Monday, July 30, 2007

Do Doctors Make Too Much Money?

An article in the New York Times says the reason health care costs are so high in the United States is because doctors are paid too much. I saw that and my eyes bugged out. I just came home from a meeting with physicians and hospital administrators and the entire meeting was spent discussing the financial challenges physicians face in keeping their doors open to see patients. The goal of this meeting was to keep health services in that community so patients will have someone to care for them. Not a person in the room would agree that the doctors earn too much.

Physicians paid too much? Lets break that down. A doctor spends a minimum of 11 years in education and training after the age of 18. Many are in training for 15 or more years. They are living on student loans and contributing zero to their family's income until the residency years. At that time they earn less than minimum wage if you factor in the 80-100 hour workweek. When a doctor emerges from training (and believe me, there is less sex and fun than is portrayed on ER or Gross Anatomy) he/she averages $160K debt, is over 30 years old and is usually feeling older. For another view of training check out this surgeon's experience.

Let's face it, people do not choose a career in medicine to make money. The opportunities are much greater in business, law or computer programing. Policemen that work overtime make more money than primary care doctors. (Before you make comments...I also believe policemen are underpaid.) Some specialties are well paid and they should be. Frankly I WANT my neurosurgeon to be highly reimbursed because I want to believe she is the cream of the crop. In fact, I want all of my doctors to be the top notch and I want them all highly paid.

The range of the average American's physician pay is between $140 -350K. Many earn less and some earn more. Many doctors work several different jobs (nursing home director, clinical research trials, insurance reviewer) just to supplement their income from seeing patients.

Health care reform is not about lowering physician salaries. Professions that are highly skilled, require extensive training and commitment deserve to be paid at the highest levels of society. There is enough waste, duplication, greed, payola, and inefficiency in health care to cover all Americans AND pay physicians well.

So what do you think? Are physician's overpaid? What about you readers in the UK , Canada, France, Germany and Australia? Are American doctors spoiled?

Thursday, July 26, 2007

SICKO -laugh and cry

I saw "Sicko" last night...Michael Moore's latest documentary about the health care industry in the U.S. Let me tell you..he got it right! The movie was chuckle out loud (col) funny and at the same time, left the viewer with a feeling of outrage. For every outrageous insurance denial story, every doctor I know could supply 100 more. See my prior post on one such denial and how it affected a young family.

If you see Sicko, you can't be in denial anymore. We don't have the best healthcare in the world. We don't take good care of our population and we don't have a compassionate society. We need to admit the brutal truth and move on.

We Americans need to quit making excuses about how hard it will be to cover every man, woman and child with health insurance. It isn't that just takes a groundswell of outrage. We need to quit being afraid of "government" controlled medicine and expand Medicare for everyone. I never hear a patient complain about Medicare. Old folks love Medicare. It needs to be revamped and remodeled anyway and this would be the time to do it. Keep it possible for folks to buy private insurance to supplement the benefits. Stop the cost shifting of 47 million uninsured (and millions more underinsured who are paying their own way ). Get rid of Medicaid and roll those dollars into Medicare. Get rid of the costly Part D pharmacy benefits that simply shift billions of dollars to big Pharma, their pharmacy benefit subsidiaries and the insurance companies. Make sure everyone has a "medical home" that can focus on preventive medicine and disease management. Reorganize medical training and reimbursement to "save" primary care as it is gasping its last breath.

Couple healthcare reform with healthy life reform. Get rid of soda in schools, build playgrounds, community gardens and re institute sports. Have carrot snack breaks in preschool and tax the #@*& out of cigarettes.

Who is going to pay for all of this? We are! But we are paying for it anyway in huge insurance bills, state and federal taxes, lower wages, staying at dead end jobs to keep insurance benefits and anxiety about growing old.

See Sicko and don't believe it can't be done. We start by making sure everyone is covered with health benefits and has good access to medical care.

Tuesday, July 24, 2007

YouTube Debate-health question

Did you see the Democratic debate? I loved the format and the fact that everyone can participate. The YouTube debate will change politics forever. The questions were finally relevant and reflected what we actually care about. We need to keep the pressure on both the Dems and the Republicans and push for healthcare reform. This is just one of the questions. We want answers!

DASH diet-for hypertension and everyone

A recent study found that a diet proven to reduce blood pressure is hardly used by any patients with hypertension. The eating plan modeled on the Dietary Approaches to Stop Hypertension (DASH) calls for eating foods low in saturated and total fats along with increasing consumption of fruits and vegetables. Despite the repeated recommendations for this diet as the MOST HEALTHY and the MOST PROVEN to reduce hypertension and high cholesterol, fewer than 22% of patients with high blood pressure were following this type of plan.

The researchers believe that our health care system's inadequate ability to merge lifestyle management into clinical practice may be one reason why so few patients eat healthily. American society's continued acceptance of a fast-food culture and consuming more food that is calorie rich and nutrient poor is to blame.

The DASH diet should be an intervention that is on the front lines in the fight against hypertension. People with mild hypertension might be able to come off their blood pressure medication by following this plan. In fact, the DASH diet would benefit everyone. Check it out at this link and see if it will help. This link will give you information about hypertension, nutrient intake, dash diet, shopping for foods and how to read nutrition labels posted on all food items.


Saturday, July 21, 2007

Doping-ruining the sport

It is sad that the prestigious Tour de France continues to be ruined by the cyclists taking performance enhancing drugs known as "doping". From baseball, to field sports and now cycling, the heroes we long to admire are selling out to this bargain with the devil.

Michael Rasmussen from Denmark is the lead cyclist wearing the coveted yellow shirt. He is now under suspicion for missing 2 drug tests and other cyclists are accusing him of cheating. He assures his fans that everything is OK, but didn't we hear this before? Lance Armstrong still remains a hero, thank heavens for his world record cycling wins, without any banned substances in his system. We need more like him. The sponsors, fans and sport authorities need to get serious about this. One dirty urine are out. No 2nd chances. The sport would benefit and our kids might have someone to look up to again.

Wednesday, July 18, 2007

Top 25 Medical Advances

USA today is hardly a scientific journal, but it is read by millions of people all over the world. They picked their "Top 25 Medical Advances since 1982" and ranked them. What do you think?
2. Smoking Cessation
3. Obesity
4. Cancer detection
5. Antidepressants
6. Infant mortality
7. Anticholesterol medications (statins)
8. Cancer vaccines
9. Automated external defibrillators
10. Direct to consumer ads
11. In vitro fertilization
12. Human genome
13. Infections diseases (mad cow, west nile virus)
14. Medical technology
15. Laparoscopic surgery
16. Hormone replacement therapy
17. Attention-deficit hyperactivity medications
18. Chemotherapy
19. Caesarean sections
20. Vioxx
21. Child safety
22. Lasik
23. Sunscreen
24. Viagra
25. Botox

I think they got it wrong. AIDS is clearly number one. It affects 40 million people worldwide and has had a devastating effect on the world. But shouldn't the Human Genome be number 2? This will revolutionize how we diagnose and treat people for the next 50 years. What about Transplant? Stem Cells? Seat Belts and Reproductive surgery?

I would add the "Quality and Safety" movement that has occurred within the past 10 years and the new focus that hospitals and caregivers have for creating standards of care that will save lives. Simple things like hand washing and preventing bed sores (pressure ulcers) will affect millions of people. Reducing hospital acquired infections and medication errors is part of this safety movement. These practices are now part of mainstream medicine and we are focused on measuring and tracking outcomes. Quality and Safety are truly a medical advance.

How the heck did Viagra and Botox make the list? Please....eliminating wrinkles is hardly important to mankind. How you got those wrinkles and what you do with your life on this planet is more important than smooth skin.

Monday, July 16, 2007

Your Stools - endless fascination

You may not cop to it, but everyone is fascinated with their bodily waste (aka: bowel movements, stools, number 2, S*#t, dump,crap, elimination).

This handy chart can finally answer all of your questions about different types of bowel movement and what is "normal". As you can see, there are many variations with type 1 being consistent with constipation. Type 6 and 7 are diarrhea.

What is normal? Anything in-between. The best way to achieve that golden state of normal elimination is through diet. You've heard it before...fruit, vegetables, fiber and water are the key to a happy colon.

No, you don't need colonics or enemas. The colon is made to be self cleansing and certain bacteria and enzymes are supposed to be there. Don't wash them away. If you take antibiotics, replace the intestinal flora with natural yogurt or probiotics. Certain medications can also cause constipation or diarrhea and may require extra fiber supplements to keep things moving normally.

This may be more than you ever wanted to know about stools, but admit did look at the picture and wonder, right?

Sunday, July 15, 2007

The Umbilical Cord-Don't Rush to Cut

If you or someone you know is pregnant, a recent study from JAMA is something you should know about. It has to do with when to cut the umbilical cord. That is probably something you never thought about, right?

The placenta and umbilical cord contain up to 60% of the fetal blood red cells and this blood is rich in stem cells. We are just learning how important these precious stem cells are in preventing blood disorders and diseases later in life. There has been controversy among obstetricians about the optimal time to clamp the umbilical cord in a normal childbirth. Early clamping is considered up to one minute after delivery. Late clamping is leaving the cord attached with blood flowing from placenta to infant for at least 2 minutes.

The researchers carefully reviewed all of the world's literature on this subject and compared studies. They found that delaying clamping of the umbilical cord for at least 2 minutes after birth consistently improved both the short- and long-term blood and iron status of full term infants and this benefit lasted for months. This benefit would be even more important in developing countries where the mothers are often anemic and infant anemia is widespread.

If you think about childbirth in nature, there would not be a rush to cut the cord. The infant is tethered to the mother for several minutes during birth and there is likely a selection advantage for this. We are entering a new era in medicine as we study best practices and use this evidence in care of patients. This is called "evidenced-based" medicine, as opposed to much of how we care for patients which is anecdotal and varies depending on where the physician is trained. Any time we can know what the current evidence shows and use that evidence to practice in the best way, patients all over the world benefit.

The evidence is clear...don't clamp the umbilical cord for at least 2 minutes so the infant can receive all of the important blood components from the placenta and cord.

Thursday, July 12, 2007

Stretching Before Exercise

You would think it would be easy to answer the question "Should athletes stretch before exercise?" A review of the literature is less than precise on this subject but here are some key points:

* Stretching performed before exercise can increase flexibility for up to 90 minutes but there is little evidence that such routines improve performance, reduce muscle soreness or prevent injuries.

* Stretching on a regular basis (3-5 days/week separate from the sport event) improves flexibility, some types of performance and may reduce injury risk.

* Passive stretching for 15-30 seconds per body area is as effective for increasing flexibility as stretching for longer periods.

* Increased flexibility is important for sports like ballet, gymnastics and swimming.

* Risk of injury to muscles, tendons and ligaments is reduced in athletes who are more aerobically fit.

* Warm-up exercises, combined with aerobic fitness give the athlete the best performance outcomes. To stretch or not is a personal decision.

The take home message is this: Everyone should do aerobic exercise a minimum of 1/2-1 hour a day and include stretching into that fitness regimen. It is up to you if you wish to stretch before a specific sport event. The evidence is not clear that it will improve your performance or reduce injury.

So get down on that floor and do some stretches now. Remember, no bouncing.

Tuesday, July 10, 2007

U.S. Surgeon General Compromised by Politics

I have tried to be non-political on this blog and focus only on EverythingHealth. But I can't ignore sharing this article from the New York Times that quotes Dr. Richard H.Carmona, the former US. Surgeon General under George Bush (the son). As the "Nations Doctor", he reports that the Bush administration forced him to weaken or suppress important public health reports, including those on tobacco, stem cells, prison health, mental health, global warming, contraception, sex ed, global health and even the Special Olympics. I am a strong believer that science and politics do not mix and when science is suppressed for political gain, we all loose. This article shocked me and it should shock you too. Please have a read: Dr. Carmona's testimony.

Monday, July 9, 2007

Melanoma or a Benign Mole?

The biggest malpractice risk for physicians is "failure to diagnose". If a patient shows up with a skin growth, most physicians will reach for the scalpel and remove it or biopsy it rather than take the risk of missing a cancer. But only 3-10% of suspicious moles are melanomas so that means a lot of unnecessary surgeries and costs are incurred.

A pilot study has shown that applying a simple tape to suspicious pigmented lesions and pulling off RNA for genetic analysis can differentiate melanoma from benign moles. The non-invasive test also seems to differentiate high-risk from low-risk dysplastic nevi. These dysplastic nevi are not cancer, but they require extensive follow-up and biopsies to make sure they don't change into a malignancy. The cost and inconvenience are enormous.

The tape stripping method is called Epidermal Genetic Information Retrieval. In this study they tape stripped each lesion up to four times and also tape-stripped uninvolved skin on each patient to serve as control specimens. All the lesions were then biopsied and sent for pathology examination. They found the harvested RNA is stable at room temperatures for 72 hours, meaning it can be harvested, stored and shipped for analysis without degrading.

The researchers were able to use genetic isolation to differentiate melanomas, high-risk and low-risk dysplastic nevi from normal skin.

This technique is not ready for prime time, but it gives us a glimpse into the future when we will be harvesting RNA and DNA and making diagnosis and treatment decisions, without ever invading the skin. The way we practice medicine now will look very primitive in the not too distant future.

Sunday, July 8, 2007

It's not raging rapids - but I'm back

Although this photo doesn't look like raging rapids, it was a beautiful hike near Cataract Canyon, Utah, on the Colorado River. I couldn't risk my camera during the rapid runs so no photos of the dangerous level 5 rapids! You'll just have to believe me.

Did you notice that last week was a major heat wave across the entire United States? The map in USA Today showed every state was red or orange...that means hot, hot, hot. It was 105 on the river. We were cookin'.

I will be back in the EverythingHealth mode after I catch up on email, snail mail (mostly catalogs and bills), medical journals, patient care and laundry.

My fever blister from the sun takes me back to one of my earliest posts on Fever Blisters-aka Herpes

When to Use Urgent Care

We all know that Emergency Departments are over-crowded with long waits and exorbitant fees.  Free standing Urgent Care is a great solu...