Comments for BeyondApples.Org http://beyondapples.org Better ways to keep the doctor away Mon, 26 Jul 2010 16:34:04 -0700 hourly 1 http://wordpress.org/?v=3.0.1 Comment on A Gentle Scolding by GlassHospital http://beyondapples.org/2010/07/25/a-gentle-scolding/comment-page-1/#comment-4396 GlassHospital Mon, 26 Jul 2010 16:34:04 +0000 http://beyondapples.org/?p=1388#comment-4396 This is the nut graf: To most people, this visit would seem incredibly routine. Mrs. MJ didn’t have an obscure diagnosis, wasn’t acutely ill, and didn’t suffer from a complex set of psychosocial issues. But its “routine-ness” is what makes it so concerning. The obesity epidemic has left thousands of Americans standing with Mrs. MJ at the crossroads between relative health and serious medical illness. And yet, our approach to these patients is non-standardized and highly fragmented. We continue to focus on urgent complaints not overall health, pharmacologic treatment over counseling, and tradition rather than science. When we do address weight gain head on, we use blunt instruments and clumsily at that. Dr. Nundy, so right! I love everything in this paragraph. I think about this every day, and it's taken me years to get to this point. This discussion is so non-standardized, that to be honest, in a busy day, for a patient that has resisted repeated entreaties to get serious about weight (or its proxies, diet and exercise) I will admit that I might not even bother. Sometimes you need that 4 minute visit, painful as that is to admit. The real questions are: who is ready for change? and in those that aren't, how do we get them there? -GH This is the nut graf:

To most people, this visit would seem incredibly routine. Mrs. MJ didn’t have an obscure diagnosis, wasn’t acutely ill, and didn’t suffer from a complex set of psychosocial issues. But its “routine-ness” is what makes it so concerning. The obesity epidemic has left thousands of Americans standing with Mrs. MJ at the crossroads between relative health and serious medical illness. And yet, our approach to these patients is non-standardized and highly fragmented. We continue to focus on urgent complaints not overall health, pharmacologic treatment over counseling, and tradition rather than science. When we do address weight gain head on, we use blunt instruments and clumsily at that.

Dr. Nundy, so right! I love everything in this paragraph. I think about this every day, and it’s taken me years to get to this point. This discussion is so non-standardized, that to be honest, in a busy day, for a patient that has resisted repeated entreaties to get serious about weight (or its proxies, diet and exercise) I will admit that I might not even bother. Sometimes you need that 4 minute visit, painful as that is to admit.

The real questions are: who is ready for change? and in those that aren’t, how do we get them there?

-GH

]]> Comment on Sometimes It Takes A Village by Jeffrey Jue http://beyondapples.org/2010/06/15/sometimes-it-takes-a-village/comment-page-1/#comment-4395 Jeffrey Jue Mon, 26 Jul 2010 02:19:58 +0000 http://beyondapples.org/?p=1345#comment-4395 I agree that Mr. HD and many others would benefit from a community based approach to their care. Many of my patients can’t access to the resources they need without assistance. Some of the barriers they face are language, the absence of a strong support system and their unfamiliarity with our confusing health care system. In the past year I've had the pleasure of working in a long term home care program whose goal is to keep our elderly in the community and prevent unnecessary hospitalizations. I agree that Mr. HD and many others would benefit from a community based approach to their care. Many of my patients can’t access to the resources they need without assistance. Some of the barriers they face are language, the absence of a strong support system and their unfamiliarity with our confusing health care system. In the past year I’ve had the pleasure of working in a long term home care program whose goal is to keep our elderly in the community and prevent unnecessary hospitalizations.

]]> Comment on Competing on Outcomes, The Way to True Health Care Reform by A.N. Mousse http://beyondapples.org/2010/07/17/competing-on-outcomes-the-way-to-true-health-care-reform/comment-page-1/#comment-4390 A.N. Mousse Mon, 19 Jul 2010 22:56:34 +0000 http://beyondapples.org/?p=1360#comment-4390 I agree. If you measure it, they will do it better. And the commenter above brings up a good point - consistency in the measuring is key. Every entity needs to measure and report the same way. You don't even have to measure the big things - small things matter. I am permanently numb on the backs of my arms because of a hurried breast surgeon's sentinel node biopsy. It is annoying and occasionally uncomfortable, but I can continue with my life without it troubling me much - but should I have to? If breast surgeons were required to track and report these outcomes you can be darn sure they'd be a lot less rushed and take care to locate and avoid the nerves as they do these surgeries. Measure and report the small things. They matter, too. I agree. If you measure it, they will do it better. And the commenter above brings up a good point – consistency in the measuring is key. Every entity needs to measure and report the same way.

You don’t even have to measure the big things – small things matter. I am permanently numb on the backs of my arms because of a hurried breast surgeon’s sentinel node biopsy. It is annoying and occasionally uncomfortable, but I can continue with my life without it troubling me much – but should I have to? If breast surgeons were required to track and report these outcomes you can be darn sure they’d be a lot less rushed and take care to locate and avoid the nerves as they do these surgeries. Measure and report the small things. They matter, too.

]]> Comment on Competing on Outcomes, The Way to True Health Care Reform by chris goeschel http://beyondapples.org/2010/07/17/competing-on-outcomes-the-way-to-true-health-care-reform/comment-page-1/#comment-4389 chris goeschel Sun, 18 Jul 2010 12:30:14 +0000 http://beyondapples.org/?p=1360#comment-4389 Agree completely~and would go one step further. Lets hope those transplant centers measure outcomes the same way, so consumers can make a truly informed choice~ perhaps using survival rates over time and quality of life measures. I suspect some report quality of life (back to work etc); some may report "survival" (alive x numbers of months or years post transplan). Your transpant center example represents an important step but the journey is long. Like my difficult choice to give up the blackberry and choose an iphone, full disclosure is important. In my case the surgery did not go well and the tradeoffs were too high.........awesome apps but lousy battery meant I had great service for a limited amount of time and then no service. Luckily I could "undo" my decision and go back to the blackberry........where the battery life is great and the apps are good, but not awesome. In patient care there is generally no going back. Thus full disclosure ~using standardized measures so patients, (where do I want to receive care) payers (what is care worth?) and providers (where do I want to work?) can all make informed choices . THAT level of competition and transparency will indeed transform health care. Agree completely~and would go one step further. Lets hope those transplant centers measure outcomes the same way, so consumers can make a truly informed choice~ perhaps using survival rates over time and quality of life measures. I suspect some report quality of life (back to work etc); some may report “survival” (alive x numbers of months or years post transplan). Your transpant center example represents an important step but the journey is long. Like my difficult choice to give up the blackberry and choose an iphone, full disclosure is important. In my case the surgery did not go well and the tradeoffs were too high………awesome apps but lousy battery meant I had great service for a limited amount of time and then no service. Luckily I could “undo” my decision and go back to the blackberry……..where the battery life is great and the apps are good, but not awesome. In patient care there is generally no going back. Thus full disclosure ~using standardized measures so patients, (where do I want to receive care) payers (what is care worth?) and providers (where do I want to work?) can all make informed choices . THAT level of competition and transparency will indeed transform health care.

]]> Comment on Sometimes It Takes A Village by Anju Nundy http://beyondapples.org/2010/06/15/sometimes-it-takes-a-village/comment-page-1/#comment-4377 Anju Nundy Wed, 16 Jun 2010 08:03:13 +0000 http://beyondapples.org/?p=1345#comment-4377 Yes Mr HD, need help with his close family and his community, he needs to positive about himself. He needs to be self lifted. Do not give up hope to live. Do what he is good at it. Keep his mind occipied.Give and take love and reachout to friends and family, laugh and joke, it is the best medicine. Doctors and hospital are doing their best to keep him going. God please Mr HD and the team of ICU and ER. From Best Wisher, Anju Nundy Yes Mr HD, need help with his close family and his community, he needs to positive about himself. He needs to be self lifted. Do not give up hope to live. Do what he is good at it. Keep his mind occipied.Give and take love and reachout to friends and family, laugh and joke, it is the best medicine. Doctors and hospital are doing their best to keep him going. God please Mr HD and the team of ICU and ER.

From Best Wisher, Anju Nundy

]]> Comment on Remembering What It Means To Be A Doctor by Checklisting Your Way to Health « Science Life Blog « University of Chicago Medical Center http://beyondapples.org/2010/04/12/remembering-what-it-means-to-be-a-doctor/comment-page-1/#comment-4364 Checklisting Your Way to Health « Science Life Blog « University of Chicago Medical Center Wed, 02 Jun 2010 17:55:25 +0000 http://beyondapples.org/?p=1252#comment-4364 [...] immediate family. At his blog, Beyond Apples, posts range from cases studies from his own clinic to tales of volunteering in a Ugandan clinic for pregnant women. Some of the most interesting posts talk about the divide between knowing what is best for a [...] [...] immediate family. At his blog, Beyond Apples, posts range from cases studies from his own clinic to tales of volunteering in a Ugandan clinic for pregnant women. Some of the most interesting posts talk about the divide between knowing what is best for a [...]

]]> Comment on The Price of Preventive Health Care (Part 1) by A.N. Mousse http://beyondapples.org/2010/04/26/the-price-of-preventive-health-care-part-1/comment-page-1/#comment-4363 A.N. Mousse Fri, 28 May 2010 16:23:00 +0000 http://beyondapples.org/?p=1276#comment-4363 Thank you so much for responding. I understand it is quite a challenge to know how much medical services and procedures cost. With a vaccine or other drug it seems slightly easier. One can know the cost of the vaccine itself - I understand that there are storage, administration, other costs that are less clear. It seems, however that a mark-up of over 400% is outrageous, even given these other factors. Did Mr. GR have to pay the full amount? These sorts of things contribute to our mistrust of medical providers - however little they may actually be at fault. Why not send Mr. GR to a pharmacist for the vaccine? It would have been less the 1/4 the cost of having it administered in your clinic. Thank you so much for responding. I understand it is quite a challenge to know how much medical services and procedures cost. With a vaccine or other drug it seems slightly easier. One can know the cost of the vaccine itself – I understand that there are storage, administration, other costs that are less clear.

It seems, however that a mark-up of over 400% is outrageous, even given these other factors. Did Mr. GR have to pay the full amount? These sorts of things contribute to our mistrust of medical providers – however little they may actually be at fault.

Why not send Mr. GR to a pharmacist for the vaccine? It would have been less the 1/4 the cost of having it administered in your clinic.

]]> Comment on About by Sandeep Tak http://beyondapples.org/about/comment-page-1/#comment-4359 Sandeep Tak Fri, 28 May 2010 05:42:53 +0000 http:/?page_id=2#comment-4359 Hi Shantanu, I came across your blog accidentally and it was a pleasant surprise to see internist involved in tobacco control and preventive care. I myself is physician with MD from AIIMS Delhi, practicing in India and has interest in tobacco control and preventive care with special interest in non-communicable diseases and diabetes. In fact diabetes is a ticking bomb going to explode in another 10 years. I maintain following blogs, www.saynototobacco.blogspot.com AND www.diabetescareindia.blogspot.com Hi Shantanu, I came across your blog accidentally and it was a pleasant surprise to see internist involved in tobacco control and preventive care. I myself is physician with MD from AIIMS Delhi, practicing in India and has interest in tobacco control and preventive care with special interest in non-communicable diseases and diabetes. In fact diabetes is a ticking bomb going to explode in another 10 years. I maintain following blogs, http://www.saynototobacco.blogspot.com AND http://www.diabetescareindia.blogspot.com

]]> Comment on The Price of Preventive Health Care (Part 1) by admin http://beyondapples.org/2010/04/26/the-price-of-preventive-health-care-part-1/comment-page-1/#comment-4358 admin Wed, 26 May 2010 23:22:16 +0000 http://beyondapples.org/?p=1276#comment-4358 Great question. That is the "list price" at my institution, which includes the vaccine and its administration. Hardly anyone (if anyone) pays that price. Prices in health care, as you probably know, are rarely transparent. If you want into a clinic and ask how much they charge for a cholesterol test or even a routine office visit, many cannot tell you. This is in part because insurers contract with clinics and hospitals to get a discounted rate. But even these rates are not easy to obtain. It took me 4 months to get a list of charges for all the preventive health care measures at my institution, including the shingles vaccine. But even these prices do not always translate to actual prices in the real world, as you've learned. Great question. That is the “list price” at my institution, which includes the vaccine and its administration. Hardly anyone (if anyone) pays that price. Prices in health care, as you probably know, are rarely transparent. If you want into a clinic and ask how much they charge for a cholesterol test or even a routine office visit, many cannot tell you. This is in part because insurers contract with clinics and hospitals to get a discounted rate. But even these rates are not easy to obtain. It took me 4 months to get a list of charges for all the preventive health care measures at my institution, including the shingles vaccine. But even these prices do not always translate to actual prices in the real world, as you’ve learned.

]]> Comment on The Price of Preventive Health Care (Part 1) by A.N. Mousse http://beyondapples.org/2010/04/26/the-price-of-preventive-health-care-part-1/comment-page-1/#comment-4357 A.N. Mousse Wed, 26 May 2010 19:00:42 +0000 http://beyondapples.org/?p=1276#comment-4357 Question - I read in two different articles recently that the shingles vaccine is $200. Why do you quote a price of $844? Question – I read in two different articles recently that the shingles vaccine is $200. Why do you quote a price of $844?

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