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Whom Does the EMR Serve? Who Owns and Who Needs THE STORY? Print E-mail
Written by A Country Doctor Writes   
Saturday, 17 August 2019 12:22

I have advocated before for putting a visit synopsis at the beginning of each visit note. I have called that the aSOAP note. I think that works immensely better than APSO notes that only rearrange the order of the elements. The reason I say that is that in today's EMR notes, it's too darn hard to find THE STORY. If a note is half a dozen pages or scrolls long, why would I want the medication changes and the reason why they were made at opposite ends of the note? The order means less than the distance between them in my opinion. The way I approach reading a note is with the two questions "What happened in the last visit?" and "Why was that the clinical decision?" In more and more of my office notes I answer these two questions for future readers, which would include me, in temporal, typographical and spatial connection with each other, right on top.

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Meet Dr Gary Donovitz: BHRT Trailblazer and Physician Entrepreneur Print E-mail
Written by Jeffrey Herschler   
Thursday, 01 August 2019 12:51

It's a quiet mid-summer evening in Ft. Lauderdale and twenty or so healthcare professionals are gathered in a posh private dining room at Timpano Italian Chop House on Las Olas. The restaurant offers a cool respite from the sweltering heat as well as the usual upscale comfort food. But that's not why we are here. The audience is here to listen to Dr. Gary Donovitz, a medical doctor with a specialty in OB/GYN and founder of BioTE Medical, a provider of bioidentical hormone replacement therapy (BHRT) to help solve hormone imbalances in both women and men. Based in Arlington, Texas, BioTE Medical's provider network exceeds 3,000 throughout the U.S. Dr. Donovitz, or Dr. D as he is affectionately known by colleagues, is also the author of the bestselling book AGE Healthier Live HAPPIER.

Dr. D arrives a little late and almost immediately starts his presentation. Fit, charming and assertive, he immediately impresses the mostly physician audience. BHRT is controversial and Dr. D addresses that head on. First, he points out that the bioidentical hormones (harvested from yams) that he recommends are not the synthetic animal-sourced hormones of the 1990s. Further, according to Dr. D, BioTE's pellet insertion method is vastly superior to creams, pills, patches and other delivery systems. He then goes on to debunk the critics who question the efficacy and safety of his BHRT program. He is eloquent, persuasive and has all of his extensive data memorized. "The slideshow is for the audience. I never look at the slides," he states. Any notion that Dr. D is a conventional physician evaporates early on when he tells the audience "I don't mind if you prescribe statins to your patients as long as you don't mind the elevated risk of osteoporosis, myopathy and metabolic syndrome associated with long-term statin use." After determining there are no cardiologists in the room (at least no one who would admit it!), Dr. D points out that "statins do not improve cardiovascular outcomes in individuals with elevated cholesterol who have not a had a heart attack or stroke." There were no objections from the audience, and one got the definite impression that Dr. D was hoping someone would speak out so he could continue to spar. He then re-focuses and, in painstaking detail, lays out his case for BHRT. His message is simple: Not only are bioidentical hormones safe, they improve quality of life and potentially extend it.

Untainted by the Big Pharma juggernaut, bioidentical hormones are created in compounding pharmacies and sourced from plants. They have been around since the 1930's and are embraced by alternative medicine providers but viewed skeptically among many conventional medical doctors. "Our goal is for BHRT to go mainstream,'' states Dr. D flatly. "We've done procedures on over a million patients and the establishment can't deny the positive results forever."

Dr. Donovitz started his career in the typical way. He states that, after finishing medical school at the University of Texas School of Medicine at San Antonio in 1980 and completing training, "I delivered a lot of babies." Before long, he grew interested in improving the quality of life of his patients and was intrigued by the potential offered by BHRT. He opened the Institute for Hormonal Balance in Arlington, Texas in 1985. After observing the results of BHRT first-hand, he saw the potential to grow the business beyond his Texas based practice. "I realized that if I scaled this business up, I had an opportunity to improve the lives of thousands," he asserts. He also saw a chance to apply his passion to teach and train other physicians eager to improve the quality of life for their patients. "Despite the fact that 'medical' is in our name, we are not a medical company," Dr. D states. "We are a consumer company." The company turns away BioTE provider applicants who are not in it for the right reason. "Yes, you can make money as a BioTE provider but, if that's your primary motivation, we don't want you," he states. For BioTE Medical, it's all about the patient and their quality of life.

Today, Dr. Donovitz stays busy running the Institute with his daughter Mandy Donovitz Cotten, Family Nurse Practitioner. He travels frequently for BioTE to lead training and education programs and constantly corresponds with the various medical societies to challenge their negative views of BHRT. He's got a CEO to manage day to day operations so he can concentrate on the things he loves. "A smart entrepreneur avoids the founder's trap," he asserts. "This is a billion-dollar company and I am not a billion-dollar company CEO." BioTE's central tenet is that hormone balance offers a genuine opportunity for people to have more successful careers, better relationships, and more productivity through the seasons of their lives. The skeptics are still out there but Dr. D's mission is to convince the naysayers one at a time.

BHRT is credited with the following outcomes:
  • Reduced fatigue
  • Increased sex drive
  • Less hair thinning
  • Reduced hot flashes
  • Less dry skin
  • Improved sleep
  • Reduced bloating
  • Better thinking and memory
That's a pretty impressive list for a natural, affordable remedy. This author has no doubt that the BHRT skeptics would be delighted to be proven wrong.

Last Updated on Thursday, 01 August 2019 13:36
How Much Should Physicians Touch? Print E-mail
Written by A Country Doctor Writes   
Friday, 26 July 2019 16:24

Touch is a sensitive thing. No pun is intended here, but whether and how we touch our patients deserves our careful thought and deliberation. So much interpersonal contact these days is virtual, with emojis, abbreviations and whole words thrown around as substitutes for human contact. Think :-), XOXO and "Hugs and kisses". And when people do touch in our healthcare environment it is often with gloves, even for simple fingerstick blood sugars, immunizations or routine ambulance transports. Shaking hands when you meet a patient for the first time is not standard procedure by any means. I wonder if it shouldn't be in this country. There's a lot of cultural history behind such a simple gesture.

When medical science becomes fake news Print E-mail
Written by FHI's Week in Review   
Monday, 24 June 2019 11:23

Brian C. Joondeph, MD contributes an enlightening post on June 22, 2019, via KevinMD:
Every week there is another health pronouncement saying what is now good for you and what is going to kill you. Unfortunately, the "what" is often interchangeable - what was supposed to kill you last week is now suddenly good for you or vice versa. Foods, supplements, and activities, all studied extensively and determined to be either good or bad, then subject to a new study, with the opposite conclusion. How can this be? Is the science that fickle? Or is this lousy research?

Read more in the current issue of Week in Review>>

Last Updated on Monday, 24 June 2019 11:29
The ethics behind the world's most expensive medication Print E-mail
Written by FHI's Week in Review   
Monday, 17 June 2019 11:52

Robert Pearl, MD, in a KevinMD post dated June 14, 2019, states:
With the recent FDA approval, Zolgensma <Novartis AG> became the  world's most expensive medication. Priced at $2.125 million per patient, the one-dose gene therapy is a potential life-saver for children with spinal muscular atrophy (SMA). Now, the treatment is at the center of an intensifying debate over the rising price of medications

Read more in the current issue of Week in Review>>

Last Updated on Monday, 22 July 2019 16:44
In our health system, who owns patients? Print E-mail
Written by FHI's Week in Review   
Monday, 10 June 2019 17:32

Philip A. Masters, MD authors an insightful piece in KevinMD on June 7, 2019. According to Dr. Masters, VP, Membership and International Programs, American College of Physicians, patient ownership "reflects a rich, complex, and multifaceted concept that has served as a foundation on which medical practice has been built over the course of history." Dr. Masters goes on to describe how many of the changes in our current health system are undermining this central value in medicine. 

Read more in the current issue of Week in Review>>
Physician Burnout Takes Center Stage Print E-mail
Written by Jeffrey Herschler   
Thursday, 06 June 2019 00:00

Physician burnout has been a hot topic in the news media lately and now a new report from the Annals of Internal Medicine puts a dollar figure on the issue: $4.6 billion. (NPR does a great analysis of the report HERE.) This is, according to the authors, a conservative estimate. Clearly, our overburdened health system can't afford this level of waste. 

Daniel Marchalik, a surgeon, contributes an excellent essay on the topic from a physician's perspective in a recent Washington Post article. (Soft paywall; login may be required.) Not surprisingly, Dr. Marchalik puts the blame squarely on EHRs. This new requirement of onerous data entry plus consolidation in the health sector, which reduces physician autonomy, appear to be the main drivers of the epidemic. Meanwhile, a Kissimmee, FL based physician has just written a book on burnout. 
So, there is lot of anecdotal evidence of the growing problem as well an enormous cost estimate delivered by a prestigious medical journal. But what is being done?

Lots of organizations are working on potential solutions. Stanford University just announced a collaboration that attempts to address the issue and research is being done on AI applications. Now that a dollar figure has been assigned, more help is surely on the way.
And it can't come soon enough. According to  practice management consultant Oyinkansola "Bukky" Ogunrinde, MHSA, "Physician burnout is not only financially costly to healthcare systems, but it also has implications in the quality of care rendered to patients which can result in compounding legal and immeasurable cost to health systems and affected patients respectively."
"Now that the World Health Organization has categorized burnout as a syndrome listed in the International Classification of Diseases - ICD-11, perhaps this will catalyze many organizations' efforts to combat the problem," she adds. "If not, the industry can expect governmental intervention by way of workplace laws and healthcare regulations - dictates that often result in additional and disproportionate cost."

Last Updated on Friday, 19 July 2019 16:31
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