Cell 2 Soul: The Humane Health Care Blog

The Impact of Doctor Loss

by Susan Kaplan

photo taken from myprivatemd.org

It didn't occur to me to worry when Dr. Blumberg's* first letter arrived on a Saturday in October.  I opened the envelope and was surprised to learn that Dr. Blumberg was doubling her concierge fees and cutting down on the number of patients in her practice.  She said to let her know if we wanted to continue with her by November 15th, still a month away.  "Well, that gives us plenty of time to consider what to do," I thought, fending off the vague anxiety generated by the phrases "increase in fee" and "reduced number of patients." 
To continue:  Download Doctor Loss - cell2soul

We read a lot about concierge medicine, but rarely from a patient's standpoint. It seems wrong to specialize in "disease of the rich."  It's enlightening to hear about concierge medicine from a consumer.

Susan Kaplan, Ph.D. is a clinical psychologist practicing in the San Francisco Bay Area.   You can reach her at: email.

 

 

Minnesota's Medical Mess

The medical ethicist, Carl Elliott tells it as he sees.  His recent Op-Ed piece in the NY Times would make a good farce -- but sadly, it is true.

Minneapolis, May 26, 2015

If you want to see just how long an academic institution can tolerate a string of slow, festering research scandals, let me invite you to the University of Minnesota, where I teach medical ethics.

Over the past 25 years, our department of psychiatry has been party to the following disgraces: a felony conviction and a Food and Drug Administration research disqualification for a psychiatrist guilty of fraud in a drug study; the F.D.A. disqualification of another psychiatrist, for enrolling illiterate Hmong refugees in a drug study without their consent; the suspended license of yet another psychiatrist, who was charged with “reckless, if not willful, disregard” for dozens of patients; and, in 2004, the discovery, in a halfway house bathroom, of the near-decapitated corpse of Dan Markingson, a seriously mentally ill young man under an involuntary commitment order who committed suicide after enrolling, over the objections of his mother, in an industry-funded antipsychotic study run by members of the department.

Read: Minnesota's Medical Mess.

No Accidents, Only Appointments

Caitlin Stiglmeier is a pediatrician who spent the month of March 2015 working in rural India.  Her occasional FaceBook pieces are captivating.  Here is a recent one, dated May 11.

"It’s difficult to comprehend, still, the full scope and magnitude of my time in India. I felt I was merely being led to communities, families, individuals for a reason, through no control of my own. I lived much 'freer' in India, relinquishing all control over a situation yet still attempting to intervene medically when I was able.

photo by Caitlin, March 2015

This family was the first of many I saw in a migrant community in Segwa, and their expressions say it all. Mom was very skeptical, wary of the white person who appeared out of nowhere and asked so many questions. Dad was elated, stating I was a 'god in the flesh', physically here to help rather than an inanimate object in a temple. The children either greeted me with smiles and laughter or tears and tentative glances.

..."  To read full piece:  Download No Accidents Only Appointments

Less Medicine, More Health

7 Assumptions That Drive Too Much Medical Care 

by H. Gilbert Welch

(The following is taken from the book's introduction)

The central problem with healthcare is that too much medical care has too little value, too many people are being made to worry about diseases they don't have an are only at a low risk to get. Too many people are being tested and exposed to all the harmful effects of the testing process: the anxiety of false alarms and the vulnerability caused by ambiguous findings, not to mention the complications of diagnostic procedures.

Too many people are being given treatments they don't need or can't benefit from. Treatment interventions can have substantial physical harms such as medication reactions, surgical complications, even death

It's not lawyers who are the problem; it's economics. Physicians are paid more to do more and insurance, not the patient, foots the bill. Paying physicians a fee every time they provide a service encourages them to order more tests and procedures. Because patients are shielded from the costs by a third-party, they have little incentive to scrutinize the value of the services.

To complicate this more, the general public harbors assumptions about medical care that encourages overuse. Assumptions like the following are extant: it's always better to fix the problem, sooner is always better or it never hurts to get more information. These assumptions flow directly from information provided to the public from many sources (doctors, drug and device makers, the media, the Internet). The public winds up with assumptions that lead to an excessively optimistic view of medical care. That leads them to seek too much care.

This book is about challenging these assumptions – and helping all of us to avoid too much medical care. As a society, we have overstated the benefits of medical care and underplayed its harms. It is possible that in many cases less medicine would be better for our health.

Less Medicine, More Health gives a few simple strategies to avoid too much medical care.

What Walsh wants from medical care is a system that excels in the care and treatment of acutely ill and injured persons. This, in his opinion, is the most important activity of medical care, but is not what most medical care is about. Much of medical care doesn't reliably lead to better health.

Spring!

A Light exists in Spring
Not present on the Year
At any other period --
                                       Emily Dickinson

Morning. 23.5.15. A walk to and around Clark Art

Hydrochloric Acid Blues

Stomach acid is an unseen factor in the digestive process.  However, for some people it is threatening because of the suffering it can inflict.  Despite numerous physicians doing their best to ease the ailments caused by my acidity issues, since childhood, I have suffered more than one long bout of struggling to moderate this culprit. An embarrassing incident, long ago when I was in the third grade, resulted in hydrochloric acid having a starring role as a villain in my life.

"The Third grade class at Immaculate Conception school was composed of about thirty students, young, shiny-faced beacons of potential. I was among the throng of hope, anxious to do everything to the high expectations of my mother and my godmother.

I had a history of stomachaches.  Nausea. Cramping. Vague discomfort.  The school nurse was accustomed to my regular visits.  She mentioned them to my aunt, a nurse supervisor at the hospital, who was visiting the school.  My aunt looked at me briefly, and answered over her shoulder "Nerves."  It was an unofficial diagnosis, but I could tell the school nurse believed it.  She didn't write a note, just picked up the phone to summon my overburdened mother to interrupt her day and rescue me."

Read full essay:  Download Hydrochloric Acid Blues

The author in Grade 2

Author Bio: Katina Pontikes writes in retirement as a form of therapy and introspection.  She lives in Houston, Texas and on the shore of Lake Chapala in Mexico, where she counts herself fortunate to enjoy the adventures of an expat. She still has stomach issues, only now she takes an acid suppressing medication, never quite able to tame the stomach monster.  Email:katcpon@yahoo.com

 

The Doctor Didn't Make it

from the May 18, 2015 New Yorker magazine

 

Overkill by Atul Gawande

The New Yorker, May 11, 2015  Free Full Text.

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.

Download Excerpts from Gawande's Overkill

 

The PA, the Prison and Paws

It takes a village…and sometimes a prison. – Ania Laver

by Rhianna Flanagan, PA-C

For easier reading  Download PAs for PAWS  Email Rhianna.

As a physician assistant student, I was randomly assigned to a federal prison for my psychiatry rotation. I was apprehensive and fearful, as a five-foot tall, 24 year-old woman, to contemplate spending five weeks at an all male federal lock-up. Before this rotation, I could not have fathomed that not only would I be sad to leave, but that the experience would leave a dramatic stamp on my life.

Three weeks into the rotation, I learned there were inmates training future service dogs. NEADS  (National Education for Assistance Dog Services) “is a non-profit organization that was established in 1976 and is based in Princeton, Massachusetts. [Their] Assistance Dogs become an extension of their handlers and bring freedom, physical autonomy and relief from social isolation to their human partners who are deaf or have a disability.”¹ I asked the NEADS liaison if I could observe the inmates in a puppy class and was thrilled when she said yes! At this class inmates received a brand new batch of three month-old puppies. I watched as grown men, some with intimidating stature, melted to the ground as they knelt and spoke in their “puppy voices.” The liaison explained to me that NEADS partners inmates with puppies as handlers to train them as service dogs. These puppies leave the prison every weekend with weekend puppy raisers (WPR) for socialization outside the prison walls.

That day, I was inspired to become a WPR myself and have witnessed the healing these animals are capable of. Every weekend I pick up my puppy for 48 hours of walks, field trips, and socialization. During field trips to stores or the park these pups bring a smile to the faces of everyone we meet. I’ve observed first-hand the ability these puppies have to brighten, not only my day, but also the days of total strangers!

As puppies, they provide “free time” and stress relief while teaching the values of patience and discipline to inmates. The puppies serve as companions and sources of constant adventure during weekends with their WPRs. As service dogs they are calming, helpful, and hardworking best friends to their owners. NEADS dogs give their companions every-day assistance and function as a social connection between their humans and the world around them.

NEADS dogs are true healers. As a PA I am inspired to take the nod from these amazing pups.  I continue to learn from these pups and strive to emulate their qualities of patience, empathy, and dedication in the practice of medicine.