Sunday, August 8, 2010
fascinating article about hiv med pipeline
http://motherjones.com/politics/2007/05/psst-got-antiretrovirals
Tuesday, July 27, 2010
Sunday, July 18, 2010
unexplored factor in rising healthcare costs
Great article about hospitals' group purchasing organizations, or GPOs, and how they drive health care costs up in a variety of ways.
Friday, June 11, 2010
12%
So it's been awhile since I posted, and that's mostly because I don't really know what I want this blog to be in the future. Since I have started my first NP job, it's tempting to post about interesting cases I see there. But there are lots of other medical blogs that already do a similar thing very well. So, I think for the time being, I will continue to post very, very sporadically, more or less as I am inspired to write. The story below is pretty, ahem, inspirational.
I had an admission yesterday who completed of chest pain. Although he put it at about 6/10, he said it had been around for awhile, was more or less constant, and had no other cardiac symptoms. He had never had it worked up before and was able to converse with me at length without any outward signs of discomfort or anxiety. So, almost certainly not a heart attack, or even angina. What he did have was a number of respiratory symptoms, and a 20 year history of smoking half a pack a day. EKG normal. Signficant wheezing bilaterally in lower lobes. Physical exam otherwise normal. Blood drawn after.
I spoke with the patient about the fact his discomfort was likely due uncontrolled asthma or COPD. I said that he would need appropriate treatment, and might need further cardiac evaluation. I offered him the option of signing up for primary care at ARTC, but he declined, opting for a provider at North General Hospital. Fine. I wrote a referral to his future internist, explaining our findings, emphasized that to him that he should see his doctor soon, and referred hom for a chest x-ray.
This morning he is in my office for a dose eval. I asked if he had gotten his insurance sorted out and the CXR done. He told me he had instead gone to the emergency room. I asked why, he said "the pain in my chest". I reminded him he had had the pain yesterday and for months prior; what made him decide to go to the ER last night? He looked at me blankly before understanding, and stated halfheartedly, "It got worse." He was, however, pleased with his care. After all, they had done an EKG, bloodwork, and a chest x-ray. Then they had written him a referral for follow-up care.
Aaargh. I can't shake the feeling he went to the ER because I scared him by telling him something was wrong with him, but he didn't want to go through the administrative hassle of signing up for an actual primary care doctor, who almost certainly would have started him on appropriate care and referred him to a cardiologist. But now, he's been worked up twice in the same day for the same symptoms, and he still doesn't have an MD to prescribe what's needed for his asthma/COPD. So basically more dollars have been spent, and the overall result was worse.
American medicine is like 12% of GDP and yet our life expectancy is shorter. Stories like the above are why.
I had an admission yesterday who completed of chest pain. Although he put it at about 6/10, he said it had been around for awhile, was more or less constant, and had no other cardiac symptoms. He had never had it worked up before and was able to converse with me at length without any outward signs of discomfort or anxiety. So, almost certainly not a heart attack, or even angina. What he did have was a number of respiratory symptoms, and a 20 year history of smoking half a pack a day. EKG normal. Signficant wheezing bilaterally in lower lobes. Physical exam otherwise normal. Blood drawn after.
I spoke with the patient about the fact his discomfort was likely due uncontrolled asthma or COPD. I said that he would need appropriate treatment, and might need further cardiac evaluation. I offered him the option of signing up for primary care at ARTC, but he declined, opting for a provider at North General Hospital. Fine. I wrote a referral to his future internist, explaining our findings, emphasized that to him that he should see his doctor soon, and referred hom for a chest x-ray.
This morning he is in my office for a dose eval. I asked if he had gotten his insurance sorted out and the CXR done. He told me he had instead gone to the emergency room. I asked why, he said "the pain in my chest". I reminded him he had had the pain yesterday and for months prior; what made him decide to go to the ER last night? He looked at me blankly before understanding, and stated halfheartedly, "It got worse." He was, however, pleased with his care. After all, they had done an EKG, bloodwork, and a chest x-ray. Then they had written him a referral for follow-up care.
Aaargh. I can't shake the feeling he went to the ER because I scared him by telling him something was wrong with him, but he didn't want to go through the administrative hassle of signing up for an actual primary care doctor, who almost certainly would have started him on appropriate care and referred him to a cardiologist. But now, he's been worked up twice in the same day for the same symptoms, and he still doesn't have an MD to prescribe what's needed for his asthma/COPD. So basically more dollars have been spent, and the overall result was worse.
American medicine is like 12% of GDP and yet our life expectancy is shorter. Stories like the above are why.
Friday, February 26, 2010
nyc surgical disparities
A recent, unsurprising study indicates minority (that is to say, nonwhite) patients are less likely to go to "high-volume hospitals", in which the certain procedures are done very frequently, than white patients.
The Yale study (I was unable to find a link directly to it) reviewed the cases of 133,821 patients in NYC who underwent one of ten procedures in between 2001 and 2004. The procedures were varied: some CV, some ortho, and some oncology. The procedures selected were ones for which published evidence indicates that going to a high volume hospital lowers patients' short term risk of death. Approximately 75% of the patients studied where white, and the remainder were black (13.1%), Hispanic (8.4%), and Asian (3.2%). For all ten procedures, according to eScience News, white people were more likely to be treated at high-volume hospitals than any other ethnic group.
Often, geography is blamed as a barrier for minority access to world class care, although the study deliberately attempted to control for this by including only hospitals in NYC. Study authors speculate one reason minority patients might be less inclined to high volume hospitals is "racial/ethnic differences in access to or use of information about provider quality" as quoted in the article linked to above.
PS Yes, I know it's ironic to refer to non-whites as minorities since they make up the majority of NYC.
The Yale study (I was unable to find a link directly to it) reviewed the cases of 133,821 patients in NYC who underwent one of ten procedures in between 2001 and 2004. The procedures were varied: some CV, some ortho, and some oncology. The procedures selected were ones for which published evidence indicates that going to a high volume hospital lowers patients' short term risk of death. Approximately 75% of the patients studied where white, and the remainder were black (13.1%), Hispanic (8.4%), and Asian (3.2%). For all ten procedures, according to eScience News, white people were more likely to be treated at high-volume hospitals than any other ethnic group.
Often, geography is blamed as a barrier for minority access to world class care, although the study deliberately attempted to control for this by including only hospitals in NYC. Study authors speculate one reason minority patients might be less inclined to high volume hospitals is "racial/ethnic differences in access to or use of information about provider quality" as quoted in the article linked to above.
PS Yes, I know it's ironic to refer to non-whites as minorities since they make up the majority of NYC.
Saturday, December 26, 2009
nyc's sugar-betes
Hope everyone's having a happy holiday weekend!
Two diabetes-related pieces of news have surfaced recently. One: unfortunately, diabetes is on the rise in NYC. According to a November 2009 report from the NYC Department of Health and Mental Hygiene, diabetes is up 13% from 2002. It is more prevalent in men than women, and in those without a high school degree than those with a diploma. Interestingly, the death rate from diabetes has not moved since 2002 (it was then and is now 18 deaths per 100,000 New Yorkers) but it is likely to be underreported. As most reports on diabetes have noted, the illness disproportionately affects African Americans, Hispanics, and those from low income neighborhoods.
The other interesting item is that NYC's Health and Hospitals Corporation (the largest public health care provider in the country) has recently launched an online program to help the 58,000 diabetics under its care. The site features advice on how to control diabetes by eating healthfully and exercising. The site also features some patient success stories to motivate readers.
Two diabetes-related pieces of news have surfaced recently. One: unfortunately, diabetes is on the rise in NYC. According to a November 2009 report from the NYC Department of Health and Mental Hygiene, diabetes is up 13% from 2002. It is more prevalent in men than women, and in those without a high school degree than those with a diploma. Interestingly, the death rate from diabetes has not moved since 2002 (it was then and is now 18 deaths per 100,000 New Yorkers) but it is likely to be underreported. As most reports on diabetes have noted, the illness disproportionately affects African Americans, Hispanics, and those from low income neighborhoods.
The other interesting item is that NYC's Health and Hospitals Corporation (the largest public health care provider in the country) has recently launched an online program to help the 58,000 diabetics under its care. The site features advice on how to control diabetes by eating healthfully and exercising. The site also features some patient success stories to motivate readers.
Thursday, December 3, 2009
grad school blues
It's that time of year. Well, yes; it's the time of year when Santa posters appear in bodega windows and the radio plays Trans-Siberian Orchestra's version of "Carol of the Bells", which sounds like it belongs on the soundtrack of The Bourne Identity. But it's also the time of year when grad school really starts sneaking up on you.
I have not gotten my hair cut since September, and it is a streak that will remain unbroken into 2010. My room, usually neat, was an unholy mess when I left it last night to meet up with my boyfriend. My wallet is a quagmire of tickets, receipts, and business cards that will only with diligent searching give up a dollar bill. I am unsure when, how, and indeed if my Christmas shopping will get done. The scenario is this: I have class Mondays, clinical Tuesdays and Wednesdays, and work Thursdays and Fridays. I also occasionally have clinical on Saturday and am at work for a few hours every Sunday. Don't get me wrong; my life is great. I am finishing up a program that leads to a great career, I am working part time as I do it, and I still have the opportunity to maintain great relationships with friends/boyfriend/family/roommates. But all this comes at a cost: the little shit is not getting done.
I doubt I'm the only one who feels this way, as I doubt I am the only one who cannot justify her disproportionate crankiness about things like this. After all, what does it matter that I just dragged 20 lbs of laundry across the street because I couldn't get my act together before it weighed as much as a small child? That I haven't blogged in forever? (Although this blog obviously a collection of seminal insights into public health, I know everyone who reads it and they've all got better things to do than wait around for a post.) Why do I care that the bottom of my backpack is littered with...litter? Or that before dragging them off today, the last time I washed my sheets was...was...hmmm...
Anyway, it does matter. It does. Not because any one of these things is in and of itself important, but because these are the things that make me feel like I'm in charge, instead of my schedule. Like I am on top of things, instead of buried under a pile of incomplete tasks. Simply put: taking care of the little shit is how I maintain my illusion of control. And that illusion is fading.
I console myself with this thought: less than three more weeks. Time will handly what I evidently cannot. On December 14, I will have my final final. On December 19, I will complete my last clinical hour. And then, in all likelihood, I will go home and take a nap. Before getting up and washing my sheets.
I have not gotten my hair cut since September, and it is a streak that will remain unbroken into 2010. My room, usually neat, was an unholy mess when I left it last night to meet up with my boyfriend. My wallet is a quagmire of tickets, receipts, and business cards that will only with diligent searching give up a dollar bill. I am unsure when, how, and indeed if my Christmas shopping will get done. The scenario is this: I have class Mondays, clinical Tuesdays and Wednesdays, and work Thursdays and Fridays. I also occasionally have clinical on Saturday and am at work for a few hours every Sunday. Don't get me wrong; my life is great. I am finishing up a program that leads to a great career, I am working part time as I do it, and I still have the opportunity to maintain great relationships with friends/boyfriend/family/roommates. But all this comes at a cost: the little shit is not getting done.
I doubt I'm the only one who feels this way, as I doubt I am the only one who cannot justify her disproportionate crankiness about things like this. After all, what does it matter that I just dragged 20 lbs of laundry across the street because I couldn't get my act together before it weighed as much as a small child? That I haven't blogged in forever? (Although this blog obviously a collection of seminal insights into public health, I know everyone who reads it and they've all got better things to do than wait around for a post.) Why do I care that the bottom of my backpack is littered with...litter? Or that before dragging them off today, the last time I washed my sheets was...was...hmmm...
Anyway, it does matter. It does. Not because any one of these things is in and of itself important, but because these are the things that make me feel like I'm in charge, instead of my schedule. Like I am on top of things, instead of buried under a pile of incomplete tasks. Simply put: taking care of the little shit is how I maintain my illusion of control. And that illusion is fading.
I console myself with this thought: less than three more weeks. Time will handly what I evidently cannot. On December 14, I will have my final final. On December 19, I will complete my last clinical hour. And then, in all likelihood, I will go home and take a nap. Before getting up and washing my sheets.
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