Help! I’ve Lost My Insurance and I Can’t Get Up!

The serendipity of the universe never ceases to amaze me. A couple of days ago I gave the keynote speech on healthcare reform at the Texas Medical Association’s CME Association’s annual meeting in Austin. A physician in the audience brought up an issue that was trumpeted in the press when the health care exchanges rolled out for open enrollment; namely, that people had lost their insurance and couldn’t see their doctors. I knew that a very small minority of people had actually “lost” their insurance, and that, in most cases, that insurance provided pretty bad coverage at fairly high prices. But I didn’t want to get into it with him, so I just agreed that yes, the Affordable Care Act certainly has flaws, then moved on to the next question.

If only I’d checked the news before my talk. I could have told him about a Kaiser Family Foundation survey of non-group enrollees (ie, they don’t have employer-provided insurance and bought …Continue reading…

74 and Counting. . . Why Gun Control is a Public Health Issue

This map shows every school shooting since December 14, 2012–the Sandy Hook Elementary School massacre. Don’t bother counting — there are 74. The only reason the map won’t break 100 in the next two months is that school is out for the summer.

Certainly, this is a moral issue. And a political issue. But first and foremost, the issue of gun control is a public health issue.

As the Johns Hopkins Center for Gun Policy and Research notes: “More than 31,000 people a year in the United States die from gunshot wounds. Because victims are disproportionately young, gun violence is one of the leading causes of premature mortality in the U.S. In addition to these deaths, in 2010, there were an estimated 337,960 non-fatal violent crimes committed with guns,2 and 73,505 persons treated in hospital emergency departments for non-fatal gunshot wounds.” Other fun facts from the Center:

The homicide rate in the U.S. is seven times higher than the combined homicide rate of …Continue reading…

Time for Healthcare Providers to Act Like La Guardia Airport

You see the photo to the left? That’s a shot of a restaurant in Terminal D at La Guardia airport. In fact, the entire terminal looks like that, with iPads at every seat in every restaurant as well as most of the tables in the waiting area. So this morning, I sat down for breakfast, browsed through the electronic menu, placed my order electronically, swiped my credit card, and waited for my baked eggs and coffee. No fuss. No muss.

Now, let’s imagine what it would be like if our doctors’ offices (and other healthcare facilities) were as technologically savvy.

A week before my annual physical, I get an alert from the app on my phone letting me know that an order for blood work has been sent to the lab, with a link to its web site. While I’m on the doctor’s office app, I update my personal information, including insurance (and email a scanned copy of my latest insurance …Continue reading…

Why Do We Wait in Doctor’s Offices?

I’m writing this from the airport awaiting a flight to New York for a business meeting. My flight is delayed 90 minutes, but that’s ok, because before I even left for the airport I received two texts from Delta updating me on its status so I could time my departure accordingly.

Compare that to the friend I wrote about in yesterday’s blog. She waited more than two hours to see the doctor . Another friend spent an hour past her gyn appointment time in the waiting room, then another hour naked, in the cold examining room with only a paper gown for warmth, waiting to be seen.

If I took a poll of my readers, I guarantee 100 percent can share a similar experience. I, for one, have walked out after an hour. I now have a policy of walking out after 30 minutes unless the appointment is for an emergent issue or the office kindly slotted me in.

Yes, I know that …Continue reading…

Medical Uncertainty: Are You a Glass Half Full or a Glass Half Empty Kind of Person?

I’m dedicating today’s blog to my good friend and neighbor who has just spent what I would deem the weekend-from-hell-waiting-for-Monday. You see, what started last week as bad cramps and a feeling of bloating, with the likely diagnosis of ovarian cysts, has now morphed into a visit with a gyn-oncologist today. Very, very quickly.

The Health Benefits of Relaxing

Coffee and  e-newspapers on the screened porch. An hour-long bike ride along country roads lined with wildflowers and cornfields, interspersed with glimpses of the Chesapeake Bay ending at a small sandy beach with a view of the Bay as far as the eye can see. A stroll through a farmer’s market with the dog. Lunch and a couple of glasses of wine at a local winery. A two-hour nap in the hammock. Cocktail hour on the dock. Dinner of wild goose breast (shot by  husband and son), snap peas, potatoes, turnips, and rutabagas picked from the garden that morning with husband, son, son’s girlfriend. Knitting and watching a movie. Bed.

That was my day yesterday (which explains why this blog is a day late [I'm participating in a 2014 FLX/WordCountBlogathon, so look for two blogs today]). At first glance, it might seen self indulgent. But let’s look at all the health benefits of my day.

 

Coffee. Studies find reduced risk of mortality, …Continue reading…

Can We Teach Physicians to Consider Cost?

My best friend’s daughter is pre-med in college. She’s brilliant, and is planning to become a developmental pediatrician (as of now, at least). By the time she enters medical school in two years, I really hope she learns not only anatomy and physiology, diagnosis, and how to insert a breathing tube, but how to consider the cost of the care she provides.

Residents have been required to learn how “incorporate considerations of cost awareness and risk-benefit analysis” in caring for patients since 2007, but how this is done is unclear. In addition, few medical schools provide any such training. Indeed, talking about cost in medical training has traditionally been tantamount to giving voice to “he-who-must-not-be-named.”

That is changing, as it must in a healthcare system that now makes up 18 percent of GDP, with costs typically rising far faster than inflation. As Molly Cooke, MD, wrote in a 2010 editorial in the New England Journal of Medicine, “We must be honest about …Continue reading…