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Obamacare: There is risk for the American public to be worse off

Davis Liu, MD

Health Policy

October 10, 2013

With the implementation of health insurance exchanges in October 2013 and the beginning of the Affordable Care Act (ACA), also known as Obamacare, there is tremendous risk for the American public to be worse off. Certainly the millions of Americans who currently are uninsured because their employers do not offer insurance coverage and those with pre-existing conditions unable to purchase affordable individual coverage, will benefit. It is those with employer-based …

Miriam Carey: The lessons of motherhood and mental illness

Claudia M. Gold, MD

Conditions and Diseases

October 10, 2013

We do not have medical records or diagnoses. The news is filled with speculation. What we do know is that Miriam Carey’s one-year-old daughter lost her mother, and that because the incident occurred in Washington, DC in front of the White House, it is shining a spotlight on the subject of mental health and motherhood. And the message should be simple. Diagnoses don’t matter. As part of our nation’s health …

We shouldn’t need the permission of administrators to heal ourselves

Doug Farrago, MD

Physician

October 10, 2013

David Bornstein did a real nice job in his New York Times column, Medicine’s Search for Meaning. He partly captures what it is like to walk in our shoes. This is not a pity party for doctors. It is a limited look at some of the stuff that tears us up inside. He explains nicely the damage we have to absorb to get to the pinnacle …

When electroconvulsive therapy is the right choice

James Marroquin, MD

Conditions and Diseases

October 9, 2013

At the end of medical school, when it was time to choose my specialty, I was torn between psychiatry and internal medicine. Psychiatry seemed most suited to my interests and aptitudes. Focusing on the mind and mental illness bridged my interest in the big questions of human existence and the practice of medicine. On the other hand, it was hard to see how being a psychiatrist would fit with the …

Managing chronic headaches in children

Roy Benaroch, MD

Conditions and Diseases

October 9, 2013

Jenny wrote in about her son, who has a lot of headaches: “My 12 year old son gets them pretty much every day, and this has been going on for six months. He missed a lot of school, and now is starting to get them again in the summer. The doctor ordered a CT scan which didn’t show anything. What can this be? Could it be sinuses?”

Headaches are common in …

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Managing chronic headaches in children

Climate change and cancer screening: Leave causation to the experts

Peter Ubel, MD

Physician

October 9, 2013

In the wake of the horrific floods that struck Colorado recently, many people have debated whether global warming is to blame. The same goes for wildfires that hit that state this summer and for the massive tornado that struck in Oklahoma this spring. In the wake of that tornado, for instance, Senator Sheldon Whitehouse from Rhode Island claimed that Republican opposition to climate change legislation was at fault, for trying …

How do we empower patients with information while not scaring them?

Paul Bergl, MD

Medical Education

October 9, 2013

“What do you think, Doctor?”

For a novice physician, these worlds can quickly jolt a relatively straightforward conversation into a jumble of partially formed thoughts, suppositions, jargon, and (sometimes) incoherent ramblings. Even for simpler questions, the fumbling trainee does not have a convenient script that has been refined through years of recitation. Thus, many conversations that residents have with patients are truly occurring for the first time. And unfortunately, this novelty …

The conundrum of forcing treatment on psychiatric patients

Allen Frances, MD

Conditions and Diseases

October 9, 2013

When is it justified to force treatment on someone?

Some would shout a resounding,impassioned, all inclusive, “Never!” No psychiatric coercion, not ever, not even under the most seemingly urgent of circumstances.

I once put the question to its supreme test — 35 years ago while having dinner with Tom Szasz. Tom was the probably the greatest defender of patient rights since Pinel (the father of modern psychiatry who, two centuries ago, started …

Radiation from x-rays and living in Denver: They’re not the same

Jennifer Gunter, MD

Conditions and Diseases

October 9, 2013

My kids were at the dentist this weekend for their routine cleaning and check ups (yes, Saturday hours!) when the hygienist mentioned x-rays. I smiled and mentioned I’d rather discuss the need with the dentist after his exam. This isn’t a dental x-ray thing, this is what I do for every test that involves ionizing radiation.

My son, Oliver, has had more radiation than most people will have. Ever. In fact, …

What if exercise counseling came in prescription form?

Suzanne Koven, MD

Physician

October 8, 2013

Mark Twain once quipped: “Everyone talks about the weather, but nobody does anything about it.”

Is the same true of exercise? Despite a growing, multibillion dollar fitness industry, despite an increase in sales of treadmills, weights, and other home exercise equipment, despite public education campaigns like Let’s Move, eighty percent of Americans — four out of five of us–do not get the recommended amount of cardiovascular and strength training. 41 million Americans belong to …

Life for patients and their families is so much more than data

James C. Salwitz, MD

Physician

October 8, 2013

One of the first things I teach medical students is to be aware that they have arrived in a bizarre land. The strange things they see, the disturbed experiences they have, the weird stories they hear, are like noting else in life. I advise students to stay in touch with their feelings, to note what shocks, frightens, or embarrasses them. Remember those emotions now, because as doctors learn their craft …

Technology should not define medical education

Terence P. Ma, PhD

Medical Education

October 8, 2013

In July, I began an exciting role at Einstein: assistant dean for educational informatics. One of my main objectives is to optimize the use of technology to advance and deepen learning. But as much as I welcome it, technology alone will not achieve our educational goals.

Recently, David J. Hefland, the president and vice chancellor of Canada’s Quest University, characterized the model of contemporary education as “students as empty vessels that must be …

Obesity in children: What is the responsibility of doctors?

Manoj Jain, MD, MPH

Conditions and Diseases

October 8, 2013

Lying in a hospital bed, my seriously obese patient could barely see her swollen and odorous right foot over her abdominal fat. The foot was soon to be amputated, the result of an untreatable infection exacerbated by diabetes and kidney failure, which developed in part because of obesity. Her two children, ages 6 and 12, hovered from the hospital bed to the couch. In between, the bedside table was strewn …

Clinicians do not have the luxury to not care about costs

Sarah Jorgenson

Health Policy

October 8, 2013

In a large lecture hall of fellow clinicians-to-be, I was told that my job as a physician is not to be concerned with costs but rather to treat patients. My wrist, moving frantically left to right on my page taking notes, stopped. I looked up and my mind wandered: What an odd message to tell those who will be listening to ill people’s symptoms, prescribing medicine, ordering tests and orchestrating …

Sub-internship: The small stones are under my guardianship

Shara Yurkiewicz

Medical Education

October 8, 2013

On my second day of fourth year, I had to make a decision.

“Mr. K would like Miralax,” read the nurse’s page.

A medical sub-internship, which a student completes in her fourth year, is designed to be an internship with training wheels. The main difference between third and fourth year is that the third year reports to an intern (who makes a decision) while the fourth year replaces the intern. Last year …

The great irony of health care reform

Wes Fisher, MD

Health Policy

October 7, 2013

The great irony of health care reform is that really, nothing is new. Everything, it seems, remains cloaked in secrecy.

Yes, there are things called exchanges now. And millions upon millions of dollars will be spent on Internet, social media, TV, print, and radio advertising touting the law. There will be counselors there to help people make an informed choice.

But there’s still a new complicated, unreadable law that promises much, but …

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The great irony of health care reform

I support the Affordable Care Act, but not Obamacare

Kenneth Lin, MD

Health Policy

October 7, 2013

More than three years after being signed into law, and more than a year after surviving a Supreme Court challenge, the Affordable Care Act, more commonly known as Obamacare, finally begins to fulfill its promise. Most of this country has long since taken sides, despite appalling gaps in popular understanding of what the law means, what it does, and what it doesn’t do.

Let me admit that I’ve never had particularly …

Why your premium may rise under Obamacare

Edward Pullen, MD

Health Policy

October 7, 2013

The Affordable Care Act (ACA) will make insurers unable to exclude Americans with serious health problems from enrolling in insurance plans. This is among the most popular aspects of Obamacare. It is also the most likely explanation for huge premium increases in plans for individuals not on employer group policies.

Persons employed by companies with insurance plans for their employees, usually called group plans, routinely accept all eligible employees, regardless of …

How the Obamacare exchanges will transform health care

Robert Pearl, MD

Health Policy

October 7, 2013

When the next phase of the Affordable Care Act (ACA) kicks into gear January 1, 2014, each state will be required to offer its residents access to health care insurance through an online marketplace, often referred to as a “health insurance exchange.” These exchanges are now open for business on Oct. 1, 2013, allowing individuals to sign up online, by phone or in-person, with health insurance coverage starting next year.

Until now, buying health …

The problem with Obamacare is that it doesn’t do enough

John Mandrola, MD

Health Policy

October 7, 2013

Obamacare is here. It’s really here.

You might be wondering what’s been going on in the hospital or office — the contact points where health care actually happens.

The funny thing is: nothing seems any different.

And this is the problem with Obamacare. It hasn’t, won’t, or perhaps couldn’t, change the fundamental problem with US health care. Namely, that it is too big, too disruptive, and too devoid of nuance. In this way, health care …

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