Brian Pierce MD

A good short podcast for the rainy dog walk around the office this morning-

More reassurance (because change is hard for both docs and patients) that we should NOT prescribe antibiotics for uncomplicated diverticulitis.

Also, no follow up colonoscopy needed if uncomplicated diverticulitis on the CT scan.

Therapeutics Education Collaboration | Episode 581: Antibiotics or no antibiotics for acute diverticulitis, that is the question! Episode 581: Antibiotics or no antibiotics for acute diverticulitis, that is the question! August 8, 2024 In episode 581, Mike and James invite Mike Kolber back to the podcast for the umpteenth time – this time we talk about a topic we haven’t discussed before – acute diverticulitis. Historica...

"Today’s big hospital systems do miraculous, lifesaving stuff. But they are not channeling Mother Teresa. Maybe it’s time to end the community benefit charade for those that exploit it, and have these big businesses pay at least some tax? Communities could then use those dollars in ways that directly benefit residents’ health."

Opinion | Why many nonprofit (wink, wink) hospitals are rolling in money Legal maneuvering, industry lobbying and lax IRS oversight leave lots of room for “operating surpluses.”

To overcome the overdose crisis, addiction treatment must be integrated into the health care system If heart disease was treated like addiction is treated today, someone having a heart attack might be told they are to blame for it, and might be sent home with a stern lecture about not having another heart attack.

Central Maine Medical Center Family Medicine Residency and Maine Family Planning offer free care in Lewiston Maine-

Lewiston health care providers set up shop in Kennedy Park to offer free services Providers were giving free services, such as blood pressure readings, blood sugar tests and cervical exams, along with providing people with resources.

When I moved here, Waldo Hospital still had family physicians doing obstetrics unlike PenBay. Not sure if that's still true.

Are low Mainecare rates a driver of this?

Belfast residents fear cuts to maternity care at local hospital In a statement last month, hospital officials said they have not made any decisions about whether to keep offering those services.

Wow, I knew it was coming back but didn't realize Mass. was seeing that many cases.

Dengue fever cases in Mass. are on pace to break local records, according to CDC data - The Boston Globe Massachusetts has had 50 cases this year, though they were likely in travelers who caught the disease elsewhere.

Doctor gets $325K settlement after claiming she was fired for complaint against Bangor hospital Brenda Gowesky worked at Northern Light Eastern Maine Medical Center for 10 years before she was fired in May 2017.

Apparently the data for pet ownership improving your health is industry funded garbage. That's fine, so far it's working well for me.

Moxie, our unofficial office mascot, just turned one. My blood pressure will likely decline as we have fewer puppy antics but continue with great walks every day.

https://arstechnica.com/science/2024/06/is-having-a-pet-good-for-you-the-fuzzy-science-of-pet-ownership/

We are heading into a prolonged period of hot and humid weather, with heat index values in the high 90s and low 100s for much of the state through Thursday or Friday. Consistently warm and humid temperatures overnight will make it hard to cool off.

Stay hydrated and find places to stay cool in the AC such as a cooling center or library.
Find a cooling center near you https://www.maine.gov/mema/response-recovery/mass-care.

Learn more about how to prevent heat-related illness https://www.maine.gov/dhhs/heat

"Health-care workforce experts worry that NPs are being lured toward work in specialty practices for the same reason that some doctors steer clear of primary care: money.

“We get what we pay for,” said Candice Chen, an associate professor of health policy and management at George Washington University.

Physicians must do a residency and usually a fellowship, and pass muster with a national certifying body to practice in a specialty such as oncology or endocrinology. But NPs generally don’t need to be endorsed by a standard-setting group before transitioning to specialty care."

Like Doctors, More Nurse Practitioners Are Heading Into Specialty Care - KFF Health News If your doctor can’t see you now, maybe the nurse practitioner can. Nurse practitioners have long been a reliable backstop for the primary-care-physician shortfall, which is estimated at nearly 21,000 doctors this year and projected to get worse. But easy access to NPs could be tested in coming ye...

Apparently there are some letters about a medical school in Maine in the Portland Press Herald lately.

While it would've been nice if Bowdoin College had kept their small rural medical school open like Geisel School of Medicine at Dartmouth, we have a great Maine focused program with Tufts University School of Medicine Maine Track and UNE has an osteopathic medicine school right in Portland.

Opinion: Maine would in fact benefit from a new medical school A first-rate university medical school could confer a lot of benefits on the state.

We have some patients who've used providers affiliated with compounding pharmacies.

Thinking of buying Wegovy online. Here’s what to know about compounding pharmacies As more people try weight-loss drugs like Wegovy, some skip the brand name and buy compounded semaglutide from online pharmacies. But some of these may not follow state and federal standards.

I don't know enough about the medical legal issues with psychiatry inpatient beds to have an opinion on this bill but I see many patients waiting a long time to get placed.

The disagreements over expanding a Maine law treating serious mental illnesses It allows judges to order those with severe mental illnesses who are at risk of harming themselves or others to get assisted outpatient treatment.

One of our local hospitalists was killed in a tragic schooner accident last year. On June 8th, Midcoast Habitat for Humanity will dedicate a street in their new Rockland development to her.

Rockland street to be named after doctor killed by schooner mast Emily’s Way will go to a new affordable housing complex developed by Midcoast Habitat for Humanity and other groups.

Well, this certainly fits my biases. Gives more detail on Amazon's One Medical struggles too.

"Walmart clearly underestimated the revenue cycle overhead associated with accepting Medicaid or Medicare, despite retaining OptumInsight to help with their revenue cycle issues."

"If we want to have a primary care system in the US, our mainstream health insurers, especially public plans like Medicare and Medicaid, are going to have to stop chiseling and pay primary care providers a LOT more, as well as dramatically simplify the task of their getting paid. They need to stop paying per visit or per test, and begin paying for relationships with patients, including virtual and email/text based interactions, and not burden that transaction with 200 core measures clinicians must submit to justify their existence. They also need to waive copayment for primary care, since those copayments serve as an potent and senseless damper on demand for primary care. "

What the Walmart Exit from Primary Care Means – The Health Care Blog The Business of Health Care What the Walmart Exit from Primary Care Means May 27, 2024 By JEFF GOLDSMITH There has been a lot of commentary on the largest “disrupter” candidate in healthcare, retail giant Walmart, throwing in the towel on their primary care clinic and virtual health businesses. ...

I usually bring mine on house calls. Occasionally it's helpful.

"In countries such as Japan, South Korea, and France, sunscreens include newer chemical filters, some of which have been shown to provide broader protection against UV rays than those used in the U.S.

The Food and Drug Administration's ability to approve such ingredients is hamstrung by a 1938 U.S. law that has required sunscreens to be tested on animals and classified as drugs, rather than as cosmetics as they are in much of the world.

So Americans are not likely to get those other sunscreens — which do a better job of blocking UVA rays that can cause skin cancer and lead to wrinkles — in time for this summer, or even the next."

Other countries have better sunscreens. Here's why we can't get them in the U.S. Skin cancer is the most common cancer in the U.S. and we need all the protection we can get. So why is it so hard to get newer, more effective ingredients approved here?

A young child died of measles in Ontario. Five required hospitalization. This is preventable.

Ontario child's death from measles is 1st in province since 1989, public health says | CBC News In a report published Thursday, Public Health Ontario said the child was not vaccinated against the highly infectious respiratory virus. It's the first recorded death from measles in the province since 1989, as far back as Ontario's data goes.

Outdoor time is good for your kids' eyesight. Here's why Childhood myopia, or nearsightedness, is growing rapidly in the U.S and around the world. Researchers say kids who spend two hours outside every day, are less likely to develop the condition.

Interesting comparison of non-profit hospital vs tech executive pay:

"More than 70% of the money comes from the government, and the rest from the suckers who have to buy their insurance on the “open market”–which includes those buying via the ACA exchange, receiving government subsidies, and government employees.

So while these huge systems act like Fortune 100 companies and reward their executives accordingly, almost all the money comes from the taxpayer.

I wish I could say we are getting good value for it.

And yes, I didn’t even mention the for-profits and the big insurers, but that will have to wait for another day…."

Want to get rich in health care? Ditch the startup and run a hospital – The Health Care Blog Health Policy Want to get rich in health care? Ditch the startup and run a hospital May 13, 2024 By MATTHEW HOLT Given that I ran a health technology conference for many years, I tend to run in a circle of people who have some ambition to get rich in health care. After all, billions of dollars of VC...

Interesting Maine addiction treatment effort by the Mi'kmaq Nation - Aroostook County, Maine:

A tribe in Maine is using opioid settlement funds on a sweat lodge to treat addiction Hundreds of Native American tribes are getting money from lawsuit settlements with opioid companies. Some are investing the new funds in traditional healing practices to treat addiction.

A new role for Point of Care Ultrasound (POCUS) in the office?

How you can make cold-brew coffee in under 3 minutes using ultrasound A "sonication" time between 1 and 3 minutes is ideal to get the perfect cold brew.

"A vaccine against tuberculosis, the world’s deadliest infectious disease, has never been closer to reality, with the potential to save millions of lives. But its development slowed after its corporate owner focused on more profitable vaccines."

How a Big Pharma Company Stalled a Potentially Lifesaving Vaccine in Pursuit of Bigger Profits A vaccine against tuberculosis, the world’s deadliest infectious disease, has never been closer to reality, with the potential to save millions of lives. But its development slowed after its corporate owner focused on more profitable vaccines.

I'm slowly getting better at this. Maybe by the time I retire I'll have it figured out. DPC has helped.

When PTO stands for 'pretend time off': Doctors struggle to take real breaks What's a typical vacation activity for doctors? Work. A new study finds that most physicians do work on a typical day off. In this essay, a family doctor considers why that is and why it matters.

"Insurers often require approval in advance for expensive procedures or medicines, a process known as prior authorization. The early 2022 dashboards listed a handle time of four minutes for a prior authorization. The bulk of drug requests were to be decided in two to five minutes. Hospital discharge decisions were supposed to take four and a half minutes.

“Medical directors would message me and say, ‘We can’t do these cases in four minutes. Not if you want to do a good job,’” Day recalled."

A Doctor at Cigna Said Her Bosses Pressured Her to Review Patients’ Cases Too Quickly. Cigna Threatened to Fire Her. Cigna tracks every minute that its staff doctors spend deciding whether to pay for health care. Dr. Debby Day said her bosses cared more about being fast than being right: “Deny, deny, deny. That’s how you hit your numbers,” Day said.

“From [results] I have seen, I wouldn’t want to drink raw milk,” Richt said. “And I wouldn’t feed it to my cats, nor my dogs, nor my calves, if I’m on a farm.”

There’s never a good time to drink raw milk. But now's a really bad time as bird flu infects cows Experts say the the danger associated with raw milk consumption may have gone to a whole new level as bird flu spreads among cows.

While Florida is making measles a threat again, Maine is protecting our children with herd immunity.

Maine reaches a milestone for school-required vaccinations The state's K-12 schools reached 'herd immunity' – when at least 95% of a population is vaccinated – for the first time since 2011, health officials said Tuesday.