Saturday, July 1, 2017

A Doctor’s View of Obamacare and Trumpcare from Rural Georgia | The New Yorker

Nineteen years ago, after medical school at Columbia University; a stint at Montefiore Medical Center, in the Bronx; and a period running homeless shelters in Times Square; Karen Kinsell moved to Fort Gaines, a tiny town in southwest Georgia, on the Alabama line. Fort Gaines is in Clay County, which is consistently ranked among the poorest of the hundred and fifty-nine counties in the state. It currently ranks third-to-last in "health outcomes," according to the Robert Wood Johnson Foundation, up from dead last. Clay County's only hospital closed its doors in 1983, long before Kinsell, who is now in her sixties, arrived and became its only doctor. "It's a bad place to live," Kinsell said recently by phone, between seeing patients, "which is why I moved here. I was looking for a place that needed me."

Kinsell runs Clay County Medical Center, a facility with four exam rooms built out of a former Tastee-Freez. It's a private practice, but she is a full-time volunteer. There is a receptionist and two other full-time staff members; they see "around thirty to thirty-five patients a day," Kinsell said. Monty Veazey, the president of the Georgia Alliance of Community Hospitals, told me that "Kinsellcare" is the only health care that's had a meaningful and positive effect here. "She's going bankrupt treating everyone that comes in," he said. "Most have no money, no Internet access, no other basic care. Many don't have insurance. How much longer can she do that? I don't know. But she's their only hope."

On Tuesday, shortly before Senator Mitch McConnell announced a delay in the vote for the Senate Republicans' health-care reform bill, Kinsell spoke by phone about the effects of Obamacare, the prospect of Trumpcare, and the plight of sick people in southwest Georgia. Her account has been edited and condensed.

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Wednesday, June 28, 2017

How ‘Wellness’ Became an Epidemic - New York Magazine

Why are so many privileged people feeling so sick? Luckily, there's no shortage of cures.

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The Lab Says It’s Cancer. But Sometimes the Lab Is Wrong. - The New York Times

It was the sort of bad news every patient fears. Merlin Erickson, a 69-year-old retired engineer in Abingdon, Md., was told last year that a biopsy of his prostate was positive for cancer.

Mr. Erickson, worried, began investigating the options: whether to have his prostate removed, or perhaps to have radiation treatment. But a few days later, the doctor called again.

As it turned out, Mr. Erickson did not have cancer. The lab had mixed up his biopsy with someone else's.

"Obviously, I felt great for me but sad for that other gentleman," Mr. Erickson said.

The other gentleman was Timothy Karman, 65, a retired teacher in Grandy, N.C. At first, of course, he had been told he was cancer-free. The phone rang again a few days later with news of the mix-up and a diagnosis of cancer.

Ultimately he had his prostate removed. "I said, 'Mistakes happen,'" Mr. Karman said.

They may be happening more often than doctors realize. There is no comprehensive data on how often pathology labs mix up cancer biopsy samples, but a few preliminary studies suggest that it may happen to thousands of patients each year.

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Doctor on demand: How app culture is reviving the house call - The Washington Post

Alison Mintzer and her family were on a flight from New York to Los Angeles when her daughter complained that she felt sick. By the time they landed, Mintzer's normally uncomplaining 6-year-old said that her neck and ears hurt. When a fever soon followed, it was enough to convince her parents that she needed to see a doctor.

Thousands of miles from their pediatrician, and unable to find one quickly in L.A., Mintzer didn't know what to do. Then a family friend suggested an app called Heal that could use new technology to drum up a relic from the past: doctors who make house calls.

Once upon a time, a visit with the doctor meant welcoming one into your home, rather than heading out to a clinic or hospital waiting room. But around the 1960s, the house call fell out of favor as doctors' offices sought to become more efficient, and the doctor-patient relationship changed from "Marcus Welby" to something less personal with the rise of hospitals and modern insurance plans.

Now, however, the trend for on-demand service in the age of Uber could revive the house call. Services such as Heal — which launched in the District in June after operating in California since 2014 — and competitors such as Pager and Curbside Care are expanding their footprints across the country. And research suggests that house calls can provide a better standard of care for some patients than a hospital visit. A University of Southern California study of a house call program in the state found that hospitalization rates dropped for patients who were enrolled in the program for six months: Of 1,000 patients, 96 were hospitalized after being enrolled, down from 159 before the program.

Costs can also drop, since patients can avoid hospital visits. A 2013 Brookings Institution report said a Department of Veterans Affairs analysis of its home-based care program found a "25 percent reduction in hospital admissions, a 36 percent reduction in hospital days, and a 13 percent reduction in combined costs."

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