January 7th, 2011 by Debra Gordon in Better Health Network, Opinion
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My cousin’s mother-in-law is in her late 90s. She had horrible osteoporosis and can barely move. She has little cognitive function left. She requires nearly 24-hour care and no one would even attempt to say she has any quality of life left. She told her son years ago that she was “ready to go,” and had had enough.
And yet when I asked my cousin’s husband if his mother had any do-not-resuscitate orders, or had ever completed an advanced director outlining her wishes of what kind of end-of-life care she wanted, he said no. His sister, he said, just wasn’t ready for that yet. So what, I asked, will you do when/if your mother gets pneumonia? Will you treat it with antibiotics? Will you put her on a respirator? If she is no longer able to eat, will you feed her through a tube?
He couldn’t answer. And he was clearly uncomfortable with the questions. Read more »
*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*
January 3rd, 2011 by Michael Kirsch, M.D. in Opinion, Research
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The medical profession’s ability to diagnose far exceeds its ability to effectively treat the conditions discovered. Consider arthritis, Parkinson’s disease, irritable bowel syndrome, strokes, emphysema, and many cancers.
When a physician orders a diagnostic test, ideally it should be to answer a specific question, rather than a buckshot approach. A chest X-ray is not ordered because a patient has a cough. It should be done because the test has a reasonable chance of yielding information that would change the physician’s advice. If the doctor was going to prescribe an antibiotic anyway, then why order the chest X-ray?
Physicians and patients should ask before a test is performed if the information is likely to change the medical management. In other words, is a test being ordered because physicians want to know or because we really need to know the results?
Does every patient with a heart murmur, for example, need an echocardiogram, even though this test would be easy to justify to patients and to insurance companies? If the test won’t change anything, then it costs dollars and makes no sense. Spine X-rays for acute back strains are an example of a radiologic reflex. Read more »
*This blog post was originally published at MD Whistleblower*
October 25th, 2010 by Debra Gordon in Better Health Network, Health Policy, Opinion, Research
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I spent last week in Gothenburg, Sweden covering the European Committee for the Treatment of Multiple Sclerosis (ECTRIMS) meeting. Lots of good science, lots of excitement over the new oral and targeted therapies coming on the market to treat this awful disease. But what I want to write about isn’t the science, but about how it will play out in the brave new world of healthcare in which we all live in today.
For instance, consider the first oral therapy to hit the market: Gilenya (fingolimod), which the FDA approved in September. Last month Novartis announced the price: $48,000 a year.
This is not a rant against the high cost of drugs, however. It is a rant against the inability of our healthcare system to take the long view of the impact of such drugs, a view that is particularly important with a chronic disease like MS that strikes healthy young adults in their early 20s and 30s. Read more »
*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*
October 1st, 2010 by Jennifer Shine Dyer, M.D. in Better Health Network, Health Policy, Health Tips, Research, True Stories
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As a medical professional who often treats children with chronic diseases, my patients turn to me not only for treatment advice but often for advice on how to improve their quality of life. I often have difficulty addressing the latter as there is a paucity of research on quality of life outcomes as compared to biomedical outcomes.
However, preliminary data from DR Walker et al. (1) have shown that comprehensive disease management improves quality of life and thereby reduces medical costs for some common chronic illnesses. Recently, a patient shared a story with me that was written by an anonymous author which demonstrates the powerful effect of seemingly small efforts on the quality of life of a disabled child. Read more »
September 22nd, 2010 by DrRob in Better Health Network, Health Policy, News, Opinion, Research, True Stories
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The man who twirled with rose in teeth
Has his tongue tied up in thorns
His once expanded sense of time and
Space all shot and torn
See him wander hat in hand –
“Look at me, I’m so forlorn –
Ask anyone who can recall
It’s horrible to be born!
– Bruce Cockburn, from song “Shipwrecked at the Stable Door”
I found the discussion around my recent post about treating colds very interesting. Sick people come to the office to find out how sick they are. Most people don’t want to be sick, and when they are sick they want doctors to make them better.
Most people.
Some people want to be sick, and some doctors want to make people sick. I am not talking about hypochondriacs — people who worry that they may have disease and become fixated on being sick. I am not talking about malingerers — people who pretend to be sick so they can get medications. I am talking about the slippery slope of defining disease. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
