Read with interest this opinion piece in the NY Times. In it Dr. Peter Salgo, a doctor,professor, and TV medical expert, bemoans this drive to make patients like customers, saying it encourages those in the medical profession to see us as numbers, not human beings.
It is a most confusing piece, to be honest.
He starts by decrying this shift from patient to customer, claiming:
This may seem a trivial matter, but it is not. You treat "patients" as if they were members of your family. You talk to them. You comfort them. You take time to explain to them what the future may hold in store. Sometimes, that future will be bleak. But you assure them you will be there to help them face it.
OK, well, perhaps I'm too young to have had a doctor like that, being only in my early 40s. I have no trouble imagining my grandfather, the doctor, having such a warm like-family attitude. But can't say I've ever felt I was treated like family. Not even by my dentist, who I've been seeing for literally 25 years.
But then Dr. Salgo loses me in his logic:
You, the patient, are the system's best hope. In the age of seven-minute health care, you need to realize that you employ doctors. That is, your doctor works for you. Although doctors shouldn't think of patients as customers, you can, and should, adopt a business mind-set when shopping for health care.
Huh? Doesn't that seem like a recipe for resentment, and unmet expectations?
And where is it written that a business-like relationships can't include honest communication and empathetic treatment? I have spent many an hour on the phone with upset customers, or frustrated sales people, or in a one-on-one with an over-stressed employee. At no point did having a "business mind-set" preclude my having an empathetic and caring response. In fact in my business listening and advising and consulting are key personal skills I need to have.
I honestly didn't get the vision of the world this essay painted.
Next week Grand Rounds will be hsoted by NHS Blog Doctor.
If you want a sneak peek at his blog I can think of no better post to read than this one: his eulogy for a friend who had schizophrenia. I haven't been reading this blog long enough to know whetehr he will bring me ot tears on a regular basis. BUt his post is a beautiful tribute to a friend who had it tougher than I can imagine:
And there were achievements. Achievements which, in context, were huge. She was an indulgent aunt. She was supported by, and sometimes supported others, with similar problems to her own. She nursed her mother through a prolonged and at times distressing final illness. Most of all, Emma did not give up. She fought. At times a losing battle, but she fought. Trapped inside this wretched illness, there was an intelligent, kind and witty person.
When I was in college it was the early 80s, the early Reagan years. This was a time when massive budget cuts impacted halfway hmes and centers for veterans and the mentally ill and the homeless. The basic result was that the people who needed those places were booted out during the day and could only come back to sleep at night. Where did they go? They wandered the streets of downtown San Jose or they hung around in the parks.
Going to an urban college with an open campus (and before there was any San Jose Redevelopment movement) we had our share of displaced folks who wandered our campus. I don't recall any of them ever causing any actual trouble. In fact many became mascots of a sort to various departments.
We had a guy who often wandered into the theatre building. I believe he used to be able to play the piano, as he would sit at the piano in the small black box theatre when it was vacant. He would play on the keys, but nothing very coherent ever emerged. I used to give this guy half my routine egg salad sandwhich from the deli across the street. I don't remember him ever speaking, to be honest. Mostly he smiled.
One memory is the most clear one I have of the guy. It was raining and my best friend and I were standing on the corner under our umbrellas across the street form the theatre building. All of a sudden he ran up and kicked water from a puddle on us. We looked up startled, and he ran several steps away, then looked back at us laughing. There was nothing malicious in this laughter. This was the laughter of a young boy who tohught he was playing with us.
If it were the movies I'm sure we would have engaged in a festive splashing fight with him. Best friends forever. As it was we did laugh with him, but then we moved on, crossed the street and got inside where it was warm and dry.
I don't know if this guy actually had schizophrenia, but as I read NHS Blog Doctor's account of his friend and how even her affinty for books and reading was eventaully taken from her, I thought of this guy who haunted the black box theatre, sitting at the piano that he no longer could play, but surely knew that once he could.
...from this week's Grand Rounds, I thought I'd comment on how doing another Rounds, now that it's grown to a huge size, impacted by thinking on including all posts vs. picking only favorites.
There is no denying that was hard work. It took me many hours. In many cases I also read comments, not just the posts, so the time wasn't spent just in the creation of the post, but in the reading all of the many submissions.
I'd like to pointout that I did not receive a single post that I thought missed the Grand Rounds boat.
-Every post was on topic...the broad topic of health/medicine
-Every post featured some commentary on original thought from the author
So, yes, it's hard work, but I think it's worth it because I got comments and emails from people saying they found new voices. And that, my friends, is what I believe the value of all of these darn Carnivals is...opening our eyes to the diversity of voices in the blogosphere and giving us a chance to expand our perspective.
Did I say it was hard work?
But it didn't change my mind: bring on the huge Carnivals...let me explore.
You know, I've been to the Metropolitan Museum in New York more times than I can honestly count. Every time I love to go to the Impressionist Hall. I know I love that exhibit. I don't wat to miss that exhibit. But every time I also go find a new part of the museum to explore. I choose which one, and I miss a lot of what there is there. In fact, I doubt I've ever been to many sections of the Met. I choose. And I explore. And I'm always rewarded.
And best of all: next time I go to the Met I know I will find my stand-by favorites...and I'll find something new. That's what brings me back.
Welcome to Grand Rounds, this week's compendium of the best in MedBlogging. Thanks to our uber-host, Nick from Blogborygmi, who manages and archives each week's Grand Rounds. I blog here at HealthyConcerns from the layperson or patient's point of view. I tell my stories as a relatively healthy person, and I tell the stories of people I meet...any of whom have a story about health care if only I ask them. Nick did a great job of getting to the heart of what I do here and pointing out some representative posts in his usual pre-Rounds article about the host over at Medscape.
On with the Rounds. I like to say that everyone has a story about health care if only you ask them, but of course there are many different kinds of stories:
Some of the best stories MedBloggers tell are the stories that get their readers talking.
See both sides here - I've refused scopes that were indicated by CYA standards, but which lab results and personal history indicated tincture of time and a change of meds was probably going to be sufficient to correct. (They were).
However, my father-in-law perished when his colon cancer went undiagnosed until it was well past too late to treat with anything but palliative measures.
But what would compel people to do the right thing? I'm not trying to bait you. I'm honestly looking for rational proposals, because I'm honestly on the fence about this. The single-payor folk do have a plan, but the personal-responsibility folk seem not to. Declining to sympathize isn't a plan, and declining to treat the uninsured is a perceived backward step politically that no one would sign up for. Is leaving them to experience the consequences of their choices enough? Was their wrong choice an informed one, and thus, fair?
Now you might have heard that blogs are no place for a long essay, and that blog readers have short attention spans, but Kathleen Seidel from Neurodiversity.com proves you wrong. She writes a very long and very thorough analysis of the Association of American Physicians and Surgeons. And she's got a passel of people who are talking about it on her site, and on other sites.
Dr. Deborah Serani blogs about possible genetic factors in eating disorders and get a wide range of responses, from people struggling with such a condition who thank her for helping them feel a little more free, a little less shamed...to people skeptical that we attribute everything to genetics and then look for instant cures.
Dr. Flea first lays out his own rant about Emergency Rooms (and sounds pretty saintly doing it, given that he makes house calls) but damned if a commenter doesn't come right back at him with the point of view of an E.R. doc:
Often, due to what their doctor may have said to them over the phone (and selective hearing no doubt plays a part here), my discussions engender suspicious looks/exclamations of disbelief and anger.
I'm not thrilled to see bloggers and commenters sparring, rather I am thrilled to see the different points of view get an airing and educating us all.
Hippocrates from HealthVoices tells the story (from my friend Toby, the Marketing Diva) of a doctor who regards with horror the concept of starting a blog. Two readers provide additional reasons to blog that Health Voices hadn't thought of:
There is something about the process of writing and publishing a blog that helps develop and strengthen our thoughts and ideas.
Sometimes you ask someone their story, and you can't (or don't want to) believe them!
I wish I had a great comeback for the "get over its" of the world. I wish that in that moment, I would have told Fred to bite me. In my shoes, would you have been able to?
I also feel that way when I read about the near-epidemic of prescription drug abuse at Treatment Online. What I appreciate about this post, though, are the practical suggestions author William E. Hapworth M.D. offers for how to make it easier to spot and stop such abuse.
Or when David at the Health Business Blog reports that health plans claim to be more "objective" than pharma reps when they push generics and OTC medication solutions. Um, I may not have gone to medical school, but I think, like David, I can figure out that health plan reps might also be motivated by money...just saving it rather than generating it.
Sometimes you ask medical folks their stories and have to say, "I never thought of it that way."
Like when Dr. Hebert explains what it's like to be a doctor covering other doctor's patients for the weekend. You've got no background other than the cold, hard facts on the chart. And even those cases that seem like they should be smooth sailing when you walk in the door can be feel like stormy seas instead. But what Dr. Hebert's story proves to me is that what I've been saying all along is really the case: it's the little gestures, the humanizing moments that make the difference between a good and bad experience with a doctor. Be human. We humans will appreciate it.
Or when kidneynotes tells us that sometimes automated blood pressure monitors, which you would think would be so easy people would be calmed by them in fact occasionally have the opposite effect...unnerving people with their visible digital accuracy.
Dr. Henochowicz at Medviews tells us the long engaging story of Dr. William Osler, and his keen interest in making sure he was autopsied upon his death. The good Dr. proceeds to lament the fact that autopsies are so uncommon today and explains that autopsies can be such wonderful tools to improve our knowledge. I did not know that.
Speaking of dead bodies, I learned about a current exhibition touring the country of cadavers that have been preserved and posed in various active poses. Orac from Respectful Insolence captures his mixed feelings about the display:
On the one hand, many of the specimens, through their meticulous and artistic dissection, had shown me human anatomy in a manner I had never imagined possible. On the other hand, I couldn't help but feel that there was something exploitive about the whole endeavor...
Even doctors can realize "I never thought of it that way", which is why Clinical Cases & Images points us to a new series on Medscape, which examines real-life case information. Because as they point out: "There is often a big difference between what we read in the books and what we see in our clinical practice every day."
I often rant about how the medical community seems to want to push towards consumer-directed health care, which would imply I was their customer, but then my time gets totally dis-respected...long waiting times, making me chase them down to get info etc. etc. Well, turns out some doctors feel exactly the same way. Like The Blog That Ate Manhattan, who complains about playing patient-phone-tag. Now, I never thought doctors had to do that!
I never thought a doctor would come up with a rational-sounding argument for selective care based on a physician's moral beliefs. Doctor Andy manages to do so. I've always thought doctors should provide the care that is medically desired and required, whether they have an additional opinion on whether it's moral. But I think there is still a vast difference between the procedure he uses as an example of one he doesn't think should be illegal, but that he shouldn't be required to perform: a breast augmentation, and what we're really talking about here: providing the morning-after pill or an abortion.
And perhaps I'm hopelessly naive, but I always thought that pediatricians, like parents, never get sick when dealing with their sick kids. (Yes, yes, I've obviously never had kids or been a teacher or worked with kids.) Graham from Over My Med Body sets me straight on that one, since it's one of the minuses of working pediatrics.
I also learn so much from Coturnix, who not only teaches me about a possible connection between jet lag and malaria (eek!!!) but how circadian rhythms impact peak copulatory times for the human species (woo hoo!) Both very important pieces of information, don't you think?
And wow, Dr. Choon from the Heart of the Matter was there over the last two decades as they introduced angioplasty as a procedure in Malaysia. Now, tell me you'd ever learn that anywhere but here in the Grand Rounds!!!
Sometimes patients tell stories, even about various treatment options, like no one else can
Like when Amy from DiabetesMine puts on a citizen journalism display of the highest order, reporting on potential new treatments and actually visiting the manufacturing site of a new device for her own condition. Now, read those posts and tell me it doesn't matter to know the person writing them may actually use the treatments and devices in question!
Dead Last Wiz shares some very valuable lessons learned after a recent procedure...like if you're in pain after a procedure, call and ask for pain meds: "You learn something new every day. I should have called. Not tried to be all brave and I don't like to bother doctors on the weekend."
Imagine NHS Blog Doctor's surprise when his new patient, who had been living in Germany, told him about their procedure of giving a vaginal examination at every pre-birth visit to the obstetrician. Yeah, she wasn't too happy about it either!
Sometimes, I'll admit it, the stories make my head hurt...especially when we try to figure out how to solve health care problems.
Tim Worstall asks us to think through some of the more extreme suggestions for how to transition to a single-payer system in the U.S. Yes, Tim, when you put it that way it does seem more than a little overwhelming!
Trapier Michael sets out to prove that Paul Krugman is advocating not only socialized health insurance, but socialized medical care, all arguments from other MedBloggers aside. Unfortunately he has yet to write Part III of this 3-part-series, where I'm fairly confident he means to tell us why that would be a horrible thing.
Interested-Participant helps Trapier out by describing a recent (and very odd-sounding) policy in Canada. Seems a new clinic was opening and patients would be accepted via lottery. Only far fewer people entered the lottery than need health care in that particular area. Conclusion (according to I-P):
Therefore, it appears that Canadian bureaucrats have figured out the way to make socialized health care work. Institute a lottery and plan on having only a small percentage of the total population enter.
Kate from HealthyPolicy reminds us that consumer-directed health care advocates think making patients more like consumers will wise them up, make them feel like they have more "skin in the game." So, she asks, how much skin should we have in the game? I wish I knew.
I also wish I knew the right answer to Andrew Barna's post at hospital impact, asking how much latitude non-physician providers should be given to expand their practices. I don't know, and I don't know who would be the objective party who could decide either!
Niels Olson tells us not just about our same-old national health care crisis, but the particular crisis going on in post-Katrina Louisiana:
"Charity Hospital, the oldest continuously running hospital in America, the last refuge for the sick and infirm in New Orleans during Katrina, has been closed since it was evacuated. The doctors and staff are working in a tent city outside the convention center and in other temporary accommodations. For over six months the state and the federal government have been arguing about what to do. Meanwhile, the only level 1 trauma center in the area remains closed and the indigent are returning, with nowhere to go for care."
If you want to help, then check out his information on a rally to save Charity Hospital.
Dr. Christian Sinclair from Pallimed makes my head hurt when he wonders whether folks in palliative care, as he is, should work more closely with organ procurement teams. Sure, sounds good right? Quicker response, greater good? But he outlines the dilemma, and it suddenly doesn't seem so clear:
On one hand palliative medicine professionals are good communicators as are organ transplant procurement professionals. We could minimize the trauma of discussing these issues with family members if we worked together more closely...BUT could we also portray that we are working 'in cahoots' to grab as many organs as we can, thus tainting the noble goals of palliative medicine with the mis-perception of becoming a vulture? I am not sure where to sit on this fence, but it is an idea that I have not come across much in the palliative medicine literature.
Mary from The Mote in the Light makes my head hurt by pointing out that someone who was once a sort of hero to me, Pete Singer, seems to have moved on to a new kind of logic I can't quite follow. I don't see how a man who so passionately and convincing argues for the life of every non-human animal can in the next breath argue that it is perfectly fine to kill born humans who are "defective" in some way. I must admit I've only read articles about Singer and his latest philosophical beliefs, not his book itself. The argument used to be that you wouldn't kill a person who was mentally less able than an animal, so killing animals is clearly not justified by saying we're somehow mentally superior. How that got morphed into thinking that now it is fine to kill those who are defective, I don't understand. But this is why I didn't like the movie Million Dollar Baby...the message was clearly that one was better off dead than quadriplegic, and I'm sure many quadriplegics and their families would disagree.
Dr. Baker from Mental Notes makes my head hurt by not only pointing out that kids are being prescribed anti-psychotic and other psycho-active more than ever, but also by pointing out that these kids are reacting to stressful environments and the drugs only treat the symptom, not the cause.
Sometimes, let's face it, medical stories are horror stories
Marcus from Fixin' Healthcare says that a solution for our health care system woes won't be just an economic solution or governmental solution. Nope, we've got a cultural problem, and I find his perspective downright scary, because it does ring true:
However, the greatest influence upon declining health status is lifestyle and that is a product of the culture. America has a culture that generates poor health and the health care system has no impact upon that situation, health insurance notwithstanding.
Talk about a horror story! Nurse Practitioner tells one that will make your hair stand on end, about a trusted medical staff member who was committing repeated child abuse on patients. What is the take-away? That medical personnel, and all of us really, should remain vigilant for the signs of such abuse...and report it!
And ask yourself how you'd be doing if you'd been through and witnessed what the little girl Keith Carlson from Digital Doorway describes in this post. Keith has written a post exhibiting the kind of empathy and sense of humanity that we want all doctors to have. It's just horrific that, as he rightly points out, this little girl's trauma is only one of many that children experience. Think she'll end up on those meds Dr. Baker was talking about above?
Kim from Emergiblog witnesses a sweet, frail, elderly lady go through an overload of pain, and can do nothing but hold her hands and pray with her for the hour it lasts. This story reminds me of my grandma, who spent her last 10 years bed-ridden, so it's a horror story for me to imagine my own grandma in pain like that, as I know she was at various times.
Finally, Jon from Unbounded Medicine rightly points out that sometimes medical stories are a little gory, but do not, I repeat, do not click on this link if you are squeamish. So why include it? Well, it's a cautionary tale, no doubt about it. Let's just say it makes the case that one should not fool around with firecrackers. And one should particularly NOT let them go off in one's hand. You get the picture?
Thankfully sometimes the stories make you smile.
Clark from Unintelligent Design attempts to make us smile with his list of his 10 favorite medical terms. Although I must add that the terms are much funnier when they're not ailments affecting newborns!
Brad from Anatomy Notes makes me smile by referencing one of my favorite shows, Scrubs, and coming up with the only medical explanation for what looks to be a reversed X-ray in the show's opening credits. Now that's some anal-retentive TV-watching Brad!
Aggravated DocSurg makes me smile with his post, oh, let's just call it the rant that it is, about a special super-duper bed that will cure all your ills...if your ills could be cured by a heated massage recliner.
Dr iBear signs himself up to teach a class of third graders about their cardiovascular system. Silly, silly man. At least he lived to tell us the tale! (And BTW: Dr ibear swears: "All the questions in the post are actual questions that the students asked me during my presentation.")
And I'm probably only smiling because I'm already a vegetarian, but I'll selfishly admit that Disease Proof's report on how reducing animal products consumption results in better health.
And at their best, the stories inspire and give you hope.
And I always like to end with hope.
if you want to visit this or other carnivals, now or in the future, try blogcarnival and BlogCarnival.com.
Ciao for now MedBloggers...come back and see us real soon :)
Thanks to Grand Rounds uber-host Nicholas Genes for his continued work with Medscape to promote Grand Rounds, and the MedBloggers who participate in it.
Each week Nicholas interviews the coming week's Grand Rounds host and posts the resulting column online a fullweek in advance of the Rounds.
Nick may have missed his calling, since he sent me a list of interview questions that were interesting and conducive to rich responses. Journalism as a second career, Nick?
Anyway, I liked this description of me:
It's clear from her posts that Camahort is an independent thinker, when she's writing about who pays for employer-based coverage or her friend's struggles with the system. HealthyConcerns is very often about the personal, too, such as her posts about her own experiences with colds and about missing that final goodbye to a dying relative.
And I also liked that he included my pitch for why inclusive Carnivals are the best kinds:
She prefers the self-organization of blogs in Grand Rounds to companies and algorithms trying to hand-pick what's hot or not: "The blogosphere is full of companies trying to say they can tell me who the most 'popular' and most 'authoritative' and most 'relevant' bloggers are...and without exception I think those companies do a pretty piss-poor job. I find nearly every new blog I start reading through links from other bloggers. The role of [weekly compendiums like Grand Rounds]...is to let people go to one place to find folks writing about subjects they care about. And to let them have a mini-surfing guide...a place to read great content and find new voices."
Now, I better buckle down and do a great job with Grand Rounds next Tuesday!
I'm hosting the ever more popular, and ever more comprehensive Grand Rounds, sometimes known as the Carnival of the Caregivers, next week, Tuesday the 21st.
If you're writing about health care, health coverage, health issues, anything-health, then send your submissions to me by Monday the 20th, Noon Pacific time.
Theearlier the better, of course, since this should be a massive undertaking :)
And yes, given my views on Carnivals, if your post is on topic (and your own writing, not just a link and quote from someone else's) it will be in the Grand Rounds.
Bring it on, baby!
I'm off to Austin, TX. My first trip there, and my first time attending SXSW Interactive, where BlogHer is co-producing five panels. I am trying Airborne for the first time. Why does it have to be something you dissolve and drink? Blech. OK, it's not compeltely foul, but it's not a fizzy delight either. You're definitely drinking medicine.
I'll let you know if this time I escape the dreaded post-air travel grunge.
Have a great weekend y'all.
And yes, I'll say y'all, even though most people say Austin isn't really Texas :)
You've heard the saying: do you work to live or live to work? (The implication being that people who do the latter are workaholics, dont'cha know.)
Anyway, Jory Des Jardins has found a new spin on that over at the BlogHer site:
Her own insurance premiums are going up; her newly widowed and unemployed mother's are ridiculous, and I know their pain. Classic quote from her mom. (Yes, her mom blogs.)
It’s shameful that a person losing their job has to pay through the nose for insurance security; and if they’re unfortunate enough to be too young for Medicare/Medicaid and don’t have a job…they are thrown into Healthcare Hell. I never thought I’d actually WANT to be older….fast.
I actually do know that healthcare drives a lot of career and employment decisions. It's that hard to get, and that expensive to pay for even when you can get it.
Hell, I want my S.O. to marry me just so I can get on his health plan. (Oh yeah, and cause I love and respct him etc. etc. etc. ) God, I hope you all have a sense of humor out there (including him.)
Cross-posted from my Personal Blog:
After spending a decade of her life caring for her seriously unlucky husband, Christopher Reeve, and then devoting her life to the charitable foundation they had founded focused on finding treatments and cures for spinal cord injuries, Reeve succumbed to the disease that she announced she had back in August.
She and Christopher had a 13-year-old son. How does that kid not end up being pretty jaded? I mean I know both Christopher and Dana "never gave up" and "kept their spirits high" and all that, but that makes it even worse. Don't we often hear that positive attitudes and proactive behavior are supposed to help? Those two were full of both the right attitude and the virtuous behaviors.
I have always fund the Reeve story so poignant. Although Christopher Reeve had serious acting training and had shown his chops on Broadway, in the movie world he was regarded as a "pretty boy" actor, best known as Superman of course. He was just starting to mature into more serious roles, and to be taken more seriously as an actor when he had his accident. And the fact that he took that mishap and tried to leverage his fame for the good was and is admirable. Dana Reeve was equally admirable...her identity became inextricably linked with Christopher's...as his caretaker. A tough role to begin with, but in the public eye, I would think more so. She used to have her own career and identity, then she became the selfless wife...and really seemed OK with it.
Then not even a year after Christopher Reeve's death, Dana Reeve has lung cancer and ends up surviving only 6 months. She dies at the age of 44. Only 2 years older than me.
Life is definitely not fair. Bad things happen to good people. And if there's a grand plan, I'd love to know what that is.