Dr. Rocky D. Bilhartz | Taking Back Medicine

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More Data, Less Logic

July 14, 2015 / Rocky D. Bilhartz / 1 Comment

“Deaths from high blood pressure should plummet under Obamacare.“

That’s the title of a recent news story that got my attention.

The article was a press release about a study performed by several non-physician investigators with a background in public health. For those less familiar, public health relates to the science of population medicine, or what’s good for the group is good for the individual. Basically, four non-physician investigators sought to analyze the impact that the Affordable Care Act (ACA), also known as “Obamacare,” will have on deaths in this country due to high blood pressure.

“Deaths should plummet,” says the story.

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The Paradox of Choosing Wisely® & Medical Board Certification

July 2, 2015 / Rocky D. Bilhartz / 3 Comments

There’s lots of unrest in medicine right now.

Some of it deals with how doctors maintain their board certifications. Newsweek recently called it “The Ugly Civil War in American Medicine.”

Physicians in America get licensed by their state to practice medicine. This is a legal requirement. And, as you might imagine, lots of stuff goes into getting that license. You first get your education, then you take some tests, then you get more education, then you take more tests, then you get continuing education… And, you get the point.

There’s also something known as physician board certification. It’s really not supposed to have anything to do with the law; yet, admittedly, in recent years, the controlling organizations that hand out these board certifications have gotten some of it written into law. But, that’s another story.

The concept of medical board certification was formally established in the 1920s and 1930s. It originated from “people” seeking to answer the question: how do you know your doctor is competent?

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Distracting Pilots Landing Planes

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

Years ago, I owned a lawn service. I ran the company.

Actually, I was the company. The only worker. Then, a buddy of mine joined up. It became our summer gig for many years.

We prided ourselves on quality. We were good at what we did. And, we were fast, too.

Jump ahead a few years. Okay, more than a few.

I now work in healthcare. And, to be honest, I wish there were more similarities now with what I did back then. I’ll explain.

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Time to Leave Early?

June 12, 2015 / Rocky D. Bilhartz / 1 Comment

Leave early.

Two words. Simple concept. But, one worth thinking about.

James Altucher explains it well, but this is the same guy who also thought he could save his business by becoming more like a Jedi Knight. Admittedly, the Jedi thing seemed to work for him, and his businesses, as well as the uncountable number of people he’s helped since then. But, becoming your own Skywalker is for a different day. Today, I’m just talking about how to leave early.

I’m not envisioning the “BIG” checkout. Although, admittedly, life is one fragile ride. My dad died suddenly a few months ago, and I felt that he left early. Two of my best friends lost their fathers since then, too. In fact, it’s amazing how you feel others’ losses more closely following your own. But, let’s scratch the Death Star talk for now.

I’m really just talking about the Pareto principle. At least what I can extrapolate from it.

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Purifying Healthcare (Part 2): One Desolate Place Without Industry

June 8, 2015 / Rocky D. Bilhartz / 0 Comments

Essentially every concept has positives and negatives.

No matter how opinionated a player on one side wants to be, there are usually always some benefits to the opposing team’s approach to the game.

In healthcare, whether you think we need a single-payer system, a multi-payer system, or no system at all, I can find you a simulator that will reveal perceived benefits for each of these strategies. The simulator will tell you the negatives, too. And, then, no matter how robust it may be, the simulator will still manage to imperfectly predict real life.

You see, what often makes sense to a simulator becomes bizarely twisted in application. Human beings display surprisingly self-directed and unpredictable behaviors. Uncertainty is a certainty.

Cause and effect are challenging to prove and our own observations even interfere. For example, there was a time when we wrongly associated ice cream consumption with the spread of the Poliovirus, merely because both were more prominent in the summer months. Life is complicated. And, everyone has an angle.

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Purifying Healthcare (Part 1): Just Another Invented Game?

June 4, 2015 / Rocky D. Bilhartz / 3 Comments

Everyone has an angle. Everyone.

Your doctor? Sure. But, he or she isn’t the only one. The pharmaceutical company? Of course. The medical device company? The hospital? The insurance company? You get the point. Everyone has an angle. Everyone has a conflict of interest. Know it. Get over it. It’s time to focus on something else.

Like filling up your car with gas. In fact, you better plug your ears when you do it. Heaven forbid one of those automated messages at the pump convinces you to buy a 42 ounce gulp of Pepsi. Just another angle, my friends. It’s called life.

But, medicine isn’t supposed to have any conflicts of interest, right? Healthcare instead should be like religion, or maybe, like politics… sorry, I’m now getting confused what’s supposed to be pure.

We just live at a time in America where so much of healthcare has become invented. And, the more we keep inventing, the more it seems that we lose track of what matters: the hopelessly out-of-date concept known as the patient-physician relationship.

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A New “Pay for Performance” Plan for Public School Teachers

May 25, 2015 / Rocky D. Bilhartz / 2 Comments

My oldest son is almost a second grader.

He attends a public elementary school in town, and very soon, he will start preparing for an exam known as the STAAR test.

The STAAR test is an “assessment of academic readiness.” In my state, it gets administered to publicly-funded school children. Students must pass the exam to continue progressing in school, and ultimately, students must master the Exit Level test to graduate high school.

There’s good and bad with standardized testing, and I’m not going to debate that point today. Instead, I’m going to tell you about a new proposal involving public school teachers.

Imagine, just for a moment, that we decided to pay our school teachers differently next Fall. It’s an intriguing idea, so bear with me. In fact, let’s pay school teachers based solely upon the scores their students achieve on the STAAR test.

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America’s Epidemic of “Less is More” in Medicine

May 16, 2015 / Rocky D. Bilhartz / 1 Comment

Dr. Atul Gawande is an American surgeon and public health extraordinaire. He is one of the most successful physician authors of this century, and he writes routinely for The New Yorker. His most recent article discussing unnecessary healthcare is, as expected, a good read.

I applaud Dr. Gawande’s passion towards advancing medicine. And, yes, there is universal agreement that we need to be better in America at providing high-quality low-cost healthcare. There just remains disagreement on what our biggest obstacles are, and how they should be overcome.

I agree with Dr. Gawande on some things, but after reading his most recent opinion piece, I must caution you about several medical inaccuracies found within it.

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Using Technology to Move Backwards

May 6, 2015 / Rocky D. Bilhartz / 10 Comments

There is a new protocol at the local hospital.

I see it as another one of these “moving in reverse” schemes. The protocol relates to how I admit patients directly from my clinic to the hospital.

I’ll simplify it for you. You are a patient seeing me in my outpatient clinic. I evaluate you and make the decision that you need to go to the hospital. Maybe, your symptoms are concerning for an impending heart attack, but for whatever reason, I need to admit you to the hospital.

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