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Latest Posts

Holiday Airline Troubles Are Reminiscent Of Health Care Experiences

One of the hot phrases in health care these days is “patient-centered,” as in “patient-centered hospitals,” “patient-centered practices,” and “patient-centered medicine.” For all of you out there working on creating such “patient-centered” systems, let me provide a bit of advice based on a recent experience my family and I had with Delta Airlines. For if you substitute the word “customer” for “patient,” you get what every business, whether in health care or not, should be focused on — the person receiving, nay, purchasing, their services. The ones you hope will return, again and again.

I’m actually writing this as I sit in the lobby of a hotel in Park City, Utah. It is a gorgeous day outside, crisp and cold, just perfect for the skiing my family had in mind when we booked this trip; it’s a short trip– just 3 days on the slopes before we head home — so every minute counts. Unfortunately, despite plenty of time sitting in airports yesterday (i.e., no tight connection), only 2 out of our 6 pieces of luggage made it here. Fortunately, one of those was the suitcase filled with skiing togs. Unfortunately, one of the missing pieces was my son’s new snowboard, also filled with all of his ski togs. So while my boys are out on the slopes (the snowboard kid wearing my ski clothes), I’m sitting in the lodge awaiting our luggage. It is nearly noon — half of the day gone, one-sixth, possibly one-third, of our vacation gone–and I have not yet set foot on the slopes. Sure, I could head over and buy all-new ski stuff. . . . but that isn’t the point.

The point is how this was handled. Read more »

*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*

U.S. Health System Performance Falls Short Of Attainable Goals

Why doesn’t the US have the best health care system in the world?  That’s the question The Commonwealth Fund Commission on a High Performance Health System asks in its report, “Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011.” Excerpt:

“U.S. health system performance continues to fall far short of what is attainable, especially given the enormity of public and private resources devoted nationally to health. Across 42 performance indicators, the U.S. achieves a total score of 64 out of a possible 100, when comparing national rates with domestic and international benchmarks. Overall, the U.S. failed to improve relative to these benchmarks, which in many cases rose. Costs were up sharply, access to care deteriorated, health system efficiency remained low, disparities persisted, and health outcomes failed to keep pace with benchmarks. The Affordable Care Act targets many of the gaps identified by the Scorecard.” Read more »

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

Organizing And Administering Our Own Care

Emerging from a foggy year of treatment for stomach cancer, I am vividly aware of how much time and energy it takes to meet the daily demands of a serious illness. When I think back over the past 35 years and my treatment for now four different cancer-related diagnoses, I am amazed by how much has changed. The diagnostic and treatment technologies are light years more sophisticated and effective.

I am also taken aback by how much more we, as patients, and our loved ones who care for us, must know and do to organize and administer our own care in response to a serious diagnosis.

From an economic standpoint, this makes sense: the marketplace drives innovations to become simpler and cheaper. In modern American health care, this means that new drugs, technologies and procedures are re-engineered so they can be offloaded from expensive professionals to patients and those who care for them – and who work for free.

Think about it: Read more »

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

Does Communicating With Patients Take Too Much Time?

I recently participated in a Twitter Chat about physician-patient communications. A common refrain from some of the providers in the group was that “there isn’t enough time” during the typical office visit for physicians to worry about communicating effectively. What’s up with that?

The goal of patient-centered communications is to engage the patient in their own health care. While most physicians endorse the concept of patient centered communications, many seem reluctant to employ such techniques in their own practice.  Why?  I suspect that many fear that too much patient involvement will increase the length of the visit.

Take the patient’s opening statement aka “patient agenda” in patient centered lingo.  This is where the doctor asks the patient why they are there.  The resulting patient narrative is an opportunity for the physician to obtain valuable information to help assess the patient.  Patient centered advocates recommend that physicians use open-ended questions like “what brings you in today” to solicit the patient’s concerns and agenda.  Active listening by the physician and paying attention to the patient’s emotional cues are also hallmarks of patient centered communications.

The reality is that regardless of how they are asked, patients are often not able to complete their opening statement.   Read more »

*This blog post was originally published at Mind The Gap*

Does Group Health’s “Medical Home” Leave The Poor Behind?

Group Health has published two papers recently, one in Health Affairs and the other in JAMA, both extolling the virtues of its Medical Home. These follow their brief report last fall in the NEJM and the lengthy description of their model in the American Journal of Managed Care. Their model has been promoted by the Commonwealth Fund, and it is cited in the currrent issue of Lancet.

The big news is that costs were a full 2% lower than conventional care, hardly a great success –- it wasn’t even statistically significant. But was even this small difference due to the Medical Home, or was it because the Medical Home patients were less likely to consume care? Read more »

*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*

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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