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How Sprained Ankles Can Lead To Cancer Drug Rationing

New York Times blogger Tara Parker Pope describes how her daughter was recently “the victim” of excessive medical investigation. Apparently, the little girl twisted her ankle at dance camp and experienced a slower than normal recovery. Four weeks out from the sprain, Tara sought the help of a specialist rather than returning to her pediatrician. The resulting MRI led to blood testing, which led to more testing, and more specialist input, etc. until the costs had spiraled out of control – not that Tara cared much because (as she admits) “I had lost track because it was all covered by insurance.”

Instead of any twinge of guilt on the part of Ms. Pope for having single-handedly called in the cavalry for an ankle sprain, she concluded that her daughter was a victim of medical over-investigation. But what would any physician do in the face of a concerned pseudo-celebrity parent (with a huge platform from which to complain about her medical treatment)? The doctor would leave no stone unturned, so as to protect herself from accusations of “missing a diagnosis” or being insufficiently concerned about the ankle sprain.

The responses to Ms. Pope’s personal “horror story” about over-treatment (and the waste of billions of dollars inherent in the US medical system) were amusing. One commenter writes, “Why not think of the unnecessary $210 billion as a fiscal ‘stimulus?’ Makes as much sense as any other program in the Age of Obama/Krugman.” And another, “[Of course there's over-treatment] because the federal government subsidizes it! Medicaid, Medicare, and third party private insurance all promote the use of wasteful health care spending. And Obamacare will put that process on steroids.”

Whether or not you agree that socialized medicine reduces healthcare costs, it seems to me that we all have a responsibility not to over-utilize medical resources so that they will still be there when we really need them. Over-investigating every pediatric ankle sprain will simply drain our collective resources, ultimately resulting in further healthcare rationing. New York Times writer Peter Singer has argued that rationing is inevitable and decisions about cancer drug treatment will become the purview of US government agencies as time goes on. I’m pretty sure he’s right.

That being the case, why spur on rationing? Ms. Pope’s victim mentality demonstrates her lack of insight into the true causes of rising healthcare costs – one of which is patient demand. Ms. Pope herself is contributing to the healthcare waste she despises by requesting excessive testing in an environment where physicians are afraid to say no due to legal pressures (or a NYT writer’s bully pulpit). Demand drives costs, and there is a finite limit on our resources. Personal responsibility must play a role in healthcare utilization, just as efforts to protect our environment and scarce resources require participation by individuals. Ultimately, one child’s ankle investigation comes at the price of another patient’s cancer treatment.

Was it the physicians’ responsibility to put the brakes on her daughter’s over-testing? Maybe, but I’d prefer to live in a world where patients can invoke additional testing when their personal judgment suggests that it’s important. Ms. Pope knew better, but requested the additional testing because her insurance paid for it. Free care leads to more care – especially more unnecessary care. Ms. Pope’s daughter was not a victim of over-testing, but a beneficiary of that luxury that may soon evaporate.

We can create a healthcare system where no ankle gets more than a physical exam and ibuprofen (so we can forcibly prevent over-utilization), or we can teach people to use healthcare resources responsibly. Unfortunately, that will require that patients have a little more financial skin in the game – as Ms. Pope has demonstrated. The alternative, a distant oversight body regulating what you can and can’t have access to in healthcare, is where we’ll probably end up. Some day in the future Ms. Pope will recall the day when she was able to get unlimited medical investigations for her daughter without question or cost, and she’ll marvel at how that freedom has been lost. By that time, I suppose, I’ll be one of those people who is being denied cancer treatment by my government.

Robots Allow Experts In The Medical Field To Bring Care To Rural Areas

Both in the United States and around the globe there is a mismatch between needed medical care and the doctors who can provide it.  Most physicians are located in urban areas where there are hospitals, teaching schools, lab and Xray and specialists to deal with most every medical condition.  Rural areas in the United States lack these resources and patients either do without,  or must travel far to be seen.  In developing countries there may be no services at all for hundreds of miles.  That is where telehealth can play a huge role in bringing medicine to the  people.

The “In-touch” robot is one technology that can work all over the world.  Through a simple lap-top computer a doctor can Read more »

*This blog post was originally published at EverythingHealth*

Best Online Resources For Alzheimer’s Disease Information

The Alzheimer World Day only took place a few days ago and we received many suggestions about creating a selection focusing on this important topic. Webicina’s new Alzheimer’s Disease and Web 2.0 collection features relevant and quality social media resources from blogs and podcasts to community sites and Twitter users focusing on Alzheimer’s disease.

Here is my top 10 social media selection for Alzheimer’s disease: Read more »

*This blog post was originally published at ScienceRoll*

Secretary-General On World Mental Health Day: We Must Invest In Mental Health

U N I T E D   N A T I O N S

There is no health without mental health.  Mental disorders are major contributors to illness and premature death, and are responsible for 13 percent of the global disease burden.  With the global economic downturn – and associated austerity measures – the risks for mental ill-health are rising around the globe.

Poverty, unemployment, conflict and war all adversely affect mental health.  In addition, the chronic, disabling nature of mental disorders often places a debilitating financial burden on individuals and households.  Furthermore, individuals with mental health problems – and their families – endure stigma, discrimination and victimization, depriving them of their political and civil rights and constraining their ability to participate in the public life of their societies.

Resources allocated for mental health by governments and civil society are Read more »

*This blog post was originally published at Shrink Rap*

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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