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Physician Questions The Need For Demographic Data With The EMR

Race is a medically meaningless concept.

Spare me the few tired cliches about prostate cancer, diabetes, and sarcoidosis being more common in blacks than whites, or even the slightly increased risk of ACEI cough in patients of Asian descent. We screen Jews of Ashkenazi descent for Tay Sachs without any racial labeling. All that information is readily accessible under the Family History section of the medical history. It is no more than custom which dictates the standard introductory format including age, race, and gender. It turns out I’ve blogged about this before at some length (pretty good post, actually). What is new is the advent of electronic medical records.

Much hullabaloo has been made about federal stimulus funds allocated to doctors as payments for adopting EMRs; “up to $44,000!” Here’s the problem with that figure, though, including how it breaks down (source here): Read more »

*This blog post was originally published at Musings of a Dinosaur*

Health News Consumers Tired Of Misinterpreted Studies

People aren’t dumb. Even if — or maybe especially if — news stories don’t point out the limitations of observational studies and the fact that they can’t establish cause-and-effect, many readers seem to get it.

Here are some of the online user comments in response to a CNN.com story that is headlined, “Coffee may cut risk for some cancers“:

* “I love how an article starts with something positive and then slowly becomes a little gloomy. So is it good or not? I’m still where I was with coffee, it’s all in moderation, it ain’t gonna solve your health woes.”

* “The statistics book in a class I’m taking uses coffee as an example of statistics run amuck. It seems coffee has caused all the cancers and cures them at the same time.” Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

The Unintelligible Language Of Healthcare

Writing about health care reform, Peggy Noonan complains of the decay of the English language:

A reporter asked a few clear and direct questions: What is President Obama’s health plan, how would it work, what would it look like?  I leaned forward.  Finally I would understand.  [Secretary of Health and Human Services Kathleen] Sebelius began to answer in that dead and deadening governmental language that does not reveal or clarify, but instead wraps legitimate queries in clouds of words and sends them our way.  I think I heard “accessing affordable quality health care,” “single payer plan vis-a-vis private multiparty insurers” and “key component of quality improvement.”  . . . . As she spoke, I attempted a sort of simultaneous translation.  . . . But I gave up.  Then a thought crossed my mind: Maybe we’re supposed to give up!  Maybe we’re supposed to be struck dumb, hypnotized by words and phrases that are aimed not at making things clearer but making them obscure and impenetrable.  Maybe we’re not supposed to understand.

Noonan is on to something, but it’s not what she thinks.  What she’s hearing is real-life language of our health care system from the people in charge of it.   And it’s not just government officials who talk this way — Sebelius’ language is just as common in the private sector.

It reveals the deepening divide between how people talk about health care and what it really means to be sick.  Noonan jokes that if Sebelius’ child were to get a high fever she might say “This unsustainable increase in body temperature requires immediate access to a local quality health-care facility,” instead of just “We have to go to the hospital.”  But I don’t believe that.

When a loved one is sick, all the abstract ideas melt away.  It becomes about trying to get help from a doctor, and a doctor doing his or her best to help.

You might think our health care system would be set up to make that process easier.  But it isn’t.

Patients and doctors report in overwhelming numbers how dissatisfied they are with what they see as the interference of well-meaning insurers, governments and others.

You might also think that the reform conversation happening in Washington would have the doctor-patient relationship at the forefront.  But it doesn’t.

Look at the “eight principles of health care reform,”  proposed by the President and supported by the big players in health care:

(1) protecting families’ financial health, (2) making health coverage affordable, (3) aiming for universality, (4) providing portable coverage, (5) guaranteeing choice, (6) investing in prevention and wellness, (7) improving patient safety and quality, and (8) maintaining long-term fiscal sustainability.

What does all of this stuff mean?  How do you talk about health care and not even use the word “doctor” or talk about “patients”?  Worse, I’m not sure more than one or two of these even qualify as “principles” as that word is normally used.  So what’s going on?

I don’t think anyone is trying to deceive anyone. Like Sebelius’ choice of words, the list is as much of a description of the problem as a solution to it.  We don’t have a consensus of what is really important in health care, so we avoid the problem altogether by using vague language that everyone can support.  What’s worrisome is that vague, abstract talk is almost certain to lead to vague, abstract solutions.

Before we try to reform health care, let’s first talk about it in plain, clear language.

*This blog post was originally published at See First Blog*

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…

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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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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…

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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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