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

Latest Posts

Sicko: Sad Commentary, Wrong Solution

5 Comments »

Alright, I can’t help it – I just watched the new movie
Sicko, so I have to write about it.  Labeled a propagandist
by some, self-contradictory by others, the value of Michael Moore’s
work is in its ability to get the public talking about a critically important
subject.  And I must agree with the New York Times reviewer on this point – Sicko was the best
edited and most entertaining of Mr. Moore’s documentaries.

Why
Socialized Medicine Won’t Work in the US (In My Humble Opinion)

Sicko
was interesting for me because it compared the healthcare systems of the US, Canada,
France and Britain.  Moore’s whole thrust is that socialized medicine is the
potential cure for America’s
healthcare crisis.  I grew up in Canada,
spent summers in France,
trained in medicine in the US,
and my mom’s British – so I have a unique and very deep appreciation for the
cultural differences of these 4 countries.  And here’s what I see: the way
a country cares for the sick is a reflection of their shared cultural
values.  Each healthcare system has its own personality – like wine made
from grapes grown in the unique soil and climate of a specific region.
Even if you export the same vines to another place, the wine will never taste
the same.  Let’s take a look at a few of these cultures (and yes I am
using somewhat stereotypical language to clarify the differences):

Americans
are fiercely individualistic.  They are passionate, driven, and believe
that success is proportional to how hard you work.  They believe in
survival of the fittest – if you’re not doing well, it’s probably your own
fault.  Everything’s a competition, and capitalism spurs on a constant
parade of advertising, marketing, sales and consumerism, all orbiting the
almighty dollar and personal convenience.  It’s critical to them that
anyone can attain the American dream – if they work hard enough.  Fabulous
riches are within the grasp of any average Joe if he concocts a really good,
money-making business plan. Americans don’t have time for health prevention,
long vacations, taking care of others – no, they’re so busy working that only a
medical emergency will jar them out of their usual pursuits.

What
sort of healthcare system would grow out of this cultural milieu?  A
hurried, high stakes, emergency intervention focused, technology driven
grab-all ruled by any stakeholder who can outsmart the competition.
Forget the poor, they’re not productive and don’t deserve equal care
really.  But that financially successful “average Joe” will receive mind-blowing
technologically advanced care that costs hundreds of thousands of dollars and
can keep him alive long beyond any reasonable need to do so.  Joe has a
shot at immortality, and somehow that makes all the work worthwhile.  Yep,
that’s pretty much what the US
healthcare system is like.

Canadians
are good natured and tolerant.  They put the needs of others first.
They will pull over in a snow storm to help you change a tire, and then they’ll
have a beer with you and talk about hockey at a local pub after towing your
vehicle out of the ditch.  They will also wait patiently and without
complaint for hours on end in a line for tickets or groceries, or whatever the
line is for.  There are so few people in Canada (compared to the land mass)
that nothing feels crowded or busy.  Their socio-political views lean
strongly toward socialism –almost no one is really rich or very poor in Canada.
Everyone is treated with the same friendly respect, living comfortably, no real
crime or racial tensions.  What sort of healthcare system would these
people invent?

A
socialized, government-run system that offers “free medical care” for all, with
insanely high taxes to cover it all.  There are long lines, competent
doctors, and moderately satisfied patients.

The
French
are argumentative and political.  They tend to value
leisure above work, they don’t like rules imposed on themselves, and believe
that their government’s purpose is to serve their needs at all times.
They protest regularly, everything is unionized and everyone is focused
on personal rights and liberties.  Employers are at the mercy of
government rules and employee whims.  They work very little and expect
extensive social services, smoking cigarettes and drinking coffee, watching the
world walk by from neighborhood cafes.  What sort of healthcare system
would these people want?

A
government-run, heavily social service oriented system that caters to a
leisurely lifestyle.  Spa treatments, alternative medicines, herbalism all
thrive, but in order to keep people from overburdening the spas, copays for
many basic services run as high as 40% of the total bill.

So
the question is this: how would Americans respond to these other brands of
healthcare?
If they were served up the Canadian system, they’d
scream at the tax rates, and become hysterical at the inability to trade up to
a platinum level of care for those who have “earned it.”  They would not
accept the long lines for care and would immediately start a scheme for
off-shoring medicine to circumvent the lines.

If
Americans were offered the French system, they’d be immediately annoyed by the
inconvenience of the office hours (months of vacation are taken at a time by
all members of society, including doctors), they’d never use the preventive
health measures (they don’t have time for that stuff), and although they’d be
glad to receive home health aides for no more excuse than  – “I just had a
baby and I’d like a government worker to clean my house” – when they saw the
tax rates it would take to make this available to all, they’d find it
unacceptable, especially with such high copays and out of pocket expenses..

So
socialized medicine will never work in the United States – not because it’s a
fundamentally flawed system, but because the American culture will not tolerate
it.  Healthcare solutions are not globally applicable – (though I’d say
that from an IT perspective, there is an information sharing system that is
needed equally badly by all countries).  Instead, systemic changes should
be personalized to the culture.  Looking to other countries for magical
fixes to healthcare woes is like expecting that all cancers will respond to the
same chemotherapy regimen.  Medical care is most effective when it is
customized to the individual, and healthcare reform will be most effective when
it takes into account the unique cultural values held by a country’s people.

In my next post, I’ll explain why health insurance companies
and big government health plans (Michael Moore’s solution to US healthcare
woes) share a common flaw.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

The Differences Between Men & Women

No Comments »

Three of my favorite medical bloggers all posted hilarious observations about the differences between men and women.  I’m not sure what got them thinking on the same wavelength – maybe it’s because Father’s Day is coming up?

Dr. Rob writes:

You may have also noted that x-chromosomes have many more genes than
y-chromosomes. Many scientists believe that the feeling by many women
that jeans make them look fat comes from the fact that there are more
genes in a women’s body, and this is actually a cry for help from the
chromosomal level. Other scientists think these scientists are just
full of hooey.

Dr. Au writes:

Michelle: You accidentally threw out your old med school ID tag, but I rescued it.

Husband: Yeah, I saw that on the table. I threw it out again.

Michelle: Why would you throw it out? Wouldn’t you want to save that?

Husband: (Perplexed) Why?

Michelle: Because…because it’s nostalgic! Your old med student ID tag! Don’t you want to save that? Think how cool that’ll be, when you’re some old crusty attending, to have your med student name tag from the turn of the century!

Husband: Not…really. Why would I want that?

Michelle: Well, why do people save anything? Why do you save your med school diploma?

Husband: I need that to get a job.

Michelle: OK, bad example. Why do you save your graduation tassels?

Husband: I didn’t.

Michelle: You threw out your med school graduation tassel?

Husband: Well, I don’t remember saving it. What would I do with it?

Michelle: Look, if I have to explain why you would save something like that, you probably wouldn’t understand anyway.

Dr. Leap writes:

They [women] think we want nothing so much as another pineapple wall hanging
that they saw in Southern Living.  But men like gifts too!  We just
like them to be a little different.  We don’t want a day at the spa; we
want a day of quail hunting.  We don’t need a pedicure; we need to go
to the Indy 500 time trials.  We prefer to buy our own underwear,
thanks, but a pair of camouflage, Gore-Tex gloves for that winter
hunting trip would be really nice…

And over the years, I have developed a simple rule of three things that
almost every man will accept as a reasonable gift.  They are:  a pen, a
watch and a knife.  This will cover the gamut of almost all men in the
Western Hemisphere, and most in the rest of the world.  See, a pen
reminds us that our ideas and insights are meaningful, and sometimes
need to be recorded.  (And is useful for writing checks to buy flowers
and silky things on Mother’s Day).  A watch reminds us that our time on
earth is short, and we must use it well.  (And that we’re late for
work).   And a knife reminds us that we have capacity and usefulness;
that we are movers in our world, always armed with something that can
serve as tool or weapon as the need arises.  (And that we probably need
a tetanus shot).

I wonder if Dr. Leap’s advice also works well for “Metrosexuals?”  What do you think guys?  Is the best Father’s Day gift a pen, a watch, or a knife?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Is that your real skin?

5 Comments »

I’ve been thinking about skin cancer lately.  A young, fair skinned friend of mine
recently had a small mole removed from her leg.
It turned out to be melanoma!  It
didn’t take me too long to make the connection between her complexion and mine,
and the fact that I’d been avoiding the dermatologist for several years,
worried that I’d come out like a punch biopsy pin cushion since I have quite a
few freckles and moles (and I’ve heard that dermatologists like to err on the
side of caution and biopsy anything remotely suspicious).  But the melanoma story galvanized me into
action.  I made an appointment with a
dermatologist (yes, I had to wait 4 months to get an appointment!) and got a
skin check.  Luckily for me, all was fine.  But I started to reflect on various conversations
I’ve had about my skin recently.  All you
Irish types out there will relate…

Conversation 1

Coworker A: Val, are you ok?
You look kind of sick.

Me: I’m just fine.

Coworker A: But Val, you look a little… bluish…

Me: That’s just my skin color.  My veins show through my skin because it has
no melanin.

Coworker A: (Appearing sympathetic) Oh, well glad you’re
alright.

Conversation 2

Coworker B: (in the middle of a conversation with me, sitting
across from one another on chairs.  I’m wearing a skirt.  Suddenly she lunges forward
and touches my knee and gasps).  Is that
your real skin?

Me: Um… yes.  What
else would it be?

Coworker B: Well, I thought you were wearing white pantyhose.

Me: Nope.  It’s too
hot for pantyhose so I just go bare legged.

Coworker B: (still in shock).  But that’s your skin?  Just like that?

Me: Yeah.  I don’t
tan.

Coworker B: (appearing sympathetic) Oh, wow.

Conversation 3

Dermatologist: Hi, I’m Dr. XXX. (Peering at me, seated on the examining table
in a paper gown.)  Are you Scandinavian?

Me: No, I’m part Welsh – you know, “Jones.”

Dermatologist: Oh, well the Vikings probably invaded Wales
at some point.

Me: (to myself) well thanks for alluding to the raping and pillaging
of my ancestors.

Dermatoligst: You’re high risk for skin cancer.  People like you need to have careful skin
exams every year.

Me: Yes I know.  But
please don’t take any unnecessary biopsies!
I think my moles are all fine.

Dermatologist: Well let’s see…(tearing the paper gown in two).  You definitely need to wear SPF 50…

Me: Sigh.  I know…

Conversation 4:

Husband: (giving me what I thought was a tender look.  He leans in…) Your eye lids are kind of pinkish purple

Me: Yes, that’s the color of the capillaries that show
through my lid skin.  Hard to get a tan
there you know.

Husband: You don’t need a tan – I like your color.  Kind of pastel pink and blue. (He leans in even closer to inspect my eye lids.)

Me: Yeah, not exactly attractive in a bathing suit. (I pull away.  He laughs.)

Husband: Well, yeah.
It’s better not to be out in the sun or on the beach, but you can still
go outside!

Me: Thanks.

Conversation 5:

Asian manicurist: (looking at my hands) Your skin is so white!

Me: Yes, I’m afraid my past efforts to alter that have failed.

Asian manicurist: How did you get your skin so white?

Me: I didn’t do anything.
It’s like that naturally.

Asian manicurist: (looking closer at my hands) I wish I had skin like yours.

Me: Why? (Hoping she’d say something flattering after all).

Asian manicurist: It looks clean.

And so I guess despite all the people I’ve worried with my vaguely cyanotic appearance, there’s one thing for sure: I look clean.  I guess I can live with that.

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

A little medical humor

1 Comment »

I got a good laugh from a few sarcastic posts lately.  This first one (via Graham) is about the
medicalization of modern life (where every symptom must have a diagnosis):

Consumer: I get
very moody if I don’t eat in the morning. If I don’t eat until 3-4pm I get
headaches, drowsiness and feel nauseous… I think I’ve always had this. Since
I usually eat enough it doesn’t really bother me. I’m 21, male, and a
vegetarian. What do I have?

Physician: You have a condition
known as hunger.

The good news: it is easily treatable

The bad news: there is no permanent cure

This condition can be treated at a specialized clinic, the one you want is
known as a restaurant. This condition can also be treated at home, but you will
need specialized supplies from a grocery store. Most sufferers find that
several treatments per day are necessary.

———

And this conversation was pretty funny (though I can’t for
the life of me find where I read it – sorry I would certainly love to give
attribution here):

Physician: we’re
going to need to get an MRI of your teenager’s head since he had a seizure.

Mom: why are you
going to get an MRI of his head, it was his body that had the seizure!

Have you heard any good jokes lately?

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

Humorous interlude about health insurance…

2 Comments »

I’m doing my best to prepare my weekly round up of the best of Revolution’s expert blogs… but it’s taking a little longer than usual, so here’s a funny little excerpt from a Dave Barry calendar to tide you over…

In the 1950s, medical paperwork was simple: The doctor gave you a bill. That was it. Whereas today, if you get involved with the medical care system in any way, you will spend the rest of your life wading through baffling statements from insurance companies. I speak with authority here. At some point in the past, some member of my family apparently received medical care, and now every day, rain or shine, my employer’s insurance company sends me at least one letter, comically titled, EXPLANATION OF BENEFITS. It’s covered with numbers indicating my in-network, out-of-pocket deductible; my out-of-network, nondeductible pocketable; my semi-pocketed, nonworkable, indestructible Donald Duckable, and so on. What am I supposed to DO with this information?

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

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

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 »

See all book reviews »