Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Using Your Mobile Phone To Change Behavior Patterns

There is excitement in the air about how mobile phones are the breakthrough technology for changing health behavior.  Last Saturday, I was convinced this must be true. In two short hours, I:

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Organizing And Administering Our Own Care

Emerging from a foggy year of treatment for stomach cancer, I am vividly aware of how much time and energy it takes to meet the daily demands of a serious illness. When I think back over the past 35 years and my treatment for now four different cancer-related diagnoses, I am amazed by how much has changed. The diagnostic and treatment technologies are light years more sophisticated and effective.

I am also taken aback by how much more we, as patients, and our loved ones who care for us, must know and do to organize and administer our own care in response to a serious diagnosis.

From an economic standpoint, this makes sense: the marketplace drives innovations to become simpler and cheaper. In modern American health care, this means that new drugs, technologies and procedures are re-engineered so they can be offloaded from expensive professionals to patients and those who care for them – and who work for free.

Think about it: Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Solving The Health Care Crisis By Understanding The Uncertainty And Variability Of Health Care

Every day in the U.S. countless experts discuss plans and policies to contain the cost of health care using words and concepts that run counter to our (the public’s) experiences with finding and using care. Most of us ignore the steady stream of proposals until one political party or the other crafts an inflammatory meme that resonates with our fears of not getting what we need. At which point, we leap into action online, in town meetings and in the voting booth. As Uwe Reinhardt noted in his Kimball Lecture at the recent 2011 ABIM Foundation Forum, researchers and policy makers “cannot even discuss the cost-effectiveness of health care without being called Nazi(s).”

Our discomfort with the array of private and public sector proposals to improve health care quality while holding down costs should not be surprising. Most of us hold long-standing, well-documented beliefs about health care that powerfully influence our responses to such plans. For example, many of us believe that:

… if the doctor ordered it or wants to do it, we must need it.

… talking about less expensive treatments makes us feel that others are trying to bargain-shop our care and that scares us.

… clinical care does not vary much among our own doctors and hospitals.

… when we talk about the “quality” of health care we are referring to Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Numbers Dominate Our Experience With Health Care

“My doctor can titrate my chemotherapy to the milligram but can’t tell me when I am going to die,” a friend who was struggling with his treatment for cancer complained to me a couple years ago.

Had he lived, he might have been reassured by the announcement last week of a new scale that allows clinicians to estimate the time remaining to people with advanced cancer.  He was spending his final days “living by the numbers” of his white blood cell count, the amount and size of his tumors and suspicious lesions, the dosage of various drugs and radiation treatments. And he was peeved about what he saw as a critical gap in those numbers.  He believed (hoped?) that because his cancer was quantifiable and the treatment was quantifiable, that the time remaining should be similarly quantifiable.  He needed that information to plan how to use the time that remained.

Many of us would make a different choice about knowing how long we will live when we are similarly ill.  But most of us are attracted to the certainty we attach to the numbers that precisely represent aspects of our diseases.

It is not just when we are seriously ill that numbers dominate our experience with health care.  Advances in technology have made it possible to quantify – and thus monitor – a seemingly infinite number of physiological and psychological health-related states. For instance: Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Can Decision Fatigue Lead To Medical Errors?

Do you suffer from decision fatigue when you are sick or anxious or overwhelmed by bad health news?  Does your doctor make less well-reasoned decisions about the 10th patient she sees before lunch?  How about the surgeon during his second operation of the day?  How about the radiologist reading the last mammogram in a daily batch of 60?

A provocative article by John Tierney in Sunday’s NYTimes Magazine adds a new layer of complexity to the body of knowledge collecting around decision-making processes.  Considerable news reporting has focused on how cognitive biases influence our judgment and how many of us experience the abundance of choices available to us as a burden rather than a privilege.  This article adds to that understanding: Our decision-making abilities appear to be powerfully affected by the demands of repeated decision making as they interact with depleted blood glucose levels. That fatigue mounts over a day of making decisions and as blood glucose levels fall between meals. In response, we tend to either make increasingly impulsive decisions without considering the consequences or to make no decisions at all. Tierney describes a study analyzing 1,100 parole decisions by judges over the course of a year:  “Prisoners who appeared early in the morning received parole about 70 percent of the time, while those who appeared late in the day were paroled less than 10 percent of the time.”

The effects reported in the article were Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

Read more »

How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

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…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

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…

Read more »

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

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

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…

Read more »

See all book reviews »