Surah Grumet used to be a family doctor at a clinic in the Bronx. "It always felt like I was trying to catch up," she said. "I was always falling behind, and it was so stressful. And it was really hard to bring up my two girls, to be there for them, and still be able to practice medicine the way that I wanted to."
Now, she lives in a suburb of Raleigh, N.C. She still practices medicine, but has no office or clinic. Instead, she works with a Durham-based practice called Doctors Making House Calls.
Grumet puts her girls on the school bus and gets in the car just before nine. Her patients are frail elderly people with multiple chronic illnesses: memory loss, heart and blood pressure problems, arthritis that makes mobility difficult.
Grumet works full time, but on her own schedule. She can spend 15 minutes with a patient, or nearly two hours. She's home before the school bus and completes her patient notes and paperwork while her girls do homework. She makes $70,000 more than she did when she worked in the Bronx.
How is this possible? In a world where many doctors struggle to make money seeing four patients an hour, how can they run a successful practice driving to patients' homes and spending all the time their patients need?
Before 1950, nearly half of all doctors' visits in America were house calls. But then the country began building big hospitals and luxurious doctors' offices, and doctors acquired sophisticated equipment they couldn't put in a medical bag. Medicare and Medicaid reimbursement systems made home visits untenable.
But the house call is now a better idea than ever.
To cut America's health care costs, it helps to look at the most expensive patients. Medicare spends a third of its budget caring for chronically ill people in their last two years of life. This group is growing fast, and growth will accelerate; the first baby boomers are now turning 70.
More ...
http://www.nytimes.com/2016/09/27/opinion/reviving-house-calls-by-doctors.html?
Tuesday, September 27, 2016
Monday, September 26, 2016
School to give medical students hands-on training - The Portland Press Herald / Maine Sunday Telegram
The University of Vermont College of Medicine is changing the way physicians are trained by switching exclusively to a hands-on approach to learning designed to encourage students to solve medical puzzles rather than just memorizing body parts and diseases.
While most medical schools recognize the importance of active learning and use it in some of their classes, UVM is believed to be among the first in the country to commit itself to switching all its medical training to the new system.
"Shifting completely away from the traditional lectures in that way, we are not familiar with any other medical school that has done that across all four years," said Lisa Howley, the senior director of educational affairs at the Washington-based Association of American Medical Colleges, which represents 145 medical schools and about 400 teaching hospitals.
The effort will get a boost from a $66 million donation from 1942 medical school graduate Robert Larner that will provide $4 million a year in perpetuity to help implement the changes. In announcing the donation Friday, the medical school, which has about 465 students, also said it was changing its name to The Robert Larner M.D. College of Medicine.
Making the switch presents a challenge to an educational system that, especially in the early years of medical school, relied on a doctor lecturing to students from the front of the room.
William Jeffries, associate dean at the UVM medical school, points to a 2014 study in the Proceedings of the National Academy of Sciences that determined students in traditional lectures were 1.5 times more likely to fail than students taught with active learning.
"If this was a clinical trial of a new drug or a treatment, we would adopt it because we knew that the other method was inferior to the first method," Jeffries said. "We have to react to that evidence."
Here's how the process works in the new system:
In class, medical students might be given a case in which a patient is complaining of arm pain. The students would focus on which bone is most likely broken and the possible implications of the injury to the circulatory or nervous system.
"That means they have to know the anatomy, and then they have to say, 'Well, in the real world, what are we going to do with that information?" said Dr. William Raszka, a pediatrician who teaches in the medical school.
"The family doesn't come in and say, 'I think my ulna's fractured.' They say, 'My son came in, he fell off the jungle gym and he's holding his hand,"' Raszka said.
To facilitate those types of discussions, the school is removing lined-up desks from classrooms and replacing them with tables where small groups of students can apply the information they learn before class and work together to find answers to questions posed by the teachers. The rarely used books in the medical school library are going to be moved into storage and the information digitized.
More …
http://www.pressherald.com/2016/09/23/school-to-give-medical-students-hands-on-training/
While most medical schools recognize the importance of active learning and use it in some of their classes, UVM is believed to be among the first in the country to commit itself to switching all its medical training to the new system.
"Shifting completely away from the traditional lectures in that way, we are not familiar with any other medical school that has done that across all four years," said Lisa Howley, the senior director of educational affairs at the Washington-based Association of American Medical Colleges, which represents 145 medical schools and about 400 teaching hospitals.
The effort will get a boost from a $66 million donation from 1942 medical school graduate Robert Larner that will provide $4 million a year in perpetuity to help implement the changes. In announcing the donation Friday, the medical school, which has about 465 students, also said it was changing its name to The Robert Larner M.D. College of Medicine.
Making the switch presents a challenge to an educational system that, especially in the early years of medical school, relied on a doctor lecturing to students from the front of the room.
William Jeffries, associate dean at the UVM medical school, points to a 2014 study in the Proceedings of the National Academy of Sciences that determined students in traditional lectures were 1.5 times more likely to fail than students taught with active learning.
"If this was a clinical trial of a new drug or a treatment, we would adopt it because we knew that the other method was inferior to the first method," Jeffries said. "We have to react to that evidence."
Here's how the process works in the new system:
In class, medical students might be given a case in which a patient is complaining of arm pain. The students would focus on which bone is most likely broken and the possible implications of the injury to the circulatory or nervous system.
"That means they have to know the anatomy, and then they have to say, 'Well, in the real world, what are we going to do with that information?" said Dr. William Raszka, a pediatrician who teaches in the medical school.
"The family doesn't come in and say, 'I think my ulna's fractured.' They say, 'My son came in, he fell off the jungle gym and he's holding his hand,"' Raszka said.
To facilitate those types of discussions, the school is removing lined-up desks from classrooms and replacing them with tables where small groups of students can apply the information they learn before class and work together to find answers to questions posed by the teachers. The rarely used books in the medical school library are going to be moved into storage and the information digitized.
More …
http://www.pressherald.com/2016/09/23/school-to-give-medical-students-hands-on-training/
Why Do Obese Patients Get Worse Care? Many Doctors Don’t See Past the Fat - The New York Times
You must lose weight, a doctor told Sarah Bramblette, advising a 1,200-calorie-a-day diet. But Ms. Bramblette had a basic question: How much do I weigh?
The doctor's scale went up to 350 pounds, and she was heavier than that. If she did not know the number, how would she know if the diet was working?
The doctor had no answer. So Ms. Bramblette, 39, who lived in Ohio at the time, resorted to a solution that made her burn with shame. She drove to a nearby junkyard that had a scale that could weigh her. She was 502 pounds.
One in three Americans is obese, a rate that has been steadily growing for more than two decades, but the health care system — in its attitudes, equipment and common practices — is ill prepared, and its practitioners are often unwilling, to treat the rising population of fat patients.
The difficulties range from scales and scanners, like M.R.I.machines that are not built big enough for very heavy people, to surgeons who categorically refuse to give knee or hip replacements to the obese, to drug doses that have not been calibrated for obese patients. The situation is particularly thorny for the more than 15 million Americans who have extreme obesity — a body mass index of 40 or higher — and face a wide range of health concerns.
Part of the problem, both patients and doctors say, is a reluctance to look beyond a fat person's weight. Patty Nece, 58, of Alexandria, Va., went to an orthopedist because her hip was aching. She had lost nearly 70 pounds and, although she still had a way to go, was feeling good about herself. Until she saw the doctor.
"He came to the door of the exam room, and I started to tell him my symptoms," Ms. Nece said. "He said: 'Let me cut to the chase. You need to lose weight.'"
The doctor, she said, never examined her. But he made a diagnosis, "obesity pain," and relayed it to her internist. In fact, she later learned, she had progressive scoliosis, a condition not caused by obesity.
Dr. Louis J. Aronne, an obesity specialist at Weill Cornell Medicine, helped found the American Board of Obesity Medicine to address this sort of issue. The goal is to help doctors learn how to treat obesity and serve as a resource for patients seeking doctors who can look past their weight when they have a medical problem.
More …
http://www.nytimes.com/2016/09/26/health/obese-patients-health-care.html?
The doctor's scale went up to 350 pounds, and she was heavier than that. If she did not know the number, how would she know if the diet was working?
The doctor had no answer. So Ms. Bramblette, 39, who lived in Ohio at the time, resorted to a solution that made her burn with shame. She drove to a nearby junkyard that had a scale that could weigh her. She was 502 pounds.
One in three Americans is obese, a rate that has been steadily growing for more than two decades, but the health care system — in its attitudes, equipment and common practices — is ill prepared, and its practitioners are often unwilling, to treat the rising population of fat patients.
The difficulties range from scales and scanners, like M.R.I.machines that are not built big enough for very heavy people, to surgeons who categorically refuse to give knee or hip replacements to the obese, to drug doses that have not been calibrated for obese patients. The situation is particularly thorny for the more than 15 million Americans who have extreme obesity — a body mass index of 40 or higher — and face a wide range of health concerns.
Part of the problem, both patients and doctors say, is a reluctance to look beyond a fat person's weight. Patty Nece, 58, of Alexandria, Va., went to an orthopedist because her hip was aching. She had lost nearly 70 pounds and, although she still had a way to go, was feeling good about herself. Until she saw the doctor.
"He came to the door of the exam room, and I started to tell him my symptoms," Ms. Nece said. "He said: 'Let me cut to the chase. You need to lose weight.'"
The doctor, she said, never examined her. But he made a diagnosis, "obesity pain," and relayed it to her internist. In fact, she later learned, she had progressive scoliosis, a condition not caused by obesity.
Dr. Louis J. Aronne, an obesity specialist at Weill Cornell Medicine, helped found the American Board of Obesity Medicine to address this sort of issue. The goal is to help doctors learn how to treat obesity and serve as a resource for patients seeking doctors who can look past their weight when they have a medical problem.
More …
http://www.nytimes.com/2016/09/26/health/obese-patients-health-care.html?
Sunday, September 25, 2016
Bariatric Surgery: The Solution to Obesity? - The New Yorker
"Half my life has been about trying to lose weight," Henry Roberts said. He was telling me about his decision to have a surgery that would reduce the size of his stomach by seventy-five per cent. Roberts (a pseudonym) is five feet six, and when we met he weighed two hundred and seventy pounds, giving him a body-mass index of forty-four; a B.M.I. between eighteen and a half and twenty-five is considered healthy. "I tried every diet, every regimen. I even had urine from a pregnant woman injected into me—that was a fad once. Have you ever tried a Weight Watchers cannoli? Weight Watchers didn't work for me, either, and I found the meetings humiliating." Roberts, who is sixty-eight and retired from his job as a public-school guidance counsellor, lives in an immaculate, art-crowded apartment in the West Village. He recently went through the breakup of a long-term relationship, but he remains close friends with his ex-boyfriend. Roberts grew up in Queens, the son of an M.T.A. worker who avoided the chemicals in canned foods "before that was fashionable," he said. Decades ago, he successfully quit smoking and drinking. Managing his weight has been more difficult. "You can't just quit eating altogether," he said. He had opted for a procedure called a sleeve gastrectomy—the stomach is surgically narrowed to resemble a sleeve—but this was not Roberts's first attempt at a surgical treatment for obesity. "I can't remember the exact year, but I know I had the lap-band procedure the weekend that Michael Jackson died," he told me. The laparoscopic gastric-band procedure worked for Roberts for about a year, but then he began to regain weight.
More ...
http://www.newyorker.com/magazine/2016/09/26/bariatric-surgery-the-solution-to-obesity?
More ...
http://www.newyorker.com/magazine/2016/09/26/bariatric-surgery-the-solution-to-obesity?
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