Saturday, July 2, 2016

The sobering thing doctors do when they die - The Washington Post

In "How Doctors Die," a powerful essay that went viral in 2011, a physician described how his colleagues meet the end: They go gently. At the end of life, they avoid the mistakes — the intensive, invasive, last-ditch, expensive and ultimately futile procedures that many Americans endure until their very last breath.

"Of course, doctors don't want to die; they want to live. But they know enough about modern medicine to know its limits," Ken Murray wrote.

A new study reveals a sobering truth: Doctors die just like the rest of us.

"We went into this with the hypothesis we were going to see very large differences," said Stacy Fischer, a physician who specializes in geriatrics at the University of Colorado School of Medicine. "What we found was very little difference to no difference."

The study in the Journal of the American Geriatrics Society examined 200,000 Medicare beneficiaries to bring some hard data to the question. They found that the majority of physicians and non-physicians were hospitalized in the last six months of life and that the small difference between the two groups was not statistically significant after adjusting for other variables. The groups also had the same likelihood of having at least one stay in the ICU during that period: 34.6 percent for doctors vs. 34.4 percent for non-doctors. In fact, doctors spent slightly more time in the ICU than non-doctors, the study found — not enough time to signify a clinical difference, but suggesting that, if anything, doctors may be using medicine more intensively.

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The Illicit Perks of the M.D. Club - The New York Times

ONE of my patients recently had her request for a relatively common medication for attention-deficit hyperactivity disorder, Vyvanse, denied by her insurance provider. I tried to appeal the decision, but her father — the chief executive of a health care company who purchased insurance for hundreds of employees — had better luck. He called up the head of the insurance company and got the drug approved.

Last year, my 5-year-old fractured her ankle. The bill for the 12-minute orthopedist's appointment was $1,125, and about half of it was covered by insurance. I wrote the doctor a letter — please revise this bill, as it is clearly erroneous — and included my "M.D." Instead, the doctor left me a message saying he was waiving the bill entirely as a professional courtesy.

Stories like these reveal an uncomfortable truth. Our health insurancesystem is so broken that pulling strings — or rank — is sometimes the only way to get the coverage you think you've paid for.

Since 2010, when the Affordable Care Act was passed, the major insurance companies have seen their stock prices soar. Though the act expanded coverage to millions, a report last year by the Robert Wood Johnson Foundation revealed that 41 percent of health plans sold on the government exchanges had physician networks described as "small" or "extra-small," covering less than 25 percent and 10 percent of local doctors, respectively. Individuals may have to change doctors or choose out-of-network services, incurring extra costs.

Wendell Potter, a former Cigna executive turned whistle-blower and a co-author of the recent book "Nation on the Take," says that "insurance companies profit by introducing hurdles in the coverage and claims process." These hurdles lead some patients to simply give up and pay or forego treatment altogether. He calls this the companies' business model.

This strategy has given rise to a new business. After his son was born with cerebral palsy, Scott Leshin, then an associate at Goldman Sachs, made it his business to read the fine print of his health insurance policy so that he could fight for the services his son needed.

His son started walking only this year, at age 10. And yet, "I still have to prove to UnitedHealthcare that he has C.P. every six months," Mr. Leshin told me. His success in getting services covered led him to found his business, SJ Health Insurance Advocates, which now has a staff of 19. He works on a contingency basis — his customers pay only when his team succeeds.

But the best way to advocate for yourself is simply to be a doctor. When my son was born eight years ago, a series of errors left my wife unmedicated for 18 hours following a C-section. Furious, I fastened my medical school faculty badge to my collar, hoping to send the message: I'm watching you. We got an apology and a private room.

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