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

Latest Posts

Hospital administrator salaries: draining the healthcare system?

Well, this conversation from the blogosphere gets my blood boiling, I can tell you! In a recent blog post about the ugly under belly of hospitals, I discussed how administrator salaries decrease hospital resources. Dr. Stanley Feld’s excellent blog post digs even deeper:

Paul Levy CEO of Beth Israel Hospital writes a blog called “Running a Hospital”. He has tried to justify his salary after the Boston Globe published his salary of over 1 million dollars per year…

Remember hospitals such as Beth Israel Hospital in Boston are tax exempt community hospitals because they have this community obligation. These tax subsides and others tax subsides are opaque to the public. However, the public pays for these subsides. They contribute to the hospitals bottom line and Mr. Levy’s bonus.

Linda Halderman M.D. wrote an essay entitled “How Much is Your Doctor Worth?”. It is also worth reading. The subtitle should be, “How Much is Your Doctor paid?” The answer after the long essay is $59.50 for a complicated office visit. [If Levy were a clinician,] he would only have to see 168,067 patients in one year or 744 patients a day to generate a gross revenue of $1,000,000 before expenses.

What is more valuable to the healthcare system? A CEO’s salary based on revenue generated incentives and fund raising or good quality medical care?This post originally appeared on Dr. Val’s blog at

Sex selection: just because we can doesn’t mean we should

As I read the opinion piece in the New York Times about fertility clinics that permit parents to choose the sex of their baby before pregnancy, I was suddenly aware that I had strong feelings about this. As I tried to analyze my indignation, I realized that my emotions came from a place beyond mere reason.

Although technically, this issue could be reduced to a matter of sperm sorting – we all know it’s much more than that. Choosing the sex of your unborn child wanders into an unexplainably uncomfortable territory – swirling unconscious feelings about the value of human life, sexual equality, and the pain of sexism that many have experienced. We have heard the horrible stories about female babies being selectively aborted, or left to die in the elements in India and China, and we wonder if choosing the sex of a baby is somehow part of the same phenomenon.

Why should it matter which sex the baby is? Why is “family balance” cited as a reason to sex select? Perhaps the balance comes from the makeup of the individual personalities in a family, or maybe from parents who plan for the right number of children, not the gender of them.

Personally, I cannot support the practice of sex selection for anything other than sex-linked genetic disease prevention (and even this makes me feel a little uncomfortable, frankly).

I’m curious to know if men and women are equally disturbed by the practice of sex selection… What do you think?

This post originally appeared on Dr. Val’s blog at

Should US physicians learn Spanish?

Last night I was having dinner at Charlie Palmer Steak and entered into a conversation (in Spanish) with one of the wait staff. He was surprised when I ordered in Spanish and we had a friendly conversation about the merits of whole grain bread. He asked me why I spoke Spanish. I answered simply, “porque soy doctora” – because I’m a doctor.

Dr. Richard Reece’s recent blog post tackles the issue of language barriers in the healthcare system. He gives some good advice for cross-cultural communications, reminds us that 25% of US physicians are foreign born, and quotes the inscription on the statue of liberty as the reason why Americans should remember to welcome foreigners. However, he also encourages immigrants to learn English and frowns upon illegal immigration.

As for me, I learned Spanish because I was worried that I’d harm a patient by misunderstanding what they were trying to communicate. Of course we try to have an interpreter at the bedside at all times, but in reality it just doesn’t happen consistently. Learning Spanish was my way of practicing safer medicine.

Now it is frustrating that some patients (at least in NYC) seem to feel as if their doctor is obliged to learn Spanish. They sometimes have an attitude of entitlement that I find hard to swallow. I try to put myself in their shoes, but honestly if I were ill in a foreign country I wouldn’t assume that it was my right to receive care in English.

Still, for me, learning Spanish was a wonderful thing. There is a certain caring that I can communicate, and a certain warmth and appreciation that I feel from my patients as they encourage me – that even though I make mistakes with my grammar, they can still understand my meaning quite well. We laugh a lot at the words I find to describe things – and it generally provides a lighter tone to the interaction. Laughter is good medicine, and if my version of Spanish brings laughter to others – then so much the better!

Do you think US healthcare professionals should make an effort to learn Spanish?

This post originally appeared on Dr. Val’s blog at

Nurses escape death penalty

Makes being a nurse in the US seem like a cake walk, right?

“The son of Libyan leader Moammar Gadaffi said five Bulgarian nurses and a Palestinian doctor condemned to death by a Libyan court had received unjust verdicts and that they would not be executed, a Bulgarian newspaper reported on Monday.

A Libyan court last month convicted the five Bulgarian nurses and a Palestinian doctor of intentionally infecting more than 400 Libyan children with HIV, despite scientific evidence that the youngsters had the virus before the medical workers arrived in Libya. It sentenced all the medical personnel to death.

‘The original files were manipulated and there were many mistakes, but it was the fault of the police officers and investigators who handled the case at the initial stage.’”

As I was thinking about how these relief workers were “ambushed” I imagined that the parents of the HIV positive children were looking for a scapegoat – there is a lot of stigma associated with HIV, and in a country where mere finger pointing can result in the death penalty… taking care of those infected with the virus can be more deadly than the virus itself.

The article also hinted that if it weren’t for the Bulgarian embassy publicizing the unjust executions, they would have occurred without a second thought.

Let’s hear it for the healthcare workers out there who put their lives in harms way to treat the innocent and helpless.  Do you know of other examples?

This post originally appeared on Dr. Val’s blog at

Mice take one for the human team… again

Gone are the days of Beaver Cleaver – and apparently the days of Mickey & Minnie mouse are numbered as well.

In this new study, humans give LSD to the little rodents:

“Of course, we don’t know what the mice experience when they are treated with these drugs,” Sealfon said. “But we do know that there is a head twitch response in the mice that provides a good correlation with drugs that are known to be hallucinogenic in humans.”

So um… why are we doing this?

The Onion spoofed animal research very nicely, picturing an obesity study lab rat nestled among snickers bars and M&Ms.

And in another recent study, we gave mad cow disease to our furry friends:

“As expected… at 9 weeks of age they developed sponginess in the brain tissue, all the mice developed behavior and memory problems, for example they stopped burrowing.”

Hey, I have an idea for a new study – let’s see what mice infected with mad cow disease do if we also give them LSD?

I feel a bit sad for the tiny critters, don’t you?This post originally appeared on Dr. Val’s blog at

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 »