Category: Health Policy

Sometimes just reading a few news articles gives you a pretty good idea of how some part of the world is working.  This morning, I found two articles suggestive of the deeper problems within health care. 

The first, outlines the competitiveness of certain types of residency programs and the lack of competition for others.  Dermatology is all the rage, while Family Medicine basically needs to accept all that apply.  Put differently, the system is designed to put the physicians who are the least competitive during schooling (translate that as you will, I will assume it means less competent for argument’s sake) into the driver’s seat for patient’s entry into the health "system". 

Then, the Well Blog at the New York Times highlights an essay from University of California, Davis physician, Dr. Faith Fitzgerald, which explores the very real barrier between patients and physicians.  Namely, why are patients not allowed to speak to a doctor?
Link [Bothering Your Doctor]

Here’s an experiment:  Try to phone your primary care physician with a real question about your health, then try the same with your physical therapist.  Which experience was easier, more enjoyable, and valuable to you?

ERIC

I’ve always felt this about resumes, although I never knew others did as well.

"I think if you’re remarkable, amazing or just plain spectacular, you probably shouldn’t have a resume at all."  Link [Seth Godin]

The spirit of health care reform! 

Massachusetts, famous in health care reform for diving head first into universal health coverage, is now making news as the state senate proposes to ban ALL gift to docs from pharmaceutical companies.  That’s right, not even a cool pen would be available to drug reps as they try convincing doctors to use their drug.  The WSJ Heath Blog covers it well. 

This article from Wired Science News reminds us of just how sneaky those big pharmaceutical companies can be.

You can also check out the blog, Drug Rep Toys to see some of the threatened gifts.  I guess those MA drug reps might have to rely on evidence and research to push their products.  Crazy!

8 = The number of gate keepers that I had to go through to before I finally spoke to a doctor for a re-fill on my asthma medicine today.  A glimpse into why our health care costs are so high? 

Speaking of numbers and costs, this bit of information has really disturbed me:  A health care credit score!  Now that’s asking for trouble. 

ERIC

Health Affairs published a report about wait times in the Emergency Departments across the country.  They increased.  For acute myocardial infarction patients, the wait increased 150% from 1997-2004.  Not good!

One of the reasons cited was that more patients are seeking care for non-emergency conditions at the ED.  Perhaps they don’t have a primary care physician or insurance. 

This problem can be seen as an opportunity for physical therapy to help ease the medical system’s burden.  More and more physical therapists are finding a home in emergency departments and it makes some sense.  As more patients with knee and ankle pain come in that could be triaged to physical therapists, the wait times for those heart attack patients might decide to fall. 

The Wall Street Journal checks in on this as well.

ERIC

This topic probably deserves a more in depth post, but this article caught my eye: "Knee Operations Can Lead To Other Injuries."  The issue here is Anterior Cruciate Ligament (ACL) reconstruction.  Reconstruction of the ACL is largely an elective procedure for many folks.  There is a collective assumption, which surgeons have no motivation to debunk, that each ACL tear requires surgery.  This is untrue.  Any physical therapist has a collective of stories about patients with ACL injuries who were able to return to their activity without surgery.  This myth is perpetuated by professional sports, which often send their athletes for surgery within a couple days of the injury. 

Many people can function perfectly well without an ACL.  The body has mechanisms in place to deal with the loss of this ligament.  The ACL, like any ligament, does not work in isolation.  Instead, other parts of the joint capsule, muscle stabilization, and sensory feedback work together with the ligament to keep bones moving the right way.  When the knee becomes ACL deficient, the body shifts its control mechanisms and often compensates nicely.  This does not occur in everyone, and no one is really sure of which people will be functional without an ACL and which will not.

However, if ACL surgery is viewed in light of information that suggests the procedure can be linked to other injuries, perhaps a more conservative approach is called for.  Every patient should be afforded a waiting period for the initial effects of the injury to subside and for an intensive rehab program before they are indicated for surgery.  This could apply to pro sports as well.  Quite a bit of time could be saved if players can become functional without such a major surgery, if only given the chance. 

ERIC