In the Spin II: You and Your Billing Code
Pass the Valium!
Previously on e-Patients.net I recounted the crazy-making quest for a second opinion on an abnormal mammogram (microcalicifications) as per the advice of New York Times health columnist and breast cancer survivor Jane E. Brody. The gynecologist who ordered the mammogram refused to authorize a second opinion, however, deferring to the radiologist, who referred me back to the clinic and so on and so forth.
My primary care provider, who carefully reviewed the films and reports (sans compensation), thought a biopsy might be the safe thing. She was not the referring entity, however. The clinic was !#$^%$#@
I started over, skipping a few bases, securing a first-rate surgeon at the county hospital as the new referral entity. In a futile attempt to waste no one’s time except my own, I hand-carried a disc of the imaging studies to the appointment.
Right?
Wrong!
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Personalized Medicine, the Next Frontier
Nancy B. Finn is a journalist with an expertise in the implementation of digital communications in health care. This is her second guest post on e-patients.net:
When an individual patient visits his or her doctor with a problem, traditional clinical diagnosis is made and treatment is administered based on the patient’s symptoms, medical and family history and results of lab tests.
In the e-health world of the 21st century, personalized medicine, a new approach to treatment and analysis of patients’ health issues, promises to revolutionize that process. Personalized medicine looks not only at an individual’s symptoms, labs and medical history but at the individual’s unique clinical genetic and genomic markers to determine a treatment program. Because these factors differ for each human being, the disease they carry and how they will respond to treatment will differ as well. Taking this to another level, personalized medicine enables doctors to make accurate predictions and assumptions not only about an existing condition but to make predictions about a person’s potential to develop a disease. This will enable clinicians to treat patients proactively rather than reactively resulting in a better outcome. Read more
Virtual Participatory Medicine Town Meeting
On Friday Senator Tom Daschle announced a campaign to get input from the public about what healthcare reform should look like. “The Transition will host Health Care Community Discussions across the Country over the holidays this December to help his Policy Team put together their final recommendations for the New Administration.”
What a novel approach. What a change from the past when plans were written behind closed doors with little or no input from the public, i.e. the people whose lives are being impacted by the healthcare decisions being made.
They want people to host Health Care Community discussions in our homes and in our neighborhoods between December 15 and December 31. Could we host a virtual one? Or at least a virtual extension of a physical one?
(I’d also like to host one in my home, official or not. You’re all invited.)
It is thrilling for the public to be invited to participate in the discussion, but with the invitation comes the responsibility to do something. Perhaps we could use this blog to come up with ideas to answer their request — grand ideas, down to earth ideas, crazy no-way-in-the-world to implement ideas, practical ones that may seem too small to consider. Let’s take this on as a “you asked for it” challenge.
Perhaps, the change that was promised, will be delivered.
A Fatally Flawed Medical Educational Model
This week, many news outlets reported on how residents should be given 5 hours of sleep after working 16 hours straight.
Think about that for a moment.
In what other job — any job in the world — would it be acceptable to even use the term “after working 16 hours.” The 16 hour workday went out with the Industrial era here in the U.S. (Residents can actually be required to be on-call for up to 30 hours at a time on a single shift, which is even more absurd.)
“I can buy a damn good amputation…”
Paul Grundy MD, of IBM, chair of PCPCC, is interviewed in the current Crain’s Benefits Outlook, a business publication about employee benefit programs. This quote alone is worth the price of admission:
I can buy a damn good amputation for my diabetic, but what I can’t get is a good system in place to prevent my diabetic from needing the amputation. We don’t reward a system in which comprehensive coordinated care and robust prevention is valued.
Amen. What are we thinking, insurers, when we fund treatments instead of preventing them??
“The Evidence Gap”: Pharma impedes patient access to better treatment
A lot of effort and study is going into improving healthcare and untangling its cost structure. So methinks it’s nearly criminal when someone blocks adoption of a treatment that’s better, especially when it’s also less expensive.
Case in point, from yesterday’s NY Times: The Evidence Gap: The Minimal Impact of a Big Hypertension Study
The surprising news made headlines in December 2002. Generic pills for high blood pressure, which had been in use since the 1950s and cost only pennies a day, worked better than newer drugs that were up to 20 times as expensive.
The findings, from one of the biggest clinical trials ever organized by the federal government, promised to save the nation billions of dollars in treating the tens of millions of Americans with hypertension.
Six years later, though, the use of [diuretics] is far smaller than some of the trial’s organizers had hoped.
What?? I use diuretics, prescribed by my e-patient doc, Danny Sands. Doesn’t every BP patient? They reduce water content in the body, lowering blood pressure. Why isn’t every BP patient doing this?
Making sense of health statistics
Cross-posted from my own blog, with a late p.s. from this morning’s paper
When John Grohol read my post the other day about evidence-based medicine, he steered me to a paper worth reading: Helping Doctors and Patients Make Sense of Health Statistics.
This is relevant to the e-patient movement because as you and I become more responsible for our own healthcare, we need to be clearer about what we’re reading. Plus, it appears we could be more vigilant about what our own professional policymakers – and even our MDs – are thinking.
The paper is 44 pages, but even the first few will open your eyes to how statistically illiterate most of us (and them) are. Consider this question, which was given to 160 gynecologists:
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How can we have informed patients, if hospitals won’t inform?
This post is prompted by a horrid subject: how do we as a society deal with one of the worst possible events – a death in our healthcare system?
The immediate topic is a 37 year old woman who died last week at Beth Israel Deaconess Medical Center (BIDMC). An article in today’s Boston Globe discusses the hospital’s policy of openness about everything, even including tragedies. I think this policy is vitally important, though potentially very risky, and I want to say why I believe it’s so important.
The question that will make a difference is: What policies, what problem-solving approach, can possibly pull the American health care system out of the tangled, knotted, entrenched mess that it’s become?
“How to Take American Health Care From Worst to First”
What do we think of THIS?? An op-ed piece in the NY Times:Billy Beane, GM of the Oakland Athletics, suggests using baseball-style number-crunching to improve healthcare, with Newt Gingrich and John Kerry co-authoring the piece. Some snips:
“Remarkably, a doctor today can get more data on the starting third baseman on his fantasy baseball team than on the effectiveness of life-and-death medical procedures.”
“Franchises have used this data to answer some of the key questions in baseball: When is an attempted steal worth the risk? Whom should we draft, and in what order? Should we re-sign an aging star player and run the risk of paying for past performance rather than future results?
“Similarly, a health care system that is driven by robust comparative clinical evidence will save lives and money. …”
One Doctor’s Prescription for Fixing U.S. Healthcare
John Grohol initially posted this in our “Found on the Net” sidebar, but I clicked through, and I think it’s important enough that it belongs as a main post. (Short doesn’t imply sidebar.) I’m particularly drawn to “equal rights for physicians,” something my gut has told me for years but which hasn’t been mentioned much. - e-Patient Dave
While many remedies for America’s ailing healthcare system have been proposed, you don’t often see them coming from physicians. Elizabeth Pector’s proposal for fixing it is now available. It promotes 12 ideas, including those such as a “Medical Home” model and “equal rights” for physicians.
white paper
e-Patients:
How They Can Help Us Heal Healthcare
