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Better Health Sponsors Blogger-Politician Healthcare Reform Discussion At National Press Club

July 9th, 2009 by Dr. Val Jones in Announcements, Health Policy, Humor
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To join the event live, please contact john.briley@getbetterhealth.com Seating is limited…

Congressman Paul Ryan

Media Personality Rea Blakey

Health Care Reform: Putting Patients First

Elected Officials Join America’s Top Medical Bloggers to Discuss the Real,

Clinical Impact of Health Care Reform

WHAT: As the health care debate heats up on the Hill, join Representative Paul Ryan as he sits down with top medical bloggers from across the country to discuss health care reform and its impact on practicing clinicians. This keynote discussion will be followed by two panels of physician and nurse bloggers who will highlight the importance of putting patients first.  Topics covered will include key barriers to health care quality, affordability, and access as well as the potential pitfalls of a new public plan and ways to fix the current system without investing billions in a new one.

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For more information on Better Health, visit https://www.getbetterhealth.com.

True Confessions Of Dr. Rob

June 11th, 2009 by DrRob in Better Health Network, True Stories
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Credit

I have to get some things off of my chest.  A guilty conscience is something that can cause lots of problems, both emotional and physical.  As David said in Psalm 32:

For when I kept silent, my bones wasted away
through my groaning all day long.
For day and night your hand was heavy upon me;
my strength was dried up as by the heat of summer.

Sounds like David lived in Georgia.

So here are my confessions:

I stole a bagel yesterday. I went to Pannera Bread Company yesterday and ordered a blueberry bagel (toasted and sliced).  I have a cup that allows me to get free coffee, so when the woman at the counter was slicing and toasting I went got myself some dark roast.  I chatted there with a woman about the fact that light roast actually has more caffeine than dark roast.  As I went to the counter I saw someone I recognized, said “hi,” grabbed my bag and headed out the door.  It was half-way to work when I realized I was now a criminal.

This morning I went back and tried to pay for yesterday’s bagel but she wouldn’t let me.  I think she wanted me to live with my shame.  I put the appropriate change into a can collecting money for a kids cancer camp.

I watch American Idol. Yes, I watched most every episode this year.  Those who think I am all counter-culture can express their shock and disgust.  I enjoy hearing them perform – they were especially talented this year – and we watch as a family.  You must remember that I started college as a voice major, so I do like to hear good singing.

I was kind of pulling for Adam (his last name is almost the same as mine), but I thought Chris and Danny were worthy as well.

Sorry to those who now think less of me.

Our office allows drug reps to visit and give samples.  We even have them give us lunch. I know there are some who think that this is the hight of immorality, but I have found them to be quite valuable.  We have done our best to keep a limit on their access to us – they are not allowed to detail us in the hallway, only when they bring us lunch.  Only 1 rep at a time and no more than 6/day (never more than one from one company).

We have a person on staff who is dedicated to getting patients medications when they can’t afford them.  She will work with the reps to find a program for them and will give samples when possible.

Why do we do lunch?  One main reason: for our staff.  I actually skip it often because I get fat if I eat too much at lunch.  Their finances are tight and so supplying them with lunch saves them money.  The docs will generally tell the flat truth to the reps (”I dont prescribe your drug very much”).  I do find that they have brought me good information at times.

Our practice has always been a lower utilizer of brand drugs when we have been measured (mainly United Healthcare), so I don’t think this has had an undue effect on us.  Still, the conscience nags when others feel that pharma is the spawn of satan.

I have checked my blog in a patient room. During the more acute compulsive blogging phases, I have checked traffic during a lul in the exam room.  I do actually feel guilty about this and have stopped doing it.  I have NEVER twittered in the exam room, however.

There.  I hope my bones don’t waste away now.

*This blog post was originally published at Musings of a Distractible Mind*

Symptoms Don’t Read Medical Textbooks

May 27th, 2009 by DrRob in Better Health Network
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“That doesn’t make any sense.”

The patient sits across the exam room and looks at me with a combination of surprise and hurt.  He had answered all of my questions to the best of his abilities, hoping that I would figure out what was causing the symptoms and fix his problem.  A bit of doubt shows on his brow as he goes over what he feels and what happened in the past.  Did he say things wrong?  Did he mistake the way it felt?  Is he just bad at explaining things?

“I am not accusing you of being untruthful.  Your symptoms are your symptoms, and you felt what you felt.  Unfortunately they don’t always read the medical textbooks and so make me earn my keep.  I believe your symptoms are real; I just don’t understand how they fit together.  It’s confusing.” I say this as reassuringly as possible.  He relaxes visibly as I speak.

But that doesn’t change the fact that the symptoms defy logic.  It’s my job to figure things out and fix things, right?  Isn’t this an admission of defeat?  Isn’t it a confession of my inadequacy?  Won’t this undermine the thing that I have said is the cornerstone of a doctor/patient relationship: trust?

Some people seem impatient for an answer, but most are OK with me not knowing for a while.  The thing that makes it acceptable for me to be confused is the longstanding nature of the relationship of a patient with their PCP.  This is one page in the book, not the whole story.  This concept – of the patient’s “story” – is one I actually use in this situation.  I say:

You know when you see a movie that is really confusing in the start?  You don’t know who is who, or why one person was mad at the other, etc.  It is just hard to figure out what is going on.  But later on in the movie things become clear.  You say “Oh, so that’s who that guy was!  That’s why she was so mad at him.”  It all clears up over time.  With your illness, we may just be at that confusion part of the movie.  It may just take time for us to be able to make sense of what is going on.

I have to say that I actually am glad for those cases where things are confusing at the start.  No, I am not happy for the patients, but the hard stuff is what separates the good docs from the bad ones.  If I can sort through things and come up with an answer when one wasn’t apparent, I am showing the merit of all of my hard work.  I justify my salary.  I go home feeling like I am more than just a bunch of algorythms.

I don’t want everyone to be confusing, but just because things seem to not add up it doesn’t mean we won’t come to a good answer eventually.

*This blog post was originally published at Musings of a Distractible Mind*

Celebrity Shampoo Scare: Why You Don’t Want To Get Your Health Information From Gwyneth Paltrow

April 27th, 2009 by DrRob in Better Health Network, Humor, Quackery Exposed
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Somehow the medical community has missed a very important news Item.  In her website goop.com (dang, I was going to go for that domain), movie star Gwyneth Paltrow weighed in on a very frightening medical subject.

Shampoo.

“A couple of years ago, I was asked to give a quote for a book concerning environmental toxins and their effects on our children.

“While I was reading up on the subject, I was seized with fear about what the research said. Foetuses, infants and toddlers are basically unable to metabolise toxins the way that adults are and we are constantly filling our environments with chemicals that may or may not be safe.

“The research is troubling; the incidence of diseases in children such as asthma, cancer and autism have shot up exponentially and many children we all know and love have been diagnosed with developmental issues like ADHD [Attention Deficit Hyperactivity Disorder].”

Apparently, she went on to point the finger at shampoo as a potential major problem in our society and raised a possible link between shampoo and childhood cancers.  Now, I am not sure how one can use shampoo on the head of a foetus (or a fetus, for that matter), but we have to tip our hat to celebrities for bringing such associations to the forefront.

So I did a bit of science myself to assess the voracity of her claims.  I too was seized with fear when I noted the following:

• All of the kids in my practice who have ADHD have used shampoo.
• All of the kids with cancer have also used shampoo.
• I used shampoo as a kid (but not as a fetus), and I have ADHD.
• The projection is that 100% of the people now using shampoo will die.

Whoa.

This really backs up my misgivings about shampoo.  I have always wondered at the claims these so-called hair-care products make so boldly.  Here are some examples of lies spread by the shampoo industry:

Clarifying shampoo – What are they claiming with this?  Is there such thing as unclear hair?  Do some people look as though they have a giant blob of hair-like substance on their head instead of many separate hairs?  Does  clarifying shampoo make each individual hair once again visible on these people?

pH Balanced – What is pH imbalance?  Is it when the pH sometimes is so acidic that it burns your hair off?  That would be terrifying if true.

Volumizing shampoo – I was not aware volumizing was a word (nor was my spell-check).  This means that the shampoo volumes things.  How can you volume something?  Does each hair get a separate volume, or does the hair suddenly get very loud.  Personally, I am afraid to open the bottles of these shampoos for fear of going deaf.

Shampoo for stressed hair – I have never thought about the emotional state of my hair.  I was not aware that it worries about things.  Perhaps it worries about being volumized or burned by non-pH balanced shampoos.  Perhaps it worries about being put on a foetus.  Does this type of shampoo contain a hair version of valium?

Vitalizing shampoo – At least vitalizing is actually a word, but would you really want vitalized hair?  My dictionary defines this as “giving life and energy to.”  Hair is dead, as we all know.  Does this “hair resurrection” cause your hair to scream every time it is brushed or cut?  Does it move about on your head independently?  What if it decides it wants to become a mullet?? Thank you, but I prefer my hair dead.

Self-adjusting shampoo – Instead of the hair having independent action, this type of shampoo seems to have an intelligence of its own.  How would it self-adjust?  Does it have a computer chip embedded in it or does it somehow have sentience?  How do we know if it will adjust in a way we want?  It could adjust to pH imbalance or de-volumization, couldn’t it?  What if this self-adjusting shampoo, which clearly has some degree of autonomy, gets ideas and causes other shampoos to break the shackles we humans put on it and forms a shampoo revolution?  An even scarier thought is if a self-adjusting shampoo comes in contact with vitalized hair!  What will happen then?  Will they fight, or will they conspire against the shampooee?

Baby shampoo – What is the life-cycle of a shampoo?  How do they find these baby shampoos and why would they steal them from their parents?  This is probably what is causing the shampoos to become self-adjusting.  I will say, shampoos do seem to multiply in our bathroom.  We probably have 16 bottles of different kinds of shampoo in our shower right now.  I just recently noticed some baby shampoo, but I thought my wife had just bought it.  I see now that we should not let the bottles touch each other if we want to have room in our shower to bathe.

So you see, while Miss Paltrow’s fears about shampoo are clearly far short of the whole story, at least they bring attention to this frightening situation.  Shampoo manufacturers are clearly in cahoots and have eyes on world domination.  The condemnation of this celebrity’s claims by “scientists” are clearly a smoke-screen to keep us from noticing the obvious plans for the destruction of humanity.

No more shampoo for me!

Gotta go now.  It’s time for my colon cleanse.

How To Fix Healthcare

April 23rd, 2009 by DrRob in Better Health Network
1 Comment »

Thanks to Andrew Sullivan who cited my post on the uninsured, I’ve gotten a lot of new comments on that subject.  While my post was just a gripe about the problem, the comments were mainly focused on solutions.  How do you fix the problem?  I even got an e-mail specifically asking me what I would do to deal with the problem of the uninsured.

You have to realize that I’m basically chicken (as are most doctors).  I like to point the finger and avoid the fingers of others.  It’s much easier to gripe than to fix things.  It’s much easier to criticize than it is to say things that can be criticized.  But I will break from the safe position of critic and give some thoughts on what I think needs doing on the problem of the uninsured/underinsured.  Those who doubt the reality of this problem have only to spend a few days in primary care physician’s office to realize that it a huge problem that is getting worse.

So here are my suggestions:

1.  The government has to take on tasks that are in the best interest of the public.

Preventive healthcare should be paid for.  This could be done via public health clinics, but having having some sort of preventive health insurance for the uninsured would not have much overall cost (compared to the whole of healthcare) and would potentially save money.

There certainly is debate as to what prevention is really worth it (the PSA test debate is a good example), but some prevention is clearly beneficial (immunizations, Pap Smears).  Simply building a relationship between people and primary care physicians also has benefits by itself.

The overall goal is to improve the overall health of the American public.  Promote behavior that deals with problems when they are still small or before they happen at all.  Just visiting a PCP isn’t the solution by itself, but it is probably a necessary component to achieve a healthier public.

2.  Promote proper utilization

One of the main costs to any system, public or private, is overutilization of services.  Any solution that does not somehow look at utilization will automatically fail.  More care costs more.

Here are areas of increased utilization:

• Emergency room visits for non-emergencies.
• Visits to specialty physicians for primary care problems.
• Unnecessary tests ordered – more likely in a setting where the patient is not known.
• Patient perception that “more care is better.”
• Nonexistent communication – ER doesn’t know what PCP is doing, PCP doesn’t know what happened at specialist or in the hospital.  This causes duplication of tests.

Solutions to these problems include:

• Better access to primary care or other less costly care centers
• Increase the ratio of primary care to specialists
• Care management for high utilizing patients
• Public education (not through the press but through better public health).
• Promoting connections between information systems – better IT adoption would help, but that IT must communicate.
• Make the malpractice environment less frightening to doctors.  A large amount of questionable care is given to protect physicians from lawsuits.  (A good example is PSA Testing.  Even though recent studies question the benefit, many doctors fear that not ordering them will expose them to risk should the patient develop prostate cancer).

How does this help the problem of the uninsured?  It reduces the overall cost of non-catastrophic care, which makes either public or private insurance focused on this more feesable.

3.  Fix problems with Pharma

Medication costs are a huge problem to my uninsured and insured populations.  There are many reasons for this, but some of them are simply due to a bad system.  For example:

• Medication discount programs cannot include Medicare patients.  Why should I be able to give a discount card to my patients with private insurance, even my uninsured, but not Medicare patients?
• High cost of generic drugs.  When a drug goes generic, there is usually only a slight drip in the price.  The system allows only limited competition for price, so the cash price remains high.  Encourage cost competition.
• Drug Rebates.  This raises the overall cost of drugs to everyone.  Rebates are sent to insurance companies by drug companies for inclusion on the formulary.  It pretty much looks like extortion.  The cost of these rebates is not absorbed by Pharma, it is passed on to those who aren’t covered by insurance companies getting the rebate.  These need to be eliminated.
• Get rid of direct to consumer marketing of drugs.  This is pure capitalism that encourages over-utilization.

All of these programs would allow reduced overall cost of medications, which would make either drug coverage more possible or make the cash price of drugs more affordable.

4.  Address Conflicts of Interest

Insurance companies are largely publicly-traded companies.  This means that their main business goal is to maximize profits by either cutting their costs or increasing revenue.  Having them the ones managing care is like putting the kid in charge of the cookie jar.  Insurance companies should get back to the business of insuring.  Care management is certainly important to control overutilization, but that should not be done by those who could profit from it (insurance companies, hospitals, physicians).

Insurance companies promote themselves as healthcare companies.  They don’t provide care, and they shouldn’t.  Perhaps there needs to be a third-party that does care management – I am not certain – but it is clear that good care management would greatly reduce overall utilization and profiteering.

How does this help the uninsured?  It reduces the footprint of the insurance industry on healthcare as a whole, which should bring down the cost if insurance.  It should let insurance companies compete solely on cost, not on provider pannels or other services they shouldn’t be giving in the first place.  If insurance costs less, there are less uninsured.

5.  Focus on the “uninsurable”

5% of Americans account for over 50% of the overall cost of care (reference).  These are the uninsurable people – those who are truley expensive to treat.  There needs to be very close management of these people.  Leaving them uninsured doesn’t reduce cost, it just shifts it to hospitals and local government.  It also leaves them unmanaged.  Of the waste in healthcare, the likelihood is that a very large percent of it is in the high-utilizers (by definition).  These people need management, either in a “medical home” or by some sort of care management.

There you have it.  Follow these rules and everything will be fine.

Yeah, right.  Alright everyone, have at it!  Tell me what you think, but don’t be a chicken: criticism should be accompanied by an alternative solution.

*This blog post was originally published at Musings of a Distractible Mind.*