Community Health Policy

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Orthopedic Procedures to be Avoided or Questioned

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Some orthopedic procedures should be avoided, or at least questioned

Common Sense Family Doctor is a regular feature on our website. Today’s topic involves orthopedic procedures. 

This essay from the Common Sense Family Doctor relates some interesting information that might provoke questions and even anger. But things we routinely did in the past (radiation for big tonsils, freezing duodenal ulcers, routine gallbladder removal for all gallstones) have fallen into disfavor based on better science.

This essay should at least call into question some procedures being recommended routinely.

Read the Common Sense Family Doctor here: Patients: steer clear of these six orthopedic procedures, published March 1, 2017

Sincerely,
Dr. Birdwell

Posted in: Community Health Policy, Health Blog

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Evidence Based Sleep Apnea Screening

Common Sense Family Doctor is a regular feature on our website. Today’s topic involves sleep apnea screening.

Read the Common Sense Family Doctor Here

Screening means testing people with no symptoms. Since it is difficult to make a person without symptoms feel better, the reason to screen is to find people who are “sick” (even though they show no symptoms) and for whom treatment may prevent serious or fatal things from happening.

Taking blood pressure is a good example of a simple screening test in a person having no symptoms, and we do it all the time because finding and treating high blood pressure is known to reduce the incidence of stroke and heart attack.

MainStreet Clinic treats a number of people whose fatigue, profound sleepiness, headaches, etc. are better because of treating their sleep apnea. But for people without symptoms, screening for sleep apnea would be beneficial only if it prevented bad things from happening in the future.

Advocates of sleep apnea screening point to the belief that untreated moderate to severe sleep apnea leads to cardiovascular events — strokes and heart attacks. But the latest and strongest clinical evidence refutes this. Today’s Common Sense Family Doctor explains why sleep apnea screening for people with no symptoms is not recommended in our MainStreet Clinic practice, and indeed in any evidence-based practice.

We believe in doing for our members what is of demonstrated value, based on you and the best information available.

Sincerely,
Dr. Birdwell

Posted in: Community Health Policy, Health Blog

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Health Screening Data and Harms

Here’s a timely essay on health screening data. The Common Sense Family Doctor says, “Causing needless worry about cancer or another absent health condition can seem trivial compared to the prospect of saving a life.” But there are many harms associated with many types of screening, and the data on lives saved is actually quite surprising.

Read more about the psychological harms of screening

Sincerely,
Dr. Birdwell

Posted in: Community Health Policy, Health Blog

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Quality Health Care Is About Time, And The Time Is Now

By Jeff Davenport, MD (Edmond) and Brian Birdwell, MD (Lawton)

First published in the Lawton Constitution

Grand schemes by government and large corporations to reform health care in the U.S. always have good intentions and yet they all share one failure: they overlook the front lines of health care, which is the primary care physician’s office.

Primary care doctors have been put in a vise by the efforts of insurance companies and Medicare to manage health care costs through price controls and imposed regulation. The paperwork burden on physicians for coding, filing insurance claims, submitting documentation and phone calls to payers adds $50 on top of the real cost for every patient encounter. Adding insult to injury, both public and private payers restrict the compensation physicians can receive for providing patient health care, which inevitably cuts down the time we may spend with our patients. To make financial ends meet, the typical primary care physician has less than 15 minutes of actual face-time with each patient.

This might be an acceptable burden if it led to quality care and patient satisfaction. But sadly, quality and satisfaction are the worst casualties of public and private sector attempts at managed care.

The most valuable component of primary medical care is TIME: time with patients; time to listen and to let patients know they are being heard; time to learn about everything that impacts our patients’ health; time to coordinate all the factors and render the highest quality of care, based on our medical training and professional judgment; time to actually care. Because “it’s about care, not coverage.” *

Entering into primary care has become an unappetizing career path for residents emerging from medical school. And this at a time when public health experts are pointing to a potential crisis in insufficient numbers of primary care doctors.

But there is hope.

A new medical and business model for the primary care doctor’s office is catching on. We call it “direct primary care,” because it is based on a simple idea: the patient joins the doctor’s clinic as a member, pays the doctor directly, and now, the doctor works only for the patient.

For around the cost of a monthly cable or cell phone bill, most consumers can be assured of access to their doctor, when they need it, and comprehensive primary medical care throughout the year, including preventive care.

We have established this direct primary care model in our clinics and hear from many other Oklahoma physicians who want to do the same in their health care practice. We agree that health insurance is an important protection, and with this model, insurance can be reserved for its true purpose: unplanned or prohibitively expensive procedures for an individual or their family.

As primary care doctors, we are not alone. Innovative employers are stepping up to offer their employees reimbursement for direct primary care membership fees. And now, thanks to the leadership of Senators Rob Standridge of Norman and Ervin Yen of Oklahoma City, the Oklahoma Senate Insurance Committee has passed Senate Bill (SB) 560 to protect patients’ and physicians’ rights to enter into direct primary care membership agreements without the interference of insurance regulations.

Voters, please contact your representatives in the legislature and thank them for supporting SB 560 in the Senate and the House. And physicians, please take a close look at direct primary care and ask if this health care model is right for you and your patients. It’s about time.

Jeff Davenport, MD is a family physician and owner of One Focus Medical in Edmond. Brian Birdwell, MD is an internist and occupational medicine physician, owner of MainSt. Clinic in Lawton. 

* “It’s about care, not coverage.” is a registered trademark in the U.S. by Direct Care Partners, LLC in Lawton, Oklahoma.

Posted in: Community Health Policy, Direct Primary Care

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