Entries Tagged as 'Lay Media'
February 23rd, 2007 · Comments Off
Interest In Health Literacy Grows
Two major newspaper stories in the past month addressed health literacy, one of the major causes of patient-clinician miscommunication, which in turn often leads to inadequate treatment plan execution, a phenomenon typically included under the aegis of patient compliance.
Sources:
‘Doctor-ese’ often stumps patients Jane E. Brody New York Times 4 Feb 2007
A Silent Epidemic Sandra G. Boodman Washington Post 20 Feb 2007
The Points Made In These Articles Are Straightforward
1. Impaired Health literacy is a national healthcare problem of huge proportions. According to the Institute of Medicine, more than 90 million Americans of all ages, races, and income and education levels, are unable to adequately understand basic health information.
2. Poor health literacy results in poor adherence to prescription instructions, infrequent use of preventive medical services, increased hospitalizations and visits to the emergency room, and worse control of chronic diseases. The consequences are poorer health and greater medical costs.
3. Doctors fail to speak to patients in plain English (or Spanish or Chinese or any other language) and fail to make sure that patients understand what they are told and what they are supposed to do and why.
Studies of health literacy have found that a surprisingly large number of adults were perplexed by the meaning of the term “orally,” didn’t know the difference between a teaspoon and tablespoon and were unable to calculate the proper dose of medicine.
A study published in the Journal of the American Medical Association in 1995 found that more than 80 percent of patients treated at two of the nation’s largest public hospitals could not understand instructions written at the fourth-grade level for the preparation of gastrointestinal X-rays known as an upper GI series. A 1999 study of more than 3,200 Medicare recipients found that one in three native-born patients could not answer a question about normal blood sugar readings even after being given a paper to read that listed the correct answer.
The disconnect between the offerings from healthcare and the capacity of patients is noted in a 1999 report by the American Medical Association which found that consent forms and medical information are typically written at the graduate school level while the average American adult reads at the eighth-grade level. Worse, a 2003 survey completed by the U.S. Department of Education found that over 40% percent of adults read at a fifth-grade level or lower, and 5 percent are not literate in English (in some cases because it is not their first language). Math skills are similarly lacking.
The Impact Of Low Health Literacy Is Equally Clear-Cut
These excerpts are characteristic:
In a study published in the Journal of Internal Medicine, conducted among 2,512 elderly men and women living on their own in Memphis and Pittsburgh, those with limited health literacy were nearly twice as likely to die in a five-year period as were those with adequate health literacy. That held true even when age, race, socioeconomic factors, current health conditions, health care access and health-related behaviors were taken into account.
Another study in the Journal among 175 adult asthma patients treated by Cornell University doctors found that “less health literacy was associated with worse quality of life, worse physical function and more emergency department utilization for asthma over two years.”
Among the many problems resulting from limited health literacy are misinterpretations of warning labels on prescription drugs. For example, among 251 adults attending a primary care clinic in Shreveport, La., those with low literacy were three times more likely to misunderstand warnings than the more literate.
Despite major reports on the need to improve health literacy issued in the last decade by organizations including the American Medical Association and the National Academy’s Institute of Medicine, little improvement has been noted in how much patients understand and remember about encounters with health care practitioners.
Primary Problems
A main obstacle has been the decreased time patients can spend with their doctors, dictated largely by managed care and other medical reimbursement plans.
A second hurdle is the embarrassment that patients with limited health literacy experience when they do not understand what the doctor has said. And, of course, asking for clarification is seriously impeded by the imbalance in power between the white-coated physician and the paper-wrapped patient. Even when conversations are conducted in the doctor’s office with a fully clothed patient, patients are often reluctant to ask questions.
Fixes
These newspaper reports included several specific recommendations for clinicians as well as patients to improve communications, many of which come with the imprimatur of the Joint Commission which recently presented 35 recommendations to address this problem, along with the implication that such suggestions might become future Joint Commission requirements for healthcare facility accreditation. Examples follow:
Doctors should assess the patient’s baseline understanding before providing extensive information: “Before we go on, could you tell me what you already know about high blood pressure?”
Doctors should use plain language, not medical jargon, vague terms and words that may have different meanings to a lay person. They should say “chest pain” instead of “angina,” “hamburger” instead of “red meat” and “You don’t have HIV” instead of “Your HIV test was negative.”
Experts on health literacy also encourage doctors to assess patients’ health literacy by asking them to read aloud a list of 66 medical terms, each within five seconds. Patients are scored on how many words they pronounce correctly.
The advice for the patients is clear – be proactive or risk poor healthcare.
Do not wait until doctors become better at communicating. If you want the best medical care, you have to take the initiative. If the doctor says something you do not understand, ask that it be repeated in simpler language. If you are given a new set of instructions, repeat them back to the doctor to confirm your understanding. If you are given a new device to use, demonstrate how you think you are to use it.
Insist that conversations about serious medical matters take place when you are dressed and in the doctor’s office. Take notes or take along an advocate who can take notes for you. Better yet, tape-record the conversation to replay it at home for you and your family or another doctor.
Also mentioned is a Pfizer-sponsored program called Ask Me 3 that was designed by the Partnership for Clear Health Communication, a coalition of national health and literacy groups. The program encourages patients to ask three simple questions and to be sure they understand the answers: What is my main problem? What do I need to do? Why is that important?
Commentary
I’ve summarized and excerpted material from these articles at length to point out (1) the importance of the problem, (2) the growing urgency demonstrated in the press, professional organizations, and regulatory agencies for a solution, and (3) the solution being promoted.
While the severity of the problem and the mounting pressure for a solution are, it seems to me, clear cut, the only solutions offered are incomplete.
Doctors, for example, are unlikely to find that “none of this [i.e., the suggested improvements in communication techniques] should take more than a few minutes,” as the experts quoted approvingly in the New York Times article declare, to be reassuring. By simple arithmetic, “a few minutes” added onto each appointment in a busy day, assuming the estimate is accurate, accumulates into “a few hours” added every week.
Even more problematic is the contention that every patient has, within himself or herself, the capacities to be a “patient expert” on his or her disorders and a self- advocate with the interpersonal skills to assure that the right information (whatever that might be) is provided and understood without being so confrontational that the relationship with the clinician is jeopardized. Neither clinical experience or personality studies would seem to support this hypothesis.
What is to be done for those individuals who cannot, especially in the sick role, assume this proactive stance?
The current Patient Literacy campaigns do not seem to take this issue into consideration, let alone provide pragmatic answers. I believe, however, that there are potentially useful responses, some of which I will be addressing in forthcoming posts.
Footnotes
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Tags: Communication · Lay Media
December 19th, 2006 · Comments Off
Many of the ‘ADD generation’ say no to meds; Newly minted grown-ups are carrying out a massive natural experiment by choosing to do without the drugs that profoundly affected their experience of childhood. By Melissa Healy, Las Angeles Times December 18, 2006
This article focuses primarily on a number of young adults who, diagnosed with and treated with medication for Attention Deficit Disorder in childhood, have chosen to discontinue those stimulants.
Commentary
This article exemplifies one of the most problematic aspects of the lay press reporting on healthcare issues by promoting a point of view that could influence readers.
There is no indication that any aspect of the story is inaccurate or intentionally misleading. On the other hand, each of the individuals who decided to stop taking their ADD medications is reported to have done well. Further, support for the discontinuation of medication is presented uncritically while doubt is cast upon theories and studies favoring the ongoing use of these medications.
And, consider the tone of these excerpts:
But as the 23-year-old navigates his way into adulthood, he’s managed to pay the roadside distractions a little less attention. And he’s learned a thing or two about getting himself from one destination to the next without taking major detours.
Looking back, he acknowledges that Ritalin did help him academically. But he also felt that it blunted his natural sociability, made it “hard to feel passionate about anything.” And the same intensity of focus that helped him in class, he believes, impaired his instincts on the soccer field — a troublesome side effect for a rising soccer star. He quit Ritalin as a freshman in high school. Off the drug, he says: “I felt more like a happier person. I just felt more like myself,” voicing an observation heard again and again among young adults who abandoned their ADD medication.
They [young adults who have taken stimulants for ADD] want, overwhelmingly, to feel normal, Fischer says — to be like other kids who can make it through a school day without being chided for daydreaming or sent to the nurse for a midday pill. Many, she says, are keen to try life without the medications to prove something: “to feel that your success, your accomplishments, your failures are truly your own and not the product of medication.”
In a nod to his ADD, Barclay says he accomplishes many of his grown-up tasks in pinball fashion, bouncing haphazardly from paying a bill to tending the home he owns to walking his dog. “I get things accomplished. It’s probably not as efficiently or as quickly as other people, but it happens in my own way,” he says.
The penultimate portion of the article is devoted to Dr. Lawrence Diller, the author of “The Last Normal Child,” in which he “raises concerns about the effect on society and children when parents, schools and the medical establishment reach too easily for such medication [for ADD].”
Diller calls it “unduly pessimistic” to believe that two-thirds of kids with ADD will continue to suffer symptoms negative enough to require medication as adults. By a young adult’s mid-20s or so, he believes that many who were diagnosed with ADD as children have developed strategies, as Devin Barclay has, to work around their weaknesses. And they are better equipped to answer the question — to medicate or not? — with a clear sense of their adult selves. Diller feels that those diagnosed with ADD — as well as their parents and counselors — should revisit “the bargain” that many made with Ritalin and other such drugs as children as they meander through their early adult years. In return for the often-reported side effects of the medication — sleep difficulties, appetite suppression, a “not quite me” feeling — children and their parents expected ADD medication to help them succeed in school at a time when sitting still and compliance with rules was highly valued. But in the adult world, young people with ADD have far wider choices, and they should make them with an awareness of their strengths and their weaknesses, Diller says — not what others expect of them. Using medication “to take octagonal kids and fit them into square holes” may be acceptable in grade school, he says. But “they will be patients for the rest of their lives,” he adds, if they pursue fields that require enormous attention to detail or intense concentration on matters that do not fire their interest.
The issues raised, whether ADHD medications should be taken indefinitely and, if not, how the decision to continue or discontinue the medication is determined, is both legitimate and important. A reporter’s responsibilities in presenting the story are less clear. In this case, a newspaper story that features reports of interesting individuals who seem to have made the right decision going off a medication, breezy summaries of research and ideas about the disease, and a clear air of approbation for independence-minded young adults who defy their parents and doctors by discontinuing their medications is, it would seem, more likely to influence those facing this decision than pages of grey print reporting findings of scientific studies.
Footnotes
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Tags: Decision-Making · Lay Media
October 2nd, 2006 · Comments Off
Doctors, firms push for patient compliance
Charles E. Buban Philippine Daily Inquirer September 08, 2006
My impression is that patient compliance been featured in the lay media with increased frequency recently. This may, of course, be no more than my imagination or a statistical fluke. Or perhaps there is a special Editors’ Calendar that calls for features on treatment noncompliance in the Fall. Regardless, this basic review of noncompliance in the Philippine Daily Inquirer is typical.
The core data of these articles are consistent:
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Illnesses that cause death and disability can be effectively treated, but patients don’t always adhere to treatment; unnecessary suffering and deaths occur as a result.
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Compliance is important for patients, clinicians, and pharmaceutical companies
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Noncompliance also leads to increased healthcare costs
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Noncompliance may be caused by many reasons (e.g., cost, misunderstandings, forgetfulness, etc.), which may occur in various combinations
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Many compliance enhancements may help (patient education and the doctor-patient relationship are often mentioned)
In addition, a specific compliance enhancement program or methodology is often mentioned.
This article is clear and accurate but is remarkable only because it is example of the kind of patient compliance piece recently seen in several newspapers and magazines.
Footnotes
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Tags: Lay Media
September 13th, 2006 · Comments Off
Patients still won’t take their medicine Dr Thomas Stuttaford The Times September 11, 2006
I cannot ascertain why The Times chose this particular moment to make this proclamation; there is no new discovery or study to report. Still, the opening paragraphs so starkly and cleary delineate the issue of patient compliance that I felt compelled to post it.
Scientists at universities and in pharmaceutical industry labs spend many years and hundreds of millions of pounds in producing each new product [medication]. Doctors debate the advantages and disadvantages of every new pill and potion.
The general public then reward all this effort by making up their own mind if they will take the drugs so painstakingly prescribed.
Tags: Basics · Lay Media
September 11th, 2006 · Comments Off
ON LANGUAGE; Age-Defying William Safire The New York Times August 20, 2006
Anti-wrinkle Vs Anti-aging Vs Age-defying
Reading Safire’s column on the emergence of Age-defying in the vocabulary of advertising prompted me to think about parallels with the ongoing Compliance Vs Adherence Vs Concordance et al controversy. The entire article is interesting and worth reading, but the sense of the piece, especially as it pertains to the “I say compliance; You say adherence” issue, can be extrapolated from this excerpt:
“Age-defying is a much more encompassing term than anti-wrinkle,” explains Rachel Hayes, beauty director at Cosmopolitan magazine. “It’s not just about wrinkles anymore; it’s about glow and firmness and radiance. Today, women want their products to multitask, and anti-wrinkle is just too limited.”How about the unisex term, anti-aging? “Age-defying is much more positive and hopeful,” Hayes replies. “It empowers a woman to have more control over her looks and to try to slow the cruelty of time. And the phrase is a lot fresher and makes a bigger promise.” I can understand the shrewdness of advertisers who are firmly anti anti-; that prefix, though suitably negative, has lost its fashionable edginess. Negation is no longer enough; to put to flight that sadist, Time, our militant emollients need a more combative word. Among the choice of participles: flouting can be confused with flaunting; thwarting has a wart running through it; contravening is bookish and frustrating, in this context, is especially inapt.
Compliance Vs Adherence Vs Concordance et al
Taking the marketer’s perspective, as Safire does in his column on the popularity of Age-defying, could be enlightening in considering the nomenclature of patient compliance as well. The chief criticism of compliance, adherence, and other terms designating the same phenomenon has been, after all, their connotations of patient subjugation to the demands of the clinician and the implicitly assumed but, as far as I can determine, unproven impact those connotations have on actual patient and physician behavior. In fact, given the interchangeability of these terms in the literature and, especially, the vernacular clinicians use among themselves, I suspect a linguist would be hard pressed to prove that a clinician’s or a researcher’s choice among these expressions corresponds to that professional’s predominate relationship mode vis-à-vis the patient (e.g., authoritarian, paternalistic, egalitarian, etc.). Nonetheless, it is clear that the consensus of the medical research community and perhaps the entire healthcare industry holds that the terminology of patient compliance should abstain from the appearance of evil (i.e., the language should not endorse the notion of a doctor-dominant physician-patient relationship), and, moreover, contends, at least by implication, that the semantics of the term used to designate patient compliance bears a portion of the responsibility for its achievement.
That being the case, however, why settle for a non-offensive, scientifically oriented terminology? If there is a belief that the words will affect perception and performance, why not consider the problem from the point of view of professionals who persuade for a living? It seems to me that, for example, a results-oriented marketing specialist assigned to create an advertising campaign for the Patient Compliance Trade Group might have some useful insights about naming, with apologies to Prince, the entity formerly known as patient compliance.
~ Continued in tomorrow’s post ~
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Tags: Basics · Lay Media
September 5th, 2006 · 1 Comment
During the Late Show with David Letterman show this Friday past, an alarm sounded, ostensibly signalling Letterman that it was time for his medications. He abruptly interrupted his current activities to locate and pick up his pill organizer, which the AlignMap Video Monitoring Staff have tentatively identified as the common seven-day pill dispenser with flip lids. (See example of this category below).
Letterman then took his medication doses and returned to his previous discussion.
Stay tuned to AlignMap for full coverage of patient compliance, including its role in late night comedy.
Tags: Lay Media
July 12th, 2006 · Comments Off
He Wasn’t Thinking Straight. So How Do You Get Through?
Sandeep Jauhar, M.D. New York Times July 11, 2006
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This is a first-person article sketching the author’s experience with a patient refusing cardiac catheterization and the difficulty in the real world of clinical practice of making the judgment of whether a given patient, if obvious signs of psychosis or dementia are lacking, is competent to make the decision to comply with treatment or refuse it.
Dr. Jauhar also discusses the 1978 case of Mary Northern, who was ruled incompetent to make a rational decision about having her gangrenous feet amputated because, while generally sane, she had the psychotic belief that her obviously diseased lower limbs were blackened only because they were dirty.
Dr. Jauhar’s own case, however, is more ambiguous. The exchange between physician and patient is described thusly:
“You’ve had a heart attack,” I started off.
“So you say,” he shot back.
I asked someone to bring in a printout of his blood tests. After I showed him the abnormal cardiac enzyme levels, he sneered and said: “Fine. So you think I had a heart attack.” Clearly, he still did not believe me.
“The best treatment for a heart attack is angioplasty,” I said.
“I don’t want it,” he said, his voice rising. “I told the doctors I don’t want a stent.”
The patient then threatened to leave. Dr. Jauhar reports his judgment that the patient was not competent to make medical decisions because the patient “did not understand his medical condition or its treatment options and the risks and benefits,” an inability to recognize his medical problems which Dr. Jauhar views as the equivalent of Mary Northern’s psychotic view of her condition.
Dr. Jauhar notes that the patient could not be released because “if something happened to him, I would be liable.” When threatened with security, the patient “backed down.” By the next morning he appeared more reasonable, was judged to be competent, and then signed out against medical advice.
Commentary
Dr. Jauhar’s article is, I believe, useful in dispelling the all too common notion that the determination of a patient’s competence is simply a matter of applying legal criteria.
In this case, in fact, I am less confident than Dr. Jauhar that his patient would have been adjudged incompetent by a court, at least those operating in the jurisdictions where I have practiced. Of course, Dr. Jauhar’s database re this patient – and his responsibility for the patient – is infinitely greater than mine, but my dissent may illuminate the problems in determining competency.
Dr. Jauhar’s patient was sarcastic and skeptical, not delusional as was Ms. Northern. He didn’t attempt to explain his situation by expounding an alternative theory that was bizarre or nonsensical. By the written account, at least, he simply didn’t agree with the diagnosis or the recommended treatment. While neither psychosis or dementia is an absolute requirement for a declaration of incompetence, mere disagreement with the physician’s diagnosis or treatment plan is not sufficient evidence of an inability to make ones own medical decisions.
To judge a patient as incompetent to refuse to follow a physician’s recommendations exclusively because the patient denies the validity of the physician’s findings is clearly a circular argument.
On the other hand, I suspect Dr. Jauhar’s concern that “if something happened to him [the patient], I would be liable,” is well-founded.
Tags: Enforced Treatment · Lay Media
July 6th, 2006 · Comments Off
Prostate Cancer Decisions Often Based on Fallacies
By Nicholas Bakalar
New York Times July 4, 2006
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This article describes a study of the processes by which 20 prostate cancer patients chose their course of treatment. Prostate cancer, because of the variety of treatments available and the lack of hard data conclusively indicating which of these treatments is superior, offers an opportune field for this kind of study.
After a urologist made the diagnosis and discussed options with the patients, each was interviewed for 60-90 minutes about their decision-making processes.
Especially striking among the findings were the following:
- Nineteen of the 20 patients were influenced in their choice of treatment by experiences of a friend or relative with the disease.
- Despite the understanding that prostate cancer was slow-growing and, in some cases, that the cancers were of low histological grade and that the bone and CT scans were negative, 12 of the 20 wanted treatment as soon as possible, and 8 of those were convinced that surgery was the best option.
- Those who desired surgery felt that decision was common sense and mistakenly believed that if the tumor was confined to the prostate, the surgery would cure the illness.
- Those who chose surgery were confident about this decision and were resistant to consider other options; those who rejected surgery were more willing to consider a variety of treatments.
Commentary
This is further evidence of the fallacy of the “rational man” on which most conceptualizations of patient compliance rely. (See Patient Behavior)
Footnotes
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Tags: Decision-Making · Lay Media
July 3rd, 2006 · Comments Off
Source: ‘Tough Love’ Lessons From a Deadly Epidemic Barron H. Lerner, M.D. New York Times June 27, 2006
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This article focuses on directly observed therapy (DOT), in which healthcare workers monitor the administration of medications, its role in quelling the increase in tuberculosis cases in New York in the 1990s, and its proposed use in the treatment of HIV. It also deals with the conundrum of determining the proper course of action when the rights of the individual clash with the public good, all in all an appropriate topic as we approach this country’s Independence Day.
Public Health & The Treatment Of Tuberculosis in the 1990s
While there were other causative factors, noncompliance was a significant problem in the rise in tuberculosis in the 1990s, especially among patients who used injection drugs or had psychiatric problems. The author notes, “In one often-cited study, 89 percent of tuberculosis patients at Harlem Hospital were lost before completing treatment.”
Not only did those patients fare poorly and possibly infect others, but their incomplete compliance led to the drug-resistant forms of tuberculosis.
With federal financing, New York aggressively expanded the use of DOT, with outreach workers administering anti-tuberculosis medications special clinics, the patients’ homes, or wherever patients could be found.
Further, those who didn’t fare well on DOT were placed under forcible detention, either at Bellevue Hospital or at Goldwater Hospital. According to Dr. Lerner, “More than 250 patients were detained between 1993 and 1998, some for as long as two years.”
From 1992 to 2001, new cases of tuberculosis dropped from 3,811 to 1,261.
HIV Treatment Monitoring
The New York health department has now proposed a similarly aggressive program for treating HIV. Specifically, these regulatory changes would include
- Simplifying consent for H.I.V. testing to encourage clinicians to screen more patients
- Tracking H.I.V. in a manner similar to tuberculosis
- Monitoring patients to ensure that they take their medications properly
Commentary
Dr. Lerner has done a laudable job of illustrating and summarizing the strengths of DOT and its effectiveness in managing tuberculosis within the confines of newspaper column. And, he points out the clinical issue that differentiates tuberculosis from HIV as a public health issue – the tuberculosis, unlike HIV, can be spread through casual contact.
Dr. Lerner’s primary argument is, indeed, primarily clinical in scope: Given that DOT is effective in reducing morbidity and mortality caused by noncompliance, thereby saving lives and decreasing the risk of epidemics to the public, public health officials should be legislatively allowed to use this tool.
If this perspective becomes the exclusive approach, of course, it begs the ethical question of how one determines at what point the danger to the public at large outweighs the rights of the individual to the extent that treatment can be legitimately coerced to the point of imprisonment, whatever nomenclature is used to designate forced detention and however humane the conditions.
It seems intuitively clear to me that at some point, public safety demands, even in a democracy, the restriction of the rights of those who endanger it – even if the individual is innocent of wrong doing and the danger is unintentional. It seems equally clear, however, that government cannot rationalize draconian measures simply because they work.
Tags: Ethics · Lay Media · Public Health
June 26th, 2006 · Comments Off
Sources:
Screening: Older Women May Be Skipping Mammograms
By Eric Nagourney; NY Times June 20, 2006
Older Women Have Far Fewer Mammograms Than They Report
By Joel R. Cooper, Health Behavior News Service June 20, 2006
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Both of these articles report on a study to be published in the August issue of The American Journal of Preventive Medicine that compared Medicare data for mammograms received by 146,669 women ages 65 and older with patient self-reports collected by the Behavioral Risk Factor Surveillance System and the National Health Interview Study for the period between 1991 and 2001.
The trend demonstrated by the results in general can be seen in isolated finding that 70 to 80 percent of women ages 65 to 69 self-reported compliance with receiving a mammogram every two years, but only 61 percent were actually screened.
African-American, Asian-American and Hispanic women in this age group received mammogram screening at even lower rates
The study did not address the causes of this disparity.
Commentary
None of this should be surprising, but it is worthwhile to note another bit of supporting evidence for the prevailing trends in patient compliance:
- Significant noncompliance exists regardless of age or treatment/screening.
- Noncompliance is typically (but not always) more pronounced among lower socio-economic and minority groups.
- As a instrument for measuring patient compliance, self-report is almost universally unreliable
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Tags: Lay Media · Noncompliance
June 1st, 2006 · Comments Off
Avoiding Tests Until It’s Too Late
By Benjamin Brewer, M.D.
The Wall Street Journal
May 30, 2006
Dr. Brewer points out and gives examples of a problem every practicing clinician will recognize – patients who, for many different reasons – avoid screening tests, sometimes with disastrous results.
Especially useful are his observations that
Getting [patients] to perceive a need and spend money and time on something they’d rather not do takes education and encouragement. … For now, salesmanship remains my main tool when it comes to screening tests. Patients need to be aware of what is needed and be proactive in asking their doctor for help.
Tracking is a daunting job for a primary-care office, where we have patients of every age, with multiple conditions of varying severity. It involves integrating results from multiple providers of care. There’s added staff time and expense to manage the process. I don’t get paid for any of the behind-the-scenes work unless the patient comes in for the test. After figuring in staff time and computer costs, I’d be lucky to break even when a person does come in for screening. Some insurers pay for screening, some don’t, and some do only for certain conditions or certain time intervals. … with the exception of a few pilot programs, commercial insurers, Medicare and Medicaid don’t cover this added work outside of the traditional office visit. … If insurers want to compensate doctors based on performance, they can expect some doctors to drop patients that won’t come in for follow-up or recommended screening tests.
Dr. Brewer’s views point toward my own contention that implementation of treatment plans, including participation in screening programs, is unlikely to significantly improve until there is an alignment of all healthcare stakeholders – clinicians, patients, healthcare systems, and payers.
Tags: Communication · Lay Media
May 31st, 2006 · Comments Off
Well-Intentioned Food Police May Create Havoc With Children’s Diets
By Harriet Brown
This essay in the May 30, 2006 New York Times raises concerns about the extent to which schools intervene in the lives of their students in hopes of improving health.
In the past, such efforts have included discrete and intermittent interventions (e.g., vaccinations and immunizations, either provided by or required by the schools), ongoing programs integrated into the school structure (exercise programs and health education), and auxiliary programs that had an impact on the students’ general health (e.g., hot lunches). Today, these elements seem to be accepted by all except religious sects that disallow certain medical measures, some conservative political groups alarmed by the intrusiveness of government, and a few others with concerns about the safety of specific medical procedures.
Ms Brown’s essay addresses the currently popular battle on obesity which is being carried out in the schools, by local initiatives and via legislation, such as the Child Nutrition Promotion and School Lunch Protection Act now before Congress, which would, in effect, set standards on food served at school cafeterias and vending machines.
While the article focuses on the wisdom of taking such actions based on unproven or oversimplified correlations between obesity and specific disease states, the ethical issues of using public authority, in this case the schools and legislation affecting schools, to intervene in the lives of individuals in hopes of improving health are even messier. Reading news stories, for example, of Arkansas Governor Mike Huckabee’s personal 100 pound weight loss and his consequent enthusiasm for enacting regulations to halt obesity causes one to wonder about the justification for those who are in positions of power pushing their own passions, however well-intended, onto others. Motives are even less clear in other situations since coming out in favor of improved school nutrition would seem a particularly safe, politically advantageous position.
Similar ethical conflicts (e.g., physicians advising Vs. coercing patients to follow a medication regimen) are not, of course, unusual in the field of medical compliance, but the school arena does merit special attention given that children are affected and the reasoning behind these decisions is unclear.
Tags: Ethics · Lay Media
