The greatest minds are assembled to discern the answer in healthcare reform. Powerful interest groups are aligned to design solutions to protect their turf. Rubrics, formulas, slogans and taglines get designed, spun, pitched and thrown out. The burden of finding alignment, an answer, a plan that suits everyone seems insurmountable — unless we don’t.
The idea of a fit for all is an illusion. Justice and equity are seen differently. We imagine some public consensus at our own peril. But honesty has been in short supply. To paraphrase Oprah: What do we know for sure?
Some people want a relationship with a trusted doctor who knows them well. They want to pick the doctor, the neighborhood and the hospital they attend. Others want immediate access and have little trust or interest in a personal relationship with a doctor.
Some people want interchangeable access to medical care in the most convenient venue — they care little if it occurs at Walgreens, doc-in-a-box, by a nurse practitioner or by a newly-minted resident — it is about access that fits their lifestyle, which may be at a late hour and may be chosen by shortest waiting time at an ER. To others, this type of medical care is anathema. Read more »
*This blog post was originally published at Dr. Wes*
There was a series of ads on the radio awhile back that went something like this:
When Mrs. Willis had a stroke, her husband never slept alone. Her daughter never had to go dress shopping for the prom by herself. And her son didn’t have to sit out the Mother-Son dance at his wedding. Why? Because she came to Hospital A…and she didn’t die!
There’s another ad for one of the big downtown hospital’s cancer center (sorry, “advanced cancer center”):
Every cancer, every stage. Your life depends on it!
Let’s see: No one ever dies at Hospital A. And the big downtown cancer center can cure any cancer. That’s certainly what those ads would have you believe. Even the little local suburban hospitals have taken to advertising: Billboards around the neighborhoods, kiosks at the outlet malls, mainly pushing the lucrative stuff like cardiac care and bariatric surgery.
Every time I see this stuff, I can’t help but wonder how much it all must cost. And how much medical care could have been provided to the uninsured instead of enriching the ad execs and billboard owners who are already rolling in dough. Clearly there is still plenty of money to be made in the hospital business, because these people aren’t stupid. They wouldn’t spend this kind of money on marketing unless there was plenty more to be made from it. I believe it’s a little business concept known as “return on investment.” Read more »
One of the canards slung at the Affordable Care Act is that it creates “death panels” that would allow the government to deny patients lifesaving treatments, even though two independent and non-partisan fact-checking organizations found it would do no such thing.
I don’t bring this up now to rehash the debate, but because the New York Times had a recent story on Arizona’s decision to deny certain transplants to Medicaid enrollees — “death by budget cuts” in the words of reporter Marc Lacey. His story profiles several patients who died when they were unable to raise money on their own to fund a transplant. Lacey quotes a physician expert on transplants who flatly states: “There’s no doubt that people aren’t going to make it because of this decision.”
Arizona Medicaid officials told the Times that they “recommended discontinuing some transplants only after assessing the success rates for previous patients. Among the discontinued procedures are lung transplants, liver transplants for hepatitis C patients and some bone marrow and pancreas transplants, which altogether would save the state about $4.5 million a year.” Read more »
The puppeteer skit features the interaction between a young man with a rash and his older physician. The patient is an informed kind of guy: He’s checked his own medical record on the doctor’s website, read up on rashes in the Boston Globe, checked pix on WebMD, seen an episode of “Gray’s Anatomy” about a rash and, most inventively, checked iDiagnose, a hypothetical app (I hope) that led him to the conclusion that he might have epidermal necrosis.
“Not to worry,” the patient informs Dr. Matthews, who meanwhile has been trying to examine him (“Say aaahhh” and more): He’s eligible for an experimental protocol. After some back-and-forth in which the doctor — who’s been quite courteous until this point, calling the patient “Mr. Horcher,” for example, and not admonishing the patient who’s got so many ideas of his own — the doctor says that the patient may be exacerbating the condition by scratching it, and questions the wisdom of taking an experimental treatment for a rash. Read more »
*This blog post was originally published at Medical Lessons*
This is my column in December’s Emergency Medicine News:
I like to think back on favorite Christmas gifts I have received down the years. I don’t think I can do any better than the children of mine who were born around Christmas. Three of the four came within one month of Christmas day. One came on December 23rd. What wonderful presents!
Going farther back, I recall sitting by the Christmas tree at my childhood home, or the homes of my grandparents. I found toy soldiers, toy horses, Matchbox cars, pocket knives and many other little-boy wonders. I remember the beautiful wooden stock and golden trigger of my first shotgun, and how it pulled me irresistably into a sense of impending manhood to know that my father and mother trusted me enough to give such a gift.
I have been thrilled to give gifts to my wife and children down the years. I smile when I consider stuffed animals, American Girl dolls, Polly Pockets, toy knights, castles, iPods, bicycles, books, a small harp, and a shiny sword. I admit that I love putting their packages under the tree.
I enjoy hearing about the things my loved ones love. It is my delight to know their hearts and to go and find the perfect thing that, when opened, will make their eyes light up and give them delight.
But there are people other than my family, and there are many kinds of gifts. I can’t help but think that if I were giving the perfect gift to my patients, some would love to open a gold-embossed Oxycontin prescription with the “infinity” emblem under “number of refills.” And others would be speechless to dump out their stocking and find their disability paperwork completed. The tears of joy would flow! Read more »
*This blog post was originally published at edwinleap.com*
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