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America has a disease industry, not a health care system

Health Policy

July 22, 2010

The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess.

But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is very fast and the speed will only accelerate. One big problem is that technology advances so fast that there is no time for a purchase – say new CT scanner or …

Dana Jennings interview, the world’s most famous patient blogger

Lisa Gualtieri, PhD

Patient

July 22, 2010

Dana Jennings writes what is arguably the world’s most famous patient blog about his treatment for prostate cancer.

Just to be clear, I don’t have any statistics about how many readers he and other patient bloggers have. I believe his blog is the most widely read and best-know patient blog because of the number of comments he receives and its prominent location in the New York Times Health section, itself …

Smoking, hypertension, obesity, and 7 other stroke risk factors

Kristina Fiore

Conditions and Diseases

July 22, 2010

by Kristina Fiore

There are 10 factors that appear to make up the vast majority of stroke risk, and half of those are modifiable, a large population study found.

Hypertension appears to be the strongest predictor of stroke, along with smoking, abdominal obesity, diet, and physical activity, according to Martin J. O’Donnell, MB, PhD, of McMaster University in Hamilton in Ontario, Canada.

“This is good news in the sense that the causes of …

Why Medicaid would be better off as a federal program, like Medicare

Aaron E. Carroll, MD

Health Policy

July 22, 2010

This is a perfect example of why Medicaid is not the same as Medicare:

Having counted on Washington for money that may not be delivered, at least 30 states will have to close larger-than-anticipated shortfalls in the coming fiscal year unless Congress passes a six-month extension of increased federal spending on Medicaid.

Governors and state lawmakers, already facing some of the toughest budgets since the Great Depression, said the repercussions would …

Read more…

Why Medicaid would be better off as a federal program, like Medicare

Viagra for muscular dystrophy and publicity for accidental insight

Jeoffry B. Gordon, MD, MPH

Conditions and Diseases

July 22, 2010

by Jeoffry B. Gordon, MD, MPH

As a family doc in practice for over 30 years I have been always tried to conceptualize disease states beyond the standard text book parameters.

Thus I was elated by the prospect of discovering a new beneficial treatment for muscular dystrophy when 5 years ago I gave some Viagra to a 57-year old patient of mine with limb girdle muscular dystrophy for the usual purpose. In …

How can doctors minimize unnecessary testing?

Robert Centor, MD

Physician

July 21, 2010

A recent comment raised a minor controversy about the strategy of minimizing tests. I actually do not think that the disagreement is that great, but I feel like exploring the issue.

This is the sentence that triggered the comment, courtesy of primary care physician Rob Lamberts:

Order as few tests as possible. No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always …

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How can doctors minimize unnecessary testing?

Understanding balance billing, a primer for patients

Lucy Hornstein, MD

Health Policy

July 21, 2010

The topic of balance billing has arisen once again, this time in this post by Movin’ Meat about the new health care insurance bill and emergency medicine.

Without further explanation, “balance billing” is generally thought of as a bad thing; a way for rich doctors to squeeze even more ill-gotten gains from their poor beleaguered patients. And that’s without even realizing what it is. …

Can Shrek and Dora combat the junk food epidemic?

MedPage Today

Potpourri

July 21, 2010

by Michael Smith

Can Dora the Explorer help kids find a taste for carrots?

It may be possible that licensed characters such as Dora, Shrek, and Scooby-Doo can tilt the balance away from junk food and toward healthy snacks, according to Christina Roberto, MS, and colleagues at Yale University.

In a study of 40 preschoolers, the presence of a licensed character on a package influenced the children’s perception of taste and their preference …

Data and transparency is needed to reduce medical mistakes

Kevin

Physician

July 21, 2010

An excerpt from On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry.

by John Toussaint, MD, and Roger Gerard, PhD

Admitting Error

In a lean environment, doctors and nurses must allow mistakes to be visible in order to perform root-cause analysis and fix the process. But showing mistakes hits most medical providers in a vulnerable place—right in the collective fear of lawsuits and a highly conditioned need to be …

Participatory medicine and evidence from medical journals

Dave deBronkart

Patient

July 20, 2010

I’ve only been studying healthcare for two years and I hesitate to be overly assertive.

But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That’s always hazardous, and it becomes insidious when it’s caused by a blind, unquestioning belief in our institutions.

Case in point:

Julie Thoren is an active practitioner of Participatory Medicine who’s seen first-hand the tremendous value …

Health care needs public acceptance of evidence based medicine

Brad Wright, PhD

Health Policy

July 20, 2010

Although a majority of Americans probably couldn’t give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying–and often interchanging–those labels to any effort by government to reform health care.

And, based on their efforts, one might conclude that the defining characteristic of any government involvement in health care is rationing. As if we don’t already ration, but will as soon as the government …

5 principles of self-care for health professionals

Lisa Chu, MD

Physician

July 20, 2010

As trained caring professionals, often we think of self-care as “selfish” or something that we do after we’ve taken care of our other “duties”, “responsibilities” and “obligations”.

Just for a moment, I invite you to think of self-care in a different way. I invite you to consider that your knowledge and practice of self-care is essential to creating a healing relationship with your patients and creating a healing environment in your …

The value of comparative effectiveness reviews is locally based

Kevin

Health Policy

July 20, 2010

by Craig A. Umscheid, MD, MSCE

In its 2010 comparison, the Commonwealth Fund has rendered the verdict yet again: the United States leaves other nations in the dust when it comes to healthcare costs — and yet provides its residents with the worst outcomes overall. In the study, the U.S. underperformed on virtually every front in comparison to Australia, Canada, Germany, Netherlands, New Zealand, and the United Kingdom.

The …

How Massachusetts can set hospital payment rates

Paul Levy

Health Policy

July 19, 2010

My suggestion last year that Massachusetts move away from the “free market” approach it uses to set hospital reimbursement rates was not well received by the hospital world.

But, this year, as people notice that their rates are being set by insurance companies in an unaccountable and unreviewable fashion, more and more are saying, “Well, maybe. What would it look like?”

There is a range of options. Let me lay out …

What libraries and community centers have to do with health care

Marya Zilberberg, MD, MPH

Health Policy

July 19, 2010

Our grandparents used to tell us, “if it ain’t broke, don’t fix it”.

Management gurus, in their race to the finish line have turned this sentiment on its head by telling us that, if it ain’t broke now, it will be soon, and if you do not fix it before it breaks, you will be behind the competition. This sentiment drives the annual corporate reorganization at every corporation that I or …

Watchful waiting may be appropriate for most prostate cancer cases

Crystal Phend

Conditions and Diseases

July 19, 2010

by Crystal Phend

Deferring curative treatment for low-risk prostate cancer may be a good option for many men ages 70 and younger, a population-based observational study affirmed.

In the national Swedish prostate cancer registry, the cumulative 10-year prostate cancer-specific mortality rate was only 2.4% for men at low risk who opted for watchful waiting or active surveillance, according to Pär Stattin, MD, PhD, of Umeå University Hospital in Umeå, Sweden, and colleagues.

This …

What bored doctors can do after they retire

Michael Woo-Ming, MD

Potpourri

July 19, 2010

As the baby boom generation nears retirement, there will be a flood of doctors left wondering what to do with their time. Some doctors will continue to work in practice and, although it is certainly rewarding to work hands-on with patients and new staff, after 30, 40, or 50 years in the business many start to explore other options.

The motivation that drives one to medicine often stays with them for …

Prior authorization required by health insurers impedes primary care

Kevin

Physician

July 19, 2010

by Charles R. D’Agostino, MD

It strikes fear in the hearts of doctors across the country; it is not the deadly Ebola virus or a new strain of cancer, but its malignancy is equally apparent.

It is the dreaded “PA”, which is insurance-speak for “prior authorization” and it seems that no matter which way we turn it appears, standing between our patients and the care they need.

To their credit, PAs are truly …

Cancer patients need compassion and balanced information

Bruce Campbell, MD

Patient

July 18, 2010

If you have to ask what jazz is, you will never know.
– Louis Armstrong

The stillness in the meeting room was electric.

First, one panelist addressed the audience members who have never experienced a malignancy. She described the unique and powerful bond that exists between cancer survivors. She described how the brush with mortality forces each survivor to renegotiate terms with Life itself. She reminded everyone that the cancer care system too often lets …

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