The WELL: inkwell.vue.375: Health Panel, 2010

#40: Alan Greene (dralangreene) Fri 5 Feb 10 09:40

Fri, 05 Feb 2010 09:40:00 PST

Thanks, Gail. Your quote is now a post-it note on my (very cool treadmill) desk:

"We've got to improve health care in this country, inch by inch if necessary, from all directions." [Read entire topic]

#39: Gail (gail) Wed 3 Feb 10 10:54

Wed, 03 Feb 2010 10:54:00 PST

I'm so sorry to hear that you guys are going through this with insurers now, Alan.

We've got to improve health care in this country, inch by inch if necessary, from all directions. Legislative, working within the healthcare field, as informed patients and advocates for family members. I've got pre-existing concerns too, and for those who don't, I wish you good luck in not being in those shoes in the future, but please remember that you or a loved one could be.

Thanks for contributing to this online roundtable. [Read entire topic]

#38: Alan Greene (dralangreene) Wed 3 Feb 10 09:00

Wed, 03 Feb 2010 09:00:00 PST

During the course of this two week discussion, we lost our health insurance because of a job change.

And Cheryl is tough to insure because she beat such a serious breast cancer. We've already had one rejection this week, even though she beat it cleanly 14 years ago with no signs whatsoever of recurrence.

I agreed passionately with Gail before. I feel it in my bones now. We need this:

Ten reasons why we need Congress to pass health care reform now:

1) Discrimination based on pre-existing conditions would end. 2) No one would lose insurance because they get sick. 3) No more lifetime limits on benefits. 4) 31 million uninsured would gain affordable health coverage. 5) Medicaid (a public plan) would cover 15 million additional people who are currently at risk. 6) Low- and moderate-income families would get subsidies for insurance and co-pays. 7) No more discrimination in premium costs based on gender. 8) New limits on insurance company profits & administrative costs. 9) Losing your job would not mean losing your health care. 10) All insurance policies would be required to provide preventive care without co-payments. [Read entire topic]

#37: paralyzed by a question like that (debunix) Mon 1 Feb 10 20:34

Mon, 01 Feb 2010 20:34:00 PST

In this physician's practice, I am already disturbed by the disconnect between the availability of treatment for various conditions and my ability to prescribe them, or not, for patients based on their ability to pay. It's not simply about who has the most money, or the most expensive all-inclusive insurance plans: sometimes we can offer the best care to those with nothing but MediCal, because MediCal doesn't fight us as much as some of the private insurers do. This is true especially when it comes to the often rare conditions we treat--too few patients for there ever to be the kind of large, controlled trial the FDA requires to create an approved indication for a drug. I see patients with the best insurance who have great care, patients with MediCal who have great care, and patients who have so-so insurance who really get stuck in between. [Read entire topic]

#36: Jon Lebkowsky (jonl) Mon 1 Feb 10 20:14

Mon, 01 Feb 2010 20:14:00 PST

If you're not on the WELL, you can still send comments and questions that moderators will post here. Just email to inkwell@well.com [Read entire topic]

#35: Jon Lebkowsky (jonl) Mon 1 Feb 10 20:02

Mon, 01 Feb 2010 20:02:00 PST

Would either of the current versions of healthcare reform legislation be helpful? And if we pass nothing, are we going to see a meltdown?

An observation: I've been privy to discussions for years about how modern medicine will double, or better than double, life spans. I know we already have technologies that can make a huge difference for many. But I'm also aware that prices are going up, way up. I've seen patients unable to buy prescriptions because the insurance policy wouldn't pay the full cost (and the patient would have to come up with hundreds of dollars for a month's Rx). My observation is that, while we might create healthcare innovations that can prolong life, and quality of life, unless we have an intervention in healthcare, only the rich will be able to afford them. I can imagine a future where any kind of quality healthcare is a luxury, only for the rich. I'm wondering how this looks from a physician's perspective? [Read entire topic]

#34: David Albert (aslan) Mon 1 Feb 10 10:49

Mon, 01 Feb 2010 10:49:00 PST

Um, yes? [Read entire topic]

#33: Julie Sherman (julieswn) Mon 1 Feb 10 09:08

Mon, 01 Feb 2010 09:08:00 PST

My experiences when I was first dealing with cancer were that my doctors were not interested in what I was doing in addition to the chemo and radiation. I did amazingly well (My oncologist said I made chemo and rad look easy). I was doing all sorts of alternative things and none of them were interested in hearing about any of the additional treatments I was doing (accupuncture, Chinese herbs, various supplements). It was annoying and a bit sad. Is this because of their training that Western Medicine is king and everything else is silly? [Read entire topic]

#32: Daniel Hoch (danielhoch) Fri 29 Jan 10 14:18

Fri, 29 Jan 2010 14:18:00 PST

this looks like it's been a great conversation so far, and I wish I had been able to be more engaged during this last week and a half. I have much to say about the recent comments on healthcare reform that I'll try to jot down later tonight.

As far as the last question goes:

" does anybody know if this movement has reached medical schools in terms of training the next generation? Do doctors need to learn a little about teaching various kinds of learners?"

I get to teach medical students at Harvard with frequent visitors from other medical schools. My impression is that there is not an easy answer to the question. The concept of the truly empowered patient, as some of us here use it, has probably not been integrated into any medical school curriculum. However, there is a lot of emphasis on changing the way doctors and patients interact. Medical schools attending to the teaching and modeling of empathy, and are emphasizing the fine arts of observation and listening. And, while medical schools recognize that no one can know everything, the doctor continues to be trained as the "expert" of the online tools and computer-aided clinical decision-support that keep us all healthy in the information age. Not Exactly a "participatory" model. [Read entire topic]

#31: Jon Lebkowsky (jonl) Fri 29 Jan 10 13:55

Fri, 29 Jan 2010 13:55:00 PST

Particpatory medicine is just getting legs, I think. It hasn't been formalized in any way, as in some kind of instruction in med schools. Our purpose in launching the Journal of Participatory Medicine was to facilitate the kind of evidence-based research you'd need to build participatory medicine programs and initiatives.

I've done social media work for hospital systems and pharma companies, and they were very aware of the Internet's impact on healthcare, patient communities, etc. It's relevant to their marketing and community engagement practices.

I have a friend whose wife is in ER physician, and he was telling me second-hand her position - that patients who've investigated their conditions online can be led down a rabbit hole of misinformation and misunderstanding. I understand the concern - patients don't have the context of medical discipline, they don't necessarily know how to take the information that's increasingly available online. But you don't address that sort of issue by wishing it would go away. Better education and information is better than less information; engaged patients are better than passive patients. Those are the assumptions, anyway - we need to gather evidence to make the case, and to point to best practices and possible insitutional responses. [Read entire topic]