Doctors are professionals who charge for their services and most patients are happy to pay these fees - after all, good medical care can be priceless. However, many doctors are often clueless about the cost of the treatments they provide- especially with regard to some of the new medicines; and even big ticket items such as surgery.
While they are aware of their professional fees, many are blissfully unaware of how much the hospital charges for its services - and how the hospital pads its bills. While many doctors fume about this in private, they usually put up with these evils as "the cost of doing business" - and since they are not united, they cannot fight the hospital management effectively. In the long run, it's their patients who suffer. It's quite funny to see the "sticker shock" which doctors get when they seek medical treatment for their family members in their own hospitals.
Why are doctors so poorly informed regarding the financial burden they levy on their patients as a result of their advise ? Many feel that money is a grubby topic which is below their dignity to consider. Others take the attitude that they need to prescribe the " best " - never mind the costs. This can be counterproductive - and many patients are driven to bankruptcy because of the high costs of medical treatment.
This is why offering all inclusive packages which cover all costs can be so helpful. This prevents last-minute financial surprises - and allows the patient to select the package which suits his budget.
In our clinic, we go one step further. IVF treatment can be very expensive - and since the outcome of a given cycle is always uncertain, the expense on IVF is potentially open-ended and limitless. This is why we offer our patients a money back option . Not only does this serve as a guarantee of our confidence in the high quality of medical care we provide; it also allows the patient to limit their financial exposure, thus putting a cap on their expenses. It also allows them to approach the IVF treatment with more realistic expectations,since they are mentally prepared that it may not be a single shot affair .
Sunday, September 30, 2007
Doctors, patients and money
Lessons learnt after spending half a day at a hospital
I just spent some time in the hospital with a friend who was ill - and this was quite an eye-opening experience. As doctors, we are used to floating in and out of hospitals which are like second homes to us. However , as a patient, the view is quite different !
I found that while the medical care was fine ( after all my friend got VIP care since I was with him - some perks of being a doctor !); the customer service was extremely poor !
We spent a long time at billing counters and filling up forms - and everytime a new test was ordered, we had to go back to pay more money to get the test done. Finally, we spent more time with the billing department than we spent with the doctor !
It would be so easy to fix this problem ! Hospitals should have more counters to fulfill their administrative duties - and each department could have their own billing station, so patients would not have to run down to the central billing counter each time to pay bills !
Since all the billing is computerised, this would be very easy to do.
I also think hospitals should have escorts ( or concierges) to help patients make their way through the complex maze the hospital represents. I am sure it would be easy to recruit volunteers from the community to perform this task - a win-win situation in places like Bombay, where there is no shortage of people !
Why does customer service get such low priority in hospitals ?
Specialists can be harmful to your health !
I recently saw a patient who had conceived after IVF treatment. She had been infertile for 8 years, and had conceived in her very first IVF cycle, so she was on top of the world. At 10 weeks, we referred her to an obstetrician for managing her pregnancy. Her pregnancy was progressing uneventfully, but the ultrasonographer who did a detailed 20 week fetal anomaly scan ( to check the baby was normal) noted that the baby had " echogenic " fetal kidneys - just a fancy word to describe the fact that the sound waves reflected by the kidneys were a little denser than usual.
The rest of the scan was normal, but seeing this "abnormality" on the report, the obstetrician referred the patient to a fetal medicine specialist.
The trouble with specialists is that they see life through a specialised prism - a prism which is full of the problems in their field. If you have screwdriver in your hand, you tend to see only screws, and he then promptly advised an amniocentesis, to confirm that the baby was normal.
He even went so far as to suggest a termination, if she didn't want to take a risk !
It is true that life is full of risks - but these should be calculated risks ! While his advise was perfectly appropriate from a medical point of view, imagine the amount of emotional harm his words caused to the couple, who are now worried out of their wits. Rather than enjoying their long - awaited baby, each day is full of tension and suspense !
Tests are meant to reassure patients, but they often end up causing anxiety and worry - most of which is needless.
Tests are not always foolproof, and all medical tests have two major limitations.
1. False negatives , which refers to patients who have the disease, but the test fails to pick this up. Doctors worry like hell about these , because they can get sued for missing a diagnosis
However, far more common than there are the
2. False positives . These are the results which are reported as positive even though the person is healthy and does not have any disease. These results create more busy work for doctors , who then need to "run more tests" in order to clarify the situation , and rule out the "true positives" ( patients with the disease who have a positive test result ). However, these false positive results can create a lot of unnecessary anxiety in the patient's mind - as well as causing distress for family members. Unfortunately, none of anxiety is ever reported or considered by the specialist, who are blissfully unaware of the harm they have done.
WE ARE ALL SICK Chicago Sun-Times
WE ARE ALL SICK Chicago Sun-Times : "The idea that drug companies help to create new illnesses may sound strange to many of us, but it is all too familiar to industry insiders. A recent Reuters Business Insight report designed for drug company executives argued that the ability to 'create new disease markets' is bringing untold billions in soaring drug sales.' One of the chief selling strategies, said the report, is to change the way people think about their common ailments, to make 'natural processes' into medical conditions. People must be able to be 'convinced' that 'problems they may previously have accepted as, perhaps, merely an inconvenience' -- like baldness, wrinkles and sexual difficulties -- are now seen as 'worthy of medical intervention.' Celebrating the development of profitable new disease markets like 'Female Sexual Dysfunction,' the report was upbeat about the financial future for the drug industry. 'The coming years will bear greater witness to the corporate-sponsored creation of disease.'"
FIMDM Health News Review
FIMDM Health News Review: " HealthNewsReview.org is a website dedicated to: * improving the accuracy of news stories about medical treatments, tests and procedures * helping consumers evaluate the evidence for and against new ideas in health care
We support and encourage the ABCs of health journalism: Accuracy Balance Completeness
What news stories are reviewed? HealthNewsReview.org reviews news stories that make a therapeutic claim about: * specific treatments * procedures * investigational drugs or devices * vitamins or nutritional supplements * diagnostic and screening tests"
Foundation for Informed Medical Decision Making
Foundation for Informed Medical Decision Making: "The Foundation for Informed Medical Decision Making is a non-profit organization dedicated to assuring that people understand their choices and have the information they need to make sound decisions affecting their health and well being. Medical Evidence - Patient Values - Informed Decision Making The Foundation believes that no one medical answer is right for all people and the decision that will best serve a particular patient often depends critically on the patient's own preferences and values."
FIMDM Health News Review
FIMDM Health News Review: "# Grade health stories on the ABCs: Accuracy, Balance, Completeness
# Support excellence in health journalism
# Support consumers' informed decision-making"
This site will help you critically evaluate the medical stories you read in your local newspaper.
Poynter Online - Unhealthy Advocacy: Journalists and Health Screening Tests
Poynter Online - Unhealthy Advocacy: Journalists and Health Screening Tests: " Journalists and news organizations sometimes seem to abandon their usual healthy journalistic skepticism when it comes to coverage of certain health screening tests. While the journalistic intent here may be benign, the practice may produce more harm than good. I lead a team that monitors U.S. health news coverage each day for a Web project, Health News Review, that evaluates and grades health news stories. In the course of that work, I've seen surprisingly strong evidence of bias in favor of screening tests. Some stories, even by reputable journalists, ignore the recommendations of the U.S. Preventive Services Task Force, probably the most important, unbiased, balanced source on such questions. And the American College of Physicians' recently released guideline on mammography for women in their 40s doesn't seem to be getting the attention it deserves, either. What gets left out of these stories is the important concept that both benefits and harms can come from screening tests. You can screen many people and find a few problem cases. But in the process, there are always false-positive test results that suggest people have a problem when they really don't. That leads to anxiety, more testing (some of which carries its own risks) and more expense. Also, with today's more sensitive screening tests, some forms of "pseudo-disease" may be found -- early hints of possible problems without clear evidence about whether they will go on to create real trouble or not. That can mean many more people are inappropriately labeled with "disease" and treated. (An excellent source on these issues is the book "Should I Be Tested For Cancer? Maybe Not and Here's Why" by Dartmouth College's Dr. Gil Welch.)"
Taking patients for a ride
I am a big believer in Information Therapy and I am happy when infertile patients use the internet to get better informed about their problems and treatment options. In fact, one of my patients jokingly calls me the "Do Your Homework" Doctor - and I think this is a compliment !
However, I cringe when I see misinformation being peddled on the net - and unscrupulous people taking infertile couples for a ride. I have already blogged about how the net is being misused to sell ineffective "medicines" such as Ovulex, so I won't go into that right now.
What's worse is women who now sell "info-products" or "e-books" to "educate" couples about infertility. While educating couples is important and there's nothing wrong with making money by doing this either , what I object to is the misleading way the information is being sold.
Basically, they prey on an infertile couple's vulnerability and ignorance. They promise the earth and can do so safely, because they are not doctors, which means they are not accountable or answerable. They create attractive websites ( for example, the identical sites at www.pregnantgetting.com and www.trickforgettingpregnant.com) using sophisticated marketing techniques developed by clever internet entrepreneurs, and sell these using google adwords, thus pushing couples into buying their products. And since their products are priced very reasonably, most couples are happy to buy - even though the same information is available for free elsewhere !
What's my objection ? Aren't they just fulfilling a need ? I strongly object to their bad-mouthing doctors on their sites. For example, one site which sells an e-book says,
So do not lose your chance to get the secret and the never been told methods that Doctors, Obstetricians & Gynecologist, may not be telling you just to protect dollars in their pockets and their entire line of businesses as well.
Please sell if you want to - but don't knock doctors in order to do so !
The Serenity Prayer for infertile couples
Counselling infertile couples after they have failed an IVF cycle can be very stressful. As a doctor, I am human too, and it's very depressing when they fail to conceive even after all the hard work and effort we have invested in the treatment. No matter how much you explain that the success rate is not 100% ; that it is often a matter of chance as to which patients' embryos which implant ; that Nature is not efficient at producing babies; and that our technology is not perfect as yet, and we cannot determine why embryos fail to implant, it still hurts when the HCG is negative. Sometimes I feel I have let the patient down by failing to get them pregnant - and this is especially true when patients are doing their "final IVF cycle" and we are the court of last resort.
At this time, the only thing I can give them is a shoulder to cry on - and a copy of the Serenity Prayer.
God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
Living one day at a time;
Enjoying one moment at a time;
Accepting hardships as the pathway to peace;
Taking, as He did, this world
as it is, not as I would have it;
Trusting that He will make all things right
if I surrender to His Will;
That I may be reasonably happy in this life
and supremely happy with Him
Forever in the next.
Amen.
I try to explain the ABCs of Rational Emotive Therapy to them - that's it not the Action ( the negative HCG because of the failure of the embryos to implant) which causes the Consequence ( the depression and sadness); but rather their Belief about the event ( that they are "worthless " because they cannot produce a baby) which causes the problems. I need to remind them that they are far more than just "baby-makers".--Reinhold Niebuhr
It's always hard for humans to deal with failure. Many infertile couples are young and successful and used to having their life going the way they want it to. They are smart and hardworking - and they are used to topping in their exams; getting the jobs they desire; the spouse they pursue; and advancing rapidly up their career path. They earn more money; buy a new car; buy a new house - everything falls into place for them ! And when they find out they cannot have a baby, this is a rude shock. This is often the first time they are confronting failure - and the reason this is so scary is that it's often the first time in their lives they are being forced to come to terms with their own biological limitations - their own mortality ! This is not a comfortable feeling , and the fact that the outcome of what they do is not in their hands , and that they may never get what they so strongly desire, can be very difficult to accept for many of them.
Many make a bad situation worse by blaming themselves for the failure. They feel that God is now punishing them because they were " selfish " and pursued a career and postponed childbearing. Also, the social stresses add insult to injury when well-meaning fertile friends and relatives say hurtful things - without even realising the damage they cause !
Some patients become very bitter, angry and unhappy as a result of the failure. Others, who are more resilient, become kinder, nicer human beings - more empathetic and understanding, because they have been through the fire of adversity. This is one of the reasons I like treating entrepreneurs - because they are used to dealing with failure - and bouncing back ! They response is - " Fine, what did we learn from this ? And what do we do differently the next time ?"
The life lesson a failed IVF cycle often teaches is that it forces you to confront your own mortality - that life can be fickle and uncertain. This can be a major life changing event - and if you enjoy the learning , you will learn the truth behind the saying - What does not kill you, makes you stronger !
Is surrogacy being used to exploit infertile couples ?
Surrogacy hogs the limelight today and we get a phone call or email practically every day from either an "intended parent" or a journalist who wants to cover this "boom in reproductive outsourcing "!
Unfortunately, very few are willing to think through the " real-life problems" associated with surrogacy. Even a busy IVF clinic like ours which performs over 400 IVF cycles every year will only see 1-2 patients every month who actually need surrogacy.
Not only is surrogacy extremely expensive, it's also full of and emotional and ethical minefields which most doctors do not want to discuss. Infertile patients can be so desperate, that they are happy to try anything new - and clutching at the surrogacy straw seems to be a logical thing to do when you have failed 5 IVF cycles.
However , it's often not medically needed. Not only do these patients end up wasting a lot of time , money and energy - they also expose themselves to potential legal battles and emotional blackmail. Moreover, since they are operating in a legal grey zone, they leave themselves open to exploitation - both by the doctor ( who can charge a bomb for the treatment) ; the surrogate; and the agency which organises the surrogate.
The key question you should ask yourself is - do you really need it in the first place ? While there is no disputing that surrogacy is a valid treatment option for women without a uterus, the real tragedy is that it is being overused and misused to treat women with repeated IVF failures - an especially vulnerable group, which is extremely easy to exploit !
Most women who fail repeated IVF cycles for unexplained reasons usually do so because of a genetic abnormality in the embryo. This is Nature's defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have "aged" and have genetic defects, which cannot be screened for.
It's extremely rare that the reason for failed implantation is a damaged uterus. However, after failing repeated IVF cycles, these women have extremely poor self-esteem, nd it's easy for unscrupulous doctors to exploit them . Since the literature is so confusing ( and confused) about IVF failure ( because we really don't have the tools to pinpoint the causes in women), they come to the conclusion that their uterus is "defective"; or that they have "immunologic issues" which is causing them to "reject" their embryos.
Because many of them have reached the end of their emotional tether , they do not want to take any more medications or suffer from the crippling blow of another failed IVF cycle. They are more than happy to allow the surrogate to go through the IVF process, so they don't have to deal with the physical and emotional pain of another failure. And when there is a demand for this extremely lucrative option, it's hardly surprising that agencies and doctors will be more than happy to supply this option for well-heeled patients - even though they may not actually need this at all, and would be better served by considering alternatives such as donor eggs or donor embryos.
Does the IVF clinic matter ?
One of the toughest choices an infertile couple needs to make is - Where do I do my IVF
treatment ? IVF can be extremely expensive , and since there is so much riding on this decision, it is critically important that you make it correctly ! So, how do you decide ?
Most couples will not apply their mind and simply go to the local IVF clinic - or where their GP or gynecologist sends them. The vast majority of patients are very passive. They rarely do any homework, and are happy to follow their doctor's advise. While this may be a good idea for some patients ( since it's so easy to just do what the doctor says), this is often not the best option. Smarter patients will explore their options, so that they can select the clinic which is right for them. After all, not every sportcar driver is going to be as good as Schumacher - and it's a good idea to try to maximise your chances of success !
Many will ask friends or relatives as to which the "best IVF clinic" is - and then follow this recommendation. They shop around by soliciting opinions , and while this can be effective occasionally, it is not a very reliable technique . Bad doctors may get a good reputation for spurious reasons, so this is not a method I would recommend.
Others will use the internet to research their options. This is a good idea - but you need to be fairly sophisticated in order to separate the wheat from the chaff in order to be able to use this correctly. There are lots of bad clinic with very good websites out there !
The best way is to shortlist 3 IVF clinics - and then interview them. You can do this by visiting them ( if you stay in a large city, for example, there are likely to be many clinics in the city itself , so you maybe spoiled for choice !) and asking for a guided tour. The others you can explore by emailing them or phoning them. You become a better and more discerning patient each time you get a second opinion, so this is a valuable exercise - don't take shortcuts which you might regret later !
Making the final decision is always a very personal matter. Some patients prefer large clinics with an international reputation. Others prefer those with the best rankings on the success-rate league tables. Other want a smaller clinic which offers a personal touch and more individualised care. There are many intangibles, such as the chemistry between you and your doctor, so it's hard to generalise what's going to be right for you - you will need to explore to find out what works best for you. The good news is that there are now many choices. You are no longer forced to settle for the nearest clinic, so you should take off your blinkers and be willing to do your homework.
This is a crucially important decision, and if you approach it intelligently, and invest the time and energy needed to perform your "due diligence", you will have peace of mind you did your best !
What else can you ask for ?
Saturday, September 29, 2007
Patient education Libraries are a cost-effective option for providing better quality healthcare
In the past, housecalls were an integral part of the practice of medicine, and no nineteenth century doctor would even dream of practicing medicine without making housecealls. However, the fact that they are now practically unheard of means we should be taking a hard look at the present traditional ways of practicing medicine so e can come up with newer models of providing healthcare more efficiently and effectively.
The major bottleneck today in providing healthcare is the doctor. Doctors are expensive and scarce resources and the question we need to ask ourselves is simple – are we using this scarce commodity wisely ? The heart of modern medicine is based on the doctor-patient visit in the clinic – but is this really necessary ? Many problems are self-limited and could be better handled without involving a doctor. Many clinical transactions do not require a face-to-face discussion, and can be better done by email or through the web. Also, patients with chronic illnesses can be taught how to manage their own illness better. How can we create an alternative model, which offers a better option ?
Many attempts have been made in the past – and all of these have revolved around using a substitute for the doctor – for example, a village health worker in India, or a “barefoot doctor” in China. The modern “ retail clinic” in the US which is located in a mall is a variant on this model, since they allow a nurse ( who is much less expensive) to offer care for simple medical problems. However , none of these are very effective solutions, because they still keep the patient dependent on an outsider.
How can we create a more patient-friendly model ? I think we can learn from the education sector. In the past, education meant that children were sent to schools, where the experts ( teachers ) “taught” the children what they needed to know to pass their examinations. Today, we understand that teaching is not just the passive transfer of knowledge from teachers to students. Good teaching involves the active participation of students so they learn to learn for themselves. In fact, this is the major reason why the US has been so much more successful than other countries in the past few decades. In most countries, students were taught using traditional rote learning methods, which means they made great clerks or professionals, but they never learnt to take risks or think for themselves . In sharp contrast, thanks to the national network of free public libraries set up by Carnegie in the US, students here were forced to go to public libraries to do their own research for themselves, so they learnt to ask questions and find their own answers.
I think the health-sector can learn from this model by setting up networks of Patient education libraries to help patients get better healthcare. I agree this is an unusual proposal, but it’s worth examining closely.
- This is quite inexpensive to do. For the cost of one new MRI scanner, one could setup over 100 libraries , each equipped with about 100 books and 10 PCs with internet terminals !
- Librarians are much less expensive than doctors. They are also far better teachers , because they are used to helping and guiding patrons so they can find the information they need
- Patients in a library are likely to be much more empowered . They will not feel scared or intimidated, as they do by their doctor. They will treat the librarian as a guide or peer , which means they are much more likely to craft their own answers and make their own decisions . They will formulate their own treatment plans and stick with these, ensuring a higher degree of compliance.
- This is a much more enlightened, participatory and democratic model, which puts patients at the center of the healthcare universe. This is where they belong, but in order to reclaim this place, they need to become well-informed, so they can be treated as equals by their doctors
Much more importantly, this model represents a completely different philosophy – one which respects patients, and teaches them to ask questions and find their own answers. This means patients will take much more responsibility for their own health , and this is especially important for patients with chronic illnesses , who can become “expert patients” and help guide others with the same illness !
How is this different from the traditional “patient education model” where the doctor educates the patient by giving them brochures or showing them videos ?
For one thing, the information is likely to be much more reliable ! Since the librarian has no vested interest in pushing surgery or promoting a particular drug, patients will get objective vetted information about cost effective, tried and tested treatments, rather than the newest , most fashionable ( and most
expensive !) drug which is being actively promoted by the drug companies.
Librarians are good at applying evidence-based medicine because they are information specialists. However, since they do not provide the actual care, they are objective and will act as guides or coaches. This allows a two-tier approach , so that armed with this information the patient goes to the doctor and discusses his options more intelligently . This makes better use of the doctor’s time as well – and helps to keep the doctor honest too !
I need to emphasise that my concept of a library is not just a collection of books in four walls. While it is important that each hospital have a patient education library to which patients can go and to which doctors can refer their patients, a lot of this will be done online as well . Information could be delivered through the web and the mobile and queries could be answered by email; or through a call-center. As clinical decision support software becomes more mature, this could also be used by librarians to help patients think through possible diagnostic alternatives.
Patient education libraries represent a great return on investment, as patients will no longer undergo unnecessary ( and expensive !) surgery; or be pressurized into popping the newest ( and costliest ) version of a drug . Since the information is being provided by someone other than the actual clinician, the information is likely to be much more objective and reliable ! These libraries could also form the nucleus of patient communities ; where patients could get together and support each other with a little help from a librarian.
Friday, September 28, 2007
Thursday, September 27, 2007
"The Best Care Anywhere" by Phillip Longman
"The Best Care Anywhere" by Phillip Longman: "'The U.S. medical market as presently constituted simply does not provide a strong business case for quality.' Casalino writes from his own experience as a solo practitioner, and on the basis of over 800 interviews he has since conducted with health-care leaders and corporate health care purchasers. While practicing medicine on his own in Half Moon Bay, Calif, Casalino had an idealistic commitment to following emerging best practices in medicine. That meant spending lots of time teaching patients about their diseases, arranging for careful monitoring and follow-up care, and trying to keep track of what prescriptions and procedures various specialists might be ordering. Yet Casalino quickly found out that he couldn't sustain this commitment to quality, given the rules under which he was operating. Nobody paid him for the extra time he spent with his patients. He might have eased his burden by hiring a nurse to help with all the routine patient education and follow-up care that was keeping him at the office too late. Or he might have teamed up with other providers in the area to invest in computer technology that would allow them to offer the same coordinated care available in veterans hospitals and clinics today. Either step would have improved patient safety and added to the quality of care he was providing. But even had he managed to pull them off, he stood virtually no chance of seeing any financial return on his investment. As a private practice physician, he got paid for treating patients, not for keeping them well or helping them recover faster."
Amazon.com: Who Killed HealthCare?: America's $2 Trillion Medical Problem - and the Consumer-Driven Cure: Books: Regina Herzlinger
Amazon.com: Who Killed HealthCare?: America's $2 Trillion Medical Problem - and the Consumer-Driven Cure: Books: Regina Herzlinger: "'Four armies are battling to gain control [of health care]: the health insurers, hospitals, government, and doctors. Yet you and I, the people who use the health care system and who pay for all of it, are not even combatants. And the doctors, the group whose interests are most closely aligned with our welfare, are losing the war.'
What to do? Herzlinger's convincing, indeed compelling and eloquent response to that question is best revealed within her narrative. However, for present purposes, here are a few key recommendations:
1. Consumers must take back the money their employers and government now take from their salaries and taxes to buy health insurance on their behalf so they can make their own purchase decisions.
2. Physicians must be empowered to design better, cheaper health care.
3. The destitute must be subsidized by 'the rest of us' so that can purchase health insurance 'like everybody else.'
4. The federal government must help subsidize the destitute, provide transparency (a key factor for all consumers, actually), and prosecute fraud and abuse."
My Home Doctor - House Call Services South Florida
My Home Doctor - House Call Services South Florida: "Now seeing patients 24hrs/day! My Home Doctor gives you and your child a better option for medical attention. We send top, local physicians and pediatricians to your home - any time - day or night. We arrive in about one hour, conduct a comprehensive, unhurried exam, and diagnose your condition. You begin your treatment plan right away, in the comfort of your own home, office or hotel room. And our services are more affordable than you might think. Click here to view how our cost measures up against other clinical treatment centers. All My Home Doctor physicians and pediatricians are board-certified, licensed and practice exemplary medicine in South Florida."
Be MedWise Tennessee
Be MedWise Tennessee: "Did You Know That Taking Medications Is As Simple as PIE? If you know what the purpose of each medication is, understand instructions for use and dosage, and know the outcomes (effect) to expect, then taking your medication can be as simple as PIE.
* P–Purpose and name of the medication
* I– Instructions for use and dosage: o How many times a day? o Time of day? o With food or without food? o How long to take it? o What if I miss a dose? o Should I avoid alcohol, sunlight, certain foods, etc.?
* E–Effect of the drug, both positive and negative "
The ‘Poisonous Cocktail’ of Multiple Drugs - New York Times
The ‘Poisonous Cocktail’ of Multiple Drugs - New York Times: "This is what doctors call polypharmacy, otherwise known as a “poisonous cocktail” of many drugs that can interact in dangerous ways and cause side effects that can be far worse than the diseases they are treating. Elderly people are especially vulnerable because they often have several medical problems for which they see different doctors, each prescribing drugs, often without knowing what else the patient is taking."
Plain Language: A Promising Strategy for Clearly Communicating Health Information and Improving Health Literacy
Plain Language: A Promising Strategy for Clearly Communicating Health Information and Improving Health Literacy: "Conclusion: Plain language makes health information easier to understand Our nation faces an enormous challenge to ensure that people with low health literacy skills have the opportunity to receive and understand the health information they need to make sound decisions. Limited health literacy is a complex communication and information problem that requires multiple approaches and methods to realize improvement. This brief examines plain language and its contribution to improving health literacy. Research and experience demonstrate that plain language is an essential element of clear communication. Although more research is needed to determine the most effective techniques to communicate clearly with all consumers and patients, existing research shows that plain language is a promising strategy to address the challenge."
Retro Medicine: Doctors Making House Calls (for a Price) - New York Times
Retro Medicine: Doctors Making House Calls (for a Price) - New York Times: "Some doctors are doing things like taking only house-call appointments or operating “micropractices” in which they work without front-office staff and nurses and see their patients in a smaller one-room office, Dr. Kellerman said. When making house calls, “you get paid,” said Dr. Steven Meed, one of eight New York physicians working for Sickday Medical House Calls, which started last year and serves patients in Manhattan. “The paperwork overhead is kept at a minimum, the fee is fixed and it’s not going to be reduced.”"
Hormone-Replacement Therapy - New York Times
Hormone-Replacement Therapy - New York Times: "Many explanations have been offered to make sense of the here-today-gone-tomorrow nature of medical wisdom — what we are advised with confidence one year is reversed the next — but the simplest one is that it is the natural rhythm of science. An observation leads to a hypothesis. The hypothesis (last year’s advice) is tested, and it fails this year’s test, which is always the most likely outcome in any scientific endeavor. There are, after all, an infinite number of wrong hypotheses for every right one, and so the odds are always against any particular hypothesis being true, no matter how obvious or vitally important it might seem."
Using pictures to improve health communication.
Using pictures to improve health communication This presentation discusses the need for effective comunnication between health professionals and patients and the potentially important role that pictures can take in insuring accurate and effective communication.
The AGS Foundation for Health in Aging
The AGS Foundation for Health in Aging - : "2nd edition of Eldercare at Home as a resource for families and friends who are caring for older people at home. Written by experienced health professionals, the book is a tool for caregivers who are working in consultation with a health care professional in providing home care for an older person. Families are increasingly involved in caring for older adults who want to remain at home. Providing that care can be one of the most rewarding experiences of one’s life. It can be one of the most challenging experiences as well. Family caregivers frequently have to deal with new, unfamiliar problems and learn new skills. They must do this in the context of strong emotional relationships. They must also involve the older person as much as possible in his or her own care. At the same time, family members need to take care of themselves so that they are able to provide the long-term care that is required and maintain their own quality of life. To meet these challenges, advice and guidance from experienced professionals can be important and helpful. The 2nd edition of Eldercare at Home gives this guidance. The book gives clear, practical instructions for dealing with common caregiving problems and supports a problem-solving approach to managing care at home and working cooperatively with health professionals. "
Help Patients Remember Instructions With The “Teach Back” Method
Help Patients Remember Instructions With The “Teach Back” Method : "The “Teach Back” Method is simply asking patients to repeat back in their own words what they need to do when they leave the office. This method allows you to check your patient’s perception and understanding of your medical instructions.
* You do not want your patients to view the Teach Back task as a test, but rather of how well you explained the concept. You can place the responsibility on yourself by using this suggested language:
* “I want to be sure that I did a good job explaining your blood pressure medications, because this can be confusing. Can you tell me what changes we decided to make and how you will now take the medications?”
* If your patient is not able to repeat back the information accurately, you should try to re-phrase the information, rather than just repeat it. Then, ask the patient to repeat back the instructions again until you feel comfortable that the patient really understands the information."
Resolving conflict between patient and physicians - a model
Resolving conflict between patient and physicians - a model During the past 20 years, the number of people with End Stage Renal Disease (ESRD) on dialysis has increased to about 350,000. Many in the field sense that along with that has been a rise in tension between dialysis patients and providers. While difficult patients may be a small percentage of all patients with ESRD, they can command a disproportionate amount of the unit staff’s time, many in the field say. In addition, not only do patients exhibiting challenging behaviors place their own health at risk, they also endanger the health of other patients and potentially the providers. Yet, the question remains how to respond when faced with such a patient. For some, the answer is discharging or dismissing the patient, but not all in the field find that a satisfactory solution. Stories abound of units that discharge patients for infractions as minor as verbal abuse. Others strive to address the underlying factors that lead to the patients’ misbehavior in the first place. Given the wide variability in units’ standards for discharge, interviewees repeatedly endorsed the notion of a project to address this problem sooner rather than later. With the number of patients on dialysis projected to double by 2010,2 many feel the time is ripe to identify ways to reduce the potential for conflict and improve the work environment for professionals and the prognosis for patients.
Making a Bottom-Line Case for Health Literacy
Making a Bottom-Line Case for Health Literacy : "Putting health-literacy principles into place obviously takes time, training, persistence, and money. The clinic offsets these expenses by putting the most cost-effective people in positions where they can do the most good. This means that patients are not always seen by primary care physicians whose time is at a premium. Instead, returning patients may be seen by physician assistants, pharmacists, nurse practitioners, or dieticians. Patients also work with nonclinical “care assistants” who follow approved guidelines to assist with problem-solving and offer social support. They help in many ways, such as: * Checking patients’ records just prior to appointments and noting any situations that need extra attention. Even when patients come to the clinic for acute problems, care assistants flag important chronic concerns. * Taking a brief, targeted health history while patients wait in the examining room. The care assistant then shares this information and other significant concerns with the clinician just prior to seeing the patient, allowing more time for clinicians and patients to focus on healthcare interventions. * Following up with patients between appointments by calling them to gather information, consulting as needed with clinicians, and then calli"
In Other Words ... How to Help Patients Manage Their Action Planning - Health Literacy
In Other Words ... How to Help Patients Manage Their Action Planning - Health Literacy: "In Other Words ... How to Help Patients Manage Their Action Planning By Helen Osborne, M.Ed., OTR/L President of Health Literacy Consulting Patients, not providers, are ultimately responsible for the day-to-day management of their own chronic condition. But figuring out what to do and being consistent about doing it is hard for almost everyone. Hilary Seligman, MD, MAS, is an assistant professor in the department of medicine at San Francisco General Hospital in California. Many of the patients she sees in her internal-medicine practice have limited literacy or English-language skills, yet regardless of their skill level, Seligman makes it a point to help them develop effective action plans that let them take charge of their own care."
Beyond the Brochure
Beyond the Brochure Most of us obtain health information through many different sources,including printed media such as newspapers, magazines, books and brochures. But for at least 90 million Americans who demonstrate low levels of literacy (Educational Testing Service, 1993), or for individuals
who have learned to rely upon oral forms of communication, written information sources are of little or no use. For such audiences, health educators and communicators need alternative
approaches with appropriate visuals and activities that stimulate learning, are interesting and fun, and motivate the intended audience to experience new behaviors.
The AMC Cancer Research Center, with collaboration and support of the Centers for Disease Control and Prevention (CDC), Division of Cancer Prevention and Control, has developed Beyond the Brochure to assist health educators and health communicators in conceiving and producing educational materials and activities that do not rely solely on the printed word. The intent is to present innovative intervention ideas and strategies that can be used to reach audiences who are not benefitting from current health communication efforts.