The C2S blog draws on the arts, the social and biological sciences to explore the many meanings of health and "dis-ease." Designed to be a locus where patients, their families and professionals can meet on a level playing field, it is the natural off-shoot of the Cell 2 Soul Online Journal. We encourage the submission of ideas, essays, poems, stories, humor, and timely reviews relating to the humanities and health care.
"The trouble with a free-market approach is that health care is an immensely complicated and expensive industry, in which the individual rarely has much actual market power.
The point of universal coverage is to pool risk, for the maximum benefit of the individual when he or she needs care. And the point of having the government manage this complicated service is not to take freedom away from the individual. The point is the opposite: to give people more freedom.
I wish we were free to assume that our doctors get paid a salary to look after our best interests, not to profit by generating billable tests and procedures."
Excerpts from an amazing op-ed in the NY Times. It pretty well says it all in a pleasant "nordic" way.
In spite of the Affordable Care Act there are many people in our country without health insurance. "The remaining uninsured are primarily in the South and the Southwest. They tend to be poor. They tend to live in Republican-leaning states. The rates of people without insurance in the Northeast and the upper Midwest have fallen into the single digits since the ACA’s main provisions kicked in. But in many parts of the country, obtaining health insurance is still a problem for many Americans."
The states with the lowest percentage of uninsured tend to be the ones that have expanded Medicaid coverage. However, it can be difficult for Medicaid patients to obtain health care, especially from specialists. See: Cherry Picking in the Aina.
It's hard to believe there are still so many health care unequalities.
This is a long, but invaluable, introduction to the topics of over-diagnosis and over-treatment. The Lown Institute has impressively addressed this topic for the past three years or so and a cadre of physician scientist and clinicians around the world have been interested in subject as well. In his polished way, Gawande covers the issue for the lay and professional reader. He asks: What can we do about the avalanche of unnecessary medical care that is harming patients physically and financially.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. Modern version of Hippocratic Oath
In this inspiring 90-minute documentary, filmmaker David Grubin takes his camera across America to focus on the challenges and triumphs in our country’s health care delivery system. The four segments that comprise Rx: The Quiet Revolution introduce us to a diverse group of doctors, nurses, and health care professionals who are transforming the way we receive our medical care: lowering costs by placing the patient at the center of their practice.
Rx: The Quiet Revolution shows us what’s happening from Maine to Mississippi, California to Alaska. You will see physicians, nurses and other healthcare professionals placing the patient at the center of their practice — transforming the way medical care is delivered while lowering costs and improving outcomes.
Filmmaker David Grubin brings you these compelling stories:
In Maine, we meet Dr. David Loxterkamp, who practices family medicine with a team of doctors working to treat patients with chronic illnesses.
In Mississippi, a state with more diabetes cases than any other, Grubin finds a rural health clinic fighting diabetes with the aid of an electronic communications device that provides greater access to medical care, helping patients take responsibility for managing this devastating chronic disease.
In San Francisco, Grubin visits a health care facility for seniors called On Lok, dedicated to making it possible for frail, elderly Americans in need of nursing home care to live with dignity in their own homes.
In Alaska, the documentary follows Native Alaskans who own and operate their own health system, caring for 65,000 people across 107,000 square miles. In spite of the number of patients and the vast distances between them, they are determined to foster an empathetic relationship between patients and their health care providers.
At 90 minutes, this may seem a daunting investment in time, but Rx: The Quiet Revolution will speak to you in powerful and compelling ways.
The Reith Lectures were inaugurated in 1948 by the BBC. Bertram Russell gave the first talk.
In 2014, there were four Reith orations by Atul Gawande on The Future of Medicine. They were presented in Boston, London, Edinburgh, and New Delhi. All can be listened to or read. In addition they can be downloaded for free to iTunes and transferred to an iPod for easy listening. O! Brave New World!
Role of Fear in Overdiagnosis and Overtreatment: an essay by Iona Heath
The title says it all regarding this extraordinary essay in the October 24, 2014 British Medical Journal. Here are a few quotations from the article. If you would like a copy of the entire paper, let me know (email DJE )and I will send it to you. I cannot post it online because of copyright issues.
In recent decades, health has become a commodity like any other. The exploitation of sickness, and fears of sickness, for the pursuit of profit has increased recently, underpinned by the rapid commercialization of healthcare.
Montaigne wrote: if you don't know how to die, don't worry: nature will tell you what to do on the spot, fully and adequately. She will do this job perfectly for you; don't bother your head about it.
Every healthcare professional is now required to consider an ever greater array of potential risks to the patient's health, however well patients might be feeling. And every responsible and rational citizen is expected to actively seek out and eliminate all possible risks to their future health and to consume medical technologies in order to achieve this aim.
A great comfort is the unpredictability of the future. No one knows exactly what will happen tomorrow. We know a lot about probability, but probability is a long way from certainty. People do not always get the result predicted by their lifestyle. Not everyone who smokes will die prematurely. Conversely, a good diet and regular exercise do not provide complete protection from random disaster.
Meghan. O’Rourke is a writer and poet who has suffered with an obscure autoimmune disorder for over a decade. Her reflections on American medicine are important and iinstructive. This article is available as full free text.
O'Rourke writes: This essay is about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes "patient–centered care" as a mantra, modern medicine is startlingly inattentive – at times actively indifferent – to patients needs. To my surprise, I have now learned that patients aren't alone in feeling that doctors are failing them. Behind the scenes, many doctors feel the same way. A crop of recent books was a fascinating and disturbing ethnographic of the opaque land of medicine, told by participant-observers wearing white coats.
Americans are inundated with medical information. It comes from every direction -- the media, the Internet, well-meaning friends and acquaintances, and an ever-proliferating collection of journals. In 'The Smart Patient -- Mistakes We Make About Our Health -- And How to Avoid Them,' Gina Kolata of The New York Times provides guidance in sorting through this welter, helping readers to make better decisions for themselves. Kolata, one of the country's most respected medical journalists, tells why anecdotal evidence should be viewed with skepticism, why large random studies are more trustworthy than observational ones, when a second opinion is a must, and what questions you should ask your doctor and -- equally important -- what ones you need to ask yourself.
I saw an ad for The Smart Patient in the NY Times and downloaded it to a Kindle. It's also available for the Nook. This is a short book, might take one to two hours to read and there is much for patients, their families and all care givers (including physicians) to ponder over. It's well worth the $2.99 price.
Minds on the Edge: Facing Mental Illness is a multi-platform media project that explores severe mental illness in America. The centerpiece of the project is a television program that premiered on PBS stations in October 2009. This video component is part of a national initiative that includes an extensive web site and an ambitious strategy to engage citizens, professionals in many fields, and policy makers at all levels of government. The goal is to advance consensus about how to improve the kinds of support and treatment available for people with mental illness.
Susan Rose, from North Adams, Massachusetts, alerted us to this excellent PBS forum. She writes: "As a person who has struggled with a mental illness for decades, I found this 2009 video compelling. The Supreme Court justice Stephen Breyer and Nobel Prize winning neuroscientist Eric R Kandel were just two of the speakers. I wish I could share this with the people closing Greylock Pavilion, our inpatient mental health unit in North Adams, Massachusetts. Everyone needs to listen to the discussion on this video. The situation is worsening because nationally many psychiatric units are closing their doors for financial reasons. The consequences of these closings will be devastating to mental health patients, their families, and the communities they served. The pain of mental illness affects everyone. The cost saved by shutting down mental health units will be offset by an increased rate of incarceration, as patients are forced into jails because there is no other place for them to go."
“The Right Care Alliance is a movement of clinicians, patient advocates, community leaders, and patients who see that overtesting, overdiagnosis, and overtreatment are endemic to modern health care – they are built into the culture of modern medicine. We see overuse as the flip side of the coin of undertreatment and lack of access, and a major cause of harm to patients."
They came to “understand the power and importance of coming together, to share our concern about practices that harm patients, and our belief in the moral necessity of working together to reduce overuse”
With colleagues, Vikas and Shannon created The Declaration of Principles of the Right Care Alliance. Please read it and consider joining this Alliance by signing this declaration. It will demonstrate your solidarity with the movement to assure all of us compassionate, safe and appropriate care.