October 2nd, 2009 by KevinMD in Better Health Network, Opinion
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“Psychiatrists may be the last batch of physicians who are still granted a luxurious amount of time with patients.”
So says Maria, a psychiatrist who blogs over at intueri.
And because time is so undervalued in our health system, some doctors are relying on psychiatrists to counsel patients in the hospital. She cites an example with surgeons, saying that “it is entirely unfair to both the patient and the psychiatrist for the surgeon to completely emotionally ‘turf’ the patient.”
Read more »
*This blog post was originally published at KevinMD.com*
September 24th, 2009 by KevinMD in Better Health Network, Opinion
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Over at Slate, Christopher Beam takes a balanced look at the issue. He acknowledges that, yes, American physicians get paid proportionally more than the average employee when compared to other countries.
But that should always come with the caveat that other countries, like Great Britain and France, heavily subsidize medical education, while the average American medical student graduates with debt in excess of $150,000. Furthermore, the cost of medical malpractice insurance is significantly more fiscally burdensome for doctors Stateside.
Listen to Princeton’s Uwe Reinhardt, a favorite economist of health reformers, who says, “doctors’ take-home pay (that is, income minus expenses) amounts to only about 1 percent of overall health care spending, or about $26 billion. That’s a drop in the ocean compared with overhead for insurance companies, billing expenses for doctors’ offices, and advertising for drug companies. The real savings in health care will come from these expenses.”
Indeed.
By the way, thanks to Mr. Beam for including a quote and link from yours truly.
*This blog post was originally published at KevinMD.com*
September 16th, 2009 by KevinMD in Better Health Network, Health Policy, Opinion
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by Charles W. Patterson, MD
Health care reform has long been one of my main interests and currently, it seems to be everyone else’s. The President said he thought a single-payer system would be best, but submitted a proposal he thought could be passed. The outcome is in doubt.
Actually, the single-payer system is the second best possible solution. The government would hold the money but would remain vulnerable to political manipulation, bureaucratic inefficiency.
The best system would be a well regulated “Everybody Hold Your Own Money and Pay Your Own Way System.” It would empower patients to deal directly with their caregivers without third-party interference or regulation and lead them to become sensitive to the potential benefit and the cost of their care.
This could be accomplished without taxes and without insurance premiums by a properly designed system of health care savings accounts (HCSAs). These should be funded with pre-tax money from regular automatic savings, like payroll deductions, and everyone should have one from birth. Children’s accounts should be funded by their parents. In only a couple of years, normally healthy people would save enough to stay ahead of their health care expenses. They would save the same money they now pay in insurance premiums, so once in place, the new system would cost less because no money would go to insurance company administration and profit, and unnecessary procedures and tests would decrease because people would keep the money they didn’t spend.
When any account becomes large enough to cover anticipated needs (with, say, 90 percent probability) the extra money could be rolled over into a retirement account, or children’s HCSAs. At death, a person’s HCSA could be rolled over to heir’s HCSAs, after an inheritance tax which would be used to fund HCSAs for the poor and unhealthy. Everyone would keep the money they didn’t spend, so they would not spend it unnecessarily.
Government’s role would become only regulatory. A commission might be needed to determine a fair market value for services and patented drugs, but it is likely that market forces would control these and make the mix of available services more appropriate to people’s needs.
To insure that account money was spent on effective care, and not wasted or stolen by fraud, standards of medical practice should be established with a Wikipedia-style online system to allow each licensed practitioner and researcher to propose, amend and vote on standards of practice in his or her’s field. A true consensus statement would then be available on every relevant standard of practice, which would be more up to date and represent truly effective practice, better than the opinions of a panel of “experts.”
The quality of evidence on any issue varies from one study to the next, and leaves room for differences in opinion about what is good treatment. HCSAs should be allowed to pay for all procedures which received an overwhelming vote of approval, and not for those with overwhelming disapproval. The more money in an account, the lower a procedure’s vote would need to be to have it included. The list of approved procedures would change, and its quality would improve as fast as new evidence and experience accumulated.
Regulations should also end patents for new drug which do the same thing as established drugs, as well as new preparations of established drugs. Advertising of prescription drugs should end, because it leads to unrealistic expectations and misdiagnosis. And these regulations should require saved money to be invested conservatively.
Charles W. Patterson is a psychiatrist.
*This blog post was originally published at KevinMD.com*
September 9th, 2009 by KevinMD in Better Health Network, Health Policy, Opinion
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Blame motivated reasoning.
Newsweek’s Sharon Begley writes about the phenomenon, which goes a long way why the myth about “death panels” continues to persist in the health reform conversation. She cites the work of sociologist Steve Hoffman, who explains: “Rather than search rationally for information that either confirms or disconfirms a particular belief, people actually seek out information that confirms what they already believe.”
And with a growing majority obtaining their news through pundit-tinged lens, such as from FOX News on the right and MSNBC on the left, there’s always fodder to confirm pre-existing beliefs.
Ms. Begley goes on to suggest that cognitive dissonance is also in play:
This theory holds that when people are presented with information that contradicts preexisting beliefs, they try to relieve the cognitive tension one way or another. They process and respond to information defensively, for instance: their belief challenged by fact, they ignore the latter. They also accept and seek out confirming information but ignore, discredit the source of, or argue against contrary information.
This is seen often in those who believe there is a link between vaccine and autism, despite convincing evidence to the contrary.
And with information freely available on the internet and on the 24-hour cable news cycle, there are endless opportunities to confirm, rather than challenge, one’s beliefs.
*This blog post was originally published at KevinMD.com*
September 2nd, 2009 by KevinMD in Better Health Network, Health Tips
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by Steve Perry, MD
I recently read a post by Dr. Bob Sears which listed several “Vaccine Friendly Doctors” in Colorado and across the nation.
As a pediatrician and vaccine advocate, I thought I’d be on this list. I am “vaccine-friendly doctor” who works with moms and dads to find the best health care plan for their babies. I read the information on both sides of the issue and weighed the science against the emotional worry that so many parents feel about vaccines. While I always recommend vaccination by the CDC schedule, I always listen to parents concerns.
But, much to my surprise, I was not on this list. After a looking closer, I found that those on the list are a small population of physicians that are “friendly” to the “alternative” or delayed vaccine schedule outlined in Dr. Sears’ The Vaccine Book. The delayed vaccine schedule calls for a drawn-out vaccine plan based on Dr. Sears’ beliefs on calming parental vaccine fears. This delayed schedule has no research or science backing it, it is simply one pediatrician’s opinion.
The biggest medical problem with the delayed schedule is that it leaves babies open to disease for a longer period of time. If a baby is vaccinated by the CDC’s tried, tested and true vaccine schedule, that baby will have immunity to over 14 diseases by the age of two! With the CDC recommended schedule, babies visit their doctor five times in the first 15 months and receive protection against up to 14 diseases in as little as 18 shots if using combination vaccines, or as many as 26 shots if using individual antigens.
We immunize children so young against these diseases because infancy is the time period that kids are MOST vulnerable to life-threatening diseases. The people at greatest risk of dying from vaccine-preventable disease are the very young and the very old. We vaccinate to save lives.
On the delayed schedule, by 15 months of age children will have only received immunity against eight diseases. They miss out on measles, rubella, chickenpox, Hep A, and Hep B. By 15 months, children on this delayed schedule are given 17 shots and visit the doctor’s office 9 times – almost twice as many visits to the doctor as the CDC schedule.
Beyond Dr. Sears advocating for a medically untested vaccine schedule, I was dismayed at his classification of physicians like myself who vaccinate according to the CDC schedule. Because we follow the American Academy of Pediatrics and the CDC’s vaccine guidelines we are “unfriendly” doctors? Because I am following the science of my colleagues I am an “unfriendly” doctor?
This type of misinformation is damaging to families and physicians. It is the power of words that plant seeds of doubt in the minds of parents to fear vaccines. It’s this misleading information that manipulates parents into feeling that they are bad parents if they don’t question the safety and validity of vaccines.
As a pediatrician, I know it can be confusing for parents who get so much information about vaccines every day online and on TV. We all want to be informed advocates for our children’s health. Reading a balance of both sides allows parents to make an informed choice.
The best place to start the conversation about vaccines is with your pediatrician or by reading reputable sites like the Colorado Children’s Immunization Coalition at www.childrensimmunization.org. This non-profit does not accept donations from pharmaceutical companies and works to improve childhood vaccination rates across Colorado.
The reason I became a pediatrician was to protect children from illness and disease. Dr. Bob may only define “vaccine-friendly doctors” as those who promote his book, but the overwhelming data on the effectiveness and safety of vaccination makes it easy for us all to become a vaccine-friendly community. I hope that parents take time to read information on both sides of the issue, brings their questions to their physician and makes fully informed decisions about their child’s health.
Steve Perry is a pediatrician at Cherry Creek Pediatrics in Denver, Colorado and co-chair of the Colorado Children’s Immunization Coalition’s Policy Committee.
*This blog post was originally published at KevinMD.com*
