by CathyG | Aug 31, 2014 | medical care
Today’s Wall Street Journal had yet another story by a disillusioned doctor: Why doctors are sick of their profession
Jauhar actually offers a balanced view. He points out that doctors were warned they would kill the goose that laid the golden eggs; many doctors still perform unnecessary surgery. I am healthy and rarely see doctors, yet when I had a small ovarian cyst, a doctor tried to persuade me to undergo a complete hysterectomy! I switched doctors and had an outpatient procedure in just a few hours.
The irony is that managed care often doesn’t prevent unnecessary or wasteful treatment. The term “preventive care” should be replaced with “risk reduction medicine.” Much of a primary care doctor’s work involves screenings of perfectly healthy, asymptomatic people that cannot be justified by research findings.
Doctors are still trained to memorize molecular structures but they need courses in statistics and decision making. Recently the WSJ published a review by a cardiologist who insisted that deaths from heart disease were down by 60%. I looked up the numbers: the reduction was 172/100,000 and that doesn’t account for things like errors in coding causes of death.
And while doctors complain bitterly about lack of respect, many of them persist in making elderly patients (and those close to end of life) suffer with unnecessary treatment. Just read any list of comments in a NYT article. I’ve heard first-hand accounts of 90-year-olds given colonoscopies, paid by Medicare; a doctor writes about aging Alzheimer’s patients getting painful needle tests for diabetes, ordered by a doctor, who can’t be stopped. yet few insurance companies give them what they need – massage, good food and privacy. I’ve heard even more horror stories of doctors who disregard DNR orders and who think they’re doing a service by keeping someone alive for a meaningless, drugged-up existence in a nursing home.
Finally, doctors have limited accountability. It is very, very hard to sue a doctor. Doctors make claims on their websites (and in practice) without disclaimers and disclosures of conflict of interest. Eye doctors actually place ads in their office magazines (“Want great vision? Talk to us about …”) without warning that these procedures do not always turn out well and sometimes make vision worse.
by CathyG | Aug 12, 2014 | health care waste
The New York Times article (Unkind Life For Young and Old, Aug 7) highlights yet another way the US wastes money. It costs $100,000 a year to maintain an aging prisoner, and prisons aren’t exactly geared for “aging in place.” They have unsafe stairwells, a ban on canes and of course no geriatricians on staff.
Geriatric prisoners rarely pose a threat to society so there’s little reason to keep them.
Jamie Fellner, author of a Human Rights Watch, was quoted in another article as saying, “Age should not be a get-out-of-jail-free card.” But why not? In some countries, people over 70 do not go to prison, period. I doubt that we’d see many people over 70 suddenly going on crime sprees; the rare cases of white collar crime, like Madoff, could be handled with supervised probation or fines.
by CathyG | Aug 6, 2014 | health care waste
The New York Times :Why We Should Know The Price Of Medical Tests. http://nyti.ms/1ooBGQP
My comment:
Oh come on … the outrageous amount we spend on health care isn’t driven by saving a few bucks here and there on price-shopping.
Just for starters, Medicare pays $300 million a year for pre-op tests for outpatient cataract surgery, when research shows these tests have no impact on outcomes. Then there are billions spend on “end of life” care because doctors and hospitals disregard DNR and DNI, even when the correct forms are in the charts.
And the billions spent on “preventive care” that doesn’t prevent anything; at most you get risk reduction, usually a small amount.
And the inflated hospital charges ($147 for a Tylenol, $500 for a bag of salt water). I’d be willing to bet that 30-50% of these “medical tests” are not even necessary.
So now they want sick people to shop around to save a few bucks? And a hospital can say, legally, that prices are secret so you can’t even if you want to?
No wonder we’re not hearing much about the Mafia. They’re probably running the medical industrial complex.
by CathyG | Jul 15, 2014 | dying with dignity
In this article, Addressing Capacity, Dr. Mark Lachs notes that 40-50% of people over 85% have some form of cognitive impairment.
In one example, a woman refuses to admit caretakers to her home. “What if there’s a fire?” she’s asked.
If she says, “I’m willing to take the risk,” she may just not be aware of what’s going on.
If she says, “I’ve lived a long life and I am willing to take that chance to maintain my privacy and independence. I can wear a life alert pendant.”
Dr. Lachs notes that people have the right to make that choice. I wish more doctors did.
by CathyG | Jun 21, 2014 | stereotypes of aging
(1) Your own personal cyanide pill. At this point, modern medicine can only do so much for you. If you want to check out, you should be able to do so, on your own terms, without explaining to anyone.
If you’re worried about upsetting your family, you should get access to a hitman from your local Mafia enclave. They’ll make it quick, clean and painless. Your family will be told, “An unfortunate accident and she had no pain at the end.”
(2) The right to use 4-letter words, including the F-word, any time, especially when you’re talking to a doctor, an insurance company, or some broker who cold-called you to transfer your IRA to his company. You’d be surprised how much gets done after you call somebody a mother-fucking idiot.
(3) The ability to make a citizen’s arrest of anyone who calls you “honey” or “dear,” especially in a professional setting. If they grew up in South Philly, they can plead mitigating circumstances.
(4) The right to knock somebody on their ass if they grab your arm without permission, thinking they’re being kind and helpful, when in fact they’re being patronizing and controlling.
Alternatively, you can hand them your big heavy backpack and say, “Oh, that’s so nice, dear – how about carrying this for me?” all the way to the door of your gym.
(5) The right to opt-out forever from all age-related mailing lists, especially those invitations from AARP and those newsletters from health care agencies, hearing aid companies and hospitals.
by CathyG | May 23, 2014 | Uncategorized
The social aspects of aging are by far the most difficult, in my experience, and the least understood. Often we experience altercasting – the way we’re pushed into roles and respond to those involuntary roles through a social interaction.
The brief video on social aspects of aging underestimated the cruelty associated with aging, which can be experienced any time after 35 or 40. It is true that some cultures treat older people better than the US does. However, it’s not clear what roles are appropriate or why special roles should be reserved for people over 60.
I do many things that are not age-appropriate – in my late sixties, I wear shorts, work on the Internet, take classes, workout – and every so often someone will say something that reminds me I’m older than most of the group. I’ve also found that any quirk or unusual quality is attributed to aging, even though it’s something that hasn’t changed for years. Age is the strongest signifier of status – even stronger than gender, sexual preference or (usually) race.
Another social phenomena is the toleration of negative stereotypes of aging. I remember watching a TV morning show years ago, where an “older” women was being interviewed because she did skydiving. The anchor was smiling in a patronizing way, as if to say, “That is so cute.” Similarly we see thousands of Youtube videos showing older women dancing, which is supposed to be amusing. One movie reviewer (wish I’d kept the clipping) wrote that, “It is funny to see older people enjoying themselves.” Can you imagine saying that about black people or disabled people?
Vernon Jordan wrote a book about growing up black. In one episode he was sitting at a table reading a book in a home his mother was cleaning. The lady of the house exclaimed, “Why, Vernon can read!” Most of us would be horrified, yet we tolerate a similar view from social and public media. We see a video of an elderly woman dancing and say, “Why, this old lady can shake her butt!”
I have never liked children and have no interest in activities that would put me around children. I’m not getting mellower; I’ve always been direct and outspoken and I’m still that way. The difference is that many people (especially medical people) expect to deal with sweet, docile old people; it has been necessary to use some colorful language to get them to pay attention, especially when I’m there alone. I don’t necessarily want “respect.” I just want to be treated like an adult who’s paying the bills; I deserve respect as a customer, not for my age.
Moreover, while other cultures treat the elderly with respect, preliterate tribes would leave elders behind when they were too weak to go on the tribal journeys. Some would kill and eat the elders. If you asked, I think many people would rather experience those customs than be locked up home with extreme pain, no meaningful life and the high probability of abuse.
by CathyG | May 4, 2014 | stereotypes of aging
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.
My role model in fact!
by CathyG | Apr 15, 2014 | medical care, single life
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.
by CathyG | Apr 1, 2014 | Uncategorized
Another WSJ article that makes my blood boil: How Doctors Rate Patients: Patient Activation.
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.”
by CathyG | Mar 31, 2014 | medical care, single life
Recently I came across this article, allegedly reporting that being married confers health benefits: http://www.medicalnewstoday.com/articles/274828
Here’s my comment:
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.
