Recently the WSJ published a silly article suggesting that older people are “nicer,” based on scores from a standard personality test. Aside from the fact that I hate personality tests, I was horrified and offended. The WSJ seems to be perpetuating the stereotype of older people as easier to push around.
One person responded with gusto. Read the letter here. He’s not nice at all, he says. Telemarketers don’t call back. His internist sends an assistant to examine him. He’s not warm and fuzzy at all.
Single people die younger. According to this article, the difference might be due to a spouse who nags you to eat better or see a doctor. I think it’s also likely that you’ll get better care from doctors when a family member can advocate for you. Read the article here.
And here’s another article about positive effects of marriage on men’s health. Click here.
One thing that gets ignored is the way the health care system views single versus married people. It’s assumed that you’ll have a family member pick you up after outpatient surgery. The Family Medical Leave provides only for care of a parent, spouse or child – not even a brother or niece, let alone a friend. People can’t get off work to drive a friend home from the hospital, especially in the middle of the day with short notice. Additionally, we keep hearing that it’s important to have family members with you if you’re in a hospital; otherwise you’re far more subject to medical errors, neglect and even outright abuse.
Some people genuinely enjoy their own solitude and single status. In terms of aging, that’s a plus, because we’re more independent and less likely to mourn. But getting care becomes a massive invasion of privacy, with limited options for support.
Concepts like “patient activation” are misleading, manipulative and even dangerous. Doctors do not want activated, engaged patients. They want docile patients who will do as they are told without asking probing questions. They do not want patients who ask why published research seems to contradict their recommendations. They do not want to hear that they are reporting statistics inaccurately. They want patients who will follow their instructions (often incomplete and poorly worded) yet they regard their patients as irresponsible children.
For example, this article writes, “They [i.e., those who are not “model patients”] fail to take their medications, skip preventive screenings and end up back in the hospital soon after discharge.”
Taking medications isn’t always straightforward. I am an educated professional who’s given my cats everything from antibiotics to sub-cutaneous fluids to insulin shots. Yet after eye surgery I’m struggling to comply with vague instructions and poorly designed eye drop dispensers.
The term “preventive screenings” is nonsense. By definition, screenings detect disease or treatable conditions. At best, screenings allow early detection and risk reduction. Screenings do not prevent disease or even death. You can get colonoscopies and mammograms as directed and still die from colon or breast cancer. Flashy numbers like “50% reduction” refer to relative rather than absolute difference; the actual impact is usually very small and the cost of false positives very large. The Society for General Internal Medicine has questioned the usefulness of annual physical exams for asymptomatic adults. If doctors really want patients to be engaged, they will interpret statistics accurately and share *all* the research.
Finally, if doctors really want engagement, they need to treat patients like adults. Following eye surgery, I’m entrusted with a complicated regimen of eyedrops and I’m told to fast the night before surgery; my non-compliance will lead to negative outcomes that are expensive to fix. Yet though I live a few minutes away from the hospital, I’m not trusted to make sure I have transportation home. The hospital wants to call my ride the morning of surgery to make sure they’re really coming. I find this call degrading and insulting.
Yes, I know the risks, but I also know how to manage those risks intelligently. I will be alert and ambulatory after surgery and if I feel unable to leave on my own I know how to get help.
“Patient activation” is just another scheme to get more money by blaming patients for mistakes, carelessness and heavy workload. If doctors spent less time on meaningless “prevention” and more time working with people who really need help, many of these issues would go away.
I’m also disgustingly healthy, eat reasonably, have good genes and exercise. I rarely see doctors. Recently, when I asked a handful of questions, a doctor said with a straight face, “Your problem is you don’t have experience with the system. You don’t know how to be a patient.”
Being happily single and disgustingly healthy, I had a few concerns about this article.
Bella DePaulo’s book, Singled Out, provides a rigorous discussion of flaws in research comparing single and married people. For instance, often researchers lump together the “never-married,” divorced and widowed, without controlling for recency of divorce or widowhood. Those who never married actually have an advantage as they age because they are used to being alone.
As for cancer patients living longer, I’d want to know, “Are these people holding on longer, even living in pain, because they’re waiting to see a grandchild get married or graduate from college? Are their spouses and children reluctant to turn off life support, as compared to the more distantly related proxies of single people?”
Rather than emphasize the health benefits of marriage (which aren’t entirely clear), I’d like to see some focus on how the medical community treats married vs single people. Many singles find that getting an “approved” ride home from out-patient surgery has been so stressful, I will avoid having elective procedures that require a ride from a responsible adult. A woman with a tall husband or son at her side will be treated far more courteously than a single woman who shows up alone. There’s nothing wrong with solitary life (see Anthony Storr’s classic book, Solitude), yet the system discriminates against them. I’m pretty social, but if I choose to be a curmudgeonly hermit, why should I be denied access to quality health care? That’s the *real* question.
In an article, “Patient satisfaction: Hospitals are not like car dealerships” (March 22, 2014) David Mokotoff
DAVID MOKOTOFF, MD | PHYSICIAN | MARCH 22, 2014 The article is here.
Mokotoff writes, “Here’s what I would like to ask the patients:
Did the condition for which you entered the hospital improve or go away?
Was the hospital bill clear and accurate and easy to understand?
Did a doctor explain procedures to you fully and in enough detail?
Was the food hot and edible?
Here’s how I commented:
Up to a point you are right. However, I am a super-healthy person who avoids doctors and declines tests. Recently I had cataract surgery as an outpatient in a top hospital. The surgery went well. My surgeon and anesthesiologist were superb once we got to the OR. To them, my case was boring because I’m so healthy.
For me, the whole experience was so stressful I developed physical symptoms. I was horrified by what I experienced: incorrect data entered in my records, repeated queries about irrelevant personal information; failure to note allergies on my chart till we got to the moment of entering the OR; required pre-op tests that are dismissed as useless in research published in leading medical journals (along with a scary high probability of false positives); inflexible requirements for finding a ride home when operations are scheduled at the last minute (hello – friends and even some relatives can’t get off from work); pre-op and post-op instructions presented in a disorganized, incomprehensible fashion (I have a Ph.D. and professional writing experience); stressful noisy waiting rooms with blaring TVs; rude nurses and technicians; and a lot more.
You may think it’s no big deal, but my relationship with the medical profession is more hostile than ever and it was pretty bad before. I was so traumatized that I’m refusing all future tests for cancer, heart disease or other illnesses. There’s no way I could handle the stresses of a major episode. I’m putting an advance directive in place and becoming an advocate for assisted dying, which I think should be made even easier.
After all, spy pilots used to get cyanide pills to avoid getting shot down in POW camps. Modern hospitals aren’t much different. You underestimate the impact of stress on otherwise healthy people.
2319 children and adults were involved in the study. 784 tested positive for flu.
29% of those who had been vaccinated tested positive, vs. 50% of those who tested negative.
This sounds good but it’s not a 61% effectiveness rate; the difference is 21%. They get 61% by dividing 29/50, which just doesn’t make sense. You decrease your risk from 50% to 29% … roughly from a half to just under a third.
Further, of those who had not been vaccinated, there’s only a 50-50 chance of getting the flu.
A stock photo with the article shows a youngish man in a hospital bed with an IV and breathing tube. There’s no claim that this man suffers from flu.
But the truth is, your risk drops from 50% (not vaccinated) to 29% (if vaccinated). That’s roughly from a half to just under a third. Not at all the same thing. And it’s not known how these findings translate to larger populations. In fact, from everything I can tell, this population is self-selected; there may be a self-selection difference between those who chose to get vaccinated and those who didn’t.
Shoofoolatte is right. There are a lot of misconceptions about early detection. Mammograms are likely to miss invasive cancers because those cancers grow so fast they can become deadly between screenings. They’re more likely to catch cancers that rarely become fatal. See http://youtu.be/C-DnznA0m9k by Dartmouth physician/professor Gilbert Welch:
He also notes that comparing survival rates can be misleading. Survival rates will always seem higher in a screened population even when the actual death rate is not changed:
What IS true is that it’s easy to get mammograms and they’re often free, especially if you have time to make an appointment. In many health systems – including HMOs – the doctors are so busy recommending unnecessary “preventive” medicine – with no evidence of positive outcome – that they have no time to see people with urgent conditions.
Mammograms can give people false security or they can get people into treatment that is useless, expensive and even harmful. The NNT is 2500 – you need to screen 2500 women to save one life. Yet we’re putting millions into mammography and some doctors won’t treat women who refuse, while making it difficult for women to get treated after diagnosis. It would be nice if we had medicine by science, not ideology.
First stand-up: a comedy club I’ll call the Seaweed Lounge. Originally I was going to follow the instructor’s advice – attend one and perform in one. But that afternoon I was talking to someone from my pottery class. She asked what my routine was and I went through it fast. She couldnt help laughing. I decided if I could get there in time and find the sign-up place, I’d do it.
Around 9 PM I get a cab over. It’s a tiny dark place with a steep staircase. There’s a sheet on the counter. One of the young guys there tells me he’s Andrew and he’s been doing this for about two months. He’s a veteran. He explains that we sign up but are not taken in order. Five minutes with the light – the warning – at one minute. He tells me where the other good clubs are; this one is tough, that one is good Oh yes, “Don’t forget to tip the bartender.”
So I order a glass of ice water and give the bartender a dollar. Then I talk to someone else who’s been doing this for two years. He does stand-up almost every day, at a different venue. The evening’s host is a blond woman named Cait. I tell her I’ve never done this before, but I’m in a class with Chip and Mary. She knows them. I ask where’s the light and she asks this guy, “Are you the ight?” As they told us in class, the light is a cell phone they wave up and down to let you know you’ve got just a minute.
Then I take a seat at the bar. Comic after comic goes up. There were just a few when I signed in. Where did they come from? Cait hosts and she seems to know them. A few are pretty good but most are pretty rough; I guess they are trying new material. They do a lot of “fuck” jokes and a lot of detail about the human anatomy. I’m wondering about my own routine which is pretty clean.
I’ve written it out and practiced with the screen capture video program so I’m pretty comfortable with my material. I’m tense but after awhile I just get tired. I want to go on and get it over with. Then tehre’s a break. Then they explain they put people they know on first. Hm…nobody told me! “You can always go home and come another time,” Mike says. No way. I am psyched and I want to go to class and tell Chip and Mary I’ve done it. So I hang in.
Another guy tells me I’m fourth in the second half. I feel a little nervous as I watch the first three and ten the host – a different host for the second set- says, “Give it up for Cathy Goodwin!” I like the sound of that.
I make it up without tripping over the stage and get the mike off the stand. I’m surprisingly comfortable and I get a laugh right away, when I talk about advice for getting old: “It’s not ‘Learn to like drinking tea…” Then I get other laughs with the loudest of course when I demonstrate some good swearing.
I get the light just before the last bit so I cram it in and put the mike back. The host shakes hands. I find my seat. I know it went well. Elise leans over and says, ‘Did you say that was your first time doing this?” I say yes but I’ve had lots of speaking experience. She shakes her head. They are looking at me differently. They even ask if I want a beer but I say I’d fall asleep. They say it’s okay to leave and I decide I’d better.
At the door Cait from the first half shakes my hand. I’m feeling accepted in a new way. I say I’l be back and I know I will. I’m hooked. And when I get home I can’t sleep: it’s been forever since I did something well and got recognized. I see why people hang out at open mikes so they get five minutes air time. It’s a drug.
It’s also midnight. I’ve been gone just 3 hours. And a lifetime.
A really good article from the New York Times. What’s scary is that useless procedures have no more validity than witchcraft or alternative medicine, yet they’re accepted and reimbursed by insurance companies. Doctors don’t like questions like, “If I have this test and the results are positive, what will you do? And what is the effectiveness of that treatment?”
From a report that appears in the August issue of Mayo Clinic Proceedings: Out of 363 studies reported in the NEJM from 2001-2010, 146 found that the current drugs or procedures were no better – or even worse – than those previously used.
Over 40% of “established practices studied” were ineffective or harmful
Just 38% were beneficial. Remaining 22% were unknown.
Examples of harm:
— routine use of hormone therapy in postmenopausal women;
— high-dose chemotherapy and stem cell transplant for breast cancer
— intensive lowering of glucose levels of intensive care patients (which increased mortality and conferred no benefit)
The article quotes a doctor who says that procedures often seem to “make sense” despite evidence of benefit. For instance, if you have cholesterol-clogged arteries, it seems reasonable to open them up – but this procedures doesn’t increase survival.
The advice to patients: “You shouldn’t ask how does it work, but whether it works at all.”
Okay, guys, we get it. Now just how many of us are going to get booted from a doctor’s practice when we attempt to put this in practice?
