December 20th, 2010 by DrRich in Opinion
Tags: Ethics
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Podcast:
In the tradition of “Yes, Virginia, &c.,” DrRich once again reprises his classic holiday message.
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‘Tis once again that time of year when we Americans gather together with our extended families and friends to celebrate the Season. It is a time for catching up – renewing acquaintances and making new ones, sharing in good news and commiserating in bad, welcoming our new arrivals and mourning our losses. It is a time for giving thanks, counting our blessings, and putting our sundry individual problems into perspective. Indeed, it is perhaps most importantly a time for each of us to remind ourselves that – despite the trials and tribulations that may cause us to become relatively self-absorbed in our daily lives – we are all part of something much greater than ourselves.
So, in a way, it’s a shame we must now cull out our obese relatives and friends, and disinvite them from these joyful and fortifying reunions.
It’s not something we should do lightly, as the obese are people, too. They enjoy the holiday gatherings as much as anyone else (more, some would say, given the abundance of sugary foodstuffs which are typically provided there). But alas, excluding the obese is now something we must do – for our own sake, of course, but more importantly, for the sake of our social networks, and indeed, for America itself. For, to allow the obese to continue participating in our traditional seasonal gatherings is something we now know (as DrRich will shortly explain) to be simply too dangerous and too counterproductive to our collective interests. We can no longer permit it.
Before demonstrating why, DrRich ought to digress for just a moment to address the burning question many of his kindly and generous readers must already be asking, namely, What about Diversity? Read more »
*This blog post was originally published at The Covert Rationing Blog*
December 19th, 2010 by DrWes in Opinion
Tags: Accountable Care Organizations, ACOs, Cardiac Electrophysiology, Cardiology, Corporate Healthcare Systems, Dr. Wes Fisher, Government-Funded Care, Healthcare reform, Large Healthcare Systems, Large Hospital System, Medical Specialists, Musical Chairs, Specialty Medical Practice, Specialty Physicians, Too Many Specialty Doctors
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The consolidation of physician specialty practices into larger corporate healthcare systems in urban areas is creating a new challenge for today’s doctors when the music stops: There might not be a chair available.
There are simply many fewer hospital systems in large urban areas than there are specialy practices, so the number of specialist positions a large healthcare system is willing to absorb might be limited. As doctors and hospital systems coalesce into as-yet-to-be-clearly-defined “accountable care organizations,” the cost of too many specialists in an organization is being carefully weighed. Read more »
*This blog post was originally published at Dr. Wes*
December 19th, 2010 by StevenWilkinsMPH in Better Health Network, Health Tips, Opinion, Research, True Stories
Tags: Bad Patient Behavior, Doctor-Patient Communication, Doctor's Recommendations, Family Medicine, General Medicine, Internal Medicine, Mind The Gap, Patient Health Behavior, Preventive Health, Preventive Medicine, Primary Care, Screening Tests, Steven Wilkins MPH
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It seem like everyone these days is focused on changing some aspect of patient health behavior. You know — getting patients to get a mammogram or PSA test, exercise more, take medications as prescribed, or simply becoming more engaged in their healthcare. If only we could change unhealthy patient health behaviors, the world would be a better place.
I agree with the sentiment, but I think that patients and their health behavior often get a “bad rap” from healthcare professionals. I would even go so far as to say that much (not all) of what we attribute to poor patient behavior is more correctly attributable to ineffective doctor communications with patients.
In my last post I talked about the link between strong physician advocacy, e.g., I recommend, and desirable health outcomes, i.e., patients getting more preventive screening.
Here’s what I mean. Mammography studies have consistently shown that screening mammograms rates would be much high if more physicians “strongly recommended” that women get screened, e.g., “I recommend” you get a mammogram. In studies where physicians advocated for screening, mammography screening rates were always higher compared to physicians that did not advocate for them. The same phenomenon can be found in studies dealing with exercise, weight loss, colorectal cancer screening, HVP immunization, and patient participation in clinical trials. Read more »
*This blog post was originally published at Mind The Gap*
December 18th, 2010 by EvanFalchukJD in Better Health Network, Health Policy, Opinion
Tags: Accountable Care Organizations, ACO, Best Doctors, Doctor Sued By A Patient, Doctor-Patient Encounter, Electronic Medical Records, Employee Health Surcharges, Employer-Provided Health Coverage, EMRs, Evan Falchuk, Google, Healthcare Benefits, Healthcare Benefits Programs, Healthcare IT, Healthcare Predictions, Healthcare Quality, Healthcare reform, Medical Advice Online, Medical Lawsuit, Microsoft, Misdiagnosis, Patient-Doctor Relationship, See First, Time Spent With Patients, Workers Compensation
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Here are 11 things that are absolutely going to happen* in 2011 (they’re in no particular order….or are they?):
1. There will be no big compromise between President Obama and the Republicans on healthcare reform. Why? Because the law is such a massive collection of, well, stuff, that it is pretty much impossible to find pieces of it that you could cut a deal on, even if you wanted to. And no, the federal district court decision on the individual mandate doesn’t change my mind…and in fact may breathe new life into other parts of the law). State governments, insurance companies, and private businesses have made all kinds of important and hard to reverse choices based on the law as is. There’s not much of an appetite outside of people trying to score political points for making big changes.
2. No major employer will drop their health benefits. No major employer is going to outsource their healthcare benefits to the government any time soon. Employers — particularly the big self-insured employers that pay for healthcare costs as a bottom-line expense — see their benefits as an integral part of their business and competitive strategies. As Congress looks at this issue more closely, they will learn this.
3. Time that doctors spend with patients will be less in 2011 than earlier years. It’s a long-term trend, and the factors that create this problem aren’t getting better. The latest government data show that the average doctor visit features face to face time with the patient of 15 minutes or less. With an aging population, increasing numbers of people getting health insurance, and no influx of new doctors, this problem will keep getting worse. Read more »
*This blog post was originally published at See First Blog*
December 18th, 2010 by Elaine Schattner, M.D. in Better Health Network, Opinion
Tags: Concierge Medicine, Dr. Elaine Schattner, Driving Up Healthcare Costs, Healthcare Dollars, Healthcare Room Service, Hospital Amenities, Medical Lessons, Patient Amenities, Patient Care, Patient Care Extras, Patient Experience, Quality of Care
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A perspective in [a recent] NEJM considers the Emerging Importance of Patient Amenities in Patient Care. The trend is that more hospitals lure patients with hotel-like amenities: Room service, magnificent views, massage therapy, family rooms and more. These services sound great, and by some measures can serve an institution’s bottom line more effectively than spending funds on top-notch specialists or state-of-the-art equipment.
Thinking back on the last time I visited someone at Sloan Kettering’s inpatient unit, and I meandered into the bright lounge on the 15th floor, stocked with books, games, videos and other signs of life, I thought how good it is for patients and their families to have a non-clinical area like this. The “extra” facility is privately-funded, although it does take up a relatively small bit of valuable New York City hospital space (what might otherwise be a research lab or a group of nice offices for physicians or, dare I say, social workers) seems wonderful.
If real healthcare isn’t an even-sum expense problem, I see no issue with this kind of hospital accoutrement. As for room service and ordering oatmeal for breakfast instead of institutional pancakes with a side of thawing orange “juice,” chicken salad sandwiches, fresh salads or broiled salmon instead of receiving glop on a tray, that’s potentially less wasteful and, depending on what you choose, healthier. As for yoga and meditation sessions, there’s rarely harm and, maybe occasionally, good (i.e. value).
But what if those resources draw funds away from necessary medicines, better software for safer CT scans and pharmacies, and hiring more doctors, nurses or aides? (I’ve never been in a hospital where the nurses weren’t short-staffed.) Read more »
*This blog post was originally published at Medical Lessons*
