healthcare

Doctors take a lot of notes when you go in for a check up. But what do they say? Try asking for them, and more likely that not, your physician or nurse won’t let you see them. It’s just policy. But is it a good one? Shouldn’t we be able to read what our doctors have to say about us?

Actually, in the 1970s, a few states gave patients the right to see their patient file. Most physicians were opposed it, saying it would be another source of unnecessary stress, that without the experience of a clinician, the file might be misinterpreted. Do you know what S.O.B. stands for? (OK, you might know what it sometimes stands for, but in this case it’s “shortness of breath.”)

But at the same time, I can see the other side of the argument. It’s your file, your health. You do have the right to know, and in a way, if you misread your file, at least that’s on the individual and not the doctor.

Still, nobody has studied the effects of personal access to patient files. That’s why this summer, a yearlong study called Open Notes will “analyze the expectations and experiences of patients and physicians, as well as examine the number of additional phone calls, e-mail messages and visits that may arise as a result of more patients viewing their doctors’ notes.”

But of course, the study still won’t solve the ethical dilemma.

Should patients be able to read their doctors’ notes?

From the New York Times. Photo by ttcopley.

Pre and post-natal health insurance coverage is, frankly, pretty messed up. (OK, messed up isn’t the first phrase that came to mind — good thing I’m typing.) Some private insurers treat pregnancy as a “preexisting condition” (like you were born pregnant) as an excuse to charge pregnant women higher premiums or to even refuse to cover childbirth costs. Thankfully, the healthcare overhaul is going to set a few of those things straight.

Starting in this fall, you can expect the following changes:
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Communication between doctors and patients is a vital piece of every medical relationship, but when things aren’t clear, whose fault is it: the doctor or the patient? Both, actually. There’s a great article in the Los Angeles Times about the issues the dynamic between physicians and patients. According to surveys, doctors describe 1 in 6 patients as “difficult.”

Many physicians also struggle with patients who are incredibly demanding, highly emotional or extremely passive. A doctor’s demeanor also comes into play. A physician who doesn’t like to relinquish control, for example, may find patients who are highly engaged in their own care annoying, while another doctor may appreciate this kind of involvement.

So it’s a matter of figuring out your doctor, and letting your doctor figure out you. I’ve personally had some negative experiences with doctors who showed no effort with their bedside manner, but is that my fault or theirs? On one hand, I’m probably an annoying patient, but on the other hand, I’m also at the doctor’s office because I’m worried about my health.

What do you think: is it the responsibility of the doctor or patient to make sure the relationship works?

Full story at the Los Angeles Times.

The most recent health care quality report reveals that infections caused by hospital care have increased over the past year. Post-surgery blood infections are up 8%, urinary tract infections after from catheter’s increased by 3.6%, and infections linked to other medical care went up by 1.6%. According to Scott Hensley at the NPR health news blog Shots, hospitals need to do a better job protecting patients from infection.

Other numbers are just as scary. Hensley writes, “About 1.7 million infections associated with hospital care occur each year, and nearly 100,000 people succumb to them.” As a solution, Hensley, along with the Agency for Healthcare Research and Quality, suggest that hospitals adopt a “culture of safety.” (Although personally, it seems like a vague suggestion — “better teamwork and communication” is advice that could be applied to, well, anything.)

Do you think hospitals are doing a good job preventing infection?

More at Shots. Photo by pinkangelbabe.

Dennis Quaid: you know him as the paternal figure in movies you never bother to see, but did you know he’s also Hollywood’s biggest advocate for hospital transparency? The actor wants medical errors and mistakes publicized for accountability. “My mission today is to drive awareness… awareness of both the harm and the opportunity to save countless lives,” Quaid said.

Quaid has also produced a documentary, Chasing Zero: Winning the War on Healthcare Harm, and created the Quaid Foundation, a research organization based in Austin, TX. The actor’s personal connection to the issue comes from the day in fall of 2007 when his twins died in the hospital, after a mixup led to the ten-day-old babies being given double the adult dosage of the blood thinner heparin. This happened at Cedars-Sinai Medical Center in Los Angeles, widely considered one of the area’s best hospitals.

Medical mistakes are often swept under the rug, but maybe it will hold hospitals and health care professionals to a higher standard if they are made more public. Have you or your family ever experienced a medical mistake?

More from USA Today.

Working mothers with newborns face a number of challenges in the workplace, especially mothers who want their baby drinking breast milk instead of formula. But now, section 4207 of the health care bill guarantees employees the right to use breast pumps at work, meaning mothers can take a break out of their work day to lactate privately.

There are some stipulations. Employees are only allowed to use the breast pumps in “a place, other than a bathroom, that is shielded from view and free from intrusion from co-workers and the public.” Companies under 50 people are also exempt from the law. Also, only certain types of workers are covered. For more information on breast-feeding at work, check out the United States Breastfeeding Committee website.

More at the Motherlode.

Much of the focus of the new health care legislation is how insurers are no longer allowed to deny patients based on medical history (which is great!), but one somewhat downplayed feature is the change to preventative care. Preventative services like immunizations, cancer screenings, and checkups will now be offered at no additional cost/out-of-pocket fees. Is this more expensive for insurers? Sure, in the short term, but the idea is that preventative treatment saves a lot of money later in the patient’s life by helping them avoid sickness. Also, patients are less likely to get sick. That’s cool too!

Here’s the catch though. Under the new law, only new insurance policies are required to offer preventative services. Meaning if you change policies, you’ll get them, but your existing benefits will likely not be upgraded until insurers modify their cost structure (read: a long time from now). And re-signing up for the same plan next fall — when the law governing preventative care goes into effect on September 23 — may not require your insurer to provide free preventative care. (The one exception to this is Medicare.)

Do you believe in preventative treatment? Would you and your family take more advantage of it if it were free?

From the New York Times. Photo by USACE Europe District.

The health care overhaul includes provisions that prevent insurers from discriminating against women. Before, no law was in place to prevent such discrimination — even for things that didn’t involve maternity care — and naturally, insurers took advantage of that gap. As House Speaker Nancy Pelosi said, “Being a woman is no longer a pre-existing condition.”

According to data from 2008, the difference in premiums ranged anywhere from 4 to 48% (yowza!). In the past, policies that included maternity coverage cost more, but now that gender discrimination is illegal, maternity coverage is now considered an “essential health benefit.”

There are many critics of the health care bill (“it’s too much!” or “it’s too little!”), but it’s hard to deny that measures like the elimination of gender discrimination are a big step forward.

The full article at the New York Times.

Here’s the best thing you’ll about health care read all day. “Patient Money” asked: how can the country reduce health care costs while not compromising quality? And instead of asking pundits and politicians, they asked doctors. Responses included a wide variety of suggestions, from insuring catastrophes only to changes in malpractice law to ending overtreatment. Here’s a great suggestion from Dr. David Ludwig on treating childhood obesity (our favorite topic of late):

“We struggle constantly to get reimbursement for services at my clinic. This is terribly short-sighted. Society could spend one thousand dollars now for comprehensive medical care for an obese child, or it could spend one hundred thousand dollars later for that patient’s coronary artery bypass surgery. Every insurance company figures it’s not their problem: an obese kid will likely be with a different carrier by the time he or she starts to experience costly health complications.”

I recommend reading the whole thing at Patient Money. Photo by a.drian.

We linked the New York Times guide to the health care overhaul yesterday, but if you were curious about the immediate effects of the changes, Crooks and Liars has got you covered. All of these points in the health care bill will come to fruition within six months of the President’s signature.

• Adult children may remain as dependents on their parents’ policy until their 27th birthday
• Children under age 19 may not be excluded for pre-existing conditions
• No more lifetime or annual caps on coverage
• Free preventative care for all
• Adults with pre-existing conditions may buy into a national

high-risk pool until the exchanges come online. While these will not be cheap, they’re still better than total exclusion and get some benefit from a wider pool of insureds.

Five more after the jump.
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