Doctors Need to Return to Making House Calls

How do you fight your way upstream when everyone is heading downstream? Still this doctor is saying it can be done. He also declares that his way will save money and quality of life for the elderly will be preserved. I think this doctor is correct, but with the current mindset of today's medical community, they would rather practice healthcare rationing than even allow physicians and others to make house calls. There are a few that believe this may be possible, but it would be difficult to find many.

Although I don't doubt we will also see some medical euthanasia, healthcare rationing will be the weapon of choice. I am already seeing this at a hospital near here. I have already been told not to come back. I know I am supposed to take this as they don't want a readmission, but when I am told to see other medical people and other hospitals were mentioned, what am I supposed to think.

Why are doctors so into medical rationing? First, medical supplies are not inexhaustible, we cannot continue to do more and more, and true doctors are becoming a rarity. I know most will agree with the first two points, but I know there are some raised brows on the third point. I say this with all sincerity and am finding this true more each day. I have several friends that have been dismissed by their doctors and guess what the reason was. They did not have living wills and do not resuscitate orders (DNR) on file with the doctor's office. Another friend was told to find another doctor because he was living too dangerously. Now what is going on? First, most doctors are starting to insist on living wills and DNR's by age 50.

I could be a little more understanding if they were saying at age 65 or 70, but at 50 seems a little crass. Well, now I know why. They know that people that young generally will not put these in place and this is one way they can weed out people they do not want as patients. Oh yes, doctors are using many excuses to tell patients that they are no longer wanted as part of their practice. Even more surprising are the number of doctors that don't want to see durable medical powers of attorney. The reason given was that they weren't going to make calls to have those listed come in if needed.

Back to house calls, you will have to excuse me for getting off track.

As the proportion of the elderly continues to increase, so will the number of people with chronic diseases. Mainly cited are diabetes, high blood pressure and heart disease. Since the largest and fastest-growing contributor to rising healthcare cost in chronic disease, this needs to be addressed. The author is very specific about U.S. Healthcare being based on a false premise. He feels that home healthcare is doing exactly what’s most needed. He says that there is more evidence that health care delivered at home enables patients to live not only longer lives, but also better lives.

In his analysis of home health care he lists two studies, Avalere Health study and this one, a 2009 study. These are both in PDF files so you know what to expect in clicking on the link. The first study showed a savings of $2.8 billion among patients with diabetes, congestive heart failure and COPD. Indeed, expanding access to home health care for chronic-disease patients could save a projected $30 billion the author states. Yet the value of home care remains under recognized. As a result, vast needs are still going unmet.

He is very sure of his data and lays out the following for what needs to be done. I will quote his points.

“Define the discipline better. The medical community, including physicians, medical schools, and hospital administrators must better describe what home care does and why it matters in order to bring it to life for policymakers and family caregivers.

Get in sync. Primary care physicians particularly, but also nurses, therapists, social workers and others, must align better with home-care clinicians to coordinate care, especially during and immediately after the transition from hospital to home.

Physician, educate thyself. Physicians should learn about home-care options and discuss them with patients who could benefit.

Adopt new technologies. More companies in the home-care business should use innovative technology to coordinate care in real time, including point-of-care laptops, telemonitoring devices, and Internet portals for physicians that allow all providers to share a patients’ information.

Remove policy obstacles. Reimbursements from Medicare and private insurers should reflect the true value of home care. But the payment system now in place sees home care, quite mistakenly, as merely an add-on with little clinical benefit. Policymakers should create a payment model that aligns providers’ clinical and economic interests, assigning proper value to good outcomes and recognizing that home care is pivotal to success.

Health care at home is patient-centered, outcomes-driven and truly collaborative, making it a microcosm of how the health care system should function across the board. Only by embracing home care can we truly reform the health care system.”

Another article on house calls and the need may be read here.

Would a SEC for Healthcare Be Appropriate?

When I started reading this, I admit I burst out laughing. A broken medical system trying to correct what is wrong with itself? Yes, this is needed, but without Federal legislation, how will this ever get off the launching pad?

Granted, I have a shortage of knowledge about the medical world, but the way hospital executives and hospital boards fabricate and forget to make things known, how can we ever expect any reliability in what they say? It is true that the Centers for Medicare and Medicaid Services cannot be reliable for ratings for most medical situations, they have too large a stake in giving out ratings where there is something to be gained and money is in the mix.

The question is what would the SEC type regulator for the medical be named. Even the SEC has had its problems in its 80 some years of existence and money produces strange results. However, it is time for change and this may be the vehicle to make this happen. This is still in the formative stage and therefore nothing is fixed or even close to being finalized.

In reading the blog by Peter Pronovost, MD, PhD, Director of the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, I have been researching what some of the possibilities might be. Dr. Pronovost did state the following in his blog, “A SEC-like entity could have private sector rule-setting, public sector auditing and transparency, and private sector reanalysis, working from a common book of truth.”

There will be a conference September 23-25 in Baltimore, MD and the details are here and it lists the planned agenda for the three days. If I had gotten my act together and read and realized that June 21 is the last day of early bird registration, I should have posted this earlier. Patients and patient-advocacy groups are encouraged to attend.

Have You Been Pressured To Have End-of-Life Talks?

This is a topic I am very conflicted about. I have seen both the good and bad sides of this and therefore much of the conflict. I am not sure that I will be objective in this, but I must try. At my age, I have been lectured to about not having a living will or a do not resuscitate order (DNR) on file. One doctor has been very emphatic of late and yet he will not answer my questions. I do ask very point blank why he wants them on file and you would think he could answer this question.

I also ask the following questions:

#1. What is the advantage of these over a durable medical power of attorney?

#2. When and how would they be used, or under what circumstances would they be used?

#3. Who makes the decision as to when they would be used?

#4. Would the family even be consulted?

Next I ask some rather pointed questions that are not related to the above:

#1. Would medical rationing become part of this?

#2. If our state adopts doctor assisted euthanasia, who would determine when this would happen?

#3. Having seen doctors and nurses ignore a durable medical power of attorney, what would stop you and this hospital from doing this?

The discussion generally stops and normally I receive no answers to any of my questions. I feel as a patient I have a right to have these and more questions answered, but the hospital that this doctor works for will not allow these to be answered.

As a result, I will not vacate my durable medical power of attorney and have made sure that the doctors and hospital know this. The two articles that have me thinking are this article and this article. Please read the second article as this person is very knowledgeable and presents the topic of how the Health Insurance Portability and Accountability Act of 1996 (HIPAA) has been interpreted and misapplied as a barrier to communication with the very people who have a deep and often lifelong relationship with elderly patients and who will be responsible for managing or providing care in the community.

That is right; they have been misapplied by uncaring doctors and nurses to avoid caregivers and often even patient advocates. During a recent hospitalization of mine, I had a person try to pull that on me when I asked a question on my own case. She was supposedly part of administration, but I didn't believe her. When she said she was not at liberty to discuss my case because of HIPAA, I had to laugh out loud. I am not proud of what came out of my mouth next, but it was a litany of words that were anything but polite. I basically told her that she was talking to someone that knew something about HIPAA and she had better start talking or I would be calling my attorney and charging her with a HIPAA violation. She made a comment that she had never heard someone so impolite and to put it where the sun doesn't shine.

Neither of us was aware that the hospital administrator was outside and with her comment he decided to enter. His first statement was that if I needed to call my attorney, she would be the first to lose her job and that she had better return to her duties on her floor, as a nurse, and that she would be disciplined as well as the person that had put her up to what she had done. She started to protest and he said, “You wish to be terminated now,” and she scurried out. As she left he said, “And you will be attending a class on HIPAA which I will be teaching.”   Yes, the nurse could not discuss my case because she was not authorized to see my records since she was not assigned to my floor.

Then he turned to me and commented that this was unusual as normally I was in his office with problems. We had a good discussion and he said that the situation would be clarified. He said I had a right to advocate for myself and that he did not appreciate the nursing staff thinking they could bypass the proper procedures. As he left, he said to me that he was glad I knew a few things about HIPAA. I tried to ask him about the living will and DNR and said no one will answer my questions. He invited me to stop by his office in a couple of weeks and he would give me answers. He said that basically everyone else was not to answer these questions.

As he got to the door, he turned and asked about the person that could not read and write. I said that the wife of the person that had accompanied him that day was teaching him to read and write. I said that she was a retired elementary teacher and that he was learning quite rapidly. A lot of words he understood and did not need a definition for which really helped once he learned the word. I told him that I had a call from him and he wanted to tell me how well things were going for him and to thank me again for pushing the envelope for him. By making his neighbor aware of the problem, this got the wife involved in teaching him. The administrator said that was a first for him, but that is was a good lesson and he had added the neighbor's wife to the papers so she could accompany him to his appointments. With that he left.

Food Companies Spend PR Dollars

This is the other item mentioned in this blog from June 13. This article is about food industry front groups and some of their activities. A good reference is this PDF file and the information contained in it. If I was not aware of some of this, I admit I might have passed on this topic.

The International Food Information Council – in addition to publishing industry-friendly reports, also infiltrates professional conferences such as the annual meeting of the Academy of Nutrition and Dietetics, the nation’s trade association for registered dietitians (RDs). Again, this is another reason to avoid doing anything with them.

It is important in today's lackluster news media that seldom checks their sources and prints what they want, that we as consumers understand what is happening to our food and not what they promote as fact. Generally, there is very poor science behind what the food industry promotes and they are now using diversion tactics to draw our attention away from the real issues.

The food industry has increased its public relations efforts to reassure the media (not hard to manipulate), the public (some believe the media and others don't), and policymakers (the most difficult to convince) that our food system is healthy and safe. A common way industry attempts to shape the public discussion is by forming a group that appears to benefit the public. Often these groups claim to represent farmers, consumers, or some other sympathetic constituency when in fact they are funded by powerful industry players. Some long-standing front groups have a broad agenda, such as pushing industry-friendly science. Others form just to lobby or conduct public relations on a specific policy for a limited time and then disappear.

It is critical to understand who these groups are and how they operate. Their tactics are designed to hide their true agenda and funders. For example, representatives of front groups often write op-eds or appear as experts without disclosing the conflict of interest. These are just a few the tactics used by front groups. This keeps the players, the Monsanto's, ADM's, ConAgra's, and other big Ag companies out of the news and everything looks good for them.

Instead of fixing problems they’ve created, the food industry’s response is to change the way these problems are talked about, to downplay them, to discredit critics, and otherwise make the problems disappear from the public’s eye. This is the reason they finance the front groups and generally no one is the wiser.

“Industry trade groups know that big corporations such as Cargill and Tyson don’t garner public sympathy. So instead, they create front groups such as the U.S. Farmers and Ranchers Alliance, which held a contest to select spokespeople to “share stories and experiences on a national stage to help answer consumers’ questions about how food is grown and raised to feed our nation.”

Ode to Carbohydrate Woman

Carbohydrate woman, carbohydrate woman

How you talk about carbohydrates

It is plain to see that you are no shaman

For no lack of trying, you are what grates

You have not magical powers

And your science is flawed

How else could we see the flowers

Down the path that you have sawed

Carbohydrate woman, carbohydrate woman

Your potion is definitely not for humans

Of any type, especially not for man

For it runs off our backs like cumins

The USDA has warped your genes

With their bad science led you astray

Hopefully someday you will see greens

And know that you must retire from the fray

Carbohydrate woman, carbohydrate woman

Carbohydrates may be good for the goose

Carbohydrates may be a poison to the man

They're not good for the gander in the loose

The ADA has loosened its hold

On carbohydrates for sure

And if I may be so bold

Maybe you need to be as pure.

Carbohydrate woman, carbohydrate woman

ADA has at last opened their minds

And said diets are fit for the human

For you, carbohydrate is the tie that binds

Your mind is as solid as concrete

Stolid and can't bend in the breeze

Carbohydrates is all your mind can secrete

As if opposition caused your mind to freeze

Carbohydrate woman, carbohydrate woman

Increasing the portions of fat and protein

Has allowed me to be more human

For you, that still remains to be seen

The academy of which you are a member

Needs to consider being more transparent

And if not, it should remember

You are not the heir apparent

Carbohydrate woman, carbohydrate woman

Glycemic control myopia fits you to a tee

You're a narrow minded, intolerant woman

And that is plain for the world to see

When, oh when will you quit

And leave this world to wiser geese

The world is not for you a good fit

With the flutter, whine, and wheeze

This is my weak attempt to poke some fun at the profession(s) that are constantly promoting carbohydrates and that we need to eat an outrageous number at each meal. The American Diabetes Association has reduced the number and stated that many of the diets are currently acceptable including low carbohydrate plans.