Articles Posted in Primary Care

PE-Color-240x300The Republicans haven’t waved a white flag—yet. They may never formally surrender. But the GOP’s seven-year, take-no-prisoners campaign to repeal and replace the Affordable Care Act, aka Obamacare, has foundered. For good?

Political prediction is a knucklehead’s sport. It’s never safe to predict what’s going to happen, especially when unpredictable tragedies rear up like  Sen. John McCain’s brain cancer diagnosis.

No matter. We now know painful truths about the politicians who have sway over our health care—and will continue to do so in vast ways, Trumpcare or no.

Donald_Trump-1-225x300Republicans in the U.S. Senate will spend a long Fourth of July break trying to figure if they can repeal and replace the Affordable Care Act, aka Obamacare, with their Better Care Reconciliation Act, aka Trumpcare. Their bill, drafted in large part by just 13 GOP senators, some of the most conservative in the Senate, failed to win sufficient support so Majority Leader Mitch McConnell even could get it up for a vote before the holiday recess.

Lots of negotiations are under way.

In case you missed it, the Congressional Budget Office provided its independent analyses, scoring the cost and effects of the bill. The CBO estimated it would save the nation $321 billion in health-related expenditures in the next decade but would strip 22 million Americans of coverage, slightly fewer than would lose health insurance under the House-approved Trumpcare.

obesity-300x161Although weight issues plague Americans as gravely as anywhere on the planet, obesity also has become a global woe, increasing sharply over the last three decades in 195 countries and afflicting an estimated 604 million adults and 108 million children—roughly 10 percent of the world’s population.

No nation on earth, even with the terrible toll that obesity takes in economic and health terms, has found a way to get its people skinnier and healthier: Weight woes are blowing up in disparate places like Saudi Arabia, Algeria, Egypt, Burkina Faso, Mali, and Guinea-Bissau, international researchers have reported in the New England Journal of Medicine. Obesity is now a major concern, too, for the people of China, Turkey, Venezuela, and Bhutan.

Public health experts worry about the skyrocketing numbers of overweight people around the planet because evidence shows obesity to be a major factor in heart disease, diabetes, cancer, and other debilitating conditions.  These afflictions, combined with weight issues—including among those considered to be too heavy but not necessarily obese—contributed to four million deaths in 2015 alone, said the experts, participating as part of the Global Burden of Disease initiative.

Kellyanne_Conway-214x300Don’t  tune out because conventional wisdom suggests it’s “just” a program for the poor. The partisans’ planned push for changes to Medicaid could have significant consequences for millions of Americans, many of them middle-class, older, disabled, and sick.

The Medicaid changes, as various officials like counselor to the president Kellyanne Conway, have described them without detail for now, also could stagger state and local governments’ finances, including the already strapped District of Columbia, which might see a half-billion- to billion-dollar hole blown in its budgets.

Although significant and merited public attention has focused on the GOP’s crusade to repeal and replace the Affordable Care Act, aka Obamacare, and especially how it affects health insurance, many Americans may not be as riveted by what happens to Medicaid. Republicans have reviled for years now a part of the ACA’s reforms that expanded the government program, but only, as a result of a U.S. Supreme Court decision, if states agreed. Thirty-one states and the District of Columbia did so, 19 did not. This meant that 11 million Americans, most of them the working poor, received health care coverage via Medicaid.

skepticism-image-197x300At one point, medical experts recommended that physicians aggressively treat patients 60 and older so the top number of their blood pressure readings ran as close as possible to 140. Maybe not so, anymore. For a while, physicians were told to treat patients so their “good cholesterol” increased significantly. But maybe this approach doesn’t protect against heart disease after all. Pediatricians once warned parents to protect newborns by not exposing them to certain allergens, especially peanuts. If you haven’t had your head buried in the sand, that counsel, of course, has just changed 180 degrees.

Thanks are due to Aaron E. Carroll, a pediatrician, health research and policy expert, and columnist with the New York Times “Upshot” feature, for reminding — yet again, as repetition is the Mother of Learning — that medical news must be taken in by patient-consumers with a “dose of healthy skepticism.” This he says is especially true about reports on nutrition.

I’ve written about the harms that result from hype and the many, sometimes dramatic reverses in health and medical news. I’ve pointed out that there are accessible resources, such as the excellent healthnewsreview.org, to watchdog coverage of medical science and so-called advances. I’ve suggested that patient-consumers look closely at key elements in research stories, including how the work was done, how long the study ran, whether its data is visible and if it was published in a reputable medical journal. This will help savvy readers look askance, even at pieces in quality news sites — such as recent articles touting turmeric or eating lots of hot peppers.

pthiel-200x300Although attention has focused on the GOP-promised repeal and replacement of the Affordable Care Act, other big changes also are afoot in the federal government that will have significant effects on health care in this country.

There are appointments pending from President Trump at the federal Food and Drug Administration and the Centers for Disease Control and Prevention. Sonny Perdue, the administration’s pick for Agriculture secretary, also will play a big public health role, as will the personnel decisions that may be made at the troubled National Institutes of Health, where, for now, Francis Collins will continue to lead.

Will the FDA be run by a venture capitalist?

Dr. Bruce Leff explains why geriatric healthcare is best practiced out of the hospital

It wasn’t that long ago — see those classic black-and-white movies — when hospitals commonly cared for many different kinds of patients in large open wards. Young volunteers, women known as “candy stripers,” could be seen rolling carts down the aisles between the many rows of beds, selling cigarettes. Families might pop in for a visit, carrying for their sick kin a chicken dinner on a plate covered by a white napkin.

With the huge changes that the Affordable Care Act has brought to hospitals and American health care, and with the shifts that are yet to come if Obamacare gets repealed and replaced, it’s easy to forget how significantly and rapidly medical services continue to transform.

price-portrait-300x253The Republican-controlled Senate has launched itself in a late-night session on the path to its long-pledged repeal and replacement of the Affordable Care Act, aka Obamacare. The GOP-controlled House on  Friday the 13th followed close behind.

Lawmakers have chosen a complex parliamentary path. GOP members are expressing confusion about their way forward, even as doubts are being voiced by GOP governors in states where the ACA has expanded health care for the poor through Medicaid. The president-elect has called for swift action — insisting on not just Obamacare’s repeal but also its replacement with an undefined plan that he says will provide health care coverage that’s better than what exists now and for more Americans.

With big, many, and byzantine legislative steps needing to be taken even beyond “repeal,” can the ACA be replaced, too — and with what?

med-records-300x200In the best of all worlds, none of us will need any time soon to race to a nearby urgent care center or to pop by the retail, walk-in clinics that have sprouted in neighborhood drug stores across the country. But if you do find yourself at one of these “doc-in-a-box” clinics, here is some good advice. A lot of this applies to regular doctor visits, too.

A tip of the hat to Dr. Peter Ubel, who posted recently at Forbes and KevinMD.com, the physician information-sharing site, his suggestions of a half dozen “essentials” that patient-consumers might need to know before a retail clinic visit. He based these on positions taken by the American College of Physicians and published in the peer reviewed  Annals of Internal Medicine.

Ubel says “doc in a box” operations (retail clinics, often staffed with physician assistants or nurses) are suitable for low-level, ordinary treatment for things like poison ivy or sore throat. When patients go to these clinics, they need later to fully inform their doctors about the care they got (see the next paragraph). They shouldn’t take referrals to specialists from staff at walk-in clinics. The facilities are OK for patients who are “relatively healthy,” and who don’t have a “complex medical history,” meaning they lack chronic or difficult conditions. Patients with greater challenges need to see their own doctors, regularly if need be. Ubel calls out his colleagues, noting that if they were more responsive to their patients, or figured out alternatives when they can’t, docs in boxes wouldn’t be flourishing as they are.

commty care ncHospitals and health systems are making stark choices between offering models to assist their communities and reduce medical costs−or raking in profits, no matter how outrageous and shame-provoking their charges might be. Evidence of the extremes came this week in reports about alternative realities.

Let’s start with the positive view, recognizing exemplary efforts in the Charlotte, N.C.-area to both help patients and to sharply cut medical costs. Forward-looking health policy experts decided to dive into the highest Medicaid users of emergency services, discovering, for example, that just one patient, a homeless alcoholic man, visited the ER 223 times in 15 months and had undergone 150 redundant and needless X-rays or other scans. Many of the top 100 “frequent flyers,” poor and repeat ER patients, took an exceedingly costly route to fill prescriptions or to seek pregnancy or other routine tests; 86 of these individuals were known to have behavioral woes, including depression or bipolar disease. The experts found that these individuals visited multiple ERs on the same day, sometimes crossing a street or two to do so. They appeared on hot or cold days, suggesting their real need might not be medical but for shelter.

Community Care North Carolina — an umbrella group, with cooperation and support from hospitals, social workers, nurses, and social service agencies — searched out the heaviest using Medicaid-ER patients. They needed to comb the streets, jails, and even a strip club. They helped the patients find responsive primary care doctors, and other assistance, for example, in managing chronic illnesses and conditions. They connected them with social service agencies for assistance with existing housing, nutrition, jobs, and transportation programs. As the Charlotte Observer reports:

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