November 9th, 2007 by Dr. Val Jones in Opinion
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“One major responsibility of an expert is to know what to ignore.”
— Scott Haig, MD
Health information is more plentiful and accessible to patients than ever before. As a physician I am thrilled that people are empowered with knowledge to take control of their health, but I am also sincerely worried about the “misses:” misinformation, misconceptions, misdiagnoses and mistakes.
The great sculptor Michelangelo believed that every piece of marble was a beautiful statue just waiting for the artist to remove the parts that didn’t belong. I believe that this principle applies to health information – the utility of the information is directly proportional to the reader’s ability to ignore the parts that are irrelevant or incorrect. Google cannot remove the irrelevant, because it can’t evaluate the science behind various claims, appreciate the nuances of an individual’s life circumstances, or confirm a diagnosis. No, as powerful and wonderful as search engines are, they are mere marble. The master sculptors in health information are physicians – trained for at least a decade in the art of analyzing data, appreciating the connectedness of various symptoms and body systems, and focused on chipping away at the irrelevant to uncover personalized solutions and cures – they are the artists whose experience and insight can make the difference between life or death.
Are sculptors flawed? Sure. Are some better than others. Yes. But the bottom line is that information in the hands of a person who can apply it in an intelligent, personalized, and relevant way is our best shot at good, quality healthcare. There is an art to medicine, and the trick is to know what to ignore. Find a good sculptor and stick with him/her so that you can live your very best and avoid the “misses!”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 1st, 2007 by Dr. Val Jones in News
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A recent research study suggests that as many as 7% of adults over 45 have had a stroke without even realizing it. Researchers performed brain MRI scans of 2000 “normal” (asymptomatic) Dutch men and women between the ages of 45 and 96, and found that 7.2% of them (145 people) had evidence of an infarct (stroke), 1.8% (36 people) had small aneurysms, and 1.6% (32 people) had benign tumors (usually a small malformation of the blood supply to the brain).
Interestingly, they also found one person with a primary brain cancer, one person with a previously undiagnosed lung cancer that had metastasized to the brain, one person with a life-threatening subdural hematoma (brain bleed), and one person with an aneurysm large enough to require surgery. So altogether, they found 4 people out of 2000 who needed urgent medical intervention.
Although the authors of the article emphasized the point that many “normal” people have harmless brain abnormalities – I was a bit surprised by the fact that they found 4 asymptomatic people unaware of a ticking time bomb in their brains.
Keep in mind that the study was conducted on middle class Caucasian adults in the Netherlands – so we cannot generalize these findings to more diverse populations. But I do think it’s a bit of an eye-opener.
MRI scans are quite expensive (well over $1000 in most cases) and are therefore not offered to the general population as a screening test. But it does make you think about saving up for one. Your radiologist may find something unimportant, or she may find something that you hadn’t bargained for. Or maybe one day the technology will be inexpensive enough to offer as a screening test in a primary care setting. But that’s not going to happen any time soon.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 28th, 2007 by Dr. Val Jones in Health Policy, Opinion
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MedPage Today issued a special report on a rising trend: cash-only medical practices. I guess I’m ahead of the curve, since I’ve been seeing a cash-only primary care physician for 2 years now – and I love it.
Dr. Alan Dappen is available to his patients 24 hours a day, 7 days a week, by phone, email and in person. Visits may be scheduled on the same day if needed, prescriptions may be refilled any time without an office visit, he makes house calls, and all records are kept private and digital on a hard drive in his office.
How much would it cost to have the luxury of a personal physician on-call for your every whim?
Would you believe only about $300/year?
What’s Dr. Dappen’s secret to success? He accepts no insurance, keeps his overhead low, offers full price transparency, has physician extenders who work with him, and charges people for his time, not for a complex menu of tests and procedures.
“I believe in doing what is necessary and not doing what is not necessary. The healthcare system is broken because it has perverse incentives, complicated reimbursement strategies, and cuts the patient out of the billing process. When patients don’t care what something costs, and believe that everything should be free, doctors will charge as much as they can. Third party payers use medical records to deny coverage to patients, collectively bargain for lower reimbursement, and set arbitrary fees that reward tests and procedures. This creates a bizarre positive feedback loop that results in a feeding frenzy of billing and unnecessary charges, tests, and procedures. Unlike any other sector, more competition actually drives up costs.”
After building a successful traditional family medicine practice in Fairfax Virginia, Dr. Dappen felt morally compelled to cease accepting insurance so that he could be free to practice good medicine without having to figure out how to get paid for it. He noticed that at least 50% of office visits were not necessary – and issues could be handled by phone in those cases. Phone interviews, of course, were not reimbursable by insurance.
“The physical exam is a straw man for reimbursement. Doctors require people to appear in person at their offices so that they can bill for the time spent caring for them. But for longstanding adult patients, the physical exam rarely changes medical management of their condition. It simply allows physicians to be reimbursed for their time. Cutting the middle man (health insurance) out of the equation allows me to give patients what they need without wasting their time in unnecessary in-person visits. This also frees up my schedule so that I can spend more time with those who really do need an in-person visit.”
Health insurance is certainly necessary to guard against financially catastrophic illness. And the poor need a safety net beyond what Dr. Dappen can provide. But for routine care, “concierge medicine” can make healthcare affordable to the middle class, and reduces costs by at least 50% while dramatically increasing convenience. For the right patient, this is a welcome relief from having to wait to be seen by in-network providers or from being billed non-preferred rates as an uninsured individual. I applaud Dr. Dappen for his efforts in healthcare reform, and look forward to a movement where costs are driven down by putting patients back in the payer seat.
October 6th, 2007 by Dr. Val Jones in News
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Have you ever been singled out in a lecture and picked on? Or maybe at a comedy club? It’s somehow awkward when everyone is looking at you, and you can’t really defend yourself. That happened to me yesterday in a lecture about how email can transform medical practices. My friend Joe Scherger was talking about the beauty of asynchronous communication, and how much time it saves – when out of the blue, he said that Blackberries defeated the whole purpose of emailing, and that people who used them lead unbalanced lives. He then pointed at me and said, “See my friend Val Jones, there? She uses a Blackberry all the time!”
All eyes fixed on me with a sort of half pity, half “tisk, tisk” expression.
“She answers all her emails within minutes… She never unplugs.”
I shrugged and smiled sheepishly. Soon the conversation turned to other subjects, and I resisted the urge to pull my Blackberry out of my bag to check my emails.
Today I heard that Intel instituted email-free Fridays as a means to force their engineers to talk to others face-to-face. Apparently, the company was worried that interpersonal skills were being lost, and that people were not developing normal working relationships because of the artificial distance created by email-only communication.
“Well, at least I’m not alone,” I thought as I read the news story. “This is a serious problem across the country.”
There has been recent debate in the psychiatric community about whether or not video games could be considered an addiction (just as drugs and alcohol can be). Some have proposed that it be added to the DSM-V due out in 2012, others have said that compulsive video game playing is a sign of other underlying pathology (such as depression or social anxiety) but not a true addiction.
But the bottom line is that overuse of the Internet can disrupt a person’s time available for meaningful interpersonal relationships, be they with a spouse, a parent, a relative, or a friend. When your husband is sitting in the same room with you and has to get your attention by IM-ing or emailing you, you know there’s a problem.
And there doesn’t seem to be much of a break in sight – with Facebook, MySpace, Linked-In, YouTube, Pownce, Twitter, GTalk, blogs, podcasts, discussion boards, chat rooms, forums, etc. available as 24-7 forms of entertainment and communication, and companies like Intel trying to forbid this kind of stuff at least 1 day per week, Blackberries are the least of our worries. I wonder if these programs are like junk food for the brain? Will we soon suffer from cerebral obesity?
I’m afraid that I recognize that there is a problem, but I’m not sure what the solution is. “Just say no” to email doesn’t work for me… I like the fast-paced interactivity and connection I get from these activities. Maybe there’s a positive feedback loop at work, though – we spend a lot of time involved in online activities and become more isolated and lonely in our personal lives. In the end we become more and more engaged with the Internet to fill the emotional gap that we’re actually creating by overusing it.
I’ll ask my husband what he thinks… perhaps I’ll send him an email about it tonight.
What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 30th, 2007 by Dr. Val Jones in Medblogger Shout Outs
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Less than a year ago, I didn’t even know what a blog was. Many physicians still don’t know about them, and yet (according to Wikipedia’s September ’07 figures) there are over 106 million blogs currently online. A recent article about medical blogs suggests that the number of health professionals blogging may be in the order of 100’s. Therefore, medical blogs are only a tiny drop in the blogosphere bucket.
As with IT initiatives in general, the medical world is sorely lagging behind. However, there is a small group of pioneers who are already making a difference in the lives of patients and colleagues around the world. I have witnessed with my own eyes how cancer patients are being directed towards optimal care through blogs like those of Dr. Heinz Josef Lenz. Although he practices in southern California, his blog has been discovered by colon cancer patients across the country – and he has a loyal following who learn about cutting edge research and clinical trial information three times a week. These patients would never have access to this kind of information without his blog – they would have to wait for research to be published in a peer-reviewed journal, and then hope that the media would faithfully translate the findings into consumer language. (Good luck with that.)
Some blogs are being used to educate peers about surgical techniques. Dr. Bates has a wonderful, detailed blog about how to correct cosmetic defects, and a group blog called Inside Surgery has information for surgeons about difficult or unusual cases.
Dr. Rob, our Grand Rounds host this week, does a wonderful job of educating others about primary care, physical exam basics, and the broken healthcare system. He does it with flair – and a whimsical approach that is very entertaining. Where else can you learn about the healthcare system AND the lifestyle habits of llamas, goats, and accordion players?
If you want to keep up with healthcare news – KevinMD is a one-man news feed of all the most interesting goings on. If you need to keep up with advances in the medical device industry, MedGadget is your one stop shop.
Of course there are many other great medical blogs out there as well (and so many nursing blogs, like Emergiblog are outstanding)- but what excites me the most is when I see patients benefiting from the information they receive directly from healthcare professionals. Blogs can truly improve access to the minds of medicine, and even save lives – Medical blogs have the power to:
1. Educate patients about their health
2. Debunk medical myths
3. Cut through the media spin associated with research and health news
4. Influence health policy
5. Instruct other healthcare professionals
6. Expose dishonest medical schemes
7. Increase awareness of clinical trials and important research
8. Provide emotional support
9. Create a networking opportunity for professionals, advocates, and patients
10. Help people navigate the broken healthcare system
If you haven’t already, I hope you’ll add your voice to the medical blogosphere, and be part of a movement to change healthcare – one blog post at a time.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
