Will this happen to your doctor?

A physician in Seattle who calls himself Dr. Bob describes how the profession is changing.

The past year or so has been one of the most challenging in many a season, on a number of fronts. Professionally, the passage of Obamacare has made it abundantly clear that the independent private practitioner is a dying breed, and likely will disappear — with the exception of cash-only, concierge-style arrangements — within the next few years. The administrative burden is crushing — unfunded mandates, such as pay-for-performance, compliance programs, HIPAA, mandated “government certified” EMRs (even though existing, non-certified ones are fully functional), and intrusive, abusive audits by the Feds and third party carriers.  

Such mandates and regulatory excesses place, or will soon place, such an overwhelming burden on the solo physician or small group as to make their continued existence unsustainable, even in the near term — and the full implementation of Obamacare will put roses on their grave. Reimbursements are dropping precipitously (my income dropped about 25% last year), as expenses spiral upward (employee health insurance rates are up 25%; malpractice rates up 15%, etc., etc.). The small business model of solo practice or small medical group is rapidly becoming extinct: its executioner, Big Government and Big Insurance.

And so, big changes are in store: my practice will be sold in the next few months to a large medical group affiliated with a nearby hospital, and I will have as a primary responsibility inpatient hospital care, with a much diminished office practice focusing primarily on my specialty of male infertility and vasectomy reversal. I have decidedly mixed feelings about this change — I anticipated going to my deathbed as a private, solo practitioner, loving the independence and rich patient relationships which this brings. 

But I am weary. After nearly 30 years in private practice, I am not sure which straw broke the camel’s back, but it is most surely broken. It is a weariness born of 14 hour days; of dictating charts and finishing paperwork until 8 or 9 pm each night, after starting the day at 7 am; of endless audits by the insurance industry and Medicare; of the constant threat of litigation; of the crushing burden of one more federal requirement mandated but never recompensed; of a host of ever-expanding administrative burdens having nothing to do with patient care, and everything to do with bureaucratic micromanagement of the profession. And this before we have even begun to see the nightmare which Obamacare will inflict. Camels weren’t designed to carry such a load.

I've started to notice this around here.

The geniuses who want to manage your health

Here's a look at the bureaucrats who are sticking their fingers ever deeper into your healthcare.

President Barack Obama's health care law would let several million middle-class people get nearly free insurance meant for the poor, a twist government number crunchers say they discovered only after the complex bill was signed.

Remember how they shoved this down the country's throat in weekend and late night sessions? Remember how lawmakers admitted they hadn't read it?

By changing the way it pays, Medicare under the Accountable Care Organization rule is effectively mandating a new business model for practicing medicine. The vague cost-control hope is that ACOs will run pilot programs he successful ones will become best practices. While the program is voluntary for now, the government's intention is to make it mandatory in the coming years. However, the American Medical Group Association, a trade association of multispeciality practice groups and other integrated providers, calls the rule recently drafted by the Department of Health and Human Services "overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve." In a survey of its members, 93% said they won't enroll.

That's what you get when you have a bunch of staff egg heads writing legislation fundamentally changing one-sixth of the economy.

Long after questions were first raised about the overuse of powerful CT scans, hundreds of hospitals across the country needlessly exposed patients to radiation by scanning their chests twice on the same day. Yet some hospitals were doing that more than 80 percent of the time for their Medicare chest patients. “If you do both, you bill for both,” one doctor said.

So existing incentives under government rules cause this, but nobody has bothered changing it.

Medicare fraud --  estimated now to total about $60 billion a year -- has become one of, if not the most profitable, crimes in America.

We've know this for years, as well, but it continues.

Certainly our healthcare system is screwed up, but are Washington bureaucrats the right people to fix it? Dream on.

Be your own therapist

Positive psychology involves more than just thinking happy thoughts. Positive psychology focuses on the strengths and virtues that help people thrive, such as courage, gratitude, compassion, resilience and creativity. While most therapists attempt to "fix what's wrong," positive psychologists also want to "build what's strong."

Therapists who practice positive psychology help individuals see their strengths and virtues and find ways to foster them. They also help people identify positive experiences and the circumstances that brought them about, as well as encourage behaviors that give life a sense of meaning and purpose. Here are some positive psychology techniques you can try:

Identify and use signature strengths. Write down your top five strengths and try to use them more and in new ways each day.  

Keep a gratitude journal. Often recommended by Oprah Winfrey, this positive psychology technique involves writing down each evening three good things that happened to you and noting why you think they happened. Many people focus on negative emotions or events and ignore the positive ones. Keeping a gratitude journal is a way to shift your focus to the more positive aspects of your life and to reflect on them.

Express appreciation to other individuals. Extend your gratitude to the important people in your life. 

Perform acts of kindness. Turning your focus to improving the lives of people around you can increase your own happiness. Try to help others in ways both random (like holding the door open for someone or letting someone go in front of you in line) and planned (such as volunteering or donating blood).

Do it yourself and save big bucks. 

The ticking male timebomb

It's known that women who postpone childbirth into their 30s and 40s place their offspring at risk for countless disorders and diseases. Why that is so might surprise you.

Writing in The Wall Street Journal, Jennifer Vanderbes suggests that it's because women in their 30s tend to couple off with older men. And when it comes to fathering healthy children, older men, it turns out, are just as much at the mercy of their biological clocks as women.

Several years ago researchers at the Mount Sinai School of Medicine reported that a man over 40 is almost six times as likely as a man under 30 to father an autistic child. Since then, research has shown that a man's chances of fathering offspring with schizophrenia double when he hits 40 and triple at age 50. The incidence of bipolarity, epilepsy, prostate cancer and breast cancer also increases in children born to men approaching 40.

After each ejaculation, a man regenerates millions of new sperm cells, and with each cellular replication, the chances rise of an error in genetic coding. 

These "new" sperm might still be able to fertilize an egg, but they can contain dangerous mutations. "As men get older, maybe there is some sperm available, but a lot of that DNA may be abnormal," says Harry Fisch, author of the pioneering 2004 book The Male Biological Clock.

Here's a chart showing the rising age at which men get married.

That's the average, meaning half get married at a later age. And here's a chart showing the rising diagnoses of autism.

This may be one piece of the puzzle of the apparent epidemic of autism.

Miracles and wonders: brain in a dish

Microelectrodes measure stem cells

Here's the real story in healthcare -- the amazing discoveries coming every day.

Researchers at the University of Florida have found a way to reanimate brain cells that have been quieted by strokes and traumatic head injuries. "The brain in the dish, or as the scientists prefer to call it, the 'biologically relevant neural model,' is a computer chip with an array of 60 microelectrodes that measure the action potential of neurons grown on top. The microelectrode array, or M.E.A., records the brain cell signals so the scientists can analyze them." After simulating a stroke, which quiets the neurons on the chip, adult stem cells are added, after which the neurons regain strength.

Scientists are at last almost ready to unveil a new drug-delivery system that uses the membranes of red blood cells. It's biocompatible, it's efficient, and evolution has already conducted extensive trials. Researchers at the University of California at San Diego say this system is better than other nanoparticle drug-delivery devices because there is no need for a synthetic membrane. There is no better way to trick the body into believing the device belongs there if it is coated in a natural membrane.

Parallel developments in research may bring sufferers of Type 1 and Type 2 diabetes very near a cure. A team of physicians at Massachusetts General Hospital have found a tuberculosis vaccine, called BCG, prevents T cells from destroying insulin-secreting cells, allowing the pancreas to regenerate and begin producing insulin again, curing the disease. Meanwhile, researchers in the U.K. have pioneered an extremely low-calorie diet of just 600 calories a day. In addition to lowering body fat, insulin levels returned to normal. Out of the eleven participants on the diet, seven were diabetes-free just three months later.

The Mermaid

Japanese researchers have developed the world’s first self-propelled endoscopy device, a remote controlled tadpole-like camera that can “swim” through the digestive tack gathering imagery along the way. This kind of endoscopy isn’t wholly new, of course, but previous iterations of ingestible cameras relied on natural muscle contractions to move them through the body. The “Mermaid,” as it is known, simplifies the process by moving quickly through the digestive tract to its destination, whatever that point may be. To speed the process, it can be inserted into the digestive system at either end, entering the body orally or--well, you know. The device is just 0.4 inches in diameter and just shy of two inches long, and uses magnetic machinery to control its movement and location. Doctors pilot the endoscope with a joystick, watching its progress on a monitor. All said, it takes only a few hours to traverse the whole system from esophagus to colon. It could help ease the strain on patients and detect hard-to-see cancers earlier than was previously possible.