Medical Mysteries: Doctors puzzled by woman’s dizziness and amplified body sounds - The Washington Post

'That's it — I'm done," Rachel Miller proclaimed, the sting of the neurologist's judgment fresh as she recounted the just-concluded appointment to her husband. Whatever was wrong with her, Miller decided after that 2009 encounter, she was not willing to risk additional humiliation by seeing another doctor who might dismiss her problems as psychosomatic.

The Baltimore marketing executive had spent the previous two years trying to figure out what was causing her bizarre symptoms, some of which she knew made her sound delusional. Her eyes felt "weird," although her vision was 20/20. Normal sounds seemed hugely amplified: at night when she lay in bed, her breathing and heartbeat were deafening. Water pounding on her back in the shower sounded like a roar. She was plagued by dizziness.

"I had started to feel like a person in one of those stories where someone has been committed to a mental hospital by mistake or malice and they desperately try to appear sane," recalled Miller, now 53. She began to wonder if she really was crazy; numerous tests had ruled out a host of possible causes, including a brain tumor. Continuing to look for answers seemed futile, since all the doctors she had seen had failed to come up with anything conclusive.

"My attitude was: If it's something progressive like MS [multiple sclerosis] or ALS [amyotrophic lateral sclerosis], it'll get bad enough that someone will eventually figure it out."

Figuring it out would take nearly three more years and was partly the result of an oddity that Miller mentioned to another neurologist, after she lifted her moratorium on seeing doctors.

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http://www.washingtonpost.com/national/health-science/doctors-puzzled-by-womans-dizziness-and-amplified-body-sounds/2014/11/24/200dcc22-593b-11e4-8264-deed989ae9a2_story.html

One reporter is crowdsourcing the price of health care - The Washington Post

Trying to shop around for the best deal on health care services can be maddening. So Lisa Aliferis, a health care reporter for KQED News in San Francisco, came up with a simple idea: ask people what charges they're actually seeing on their bills and try to make sense of the madness.

We already know there's a huge variation in what hospitals charge for the most basic health-care services, based on their internal price listings. For instance, the average cost of a primary care visit ranges from $95 in Miami to $251 in San Francisco, according to a comprehensive study of employer-provided insurance coverage earlier this year. A first-of-its-kind data release from Medicare last year showed similar variations in the prices charged by hospitals.

But insurers and patients rarely pay the listed price. Aliferis — in a partnership with KPCC, a public radio station in Los Angeles, and Clearhealthcosts.com, a health transparency startup — tried to capture information of actual prices that people, who reported the information anonymously, were seeing on their medical bills — breaking down what the insurers were charged and what people actually paid.

She found big price differences within the same state, based on facility and insurance status. Private insurers in the Los Angeles and San Francisco areas paid anywhere between $128 and $694 for a mammogram, a procedure performed about 38 million times a year. A Medicare patient was charged $255 for a lower back MRI, while another uninsured patient was charged $6,221 at an academic medical center for the same procedure, Aliferis wrote.

Her database relies on reports for individuals and hasn't been without its problems. The most common complaints, Aliferis writes, is that it's still hard to comparison shop — it's not going to be easy as buying a retail item online. Also, the price of a health-care service doesn't say anything about the quality of that service. In health care, there's really no correlation between the two.

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http://www.washingtonpost.com/blogs/wonkblog/wp/2014/11/24/how-one-reporter-is-using-crowdsourcing-to-help-make-the-health-care-more-transparent/

When The Doctor Says This Won’t Hurt A Bit — And Incredibly, It’s True | CommonHealth

In May, my six-year-old daughter, Julia, smashed into our front door handle and got a deep, bloody gash in her forehead.

We rushed her, head wrapped like a tiny mummy, to the medical center at MIT, where we generally go for pediatric care. Julia wept while the nurse cleaned and examined her lacerated skin. After a short exam, she sent us to the emergency department at Children's Hospital Boston for stitches. "How bad is that, generally?" I asked, having never experienced suturing either for myself or my cautious, risk-averse, older daughter.

"It can be traumatic," the nurse said.

Julia cried, "I don't want stitches."

It's a large needle, but Julia is too busy coloring to notice.

So I braced myself for the worst: an endless wait and nerve-wracking bustle; screaming, germ-laden children and brusque, end-of-shift staff. But more than anything, I dreaded the inevitable pain in store for my small child with the deep cut.

(I know, kids get banged up on the path to adulthood and some pain is unavoidable. Still, when bloody heads are involved, I tend to overreact.)

Indeed, I was in full Mama Bear mode when into our exam room strode Dr. Baruch Krauss, the attending physician that evening.

Dark, lean and intense, Dr. Krauss shook my hand and then went straight to Julia, complimenting her pink, sparkly shoes. She lit up and was eager to chat. They talked about exactly how old she was (nearly six-and-three-quarters) and what she likes to do (climb trees). Then he gently rubbed a bit of Novocaine gel on her cut and said he'd be back.

I hovered nervously around Julia, checking and rechecking the cut and generally exuding anxiety, while my husband sat quietly, telling me to calm down. Sure, that'll work.

Five times over the next 40 minutes or so, Krauss came in and re-applied the anesthetic, gently squeezing the site with his thumb and forefinger. Why, I wasn't sure. Was it a dosing thing? Was he just numbing the wound even more before the scary stitching began? With each visit, he engaged Julia to learn something new about her. For instance, she loves to draw.

And, she loves snacks. On my way back from the cafe with treats, Krauss stopped me in the hall and said something like, "I'm going to stitch her up; it really won't be bad." I rolled my eyes. But, he added, "I need you to work with me. I'm going to give you a task." Fine, I said, though the whole thing sounded a little gimmicky.

Krauss returned with an oversized 101 Dalmations coloring book and a handful of Magic Markers. He opened to a page overflowing with dog outlines. "Julia," he said. "I want you to color each dog's ear a different color, OK? Which color do you want to start with?"

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http://commonhealth.wbur.org/2012/09/doctor-says-it-wont-hurt

Private Oncologists Being Forced Out, Leaving Patients to Face Higher Bills - NYTimes.com

When Dr. Jeffery Ward, a cancer specialist, and his partners sold their private practice to the Swedish Medical Center in Seattle, the hospital built them a new office suite 50 yards from the old place. The practice was bigger, but Dr. Ward saw the same patients and provided chemotherapy just like before. On the surface, nothing had changed but the setting.

But there was one big difference. Treatments suddenly cost more, with higher co-payments for patients and higher bills for insurers. Because of quirks in the payment system, patients and their insurers pay hospitals and their doctors about twice what they pay independent oncologists for administering cancer treatments.

There also was a hidden difference — the money made from the drugs themselves. Cancer patients and their insurers buy chemotherapy drugs from their medical providers. Swedish Medical Center, like many other others, participates in a federal program that lets it purchase these drugs for about half what private practice doctors pay, greatly increasing profits.

Oncologists like Dr. Ward say the reason they are being forced to sell or close their practices is because insurers have severely reduced payments to them and because the drugs they buy and sell to patients are now so expensive. Payments had gotten so low, Dr. Ward said, that they only way he and his partners could have stayed independent was to work for free. When he sold his practice, Dr. Ward said, "The hospital was a refuge, not the culprit."

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http://www.nytimes.com/2014/11/24/health/private-oncologists-being-forced-out-leaving-patients-to-face-higher-bills.html?