6 top medical comments, May 3rd, 2009

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

1. Carla Kakutani on the lack of primary care access in Massachusetts:
So we have a chicken and egg problem. Do we wait health care reform until we have revived US primary care, or is that even possible without health care reform to create the disruption needed to change our entrenched fee-for-service, procedure-happy payment system that is killing off primary care?

2. Shadowfax on whether hospitalists or intensivists should manage ICU patients:
Hospitalists are the future of ICUs the same way that FPs are the future of ERs.

As long as there is a market niche, there will be someone to fill it and IM hospitalists are the rational and capable people to provide that service. At any hospital that can support a closed unit (which depends more on volume than availability), there will be more and more pressure to move to a closed model.

3. Debe on whether the bipolar child and ADHD are purely American phenomena:
I think it is sad that, in the year 2009, people have a problem understanding that the brain is part of the body and it too can have illnesses. Maybe these disorders are diagnosed in America more often due to better research. Better research leads to better abilities to diagnose and recognize mental illness.

We must learn to stop thinking of mental illness as a shortcoming. ADHD and bipolar disorders are physiological. These things should be thought of just like one might think of diabetes or any other “medical” problem.

We wouldn’t be having this debate if the children had diabetes or cystic fibrosis and took “gobs” of drugs each day for their ailments. Yet, it is a huge issue simply because it is a “mental” illness.

4. Trisha Torrey on banning drug company sponsorship:
We demand school teachers do continuing education, but nobody subsidizes them. They pay for it themselves, and they don’t command nearly the income doctors do.

5. Anonymous on Medicare considering physician essays for hospice care:
Unintended consequences, they should look up the term. If that happens, I will never set up anyone for hospice. They can just get a bill from acute care.

6. William on anti-vaccine ads:
Then there’s actually people who have kids with autism. They are told that this is an incurable disease and they don’t know why, and there’s nothing they can do about it. They are desperate, and probably angry, and it just so happened that vaccines became the target for their frustration.