Secret Shoppers In Medicine

The number of patients seeking care in the United States is outpacing the number of doctors available. That means the amount of time it takes to acquire an appointment for an office visit is growing. This problem will only grow when newly-covered patients enter the market with the healthcare reform. The government wants to make sure that when these new patients do seek care, under government coverage, they're not treated differently than privately-insured patients. That's why they sought to conduct a survey that's basically a "secret shopper" situation.

Survey participants would call 4185 medical offices across nine states (Florida, Hawaii, Massachusetts, Minnesota, New Mexico, North Carolina, Tennessee, Texas and West Virginia). These participants would present a situation where they are a new patient with varying symptoms, once with private insurance and once with government aid. They were to report back whether they are refused care or told a longer wait time in the latter situation. In a sampling of 11% of these prior contacts, the office would be called a third time and the caller will introduce themselves as Health and Human Services officials in acquiring information on how many private and government-assistance insurance patients the office says they accept. These numbers would be compared to what the prior "secret shopper" patients were told.

While this survey would give a good report on how physicians realistically respond to differing insurance situations, many doctors are not happy with the government basically becoming a "Big Brother" in spying on them. However, with the coming healthcare reform and the influx of new patients, an accurate accounting must be acquired to assure that patients are treated fairly and not discriminated against because of how they pay for services. The White House has since put aside the proposed plan, seeking other solutions on how to improve patient access. What do you think? Was this a step too far for the government in their quest for information or was it a reasonable survey situation?

Free Medical Translation

Often, physicians and patients will have a communication gap because of differing language. Waiting for a translator to be located and arrive takes time away from the physician's busy schedule, as well as sacrificing precious time that could be spent treating the patient. It would be wonderful if there was a piece of technology that could aid in this process. And now there is.

MediBabble is an iPhone/iTouch app that can be downloaded for free from iTunes. It contains a standard set of medical questions in a number of languages (Spanish by default, but Mandarin Chinese, Cantonese, Russian, and Haitian Creole can be downloaded through the app). The physician chooses which question they would like to ask and then the phrase is read aloud for the patient in their chosen language. The patient answers with either yes/no or a gesture so that all responses can be understood even if the physician does not speak their language. And if the patient cannot hear, the questions are automatically translated to the selected language so that they can be read instead. Best of all, the app doesn't require an active internet connection for translation. Once it's been downloaded, the physician can use it anywhere, regardless of connectivity.

The app has been getting a lot of attention through the media already and is set to expand and refine through future developments. Already, the app contains thousands of questions that can be used, all based around a standard patient exam so that the necessary information can be conveyed. It is a great resource for health professionals and definitely worth a look. Check it out today.

iPad Required for Freshmen

Textbook costs are high and only getting more expensive. As a result, students' budgets are becoming more and more stretched. Often, students will have to lay out a large amount of money for a textbook that they'll only use certain chapters out of. When they go to resell these books, they often do not recoup much of their initial costs either. News recently came through The Chronicle of Higher Education that Brown University may have found a way around these issues by going digital; or they may be causing a larger monetary problem for their medical students.

Students entering the medical school at Brown University in Fall 2011 will be required to purchase an iPad in order to use the Inkling app to obtain a number of required textbooks, either full texts or certain chapters as they're assigned. On one hand, this would eliminate the rising costs of printed texts since everything can be delivered electronically and only the relevant sections would need to be bought. On the other hand, this is a large upfront cost that will be required of all students coming in to obtain the necessary iPad. There will not be a chance that students can get by cheaper by buying used textbooks, since they will no longer exist in the electronic marketplace. Every student will have to pay out the same amount in order to take the classes. So, is this move to technological adoption a benefit or an impairment for students?

New Cigarette Warning Labels

The deadline for unveiling the new warnings for cigarettes is here and the FDA has chosen the 9 images that will now be used on a significant area of cigarette packs. Requirements state that they must cover at least 50% of the package back and front. In cigarette ads, the images must cover at least 20% of the ads that measure over 12 inches. The hopes is that these disturbing images will cause current smokers to think twice about their habit, as well as dissuading new smokers from picking up the habit.

"With these warnings, every person who picks up a pack of cigarettes is going to know exactly what risk they're taking." ~ Kathleen Sebelius, Health and Human Services Secretary 

Despite protests by the tobacco industry, the government is requiring that these warnings must by in place by September 2012. The question is, will this dissuade smokers or will they simply overlook the graphics while reaching for their next cigarette? Using tobacco leads to the loss of 443,000 lives every year, with over 8 million people suffering from a tobacco-related illness, but can this number be brought down with the use of disturbing imagery?

The opinions are split. On one hand, there's the immediate reaction to these images as being "gross", which would dissuade consumers from picking them up, thus lowering the number of deaths and illness associated with use. On the other hand, tobacco users have long known the health implications of their habit, so being faced with these images might simply desensitize them rather than changing their behavior.

The final outcome of these warnings has yet to be seen. What do you think? Will it be a good move in terms of improving health or will it backfire?

Recovery in College

College is a time when students embark on a new phase of their lives, when they start living on their own and learn the information that will form the basis of their future careers. However, for some students, college is also a time when they are making a new start separate from their former addictions.

A number of colleges across the country have set up residence halls for students who are currently in addiction recovery. These students are facing temptations not only in the normal college atmosphere, but also if they choose to return home. There is the temptation to partake in alcohol and other drug use while in college. Students who are already prone to addiction must have a support system in place to help them with these behaviors exhibited by their peers. Additionally, they may be trying to separate themselves from addictive behavior that's exhibited among their peers and family back home, so they must have a safe place to live when college is on break. These recovery residence halls provide for both.

Examples of such residence halls include the planned Tribeca Twelve, which covers universities throughout the Manhattan region. The residents will be tested periodically to make sure they're still clean and, if not, their relapses will be dealt with individually. This hall will have a support system among students, accessibility to counselors, and sober social events that will allow students to partake in the social aspect of college without the temptation of addictive substances.

“We want to show students they can have fun while being sober. These are emerging adults, and emotionally, they tend to get stuck at the age they started using heavily. We want to help them break through that and get unstuck from the emotional state they were frozen in when they started using.” ~ Mark Mishek, President and CEO of Hazelden (which runs Tribeca Twelve)

This residence hall is modeled on the already-successful StepUp® program at Augsburg College. Situated in Minneapolis, it already benefits from being located near a number of addiction support meetings. Additionally, with its low residence numbers (75 annually), individualized support can be provided through meetings, counseling, and community-building activities. Requirements for residence includes staying sober six months prior to moving in, living in the hall for 1-2 years, and maintaining sobriety while living in the residence hall.

By providing a supportive community to college students in recovery, the rate of sobriety can be maintained, as well as providing a positive environment where academic outcome is actually better than their peers. Without the need to focus on the temptations of addiction, they can more readily focus on their classes and achieve academic success.

Gender Matters In Addiction

It's long been known that men and women's bodies respond differently to both addiction and treatment. This is especially true when it comes to alcohol addiction. A new article in Harvard Magazine delves more deeply into this gender-based response.

When women drink alcohol, their bodies do not metabolize the substance as quickly as men. In fact, women only absorb about 25% of alcohol in their stomachs and intestines when compared to men. That means 75% more ethanol enters their bloodstream. When coupled with the fact women have lower water content in their bodies and they also have a lower body mass, the effects of alcohol in women is much higher than in men. This quickened response to alcohol in women has also led to women becoming dependent faster than men. That means they require intervention sooner than their male counterparts.

With these differences in mind, the medical field should focus their attention on women in screening and treatment. Mixed gender treatment is not necessarily a worthy solution, as the needs of women and the motivations for drinking will be different than in men. Additionally, with noted body differences, the approach to treatment and intervention must be gender-focused to make it more individualized.

The improvement of patient health is of utmost importance and the best way to achieve such positive outcomes should be researched. Addiction treatment for everyone is an issue that medical professionals should pay attention to.

Conservative Prescribing

A common response to health issues is to prescribe medication to solve the problem. This has caused our society to become dependent on these drugs and, in some cases, the medication is actually not helping at all. A recent article in the Archives of Internal Medicine has called for a more conservative method of prescribing.

Doctors must take a new approach to treatment, according to the authors. Instead of jumping straight to medication as the solution, they should look into other treatment choices that may help. Using prescribed drugs always brings with it the possibility of adverse reactions in the patient. They may suffer worse symptoms from the drug than from their original illness, so it's important to find a way to prevent this from happening. One obvious way is to find treatment that doesn't rely solely on medication.

Would the patient's situation be improved by a change in diet? Are the symptoms merely covering a larger, underlying problem? Is there a way to practice prevention rather than dealing with the aftermath? It's important that physicians make a larger change in patient outcome rather than treating each problem as it comes along. By relying on medication, these larger changes are often not undertaken, and that may cause larger long-term issues.

By accepting a mindset of conservative prescribing, health professionals can eliminate the reliance on medication and can actually help improve their patient's long-term outcome by aiding in a change in overall behavior rather than a short-term solution for the problem that has arisen.

When Lies Save Lives

We are taught early in our lives that lying is bad. But how about if it's for a good cause? Time has just published an article about doctors lying in order to get better care for their patients. The example case for this article was a doctor who ordered a non-contrast CT to, as they said, look for possible kidney stones, but the real reason was to confirm a suspected inflamed appendix and get the patient into surgery even sooner. In the end, the patient benefited because the doctor's suspicion was confirmed and the appendix was taken care of. However, is this type of behavior okay to condone?

There are some cases where little white lies benefit the patient, but there are others where it's not so easy. Ordering the wrong tests or unnecessary tests means the insurance company is billed for procedures that weren't warranted and the physician is reimbursed for these expenses. Additionally, when doctors play a hunch and order the incorrect test, there's always the possibility that the results will not confirm the suspected diagnosis and then it may be harder to order the correct, more time-consuming, test because there's no backing for the suspected diagnosis. 

The question then becomes two-fold. Should doctors continue to act in such a manner? And should this behavior be openly taught to medical students so that it continues throughout the next generation? Medical students learn by watching their superiors and emulating them. When they are shown that little white lies to get around medical rules is acceptable, they are more apt to do the same. However, this has the potential to put the patient, the physician, and the entire medical industry in danger. There are rules for a reason, but sometimes these rules prevent swift action for the patient. What is the best solution?

Improving Internal Medicine

Earlier, we posted about NPA's top five suggestions to improve family medicine. Today we look at their suggestions for internal medicine. A number of the suggestions are the same for the two areas, with some slight differences. However, all suggestions are worth consideration and should be integrated into everyday practice to improve patient outcome.

1. Reduce Immediate Imaging for Lower Back Pain: Patients often come to their doctor complaining of lower back pain. In fact, it's the fifth most common complaint that physicians hear. However, the first response should not be to order imaging. Ordering this test not only increases the costs to patients, but it does not actually improve outcomes. If no other cause or improvement can be seen in six weeks, and the patient is not showing any other red flags that warrant earlier testing, then imaging of the lumbar region is recommended.

2. Urinalyses and Blood Chemistry Panels Unnecessary When Showing No Symptoms: When a patient comes in, the common reaction is to order tests. However, these tests may be both unnecessary and costly when the patient is showing no obvious symptoms for the disorder being tested for. The only exception is if an adult is showing signs of hypertension. Then it is warranted to screen for Type 2 Diabetes, since the patient may not be showing symptoms for the disorder.

3. Cardiac Screenings and ECGs May Not Be Necessary: If a patient is showing no signs or symptoms of cardiac illness, order a screening as a preventative measure is both costly and unnecessary. If you order such screenings, there's a chance that the results will be a false positive and treatment may actually harm the patient.

4. Generics Are Okay When Lowering Lipids: Brand names are costly and often unnecessary when generic drugs can do the same job with a lower cost. Patients should be prescribed the generic version of the drug by default and only required to pay for the more expensive brand name drug if improvement is not seen or if the patient has a negative reaction to the generics. The lower costs may also have the benefit of higher use, since patients will not have to worry about paying a higher amount for their prescription or debating whether they can afford it at all.

5. DEXA Osteoporosis Screening Is Age Dependent: If a woman is under the age of 65 or if a man is under the age of 70 and shows no risk factors, they do not need to be screened for osteoporosis. Screening is costly and has shown no positive benefits. Wait until the patient is within the risk age group and then start screening, or screen earlier if they have shown risk factors such as vitamin deficiency, smoking, or having a small/thin frame.