If prices are set too low, it could lead to shortages and longer wait times for services. Without sufficient cost controls, however, the cost of a single-payer system could be too high to be feasible.”

Pondering the public option

Given a single-payer plan’s potential challenges, ACP also is endorsing a public option model, which provides the choice of a government-sponsored health insurance plan to compete with existing private insurance options.

“Depending on its structure and implementation, a public choice (or public option) model available to all could help to achieve universal coverage, better access, and improved outcomes without the disruption of a single-payer approach,” the ACP authors noted.

The public option has its own drawbacks, they acknowledge. Those include an inability to achieve better savings on prescription drugs, compared with a single-payer system. The public option approach also doesn’t do away with the current administrative burden, and access issues related to narrow provider networks would persist.

Dr. McLean noted that a more highly regulated insurance market would be needed to help make the public option model work.

“Insurance companies don’t have regulation in a lot of things that they do,” Dr. McLean said. “We see that as quite problematic. They are kind of running amok at this point.”

Expanding the role of primary care

In either reform scenario, primary care would play a much greater role.

“We need to promote primary care,” Dr. McLean said. That includes better incentives to draw physicians to it. “We have to pay them enough,” he added.

The health care models will need to move away from higher pay to specialties for high-cost, high-volume procedural reimbursement. And they’ll need to recognize the need for placing a higher value on the cognitive services provided at the primary care level.

Also in need of change: physicians’ administrative burdens. Reforms need to address the burden created by value-based care and the poor application and misapplication of quality measures.

Migration to a single-payer environment could would make reducing the administrative burden a lot easier, Dr. McLean said. But it also could be done with a public option approach.

That’s where regulators can play a big role in working with insurers to help address administrative burden – streamlining prior authorization of procedures, the types of forms used, and other policies, Dr. McLean explained.

“The number of insurers and their ability to have their own rules and regulations [make it] incredibly complex for patients as well as physicians trying to figure out how to deliver the care that they need,” he noted.

Dr. McLean hopes that the ACP’s papers will spark conversation, particularly among legislators and regulators.

“The bottom line is we cannot afford to not do something bold,” he cautioned. “It is just not working. Our patients deserve better, and we can do better.”

[email protected]