December 11th, 2008 by Dr. Val Jones in Opinion
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Some thoughts to chew on from Grace-Marie Turner:
But expanding SCHIP to cover all children would be a mistake, for four reasons:
1. First, Congress should make sure poorer, uninsured children are covered first. At least two-thirds of uninsured children already are eligible for SCHIP or Medicaid but aren’t enrolled. If SCHIP were expanded to cover children in higher-income families, their parents would rush to the head of the line to get the taxpayer-subsidized coverage. When a “free” government plan is offered, it’s nearly impossible to resist. Poorer children would be left behind as states focus on enrolling higher-income kids.
2. Second, expanding the program would “crowd out” the private insurance many higher-income kids already have. Hawaii offers proof. Earlier this year, the state created a new taxpayer-financed program to fill the gap between private and public insurance in an effort to provide universal coverage for children. But state officials found families were dropping private coverage to enroll their children in the government plan. When Gov. Linda Lingle saw the data, she pulled the plug on funding. With Hawaii facing budget shortfalls, she said it was unwise to spend public money to replace private coverage children already had.
3. Third, putting many millions of children on a government program will quickly lead to restrictions on access to care. A young boy died in Baltimore not long ago from an untreated tooth infection, even though he was enrolled in SCHIP. Few dentists can afford to take SCHIP patients because the program’s reimbursement rates are so low. The boy’s mother couldn’t find a dentist to see him. In Massachusetts’ move toward universal health coverage, more people have insurance, but they are finding that physicians’ practices are often filled, with waiting lists for a new patient appointment at 100 days and counting. Putting more children on SCHIP will add to the program’s financial pressures, making it harder for poorer kids to get care.
4. Finally, government insurance means that politicians and bureaucrats, not parents, make decisions about the care children receive and about what services will or will not be covered.
December 11th, 2008 by Dr. Val Jones in Humor
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This post originally appeared on my blog last Christmas season – for those of you who missed it, the amusing story is reprinted below:
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My sister Vicki lives in Grand Rapids, Michigan with her husband, three children and an alarmingly large and slobbery Saint Bernard named Gilbert. Several Christmases ago she decided to teach her then 5 year old son, Harrison, about Christmas tree decorating. She took him to a Christmas tree farm and helped him select a tree. They hauled it back to the house and my sister managed, with no help whatsoever from Gilbert, to set it up in a nice corner of the living room. The tip of the tree reached the ceiling and its full figured branches spread from icy window to window.
Vicki and Harrison spent hours and hours winding lights, tinsel, ornaments, paper angels and popcorn strings around the tree. Little Harrison couldn’t wait to see the final product, with glittering lights and a magical star to top off their fine work. They decorated into the early evening, and the living room grew dark as the sun set over the snow covered neighborhood. At last it was time to plug in the tree lights.
As Vicki plugged in the lights for the first time, Gilbert roused himself from his resting place in front of the fireplace and shook off his drowsiness. Harrison held his breath in eager anticipation of the twinkling display that he had helped to create. My sister turned off all the overhead lights.
As the plug entered the outlet, the tree lit up with thousands of tiny glittering lights. Harrison
marveled at his glorious creation. “Mom, it’s the most beautiful tree in the world!”
My sister sat down on the couch and hugged her son tightly in her lap as they relaxed and enjoyed the view. Suddenly, Harrison’s eyes fixated on one of the branches.
“Mom… look! There’s an icicle on the tree!!”
My sister squinted and followed the direction of Harrison’s pointing finger.
Sure enough, there was a glassy, 5 inch long, icicle-appearing object perched in a tree branch in the middle of the tree.
Harrison’s raised his voice with glee: “Mom! It’s a Christmas MIRACLE!!”
The little boy broke free of his mom’s grasp and ran up to the tree to inspect the icicle at close range. As he reached out his hand to clasp it, his look of amazement turned to horror. The icicle was in fact a long
string of dog drool that had flicked off of Gilbert when he shook himself out of his sleep.
“Ewww!!!” Harrison screamed.
My sister slowly realized what had happened and started laughing uncontrollably. Gilbert wanted to get in on the fun and began barking and running in circles. He became tangled up in the extension cord and pulled the tree right out of the tree stand. At that moment, Vicki’s husband returned from shopping with the other 2 children. As he turned on the lights he found my sister trapped under an unraveling Christmas tree, a hysterical child frantically wiping his hands on paper towel, and a barking, drooling Gilbert in the midst.
“What happened here?!” he shouted, attempting to rescue Vicki from underneath the tree.
“It’s a Christmas miracle” was her muffled cry.
And this story will be in our family for a long time to come.
December 10th, 2008 by Dr. Val Jones in Primary Care Wednesdays
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By Steve Simmons, M.D.
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Steve Simmons, M.D.
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In the early 70s Marcus Welby MD, embodied the expectations of patients and the hopes of doctors seeking to emulate his bedside manner. Sadly, when we look at medicine today, patients and doctors alike are left wondering what happened to Welby’s style of patient-focused medicine. Much has changed in healthcare during the nearly 40 years since the show first aired. Patients are more informed and expect to be included when clinical decisions are made. Insurance companies and government bureaucracies have wrested control of the patients from their doctors. Doctors must now focus on business and mind-numbing paperwork to the detriment of their medical knowledge and patients. Runaway costs and an impersonal health care system dominate the landscape of the early 21st century.
The interests of the patient should be paramount and the doctor-patient relationship sacrosanct; however, by inviting a third party into this relationship the interests of the patient are frequently subverted. The office meetings of the past, where difficult medical cases would be discussed, have been replaced with business meetings, insurance coding seminars, and a parade of experts reminding physicians to sit during the office visit to create the impression of more time being spent with their patient. The inevitable frustration patients feel is directed towards their physician, who in turn has been saddled with his own frustration trying to merge ethical and business concerns.
Doctors are leaving primary care in droves, half planning to work less, become administrators, or retire. A survey of medical students discovered hectic clinics, burdensome paperwork, and systems that do a poor job of managing patients with chronic illness as reasons for not choosing primary care medicine. Only 2% of students plan to select general internal medicine as a career. Most students are becoming specialists, where they can make more money, glean respect, and better control their schedule. If national healthcare becomes a reality, today’s critical shortage of primary care doctors will become problematic when the uninsured start looking for a doctor.
What qualities do we want in a primary care physician and what role do we need him to play in our lives? A succession of TV doctors: Welby, Hawkeye, and now, House, share the virtues of diligence, attention to detail, and moral courage. They can help us track the evolution of our patient’s expectations over four decades. Dr. Welby’s patients willingly followed his guidance and instruction, while Dr. House’s patients live in the Information Age and have probably searched the internet before seeking his help. Unfortunately, the admiration felt for Dr. House helps demonstrate that an entire generation expects an aggressive and uncaring doctor, thinking it the norm.
In 1979, Alan Alda gave the commencement address at Columbia University Medical School, titled, “On Being a Real Doctor.” He said, “We both study the human being and we both try to offer relief–you through medicine, and I through laughter–but we both try to reduce suffering.” Few believe today’s healthcare system is focused on suffering. Third party payers are holding on to the money, controlling care, and this influences doctors. Patients like physicians have lost focus on what really matters: to ease suffering.
I sometimes imagine Dr. Welby practicing medicine today. Towards the end of his day I see him sitting behind his desk, entangled in red tape, frustrated by his inability to untie the knot binding medical and financial realities. His waiting room is full of patients, dragging the same red tape behind them.
Fortunately, if one doctor’s argument is correct and all primary care physicians are Marcus Welby, we have reason to hope. Our healthcare system is broken, but not irrevocably. Doctors and patients can stop wrestling against their constraints, turn away from their frustration, and find each other. Patients will use access to information and drive health reform forward; many are speaking up today. Doctors would do well to remember we are all patients but the onus of explaining the healthcare crisis and proposing meaningful change falls on physicians. In our practice, doctokr Family Medicine, we try to cut red tape wherever we can, striving for an open and transparent practice, placing the doctor-patient relationship central in everything we do. I believe you can find a doctor like Marcus Welby in your community and hope our posts will encourage you to try.
Until next week, I remain yours in primary care,
Dr. Steve Simmons, doctokr Family Medicine
December 9th, 2008 by Dr. Val Jones in Audio, Expert Interviews
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Dr. Michael Shabot
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I recently interviewed Dr. Michael Shabot, Memorial Hermann Hospital System’s Chief Medical Officer, about how his hospital is taking steps to improve patient safety and healthcare quality. His hospital was awarded the 2008 National Health System Patient Safety Leadership Award at a ceremony at the National Press Club.
You may listen to your 20-minute interview here, or read my summary of it below.
[Audio:http://blog.getbetterhealth.com/wp-content/uploads/2008/12/shabot.mp3]
Dr. Val: Tell me about what Memorial Hermann has been doing in the area of hospital quality and safety.
Dr. Shabot: We operate Memorial Hermann Healthcare System on the premise that all patients, visitors, and staff will have an absolutely safe environment. In fact, six of our hospitals have gone a year without a single case of hospital-acquired blood stream infections, or ventilator-associated pneumonia.
Larry Kellner, the CEO of Continental Airlines, can travel on any one of his airplanes without checking on the credentials of the pilots. But would you advise a family member to go to a hospital without checking its credentials or being under the care of a physician whom you know and trust? I wouldn’t.
Every single one of our hospital employees has gone through our “cultural transformation” training. They are taught new ways of doing their current jobs – based on safety training with a proven track record in the aircraft and nuclear energy industries. We also feature employees who have “good catches.” Last month’s “good catch” employee found a medication that was packaged incorrectly from the vendor. It was in the correct bin of our computerized dispensing system, the outer package was correct, but the bottle inside contained a different dose. And this medicine was going to be given to a tiny baby in our neonatal ICU. That incorrect dose could have caused terrible harm, but thanks to the alert nurse – we caught the error.
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December 8th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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Forgive me for not keeping up with my own weekly feature: “heard around the blogosphere.” I’ve been very selfish lately, reading and chuckling to myself without sharing. Let me try to remedy that… Here are my top 10 amusing/noteworthy quotes from around the blogosphere:
1. Dr. Rob: “Santa: I suppose if a guy like me can deliver presents to all of the children of the world without developing a significant budget shortfall, perhaps Obama can deliver quality care for all Americans and save money. I would suggest he talk to me before he tries, however, because it isn’t as easy as it looks.”
2. Terra Sigillata: “My hiking boots are old enough to go to college.”
3. Edwin Leap: “Disability is not a career choice.”
4. Ten Out of Ten: “At the interdepartmental meeting the surgeon was irritated at all the hospital cafeteria food being fried and suggested offering some healthy entrees. Turns out they tried that once before but could never sell the healthy stuff.”
5. Respectful Insolence: And then Carol Alt had to come along. Move over, Jenny and Suzanne, there’s a new model woo-meister in town, and she’s looking to out do you both with her vegan raw food woo after having been totally convinced by–you guessed it!–an anecdote.
6. Scalpel or Sword: “Sometimes, [in the ER] what looks like a quickie really isn’t, so one has to be careful.
PATIENT 1
Chief Complaint: sprained ankle (Great, send them
back!)
Nurses note: pt c/o twisted ankle and vaginal discharge for one week. (Never mind.)
7. Scanman: “Soon, specialists will uniformly be comprised of American medical graduates, while the majority of generalists will be composed of mid-levels and foreign-trained physicians. It’s an interesting demographic glimpse of the future American medical workforce… A new kind of caste/class system where the financially less desirable, menial jobs are relegated to second class citizens.”
8. KevinMD: “Primary care is associated with negative connotations such as bureaucracy, paperwork, and being perceived as the lowest physician on the totem pole. Or as this doctor puts it, “‘PCP’ now seems to be synonymous with overworked, underpaid ‘loser’ who at least by some people’s opinions aren’t carrying their weight.” Taking a tip from marketers, how about re-branding the profession?… “
9. GruntDoc: “C=M.D. C=75% and that means I know 3 out of 4 diseases, and that ain’t bad.”
10. PearSoup: To pregnant mommy: “Mommy, If there was a fat person contest you would win! Yay!”
