So what do I tell all my patients that ask about the new RSV vaccine? RSV has always been around in kids but I can’t remember any of my elderly patients with that diagnosis. Does anyone think this is just big pharma finding a way to make money?
I guess it is time to get back into the fray and start posting again.
I’ve been too busy to really get back to my blog, but it’s time to start posting again. My compensation is RVU-based and if I don’t work, I don’t get paid. It actually makes for a bad incentive. It makes me want to work more and not take time off which I really need to do. I have a performance bonus in my contract, but it is essentially unattainable unless I want to work 12 hour days. I really enjoy my job which is outpatient internal medicine but there’s been a lot of stress in the last year because I’ve only been working with one MA. I typically work with two MAs, which has slowed my production and made my staff stressed. Unfortunately in my area we haven’t even been able to interview an MA. They all seem to have left healthcare. I wonder if other people have experienced that. I don’t know if they’ve left because they wanted higher pay or they did not want to get the Covid vaccine, who knows.
It has been over 12 years since I actively admitted my patients
and I truly miss it. I loved the inpatient activity, intensive care unit, the camaraderie with all the staff, but going home in the evening at the end of the day at five or 6 o’clock sure beats going back into the hospital and spending two hours doing rounds.
The changing appearance of medicine over the years-not always for the best?
I was very pleased to see when residents hours were limited to avoid burnout and fatigue induced mistakes.
Why didn’t I get COVID?
My mom spent 2 days with me and my wife and the day after she went home she was sick and tested positive for COVID. It has now been a week and neither of us have become sick. So what’s the deal, we both should have become sick and COVID positive.
So why do I still have to wear a mask in my office and in the hospital? This virus has become endemic and we should accept the fact that some will get mild symptoms and a few may get quite I’ll. We never masked up when dealing with the flu.
We need to wake up and start thinking rationally as we move forward in managing this disease.
So more time has passed and fewer of my patients are getting COVID so when will healthcare workers get to leave the mask off?
Masks?
So are we ever going to get rid of masking in healthcare facilities? Nobody wears masks outside of the office then we step into the office and suddenly everybody wears masks, that makes no sense.
So yes, it is 2023 and we are still wearing masks. Some of my staff cough more often when wearing masks and I have coughed more myself and sneezed. I can stand out in my parking lot and talk to patients and others, but step into my office and we all have to pull out the masks. This is getting ridiculous! I understand masking if someone is sick and coughing but the healthy should not have to. It should be a personal choice.
Fauci
So Fauci admits he considered the possibility of collateral damage when instituting his draconian measures during the lockdown due to COVID. How do we weigh the effects of the lockdown versus the devastating effects on our economy and even more so on our children and their future growth?
We need to plan for the next devastating worldwide pandemic and make sure we get it right. It would be foolish to think there will not be some type of worldwide event similar to COVID.
So we can eat together and go to meetings without wearing a mask so when can we ditch the masks in the office?
It’s been awhile since my last post
I really don’t want to get into politics but politics has more than just crept into medicine. Patients ask me if they should get the COVID vaccine or boosters and I preface my advice by saying it depends upon whether the person is a red state or a blue state supporter. I don’t feel I should be sharing my personal political views with my patients nor should my politics influence how I provide care to my patients.
Our country has become polarized to the extreme and it is now affecting how I care for patients. Healthcare should not be influenced by the political hot topics of the day. Physicians should be able to weigh the evidence and provide what we feel is the optimum care to each individual patient without fear of criticism from our peers or even the certifying boards. I am certainly not advocating for unfounded, off the wall, sensationalized uses of therapeutics. We must carefully review the data from multiple studies and keep an open mind.
Is the Hospitalist model still the best for complex patients?
Many times complex patients bounce between multiple hospital stays and then see multiple specialists in the outpatient setting before finally getting in to see their primary care internist in the office. In most cases the primary care provider knows the patient better than the hospitalists tasked with providing the inpatient care.
As an Internist that cared for my patient’s in both the inpatient and outpatient setting in the years before hospitalists took over inpatient care, I would like to make the case for returning to a model where the complex patient can be cared for by a group of Internists that provide both inpatient and outpatient care. This model would be for complex patients not the general admission of less complicated patients.
In my own practice I see patients that have conflicting recommendations after discharge and I have to spend an inordinate amount of time and effort to sort out the issues. This often leaves the patient and family frustrated and anxious.
I would suggest that in large group practices a small core of Internists could care for the complex patient in both the inpatient and outpatient setting. This would probably require financial support from the group or hospital because it is doubtful this model would provide enough RVU production to adequately reimburse the physicians.
Observations about our response to COVID-19
So what have we learned? One thing that I have observed is that physicians are just as polarized about how to treat COVID-19 as politicians are polarized about the COVID-19 response. That is unfortunate because I would hope that physicians as scientists would be unbiased, read everything that we could get our hands on and make our own decisions. In my institution there was quite a difference of opinion and how to treat patients in the outpatient setting that were COVID-19 positive. Most of the time they were sent home from the emergency room with Tylenol or ibuprofen and told to follow up with their primary physician. It would appear that even fewer were started on vitamin C, vitamin D and zinc. Even fewer were start announcing the fluvoxamine which was supported in an article in the Lancet.