Tuesday, April 12, 2016

Doctors Often Make More Money Prescribing More Expensive Drugs

Currently, physicians have an incentive to use the most expensive drugs possible, as they are reimbursed by Medicare in proportion to the price of the drug.  However, this may not be the best for patients' health, as less expensive drugs might work better.  A new experimental program will reimburse physicians at a flat rate.  Therefore, under this philosophy, physicians would no longer have an interest in prescribing more expensive drugs unless they believe that the patient would benefit more.  Some groups oppose this, saying that health outcomes in cancer patients improved while spending rose, and that Medicare reimbursement is already low, making certain treatments more difficult to perform.
I agree that such critics have a point.  Many physicians probably prescribe expensive drugs based on their physiological results, but there could be others who prescribe them for more financially related reasons.  I think a potential solution to this is to keep the current reimbursement system and not prescribe expensive medications unless the patient meets certain qualifications.  Therefore, only the sickest patients receive more potent drugs.  This does not necessarily mean, though, that the most expensive drugs are more potent.  Are there any other ways to solve this problem?  Feel free to comment.

From: http://www.kspr.com/news/health/medicare-change-perverse-incentive-or-perverse-reform/21051714_38973830

Monday, March 21, 2016

What Makes Medicine Worthwhile

I think the below article makes an important statement that would put a smile on many doctors' faces.  The author proclaims that she has considered leaving medicine on numerous occasions for unspecified reasons, but continues to practice to fulfill her desire to care for patients.  In reality, many activities of being a doctor involve spending time outside of patient contact, including diagnosis, prescribing, and discharge.  But, the author notes, one study done by Harvard University concluded that relationships with other people was a key to a happier life.  Indeed, the author believes that the time she does spend with patients is an "immense privilege," an opportunity to fix even the smallest details of a person's life.
I agree with this line of thought.  People's satisfaction with their lives largely depends upon their actions, thoughts, and feelings, all of which make up one's health.  Doctors are fortunate to have the opportunity to readjust each of these aspects, if need be, to improve the health of one's life.  Ultimately, this is what makes the world a more satisfying place for all.  I plan that this professional endeavor will keep me involved in medicine despite the many difficulties of being a doctor.

From: http://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2016/mar/21/junior-doctors-strikes-nhs-leaving-medicine-people-make-me-stay

Thursday, February 25, 2016

How Necessary Is Pain Management?

Pain management may consist of a variety of specialties, including anesthesiology, neurology, psychiatry, and physical medicine and rehabilitation.  Recently, especially due to increases in the recreational use of opiates, many physicians are becoming more hesitant to prescribe narcotics.  However, chronic pain is a problem for an estimated 100 million Americans.  Clearly, there is a need for such treatment.  The question is how should this treatment be performed. 
Some of the best pain clinics probably include specialists from all the above mentioned disciplines.  In this way, a patient's pain treatment could be tailored to their individual situation.  For example, someone who had experienced psychological trauma might benefit more from the psychiatrist, whereas someone who has back pain after surgery would need intervention from an anesthesiologist.  Eventually, the physician would have to cut back the medication to prevent addiction.  According to the article, one physician says he "uses a multidisciplinary approach that could include surgery, yoga therapy and Pilates," which works 90% of the time to wean patients off of their medication. 
Unfortunately, chronic pain is rarely entirely relieved, and so patients should not expect perfect results from their treatment.  It is also important to note that consultations, which may be greatly beneficial, are not always covered by insurance.  This is especially difficult for neurologists, who can spend hours at a time talking to individual patients.  Insurers might see better results and ultimately save money if they reimburse for more holistic approaches to pain relief instead of merely procedural interventions.  
Is it possible to convince insurers to do this, however?  What happens to patients who become addicted?  Will they seek narcotics from other sources if pain management physicians drop them?  And are other specialists successful in weaning patients off their medication if the problem is truly chronic?  Feel free to comment!


Sunday, December 27, 2015

Aging Parents Continue Caregiving for their Children with Disabilities

I find this topic incredibly important as it becomes more prevalent in our society.  In the past, children with severe disabilities may not have survived longer than their parents.  Today, however, this is more possible with recent developments in medication.  Still, we usually think of children providing for their elderly parents, but what happens when the opposite must occur?  If the parents die, where do the children with disabilities look for further care?  And do many caregivers continue to care for these children even if they are unable to do so?  According to the article, some agencies are now bringing together those who work with the elderly and those who work with the disabled.  I hope these groups will devote funding and caregivers trained to handle these types of situations. 

From:  http://www.jewishjournal.com/opinion/article/aging_parents_of_disabled_adult_children_are_feeling_the_strain

Monday, November 30, 2015

Could Specialists Act As Primary Care Doctors?

 My opinion:  I've frequently thought about this issue myself, but I wasn't sure if this were even possible.  Specialists, like cardiologists and gastroenterologists, went through an internal medicine residency (which is primary care) before they did fellowships in their desired subspecialties.  The article discusses a new program where retired specialists could be re-trained to perform primary care.  I think this is a great idea, especially since many of these doctors could use a refresher on how primary care is practiced today.  I don't know if many retired doctors would be willing to do this, however, but it does appear that they often retire late, or continue to work part-time well into their 70s or later.  Another problem is licensing these physicians, as many of them may not want to take long board exams.  Perhaps boards could become more lenient for primary care physicians, since they do not need as much expertise in specialty disciplines.  This could also encourage more people to pursue primary care in general.  s this idea as realistic as it sounds?  Feel free to comment.

From: http://www.wsj.com/articles/second-acts-a-retired-surgeon-takes-on-a-new-medical-mission-1448852623

Saturday, November 7, 2015

Anti-Vaccine Sites Rely on False Information, According to Study

The article remarks that 65.6% of the anti-vaccine websites studied say vaccines are dangerous, 62.2% say that they cause autism and 41.1% say they cause brain damage.  64.7% used scientific evidence and 30% used anecdotes to support the statistics.  Also, some of the websites seemed to promote alternative medicine.  Ultimately, the authors believe that officials should communicate with the anti-vaccine movement differently, possibly by involving health discussions that both sides agree upon, in order to address their concerns. 

In my opinion, while anti-vaccine sites may not use as much evidence based reasoning, I think there might be a point to the anecdotes.  Though they might represent a very small proportion of the population, some people might not react well to vaccines, especially if they have weak immune systems.  I think, if possible, it might be best to check a patient's immune history before prescribing a vaccine.  With children, perhaps it would be better to start with safer, more accepted vaccines first to see if they have any adverse reactions.  I do think, as the article mentioned, that many diseases have been eradicated due to the usage of vaccines.  In 2014, the highest number of measles cases occurred since 2000, and these were mostly in people who did not get vaccinated.  Furthermore, in regards to the authors' conclusions, I'm uncertain that promoting unrelated healthy behaviors will convince the anti-vaccine movement that vaccines are safe.  Rather, the picture should focus mostly on vaccine data that has already been generated.  Is lax regulation of the production of vaccines part of the problem?  And is there some vaccine research that has yet to be done?  Feel free to comment.

From: http://www.medicalnewstoday.com/articles/301904.php

Wednesday, October 28, 2015

Umbilical Cord Blood Can Cure Diseases, But Not Frequently Used

My opinion: I think this is a great, easy way to contribute to healing others' illnesses, but I was not aware that this was possible until reading the article.  Cord blood from the umbilical cord contains stem blood cells that can replace blood cells in leukemia, sickle cell anemia, as well as other diseases.  It is simple to obtain, unlike extracting blood from bone marrow, and they also are less likely to be rejected by the body's immune system.  They can even be put in cryogenic storage indefinitely, which cannot occur with bone marrow.  Currently, only 5-6% of cord blood is saved in the United States.  After birth, the moms probably just want to focus on the health of their child, so I think hospitals might have to ask mothers beforehand if they are ok with donating the cord blood. They also need to be more connected to cord blood banks.  This way, it is possible that blood will be more accessible to those who need it, and blood drives may not be as necessary in the future.  I really believe that this is a fairly simple solution, which is not an easy find in medicine, and that administrative issues need to be overcome to deliver it.  Feel free to comment.

From: http://www.tucsonlocalmedia.com/marana/article_706c566c-7ccf-11e5-93fe-abb879e404a6.html