Category Archives: change

Trends in Medicine

–Tom Bibey

We’ve been around long enough to see the trends come and go. I’ve seen Aldactone fall in and out of favor three times now as the latest “hip” drug. When I see some young fellow tout the latest study on the merits of the drug as some new thing, I ache from his lack of wisdom.

(Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

 Dr. Bibey, who has some gray hair, gives us perspective on the changing knowledge of medicine. We have embraced Evidence Based Medicine (EBM), but the evidence changes. We once encouraged menopausal women to take hormones to protect their hearts, then learned that was not helpful. We encouraged anti-oxidants, then learned that did not make a difference. Talk with your preceptor and explore the other trends that have come and gone as our knowledge and science has grown.

A Modern Country Doc–alphabet soup

Inside the Mind of –Tom Bibey

COLA, CLIA,OSHA, HIPAA, EMTALA. I’ve heard the powers that be are going to start up the NBEMAA (National Bureau for the Elimination of Medical Abbreviations Agency) to question everyone’s integrity for use of nongovernment approved abbreviations. Now if they do, I guess I’m gonna call it a day. The hypocrisy would just be too much.

 (Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

 Modern medicine is an alphabet soup of acronyms. It can be quite overwhelming to the student. With the turn of the 21st century we’ve added EMR or EHR –electronic health or medical records, HCH or MH—health care home or medical home, but MH can also mean mental health. You may encounter NCQA and JCAHO, both efforts to improve and monitor the quality of care in the US. The ACA, Affordable Care Act, which some folks call Obama care, the national health reform passed during President Obama’s first term and now under attack, also brought us ACOs—accountable care organizations, which are supposed to be different from the HMOs-health management organizations of the 1970s and 1980s. I know that was a run on sentence, but one acronym seems to give birth to others. You can probably add some others to this list. The bottom line is that medical care in the US is complex. All the efforts try to guarantee quality, affordable health care for the patient, but often seem like barriers between the doctor-patient relationship.

Inside the Mind of a Modern Country Doc

–Tom Bibey

I have seen a lot of changes in my three decades of practice. Technological advancement offers new treatments, and I am grateful for them. Heck, I have partaken of this myself. Last fall I had a retinal detachment, and with modern ophthalmology I was back to 20/20 in no time. Don’t get me wrong, I’ve nothing against being modern.

Computers have improved our ability to compile data, but also have rendered privacy obsolete. Sure, I know the Government enacted the HIPAA privacy rules, but that was only to keep everyone else from cutting in on their business.

Look at it this way: HIPAA was enacted by the same crowd who invented the Social Security number. I don’t know about you, but that scares me a bit. As a small businessman for years, I know the importance of the bottom line. Years ago, the staff and I agonized about increasing office visits from fifteen to eventeen dollars. We were very concerned as to how a two-dollar increase might play in the local circles. My aunt would hear about it and talk bad about me in Sunday school. In small towns, you have to be careful about a bad PR rep at church or in the beauty shops. A local restaurant owner who got greedy and went up a full dollar on a perch plate was out of business in a month. When you live with people, your decisions tend to be conservative, and we were sensitive to local economic issues.

Our bottom line was how our patients fared. If they were happy, and we cleared enough to go another year, we counted it a success. It was like one of my patients said, “I want you to make enough to retire, Doc, just not in a few years.” I agreed and found it good counsel.

Somewhere along the way, medicine evolved into big business. Once the bottom line became a stockholder report, the rules began to change. An old doc, Dr. William Gray, had the same answer for every problem. “I don’t know what’s wrong here, but it’s got something to do with money.” Well, old Doc is long gone, but I think he’s still right.

(Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

You may encounter gray-haired physicians like Dr. B on your rural rotations. They are often nostalgic about the “good old days of medicine” as portrayed by Barnard Hughes in Doc Hollywood (1991), a movie that starred Michael J Fox as a hip plastic surgeon headed to LA, long before his Parkinsons manifested. You catch the same flavor in the TV sitcom Marcus Welby MD.  In the good old days, little came between the physician and the care of the patient. Most physicians were in solo practice or in small groups and ran their own businesses. They had a lot more autonomy. As with everything, there are pros and cons. In the next blog posts we will explore Dr. B’s take on the good old days meeting modern high tech medicine where lots of “Chart Jockeys” monitor the care that is provided to patients. Dr. B also blogs about blue grass, has written a novel and has another in the works. 

As you shadow and talk with these practitioners who have seen the changes in medicine over the past three decades what do they see as the losses and gains? What changes do they imagine that you will witness over the span of you own career?