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Obamacare plans aren’t attractive to the middle class

Health Policy

July 18, 2014

The administration issued a report recently that says individuals who selected plans in the federal health insurance exchanges have a post-credit premium that is on average 76% less than the full premium for the plans they selected. And, 69% are paying less than $100 after the subsidies — 46% are paying $50 or less.

The administration also pointed out that 65% of individuals selecting the silver plan in the federal exchange chose …

Water births aren’t safe. Here’s why.

Roy Benaroch, MD

Conditions and Diseases

July 18, 2014

You’d think, being land-based mammals, we’d all be able to agree on the basic fact that humans breathe air, and that newborn human babies ought to be born into the air. You know, so they can breathe. That’s how human babies have always been born, and that’s how all other primates are born, and that’s how all other land mammals are born. (Hats off to our cetacean cousins for their …

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Water births aren’t safe. Here’s why.

Authorities overestimate patients’ health literacy

Jessie Gruman, PhD

Patient

July 18, 2014

I’m impressed by how much we struggle with seemingly simple health decisions when faced with sorting through too much information.

Buying sunscreen: It’s a simple task, right? Most of us do it every year about this time. And among actions we can take to reduce our risk of cancer in general and skin cancer specifically, this choice is fairly important.

So my colleague was surprised to hear this snippet of conversation as she contemplated …

6 guiding principles as you enter medical school

Maria Yang, MD

Medical Education

July 18, 2014

Dear Jane:

Thank you for asking me about my perspectives on medical school. Here are some general principles that you might find useful in your own training:

1. View everyone as your teacher. Everyone you encounter will teach you something. Be open to what they have to offer.

Yes, your professors and attendings, the “official” teachers, will educate you. Patients, however, will often be your best teachers. Listen to what they say, watch how …

Stupidity is worse for us than either sugar or saturated fat

David L. Katz, MD

Conditions and Diseases

July 18, 2014

A recent meta-analysis by an accomplished international team of researchers, published in a prestigious medical journal, shows that high intake of saturated fat is exactly as bad for health as a high intake of sugar and refined starch. The study also suggests there is something far worse.

The study, which pooled data from prior research and in the process aggregated findings for over 500,000 people, compared the rates …

Obamacare: Not everyone thinks the same way you do

Bob Doherty

Health Policy

July 17, 2014

“Everyone I know agrees that President Obama’s problem is that he isn’t liberal enough. Everyone I know believes that the problem with Obamacare is that it gives insurance companies too much power, when what we really need is a single payer system where the government runs everything, like Canada. Everyone I know believes that the answer to gun violence is to ban guns, and if the Supreme Court won’t allow that, to at least license, …

Our health system doesn’t serve the developmentally challenged

Arshya Vahabzadeh, MD

Health Policy

July 17, 2014

I have made several observations as to why developmentally challenged people are losing out in our health care systems. Given that there are 11 million children in the United States with an emotional, developmental or behavioral condition, we really can’t afford to neglect this important issue.

My first observation is that primary care remains a chronically undervalued component of health care delivery in the U.S. Despite the 60 million Americans …

A simple trick to remember your doctor’s recommendations

Davis Liu, MD

Physician

July 17, 2014

An excerpt from The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy.

You’ve told your story. Your doctor gets it. He has completed the physical exam. He formulates a plan to get you better. The next skill you should master may be as important as being a great storyteller. Your doctor has told you the …

Cost-effective diagnosis was the only option

Andreas Mauer, MD

Medical Education

July 17, 2014

Most physicians recall the medical school ritual of unboxing our first stethoscope. From the first physical diagnosis course, we were all solemnly instructed as to the importance of the physical examination in the diagnosis and of management of illness. Given that perhaps the most notable use of the stethoscope is cardiac auscultation, it would seem that this should hold particularly true for cardiology.

And yet, on moving from classroom to bedside, …

The economic case against the death penalty

Allen Frances, MD

Physician

July 17, 2014

I am not strongly against the death penalty on principle or on moral grounds — assuming, of course, that it could somehow be narrowly and efficiently restricted to a very few egregiously deserving and certainly guilty criminals.

I don’t even find it particularly appalling (or cruel and unusual) punishment that a killer may have some few minutes of physical discomfort before expiring during a clumsily administered execution. My experience as a …

Perfection fuels physician burnout

Starla Fitch, MD

Physician

July 17, 2014

Whenever I talk with groups of medical professionals about job frustration and burnout, there’s a theme that shows up that’s hard to ignore. I call it “the pain of perfection.”

Most of us pursued careers in medicine to help others. And if we’re honest, we must admit that we have type A tendencies infused in our bloodstream.

Can I see a show of hands, please?

That part of us, the one that strives …

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Perfection fuels physician burnout

Replacing transcriptionists with physicians is a fool’s bargain

Christine A. Sinsky, MD

Physician

July 16, 2014

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My general internal medicine practice is equidistant from the three academic institutions and a Veterans Administration facility, and thus I have patients who receive primary, secondary and tertiary care at each of these institutions.

The notes I receive back from one of these organizations are hands down the best of the four institutions. These notes are personal, concise, precise and clear. If …

Conducting research without the consent of the research subject

Ruth Macklin, PhD

Medical Education

July 16, 2014

A new study poses one of the most vexing ethical questions concerning research with human beings: When is it acceptable to conduct research without the consent of the research subject?

In emergency situations, patients often arrive at the hospital unconscious or with severely impaired decision-making capacity. Progress in medical practice depends on results from carefully designed research; yet in these emergency cases such patients are unable to fulfill one of the …

Always start your diagnostic search from the beginning

Hans Duvefelt, MD

Physician

July 16, 2014

It is a trade secret among patients of many practices: If you’d like to be seen by your personal physician with no waiting and without an appointment, just ask for a free blood pressure check and then mention to the medical assistant that you are not feeling well at all. They can’t send you home without being seen and they don’t have enough to go on to call an ambulance; …

It’s very difficult to assess a doctor’s true skill or performance

Robert Pearl, MD

Physician

July 16, 2014

How do you really know if your doctor, surgeon or hospital is good, bad or somewhere in between?

I frequently speak with large audiences, ranging from CEOs to Stanford business school students.

I often start by asking participants to raise their hands if they receive excellent health care. Each time I ask, about 90% of the hands in the room shoot up. But all the hands come down when I ask, “How do …

Medical judgment is paramount

Michael Kirsch, MD

Physician

July 16, 2014

The world is asunder. Iraq is sinking into a sectarian abyss. ISIS, a terrorist group, now controls a larger territory than many actual countries. Russia has swallowed Crimea and has her paw prints all over eastern Ukraine. China is claiming airspace and territories in Southeast Asia increasing tensions with Japan, Vietnam and the Philippines. The Israeli-Palestinian peace process is in another deep freeze. Terrorists in Sudan and Nigeria are kidnapping …

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Medical judgment is paramount

Everything in medicine requires context

Robert Centor, MD

Physician

July 16, 2014

FiveThirtyEight had a provocative article: “Patients Can Face Grave Risks When Doctors Stick to the Rules Too Much.”

The subsequent comments have debates over the value of guidelines. Guidelines are like a box of chocolate, you never know what you are going to get. Many clinical questions yield competing guidelines. We all know the controversies over breast cancer screening and prostate cancer screening. Recently blood pressure targets and lipid management have …

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Everything in medicine requires context

Kids in the summer: There’s more to it than academic progress

Claire McCarthy, MD

Physician

July 15, 2014

I flunk as a parent. I have no plans for my youngest kids this summer.

The older ones are working. But the 13-year-old and 8-year-old, the ones at the formative stages of their academic and skill development (if you believe what everyone says), are doing squat. No camp. No enriching activities. No special trips. Well, we do rent a house at the beach for two weeks every summer, that’s something, but …

His reputation precedes him: Meet the bad news doctor

James C. Salwitz, MD

Physician

July 15, 2014

Kasey sits alone in the examining room, staring at the drug company calendar of a perfect Caribbean beach hanging above the doctor’s desk, but not seeing it at all. She is very frightened. After three years of treatment for cancer, she is in trouble. Kasey feels fine: no shortness of breath, no cough, no pain. Still, she is there to get the report on her CT scan, and she knows …

Why the ER is a mixed blessing for society

Edwin Leap, MD

Physician

July 15, 2014

We live in an incredible age. Life expectancies continue to rise. The environment in the U.S. is cleaner than it has ever been. The sum of the world’s knowledge is at the fingertips of any and every smartphone user, waiting to be accessed when they finish playing Candy Crush. The face of poverty in America is still terrible to behold; but it bears little resemblance to poverty down the long …

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