Over at The Health Care Blog Lisa Gaultieri, an Adjunct Clinical Professor in the Health Communication Program at Tufts University School of Medicine observes that, too often, the computer becomes a barrier between the clinician and the patient. She offers insight into how to integrate a laptop into the conversation.
“Just Say No” Is Only Part of the Solution to Reducing Health Care Costs
David Leonhardt had a piece in the New York Times today called “In Medicine, the Power of No,” that focuses on reducing health care costs by scaling back our current “do everything possible” approach to care. “Deep down, Americans tend to believe that more care is better care,” he writes, “We recoil from efforts to restrict care.”
The era of managed care revealed a pretty clear picture of how Americans feel about forced limits on the care they can receive. More recently, Conservatives fomented panic with their attacks on health reform that focused on the looming threat of government rationing of care—including “death panels” and refusals for surgery and treatments based on cost alone. Leonhardt writes;
“From an economic perspective, health reform will fail if we can’t sometimes push back against the try-anything instinct. The new agencies will be hounded by accusations of rationing, and Medicare’s long-term budget deficit will grow.
“So figuring out how we can say no may be the single toughest and most important task facing the people who will be in charge of carrying out reform. ‘Being able to say no,’ Dr. Alan Garber of Stanford says, ‘is the heart of the issue.’”
I agree that a sea-change is needed in how Americans view health care—but I think it would be a mistake to assume that health care costs are out of control because consumers are clamoring for more and more care and need to be reined in.
Medical Mistakes: How Some Hospitals Reduce Malpractice Suits
The New America Foundation’s Joann Kenen has posted an insightful piece on how some innovative medical centers deal with medical mistakes: Rather than stonewalling patients and relatives, they “Disclose. Apologize and Fix.”
I’ve written in the past about how “Sorry Works.” (You’ll find part 2 of the post here. )
But as Kenen points out, this is not just about apologizing. Or as she puts it, it’s not enough to say: “Something went wrong. We’re sorry. Here’s a check. Ciao.”
Moreover, she notes that “there are many obstacles to expanding this model. The best known examples [of places where full disclosure has proved successful are], like the University of Michigan or the Lexington VA center, staff models. The doctors are part of the hospital staff and everybody is covered by the same malpractice insurer. That’s not true in most hospitals, and there can be numerous doctors, numerous insurers, all with their own take on what happened and whether to disclose — or deny.”
The Association of American Physicians and Surgeons Sues to Overturn Reform; The National Physicians Alliance Replies
Over the past two years, I have met the leaders of a relatively new physicians’ organization, the National Physicians’ Alliance, and I have been impressed by their agenda. Quite simply, they put patients first. Here is their mission statement:
“United across medical specialties, the National Physicians Alliance was founded in 2005 to restore physicians' primary emphasis on the core values of the profession: service, integrity, and advocacy. The NPA works to improve health and well being, and to ensure equitable, affordable, high quality health care for all people. The NPA strictly refuses financial entanglements with the pharmaceutical and biomedical industries. To learn more, visit this site.
I would describe the NPA as “the new AMA.” The NPA has been growing quickly, and it is stepping up to make its voice heard.
At the end of March, when the Association of American Physicians and Surgeons (AAPS) announced that it was going to sue to try to overturn health care reform on constitutional grounds, I asked Valerie Arkoosh, president of the NPA, if the organization would like to comment.
Where There’s Back Pain There’s Sure to be Profit
Back pain is endemic: It affects 8 out of every 10 people at one point in their lives. Americans spent some $86 billion in 2005 on doctor’s visits, surgery, imaging, and drugs to treat back and neck pain—and costs continue to rise each year. Despite being ubiquitous—and an enormous drain on medical resources—back pain continues to be poorly treated as well as over-treated. Recent research has shown that doctors consistently fail to follow accepted guidelines in treating their patients; ordering X-rays and MRIs when they aren’t useful, prescribing expensive prescription drugs when over-the-counter pain relievers would work just as well and resorting to surgery without evidence that it will actually relieve pain and disability.
The trend, unfortunately, is continuing. A new study published in this week’s issue of the Journal of the American Medical Association found that although the rate of lower-back surgery among older Americans had declined slightly between 2002 and 2007, the rate of the most complex, medically risky and most expensive type of lower back surgery increased 15-fold (from under 1% of operations to 14.6%) during this same time period. There is little upside to this increase in intervention: Besides driving up health care costs, the authors found that overuse of the expensive, risky technologies put patients at increased risk of death and life-threatening complications without providing a corresponding increase in pain relief or mobility.
Myths & Facts About HealthCare Reform: Who Wins & Who Loses?
will try to dispel the myths and reveal the facts about the reform
legislation. What will reform mean for insurers, hospitals, doctors,
Medicare patients, seniors who are now on Medicare Advantage, Medicaid patients
and state budgets? Who wins and who loses?
You may be surprised by some of the answers.
The legislation is rich in details that have been ignored. Liberals
as well as conservatives are making assumptions that just don’t square with the
facts.
Below,
I focus on the impact that reform will
have on the private insurance industry–and on the industry’s customers.
MYTH # 1: Health Care Reform represents a “boon” for
private insurers.
FACT: It is s
true that, beginning in 2014, virtually all Americans will be required to buy
insurance, or pay a fine. But while insurers will pick up a boatload of new
customers, many will be refugees from a health care system that treated
them poorly. Think of the
boat as a life raft. These could be very expensive customers.
Moreover,
between now and 2014, insurers will face some serious financial hits. These
new regulations will make our health care system fairer and more
affordable. But the rules also suggest that going forward, for-profit
health insurance may not be a viable business–unless these
companies learn how to keep patients healthy, while insisting on value for
health care dollars. Insurers that over-pay drug-makers or hospitals will find
that they can no longer turn a profit by simply passing the added expense along
in the form of higher premiums.
NYC Screening of Money-Driven Medicine – April 7
The
Committee of Interns and Residents (CIR/SEIU), the union that represents residents
and interns nationwide, is hosting a screening of Money Driven Medicine ,a film produced by Alex Gibney, directed by
Andy Fredericks, and based on Maggie’s book , this Wednesday, April 7.. Maggie
will be doing a Q&A following the film. :
St Luke's Hospital
Muhlenberg Auditorium, Floor 4
1111
Amsterdam Ave
New York,
NY 10025
Film
Begins at 5:15 PM
Food will be
served. Public Invited.
Statins for People Who Don’t Have Cholesterol Problems
I loved the lead to a story that ran in the New York Times yesterday:
“With the government’s blessing, a drug giant is about to expand the market for its blockbuster cholesterol medication, Crestor, to a new category of customers: as a preventive measure for millions of people who do not have cholesterol problems.
“Some medical experts question whether this is a healthy move.”
It is such a rare pleasure to run into intentional understatement in the mainstream media. Kudos to NYT reporter Duff Wilson for not only recognizing irony, but managing to incorporate it into the lead of a NYT story.
The article goes on to point out that cholesterol-lowering drugs, known as statins, “may not be as safe as doctors previously thought.” Meanwhile, the benefits for healthy patients are . . . well, “slim to none” is the phrase that comes to my mind.
To all readers:
To all readers:
Yesterday (Monday March 29) some readers experienced problems when trying to leave comments on HeathBeat. TypePad is now monitoring the situation and seems to have fixed it. But if anyone continues to have a problem, please e-mail me at maggiemahar@yahoo.com
Also, please note—if takes a while to post the comment (either because it’s long or because you’re interrupted), you may find that when you try to send it, you get a message saying that your comment cannot be accepted. This is because you’ve “timed out.” Just “copy” your comment, close HealthBeat, open HealthBeat again, go to the post you were commenting on, and “paste” your comment in the box. It will then be accepted.
Also, I’ve been catching up with responding to comments. If you didn’t receive a response in the past week, you might want to check back . . .
Thanks, Maggie
Atul Gawande in the April 5 New Yorker: Now What?– Gawnde and Berwick on the Same Page
In the April 5 New Yorker Atul Gawande writes about the backlash that health care reformers can expect in the months ahead. He reminds us that when Medicare passed “it faced a year of nearly crippling rearguard attacks.”
Few remember that the American Medical Association was absolutely opposed to the idea of providing medical care for all elderly Americans. They guild didn’t want the government involved, calling Medicare “the most deadly challenge ever faced by the medical profession.” The Ohio Medical Association, with ten thousand physician members, declared that it would boycott Medicare, and a nationwide movement began. (The opponents changed their mind a year later when they realized that, thanks to Medicare, their salaries had climbed by 11 percent in just on year.)
“Race proved an even more explosive issue,” Gawande reports. Hospitals were told that if they wanted Medicare dollars, they would have to integrate. Two months before coverage was to begin, “half the hospitals in a dozen Southern states had still refused to meet Medicare certification.” But LBJ stood firm on the issue.