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Health care reform analysis from a former insurance and hospital executive

Kevin

Health Policy

October 3, 2009

by Marie Cooper

I have been in senior executive management in both managed care and a major hospital system. I find the hysteria over “reform” bitterly amusing because it is so misdirected.

The real problem with health care in America? Greed, indifference and incompetence, pure and simple. But not in the places everyone is pointing.

Insurer side

Insurance companies have to maximize their revenue because they answer to their boards. They …

What the United States health care system can learn from Mexico

Kevin

Health Policy

October 2, 2009

by Esther Buddenhagen, MSW

I write as a lay person concerned about the gap between what many people should receive and what they actually receive. The question of good medical care for ordinary people is being buried not only by insurance issues but by failure to come to terms with what primary care should be about.

Even Atul Gawande, who is particularly good at making distinctions between good and …

Not all doctors discuss the risks and benefits of prostate cancer screening to patients

Kevin

Conditions and Diseases

October 2, 2009

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Men might not be getting the information they need to make an educated decision about prostate cancer screening, two new studies suggest.

Among 375 men surveyed by telephone, only 69.9% had discussed a prostate-specific antigen (PSA) test with their physician before making a decision about screening, according to the …

Informed consent is central to the doctor-patient relationship

Dr. Martin Young

Conditions and Diseases

October 1, 2009

The doctor-patient relationship must remain the central focus of good health care. Diminish or hinder that relationship, and no technological advance, funding system, or government intervention in the world will be able to compensate. Many complaints about present health care systems can be seen as evidence of relationship dysfunction, not in the least due to the interference of third parties, administrators, payers and insurers, who wield the financial clout. Transparency …

Medical ghost-writing influences doctors to prescribe more drugs

Daniel J. Carlat, MD

Medications

October 1, 2009

Recently, a former staff medical writer at a MECC (Medical Education Communication Company) anonymously alerted me to a particularly sleazy advertising tactic used by a medical writing company. This person had worked as a pharma-supported medical writer for several years, but recently quit because, “I really couldn’t stomach the ethical problems associated with writing for the pharma industry.” Recently, looking for medical writing jobs, this writer came across a company …

A formula to help Congress with health care costs

Kevin

Health Policy

September 30, 2009

by Gary R. Gibson, MD, FACP

In his 2007 book Critical, Tom Daschle said lawmakers were “flummoxed” when attempting to craft specific reform legislation. They seem flummoxed again as they fail to recognize the primacy of the patient-physician covenant and try to analyze a complex problem without a suitable conceptual model.

The formula below represents a valid conceptual model describing health care costs.

“E” is expressed in monetary units …

What doctors can learn from patients in the health care reform debate

Wendy S. Harpham, MD

Health Policy

September 30, 2009

Two things are missing from the bustling conversations on health care reform jamming the Internet highway. First, where among the finger-pointing anecdotes and critical analyses of our “broken” American medical system are the stories and discussions of all that is right? Second, where is our sense of hope?

I’ve experienced American health care from an unusual, yet useful, vantage: that of a physician with chronically recurring cancer. From both sides of …

Are hospice doctors relying too much on symptom scores to assess pain?

Eric Widera, MD

Conditions and Diseases

September 29, 2009

A recent issue in The Lancet included an article entitled “The Death of Ivan Ilyich and pain relief at the end of life.” This is a thought provoking article focused on the question of whether there is overuse of pharmaceuticals to treat various forms of suffering in hospice and palliative medicine.

The authors argue that a good death, as seen through their interpretation of The Death of Ivan Ilyich, may include …

Migraines and the stigma of chronic pain medication use

Kevin

Medications

September 28, 2009

by Diana Lee

A recent episode of the A&E show Intervention about a woman with occasional migraines and other serious health problems who takes up to 50 Percocet pills a day made me uncomfortable. Maybe Danielle, the woman featured in the episode, really does have migraine attacks. But she is also an addict. One condition really has nothing to do with the other. Many people with acute or chronic pain use …

Will there really be an impending shortage of cardiologists?

Larry Husten, PhD

Health Policy

September 28, 2009

There can be little doubt that the lethal combination of aging baby boomers, the obesity epidemic, and the growing success of medical and interventional therapies for CV disease (resulting in more and more survivors of major events) is going to produce a flood of cardiovascular disease in the coming decades, and cardiologists in great numbers will be needed to care for these people.

However, that doesn’t mean that the message conveyed …

What’s the latest on prostate cancer and the PSA screening test?

Kevin

Conditions and Diseases

September 28, 2009

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Prostate specific antigen (PSA) tests may lead to unnecessary treatment of healthy men for prostate cancer, and there is little evidence supporting the common but controversial test for routine cancer screening, two new studies found.

Measurements of blood concentrations of PSA failed to predict cancer with the accuracy generally …

Should letting a premature infant die be considered health care rationing?

Kevin

Conditions and Diseases

September 27, 2009

by an anonymous NICU nurse

There is a medical controversy brewing over in England that is threatening to invade the United States. Ms. Capewell, a 23-year old British mother, is claiming English doctors let her 21 5/7 week infant die, only because they were following national perinatal guidelines.

If only he was born at 22 weeks, she insists, they would have tried everything to save him and admitted him to the …

Is the seasonal flu vaccine associated with H1N1 pandemic influenza?

Kevin

Conditions and Diseases

September 26, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

In unpublished data, Canadian researchers have suggested that seasonal flu vaccination may increase the risk of catching the H1N1 pandemic strain, but such a pattern has not been found in the U.S., the CDC said.

The Canadian data appear to suggest that people who had been vaccinated against …

Does the bulk of excessive medical care happen in the ER?

Michael Kirsch, MD

Physician

September 25, 2009

by Michael Kirsch, MD

The concept of medical excess is very difficult for ordinary patients to grasp. The medical community has worked hard for decades teaching them that more medicine meant better medical care. The public has learned these lessons well. Physicians who sent their patients for various diagnostic tests or specialty consultations were regarded as conscientious and thorough. Patients approved of doctors who prescribed antibiotics regularly for colds and other …

Radiologists and communicating mammogram results to patients and their doctors

Kevin

Conditions and Diseases

September 24, 2009

by an anonymous radiologist

I recently read the article and comments on this link from this post, concerning radiologists, from Musings of a Dinosaur.

I was disturbed to discover the animosity with which this topic is covered. The tenor of the blog is that radiologists are greedy, self-serving and are out to erode the doctor-patient relationship. The suggestion that radiologists would schedule percutaneous breast biopsies for their financial enhancement is both …

What does socialism have to do with the health care reform debate?

Kevin

Health Policy

September 24, 2009

by David Alway, MD

In thinking about socialism and medicine in the United States let’s adopt socialist point of view and ponder some logical conclusions.

Injustice Exists

The socialist notices that some people are starving, don’t have adequate shelter, or are relatively uneducated. He also observes that others are very well off, having access to the finest meals, enough money to buy grand homes and are well-educated. This state of affairs, …

Should soft drinks be taxed and be called a public health hazard?

Kevin

Health Policy

September 24, 2009

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Soft drinks and other beverages loaded with sugar should be taxed as a public health hazard, much as cigarettes are, a group of prominent medical researchers says.

Since extensive evidence ties sugary drinks to an epidemic of obesity and related health problems, such as heart disease and diabetes, they …

Is medical technology making doctors less relevant?

Edwin Leap, MD

Conditions and Diseases

September 23, 2009

It happens over and over. I call a surgeon about a patient with abdominal pain.

‘Well, what’s the white count?’

‘Normal.’

‘Did you get a CT Scan?’

‘Yes, and it was normal. But they just look uncomfortable.’

‘Sounds like nothing for me to do. Call the hospitalist.’

It happens in other specialties. Cardiologists who aren’t interested in a patient with a normal stress test, pediatricians unimpressed with negative chest x-rays and normal labs. ENT’s unconcerned if …

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