July 20th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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President Obama, where is your promise about transparency and accountability in Obamacare?
A major problem in the healthcare system is the lack of transparency and accountability. It has been unchecked for a very long time.
Both primary and secondary stakeholders act in their self-interest. These stakeholders have had ample opportunity to be non-transparent and non-accountable. All the stakeholders have abused the healthcare system.
I hit a nerve with my last blog “Patients And Physicians Must Control Costs”. Multiple readers responded with the usual comments:
“Patients are not smart enough to handle their own healthcare dollars.”
“Your basic idea makes sense, but in reality I doubt that a patient knows enough to make intelligent medical/financial decisions, because there are too many unknowns and variables.”
“Physicians over use the fee for service system in order to make more money.”
“If a physician tells a patient that there is only a 1/10,000 chance that an MRI will yield something useful, if the patient doesn’t have to pay for it, the patient wants the MRI.
Patients (consumers) must be taught and motivated to manage their own healthcare dollars. Patients’ choice Read more »
*This blog post was originally published at Repairing the Healthcare System*
June 28th, 2011 by Dr. Val Jones in Opinion
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I’ve often heard physicians say that “the history is 90% of the diagnosis.” In other words, they can usually determine the underlying cause of a patient’s problem just by listening to their account of how it evolved. The physical exam is merely to confirm the diagnosis, and is often cursory, limited, or ignored.
I believe that the physical exam is far more important than it seems – and I learned this during my recent oral medical specialty board examination. Although I have been sworn to secrecy regarding the content of the test questions, I will share an epiphany that I had during the exam.
The examiners’ job is to describe a patient and then ask the examinee what else she’d like to know and what she’d do next. With each description, I found myself struggling to visualize the patient – wishing I could see their face and hear their tone of their voice as they described their condition. I hadn’t realized that so much of my clinical judgement was based on laying eyes on a patient – I needed to see if they were in pain, if they were straining to breathe, if their skin was pasty or pale, if they were disconnected and potentially drug-seeking, if they were fidgety, if they were articulate, forgetful, or well-groomed. All of these subtle cues were gone. I was left staring at the examiner – who himself couldn’t describe the patient more fully because he was to stick to the script, reading verbatim from a prepared list of signs and symptoms. Read more »
June 2nd, 2011 by Toni Brayer, M.D. in Health Policy, Opinion
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It is my job at EverythingHealth to steer the reader to great information. For this reason I am providing you with a Link to The New England Journal of Medicine article titled “The $650 Billion Dollar question – why does cost effective care diffuse so slowly?” I have retitled it “Why Health Care Costs So Much”.
The United States spends much more on health care than other industrialized nations with no improvement in outcomes or health status of it’s citizens. If we enacted some of the policies that other nations use, we would have $650 Billion to spend on education, infrastructure, social security and other societal needs. Why can’t we get there?
Read here to understand the barriers. It isn’t simple. Resistance to change and instituting cost effective care has many stakeholders including legislators, doctors, hospitals, drug and equipment manufacturers, academic training centers, insurance companies and even the media. We, the public, are also to blame for not understanding that reform which lowers costs would benefit all of us. There is no free lunch. When the cost of care goes up for employers, that keeps our wages stagnant. When millions are uninsured, the cost of their care is born by everyone and it is inefficient care.
The article authors tell us: Read more »
*This blog post was originally published at EverythingHealth*
May 7th, 2011 by Happy Hospitalist in Opinion
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So I’m rounding in the ICU the other day when I came upon this new hospital medical device. It’s called a pupillometer. What does this pupillometer do? It measures subtle changes in the light reflex of the pupil to help take the physical exam to the next level of precision.
Or eliminate it, depending on how you look at it. What used to be a basic physical exam skill is now being replaced by a $6000 piece of medical technology that can distinguish tiny changes in pupil size. Now the real questions remain. Has this pupillometer device gone through the rigors of randomized trials in the ICU to define whether a $6000 flashlight changes outcomes or mortality? And if not, how do we allow medications to require such testing but not the technology that often changes nothing and simply makes health care more expensive.
The way I see things, if I’m trying to decide whether someone’s pupils constrict 1% vs 3% vs 10%, I’m getting a palliative care consult instead and putting the pupillometer back in my holster.
First the vein light. Now the pupillomter. And I thought the super bright LED pen light was all the rage.
*This blog post was originally published at The Happy Hospitalist*
May 1st, 2011 by Shadowfax in Health Policy, Opinion
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One interesting comment I have seen come up over and over is the idea that end-of-life costs are the thing that is spiralling out of control and that if we could somehow find a way to curb the costs of futile care, then that would somehow solve the health care inflation crisis. Andrew Sullivan endorsed such an idea the other day, a “Modest Proposal,” which is not nearly as radical or amusing as Swift’s. And indeed, there is a modicum of sense in the idea.
Estimates are that spending in the last six months of a person’s life account for 30-50% of their overall health care costs, and that the spending in the last year of a person’s life accounts for 25% of overall medicare spending. So — simple solution, right? cut down on the futile care, and we’re good to go.
Only problem — as a doctor, I sometimes have a hard time telling when someone is in their last DAY of life, let alone last year. Read more »
*This blog post was originally published at Movin' Meat*
