July 31st, 2007 by Dr. Val Jones in Health Policy, News
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Two sad cases were reported lately – one by Medgadget in which a young child with Treacher Collins syndrome was denied a special bone-implanted hearing aid. Children with this genetic syndrome usually have normal intelligence, though their appearance reflects underdeveloped facial bones. Apparently her insurance company would pay for the procedure to install the hearing aid, but the $15K device was not covered in her parents’ insurance policy. Her parents could not afford the device, and the child has little hope of developing the ability to speak normally without the aid.
The second case was of Britain’s most elderly woman – a 108 year old who was told that she’d need to wait 18 months to receive a hearing aid from the National Health Service. Mrs. Beal is wheelchair bound, and unable to communicate without a hearing aid. Her favorite hobby is listening to music. Doctors say that she is unlikely to live long enough to receive the new hearing aid.
These two cases demonstrate that care is rationed in both a free market healthcare system, and a government run single payer system – and that rationing affects the disabled and the elderly first. This is the sad inevitability of limited resources, with only the independently wealthy enjoying the best of what healthcare can offer. Perhaps charity alone will hear the cries of these hearing impaired individuals?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 20th, 2007 by Dr. Val Jones in Opinion
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Little did I know that there is a raging debate about whether or not it’s a good idea to circumcise male babies. I was reading #1 Dinosaur’s blog and almost fell off my chair at the passionate series of comments. Apparently, 90% of American males were circumcised in the 1960s, but that rate has dropped to about 57% today.
Pro Circumcision: circumcision decreases the rate of transmission of HIV and HPV and is hygienically desirable. It does not appear to adversely affect sexual function, is a fairly minor and non-traumatic procedure, and is a reasonable health intervention.
Against Circumcision: condoms are more effective at reducing HIV and HPV transmission than circumcision. It is ethically wrong to circumcise an infant because he cannot give his consent and the procedure is painful. Some people believe that there is an important sensory nerve in the frenulum that is often severed during circumcision.
The American Academy of Pediatrics takes the position that: Existing scientific evidence demonstrates potential medical benefits of
newborn male circumcision; however, these data are not sufficient to
recommend routine neonatal circumcision.
The American College of Obstetricians & Gynecologists takes no position: Newborn circumcision is an elective procedure to be performed at the
request of the parents on baby boys who are physiologically and
clinical stable.
I had always assumed that circumcision was a personal choice that people didn’t feel that strongly about one way or the other. I guess I was wrong!
Why do you think this topic is so passionately debated?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 20th, 2007 by Dr. Val Jones in Medblogger Shout Outs, News
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I was perusing Dr. Hsien Hsein Lei’s blog and noticed a link to a pretty interesting tool. Dr. Lei describes it as a “low tech paternity test” and it’s a probability calculator that relies on 3 traits: blood type, eye color, and ear lobe type. Yep, it’s sometimes possible to exclude certain father candidates based on these traits.
Apparently attached earlobes (that don’t hang) are a recessive trait, so if a child has unattached earlobes, both parents can’t have attached earlobes. And as far as eye color is concerned, two blue eyed parents can’t have a brown eyed child – so there’s some opportunity for exclusion there (I was interested to see that two dark brown eyed parents can have a blue eyed child, though it’s rather unlikely).
Did you know about the genetics of ear lobes? I learn something new every day.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 26th, 2007 by Dr. Val Jones in True Stories
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Even though the gender gap in medicine is closing quickly (about 50% of medical students are female), young female physicians in practice are often viewed with suspicion. Dr. Michelle Au, an anesthesiologist and graduate of my alma mater, is regularly asked if she’s “a real doctor” or if she’s the nurse or a student of some sort. This week she blogged about her experiences, and there was a large volume of interesting responses.
I myself have had a rough time of it in the past (now I guess I look old enough to “be a real doctor”), and was routinely assumed to be a nurse, physical therapist, or even pharmaceutical rep. I actually wasn’t that offended by being miscast – mostly because I took it as a compliment not to look like a doctor. Although it’s somewhat unclear what a real doctor is supposed to look like, I have a feeling he’s older, balding, and paunchy.
But one day I was a little annoyed when my age and gender was equated with incompetence, which crosses the line for me. Here’s how the conversation went between me and the parents of a toddler with a small cut on his forehead:
Me: “Hi, Mr. and Mrs. X, I’m Dr. Jones. I see that Johnny bumped his head and will need a few stitches.” [Enter long history and physical discussion here].
Mrs. X: “Are YOU going to put in the stitches?” She asked nervously, scanning the ED for other physician suturing candidates.
Me: “Yes, I assure you I will be very careful. I’ve sutured many similar lacerations.”
Mr. X: “Yeah, but don’t you think he needs a plastic surgeon?”
Me: Looking at the small cut that only required 2 or 3 sutures. “I understand that you want the best possible cosmetic outcome for your son, but I assure you that this cut is so small that the plastic surgeon wouldn’t close it any differently than I would.”
Mrs. X: Spotting a tall, male intern fiddling with some bandages on a supply cart. “Well, can’t he do it?”
Me: Viewing the clumsy medicine intern. “Well, yes, he could. Shall I ask Dr. Big Hands if he can come and suture your son’s forehead? He’s never closed a lac before and has been dying to try one.”
Mrs. X: Um… Well, maybe you should just do it.
Outcome: I did a beautiful, delicate job of closing the small laceration, and the parents watched in awe as I used the tiniest needle and thread to create a seamless finish.
Mr. X: Thanks for your help. You did a really great job.
Have any of you readers had similar experiences?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 14th, 2007 by Dr. Val Jones in True Stories
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I was reading a touching post in Fat Doctor’s blog about her
son – how she wanted to protect him from mean kids who would inevitably hurt
him at some point along his school career.
She spoke about how painful child vs. child cruelty can be, and how some
of us carry those wounds and insecurities into adulthood.
I was a bookish little girl, pudgy with pale skin, freckles
and braces… unathletic but enthusiastic.
Our gym teacher liked to begin each class by appointing two team captains
and allowing them to choose teammates one after the other until everyone had
been assigned a team. So whether we were
going to play softball, floor hockey, basketball, or any other sport, it always
began the same way, two captains vying for the top athletes to build a team
that could crush the other.
The outcome was predictable.
The top “jocks” were usually selected as team captains, and they
proceeded to invite their favorite friends to their team, followed by the
mediocre kids, and finished with the chubby or clumsy kids at the end.
I was usually chosen second to last. But there was one little girl who finished
last every time – Tina Appleberry. She
was book smart like me, but although she wasn’t chubby, she had poor eyesight
and thick glasses and was rather uncoordinated and fearful of balls. Most kids didn’t like Tina because she was awkward
and unattractive. And I used to watch
her facial expression as she listened to the reticent team captain calling her
name last… because there was no one else to call.
Tina was a sad girl, and the years of being selected last
for sport teams had taken a toll on her.
She lacked self confidence, she was easily embarrassed, and she fully
believed that she wasn’t worth much at all.
I felt so badly for her… and shared her pain. Being second to last wasn’t that much easier
– and I loathed gym class. I would try
to get my parents to write as many excuses as I could think of to get out of
it, so I didn’t have to suffer the humiliation of my peers testifying in unison
that I was nearly the worst person in my grade at sports.
One day we had a substitute gym teacher. She clearly had no idea who the jocks were or
what the pecking order of kid selection was supposed to be. I was putting on my sneakers in the corner,
wishing that I could be invisible, when she walked up to me and announced that
I would be a team captain that day.
There were sighs and snickers as I followed her to the middle of the gym
floor and stood next to the class’s top jock, Johnny Tanner. The rest of the class lined up in single file
in front of us so we could see our range of choices.
The teacher told me to choose first. I surveyed the children lined up against the
wall, eyes fixed on me, eager to see who I’d pick first. I paused.
“I call Tina Appleberry,” I said. And you could have heard a pin drop. Tina almost fell over in astonishment. She slowly walked towards me to stand by my
side, lopsided pigtails and all. I
smiled at her, she smiled back. The
other kids didn’t know what to make of my choice – some thought I was stupid,
others thought I didn’t understand the rules (that you choose your favorite kid
first). But that day I knew that I had
won a small victory – a victory that outweighed the sum of all gym game
outcomes in grade school. And I can only
hope that Tina remembers that she was not always chosen last –and that her childhood
wounds are a little less deep because of that day.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
