Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

The Leather Band-Aid: J&J’s Competition?

No Comments »


Scott Amron from Amron Experimental has a new idea for our gilded age, the leather bandage. Three of these will cost you $15, but will look very appropriate next to your Armani jacket.

Product page: Hurt Couture

(hat tip: Interior design room)

*This blog post was originally published at Medgadget*

Where Docs Agree on Health Care Reform

No Comments »

Asking a bunch of doctors and nurses what they want out of health care reform is like asking a group of teens what toppings they want on a pizza: You’re going to get a lot of different answers, with the loudest proclamations reserved for what they don’t want.

Such a group came together July 17 at the National Press Club in Washington, D.C. at an event called Putting Patients First, hosted by Better Health. The unanimous conclusion: Get government out of the health care delivery continuum.

Val Jones, M.D., CEO of Better Health, said, “I don’t think people outside the doctor-patient relationship should be making life and death decisions” on behalf of the patient or doctor. Rep. Paul Ryan (R-Wis.), the event’s keynote speaker, said government has an obligation to establish conditions for free markets to thrive. Ryan blamed insurance companies for the problems with health care today – essentiually stating that insurers dictate the care that providers can deliver – and he called for a solution that does not involve heavier government.

“Government bureaucracy is not the answer to insurance bureaucracy,” Ryan said. The government’s failure to control costs in Medicare and Medicaid “shows us we should get government out of the way and put more faith in the market. Providers should compete against each other for our business.”

Ryan claims that the so-called ‘public option’ in President Obama’s proposed health care reform initiative would allow the government to be “referee and player in the same game,” and that companies hoping to compete for consumer health care dollars would be at an unfair disadvantage. Obama’s plan would result in “cookie-cutter standards” for determining individual patient care, set unfairly low reimbursement rates and create an economic barrier to young talent hoping to enter the medical profession.

Ryan added that Obama’s plan offers no incentives for people to get and stay healthy, which would lower health care costs. But offering reduced insurance rates to a consumer who, say, quit smoking or lost excess weight “would be illegal” under Obama’s plan, Ryan noted. “So there’s no incentive” for people to take better care of themselves. Ryan has a plan that he says would include a “carrot and stick” provision to reward people for maintaining a healthy lifestyle.

Between two expert panels, Robert Goldberg, Ph.D., co-founder of the Center for Medicine in the Public Interest, showed a video, complete with scary background music, of  patients in Canada and the U.K. complaining about abhorrent wait times to see doctors and government-mandated denial of life-saving treatments. Goldberg concluded that government-run health care in the U.S. would yield a similar system, with patients wasting away in the long shadows of a bureaucratic monster while doctors and nurses stood by, helplessly bound by the new rules. (One panelist later noted that polls show 70 percent to 80 percent approval among Canadians for that country’s health care system.)

The event did yield some progressive ideas for improving the U.S. system.

Alan Dappen, M.D., associate clinical professor at Virginia Commonwealth University School of Medicine, Department of Family Practice, and founder of DocTalker, a practice in Fairfax, Va., has moved a huge chunk of his patient consultation onto the phone. Patients still pay for his time – just as they would for  an office visit – but the system is much more efficient than having every patient come in for every ailment. “If you have a tick bite or an ear infection I don’t necessarily have to see you,” he says. Further, he says, the documentation for treating such minor ailments “should not go through 30 people” at an insurance company to ensure the doctor is paid or the patient is reimbursed. “That’s just ridiculous.”

Dappen has been practicing this way for eight years and says it takes on average 10 minutes to solve a patient’s issue over the phone. “Most of our patients are helped to satisfaction,” he said. And as a result of the time saved on patient visits, he added, he has time to do house calls – and is the only doctor in Fairfax County who does so.

Rich Fogoros, M.D., a former professor of cardiology and cardiac electrophysiology and longtime practitioner and researcher who is now a consultant and writer, suggested that primary care physicians go “off the grid” – i.e. refuse to participate in any insurance plan. That, Fogoros said, will force regulators and insurers to acknowledge that current practices by insurance companies have destroyed the doctor-patient relationship.

Kevin Pho, M.D., an internal medicine physician in Nashua, N.H., and author of the blog Kevin, M.D., said the most common complaint he hears from his patients is how little time they get to spend with him during a typical visit. “We are incentivized to see as many people as possible,” Pho said, not to provide the best care possible for each patient. One solution: hourly pay for doctors, siilar to the ‘billable hours’ system used by lawyers.

James Herndon, M.D., an orthopaedic surgeon and chairman emeritus of the Department of Orthopaedic Surgery at Partners health care (an integrated health system founded by Massachusetts General Hospital and Brigham and Women’s Hospital) in Boston, Mass., voiced concern about doctors in hospitals who won’t take care of the uninsured and underinsured. The doctors “keep pointing them elsewhere until they end up in the trauma unit, which is the last resort,” he said. “I would mandate that [all doctors on staff] see their share” of those patients.” Herndon added that he favors “public support,” such as some form of a tax, to ensure doctors are compensated for providing that care. He also conceded that the health care industry has become too profit focused. “The CEO of United Health made $1.2 billion” in one recent year. “We need to get rid of excess profit in insurance.”

Kim McAllister, R.N., the author of Emergiblog, said that, no matter which plan emerges from the ongoing debate in Washington, “People will circumvent it by showing up in the emergency room.” She recounted a story of a patient in California who went to the emergency room for a headache – twice – because he couldn’t get a timely appointment with his physician. She favors a health care savings account model under which each consumer could then “decide what provider they see and when they see that person.” McAllister suggested allowing the money to roll over from year to year – another nod to rewarding healthy lifestyles – although she strongly implied that allotments would be scaled based on a person’s income.

And this hit a point on which most of the participants seemed to agree: For consumers who really cannot afford health care in a free-market system, the government should have funds available to help them pay.

National Museum of Health and Medicine: Gem Of The Walter Reed Campus

No Comments »

In yet another example of a fortuitous Twitter connection, Tim Clarke, Deputy Director of Communications for the National Museum of Health and Medicine reached out to me after I tweeted about Walter Reed. He graciously offered to give me a guided tour of the museum, located on the Walter Reed campus where I volunteer with the Red Cross.

We spent about an hour reviewing some fascinating exhibits, including the history of body identification techniques. If you’re a fan of NCIS, then you should run (not walk) to this museum to gain insight into the incredible evolution of forensic science over the past 150 years. The exhibit begins with Paul Revere’s dental tools (did you know he was a part-time dentist?) and the story of how he identified the body of a fallen soldier for whom he’d done some unique silver smith work.

The time of death and relative age of human remains can be gauged by bone erosion (they become smoother with age) and material evidence (the type of button found near the remains can be used to identify the season of death – larger buttons were used for heavy winter overcoats for example) among other things.

Did you know that finger print analysis is not automated? Apparently, to this day, a technician must be involved in the computer-generated comparisons because finger prints are too complex for 100% accuracy with computer models.

However, with the advent of DNA analysis, extraordinary advances have been made in our ability to identify remains. In one particularly fascinating case, Charles Scharf’s body was identified after his wife brought in a letter that he’d sent to her from Viet Nam in 1965. She had kept it in a plastic bag in a shoe box since that time. Charles had sealed the letter with his saliva, and because of the excellent condition of the envelope, tiny pieces of DNA remained in the glue. In 2006 pathologists were able to link his remains to his DNA sample, and finally confirm his fate.

Modern autopsies can be performed rapidly with the guidance of CT scanners. The likely internal injury that caused a soldiers death can be identified via CT, and then rapidly confirmed by pathologists. Research into armed forces injuries can result in improved equipment and increased safety. In one case, a retrospective analysis of CT scans demonstrated that military personnel had larger chest cavities (on average) than initially thought – this resulted in the provision of longer needles for chest tubes in trauma bays.

And speaking of trauma bays, the museum has transported an entire trauma tent from Balad Air Force Base in Iraq to memorialize medical care during the war. A 3000 pound concrete slab of flooring provides the base of the exhibit, complete with original blood and betadine stains, gouges in the plastic floor sealant, and duct tape. Original metal tent doors and canvas show evidence of sand storm damage, with sand still coating the tent air ducts. Action photos taken at the trauma bay surround the exhibit. Nothing brings home the reality of war like this living 3-D memorial.

Just to the left of the tent is a large photo of a Black Hawk helicopter and a wounded soldier being carried by EMS through a canvas archway. On the ceiling of the archway is an American flag. I turned to Tim and asked him why the flag was on the ceiling and he said,

“That was so the soldiers could look up from their stretchers as they arrived at the medical facility and know that they were ‘home.’ They were safe now, and were going to be taken care of.”

Tim also introduced me to the Abraham Lincoln exhibit, where the bullet that sealed his fate (along with skull fragments, a tuft of his hair, and his surgeon’s sleeves) are on display. It’s an extraordinary feeling, being so close to history.

I’m really glad that I had the chance to experience history with Tim, and I strongly recommend that you contact him to set up your own guided tour. If you’re a member of a professional society, or are coming to DC for a meeting or event, why not make the National Museum of Health and Medicine a part of your travel plans?

Cute Kid And Animal Photos

1 Comment »

My brother-in-law is a police sargeant and amateur photographer. His wife is an elephant keeper. Chuck took a headshot of me in the past, and I just couldn’t resist sharing some of his recent work with you. Which one do you like best?

A Year In The Life Of A Woman With Type 1 Diabetes

No Comments »

My friend and fellow blogger Kerri Morrone Sparling has created a photo montage (one photo taken each day for 365 consecutive days) of her life with diabetes. It is a fascinating pictorial experience  that somehow captures the reality of the disease – and living life to the fullest despite daily blood sugar monitoring.

Please take the time to experience it here.

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles