July 1st, 2008 by Dr. Val Jones in Expert Interviews
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Some 600,000 physicians are facing a 10.6% cut in Medicare payments beginning July 1.
Congress failed to pass a measure to block a steep reduction in the Medicare physician payment rate before adjourning for a weeklong July 4 recess. That failure allows a 10.6 percent cut to take effect on July 1 that could end up limiting or denying care to millions of Medicare beneficiaries. [
AAFP News Now]
I reached out to Dr. Nancy Nielsen, the President of the American Medical Association, for comment. [Listen to the podcast]
Dr. Val: How will the Medicare cuts affect seniors in this country?
Dr. Nielsen: Because the 10.6% cuts to all physicians who see Medicare patients goes into effect today, we are really on the brink of a meltdown. Physicians say that a cut of this size will force them to make terrible choices, just to keep their practices open. In a recent survey, 60% of physicians said that the cuts would cause them to limit the number of new Medicare patients that they treat. This is the last thing we need at a time when baby boomers are aging into Medicare. It’s not why any of us went into medicine – to shut doors and turn patients away. So this is really, really painful.
Dr. Val: What do you say to those who claim that doctors are simply protecting their own salaries when opposing this cut?
Dr. Nielsen: We’re really not hearing that argument because people understand that this is about whether or not payments keep up with the costs of rendering care. At least 50% – 65% of income that comes into a physician’s office is spent on overhead. That includes rent, liability insurance, staff salaries, equipment and supplies. None of the manufacturers of hospital gowns or exam table paper are cutting the cost of those supplies to us by 10%.
When you’re spending up to two thirds of your income on overhead, you simply can’t tolerate payments that haven’t kept up.
Dr. Val: What can patients do to protect themselves from being denied access to medical care?
Dr. Nielsen: Patients need to understand that this issue is about them. We physicians embarked on careers in medicine to serve them, and we’re hoping that Medicare beneficiaries and military families will reach out to the senators who did not vote with us and tell them that this is a critical issue that needs to be fixed. The AMA has a Patient Action Network available online or by calling a toll free number: 1-888-434-6200. Individuals should contact us to take a stand against these cuts. Patient groups have been very supportive – the AARP and representatives from the disabled community and assisted living were with us pleading with the Senate to block the Medicare cuts.
Dr. Val: What is the AMA doing to protect access to healthcare?
Dr. Nielsen: The Medicare crisis is an access issue. It is the insurance that seniors depend on and that our country has promised them. We do not want a Medicare meltdown. The responsibility for this crisis lies with the Senate. We are hoping that the Senate will come back from vacation and do the right thing.
Last year the AMA embarked on an unprecedented campaign to encourage all Americans to put pressure on politicians to find a way to cover the uninsured. This is the other major access initiative that we’re promoting.
Dr. Val: What do you make of the “concierge medicine” movement where doctors — who are fed up with insurance — simply stop accepting it?
Dr. Nielsen: It’s a symptom of doctors becoming frustrated with bureaucratic red tape and payment problems. Many don’t feel that they have enough time to spend with their patients, and can’t afford to practice the kind of medicine they want to with insurance-based payments. Concierge practice is not a big movement, but there are some good physicians who have made that choice. We’re hoping that more physicians are not forced to stop taking insurance, but those who choose this route report being very happy, and so are their patients. The problem is that for patients who cannot afford concierge medicine, it’s not a solution at all.
Dr. Val: What would you like to say to the American public today about the Medicare cut crisis?
Dr. Nielsen: We need your help and we need it immediately. Please call your senators over the long weekend and plead with them to do the right thing and help us avoid a Medicare meltdown – a crisis that is not in anybody’s best interest.
[Listen to the podcast]This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 1st, 2008 by Dr. Val Jones in Health Tips
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This is the final week of the WOMAN challenge – a great health initiative with a slightly awkward acronym (“Women and girls Out Moving Across the Nation.”) Designed by the department of Health and Human Services, the goal was to get 10,000 steps/day 5 days a week for 8 weeks total. Today they sent me a final list of stress-reducing tips that I thought I’d share with you (along with some personal commentary):
Tips to relieve stress
1. Be physically active – physical activity may prevent stress-induced suppression of the immune system The American Heart Association recommends a minimum of 30 minutes of cardiovascular exercise per day, 5 days a week, and 2 weight training sessions per week for optimum health.
2. Eat regular, healthy meals – with plenty of whole grains, fruits and vegetables.
3. Laugh (especially at yourself) – laughter releases feel-good chemicals in the brain.
4. Have fun with friends – friendship can reduce loneliness and stress inducing symptoms of depression, and may even prolong your life.
5. Confide in someone you trust – you don’t have to go it alone!
6. Make time to relax – if you don’t actively set aside time to unwind, you might not do it.
7. Get a full 8 hours of sleep each night – people who get too little sleep may be at a higher risk for health problems and even death
8. Keep a journal – writing down your thoughts can be cathartic and help you express pent up emotions.
9. Organize your daily tasks – disorganization can add to anxiety and feelings of stress. A cluttered home may be a risk factor for weight gain.
10. Learn healthy ways to deal with anger – your anger may be justifiable, but holding it in may do more harm than good. Alternatively, lashing out at others will certainly increase your stress. In some cases, anger management counseling can help.
11. Ask for help – if stress is severe, you may benefit from talking to a mental health professional. They can help you work out a plan to reduce your stress or anxiety.
12. Talk to your health care provider – if you think your stress may be related to an anxiety disorder, post traumatic stress disorder, or if you’re leaning on alcohol or other substances to deal with your stress – make sure you tell your doctor about it so you can find a way forward together.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 30th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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Thanks to science writer Carl Zimmer for highlighting this totally disgusting fish parasite. Read the description and check out the photo link if you dare.
“Parasites often choose very particular–and peculiar–places to live. This crustacean invades a fish’s mouth, devours its tongue, and takes the tongue’s place. It then acts like a tongue; the fish can use it to grip and swallow prey.”
The fish’s version of “has the cat got your tongue?”
In the mood for more creepy stuff? Check out my previous posts:
Spider bite
Malaria
Rabid bat bite
Total body warts
Poisonous snake in ICUThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 30th, 2008 by Dr. Val Jones in Opinion
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As newly minted physicians begin their residency training and clinical care responsibilities on July 1, hospitalized patients might expect a bumpy transition. At least, that’s been the urban legend – “don’t get sick in July!” But is that really true? Are patients at higher risk for medical errors at teaching hospitals in July?
Some say, “no” and some say “yes.” I’m in the “yes” category, and some research suggests that medication error rates do in fact increase in the month of July. In the “no” category we have Jerome Groopman, renowned Harvard physician and author of “How Doctors Think.” He simply says, “Today, most hospitals closely watch over interns.”
This is what I wrote in a previous blog post:
There are many ways that an intern can make mistakes, without ordering a single test or procedure, and under the full scrutiny of red tape regulations and documentation practices.
When an intern fails to recognize a life threatening condition and chooses to do nothing, or to let the patient wait for an extended period of time before alerting his or her team to the issue, serious harm can befall that patient. And that harm is not caused by inexperienced procedural technique, or ordering the wrong medicine – it’s caused by doing nothing. This “doing nothing” is the most insidious of intern errors – and it is not remedied by any form of hospital quality improvement initiatives. It is the risk that a hospital takes by having inexperienced physicians in the position of first responders. Interns gather large amounts of information about patients and then create a summary report for their supervisors. The supervisors (more senior residents) don’t have time to fact check every single case, and must rely on the intern’s priority hierarchy for delivering care.
But many hours pass between the time an intern examines a patient and when a supervising physician checks back in with that patient. And within that period of time, many conditions can deteriorate substantially, resulting in the loss of precious intervention time.
Dr. Groopman describes an experience from his own life in which a surgical intern (in July) correctly diagnosed his son with an intussusception
(twisted bowel) but then incorrectly determined that the baby could wait to go to the O.R. Of course, untreated intussusceptions are nearly always fatal, and each minute that passes without intervention can increase the risk of death.
And so, in my opinion, it is in fact more dangerous to be admitted to a teaching hospital in July, but not necessarily for the reasons that people assume (procedures performed by inexperienced physicians or drug errors – though those mistakes can be made as well). Rather, it is because interns don’t have the clinical experience to know how to prioritize their to-do lists or when to notify a superior about a patient’s health issue. Timing is critically important in quality care delivery – and that variable is not controlled by our current intern oversight system.
Now that I’ve completely terrified you – I will offer you a word of advice: designate a patient advocate for your loved one (or yourself) if you have to be in the hospital as an inpatient (especially in July). If you can, find someone who is knowledgeable about medicine – and who knows how to navigate the hospital system. A nurse, social worker, or physician are great choices. That person will help you ensure that concerns are prioritized appropriately when your intern doesn’t yet fully appreciate the dangers behind certain signs symptoms. If you have no advocate, then befriend staff members who are particularly caring and experienced. Be very nice to them – but don’t be afraid to insist on being examined by the intern’s supervisor if you really are concerned. Unfair as it may seem, sometimes the most vocal patients get the best care.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 30th, 2008 by Dr. Val Jones in News
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I read a touching story at the BBC news center about a young woman with Alpert’s Syndrome. This rare syndrome is present in only 1 in 170,000 births. It results in facial disfigurement and mitten-like hands.
The physical defects of Apert’s syndrome were first described by Fredrick Apert in 1942. These characteristics include: A tower-shaped skull due to craniosynostosis (premature fusion of the sutures of the skull)—an underdeveloped mid-face leading to recessed cheekbones and prominent eyes, malocclusion (Faulty contact between the upper and lower teeth when the jaw is closed) and limb abnormalities such as webbing of the middle digits of the hands and feet.
Bones of the fingers and toes are fused in Alpert’s infants giving a “mitten-like” appearance of their hands. Children with Apert’s syndrome can have unusual speech characteristics such as hyponasal resonance due to an under-developed mid face, small nose and long soft palate and, sometimes, cleft palate.
What struck me about the girl’s story was how she described how it felt to be teased growing up, and how the worst part of the teasing was that no one stuck up for her. I’ve seen kids do this kind of thing before, and I can imagine how painful it is when no one has the courage to go to bat for you. I’ve often wondered how “doing nothing” to defend a little one might be just as bad as actively harrassing them. I’d encourage parents to teach their children not to tease others, and beyond that, to come to the defense of those being teased. I bet this will do a lot of psychological good for the victims.
The good news in this case is that the girl has had some very successful reconstructive surgery and has a fairly normal life. The teen is even thinking about boyfriends, and preparing for college. Many thanks to the surgeons who did such a wonderful job.
And coincidentally, the Happy Hospitalist brought this story to my attention: a 4 month old kitten was in a horrible accident that resulted in her losing the front half of her face. Veterinarians were able to save her life, though she remains quite deformed. I am told that the kitty is not in any pain, and is enjoying her life as a therapy pet. She brings hope to those recovering in the hospital from surgeries and serious illnesses. I suppose they see her as a loving animal who is cheerfully going about her kitty business, without giving much thought to her previous injury.
These stories of hope are made possible by the surgeons and veterinarians who devote their lives to saving face. In so doing, they provide the rest of us with valuable lessons, and new friends of exemplary courage.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
