Friday, February 3, 2017

When the Doctor Doesn’t Look Like You

So, your doctor doesn't look like you ?  Don't sweat it !

For more than 50 years, international medical school graduates have filled the gaps in the physician work force in the United States. Currently, they make up fully one-quarter of all practicing physicians, and although a majority are foreign-born, approximately 20 percent are American citizens who have chosen to go abroad, most notably to the Caribbean, for medical school.
Regardless of whether they are United States citizens, all international graduates must go through an arduous regulatory process before practicing in this country, a process that includes verification of medical school diplomas and transcripts, residency training in American hospitals and the same national three-part licensing exams and specialty tests that their medical school counterparts in this country take. Many go on to choose specialties or work in the rural and disadvantaged geographic locations that their American counterparts shun. International graduates, for example, now account for nearly 30 percent of all primary care doctors, a specialty that has had increasing difficulties attracting American medical students.
Editorial comment:
That figure, 25% surprised me.  However in some regions of the U.S. the figure is much higher, especially in rural areas, or less attractive settings.
Though these doctors have filled an important national health care need for over half a century, doubts regarding the quality of care they provide have continued to plague them. Health care experts interested in this issue have been stymied over the years by inadequate methodologies for evaluating the effectiveness of large groups of physicians and so have chosen instead to focus on exam scores, an admittedly crude proxy for quality of care.
Though these doctors have filled an important national health care need for over half a century, doubts regarding the quality of care they provide have continued to plague them. Health care experts interested in this issue have been stymied over the years by inadequate methodologies for evaluating the effectiveness of large groups of physicians and so have chosen instead to focus on exam scores, an admittedly crude proxy for quality of care.
But even that data has proven confusing. Studies initially revealed that international graduates tended to score lower, while more recent research shows that they routinely outperform their peers on training exams in areas like internal medicine.
Now researchers from the Foundation for Advancement of International Medical Education and Research in Philadelphia have published the first study incorporating new research methods for evaluating the performance of large groups of physicians. And it turns out that contrary to certain individuals’ worst fears, accent or nationality did not affect patient outcomes. Rather, the main factor was being board-certified: completing a full residency at an accredited training program, passing written and, depending on the specialty, oral examinations, and having proof of experience with a defined set of clinical problems and technical procedures.

Foreign medical graduates also tend to 'cluster' choosing to practice in like minded communities, Asian, Phillipino, Latino, Jewish, and other minorities. These demographics also tend to refer internally when possible.

Racial prejudice exists even in health care.




How Good Are Foreign-Trained Doctors? - The New York Times

Wednesday, February 1, 2017

Did President Trump Just Save Western Civilization?

My mind has been busy analyzing the UNpredictable actions of Donald Trump.

It should be no surprise to you Donald Trump grew up as a CEO of an enterprise.  His mantra is take charge and own your decisions.  CEOs report to their Board of Directors and must inevitably satisfy them and the shareholders. Shareholders like dividends,  from profits.  Enough said?  The U.S.A. by any financial analysis is in debt by  20 trillion dollars.  How much are our assets ?  Accountants will tell us that our net worth is the amount of assets less our liabilities (debt). Are you getting the picture?

The mainstream media spent the weekend lying about President Donald Trump instituting a Muslim ban, lying about the contents of the recent executive order, lying about those impacted by the new guidelines and lying about why seven specific countries were included in the travel restrictions.

President Trump was painted as a monster for placing a temporary ban on accepting Syrian refugees - while other world leaders bent over backwards to virtue signal and express their willingness to destabilize their countries.

While the mainstream media, politicians, corporations and Hollywood celebrities were virtue signaling - President Trump made a few phone calls and may have just saved Western Civilization


The financial facts are outlined in this You Tube Video by Stefan Molyneux, the voice of Freedom Radio.


Trump has the integrity to lead, and not follow.  The media only reports part of the story choosing to focus on the headline rather than the meat of the story.  Hence the great outcry when 500 . or so regugees and Visa card holders were temporarily held from entering  OUR country. They were individually vetted and those who cleared were allowed admission to our free country.  Freedom cannot endure without order and a plan. Yes, many were inconvenienced.  Trump has our attention, and hopefully those who sit on the couch never questioning, nor participating in the American experiment will wake up.  It will take some time to filter the swamp.

Trump is the ultimate negotiator. He leads with a high price from which he can afford to offer relief when the other side contributes to the deal.

Mr. Molyneux has given me great hope with his knowledge and explanation of what Donald Trump was up to this past week, while women were marching (by the way that march was planned months ago as a victory parade for the defeated Hillary Clinton,  not as an anti-trump protest)

DISCLAIMER:  I am not an avid supporter

Monday, January 23, 2017

The Story of Your Enslavement

It seems fitting to analyze the quick shift from liberal to conservative government.  Can we even define the change in those terms.?

The ruling congress is Republican while the President can hardly be called a Republican except for his ties and history of capitalism.  The Democrats have been flailing about  with larger and larger government and never ending hackneyed sound bytes about social welfare and increasing health care bureaucracy while at the same time blabbering on about health care savings.

Are we enslaved by either system?  Do both systems prey upon us in a universal manner ? The video should prick your interest.

Wednesday, January 11, 2017

Healthcare Stole the American Dream - Here’s How We Get it Back | Dave C..., Bay Area Cancer Patient.. - gmlevinmd@gmail.com - Gmail

Healthcare Stole the American Dream - Here’s How We Get it Back |



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Doctors giving regular checkups will get the most bang for their buck if they advise adults to quit smoking, convince teens to never start, and keep children 

Monday, January 2, 2017

Top 12 Inspirational Leadership Quotes For 2017

New Year's is the time for resolutions.  Here is the  checklist for your leadership traits.

A good place to start is to review the qualities and practices of exceptional leaders, which have remained the same since the beginning of civilization, as summarized in a book M.A. Soupios and I co-authored, The Ten Golden Rules of Leadership.

Here are 12 quotes from the book that provide a glimpse into the qualities and practices of great leaders:
  1. Skills and experience might land you a leadership position, but they don’t make you a true leader.
  2. Leadership comes from inside—and the greatest leaders first question themselves before they tackle the world around them. To aid in this critical interrogation.
  3. The "fate" of organizations is not based on the stars. The character of an organization's leadership determines a company's destiny.
  4. The assumption of authority brings out the leader’s inner world.
  5. Leadership cannot be done by the numbers.
  6. Toxic environments are not the result of spontaneous bad fortune. They are the resultof toxic leaders.
  7. Of all the many potential shortcomings an assumed leader might bring to an organization, nothing is more lethal than the arbitrary application of power.
  8. Supervisors who constantly micromanage, who second-guess every subordinate decision, who gleefully await any and all opportunities to criticize and bully, are a toxic presence in any environment.
  9. The most lethal distortions come not from the lips of our opponents or competitors. They tend to flow, instead, from our own hearts.
  10. Truth is an invaluable corporate asset. Don’t let it go waste. Embrace it.
  11. Never underestimate the power of personal integrity; always set an honorable agenda; adhere to a code of professional conduct; never try to justify dishonesty and deceit; rather fail with honor than win by cheating.
  12. Honest assessment is an essential requirement of effective leadership….The problem is that the higher up the ladder you go, the less likely it is that you will receive complete and accurate information.

The Ten Golden Rules Of Leadership

The answers to these questions are condensed in a little book The Ten Golden Rules Of Leadership (New York: AMACOM, 2015) I co-authored with Michael Soupios.
Rule 1 Know Thyself
Rule 2 Office Shows The Person
Rule 3 Nurture Community In The Workplace
Rule 4 Do Not Waste Energy On Things You Cannot Change
Rule 5 Always Embrace The Truth
Rule 6 Let Competition Reveal Talent
Rule 7 Live Life By A Higher Code
Rule 8 Always Evaluate Information With A Critical Eye
Rule 9 Never Underestimate The Power of Personal Integrity
Rule 10 Character Is Destiny

True leadership is ultimately traceable to factors of character and personal integrity; much of what called “destiny” lies in our hands, not in mysterious forces beyond our control.








Top 12 Inspirational Leadership Quotes For 2017

Monday, November 16, 2015

Teaching Doctors the Art of Negotiation - The New York Times



Doctors negotiate every day, almost constantly — sometimes dramatically, often imperceptibly. They hold family meetings to resolve sensitive end-of-life issues. They address barriers to medication adherence. They encourage patients to receive uncomfortable screenings like colonoscopies and mammograms. They refuse treatments that are requested but not medically indicated. Yet they receive almost no formal instruction in how to do so.
Dealing with medical colleagues creates an additional layer of negotiating complexity—especially in busy academic centers with competing demands on specialists’ time. Medicine is increasingly a team sport. In 1970, only about 2.5 full-time clinical staff cared for the average hospital patient; today, that number is greater than 15.
Doctors consult other doctors many times a day to discuss potential treatment options and decide on the best course of action. They work closely with residents, students, nurses, physician assistants, care coordinators and others to implement those plans. At each interaction, opportunities for collegiality and efficiency — or rancor and resentment — abound. That can mean the difference between a timely or delayed blood draw, accepting or refusing a consult, or getting those biopsy results today versus tomorrow.
Recognizing the importance of negotiation, medical schools are starting to invest in communication training for students — and it seems to be paying off. Research suggests communication training can improve patient adherence, diagnostic accuracy and chronic disease management. But good communication, by itself, is only part of the solution. We need to teach doctors how to negotiate.
Negotiation, in this context, is not about winning or losing, or haggling over price or scare resources. It’s about exploring underlying interests and positions to bring parties together in a constructive way. It’s about creative, innovative thinking to create lasting value and forge strong professional relationships. It’s about investigating what is behind positions that may seem irrational at first to understand the problem behind the problem.
The medical profession is no longer one in which doctors dictate a given treatment course to patients, who are then expected to follow it. Rather, clinicians and patients deliberate about treatment options, weigh costs and benefits together, and determine the best course of action. This approach requires eliciting patient concerns and addressing underlying fears to arrive at the most effective strategy for maximizing health and well-being. As diseases like H.I.V. and some cancers that were once uniformly fatal become chronic conditions, and a greater diversity of treatment options becomes available, the ability to negotiate long-term care plans will only grow in importance.
Physicians are also increasingly assuming leadership roles. They are expected to negotiate with a vast array of third parties, including health plans, governments and pharmaceutical companies. Health care changes double down on this expectation. The Affordable Care Act creates incentives for doctors and hospitals to band together to create networks known as Accountable Care Organizations — provider groups responsible for caring for an assigned patient population. Under new Medicare rules, providers can be paid less if they have low patient satisfaction scores or excessive readmissions. As quality metrics and cost-effectiveness play a larger role in reimbursement, physicians will need to negotiate with governments and insurers to establish fair and reasonable performance measures.
Each medical encounter, then, becomes a multiparty mini-treaty signed by doctor, patient and family members — and sometimes, consulting physicians, ancillary staff, insurers, hospitals and governments. Law, business and public policy schools all offer classes in negotiation, recognizing the interdisciplinary and interdependent nature of their professions. Isn’t it time medical schools did, too?
Remember, almost everything is negotiable.

Dhruv Khullar is a dual degree candidate at the Yale School of Medicine and Harvard Kennedy School, where he is a fellow at the Center for Public Leadership. Follow him on Twitter:@DhruvKhullar.










Teaching Doctors the Art of Negotiation - The New York Times