Things tagged health:

Busy Doctors, Wasteful Spending

Sandeep Jauhar in the NYT:

Of all the ways to limit health care costs, perhaps none is as popular as cutting payments to doctors. In recent years payment cuts have resulted in a sharp downturn in revenue for many hospitals and private practices. What this has meant for most physicians is that in order to maintain their income, they’ve had to see more patients. When you reduce the volume of air per breath, the only way to maintain ventilation is to breathe faster.

As our workdays have gotten busier, we doctors have had less time to devote to individual patients. An internist I know in private practice used to see 15 patients a day. “Now reimbursement is so low I have to see at least 30,” he told me. “If I stay in the room more than 10 minutes, my assistant will call me and tell me to hurry up.”

Racing through patient encounters, we practice with an ever-present fear that we will miss something, hurt someone and open ourselves up to legal (not to mention moral) liability. To cope with the anxiety, we start to call in experts for problems that perhaps we could handle ourselves if we had more time to think through a case. The specialists, in turn, order more tests, scans and the like.

And therein lies the sad irony of the health cost containment paradigm in this country. There is no more wasteful entity in medicine than a rushed doctor.



Can Botox Solve the Depression Epidemic?

Finzi began musing on the facial feedback hypothesis, which holds that physical expression is an integral component of emotion. You can feel sad or angry without moving your face, but, the theory holds, those emotions will not be as strong or persist for as long if your face is not moving in the expected manner. Put another way, relative to emotion, the face and its muscles are a privileged area of the body. Whatever you do with your face transmits feelings back to your brain.

In 2003, Finzi treated several subjects suffering from moderate to severe depression with Botox, paralyzing the muscles in their brows that create expressions of sadness, anger, and fear. The results were astonishing.



This Old Man

Roger Angell in The New Yorker:

I’ve endured a few knocks but missed worse. I know how lucky I am, and secretly tap wood, greet the day, and grab a sneaky pleasure from my survival at long odds. The pains and insults are bearable. My conversation may be full of holes and pauses, but I’ve learned to dispatch a private Apache scout ahead into the next sentence, the one coming up, to see if there are any vacant names or verbs in the landscape up there. If he sends back a warning, I’ll pause meaningfully, duh, until something else comes to mind.

On the other hand, I’ve not yet forgotten Keats or Dick Cheney or what’s waiting for me at the dry cleaner’s today. As of right now, I’m not Christopher Hitchens or Tony Judt or Nora Ephron; I’m not dead and not yet mindless in a reliable upstate facility. Decline and disaster impend, but my thoughts don’t linger there. It shouldn’t surprise me if at this time next week I’m surrounded by family, gathered on short notice—they’re sad and shocked but also a little pissed off to be here—to help decide, after what’s happened, what’s to be done with me now. It must be this hovering knowledge, that two-ton safe swaying on a frayed rope just over my head, that makes everyone so glad to see me again. “How great you’re looking! Wow, tell me your secret!” they kindly cry when they happen upon me crossing the street or exiting a dinghy or departing an X-ray room, while the little balloon over their heads reads, “Holy shit—he’s still vertical!”



I Hope My Father Dies Soon

Watched “How to Die in Oregon” last night. Terribly flawed documentary, which I don’t recommend, but pretty brutal, and very convincing. We put cats and dogs down to avoid their unneeded suffering. Why not our parents?

Scott Adams on his blog:

My father, age 86, is on the final approach to the long dirt nap (to use his own phrase). His mind is 98% gone, and all he has left is hours or possibly months of hideous unpleasantness in a hospital bed. I’ll spare you the details, but it’s as close to a living Hell as you can get.

If my dad were a cat, we would have put him to sleep long ago. And not once would we have looked back and thought too soon.

See also this great news story: French couple, 86, slam ‘cruel’ law in suicide note

The couple, together since their teens, checked into the world-famous Hotel Lutetia on Thursday night and at some point in the night, they took medication designed to induce a painless death, according to Le Parisien. The couple also ordered breakfast to be delivered to their room in the morning to ensure they would be found quickly.

Georgette and Bernard were discovered dead, hand-in-hand, in their bed on Friday morning by a member of staff. Two letters were left by their bedside.

On Monday it was revealed that one of them contained a scathing attack on France’s prohibition of euthanasia.



Can a Jellyfish Unlock the Secret of Immortality?

Nathaniel Rich in the NYT Magazine:

Sommer was conducting research on hydrozoans, small invertebrates that, depending on their stage in the life cycle, resemble either a jellyfish or a soft coral. Every morning, Sommer went snorkeling in the turquoise water off the cliffs of Portofino. He scanned the ocean floor for hydrozoans, gathering them with plankton nets. Among the hundreds of organisms he collected was a tiny, relatively obscure species known to biologists as Turritopsis dohrnii. Today it is more commonly known as the immortal jellyfish.

Sommer kept his hydrozoans in petri dishes and observed their reproduction habits. After several days he noticed that his Turritopsis dohrnii was behaving in a very peculiar manner, for which he could hypothesize no earthly explanation. Plainly speaking, it refused to die. It appeared to age in reverse, growing younger and younger until it reached its earliest stage of development, at which point it began its life cycle anew.



What Big Medicine Can Learn from the Cheesecake Factory

Atul Gawande in The New Yorker:

Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care?



The Heretic

Tim Doody in The Morning News:

For decades, the U.S. government banned medical studies of the effects of LSD. But for one longtime, elite researcher, the promise of mind-blowing revelations was just too tempting.



Studies of Human Microbiome Yield New Insights

Carl Zimmer in the NYT:

For a century, doctors have waged war against bacteria, using antibiotics as their weapons. But that relationship is changing as scientists become more familiar with the 100 trillion microbes that call us home — collectively known as the microbiome.

“I would like to lose the language of warfare,” said Julie Segre, a senior investigator at the National Human Genome Research Institute. “It does a disservice to all the bacteria that have co-evolved with us and are maintaining the health of our bodies.”

This new approach to health is known as medical ecology. Rather than conducting indiscriminate slaughter, Dr. Segre and like-minded scientists want to be microbial wildlife managers.



Things Adult Medicine Could Learn From Pediatrics

Perri Klass, M.D. in the NYT:

In adult surgery, it is not routine to promise that someone can be with you in the operating room till you go to sleep, or to have family members a standard part of recovery room care. Many hospitals will let a family member stay overnight with an adult patient, but policies vary hospital by hospital, ward by ward.

“We accommodate family members much more in pediatrics,” Dr. Monash said. “We don’t have visiting hours where everyone has to leave.” [ … ] It seems to me we should be able to promise any hospital patient that a relative, a friend, can stay close at hand. We should be able to promise anyone going in for surgery that when she wakes up, someone familiar will be there.



How Doctors Die

Ken Murray:

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds–from 5 percent to 15 percent–albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home.