Doctors Are Angry. I Get That. But . . .

surgeonI knew this would be the toughest audience yet in my three years of teaching/speaking about the US healthcare system and healthcare reform. I even put on a flak jacket at the beginning of my talk as a way of breaking the ice (and protecting myself; I mean, these guys pack scalpels!). And I made it through the two-hour talk and their anger without losing my composure or my sense of humor (thank god for that sense of humor).

Now I’m sitting in the airport waiting for my flight home and find myself tearing up. Not because the doctors were mean or cruel — they weren’t — but because of how much distance there is between  reality and perception, how much anger is out there, how too many people rely only on anecdotes and commentary instead of facts to develop opinions, and how scary it is to look at where we are and where we need to be — and realize that, more and more, it is unlikely we will ever get there given the rhetoric and anger in this country.

The doctors this morning, most of whom have been in practice … Continue Reading

ACA Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; malpractice insurance Obamacare patient-centered care patient-centered healthcare Uncategorized

74 and Counting. . . Why Gun Control is a Public Health Issue

Screen_Shot_2014-06-10_at_1.48.46_PMThis map shows every school shooting since December 14, 2012–the Sandy Hook Elementary School massacre. Don’t bother counting — there are 74. The only reason the map won’t break 100 in the next two months is that school is out for the summer.

Certainly, this is a moral issue. And a political issue. But first and foremost, the issue of gun control is a public health issue.

As the Johns Hopkins Center for Gun Policy and Research notes: “More than 31,000 people a year in the United States die from gunshot wounds. Because victims are disproportionately young, gun violence is one of the leading causes of premature mortality in the U.S. In addition to these deaths, in 2010, there were an estimated 337,960 non-fatal violent crimes committed with guns,2 and 73,505 persons treated in hospital emergency departments for non-fatal gunshot wounds.” Other fun facts from the Center:

The homicide rate in the U.S. is seven times higher than the combined homicide rate of 22 other high-income countries because the firearm homicide rate in the U.S. is 20  times greater than in these … Continue Reading


Why Do We Wait in Doctor’s Offices?

indexI’m writing this from the airport awaiting a flight to New York for a business meeting. My flight is delayed 90 minutes, but that’s ok, because before I even left for the airport I received two texts from Delta updating me on its status so I could time my departure accordingly.

Compare that to the friend I wrote about in yesterday’s blog. She waited more than two hours to see the doctor . Another friend spent an hour past her gyn appointment time in the waiting room, then another hour naked, in the cold examining room with only a paper gown for warmth, waiting to be seen.

If I took a poll of my readers, I guarantee 100 percent can share a similar experience. I, for one, have walked out after an hour. I now have a policy of walking out after 30 minutes unless the appointment is for an emergent issue or the office kindly slotted me in.

Yes, I know that doctors get behind schedule. I know emergencies happen. What I don’t understand is why, in today’s world of instantaneous communication , the office can’t send a text updating us … Continue Reading


Medical Uncertainty: Are You a Glass Half Full or a Glass Half Empty Kind of Person?

indexI’m dedicating today’s blog to my good friend and neighbor who has just spent what I would deem the weekend-from-hell-waiting-for-Monday. You see, what started last week as bad cramps and a feeling of bloating, with the likely diagnosis of ovarian cysts, has now morphed into a visit with a gyn-oncologist today. Very, very quickly.


The Health Benefits of Relaxing

Coffee and  e-newspapers on the screened porch. An hour-long bike ride along country roads lined with wildflowers and cornfields, interspersed with glimpses of the Chesapeake Bay ending at a small sandy beach with a view of the Bay as far as the eye can see. A stroll through a farmer’s market with the dog. Lunch and a couple of glasses of wine at a local winery. A two-hour nap in the hammock. Cocktail hour on the dock. Dinner of wild goose breast (shot by  husband and son), snap peas, potatoes, turnips, and rutabagas picked from the garden that morning with husband, son, son’s girlfriend. Knitting and watching a movie. Bed.

That was my day yesterday (which explains why this blog is a day late [I’m participating in a 2014 FLX/WordCountBlogathon, so look for two blogs today]). At first glance, it might seen self indulgent. But let’s look at all the health benefits of my day.


Coffee. Studies find reduced risk of mortality, particularly from heart disease. Protects against Parkinson’s disease, type 2 diabetes and liver disease, including liver cancer; improves cognitive function and decreases the risk of depression. Bike ride. … Continue Reading


Why Can’t I Buy Health Care Like I Can Buy a Car?

Just back from buying a new (well, 2-year-old) car (Ford Explorer, silvery green, all the bells and whistles and, get this, it even tells me how many miles I can drive given the amount of gas in the tank!). So forgive the short post, but, as most of you know, buying a car is downright exhausting (oh, and did I mention the two glasses of wine the husband and I drank to celebrate after?).

Yet here’s the thing. . . we bought our car at Car Max and I knew exactly how much that car was going to cost before I signed on the dotted line. I also knew the quality of the car (based on its history) and everything the car included (did I mention the rear camera and air conditioned seats?). The dealer also gave me a warranty — if something went wrong in 30 days, they would fix everything, no questions asked, no out-of-pocket payment on my part.

Let’s compare that to the CT scan I had a few weeks ago (and wrote about here). I had no idea what it would cost. Was given no opportunity to … Continue Reading


Surprise! Canadians Are NOT Flocking to Our Shores for Health Care

(If you’re wondering about the sudden flood of blogs. . I’m trying to blog every day for 30 days as part of a blogathon).

Picking up on yesterday’s blog about national health care in the United Kingdom, we now turn our attention to our northern neighbors in Canada. Where, we hear, residents are forced to flee their country and come to the land of the free and the brave in search of timely, quality medical care.

Except they don’t.

A 2002 study published in Health Affairs put that assumption to the test and found that relatively few come south and those that do usually have family in the states.

I think the researchers put it best:

“All of the evidence we have, however, indicates that the anecdotal reports of Medicare refugees from Canada are not the tip of a southbound iceberg,  but a small number of scattered  cubes. The cross border flow of care-seeking patients appears to be very small.”

“Indeed, the numbers found are so small as to be barely detectible relative to the use of care by Canadians at home.”

Oh, and from another study comes this finding about … Continue Reading


Why are we so divided?

I just finished teaching a class at the College of William and Mary on the US healthcare system. Of course it included a session on the Affordable Care Act. But before I could teach about the ACA, I had to teach about our system itself and its problems.  After all, how can you understand the need to improve things if you don’t understand the underlying problem in the first place? So here is the Cliff Notes version.

We spend more per capita than any other industrialized nation and yet are at the bottom on nearly every indicator of quality.(1) As the Institute of Medicine noted: “Much of health spending does little to improve health and. . .may be associated with poorer health outcomes.” Since 1945, the rate of healthcare costs in this country has risen so far above the rate of inflation, that if other prices had risen as much a dozen eggs would cost $55. The federal government spends more on health care than on defense. Medical errors in this country are so prevalent that they are now the third leading cause of death behind heart disease and cancer.(2) We waste $1 billion a year on overtreatment, errors, excessive … Continue Reading


The FDA and Plan B: Another Epic Fail

UPDATE: The Justice Department appealed the New York ruling tomorrow and asked for a stay on the order to make Plan B available to all women over-the-counter. Another epic fail!

I’m not happy with the front-page news that greeted me this morning: The FDA has agreed to make Plan B, aka, emergency contraception, available over the counter for girls as young as 15, although all women will have to show an ID. Previously, you had to be 17 to access it without a prescription and even older women had to ask a pharmacist for it, which is not only embarrassing, but the pharmacist could refuse to provide it and, if the pharmacy was closed, she was out of luck.

So I do have to (grudgingly) applaud the FDA for at least getting rid of the pharmacy requirement. Given that many drugstores are open 24 hours a day, women will now have access to Plan B when they need it. But the rest of the ruling. ..meh.

I’ve written about the Plan B controversy before, when the FDA recommended it be available over the counter with no age restrictions and when, in a highly unusual, this-never-happens-move, Health and Human Services Secretary … Continue Reading