Clinicians are actively fighting anything that takes them out of the loop. I wanted a phone consult with a lipid specialist because I responded to Niaspan in an interesting way. Nope. Has to see me. Doesn't need to touch me (which is pointless anyway). All metrics in my record. I'm out of town during the week. Of course, I am not the customer. The doctor is according to his practice and my insurance company is otherwise. I am currency between the two. The funny thing? I know far more about lipid chemistry than any GP I have met and almost all specialists (when you have a couple of decades to read the actual studies all focused on one subject, you get dangerous) so I can punt on this. It was a suggestion from my GP and the pricks don't really wish to help if it isn't on their terms.

Woman's Wellness. Pelvic exams are dying and never should have happened (contraindicated not just not recommended- UCSF study). Clinical breast exams in the young are pointless (mature woman disease) and USPSTF concluded no value in mammogram population. Pap smears are clinically collected specimens when substitutes abound (e.g. douche collection or acellular techniques that analyze swabs or urine). Anything from the 1950s going away? Nope. Indeed, the pressure to submit is increasing as GPs and OB GYNs get desperate to be wellness consultants for the ACA. Of course all this wellness got a couple of million women cut on for no reason. The war on (almost always innocent) dysplasia needs to stop when all the increases of longevity are traced to better treatment not earlier detection (studies abound and the popular wisdom regarding preventive medicine is wrong…because the "diagnostics" are looking, poking and prodding which means you cannot reliably intercede earlier….ditto other preventive measures…poor efficacy).

Medicine is about accurate diagnostics and effective response. America's regimen of preventive care is nothing more than mysterious laying of hands (oddly enough targeting the young, healthy and female…ahem). Lets end the physical and get back to healing the sick. When you can walk in off the street and buy a comprehensive metabolic panel, lipid panel, thyroid function, et al from a lab without doctor's interference for $60 you know it's all over but the fat lady singing. Those same tests cost $400 with a GP interpreting data with no more insight than the patient can with a modicum of research (if that's even necessary). When Trovagene announces they can detect oncogenic HPV infection via urine specimen, it's back to plumbing problems and babies for OB GYN (none of the rest can withstand scrutiny and women continue to die of CV disease in dizzying numbers because the heart and arteries ain't sex organ). Diagnostics are reducing the opportunity for false-positive-in-waiting rituals that do not work and never have (e.g. annual physicals). Data trumps all. Doctors back to healing.

The system will not go quietly of course. Billions at stake. Lots of power and intrusion (power of the pad). Some other unhealthy vices being fulfilled. The field attracts some odd birds.

But it is time….it has been time for 3 decades plus. Less prestige for doctors…less power…fewer naked people but the consumer's need is finally met without the theater, humiliation, time and expense.