Group items tagged

'If you met me, you'd never know I was mentally ill. In fact, I've gone through most of my adult life without anyone ever knowing - except when I've had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis. I was surprised when, after one of these run-ins, my psychopharmacologist said this sort of behavior was all too common. At least 14 studies have shown that patients with a serious mental illness receive worse medical care than "normal" people. Last year the World Health Organization called the stigma and discrimination endured by people with mental health conditions "a hidden human rights emergency." If you met me, you'd never know I was mentally ill. In fact, I've gone through most of my adult life without anyone ever knowing - except when I've had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis. I was surprised when, after one of these run-ins, my psychopharmacologist said this sort of behavior was all too common. At least 14 studies have shown that patients with a serious mental illness receive worse medical care than "normal" people. Last year the World Health Organization called the stigma and discrimination endured by people with mental health conditions "a hidden human rights emergency." I never knew it until I started poking around, but this particular kind of discriminatory doctoring has a name. It's called "diagnostic overshadowing." According to a review of studies done by the Institute of Psychiatry at King's College, London, it happens a lot. As a result, people with a serious mental illness - including bipolar disorder, major depression, schizophrenia and schizoaffective disorder - end up with wrong diagnoses and are under-treated. That is a problem, because if yo

John K. Iglehart: 'President Barack Obama, sealing a hard-fought and historic victory, has signed into law the Democrats' comprehensive health care reform bill, the Patient Protection and Affordable Care Act, a sweeping measure that would expand coverage to 32 million uninsured Americans. Appearing March 23 in the White House, Obama said, "Today . . . health insurance reform becomes law in the United States of America. . . . We have just enshrined the core principle that everybody should have some basic security when it comes to their health care." '

H.J. Aaron (health economist) and R.D. Reischauer (former director of HBO): "Health care reform advocates will and should celebrate their history-making legislative success.... But supporters must not relax. They should prepare to meet the serious challenges that remain.... Far from having ended, the war to make health care reform an enduring success has just begun. Winning that war will require administrative determination and imagination and as much political resolve as was needed to pass the legislation."

The researchers found that in areas where end-of-life care costs were normally high, having an advance directive significantly lowered the cost of care. On average, end-of-life care spending was $5,585 less per person in the high-spending regions when someone had an advance directive. > Having an advance directive didn't necessarily limit the initiation of aggressive treatments, but seemed to lead to their earlier withdrawal. Author said this finding was particularly important because some people make the argument that having an advance directive might limit all of the care you receive at the end of your life. But, this finding shows that while treatments are often started, for "patients with an advance directive, there's an earlier recognition of when treatments aren't working and when it's time to go to hospice."

"Those who work in geriatric care are among the worst paid in the health care system. Is the time I spend as a surgeon excising a patient's cancer worth 10 times more than the time the primary care doctor spent finding the cancer in the first place?" Dr. Gawande, who examined the problems of medical care for the aged last year in The New Yorker, pointed out that as we grow older, "we don't get one problem at a time." "People with multiple problems need time, and that is not cheap and is currently not paid for by medical insurance," he said. "It's not possible to address five different problems in a 20-minute visit." Dr. Gawande, who examined the problems of medical care for the aged last year in The New Yorker, pointed out that as we grow older, "we don't get one problem at a time.... People with multiple problems need time, and that is not cheap and is currently not paid for by medical insurance," he said. "It's not possible to address five different problems in a 20-minute visit."

Peter B. Bach, M.D., M.A.P.P.: The Debate over Regional Variation in Health Care Spending: "The regional variations in health care spending that are documented by the Dartmouth Atlas of Health Care have been cited by many as a justification, and possible basis, for changes in provider payment rates. ..."

Most people in health care understand and accept the need for clinical hierarchies. The problem is that we aren't usually prepared for them; nor are we given protocols for resolving the inevitable tensions that arise over appropriate care. Doctors and nurses are trained differently, and our sense of priorities can conflict. When that happens, the lack of an established, neutral way of resolving such clashes works to everyone's detriment. This isn't about hurt feelings or bruised egos. Modern health care is complex, highly technical and dangerous, and the lack of flexible, dynamic protocols to facilitate communication along the medical hierarchy can be deadly. Indeed, preventable medical errors kill 100,000 patients a year, or a million people a decade, wrote Rosemary Gordon and Janardan Prasad Singh in their book "Wall of Silence."

'...the Cochrane Collaboration reported last year that patients who used tools to guide their decisions had a better grasp of their choices and risks. They were also more likely to select less intense or invasive treatment when considering major elective surgery, though results were mixed for other decisions. The influence of decision aids on adherence to medication or overall costs was "inconclusive," according to the report. 'But that uncertainty does not reduce the ethical obligation to better inform patients, or lessen the promise of tools that help patients understand their options and identify their values, some doctors say. "It is the right thing to do," said Dr. Victor Montori, associate director of the Health Care Delivery Research Program at the Mayo Clinic Center for the Science of Health Care Delivery....'

Readers largely support measures to allow death in dignified environment with palliative approach, as opposed to repeated aggressive interventions that are rarely successful when the prognosis is poor.

Bob Doherty is the main Washington lobbyist of the ACP - after the AMA, the largest organization of US doctors (representing internal medicine physicians, whether primary care or subspecialist). He's had some very interesting posts since the Massachusetts Senate upset. His blog is a finalist in the sixth annual Medical Weblog Awards for the Best Health Policies/Ethics Weblog. Doherty articulates the ACP's case for supporting the current Senate&House Health Care Reform legislation (whose failure he & many others will end up leading eventually to more draconian limits on doctors & patients, in order to control the currently unsustainable growth in US health care costs (now approaching 20% of GDP).

The North Shore-LIJ Health System, with 16 hospitals and more than 300 outpatient centers in Long Island and New York City, is laying the groundwork to be an insurer, as well as a provider of health care.

Agrees with Obama's 7/22/09 analysis of need to overhaul health care system - compassion coincides with need for cost constraint.

Swiss private & universal health care

The fundamental fix for health care reform is likely to be achieved only through trial and error and incremental gains.\n

Pho is a fairly conservative primary care doctor in New Hampshire, but believes that defeat of the current Senate/House legislation will eventually lead to more draconian restrictions on doctors and patients, since the cost of medical care will otherwise become untenable in the U.S.

Conservative criticism of Republican scare tactics about Medicare limiting futile care at EOL