Musings on Medicine and the Health Care System

Elective Deliveries: A Sign of a Healthcare System Out of Control

My husband is always getting on me about the number of tabs I have open in my browser at any one time. I think one time I had more than 100 open.

Within the past few days, at least 10 of those tabs dealt with the same topic: medical tests and procedures that we either don’t need or that don’t work. There are simply too many for a single blog, so I’m focusing on one here and will write more about others in the coming days.

The lucky winner? Births.

Seems like an obvious medical procedure, doesn’t it? Baby is delivered when mom goes into labor or, if problems develop or mom goes over her due date, labor is induced. So why, as  Kaiser Health News recently reported, are 10 to 15 percent of U.S. babies  delivered early without medical cause, up to 40 percent in some hospitals?

Early delivery increases the risk that the baby will have feeding and breathing problems, infections, and developmental problems, requiring a stay in costly neonatal intensive care units. It also increases the risk that mothers will need caesarian sections (indeed, many of these births are scheduled c-sections).

Why the early deliveries? Convenience for … Continue Reading

Labels:
fraud get better health healthcare costs healthcare reform healthcare system; ineffective procedure payment Uncategorized waste

A Product Label for Pregnancy

 

I just learned that the European version of the FDA is holding a three-day meeting this week to review the safety of the most commonly used contraceptives in the world: combined estrogen/progestin birth control pills (full disclosure: my husband works for a pharmaceutical company that sells this type of contraceptive). The French government recently announced that it is not going to pay for these oral contraceptives and want some taken off the market because of a perceived increased risk of venous thrombosis, blood clots that can travel to the lungs.

In addition, the FDA recently required manufacturers of these drugs to add a “black box” warning about the increased risk. However, two well-designed studies found no increased risk between these third- and fourth-generation contraceptives and earlier generation birth control pills.1,2

The reality is that all forms of estrogen-containing contraception, whether pill, patch, or ring, carry a risk of blood clots. Generally, 6.29 women out of 10,000 women using these forms will experience a clot versus 3.01 in nonusers.3 The risk is highest, however, in women over 35 who smoke or have hypertension.

Plus, those supposedly “safer” birth control pills have side effects that cause women to stop taking them, such … Continue Reading

Labels:
Uncategorized

The Hidden World of Depression

The teenaged daughter of a good friend was just hospitalized for depression. Yes, depression.  Not cancer. Not some runaway infection. Although in my mind, depression is both. A cancer that destroys your life from the inside out and an infection that, if not treated early and well, becomes resistant to the best therapies and turns septic.

I talked about my own depression a bit in an earlier blog. But the situation with my friend’s daughter  reminded me again of how differently we respond to a mental illness than a physical illness.

For instance, as this girl was being driven to the hospital, her brother left her a voice mail telling her, basically, to “buck up.” To get her act together and “beat this.” Once the girl was out of immediate danger, her grandmother emailed and said she hoped she could “get her life on track” since she had so much promise.

Um, people. This girl was not out stealing cars, shooting up drugs and failing school. She was caught in what I can tell you from personal experience is a quicksand of apathy and pain into which, unless you are by the miraculous combination of medication and therapy pulled out … Continue Reading

Labels:
Uncategorized

Healthcare Reform 2.0: Five things you need to know to grow your business in 2013

How much do you know about healthcare reform — and I don’t mean just the Affordable Care Act (aka “Obamacare”). I mean the coming tsunami of change that has the potential to completely revamp one of the most dysfunction systems in our country (as you know from reading my blog).

Do you know. . .

Why we need healthcare reform? What healthcare reform means for your employees and employer? How healthcare reform will change your interactions with the healthcare system? How healthcare reform may make it safer for you to get sick? Why healthcare reform will save you money?

If you can’t tell me the answers to these questions, then you need to block off 1-2 p.m. (eastern) February 5 for my webinar: Healthcare Reform 2.0: Five things you need to know to grow your business in 2013. You can also view it on demand.

And, as a “thank you” for reading this blog, I’ll give you half off the registration fee. Just use code GS12713 when you register.

 

Labels:
Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; managed care Obamacare patient-centered healthcare payment

Customer Service: Mexican Resort, Doctor’s Office, or Hospital—It’s All the Same

Just back from the nearly-didn’t-happen Cancun vacation (thanks so much for everyone’s well wishes and sympathies re: the passport saga). The resort was lovely and the vacation fabulous. And yet, we won’t return to that property. Why? A couple of customer service snafus that never should have happened.

This is an all-inclusive resort (read: all food, alcohol, tips and activities are included in the price). The resort has five dinner restaurants plus a large buffet and touts its “reservation-free” policy. So imagine my surprise when it announced that if you wanted to ensure seating at one of the restaurants or the “special” buffets for New Year’s Eve, you had to make a reservation, rather than the first-come-first-served policy that had been in place all week.

This wouldn’t have been a problem except that, in order to make a reservation, you had to purchase one bottle of wine for every two people from the “premier” wine list (think $75 and up). Can you say, “bait-and-switch?” Needless to say, hundreds of guests, including my family and me, were furious.

Other snafus? Tip jars in plain sight, employees soliciting tips, and horrendous, yes, bad-enough-to-make-me-walk-out, service in one of the restaurants. It wasn’t a … Continue Reading

Labels:
customer service healthcare system;

What Losing My Passport Taught Me About the Goodness in People

(Disclaimer: this blog is not about the healthcare system. We will return to our regularly scheduled programming after the holiday).

My family and friends will tell you that I’m not the most, um, patient person in the world. That I can be, well, somewhat “abrupt” with people, particularly bureaucrats and customer service people. It’s something I’m trying to change, though.

I made this resolution a couple of months ago after spending several days with my friend Alisa, who has been learning about and trying to live her life according to Buddhist principles. What principles? Simple things, like: Do no harm. Listen to people. Slow down. Be in the moment. Recognize that other people’s happiness is just as important as your own. And don’t kill bugs, even when you find a large spider in your bathroom.

Many of you know the saga of the lost passport and delayed trip to Cancun, where, for the past two days, my husband, our three sons, one son’s fiancé, and one son’s girlfriend have been soaking up the rays and rum on what was supposed to be the trip to celebrate my 50th birthday.

The good news is that I got a new passport, thanks … Continue Reading

Labels:
customer service Goodness of people

What a Lost Passport Taught Me About What’s Really Important

I write this while sitting on the couch in a Residence Inn outside of Washington, DC watching a Soprano Rerun and eating bad Chinese food.

  This is not where I’m supposed to be. I’m supposed to be at a beautiful resort in Cancun with my husband, our three sons, one son’s fiancee, and one son’s “I hope-she’ll-eventually-be-the-fiancee” girlfriend celebrating my 50th birthday.

I decided to do this trip and bring the tribe along because this family is the best thing I’ve ever done. I  could think of nothing better to celebrate  my half century mark than giving a gift to the people I love most in the world to thank them for the gift they’ve given me.

Then last evening, while pulling everything together for the trip, I couldn’t find my passport. I’d used it to renew my driver’s license last week, and as ID at the hotel where we stayed for Christmas. And now it was gone.

We tore the house apart. Nothing. The hotel couldn’t find it. It had vanished. I don’t think I’ve ever felt so powerless in my life.

The kids and husband left early this morning for Mexico. And I tried as hard as … Continue Reading

Labels:
cancer cancer drug healthcare system; illness

Guns, Yes, But What About Mental Health?

I’ve been treated for major depression for 22 years.

I tell you all this because it’s time that those of us with psychiatric diagnoses cut the  chains of stigma that keeps mental illness locked in a closet, relegated to whispers, viewed as a sign of weakness, poor parenting, indulgence. Just as it’s time to have an honest discussion about gun control in this country, it’s also time to have an honest discussion about our mental health system.

We still don’t know if Adam Lanza, who killed 26 women and children last week and then shot himself, had been diagnosed with a psychiatric disorder. But I’m pretty sure there is a mental illness in there somewhere. I’m pretty sure his mother went through hell trying to find him treatment and help. And I’m pretty sure she was stymied at every turn.

I know this because I’m watching my friend go through the same thing with her 9-year-old son. Like the heartbreaking essay by Liza Long now circulating widely on Facebook, my friend has a son with serious mental health issues. One day he’s a lovely, smart, kind little boy. The next he’s completely out of control, a danger to himself and … Continue Reading

Labels:
violence

Ballistic Trauma–and 26 Dead

It’s called ballistic trauma. That’s the medical terms for getting shot. With a gun. Any gun. But these days, I’m thinking, we need to come up with some new term, something that describes the unimaginable horror that happened in Newtown. And Aurora. And Blacksburg, And about 15 other places in the past few years.

Do you know what happens when a bullet enters the the human body?

I didn’t either until I looked it up. Nor did I realize that there’s actually a field of study called “wound ballistics,” devoted to measuring and tracking the gruesome results that come from the kinetic energy of a bullet fired into a living thing.

There are two reasons for such study: to identify the best way to kill someone, and to help surgeons better understand the damage a bullet causes so they can try and repair it. You can actually read a chapter about this, courtesy of the Department of Defense.

Here’s what the chapter says: “With the perfection of guns that could shoot high-velocity missiles came the observation that the resulting wounds appeared as though they had been caused by an actual explosion within the body. External signs of injury were often … Continue Reading

Labels:
Uncategorized