ER, homeopathy style

July 3, 2009

Classic.

(via Dr. Val)

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A version of this op-ed was published on June 18th, 2009 in The New York Times’ Room for Debate blog.

In his recent address to the American Medical Association, President Obama noted that our health care system “rewards the quantity of care rather than the quality of care.” This perverse incentive leads to unnecessary and potentially harmful medicine, while also being a major contributor to spiraling health care costs.

Doctors enter the profession to care for patients, and most are not trained, or have the inclination, to run a business. But our health system’s incentives provide a strong motivation to do just that. In fact, doctors often find themselves in a position where the pressure to generate revenue becomes as important as how they practice medicine, and those who do not pay close attention to the financial bottom line are at a competitive disadvantage. It is no wonder that both physicians and patients are growing disenchanted with the current direction of American health care.

Some health policy analysts entirely blame the medical profession for the role they play in rising health care spending. And indeed, doctors have tremendous influence in the tests being ordered and treatments prescribed. But singling out physicians would be like wholly blaming the players for a proverbial game’s flawed rules. More important than focusing on the players, we need to change the rules.

That means re-aligning incentives to best serve the interests of patients. Physician payments need to be divorced from the volume of care, and associated with evidence-based patient quality measures and a reduction in medical errors.

Furthermore, we need to value the time doctors spend with patients. Instead of being encouraged to squeeze in appointments and rush through office visits, doctors should be incentivized to take the time to counsel and guide, along with improving their communication with patients, not only in person, but over the phone and on the Internet.

Clearly, successful health reform depends on modifying physician behavior. Doing so requires that we change the incentives that motivate doctors.

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As you have read here and elsewhere, Apple’s Steve Jobs recently underwent a liver transplant for a rare form of pancreatic cancer.

He, however, is not talking publicly about his case, and Apple is tightly controlling the information surrounding Mr. Jobs’ health.

Certainly, he is entitled to his medical privacy, but there are some who believe he should use his stature and celebrity to raise the awareness of pancreatic cancer. It is indeed one of the most dire diagnoses, with an often fatal prognosis. Perhaps it is because of the dismal statistics that funding for pancreatic cancer is so low. Indeed, the National Cancer Institute spends over $13,000 per prostate cancer death, compared to $2,200 for pancreatic cancer.

On a blog post, the New York Times’ Tara Parker-Pope notes that celebrities can do an effective job in raising the awareness of disease, and goes on to cite the Last Lecture’s Randy Pausch and actor Patrick Swayze, each of whom also had pancreatic cancer.

Indeed, although it’s not known what Mr. Jobs has contributed behind the scenes, Ms. Parker-Pope writes that, “I do hope that this remarkable man and creative thinker who helped revolutionize computers, music, phones and animated movies will, someday soon, finally open up and lend his special brand of magic to the cancer community.”

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Is Chantix safe, and why Zyban, or bupropion, also received a black box warning

July 2, 2009

Popular smoking cessation drugs Chantix and Zyban received black box warnings from the FDA, the strongest of its kind.
Chantix, in particular, is quite effective in helping patients to quit smoking, but has been dogged by instances of increased suicidality, especially in those already having a psychiatric diagnosis.
As this report in MedPage Today states, “Reports [...]

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Did propofol, or Diprivan, kill Michael Jackson?

July 1, 2009

As predicted, the details surrounding the singer’s death continue to get more bizarre.
Recent reports have stated that the powerful anesthetic Diprivan, generically known as propofol, was found in the singer’s house. Apparently, according to a nurse, Jackson “was begging for the powerful sedative to help him get over insomnia.”
There are zero circumstances where [...]

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Why removing the tax breaks for non-profit hospitals could be dangerous

July 1, 2009

It’s because of the unintended consequences, of course.
In their regular column in Slate, physicians Zachary Meisel and Jesse Pines talk about the recent attention that non-profit hospitals are garnering. The problem is this. Many are acting like for-profits, and in some cases, have been caught mistreating the uninsured and those who are on [...]

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America’s failed attempt at a single-payer system, the Indian Health Service

July 1, 2009

Contrary to what you may have been led to believe, the United States has already tried its hand at a pseudo-single-payer system. The VA is one example. Another, albeit less highly publicized, is the Indian Health Service. (via WhiteCoat)
Based on an agreement in 1787, the government is responsible to provide free health care [...]

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Vicodin and Percocet banned and taken off the market, or is a black box warning more likely?

June 30, 2009

The FDA has declared war on acetaminophen, with Vicodin and Percocet being collateral damage.  You can bet Dr. Gregory House is sweatin’ pretty hard over this news.
In the last few days, acetaminophen, otherwise known as the brand name Tylenol, has been squarely in the FDA advisory panel’s crosshairs. In general, it’s a very [...]

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Reader take: Moral hazard, and whether patients should consider cost in their health care decisions

June 30, 2009

The following is a reader take by an anonymous medical student.
One of the ideas that comes up in the search for explanations of high healthcare costs is the so-called “Moral Hazard”—the idea that insured patients are more likely to agree to unnecessary procedures because they don’t pay for them directly. Not everyone thinks it [...]

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Why would a doctor stop seeing patients?

June 30, 2009

It’s no secret that training a doctor takes a tremendous amount of time and money, both from the physician and the government, who subsidizes a substantial amount of the cost of training.
So, in the midst of a physician shortage, internist Toni Brayer wonders about doctors who simply decide to stop seeing patients.
After talking to a [...]

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Why did Michael Jackson have a heart attack, and CPR by Dr. Conrad Murray

June 29, 2009

Michael Jackson suffered a cardiac arrest. And still, that’s really all we know for sure.
Medical websites continue to speculate on the possible causes. Over at theheart.org, doctors who were interviewed continue to speculate on Jackson’s narcotic use, including Demerol, which I wrote about a few days ago. Indeed, a spokesperson for [...]

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Can the American Medical Association still be an influential voice in health reform?

June 29, 2009

The repercussions after Obama’s speech to the AMA’s delegates continue to be felt.
Not least of which are the murmurings of the other professional physician groups, who say that the AMA does not represent a majority of physicians. In this piece from pediatrician Rahul Parikh, he notes that about 30 percent of physicians are AMA [...]

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Does insulin cause cancer, and should you stop taking Lantus?

June 29, 2009

The potential link between a specific form of long-acting insulin, known as insulin glargine and branded as Lantus, and cancer, could be gaining momentum.
First off, let me say that both human and porcine insulin are safe, and have no association with cancer. The report specifically relates only to a synthetic, long acting form of [...]

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Patients die when doctors don’t talk to one another

June 29, 2009

Poor communication in medicine can kill.
I wrote a piece a few years ago on the issue (What we have in health care today is a failure to communicate), and fellow primary care doctor Rob Lamberts revisits the topic in a recent post.
In fact, he goes one further, saying not only does it cost money, “It [...]

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The biggest threat to President Obama’s healthcare reform efforts comes from his own party

June 28, 2009

I wrote back in February that one of the biggest threats to health reform was not from conservatives and the right, but from within President Obama’s own party.
Today, some four months later, the Washington Post reports that that’s pretty much what’s happening. In its report, the Post writes:
In the high-stakes battle over health care, [...]

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