Comments on: The future of general internal medicine http://www.medrants.com/archives/2553 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: dr. manthappa. m http://www.medrants.com/archives/2553/comment-page-1#comment-540929 dr. manthappa. m Wed, 15 Dec 2010 15:49:43 +0000 http://medrants.com/?p=2553#comment-540929 i feel the future of internal medicine is bright. imagine a 50 year old patient with COPD, type-2 DM, HTN, IHD who has been admitted with cellulitis of leg. such patients with multiple problems (most patients have multiple problems) are best cared by a physician. if this above patient has to be cared by subspecialists then we have to bring in a pulmonologist, an endocrinologist, a cardiologist, an infectious disease specialist and may be a surgeon also. each one will look at one body part and never at the patient as a whole. each ones orders may clash with others orders. there is bound to be a cordination problem. a single internal medicine specialsit can manage this patient more effectively than all these specilaist combined, because then there is one person knowing about all the problems of the patient, hence he can process this information better and come out with a an efficient management plan. i feel the future of internal medicine is bright. imagine a 50 year old patient with COPD, type-2 DM, HTN, IHD who has been admitted with cellulitis of leg. such patients with multiple problems (most patients have multiple problems) are best cared by a physician. if this above patient has to be cared by subspecialists then we have to bring in a pulmonologist, an endocrinologist, a cardiologist, an infectious disease specialist and may be a surgeon also. each one will look at one body part and never at the patient as a whole. each ones orders may clash with others orders. there is bound to be a cordination problem. a single internal medicine specialsit can manage this patient more effectively than all these specilaist combined, because then there is one person knowing about all the problems of the patient, hence he can process this information better and come out with a an efficient management plan.

]]> By: kevin maris http://www.medrants.com/archives/2553/comment-page-1#comment-83294 kevin maris Tue, 01 Nov 2005 14:39:53 +0000 http://medrants.com/?p=2553#comment-83294 I was involved in an automobile accident where I was broadsided by an uninsured motorist that did not have a driver license and did not own the car. Luckily, I had great uninsured motorist insurance. The problem was that United Healthcare would not approve the only procedures that would solve my problem, even though they would be totally reimbursed for the procedure. I am in need of a disc replacement surgery which UHC has covered before for other patients, but, they send me denials saying that they do cover because they say it is an unproven procedure. This is the only procedure that will solve my condition. I am unable to work because the pain of driving for more than 20 minutes or sitting in a chair for 20 minutes is too severe. I get no sleep because the pain wakes me up every 30 minutes. They provide phone numbers in their letters that are disconnected. They provide no way to contact them by email although doctors have a way to email them. They provide no address to contact them. If you call their 1 800 numbers it will put you into loops and disconnect you countless times. The customer service reps regularly give me phone numbers that do not work or that have a message box that is constantly full. They will not let you speak to anyone that can assist you. I think they are instructed to give you the run around until you give up. If you press them on anything they tell you another department handles that and they switch you to a number that tells you to call the 1 800 number then disconnects. It is genius if you think about it. Deny, confuse, point in the wrong direction, and make communication impossible. That way they can say they did not do anything wrong -- because they did not do anything at all - thereby it could not be wrong. It is a racket. When I ask them to tell me any other procedure that might solve my condition, they say they do not have one but will deny the only option that I do have. I am stuck in insurance hell and my life is being ruined because of it. I can not work, I can not fufill my obligations to my family, I can not sleep, I can not have sex, I can not drive distances and I have had to stop three times during my typing of this message because of pain. One operation will solve this but they will not approve it. Or they are waiting as long as they can to approve it. My life is ruined right now. I am at the end of my rope. I am getting despondent and do not know what to do. If anyone knows how to get things approved, have had similar experiences or know about the appeals process, please email me. I am just about to contact the Attorney General, the Insurance Commissioner and a private attorney. Any supporting information would help. Sincerely in distress and pain, Kevin maris I was involved in an automobile accident where I was broadsided by an uninsured motorist that did not have a driver license and did not own the car. Luckily, I had great uninsured motorist insurance. The problem was that United Healthcare would not approve the only procedures that would solve my problem, even though they would be totally reimbursed for the procedure.

I am in need of a disc replacement surgery which UHC has covered before for other patients, but, they send me denials saying that they do cover because they say it is an unproven procedure. This is the only procedure that will solve my condition. I am unable to work because the pain of driving for more than 20 minutes or sitting in a chair for 20 minutes is too severe. I get no sleep because the pain wakes me up every 30 minutes.

They provide phone numbers in their letters that are disconnected. They provide no way to contact them by email although doctors have a way to email them. They provide no address to contact them. If you call their 1 800 numbers it will put you into loops and disconnect you countless times. The customer service reps regularly give me phone numbers that do not work or that have a message box that is constantly full. They will not let you speak to anyone that can assist you. I think they are instructed to give you the run around until you give up. If you press them on anything they tell you another department handles that and they switch you to a number that tells you to call the 1 800 number then disconnects. It is genius if you think about it. Deny, confuse, point in the wrong direction, and make communication impossible. That way they can say they did not do anything wrong — because they did not do anything at all – thereby it could not be wrong. It is a racket. When I ask them to tell me any other procedure that might solve my condition, they say they do not have one but will deny the only option that I do have. I am stuck in insurance hell and my life is being ruined because of it. I can not work, I can not fufill my obligations to my family, I can not sleep, I can not have sex, I can not drive distances and I have had to stop three times during my typing of this message because of pain.
One operation will solve this but they will not approve it. Or they are waiting as long as they can to approve it. My life is ruined right now. I am at the end of my rope. I am getting despondent and do not know what to do. If anyone knows how to get things approved, have had similar experiences or know about the appeals process, please email me. I am just about to contact the Attorney General, the Insurance Commissioner and a private attorney. Any supporting information would help. Sincerely in distress and pain,

Kevin maris

]]> By: matt http://www.medrants.com/archives/2553/comment-page-1#comment-82195 matt Wed, 26 Oct 2005 06:10:22 +0000 http://medrants.com/?p=2553#comment-82195 tina inurers lump the "primary care" field to inlude 1.family practice(3 yrs training required post med school 2.general internists(3 yrs traing required post med school 3.general practitioners ( 1 year training after med school 4.physician assistants and 5. nurse practitioners Endocrinologists have 2 years taining beyond that of internists. There is a lack of endocrinologists in most communites. Endocrinologits get same pay as general internists. Pay is determined by insurance companies, and generally NOT affected by level of training. Most endocrinologists do not do primary care as they are too busy seeing people that have been referred to them by other doctors. tina

inurers lump the “primary care” field to inlude

1.family practice(3 yrs training required post med school

2.general internists(3 yrs traing required post med school

3.general practitioners ( 1 year training after med school

4.physician assistants and 5. nurse practitioners

Endocrinologists have 2 years taining beyond that of internists. There is a lack of endocrinologists in most communites. Endocrinologits get same pay as general internists. Pay is determined by insurance companies, and generally NOT affected by level of training.

Most endocrinologists do not do primary care as they are too busy seeing people that have been referred to them by other doctors.

]]> By: futuremd.blog-city.com http://www.medrants.com/archives/2553/comment-page-1#comment-80618 futuremd.blog-city.com Fri, 21 Oct 2005 00:43:30 +0000 http://medrants.com/?p=2553#comment-80618 I agree. And yet, just today, a transitional intern was trying to get me to pick Radiology or Anesthesiology instead of Internal Medicine because of all of the hassles associated with IM: paper-work, poor quality of life, etc. Insurance companies pay for procedures, not thought (as you point out). You can't blame people for going where the money and quality of life are. Still, I'm sticking with IM. I agree. And yet, just today, a transitional intern was trying to get me to pick Radiology or Anesthesiology instead of Internal Medicine because of all of the hassles associated with IM: paper-work, poor quality of life, etc. Insurance companies pay for procedures, not thought (as you point out). You can’t blame people for going where the money and quality of life are. Still, I’m sticking with IM.

]]> By: tina http://www.medrants.com/archives/2553/comment-page-1#comment-80613 tina Fri, 21 Oct 2005 00:37:15 +0000 http://medrants.com/?p=2553#comment-80613 Can you see a general internist instead of a general practitioner for a medical problem or do you have to have a referral? Is an endocrinologist by default a general internist with extra training? How does the pay for a general internist compare with a general practitioner and an endocrinologist? What about training? Can you see a general internist instead of a general practitioner for a medical problem or do you have to have a referral?

Is an endocrinologist by default a general internist with extra training?

How does the pay for a general internist compare with a general practitioner and an endocrinologist? What about training?

]]> By: oskie94 http://www.medrants.com/archives/2553/comment-page-1#comment-80394 oskie94 Thu, 20 Oct 2005 13:57:42 +0000 http://medrants.com/?p=2553#comment-80394 I think what is missing from this discussion is the social ecology of medical school and residency training. Medical students and residents are not stupid people. They are able to "thin slice" and analyze the situations on a daily basis and judge which physicians have the control, autonomy, and satisfaction in their practice. I know many of the resident in non-primary care specialties with a more controllable lifestyle almost pity the internal medicine residents. They are the proverbial "dumping ground" of the hospital, they have very little control over their service or environment, and appear to have to answer to everyone. Compounding this is the relatively low reimbursement for inversely complex and complicated work. I think more attention should be paid to actually analyzing which kind of medical students from which backgrounds excel and enjoy internal medicine and recruiting them to the field. Are osteopathic graduates more generalist oriented? How about those with a social science or humanities background? How about older, non-traditional students? Finally, the field needs to do some heavy marketing. Attending physicians should emphasize the positive and work within their institutions to make the departments visible, indispensable, and able to influential in the organization. I think what is missing from this discussion is the social ecology of medical school and residency training. Medical students and residents are not stupid people. They are able to “thin slice” and analyze the situations on a daily basis and judge which physicians have the control, autonomy, and satisfaction in their practice. I know many of the resident in non-primary care specialties with a more controllable lifestyle almost pity the internal medicine residents. They are the proverbial “dumping ground” of the hospital, they have very little control over their service or environment, and appear to have to answer to everyone. Compounding this is the relatively low reimbursement for inversely complex and complicated work.

I think more attention should be paid to actually analyzing which kind of medical students from which backgrounds excel and enjoy internal medicine and recruiting them to the field. Are osteopathic graduates more generalist oriented? How about those with a social science or humanities background? How about older, non-traditional students? Finally, the field needs to do some heavy marketing. Attending physicians should emphasize the positive and work within their institutions to make the departments visible, indispensable, and able to influential in the organization.

]]> By: bruce http://www.medrants.com/archives/2553/comment-page-1#comment-79863 bruce Wed, 19 Oct 2005 14:28:53 +0000 http://medrants.com/?p=2553#comment-79863 How does one reinvent the public (and medical) perception of internal medicine? Both the specialists who benefit from our heavy lifting and the patients who get excellent care for less money than they should be charged are free riders. Quality general internists have encountered forced altruism, unless they decide to let quality slide in favor of seeing more patients and making less money. I myself have decided to go back to fellowship, as it is clear I cannot swim upstream for the next 40 years. In ten years when the country is experiencing another medical crisis because everyone is either an ophthalmologist or radiologist the only ones to blame are the politicians for their short-sightedness, and the public for the years of neglect the have given us. b How does one reinvent the public (and medical) perception of internal medicine? Both the specialists who benefit from our heavy lifting and the patients who get excellent care for less money than they should be charged are free riders. Quality general internists have encountered forced altruism, unless they decide to let quality slide in favor of seeing more patients and making less money. I myself have decided to go back to fellowship, as it is clear I cannot swim upstream for the next 40 years. In ten years when the country is experiencing another medical crisis because everyone is either an ophthalmologist or radiologist the only ones to blame are the politicians for their short-sightedness, and the public for the years of neglect the have given us.
b

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