We as scientist, as healers, have become distracted, divided, and it is easy to feel conquered by the outside forces of the corporate and legal practice of medicine. These forces have their own agenda. They will not lead science the way we should be leading it. We do not need to lose our leadership role in the scientific community. There is no one better to lead than us. We have shown this in the past, and we must not give up this role. No one can take it from us unless we remain silent. We have more educated people, more ways of communicating to share our thoughts and explain our ideas.

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Normalization of deviance is a concept first used to describe the NASA Challenger disaster. It refers to an insidious phenomenon whereby “people within an institution become so insensitive to deviant practice that it no longer feels wrong.”1 Looking back over the past several decades, we observe normalization of deviance within our U.S. healthcare system: serious problems that have slowly become ingrained into the culture. Examples include five-minute appointments, difficulty accessing one’s physician, lack of price transparency, complexity of coding and other documentation,2 and loss of physician autonomy and work-life balance.3 It is no coincidence that 2019 marks the first year in history that employed physicians outnumber independent physicians.

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Scenario #1. Your nurse is teaching an incontinent male patient to self-catheterize. His wife wants to record the encounter on her cell phone to “help” her husband perform the task in the future. The male nurse does not want to be recorded; he is concerned with his own privacy. Moreover, he is not sure that the patient actually wants his wife to film this. The wife is adamant that filming is necessary. The practice has plenty of other resources to assist the patient in completing this self-care task.

 

Scenario #2. You operate an OB/GYN practice. In your waiting room, a 12-year-old girl, whose mother is a patient of the practice, covertly snaps a photo of a 13-year-old patient when she is called back to the treatment area.

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Of all the reasons I’ve seen for selling a car, my favorite was the one a friend listed with his station wagon: “We outgrew it!” Just as his family needed more seats than the little Mazda could offer, our family has managed to cram two adults, three children, a giant fuzzy dog, and often an assortment of family and friends into our little townhouse … for a while. We stored; we stacked; we chuckled when we read about a family trying to find each other in their massive house. We might not know where we’d put one more chair when company came – but there was one problem we were not going to have.

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Recently, I was at an interdisciplinary team (IDT) meeting as medical director for a hospice. During the meeting, one of the nurses reported that one of her patients had a severe sore throat. She also relayed the information that her primary care physician (PCP) had declined continuing as her PCP once she became enrolled in hospice. By default, then, I was her PCP. Fortunately, I had time between the end of the meeting and my next appointment to stop by her house, which was not particularly out of the way. The patient was an elderly woman on hospice with end-stage chronic obstructive pulmonary disease.

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“What do you do?” This is often the question used to spark a conversation in a new acquaintance, to get to know who they are. But aren’t you more than what you do for a job? And isn’t it more interesting to know what a person is passionate about, not necessarily what they spend their 9 to 5 doing? I think this common question highlights the fact that our identities often are interwoven into our job titles. But is this really healthy? Is it truly the whole story of who we are? And, more importantly, in our example as physicians, do our patients really want us to simply be a doctor?

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The legal landscape for non-compete restrictions has been undergoing change. Legislatures and courts have been taking a renewed look at these restrictions, and in some cases aggressively limiting the type and scope of non-competes including those for physicians. While limitations are springing up, non-competes continue to be valid in most states. As a result, physicians must still be mindful and strategic when entering into contracts containing non-compete clauses. 

 

What is a non-compete?

 

Non-competes are a type of contract provision known as a restrictive covenant which can apply during employment and after employment ends.1 Non-competes are designed to restrict physicians from competing by precluding them from working for a competitor, or setting up a competing medical practice, usually for a specified time period after employment ends within a designated geographic area.

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A Federal law enacted nearly six decades ago to combat interstate organized crime has become the latest weapon in the government’s arsenal against healthcare fraud. The Travel Act, signed by President John F. Kennedy in 1961, prohibits interstate or foreign travel, or use of the mails or any facility in interstate or foreign commerce, for the purpose of distributing the proceeds of an unlawful activity, committing a crime of violence in furtherance of an unlawful activity, or to promote, manage, establish, or carry on an unlawful activity. It makes travel or the use of the mails or other interstate facilities in furtherance of a state or federal crime a separate federal offense.

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“From Pittsburgh to the World” is the message on a banner at the Global Links headquarters in Green Tree. Surrounding the banner is detailed pottery from Cuba, lucky ekekos from Bolivia and beautifully painted feathers from Nicaragua. Adjacent to these mementos of thanks from communities around the world is a window that sits eye-level with I-376 West and the rapid traffic and massive semi-trucks that come with it. The colorful art and the grey interstate form a striking dichotomy … and a striking partnership. Those massive semi-trucks that pass by may just have left Global Links filled with medical surplus such as life-saving sutures, hospital beds, wheelchairs, breathing machines, blood pressure cuffs and oto-ophthalmoscopes.

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Catherine A. Chappell, MD, MSc
Debra L. Bogen, MD, FAAP, FABM

One of the most significant consequences of the opioid crisis is the increasing prevalence of hepatitis c virus (HCV) infection among young persons, including pregnant women. In 2015, the Centers for Disease Control (CDC) reported a 364% increase in HCV infection among persons less than 30 years of age.1 Now in Pennsylvania, young persons outnumber the “Baby Boomers” (persons born between 1945 to 1965) with HCV infection.2 Currently, recommendations are to universally screen all Baby Boomers for HCV.3 However, there are conflicting guidelines regarding HCV screening during pregnancy. While the Infectious Disease Society of America (IDSA) recommends universal antenatal HCV screening, the American College of Obstetrics and Gynecology (ACOG) recommends risk-based screening.

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