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

Latest Posts

The Problem With Casual Medical Advice

It’s happening more frequently: Requests for medical advice by email. The more I do, the more people I meet. The network grows and friends of friends learn about what I do.

So junior has a little pain and shows at the local ER where the requisite CT shows a little thickening of the ileum. Someone suggests that the family drop me a line. Here’s the problem: There’s more to this than digital correspondence will allow.

While the statistical reality of this child’s situation is that this finding represents a little edema from a virus, the differential is precarious: Crohn’s disease, lymphoma, tuberculous ileitis, eosinophilic enteropathy.

A case of this type requires the thorough exploration of a child’s story and a compulsive exam that takes into consideration the problems in the differential. Worrisome considerations need to be framed and discussed in the context of the child’s total presentation and real likelihood of occurrence. The sensitive dialog surrounding our diagnostic approach to this child requires a relationship. And the various approaches require an element of negotiation with the family. All of this takes time, emotional intelligence, and good clinical judgment.

Children are complicated creatures. Parents are more complicated. Loose, off-the-cuff advice based on shotty information shortchanges both parties.

Of course the easiest response to these regular queries is that my employer, malpractice carrier, and the Texas State Board preclude offering medical advice without an established relationship or the maintenance of a medical record available for peer review. Everybody understands legalese. Few, however, understand the complexity of a properly executed medical encounter.

*This blog post was originally published at 33 Charts*

11 Healthcare Predictions For 2011

Here are 11 things that are absolutely going to happen* in 2011 (they’re in no particular order….or are they?):

1.  There will be no big compromise between President Obama and the Republicans on healthcare reform. Why? Because the law is such a massive collection of, well, stuff, that it is pretty much impossible to find pieces of it that you could cut a deal on, even if you wanted to. And no, the federal district court decision on the individual mandate doesn’t change my mind…and in fact may breathe new life into other parts of the law). State governments, insurance companies, and private businesses have made all kinds of important and hard to reverse choices based on the law as is. There’s not much of an appetite outside of people trying to score political points for making big changes.

2. No major employer will drop their health benefits. No major employer is going to outsource their healthcare benefits to the government any time soon. Employers — particularly the big self-insured employers that pay for healthcare costs as a bottom-line expense — see their benefits as an integral part of their business and competitive strategies. As Congress looks at this issue more closely, they will learn this.

3. Time that doctors spend with patients will be less in 2011 than earlier years. It’s a long-term trend, and the factors that create this problem aren’t getting better. The latest government data show that the average doctor visit features face to face time with the patient of 15 minutes or less. With an aging population, increasing numbers of people getting health insurance, and no influx of new doctors, this problem will keep getting worse. Read more »

*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…

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 »