Wednesday, July 29, 2015
Doctors don't like to talk about death, and they often avoid doing so. Most physicians — including me — never studied palliative care in medical school and were rarely trained in how to communicate with patients. By the time I finished residency in 2002, I had to show competency in running Code Blues, inserting arterial lines and performing lumbar punctures, but not a single senior physician had to certify that I could actually talk with patients.
The recent expansion of the field of palliative medicine, with doctors who are experts on having these discussions, is a giant step in the right direction. But the growth of this specialty has not kept up with the need: There are 4,400 such doctors in the United States today, but the need is estimated to be as high as 18,000 physicians. Incentives such as student loan forgiveness, higher baseline salaries and more robust insurance reimbursements would encourage more students to consider the specialty as a profession. But it would take time for society to reap the benefits.
Recently Medicare announced plans to reimburse doctors for having advance care planning conversations with patients. This is an important start. But it's not enough to simply reimburse for these discussions, which are not one-time exchanges but rather a process over time. Neither is it realistic to expect most doctors who have never been trained to have these dialogues to all of a sudden be experts, which studies have suggested is difficult. We need to make sure that these exchanges are high-quality, informed, shared decision-making encounters where patients understand each of their options along with the risks and benefits.
Thursday, July 23, 2015
It was 8 o'clock on a weeknight and Brooklyn resident Sarah Sheehan was reeling from a painful earache.
She wouldn't be able to see her doctor until the next morning, and that would require a 45-minute subway ride uptown. That's when Sheehan, co-founder of an education technology business, remembered receiving a promotional code for a new company called Pager, an Uber-like service that sends doctors to patients' homes.
Pager and similar companies like Heal and Medicast aim to streamline medical care -- cutting out waiting rooms, receptionists and trips to the doctor's office.
"It's a completely different experience when you're sick and able to stay in your pajamas," says Sheehan. "Someone comes to your home, they're kind to you, they answer all your questions and give you all the time you need."
As complaints grow about exorbitant drug prices, pharmaceutical companies are coming under pressure to disclose the development costs and profits of those medicines and the rationale for charging what they do.
So-called pharmaceutical cost transparency bills have been introduced in at least six state legislatures in the last year, aiming to make drug companies justify their prices, which are often attributed to high research and development costs.
"If a prescription drug demands an outrageous price tag, the public, insurers and federal, state and local governments should have access to the information that supposedly justifies the cost," says the preamble of a bill introduced in the New York State Senate in May.
Wednesday, July 22, 2015
In most cases, surgeons have to actually see a patient to determine whether the benefits of surgery outweigh the risks. But in this case, a senior surgeon, on the basis of the file alone, said the patient was too "high risk." The reason he gave was that state agencies monitoring surgical outcomes would penalize him for a bad result. He was referring to surgical "report cards," a quality-improvement program that began in New York State in the early 1990s and has since spread to many other states.
Sunday, July 19, 2015
With few exceptions, every major class of current psychotropic drugs — antidepressants, antipsychotics, anti-anxiety medications — basically targets the same receptors and neurotransmitters in the brain as did their precursors, which were developed in the 1950s and 1960s.
■ Last month, in a continuing care retirement community in Ithaca, N.Y., Helen Wyvill, 72, noticed that a friend hadn't shown up for their regular swim. She wasn't in her apartment, either.
Had she gone to a hospital? Could friends visit or call? Was anyone taking care of the dog?
Questions to the staff brought a familiar nonresponse: Nobody could provide any information because of Hipaa.
"The administration says they have to abide by the law, blah, blah," Ms. Wyvill said. "They won't even tell you if somebody has died.