Providing the right amount of healthcare

Less is more.  A lesson that can't be repeated often enough.

Providing the right amount of healthcare: "But a growing number of studies show that more healthcare is not always better and the more expensive drug or treatment option is not necessarily the right choice.  In fact, sometimes more care – specifically care that you don’t need – can be harmful for your health, and expose you to unnecessary risks."

The worst kind of guideline in prostate cancer screening

A thoughtful discussion of the ACP guidelines for screening of prostate cancer.  An important reminder that when treating a patient (as in life) sometimes the answer should be "no".

The worst kind of guideline in prostate cancer screening: "First, when as a profession did we decide that we had an ethical obligation to offer interventions that cause more harm than good? When we offer an intervention that is on the whole detrimental, are we not sending our patients a mixed message? "

Proton Beam Therapy Heats Up Hospital Arms Race - Kaiser Health News

We've talked about this before, as have many others, all apparently to no end.  Building these machines helps no one.  It improves the hospitals bottom line by selling a more expensive service that may sound good but time and again has proven to be no better than existing, cheaper technologies.

Proton Beam Therapy Heats Up Hospital Arms Race - Kaiser Health News: ""We don’t have evidence that there’s a need for them in terms of medical care. They’re simply done to generate profits."

The higher costs of proton services ultimately trickle down to taxpayers, employers and consumers in the form of higher health insurance premiums. "

Will high tech innovations actually improve health outcomes?

Will high tech innovations actually improve health outcomes?:

We've talked about this before, but yet another reminder that we know how to better care for people, we just are not doing it yet.

"If you really want to see the future of medicine, skip TEDMED and head over to Camden, New Jersey"

“There is a bias in medicine against talking to people and for cutting, scanning and chopping into them. If this was a pill or or a machine with these results it would be front-page news in the Wall Street Journal. If we could get these results for your grandmother, you’d say, ‘Of course I want that.’ But then you’d say, what are the risks? Does she need to have chemotherapy? Does she need to be put in a scanner? Is it a surgery? And you’d say, no, you just have to have a nurse come visit her every week.”

Poverty as a Childhood Disease - NYTimes.com

Another reminder, true health policy needs to be about more than just fixing a broken leg, it needs to address underlying issues that can impact one's health for the rest of their lives...

Poverty as a Childhood Disease - NYTimes.com: "These remind us that — more so than in my mother’s generation — poverty in this country is now likely to define many children’s life trajectories in the harshest terms: poor academic achievement, high dropout rates, and health problems from obesity and diabetes to heart disease, substance abuse and mental illness."

More US babies die day they are born than any industrialized country, report shows - Vitals

Still think we don't have a health care/public health crisis in this country?

More US babies die day they are born than any industrialized country, report shows - Vitals: "The U.S. is a worse place for newborns than 68 other countries, including Egypt, Turkey and Peru, according to a report released Tuesday by Save the Children."

Under Obamacare program, doctor visits would become data points

Perhaps the most important non-access related element of the ACA was the creation of PCORI.  Over time, their research has the potential to transform the way medicine is practice.  Research that is long overdue.


Under Obamacare program, doctor visits would become data points: "“Right now, were spending trillions on health care and 99.9999 percent doesn’t contribute anything to medical knowledge,” says Farzad Mostashari, national coordinator for health information technology at Health and Human Services. “That’s the real vision, that we actually take routine care, the heallth care happening in the real world, and have that contribute to knowledge.”"

We still have a health-care spending problem - The Washington Post

Disappointing but not surprising news.

We still have a health-care spending problem - The Washington Post: "most of this slowdown, 77 percent, has been due to years of a weak economy, which causes people to put off health services when they can and prompts employers and states to reduce health spending"

Want to cut health costs? Show doctors a price tag.

Want to cut health costs? Show doctors a price tag.:

It's the little things... the big things help too but don't underestimate the impact of small steps like this.

"Keep in mind, nothing changed for the doctors. The hospital would not penalize them for ordering more expensive tests; the costs would just get billed to the insurance provider. Still, the simple display of information suggests that “physicians can act in a cost-conscious manner even without direct incentives.”"

When your surgery goes wrong, hospitals profit

When your surgery goes wrong, hospitals profit: "“Part of what we have been trying to unravel is why some of the simple quality control measures that we know work are very slow to penetrate,” Gawande told me in an interview. “This puts in perspective how weak the incentives are [to improve quality]. Complications produced massively higher profits.”"

Hospitals In 5 States Clamp Down On Delivering Babies Before 39 Weeks – Capsules - The KHN Blog

Some low hanging fruit in our health care system - we know that babies born at 37 and 38 weeks are at a higher risk of death and other problems.  None-the-less an estimated 10-15 percent of US babies born every year are delivered early without medical cause.  This work shows that many of those elective early births can be delayed.

Hospitals In 5 States Clamp Down On Delivering Babies Before 39 Weeks – Capsules - The KHN Blog: "A study published Monday in the journal Obstetrics & Gynecology showed a group of 25 hospitals in five states were able to cut their rates of elective early deliveries from nearly 28 percent to under 5 percent in one year. "

Dying - avoiding the conversation is not the answer

I try and write about different aspects of health care (all of which can stand to be improved); Access, quality and cost is one of the traditional paradigms I use.  But today I want to briefly focus instead on a topic that transcends those categories, how our health care system deals with death.  This topic is incredibly important to me for two reasons - First, I have been through the passing of my parents and in-laws - four unique deaths that each taught me different lessons; and second, the use of the term "death panels" in the health care debate that made it even harder to have these vital conversations.

I'm no expert, but I do know that as we approach the end, or even better before we approach the end, we should as patients think about these issues.  Additionally, our providers should be prepared to help guide us through the process.

For your consideration, I share three recent articles.  Note that the first two link to additional classic articles on the topic that I encourage you to click through to.  The third article is a bit of a primer - just knowing what you want to do with respect to codes when you go into the hospital goes a long way towards addressing these issues, or at least helps start the conversation.

A duty to guide patients through the process of death: "Even in theses extremely devastating cases, We can still make a huge difference in the lives of our patients in the way in which we help them handle their own death."



Are physicians more afraid of death than the general population?: "If we aspire to become effective escorts to the patients whom we are privileged to shepherd in our medical ministries, then we might consider revising Luke’s well-known proverb to read: “Physician, emotionally heal thyself.”"


5 essential concepts to know about code status: "a few important and often unrecognized considerations that patients and their families should be aware of when discussing code status with their healthcare team."

The Republican plan for replacing Obamacare doesn’t replace Obamacare

Clear analysis of what the choice between the two approaches really comes down to.

The Republican plan for replacing Obamacare doesn’t replace Obamacare:

"...Or, to put it differently, Obamacare is trying to solve the problem of too little insurance. The Republican ideas are trying to solve the problem of too much insurance."

Now can we move on and work on how to implement the thing in the best possible way?

It's our duty as physicians to avoid needless tests

It's our duty as physicians to avoid needless tests: "But it’s not just the fact that our duty as citizens should force us to be good stewards of health care resources. It’s our duty as physicians to avoid needless tests that could add to potential morbidity."

Another voice in the growing chorus to "Choose Wisely".

Uwe E. Reinhardt: U.S. Health Care Prices Are the Elephant in the Room - NYTimes.com

A good overview and reminder of the health care price issues we face in this country.  First there is the problem of transparency, we have no idea what anything costs.  But it goes farther than that, even if we know what something costs, the individual patient/consumer has no bargaining power to impact that price.  Other countries have successful models to deal with these issues, but if I mentioned what they are I'd be called a heathen communist.  (You know, like that communist country Japan...)

Uwe E. Reinhardt: U.S. Health Care Prices Are the Elephant in the Room - NYTimes.com:

Salesmen in the Surgical Suite - NYTimes.com

In most industries an aggressive sales staff is an asset.  In medical care it costs lives.  Yet one more reason why our health care problems will not be fixed by the "free market".

Salesmen in the Surgical Suite - NYTimes.com:

The filtering of medical evidence has clearly failed

A stark reminder that not all evidence-based treatments are truly evidence based.

The filtering of medical evidence has clearly failed:

Patients should decide what the end of life is like, study says - latimes.com

While I think  we should be engaging in these conversations simply because it helps the patient.  The fact that it saves money is an added bonus making it criminal that it's not happening more.


Patients should decide what the end of life is like, study says - latimes.com: "Studies have shown that when a patient’s desires are taken into account, death is less likely to occur in an intensive care unit, physical distress is reduced, and death comes no sooner, they wrote."

**UPDATED** DHS: extra cost to feds of Arkansas "private option" will be little to none | Arkansas Blog

 The Arkansas Department of Human Services released a report - or at least the executive summary of a report - on how the costs for their "private option" Medicaid expansion will not lead to extra costs for the Feds.  Many (including me) remain skeptical.  Nonetheless, it's worth paying attention as other larger states consider jumping on the bandwagon.  Linked below is an excellent analysis of the report and the issue in general (the article includes a link to the actual release).

**UPDATED** DHS: extra cost to feds of Arkansas "private option" will be little to none | Arkansas Blog:

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Hospital Ratings Are In The Eye Of The Beholder - Kaiser Health News

It's hard for patients/consumers to base decisions on metrics when the metrics don't agree.

Hospital Ratings Are In The Eye Of The Beholder - Kaiser Health News: ""We've alternatively been labeled the least safe hospital in Maine and the safest hospital in Maine," said Dr. Douglas Salvador, vice president of quality at Maine Medical Center in Portland."

Healing the Hospital Hierarchy - NYTimes.com

Great column discussing doctor-nurse relationships. This relationship is a crucial part of our health care delivery system that will need to be part of overall reform efforts.  The team approach is often discussed as part of the solution; utilizing appropriate level practitioners to deliver care.  The author provides a stark reminder that this is not an insignificant task - hierarchies built up over 100 years will not be changed with the flick of a pen.

Healing the Hospital Hierarchy - NYTimes.com:

ACP: 5 excuses physicians and patients should question

We all know that ultimately, it's changing the delivery of health care that  is needed to bend the cost curve.  I've written before about the Choosing Wisely campaign, a very important initiative to help patients choose appropriate care/testing.  Unfortunately we know that any attempt to change the status quo is bound to be met with resistance.

This excellent column addresses some of that resistance.  Yul Ejnes the the Immediate Past Chair, Board of Regents, American College of Physicians discusses five excuses not to follow the Choosing Wisely guidelines.

ACP: 5 excuses physicians and patients should question:

Note that with this post I'm returning to my health care blog.  For the past several years I've been posting on Facebook instead.  Given my imperfect nature I was finding sometimes I'd also share on LinkedIn and/or Twitter and sometimes not.  I'm now using twitterfeed.com to automatically share across platforms.  We'll see how this works...