December 15th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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I hope you enjoy this week’s round up of quotable quotes from the medical blogosphere…
Scalpel or Sword quotes Taiwanese hospital administrator who chose “Hello Kitty” as a new design theme for their maternity ward: “I wish that everyone who comes here, mothers who suffer while giving birth and children who suffer from an illness, can get medical care while seeing these kitties and bring a smile to their faces, helping forget about discomfort and recover faster.”
Charlie Baker on hospital financing: Calculating hospital operating margins actually draws a starker picture. Hospitals collectively lose $30 billion on Medicare and Medicaid and earn $66 billion on commercial business, thereby generating a $36 billion gain overall on their insured patients. They lose another $13 billion on their uninsured patients, netting out to a $24 billion – or 3.6% – operating margin.
This means private sector employers and their employees and families are paying as much as 10-11% more than they would otherwise pay for health insurance – to fund the provider operating deficit created by Medicare and Medicaid.
Paul Levy: There are two types of hospitals, the kind that have had a wrong-side surgery and the kind that will have one.
Edwin Leap: Over the past few years, I’ve observed some curious phenomena. For instance, the raging debate over pharmaceutical companies. Sure, bad data is bad data. And of course, we shouldn’t have our prescribing practices ‘purchased’ by gifts, trips or cute reps.
But, what I find fascinating is the collective anger against those companies for trying to ‘profit.’ Ghastly! Companies, publicly traded ones, in America,trying to make a profit? What are they thinking? I mean, considering doctors and nurses work for free, with no thought to financial benefit…right?
Let’s face it, like it or not, those huge companies make life better. They create and market substances that keep us healthier; and of course, in some instances they offer very vanity driven products that keep us having sex longer or getting fewer wrinkles. But on the balance, we wouldn’t want them to go away, any more than we really want oil companies to disappear.
Respectful Insolence: given the utter lack of scientific support for the vast majority of CAM modalities and the weak support for the remainder, what’s left if you’re a CAM advocate trying to prosletyize about how great CAM is?
Argumentum ad populum, of course. Otherwise known as the bandwagon fallacy or appeal to popularity, it is one of the most favorite logical fallacies of all.
Terra Sigilata: Readers often ask me and other sci/med bloggers why revered academic medical centers are increasingly offering these questionable approaches. The truth is that there is a market for them. A good market. And one that will gladly pay out-of-pocket for such things.
Never mind if the approaches are effective. Or safe. Or can delay treatment with science-based approaches known to be effective.
Smoking, abusing alcohol, using CAM: Just because a lot of kids do it, does that mean it is right for yours to do so as well?
DB’s Medical Rants: Because prices are increasing, Medicare has tried classic bureaucratic techniques to minimize expenses. Our billing system requires extensive documentation. If we do not document well, then we are not paid appropriately.
In an effort to pay physicians more appropriately, Medicare adopted RBRVS. But then they made a huge mistake. They let the AMA develop the RUC – The primary care reimbursement mess. The members of that secret society include very few primary care physicians and many proceduralists.
Movin’ Meat: Wondering why it is that my placing a stethoscope on a patient’s chest is universally interpreted as a signal for the patient (or a family member) to begin talking.
PixelRN: The other day I was talking to a veteran CCU nurse. She told me that she worked at the hospital where the first defibrillations were studied and performed. Like many health care studies, the testing was done on animals – dogs in this case.
She then went on to tell me that one of the requirements for working in her CCU (back in the 1970’s) was that you actually had to defibrillate a dog to show that you were competent in that skill! Yes, the dogs were sedated before hand, but still.
Nurses see (and do) the craziest things.
December 12th, 2008 by Dr. Val Jones in Celebrity Interviews
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Dr. Richard Carmona
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I’ve interviewed Dr. Richard Carmona (the 17th Surgeon General of the United States, and former EMT, nurse, and surgeon) several times on this blog and have been intrigued by his insights and approaches to health. In our most recent interview, he discussed obesity from a provocative new angle: national security.
Dr. Val: What do you mean that obesity is a national security issue?
Dr. Carmona: There are many competing interests on Capitol Hill – the war, the economy, etc. and obesity is something that just doesn’t get enough traction. When I was serving as Surgeon General, I realized that obesity was acting as an accelerator of chronic disease and was the number one health threat to our country. But after several failed attempts to get attention focused on this issue, I realized that I had to present the message in a unique way in order to get it to resonate. It occurred to me that if I used different language to describe the threat, people would allow me to connect the dots and explain the problem fully.
Retaining EMS, police, firemen, soldiers, sailors, and airmen has been challenging because many of them can’t pass their physical fitness tests due to obesity and sedentary lifestyles. Health is therefore inextricably tied to national security. Describing the health threat in these terms helped legislators to understand the complex ramifications of the condition.
Dr. Val: How rigorous are these fitness tests? Are we talking about soldiers not being able to run a 5-minute mile, or is it less challenging than that?
Dr. Carmona: The fitness tests are based on research from the Cooper Clinic in Texas and include a measure of aerobic capacity, strength, and flexibility. There are standardized minimums based on gender and decade of age, and although I don’t have the exact minimums memorized for each age group, they’re very reasonable. We’re not talking about having to run a 5 minute mile. More like having to run a mile and a half in 15 minutes or having the flexibility to touch your toes in a seated position. As far as push-ups are concerned, the qualifying range is about 20-45.
Dr. Val: One of my blogger friends relayed a story recently about a surgeon who asked his hospital cafeteria to serve healthy options instead of fried food. They responded that no one would buy the healthy food and they’d go out of business – so economic necessity required that they continue to serve unhealthy food. What would you say to that surgeon?
Dr. Carmona: I’d invite that surgeon to come out to Canyon Ranch where we serve healthy gourmet meals every single day. Our chefs are very innovative and entrepreneurial – they make healthy food taste delicious, and at a cost-effective price. Americans need to learn how to make healthy food delicious. My friend Toby Cosgrove is a surgeon at the Cleveland Clinic, and he was able to spearhead a healthy food initiative there that has been very successful. We strive to find new and creative ways to prepare healthy food at Canyon Ranch – and are always coming out with new recipes and cookbooks to keep people interested in healthy eating.
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I caught up with Dr. Carmona at the STOP Obesity Alliance briefing about the new GPS (Guide for Policy and Program Solutions) initiative. Please click here to learn more about the STOP Obesity Alliance.
December 11th, 2008 by Dr. Val Jones in Opinion
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Some thoughts to chew on from Grace-Marie Turner:
But expanding SCHIP to cover all children would be a mistake, for four reasons:
1. First, Congress should make sure poorer, uninsured children are covered first. At least two-thirds of uninsured children already are eligible for SCHIP or Medicaid but aren’t enrolled. If SCHIP were expanded to cover children in higher-income families, their parents would rush to the head of the line to get the taxpayer-subsidized coverage. When a “free” government plan is offered, it’s nearly impossible to resist. Poorer children would be left behind as states focus on enrolling higher-income kids.
2. Second, expanding the program would “crowd out” the private insurance many higher-income kids already have. Hawaii offers proof. Earlier this year, the state created a new taxpayer-financed program to fill the gap between private and public insurance in an effort to provide universal coverage for children. But state officials found families were dropping private coverage to enroll their children in the government plan. When Gov. Linda Lingle saw the data, she pulled the plug on funding. With Hawaii facing budget shortfalls, she said it was unwise to spend public money to replace private coverage children already had.
3. Third, putting many millions of children on a government program will quickly lead to restrictions on access to care. A young boy died in Baltimore not long ago from an untreated tooth infection, even though he was enrolled in SCHIP. Few dentists can afford to take SCHIP patients because the program’s reimbursement rates are so low. The boy’s mother couldn’t find a dentist to see him. In Massachusetts’ move toward universal health coverage, more people have insurance, but they are finding that physicians’ practices are often filled, with waiting lists for a new patient appointment at 100 days and counting. Putting more children on SCHIP will add to the program’s financial pressures, making it harder for poorer kids to get care.
4. Finally, government insurance means that politicians and bureaucrats, not parents, make decisions about the care children receive and about what services will or will not be covered.
December 11th, 2008 by Dr. Val Jones in Humor
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This post originally appeared on my blog last Christmas season – for those of you who missed it, the amusing story is reprinted below:
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My sister Vicki lives in Grand Rapids, Michigan with her husband, three children and an alarmingly large and slobbery Saint Bernard named Gilbert. Several Christmases ago she decided to teach her then 5 year old son, Harrison, about Christmas tree decorating. She took him to a Christmas tree farm and helped him select a tree. They hauled it back to the house and my sister managed, with no help whatsoever from Gilbert, to set it up in a nice corner of the living room. The tip of the tree reached the ceiling and its full figured branches spread from icy window to window.
Vicki and Harrison spent hours and hours winding lights, tinsel, ornaments, paper angels and popcorn strings around the tree. Little Harrison couldn’t wait to see the final product, with glittering lights and a magical star to top off their fine work. They decorated into the early evening, and the living room grew dark as the sun set over the snow covered neighborhood. At last it was time to plug in the tree lights.
As Vicki plugged in the lights for the first time, Gilbert roused himself from his resting place in front of the fireplace and shook off his drowsiness. Harrison held his breath in eager anticipation of the twinkling display that he had helped to create. My sister turned off all the overhead lights.
As the plug entered the outlet, the tree lit up with thousands of tiny glittering lights. Harrison
marveled at his glorious creation. “Mom, it’s the most beautiful tree in the world!”
My sister sat down on the couch and hugged her son tightly in her lap as they relaxed and enjoyed the view. Suddenly, Harrison’s eyes fixated on one of the branches.
“Mom… look! There’s an icicle on the tree!!”
My sister squinted and followed the direction of Harrison’s pointing finger.
Sure enough, there was a glassy, 5 inch long, icicle-appearing object perched in a tree branch in the middle of the tree.
Harrison’s raised his voice with glee: “Mom! It’s a Christmas MIRACLE!!”
The little boy broke free of his mom’s grasp and ran up to the tree to inspect the icicle at close range. As he reached out his hand to clasp it, his look of amazement turned to horror. The icicle was in fact a long
string of dog drool that had flicked off of Gilbert when he shook himself out of his sleep.
“Ewww!!!” Harrison screamed.
My sister slowly realized what had happened and started laughing uncontrollably. Gilbert wanted to get in on the fun and began barking and running in circles. He became tangled up in the extension cord and pulled the tree right out of the tree stand. At that moment, Vicki’s husband returned from shopping with the other 2 children. As he turned on the lights he found my sister trapped under an unraveling Christmas tree, a hysterical child frantically wiping his hands on paper towel, and a barking, drooling Gilbert in the midst.
“What happened here?!” he shouted, attempting to rescue Vicki from underneath the tree.
“It’s a Christmas miracle” was her muffled cry.
And this story will be in our family for a long time to come.
