Hola! Puerto Rico opens for health tourism

puerto rico health tourismWhat is health tourism and why Puerto Rico?

I read the other day that Puerto Rico wants to jump into the medical tourism ring and compete with those countries where it is already pretty well established, such as Mexico and Costa Rica.

Medical tourism, as the name implies, is traveling to another country to receive more affordable medical care.

[Puerto Rico’s] administration says that it commissioned a market study from which it deduces that medical costs on the island are between 40 percent and 60 percent lower than in the mainland U.S.

Such a move, if successful, could be a … Continue reading

Do you need an annual pelvic exam?

annual pelvic exams unnecessaryYet another screening exam found unhelpful

Earlier this month, the American College of Physicians (ACP) published its recommendation in the Annals of Internal Medicine that routine annual pelvic exams are unnecessary for healthy, non-pregnant women with no gynecologic symptoms (bleeding, discharge, pain, etc.).

The ACP looked at evidence on pelvic examinations dating back almost 70 years and concluded:

… no data support the use of routine pelvic examination (excluding cervical cytologic [Pap] examination) for reducing the morbidity [disease] or mortality [death] of any condition. Furthermore, limited evidence suggests that screening pelvic examinations may be associated with pain, discomfort, fear, anxiety,

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Dr. Oz – Pitchman for profit

Called before the Senate

Over a year ago I wrote a post dissing Dr. Mehmet Oz for his overuse of the word “miracle” on his TV show. As I said, there are no miracles when it comes to getting and staying healthy—just common sense, hard work and perseverance.

But those things are boring and don’t make good television, do they? Talk shows (and that’s really all the Dr. Oz show is) need to keep ratings high. They need to excite viewers and encourage them to buy the advertised products, or ratings fall and advertisers pull their support.

Fortunately for those … Continue reading

Do you need an annual exam?

The yearly reminder

The other day I received in the mail a form letter from my physician’s office reminding me that I am due for my annual “well woman” visit. The letter also pointed out that if I have an ACA-compliant health insurance plan, the cost for the exam would be 100% covered as a preventive benefit.

I have three problems with this letter.

  1. Although my current physician is part of my new insurance plan’s network, the hospital she works out of is not. What if I needed to have surgery or be hospitalized? My care would then be given
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“American Addict”

american addictA uniquely American public health crisis

Last weekend I finally watched a film that has been sitting in my Netflix queue for some time. American Addict, produced by a physician, Gregory Smith, MD, is a well-made, informative and compelling documentary about America’s drug culture.

I don’t mean dope and crack and methamphetamine. I’m talking about the overuse and abuse of prescription drugs—pain pills, sleeping pills, antidepressants, antipsychotics, and stimulants.

It’s a public health crisis that is costing this country billions of dollars in health care costs, health insurance fraud, criminal activity, local and federal drug enforcement, loss of employment … Continue reading

Patient satisfaction scores

They aren’t what they seem

When I buy a product on Amazon or Ebay, I like to read the reviews, see how many stars a product or seller rates. Did the product arrive on time and in good condition? Is the product as the seller described? Did the product work as expected?

A high rating, indicating customer satisfaction, should be a good thing, right?

Normally, yes. But not when it comes to judging physicians.

For example, a friend of mine is a surgeon, a really good surgeon. Last year he saw a morbidly obese woman to consult about an elective … Continue reading

Slow medicine: “God’s Hotel”

slow medicine gold's hotelA remembrance of things past

I picked up a book the other day that filled me with nostalgia, a yearning for a return to the way medicine used to be practiced 30 or more years ago.

Yes, I’m probably guilty of looking at the past through rose-colored glasses, but reading God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine by Victoria Sweet, MD, reminded me of the era before “bureaucratic medicine” when doctors and nurses had more time and more autonomy to deliver the slow medicine or patient-centered care she describes.

Related post: “Knocking on Continue reading

“The Treatment Trap”

the treatment trapWhat is too much medicine and why is it bad?

I’ve talked about it before: Health care costs are crazy high; the cost of insurance is increasing to meet those costs; and more patients than ever are being harmed by the treatment that is supposed to help them.

The overuse of medical care is directly responsible, and increased patient (consumer) awareness is needed to help turn this trend around.

Reading The Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health and What You Can Do to Prevent It by Rosemary Gibson and Janardan Prasad Singh would be … Continue reading

Is your electronic health record (EHR) accurate?

electronic health recordsAccess to your records is important

If, like me, your health care has been disrupted by new insurance coverage and the loss of your doctors and/or hospital network, it’s important that you have a hard copy of your health records.

I’ve always advised patients to keep copies of all their important health reports—x-rays, lab results, operative and pathology reports, etc.

A timeline of surgeries and hospitalizations is a good idea, too.

And it’s vital to keep an up-to-date medication list, including any frequently used over-the-counter products such as baby aspirin, ibuprofen, antacids, vitamins and herbal supplements (to name but a … Continue reading

Helping doctors save you money

lab slipA doctor posted this photo the other day. It’s a typical lab result slip with a twist—look closely and you’ll see a column for “cost”.

When doctors want to treat an infection, they generally get a “culture and sensitivity” first. That is, they take a sample of whatever is infected (urine, skin, blood, or other) and send it to the lab. The lab grows (“cultures”) and identifies the bacteria, and then tells the doctor which antibiotics the bacteria is “sensitive” to, that is which will kill it.

Antibiotics can be extremely expensive, especially the newest ones that can cost Continue reading

End of life: “Knocking on Heaven’s Door”

end of lifeThe anatomy of a prolonged death

In 2001, author Katy Butler’s father suffered a stroke. Thus began her and her family’s long journey through our health care system detailed in Knocking on Heaven’s Door: The Path to a Better Way of Death.

After his death, I would not rest until I understood better why the most advanced medical care on earth, which saved my father’s life at least once when he was a young man, succeeded at the end mainly in prolonging his suffering.

During vigorous rehabilitation to regain strength following the stroke, Ms. Butler’s father developed a hernia—a … Continue reading

A plea for patient-centered care

“I need to sleep!”

As a nurse, I’ve always known that a hospital is a lousy place to be sick. Why? You can never get a decent amount of sleep! And who needs sleep more than someone who is recovering from an illness or injury?

I loved this YouTube video I ran across while reading an article about patient-centered care:

It was made by 15-year-old Morgan Gleason, who, according to the article

First…contracted meningitis while getting an infusion for an autoimmune condition. Then, hospitalized, Tuesday morning she got fed up with how she was being treated, and laid down

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The Machine That Goes “Bing!”

Well, 2013 is ending and what a year it’s been in health care! I fear 2014 will deliver more confusion, cost and concerns related to health care and health insurance, but for now I’d like to end this year on a humorous note.

Like me, many of you will be old enough to remember seeing the Monty Python movie The Meaning of Life when it hit the theaters in 1983. Even though it’s 30 years old, there is a hilarious operating room scene that is still applicable today.

In it, the doctors are so obsessed with new technology, including the … Continue reading

“When Doctors Don’t Listen”

when doctors don't listenContext matters

Last week I discussed my worry that doctors would no longer have relationships with patients, but rather would plug us into pre-determined screening, diagnostic and treatment “pathways” without much regard for our personal stories.

Then I read the book When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests by two ER physicians, Leana Wen, MD, and Joshua Kosowsky, MD.

And they agree “cookbook” medicine is a problem. They see it all the time in the emergency rooms.

Medicine has morphed from thoughtful engagement between doctors and patients to cookie-cutter recipes that regard all individuals alike…this cookbook

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Can we save patient-centered care?

anna quindlen patient-centered care“Do you know who I am?”

I’ve always been a fan of the Pulitzer-prize winning author Anna Quindlen, and last week I ran across the text from an address she gave to a roomful of doctors and medical students at the Association of American Medical Colleges in November. (Note: the full text will only be available through this link until January 31, 2014.)

A mother and DES daughter, Ms. Quindlen describes herself as “medically adept.” She has also dealt with the illness, injury and deaths of both her parents. She is an intelligent, educated, motivated health care consumer, or … Continue reading