April 14th, 2011 by Jessie Gruman, Ph.D. in Health Policy, Opinion
Tags: Archives of Internal Medicine, Do-It-Yourself Healthcare, Health Apps, Internet Research, Medicare Part D, Outsourcing, Personal Health Records, PHR, Self-Diagnosis, Self-Treatment, Technology
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The outsourcing of work by businesses to the cheapest available workers has received a lot of attention in recent years. It has largely escaped notice, however, that the new labor force isn’t necessarily located in Southeast Asia, but is often found here at home and is virtually free. It is us, using our laptops and smart phones to perform more and more functions once carried out by knowledgeable salespeople and service reps.
This was particularly salient to me this week: I spent an hour online browsing, comparing prices, reading customer reviews and filling out the required billing and shipping information to get a great deal on a new lamp. An airline would charge me 99 cents to talk to a person but provides information for free online. Calls to Amtrak to make train reservations are routinely answered with a message that the wait to talk to an agent is 30 minutes, but that I can book travel myself – plus get better deals – if I do it online. My bank has a small staff, limited hours and it charges extra for paper checks and mailed hard copy statements… but its Website is welcoming and useful, even at 3 a.m. Read more »
*This blog post was originally published at CFAH PPF Blog*
April 13th, 2011 by BobDoherty in Health Policy, Opinion, Primary Care Wednesdays
Tags: Accountable Care Organizations, ACOs, Cynicism, EMRs, HIT, Internal Medicine, Meaningful Use, P4P, Primary Care, Primary Care Models
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When I talk to internal medicine audiences around the country about the latest health policy flavor of the day – accountable care organizations (ACOs) – a typical reaction is skepticism trending toward cynicism. Many don’t quite get what ACOs are all about and certainly don’t want to be lectured about how they need to re-invent their practices. And they don’t buy the idea that ACOs will somehow save internal medicine primary care. The same can be said, perhaps to a lesser extent, about their reactions to PCMHs (Patient-Centered Medical Homes), P4P ( pay-for-performance), HIT (health information technology), MU (meaningful use), and the whole alphabet soup of other reforms being proposed to reform health care delivery and payment systems.
And who can blame them? Older internists have seen this all before, and the word has gone out from them to medical students and younger doctors not to trust policy prescriptions that promise to save primary care. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
April 13th, 2011 by Dinah Miller, M.D. in Health Tips, Opinion
Tags: Empathy, How Do You Know If Your Therapist Is good?, Psychiatry, Psychotherapy, What Makes A Good Therapist?
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This is for Dr. D.
We were having lunch when Dr. D mentioned she wanted to write a book aimed at teaching residents how to
do psychotherapy. It would start with a section on What Makes a Good Therapist? What does she thinks makes a good therapist? Real life experiences which impart an ability to empathize. Do we grow from our own difficulties? More specifically, do we grow in to better therapists? I asked another shrink this, and he said that people like to believe there is some meaning to their suffering, and perhaps it’s nice to believe that if you’ve been stuck suffering, then it makes you a better therapist, but he wasn’t so convinced it was true. Me? I don’t know, maybe. Or maybe not. Personally, I’m fine with the idea of not suffering, at all, ever again, so long as I live.
In residency, I was taught that warmth and empathy are important to being a good therapist. Read more »
*This blog post was originally published at Shrink Rap*
April 13th, 2011 by Linda Burke-Galloway, M.D. in News, Opinion
Tags: ACOG, American College of Obstetricians and Gynecologists, Dr. Linda Burke-Galloway, FDA, Healthcare reform, High Risk Pregnancy, K-V Pharmaceuticals, Makena, Pharmaceuticals, Pregnancy, Pricing, Uncategorized
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This post is written as a follow-up to The Hijacking of Pregnant Women.
It is said that sometimes you have to rock the boat in order to shift the course of progress. Well today pregnant women have reason to celebrate. The winds of change are apparent.
Bowing under pressure, K-V Pharmaceutical Company reduced the price of Makena from $1500 to $690. Makena is the trade name for hydroxyprogesterone caproate or 17OHP. It is a drug recently approved by the Federal Drug Administration (FDA) to reduce premature deliveries before 37 weeks if it is given before 21 weeks gestation. It has been used for years as an off-label drug and costs approximately $10 to $20 to make by compound pharmacists. When the FDA gave K-V an exclusive right to manufacture the drug, their integrity flew out the window. The pricing strategy of K-V is a case study of corporate greed. Most drug companies will use the “research and development” logic to explain their rationale for marking up the cost of a drug. In the case of Makena, that excuse is valid. The research and development of Makena had already been done by Squibb Pharmaceuticals who had sold the drug for years. Is it any wonder why U.S. citizens will cross geographic borders and purchase drugs from their Canadian and Mexican neighbors?
Kudos are in order to the American College of Obstetricians and Gynecologists (ACOG) who took the lead in questioning K‑V’s pricing strategies. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
April 13th, 2011 by AndrewSchorr in Opinion, Patient Interviews
Tags: Breast Cancer, Fatigue, Kathy Sparks, Medical Fatigue, melanoma
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How is it that a person with an illness forgets to take their medicine, or refuses to get a treatment, or forgoes important monitoring? I’ve been thinking about that because someone close to me has hit that “medical fatigue” wall. There has been no effective treatment for their digestive system illness and they are tired of the prods, pokes, and special exams. They just want to live their life and “cope.”
One can understand – especially in a child or teenager. Imagine someone with diabetes. Diet, exercise, monitoring, medication. It can be so tiring. If only the illness – the boogieman or what some call “the beast” could just go away!
But it can’t and it doesn’t. And medical treatments may well be imperfect. They probably are. So do you give up? There is no “right answer,” only a right answer for you. Here are some examples: This week I am interviewing Kathy Sparks of suburban Seattle. Kathy is a nurse who was diagnosed with melanoma on her forearm. It was cut out. Then more was cut out. Then it came back. She had chemotherapy with lots of side effects. A remission followed, and then it came back again, this time in her breast. As time passed doctors gave her only months to live. Unwilling to try to fairly toxic chemo again, she spent time making peace with her impending demise. Read more »
*This blog post was originally published at Andrew's Blog*
