The Remedy for Physician Burnout is not Therapy. Are You Kidding Me?

Therapy and medications are for mental disorders. By definition, they are not caused by events, excet in the same way stress worsens all medical conditions. When a real stress happens, the remedy is not treating the victim. It is actions to fix the stress. How about starting some real resistance to counter burnout? Do not count on organized medicine, a wholly owned susidiary of the Deep State. Doctors are all on their own, in defending clinical care.

Remember when you broke a rule in school and were made to write, you will not do so, 250 times? That was a form of corporal punishment and physical abuse. MD's should be litigating their being physically abused by forced typing. No typing should be allowed when a video recording of an encounter is 100 times more effective. Then go after the lawyer profession for their frivolous but ruinous litigation. Include the accomplice judges allowing frivolous lawsuits, which are the majority of them. Challenge regulators and reviewers for the quackery of their unproven rules. Let others burnout dealing with the medical profession, and not the doctors. Deter them.

The idea of burnout is simple. When you get rid of a doctor, the payer saves $5 million a year in health care costs. The case not being made is that each doctor restores 70% of patients to health and function worth $100 million a year to the economy and to the tax base. That is the pure cash value. It puts no value on the suffering alleviated.

Government Thugs Shut Down Lemonade Stand

They were called by a competitor. No harm had taken place.

These government thugs must be stopped by ruinous litigation. To deter.

http://denver.cbslocal.com/2018/05/29/lemonade-stand-shut-down/

Unconstitutional Undue Burden of Regulatory Quackery

The rate of positives has been low. The positives were likely false positives. Any savings will be consumed by the defamation liability for those falsely labeled as positive. The law should allow falsely accused recipients to sue the county, the maker of the test kit. To deter.

Originally, Sovereign Immunity was justified by the King's speaking with the Voice of God. This is a psychotic delusion.  Sovereign immunity has no justification.

Here.

The Problems with Informed Consent

PA Supreme Court mandated attendings must obtain informed consent. That decision is regulatory quackery designed to deny access to care. It violates the constitution by placing an undue burden. This phrase  was used to strike down laws restricting abortion times many in US Supreme Court decisions. It is undue because it has no effect on treatment outcomes. All regulation should be proven safe and effective or it is regulatory quackery, an intentional taking by government, and a type of fraud if one understands the Rent Seeking Theory, theft. Medicaid abuse is defined as the payment for a procedure that is not necessary. The PA Supreme Court should mandate an additional payment to doctors for its decision, and then get arrested for suborning Medicaid fraud. If they refuse to mandate an additional payment, I demand they mow my lawn for free.

Here are the problems with informed consent:

1) There is no informed consent. Give a 3 hour lecture on a treatment. Test the patient 15 minutes later, they know nothing about it, nor do most want to. Most just want the problem to go away;

2) patients and guardians have a duty to Google, with the internet available to 100% of the population, along with chats by patients receiving the treatment, including disgruntled ones;

3) patients are not qualified to decide the specifics of treatment; I do not want to know anything about piloting a plane. I just want to get to Chicago. Nor do I wish to learn anything about the disgusting management of plumbing, I just want the toilet to flow again, and to stop flooding the bathroom;

4) there is no informed consent because the patient has a gun to the head consisting of extreme motivation by pain, the threat of death, the loss of normal function from the disorder;

5) the sole informed consent is the question of the patient to the doctor, what would you do personally in this situation? That is the sole real question, that actually is beneficial. The answers can be shocking. For example, the answer from many cancer specialists is not what they tell patients, radiation, chemo, surgery. It is, I would go home, play with grandchildren.

Statement on Nurse Practitioners with Independent Prescribing

 

 

If any member of the legislature were having crushing chest pain, and had shortness of breath, with a family history of premature  deaths by heart attacks,  would they want to be seen by a cardiologist or by a nurse practitioner filling out a form on the electronic record? Why are the lives of black people on Medicaid worth any less than that of the legislator? If should be part of any nurse practitioner enabling statute, that legislators, their families, their staffs, their families may only be seen by nurse practitioners. 

The movement to allow nurse practitioners to prescribe unsupervised, will result in a two tiered health system, one for whites, one for blacks. It stems from racial animus. The aim is to raise the mortality of black people even higher than it is already.

Their role is falsely justified by lack of access to medical care. There is no doctor shortage. There is a shortage of doctor time. Half of that time is consumed by regulatory quackery. Regulatory quackery is a rule that has not been shown to improve patient outcomes. Its intention is take up doctor time with worthless procedure so that fewer payments are made for real patient care by government and by insurance companies. Because regulatory quackery has consumed $trillions and prevented the real care of millions of patients, it is the greatest financial fraud crime  in the history of mankind. Examples of regulatory quackery include, the electronic medical record, pre-authorizations with all out, implacable resistance to paying for any care, including cheap generic medications, almost all accreditation standards, privacy destroying patient registries, such as those for pain medications, pseudo-scientific and false practice guidelines.

Nurse practitioner programs are so competitive that only people with nearly perfect grades get in. Most qualify to get into medical school. They have chosen to bypass that harder road to clinical competence, to begin making money earlier, and with less student debt. That corner cutting should not be rewarded with independent prescribing privileges.

As a result, they know one quarter that specialists know, and half as much as primary care physicians. They are fit only to prescribe for patients doing well, needing routine refills without any change. They are fit to diagnose routine, common and mild disorders. They are fit to administer first aid and nursing care.

New patients with serious or life threatening conditions should not be evaluated by them. They can read off checklists, but have none of the skills that come from the experience of doctors.

Even after 5 years of experience, because they have not been challenged by difficult experiences of physicians, they will require supervision.

A patient commented on the internet. A nurse practitioner insistently called the growing lesion on his arm  an "age spot" for a year. The patient demanded to see the dermatologist. The doctor arrived at the door, and from that distance, stated, “That is a squamous cell carcinoma. It has to come out.” Squamous cell carcinoma is a common skin lesion in the elderly.

The Serious and Insurmountable Problems of Evidence Based Medicine

Evidence based medicine has problems, 1) delineation by academic professors with half the clinical experience and therefore half the insider knowledge of clinicians; 2) obsolescence; 3) based on wrong statistical application; 4) violation of the rules of statistical testing by exclusion criteria, in all studies; 5) misapplication to individual patients (a treatment killed 99% of patients who had it, this patient has done well on it, follow guidelines and stop this effective treatment?); 6) ignorance of the individualized dose-response curve; 7) conflict of interest by scientists inherent to all professions; 8) tyrannical, left wing, big government bias of medical academia and of organized medicine. Medical science is fake news. 

1) Something works in medicine. It spreads around the world in months. When patients are doing well, medicine is a highly paid, piece of cake. It is almost like stealing. When patients are not doing well, it is a living hell of time, effort, and extremely low pay for doctors. So the incentives are in the right direction. Doctors may be trusted to want patients to do great. And the loss of work by patients' cures is not a problem due to the shortage of overly busy doctors.

2) A couple of years later, an academic doctor sees this response, designs a study, writes a research proposal, gets funding, carries out the study, writes up the results, waits for its publication. So, 7 years has passed. A number of studies accumulate. A committee reviews them. They enter a textbook, as accepted practice. It has now been longer than 7 years, by the time a guideline is written based on published studies. Meanwhile, the docs are doing almost nothing the way they were 7 years ago. The standard of care has moved on, except in the minds of guideline writers, government officials using guidelines like laws. These officials only want to slow clinical care to save money by piling bureaucratic procedures, and by denying dark skinned people that white people are getting.

3) On the first day of high school statistics class, coin tossing is discussed. That event is described by the binomial distribution statistic.

4) Studies comparing the fractions of responders to a treatment and to a placebo are supposed to represent the larger population. The parametric statistic is used to compare the fractions. The parametric statistic is the one whose formula describes a bell shaped curve, a common distributions of populations. Before carrying out such a test, one must show that 4 assumptions have been fulfilled. The most important is random selection. So any selection bias, such as an exclusion criterion, makes it so that the test is not even allowed to be done, let alone have any validity. All studies have exclusion criteria and violate the central assumption of parametric statistical testing. The populations in these studies do not represent those in the clinical setting. Doctors do not have exclusion criteria in their practices. Imagine excluding suicidal patients from a depression treatment study. That is routinely done in the FDA approval of new anti-depressants. Worthless.

5) Clinical care differs from the comparisons of the fractions in groups. It is closer to coin tossing. Have or not have a diagnosis. Give or not give a treatment. Have a good result or a bad result. The binomial statistic is more appropriate to clinical care than the parametric. Nevertheless one is not allowed to apply parametric statistics to a population best described by a binomial distribution.

6) Dose response curve is ignored. Low doses of radiation are good for the health, for example, as in radiation hormesis. One must delineate the dose response curve of all remedies. Then one must do so in the individual patient, and this is where experience based medicine beats evidence based medicine in outcomes.

7) Most evidenced based guidelines are not only written by under-achieving, atavistic, and know nothing academics, they are written by associations with undisclosed conflicts of interest. For example, cardiologists proposed doing EKG's on all children receiving stimulants for Attention Deficit Disorder (ADHD). They would be doing the EKG's, and reading them. Cardiologists want to make more money, since the management of cholesterol lowered the number of cardiac problems.  Child cardiac function has not been harmed by stimulants. Once a year, a child, out of hundreds of others, reports a newly rapid heartbeat,  at rest. That child is taken off the stimulant and placed on something else. No EKG is necessary. Requiring EKG's would deter the use of stimulants, and increase the rate of accidental injuries by impulsive acts of untreated children with ADHD;

8) Most medical academics are big government dependent, left wing, anti-corporation advocates of more regulatory oversight, and regulatory quackery. Many researchers are in the Ivy League. These schools may be dismissed. Others in top state universities with high levels of taxpayer funding. So they choose the subjects to research to advance their political agenda. Then, one has to read the fine print in the Methodology Section. In a study of medical error, the rates were inexperienced residents. They were trained to do their ratings by lawyers. Most of the people claimed to have been injured by medical error were treatment non-responders, mostly because of advanced age, and multiple organ failures. So their bias is expressed by subject selection, and methods unfairness. You will never have major studies done on the benefits of caffeine, or of nicotine.

In a legal context of any kind, the suborning of quackery is a violation of the Fifth Amendment procedural due process rights of the defendant to a fair hearing. Evidence based medicine is  itself is a constitutional tort. I would urge all defendants to sue the plaintiff lawyer, the plaintiff, the plaintiff experts, guideline writers, as individuals, their universities, their chairman that failed to supervise them, their association. The association should be charged with civil RICO. That is subject to punitive damages (triple) because it is an intentional act, not just negligence. If it can be shown to have been financially self serving, it can be converted to criminal RICO, and the guideline writers should be arrested, tried, and sentenced to prison. To deter.

Stuff on civil RICO, only 600 pages.

Put this forward to the defense lawyer. He will never agree, because it would fully deter the other side, and end his business.

Update (May 7, 2017). 

Article reviews book on failure of medical research.  Bias, need for funding, pressure to publish positive results, rejection for publication of negative results, mistakes in methods.