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

Need a new doctor?

Switching doctors will become more common

My family is one of those that has lost our current insurance plan. And in researching new plans, I’ve found that individual market plans, both on and off the health care exchange, have significantly smaller provider networks.

Our current doctors and hospitals are not “in network” for any of the new plans, so we will have to change.

I understand why the insurance companies need to do this. To keep premiums and out-of-pocket costs even remotely affordable (I still think they are way too high), more expensive doctors and medical centers have to be … Continue reading

Obamacare needs more work…

…because health care is still sick

So the political brouhaha is over in Washington, DC (for now) and Obamacare can continue it’s rollout unchecked–except by the federal exchange’s own technical ineptitude.

But eventually the online marketplaces will be functioning as they are supposed to, and all Americans–regardless of their economic or health situations–will be able to buy affordable health insurance and have access to the best care possible.

Or will they?

Our health care system has long been described as broken, sick, on life support. Obamacare has taken the system back into surgery to try and repair some of … Continue reading

Tips to save money on specialist visits

…or mistakes I wish I hadn’t made

We are entering a new era in health insurance coverage and paying for health care. Kind of.

More people will have an opportunity to buy insurance through the new exchanges. However, we will also be expected to pay much more towards our care through considerably higher deductibles and co-pays.

And I suspect this is a trend that will spread to more and more insurance plans in the near future.

My family’s new deductible will be about $10,000, so I will be more motivated than ever to limit my health care expenses. But we’ve … Continue reading

Patient safety – “Unaccountable”

Medicine’s code of silence

unaccountable02I remember I was a very new and young nurse when I realized most patients haven’t a clue what goes on behind the privacy curtain of medical care in a hospital.

Working in the operating room, I quickly learned who were the best—and the worst—surgeons.  The best had skill and good judgement, and I would enthusiastically refer my family and friends, if needed.

And the worst? “Why do these docs still get patient referrals?” I used to wonder. “Why doesn’t the hospital do something? How are patients supposed to know?”

I still ask myself these questions.… Continue reading

Parents: Don’t insist on CT scans!

ct scans on childrenToo many CT scans ordered on children

This morning I read a post by a pediatric intensive care (PICU) doctor who admitted too many CT scans are still being given to children, despite recent evidence that radiation exposure from the scans carries a not insignificant future risk of cancer.

I posted about the results of this study a couple of months ago: Children are more “radiosensitive” than adults; CT scanners can vary dramatically in the amount of radiation exposure; and radiation exposure is cumulative–more CT scans relate to a higher risk.

This doctor focused on the overuse of … Continue reading

Patient safety: “What You Don’t Know Can Kill You”

patient safetyEven doctors are afraid of hospitals

One of my best friends is a physician, and we have an agreement: if either of us needs to go into the hospital for surgery, the other will be there to make sure everything is done right.

Hospitals are scary places, even for–especially for–health care professionals.

Dr. Laura Nathanson’s husband died as a result of incorrect diagnosis and delayed treatment due to poor communication between his doctors. To help inform and guide other families, she wrote a book, What You Don’t Know Can Kill You: A Physician’s Radical Guide to Conquering the Obstacles to Continue reading

Pushing back against too much medicine

As someone who advocates for less medical care, I’m always thrilled to see physicians and others in the health care industry step forward to protest over-testing, over-screening, over-diagnosing, over-treating and over-charging.

Here are some of my favorite health care blog posts and news articles from the last week.

“Testing Wisely” by Dr. Rob Lamberts 

Dr. Lamberts is embracing the newest trend in primary care: the direct-pay model. He does not accept health insurance, but rather charges a modest (age-based) monthly fee per patient. Booting the insurance companies not only lowers his overhead costs considerably, but frees him from so many … Continue reading

The Sunshine Act

Shining a light on the physician-Big Pharma relationship

One of the little-known laws buried in the Affordable Care Act (ACA) is the Physician Payments Sunshine Act, which takes effect today.

I understand the impetus of this law, but I am less sure of its positive effect.

The Sunshine Act (the drafters no doubt had a mental image of exposing something slimy to the light) seeks to illuminate the financial relationships between doctors/teaching hospitals and drug companies/medical device manufacturers.

Conflicts of interest and questionable ethics have been problems for years as public funding has decreased and private industry money has … Continue reading

“The Happiness Project”

twelve patientsThe unloved woman

I recently read two books that provoked my thoughts. The first was Twelve Patients: Life and Death at Bellevue Hospital by Dr. Eric Manheimer, the medical director of what is probably the largest public hospital in America.

Located in New York City, Bellevue sees patients from all demographics—incarcerated, homeless, undocumented, uninsured, mentally ill, addicted—and treats the worst trauma cases in the city.

Dr. Manheimer sees it all, and he writes compelling stories about the patients and their situations. He also comments on America’s health and health care in general.

His chapter entitled “The Unloved Woman” struck me … Continue reading

Check and check again

Medical errors happen

The other day I saw my doctor for an annual exam.

This year I was determined to ask my doctor NOT to order a vitamin D level.

I have had my vitamin D level tested for the last three years and it costs me approximately $100 out of pocket. (It is not considered preventive by the Affordable Care Act.)

Earlier this year, the health advocacy group Choosing Wisely recommended against routine screening for Vitamin D level in healthy adults. Well, I am a healthy adult, and my previous vitamin D levels have been normal—albeit at the lower … Continue reading