Better Health bloggers from across the country participated in a historic discussion about healthcare reform at the National Press Club on July 17th, 2009. I managed to condense a 3 hour event into a 4 minute video… for those of you who were unable to make it, here’s my highlight reel… Thanks to Freddie Dorn at Picture This Video for helping to create it!
Dr. Jim Hill is a friend of mine and co-developer of the National Weight Control Registry – the nation’s largest database of individuals who have lost at least 30 pounds and kept off the weight for at least 1 year. Jim has been studying their commonalities – and has determined that there is in fact a recipe for long-term weight loss success. I shared the recipe with ABC news today. My interviewer (Natasha Barrett) was really funny, and had tendencies to blurt questions in the middle of our conversation (such as: “what do you think of granola bars?”)
With healthcare costs spiraling out of control, and major rationing efforts under consideration – can we really afford to allow purveyors of pseudoscience to use up scarce Medicare/Medicaid resources? It’s hard to imagine that Obama’s administration would approve of extending “health professional” status to people with an online degree and a belief in magic – but a new amendment would allow just that. What happened to our “restoring science to its rightful place” and why are we emphasizing comparative effectiveness research if we will use tax dollars to pay for things that are known to be ineffective?
I hope someone reads and removes this amendment pronto (h/t to David Gorski at Science Based Medicine):
Here’s the language that Sen. Harkin has slipped into the 615 page Senate version of the health care reform bill:
HEALTH PROFESSIONALS.—The term “health professionals” includes—
(A) dentists, dental hygienists, primary 25 care providers, specialty physicians, nurses, nurse practitioners, physician assistants, psychologists and other behavioral and mental health professionals, social workers, physical therapists, public health professionals, clinical pharmacists, allied health professionals, chiropractors, community health workers, school nurses, certified nurse midwives, podiatrists, licensed complementary and alternative medicine providers, and integrative health practitioners;
Background Reading:
What Do Chiropractors Believe?
Regular readers of Better Health will recall my personal frustration that my mother-in-law received 2 months of physical therapy, a head CT, and extensive blood testing in response to a shingles outbreak that I was able to diagnose easily over the phone.
The misdiagnosis that resulted in chronic post-herpetic neuralgia and a $10,000 waste of resources, has continued to vex me. After Mrs. Zlotkus and I realized what was going on, I outlined for her the usual treatment regimen for shingles pain – explaining that most people needed a fairly high dose of the nerve pain medicine before they experience any relief at all, and to make sure her doctor gave her an adequate dose before deciding whether or not it worked.
And you can guess what happened next.
Mrs. Zlotkus was seen by a young and inexperienced neurologist who insisted on giving her a very tiny dose of the nerve medicine (it has an excellent safety profile even at very high doses). Of course, it didn’t help. She was given 100mg twice a day (where shingles sufferers often need as much as 1800mg/day) with instructions to return in a few weeks. The doctor also told her that she “couldn’t be sure the pain was due to shingles since she hadn’t seen the original rash.”
That’s like an ER physician saying to a trauma victim that they can’t be sure of the cause of the injuries because they didn’t witness the car accident.
At that point I instructed her to find an experienced pain management specialist who’d know how to titrate her medication appropriately – and who might even be able to do a nerve block to get her some immediate pain relief.
Luckily, Mrs. Zlotkus “knew somebody who knew somebody” and was able to make an appointment the next day with a senior anesthesiologist experienced in nerve blocks. The pain management physician knew just what to do, administered the nerve block, increased her medication dose, and sent her on her way. She experienced immediate relief of her symptoms and felt like a new woman.
If Mrs. Zlotkus had gone directly to the anesthesiologist in the first place, she might have saved herself months of agony and a $10,000+ bill to Medicare. (Better yet she would have gone to her PCP when she first noticed scabs on her scalp and he would have prescribed an anti-viral medicine that could have aborted the entire pain syndrome.) But how was she to know which provider was right for her? How could she know that her neurologist was prescribing her the wrong dose of pain medication, and that a nerve block might solve all of this nicely. Without the correct diagnosis, a cascade of wasted resources and personal suffering ensued. Without me nudging her in the right treatment direction – perhaps she’d still be doing neck stretching exercises in physical therapy?
I am a fan of the “medical home” concept as described by the AAFP and wonder if it could have made a difference in Mrs. Zlotkus’ care:
“In this new model, the traditional doctor’s office is transformed into the central point for Americans to organize and coordinate their health care, based on their needs and priorities. At its core is an ongoing partnership between each person and a specially trained primary care physician. This new model provides modern conveniences, like e-mail communication and same-day appointments; quality ratings and pricing information; and secure online tools to help consumers manage their health information, review the latest medical findings and make informed decisions.
Consumers receive reminders about necessary appointments and screenings, as well as other support to help them and their families manage chronic conditions such as diabetes or heart disease. The primary care physician helps each person assemble a team when he or she needs specialists and other health care providers such as nutritionists and physical trainers. The consumer decides who is on his or her team, and the primary care physician makes sure they are working together to meet all of the patient’s needs in an integrated, ‘whole person’ fashion.”
In summary, there’s a lot of waste in our medical system caused by a lack of coordination of care, hasty diagnoses, and defensive medicine. Even the most common diagnoses (like shingles) can end up setting off a chain reaction of over testing, incorrect treatment and personal suffering. We need an “OnStar” system for healthcare – a way to help patients navigate their way to the right care at the right time. The medical home model is as good a GPS system as any… so long as the primary care physician at the center of the coordination of care is not so rushed that she can’t do her job properly. And that’s the secret to making the medical home work – giving the doctor enough time to unravel the problems at hand and figure out the best next steps in care. If we get this right, we can probably say goodbye to CT scans for shingles.
Defense Secretary Gates With Dr. Val
I recently wrote about the heroic efforts of volunteer pilots involved in Mercy Medical Airlift and Air Compassion for Veterans. I met Steve Craven on a shuttle to a Red Cross event with US Defense Secretary Robert Gates. Steve kindly explained a little bit about what some airlines are doing to contribute to our active duty and veterans’ medical transportation needs. I was soon contacted by American Airlines to help them with awareness efforts of their own veterans initiatives.
I interviewed Captain Steve Blankenship, the Managing Director of Veterans Initiatives at American Airlines. Feel free to listen to the podcast or read a summary of our discussion below.
[audio:https://getbetterhealth.com/wp-content/uploads/2009/07/captain-blankenship.mp3]Dr. Val: Tell me a little bit about yourself, Captain.
Blankenship: Being a veteran myself (20 years with the US Cost Guard) a count it a real privilege to serve our veterans. During my first 8 years with the Coast Guard I was a helicopter rescue crewman doing search and rescue based out of Miami, Florida. I eventually went to navy flight training and retired from the military in 1991 and was hired to fly for American Airlines for the next 14 years. In 2004 I helped to launch their Veterans Initiative.
Dr. Val: Tell me about Operation Iraqi Children and Snowball Express.
Blankenship: There are so many children who have never been in uniform, but who have paid the ultimate price of losing a mom or a dad in war as they defend our freedoms. American Airlines is particularly proud to be supporting childrens’ initiatives. The Snowball Express program involves private flights around the country to pick up kids and their surviving parent to take them on a fun-filled trip during the difficult winter holiday season.
Actor Gary Sinise helped to co-found Operation Iraqi Children where we shipped over 25 tons of toys and educational materials to Iraq. Our troops were able to give out 10,000 individually wrapped gifts to young children in Iraq.
Dr. Val: What about American Airlines’ support of the iBot Mobility System for wounded veterans?
Blankenship: The iBot is a special kind of wheelchair (designed by the guy who created the Segway) that allows its user to sit at an eye level with someone standing next to them. They can also climb stairs. To date we’ve raised over $700,000 to buy these iBot Mobility devices for our wounded warriors.
Dr. Val: What else is American Airlines doing for veterans?
Blankenship: We fly wounded warriors and their families on charter flights from Brooks Army base to Disney World. We have three dedicated “yellow ribbon” airplanes that we use to fly recovering service men and women to events so they can get out of their rehab centers for a period of time and have fun with their families. This kind of charity comes naturally to us because American Airlines was founded by a military veteran and over 10% of our current staff are either active duty military personnel or veterans.
Every day we go to work, we recognize that the right and privilege we have to fly our airplanes and transport our passengers was paid for by the men and women who wear the cloth of our nation. American Airlines is continually looking for ways to thank them and support the efforts of our military.
Dr. Val: How do military and their families find out more about your programs and services?
Blankenship: They can send me an email directly and I’ll make sure they’re referred to the right place.
steve.blankenship@aa.com
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