Meme: EHR Dreams vs. EHR Reality

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7 Reasons Why President Trump Can’t Repeal Obamacare.


Republicans have been waiting a long time for this moment. They have tried, time and again, (and again and again!) to repeal Obamacare. Now at long last, after sixty previous attempts to overturn the Affordable Care Act, commonly known as Obamacare, their moment has arrived. President-elect Trump has made it clear that overturning the law would be a priority, as has Paul Ryan. We all watched the surreal and awkward moment, when the current President welcomed into the White House the man who would be responsible for overturning what he thought would be his legacy. President elect Trump believes that he can repeal Obamacare and return premiums to their previous levels. But I think Obamacare will live on in one form or another, here’s why.

  1. Millions will lose health insurance.

Before Obamacare took effect, nearly 20% of the US population did not have health insurance. The number of people who had access to insurance through an employer had been steadily dropping, the drop disproportionately affected low income levels. Those are the exact people who the law targeted. You know those people, you are those people. Working 2 or 3 part time jobs in our new economy and getting health insurance from none of them, yet being too “rich” to qualify for Medicaid. Either through exchanges, through Medicaid expansion, or through young adults on their parents’ plans, Obamacare now covers about 20 million people.

What does it sound like when 20 million people lose health insurance? Hand clapping, vigorous hand shaking, and hugs.

2. Removing “The Mandate” won’t work.

The requirement that people purchase health insurance  is reviled by many, on both sides of the aisle, and was the cause of a failed supreme court challenge.Yet, over the years the rhetoric has changed from “repeal” Obamacare to “repeal and replace”. Why? As unpopular as the mandate is, some parts of Obamacare are actually pretty popular. Like how insurance can no longer weasel out of covering kidney stones because you having kidneys was a pre-existing condition (true story!).

If President Trump cherry-picks these good parts and removes the mandate he is going to be accomplish one thing: He’s going to jenga the heck out of America’s private insurance market.

Why? Insurance can only be as cheap as the people in the plan. If you remove the mandate forcing healthy people to purchase plans, the costs will continue to increase, and that “death spiral” that Republicans keep talking about is going to become their problem.

3. Your rising insurance premiums: It not Obamacare, it’s Epipens.

Ok, that was a catchy title, but I can’t really pin this one on Mylan, though I really, really want to.  The truth is that premium increases– perhaps the very thing thing that spurred many to go to the polls– have very little, if anything to do with Obamacare. The real reason behind the increase in our health premiums is simple; our health care system is just too damn expensive. The rise in medical costs has far outpaced wage increases for the last few years. My own health care premiums and  deductibles started jacking up beginning the year before Obamacare took effect, and have continued to rise since then, as likely yours have too. As much as we would like to believe it to be so, there is simply no rule or regulation within Obamacare that would cause these increases in costs. But there are plenty of new technologies that would.

Right now, hospitals all over the country, are replacing their CT scanners with newer ones that are much more sophisticated, more precise, and significantly shinier. Oh they’re also a hell of a lot more expensive, too. Ask any radiologist worth their chops and they’ll tell you that the newer machines are not truly necessary. So why are they changing them? So they can advertise to you, dear patients,  that they have the best new technology. Multiply this technology factor by dozens of departments and again by thousands of hospitals, clinics, and medical offices across the country and you start to get the gist of what I’m talking about here.

But actually you still haven’t. Because while you’ve heard of epipen, you haven’t heard of the numerous other drug makers who are busy rebranding, repackaging, and reinventing their old medications so that they can re-patent them and hit you right where it hurts the most. The crotch. Oh you thought I was going to say something else there? No, they are all trying to intentionally kick us in the collective crotch. How else were they supposed to grab your wallet? It’s at that moment, that you get a letter from your insurance company stating that your insurance premiums, copays, and deductibles have increased for the fifth year in a row. And that’s when know this game of Roshambo is in full swing. Continue reading

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Top 5 Things That Indian People Hold Sacred (besides cows).

Being an Indian American doctor who happens to be Hindu, I hear a lot from patients, staff, and in the public sphere about my apparent “worship” of cows. This characterization represents a misunderstanding of the complex role that the cow has played in Hindu mythology. Volumes could be written about this, but to boil it down to a few sentences, I would say that the roots of Hinduism go back to an agrarian culture. Having cows not only meant financial stability,  but their milk provided sustenance that kept people alive. Many incorrectly  refer to the appearance of a Hindu god taking earthly presence in the form of a cow as proof of the cows divinity. But actually they’ve got it backwards, the cow is not sacred because it appears in scripture, it appeared in scripture because of its value to sustaining life. That reverence to the cow is one which has been handed down through the ages. To put it simply, bovinity does not equal divinity, rather it may be the other way around.

While most people are aware of the cow’s revered place in Hindu society, many are not aware of the multitude of other things that Indians also revere. Here’s a list of 5 things that Indians also hold as “sacred” that many people do not know about, but probably should!

1.   Doctors: Relative to American doctors, Indian physicians are compensated much less. But the admiration and respect they command in Indian society is vastly greater. Indian physicians enjoy a revered place in Indian society that far supasses the place of American physicians today.

2.   Books: While America’s libraries are struggling to stay relevant in the internet age, books have always held high regard in Indian society. In my household, books were never to be defaced or damaged, or God forbid, placed  on the floor! Books are not supposed to be left open, but rather they are supposed to be closed and put away after being read.

3.   Parents: This may sound quaint, but respect for elders is elemental in Indian society. Growing up in an Indian household, the word of ones parents is akin to the word of God. Thus it is common for adult children to care for their elderly parents. Placing parents in a nursing home is uncommon as adult children often live in extended households and care for their parents as they age. Continue reading

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Why Doctors Don’t Like to Send You Test Results.

 Recently I  read an article in the NY Times by Elisabeth Rosenthal. She’s the same author of the enlightening article “My doctor charged me $117,000 and all I got was this lousy hospital gown” That may not have been the exact title of the article.

Following that article she wrote a follow-up about the long and difficult ordeal it was to obtain medical records for the original article,  and how silly this seems in this modern technology age. Indeed, if Netflix can beam movies directly to your google glasses, why wouldn’t healthcare providers and facilities be able get  them to you nearly as quickly.

In this she asks a profound and important question that requires a nuanced, intelligent, well researched answer. This she did not not provide.  Instead she, in my opinion,  callously and cynically took the low road in positing that physicians are money grubbing, greedy bastards who hoard the medical records of their patients in order to keep them coming back. Furthermore, she states, we do so while hiding behind a feigned wall of privacy concerns.

Ms. Rosenthal  makes these bold statements on the basis that they must be factual because a Harvard Law professor told her so.

And who knows more about medicine than lawyers, right? Continue reading

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Doctors’ Prescription to Reduce Gun Violence

Like a lot of people, I get pretty numbed to gun violence on television. I stopped watching the local news because all they seem to show is news about shootings. The general public’s perception about gun violence is that it’s always somebody else, that the person  who was shot had somehow been involved in crime. The numbness we feel to gun violence often ends for most of us when things hit close to home, when you or someone you know is affected.

That happened for me 15 years ago,  as I was off in medical school in another country. I got a call that a childhood friend had been killed, shot in the head while driving to his job in Danbury, Connecticut. We had been best friends since the moment we met in first grade at St. Rose elementary school in Newtown. We were buddies through grade school, his house was my first sleepover. He taught me some of his karate moves. But while he probably could have beat up any of us, he never fought with anyone except for the time some kid in class started calling me the “N” word.  We remained best friends until I switched schools in 6th grade. After I heard the news, I was immediately ashamed that I had not really kept in touch with him since high school. There was no known motive for Mark’s shooting, his life and everything he would have been was just erased from the earth, without reason. To this day, his crime has not been solved.

Things rang close to home again more recently, as I was making rounds in the hospital. I was aghast to see, on a patient’s television screen, an aerial view of people running out of my hometown’s other elementary school, Sandy Hook elementary, which my brothers and sister had attended years ago. Continue reading

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Stem Cells and COPD: What You Need to Know.

I enjoy fielding questions from patients. Yes, I sense you’re rolling your eyes, but really, anything that I can answer that helps keep them out of the hospital is, I feel, time well spent. Recently though,  I’ve been fielding a number of questions that have me concerned. These questions often have a leading tenor about them like, “are you using stem cells for COPD yet?” The questions imply that stem cells are the de rigeur treatment for COPD. Now I may not be at the leading edge of any fashion, but being unfashionable in my treatment regimens? Never!

I can’t blame anyone for wanting to seek out treatments for COPD. It is after all, a leading cause of death and illness in the U.S. And it’s widely regarded that the changes caused by COPD/emphysema in the lungs are permanent. While there are now several different treatment options for emphysema/COPD, very few can prolong life. So if I had a family member with emphysema, I might naturally seek out treatments for COPD that go beyond the usual treatments, and with all the hype surrounding stem cells, why not take a look?

What people find when they google “stem cells and COPD” is in a word, distressing. It’s a fantasy world full of promises of health, healing, and better breathing. Equally distressing are the things that people who visit these sites aren’t recognizing: the greed, lies, lack of ethics, illusions, and misleading claims. Continue reading

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Top 5 Ways That Television is Ruining Your Sleep.

As a sleep physician, I spend a lot of time educating patients about what sleep is and how it works. Sleep, as I often explain, is not simply the lack of being awake; anymore than landing a plane is simply the lack of flying. It’s becoming increasingly understood that sleep is an actively generated state, created by a series of neuro-hormonal changes which work in concert to nudge the brain into the sleep state. To stretch the plane analogy further, if being asleep were like the plane being on the ground, then falling asleep is like the act of landing the plane. And just like when you land a plane, there are a lot of variables that are involved. There are numerous events that must happen in succession, each affecting and triggering other events which ultimately induce the brain to sleep. A recent study demonstrates just how watching too much television can wreak havoc in this delicate process. Here’s just a few of the ways that television can ruin your sleep.

     5. Watching television makes you go to bed later.

Television watching has steadily increased in our society, and its migration into our bedrooms marked a time when it began to disrupt our collective sleep and sleep habits. The most obvious effect that this might have is the most simple; we stay up later watching a program that has our attention. This few minutes a night may seem innocent enough. But our brains have a pre-determined amount of sleep they need to function well. When we miss that sleep we build up a “sleep debt” that can make us tired all of the time. Even if we catch up on a bit of sleep the next day, unless that sleep debt is paid back, the brain will still be fatigued.

     4. Watching television alters your brain’s bedtime habits. Continue reading

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The Shocking Truth Behind “Shocking” Healthcare Social Media Statistics

As a regular follower of social media, I am keenly aware of changes in the healthcare landscape as it relates to social media. While there’s much talk about the impact of social media in healthcare, most of the action sits on the consumer side of the equation. Much of the medical world has to yet to tap into its potential. For most healthcare providers social media engagement amounts to little more than watching as others dip their feet, testing  the waters. A few watch as they anticipate their own entry into the arena. Still many others watch with the expectation that the water would soon become bloody.

So its with a burlap full  of salt that I read various healthcare social media stats promulgated in various infographics, twitter feeds, and blog posts celebrating Medicine 2.0 powered by social media. Collectively they hash and rehash a series of surprising statistics that aren’t exactly bogus, but aren’t exactly completely factual either.

A recent one caught my eye with the claim was that “53% of physicians practices have a facebook page”. This was curious to me, because as I read this in the physician lounge and  took my own poll, the results was much closer to 5% than 50%. Continue reading

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Top 5 CPAP Travel Tips from a Sleep Doctor and CPAP User.

Sleep Apnea is a condition that aflicts millions of people.  There are 2 types of sleep apnea, central, and obstructive. Obstructive is by far the most common, and is usually what is referred to when people talk about “sleep apnea”. Obstructive sleep apnea occurs when, during sleep, the airway passages in the throat close and block the movement of air. Common symptoms are snoring, gasping during sleep, sleepiness during the day, and the overall feeling that your sleep was not restful. While we all may have a laugh recalling that uncle or grandpa that was “sawing logs” all night when they slept over, the truth is that sleep apnea can have profound negative effects on overall health. Sleep apnea has been linked with stroke, cardiovascular disease, hypertension, and is an important contributor to deaths and injuries due to traffic accidents. The most common and effective treatment for sleep apnea is the use of a CPAP (Continuous Positive Airway Pressure) device. As a sleep physician, and a CPAP user myself I know the importance of using your CPAP whenever you sleep, that includes during travel.

Whether I’m travelling across a state line or an equatorial line, whether the destination is medical education, or a mediterranean beach, my CPAP is along for the ride. Because of this, I’ve also run into pretty  much every complication, problem, pitfall, morass, and quagmire that you can have when travelling with your CPAP. Thus I present to you, gleaned from both my experiences and those of my patients, my Top 5 tips for travelling with your CPAP.

  1. Bring Your CPAP With You!

This would seem obvious, but it’s not. Alot of people see their CPAP as an assistive  device which they only need to use when they need it. But they really need to look at it for what it is: therapy. You take your hypertension and diabetes medicines with you when you travel, think of your CPAP the same way. Besides, if you’re travelling for business, you need to be sharp and focused. If you’re travelling for pleasure, well who wants to spend their hard earned vacation being tired and irritable? CPAP will help you get the most out your travels! Continue reading

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Me and My A.E.D.

“Everyone should have BLS training. . . we’ll all be better off because of it”     -Me.

I arrived at my designated gate at Chicago’s O’Hare Airport.  The run there kept the adrenaline level up in my system, though the hubbub was now well behind. I pulled the crumpled boarding pass out of my pocket as I caught my breath. No that’s a hotel receipt. Check the other pocket, there it is, Zone 3, that can’t be that bad; I thought,  there’s gotta be, what maybe 6 or 7 zones, right? “Welcome aboard American Airlines flight to Flint, Michigan” the gate attendant announced. We welcome our platinum medallion, gold medallion, silver medallion, bronze high-flyers, copper star club, as well as plastic fantastic, and purple star members, followed by zones one and two” The last of the passengers was already through the jetway. “Now boarding zone three, welcome aboard”.

After handing over my crumpled boarding pass for scanning, I made my  down the jetway and onto what appeared to be a small but fairly packed little jet. Passengers on each side of the aisle eyed me as I walked past, a few noticed that my jeans were soaked from the knees down. Some caught the odor that  trailed behind, a light of recognition igniting in their eyes as they realized what it was. Does he really smell like that? Is he the one that’s dragging that awful scent through this cabin?

6 hours earlier things had been going very differently for me. My colleagues and I had just given a well received talk at the annual Chest convention. I had reconnected with old friends that I hadn’t seen since training.  I had just personally  thanked Kevin Pho (of KevinMD fame) in the hotel coffee shop for giving our keynote address and getting our membership fired up about the future of medicine and social media. It was with this sense of excitement and renewed enthusiasm that I boarded my plane to catch a connection at O’Hare.

I also distinctly recall that, at the time, my pants were absolutely one-hundred percent completely dry. Continue reading

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