It is an article of faith that, in Barbara Starfield’s words, adults whose regular source of care is a primary care physician rather than a specialist have lower mortality, even after accounting for differences in income, and she draws upon studies at both the county and state levels to prove it. Now a new paper in JAMA about England’s Primary Care Trusts refocuses the discussion on poverty.
While Starfield’s county-level studies are often cited as evidence that more primary care physicians and fewer specialists lead to lower mortality, they actually showed virtually no differences at all. And when repeated by Ricketts, the small differences noted were not consistent throughout various regions of the U.S. On the other hand, “counties with high income-inequality experienced much higher mortality.” So, in reality, the county studies demonstrated the strong impact of poverty and the marginal impact (if any) of primary care. Read more »
In this video, you will see an interview I was asked to do on November 11th on local TV about alcoholic energy drinks like Four Loko that has been in the news recently. I talk about the potential harmful effects of the ingredients of a product like this. As of this posting there have been a number of states, colleges, and universities who have taken steps to ban these type of beverages.
At the end of the interview, I talk about how I don’t think banning a product like this is going to solve the problem. In the article “Banning Four Loko Doesn’t Solve Problems,” Alex Belz from The North Wind explains:
It seems these health officials are either unaware of or choosing to ignore the fact that combining a caffeinated beverage with an alcoholic one is a time-tested formula for a decent drink. So far, they’ve not proposed banning drinks like Jager Bombs and vodka and Red Bulls from being served in bars, but perhaps that’s just around the corner.
As of this post, it has been only hours since the ban was announced in Washington State. Since the ban does not take effect for about seven days, guess what is happening? According to The Seattle Times, a “Buying Rush Follows Washington Ban On Four Loko.” Read more »
Research has shown that giving to others can lead to a healthier, happier, and longer life. Generous behavior reduces depression and risk of suicide in adolescents. Volunteerism on the part of older adults significantly reduces mortality. Giving to others enables people to forgive themselves for mistakes — a key element in well-being.
One way to have a lot of fun on the Internet and get a health boost while doing so is to log on to a cool site called Kiva. For as little as $25.00, ordinary people like you and me can be part of the worldwide microloan (or microcredit) community. Kiva’s mission is to connect people through lending for the sake of alleviating poverty. Read more »
When perusing my Twitter feed [one] morning, I stumbled onto this post directed to me:
Patients reaching me in public social spaces is becoming a regular thing. I’ve discussed this in the past, but I think it bears repeating. So here’s what I did:
I understood the mom’s needs. Patients resort to “nontraditional” means of communication when the traditional channels fail to meet their needs. Recognize that these patients (or parents in my case) are simply advocating for themselves. My specialty struggles with a shortage of physicians, so we’re dependent upon phone triage to sort out the really sick from the less-than-sick. It’s an imperfect system and consequently parents find themselves having to speak up when the gravity of their child’s condition hasn’t been properly appreciated.
I took the conversation offline. I don’t discuss patient problems in places where others can see, so my first order of business in this case was to get the conversation to a place where it can be private. I called the mom, found out what was going on, and rearranged her appointment to a time appropriate to the child’s problem. Read more »
*This blog post was originally published at 33 Charts*
I’ll cut to the chase: I loved this book. Five stars. Two thumbs up.
When I read books, especially psychiatry books that I write about on Shrink Rap, I often read more carefully and sometimes more critically. I was so immersed in reading “Just Like Someone Without Mental Illness Only More So” that I didn’t stop to think, I just went on the journey.
Mark Vonnegut is a pediatrician and the son of my favorite author when I was in junior high school. His memoir is a poignant and candid account of his struggles with, well, life in general, and life with a psychotic illness in particular. Schizophrenia, bipolar disorder — who knows? (I’ll vote for bipolar disorder.) Some illness where he had three episodes in his twenties, then another episode 14 years later.
Thorazine and lithium and megavitamins and psych wards. Xanax and alcohol and how humiliating it is to be psychotic on a stretcher in the ER hallway of the hospital where he works. Divorce and remarriage. First and second families. Childhood as the son of a financially struggling, not-yet-famous eccentric writer, and adulthood as the son of an icon. Vonnegut is a hippy, a mainstream doctor, a middle-aged softball player, then finally a guy who accidentally poisons himself with wild mushrooms. Read more »
*This blog post was originally published at Shrink Rap*
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