The Health Care Blog – Page 638 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

So it Turns Out that Lots and Lots of People Still Want to Be Doctors

May 3, 2012• 8

By Aaron Carroll, MD

As I noted last week, I get a little annoyed by the seemingly constant public complaints of physicians, coupled with threats to leave medicine and dire warnings that no one will want to be a doctor in the future. This is in spite of it still being one of the most trusted professions around, and one that is darn well compensated. So it’s nice to see that the general public hasn’t bought into this meme yet (from the AAMC 2011 Medical School Enrollment Survey):

First-year medical school enrollment in 2016–2017 is projected to reach 21,376. This projection represents a 29.6% increase above first-year enrollment in 2002–2003 and comes close to reaching the 30% targeted increase by 2015 the AAMC called for in 2006.

Of the projected 2002–2016 growth, 58% will be at the 125 medical schools that were accredited as of 2002. New schools since 2002 will experience 25% of the growth, and the balance (17%) will come from schools that are currently in LCME applicant- or candidate-school standing.

Continue reading…

CajunCodeFest Highlights the Silicon Bayou

May 2, 2012

By Hemali Thakkar

When you hear of ‘health tech’ or ‘health innovation,’ the first places that come to mind are usually Silicon Valley, Boston or New York City. Yet, this past weekend’s event shook that notion for everyone that attended. It is not just big cities like SF, Boston or NYC that are experiencing a surge of innovation and entrepreneurship. In fact, even the smallest towns across the nation are taking technology and the power of internet to confront our nation’s growing health problems. CajunCodeFest, in Lafayette, Louisiana, is no exception.

An incredible crew of nearly 300 entrepreneurs, health experts, students, coders, and professionals gathered in Lafayette this weekend, representing 3 countries, 15 states, and 40 cities. With Louisiana having the second highest obesity rates (after Mississippi), the code-a-thon marked an important stepping stone for the state in its battle against obesity. As obesity rates continue to rise, the epidemic is now considered one of the nation’s biggest public health problems. The Louisiana Secretary of Health and Hospitals, Bruce Greenstein, put it loud and clear during his opening remarks, stating how “we have failed to take personal responsibility” for our obesity problems and we continue to blame others for this growing issue. That’s why the CajunCodeFest taking place in Lafayette was more important than ever.

Medical Research We Never Hear About: The Problem of Unpublished Studies

May 2, 2012• 5

By Claire McCarthy, MD

Every day, there is another medical study in the news. There’s another newspaper or TV story telling us that X can cure depression or make you thinner or cause autism or whatever. And since it’s a medical study, we usually think that it’s true. Why wouldn’t it be?

But what most people don’t realize, let alone really think about, is that there might be other studies that show that X does none of those things — and that some of those studies might never have been published.

Just this week, the journal Pediatrics released an article that perfectly demonstrates this problem. There have been a number of studies that have shown that a certain type of medication, selective serotonin reuptake inhibitors (SSRIs), can help stop the repetitive behaviors of autism, like hand-flapping or head-banging. If you were to do a search of the medical literature, as doctors and parents and patients often do, you’d think that using SSRIs is a good idea. But when researchers dug deeper, they found that there were just as many unpublished studies that showed that SSRIs didn’t help. If they had all been published (they were all good enough to be published), that same search of the medical literature would have shown that using SSRIs isn’t a good idea.

This is bad. We rely on studies to guide our decisions. What is going on?

The journals that publish articles certainly play a role. After all, it’s cooler to publish a study that has a grabby headline, that promises an answer or a cure. That’s much more likely to get readers than a study that says that something doesn’t do anything at all. But it turns out that the researchers themselves play a bigger role.

Obama Supporters Put High Court on Trial

Apr 30, 2012• 44

By Betsy McCaughey

As the U.S. Supreme Court deliberates the Obama healthcare law, the court itself is on trial.

Obamacare supporters are attacking the justices as “hacks dressed up in black robes,” calling for limits on their life tenure, and claiming judicial review is undemocratic.

Worse, President Obama and his Secretary of Health and Human Services Kathleen Sebelius are shoveling money into implementing the law as fast as possible and refuse to discuss an alternative. That’s irresponsible. What’s needed now is not court bashing but contingency planning.

The Obama administration and allies in Congress have nine weeks to plan how to pick up the pieces on a vast array of health insurance issues. It’s the President’s duty to have a plan. It will signal his respect for the nation’s system of checks and balances — something he has utterly failed to show.

Heady Times for Health Care in the Cloud

Apr 30, 2012• 1

By Jonathan Bush

In 1990, when I got my first health care job driving ambulances, not a soul in the New Orleans EMS department had a cellphone. Not even the head of the service. The mayor, his chief of staff and the police chief each had one. That was about it. These phones weighed like 15 pounds and were hardwired to a car battery. And we ambulance drivers documented our care on “run sheets” found on metal clipboards but, since so few people bothered to read them, we also wrote key vital signs and other metrics on a three-inch-wide piece of white tape smacked across the patient’s abdomen.

Today, everyone in New Orleans — and everywhere else — has a cellphone. These cellphones have the computing power to find, and add to, and direct everything that anyone would need to know about a patient anywhere in the world… but they don’t do it! Today’s “do-everything” cellphones are the size of your wallet, yet most ambulance crew run sheets are still paper, found on metal clipboards. And most good patient data is still found on those three-inch-wide pieces of tape.

Why? I’ll give you one good reason and one bad one.

A Health Care Setup Both Sides Could Live With

Apr 28, 2012• 5

By Donald H. Taylor Jr.

Before long the Supreme Court is expected to rule on the health care reform law, a decision that will have tremendous policy ramifications and could reshape the presidential election.

But even if the court overturns the Affordable Care Act, as some observers predict, that won’t change the reality that our country’s health care system is seriously broken. In short, regardless of what the court says, people will still be getting sick, costs will keep rising and too many people will be uninsured. And our federal budget will never be sustainable if we can’t bring health care costs under control.

The Democratic Party and progressives invested a huge amount of political capital in getting Congress to pass the ACA in 2010. The act was not perfect, but it did provide a start to the many years of work needed to create a sustainable health care system. In speeches, Republicans and conservatives acknowledge that our health care system is unsustainable and have spoken of a need to “replace”; however, in the two years since the ACA passed, they have failed to be clear about what they actually favor.

As we look to what we’re actually going to do about the problem, what’s clear is that progressives and conservatives both need to move beyond their familiar positions to find a new kind of deal. This seems politically impossible before November, but politicians on both sides would do themselves – and the country – a big favor if they quietly started devising a solution that everyone can live with, even if neither side gets everything it wants.

For progressives, universal coverage has always been the Holy Grail and dream deferred, not just of health policy, but of all social policy. I don’t think conservatives have a health policy interest that is so clear and heartfelt as universal coverage is for progressives, but if I had to take a stab, I think it is their belief that people don’t have enough “skin in the game” and are therefore wasteful of other people’s money.

What if We Regulated Legal Services Like Health Care?

Apr 27, 2012• 18

By John R. Graham

Well, the future of American health care is now controlled by lawyers. That may not be news – doctors, drug makers, and medical-device makers have long complained about the cost of lawsuits. But this different: The future of PPACA is in the hands of the Supreme Court. Hundreds of lawyers billed thousands of hours analyzing and preparing briefs for the case. And that’s after countless hours spent by Congressional staff lawyers putting the bill together in 2009 and 2010. The result? A “law” so confusing that even the legislators – themselves mostly lawyers – could not bother to even try to read it.

It makes one think: If the lawyers are designing the health-care system, shouldn’t they be forced to operate under regulations similar to those they’re imposing? How, for example, do lawyers get paid? Today, they negotiate fees with clients. That hardly seems fair. In health care, doctors don’t negotiate fees with patients, they get paid according to an opaque schedule determined by health plans. Lawyers should do the same. The solution is “legal insurance”. After all, who amongst us knows when we’ll need a lawyer? It is often an unpredictable expense, and yet the “market” seems to have failed to provide such insurance. Government must intervene.

Bringing Medicine into the Age of Computers, Finally

Apr 27, 2012• 2

By Paul Levy

The economic stimulus package passed in 2009 contained billions of dollars designed to encourage hospitals and doctors to install electronic health records (EHRs). At the time, an exceptionally small number of health care providers had computerized medical records. It is hard for those of us who are used to dealing with credit card companies, airlines, automobile service departments, utility companies, and the like to imagine that the medical world was living in the Dark Ages.

Here was an industry that hadn’t even arrived in the 20^th century – much less the 21^st century — in terms of computerization. Accordingly, the idea of the legislation was to both create jobs and also pull the industry up by its bootstraps.

Everyone understood that this would not be an easy task, but it was the right thing to do. Without EHRs, if you show up at a new hospital and the doctor there needs your medical history from your home institution, the file of paper records needs to be extracted from the archives. Then, believe it or not, it is faxed a page at a time to the doctor who is treating you. That’s if you are lucky. Many times, the process is just too burdensome and time-consuming. If you are waiting in an emergency room, chances are they will not even try to obtain this information. The result is that tests you might have had recently will have to be repeated, a high cost, when you enter the new facility.

But not having EHRs is a problem even if you go to your regular hospital. There, too, your doctor needs to put in a request for someone to dig up your files and have them delivered or faxed to his or her office. Not only does this create delays, it offers a high probability that your doctor will not have key information about you as he or she begins to diagnose and treat you.

Doctor Versus Doctor

Apr 27, 2012• 13

By Jim deMaine

I felt sad when I went to make rounds in the hospital.

One of my patients, a colleague, had been readmitted in poor condition for recurrence of a primary lung sarcoma.

I spent a few minutes examining Dennis and chatting. He then, with a quizzical look, said, “Jim, I’m going to have to sue you. I know I’m dying. My wife Alice and the kids are still pretty young.” He saw my look of surprise and added, “You know, I don’t have much life insurance or other very significant funds for them to live on. It’s nothing personal. I know you’ve given me good care, but my wife is upset and tends to blame you for the outcome. I guess the hospital and others will be named.”

There wasn’t much more for me to say at the time except, “Dennis I can find another attending for you if you’d like.” He replied, “No, I want to stay with you.”

Dennis was a well liked family doctor. About five years earlier a “coin lesion” was discovered on a chest X-Ray. This 2cm spot in the right upper lobe had a smooth rounded border and didn’t contain calcium. A CT scan showed no enlarged lymph nodes and no other spots elsewhere. A needle biopsy of the spot was not diagnostic. We knew the spot was new because an X-Ray five years earlier was normal. He hadn’t traveled to an area where Valley Fever or other fungal infections were common.

Connecting the Dots

Apr 27, 2012• 1

By Will Saunders

Data is only data until it is structured. Then it becomes powerful, relevant and insightful.

That was a key message from Ursula Burns, Xerox chairman and chief executive officer, on the first day of the World Health Care Congress in Washington, D.C. In opening the event with a fireside chat with Dr. Nancy Snyderman, chief medical editor for NBC News, Ursula talked about Xerox’s vision to improve health care including empowerment– ensuring that patients have a stake in their health, and realizing the true value of data. As Ursula said, “It’s not the data itself, but it’s recognizing actionable data.”

Here’s another way to think of it: Xerox provides the “smarts” around each aspect of health care such as:

·Easier access to data through solutions, such as advanced document recognition, intelligent data entry and fraud detection;

·Turning information into insights through real-time clinical decision, patient behavior modeling, population management, and Meaningful Use reporting; and

·Putting insights into action, for example, through a health information exchange – connecting electronic medical records (EMRs) to give caregivers information, analytics and decision support tools that help improve patient care.