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Health Care Education

More News in the Global Obesity Crisis

 According to the AMA, obesity is now a disease. Setting aside the particular condition, this decision reminds us that the concept of “disease” is complex, as are the social constructs attached to the disease label.

For example, the disease label may imply responsibility or lack of same by the person who has it. And in fact the person with a disease often attains the label of “patient.” Being a patient implies to many that they are passive recipients of care by the health care system rather than personally responsible for engaging in choices and behaviors that reduce or eliminate the condition. Diseases often carry with them stigma and shame, legal exculpation from responsibility, employer obligation to accommodate, insurer/government obligation to pay for and so on.

Expect this decision to generate considerable debate, emotions, and both intended and unintended consequences. Read more…

A profound article, and must read for all patients and physicians

By Brian L. Grant MD

This article on doing no-thing is the best medical article I have read in some time. Properly applied, this technique would do more to solve our health care crisis than all the PPO discounts, new drugs, payment reforms or other interventions and improvements to our system. Doing no-thing, properly applied would reduce prescriptions of unnecessary harmful drugs, surgery, diagnostics, and more. So much of health care is not necessary. Sometimes this can only be learned in hindsight, but often it is obvious from the start.

Doing nothing is perhaps a bit of a misnomer. The act of listening, empathizing and caring – when active interventions are not of benefit to the patient.

The comments on this article are well worth a read. Some are highly critical of the author and others are most supportive. Read more…

How Budget Conscious Doctors Can Lower Health Care Costs

When shopping, people tend to search for the best deal with the greatest value. But when it comes to receiving health care services, why is the price tag never a clear part of the discussion?

After TIME Magazine featured the report “Bitter Pill: Why Medical Bills Are Killing us,”  Cleveland Clinic CEO Dr. Toby Cosgrove argues that one potential cause of  out-of-control healthcare costs may be that doctors often have no idea how much medical procedures actually cost. He argues that by informing doctors about the specific costs of health care procedures, doctors may try to find more cost-effective alternatives.

And in a new study by Johns Hopkins published in the journal, JAMA Internal Medicine,  researchers showed that informing doctors of the cost of tests, services, and supplies they use actually can lead to hefty medical savings.

The researcher split physicians into two groups over the six-month experiment to see if showing the tests prices would change a physician’s decision about services.  One group was given the tests with prices on them, while the other group’s tests did not have a price.

The researchers compared the buying behavior of the physicians and found that showing the pricing information resulted in a 9% cut in use of the tests overall and a savings of over $400,000 over the six months. By comparison, there was a 6% increase in the use of the tests without pricing information over the same time period. Read More…

The researchers say the savings can be largely credited to the simple principles behind comparison shopping.

To challenge this theory, CEO Dr. Toby Cosgrove decided to make it a point to deconstruct the costs of their top three procedures, record the price of sutures, the number of instruments uses and record how long patient’s spend in post-anesthesia care.

“Take, for example, nitric oxide, a drug commonly used in heart, lung and chest surgeries to keep tissues well-supplied with oxygen during the operation. When it’s effective, it’s very effective, but it doesn’t help all patients. When we realized we were spending $2 million a year on the drug, we drilled down to see who was using it and why.

We found that doctors and OR staff did not have a standard protocol to guide them on when and how much to rely on nitric oxide; we had to educate them that if the drug didn’t work within a half hour of being administered, it won’t work at all, so repeated doses were wasteful. The result: nitric oxide use dropped by half, saving $1 million without any adverse effect on patient care,” Dr. Cosgrove said.

Read More…

When his team saw where they could easily cut costs, they made a goal to save $100 million in a year by focusing on what and how they use equipment and supplies they purchase. Within a year, they topped their $100 million goal and after three years have saved $155 million.

And while it’s crucial that quality of health care services always comes before price, it is equally important to realize that even the smallest cost saving practices create a monumental difference in our costly health care system.

Job Prospects for Radiology Graduates in Decline

A recent MCNTalk article describes changing perceptions and beliefs by U.S. doctors.

This New York Times posting “Job Prospects are Dimming for Radiology Trainees,” describes major disruption in the field of radiology – once one of the most coveted specialties from a compensation and lifestyle standpoint.

Recent radiology graduates with huge medical school debts are having trouble finding work, let alone the $400,000-and-up dream jobs that beckoned as they signed on for five to seven years of relatively low-paid labor as trainees….

“The times of graduating from medical school and driving a Porsche are done,’ said Dr. Dana Lowenthal, a first-year radiology resident and fourth-generation doctor. “It was never easy, but there was light at the end of the tunnel. This is new territory.” Read More…

A reader may feel a certain disconnect when noting that the 10% decline in average radiologist income still places them in the top echelons of the nation and are double that of primary care doctors. But it would appear, as we are seeing a similar trend with new law school graduates, that the prospects for new radiology trainees are far less promising. And that technology and payer behaviors, especially Medicare, are having a very disruptive impact on the profession.

Many U.S. Doctors Appear Alienated From Their Profession

By Brian L. Grant MD

The AMA News reports that many physicians are reducing their hours treating patients and in some cases, leaving or considering leaving the profession altogether.

Some decreased productivity is a result of being employed rather than independent. Morale in many physicians is said to be suffering. The causes can be debated, but the phenomenon is real.

When I entered the profession in the early ’80s, physicians prided themselves on autonomy and enjoyed a great deal of respect. Little did my colleagues and I know that U.S. healthcare was in the twilight of an era of professional control.

We have shifted to a world where the “system” is under challenge by many factors: runaway costs, massive engagement by market driven businesses in the technology, device, and pharmaceutical industries, consolidation of hospital groups, buying of physician practices and many other forces.

Physicians no longer enjoy, by and large, the sense of control and respect that once was their domain. To a degree we may have brought in on ourselves and there have been some decent trade-offs made by some. For example, work-life balance for many has become more important than professional power and pride.

The large number of women who have entered the profession (48% of current medical school graduates) have encouraged new models for women and men in balancing work and family. But to the degree this means fewer hours worked, it is equivalent to less care being provided per doctor working. (For more information on women in medicine, see http://www.catalyst.org/knowledge/women-medicine.)
In order to address the growing physician shortage, many solutions are being considered. This includes leveraging the talents of other professionals, altered delivery models, encouraging more medical immigration (to the detriment of the countries who have trained professionals only to see them leave), and striving towards new delivery models using technology and innovation.

In the end, medicine as we knew it may be history.

Read more…

The practice changes physicians are planning in 2012

Practice plan Physicians agree
Continue as I am 49.8%
Cut back on hours 22.0%
Retire 13.4%
Relocate to another practice or community 10.9%
Seek nonclinical job in health care 9.9%
Cut back on patients seen 9.6%
Switch to cash/concierge practice 6.8%
Work part time 6.5%
Work locum tenens 6.4%
Seek job outside health care 6.4%
Seek hospital employment 5.6%
Close practice to new patients 4.0%
Other 5.5%

 

Junk Food is Not an Accident

By Brian L. Grant, MD

Every so often a book is published that impacts how we live or at least how we see our world.

The new book “SALT SUGAR FAT, How the Food Giants Hooked Us”, by Michael Moss may be one of them.

Like “The Jungle” by Upton Sinclair, that exposed the abuses of the meatpacking industry on immigrants in 1906 or “Fast Food Nation” by Eric Schlosser, that helped expose the abuses of factory farming of animals that help make today’s fast food – this new book by Moss describes how the fast food industry has succeeded in creating products that compel consumption, contributing to our current obesity epidemic.

Moss is a reporter for the New York Times. Excerpts of his book appeared in the New York Times Magazine on February 24. In addition, we have included the recent review of his book from the New York Times, and a link to the Amazon description, author interview and reader reviews.

Marketing and research work. We are persuaded to consume, to embrace styles and brands, and otherwise spend our money based upon real or perceived values and needs, informed by marketing efforts. In most cases the only damage is to our wallet if we consume goods or services that we don’t need. And many times what we get is quite useful and valuable.

The food industry faces a challenge. The success of food marketing requires food consumption. The more successful the marketing is, the more food is consumed. This consumption, especially of the sorts of processed foods that the global giants create, is a driver for obesity.

To quote the review:

“…that is the nub of Mr. Moss’s case: By concentrating fat, salt and sugar in products formulated for maximum “bliss,” Big Food has spent almost a century distorting the American diet in favor of calorie-dense products whose consumption pattern has been mirrored by the calamitous rise in obesity rates. Entire food categories were invented to support this strategy (Mr. Moss is particularly fascinated by Kraft’s near-billion-dollar line of Lunchables snack trays), as processors bent the American appetite to Wall Street’s will.” Read More…

Read the article, the reviews, and the book. After doing so, you may never enjoy Cheetos or Dr. Pepper quite as much.

Will the NFL Brain Injury Lawsuits Change the Game?

With the Super Bowl a receding memory, we are reminded about the physical nature of football in this Business Week article.

Many players and their families believe that football has been a source of permanent brain damage resulting from multiple head injuries in the course of play for some. A former Princeton quarterback in the 50s, Gene Locks, and a group of allied plaintiffs’ lawyers are taking up the cause and the league is on the defensive.

While Locks and other lawyers say they have no interest in putting the NFL out of business, they will represent more than 4,000 former players and their wives who accuse the $9.5 billion-a-year business of covering up life-altering brain injuries.

A protracted battle could provide the plaintiffs’ lawyers with an opportunity to reveal sordid details about a period during which they allege the NFL intentionally obfuscated evidence of the long-term brain damage suffered by its willing gladiators.

If this is true, and if the ugly particulars are played out in depositions, internal documents, and court testimony, such a legacy could alienate fans already uneasy about the suicides of former players such as Dave Duerson, Andre Waters, and Junior Seau, all of whom suffered from neurodegenerative brain disease linked to concussions.  Read More…

The outcome is far from decided and will be determined in part by public opinion, the courts, and hopefully additional meaningful scientific studies.

Gag Law Prohibits Doctors from Doing their Job and Protecting Patients

Physicians have multiple roles. In addition to treating illness and injury, they have a public health duty to address risk factors in individuals and society that contribute to morbidity and mortality.

Responsible gun owners know how to behave around guns, including proper storage and use. In the same way that responsible parents use car seats and seat belts for their young passengers, responsible parents who are gun owners must secure their weapons to avoid accidental misuse.

A recent Slate article, “Pediatricians vs. the NRA,” demonstrates the ability of the NRA to successfully introduce legislation that suppresses a physicians ability to do their jobs and to exercise their free speech rights.

The “Privacy of Firearm Owners” law passed in Florida in 2011 prohibits doctors from “making written inquiry or asking questions concerning the ownership of a firearm or ammunition by the patient or by a family member of the patient.”

Fortunately, the law is under attack and being challenged. Hopefully, it is also being ignored by many physicians who understand that there are bigger issues at play here – and that those who write such laws should be confronted with the obligation of enforcing it by trial and punishment. There are times when civil disobedience may be called for. This would appear to be one of them.

Is Dr. Oz Abusing His Pulpit By Promoting Nonsense?

Dr-Mehmet-Oz-300x241The detailed and lengthy New Yorker article, “Is the Most Trusted Doctor in America Doing More Harm than Good?” profiles Dr. Mehmet Oz, a cardiothoracic surgeon and television personality.

Dr. Oz is a clearly talented, smart, and charismatic man who, with the help of Oprah, is considered by many to be “America’s Doctor.”

In medicine there is a continuum between hard science, that which can be objectively observed and tested, so-called ‘art’, and unsubstantiated beliefs masquerading as science.

A warm touch, good listening, and a smile by a physician feels good and can instill confidence, but does it heal in the same way that an effective antibiotic or surgery does?

There is certainly no harm in being a good person and given the nature of many illnesses, conveying warmth while the body heals itself may be more than enough.

But promoting amulets, strange foods, and other hocus pocus presented by charlatans does a disservice to society. Oz appears to personally promote unproven products and their promoters in his show – conveying an irresponsible and unearned aura of legitimacy. It appears he has embraced celebrity at the expense of credibility and his millions of fans are none the wiser.

The Difference: Looking Healthy vs. Being Healthy

Every January, millions of people resolve to change their habits of years past in hope of making better choices for the new year.

And while vowing to become debt-free, to quit smoking, or to be more organized rank among top resolutions, statistics show that the No. 1 goal for millions of Americans is to lose weight.

After reading the New York Times article “Our Absurd Fear of Fat,” the author addresses our nation’s obesity epidemic and poses an argument about a key issue: What truly makes someone healthy?

The author proposes that our nation’s definition of “normal” or “healthy” weight may not be supported by medical literature. He states that a study by Katherine M. Flegal and her associates at the C.D.C and the National Institutes of Health, found that:

“All adults categorized as overweight and most of those categorized as obese have a lower mortality risk than so-called normal-weight individuals…The study found a 6 percent decrease in mortality risk among people classified as overweight and a 5 percent decrease in people classified as Grade 1 obese, the lowest level (most of the obese fall in this category).

This means that average-height women — 5 feet 4 inches — who weigh between 108 and 145 pounds have a higher mortality risk than average-height women who weigh between 146 and 203 pounds. For average-height men — 5 feet 10 inches — those who weigh between 129 and 174 pounds have a higher mortality risk than those who weigh between 175 and 243 pounds.”

With so many mixed messages about what “healthy” looks like or entails, it is often difficult to create a realistic goal about our weight. On one hand, we are trying to reverse our nations obesity epidemic, while on the other, we are also trying to combat our nation’s unhealthy obsession to be overly thin.

We invite our readers to comment on what they think about this article and share resolutions that have helped kick-start the new year in good health.