December 6th, 2010 by Michael Kirsch, M.D. in Better Health Network, Health Policy, Opinion
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In response to my recent post where I averred that the cigarette companies were treated as scapegoats, I have had several cyber and actual conversations about personal responsibility. I believe that folks should realize the consequences and the benefits of freely-made decisions.
While we want American society to be compassionate, we do not want to punish success and reward failure. Our goal is to do all that we can to maximize everyone’s success. We should be ready to assist those who need and deserve our private and governmental assistance, but personal effort and responsibility are necessary elements of these interventions.
In our gastrroenterology practice, when we see patients who are in financial difficulty, my physician partners and staff will do all that we can to help them. While it is not our policy to do colonoscopies for free, we will make whatever adjustments that are necessary to make sure that the patient receives necessary medical care. However, when patients who owe us money hang up on our calls, or express their view of medical entitlement with foul language, then we forward these accounts to a collection agency.
There is also a self-interest angle to supporting assistance for those in need: One day we may need a boost ourselves. Recall the concept of privatizing social security, a sound proposal that was vilified and snuffed out during George W. Bush’s presidency. Antagonism against this modest proposal was seasoned with a large measure of arrogance, a splash of hubris and a dash of paternalism. Read more »
*This blog post was originally published at MD Whistleblower*
November 30th, 2010 by Elaine Schattner, M.D. in Better Health Network, Health Policy, News, Opinion, Research
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Over the long weekend I caught up on some reading. One article* stands out. It’s on informed consent, and the stunning disconnect between physicians’ and patients’ understanding of a procedure’s value.
The study, published in the Sept 7th Annals of Internal Medicine, used survey methods to evaluate 153 cardiology patients’ understanding of the potential benefit of percutaneous coronary intervention (PCI or angioplasty). The investigators, at Baystate Medical Center in Massachusetts, compared patients’ responses to those of cardiologists who obtained consent and who performed the procedure. As outlined in the article’s introduction, PCI reduces heart attacks in patients with acute coronary syndrome — a more unstable situation than is chronic stable angina, in which case PCI relieves pain and improves quality of life but has no benefit in terms of recurrent myocardial infarction (MI) or survival.
The main result was that, after discussing the procedure with a cardiologist and signing the form, 88 percent of the patients, who almost all had chronic stable angina, believed that PCI would reduce their personal risk for having a heart attack. Only 17 percent of the cardiologists, who completed surveys about these particular patients and the potential benefit of PCI for patients facing similar scenarios, indicated that PCI would reduce the likelihood of MI.
This striking difference in patients’ and doctors’ perceptions is all the more significant because 96 percent of the patients “felt that they knew why they might undergo PCI, and more than half stated that they were actively involved in the decision-making.” Read more »
*This blog post was originally published at Medical Lessons*
November 15th, 2010 by GruntDoc in Better Health Network, Health Policy, Opinion
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From a recent post of the Retired Doc’s Thoughts blog entitled “What Are the Plans Of Don Berwick’s ‘Leaders With Plans?’“:
“I wonder which is worse: A medical leader recommending price controls out of ignorance of basic economics or being aware of the likely outcomes and mak[ing] that recommendation anyway?”
Wow. I’m speechless. Thanks to Retired Doc for getting this out in a cogent summary.
*This blog post was originally published at GruntDoc*
July 27th, 2010 by GarySchwitzer in Better Health Network, Health Policy, News, Opinion, Quackery Exposed, Research
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Kudos to Christopher Snowbeck and the St. Paul Pioneer Press for digging into new Medicare data to report that the state the newspaper serves is out of whack with the rest of the country in how many expensive MRI scans are done on Minnesotans’ bad backs.
Snowbeck artfully captures the predictable rationalization and defensive responses coming from locals who don’t like what the data suggest. Because what they suggest is overuse leading to overtreatment. So here’s one attempt a provider makes to deflect the data:
“The Medicare billing/claims data, which this report is generated from, would not capture conversations between a patient and provider that may have addressed alternative therapies for lower back pain,” said Robert Prevost, a spokesman for North Memorial Health Care. “It’s important to recognize the limitations of this data.”
No, data don’t capture conversations. But wouldn’t it be fascinating to be a fly on the wall during those many patient-physician encounters that led to an MRI to see what level of truly informed shared decision-making (if any) took place? Read more »
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
July 13th, 2010 by EvanFalchukJD in Better Health Network, Health Policy, News, Opinion, Research, True Stories
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If a website touted misleading healthcare information, you’d hope the government would do something about it. But what do you do when the government is the one feeding the public bad information?
Last week the Obama administration launched the new Healthcare.gov. It’s mostly an online insurance shopping website. It’s very much a federal government version of sites like eHealthInsurance.com or Massachsetts’ HealthConnector site, which have been around for years.
So when HHS Secretary Kathleen Sebelius, in announcing the new site, claims it gives consumers “unprecedented transparency” into the healthcare marketplace, you should wonder what she means. But that’s not the big problem with this site. Read more »
*This blog post was originally published at See First Blog*
