health14-blog

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예방의학 교육

- 예방의학은 임상 의사에게 도움이 되나?

- 의사들은 예방의학이 무엇이라고 생각하고 있나?

- 의사들은 예방의학이 유용하다고 생각하나?

- 의사들이 유용하다는 예방의학은 무엇인가?

[health14-blog]

김대중

그는 한국이라는 나라의 국격에 과분한 정치인이었다. 시대를 앞선, 남성 페미니스트였고 국제주의자였으며 비전과 대안이 있는 정치인이었다. 그에 관하여 좀 더 알아볼 필요가 있다. 동시대의 선진국 지도자들보다 몇 곱절 훌륭한 위인이었다.

[health14-blog]

조지 W. 부시

마이크 치노이. 북핵 롤러코스터: 전 CNN 전문 기자가 쓴 북미 협상 인사이드 스토리. 박성준, 홍성걸 역. 서울: 시사IN북; 2010.

북한 국민에 동정적이었던 그와 그의 외교 정책의 총체적 실패. 결국 그는 북한으로 하여금 핵 무장과 미사일 개발을 가속화하여 북한 국민의 고통을 20여 년간 연장시키는 데 결정적 기여를 한 셈이 아닌가. 무능으로 점철된, 자기 만족에 불과했던 부패한 이들의 대북 정책.

[health14-blog]

속상해

오늘 윤권이 고등학교 첫 시험인데. 전화를 못했다. 속상해, 속상해.

[health14-blog]

정부 관료의 행태

중요한 사업의 평가를 사전 준비도 없이 6개월만에 끝내는 연구를 발주해 놓고 연구자가 없다고 징징거리는 행태.

결국 당사자와, 그 일에 애정이 있는 연구자로 하여금 어색한 관계에 놓이게 만드는 그런 행태.

자기들은 뒷짐지고 당사자들이 뛰어 다니게 만드는 그런 행태.

일은 벌이고 수습은 남들에게 맡기는 그런 행태.

[health14-blog]

의사협회 선거 결과

이명박, 박근혜 대통령을 탄생시킨 국민인데 최대집 씨가 의협 회장이 되었다고 왜 그리 흥분하나 싶다.

[health14-blog]

정권의 일역으로, ‘문재인 케어’ 실천의 주역으로 정책의 성격을 규정한 선생님의 글. 글을 쓴다고 또 며칠을 새셨을까.

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How to use equipment for your muscles?

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주치의 제도

한국 의료계(의사 집단)가 주치의 제도를 진지하게 논의할 용의가 없다면 다른 대안을 찾아야 할 것 같다.

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환자 안전 참고 문헌

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트리샤 선생님 말씀

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보건소 ㅠㅠ

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선진국

어느 순간부터인가 나는 한국을 ‘선진국’이라고 말하는 데 주저하지 않게 되었다.

내가 중요하게 여기는 어떤 점에서 한국은 여전히 야만적인 나라다. 무엇보다 국가나 정부가 그렇고 이 나라의 영향력 있는 국민 대다수도 그렇다. 성 평등과 성 소수자 인권 보장, 안전, 건강은 언제나 사회적 우선순위 밖에 있는 것이다.

그러나 한국 밖에서 이 나라는 이미 선진국이다. 경제 성장 외에도 그렇게 볼만한 점이 분명 있다. 그런 저력은 야만적인 모습을 바꾸는 동력일 수 있다. 비판을 딛고 더 나아질 수 있다는 점을 분명히 하는 것이 중요하다.

그런 점에서 어느 나라든 선진국일 수 있다.

[health14-blog]

작은 변화

안녕하세요, OO님.

여러분들께서 걱정해 주셔서 마음이 든든합니다. 모두들 맡은 자리에서 흔들리지 않고 자기 역할에 충실하게 일하고 있답니다. 변화에 두려워하지 않고 헤쳐나가고. 이런 변화가 조금씩 바뀌어가겠지요.

감사합니다.

[health14-blog]

멕시코 일차의료

AAHPG mailing list에 흥미로운 메일 교환이 이루어지는 중. ���리 순서에 따라 옮겼다.

Max Hotopf wrote:

Recently talked to the largest for-profit lab group (Proa) in Mexico. CEO said that pharmacy chains in Mexico were now employing doctors on their retail premises and offering primary care consultations for just $1 to $1.50, as compared to the $20 plus that doctors apparently charge from their own primary care units. He reckons that pharmacy chains are already doing 500,000 consultations a day on this basis.

The obvious conclusion to be drawn from this is that the pharmacies will get more drug sales and that the practice will lead to heavy overprescription. On the other hand, at this price, the move effectively means that almost all Mexicans will get affordable access to primary care.

Which is the lesser of the two evils?

AJ Oliver replied:

Doesn’t it depend on how good the consultation is? For the price of a can of coke, I would guess not very good at all.

Michael Gusmano replied:

Dear Max,

This is interesting, thanks for sharing this. What do you know about the payments to physicians in these settings? Are they tied to drug sales in any way? The possibility of over prescription may exist anyway, but it would be helpful to know more about this.

Best,

Michael

Max Hotopf responded to AJ Oliver:

Well, yes probably. But how good would it be in the primary care unit, given that commission payments for referrals are probably rife there, anyway?

We had a conference in Latam last week. What was fascinating was that almost all the private sector in Brazil is working on a fee for service basis. So you get rewarded for keeping a fit young boy with a broken arm in intensive care for two days.

I think it is safe to say that fraud and wastage is colossal. Up until very recently the insurers have not taken any action at all, because if the case goes to a court of law, the judge in Brazil always sides with the doctor.

This is a general problem in all emerging markets in the private sector and I think wastage levels run at over 30pc or more. Chinese public sector hospitals get half their revenue from drug sales....

This was recently outlawed by the state but given that it has not fixed the underlying problem, it is simply going to continue.

This is the world's most corrupt industry. And the medical profession should take a lot of the blame!

Paul Batchelor responded to Max Hotopf:

Don’t follow the logic Max. If a system is designed with the wrong (perverse) incentives and one group takes advantage of those, why should they take (a lot) of the blame. Surely the clowns that design the system might be a more appropriate target.

Best,

Paul

Max Hotopf responded to Paul Batchelor:

Well, the problem with the medical profession is that it has a lot of power and wants to have its cake and eat it. It is often the group with the most influence over much of the system. So Indian doctors medical councils have for years been attempting to stop the training of more specialists because this would lead to lower pay. They have managed to achieve this which has led to many deaths. This scenario is played out in many countries. German radiologists got a law passed which means that a medical image taken in Germany can not be interpreted outside Germany. Which is obviously bilge. Usually the defence is that they are acting in the interests of patient safety.

The problem is that the general public and policymakers generally perceive doctors as objective and disinterested experts on medical systems. This view is amplified by clever pharma and medtech companies to attain their ends. BUT DOCTORS ARE NOTHING OF THE KIND!

Rant over :-)

Max Hotopf added:

In this context my colleague Lee has pointed out that CVS has just bid for Aetna!

Tuba Agartan responded to Max Hotoph:

Hi Max,

To comment on your earlier question on pharmacy chains and primary care, the US have been experimenting with this for a while now. Chains such as the CVS opened MinuteClinics where they employ usually nurse practitioners or physician assistants to provide primary care. The justification is the shortage of primary care providers but of course the point about messy incentives are relevant here too. I went there twice during the holidays and the provider actively sold me over-the-counter medications. This created a lot of debate when it was first proposed but now it seems to continue without much hassle. See here for a story in Huffpost.

https://www.huffingtonpost.com/2015/01/12/retail-clinics_n_6445506.html

Best,

Tuba

Tuba I Agartan, PhD

Associate Professor of Health Policy and Management Providence College

&

Takemi Fellow, Harvard T. H. Chan School of Public Health

Joseph White responded to Max Hotoph:

Hey, business is business. But I really think some restraint is called for in the attacks of fee-for-service as inherently creating corruption. I don't know what happens in Brazil, but I don't think there ever was a time in the U.S. where a simple broken arm would lead to two days in intensive care.

Professionalism doesn't work anywhere near as well as the physicians claim. Physicians are economic actors. But they also are no more awful and immoral than much of anyone else; most people have notions of proper behavior and try to live by them; and the story on docs behaving in exploitative manners is way more complicated than simple homus economicus stories would tell.

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