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Some Still Won’t Sell It: Do You Know If Plan B Is Available In Your Area?

emergency contraception, plan b, morning after pill, women's health, reporting on healthNow that the latest controversial decision over federal “morning after” pill restrictions has faded from the headlines, it’s worth following up on this question: how available is emergency contraception right now in your own community?

To recap: last week, HHS Secretary Kathleen Sebelius overruled her own science advisors in a decision preventing the “morning after” contraceptive pill Plan B from being sold over the counter at drugstores and to girls under 17 without a prescription. The election-season decision, largely regarded as highly political, could be reviewed by a federal judge after a legal challenge by a pro-choice group.

Of course, Plan B has been controversial ever since it was first approved by the FDA in 1999 (you can see Read more »

*This blog post was originally published at Reporting on Health - Barbara Feder Ostrov's Health Journalism Blog*

Kathleen Sebelius Vetoes OTC Access To Morning After Pill For Young Teens

There’s plenty of of analysis, criticism and praise of HHS Secretary Kathleen Sebelius’ controversial decision to prevent the “morning after” contraceptive pill Plan B from being sold over the counter at drugstores and to girls under 17 without a prescription. The top question: how much did election-year politics affect the decision?

President Barack Obama, father of two daughters, defended Sebelius today and said he was not involved in her decision. The New York Times quotes him:

The reason Kathleen made this decision is that she could not be confident that a 10-year-old or an 11-year-old going to a drug store should be able — alongside bubble gum or batteries — be able to buy a medication that potentially, if not used properly, could have an adverse effect.

Here’s a roundup of the national conversation so far:

NPR’s Julie Rovner reports today on the angry reactions from women’s health advocates, who note that Sebelius’ reasoning – that young girls might not use the OTC birth control correctly – sets a double standard for birth control. She quotes former assistant FDA commissioner Susan Wood: Read more »

*This blog post was originally published at Reporting on Health - Barbara Feder Ostrov's Health Journalism Blog*

Does The U.S. Have Plans To Pay For Long-Term Care?

The Obama administration has dealt a mighty blow to one part of the health reform law by effectively killing off the CLASS Act, which was to be a baby step in the development of a national program to pay for long-term care.   The CLASS Act, short for Community Living Assistance Services and Support Act, was supposed to be a voluntary and federally backed insurance program for people to use to cover potential long-term care needs.  The idea was for Americans to pay premiums into the fund during their working years.  If they later became disabled and needed assistance, they would be entitled to a daily cash benefit of, say, $50 to buy services of a personal care attendant or make home improvements that would allow them to stay in their homes—the preference of most seniors.  Advocates of the CLASS Act even envisioned that some of the benefit could be used for nursing home care.

The program, though, was never popular with insurance companies and politicians who listened to them, and the Act barely made it into the final bill.  It ran into trouble from the beginning.  The Secretary of Health and Human Services, Kathleen Sebelius, was tasked with Read more »

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

Affordable Care Act Expands Women’s Preventive Health Services

There was no large fanfare but there should have been as a result of the Institute of Medicine’s (IOM) recent recommendations that require new health insurance plans to provide preventive services at no cost to the patient. That’s right. No cost. Oh, how women needed this victory in the midst of these trying, turbulent times of economic scarcity. You will no longer have to go to a healthcare provider’s office and turn your pockets inside out or empty your pocketbook on the table before someone will give you a PAP smear or an annual exam. We all know the old adage: “An ounce of prevention is worth a pound of cure.” Well, our healthcare policy makers actually believe this. This policy represents change; change that will make a difference in the quality of your life. And your daughter’s life. And your grandmother’s life. It will help your bank account when you no longer have to write that check for preventive services that could prolong and add to the quality of your life. What brought about this change? The Affordable Care Act. Yes, that same healthcare act that has been politically vilified and called everything except a child of God. That Act.

On August 1, 2011, the Department of Health and Human Services, under the leadership of Secretary Kathleen Sebelius, issued a press release outlining Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

The PPACA: Does It Pass The Playground Test?

Could understanding the tacit rules which govern play on a neighborhood playground help us explain why some aspects of implementing healthcare reform are unlikely to succeed? Recent news involving McDonald’s Corporation suggests so.

On the playground, there are some simple precepts — like the fact that older and stronger kids get to make up the game, and the rules. That’s understood and mostly okay. As if these leaders are considered modestly benevolent and the rules are workable, the game is good and all benefit. And all players on the playground know this basic tenet of fairness: That the rules of the game shouldn’t change in the midst of the competition, and, taking it one step further, if the rules have to be changed they weren’t very good in the first place. Soon, if those in power become too controlling, too conflicted, or too self-serving, kids stop showing up, and the games cease.

In enacting this, our government gave us a very complicated game, with oodles of rules. (For the record, the PPACA of 2010 is 475 pages and 393,000 words.) But then, on further consideration of the rules, important players (McDonald’s) decided that they could not play. They were pulling out of the game, and they had many friends (Home Depot, CVS, Staples, etc.) who may not have spoke outwardly, but surely felt the same way. Read more »

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

Latest Interviews

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…

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How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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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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