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Latest Posts

Choosing The Best Health Care For You: What Information Helps You Decide?

Our ailing economy has boosted the number of people who are unemployed, without health insurance or with minimal coverage. The popularity of high deductible health plans is soaring as employers and individuals look for affordable insurance.  Twenty-nine percent of bankruptcies are said to be caused by medical bills. Many of us now choose health care services and providers carefully, trying to stay within tight budgets.

The American people, long protected from the price of health care by insurance, are now forced to act as consumers.  This situation is a free marketer’s dream.  According to this model, we will rationally calculate the price/quality trade-offs of each doctor visit, procedure, test and drug.  We will stop overusing services. We will demand better care. And the result will be reduced health care costs for the nation while the quality of care and the health of individuals will remain the same, if not improve.

There’s nothing like a good theory.

But the theory can only be tested if a) It’s easy to find publicly reported, relevant quality information about the services we need, matched with what we would pay out of pocket; and b) We use that information as the basis of our health care decisions. Neither of these conditions can be met today.

A new Cochrane review Read more »

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

Convincing The Public Of The Importance Of Evidence-Based Medicine

On October 4th, 2011, I delivered the Alex Drapos Memorial Lecture at Clark University as part of their ongoing President’s Lecture Series.  Here’s what Jim Keogh, Director of News and Editorial Services, reported about my talk:

Gruman said American health care treads a fine line between trying to serve the good of the many and the interests of the individual. But no one has yet figured out a cost-effective, yet humane, way to do both. She asserted that the skyrocketing expense of health care — expected to rise to $4.64 trillion by 2020 — isn’t reflected in the quality of treatment people receive.

“Should we be able to choose whatever medicine we want, even if there’s no evidence it’s effective?” ~ Jessie Gruman

“There is much ineffective, extra, inappropriate care being delivered,” Gruman said. As an example she cited Read more »

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

Is The Prescription Of Real Exercise Underused?

I recently wrote about the incredible sensations that come with vigorous exercise. Perhaps it was the post ride cannabinoid flurry, but it’s possible that I went too far in suggesting that ‘we’ (doctors, patients, the whole of Western Society) default first to pills before healthy living.

Two commentors called me out on this snark. They wrote about valid points.

One comment focused on the fact that her AF medicines were causing side effects that made vigorous exercise difficult. The second objected to my inference that exercise alone could substitute for the many benefits of modern medicine.

To the idea that medicine Read more »

*This blog post was originally published at Dr John M*

Multaq Simply Does Not Work To Control AF, So Why Is It Still So Over-Hyped?

Did you know September is AFib awareness month?

As a believer in education as the first, and best treatment of AF, I think it’s great to enhance the public knowledge of this highly-misunderstood disease.

By all means…

Tell people about AF’s risks: stroke and heart failure.

Tell them that their fatigue, poor exercise tolerance and breathlessness might not be old age; it might be AF.

Tell them about the importance of early intervention.

Tell them that obesity, inactivity, sleep disturbances, alcohol, and incessantly worrying about everything makes AF more likely to occur, and to stay.

Tell them that Read more »

*This blog post was originally published at Dr John M*

Cardiovascular Problems? Stay Out Of The Heat

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The brutal heat wave gripping much of the country this week is unpleasant for healthy folks. For people with cardiovascular trouble, hazy, hot, humid days can be downright dangerous.

Your body shouldn’t get too hot (or too cold). If your temperature rises too far, the proteins that build your body and run virtually all of its chemical processes can stop working. The human body sheds extra heat in two ways, both of which stress the heart:

Radiation. Like water flowing downhill, heat naturally moves from warm areas to cooler ones. As long as the air around you is cooler than your body, you radiate heat to the air. But this transfer stops when the air temperature approaches body temperature.

Radiation requires rerouting blood flow so more of it goes to the skin. This makes the heart beat faster and pump harder. On a hot day, it may circulate two to four times as much blood each minute as it does on a cool day.

Evaporation. Read more »

*This blog post was originally published at Harvard Health 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…

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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…

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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…

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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…

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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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