Greetings from the LHH! Having been injured, sick, or traveling, or, actually 2 of the 3 since April, it’s not been the best for my kayaking. But Monday morning was cool, the wind was minimal, and I got out on the water at about 6:30 AM to catch the sun still rising. A perfect day for a paddle. I hit the Oyster River just as the tide was coming in, which is my favorite time to paddle. A little harder going out, but a little support on the way back in. Plus low tide and early morning is when the birds are most active. I saw lots of herons and cranes. It was like they were out there to welcome me. I didn’t like paddling alone when I first started kayaking, but now I appreciate the silence and the inner stillness that comes from the steady exercise, the exposure to the natural world, and being alone with my thoughts. It truly is good for the soul. I hope you have a discipline that gives you this sort of opportunity for inner peace.
I did my first site visit yesterday for the summer internship season, and will be doing two more today. Early reports indicate the students are doing very well, so I am pleased. 18 more trips to go!
On to the links! A little more healthcare oriented than I have been of late. But as usual, willing good for all of you!
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Read
What: Evil HR Lady, Decoding office etiquette: guiding interns effectively
https://resources.workable.com/stories-and-insights/decoding-office-etiquette-guidelines-for-interns
Why: I love the Evil HR Lady. The punchline: people who are new to the workforce need more direct and clear instruction about propriety. This article gives some advice about how to provide that clarity. I will be sharing this with my juniors next year.
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What: HFMA, Site-neutral payment and the battle for healthcare’s soul
Why: Want to understand why healthcare is so expensive? Follow the money. Specifically, the Medicare money. The Federal Government is the biggest payer of medical care in the country. As a result, Medicare policies shape the way the rest of the market operates.
Medicare pays two-to-three times more for administering the same drugs in hospital-owned facilities (including physician offices) than in independent physician offices.a This practice creates financial incentives for hospitals to acquire physician practices.
And so they have. The Medicare Payment Advisory Commission (MedPAC) reports that Medicare paid hospital-based prices for more than half of all chemotherapy drugs administered in 2021, up from one-third in 2012.
Look, if you are hired as a CEO of a hospital, you have a fiduciary duty to make sure that the hospital earns as much money as possible. If you are a CEO of a non-profit hospital, that extra money is supposed to be used to provide more care. The mantra is non-profit hospitals is “no money, no mission.” And so when Medicare sets up a compensation system that rewards care in hospitals more than in non-hospital settings, everything starts moving into the hospitals.
Water flows downhill.
It’s that simple.
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What: It's Not Burnout, It's Moral Injury | Dr. Zubin Damania on Physician "Burnout" (6 min)
Why: I’m sharing this because it’s something I have been thinking about. I’ve been thinking about it in two ways:
Burnout/Moral Injury - whatever you call it, healthcare providers are feeling broken, many are leaving the practice of medicine or worse because of this thing. How do we fix it? I’ve been thinking about my 3Cs of Meaning heuristic with this. I think what ZDogg describes is broken Competence, in that the system in which providers are working denies their competence and zeroes out their sense of meaning (hence they are leaving practice or worse).
I have a problem with the way the language of trauma is being used to describe situations that are not trauma. Participating in war is different than being a healthcare provider. I acknowledge the reality of healthcare providers’ pain, but we are too loose with words today. The trauma of war should have a different word than the emotional challenges associated with the practice of medicine. We have overextended the meaning of trauma to apply to too many things. We, as a society, need to differentiate more than blur.
I have more thoughts on both angles - I’d be interested in your thoughts.
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Listen
What: Advisory Opinions, Offensive T-Shirts Get Their Day in Court
Why: I want you to skip forward to 51:45. At this point, they start a discussion of liberty vs power with respect to the Constitution. Liberty allows us to defy power. It protects our freedom of action from the powerful. Great conversation on an important topic for free people.