MCN | Medical Consultants Network
The Power of a Second Look
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“Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t.”
Atul Gawande provides an insightful look into how and when to let go of a dying relative in regards to patient care.
A recent report on disease and the internet showed that an increasing number of people with chronic illness are turning to online communities for information and support from others suffering from the same ailment. This isn’t all that surprising given the fact online communities often replace traditional ones if a person is isolated. What is surprising, I prefer groundbreaking, is the site PatientsLikeMe accurately predicted a drug outcome before the published results by allowing its users to track their progress.
PatientsLikeMe, one of many social networking sites dedicated to health, has 65,000 members that span 16 different disease communities.
Conflicting duties may occur in the law. This case from the American Medical News is an excellent example. A grand jury issued a subpoena to the Cleveland Clinic for medical records. The patient whose records were released sued for breach of privacy. The case is not settled.
While I assume that the Cleveland Clinic is a smart place with many able attorneys, it may be the case that in this matter, they were caught between conflicting duties. Apparently they were prohibited from notifying the subject of the subpoena of the inquiry, since it came from a grand jury. But it is likely that further steps may have taken place before complying. Anyone can issue a subpoena. They do not require or generally receive any sort of judicial review and may be inappropriate or overbroad, and can be objected to if not quashed. They may however not be ignored.
A key issue with any subpoena is that the subject of the subpoena ought to be notified and given the right to object, and the recipient of a subpoena on a patient ought not automatically comply without careful review as to privacy issues. Physicians ought to consider consulting their own attorney in such matters. Many times their malpractice carrier will provide assistance at no cost in such matters.
http://www.ama-assn.org/amednews/2010/05/03/prca0503.htm
Significant pay disparities exist in medicine between primary care and many specialties. This commentary from Business Week suggests that the Medicare reimbursement baselines, upon which many payers base reimbursement, should be revised to narrow the disparity. Absent this issue being addressed, the author suggests that access to care will be adversely impacted.
When a physician has an economic interest in a testing facility, does it influence his/her practice, or likelihood of ordering a test? Should his ownership be disclosed to his patients? The NY Times Ethicist weighs in.
A nonprofit system, salaried doctors on staff, an ambitious electronic health records system, but most importantly the idea of competition based on health outcomes rather than price are just a few things that make Kaiser Permanente an unconventional HMO provider.
With the passage of health reform, we are now seeing frequent reports of its shortcomings. The new legislation still relies upon a private insurance market and the expectation that individuals will buy insurance or suffer penalty. People, especially those with lower incomes, will behave rationally and in what they perceive to be their economic interests. This many for some include preserving scarce cash today, and not focusing on an uncertain and expensive need for future health care. Rather than argue that people should behave responsibly and address future health issues with insurance, this article, from April 20 in the NY Times, and the individuals describes speaks for itself.
The New York Times Magazine of April 18 carried this article that addresses one of my pet peeves – the abuse of our beautiful language. Actually the article is too kind to the word, focusing on the first use and evolution of the term. What benefit is there to a word that has a perfectly fine equivalent called – health?
Wellness has become a buzzword and a marketing term to promote all sorts of expensive maneuvers and services, often in the workplace, to improve the health of individuals, often involving incentives, paid consultants and the like. I have yet to see a scholarly report that establishes the effectiveness of such programs and their cost benefit. I believe it most likely that those who wish to be healthy need no external incentive or program, and are already taking care of themselves, and those who can’t or won’t engage in healthy choices in their lives are unlikely to be significantly persuaded by a workplace program.
How many people are in the dark about what it takes to be healthy, especially adults in the workforce?
The Wall Street Journal reports on increasings shortages of physicians, especially in primary care, which generally pays less than many specialties. While this is a current issue and problem, the challenge may be exacerbated by health reform, which will increase access to health care while not addressing the supply side. Another reality of the health care force is the declining hours being worked by many physicians as compared to the past. This is a result of many factors, including shifting priorities of some physicians, especially women, who now comprise about half of medical school classes. More flexible and balanced working arrangements demanded and practiced by those in their family raising years has an impact upon overall availability.
When I was in training, awareness of disparate incomes of specialties vs. primary care was not in the general awareness of most students, or if it was, did not seem to lead the practice decisions of many. Today there is heightened awareness of earning potential and a flight toward specialties and away from primary care.
I believe it likely that this shortage will lead to many creative and regulatory changes, including an increase in the use of mid-level practitioners for routine matters, including nurse practitioners, physician assistants and the like.
It seems that many of the postings are about cost containment in health care and the challenges inherent in this. This article from today’s NY Times, lays out some of the conceptual and cultural issues that create resistance, as well as some of the pending initiatives to provide data on clinical effectiveness – that might ultimately guide payers and clinicians.
