Healthcare Failings Due to Not Doing the Basics

For anyone interested in understanding what drives a lot of the costs in the healthcare system, the New York Times health series about the six killers in America, heart disease, cancer, stroke, chronic obstructive pulmonary disease (emphysema), diabetes, and Alzheimer's is an excellent place to start.

Some themes begin to emerge. For heart disease, the way to prevent future heart attacks is to ensure that patients understand how to take their medications and that it is often for life. For successful cancer treatment, the goal is early detection and undergoing the simple, but for some, unpleasant tests to screen for breast, colon, and prostate cancer. For stroke, it is to ensure that missed opportunities aren't missed.

Ulimately, much of the differences between a fair outcome and great outcome is focusing on the little things - taking medications regularly and as directed, getting the preventive screening tests done, and making sure that the little things are always taken care of.

Much like any coach knows before a team can be successful, each of the players must know the fundamentals. In hockey that would be skating, stickhandling, passing, and checking. It doesn't matter how expensive your skates are or what high tech materials your stick is made out of. Unless you and your team know the basics, you will fail. Unfortuantely, the healthcare system as a whole hasn't yet mastered the fundamentals.

Lessons of Heart Disease, Learned and Ignored

A fascinating piece about heart disease not because the information is cutting edge, but rather because the failures in preventing future heart attacks are due to the inability for doctors to communicate to their patients about continuing their treatments consistently, regularly, and in most cases indefinitely. The article Lessons of Heart Disease, Learned and Ignored looks at an individual who proudly stopped taking his prescription medications after losing weight and exercising. He had his first heart attack nine years earlier and reasoned, incorrectly, that by changing his lifestyle that he could avoid taking medications altogether. Had he consulted his doctor before stopping his medications, he most likely would have avoided his second heart attack.

This is a common occurance in my experience as well. Many patients don't want to take medications that are potentially life saving because they aren't natural, yet when challenged to make significant lifestyle changes to lose unnaturally heavy weight and unhealthy habits they don't want to. Any patient should always consult with his doctor before stopping any prescription medications. If you are concerned that your doctor is simply writing medications and not working with you to keep you healthy, consider switching doctors. Realize, however, that there are situations that medications must be taken to keep you well. That perhaps is the most difficult idea for many patients to swallow.

Healthcare Reform - Dutch or Swiss?

The New York Times reported that Health and Human Services Secretary Leavitt was going to Switzerland and the Netherlands to see how these countries provide healthcare. In those countries there is an individual mandate, i.e. everyone has to buy health insurnace. Employers are not required to provide health insurance.

Unlike Canada and Great Britian, it appears these countries don't use the government set up the system. Will elements of the Swiss and Dutch healthcare systems work here? It probably will depend on who sits in the White House and who controls Congress.

Adult Vaccination Update

As it does regularly, the CDC revised its recommendations for adult vaccinations. Now adults who are worried about shingles or zoster, which is a very painful skin eruption that typically occurs in older adults, can get vaccinated at 60 years of age. Also new is the recommendation that all adults without proof of immunity to the chicken pox (varicella) virus should get vaccinated.

Not sure what immunizations you need? Print out the adult vaccination schedule and have your doctor explain. It's the easiest way to make sense of the alphabet soup of immunizations. In the 21st century as an increasingly number of bacteria are more resistant to antibiotics and viruses exist that can cause debilitating illnesses, vaccinations continue to have a role in keeping people healthy. Most of us immunize our children. Adults deserve the same level of care. Talk with your doctor the next time you see her.

Too Many Drugs?

The New York Times article titled "The Poisonous Cocktail of Multiple Drugs" illustrates a fairly common occurance for many patients, taking multiple prescription medications. Known as polypharmacy, patients have many different medications prescribed by multiple doctors who don't know what the other one wrote. As a result, these patients, unfortunately, are at higher risk for having medication side effects or interactions.

As people live longer with more chronic illnesses, their care becomes more complex. This is why patients may find it valuable to have one primary care doctor coordinate care and ensure that the treatments rendered by various specialists are compatible with each other. The other is having technology like the free web-based eRx Now system to help busy doctors check different medications for drug interactions and track a person's treatment.

Without either of these interventions, the case of the 78 year old lady who passed out from a stomach ulcer due to the combination of aspirin, ibuprofen, and Celebrex, will undoubtedly continue.

Finding the Right Doctor

A recent article in the Atlanta Journal Constitution titled "Rx for a doctor: Here are some tips for finding the right physician" had comments from yours truly.

Overall, it provides an excellent starting point on how to find a primary care doctor.

Better Screening Test for Cervical Cancer - Are Pap Smears Obsolete?

Very exciting news about the war against cancer. A published article in the New England Journal of Medicine found that screening for the human papilloma virus (HPV) was far more accurate in detecting cervical cancer than the current PAP smear.

Highlights from the article.

The HPV test, which looks for the virus that causes cervical cancer, correctly spotted 95 percent of the cancers. The Pap test, which checks for abnormal cells under a microscope, only found 55 percent, according to researchers at McGill University in Montreal.

The Canadian study, which was government-funded, included 10,154 women ages 30 to 69 in Montreal and St. John's, Newfoundland. The women got both tests. Still to be determined is the best way to start using the HPV test by itself and what follow-up action to take after positive results, the researchers said.

Dr. Carolyn D. Runowicz, who wrote a journal editorial, noted that the two studies used a different kind of Pap test, not the liquid-based technology used in the U.S, which may be more sensitive The results of a British study that used liquid Pap are due to be presented in November.

"We're not ready for prime time. We're moving in that direction. But we're not there yet," said Runowicz, a former president of the American Cancer Society.