Archive for the ‘General’ Category

The Concierge Revolution: Bringing Back Marcus Welby

Thursday, February 21st, 2013

During  a historic time of change within the healthcare sector, most notably the passage of the $938 billion Affordable Care Act (ACA), which will reduce healthcare spending by $138 billion according to the independent Congressional Budget Office, doctors are feeling new pressures. As the Physician Administrator for Evanston Northwestern Healthcare (now NorthShore University HealthSystem Highland Park Hospital) for more than ten years, I saw this first hand. Just think, a single physician routinely sees 1,500 to 2,000 patients in one year’s time, and the average time spent with a patient is now reduced to about 7 minutes and dropping (that includes time spent with the nurse as they take vital signs). With reimbursements being slashed and the number of chronic patients at 145 million, doctors today are expected to do so much more in less time.  This is one of the main drivers for many primary care physicians and even some specialists to look for another way.  They want to practice medicine the way they believe it should be…as they imagined it would be when they first graduated from medical school.

Concierge/personalized care practices have continually been gaining traction over the past decade.  Personalized medicine means true consumer medicine –  for patients, it means little or no office waiting, more face-to-face time with their own doctor, prompt return of phone calls, important additional services not covered by their insurance and a renewed sense of personal connection between patient and doctor. For the physician, it means having more time and resources exclusively dedicated to patient care rather than to the “business” of modern medicine. Now more than ever, physicians are exploring their options as they navigate through new legislation and our country’s ever evolving healthcare system. They are not giving up on medicine. Rather they’ve given up on a broken system and created their own – one that that works for them, for their staff, and most importantly for their patients.

Roberta Greenspan is the Founder of Specialdocs Consultants, Inc., a medical practice consulting firm dedicated to converting traditional medical practices to “personalized care or concierge” models.

To hear Roberta Greenspan and Michael Friedlander on the Concierge Revolution, click here.

PTSD Can Last a Lifetime

Tuesday, August 14th, 2012

Picture this: Late at night, in the middle of winter, a 69-year-old woman, less than 5 feet tall, flees her north suburban home, carrying two shopping bags filled with her belongings. When found wandering by police, she insists that someone is trying to kill her. 

The woman in question is Sonia Reich (mother of Chicago Tribune jazz critic Howard Reich), who is the subject of “Prisoner of Her Past,” a documentary from Kartemquin Films, renowned for “Hoop Dreams.” Sonia, who managed to hide from the Nazis as a young girl in the woods outside a small Polish village (now a part of Ukraine) has been diagnosed with late-onset post-traumatic stress disorder (the same PTSD which we normally associate with army veterans). Prisoner of Her Past, directed by Gordon Quinn, deals with the type of PTSD which appears years, or even decades after the trauma occurs. Moreover, the extent of Sonia’s PTSD is so great that not only is she suffering from the usual symptoms (sleeplessness and hypervigilance among others) but that she also, as her son writes, “had so deeply absorbed her childhood traumas into the fabric of her being that there simply was no way she could ever escape them…they were replaying themselves in an endless loop in her traumatized psyche.”

PTSD is something we need to think about seriously as we deal with the aftermath of traumatic events like the recent mass shootings in Colorado and Wisconsin and the return of servicemen and women from Iraq and Afghanistan. It is estimated that one in five soldiers suffers from PTSD or major depression. Brian Scott Ostrom is one of them. He was the subject of a 2012 Pulitzer Prize-winning essay in the Denver Post.  After serving four years as a reconnaissance marine and deploying twice to Iraq, he has struggled with daily life, from finding and keeping employment to maintaining healthy relationships. But most of all, five years later, he’s struggled to overcome his brutal and haunting memories of Iraq.

PTSD Awareness Day was first established by Congress in 2010 after Sen. Kent Conrad, (D-N.D.), proposed honoring North Dakota Army National Guard Staff Sgt. Joe Biel, who took his own life following two tours in Iraq. Biel’s birthday was June 27. “National PTSD Awareness Day should serve as an opportunity for all of us to listen and learn about post-traumatic stress and let all our troops — past and present — know it’s okay to come forward and ask for help,” Conrad said in a statement.

Secretary of Defense Leon Panetta called the recent surge in the number of military suicides “troubling and tragic” at a suicide prevention conference sponsored by the departments of Defense and Veterans Affairs in Washington last week. 

There were 154 suicides among active-duty troops in the first 155 days of the year, according to a recent report from the Associated Press, a number that is 50 percent higher than the number of U.S. forces killed in action in Afghanistan over that time period. It is the highest rate in 10 years of war. Panetta also said he wants to make the Department of Defense a “game-changing innovator” on research in areas related to suicide prevention, including in post-traumatic stress and traumatic brain injury.

Do Olympic Athletes Risk Permanent Injury?

Monday, August 13th, 2012

Those of us joining the more than 3 billion people around the world in Olympics watching, may find one part of the experience uncomfortable and even withering – the sight of healthy men and women and boys and girls risking life and limb for a laurel wreath. There was German weightlifter, Matthias Steiner, dropping a 432-pound barbell on his neck;. South Korean weightlifter Jaehyouk Sa, dislocating his right elbow while trying to push his lifts up to 357 lbs; and American sprinter, Manteo Mitchell, running 200m in the 4×400-meter relay preliminaries with a broken leg.

Now, the experts have stepped up to calm the concerns of the audience. It is a time of extremes, but scientific evidence suggests no-one will push beyond the limit. “You’ll never die because of intensity of exercise,” said Gregoire Millet, director of the Sport Science Institute at the University of Lausanne in Switzerland. “You will never die because you push yourself so hard.”

Enter The Governor

Research, much of it led by Tim Noakes, a professor of exercise and sports science at the University of Cape Town in South Africa, suggests that however much some athletes may want to push beyond all previous performances, a switch in the brain – known as the “central governor” – will keep them safe. “The brain uses the symptoms of fatigue as key regulators to ensure that the exercise is completed before harm develops,” Noakes wrote in a recent paper in the journal Frontiers In Physiology. For Richard Budgett, chief medical officer at the London 2012 Games, having the “central governor” around is a good thing. Himself a former Olympic gold-medal winning rower, Budgett is also eager to point out that many myths about potentially negative health effects of many years of hard exercise are generally not borne out by the scientific evidence. Studies in weightlifters, for example – who many might suspect would suffer lower back pain and damage as they get older – show that these athletes actually have less back pain in later life than other people. A scientific paper published in 1997 on the health status of former elite athletes from Finland found those who focused on aerobic sports in particular had long, healthy life expectancy and low risk of heart disease and diabetes in later years.

What About Accidents?

Of course, what the mavens aren’t addressing are the accidents along the way to Olympic glory: In March of 2010, Courtney King-Dye, 33, an Olympic dressage rider heading to Beijing, fell on her head, suffering a traumatic brain injury. She was in a coma for a month. Four years later, King-Dye says, “I’m still a definite fall risk, can’t walk without my cane, can’t brush my hair or teeth or eat with Righty (her right hand) and now I talk like a 5 year old instead of a 3 year old.”  And weightlifter, Jaehyouk Sa’s career may be cut short by his injury.

Take it to the Limit

There has been some scholarship recently about what the human body can bear as we see athletes routinely break records because they are fitter, stronger and faster. A recent article in the New Yorker used the spectacle of the World’s Strongest Man competition to opine on whether the athletic arms race has gone too far.

As an example, Brian Shaw, one of the sport’s superstars has deadlifted more than a thousand pounds; pressed a nearly quarter-ton log above his head; harnessed himself to fire engines, Mack trucks, and a Lockheed C-130 transport plane and dragged them hundreds of yards. To be fair, this is hardly comparable to the Olympics since these competitions don’t regulate drug and steroid use and so put their athletes at much greater risk. In 1977, one of the leaders in the early rounds was Franco Columbu, a former Mr. Olympia from Sardinia who weighed only a hundred and eighty-two pounds. Columbu might have gone on to win, had the next event not been the Refrigerator Race. This involved strapping a four-hundred-pound appliance, weighted with lead shot, onto your back and scuttling across a parking lot. Within a few yards, Columbu’s left leg crumpled beneath him. All the ligaments were torn, and the calf muscle,the hamstring, and the front patella sustained enormous damage. The injury required seven hours of surgery and threatened to cripple Columbu for life (he later settled a lawsuit against the World’s Strongest Man for eight hundred thousand dollars.)

In the end, we need safety more than we need glory and we commend the legions of regulatory bodies and coaches who take the safety of their athletes seriously.

Walking and Texting – Hazard To Your Health

Monday, August 6th, 2012

In the old days, it was people reading a book while they walked. But these days, one of the most perilous activities to your health may be: texting on foot. Police are even enforcing 60 year old jaywalking laws in order to get people to watch where they’re going. 

According to the Consumer Product Safety Commission, 1,152 people wound up in hospital emergency rooms in the last year for injuries caused when walking and using a cell phone or electronic device. Injuries to distracted walkers have quadrupled in the past seven years, according to emergency room numbers, and that’s probably a low estimate because either patients don’t admit a cell phone was involved or doctors don’t include that sort of detail on hospital reports.

No one is impervious.  According to a recent Newsweek article, “texting has become like blinking: the average person, regardless of age, sends or receives 400 texts a month, four times the 2007 number.” Teens are particularly vulnerable. That same Newsweek article clocked the average teen processing 3,700 texts a month, double their 2007 numbers.  Another report by the Pew Internet & American Life Project looked at the behavior of nearly 800 teens ages 12 to 17 during a three-part survey between April and July 2011 and a series of focus groups involving 57 people ages 12 to 19. Teens on average were shown to be sending and receiving 60 texts each day, up from 50 in 2009. The increase is being led by older teens ages 14-17 who went from a median of 60 texts a day to 100 two years later (that’s 6 texts an hour assuming you sleep for 8 hours).  Girls are still the most active texters, sending and receiving a median of 100 texts a day compared to boys sending 50. However, boys are texting more than they were just two years ago — in 2009, they sent about 30 each day. Worldwide, the highest average is in the Philippines, with an average of 27 texts sent per day by subscribers.

Life Expectancy in the US Dropping

Wednesday, August 1st, 2012

In 2009, a baby born in America could expect to live an average of 78 years, according to estimates from the U.S. Centers for Disease Control (CDC).  But this is now changing: A study in the Journal of Health Metrics shows the United States now ranks behind 10 other developed countries when it comes to life expectancy, even though Americans spend more on health care than people in most other countries.

Another study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, found that between 2000 and 2007, more than 80% of counties in the US fell in standing against the average of the 10 nations with the best life expectancies in the world. Five counties in Mississippi have the lowest life expectancies for women, all below 74.5 years, putting them behind Honduras, El Salvador, and Peru. Four of those counties, along with Humphreys County, MS, have the lowest life expectancies for men, all below 67 years, meaning they are behind Brazil, Latvia, and the Philippines.

Nationwide, women fare more poorly than men. The researchers found that women in 1,373 counties – about 40% of US counties – fell more than five years behind the nations with the best life expectancies. Journal of Health Metrics editor, Dr. Chris Murray says “It’s a real surprise to us in the study that women are faring so much worse than men. American women still live longer than men by five to eight years. But they have picked up some bad habits: Women are now smoking more.  The obesity epidemic in women is greater than in men. Progress in tackling blood pressure is much worse in women,” Murray added.

So, what we need right now is more Blue Zones in the US.  The phrase was coined by in 2004 by author, Dan Buettner, who teamed up with National Geographic and hired the world’s best longevity researchers to identify pockets around the world where people reach age 100 at rates 10 times greater than in the United States – the blue zones. Some of them are:

  • Okinawa, Japan
  • Sardinia, Italy
  • Loma Linda, California
  • Nicoya, Costa Rica
  • Ikaria, Greece

So, where are our Blue Zones? Women live the longest in Collier, FL, at 86 years on average, better than France, Switzerland, and Spain. Men live the longest in Fairfax County, VA, at 81.1 years, which is higher than life expectancies in Japan and Australia. Women are also living long lives in Teton, Wyoming; San Mateo and Marin, California; and Montgomery, Maryland. For men, long life spans also can be found in Marin, California; Montgomery, Maryland; Santa Clara, California; and Douglas, Colorado.

The UK: American Healthcare Reform’s Mirror Image

Wednesday, July 25th, 2012

If you want to see a twin of our healthcare reform battle, try the other side of the Atlantic: England is undertaking the biggest reform of its government healthcare program, the National Health Service, as part of its massive 5-year austerity program. “After a year in parliament, more scrutiny than any bill in living memory, and more than 1,000 amendments in the House of Commons and the House of Lords,” as the Guardian newspaper put it, “MPs cast their final vote for the (reform) bill.” At its heart are plans which will give primary care providers more sway over the NHS’s £106 billion annual budget, and introduce more private competition. British reform moves quicker than ours — the program takes effect over the next 12 months. A major plank of the reform is the NHS Mandate, under which the government will set targets for improvement in 60 areas of care, such as patients surviving after cancer treatment, and medical errors. The goals? Reduce administration costs by one third.

And, in another instance of seeing double, we’re watching the other side working hard to repeal it and vowing to do so on Day One if they win the next election. “The government’s reforms to the NHS in England have undermined the service and opened the door to privatization,” said (opposition) shadow health secretary Andy Burnham, who championed Labour’s motion, which claims that treatments and services are being rationed in the NHS. In an opposition-led debate on the NHS on 16 July 2012, Mr. Burnham said: “We will repeal the bill; it is a defective, sub-optimal piece of legislation that is saddling the NHS with a complicated mess.” But (government) Health Minister, Simon Burns said: “Far from the meltdown that some gleefully predicted, we have seen a robust and resilient NHS delivering better care for patients. Waiting times remain low and stable, in fact below where they were at the last general election.”

So, just to recap, here we have the conservatives championing reform and austerity and the liberals pleading for repeal in opposition to a privatized system and rationing.  All of this, of course, is part of the cost-cutting program that some say caused Britain to fall back into a double-dip recession. After the 2010 general election, Prime Minister David Cameron, leader of a coalition of the Conservatives and the Liberal Democrats, initially said that the austerity program would finish by 2015. During this period, more than £80 billion would be raised by spending cuts and tax rises. However, the program was extended to 2017 last fall with further savings £30 billion hoped for.

Just How Fat Are We?

Tuesday, July 24th, 2012

In the race to create the most addictive app (or maybe it’s a next-generation Angry Birds game) the BBC has launched an online Biomass Meter that tells you where the percentile where you fall in terms of corpulence worldwide and, most compellingly, lets you see where in the world you’d fit in given your waistline (I’d be at home Brazil, Iran or South Africa). This calculator is based on research data pulled together by a team of researchers at the London School of Hygiene and Tropical Medicine, using UN data on population size in 177 countries, together with estimates of global weight from the WHO and mean height from national health examination surveys.

Interesting timing given that (according the New York Times) last month, researchers affiliated with the World Health Organization and the London School of Hygiene and Tropical Medicine reported that, worldwide, people’s waistlines are expanding, with the total combined weight of human beings on Earth now exceeding 287 million tons. About 3.5 million tons of that global human biomass is due to obesity, a third of which exists in North America, although we account for only 6 percent of the world’s population.

The biggest culprit ? Voluntary inactivity, according to a study in the Lancet. Led by Pedro C. Hallal, a professor at the Federal University of Pelotas in Brazil, the study finds that 31.1 percent of the world’s adults, or about 1.5 billion people, are almost completely sedentary, meaning that they do not meet the minimum recommendation of 150 minutes of walking or other moderate activity per week, or about 20 minutes a day.

But surely we can look to our teenagers as models of physical vitality, correct? Not quite. Teenagers do worse. More than 80 percent of young people ages 13 to 15 worldwide are not getting the hour a day of vigorous exercise recommended for their age group. North America leads (or wheezingly lags) the world in not exercising, with 43.3 percent of Americans not doing the bare minimum. But, it’s spreading: more than 30 percent of Russians and 27 percent of Africans are sedentary. And what’s the most sedentary nation on Earth? Malta, population 419,000, 72 percent of whom won’t be appearing on The Biggest Loser.

According to the Lancet study, the effect of being a couch potato is comparable to smoking. “Smoking and physical inactivity are the two major risk factors for non-communicable diseases around the globe. Of the 36 million deaths each year from non- communicable diseases, physical inactivity and smoking each contribute about 5 million deaths each.”

US News Names New Hospital as Best

Monday, July 23rd, 2012

Massachusetts General Hospital or Mass General is No. 1 for the first time, according to the US News & World Report Best Hospitals rankings. It marks the end of a 21-year run for Johns Hopkins that started in 1991, the year after U.S. News began publishing Best Hospitals.

When Mass General was founded, James Madison was President, Napoleon was Emperor of France and the Juliana, the first ever steam-powered ferryboat, began operation.   Only Pennsylvania Hospital (1751) and New York–Presbyterian Hospital (1771) are older. The fact that Mass General hasn’t taken the top spot before may come as a surprise to some, given its pedigree: It was the original teaching affiliate and flagship of Harvard Medical School; it remains the largest hospital-based research program in the United States, with an annual research budget of more than $400 million; and is renowned in such specialties as diabetes & Endocrinology, Ear, Nose & Throat, Neurology & Neurosurgery, Ophthalmology, Orthopedics, and Psychiatry.

The 950-bed medical center each year admits about 48,000 inpatients and handles nearly 1.5 million visits in its outpatient programs at the main campus and satellite facilities. It also delivers more than 3,600 babies annually. It is now the largest non-government employer in the city of Boston, with more than 19,000 employees, including a nursing staff of 2,900. In addition, its 3,600-member medical staff includes physicians, dentists, psychologists, podiatrists, residents and fellows.

MGH is owned by Partners HealthCare, which was formed by MGH and Brigham and Women’s Hospital in 1994. MGH is also a member of the consortium which operates Boston MedFlight.

June 2012: Jobs Fizzle

Monday, July 16th, 2012

80,000 was the number. 200,000 is what we need for this to feel like a recovery. And 8.2 is the number that keeps hanging on.  The nation’s unemployment rate was unchanged at 8.2% (that’s 13 million unemployed workers) for the second consecutive month, the Labor Department said Friday.   Businesses added just 84,000 jobs, while governments cut 4,000. Monthly job growth averaged 226,000 in the first quarter but slowed dramatically to an average 75,000 a month in the second quarter.

In response, the Dow Jones industrial average fell 124.20 points to close at 12,772.47, wiping out the Dow’s gain for the week, and Treasuries rose as investors moved their money into lower-risk assets. And the Presidential campaigns took the opportunity to issue a number of extrapolations and the usual host of inaccuracies and overreaches. The Democrats claimed that the unemployment rate has been trending down since hitting 10.10% in October 2009; what they forget to point out is that that’s because of the large numbers of discouraged workers – almost 1 million — who’ve stopped looking for jobs. The Republicans, on the other hand, said that the jobs report proves that the Obama administration’s policies haven’t worked, forgetting that the US was hemorrhaging 700,000 jobs a month when Obama took office. According to Politifact, Obama’s record is 22 consecutive months of private-sector job growth, beginning in Feb. 2010, during which the number of jobs grew by almost 3.16 million, or about 143,000 per month.

Putting the candidates aside, the reasons for the anemic job numbers have started to sound like a bad drinking-game song being played by the pundits as they make the circuit of the talk shows: The warm weather drew construction and manufacturing activity into January and February, but dampened spring hiring; the manufacturing sector contracted for the first time in three years in June;  retail sales were weak, Corporate profits fell in the first quarter of 2012,  the first decline since 2008, according to the Commerce Department; the European Central Bank cut interest rates – a sign of nervousness about their prospects; the end-of-year fiscal cliff sent ripples through the public and private sectors with its specter of higher taxes and reduced government spending; a lame-duck Congress couldn’t pass a Jobs Bill; Republican governors made draconian cuts and instituted public-worker layoffs at the state level; and the Administration didn’t put a big enough stimulus in place which is creating an undertow. Take your pick.

So, are there any bright spots? A few.  Friday’s report showed ticks upward in average hourly earnings (to $23.50, from $23.44 in May) and the length of the typical private sector workweek (34.5 hours, from 34.4). Also, a curious fact is that the number of teens in the workforce spiked by 140,000 to 4,528,000, or 3.2% of the entire U.S. workforce:  So why are teens making out so well in this first month of summer while everyone else, well, isn’t? The Daily Kos reports from 5 May 2012:  President Obama’s Jobs program, which is lining up commitments from the private sector and from government to create summer jobs and internships for young people, has announced commitments for 90,000 paying jobs, up from the 70,000 previously announced in January.

10 Percent of America’s Veterans Have No Healthcare Coverage

Tuesday, June 12th, 2012

Ten percent of the nation’s 12.5 million non-elderly veterans do not have health insurance coverage or use Veterans Administration (VA) health care according to the 2010 American Community Survey (ACS).  The Urban Institute report, which was released by the Robert Wood Johnson Foundation, is the first to provide estimates of a lack of insurance among veterans and their families both nationally and at the state level, and to assess the potential for the Patient Protection and Affordable Care Act (ACA) to reduce these rates.  Veterans are less likely be uninsured than the overall population.  Uninsured veterans and their families report significantly less access to healthcare than their counterparts with insurance coverage.  Forty-one percent of veterans who lack healthcare coverage have untreated medical needs, while nearly 34 percent have put off getting care because of the expense.

The ACA’s coverage provisions have the potential to increase coverage among the U.S. population, including uninsured veterans.  An estimated 50 percent of veterans who currently do not have insurance would qualify for expanded Medicaid coverage; another 40 percent have the potential to receive subsidized coverage through health insurance exchanges if they lack access to affordable employer coverage.  Not surprisingly states that have made minimal progress in setting up health insurance exchanges have the most uninsured veterans — nearly 40 percent.  Success in bringing coverage to uninsured veterans will depend primarily on aggressive ACA implementation and enrollment efforts.

The Veterans Administration (VA) –  with more than 1,400 hospitals nationally and nearly 15,000 physicians – covers the majority of veterans, although not all: Eligibility is determined by income, injuries sustained in combat and length of service.  Because of the eligibility requirements, 1.3 million veterans and 0.9 million family members have no healthcare coverage.

Uninsured veterans typically are younger than those with coverage and less likely to have been injured in combat.  Uninsured veterans tend to have higher unemployment rates, less income and usually are not married — all of which reduce the odds of having private coverage.  “Their lower likelihood of being full-time workers and being married likely contribute to their lack of coverage, as these attributes are characterized by lower access to employer-sponsored health insurance,” according to the Urban Institute study.

Writing for the Non-Profit Quarterly, Rick Cohen notes that “Among the states with the worst rates of uninsured veterans, Louisiana, Oregon, and Idaho all top 14 percent, and Montana comes in at a woeful 17.3 percent.  This past weekend, the streets of Washington, D.C. were occupied by participants in the Rolling Thunder demonstration, the annual Memorial Day gathering of veterans (and non-veterans) on motorcycles focused on calling the nation’s attention to the POW/MIA issue.  The Robert Wood Johnson Foundation report would suggest that, in the U.S., there is an abundance of veterans and their families who are being treated as if MIA when it comes to health insurance.”

According to Dr. Jonathan D. Walker, assistant clinical professor at the Indiana University School of Medicine in Fort Wayne,  “A Harvard study estimated that more than 2,200 veterans died in 2008 due to lack of insurance.  You may have thought that veterans can automatically be treated at a veterans’ hospital, but this is not the case.  Uninsured veterans face a “means test” based on their income.  The test determines their priority level for care and how much they have to pay.  And if the system doesn’t have enough money, it can stop enrolling veterans if they fail the means test – as happened from 2003 to 2009.  But even if the VA were able to fully cover every veteran, it would still leave a lot of veterans without care because they do not live near a VA hospital.  And even if they live near a hospital, they still may need to drive far away to get services that aren’t available locally.  There are laws that make it illegal for an insurance company to force patients to drive an excessive distance to stay in their network, yet we think nothing of making veterans drive long distances simply to get the care to which they are entitled.”