Wednesday, March 20, 2019

Kaiser Permanente: "Up To A Third Of Knee Replacements Pack Pain And Regret"


Kaiser Health News, the web site for Kaiser Permanente, posted this article "Up To A Third Of Knee Replacements Pack Pain and Regret" last December.


The gist of the article is that: "Doctors are increasingly concerned that the procedure is overused and that its benefits have been oversold." (note the use of passive voice)

They cite a 2014 study in the journal Arthritis & Rheumatology which essentially reports that up to one-third of the patients may not have arthritis symptoms sever enough to merit this procedure.

This becomes an issue of informed consent where the potential candidate for surgery should be made aware of the appropriateness of this surgical procedure.

There is the issue of the lifespan of these implants, especially when patients are increasingly having this procedure in their 50s:

"Yet even the newest models don’t last forever. Over time, implants can loosen and detach from the bone, causing pain. Plastic components of the artificial knee slowly wear out, creating debris that can cause inflammation. The wear and tear can cause the knee to break. Patients who remain obese after surgery can put extra pressure on implants, further shortening their lifespan."

And, if there is a need for a revision of this surgery, the complication rate could be as high as 35% for men, and 20% in women, for patients under 60.





Wednesday, May 31, 2017

#PatientEngagement - "Attending: Medicine, Mindfulness, and Humanity"

The word "mindfulness" is rapidly becoming overused, but for understanding better patient engagement I heartily recommend Attending: Medicine, Mindfulness, and Humanity by Ronald Epstein, MD.


Before I can do another post with a full review, I have to say it is a book both for patients and clinicians. I'm constantly saying (almost my mantra) that what patients need the most are empathy and information. Ron explains with examples from his own practice ways to accomplish this, even when both parties are frustrated by time, and sometimes emotion.

Sunday, May 28, 2017

Healthcare consumerism: curated resources

These are the Web sites I've visited or are about to visit about healthcare consumerism in regards to optimizing healthcare delivery using the market-based tools of transparency and competition. (updated continually)

Fair Pricing

Healthcare Bluebook

Clear Health Costs

Fair Health Consumer

Pratter ("price matters")

Medibid

Prescription Drug Pricing

Good Rx

Pharmacy Checker


Determining Medical Necessity for Treatments & Services

US Preventive Service Task Force (USPSTF)

Choosing Wisely

Cochrane

Understanding Medical Research Reports

Health News Review



Tuesday, May 23, 2017

@pgpfoundation #FiscalSummit on #healthcare reform; livestream today




First, I hope everyone concerned about the economics of healthcare reform can join this panel discussion hosted by the Peter G. Peterson Foundation.

On their Web site there are other resources worth checking out, primarily this page dedicated to finding solutions to healthcare:
Improving our healthcare system to deliver better quality care at lower cost is critically important to our nation’s long-term economic and fiscal well-being. The U.S. currently devotes 18 percent of our economy to healthcare. Without reform, healthcare spending will grow to one-fifth of our total economic output within 10 years, which will make it increasingly difficult to find the resources to invest in other sectors of our economy.

At the bottom of this page there are more links to other resources discussing a fiscal solution to healthcare.

Friday, May 19, 2017

Quick scan: An American Sickness

I found out today about this new book published this past April: An American Sickness: How Healthcare Became Big Business and How You Can Take It Back, by a tweet linking to a Medium post by the author Elisabeth Rosenthal. I instantly recognized this as an important read (maybe I even pride myself on that skill).


Certainly books and commentary about the broken delivery in the US healthcare system are the rage now, and justifiably so, but I hope to find an author who can do a better treatment (pun!) of the topic than the sanctimonious rest.

I had to run out and buy the book, but had to give it a quick scan just to confirm my intuition.

Rosenthal starts the book by exploring the American system and its ills (the hot mess that it is), by using the traditional way a new patient is interview by the clinician: History & Physical, which includes the chief complaint, history of present illness, the review of systems, of course the physical exam and any labs or imaging results that may be available. The a diagnosis is offered, actually a series of diagnoses based on probability called the differential diagnosis, if one diagnosis is not immediately apparent. Treatment option could then be explained.

This might seem like a cute trick if you've been to medical school, but I think it is important for everyone to be familiar with this procedure. People should understand and let's hope practice being a good historian when it comes to their medical histories.

Now the carnage begins on Medicine USofA, a kind of vivisection of the beast but in a thoughtful, analytical way that only someone with clinical experience could do a good job of.

I skipped to chapter 12 "The High Price of Patient Complacency." It rightly suggests the need for everyone to learn the knowledge and skills necessary to be an assertive patient. Unfortunately entering the medical system these days requires a battle mindset, anticipating the various traps and deceptions all meant to increase profits of the providers. This sounds very cynical, but hospitals and clinics have in mind to keep their practices should be moving from a cost to a profit center.

During this past election cycle, I felt that the American public would benefit from a full week of reports about how to become an engaged patient in a failing healthcare system, but we got something else.

I hope social can embrace later chapters of this book, and realize they is more hope than being stuck with a victim mentality, being a passive aggressive participant in a pursuit towards health both physical and financial.


@DoSpace: Adaptive Technology for the Visually Impaired

I just finished a fascinating conversation with Doug, the lead technical trainer for Outlook Nebraska, Inc. at DoSpace, Omaha. I asked his permission to blog about his story and his use of technology as someone who has been blind for 22 years, and has had a kidney and pancreas transplant, all as a result of diabetes type I.

His keyboard sits atop a closed laptop, and he has an earbud to hear the spoken version of the text he's accessing. He wears a continuous glucose monitor which is sync'ed with his iPhone so he has a real time readout.

For email, he says Microsoft Outlook is the best for accessibility, but notes Gmail is good but is not quite complete because it doesn't label images or buttons simply labeled as a "button." He uses the KNFB Reader for optical character recognition on his iPhone, whose final cost is over $100. He's very pleased with how it performs, except with round medication bottles. Doug mentioned that he has an advantage in the dimly-lit restaurants when reading the menu.

Outlook Nebraska employs 80 visually-impaired people, which is remarkable since 70% of the visually-impaired are unemployed. As it happens, accessibility devices for the blind are expensive, in addition to needed medication, so having an income is important. But Doug has developed a successful career following his passion for technology, and is looking to expand the market for the products Outlook Nebraska produces.




Patient engagement: news & trends

A very important topic for which I've been seeing some good resources:

High drug prices: Don’t let industry excuses go unchecked–or patient voices go unheard

Few Doctors Discuss Cancer Costs With Patients, Study Finds
The results of this study was released in anticipation of the annual ASCO (American Society of Clinical Oncology) meeting next month.

An American Sickness: How Healthcare Became Big Business and How You Can Take it Back
It's always interesting to note how I come upon an important resource. In this case, it was from a tweet linking to Medium post (above) from the book's author Elisabeth Rosenthal. I will be picking up the book today.

(more to follow...)