July 28th, 2010 by DrRob in Better Health Network, Opinion, True Stories
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I went to a patient’s funeral this past weekend. I generally don’t do that for people whose relationship I’ve built in the exam room. It’s a complex set of emotions, but invariably some family member will start telling others what a nice doctor I am and how much the person had liked me as a doctor. It’s awkward getting a eulogy (literally good words) spoken about me at someone else’s funeral. This patient I had known prior to them becoming my patient, and his wife had been very nice to us when we first moved here from up north.
But that’s not why I am writing this. As I was sitting in the service, the thought occurred to me that a patient’s funeral would be considered by many to be a failure for a doctor. Certainly there are times when that is the case — when the doctor could have intervened and didn’t, or intervened incorrectly, causing the person to die earlier than they could have. Every doctor has some moments where regrets over missed or incorrect diagnosis take their toll. We are imperfect humans, we have bad days, and we don’t always give our patients our best. We have limits. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
July 21st, 2010 by DrRob in Better Health Network, Health Tips, Opinion, True Stories
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Dear Patients:
You have it very hard — much harder than most people understand. Having sat for 16 years listening to the stories, seeing the tiredness in your eyes, hearing you try to describe the indescribable, I have come to understand that I, too, can’t understand what your lives are like. How do you answer the question, “How do you feel?” when you’ve forgotten what “normal” feels like? How do you deal with all of the people who think you are exaggerating your pain, your emotions, your fatigue? How do you decide when to believe them or when to trust your own body? How do you cope with living a life that won’t let you forget about your frailty, your limits, your mortality?
I can’t imagine.
But I do bring something to the table that you may not know. I do have information that you can’t really understand because of your unique perspective, your battered world. There is something that you need to understand that, while it won’t undo your pain, make your fatigue go away, or lift your emotions, it will help you. It’s information without which you bring yourself more pain than you need suffer. It’s a truth that is a key to getting the help you need much easier than you have in the past. It may not seem important, but trust me — it is. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
July 6th, 2010 by DrJosephScherger in Better Health Network, Health Tips, News, Research
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Most of us know that salt raises blood pressure in many people. When I learned that in medical school almost 40 years ago, I have not touched a salt shaker since. I enjoy having a low normal blood pressure. A new study published in the Journal of the American Society of Nephrology (July 2010) suggests that sugar, especially the fructose that comes from corn syrup, may also raise blood pressure.
A study team from the University of Colorado in Denver looked at sugar intake among thousands of Americans in a major national nutrition survey between 2003 and 2006. Those who consumed more added sugars, such as the fructose in soft drinks, had significantly higher blood pressures than those who did not and ate more natural foods such as fresh fruit. Fructose from corn syrup is a major cause of the obesity epidemic and may also be contributing to high blood presure, the most common chronic disease in adults. Read more »
*This blog post was originally published at eDocAmerica*
May 4th, 2010 by JenniferKearneyStrouse in Better Health Network, Health Policy, Health Tips, Opinion, Research
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At a [recent] session on caring for adult survivors of pediatric diseases, Bradley J. Benson, FACP, and Niraj Sharma, FACP, had some interesting statistics to share.
For example, more than 90% of children with a chronic or disabling health condition are expected to live more than 20 years, meaning they’ll eventually need an internist’s care, and every year more than 500,000 children with special healthcare needs turn 18.
As Dr. Sharma noted, “We’re not talking about a handful of folks.” Read more »
*This blog post was originally published at ACP Internist*
April 8th, 2010 by JenniferKearneyStrouse in Better Health Network, News
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An article in the New York Times this week looks at a raft of new public health initiatives passed by Congress that are aimed at boosting disease prevention. Examples include requiring restaurants with at least 20 locations to include nutrition information on their menus and mandating employers with at least 50 employees to allow new mothers to express breast milk at work. In addition, Medicaid will now cover smoking cessation counseling for pregnant women and Medicare beneficiaries will be eligible for an annual physical. The initiatives are expected to eventually save money by decreasing the country’s chronic disease burden. (New York Times)
Researchers from Johns Hopkins University recently did a study applying physicians’ ethical codes to the conduct of the fictional doctors on “Grey’s Anatomy” and “House, M.D.” Perhaps to no one’s surprise, TV doctors are behaving very badly. As the abstract of the study states, both shows feature “egregious deviations from the norms of professionalism and contain exemplary depictions of professionalism to a much lesser degree.” (Philadelphia Inquirer, Journal of Medical Ethics)
*This blog post was originally published at ACP Internist*
March 13th, 2010 by DrDavidKroll in Better Health Network, True Stories
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A few weeks ago, I wrote a post about being stricken with pneumonia and my reflections on what it must be like for people who live continually with chronic illnesses. I was surprised by the response from many readers, quite a few of whom I’ve never seen comment here, who voiced understanding and even relief that a “normal” would take the time to reflect on what their life might be like.
Well, my illness is continuing even longer than my pulmonologist had expected and this has evoked for me a whole new layer of emotions. I write the following not for sympathy or concern, but rather for the Medicine and Health channel of ScienceBlogs to give voice to those much worse off than I who may not otherwise have a voice in our national health care dialogue. Read more »
*This blog post was originally published at Terra Sigillata*
February 24th, 2010 by Happy Hospitalist in Better Health Network, Opinion, True Stories
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As a hospitalist I sometimes come across patients who, for what ever reason, refuse to take the medications prescribed by their in-patient doctors. Some patients refuse out of fear. Some doctor told them years ago that taking medication X would make them worse. Some patients refuse out of ignorance of their disease process. Most of the time however, they just don’t understand why the medication is necessary. Some patients just refuse out of stubbornness. And some patients refuse because they have a really good reason.
However, when you’re dealing with critical illness and the only thing that’s going to save your patient’s life is a treatment plan they are refusing, sometimes you have to be in their face with reality. So how do I handle situations with patients who have the capacity to make poor medical decisions but refuse life saving medications? How do I convince my hospitalized patients to take their medications I’ve prescribed? Read more »
*This blog post was originally published at Happy Hospitalist*
October 28th, 2009 by Happy Hospitalist in Better Health Network, Opinion
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What we need is health reform, not health insurance reform. If we do nothing about health care inflation, we are all doomed. Every last one of us. Taking care of sick people is expensive. The only way to get rid of health care inflation is to stop spending money. At some point we will either have to
- decrease illness
- decrease treatment and/or
- decrease the cost of treatment
There are no alternatives. As an American which action plan would you rather see take hold? Realize that every cost action has a reaction. You can decrease disease by prevention. You can decrease treatment by bundling. And you can decrease the cost of treatment by making it more efficient or simply paying less until access becomes an issue. I am certain that keeping the financial stability of America will require all three. But the only one you as a patient have control over is #1. As a country, we can prevent 80% of diabetes, heart disease, stroke and cancer by taking care of ourselves with lifestyle modification. Read more »
*This blog post was originally published at A Happy Hospitalist*
January 27th, 2009 by drval in Announcements, Audio, Expert Interviews
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Better Health’s policy writer, Gwen Mayes, caught wind of an interesting new conference being held tomorrow in Miami. She interviewed Ken Thorpe, Ph.D., one of the conference organizers, to get the scoop. You may listen to a podcast of their discussion or read the highlights below. I may get the chance to interview Billy Tauzin and Donna Shalala later on this week to get their take on healthcare reform initiatives likely to advance in 2009. Stay tuned…
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Mayes: Tell us about the upcoming conference in Miami on January 28th called “America’s Agenda: Health Care Policy Summit Conversation.”
Thorpe: The conference will start a conversation on the different elements of health care reform such as making health care more affordable and less expensive, finding ways to improve the quality of care and ways to expand coverage to the uninsured. The conference is unique in that we’ve brought together a wide range of participants including government, labor, and industry for the discussion, many of whom have been combatants over this issue in the past.
Mayes: Will there be other meetings?
Thorpe: This is the first of several. There will others in other parts of country over next several months. President Obama and HHS Secretary Designee Tom Daschle have talked about engaging the public in the discussion this time around. So part of this is an educational mission and part of it is to reach consensus among different groups that have not always agreed in the past.
Mayes: What encourages you that these groups will be more likely to reach consensus now when they haven’t in the past?
Thorpe: The main difference is that the cost of health care has gotten to the point that many businesses and most workers are finding it unaffordable. In the past, most businesses felt that, left to their own devices, they could do a better job of controlling health costs by focusing on innovated approaches internally. What we’ve found, despite our best efforts, working individually we haven’t done anything to control the growth of health care spending. The problems go beyond the reach of any individual business or payer and we need to work collectively.
Mayes: How will health care reform remain a priority in this economy?
Thorpe: The two go hand in hand. As part of our ability to improve the economy we’re going we have to find a way to get health care costs down. Spiraling costs are a major impediment to doing business and hiring workers. To the extent we can find new ways to afford health care it will be good for business and workers.
Mayes: Health information technology is also an important aspect. What are the common stumbling blocks to moving forward?
Thorpe: There are three issues we have to deal with. First, we have to have a common set of standards for how the information flows between physicians and physicians, and with payers and hospitals. What we call interoperability standards. Second, we have to safeguard the information. Finally, cost is the biggest challenge because most small physician practices of 3 or 4 physicians don’t have electronic record systems in place. To put in a state-of-the-art system can cost $40,000 per physician and most cannot afford this expense. I think the stimulus bill will provide funds to help with these costs.
Mayes: There’s always growing interest in the patient’s role. How will this be addressed?
Thorpe: We have to find a better way to engage patients in doing better job of reducing weight, improving diet and those with chronic disease to follow their care plan they worked out with their physician. We also want to make it more cost effective for patients to comply with the plan. Patients who comply with health plans will have better outcomes at lower costs.
Mayes: Who’s on the agenda in Miami?
Thorpe: It’s at the University of Miami so it will be hosted by President Donna Shalala who was Secretary of HHS under the Clinton administration so she is well versed on health policy. Also attending is the head of PhRMA, Billy Tauzin, a former Congressman and former majority leader of the House, Dick Gephart. There will be some lay people as well for a nice cross section of consumers, labor, providers, business and others.
Mayes: How can people learn more about American’s Agenda and the conference?
Thorpe: The executive director of American’s Agenda is Mark Blum. He can be reached at 202-262-0700 or at America’s Agenda.org.
November 27th, 2008 by drval in Expert Interviews
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Happy Thanksgiving everyone - I thought I’d blog about food today, and to try to persuade you to trade that pumpkin pie for a glass of milk…
I learned some interesting things at the Dairy Science Forum on November 13th in DC. Dr. David McCarron presented some compelling data on the effects of the DASH diet on reducing blood pressure. The DASH diet is fairly high in dairy products (2-4 servings/day), fruits, and vegetables. In comparison with a low-salt diet (which reduces systolic blood pressure by an average of 1 point), the DASH diet can cause an average reduction in systolic blood pressure of ten points. If you have high blood pressure (and your kidneys are functioning normally) you probably shouldn’t worry all that much about the salt. It’s more important to stick with the DASH diet.
I interviewed Dr. McCarron about the role of dairy in blood pressure management. Here’s what he had to say:
Dr. Val: If salt isn’t the real enemy, and dairy can help to reduce blood pressure, why isn’t that message getting out?
Dr. McCarron: We have national nutrition policies in place that are old and out of date. The healthy eating paradigm - low fat, low sugar, low salt - was established 40+ years ago and when new evidence is obtained, it’s really hard to crack through that illusion of knowledge. There is excessive mistrust of new data because of the attitude that if it conflicts with our previous beliefs, it can’t be true. I believe that the Internet will be critical in allowing the evidence to bubble up. For example, a diet rich in dairy food is absolutely associated with a reduction in virtually all chronic medical conditions. We have data to support this for people of all ethnicities and from around the world. I think that consumers are looking for clarity and simplicity in their nutritional advice - and basically they need to know that a healthy diet requires 3-4 servings of dairy and 5-6 servings of fruits and vegetables/day. If you do that alone (along with regular exercise) you’ll be amazed by the results.
Dr. Val: What is the proposed mechanism by which dairy has all these positive effects?
Dr. McCarron: It’s almost impossible to nail down specific mechanisms because milk products contain so many ingredients (electrolytes, key vitamins, bioactive proteins, and essential fatty acids). Trying to understand which piece is impacting very complicated physiological control mechanisms within the body (that have 30-40 different vectors feeding into them) is extremely difficult. In fact, the permeatations make it almost impossible. We can’t come up with the proof that we do for drugs (which contain only one bioactive ingredient). What we do know, though, is that dairy is a vital component for chronic disease reduction and prevention. Unfortunately the policy people say, “you haven’t explained to me how this works, so I’m not going to consider it.”
Dr. Val: But what about the research suggesting that whey protein contains lactokinins that function similarly to ACE inhibitors (a type of blood pressure medicine)?
Dr. McCarron: That’s been known for over a decade. There’s no question that there are small peptides (proteins) in milk that have a positive impact on blood pressure, mood disorders, and weight reduction. The industry doesn’t want to talk about it because it makes milk sound like a drug, which isn’t effective marketing. Also the average consumer doesn’t have enough background to understand what that means (lactokinins have ACE inhibitor-like effects in vivo), so we need to simplify the message and disseminate it via the Internet.
References:
NEJM, 1998 Effects of Dietary Patterns On Blood Pressure
Am J Hyper, 2004 McCarron and Heaney
JAMA, 2002 Pereria et al
Science, 1984, McCarron et al
JAMA, 1996, Bucher et al
