5 top medical comments, April 12th 2009

Here are some of the more interesting comments readers have left recently.

1. Dr. Gwenn on limited health literacy:
For us to do a better job with patients and teach them to be better advocates for themselves, we need more time – plain and simple. At the same time, patients need more community supports to understand the complex health world and build the skills they need to work with “Dr. Google” and the health system at large. This isn’t just about health literacy – it starts to involve computer literacy, media literacy and reading literacy. This is where the rubber meets the road. As physicians, we should be pushing for whatever system changes are necessary for our patients to get the supports they need on all levels.

2. Cathy on withholding Alzheimer’s care:
This discussion, in one form or another, has been around for awhile now. What is the drugs used to keep ALZ patients alive? If there is such a thing I never heard of it in the 12 years my mother suffered with this disease.

Or are you talking about with holding treatments that have nothing at all to do with their ALZ, just because they also have ALZ? Is it being suggested we not treat them for acute illnesses? Or chronic diseases unrelated to ALZ for the sole purpose of hurrying death along?

These people are among the most vulnerable in our society. If we are talking about killing them off, because I am not understanding what you mean by with holding treatment for ALZ, then there are words (very unkind ones) for such actions.

3. Momwithastethoscope on screening ADHD children with an EKG:
Is it more cost effective to screen our ADD patients in the same manner as an athlete who presents for a sports physical? A family questionnaire that asks about sudden death in less than 50 year old family members and symptoms such as shortness of breath, vital signs including blood pressure & perfusion of all 4 extremities, weight, body habitus, fitness level, cardiac auscultation, and regular reevaluation are easily done in primary care offices. The differential of sudden death in children and adolescents is one most pediatricians can recite readily – tracking these causes still remain elusive (& dynamic). My point is that one EKG may identify a W-P-W, but some of these cardiac causes are acquired over time – repeated testing (yearly? biannually?) is not cost effective. Regular follow-ups for children on stimulant medications makes more sense.

4. Amri on hospital readmission rates for Medicare patients:
In the process of health reform, this is going to be a big topic. It rears its ugly head with Medicare and Medicaid but it is a problem across the board with both the insured and uninsured.

When health plans and CMS start reimbursing and recommending docs based on quality including readmission rates for same initial diagnosis, I think we will see some change of philosophy about how much we focus on compliance and appropriate follow-up. Sure there is patient responsibility, but the structure has to be in a place where patients understand their role at a more granular level.

Also, health plans have to change their reimbursement guidelines so that clinicians can spend the time they need with patients to produce long-term health outcomes that don’t result in readmission or exacerbated morbidity.

5. Anonymous on whether an anti-smoking ad goes too far:

This was the first thing I saw this morning while watching the news. I have taken to turning off a station when I get one of these manipulative anti-smoking advertisements. They are invasive and unpleasant, and those who believe that the means is justified by the ends should consider the selective moralism involved in this focus on one behavior in a culture of machines, pollution, war, etc. I no longer smoke, but I don’t believe it’s the root of all evil in our culture, and I don’t begrudge someone who needs to relax the occasional cigarette.

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