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

Latest Posts

Hospice Patients Spend Less Overall Time In Hospital But More Days In The ICU

Chronically-ill Medicare patients spent fewer days in the hospital and received more hospice care in 2007 than they did in 2003, but their intensity of care increased as well, according to a report by the Dartmouth Atlas Project.

While in the hospital less, patients had many more visits from physicians, particularly specialists, and spent more days in intensive care units, as result of growth in intensive care and specialist capacity, the researchers said.

Intensive interventions can lower a patients’ quality of life and cost more, the researchers noted. About one-fourth of all Medicare spending stems from the last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease, the authors noted. Following patient preferences for end-of-life care may reduce such spending. Read more »

*This blog post was originally published at ACP Hospitalist*

Emergency-Palliative Care: “We Can’t Save You”

An alert reader alerted me to this related piece in Slate: “We Can’t Save You: How To Tell Emergency Room Patients That They’re Dying.” An excerpt:

The ER is not an easy place to come to these realizations or assess their consequences. A handful of physicians are trying to change that. Doctors like Tammie Quest, board-certified in both palliative and emergency medicine, hope to bring the deliberative goal-setting, symptom-controlling ethos of palliative care into the adrenaline-charged, “tube ’em and move ’em” ER. Palliative/emergency medicine collaboration remains rare, but it’s growing as both fields seek to create a more “patient-centered” approach to emergency care for the seriously ill or the dying, to improve symptom management, enhance family support, and ensure that the patient understands the likely outcomes once they get on that high-tech conveyor belt of 21st-century emergency medicine.

Emergency medicine and palliative care-certified? That’s an interesting mix. We have a great palliative care service where I work (in fact, it just won the national “Circle of Life” award.) It makes a lot of sense to have a palliative care nurse stationed in (or routinely rounding) the ER, though. I think I’m going to suggest this to our hospice folks.

*This blog post was originally published at Movin' Meat*

Transitioning Primary Care To “Patient-Centered” Team Care

While the “patient-centered medical home” may be a good idea, it needs a better name. It sounds like a hospice, reports surgeon and columnist Pauline Chen, M.D. She outlines the initial experiences of practices making the transition to the new practice model.

One problem uncovered by pilot projects is that doctors in transition to the practice model have to spend inordinate amounts of time of things other than patients. And while the patients want and welcome the changes, they face a learning curve too, as they move from seeing just the doctor to working with a team of providers for their care. 

Physicians suggested using resources from the Patient-Centered Primary Care Collaborative, a collaborative group set up to help offices make the transition. (New York Times)

*This blog post was originally published at ACP Internist*

The Beauty Of Life And Death, Too Easily Forgotten

Yesterday I had a university student shadowing me in the emergency department. AF is a bright student, a hard worker who will make a wonderful physician. She is always curious and insightful when I ask her questions, or show her new things. Today,  she saw something that was new for her, but perhaps too common for me.

I walked into the room of an infirm, frail old gentleman who was gracious and polite, as was his family. It turns out he came to us with a terminal illness. I did not know it, but his physician was meeting him. So, as AF and I walked into the room, the patient’s physician walked in after us, and continued a conversation about hospice that he had apparently begun earlier in the day.

Realizing I had nothing to add, and would not be needed, I slipped away with my shadow behind. She looked at me, tears welling, and excused herself. Later she returned and explained that when she saw the wife’s wedding band, and knew what hospice meant, she could not restrain her tears. Read more »

*This blog post was originally published at edwinleap.com*

When Grief Turns Into Rage

Twice in the last few months I have encountered grief as rage. Both were in the setting of the cardiac arrest of individuals who were already very ill. One was aged, with severe, end-stage heart disease. One was of middle age, but with metastatic cancer and on hospice.

In one instance, family members became angry because we did not leave the body in the ER for eight hours so that everyone could come and pay their respects. (Which I always thought was the purpose of a funeral home.) 

In another, a family was angry because we did not allow everyone back into the room during the resuscitation of their cancer-stricken loved one — a resuscitation the family insisted upon, and which required rescinding hospice status. From observing their demeanor, their presence would have caused total chaos. Read more »

*This blog post was originally published at edwinleap.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 »

Commented - Most Popular Articles