October 10th, 2009 by Happy Hospitalist in Better Health Network, Opinion
Tags: Anti-freeze, Comfortable, Competency, Death, Ethics, Euthanasia, Internal Medicine, Mental Health, Palliative Care, Psychiatry, Psychology, Suicide
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Here’s an interesting case. A young woman drinks antifreeze to commit suicide, writes a note saying she does not want any medical treatment and calls an ambulance so she can die peacefully with the help of medical support.
I read a lot on Happy Hospitalist about a patient’s right to demand what ever care they feel is necessary to keep them alive and the duty of the physician to provide whatever care the patient feels they require, no matter how costly or how miniscule the benefit. Readers like to say it’s not a physician’s obligation to make quality of life decisions for the patient.
So let’s analyze this situation. Does a patient have the right to demand medical care and the services of physicians to let them die without pain? Does a patient have the right to demand a physician order morphine and ativan to keep a depressed but physically intact patient comfortable as they slip away in a horrible antifreeze death under the care of medical personel? Read more »
*This blog post was originally published at A Happy Hospitalist*
October 8th, 2009 by KevinMD in Better Health Network, Health Policy, Opinion
Tags: Charity Care, Costs, Emergency Medicine, Finance, Healthcare Insurance, Healthcare reform, Insurance Claims, Managed Care
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I have been in senior executive management in both managed care and a major hospital system. I find the hysteria over “reform” bitterly amusing because it is so misdirected.
The real problem with health care in America? Greed, indifference and incompetence, pure and simple. But not in the places everyone is pointing.
Insurer side
Insurance companies have to maximize their revenue because they answer to their boards. They are in no rush to fix claims systems that make copious errors and delay payments to providers. There are hundreds of claims processing software programs out there. Some are acceptable, some are useless. None are really good or efficient. And there is the human error factor. A careless mistake by an apathetic claims processor can create payment problems that could literally last for years. Read more »
*This blog post was originally published at KevinMD.com*
October 7th, 2009 by Nancy Brown, Ph.D. in Better Health Network, News, Opinion
Tags: Child Psychology, Conditional Love, Love, Parenting, Pediatrics, Psychiatry, Psychology, Unconditional Love
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Conditional love is finally getting the press it deserves – and it is all bad! Sorry Dr. Phil and Supernanny, many of us do not believe that what children need or want (specifically approval or love) should be offered contingently or doled out as rewards or withheld until they behave according to our wishes. Praising children for doing something right or punishing if they do something wrong – are both conditional and counterproductive.
Research completed in 2004 (Assor & Roth) with adults and recently replicated with ninth graders (Deci) suggests that children who received conditional approval were in fact more likely to do what a parent wanted, but as adults, the children tend to not like their parents much, feel internal pressure to do things versus a sense of choice or control, and they often felt guilty or ashamed of their behavior. In addition, children who reported feeling more loved when they lived up to their parents’ expectations feel less worthy as adults. Read more »
This post, The Long-Term Consequences Of Conditional Love, was originally published on
Healthine.com by Nancy Brown, Ph.D..
October 7th, 2009 by DrRob in Better Health Network, Health Policy, Opinion
Tags: Bipartisan, CMS, Drug Discounts, Geriatrics, Health Insurance, Healthcare reform, Medicare, Obama, Patient Assistance Programs, Pharmaceuticals
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Dear Mr. Obama and all of you congress folks:
I know you have been arguing about how to fix our system (and it really does need fixing). I know there is not much you can all agree on. I know it wasn’t all that much fun to face those yelling people at the town hall meetings. The press hasn’t been nice, and the polls aren’t good either. You guys are having a rough go of it.
So I am going to do you a big favor.
What you need right now are some quick wins – some things you can do that will make people happy quickly, and things that can be done without much cost. This is low-hanging fruit that can be picked without a high ladder; it is fruit that will sweeten things and make swallowing the more bitter pills a little easier. Here is what you need to do first:
1. Allow Medicare Patients to Use Drug Discounts
Read more »
*This blog post was originally published at Musings of a Distractible Mind*
October 7th, 2009 by Happy Hospitalist in Better Health Network, Health Policy, Opinion
Tags: Costs, Defensive Medicine, Internal Medicine, Legal, Medical Malpractice, Missed Diagnosis, Possible, Primary Care, Probable, Wrong Diagnosis
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Some put the figure for defensive medicine at 10% of medical expenses a year. That’s $250 billion dollars. Others claim it to be 2-3% per year or about $60 billion dollars a year.
Now ask any physician what it is. I’d say it’s closer to 30% a year. That’s $750 billion dollars a year. Why? Because I know what is going through the minds of physicians when they put the pen to the paper. In America, we strive to exclude the long tail diagnosis. Why? Because getting sued for 67 million dollars because you treated a torn aorta when all the evidence pointed to an emergent MI has a way of making doctors evaluate the possible, instead of focusing on the probable.
Defensive medicine is not about losing a lawsuit. It’s about getting sued and the lack of boundaries that protect a physician from having bad outcomes with competent medicine, even if that competent medicine was the wrong medicine for the wrong patient at the wrong time, a fact known only after the fact when a bad outcome occurs. Read more »
*This blog post was originally published at A Happy Hospitalist*
