March 19th, 2009 by KevinMD in Better Health Network
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In a surprise, President Obama has signaled a willingness to discuss medical liability as part of the health reform process.
Good for him for standing up to the trial lawyers, a core constituency of the left.
That’s a good sign, as the costs of defensive medicine brought on by the broken malpractice system, should be addressed if there is any hope of reducing health care spending.
Trial lawyers like to say that medical malpractice represents “less than one percent of the cost of health care,” but that fails to account for the substantial sum attributed to defensive medicine doctors practice to avoid the threat of malpractice, estimated to be $210 billion annually.
Furthermore, the argument that malpractice reform will harm patients “by limiting their ability to seek compensation through the courts” doesn’t hold water either.
That’s because the current system does a miserable job of compensating patients for medical errors, where more than 50 cents on every compensated dollar goes to pay lawyers and the courts. Not to mention that a typical malpractice trial may last years before an injured patient receives a single penny.
So, don’t believe the arguments of the trial lawyers, who prefer the financial security of the status quo.
Any alternative system, such as no-fault malpractice, mediation, or health courts, will go a long way both to reduce the cost of medical care, and fairly compensate more patients for medical errors at a significantly more expedient rate.
Lawyers are aware of these facts, and to their credit, are going on a preemptive offensive to head off tort reform. If I were the AMA, I would start pro-actively circulating some of the above talking points, rather than reacting to the trial lawyers.
**This post was originally published at KevinMD**
March 19th, 2009 by Stacy Stryer, M.D. in Uncategorized
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It’s already March 19th and I don’t have any ideas for April Fool’s Day for my kids. I am desperate and need help. In previous years I have put gummy worms in their sandwiches, short-sheeted their beds, convinced them school was cancelled, given them mashed potatoes that looked like ice cream sundaes, and offered cookies with (fluoride-free, of course) toothpaste as the filling. Last year I tried to pretend I had broken my arm. While my adult friends believed me, my kids just rolled their eyes. So, as you can see, my ideas are not working anymore and I need something grand and convincing.
Humor has always been an important part of our family. When my children were younger, we used humor to convince them to do things they didn’t want to do. For instance, in order to get them to clean their rooms we would put shoes on our heads, walk to their rooms, and dump them in the closet. My older daughter’s favorite game was to dress up as Cinderella (in rags, of course) and have me shout orders at her — I was not allowed to say “please” because I was, obviously, the evil stepmother. It’s amazing how clean the playroom could become those days.
When my husband had a brain tumor, I used humor to temporarily destress an incredibly difficult time period. Those days it was not uncommon to see us eating jello through a straw, dessert before dinner, or ice cream without a spoon. One desperate day we all dressed up in our rain gear, with umbrellas, and took a shower together while singing, “I’m singing in the Rain.”
Last year my daughter had 2 friends spend the night before presenting a history project in a county contest. They had worked incredibly hard on this project while continuing their other demanding curriculum, and they were exhausted, nervous, and stressed. So I went to the store and bought shaving cream and whip cream. After dinner I sent them outside in old clothes and let them spray each other. They ran around for over an hour in the dark, laughing and playing. To this day they still talk about it.
Humor and laughter are an important part of our lives. They relieve tension, reduce stress, and provide us with a temporary distraction from unpleasant thoughts or lives. They allow people to forget about anxiety and pain, even if it’s momentary. Scientific studies that have even shown that humor improves overall health and, more specifically, the ability to fight off infections, decrease the risk of developing a heart attack, and improve blood sugar control . Psychologically, it has been related to decreased loneliness and depression, and improved self esteem and feelings of hopefulness . Laughter clubs and therapy have been developed and exist in and out of hospitals throughout the United States.
humor in our family (response to "smelly" fish)
So, now you understand why it is so important for me to find some new, more exciting April Fool’s Day gimmicks for my family – ones that will really make them laugh! I am willing to share my “Vanilla” Sundae recipe with you, which has been used by many extended family members and friends.
April Fool’s Day Ice Cream Sundaes
Ingredients:
1. Instant mashed potatoes
2. Chocolate sauce
3. Whip cream
4. Maraschino cherry
5. Vanilla ice cream
Make the mashed potatoes according to directions and let them cool. Use an ice cream scoop to put 2 scoops in a bowl. Top with chocolate sauce, whip cream and, of course, a cherry. Serve. Have real vanilla ice cream available to serve so the victim can actually enjoy dessert in the end.
March 18th, 2009 by AlanDappenMD in Primary Care Wednesdays
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The U.S. government finally has announced intentions to become involved in our $2.2 trillion healthcare system. Now everyone wants to say something. Most longtime players in healthcare indignantly rebut any new input and opinions with “How dare you! … You stay away from my holy cow of entitlements (insured patients), or salary (doctors), or bonuses (insurance companies), or profits (pharmaceutical companies), or the ability to sue (lawyers.)”
I join my voice to President Obama’s statement that the single most important problem to solve in our healthcare systems is cost. The tidal wave of catastrophe rushing towards America is the expenditure of healthcare dollars doubling every 7-10 years.
Few will argue against the ideal of universal health coverage, yet this noble ideal comes with an enormous price tag and many less than honorable behaviors by all players in the system. The wasted and misallocated money lost every year in healthcare makes Madoff’s Ponzi scheme look like child’s play, and yet it continues. We finally have awoken the dormant giant of politicians to do what no one else says they will do, and the government’s intervention in the form of healthcare reform seems imminent.
Doctors were captains of the healthcare system until 1980s. They were dethroned because health care costs had doubled every seven years since 1945. Then insurance companies gladly took the helm. Guess what? After 20 year of their leadership, the price of healthcare has continued to double on average of every 10 years. Now the government is positioned to step in and fix it.
Big Brother might “force” each of us healthcare players to be held accountable including all of us as patients. This fear of change leads to finger pointing, name calling, blaming, grandstanding, and claiming, “Oh the ridiculous price healthcare … it’s not my fault and I shouldn’t have to change or fix it.” Nothing could be further from the truth. We all have to fix healthcare, and never forget, it’s about the price.
How do we create a health care system that provides the widest access, the best bang for the buck, the fairest distribution of money, and inflates at the same speed as the rest of the economy?
For primary care, two pathways are clear: the career path or the professional practitioner path. With the career model, doctors can work for someone else (like Kaiser, Medicare, an insurance company, or a hospital), and can expect a salary and benefits. In return, these employers oversee and influence how career doctors do their jobs, their hours, their interactions with patients, how they communicate with patients, and often what medications should be prescribed. We have 20 years of experience with the “career pathway.” We allowed others to interfere in the doctor patient relationship, help us ”manage” our patients, and decide what’s “reimbursable.” The soul of our work and the trust of our patients evaporated. Many believe this pathway will spell the extinction of the primary care “specialist.”
The other pathway is the primary care doctor as a professional, with a mission that focuses on the patient not just for quality, but for trust and price, and following these key objectives:
- Restoring the soul and viability of the doctor patient relationship,
- Delivering the highest quality care, and
- Restoring a pricing integrity which reduces cost.
This professional primary care doctor will restore the patient-doctor relationship with a modern office that is mobile, can be reached anywhere and anytime, has virtually no staff, minimal overhead costs, transparent pricing, and is powered through a customized software that finds the patient chart, instantly looks up any pharmacy or radiology center, can contact any specialist, can instantly look at differentials, drug interactions, gets notifications when patients have something “due,” has a large number of patient education resources that can be emailed to the patient including articles from the medical literature and refereed internet sites that can educate patients, and does all the billing from the same platform the moment that the note is closed.
An individual’s day-to-day health is not “best managed” under third-party payers. We need insurance or government to manage expensive problems or catastrophe, like cancer, serious injuries or ongoing health problems. Yet sixty years of conditioning has left most unable to see the obvious: extract the day-to-day care cost from the insurance model and return these funds to all Americans (about $700 billion/year), stop holding the consumer hostage, make doctors compete again for the consumer on price, quality, knowledge, access, convenience, relationship — just like every other service industry. Finally, bring an end the $20 co-pay mentality for the patient and “the funnel” for the doctor.
This is possible, and is being done today with the practice I founded, doctokr Family Medicine, (www.doctokr.com). Our patients pay out-of-pocket for all the primary and urgent care healthcare services they receive. We charge on a transparent time-based fee basis, where five minutes of the doctor’s time costs around $25. Our patients can contact or see us anytime, day or night, and consult with us via phone, email, in our offices or by house calls, with over 50% of all of our patients’ healthcare issues being resolved by phone or email. About 75% of our patients pay less than $300 per year for all of their primary and urgent care needs. We’ve built a relationship with each patient and spend as much time as they want with us.
In the weeks ahead I invite all readers and colleagues to consider the road less traveled. Consider primary care doctors standing-up, reclaiming their profession, embracing and being embraced by the American population. And imagine happier patients and doctors, healthier patients and that the delivery of that care costs 50% less than now.
Until next week, I remain yours in primary care,
Alan Dappen, MD
March 18th, 2009 by Gwen Mayes, J.D. in Better Health Network
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It’s definitely not your mother’s public health campaign.
When the National Heart, Lung and Blood Institute (NHLBI) launched the Heart Truth campaign seven years ago to raise awareness of women’s heart health their partners were your typical patient groups and professional medical societies.
Not anymore. Today, their front row partner is Coca-Cola. Diet Coke that is.
Dr. Val and I were among a small group of women’s health advocates who met last week to hear the latest on NHLBI’s campaign with Diet Coke and how the fashion industry is bringing an important public health message to women.
Diet Coke’s commitment to the Heart Truth campaign is unprecedented, one of the “largest public awareness initiatives we have ever undertaken,” said Celeste Bottoroff, VP Living Well, Coca-Cola North America.
Leading Diet Coke’s campaign? Endless-legs Heidi Klum and other fashion-conscious women who have revamped the little red dress campaign into a national symbol with guts, curves and most importantly results.
“In 2002, only 34% of the women in this country knew heart disease was the leading cause of death among American women,” Dr. Elizabeth Nabel, NHLBI director, told the group. “But we’re making progress. Today, as a result of the Heart Truth campaign and others like it, 65% of the women now know it’s the number one killer.”
Nabel led a discussion of the common myths associated with women’s heart heath and recalled her own experiences as a cardiology resident when women were caregivers who supported husbands, fathers and other male family members through heart ailments but often ignored or brushed aside their own symptoms for fear that treatment would interfere with domestic chores such as childrearing, cooking, and cleaning. “Even when older women came in with heart problems, they weren’t treated as aggressively as men,” Nabel admitted.
“Most women still need educating,” she remarked. “80% of middle-aged women still have at least one risk factor for heart disease. And just one, doubles your risk of actually having heart disease.”
Joining Nabel were Phyllis Greenberger, President and CEO of the Society for Women’s Health Research, Susan Bennett, MD, Clinical Director of the George Washington University Hospital’s Women’s Heart Program and Robyn Flipse, MS, RD, author and nutrition consultant to discuss the campaign’s most important messages. First, heart disease is not a man’s disease, a point often raised by group’s such as those headed by Greenberger who cited research indicating that only 17% of cardiologists and 8% of primary care physicians know that heart disease is the leading cause of death among women.
And it’s not just for the aged either. “When a 40 year old woman has heart disease it’s worse than a 40 year old man,” said Bennett recalling patients in their 20s and 30s in her practice. “It’s never too late to change your lifestyle,” Flipse added. “The body is very forgiving. Even a 10% drop in weight can have a positive impact on blood pressure, cholesterol and other important risk factors.”
The Heart Truth campaign, thanks to the vision of Dr. Nabel and the willingness of NHLBI to partner with a highly visible, social icon such as Diet Coke is just what’s needed to cut through the feel good messaging that most public health campaigns resort to. Having lived with heart disease my entire adult life (now well into middle age), it’s a welcome boost of energy and the visibility possible with this campaign is unparalleled. Along with it comes some very important information that can save women’s lives.
Look for the heart truth emblem on 6 Billion Diet Coke cans, at community public forms, at American Idol, and fashion shows across the country. Diet Coke, with Heidi’s help, has even designed a new red dress label pin which strongly resembles an hour-glass. And what woman doesn’t want that?
March 17th, 2009 by Dr. Val Jones in Humor, True Stories
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Today I was able to give good news to a patient: he was going to be discharged home in 48 hours. He was a feisty elderly man, admitted after having a stroke. His response to the news:
“Well, thanks for telling me, doc. At least I know when I’ll be getting out of here so I’m not stuck in a vacuum, like some kind of science fiction movie.”
