Today I received confirmation that my chapter dealing with HIV-infected health care workers, in Thompson-Reuters' Health Law Guide (a near- encyclopedic publication for attorneys), has been forwarded to the publisher. In that chapter, I describe the low risk of blood borne HIV infection transmission from health professional to patient, or from patient to health professional, but the unquantified risk of judgment deficiencies in AIDS-dementia affected health care professionals in practice. The term "unquantified" indicates that I have not been able to determine the number of professionals who have the condition, the measurable effect of that deficiency on that population's judgment, or its consequences for patients.
Today's New York Times features a thoughtful article about aging physicians with dementia, a troubling subject which deserves attention (not just for physicians, but for those in other professions, as well). These demented physicians may go unnoticed and unreported by their colleagues and noticed, but not necessarily dealt-with by family members and others who are emotionally and economically related to them.
My only significant point of disagreement with the Times article is that periodic neuropsychological testing should be more frequently used by credentialing bodies to evaluate physicians' and other health (and non-health) professionals ability to practice safely. Use of testing would protect not only patients, but the professionals whose judgments and learning capacities are impaired, and thus prevent calamities and tragedies for both groups.
As one who has had the experience of a quiet conversation with a professional, telling him(or her) that the time has come to retire to protect patients and himself from deterioration in his judgment and skills, and then been thanked by the practitioner and (separately) his family for doing so, I know that it can be done.
Tuesday, January 25, 2011
Tuesday, January 18, 2011
If A Little X-Ray Is Good For You, Is More Better?
A recent airport visit and and article on an online medical service, prompted me to recall a superb lecture at an American Society of Hematology Annual Meeting several years ago and the nagging question with which I left the hall. The subject was the biologic effect of radiation and the speaker scientist guided his audience through the intricacies of cellular responses to radiation, making the point that cellular repair systems spring into action within 10 seconds of exposure and may remain activated. And then he said something disconcerting, to the effect that he had been impressed with the interest of certain officials involved in the American defense system, in upping the exposure of Americans to radiation with the expectation that this exposure would augment their bodies' "resistance" to further radiation. The idea struck me as bizarre, since I and generations of physicians had been taught that there is no safe dose of radiation, and that with each increase in exposure, the frequency of mutations (with increased risk of cancer) increases. But then at the airport was this machine, supposedly in the interest of preventing terrorism, radiating a portion of the population . . . Oh really?
Added April 6, 2011: Drugs for treatment of radiation exposure.
Added April 6, 2011: Drugs for treatment of radiation exposure.
Wednesday, January 12, 2011
HHS - Psychotherapy Notes and Testing Data Study Announcement
NOTE: FOLLOW All of the instructions below to register
HHS to Host Webinar as Part of Psychotherapy Notes and Testing Data Study under the HITECH Act
HHS to Host Webinar as Part of Psychotherapy Notes and Testing Data Study under the HITECH Act
January 12, 2011
The Substance Abuse and Mental Health Services Administration (SAMHSA) is conducting a Confidentiality and Privacy Issues Related to Psychological Testing Data study, in close cooperation with the Office for Civil Rights (OCR) pursuant to section 13424 of the Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of the American Recovery and Reinvestment Act (ARRA) (P.L. 111-5). This study is addressing whether the HIPAA Privacy Rule’s special protections relating to the use and disclosure of psychotherapy notes should also be applied to “test data that is related to direct responses, scores, items, forms, protocols, manuals or other materials that are part of a mental health evaluation.”
As part of this study, SAMHSA is hosting an interactive webinar on January 18, 2011, 12:00pm – 2:00pm (EST), to bring together professionals in the areas of mental health and privacy protection, summarize what its project team has learned to date, and provide participants with opportunities to ask questions and submit comments.
Pre-registration is requested and can be accomplished at the following website: https://www.mymeetings.com/
If you have any questions about the webinar or the Confidentiality and Privacy Issues Related to Psychological Testing Data project, please contact David Bercham at 301-251-0300, x215, or through email at David.Bercham@AMSAQ.com.
Sunday, January 9, 2011
US Income, Poverty and Health: FindThe Facts Yourself
If you prefer facts to rhetoric:
The world's industrial development, wealth and health: where do we stand? A brief informative video illustrates changes over the last 200 years.
http://www.youtube.com/watch?
http://www.cdc.gov/nchs/
http://www.nih.gov/
http://www.macfound.org/atf/cf/{B0386CE3-8B29-4162-8098-E466FB856794}/HCD_NET_Status_Health.pdf
http://www.census.gov/prod/2006pubs/p60-231.pdf
For more, Google "US income poverty and health". Read, think and then communicate with your Congressperson who needs input from constituents rather than more campaign support from lobbyists.
The world's industrial development, wealth and health: where do we stand? A brief informative video illustrates changes over the last 200 years.
http://www.youtube.com/watch?
http://www.cdc.gov/nchs/
http://www.nih.gov/
http://www.macfound.org/atf/cf/{B0386CE3-8B29-4162-8098-E466FB856794}/HCD_NET_Status_Health.pdf
http://www.census.gov/prod/2006pubs/p60-231.pdf
For more, Google "US income poverty and health". Read, think and then communicate with your Congressperson who needs input from constituents rather than more campaign support from lobbyists.
Tuesday, December 21, 2010
What Do Hearing Aids, Diaphragms, Condoms & Diabetes Glucose Meters Have in Common?
Quick answer: none of them work when left, unused, in a bedroom drawer.
My focus today is on diabetes and my point is: get a reliable meter (your insurer may have specific models available for you) and test frequently enough (3-4 times a day every day) so that you become the super expert on your diabetes. How does your body react to your medicine? When does your medicine "kick-in"? What are your high and low periods for glucose? When your glucose is high - how do you feel? When your glucose is low, how do you feel? What foods raise your glucose level and how soon after eating them does your glucose rise? When does it drop again? Modern meters give reads which can be recorded in a logbook, or, using computer software for a suitable meter, downloaded, printed and in deliverable form so that your doctor can review your daily records each month and you and your doctor can discuss the findings while your doctor also checks your retina for diabetic changes, your feet for diabetic problems, the parts of your body between your head and your feet, and some appropriate laboratory testing, and then gives you advice on management.
With this information you have a much better understanding of your diabetes, its treatment, and how you can control your sugars!
TV commercials, ads in newspapers and magazines and brochures tout the benefits of new free give-away glucose meters for diabetics from companies which didn't exist a year ago. I chose my meter with my physician and confirmed the wisdom of my purchase by looking - not at my TV set or throwaway ad - but in Consumers' Union (Consumer Reports) which rated a variety of meters in terms of cost and accuracy a year or two ago. The initial cost of a meter is only a small part of its actual cost: glucose test strips, lancets and other simple materials used in testing all are expensive which makes insurance coverage highly beneficial. Some meters are more accurate and reliable than others. The best lancets (which are not significantly more expensive) have very fine needles which are essentially painless. Some meters use strips which require a large blood drop which can be difficult when your fingers are cold, or your hands are stiff, arthritic and have impaired feeling sensation.
A practical example: if at 11:30 AM your glucose is high, is it because your medicine hasn't acted yet, because you ate late, because you ate too much for breakfast, or because you skipped your morning walk? If you've been testing regularly you might know that instead of taking more medicine, you should take a 30 minute walk and then retest to probably find that your glucose came down because the medicine had more time to work and you burned off glucose with your moderate exercise. Wow - doesn't it feel good to be in control?
My focus today is on diabetes and my point is: get a reliable meter (your insurer may have specific models available for you) and test frequently enough (3-4 times a day every day) so that you become the super expert on your diabetes. How does your body react to your medicine? When does your medicine "kick-in"? What are your high and low periods for glucose? When your glucose is high - how do you feel? When your glucose is low, how do you feel? What foods raise your glucose level and how soon after eating them does your glucose rise? When does it drop again? Modern meters give reads which can be recorded in a logbook, or, using computer software for a suitable meter, downloaded, printed and in deliverable form so that your doctor can review your daily records each month and you and your doctor can discuss the findings while your doctor also checks your retina for diabetic changes, your feet for diabetic problems, the parts of your body between your head and your feet, and some appropriate laboratory testing, and then gives you advice on management.
With this information you have a much better understanding of your diabetes, its treatment, and how you can control your sugars!
TV commercials, ads in newspapers and magazines and brochures tout the benefits of new free give-away glucose meters for diabetics from companies which didn't exist a year ago. I chose my meter with my physician and confirmed the wisdom of my purchase by looking - not at my TV set or throwaway ad - but in Consumers' Union (Consumer Reports) which rated a variety of meters in terms of cost and accuracy a year or two ago. The initial cost of a meter is only a small part of its actual cost: glucose test strips, lancets and other simple materials used in testing all are expensive which makes insurance coverage highly beneficial. Some meters are more accurate and reliable than others. The best lancets (which are not significantly more expensive) have very fine needles which are essentially painless. Some meters use strips which require a large blood drop which can be difficult when your fingers are cold, or your hands are stiff, arthritic and have impaired feeling sensation.
A practical example: if at 11:30 AM your glucose is high, is it because your medicine hasn't acted yet, because you ate late, because you ate too much for breakfast, or because you skipped your morning walk? If you've been testing regularly you might know that instead of taking more medicine, you should take a 30 minute walk and then retest to probably find that your glucose came down because the medicine had more time to work and you burned off glucose with your moderate exercise. Wow - doesn't it feel good to be in control?
Sunday, December 12, 2010
How Much Is Your Relationship With Your Doctor Worth?
An over-65 year old friend and I had an interesting conversation. He was being asked to pay almost $2000 a year for himself and the same amount for his wife to remain patients of a physician who was reducing his practice to 600 patients. The only patients who would remain in the practice were to be those paying the access ("access" is my term, not the physician's) fee.
I wondered about this arrangement, which has the name of a major American household product company associated with it. But the first issue, was the most difficult. In economic terms, how does a patient (who is not an expert on the competence, quantity or quality of care a particular physician generally provides, but may have strong emotional ties to the physician) calculate the value of his or her relationship with a particular physician?
I had lots of questions. How does the physician's proposal match up with licensing obligations and his role as a Medicare provider or a provider under the Affordable Care Act ("Health Reform")? How does the proposed relationship coordinate with the various HMOs, PPOs and other insurance arrangements of my friend, which describe themselves as paying for a limited group and range of services and have their own set of "access" requirements? How do the arrangements mesh with the physician's need to take time off from call, sleep, go on vacations, and attend medical education meetings? Assuming that the physician has "on-call" coverage arrangements with other physicians, will those physicians honor the "special relationship" that the up-front cash access payment to the doctor is said to provide? Will consultants to whom the patient may be referred be limited to physicians who engage in similar financial arrangements? Will the patient receive money back if he or she develops a condition requiring intensive care from a different physician, such as an oncologist (cancer), hematologist (benign and malignant blood disorders), nephrologist (kidney disease) or other specialist? What will happen if the physician decides to reduce practice size even further? What will happen if the physician decides to retire? Is the physician moving into "borderline" issues in which the physician is at an unfair advantage, and the patient at a serious disadvantage, in the economic arrangement? Does the "access" fee create a conflict of interest?
In these days of "full disclosure," does the arrangement require special disclosure of information to the patient which might affect the patient's decision: information relating to the quality and quantity of continuing medical education, physician health (including medications taken and substance abuse) or social problems, deficiency notices from medical organizations, hospital medical staffs, governmental bodies, or personal debt which might impact on his practice? After all, the patient is being asked to pay for access not for actual health care, and perhaps "truth in advertising" concepts should apply.
Is the proposed arrangement beneficial to my friend? I don't know. But he has a lot to discuss with his wife and their doctor. After all, we're not just talking about which dishwashing detergent to buy here.
I wondered about this arrangement, which has the name of a major American household product company associated with it. But the first issue, was the most difficult. In economic terms, how does a patient (who is not an expert on the competence, quantity or quality of care a particular physician generally provides, but may have strong emotional ties to the physician) calculate the value of his or her relationship with a particular physician?
I had lots of questions. How does the physician's proposal match up with licensing obligations and his role as a Medicare provider or a provider under the Affordable Care Act ("Health Reform")? How does the proposed relationship coordinate with the various HMOs, PPOs and other insurance arrangements of my friend, which describe themselves as paying for a limited group and range of services and have their own set of "access" requirements? How do the arrangements mesh with the physician's need to take time off from call, sleep, go on vacations, and attend medical education meetings? Assuming that the physician has "on-call" coverage arrangements with other physicians, will those physicians honor the "special relationship" that the up-front cash access payment to the doctor is said to provide? Will consultants to whom the patient may be referred be limited to physicians who engage in similar financial arrangements? Will the patient receive money back if he or she develops a condition requiring intensive care from a different physician, such as an oncologist (cancer), hematologist (benign and malignant blood disorders), nephrologist (kidney disease) or other specialist? What will happen if the physician decides to reduce practice size even further? What will happen if the physician decides to retire? Is the physician moving into "borderline" issues in which the physician is at an unfair advantage, and the patient at a serious disadvantage, in the economic arrangement? Does the "access" fee create a conflict of interest?
In these days of "full disclosure," does the arrangement require special disclosure of information to the patient which might affect the patient's decision: information relating to the quality and quantity of continuing medical education, physician health (including medications taken and substance abuse) or social problems, deficiency notices from medical organizations, hospital medical staffs, governmental bodies, or personal debt which might impact on his practice? After all, the patient is being asked to pay for access not for actual health care, and perhaps "truth in advertising" concepts should apply.
Is the proposed arrangement beneficial to my friend? I don't know. But he has a lot to discuss with his wife and their doctor. After all, we're not just talking about which dishwashing detergent to buy here.
Tuesday, December 7, 2010
Our Nation's Employment Hot Spot
Before anyone becomes wildly enthusiastic about changing the projected path of America's Health Care in the next session of Congress check the Bureau of Labor Statistics databases which clearly demonstrate that health care is the employment bright spot in our economy. Make health care unaffordable or unachievable, put healthcare workers out of jobs, and we will worsen our depression and economic outlook.
To pique your interest, here is the health care employment summary chart comparing health care employment in 2010 with 2000. If you want to see more (suggested - follow straightforward instructions at the BLS site), click here.
Employment, Hours, and Earnings from the Current Employment Statistics survey (National)
Series Id: CEU6562000101
Not Seasonally Adjusted
Super Sector: Education and health services
Industry: Health care
NAICS Code: 621,2,3
Data Type: ALL EMPLOYEES, THOUSANDS
Download: Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Annual
2000 10739.7 10751.2 10776.4 10782.0 10804.3 10868.7 10892.0 10902.9 10894.7 10925.9 10962.2 10993.7 10857.8
2010 13618.5 13622.4 13671.5 13694.2 13715.1 13768.7 13809.9 13826.9 13804.2 13859.5(P) 13900.5(P)
P : preliminary
Bottom Line: Further tampering with health care may be damaging to America's healthy economy.
To pique your interest, here is the health care employment summary chart comparing health care employment in 2010 with 2000. If you want to see more (suggested - follow straightforward instructions at the BLS site), click here.
Employment, Hours, and Earnings from the Current Employment Statistics survey (National)
Series Id: CEU6562000101
Not Seasonally Adjusted
Super Sector: Education and health services
Industry: Health care
NAICS Code: 621,2,3
Data Type: ALL EMPLOYEES, THOUSANDS
Download: Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Annual
2000 10739.7 10751.2 10776.4 10782.0 10804.3 10868.7 10892.0 10902.9 10894.7 10925.9 10962.2 10993.7 10857.8
2010 13618.5 13622.4 13671.5 13694.2 13715.1 13768.7 13809.9 13826.9 13804.2 13859.5(P) 13900.5(P)
P : preliminary
Bottom Line: Further tampering with health care may be damaging to America's healthy economy.
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