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Latest Posts

Why Government Healthcare Is Your Best Bet

A friend who works with the unemployed called me up the other day huffing with indignation. The local charity clinic, apparently overwhelmed, had changed its policies so that her unemployed uninsured would no longer be able to seek care there.

“Someone has to do something!”

Um, what exactly would that be? I’d love to help, but I have bills to pay (as do charity clinics) so I can hardly provide medical care without seeking payment. I understand her desperation (and that of the people she so valiantly helps) but who, exactly, is supposed to do what, precisely?

Things are going to get worse before they get better, I fear. The unemployment issue goes way beyond a devastating economic downturn. It’s a reflection of the most basic economic principle of supply and demand. Wages are the “price” of labor — prices go down when supply goes up. In the case of labor, it’s when you have large numbers of people willing to accept lower wages. Can you say “outsourcing?” Watch as the jobs flow overseas while we’re still left with all these people, but not enough jobs to support themselves. In the meantime they all still need healthcare, but can’t pay for it.

Someone has to do something!

Guess what? It just so happens that we really do have a healthcare infrastructure in this country. Between the Veterans Administration (VA) and public healthcare clinics, we have rather a good start at building a truly national healthcare system. Perhaps now is the time to expand it. Read more »

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

Primary Care: Has It Been “Oversold?”

Citing a new study by the Dartmouth Atlas, the Wall Street Journal’s health blog provocatively asks: “Has the notion of ‘access’ to primary care been oversold?”

The Dartmouth researchers found “that there is no simple relationship between the supply of physicians and access to primary care.” That is, they found that having a greater supply of primary care physicians in a community doesn’t mean that the community necessarily has better access to primary care. Some areas of the country with fewer primary care physicians per population do better on access than other areas with more primary care physicians.

The researchers also report that the numbers of family physicians is more positively associated with better access than the numbers of internists, although they call the association “not strong.” Although both general internists and family physicians are counted as primary care clinicians, “in [regions] with a higher supply of family physicians, beneficiaries were more likely to have at least one annual primary care visit. In [regions] with a higher supply of general internists, fewer beneficiaries had a primary care visit on average.” Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Doctors Wanted For Hazardous Journey

“MEN WANTED FOR HAZARDOUS JOURNEY. SMALL WAGES,
BITTER COLD, LONG MONTHS OF COMPLETE DARKNESS,
CONSTANT DANGER, SAFE RETURN DOUBTFUL. HONOR AND
RECOGNITION IN CASE OF SUCCESS.

With this want ad, circa 1914, Sir Ernest Shackleton recruited 28 souls with an unimaginable challenge: To cross the unexplored Antarctica on dogsled. The polar explorer knew exactly what human characteristics he needed to pull off such a feat and understood that straight talk would resonate with a few select men.

Shakleton and his crew boarded their ship, the “Endurance,” and sailed the world’s most dangerous oceans straight into harms way — still considered one of the world’s greatest survival stories. Amazingly, all men survived against unimaginable odds. Their story reminds us that we all stand on the waves and wakes of dreamers, doers, slaves, and fools, all who say, “We did it, took our chances, immigrated to the U.S., headed West, built a new business, risked it all.”

And, if you listen closely, you will hear their stories as an invitation that has been repeated throughout history: “What will you do? Whether your turn or your calling, what will you do?”

Today, I’m posting a similar want ad to medical colleagues. The journey may be far less physically dangerous, but considering prevailing attitudes, perhaps it’s as daring in imagination. Read more »

Primary Care Crisis: Why The Patient-Centered Medical Home Will Fail

Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy. With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice.

As a practicing primary care doctor, I’ve watched with great interest the solutions for the primary care crisis. And I’ve been utterly disappointed.

Patients so far don’t like the patient-centered medical home (PCMH) as noted in Dr. Pauline Chen’s New York Times column. The changes recommended won’t inspire the next generation of doctors to become internists and family doctors. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

A Letter To Medical Students Considering Primary Care

Dear Student:

Thank you for your consideration of my profession for your career. I am a primary care physician (PCP) and have practiced for the past 16 years in a privately-owned practice. (At some point I intend to stop practicing and start doing the real thing. It amazes me at how many patients let me practice on them.)

Anyhow, I thought I’d give you some advice as you go through what is perhaps your biggest decision regarding your career. Like me, you probably once thought that choosing to become a doctor was the biggest decision, but within medicine there are many options, giving a very wide range of career choices. It is the final choice that is, well, final. What are you going to do with your life? ”Being a doctor” covers so much range, that it really has little meaning. Dr. Oz is a doctor, and he has a very different life from mine (for one, he’s not the target of Oprah’s contempt like I am -– but that’s a whole other story).

Here are the things to consider when thinking about primary care:

1. Do you like talking to people who are not like you?

Primary care doctors spend time with humans -– normal humans. This is both good and bad, as you see all sides of people, the good, bad , crazy, annoying, funny, and vulnerable sides. If you see mental challenge as the main reason to do something, and would simply put up with the human interaction in primary care, don’t do it. The single most important thing I have with my patients that most non-PCPs don’t have is relationship. I see people over their lifetime, and that gives me a unique perspective.

2. Do you prefer variety over predictability?

Every room I walk into is different –- often vastly different -– from the last. I could be walking in on a crisis or a stable recheck. The person could be elated or crying. They could be 90 years old or two days old. They could have something wrong with any system, and it could range from mild to life-threatening. I’d go nuts doing the same thing every day, be it looking just at skin or just dealing with the kidney. But some folks do better with routine and a lack of surprise, they don’t want their days to be unpredictable. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

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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