"Falling Back" Cover Art Created by Brittany Smirnov, D.O.

ISSUE 8 | VOLUME 1

SEPTEMBER/OCTOBER 2020 2020 IS THE YEAR OF CLEAR VISION FOR PHYSICIANS AND PATIENTS ALIKE

WWW.PHYSICIANOUTLOOK.COM

PUBLICATION DEDICATED SOLELY TO PHYSICIANS AND THEIR PATIENTS

Cover Art by Physician Artist Dr. Brittany Smirnov

F R O M T H E P U B LIS H ER

United We Stand, Divided We Falter Wri t t en by Ma r l e n e Wu st- S mi t h, M . D.

W

hat would you think about health reform that 1) lowered your insurance premiums, 2) gave you more choices in terms of the type of plan you could select for yourself and for your family members, 3) made premiums you pay for health insurance tax deductible, 4) lowered your cost for prescription drugs, 5) mandated price transparency and 6) did not exclude you or price gouge you if you or a family member have a pre-existing condition?

What if that health reform eliminated surprise billing for patients BUT did so in a way that didn’t threaten the livelihood of physicians (especially our Emergency Room and Anesthesiologists and other specialist colleagues who cannot afford to give any more control over the services they provide to insurance companies, hospital systems and private equity groups)?

2 | S E P T E M B E R / O C TOBE R 2 020

What if that health reform stripped away the secrecy and Safe Harbor protections afforded to the powerful, medical Mafia-like middlemen (the Pharmacy Benefits Managers and Group Purchasing Organizations) that currently control our healthcare dollars?

Although physicians are often blamed as the culprit for high healthcare costs, the truth is that physicians account for only 11% of every healthcare dollar 1 spent in the United States . Increasingly physicians have been forced into hospital-employed models because insurance companies reimburse so little for their services that independent physicians can no longer afford to own and operate their own practices.

Over the last decade and a half physicians have become more and more disillusioned with the practice of medicine.

Many are depressed, some commit suicide and many have left or are contem-

plating leaving medicine for non-clinical careers. Non physician providers (NPPs) are being used to replace physicians while we are left “holding the proverbial bag” and all of the liability.

It is inspiring to discover, however, that there are still physicians like Dr. Alissa Zingman. She and others like her have an unrelenting passion for fostering and developing a strong bond between physician and patient, and she does so using a team-based approach. In her practice (which specializes in the treatment of hypermobility syndromes) she uniquely “embeds” physical and muscle activation therapy into almost every encounter. Her patients travel great distances to see her, and she maintains a relationship with them via telemedicine and by coordinating care with their own primary care physicians when needed. Dr. Zingman is non-participating with all insurances, and provides all of these services under a

very reasonable published fee-for-service pricing schedule.

Imagine health reform where more physicians were free to practice the kind of medicine that actually meets patients’ needs.

Imagine health reform that gives patients from ALL socioeconomic backgrounds flexibility with their health plan and insurance coverage. Reform that allows the patient (not the insurance carrier) to decide if they want care “in” or “out” of network. I see a future that is bright for physicians and patients, one filled with a renewed commitment to personalized, bureaucracy-free care that respects physician autonomy while simultaneously keeping costs down and choices abundant for patients.

We physicians need to unite and use our education, our medical licenses and our ethical integrity as the invaluable commodities they are. We have to reclaim ownership of our value and professional identities and get back to doctoring.

As we approach the last quarter of 2020 and an important election, I urge each of you to take the time to understand the issues surrounding healthcare and to speak up for what we and our patients really need.

Most importantly, do not allow hatred and intolerance to permeate our profession. We need to remain united on issues we can agree on, and health reform is one of those rare issues that we can link arms on.

Exercise tolerance, revel in our shared humanity and call out behaviors and opinions that lead us down destructive divisive paths.

ROOT CELLAR DESIGNS

Hand Made Face Masks

United we Stand.

Divided we Falter, and ultimately Fail. 1 Dr. Marlene Wüst-Smith Publisher

References 1- https://www.beckershospitalreview.com/ compensation-issues/physician-pay-accountsfor-86-of-total-healthcare-expenses.html

SPECIAL FALL SALE A PAIR OF FACE MASKS (SMALL, MEDIUM OR LARGE) FOR $34.99 rootcellardesigns.com/shop/fallmasksale

WWW.PHYSICIANO U T LOOK . C OM | 3

DR. LULU'S YOUTH HEALTH CENTER

Pediatrician & Youth Mental Health Coach Looking for a Pediatrician and Coach for your Distressed Teen?

Contact Us 802-768-1180 | www.YouthHealthCenter.com Email Us: askdoctorlulu@gmail.com

SEPT E MBE R | O CTO B ER 2 0 2 0

Table Of Contents FROM T HE PU B LI SHER

United We Stand, Divided We Falter

By Marlene Wust-Smith, M.D./p.2 VI PP SPOT LI G HT

Invisible Illness: Chronically (Ch)ILL

By Marlene Wust-Smith, MD/p.6 Tiny and Ch (Ill): The Story Of A Child With An Invisible Illness

By Marlene Wust-Smith, MD/p.9 The Hidden Pandemic: Child Abuse And Witnesses Of Domestic Violence

By Rupali Chadha, MD/p.10 B A B B LI N G S

The Sekhmet Writing Project 5|12: The Empowering Ones

By Megan Babb, DO/p.12 ADVOC AC Y I N AC T I ON

A Bipartisan Proposal To Protect People From Surprise Medical Bills: H.R. 3502

By Saba Rizvi, M.D., DO/p.16 OFFI C E SPAC E

Financial Intelligence

By David Norris, MD, MBA/p.18 Trust Toolbox - Take Back Your Time With A Prescribe-Able FAQ Library

By Nathan Eckel/p.22 T I ME FOR YOU

Fall Memories Of A Cuban Kitchen

By Alicia Roselli/p.24 IN TELLI G EN C E ON T HE MOVE

It’s Just A Cath They Said

By Arasi Maran, M.D./p.27 T HE LA ST WORD

The Patient-Physician Relationship Is A First-Degree Interaction

By Craig Wax, DO/p.28 Measure A Smile

By Guy L. Culpepper, MD/p.29 Front Cover: Dr. Brittany Smirnov WWW.PHYSICIANO U T LOOK . C OM | 5

P HOTO C RE DIT BY DR. A LISSA ZIN GM A N

V IP P S P OT LIG H T

Invisible Illness CHRONICALLY (CH)ILL Wri t t en by Ma r l e n e Wu st S mi t h, M . D.

“I’m Dr. Zingman, you can call me Alissa.”

T

his is how she introduces herself to her patients. Many female physicians get upset when patients and staff do not realize they are doctors, and call them “nurse” or by their first name while addressing male colleagues as “Doctor.” Not Alissa; her philosophy: “What’s so bad about being called your first name? If it makes the patient happy, then why not? I feel like it helps establish that we are in a partnership.”

This is the story of a brave, tenaciously resilient, brilliant and inspiring Orthopedic Surgeon-turned Musculo6 | S E P T E M B E R / O C TOBE R 2 020

skeletal Preventive Medicine physician who has defied all odds and opened her own thriving practice. She specializes in the very genetic condition with which she was born, one with which she was not diagnosed until she was a physician herself.

Imagine being a doctor and KNOWING that for your entire life you have had a significant condition, but you have grown up with no one believing you, and were consistently told “it’s all in your head.” Throughout the years she (and many like her) have been labeled as being attention-seeking, anxious, a worrier, a hypochondriac, a malingerer, and maybe even “crazy.”

Hypermobile Ehlers-Danlos Syndrome (EDS) is one of the most common but likely most misunderstood and under-diagnosed of all of the Invisible Illnesses. Imagine something as simple as brushing your hair causing rib dislocations and a pulmonary contusion requiring a trip to the Emergency Room in an ambulance. This happened to Dr. Zingman, but she takes episodes like this in stride. It’s another “day in the life” of someone with EDS, and she doesn’t let the little (or big) bumps in the road slow her down. She shows her patients how to LIVE, and how to not let their condition define them or limit their dreams.

P HOTO C RE DIT BY KL A RA AU E RBAC H

Patients come to her practice (https://prismspineandjoint.com/) from all over the country. Some patients and their families even move temporarily (or permanently) to Maryland so that they can improve the quality of their lives through her care. She spends 120180 minutes with every patient at their first appointment, and then 2-3 hours at sessions thereafter (where patients also see other members of her practice, including physical therapists who she herself spends at least a month training in her methods before she considers having them see patients independently, and Muscle Activation Techniques Specialists whom she has taught to

modify the technique to make it safe for patients with various skeletal instabilities https://muscleactivation.com/).

Muscle Activation Techniques have been a “life-saver” for her.

Alissa also diagnoses patients with Mast Cell Activation Syndrome, Dysautonomia, and other associated conditions that she states must be properly managed with diet, lifestyle and medication in order to achieve proper function of the nervous and musculoskeletal system. In addition to her Orthopaedic training, she uses osteopathic techniques and eastern medicine techniques. “I don’t argue with success,” she explains. “I know that I did

not learn everything I need to know in medical school.”

Dr. Clair Francomano, MD of Indiana University’s Medical and Molecular Genetics Department is a leading EDS specialist/geneticist who diagnosed Dr. Zingman and became one of her mentors. The two still actively collaborate to discuss complicated patients and research endeavors. Alissa also works closely with Dr. Fraser Henderson, MD the Director of Neurosurgery at Doctors Hospital and Director of the Chiari Center of Excellence in Maryland, where he focuses on the understanding and treatment of deformity-induced injury to the brainstem and spinal cord in Chiari Malformation and EDS. Alissa works so closely with Dr. Henderson and his partners that she is opening her new office adjacent to his practice. While this is an expensive project, she states that this coordination of care is “critical to the management” of complex cases.

The best interest of her patients is clearly Alissa’s top priority. She hopes to be laying the groundwork for a multidisciplinary treatment and research center that also will educate fellow physicians and allied health professionals.

Dr. Zingman even started a nonprofit foundation during COVID pandemic downtime to help support this work (www.edsrf.org). Though this is a brand new venture for her, the foundation already has raised enough to have one full time employee dedicated to assisting EDS research and physician education. Alissa coordinates care like no other and advocates for her patients with a variety of physician colleagues with whom she is “extremely grateful and fortunate” to collaborate.

I spent almost two hours listening to Dr. Zingman’s story when we were finally able to connect. She reminded me of why I went into medicine in the first place, and highlighted the importance of LISTENING to and BELIEVING in our patients. Treating patients like her is why I personally became a WWW.PHYSICIANO U T LOOK . C OM | 7

P HOTO C REDIT BY DR. A LISSA ZIN GM A N

doctor, and to a large extent, why I no longer see patients in a typical traditional office setting. I refuse to be chained by time limitations, click-centric Electronic Health Records designed to pad healthcare bills, questionable quality metrics, patient satisfaction surveys and all of the other trappings that organized medicine has become.

I couldn’t help but imagine myself as Alissa’s doctor as we spoke. “Medical mysteries” and those who have been misunderstood are my niche, my “specialty”...in my mind I was in the exam room with her, spending much more time than had been allotted because her story was so fascinating. I was channeling my inner “Greg House, M.D.,” trying to figure out her diagnoses as the medical sleuth I had been trained to be.

What started as a series of knee and ankle surgeries in her teens, included a few episodes of syncope and chronic neck and shoulder pain and subluxations in medical school, progressed during her residency to daily vomiting and gastritis as well as dizziness and six herniat8 | S E P T E M B E R / O C TOBE R 2 020

ed discs. She developed aphonia due to severe vocal cord dysfunction between her two residencies. After being misdiagnosed with a panic attack, she was referred to a vocal cord specialist who provided referrals that finally led to Dr. Francomano. Her journey included incorrect diagnoses ranging from asthma to attention deficit disorder to posterior tibial tendon tear to celiac disease.

Even though I was at home during our call because of quarantine, I half-expected during our interaction to hear a knock on my door from my nurse telling me “the strep test you ordered was negative” (“internal code” for “hurry along Dr. Smith...the waiting room is full and your patients in Rooms 1 and 3 are getting restless). It was hard to stop talking and asking her questions, though, because her story was so interesting, so captivating.

Dr. Zingman works full-time while fitting in 10-16 hours of physical therapies per week, at least one urgent care visit per year for dehydration, intermittent pain due to a dislocation, month-

ly appointments for prolotherapy or temporomandibular joint appliance fittings or gastrointestinal studies, and countless other challenges. She has had 5 orthopaedic surgeries, did one of her medical school rotations in a wheelchair, and has spent the last few years on a severely restrictive low FODMAP and low histamine elimination diet.

Dr. Zingman is actively involved in research collaborations looking at the natural history of EDS, healthcare dollars wasted in delayed diagnosis and ineffective treatments, the state of physician education, and the role of manual and exercise therapies in skeletal instabilities and dysautonomia.

The foundation provides support to bolster the research efforts of leading EDS clinicians and is creating tools to aide physician education and care coordination.

The one time she became quiet during our interview was in discussing insurance companies, as she is deeply saddened that insurance companies will not cover the level of care she provides for her patients. I applaud her for not accepting insurance. It allows her to be the best possible doctor to her patients.

One of my favorite things I learned about Alissa: she tells her patients that their bodies are like expensive, high-end sports cars that can perform fancy maneuvers and require a specialized owners manual, when most mortal humans are born with boring, mostly maintenance-free, dependable sedans. She celebrates her patients and teaches them how to love their bodies, no matter how many times they feel betrayed by subluxations, fatigue, digestive issues and pain. She ensures they understand their condition is not their fault and that they can get better: they’ve just been following the wrong user manual. Then, she does her best to provide the correct manual and teach patients to become as independent as possible in addressing their joint subluxations and injuries.

Her life mission is to help EVERY patient with EDS. She is well on her way. 1

P H OTO C RE DIT: RE N E E CORE Y

V IP P S P OTLIG H T

Tiny and ch (ILL) THE STORY OF A CHILD WITH AN INVISIBLE ILLNESS

I

first came across Dr. Zingman

I voraciously read ever y post

in an HSI A, so that she could get

a few years ago when I was the

t hat Dr. Zingma n sha red about

care from Dr. Zingman and other

pediatrician for a very special

herself on t he mutua l physicia n

specia lists like her as needed.

little girl. I f irst suspected that

mom social media group we both

In f uture issues of Physician

Brae had Ehlers-Danlos-Syndrome

belonged to. Unbeknownst to her

Outlook I will be discussing t he

when she was a very young infant.

until recently, Dr, Zingman helped

concept of using HSI A s-- Hea lth

EDS is not well understood as a

me immeasurably become a better

Sav i n g s I nve st ment A c c ou nt s- -

condition and for some patients

doctor to Brae by helping to edu-

federa lly insured persona l hea lth

affects almost every organ in their

cate me on the spectrum of condi-

savings accounts t hat wou ld ac-

bodies. EDS can present with issues

tions caused by genetic defects in

crue va lue over time.

involving a person’s joints, their

the collagen vascular system.

Here is a picture of a ver y hy-

skin, neurologic system, eyes, heart,

It is my hope that by the time

per f lex ible Braelyn ca sua lly us-

gastrointestinal tract, immunologic

Brae grows up she will have the

ing her foot a s a phone during a

system and can even affect their

t ype of hea lth coverage that will

ma ke-pretend chat. Visit Physi-

g ums. It is not uncommon for

a llow her to get excellent afford-

cian Outlook on line to read her

patients and their families to be

able, covered care at her home hos-

mom’s f i r st per son a c c ou nt of

dismissed as hypochondriacs and

pitals in Pennsylvania but that she

what it is like to have an “Invisi-

be misdiagnosed.

will also have enough money saved

ble Illness.” 1

WWW.PHYSICIANO U T LOOK . C OM | 9

V IP P S P OT LIG H T

The Hidden Pandemic

CHILD ABUSE AND WITNESSES OF DOMESTIC VIOLENCE Wri t t en by Ru p al i C ha dha , M . D.

S

everal months into a global pandemic, the stress, financial and emotional, has begun to weigh on us all. Most adults have decent coping skills to manage added stress and even adults, in many cases, are unraveling.

Alcohol sales are up a staggering 300% and liquor stores have been deemed an “essential business.” Most adults are joking about the Covid 15 or 19 pounds they have packed on. And many relationships are stressed either due to distance or not enough space. Still, as adults, we can have more insight, skills and fortitude to deal with the additional stress in a pandemic.

But what to say of children? The added stresses and possible trauma to children may be the most unfortunate unseen devastation of a pandemic, especially with closed schools and activities.

1 0 | S E P T E M B E R / O C TO BER 2020

Children are now engaged in most states in distance learning and are cut off from other non-family adults and children entirely. Even more heartbreaking is that not only do children lack the adult coping mechanisms to manage stress, they can therefore also more easily become victims.

About a month ago, I was approached by an ex Pharma executive turned community activist who told me of the work she was doing to bring about healing for children and how her work had become more challenging in the midst of a pandemic. I was surprised to meet her in happenstance, but not surprised to hear about what was happening. Children of abuse or who grow up in environments where there is domestic violence, are losing their only grip on hope: schools. Until March, a

teacher or school counselor or coach, all who are mandated reporters, could intervene if a child was suffering from physical or emotional trauma. Or even perhaps another parent in the carpool or a church pastor may have noticed, then intervened. As more and more of our daily routines and lives suffer, the less and less likely it is that these children are seen at all.

Kristie Bruce-Lane, a mother and career woman, but more importantly a very compassionate community organizer, who founded the Thumbprint Project Foundation in San Diego, CA, explained the pressing need for a docu-series to highlight the issue of childhood abuse and domestic violence especially during these times of Covid. “As a foundation we decided to produce the docu-series ahead of schedule due to the impact

PHOTO CREDIT BY DR. NEIL YBANEZ

the pandemic is having on the children who come from “unsafe homes” where there is an undercurrent of domestic violence. These children are trapped behind closed doors, caught in the cross-fire, with no voice and no outlets. Contact with healthcare workers, teachers, coaches, and family members have been severed due to the stay at home orders.

Developmentally, some are unable to voice their fears when they are scared.

Some do not even know how to use a phone to call for help. They are not passive witnesses to the abuse - they see and hear everything!” And furthermore, they may directly be victims of actual abuse themselves.

Asked why the name “thumbprint,” Bruce-Lane explained, “There is acknowledgment that a child who is exposed to domestic violence abuse,

both physical and verbal, during their upbringing will suffer developmental and psychological damage. Exposure to violence in the home negatively wires and encodes the child’s developing brain (negative neural pathways are formed), forming a ‘thumbprint.’ This ‘thumbprint’ shapes a child’s behaviors, sense of self, and how they view others. If not addressed, these negative behaviors will assimilate into their lives and will perpetuate. The generational cycle persists.”

In fact this is precisely why so many physicians too are concerned and we have seen this in history before. After World War II, many war torn areas of Europe had school closures as well.

Children had lost access to in person learning, and without the internet, all learning in many cases. The generational effect of that was seen in wages (the only thing measurable and only calculated outcome at that time) for those children for decades to come. While there was no data on childhood abuse or witnessing domestic violence, there was likely an effect. And like now, many of our most vulnerable children lost their one square meal a day, lunch, which was given at school. Lest history repeat itself, knowing these risks of not just an educational deficiency, but the effects of neglect, poverty and violence, must be accounted for or will leave a lasting thumbprint again.

Physical injuries of course heal in time but the after effects to the development and resiliency of the child often do not. Children who are not directly abused, but the witness to domestic violence, have lasting scars too. Childhood domestic violence has a lifetime effect emotionally and an economical impact on our communities in addition to contributing to our homelessness crisis.

Bruce-Lane commented, “When I find myself driving in cities across our nation and I see a homeless person living on the streets of our communities, I often ask myself ‘what happened to that person and was a factor in them choosing that path of life on the streets?’ Because no one really chooses that life, no one says

when they are a child the thing they dream about the most is living on the street.” There is a recognized hopelessness due to trauma that these individuals suffer. After layers of trauma, it becomes difficult to unravel later in life. Many times the link between the trauma then and the outcomes now are substance abuse and mental illness, both which can thrive in survivors of childhood abuse.

So what can we do in a pandemic to identify and heal these children?

Children are not only not seen in schools by coaches and teachers, but regular in person visits for wellness checks and even emergency rooms too are avoided so that doctors miss many of these little victims, unless the injuries are physical and severe. Awareness is the first step! It is important for stressed couples to know that there are resources if their homes are turning or are violent. For doctors it is important for us to be aware of this hidden pandemic. We ought to assess for abuse at every telehealth visit as well. We can be more aware of the added challenge that now it is even harder than before to talk to a child alone; to build that bond on a computer.

Additionally we can take advantage of community resources like Bruce-Lane has helped build.

As the President and Founder of The Thumbprint Project Foundation, she offers this, “These kids are our kids….. they are our community’s kids. When they suffer we all suffer. When disaster strikes like a death due to the child being caught in the cross-fire, we mourn as a community. These kids touch so many other lives - family, teachers, and coaches, and they are our future generation. If they end up going down the wrong path, we go with them as a community.” And there are likely groups like this in every city and state and as doctors we can find them and work with them, especially those of us in the fields of pediatrics, psychiatry and emergency medicine. 1 Thumbprint - Childhood Domestic Violence - The Hidden Public Crisis was released on September 16, ahead of Domestic Violence month in October. It is available on both Vodcast and Podcast.

WWW.PHYSICIANOU T LOOK . C OM | 11

B A B B LIN G S

The Sekhmet Writing Project 5/12

Fiv e | T w e lv e: T h e E m p o w e ri

THE EMPOWERING ONES Wri t t en by D r. M ega n B a bb

S

tillness. It is one of my favorite states of being. When achieved, it provides a moment of pause in chaos, even in the smallest of measurements. Breaths become deeper.

The heart rate slows. Peace floods the body. For the life of a physician, these precious moments can be seldom. From the moment we wake to the moment we lay our heads down to rest, the activities and decisions needed to be made can be dense, making these moments of stillness unlikely. And for female physicians, these moments seem to be even rarer.

Though often away from our families for long periods of the day, the roles of mother and/or wife for a female physician do not pause. This means that while we move through the hustle-bustle of work - seeing patients, rounding at the hospital, answering 1 2 | S E P T E M B E R / O C TO BER 2020

pages, returning phone calls, there is an expectation that we are also required to wear the hats of mom and wife simultaneously. A female colleague and I were discussing this not too long ago. Just prior to this, while she was in the middle of a case in the OR, her son kept repetitively calling her. After the fourth time, assuming there was an emergency, she asked one of the scrub-techs to answer the phone for her. It turns out the emergency was a lost pair of cleats.

When she told him, “I am in surgery, your father is at home with you, please ask him,” her son responded, “He told me to call you.” The OR laughed but she didn’t. While we are busy being many things to many different people, it is no wonder female physicians often lose a sense of self in the process.

When I was a young adult my grandmother used to say, “Give wom-

en the benefit of the doubt. No matter what they do, do not judge by reducing them to an anecdote. They are likely going through far more on the inside than what she is shown on the outside.”

This set a standard to always support (rather than judge) women who are around me. Women have been putting the needs of others before ours for so

Dr. Amelia Bueche

e ri n g O n e s

long that it is hard to imagine what the world would be like if we only supported one another. Perhaps then, that lean, just might be the key to finding stillness and empowerment.

Dr. Amelia Bueche, the creator of This Osteopathic Life Dr. Amelia Bueche is a family physician and life coach who teaches other female physicians about finding empowerment and in turn, how they can find stillness. In 2012 there was a shift in medicine as the enrollment of females in medical school began to exceed fifty percent of total enrolled students. However, since that time, we have not seen an equivalent shift in women in various surgical specialties and positions of leadership. “This didn’t add up for me,” she said, “If women were beginning to find a larger

space in medicine, then why was that space not extending equally to all areas of medicine?” Understanding why this was occurring became the catalyst to her understanding where the solutions to solve this issue could be found.

“I wanted to find the health within our broken system. For decades the system has not been favorable to women. I discovered that in order to correct the wrongs of the system, I must first show women how to feel empowered.”

What she found was that because of the competitive nature and rigor of being a physician, there is a tendency to silence the strengths innate to women.

Women have been flexible and capable of changing to the system for decades however the system was proving to be less capable of such change. “I wanted to create a space where women could realize that the talents they already possess are exactly what the system needs to find health.”

Through her work as a life coach as well as through her work with her program The Osteopathic Life, she is empowering women to see the value they bring to the table. Though our exterior appears robust, the healthcare system has struggled internally for years. Physician burnout has been one of the greatest tragedies to come from the failing system. What Dr. Bueche is doing is teaching women how to push back past status-quos and challenge the policies that have led to such an uphill climb towards equity. “Being the mother to three children, I have found my stillness to come from upholding boundaries and declaring my intentions. It is not enough to think about a goal but vital that we say that goal aloud. We find our empowerment by making the space for ourselves to achieve our goals. If we are consistent and reliable to ourselves just like we are to others, we will find that the empowerment we long for, is already within.”

Not that long ago when I was just starting my career as an attending physician, I went to a seminar on leadership. I found the day-long experience

Dr. Sunny Smith

to be interesting. As I sat there and listened to the speakers talk about leadership and how to be an effective team player, I realized none of the speakers were physicians. The characteristics of a leader I am sure don’t vary much from one profession to another, however the system in which a leader is called upon, very much does. When physicians are expected to be the calm amongst chaos, when the expectation for stillness is a requirement to practice good medicine, I wondered why in a course for physician leadership there was not an emphasis on how to find stillness. I would wonder this for many years, until one day I stumbled across a facebook post.

Dr. Sunny Smith, THE creator of Empowering Women Physicians Dr. Sunny Smith is a family practice physician and former academic professor at the University of California, San Diego who was the owner of that Facebook post. Her post was about empowering female physicians to find their stillness so that they may be stronger allies for themselves as well as the patients they serve. A few years ago, Dr. Smith began her journey of finding stillness by becoming a life coach.

At the time, there were only a handful of physicians setting out to gain the same set of knowledge as she. As said on her website, Empowering Women Physicians, “We are literally responsible for people’s lives at work and at home.

Pretty much all day every day. We recognize this as an amazing privilege.

However, we’ve also learned a lot of self WWW.PHYSICIANOU T LOOK . C OM | 13

sacrifice.” For women this self-sacrifice can often lead to a loss of self. We give so much of ourselves in our daily life, we struggle to make time to find time for ourselves.

Over the course of the past couple of years, I have been following Dr. Smith and her work. In a space where the challenges that face female physicians can be overwhelming, having a female physician to provide leadership is empowering in it of itself. She provides her leadership skills through classes and workshops dedicated solely to female physicians.

Because of her work, female physicians are not just finding more moments of stillness in their day-to-day life, but they are finding how to use empowerment to change the course of their lives.

In a broken system, how are we expected to heal others when we ourselves have little time to heal? Stillness, just like all other emotions, is fleeting. However when we have the opportunity to collect many moments of stillness, we are able to achieve a state of fulfilment. This is exactly what the works of female physicians, Drs. Amelia Bueche and Sunny Smith allow us to accomplish. They are leading the way to a new form of leadership in medicine. A form of leadership where women are included and represented. Something that is long overdue.

May they continue to spread their work to help generations and generations of female physicians. 1

LIVE. LIFE. FULL.

For more information about Dr. Amelia Bueche please visit: https://www.thisosteopathiclife.com/ For more information about Dr. Sunny Smith please visit: https://empoweringwomenphysicians.com/ Dr. Megan Babb is THE ORIGINAL SEKHMET of our time. To read more of Dr. Megan Babb’s written works, you can find them by following her on Twitter and Instagram by clicking at the following links:

DR. MARCEA WHITAKER

Twitter: @MeganBabb1522 Instagram: Mbabb1522 Vocal.Media: https://vocal.media/authors/ dr-megan-babb

Feeling stuck in the life you are living? There is more.

Find out how to break free and finally live

Physician Outlook Magazine: https://www. physicianoutlook.com/home 1 4 | S E P T E M B E R / O C TO BER 2020

LIFE COACH AND PHYSICIAN

INFULLBLOOMHEALTHANDLIFECOACHING.COM

410-705-4850

AHIMSA

D R. D E S I G N E D , K I D A P P R O VE D SAFE, ECO-FRIENDLY AND FUN!

WWW.AHIMSAHOME.COM WWW.PHYSICIANOU T LOOK . C OM | 15

ADVO C AC Y IN AC TIO N

A Bipartisan Proposal

TO PROTECT PEOPLE FROM SURPRISE MEDICAL BILLS: H.R. 3502

A

Wri t t en by S a ba Ri z v i , M . D.

bill proposed by Congressmen Dr. Raul Ruiz (D-CA) and Dr. Phil Roe (R-TN) and referred to the U.S. House Committees of Energy and Commerce, Ways and Means, Oversight and Reform, and Education and Labor.

The focus of this bill is to protect health consumers from receiving surprise medical bills. To evaluate the factors surrounding surprise medical or “balance” bills, it is necessary to provide some context.

Traditionally, three players are usually involved in patient care: the patient, the patient’s insurance provider, and the patient’s doctor. Sometimes, a fourth party is involved: the staffing company that employs the physicians and bills on behalf of the physician’s services.

Approximately 57% of Americans have received a surprise medical bill.

The major source of these bills is certain services that were thought to be “in-network” as assigned by the patient’s insurer but were not covered by health plans.

These balances of services not paid by the patient’s insurer were revealed to patients 1 6 | S E P T E M B E R / O C TO BER 2020

upon receiving a “surprise” bill from their physician or health professional.

This commonly – but not always – occurs when patients are taken to the emergency department at a hospital. Patients cannot be expected to know their insurance network arrangements during an emergent situation. Yet, through no fault of their own, they receive a large bill for services rendered.

A similar situation occurs when a patient receives services at a hospital. While the hospital may be listed as “in-network” under the patient’s insurance plan, frequently utilized physicians, labs, or radiology services may not be contracted with the patient’s insurer. When insurers and providers cannot reach a contractual agreement on payment, physicians fall outside the health plan’s network until terms can be brokered by both parties.

To date, no laws have been established to require insurers or their hospital partners to make network arrangements transparent to the patient. One prudent solution is to require hospitals to advertise all regularly used out-of-network

services, for example, regularly used anesthesia, radiology, or lab services. The same level of transparency should be expected from a patient’s health insurance provider.

Thus far, two competing policies have prevailed in Congress as a proposed fix to this problem: (1) Government-assigned market-based payment rates for healthcare providers, known as benchmarking, rate-setting, or price controls.

(2) Independent Dispute Resolution (IDR): An independent arbiter is assigned the task of coming to a binding rate agreement for disputed claims between the insurer and the physician or other healthcare professional.

Free2Care (F2C) is strongly opposed to any legislative measure that uses any modality that would tie physicians to in-network rates as set by insurers.

The devastating and unintended consequences of rate-setting for physicians are below.

Physicians will decline to work within such a system.

“California’s surprise medical billing law has created unintended consequences that increase healthcare costs and reduce quality… Price controls have led to fewer doctors on call in emergency rooms, and independent doctor practices consolidating into bigger hospitals. When the government puts its thumb on the scale, it’s ultimately patients that are hurt the most,” said Dr. Wayne Winegarden, senior fellow and director of the Center for Medical Economics and Innovation at the San Francisco-based Pacific Research Institute, in his recent brief, “The Menace of Medical Rate Setting: The Case of California’s AB 72”.

• Healthcare consolidation will occur, thus increasing healthcare prices.

• Quality of care will suffer F2C believes that Congressmen Ruiz and Roe’s proposal, H.R. 3502, is the best solution to this complex problem.

The proposal carries the most bipartisan support and provides a sensible alternative to benchmarking.

H.R. 3502 supports an independent dispute resolution (IDR) process, similar to those already enacted by state legislatures in two of the largest and politically opposite states: Texas and New York.

The bill currently has 110 Republican and Democratic co-sponsors, making it the Congressional surprise medical bill proposal with the largest number of bipartisan supporters, by far.

F2C fully supports removing the patient from the dispute process.

F2C fully supports provisions that lessen the burden of cost-sharing on patients, especially during emergency visits to hospitals. We do not believe in adding insult to injury with large surprise medical bills. A medical emergency should fall within the category of the prudent layperson standard.

F2C strongly supports batching of claims to relieve the burden of resubmitting multiple claims with the same CPT codes for the same services rendered by physicians or other health professionals.

Resubmitting claims along with potential fees associated with each submittal would be a deterrent to the submission of claims.

F2C strongly approves of the IDR process to be the most fair and equitable in resolving payments between insurers and physicians, as no such industry standard currently exists. F2C also supports quality standards of neutrality and oversight of the IDR process, as maintained by an oversight agency. Each arbiter’s record should be subject to audit with the regulatory consequences of any proven bias. H.R. 3502 is the only current Congressional proposal for IDR that allows both sides to present their best cases. Other Congressional proposals that would prevent providers from presenting data that would be favorable to their case are fundamentally unfair and not consistent with a functional private healthcare marketplace.

F2C strongly supports legislation that protects patients from the undue burden of receiving unwarranted medical bills.

F2C supports any and all measures that advocate for greater transparency in

healthcare. Patients, as consumers, should be knowledgeable about the services provided to them. Both the insurance industry and hospitals must make reforms to provide more clarity to patients about what is and is not covered by the services they receive.

F2C supports any and all measures, including oversight, that keeps the overall cost of healthcare down. Analysis and review of this data will lower the cost of medical care by not only stabilizing it at its current levels or slowing its rate of increase, but also driving it down. This requires identifying, exposing, and eliminating the layers of waste, redundancy, fraud, corruption, and profiteering inherent in those layers.

Additionally, physicians are often not aware of charges billed under their name. Congress should assure, through the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act and other legislation, the due process rights of physicians who ask for transparency in reporting of charges under their names. By doing so, Congress will help physicians ensure that no abuse or fraud is being committed under their name by a third-party billing service.

Conclusion F2C fully supports HR 3502 that proposes a principled solution to a complex healthcare problem tainted with profit-driven motives.

The bill’s provisions offer the most bipartisan, fair, and equitable solution while closely monitoring their impact on patients and the healthcare market.

No patient should have to pay expensive medical bills for services thought to be covered by their insurance provider, especially during medical emergencies.

Patients should not be accountable for payment of such services when they are not involved in contract negotiations between any of the parties involved.

Bringing more transparency to the opaque healthcare market will benefit both patients and their physicians. 1 Congress should act now to pass H.R. 3502 WWW.PHYSICIANOU T LOOK . C OM | 17

O F F IC E S PAC E

Financial Intelligence TO HAVE THE PRACTICE YOU DESIRE, YOU NEED THIS.

I

Wri t t en by D a vi d N o rri s, M D, M B A

magine you’re early in your medical career, such as a medical student, and you are getting ready to see a patient. You glance over their chart before you walk into the exam room.

Their vitals look fine. Then you flip to the results of the laboratory blood work. You glance over the paperwork, hoping the report has normal values listed, or better yet, the report will flag anything abnormal.

The reports from this lab don’t do that. All you get is a number. What do you do? Do you shrug your shoulders and determine the patient is fine and send them on their way? Alternatively, do you hit the pause button, research, and learn how to use the lab results, so you make the best decision for the patient? A competent medical student, 1 8 | S E P T E M B E R / O C TO BER 2020

who is hoping to be a successful physician, would take the time to learn how to interpret the lab values and incorporate the data with other findings. You want to solve the real problems your patient is facing.

Unfortunately, we physicians take a different approach when it comes to the financial health of our practice.

I’ve worked with many physicians who treat their practice as the patient above. There doesn’t seem to be any problems on the surface. The financial reports are complicated, intimidating, and challenging to understand. Many will shrug their shoulders and move on, and they will miss finding the real problems affecting their practice. We wouldn’t do this with a patient, and we shouldn’t do this with our business.

Get the Knowledge With all of the resources available today, you don’t have any substantive excuse not to improve your financial intelligence. You can pour over various websites and piece the information together. Alternatively, books such as mine will help you take the step to raise your financial intelligence level.

This isn’t a sales pitch for my book.

Instead, my goal is to motivate you to take action and improve your financial intelligence. I believe there are three significant reasons why you should begin to study this critical information.

First, it will teach you a different way of thinking about money. How you view money in your business is likely how you see and handle money in your private life. What’s your individual fi-

clients were happy and didn’t dig into the numbers. He was counting on their lack of financial intelligence so he could line his pockets with their money.

Third, you’ll be better armed to protect yourself against fraud and theft in your practice. The most common fraud occurs in the back office of small businesses where only one or two people have access to and handle all the money. If you cannot read and use financial reports, it becomes much easier to steal from you.

Finally, and most importantly, your patients need you to be financially healthy.

nancial life like? Are you making good decisions? We will view money problems at home the same way we view money problems at work. If we can improve our financial intelligence at work, that knowledge and experience will carry over into our personal lives. Improve in one area, and it won’t be long until you see improvements in other areas too.

Second, understanding financial reports will help defend you against less-than-reputable investors. You will know how to read their financial statements and prospectus. When things don’t make sense, your “spidey senses” will go off. Remember, not every huckster can be easy to identify. Bernie Madoff wasn’t as he fleeced many wealthy, supposedly smart investors. A few folks tried to sound the alarm, but most of his

Your Practice is More Important Than Your Patient I would argue understanding the financial health of your practice is more important than patient care. Without a solid knowledge and understanding of your practice’s financial matters, you put your patients at risk.

Your practice will need to be profitable if you want to continue to serve your patients. Why? You’ll need capital for improvements and investments in new and safer technologies. You’ll need money so you can attract and retain high-quality personnel. Today’s profit is tomorrow’s capital for investments. Without profit, you’re at risk of hurting yourself, your employees, and your patients.

Consider what happens to your patients and employees when you can no longer keep the doors open? Where will they go? Who will take them in? Who will provide them care? With financial intelligence, you’re doing your patients, employees, partners, and yourself the right thing because you will make the right business decisions.

Get financial intelligence today and use it to determine the financial health of your practice. Feel free to reach out to me should you have any questions. I’m more than happy to help. 1

Unlock The Future Of Healthcare RESTORING THE RIGHTS OF PHYSICIANS AND THEIR PATIENTS. VISIT HPEC.IO TODAY!

David J Norris, MD, MBA www.davidnorrismdmba.com © David Norris, LLC, 2020 WWW.PHYSICIANOU T LOOK . C OM | 19

PADPCA is a non-profit organization of Independent Direct Primary Care physicians in Pennsylvania.

WE ARE GRATEFUL RECIPIENTS OF OUR STATE MEDICAL SOCIETY’S 1ST ANNUAL PRACTICE INNOVATION GRANT. Thank you PAMED Society!

As the model grows rapidly across the country, PADPCA is informing and educating the public, medical schools, residencies, physicians, and employer groups in PA about our transformative model of healthcare delivery.

DPC = Transparency + Affordability + Access + Attention + Patients + Physicians–the Middlemen

www.facebook.com/PADPCA/

www.twitter.com/padpca

YOU CAN HAVE THE PRACTICE YOU DESIRE No one teaches you this in medical school.

You learn everything you need to know to care for patients but practically nothing about running a practice.

Nearly 50% of physicians are owners, partners, or associates in private practice. That means there are a whole lot of doctors out there running practices who learn as they go.

But just like you use exams, tests, and images to discover what’s ailing a patient, you need to learn the tools that will help you discover what’s ailing your business.

Why are costs always creeping up?

How can you increase the quality of the time you spend with patients?

Why are patient satisfaction surveys coming ack so low?

Are you intimidated when you are faced with the financial decisions of your practice?

Do you understand how to utilize productivity reports?

How do you feel when you are handed the financial reports of your practice?

When you work to discover what’s really causing your operational challenges, you’ll resolve them for good. These books will provide you the valuable knowledge you need to develop a thriving practice.

DAVID J NORRIS, MD,MBA

WWW.PHYSICIANOU T LOOK . C OM | 21

O F F IC E S PAC E

Trust Tools

TAKE BACK YOUR TIME WITH A PRESCRIBE-ABLE FAQ LIBRARY Wri t t en by Na th a n E c k e l , p hy si c i a n spo u se

W

hat would you do to get a few minutes of breathing room in your day?

In today’s post-COVID health landscape many solo physicians are finding that it’s not enough to go about business as usual. They are realizing that they need to think ahead of the rest. And that kind of creative thinking takes time and energy.

The good news is that in the last 6 months we’ve seen something that has never happened before. We’ve seen medical norms change in response to COVID-19. And much of this change is actually very good. Because patients are not only flexible about telehealth and technology, many are embracing it because of the convenience and time it saves them.

2 2 | S E P T E M B E R / O C TO BER 2020

So if you’re interested in a simple way to utilize this shift to benefit your patients as well as yourself - and get the extra bandwidth you’d never have otherwise, keep reading… because the answer is so much simpler than you might realize.

In last month’s article I talked about how to protect your staff’s time simply by changing your inbound phone processes.

But this month I’m not going to ask about your staff’s phone conversations.

Instead I’d like to ask you about your own 1 to 1 patient conversations. Specifically, I’m asking if you ever find yourself repeating similar conversations throughout the day - with different patients.

Well, do you?

I would imagine some days you feel like Phil Connors, Bill Murray’s char-

acter from the classic movie Groundhog Day. Because your patients are constantly asking similar questions. And before you get to the specific nuances of their situation, you might find yourself repeating pretty basic stuff first.

There’s a lot of talk about energy use and energy policy these days, and rightfully so.

Regardless of the way they vote, 99% of your fellow physicians are using their conversations like fossil fuels.

Single use conversations. Then they are repeating the same information with a different face. All day long.

What if there was an alternative to consuming your energy in this way?

Forward thinking physicians are beginning to view their conversations

P HOTO C RE DIT IN GRA M IM AGE S

beyond the traditional 1:1 patient interaction. They rightfully see themselves as subject matter experts, and they realize that much of their know-how can be pre-recorded and prescribed to patients.

Whether you use the mechanism of a podcast, a dial-by-number phone extension, or a website portal, this accomplishes amazing outcomes for both of you.

Here are just three: 1. You save time.

2. The patient listens to you on patient time.

3. You elevate your relationship.

Moreover, as you delegate this learning activity to your patient, you are changing the dynamic of your relationship. Simply by exposing your

patient to a new way to learn from you outside the exam room, you are changing the dynamic from an authority figure to a trusted advisor or perhaps a coach.

The effect of this is to help your patients choose a healthier lifestyle and partner with you in walking that out.

Whether you are a family doctor, a pediatrician, a surgeon or an interventional cardiologist, you can have an impact. You can help patients proactively choose healthy actions that elevate their lifestyles - and save time.

Sometimes the best benefit isn’t even the time savings. Sometimes the best benefit is in helping you offload unproductive conversations that can be difficult to quickly address in the moment.

Similar conversations throughout the day - with different patients.

Have your patients ever asked you one of these?

- The Question that Creates More Questions - The Question that Takes Too Much Time - The Legal Technicality Question - The Loaded Question - The Unpopular Policy Question What did I miss? I’d love to add your favorite one to the list.

This is just one of several tools in the “Trust Toolbox” that strengthen your ability to serve your patients. 1 For an early look at how to implement this, reach out at nathan@patientpaperwork.com.

WWW.PHYSICIANOU T LOOK . C OM | 23

TIM E F O R YO U

Fall Memories

FROM A CUBAN KITCHEN Wri t t en by Al i c i a Ro s e l l i , Edi t o r-In- C hi ef

T

he nip in the air that comes with fall in upstate NY sparks a shift in my inner foodie, and I start to crave the warm and hardy dish called “potaje.” If you look up the translation, you’ll likely find the word “soup,” which hardly seems appropriate for the substantial, all-in-one meals I learned from my mom. She was a college professor who worked full time to support her family, and did not have the luxury of hours in the kitchen.

The pressure cooker was a constant companion.

If I’m honest, the pressure cookers of old were kind of scary - even though I used them for years, I was intimidated every time by that steaming, spouting, can blow at any time contraption on 2 4 | S E P T E M B E R / O C TO BER 2020

my stovetop. Enter the InstaPot! If you don’t have one yet, and you’re a busy professional who values healthful eating but has no time to spare, meet your new best friend.

I digress. Back to the warm and hardy potaje - I have three favorites to share with you. The instructions assume an InstaPot but you can use a regular pressure cooker or none at all, just note the cooking times will be much longer.

Directions:

If you’re using ham steak, remove (but save!) the bone and chop the rest.

When making garbanzos, pressure cook alone with vegetable broth

(and ham bone) on high for 20 min; quick-release steam; sauté vegetables (minus cabbage) and add to garbanzos and broth; stir in chopped ham.

Lay cabbage slices on top. Cover and cook for an additional 20 minutes (no pressure) until potatoes and cabbage are soft.

For split pea or lentils, use the sauté setting to sauté the vegetables and garlic in olive oil until tender.

Add remaining ingredients (including ham bone) and cook at high pressure for 20 minutes. Let pressure release naturally. 1 Buen Provecho!

P HOTO C RE DIT IN GRA M IM AGE S

SPLIT PEA

LENTIL

GARBANZO

1 lb. split peas,

1 lb. lentils, rinsed

1 lb. garbanzo beans and 1 T salt,

soaked overnight in water

1 large bell pepper, chopped

soaked overnight in water

1 large bell pepper, chopped

1 large onion, chopped

1 large bell pepper, chopped

1 large onion, chopped

1c celery, chopped

1 large onion, chopped

1c celery, chopped

1c carrot, chopped

3 cloves garlic, minced

1c carrot, chopped

3 cloves garlic, minced

4 medium potatoes, cut up

3 cloves garlic, minced

1 T salt

1/2 cabbage, sliced

1 T salt

1 bay leaf

6c vegetable broth

6c vegetable broth

6c vegetable broth

1 ham steak with bone, chopped

1 ham steak with bone, chopped

1 ham steak with bone, chopped

(optional)

(optional)

(optional)

Olive oil

Olive oil

Olive oil

WWW.PHYSICIANOU T LOOK . C OM | 25

MYDOQTER.COM

Dr. Annie Gonzalez 3659 South Miami Avenue, Suite 6002 Miami, FL 33133

36 5 9 S o u t h M ia m i Av e n u e , S u it e 6 0 0 2 M ia m i, F L 3 313 3

America’s First Medical Professional Social Media Site!

Preserving the Sanctity of the Doctor-Patient Relationship

IT’S ALL ABOUT PROCIAL (PROFESSIONAL-SOCIAL) CONNECTIONS! myDoqter™ is for patients and physicians, helping patients to find the best physician and enabling physicians to market their practice.

PHOTO C REDIT ERIC ZA BRISKIE, MD. P GY-2 IN PSYC HIATRY, VA N DE RBILT U N IVE RSITY

IN T E L L I GE N CE O N TH E M OV E

It’s Just A Heart Cath They Said Wr i tte n b y Ar asi Ma r a n , MD, FAC C

M

r. & Mrs. Green come to the prep area Hello, why are you here It’s just a heart cath they said Told the kids to do their own thing It’s not a big deal Go on about your life It’s just a heart cath they said Take some pictures See some blockages Place some stents All goes well, till it doesn’t Perforation, drop in blood pressure Get a balloon, place a covered stent, No Blood pressure, start CPR Intubate, drain the pericardium Place an Impella Whew, we got him back It’s just a heart cath they said Go to waiting room, see a woman Sitting alone, anxious Where is your family They are ... not with me It’s just a heart cath they said My husband, the father of my children How is he? He is fine… right?

It’s just a heart cath they said It was perfect till it wasn’t It was magical till it became a nightmare

Call the children In different parts of the country One is driving, one is with her children It’s just a heart cath they said Is he fine?

Will he be ok?

Will the man I married Will our father - come back to us?

The way he used to be It’s just a heart cath they said Time will tell We were fast and efficient There was no delay in treatment The rest is up to nature It’s just a heart cath they said Till it isn’t 1 WWW.PHYSICIANOU T LOOK . C OM | 27

C REDIT P HYSIC IA N A RTIST DR. DOU N A M ON TAZE R

T H E LA S T WO RD

The Patient-Physician Relationship Is A First-Degree Interaction BOTH FFS AND DPC CAN QUALIFY

T

Wri t t en by C ra i g M . Wa x D O

he unique similarity between FFS (fee for service), and independent DPC (direct primary care, direct care) is that the physician, seller of services, sets the rate based on overhead and market factors and competition.

Whether we are talking about an incident-based service like FFS, or a monthly membership service like DPC, the seller must be responsible and responsive to the market and individual patient needs and wants. Solo or small practices can make changes and, “turn on a dime,” unlike large corporate practices are those controlled by middlemen or government.

This phenomenon of individual, unique physician and patient, coupled with first-degree transaction of service for payment at time of care, keeps the patient physician relationship private, se2 8 | S E P T E M B E R / O C TO BER 2020

cure and sacrosanct. Both parties are invested in each other without middleman or government intrusion, which history has shown, always breaks down the healing patient physician relationship.

Both FFS and DPC are subject to piracy by middlemen and the government. Any change in funding source, rules of engagement, or law, can have drastic and destructive effects on the patient physician relationship. This is why organizations like AAFP, ACOFP, AMA and AOA must advocate for physician independence to maintain a unique first party transaction relationship with the patient. This is true of FFS and DPC. Although FFS is incident based payment at time of service, and DPC is a monthly membership-based model, they both benefit from first-degree transactions. FFS allows personally organized

and coordinated individual patients to conserve resources and select the care they need, when they need it. DPC, a membership-based model, allows for peace of mind and potentially greater value if the individual patient would prefer more physician coordination. Choice of FFS or DPC should be up to each individual, unique patient with their own needs and value system.

When seller and buyer are coupled by volitional first-degree transactions, everyone wins and no one has to lose.

It is indeed the best case scenario. Physicians have the best opportunity for success, job satisfaction, and personal fulfillment. Patients have the best opportunity to prioritize and allocate the resources based on their own value systems, and have the best opportunity to be healthy. 1

P HOTO C REDIT PA BLO N AVAZO P H OTOGRA P H Y

Measure A Smile Wri t t en by Gu y L . C u l pepper, M . D.

In this age of data, how do we measure a smile?

And watch this magic:

M

y work as a family doctor is judged by my numbers. Everything must be numbered. Each mammogram, colonoscopy, and A1c is sliced, diced, and numbered. Even your disease has a number.

If I signed a form, moved my numbers to a hospital group, I’d get paid double!

“I’d care for you, if I had the time. But I’ve got these boxes to check.”

By the way, I chose not to join a hospital group. I’m an independent physician.

I’m a brilliant physician. I know that’s true because your insurance company tells me that all my boxes are checked.

But I’m confused about the smile.

They make it easy to be brilliant. All these forms show me right where to put your numbers. They even tell me what your number should be.

The more numbers I use, the more I get paid.

Same doctor, different group, suddenly smarter! Rich and brilliant.

I took a little longer with you, interested in your life, and I saw you smile.

You are happier, healthier. I don’t know how to charge for that?

Could it be that there is more to healthcare than numbers? 1

WWW.PHYSICIANOU T LOOK . C OM | 29

SEND THE GIFT OF GRATITUDE

TO THOSE WHO DESERVE IT MOST

THE A

HEARTS

YOU

COCKTAIL,

SEND

CAN

GROCERIES,

BE

OR

REDEEMED

WHATEVER

FOR

THEY

SENDTHANKSNOW.COM

A

COFFEE

NEED

BREAK,

RIGHT

NOW.

AT THE STILL SOUL INDIVIDUALS WILL HAVE AN OPPORTUNITY TO EMBARK ON VERY UNIQUE EXPERIENCES. They will be able to undergo the healing process associated with the loss of a loved one or through soul discovery learning about past lives and how these lives affect their day-to-day life. In addition to this, they will be able to learn techniques that facilitate communication with their spirit guides. www.thestillsoul.com

Publisher: Marlene Wüst-Smith, MD Editor in Chief: Alicia Roselli Managing Editor: Alejandra Suarez Assisting Editor: JR Hill VP of Advertising: Pamela Ferman Director of Art and Production: Ricardo Castillo Contributing Authors: Megan Babb, DO; Rupali Chadha, MD; Guy L. Culpepper, MD; Nathan Eckel; Arasi Maran, MD,FACC; David Norris, MD, MBA; Saba Rizvi, M.D.; Craig Wax, DO; Cover Art: Dr. Brittany Smirnov (front cover) Other Art: Dr. Neil Ybanez; Dr. Douna Montazer; Eric Zabriskie, MD. PGY-2 in Psychiatry Published By “Physician Outlook Publishing” Editorial Policy Physician Outlook Magazine is a national magazine dedicated to empowering physicians and their patients to improve the world of medicine together. Editorial decisions are based on the editor’s judgement of the quality of the writing, the timeliness of the content and the potential interest to the readers of The Physician Outlook Magazine. The magazine may publish articles dealing with controversial issues.

The views expressed herein are those of the authors and/or those interviewed and might not reflect the official policy of the magazine. Physician Outlook neither agrees nor disagrees with those ideas expressed, and no endorsement of those views should be inferred unless specifically identified as officially endorsed by the magazine. Letters to the Editor Email: aroselli@physicianoutlook.com Information on Advertising, Subscriptions, Job Board Email: hello@ physicianoutlook.com “Physician Outlook is a registered trademark”

WWW.PHYSICIANOU T LOOK . C OM | 31