December 21st, 2010 by Michael Sevilla, M.D. in News, Opinion
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Every once I awhile a story catches my eye as I scan the news websites. There was one this morning on CNN with this catchy title: “Mom Defies Doctor, Has Baby Her Way.” The article describes a story where a mother was going to have her fourth baby. Her previous three were born via C-section. Mom did not want another C-section done, and “defied” her doctor’s order for the procedure. “You’re being irresponsible,” the patient was told.
The middle of the article talks about the current thinking and statement of the American College of Obstetrics and Gynecology saying that “it’s reasonable to consider allowing women who’ve had two C-sections to try to have a vaginal delivery.” Of course, there’s risks with proceeding with a vaginal delivery and risks of another C-section.
What’s always interesting to me are the comments following the article. I applaud the physicians who are fighting back the anti-physician sentiment and those who are pushing (no pun intended) the only home birth agenda.
In the article, this person is being held up as a hero — as someone who defied the paternalistic medical establishment and did it her way. Good for her — or is it? What if that 0.4-0.9 percent possibility of severe complication occurred and there was a problem with mom and/or the baby? What would happen then? Read more »
*This blog post was originally published at Doctor Anonymous*
November 25th, 2010 by DrRich in Better Health Network, Health Policy, Humor, Opinion, True Stories
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In what has become a tradition over the past few years, DrRich proudly reprises his annual Thanksgiving message to his beloved readers:
Gathered around the Thanksgiving table, DrRich’s large extended family, carrying out a longstanding tradition, each offered in their turn one reason for being thankful on this most reflective of American holidays. DrRich listened respectfully as each of his loved ones, and each of the ones he was obligated to tolerate benignly because they had married (or in some other manner had committed to) one of his loved ones, recounted a cause for thanks.
There is no need for DrRich to recite their utterances here, because they were all perfectly predictable and fairly mundane, having mostly to do with items such as maintaining good health, finding a job, being able to afford one’s mortgage payments, getting a passing grade in French, receiving a new puppy, Mr. Obama’s remarkable presidency, the apparent continued structural integrity of the Universe despite Mr. Obama’s presidency, etc., etc.
When it was at last DrRich’s turn, he, in retrospect perhaps somewhat inadvisedly, was unable to refrain from displaying his keen insight and superior analytical abilities on matters related to healthcare (a topic, anyone would have to admit, about which most of us would very much like to feel thankful). Lifting his glass, DrRich pronounced that he was most deeply and humbly thankful for the 47 million Americans without health insurance.
And further, especially thankful that their ranks must surely be growing, given the recession, advancing unemployment, imminent collapses of businesses and indeed entire industries, etc. And even though Obamacare promises to significantly reduce that number, DrRich went on to express his fervent wish that large numbers of the uninsured might still be with us a year and two years and even ten years hence, for the great and good benefit of us all. Read more »
*This blog post was originally published at The Covert Rationing Blog*
November 17th, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion, Research
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It is an article of faith that, in Barbara Starfield’s words, adults whose regular source of care is a primary care physician rather than a specialist have lower mortality, even after accounting for differences in income, and she draws upon studies at both the county and state levels to prove it. Now a new paper in JAMA about England’s Primary Care Trusts refocuses the discussion on poverty.
While Starfield’s county-level studies are often cited as evidence that more primary care physicians and fewer specialists lead to lower mortality, they actually showed virtually no differences at all. And when repeated by Ricketts, the small differences noted were not consistent throughout various regions of the U.S. On the other hand, “counties with high income-inequality experienced much higher mortality.” So, in reality, the county studies demonstrated the strong impact of poverty and the marginal impact (if any) of primary care. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
November 10th, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion
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In a high-profile paper in the September issue of Health Affairs, Thorson and coworkers showed that the care at St. Mary’s Hospital in Grand Junction, CO was superior to that of 20 other unnamed hospitals. Grand Junction is, of course the smal town in SW Colorado that became famous when President Obama visited there during the health care reform debates during the summer of 2009, and here’s what he said:
“Hello, Grand Junction! It’s great to be back in Southwest Colorado. Here in Grand Junction, you know that lowering costs is possible if you put in place smarter incentives; if you think about how to treat people, not just illnesses. That’s what the medical community in this city did; now you are getting better results while wasting less money.”
So, Grand Junction, a town of 58,000 people located in SE Colorado, where there are virtually no blacks and fewer Native Americans but where family practice rules, is supposed to be the model for the nation. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
November 9th, 2010 by Lucy Hornstein, M.D. in Better Health Network, Health Policy, Opinion
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Forgive me for being a little late to the healthcare insurance reform discussion. I was busy, y’know, providing actual healthcare to sick people while that whole rigamarole was going on. But that one sentence, uttered over and over by everyone from the President on down, always stuck in my craw. At long last, I’m finally able to properly articulate my response.
Trying to pass sweeping health insurance reform legislation while telling people that, of course, they “can keep their current plans if they want” is like legislating tough new laws against wifebeating and assuring women that, of course, they can stay with their husbands if they like.
No one tries to force victims of domestic violence to leave their abusers, but they do try to help them understand that they have options, and that they don’t deserve to be treated so poorly. I firmly believe that people who like their current insurance plans probably have several things in common. Read more »
*This blog post was originally published at Musings of a Dinosaur*
