June 21st, 2011 by Jennifer Wider, M.D. in Health Policy, Opinion
Tags: Antonette Zeiss, Comprehensive Women's Health, Depression, Female Veterans, Military Sexual Trauma, MST, Post-Traumatic Stress Disorder, PTSD, Sally Haskell, US Military, VA, Veterans, Veterans Affairs, Women, Women's Health Issues
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Women are the fastest growing segment in the US military, already accounting for approximately 14 percent of deployed forces. According to statistics from the Department of Veterans Affairs (VA), 20 percent of new recruits and 17 percent of Reserve and National Guard Forces are women. As the number of women continues to grow in the military, so does the need for health care specifically targeted to their unique concerns.
Historically, lower rates of female veterans have used the VA system. “Research has shown that women didn’t define themselves as veterans in the past, and this is changing,” said Antonette Zeiss, PhD, a clinical psychologist and Acting Chief for Mental Health Services at the VA Central Office in Washington, DC.
Now, “Women are among the fastest growing segments of new VA users with as many as 44 percent of women returning from Iraq and Afghanistan electing to use the VA compared to 11 percent in prior eras,” said Sally Haskell, MD, Acting Director of Comprehensive Women’s Health, at the VA Central Office.
This change is due in large part to Read more »
*This blog post was originally published at Society for Women's Health Research (SWHR)*
June 21st, 2011 by StevenWilkinsMPH in Opinion
Tags: Complaints, Disrespect, Doctor-Patient Communication, Improvement, On Time, Patient Dissatisfaction, Patient Experience, Patient Satisfaction
1 Comment »
While by no means a representative sample of how we think about physicians, there is a clear pattern to the comments. A lot of people feel disrespected by their doctors…and they are pretty angry.
Here’s what patients (including a lot of former patients) had to say. I attempted to summarize the comments by category and included the top five categories of comments below.
#1 – “Being on time is a two way street.” – patients are expected to be on time for their appointments – why aren’t physicians expected to be on time. Doctors think and act as if their time is more valuable than the patient’s time.
#2 – “Listen to what I have to say.” “Doctors should realize that many patients have more life experience and have done more research about a condition and drug and may possibly know more than them. God forbid!” “If you do not like listening to your patients and getting proper information from them, you are in the wrong business.”
#3 – “Don’t just hear one or two of my complaints.” You try telling the doctor all the problems you have and the doctor stops you mid-way, telling you that he or she will take care of two and to come back again for other issues!” “What about someone like me who is on disability for a multitude of health problems? What then?”
#4 Read more »
*This blog post was originally published at Mind The Gap*
June 20th, 2011 by DrRich in Opinion, Research
Tags: ACS, Acute Coronary Syndromes, Artery Blockage, Blockage, CAD, Cardiologist, Cardiology, Coronary Artery Disease, COURAGE Trial, Guidelines, Heart Attacks, JAMA, Plaques, Rupture, Statins, Stent, TheHeart.org
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In 2007, when the results were published from the COURAGE trial, all the experts agreed that this study would fundamentally change the way cardiologists managed patients with stable coronary artery disease (CAD).*
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*”Stable” CAD simply means that a patient with CAD is not suffering from one of the acute coronary syndromes – ACS, an acute heart attack or unstable angina. At any given time, the large majority of patients with CAD are in a stable condition.
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But a new study tells us that hasn’t happened. The COURAGE trial has barely budged the way cardiologists treat patients with stable CAD.
Lots of people want to know why. As usual, DrRich is here to help.
The COURAGE trial compared the use of stents vs. drug therapy in patients with stable CAD. Over twenty-two hundred patients were randomized to receive either optimal drug therapy, or optimal drug therapy plus the insertion of stents. Patients were then followed for up to 7 years. Much to the surprise (and consternation) of the world’s cardiologists, there was no significant difference in the incidence of subsequent heart attack or death between the two groups. The addition of stents to optimal drug therapy made no difference in outcomes.
This, decidedly, was a result which was at variance with the Standard Operating Procedure of your average American cardiologist, whose scholarly analysis of the proper treatment of CAD has always distilled down to: “Blockage? Stent!”
But after spending some time trying unsuccessfully to explain away these results, even cardiologists finally had to admit that the COURAGE trial was legitimate, and that it was a game changer. (And to drive the point home, the results of COURAGE have since been reproduced in the BARI-2D trial.) Like it or not, drug therapy ought to be the default treatment for patients with stable CAD, and stents should be used only when drug therapy fails to adequately control symptoms.
When the COURAGE results were initially published they made a huge splash among not only cardiologists, but also the public in general. So cardiologists did not have the luxury of hiding behind (as doctors so often do when a study comes out the “wrong” way) the usual, relative obscurity of most clinical trials. Given the widespread publicity the study generated, it seemed inconceivable that the cardiology community could ignore these results and get away with it.
But a new study, published just last month in JAMA, reveals that ignore COURAGE they have. Read more »
*This blog post was originally published at The Covert Rationing Blog*
June 20th, 2011 by Davis Liu, M.D. in Opinion
Tags: AIDS, Atul Gawande, Autonomy, Cookbook Medicine, Cowboys, Diabetes, Dr. Peter Pronovost, Guidelines, Harvard Business School, HIV, Insulin Dependent Diabetes, Intuitive Medicine, Non-Insulin Dependent Diabetes, Patient Safety, Pit Crews, Precision Medicine, Professionalism, Professor Clay Christensen, Protocols
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Doctors are professionals. But are doctors cowboys or pit crews? Recently, physician writer, Dr. Atul Gawande, spoke about the challenges for the next generation of doctors in his commencement speech titled, Cowboys and Pit Crews, at Harvard Medical School. Gawande notes that advancement of knowledge in American medicine has resulted in an amazing ability to provide care that was impossible a century ago. Yet, something else also occurred in the process.
“[Medicine’s complexity] has exceeded our individual capabilities as doctors…
The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves. One needed only an ethic of hard work, a prescription pad, a secretary, and a hospital willing to serve as one’s workshop, loaning a bed and nurses for a patient’s convalescence, maybe an operating room with a few basic tools. We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.”
Despite all of the advancements in medicine, the outcomes and consistency in treatment and care are not as good as they could be. Doctors are not doing basic things. The fact that Gawande, author of The Checklist Manifesto, spoke at one of the finest medical schools in the country indicates how much more the profession needs to go.
“We don’t have to look far for evidence. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
June 19th, 2011 by BobDoherty in Health Policy, Opinion
Tags: Affordable Care Act, Cardiac Stents, Department of Health and Human Services, Dr. Rita Redberg, Effective Treatment, Ineffective Treatment, Medical Insurance Coverage, Medicare, New York Times, Taxpayer, U.S. Preventive Services Task Force, University of California, Unnecessary Procedure
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“Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it.”
So argues Dr. Rita Redberg, a cardiologist and professor of medicine at the University of California, in a provocative op-ed published in the New York Times. She writes that Medicare “spends a fortune each year on procedures that have no proven benefit and should not be covered” and offers the following examples:
“Medicare pays for routine screening colonoscopies in patients over 75 even though the United States Preventive Services Task Force, an independent panel of experts financed by the Department of Health and Human Services, advises against them (and against any colonoscopies for patients over 85), because it takes at least eight years to realize any benefits from the procedure.”
“The task force recommends against screening for prostate cancer in men 75 and older, and screening for cervical cancer in women 65 and older who have had a previous normal Pap smear, but Medicare spent more than Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
