In a recent Wall Street Journal article, “A Better Journey to the Final Exit,” reviews three books that address interesting issues regarding illness and death.
While these two subjects are often painfully uncomfortable topics of discussion, three authors confront specific issues that may help prepare us for the “final exit”.
The first book, “Happier Endings,” by Erica Brown proposes that even joy and inspiration can come from death. She shares stories of how other cultures deal with death through rituals or spiritual traditions in order to prepare and accept death’s inevitability.
Another book, “In the Kingdom of the Sick,” sheds light on the social history of chronic illness in America. Laurie Edwards, a science writer who suffers from chronic illnesses herself, seeks to bridge a communication gap—between society and the chronically ill.
After extensive research, the book questions whether stress, depression and anxiety (fueled by purported medical information on the Internet) create psychosomatic patients who merely believe they have certain illnesses or whether their ” stress and depression might result from the isolation and anxiety of having legitimate symptoms dismissed. If patients felt more supported and doctors “less besieged” in their first encounters in the doctor’s office, Ms. Edward says, physician-patient collaboration could narrow the gulf between patient and healer.” Read More…
The last book, Letty Cottin Pogrebin’s “How to Be a Friend to a Friend Who’s Sick,” is a guide to bedside manner for friends and family. She explains that while most family and friends mean no harm when trying to console or talk to loved one who is ill, many commit major bedside manner faux pas out of discomfort.
In her recent essay, “What to Say to a Friend Who’s Ill,” she provides a detailed account of inappropriate things people say to their ill friends out of nervousness and discomfort. She also provides a list of the “10 Commandments for Conversing with a Sick Friend” :
1. Rejoice at their good news. Don’t minimize their bad news.
2. Treat your sick friends as you always did—but never forget their changed circumstance.
3. Avoid self-referential comments.
4. Don’t assume, verify.
5. Get the facts straight before you open your mouth
6. Help your sick friend feel useful.
7. Don’t infantilize the patient.
8. Think twice before giving advice. .
9. Let patients who are terminally ill set the conversational agenda.
10. Don’t pressure them to practice ‘positive thinking.’
As the future of Obamacare falls into place, many health insurers are pleased with recent outcomes.
The government recently made decisions regarding Medicare Advantage rates, the future of Medicaid, and the Patient Protection and Affordable Care Act.
Instead of Medicare Advantage rate cuts, participating insurers will receive a 3.3 percent i crease in payment reimbursements, which is more than what some had hoped for. In addition, the Department of Health and Human Services is now fully responsible for Medicaid expansion costs.
“Expansion would broaden the coverage umbrella to include patients below age 65 who have income that’s 133% above the federal poverty level.” Read more…
Although many are able to rest easy after the conclusion of this decision, there are still numerous decisions to be made concerning state health insurance laws.
To read more about details of these new decisions click here.
David Hanscom, MD, is a long-time friend, colleague, and neighbor in Seattle. He is also a noted orthopaedic spine surgeon.
David has a personal story about his own experience with chronic pain and recovering from it. He has dedicated his professional life to understanding chronic pain in a holistic fashion.
He is a surgeon who is judicious and very conservative, especially when it comes to addressing pain.
His personal website outlines his own methodology and is highly recommended.
We invite our readers to visit his website and read his book:
One of MCN’s favorite radio programs is “This American Life” from National Public Radio. The March 22, 2013 show, “Trends With Benefits,” was on the massive growth in federal disability benefits in the U.S. Much of this is no surprise to those of us who work in the sector. To quote their blurb:
“The number of Americans receiving federal disability payments has nearly doubled over the last 15 years. There are towns and counties around the nation where almost 1/4 of adults are on disability. Planet Money‘s Chana Joffe-Walt spent 6 months exploring the disability program, and emerges with a story of the U.S. economy quite different than the one we’ve been hearing.”
Well worth a listen. This American Life: Trends With Benefits
And additional information in available from the author on the web at:
A recent MCNTalk article describes changing perceptions and beliefs by U.S. doctors.
This New York Times posting “Job Prospects are Dimming for Radiology Trainees,” describes major disruption in the field of radiology – once one of the most coveted specialties from a compensation and lifestyle standpoint.
Recent radiology graduates with huge medical school debts are having trouble finding work, let alone the $400,000-and-up dream jobs that beckoned as they signed on for five to seven years of relatively low-paid labor as trainees….
“The times of graduating from medical school and driving a Porsche are done,’ said Dr. Dana Lowenthal, a first-year radiology resident and fourth-generation doctor. “It was never easy, but there was light at the end of the tunnel. This is new territory.” Read More…
A reader may feel a certain disconnect when noting that the 10% decline in average radiologist income still places them in the top echelons of the nation and are double that of primary care doctors. But it would appear, as we are seeing a similar trend with new law school graduates, that the prospects for new radiology trainees are far less promising. And that technology and payer behaviors, especially Medicare, are having a very disruptive impact on the profession.
By Brian L. Grant MD
The AMA News reports that many physicians are reducing their hours treating patients and in some cases, leaving or considering leaving the profession altogether.
Some decreased productivity is a result of being employed rather than independent. Morale in many physicians is said to be suffering. The causes can be debated, but the phenomenon is real.
When I entered the profession in the early ’80s, physicians prided themselves on autonomy and enjoyed a great deal of respect. Little did my colleagues and I know that U.S. healthcare was in the twilight of an era of professional control.
We have shifted to a world where the “system” is under challenge by many factors: runaway costs, massive engagement by market driven businesses in the technology, device, and pharmaceutical industries, consolidation of hospital groups, buying of physician practices and many other forces.
Physicians no longer enjoy, by and large, the sense of control and respect that once was their domain. To a degree we may have brought in on ourselves and there have been some decent trade-offs made by some. For example, work-life balance for many has become more important than professional power and pride.
The large number of women who have entered the profession (48% of current medical school graduates) have encouraged new models for women and men in balancing work and family. But to the degree this means fewer hours worked, it is equivalent to less care being provided per doctor working. (For more information on women in medicine, see http://www.catalyst.org/knowledge/women-medicine.)
In order to address the growing physician shortage, many solutions are being considered. This includes leveraging the talents of other professionals, altered delivery models, encouraging more medical immigration (to the detriment of the countries who have trained professionals only to see them leave), and striving towards new delivery models using technology and innovation.
In the end, medicine as we knew it may be history.
The practice changes physicians are planning in 2012
Practice plan Physicians agree Continue as I am 49.8% Cut back on hours 22.0% Retire 13.4% Relocate to another practice or community 10.9% Seek nonclinical job in health care 9.9% Cut back on patients seen 9.6% Switch to cash/concierge practice 6.8% Work part time 6.5% Work locum tenens 6.4% Seek job outside health care 6.4% Seek hospital employment 5.6% Close practice to new patients 4.0% Other 5.5%
Source: “A Survey of America’s Physicians: Practice Patterns and Perspectives,” Physicians Foundation, Sept. 21 (link)
By Brian L. Grant, MD
The new book “SALT SUGAR FAT, How the Food Giants Hooked Us”, by Michael Moss may be one of them.
Like “The Jungle” by Upton Sinclair, that exposed the abuses of the meatpacking industry on immigrants in 1906 or “Fast Food Nation” by Eric Schlosser, that helped expose the abuses of factory farming of animals that help make today’s fast food – this new book by Moss describes how the fast food industry has succeeded in creating products that compel consumption, contributing to our current obesity epidemic.
Moss is a reporter for the New York Times. Excerpts of his book appeared in the New York Times Magazine on February 24. In addition, we have included the recent review of his book from the New York Times, and a link to the Amazon description, author interview and reader reviews.
Marketing and research work. We are persuaded to consume, to embrace styles and brands, and otherwise spend our money based upon real or perceived values and needs, informed by marketing efforts. In most cases the only damage is to our wallet if we consume goods or services that we don’t need. And many times what we get is quite useful and valuable.
The food industry faces a challenge. The success of food marketing requires food consumption. The more successful the marketing is, the more food is consumed. This consumption, especially of the sorts of processed foods that the global giants create, is a driver for obesity.
To quote the review:
“…that is the nub of Mr. Moss’s case: By concentrating fat, salt and sugar in products formulated for maximum “bliss,” Big Food has spent almost a century distorting the American diet in favor of calorie-dense products whose consumption pattern has been mirrored by the calamitous rise in obesity rates. Entire food categories were invented to support this strategy (Mr. Moss is particularly fascinated by Kraft’s near-billion-dollar line of Lunchables snack trays), as processors bent the American appetite to Wall Street’s will.” Read More…
Read the article, the reviews, and the book. After doing so, you may never enjoy Cheetos or Dr. Pepper quite as much.