December 23rd, 2010 by BenKavoussi in Opinion, Quackery Exposed
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In November 2010, the California Department of Consumer Affairs (DCA) finally decided to act responsibly and forbid the prevalent practice of Chinese bloodletting by licensed acupuncturists. The practice became a concern for the DCA when allegations of unsanitary bloodletting at a California (CA) acupuncture school surfaced.
The incident allegedly occurred during a “doctoral” course for licensed practitioners. The instructor was reportedly demonstrating advanced needling and bloodletting techniques. During the process, he took an arrow-like lancing instrument that is called a “three-edged needle” (三棱针), sharpened it with sandpaper, cleaned it with alcohol, and then asked a student-volunteer to roll a towel around his neck. The instructor then cleaned the student’s temporal region with alcohol, and punctured a superficial blood vessel with the arrow-like instrument. The student then held his head over the garbage can, gushing blood for awhile. Read more »
*This blog post was originally published at Science-Based Medicine*
December 18th, 2010 by EvanFalchukJD in Better Health Network, Health Policy, Opinion
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Here are 11 things that are absolutely going to happen* in 2011 (they’re in no particular order….or are they?):
1. There will be no big compromise between President Obama and the Republicans on healthcare reform. Why? Because the law is such a massive collection of, well, stuff, that it is pretty much impossible to find pieces of it that you could cut a deal on, even if you wanted to. And no, the federal district court decision on the individual mandate doesn’t change my mind…and in fact may breathe new life into other parts of the law). State governments, insurance companies, and private businesses have made all kinds of important and hard to reverse choices based on the law as is. There’s not much of an appetite outside of people trying to score political points for making big changes.
2. No major employer will drop their health benefits. No major employer is going to outsource their healthcare benefits to the government any time soon. Employers — particularly the big self-insured employers that pay for healthcare costs as a bottom-line expense — see their benefits as an integral part of their business and competitive strategies. As Congress looks at this issue more closely, they will learn this.
3. Time that doctors spend with patients will be less in 2011 than earlier years. It’s a long-term trend, and the factors that create this problem aren’t getting better. The latest government data show that the average doctor visit features face to face time with the patient of 15 minutes or less. With an aging population, increasing numbers of people getting health insurance, and no influx of new doctors, this problem will keep getting worse. Read more »
*This blog post was originally published at See First Blog*
October 23rd, 2010 by Lucy Hornstein, M.D. in Better Health Network, Health Policy, Humor, Opinion, True Stories
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Regular readers have heard me rant about the fragmentation of medical care in this country. Each body part not only has its own medical specialist, but in some cases its own allied health profession. Such is the case with the feet.
Doctors of podiatric medicine have to complete a four-year course of study after college, followed by a three-year podiatry residency. At the end of all that, I grant, they are expert in the care and management of complex disorders and conditions of the foot, ankle, and lower leg. I refer to them regularly, especially for stubborn ingrown toenails. (I did indeed learn how to remove offending portions of nail bed, but over the years I’ve gotten away from it.) They fail, though, when they try to extend their reach beyond their grasp, which is the case of the podiatrist above the knees. Read more »
*This blog post was originally published at Musings of a Dinosaur*
October 11th, 2010 by Dinah Miller, M.D. in Better Health Network, Health Policy, Opinion
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Look, he came back! Guest blogger Mitchell Newmark, M.D., put on his armor and came to blog with us again.
The Relative Unimportance of Diagnosis In Psychiatry
As we will soon be witness to the emergence of DSM-V, the new rule book for psychiatric diagnosis, I am reminded of all the pitfalls of diagnosis in psychiatry. In other fields of medicine, diagnosis is based primarily on etiology, with objective findings, rather than on symptoms alone, as it is in psychiatry. When you go to your internist with stomach pain, there’s an endoscopy to look for ulcers, a sonogram to look for gall stones, a blood test to look for hepatitis. But in psychiatry, there is no CT scan to check for bipolar disorder, no blood test to assess if the patient has schizophrenia, no spinal tap to check for major depression.
For the psychiatric community at large, diagnosis is important for many reasons. It helps doctors sort out patients so that clinical trials can be conducted on similar groups of patients. It enhances communication among psychiatrists when behavioral, affective and cognitive symptoms can be categorized. But for the individual patient, it is less useful. Some patients fit nicely into DSM categories, and others don’t. There are many patients who have unique combinations of symptoms across several diagnostic criteria. This leads to assigning multiple diagnoses, and confusing the treatment picture. Read more »
*This blog post was originally published at Shrink Rap*
June 10th, 2009 by EvanFalchukJD in Better Health Network, Health Policy
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The OSHA-ization of health care quality continues.
A research group and a consulting firm have been hired by the state of Massachusetts to head up a new initiative to publish cost and quality information on Massachusetts doctors. But the quality measures they will use are the same old ones we have seen for a long time. They mean very little to most patients, and even less to doctors as a measure of how good their work may be.
To understand what I mean, look at what is being measured.
For the category “Adult Diagnostic and Preventative Care,” there are only four quality measures. They are:
- rates of colorectal screening tests
- the number of patients in an insured population who lowered their blood pressure in a given year
- correct imaging test use for lower back pain
- rates of use of a spirometry test for COPD
The good news is Massachusetts doctors do better than the national average on these measures. The bad news is it’s hard to say what that means as far as how good any doctor is who is measured this way.
Maybe it’s better in women’s health. There, the four quality measures are:
- rates of breast cancer screening for women 40-69
- rates of cervical cancer screening for women 21-64
- rates of chlamydia screening for women 16-20
- rates of chlamydia screening for women 21-25
Hmm. So if I am a 30 year-old woman trying to figure out how good my doctor is, the only thing that is being measured is whether he does a cervical cancer screening on me or not. How about pediatrics?
- rates of well visits
- correct antibiotic use for upper respiratory infections
- follow-up with children starting medications for ADHD
I could go on, but there’s a pattern. All of these “quality” measures are crunching medical billing data and styling it as a quality metric. And so every metric is going to be focused on things that are easily measurable by a review of those bills.
But there’s a more disturbing pattern. The information is simply not valuable to consumers. Worse, I think it is deeply misleading. A medical group that does chlamydia screenings on 100% of its patients may be good or bad – or it just may be smart enough to know that if they do the state of Massachusetts will rate them with five gold stars. But consumers won’t be able to tell the difference. All they will know is that practice A is “high quality,” while practice B isn’t. Some doctors are starting to sound the alarm about this.
And this is the larger point. Our health care is organized in a way that systematically undervalues the thinking, processing and deciding aspects of medicine- the things that really matter to you when you’re a patient who is sick trying to get help. Our system treats medicine as an assembly-line process amenable to assembly-line metrics. But it’s not.
Doctors, like others in professions requiring judgment and reflection, need time to think, and ought to be judged by how well they do that. Since the leading cause of misdiagnosis is a failure of synthesis – a failure by the doctor to put together available information in a way that leads them to the right conclusion – our system ought to be built around helping make sure this happens each and every time.
So, instead of a web site where you could see how often a medical practice does chlamydia screenings, imagine you could find out how often doctors at a hospital got their patients the right diagnosis and treatment? Now that would be a useful way to measure quality.
*This blog post was originally published at See First Blog*
