Author-physician Dr. Atul Gawande has done it again with a well-written article in The New Yorker magazine entitled, “The Hot Spotters.” It deals with the fact that 5 percent of people with chronic illness make up over 50 percent of all healthcare costs.
If we can zero in on providing better preventive care for those people, we can finally get our arms around runaway healthcare costs. How great that you don’t even have to have a New Yorker subscription to read it. Here are a few cliff notes until you get to it:
— In Camden, New Jersey, one percent of patients account for one-third of the city’s medical costs. By just focusing attention on the social and medical outpatient needs of those people, they not only got healthier but costs were cut in half.
— Our current system is unable to reign in costs. We need to completely re-design and fund how we do primary care.
— Charging high co-payments to people with health problems just backfires. They avoid preventive care and end up hospitalized with expensive and life-threatening illnesses that are much worse and more costly. Read more »
This video is an excellent testimony of what a truly engaged and knowledgable patient with diabetes looks and sounds like. Kudos to the Mayo Clinic for sharing this wonderful piece about shared decision making.
Pay particular attention to the fact that the patient in the video was treated for diabetes by her primary care physician for eight years before being referred to a clearly “patient-centered” endocrinologist. Also note her belief that a patient-centered approach to chronic disease management probably results in shorter, more productive visits in the long run.
November is American Diabetes Month, and in the video below I talk with a local TV news reporter about risk factors, complications, and ways to prevent diabetes. The interview was only about two minutes and there’s much more to be covered, so check out the American Diabetes Association’s website for more information.
If you find this video helpful, I invite you to view more of my TV interviews on my YouTube channel. Happy November!
As doctors, sometimes the biggest lessons that we learn about disease pathology are those that we learn from the people that have that disease. Diabetes is one such disease.
I recently gave a show-and-tell lecture about insulin pumps to the new interns and residents as well as the 3rd-year medical students on their pediatric clerkship with the inpatient endocrine service. We discussed different types of pumps (point A on the picture) and they got to push the buttons and send a bolus or change a basal rate. They also looked at real time CGM (Continuous Glucose Monitors, points C and D on the picture) sensors used to check glucoses levels every five minutes. Read more »
If you think the overcrowding in emergency rooms across the country is because of the uninsured, think again.
A new study in the Annals of Emergency Medicine reports that of patients who are frequent users (over 4 times a year) of emergency departments (ED), the uninsured represent only 15 percent of those frequent users.
Also, the frequent ED users were more likely than occasional users to have visited a primary care physician in the previous year.
They also found that most patients who frequently use the ED have health insurance and the majority of users (60 percent) were white. These findings contradict the widely held assumption that frequent users are minorities or illegal immigrants without insurance. Read more »
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