Markham's Behavioral Health

U.S. primary care near collapse, physicians warn

The American College of Physicians, according to a Reuters report on January 30, 2006, is warning that the primary care health system is on the verge of collapse.

Hello! I've known this was coming for 20 years and it will get worse before it gets better.

Want to know why?

You will hear all kinds of gobbeldy gook over the next few years, but the bottom line is that PCPs don't make enough money for all the work. It is as simple as that.

Managed Care companies reimburse for procedures not patient care. Primary Care Physicians, Pediatricians, etc. don't get paid for talking with patients, assessing medical conditions, and planning and organizing care. They get paid for giving shots, setting bones, and other mechanical tasks. On top of this, the overhead in a PCPs office is horrendous with all the cockamamie paperwork, billing, etc.

A PCP can make $125,000.00 per year if he or she is lucky. An Anesthesiologist can make $400,000 no sweat. Both have equivalent training, and the anesthesiologist has much less overhead and call.

Young physicians head for the specialties because that's where the money is not primary care.

If you want to know why the American Health System is so screwed up follow the money.

The question is not, did Dr. Johnson do a good job taking care of his patient. Rather, it's how's the stock doing?

Once creative answer is Simple Care.

Link: MedlinePlus: U.S. primary care near collapse, physicians warn.

Quote of the day

"When marrying, ask yourself this question: Do you believe that you will be able t converse well with this person into your old age? Everything else in marriage is transitory."

Friedrich Nietzsche

Why Molly Ivins won't support Hillary for President

On January 20, 2006 Molly Ivins states clearly why she won't support Hillary for President. I agree with her and have been thinking the same thing Molly articulates in her column. For months I have been feeling like I am nuts, and it is affirming that someone else who observes politics and the state of political affairs sees the same things that I do.

I'd like to make it clear to the people who run the Democratic Party that I will not support Hillary Clinton for president.

Enough. Enough triangulation, calculation and equivocation. Enough clever straddling, enough not offending anyone This is not a Dick Morris election. Sen. Clinton is apparently incapable of taking a clear stand on the war in Iraq, and that alone is enough to disqualify her. Her failure to speak out on Terri Schiavo, not to mention that gross pandering on flag-burning, are just contemptible little dodges.

Molly is from Texas, and I am from New York. I have to put up with Hillary's equivocating when she is representing me. She will be running for her Senate seat this fall and will surely win because the Republicans have no one to challenge her, but I don't know if I would vote for her if there was a half way decent alternative.

As Molly said, it would be nice to find a real leader and not some sychophant pandering to the base of the Republican party looking for a few cross over votes.

It seems to me that the mental health of the nation is in peril with all the lies and equivocating. It would be nice if we had leaders who have a vision for America that would restore our faith in ourselves again.

Link: I Will Not Support Hillary Clinton for President.

Oprah takes President Bush to the woodshed according to Andy Borowitz

On January 30, 2006 Andy Borowitz reports that Oprah has taken President Bush "to the woodshed".

Ms. Winfrey devoted an entire hour-long episode of her show to excoriating the President, who sat on her sofa and felt the full force of her wrath.

What inspired the talk show legend’s ire was Mr. Bush’s 2003 State of the Union Address, in which Mr. Bush claimed that the Iraqi dictator possessed weapons of mass destruction, claims that later proved false.

Read Borowitz's full report by clicking on the link below.

Link: The Borowitz Report .com.

The lie of "consumer driven health care"

What's wrong with Bush's idea about consumer driven health care? David Sirota has some interesting comments on his blog today, January 30,2006, that are well worth reading and thinking about.

Sounds like the theory of "consumer-driven" health care is on solid ground - until you realize one key flaw: creating a "consumer-driven" system requires consumers to be able to make informed choices about what they are buying. And the problem is that not everyone is a physician. How can a citizen be expected to know what health care services to buy and what not to buy if they don't have a medical degree? Consumers may want to save costs, but how are they expected to know to get this test, and not that test, this treatment and not that treatment, this surgery but not that surgery?

Look, there are a lot of areas where "consumer-driven" forces have played a terrific role. Take car insurance and mortgage rates - the Internet has allowed people to compare different rates and plans, creating more competition, and some downward pressure on prices. But that has only worked because insurance and mortgage rates/plans are fairly standard and can be understood by the average consumer with a little research.

The same, obviously, cannot be said about medical decisions. A consumer cannot possibly be expected to know what services to buy and not buy. There's a reason, after all, that doctors have to go to school for years and years and years before they are liscensed to treat people and make medical decisions for patients.

It is the shame of the United States that health care has been turned into a commodity to be bought and sold in the marketplace with the expectations that health care businesses can profit from human illness and disease.

Link: Sirotablog.

TV in the bedroom halves your sex life

Forget Viagra. Get rid of the freaking TV.

According to a study done in Italy reported by Reuters on January, 16, 2006, having a TV in the bedroom decreases sexual activity by as much as 50%.

A study by an Italian sexologist has found that couples who have a TV set in their bedroom have sex half as often as those who don't.

"If there's no television in the bedroom, the frequency (of sexual intercourse) doubles," said Serenella Salomoni whose team of psychologists questioned 523 Italian couples to see what effect television had on their sex lives.

I suppose less sex could be a good thing or a bad thing depending on your preferences.

Link: MedlinePlus: TV in the bedroom halves your sex life - study.

Concerta seems to help teens with ADHD

Reuters reported on January 13, 2006 on a study in the January, 2006 Archives of Pediatric and Adolescent Medicine which seems to show that Concerta helped decrease the symptoms of ADHD in adolescents.

Wilens, of Massachusetts General Hospital, Boston, and colleagues studied the effects of Concerta in 220 adolescents with a confirmed diagnosis of ADHD. They successfully identified an effective dose of the drug in 177 subjects and these individuals were randomly assigned to 2 weeks of treatment with their individualized dose or inactive placebo.

Compared to placebo, those given the active treatment showed a significant reduction in investigator-rated ADHD at 2 weeks. The investigators rated 52 percent of the methylphenidate patients as being "much" or "very much" improved, compared to 31 percent of placebo patients.

It is interesting, however, that about 1/3 of the patients improved with a placebo. How much of a difference is there between the 52% of the patients who showed improvement with the drug and the 31% without the drug?

I also don't know who did the study and whether they have ties to the drug company.

Link: MedlinePlus: ADHD drug may help hyperactive teens.

Quote of the day

"Truth is whatever power wants it to be, but what if the emperor has no clothes on even when it thinks and says it is dressed in the finest raiment? It's the beginning of the end. You can smell it in the air."

Harry Holleywood

Pataki tells Feds that Medicare D prescription drug plan is "not acceptable".

I am not a big fan of my Govenor, George Pataki, but by golly I am willing to give credit where credit is due and on January 13, 2006 he basically told the feds with their crazy insane Medicare Part D to go to hell, New York will take care of its own elderly and disabled at least for the next week. I give the guy a lot of credit and the Bush Administration is going to hell for this travesty that they have perpetrated upon Americans under the guise of helping them with the Medicare Part D prescription drug plan.

After the brownouts in California with the de-regulation of the utilities and the piracy by Enron, the pharmaceutical companies take over the Federal medicare drug program has got to be the ulitmate proof that Reagonite de-regulating free market policies can be very bad for Americans. Perhaps people's anger and outrage can be channeled for positive change to restore Americans' confidence in their government.

"We have worked hard during the past 11 years to ensure that all New Yorkers, and especially our seniors and disabled, have access to the quality health care and prescription drugs that they need. Today, nearly one million more people have comprehensive health coverage and 250,000 additional seniors now have access to affordable prescription drugs through EPIC.

"But in recent days, because of the new Medicare prescription drug program that has been put in place by the Federal government, there have been instances of people being denied their medications or being charged exorbitant amounts. That's not acceptable."

Not acceptable, indeed! So the Governor said that New York will pick up the tab for the next 7 days and settle up with the feds later. What happens after 7 days is kind of up in the air. I gotta feeling it is going to take Washington more than 7 days to clean up their mess. Meanwhile millions of American elderly and disabled will suffer along with their families, their caretakers, their physicians, their pharmacies, as they struggle with the fiasco that George built.

"In the meantime, to ensure that every New Yorker has access to the medications they need, I have directed the Department of Health to take immediate action to suspend current Medicaid rules and for the next seven days pay the costs of prescription drugs for those individuals who are eligible for both Medicaid and Medicare.

"We will seek reimbursement of these costs from both Washington and the health insurance plans that are receiving federal subsidies to provide drug coverage. Over the coming days, we will carefully monitor the situation and continually reassess our options to ensure that the new Federal program is properly implemented and New Yorkers are able to get the medication they need."

Link: www.ny.gov - STATEMENT FROM GOVERNOR GEORGE E. PATAKI.

16 States have turned psychiatric hospitals into jails

16 States have turned psychiatric hospitals into jails. In Rhode Island a psychiatrist had the integrity and courage to defy state authorities and refuse to civily committ a sex offender who had completed his prison term.

There is a good article in the January 20, 2006 issue of the Psychiatric News describing this issue. It is an issue which every American has a stake in.

For Rhode Island psychiatrist Brandon Krupp, M.D., it's as simple as this—psychiatric hospitals aren't jails, and psychiatrists aren't jailers.

That's what he told state authorities when he resigned from his position as chief of psychiatry at Eleanor Slater Hospital in Cranston, R.I., after Gov. Donald I. Carcieri sought continued hospitalization of a convicted sexual predator who had completed a 17-year prison sentence.

Krupp's resignation and his declaration—psychiatrists aren't jailers, hospitals aren't jails—have received widespread support. Even Carcieri, in a public statement about the case, seemed to acknowledge that hospitalization was not the ideal solution for what to do with people no one wants in their community.

Link: Psychiatry Chief Quits After Order To Commit Offender -- Moran 41 (2): 1 -- Psychiatric News.