Dr. Rocky D. Bilhartz | Taking Back Medicine

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Escaping the Fog

September 23, 2015 / Rocky D. Bilhartz / 4 Comments

I wish someone would have told me I didn’t have a clue what I was saying. That I didn’t have the foggiest idea what the heck I was talking about.

I was an upper-level medical resident. Confident. Running a team of internal medicine physicians who were also in training.

“You need to order a CAT scan on this patient,” I told the resident doctor working underneath me. “At least, for medical-legal reasons,” I said.

The patient was having some vague chest pain. It clearly wasn’t a heart attack. I knew that. It was probably a twinge in the chest muscle. The patient could have probably gone home from the emergency department with reassurance, but the doctor there had already decided the patient should spend the night in the hospital.

“We need to rule out pulmonary embolism,” I told the young physician on my team. “The attorneys would have a field day if we missed that.”

At that particular moment, I had only seen the inside of a court room once before. And, it wasn’t for medical reasons.

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Inspecting the Inspectors

September 14, 2015 / Rocky D. Bilhartz / 3 Comments

This story is a great one.

It’s about a female dog with only three legs. Her fourth leg was amputated following a traumatic accident as a puppy.

Now, when she walks, she has a hitch in her step. And, when she hitches, she kicks the stump of her injured leg outward.

Step, step, hitch. Step, step, hitch.

One day, the female dog has puppies. And, her puppies do what all puppies do. They nurse. They watch. They learn a little about the world around them from each other. But, mainly, they learn about life from watching their mom.

Before long, the puppies are walking. And, how might they walk? You already know. They walk with a hitch in their step. Just like mom.

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Regulate THIS!

September 2, 2015 / Rocky D. Bilhartz / 4 Comments

Pharmaceutical drugs cost too much. The new ones are always so expensive.

Hence, we need more regulations. And, the government should impose them. Set price limits. Cap drug-maker profits. This will make it better for all of us. The paternalism of our government should be the strongest when we are ill. Because we may need that medicine.

The government should regulate things more so we can get it cheaper.

Case in point. One new medication now available to cure a chronic liver disease costs about $84,000 per treatment course. The actual production cost for the company that makes the drug is supposedly around $100. Granted, the company paid $11 billion for the patent rights, and then took a risk that the drug would even get through Food & Drug Administration (FDA) approval. But, ultimately it did, and this year alone, the company will likely receive over $17 billion in revenue from it.

Wow. Then, they likely will make more profits next year.

And, the year after.

Why isn’t the government protecting us from such pharmaceutical price gouging? Where are the regulations? We need them.

Here’s the bitter irony.

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Getting Back to Principles

August 26, 2015 / Rocky D. Bilhartz / 2 Comments

Often, things aren’t what they seem.

Take the image above, for example. Which shade of gray is darker? A or B? Look closely. I wouldn’t want you to miss this one.

Now, place your finger horizontally between A and B. Cover up the transition zone between the letters. Block the area with all the shadows. Look again.

Very interesting, right? The two colors are the same. Remember, things aren’t always what they appear to be. In fact, when you find yourself on the side of the majority, you should think even harder.

We already discussed causation and correlation, but it’s time to go deeper than that. Stuff just happens all the time for reasons that we seem to miss. We assume the problem is one thing. At least, it appears to be acting that way on our stage. But, if only we could see deeper. Far below the surface. Would we see things the same way?

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You Can Expect to Die If You Live

August 5, 2015 / Rocky D. Bilhartz / 9 Comments

“Life expectancy in the United States lags behind other countries.”

I hear that statement a good bit when people try to explain America’s healthcare problems to me.

The statement almost always precedes this one:

“The United States is spending tons of dollars on healthcare and getting far less return on its investment than other countries.”

Basically, there are problems with healthcare in America and this results in lower-than-hoped-for life expectancy.

We spend too much on medical tests. We diagnosis many diseases. But, we don’t follow through with managing them well, so our population doesn’t live as long as our competitors.

I’ve even found myself, from time to time, nodding along with people making these statements and using this kind of reasoning. Then, it finally occurred to me.

We actually have no idea what we are talking about.

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How to Spend Eleven Billion Dollars

August 1, 2015 / Rocky D. Bilhartz / 2 Comments

Eleven billion dollars.

Sounds like a lot of money, doesn’t it?

It is. But, I’ll give you even more perspective, Tony Robbins style.

Eleven seconds ago you started reading this page. A few blinks of an eye. But, eleven million seconds? That was a few months back. 127 days to be exact. Can you remember what you were doing then? Eleven million seconds have passed since you did it.

But, when you jump to billions, you’ll begin to see my point. Take eleven billion seconds. How many days ago was that? Not days, really. Try years. I’ll give you a hint. You weren’t born yet. Our country wasn’t even born yet. Eleven billion seconds ago was almost 350 years in the past. It becomes days versus centuries when you go from millions to billions. They are solar systems apart, even when traveling at the speed of light.

So, back to eleven billion dollars.

Remember, as Everett Dirksen once said, “a billion here, a billion there, and pretty soon you’re talking about real money.”

Eleven billion dollars is what the Department of Defense (DoD) is about to spend to revamp their electronic health record (EHR) system. That’s right. Computer software. For medicine.

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The Government Takeover of Quality in Medicine

July 24, 2015 / Rocky D. Bilhartz / 4 Comments

This is a video (21 minutes, 33 seconds) of my lecture given at the Summit at the Summit: A National Grand Rounds on the State of American Medicine. The lecture aired during the conference webcast on July 23rd, 2015. Conference lectures can be re-watched by registering at LetMyDoctorPractice.org. The transcript of my lecture appears below.

HISTORICAL BACKGROUND

Quality in medicine appears to have been formally first addressed around the 4^th century B.C.E. in a collection of approximately 60 treatises known as the Hippocratic corpus. These writings outlined diagnostic methods of physicians but also detailed treatment failures for the benefit of all.

The corpus’s most famous surgical text, On Fractures, opens with a promise to discuss mistakes:

“I must therefore mention which of the physician’s mistakes I want to teach you not to do.”

The quest for quality throughout the corpus was distinctly a personal matter, centered on humility and the challenges of medicine:

“Life is short, the art is long, opportunity fleeting, experiment perilous, judgment difficult.”

This is one of the most famous statements of the Hippocratic corpus–its focus noticeably removed from a world-group or professional responsibility.

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The Surgeon Scorecard is Here! (It’s Just Not Meaningful)

July 17, 2015 / Rocky D. Bilhartz / 2 Comments

An independent company, known as ProPublica, made healthcare news this week by releasing the complication rates of nearly 17,000 surgeons nationwide.

ProPublica is another one of these non-profit groups that has been granted charity status by the Internal Revenue Service. Their self-stated mission is investigative journalism in the public interest.

You should know that ProPublica claims to be supportive of the “little guy.” I, too, like underdogs, so I enjoyed reading on their own website about their goal to shine “a light on the exploitation of the weak by the strong… [to expose] the failures of those with power to vindicate the trust placed in them.”

Giddy up, ProPublica.

I also favor transparency in medicine. In fact, I wrote a book, in part, to outline my support for it. But, ultimately, what I care about most is taking back medicine. Returning the practice of it to those things that are really meaningful to patient care. And, in our modern era of excessive third-parties mooching off the healthcare system, my focus has settled in on chiseling away at the less meaningful.

With that in mind, I’ll tell you about the “Surgeon Scorecard” that ProPublica has now made public.

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