Musings on Medicine and the Health Care System

Why I Fired My Doctor

I fired my doctor few weeks ago. The reason has a lot to do with what’s wrong with our healthcare system today while the new doctor I hired has a lot to do with what could be right with our healthcare system.

I write a lot these days about something called a “patient-centered medical home.” It enables patients to access care when needed; communicate in a variety of ways with their physician, including email; and be treated as a partner in their healthcare rather than a subservient patient—subservient to the doctor, of course. In a patient-centered medical home, your medical records are accessible, typically on line, and all test results are communicated within 24 hours of receipt.

I’d been seeing an internist in a small private practice for the past six years. He practiced with his wife, a family practitioner, who saw our kids. Initially, all was good. I could get appointments as needed; was treated respectfully; and received good care. But gradually I began to notice that it was harder and harder to get in to see this doctor during the week—often because the office was closed. I became frustrated when I couldn’t communicate with him except by playing … Continue Reading

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A Tale of Lost Luggage–and Its Implications for Health Care

One of the hot phrases in health care these days is “patient-centered,” as in “patient-centered hospitals,” “patient-centered practices,” and “patient-centered medicine.” For all of you out there working on creating such “patient-centered” systems, let me provide a bit of advice based on a recent experience my family and I had with Delta Airlines. For if you substitute the word “customer” for “patient,” you get what every business, whether in health care or not, should be focused on — the person receiving, nay, purchasing, their services. The ones you hope will return, again and again.

I’m actually writing this as I sit in the lobby of a hotel in Park City, Utah. It is a gorgeous day outside, crisp and cold, just perfect for the skiing my family had in mind when we booked this trip; it’s a short trip– just 3 days on the slopes before we head home — so every minute counts. Unfortunately, despite plenty of time sitting in airports yesterday (i.e., no tight connection), only 2 out of our 6 pieces of luggage made it here. Fortunately, one of those was the suitcase filled with skiing togs. Unfortunately, one of the missing pieces was my son’s new … Continue Reading

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Plan B: Another Double Standard

For what appears to be the first time in history, the head of the Health and Human Services Department has overturned a decision by the FDA. Was this regarding a drug that was so potentially dangerous it could kill or permanently maim people? A drug for which we have little clinical trial evidence or history? A drug that is produced in appallingly unsafe conditions?

No. It is a drug–actually, a single pill–for which we have years of safety and efficacy data, that is exceedingly safe and easy to use, and, get this — doesn’t even require a prescription from a doctor–if you’re 17 and older.

What it does is require is that the patients buying it be at least 17 years of age and head to the back of drugstores to give their names and identification to a pharmacist before receiving it. Oh, and if the pharmacist doesn’t want to provide it, he/she doesn’t have to. And it does require a prescription for those 16 and younger.

It’s Plan B, aka “emergency contraception.” All its manufacturer was asking was that we stop requiring that women who need it — those who had unprotected sex, missed a couple of birth control … Continue Reading

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Messing with Success: Leave Medicare Alone!

I’m listening to the news at the tail end of a beautiful Friday afternoon and I am so angry I could spit. I just heard about the new budget plan passed by the House which calls for requiring Americans 65 and older to use “vouchers” to purchase private health insurance in 10 years and works to dismantle one of the most successful healthcare programs in the world — Medicare.

Yes, you heard me right, Medicare. Because the reality is that Medicare does a pretty decent job of covering core health care needs of a large component of American society and, because of its size, is the only health insurance program in the country that can literally change how medicine is practiced through its policies.

Yes, there is fraud and waste. But we are also getting better at reducing it. But to turn millions of older Americans loose onto the commercial health insurance market and expect it to translate into cost savings is one of the most ludicrous, ridiculous things I’ve heard in my more than 25 years of writing about health care in this country. Here are just a few reasons why:

1. Medicare beneficiaries already have the ability to … Continue Reading

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Happy Birthday Health Reform!

Who would have thought when we first looked upon you a year ago, barely formed, still somewhat embryonic, that you would have grown so much in just a year, and created so much, well, trouble? Yes, I’m talking about you, health reform. After all, aren’t you the reason for the sea change in Washington? Aren’t you behind several pending appeals that will get to the Supreme Court? Aren’t you the reason that the country is going to hell in a handbasket?

But wait. Let’s look at some other major milestones of the past year.

— You sent $250 checks to Medicare beneficiaries to help cover the “donut hole” in their drug coverage.— You created special insurance pools designed to provide health care NOW to people with preexisting conditions who can’t get coverage.— You allowed parents to keep their kids on their health insurance until the children turn 26, providing a major safety net. — You did away with lifetime caps, enabling those with some serious medical conditions to continue receiving health insurance.

And that’s just in a year. Imagine what the next year and the year after that will bring. So I’ll say it again, Happy Birthday, Healthcare Reform. … Continue Reading

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Why are we so afraid of death?

My cousin’s mother-in-law is in her late 90s. She had horrible osteoporosis and can barely move. She has little cognitive function left. She requires nearly 24-hour care and no one would even attempt to say she has any quality of life left. She told her son years ago that she was “ready to go,” and had had enough.

And yet when I asked my cousin’s husband if his mother had any do-not-resuscitate orders, or had ever completed an advanced director  outlining her wishes of what kind of end-of-life care she wanted, he said no. His sister, he said, just wasn’t ready for that yet. So what, I asked, will you do when/if your mother gets pneumonia? Will you treat it with antibiotics? Will you put her on a respirator? If she is no longer able to eat, will you feed her through a tube?

He couldn’t answer. And he was clearly uncomfortable with the questions.

Therein lies the rub. These are conversations that this woman, her doctor and her family should have had years ago. Heck, I’m only 48 and yet my husband and I completed our durable powers of attorney and advanced directives outlining our end-of-life wishes years ago. … Continue Reading

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Quote of the Day

“With this disappointing decision, the FDA has chosen to place itself between patients and their doctors by rationing access to a life-extending drug. . . We can’t allow this government takeover of health care to continue any longer.”

That quote, courtesy of this morning’s Washington Post, incensed me to such a degree that I am writing this blog despite the two deadlines I have today. The speaker is Sen. David Vitter (R-La). The “disappointing decision” he refers to: The FDA’s decision to remove the breast cancer indication for Avastin (bevacizumab).

I wrote about this earlier, and you can read the post here, but that was before yesterday’s decision. I’m not going to comment here on the benefits or risks of Avastin. . . except to say that I’m sure there are individual women who are alive today because of it, and, quite possibly, individual women who are dead today despite it. But that’s not how we do medical science, based on individual patients. We do medical science based on large clinical studies (which are often designed with and approved by FDA officials). It’s not a perfect system, but it’s the system we have.

For more than 50 years, that system … Continue Reading

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