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

Latest Posts

Why Did The USPSTF Change The Pap Test Guidelines For Women?

Women have been told they should have screening for cervical cancer with a pap test every year.  The visit to the gynecologist or internal medicine physician has been a right of passage for most young women and most are very compliant with that annual visit throughout their lives.

Well, the times they are a-changin’ because new guidelines issued by the US Preventative Services Task Force and the American Cancer Society say women should undergo screening NO MORE OFTEN than every 3 years starting at age 21.  To further strengthen this recommendation, even the American Society for Clinical Pathology (those folks that read the pap smears) agrees with the recommendation.  They also recommend stopping routine pap smears after age 65 for women who have had 3 negative Pap test results in the past 10 years.  These women are just not at high risk.

So why the change? Read more »

*This blog post was originally published at EverythingHealth*

Physicians Pressured Not To Order Tests, Then Sued If They Don’t

Cardiologists in Connecticut are standing up to the lack of liability protection in the state’s new low-income health plan called SustiNet:

The SustiNet program would create large pools of people, including those who can’t currently afford health insurance, that would theoretically drive down premium costs by competing with the plans of private insurers. Among other cost savings, it would designate a single doctor or practice for each patient, to reduce emergency care use, and create new “best-use” procedures for a variety of ailments to reduce the number of tests doctors order.

But a key provision of the plan was that doctors, in return for following the new procedures and ordering fewer tests, would be protected from malpractice suits if the outcome of a case was not favorable for the patient. However, with backing from the Connecticut Trial Lawyers Association, that provision was removed from the SustiNet bill two weeks ago.

Cardiologists are considered a particularly important group for the new best-use procedures because they tend to order a battery of expensive tests when patients show signs of heart trouble. If specialists like them failed to participate in the SustiNet program, cutting medical costs could be more difficult.

On Tuesday, the Connecticut chapter of the American College of Cardiology withdrew its support for the bill and said that it would circulate an open letter to House Speaker Christopher G. Donovan and Gov. Dannel P. Malloy saying that it could not support the bill without the malpractice protection.

As screws continue to get tightened on doctors’ ability to order tests thanks to third-party oversight bodies, look for more physicians to play hardball about liability limits at both the state AND national levels.

Doctors are being forced to do do their part to control health care costs as a result of our increasingly government-controlled health care initiatives. It’s high time for the trial lawyers’ to do the same. And there’s already precedent to doing so: just look to the legal protections military doctors enjoy when caring for their members. While legal recourse still exists in the military, the challenge of suing the government on behalf of their employees thwarts frivolous claims.

-WesMusings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

All Teens Under Pressure To Be Above Average

My heart is going out to teens these days, especially in my high-achieving community. It seems school districts and parents alike have lost the sense that “average” is really OK, and in some cases, much healthier than “above average.”

An emotional goal of adolescence is to answer the question “who am I” acquiring self-certainty as opposed to self-consciousness and self-doubt. Most teens approach life expecting to succeed and achieve their goals rather than being paralyzed by feelings of inferiority. On a normal path, adolescents seek out people who inspire them and gradually develop a set of ideals and goals for their future. This is all perfectly normal, and if all goes well, teens become young women and young men who believe they can do whatever they set their minds to and are willing to work hard enough for. This process gets stunted if the expectations set for them are unreasonable. Read more »

This post, All Teens Under Pressure To Be Above Average, was originally published on by Nancy Brown, Ph.D..

Physicians Under Pressure To Prescribe Narcotics

When it comes to opiate drugs, like morphine, there is a bitter debate between patients who are in chronic pain, and the doctors who are vilified for under or over-prescribing these medications.

But there are some other subtle influences that push doctors to prescribe these drugs, in some cases inappropriately. An ER physician talks about the issue, saying, “when dealing with a patient who is in pain, or appears to be, it can be impossible to sort out when a patient needs opiates for legitimate reasons, and when it is merely feeding a long term addiction. We are trained to provide comfort and relief from suffering to our patients, and we generally will err on the side of treating pain, rather than withholding addictive medications.”

There is also the pressure to provide “patient satisfaction,” and indeed, low scores in this area can place a doctor’s job in jeopardy. Taking a stand against those who inappropriately request opiates will result in low patient satisfaction scores, and “will often times result in arguments, profanity, and calls and letters to administration.”

What’s the answer? Perhaps a little less reliance on these scores, since a good patient satisfaction score is not necessarily correlated with proper medicine.

*This blog post was originally published at*

Kids Pressured To Be On Academic Treadmill Year-Round

I used to feel guilty when I would say “no thanks” but not any more. I no longer by the line:  “Ok…but you do know she might get behind…many of the other kids do continue for the summer.”

I’m ok with it…and so are my kids. And, you know what, not once have they “fallen behind” in any of their activities, even the ones they are at the top of their game on, in sports or in the arts.

It’s a myth that the sports world is the only world with year ‘round pressure. The music and arts worlds have it, too. Those worlds, in fact, can be more insidious about it because it’s done under the guise of “enrichment” and “culture”. The 24/7 wear and tear on our kids bodies, minds, and souls is, nonetheless, the same as with a ‘year round sport and it’s time music, dance and other fine arts parents recognize that their kids, too, need an off season.

The way to look at it is that any school year after school activity that occupies a great deal of time and focus and goes on for most of the school year, or more than 1 celestial season, requires an off season. The model is in the pro worlds. Pro athletes get off seasons and professional dancers and musicians do take breaks from the intense rigor of their professional season.

Our children have 1 childhood and only so much time in it to explore themselves and pursue activities that interest them. Given how much of the school year’s schedule is dictated by adults, the summer is the best time to hand over the reins to our kids and find out what they want to do and make it happen. The summer is the most perfect time to spread wings and try on something new, something that they may have had to shelve by necessity during the school year.

So, don’t buy into the “she’ll get behind” line – in sports or in the arts. Give your kids the off season this summer they deserve. Just like the off season in the pro worlds, kids use the time so productively that by the time they return to their beloved passions, they have a new found energy, zeal and focus. The rust will come off amazingly quickly and they’ll surge ahead again as if the summer never occurred.

Why not just keep on going, you ask? You could…but you may end up turning an activity your kids love into a complete grind and burn them out entirely. Plus, injury rates increase dramatically in sports and the arts when kids don’t have a break. Musicians and dancers put wear and tear on their bodies just like athletes, but with different muscle groups. Those areas of their bodies need to rest and rehab, in addition to their minds and souls having a chance to not focus so intensely for a while.

Childhood isn’t about specialization, it’s about variety. We’ve forgotten that along the way, and our kids’ bodies and spirits are paying a steep price.

*This blog post was originally published at Dr. Gwenn Is In*

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 »