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Patient choice: trust the doctor?

I’ve invited my Revolution colleagues to form a “blog fodder chain” – when we see something interesting on the Internet, or have a difficult question, we forward it to one another as a kind of challenge to write about it in our blogs.

I have to say, though – they keep sending me the hard stuff. Examples of physicians gone bad, morally questionable healthcare practices, and hot topics full of mine fields. I keep hoping for the “which puppy do you think is cutest?” question. But no such luck for Dr. Val…

Our Chief Privacy Officer challenged me again with some powerful food for thought. A recent article in the New England Journal of Medicine reports that some physicians withhold information (about treatment options) from patients if the physician objects to the options on moral or religious grounds.  Med bloggers Kevin MD and Medpundit also have recent posts about this article.

Well, of course this inspires initial indignation. Aren’t physicians supposed to offer all the options, with factual explanations of their pro’s and con’s, and then let the patient decide what they’d like to do?

Well, yes, they are. But the funny thing is that time after time when I’ve tried to do that for patients, they’ve expressed annoyance at me. They say, “you tell me what I should do, you’re the doctor!” And so after hearing this over and over again, I ended up truncating my explanation of options to the most “reasonable” ones and then allowing the patient to ask for more if they’re interested. Am I allowing my personal values to determine the hierarchy of options I present? Yes, probably so.

I’ve noticed that attention spans, even when it comes to important medical decisions, appear to be fairly short. Eyes glaze over when we try to explain all the subtleties of the options, and in the end (if the patient likes you and trusts you as a human being) he or she just wants to know what you’d choose if you were in his/her shoes – and why.

Am I being paternalistic? I hope not. I want patients to choose what’s best for them, but strangely enough their choice is often to let me decide. The power that patients impart to us is an honor and a privilege – and the reason why doctors are held to a higher moral standard than many other professionals. They are right to hold us to that standard. We must not squander their trust.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Kuwait tops USA in percent overweight

I was surprised to find that Kuwait has just edged out the USA in the percent of its population that is reported as “overweight:” 74.2%.  Forbes has an interesting visual flag display of the world’s fattest nations.

So what happened to Kuwait?  One fairly unhelpful press release suggested that the increase in overweight and obesity was due to changes in diet and exercise habits.  Thanks for that insight.

A recent study concluded that the risk of being overweight in Kuwait was positively influenced by income levels and yet the risk of obesity was inversely related to income levels.  So, if you’re wealthy you’re more likely to be chubby, but if you’re poor, you’re at risk for obesity?  Not sure I understand why that’s so.  Maybe everyone has plenty to eat, but only the wealthy can afford gym membership?

Another study correlated increased weight with frequency of dental visits.  Does that mean that the more dental work you need the more likely you are to be overweight/obese?  I guess Kuwaitis don’t brush their teeth.

What really happened to Kuwait?  This happened.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Relationships and weight gain: Valentine’s Day musings

My friends in the Revolution Weight Management Center asked me to blog about weight and relationships… at first I wondered if they were trying to stage an intervention or something: have I gained that much weight since I started working here? Ha ha. No, I haven’t… but maybe that’s because I have such a skinny husband?

As it turns out, research suggests that married couples are influenced by one another’s dietary habits. If you marry a person with poor eating habits, you are much more likely to adopt them yourself. Also, they say that marriage leads to more regular (read frequent), larger meals and increased financial pressures, stress levels and decreased exercise frequency.

Well, I guess choosing the right spouse has never been more important for weight control? Marriage doesn’t automatically lead to weight gain, but you should eye your boyfriend/girlfriend/fiancé(e) with suspicion at the dinner table. When I was dating my husband I noticed that he ate small portions, never finished his plate, and didn’t like dessert. He liked to run, had good sleeping habits, drank in moderation, and wouldn’t notice a super model if she fell in his lap. Sound too good to be true? I still ask myself that every day. They don’t make too many like Steve, I’ll tell you!

Anyway, I must confess that before our wedding I was in the best shape of my life, running about 20-25 miles a week, shunning all products containing high fructose corn syrup, and taking good care of my health. Now I exercise irregularly, sneak in rich dining experiences, and skip meals. I weigh about the same, but have (I’m sure) exchanged fat for muscle.

What do I make of this? Well, I need to force myself to go running again with my husband (he patiently runs at my pace as I lumber along next to his gazelle-like frame) and be more mindful of my eating habits. This is a never-ending battle for me, but it is made so much easier by having a supportive spouse who never deviates from good health practices.

So as Valentine’s Day approaches, observe your loved one’s eating and exercise habits with a critical eye. You are likely to be influenced by them more than you know. And for those of you who have a “Steve” in your life, thank your lucky stars, put down the box of chocolates, and show him how much he’s appreciated!

P.S. Steve would like to tell you that he (thanks to me) now enjoys dessert and craves ice cream from time to time. I guess my influence on him hasn’t been as positive.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Hospital administrator salaries: draining the healthcare system?

Well, this conversation from the blogosphere gets my blood boiling, I can tell you! In a recent blog post about the ugly under belly of hospitals, I discussed how administrator salaries decrease hospital resources. Dr. Stanley Feld’s excellent blog post digs even deeper:

Paul Levy CEO of Beth Israel Hospital writes a blog called “Running a Hospital”. He has tried to justify his salary after the Boston Globe published his salary of over 1 million dollars per year…

Remember hospitals such as Beth Israel Hospital in Boston are tax exempt community hospitals because they have this community obligation. These tax subsides and others tax subsides are opaque to the public. However, the public pays for these subsides. They contribute to the hospitals bottom line and Mr. Levy’s bonus.

Linda Halderman M.D. wrote an essay entitled “How Much is Your Doctor Worth?”. It is also worth reading. The subtitle should be, “How Much is Your Doctor paid?” The answer after the long essay is $59.50 for a complicated office visit. [If Levy were a clinician,] he would only have to see 168,067 patients in one year or 744 patients a day to generate a gross revenue of $1,000,000 before expenses.

What is more valuable to the healthcare system? A CEO’s salary based on revenue generated incentives and fund raising or good quality medical care?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Sex selection: just because we can doesn’t mean we should

As I read the opinion piece in the New York Times about fertility clinics that permit parents to choose the sex of their baby before pregnancy, I was suddenly aware that I had strong feelings about this. As I tried to analyze my indignation, I realized that my emotions came from a place beyond mere reason.

Although technically, this issue could be reduced to a matter of sperm sorting – we all know it’s much more than that. Choosing the sex of your unborn child wanders into an unexplainably uncomfortable territory – swirling unconscious feelings about the value of human life, sexual equality, and the pain of sexism that many have experienced. We have heard the horrible stories about female babies being selectively aborted, or left to die in the elements in India and China, and we wonder if choosing the sex of a baby is somehow part of the same phenomenon.

Why should it matter which sex the baby is? Why is “family balance” cited as a reason to sex select? Perhaps the balance comes from the makeup of the individual personalities in a family, or maybe from parents who plan for the right number of children, not the gender of them.

Personally, I cannot support the practice of sex selection for anything other than sex-linked genetic disease prevention (and even this makes me feel a little uncomfortable, frankly).

I’m curious to know if men and women are equally disturbed by the practice of sex selection… What do you think?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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