By Evan Falchuk
Over at The Health Care Blog, Matthew Holt riffs on my post about Steve Pearlstein”s web chat about health care reform. Holt suggests I have “veered towards the side of unreason” after reading Pearlstein’s column and webinar.
Holt is wrong. I veered towards the side of unreason a long time ago, and it’s great over here.
But seriously, Holt is one the true thinkers in health care, so I wanted to add a couple of observations.
By Evan Falchuk
Did you know that doctors are paid too much, wrongly complain about medical school debt, and falsely believe there is a medical malpractice crisis?
Did you know that doctors are hopelessly conflicted sellers of medical care, motivated by the search for extra income?
Well, then you haven’t read the Washington Post’s Steven Pearlstein’s work on health care reform.
By Evan Falchuk
The OSHA-ization of health care quality continues.
A research group and a consulting firm have been hired by the state of Massachusetts to head up a new initiative to publish cost and quality information on Massachusetts doctors. But the quality measures they will use are the same old ones we have seen for a long time. They mean very little to most patients, and even less to doctors as a measure of how good their work may be.
By Evan Falchuk
Preventable disease is a terrible burden, made all the more tragic by the fact that it can be avoided.
Policymakers in Washington take this a step further, claiming that we can save huge amounts of money by systematic programs to prevent disease and encourage wellness. The document explaining the Republicans’ new “Patient Choice Act” says that wellness and disease prevention can save trillions of dollars (.pdf). President Obama seems to agree, saying these programs like these can create “serious savings” that represent “huge amounts of money in the long term.”
There’s one problem: study after study says it’s not true.
By Evan Falchuk
The New York Times interviews President Obama about health care:
I’m a pretty well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor. But ultimately he is the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.
It’s shockingly bad advice.
Numerous studies show that patients get the wrong diagnosis as much as 20% of the time, and get the wrong treatment half of the time. Thirty-five percent of doctors and 42% of patients report errors in their own care or that of a family member. Studies show that most errors happen because of a failure to analyze the patient’s problem correctly. Experts, like Dr. Jerome Groopman from Harvard, say that doctors, strapped for time and dealing with complicated problems, easily fall prey to cognitive pitfalls that create poor quality.
Ask questions, be skeptical, disrupt your doctor’s thought process. Make sure the decisions about your care are right.
Above all, remember it is you, the patient, that are in charge, not the “guy with the medical degree.”
(h/t @epatientDave via twitter)
By Fritz Hofheinz, M.D.
There are many forms of cancer, each in its own way, potentially deadly. For a recent Best Doctors member, a three-year-old girl, her fight was against a rare cancer – pleuropulmonary blastoma. The young girl, who we will call Mary, heroically beat her cancer at age three – going through surgery, chemotherapy, radiation and finally bone marrow transplant.
Three years later at the age of six, a follow-up scan brought the bad news of a “mass” in her chest and suspicious masses in her liver. A biopsy of the liver was read as “possible” cancer. After hearing the stomach-sinking “C” word, the young girl began to suffer from post traumatic stress disorder. (more…)
By Fritz Hofheinz, M.D.
One of the benefits of being a medical director at Best Doctors is having the opportunity to match the large volume of complex clinical cases we see with the nation’s (and world’s) best expert physicians. We meet people from all walks of life with every medical problem imaginable and have the opportunity to play a role in making them better. While my life as a primary care physician is often bogged down in administrative quicksand and unsolvable systems issues, my Best Doctors’ life helps bring some meaning back to the healthcare system. In the next couple of posts I will share some really moving cases where remarkable things happened when patients simply “stopped the train” and asked for a second opinion.
Mark Twain once said, “The past does not repeat itself, but it rhymes.” In humans however, unfortunately the past does sometimes repeat itself. The genes that define so much of who we are sometimes make us more likely to contract one ailment or another. The “family history” which we are all so familiar hearing from our physicians is a simple and effective attempt to construct a window into some of these genetic predispositions. The family history can be crucially important in some circumstances (like the following case). Given the complexity of illnesses and patient’s sometimes vague recollections of their relative’s illnesses however it is understandable that sometimes family history gets “short shrift” in the heat of an eight minute visit. (more…)
By Evan Falchuk
Dr. Val blogs today about cash-only physician practices, as well as other concierge-style practices.
They’re both emerging models of primary care in which the doctor basically opts out of the traditional insurance system. By doing that, doctors typically see fewer patients, spend more time with each patient. They can even make more money per patient, by getting rid of the overhead otherwise tied up in doing medical billing. It sounds great, and it is, for patients fortunate enough to be in a practice like that. But it has its share of critics, who worry that these kinds of practices leave behind those who are less well-off.
But what if a doctor set up a low-cost concierge practice, catering to people without insurance? Wouldn’t that be a great idea?
