July 14th, 2010 by John Mandrola, M.D. in Better Health Network, Health Policy, News, Opinion
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It happened. Guilty. I confess. Reading about Dr. Berwick’s recess appointment to lead the Centers for Medicare and Medicaid Services (CMS) induced me to watch a Fox news clip. Gosh, I feel bad about it. It felt good, though.
Patients — that’s you and me — should know that CMS controls doctors, nurses and especially hospital/practice managers. They are ten times more scary than the radar patrol car on the highway.
Dr. Berwick likes the British system of healthcare delivery. In Europe healthcare is free, and everyone likes free stuff. Free stuff happens all the time, doesn’t it?
In Cambridge, Mass — at Harvard — free stuff for all seems a plausible tenet. There must be a lot of coffee shops and free time in Cambridge. In the real world — on Main street, on the farm, in the factory, or really everywhere other than college — people know getting something for nothing is fantasy.
It hasn’t happened yet, so my Dad’s advice about not worrying too much about future events still holds true, but Dr Berwick’s recess appointment to lead the all-controlling CMS has the potential to make caring for patients even more challenging. Yes, more regulations, longer EMR notes with a really careful review of systems, and less pay to doctors will surely improve patient care. Scary indeed. Read more »
*This blog post was originally published at Dr John M*
July 10th, 2010 by John Mandrola, M.D. in Better Health Network, Humor, True Stories
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After a long weekend there are procedures to add to an already-busy schedule, colleagues are on summer vacation, and of course there are many “action tags” or “tasks” — or other likewise unreimbursed chores — to check off the to-do list before clicking in the pedals for a pre-dinner ride. And so it was recently.
Today, though, Jack was visiting. It was a good decision to ask Jack, our nine-year-old nephew from Hoosier-ville, to accompany me for some evening errands.
I had forgotten the unabashed curiosity of a nine year old. Nine is indeed a good age for children — a sweet spot, so to speak. Read more »
*This blog post was originally published at Dr John M*
June 27th, 2010 by John Mandrola, M.D. in Better Health Network, Opinion, Research, True Stories
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In cancer treatment, detection of a tumor in an early stage markedly increases the chance of favorable outcomes.
Can the much-aligned blood thinner, warfarin, occasionally help in early detection of cancer?
Few pharmacologic agents receive more bad press than warfarin. Stories, which are too numerous to count, like “Did warfarin kill my father,” can be widely found on Internet forums, search engines, and are often quoted by reluctant patients — whose numerator of bad warfarin experiences is one.
It is true that warfarin has a narrow therapeutic window — a small difference between an effective dose and dangerous dose. Read more »
*This blog post was originally published at Dr John M*
June 19th, 2010 by John Mandrola, M.D. in Better Health Network, Opinion, True Stories
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We all know about “doctor time.” No matter how hard I try, the clock seems to out sprint me. Morning rounds in the hospital go longer than expected, a colleague stops you with a question, a son forgot his lunch, or something else. The list is long.
In fact, as a very well-educated patient, it seems that the doctors I choose for myself and family are even later than I. It seems that most good doctors have long waits. A coincidence?
However accepted “doctor time” is in the office or hospital, it doesn’t work the same in the bike racing world. In the land of genetically endowed androids, the clock waits for no one in particular. It turns out that our pizza-sponsored team has a few doctors who run on “doctor time” in real life. Read more »
*This blog post was originally published at Dr John M*
June 12th, 2010 by John Mandrola, M.D. in Better Health Network, Health Tips, Opinion, True Stories
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Life sometimes gets in the way of daily posting. Specifically, the treadmill of life sometimes roars too fast.
But as I strolled through the hospital this morning, there was a plain piece of white paper taped to the wall around the nurses station. Although I’m not overly religious (and even highly conflicted about which rituals are the right ones), these words from a pastor/celebrity stopped me for a moment:
Attitude
The longer I live, the more I realize the impact of attitude on life. Attitude, to me, is more important than facts. It is more important than the past, than education, than money, than circumstances, than failures, than success, than what other people think or say or do. It is more important than appearance, giftedness or skill.
It will make or break a company, a church, or a home. The remarkable thing is that we have a choice every day regarding the attitude we will embrace for that day.
We cannot change the past, we cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing we can do is plan on the one thing that we have, and that is our attitude.
I am convinced that life is 10 percent what happens to me and 90 percent how I react to it. And so it is with you. We are in charge of our attitudes.
As a cardiologist programmed to “alert” most of the time, words such as these help me. I haven’t seen the studies yet, but I’m guessing that positive attitudes reduce inflammation, which is good for our atria, and our arteries.
JMM
*This blog post was originally published at Dr John M*
