Seeing A Permanent Solar Eclipse

This past summer I got to witness one of the great natural wonders of the world, a total eclipse of the sun. It was one of those events that I have dreamed about my entire life. Though my view wasn't perfect due to heavy cloud cover that rolled in over our Midwestern location just as the eclipse took place, we got just enough clearing to see the corona. And to me that was a win. I will never forget the phenomenon and I hope my young son, who I brought along with me, will too.

Now there is an unfortunate woman in New York who may being seeing the solar eclipse forever, not just in her mind's eye, but permanently in her vision. An article in JAMA Ophthalmology written by solar retinopathy specialist Avnish Deobhakta (there really is such a sub subspecialty in ophtho?!), details the cautionary tale of this patient who was too eager to watch the eclipse without first getting the proper equipment.

The patient is a young woman in her 20's who decided she wanted to watch the eclipse at the last second. She stared at the blinding sun for about six seconds before she had to turn away. Then she decided to borrow a stranger's regular sunglasses and continued to stare at the partial eclipse for another 15-20 seconds. Within hours she was having visual difficulties.

When ophthalmologists examined her eyes with a special instrument that can see individual retinal cells, they found a perfectly shaped burn that corresponded to the partial eclipse she witnessed, including the crescent cutout made by the moon partially obstructing the sun. Six weeks later, she still has a hole in her vision where the retinal cells remain damaged.

Again this shows that one should pay heed to doctors' warnings. Physicians for weeks cautioned people to wear eclipse glasses or they could suffer permanent eye damage. Apparently some people just didn't get the message.

Day Without An Anesthesiologist

Another day, another meaningless protest. Ever since the inauguration of President Trump, it feels like there has been a protest nearly every single day. Some people might say this is a healthy expression of democracy in action. I say it's another reason for people to skip work and school.

Today has been designated the Day Without A Woman. Women are staying away from their jobs and stores to prove how important they are. Ironically this boycott by women only goes to show how inconsequential we as individuals are in society. Life goes on whether we show up or not.

By contrast, if you have a day without an anesthesiologist, all hell would break loose. Suddenly ASC's and hospitals around the country would virtually shut down. Their main profit centers, the operating rooms, would go silent, depriving the centers of their life blood. Pain scores would shoot up as the expert care of our pain specialists are removed. There will be lots of broken teeth and traumatized airways as inexpert intubations prevail. Hearts would go unmended. Cancers unresected. Broken hips unreplaced. It would be a calamity.

So all those women can go out there with their pussyhats and march all they want. If nobody notices any difference with them gone, did they really make that much of a contribution? But watch out if anesthesiologists walk out en masse. The country would come crumbling down before the first surgeon can ask, "Is anesthesia here yet?"

Medicare For All?

President elect Trump has stated that his plan to replace Obamacare would allow everybody access to health insurance. While the Republican Congress struggles to decide what to replace the PPACA with, perhaps Trumpcare would be another version of the old public option, a Medicare for all.

It doesn't sound as preposterous as it seems. What are some of the advantages of allowing universal access to Medicare? First of all, it would have almost immediate bipartisan Congressional support. Universal Medicare was championed by Bernie Sanders during the primaries. Much wasted bloviating on both sides of the aisle would be eliminated by implementing universal Medicare instead of arguing about tax credits and and pandering to the wealthy.

Medicare is also widely accepted throughout the country. Virtually every hospital and physician already accepts Medicare. There would be far less concern about narrow hospital and physician networks. You can just go to your old doctor and the plan will be accepted. The claim that you can keep your doctor if you like your doctor will finally be true.

Universal Medicare is portable. Change jobs? Keep your Medicare. Move across state lines? Same Medicare in all fifty states. Universal Medicare would also drive competition in the health insurance market. Already hundreds of counties have only one choice for health insurance. Universal Medicare would give these companies more competition to lower prices and allow people to buy insurance if the private companies don't offer any plans. In essence, the entire country becomes one giant risk pool for health insurance, which was one of the goals of Obamacare.

Don't forget people actually like Medicare. It's one of the untouchable pillars of the federal government. It would have immediate mass appeal. Intuitively it makes sense to most people. This is what people think of when they talk about universal health insurance in other industrialized countries. Its appeal would make the legislation much easier to pass.

How to pay for it? People will buy into it just like they purchase any other health insurance plans. Unlike regular Medicare, people will buy the insurance, with the premiums based on income. The more money you make, the more you pay for Medicare plans.

Business deductions for health insurance could also be eliminated to help pay for universal Medicare. Right now this sweetheart deal brokered in the early 20th century gives unfair advantage and income to people who work for companies that offer health insurance. Small business owners, private contractors, part time workers, and millions of others don't get this deal. Removing health insurance deductions for businesses would free up billions of dollars and remove price distortions in the health insurance markets.

So could Trumpcare be a form of Medicare for all? It's hard to fathom what goes on under his orange hair every day but who knows? He is not beholden to either political party and can put forward his own plans without worrying about appeasing the right or the left. He just might do something this bold and Big League.

Meet Tom Price

If you have any questions about who is going to lead the medical care of this country for the next several years, the New York Times has a lengthy article about Dr. Tom Price, the nominee for the next secretary of health and human services. It recounts his ascent from a community orthopedic surgeon to majority leader of the Georgia Legislature and now potential boss of the largest expenditures in the federal budget.

In a one sentence blurb, the article briefly mentions that Mr. Price has a plan to replace Obamacare with something better and more substantive. While the mainstream press may keep harping on the Republicans' lack of a real plan to get rid of the PPACA, Mr. Price has already published very long and specific ideas he introduced as the Empowering Patients First Act. So next time you hear some uneducated colleague moan about Republican grandstanding, you can just point to Mr. Price's website and show them that there are plans in place if one cares enough to make an effort.

Doctors For Trump

Let's get this straight. Not everybody who voted for Donald Trump for president is an uneducated disgruntled white male unemployed factory worker, as the liberal press would like to have you believe. Hundreds of thousands of doctors also voted for him. You can hardly call them uneducated.

For many physicians, their votes had nothing to do with Russian hacking of the Democratic National Committee or the FBI investigation of Hillary Clinton's careless handling of classified emails. No, the disastrous prospects of continuing Obamacare was probably one of their top priorities in sending Republicans into all federal branches of power.

We already know that President Obama lied when he promised that the PPACA would allow people to keep their insurance policies and doctors if they want it. His statements about Obamacare lowering healthcare costs have also proven to be false. The whole package was passed by hoodwinking Congress and the voting public. Now, insurance premiums have gone through the roof. My family's personal health insurance costs will increase almost 25% this year. If we switched to a cheaper plan we would lose our family doctor. Yet we consider ourselves lucky. Millions of people across the country will only have one insurance company to choose from thanks to the crippling costs mandated by the law.

Despite these drawbacks, I've been reading a lot of anger and frustration in medical forums like KevinMD about the potential demise of Obamacare as we know it. They predict doom and gloom for patients and medicine in general if Republicans dare repeal it.

Funny thing is, most of these prognostications were written by medical residents or faculty physicians in academic settings. These are hardly the unbiased views of what's really going on in the healthcare business. In fact, they are completely shielded from the real world of medicine.

They're not out there fighting for every penny from the insurance companies for proper reimbursements. These academics aren't dealing with losing long term patients because they are no longer part of the ever tighter insurance networks. As part of an academic institution, these big hospitals are usually included in almost all health plans. And if they did lose a few patients to insurance changes, how much did they really care?

How can medical residents be complaining about the demise of Obamacare when they haven't experienced how hard it is to make one honest nickel running a medical business? Have them come back in a few years when they've had the opportunity to implement all of Obama's expensive mandates like electronic medical records or alternative payment models.

So forgive me if I ignore all the whining and kvetching about an unfair Electoral College bypassing the will of the people. Millions of voters, thousands of doctors among them, voted for Donald Trump. Nobody said we had to vote against our own self interest in order to be good compassionate physicians. In fact, patients may find their doctors to be happier and more friendly once many of these Obama era rules are banished.

The AMA Is A Political Whore

Before the recent presidential election, most doctors suspected that the American Medical Association is nothing more than a political lobbyist group pretending to act on behalf of physicians. In reality, they care more about money and politics than the welfare of doctors who they claim they represent. That is why only about 15% of physicians in this country still belong to the AMA. Now after the election, our suspicions have been confirmed.

Back during President Obama's first term in office, the AMA gave a crucial endorsement of the PPACA, aka Obamacare. A letter written by AMA President, Dr. Jeremy Lazarus, to the Wall Street Journal stated, "While the law is not perfect, the AMA, the nation's largest physician organization, supported it because it makes necessary improvements to our health care system." This nod of support from an organization claiming to represent the doctors of the country gave the politicians an alibi to vote for legislation that they knew to be seriously flawed. Even up to last year, a study published in JAMA by authors affiliated with the federal government, praised the effectiveness of the health law.

Meanwhile, a survey of 20,000 physicians found a different reality. Almost half of the doctors described Obamacare as a failure. Only a quarter considered it a success. Fully two thirds of doctors in the survey did not accept health insurance that were offered on the Obamacare insurance exchange markets. This highlights the flaws of the system, namely people had more access to insurance, but less access to actual healthcare.

Since the election of Donald Trump, the AMA has displayed a sudden shameless change of heart about its endorsement of Obamacare. When Trump nominated Tom Price, a Congressman from Georgia and orthopedic surgeon by trade, for the position of the Secretary of Health and Human Services, the liberals were sent into fits of outrage. Why? Mr. Price has pretty much devoted his government career into devising ways to repeal Obamacare. The only reason he hasn't been more successful was because of Senate Democrats and President Obama. Now he and the Republicans are in a strong position to fulfill their vision.

So what does the AMA say when confronted by a person whose goal is to dismantle their major legislative accomplishment of the past decade? They heartily endorse Mr. Price for head of the HHS! What kind of logic is this? How can the AMA very publicly and loudly support a law that is despised by thousands of doctors yet quickly turn around and encourage the confirmation of the man who vows to destroy the same law?

The answer obviously is that the AMA has no moral or guiding principles other than political expediency and money grubbing. The AMA is like the prostitute who will sleep with the client with the most money. They don't care what acts they have to do to gain favor just as long as they are able to bring in more cash into the organization. If that means screwing their own membership, then so be it. Most doctors know that the AMA survives mainly as a legacy group with very little real support from the medical community. Nowadays doctors are more likely to be involved with their own state and national specialty societies than be in the AMA. But the AMA will continue to use its name recognition and historic relevance to push its own greedy survivalist agenda in Congress instead of acting on behalf of the doctors they falsely claim to represent. President-elect Trump just revealed that the American Medical Association is nothing but a government slut.

Medicine In A Time Of Hate

Pranay Sinha, a third year medicine resident at Yale, shared his experience with racial hatred post presidential election. He thought he would be lauded for going above and beyond the call of duty taking care of an older white patient. Instead he was shouted down and fired by the patient. This sets Dr. Sinha into all sorts of mental turmoil.

Was he being singled out because he is a foreign medical graduate? Was it racial intolerance, since he never saw the patient treat white doctors the same way? Is it acceptable for doctors to be angry at their patients? When patients are sick and vulnerable, are they responsible for their words and actions? Should he develop thicker skin or should doctors demand respect from their patients the way we show respect to them? Has the presidential election emboldened people to drop their facade of tolerance and revealed their true colors?

As physicians, it's hard to get angry at patients without coming off as uncaring and impatient. I've had patients swing at me with their fists, spat on, scratched at, verbally abused, or generally not following orders. Yet I attribute them to the patients' general circumstances. They're in an unfamiliar environment, practically naked, most likely hungry and cold, with needles stuck in them or getting stuck every single day. I try not to judge them based on their aggressions. But many days it requires the patience of Job to make it through the day. And frequently, when I see the patient again later on they have usually forgotten about any slights that have been thrown my way and we can resume a normal relationship. But it is a challenge every doctor has to master to have a successful career, no matter their color or ethnicity.