Choosing Wisely: 5 Questions to ask your doctor

choosing wisely 5 questionsCutting the waste

I’ve posted several times about the Choosing Wisely campaign.

Developed by Consumer Reports and the American Board of Internal Medicine, Choosing Wisely hopes to educate both physicians and patients, and cut back or eliminate unnecessary medical tests, procedures and treatments.

Over-testing and over-treatment are estimated to cost about $200 billion every year. I think that’s a conservative figure, as the financial—not to mention emotional—consequences of too much medicine can be difficult to quantify.

Bringing about change in our behemoth, for-profit healthcare system is a daunting task, and I’m always happy to see signs that it’s catching Continue reading

Active surveillance for thyroid cancer

Papillary thyroid cancers are overtreated

In 2010 my husband almost died while being treated for a small papillary thyroid cancer.

Papillary tumors are by far the most common type of thyroid cancer, and are typically very slow growing. Most doctors I know say that if you have to get cancer, papillary thyroid cancer is the one to pick!

My husband didn’t choose to get thyroid cancer, of course, but once his primary care physician found the lump during a routine physical, he was put on a fast track to being overtreated.

Back then, we just didn’t know any better.

I … Continue reading

The Seven Year Rule

Newer drugs are not necessarily better drugs

A few days ago at the gym, I was leafing through an issue of Health magazine.

What caught my eye was not the article about preventing stress injuries, or the recipe for a zingy, low-fat curry, but rather the pages devoted to ads for prescription drugs. Drugs to treat psoriasis, hepatitis C, dry eyes, depression, Alzheimer’s, diabetes, arthritis, and overactive bladder, to name but a few.

Each ad took three pages. After doing a little mental math, I discovered the ads for these new prescription drugs made up more than 30% of the … Continue reading

Healthcare’s perverse financial incentives

A hospital puts profits over patient safety

First do no harm.

That’s part of every medical school graduate’s oath. It should be the motto of anyone working in healthcare.

But I just read a disheartening piece of investigative journalism in my local newspaper, the Seattle Times, about a hospital where I trained, worked, and received care. The story highlights how the perverse financial incentives in healthcare (do more, get paid more) undermine patient care and safety.

…the aggressive pursuit of more patients, more surgeries and more dollars has undermined Providence’s values — rooted in the nonprofit’s founding as a

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Baby boomers and HCV screening

harvoni and hcv screeningDon’t get health advice from commercials!

While nursing my cold last weekend, I was watching TV and one prescription drug commercial caught my eye. (One of oh so many. FTC—please make these go away!)

Actually, the ad didn’t mention any drug by name, but it was sponsored by Gilead Sciences, the makers of the new hepatitis C drug, Harvoni.

The commercial was aimed at baby boomers, who were advised to get tested for the hepatitis C virus (HCV).

One in 30 baby boomers could have HCV and not know it, the voice over said, “…because Hep C can hide Continue reading

Choosing Wisely – Use less healthcare

My goal for 2017? Use as little healthcare as possible

How will healthcare change under a new president and political party?

That’s a question I can’t answer. As I wrote in my last post, both candidates had multiple-point plans to tweak/improve/repeal/replace the Affordable Care Act, aka the ACA or Obamacare.

But I don’t know what will change or when.

What I know for sure is that for 2017 my premiums will be 20% more expensive, my co-insurance and co-pays will be higher, and my current primary care doctor will no longer be in-network.

I can and will shop around … Continue reading

“Bridge Over Diagnosis”

I’m going with an overdiagnosis theme this week.

Here’s the latest healthcare parody video from pharmacy professor James McCormack, as he continues his much-appreciated effort to raise awareness of overscreening, overdiagnosis, and overtreatment in this country.

As usual, this video is full of supporting statistics and excerpts from leading healthcare journals, so take time to pause the video and really understand the information being shared.

As I said in a previous post, overdiagnosis and the resulting unnecessary treatments cost hundreds of billions of dollars every year.

Equally bad, if not worse, I think, is … Continue reading

Risk Benefit Theater – Screening mammograms

I’m all about high-value, evidence-based healthcare.

I’ve written a lot of posts about the problems, including high costs, of overscreening and overtreating. (We spend hundreds of billions of dollars every year on unnecessary healthcare!)

So I love this video by Andrew Lazris, MD, and Erik Rifkin, PhD. They use the visual of 1000 women sitting in a theater to illustrate why screening mammograms are not the life savers many women think they are.

A picture (or video) is worth a thousand words, isn’t it?

I understand Lazris and Rifkin want to create more videos to … Continue reading

Life Line Community Healthcare and Life Line Screening

Buyer Beware

I’ve posted before about the limitations of Life Line Screening.

The screening tests they offer in their basic “wellness” package are either not recommended at all because they aren’t effective screening tools (carotid ultrasound), or are not recommended for the general public (abdominal aortic aneurysm ultrasound). Please read my previous post for more information on that: Don’t reach for Life Line Screenings

Screening tests are best discussed with your primary care physician. He or she will help you know which tests are right for you—based on your age, health history and family history—as well as how often they … Continue reading

Don’t reach for Life Line screenings

I first posted about Life Line screenings two years ago. I’m re-posting today as this post still gets a lot of traffic and I wanted to reopen the comments. 

life line screeningsOvertreating, overspending

I just received an invitation in the mail!

Not to a party or a wedding or anything fun, but to a Life Line Screening event being held at a local church. The letter says they’re holding a spot for me on this particular date, but I must call NOW to confirm and register, because spaces are LIMITED!

“These aren’t just routine medical procedures—they can help save your life”

Oh, … Continue reading

Drug commercials do more harm than good

I think it was a mistake to allow prescription drug commercials on TV. In my humble opinion, at least.

But I’m not alone in disliking these commercials, or direct-to-consumer (DTC) ads, as they’re called.

The news website Vox recently released a video that explains more about how DTC ads came to be ever present on our TVs. They attempt to be fair and present both sides of the debate, but it seems to me they lean negative. What do you think?

One of my objections to DTC ads is that these multi-billion dollar campaigns are … Continue reading

The high cost of healthcare in America

They say a picture is worth a thousand words, and the online news site Vox recently sought to open Americans’ eyes as to how much more we pay for healthcare compared to other countries.

America’s healthcare prices are out of control. These 11 charts prove it.

I can’t copy their charts, but basically they are bar graphs. The bar that shows how much patients in the US pay for similar drugs and services towers over the others like a skyscraper over a neighborhood of single-family homes. Like this:

healthcare costs graph

Vox got its information from the International Federation of Health Plans (IFHP)Continue reading

Why shared decision making matters

As a nurse who worked for a surgeon, I had to spend a lot of time talking to patients and educating them about their proposed surgeries.

The surgeon talked to them first, of course, but often patients don’t remember everything the surgeon said. Or they think of questions after the consult.

If I couldn’t answer a question, or if I thought the patient really didn’t understand what the surgery entailed—why it was being done, other options to surgery, recovery time, etc.—I would ask the surgeon to please speak with the patient again.

If I was going to sign my name … Continue reading

Healthcare journalist Peggy Girshman writes her own eulogy

I’ve been a fan of Peggy Girshman’s science and healthcare writing for a long time, so it was with great sadness that I read about her death in March at the young age of 61.

But in tribute to her award-winning journalism career, which included long stints at both NPR and Kaiser Health News, she actually wrote her own eulogy!

She wanted to share a few simple lessons she had learned from her years on the job of reporting healthcare-related stories. Because they resonate with my own view that we need more health and less medicine, I wanted … Continue reading

“End of the Line” for medical guidelines

Knowledge is king

That’s the take home message from Professor (of pharmacy) James McCormack’s latest parody video, End of the Line, which takes a whack at healthcare’s increasingly pervasive and rigid medical guidelines.

 

If followed to the letter, these guidelines (often based on research funded by drug companies) would have everyone diagnosed with a disease and taking one or more medications. Medical guidelines may be great for the drug business, but not so much for individualized, patient-centric care and shared decision-making.

Chronic disease state guidelines (blood pressure/lipids/glucose/bone density) do not provide clinicians with

Continue reading