A 69-year-old woman who swims in my master program came back to the pool after a total knee replacement. I asked her how she was doing. She said she is still in a lot of pain because of her physical therapy. She said that her physical therapist was disappointed that she still was still unable to achieve full flexion of 120 degrees. Why 120 degrees? Did you set that goal I asked her? “No,” she said, “the therapist did.”
She went on to tell how she already had more range of motion in her knee than she did before the surgery. My friend was quite satisfied with her progress and wanted to stop physical therapy. The pain from the PT was worse than anything she had experienced before the knee replacement. I knew she and her 80-year-old boy friend were going on a cruise and she didn’t want to still be hobbling around.
It turns out that patients and physicians disagree on quite a few things. We hear a lot about patient-centered care. You know, that’s where the provider is supposed to consider the patient’s needs, preferences, and perspective when diagnosing and treating health problems. But medicine is still very provider-centered. Read more »
*This blog post was originally published at Mind The Gap*
This video was recorded at the American Academy of Family Physicians (AAFP) meeting in Denver last week. Hughes Melton, M.D., was awarded the “2011 Family Physician of the Year” award. The video below shares his story. I also encourage you to read more of his story from the news article on the AAFP website.
I have always been inspired by hearing the stories of the “Family Physician of the Year.” One of my wild and crazy dreams is to achieve this award someday, but I know that I definitely have a long way to go.
I often am asked how I incorporate wellness in our family medical practice, and I must admit that I’ve mixed feelings when it comes to the question because it implies that I’m not already trying to practice wellness simply by practicing medicine. I feel that the two are synonymous.
To those who want to know more about wellness and primary care, here’s my approach:
• I never try to sell anyone on a “wellness” program.
• I follow specific guidelines on certain chronic illnesses, mostly adhering to evidence-based guidelines and not expert opinion or opinion by committee.
• I offer the best advice I can to patients and try to guide them in the right direction when I feel they are taking pathways that worry me and that could be harmful (e.g. like using megavitamin and nutrient therapies or colonics, to name a few).
• I try to be as cost effective as possible when it comes to treatment.
• I see our patients once a year to comply with the legal definition of “face-to-face visits,” but not because scientific evidence substantiates this time honored ritual as “wellness.”
• I use calendar reminders in our electronic health record, MD-HQ to set up needed labs like cholesterol or Hgba1C or to schedule flu shots based on guidelines.
“We want our employees to spend their time on real issues,” said Charlie Salter, VP of Benefits at ConAgra. He means it. Charlie and ConAgra have built their healthcare benefits around some simple concepts that are yielding impressive results. How impressive? Close to flat healthcare cost trend since 2007.
Charlie’s work is part of a growing trend among America’s most innovative companies: Designing healthcare benefits in ways that have a real impact on quality and cost. It’s why I [recently] asked Charlie to share the podium with me in Boca Raton. ConAgra is showing it’s possible to control healthcare costs by helping people do the right thing.
The vision behind ConAgra’s programs is simple: Employees have to be responsible for managing their own care. But, says Charlie, this is easy to say, harder to do. “So we do as much as we can to make it as easy for people to do the right thing.” ConAgra gives its employees a significant financial stake in their well-being, through a health plan that has a $1,500 deductible. ConAgra supplements the plan with a health savings account (HSA) that lets workers use pre-tax dollars to pay for the deductible. Like other HSAs, any money the employee doesn’t spend is theirs to keep. It means employees are more engaged in healthcare decisions. Read more »
*This blog post was originally published at See First Blog*
Peter Orszag wants doctors to work weekends. The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:
Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or a television network that didn’t measure its ratings. Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones.
And he’s right, to a point.
I’ve pointed to studies showing that mortality rises on the weekends, in part due to skeleton staffs that hospitals employ on Saturday and Sunday. And, since Mr. Orszag is an economist, the cost factor is noted. Tests that get pushed off until Monday cost the health system serious dollars. The problem I have is that Mr. Orszag, like most health reformers, offers doctors little incentive in return. Read more »
*This blog post was originally published at KevinMD.com*
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