Thursday, April 30, 2015

Video Is About to Become the Way We All Visit the Doctor | WIRED

The country's largest health insurer is putting telemedicine on par with a regular trip to the doctor's office, effectively saying a video visit is as good as brick-and-mortar medicine. 

UnitedHealthcare today is announcing a partnership with three telemedicine companies to cover video-based doctor visits just as it covers in-person visits. The tech set has for decades predicted that we would one day get our medical care via video chat, but it wasn't until recently that forward-thinking physicians started taking the promise of telemedicine seriously. The decision by so influential a player in the healthcare industry to telemedicine is the strongest sign yet that the technology is entering the mainstream.

United says it will cover virtual doctor visits offered through NowClinic, Doctor on Demand, and American Well. These platforms connect patients with thousands of doctors—albeit not the patient's usual doctor—via video chat. These consultations typically cost $40 to $50 a pop, but now that United is covering these visits, members will only have to pay their usual co-pay, making virtual medicine much more affordable for more people. For now, these virtual visits will be available only to UnitedHealth's self-funded customers, but the feature will expand to most members by next year.

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NYTimes: Hospitals Provide a Pulse in Struggling Rural Towns

BEATRICE, Neb. — "This real estate to be auctioned," reads a banner stretched across the abandoned warehouse of a store-shelving manufacturer that once employed generations living in and around this town of about 12,000.
This isolated rural community has lost a lot of the energy of its heyday, when shoppers roamed downtown sidewalks, freight trains rumbled past the Big Blue River, and streets clogged at quitting time as factory workers spilled out of their plants.
But it has yet to lose its economic pulse, thanks in large measure to the Beatrice Community Hospital and Health Center, housed in a sprawling new building of concrete and green glimmering windows on the outskirts of town. The hospital has become an economic anchor for the area.
Once home to vibrant downtowns, along with thriving local manufacturers and merchants, small towns were traditionally strongholds of the American middle class. In recent decades, many barely managed to hold on as young people migrated to cities and those who stayed behind had trouble even finding work.
Now, however, those towns that have been able to attract hospitals and other health care facilities have emerged as oases of economic stability across the nation's heartland.

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NYTimes: When a Medical Proxy Saves a Life

"I'm begging you," pleaded my 93-year-old grandmother. "I want to quit while I'm ahead. I'm too tired. It's been a good, solid run and I'm done."
I was sitting in my cubicle in Midtown Manhattan trying to untangle the phone cord so I could hear every word of the argument she was making from her hospital room in Florida, where doctors were waiting to hear if they should go ahead with surgery to treat her sepsis, or take her to hospice, where she would most likely die of the infection by the end of the week.
"I understand," I said, resigned to letting her go. "I'm on your side. It's your life. Let me talk to Mom one more time."
My grandmother had agreed to make my mother, her daughter-in-law, her health care proxy — which meant that Mom was responsible for making her medical decisions, should she be unable to make them on her own. But neither of them fully understood the legal details and to my grandmother, at least, Mom had the final say. If Grandma was going to forgo the surgery, Mom had to agree. And she didn't.
"Everyone assumes that because Grandma's 93 she can't be suicidal," my mother told me, a few minutes later. "Judith is clinically depressed. She needs the surgery and she needs antidepressants."
My mother's pro-surgery argument felt a bit ironic. As my mother tells it, my father's last words to her, before he went into a routine surgery, were: "And God help you if anything happens to me. You'd be stuck with my parents."
He died of cardiac arrest several days later. I was 10 months old.

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Tuesday, April 28, 2015

Dr. Me: Adventures in Home Diagnosis - The New Yorker

Am I sitting down? I have some bad news to break to me. A lot of doctors would have texted, but I wanted to tell me this in person. This case wasn't easy to diagnose, even for someone like me, who graduated from med school (WebMD Online University, '11). But first I'm going to have to ask me some questions. Do I take any medications—other than Splenda, of course? Has anything changed since I saw me during my last visit, this morning? On a scale of one to ten—ten being chapped lips—how much does it hurt when I push here? Three and a third? I see. The medical community is divided on this, but the latest studies posted on and indicate that I could be suffering from circuitous spleen, an allergy to elevator air, or feline tonsillitis. Or it could be a problem with my pushing finger. I'm afraid it could also be a gateway ailment to—

Oh, wait. About the other thing? I know I was worried, but according to it's definitely not early onset (five hundred and forty-seven likes). That card left the deck at least ten years ago. What a relief, right? Average onset is still a possibility, but it doesn't run in the—Oh. Her? Is she really family?

There is also a chance that it's a disease so rare that I am the only one who has ever had it. Hey, hey. Chin up. Worst-case scenario, we get a malady named after me. And, come on, remember the incurable hair cancer? And how I pulled through, even though all the commenters on EwCan',,, and said, Two days to live, max. Life goes on, or at least it did then.

I need me to take a deep breath. Oooh. How long have I had that stabbing pain? Have I ever smoked? No? What about the puff I took behind the 7-Eleven to make Eric Ifker like me?

On a personal note—and please understand that everything I tell me is completely confidential—may I ask, How many sexual partners have I had, other than myself? Great. That rules out some icky outcomes.

Unfortunately—how to put this? Before I begin, maybe I should prescribe two extra-strength doses of Long Island Iced Tea. It may also be a good idea to review my chart again. I see that I became a patient of mine when my previous physician, Dr. Mort Rappaport, failed to—not to malign a colleague, but he insisted that it was unlikely I had Dutch elm disease. It says here that I then went to myself for a second opinion since there was no co-pay. (Thank you, United Patty Care Health Group.)

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