Death of Traditional Internal Medicine

Interesting post by an internal medicine physician on the death of the traditional internist. In the old days, internists would take care of their patients both as outpatients (in clinic) and as inpatients (in the hospital).

Dr. Knope argues that this practice is essentially dead and I think he's right. In today's healthcare world, care is extremely fragmented. A typical internist sees 20-30 patients in clinic daily and seeing patients in the hospital is often impractical.

Moreover, access to one's internist is not always simple - patients can often wait a month or more for minor problems and thus visit urgent care centers or "minute clinics." The patient could be prescribed medications or interventions at these visits that get lost in follow up with the internist or when he or she gets hospitalized.

Dr. Knope chose to opt out of the mess by opening a "concierge" practice, where a few wealthy patients pay him to be at their beck and call for all problems, whether in the clinic or the hospital. This, however, is not a practical solution to the problem, which he admits.

I think the primary care specialties have recognized this problem and thus argued for the establishment of a "medical home" model, which would at least centralize all of the patient's medical information and allow for more efficient coordination of care. The ACP has done a lot of advocacy on this issue and I believe important measures supporting this process were passed with the new health care reform law.

I don't think the traditional internist will survive, except in rural areas or niche practices like concierge medicine, but the hope is that the new breed of internist will better utilize technology and performance improvement measures to deliver holistic care that results in better health for patients and society.

Dr. Mustafa Barghouti at Brown

Just came back from a lecture by Dr. Mustafa Barghouti at Brown University. He gave a talk entitled, "Palestine in Crisis: What We Can Learn from Gandhi" in which he advocated for nonviolent resistance to Israeli occupation and equality for Palestinians.

Dr. Barghouti argued that the current state of affairs in Palestine amounts to apartheid and that segregation occurs at all levels, even down to the roads Palestinians are allowed to travel on. In fact, the wall built by Israel is referred to as the "Apartheid Wall." He related how others, such as former President Jimmy Carter, have come to the same conclusion. (President Carter authored a book called, "Palestine: Peace not Apartheid.")

What I found interesting about the talk was how committed Dr. Barghouti was to the use of nonviolent protest and democratic reforms to achieving peace in Palestine. His party, the Palestinian National Initiative, holds weekly protests and is very active in promoting Palestinian rights.

He talked about how what impressed him most about Palestinians was their resilience in the face of adversity. He told the story of a Palestinian man who attempted to cross an Israeli checkpoint to sell olive oil. The man had 26 barrels of olive oil, which was his entire harvest.

The soldiers would not let him pass unless he cursed himself and his people. The man refused to do so and the soldiers destroyed each of his barrels, one by one. The man returned home, devastated. The people of his town learned of his ordeal and, together, they came up with 26 barrels of olive oil, so that the man could still earn income that would have to sustain him for a year.

There are clearly many injustices occurring in Palestine and Dr. Barghouti's approach is to seek justice by appealing to our sense of dignity and equality. He is taking the moral high ground by avoiding the politics of hatred or the emotionalism of revenge. It is no wonder that people of all faiths, Christians, Jews and Muslims are coming together to help his cause of advocating for Peace in Palestine.

Some relevant links:
1. Dr. Barghouti on the Daily Show with Jon Stewart
2. Goldstone Report on Israeli operation Cast Lead

San Francisco police chief applauded during apology to Muslim community

Bay City News Service
Posted: 04/02/2010 04:56:44 PM PDT
Updated: 04/02/2010 08:14:56 PM PDT

San Francisco police Chief George Gascon was greeted with applause this afternoon by hundreds of members of the local Muslim community after offering a public apology for statements he made last week on terrorism.

"I am very sorry that I offended you," Gascon told the audience — many of whom were from the local Yemeni, Afghan and Pakistani communities — following their afternoon prayer service, held in a downtown hotel conference hall in order to accommodate the crowd.

"That was never my intent," he said.