Musings on Medicine and the Health Care System

Preparing for a (Gulp!) Colonoscopy: What It Says About Our Healthcare System

As of November 30, I am now, as my gastroenterologist puts it, 39 + 11 years old. You know what that means! So, a couple of weeks ago I called his office to make an appointment.

I would have preferred to simply make the appointment online or even e-mailed the office, but since the practice didn’t offer this, I fought my phonaphobia and punched in the numbers. Of course, I went through five prompts before getting a live person and was put on hold for a few minutes. About 10 minutes later, I finally had my appointment.

I was told to arrive at 2:30 p.m., which I dutifully did. Then the receptionist gave me a stack of paperwork to complete. And a pen. Among the information I had to provide:

• My husband’s Social Security number, since our insurance comes courtesy of his job. Not sure why this was needed, since the receptionist made a copy of my insurance card, which has all pertinent information on it. Not to mention that in this day and age of identity theft, I don’t like giving out Social Security numbers to anyone. But the last time I refused to provide a Social Security number … Continue Reading

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Affordable Care Act customer service doctor offices get better health good health health insurance healthcare costs healthcare reform healthcare system; patient-centered healthcare prevention

Have a Concussion? There’s an App for That

If my best friend’s daughters weren’t finished with the high-level soccer they used to play, I’d know exactly what to get her for Christmas—the concussion app I saw yesterday here at the mHealth Summit in Washington, D.C.  The app, one of hundreds being demonstrated at the mobile health conference, is marketed by the psychological assessment company Par Inc. It is targeted toward parents and coaches of youth soccer teams who, it turns out, are often the “first responders” when a child is injured. They have to be: many youth teams do not have athletic trainers at the field.  Yet, between 100,000 and 140,000 children and adolescents are treated in emergency departments each year for concussions, with an estimated 2.5 concussions occurring for every 10,000 athletic exposures in this age group. Today we know that concussions are far from benign. Indeed, left untreated, the child can suffer significant cognitive deficits. The app leads users through a series of prompts describing the child’s symptoms (what the parent/coach observes) and signs (what the child describes), runs the results through an evidence-based algorithm, then delivers a recommendation. In some cases, the message is “call 911!” and touching the “911” on the screen immediately connects you … Continue Reading

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concussion

mHealth: Changing the Paradigm of the Doctor/Patient Relationship

I’m in Washington, D.C., at the mHealth Summit, and what I’m hearing is so exciting I had to share. For those who don’t know, mHealth—or mobile health—is the hottest thing happening in health care, with the power to completely transform our healthcare system.

The overriding goal is to untether providers and patients from the requirement that our interactions occur face-to-face and enable us to interact in real time, whenever we want. It goes deeper than that. Wireless technology can even monitor our health without a healthcare provider involved.

Don’t believe me? How about a tiny device for your iPhone that monitors your heart rate, pulse, blood pressure and even movements, then runs the data through a complex algorithm and alerts your doctor or nurse if there’s a problem? This is a real app being demonstrated here.

So why have I unchained myself from my computer and come out into the world for three days? Because I’ve been hired to write a book on mHealth for two physicians and a consultant with a large healthcare organization. It’s one of the most fascinating projects I’ve worked on in a long time, and I’ll be writing more about it here. It’s fascinating … Continue Reading

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healthcare system;

Please Get Out of My Uterus

My first contraceptive was an IUD. But if I worked for a religious organization/company that provided my health insurance there’s a good chance I’d have to pay the $500 to $1,000 an IUD costs myself because my employer-provided health insurance–for which I pay a premium–wouldn’t cover it.

That’s what a federal judge ruled last week when he granted a preliminary injunction filed by Christian publisher Tyndale House to exempt IUDs and emergency contraception (Plan B) for its employees (read: women). Why? Because, the company claims, they are forms of abortion (note: this blog is not a treatise on whether abortion is right or wrong).

So if I read the ruling right, it means that if I work for Tyndale, and I either can’t use or choose not to use hormone-based contraception, I have to fork up a substantial chunk of change for an IUD. And, for the record, an IUD is also prescribed for women with heavy menstrual bleeding–even those who don’t need contraception. Will the company also withhold coverage for this indication?

In addition, if I’m raped, or the condom broke, or I forgot a couple of pills, or my partner didn’t use a condom, or there was … Continue Reading

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abortion contraception health insurance IUD Plan B Tyndale House

Want to Reduce Cancer Deaths? Give Everyone Cancer

I stole that headline from an amazing op-ed in Thursday’s The New York Times written by the co-author of what will likely be one of the most provocative medical studies published in years.

For their study, published online last week in The New England Journal of Medicine, the authors used trend data from the National Health Interview Survey on the proportion of women 40 years of age or older who underwent screening mammography, then compared those numbers against data on breast cancer incidence and survival rate.

They found that 1.5 million more women have received a diagnosis of early-stage breast cancer since the introduction of screening in the 1980s, but there was no change in the number of women with life-threatening metastatic breast cancer. This means that screening, which, as the authors point out, is touted as one of the most important thing women can do for their health and credited with saving millions of women from death from cancer, is neither. Plus, the data they relied on was produced before today’s more advanced mammography techniques, which are capable of picking up even earlier cancers.

So how to explain the drop in breast cancer deaths over the past 30 years … Continue Reading

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cancer mammograms

Would You Pay an Extra 4 Cents Per Pizza to Provide Health Insurance to Thousands?

A good friend of mine emailed me the other day to say that she is “so sick of listening to business owners whine about Obamacare.” So this blog is for her.

She was referring to the news that restaurants like Papa Johns, Applebee’s, and the parent company of Red Lobster and Olive Garden announced  they would cut employee hours, close restaurants, lay off employees, and stop hiring new employees because the Affordable Care Act (ACA) requires that companies with 50 or more employees provide health insurance.

A bit of background: Beginning in 2014, the ACA (and, for the record, I find the word “Obamacare” derogatory to one of the most important legislative acts since Medicare) requires that nearly all Americans have health insurance. Low- and moderate-income Americans will either receive coverage through Medicaid or receive government subsidies to buy health insurance through virtual marketplaces called health insurance exchanges, or to help cover the cost of employer-provided insurance. (Don’t worry, I’ll blog about those exchanges in a future post).

But the majority of health insurance in this country is provided by employers, so the ACA contains contingencies to ensure  those companies don’t suddenly drop health insurance as a benefit. Businesses with … Continue Reading

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Affordable Care Act Applebee's employer mandate Obamacare Papa John's

Rational Rationing

Full disclosure: I stole that headline from an article on Pharmalot that triggered this blog. It reported on a New York Times op-ed piece by doctors at Memorial Sloan-Kettering Cancer Center in New York City about why the hospital won’t use the newly approved drug for metastatic colorectal cancer, Zaltrap.

Their reason? The drug is not any better than the currently used treatment, Avastin, and it costs more than twice as much, about $11,000 for a month of treatment.

Rational? Yes. Rationing? No.

It’s not rationing because patients can always go to another hospital and get the drug, which I know they’ll do because in this country we believe “new” is always better in medicine.

I saw this in action when I was a newspaper reporter (remember newspapers? You held them in your hands and got ink on your fingers?). Back in the day, I covered the “bone marrow transplant” story. This was when women with breast cancer demanded  bone marrow transplants even though there was no evidence that this highly toxic, highly dangerous, extremely expensive approach worked. Since the procedure was considered investigative, their insurance companies refused to pay for it. The women sued insurance companies, went to the … Continue Reading

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cancer drug healthcare costs Memorial Sloan Kettering rationing Zaltrap

Why We Need Death Panels

Well, not death panels per se, but a shift  from our insistence that death is something we can defeat with technology to an understanding that, despite our best efforts, the death rate in this country is still 100 percent. The only question about our death is whether we are in charge, or whether we want to cede that power to our families and doctors who,  evidence shows, are often reluctant to give up, particularly when there are more tests, treatments, and expensive technology to throw at patients.

Two personal stories vividly illustrated this disconnect. Last year, doctors removed the breast of my husband’s 80-year-old aunt and started her on chemo when she was diagnosed with cancer, despite the fact that she has late-stage dementia.

And doctors are treating–albeit not aggressively–the early-stage vulval cancer my friend’s 90-year-old mother-in-law was recently diagnosed with.

And yet, a survey of nearly 1,700 California adults found that while more than 80% of patients think it’s important to have their end-of-life wishes in writing, less than a quarter did. Only 8% said a doctor had ever talked to them end-of-life issues.

Talking to patients about end-of-life issues could improve the way they die. So why … Continue Reading

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end-of-life care

Patient-Centered Healthcare–NOT!

Just back from Seattle where I gave a presentation to the Northwest American Medical Writer’s Association chapter on branding and customer service. Talk about relevant! Because boy, do I have a healthcare-related customer service story to tell here.

Remember the tooth saga? About a month ago I requested that all test results from the ER and hospitalization related to that fun time be put into my electronic medical record. Why I had to request them I have no idea; they are, after all, my results, right?

In reviewing them, I noticed that three fasting blood sugars–one in the ER and two in the hospital–were very high. I’m talking diabetes high. I figured it was likely due to the infection, but I followed up with my doctor, who brought me in for a visit. He agreed they were high and ordered blood work. Then, when I reminded him that my father had died  young from pancreatic cancer, suggesting a family history, and that new-onset diabetes in someone with no risk factors could be an early sign of pancreatic cancer, and that I’d recently and unintentionally lost 25 pounds (yay!), he ordered an abdominal ultrasound.

Blood sugar came back fine. I had … Continue Reading

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customer service patient-centered healthcare