– DIY End of Life Planning

Pat Salber

Posted 5/10/12 on The Doctor Weighs In

For most of us, talking about death doesn’t come easily. Yet, it’s something we all experience — the loss of those we know and love, and ultimately, our own death quote from

In this wonderful age of digital empowerment, we can now take charge of many things that we used to have to depend on others to do for us.  Examples include booking vacations and managing our investment portfolios. Now, there is a website, DeathWise, that can help you manage your death–well, not exactly your death, rather the planning for your death.  This can mean the difference between an orderly exit or one that leaves your family and friends combing through your papers and guessing your wishes.

In my family, no one ever talked about death, let alone planned for it. One example was the death of my maternal grandmother who, at the age of 78, died in her bed in the apartment she had rented for almost 40 years. Neither her daughters, their spouses, nor the rest of her extended family had any idea about the details of her life despite the fact that we all lived within 30 miles of her house and saw her frequently. We were pretty surprised to find out that all of “her” furniture actually belonged to the landlord.

And, that her frugal habits included saving every rubber band that ever made it into her hands – all rolled up into a gigantic rubber band ball. We didn’t know where her papers were, what type of service she would like or even if she preferred cremation or burial. We muddled through, spending days in her apartment opening cupboards, poking around in drawers, and rifling through papers, bankbooks (remember them?), and check stubs. We hoped we did what she would have wanted, but we weren’t really sure.

Continue reading “ – DIY End of Life Planning”

TedMed 2012: Day 1

Patricia Salber

Posted 4/10/12 on The Doctor Weighs In

TedMed 2012 has begun.  And how!  The opening event was “Traces-Urban Acrobats.”  Urban Acrobats?  It was mouth-droppingly over-the-top athleticism.  One long sequence consisted of the members of the troup jumping, gliding, and soaring through hoops at varying heights–always landing on their feet and making it look easy.  This was not circus stuff, this was, as our program book described it, “the human body…pushed to its limits.”  Great way to start an long anticipated event.  Take a look:

Continue reading “TedMed 2012: Day 1”

Surveyed Physicians Are Gloomy About Health Care Reform

Patricia Salber

Posted 3/12/12 on The Doctor Weighs In

Recently, The Doctors Company (TDC), the country’s largest insurer of physician and surgeon medical liability, decided to survey doctors to determine what they are thinking and feeling about health reform.  The results are pretty gloomy.

To put this in context, it is important to understand a bit about how TDC conducted the survey.  First of all, the universe of doctors they reached out to were doctors insured by The Doctors Company.  That means large self-insured medical groups, such as those affiliated with Kaiser Permanente, were not included.  Nor were doctors whose insurance was provided by their employers or doctors using other insurance carriers.  This matters because if the TDC insured physicians are not representative of doctors as a whole, the results of this survey would not necessarily reflect the attitudes of all doctors.

Continue reading “Surveyed Physicians Are Gloomy About Health Care Reform”

MedShare – Recycling Medical Supplies for the Good of the World

Patricia Salber

Posted 3/06/12 on The Doctor Weighs In

This post was inspired by Kathryn Johnson, Western Regional Council Member of  MedShare, a friend, and a most wonderful connector of people.

Today, I drove over to San Leandro, California, the San Francisco Bay Area town where I went to high school.  I wasn’t there to reminisce, however.  I was there to visit one of the most innovative medical charities in the country, MedShare.

MedShare’s Western Region Executive Director, Chuck Haupt welcomed a small group of visitors to MedShare’s 32,000 square foot West Coast facility by framing the need that the charitable organization is meeting.   He showed us a video of the birth and death of a baby born to an HIV positive mom in Lesotho (Southern Africa).  The baby was born limp and in respiratory distress.  In the US, a newborn like this would have been rushed to the neonatal ICU (NICU), intubated, placed on a respirator and then be expertly cared for by a highly trained medical team, with a NICU nurse devoted just to her.  This Lesotho baby was rushed to a nurse already caring for seven other sick babies who were receiving oxygen from a jerry-rigged device that allowed oxygen from a single tank to be shared with other babies in distress.  This newborn died because there was not enough tubing to share the O2 with an eighth.

Continue reading “MedShare – Recycling Medical Supplies for the Good of the World”

Do I Really Need That Test? Learning to Ask More Questions.

Patricia Salber

Posted 1/28/12 on The Doctor Weighs In

Kudos to the American College of Physicians (ACP), the medical society that represents Internists, for taking a leadership role in the battle against waste in healthcare.  The College’s recently published Ethics Manual (Sixth Edition) clearly points out that physicians not only have an obligation to individual patients, but also to society.  In particular, the College takes on the issue cost-effectiveness of care pointing out that:

”Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available.”

Continue reading “Do I Really Need That Test? Learning to Ask More Questions.”

Paying for Insurers’ “Choice?” A Look at Physician Practice Administrative Costs

Patricia Salber

Posted 1/08/12 on The Doctor Weighs In

A number of years ago, a family doc friend of mine took me on a tour of his small group practice.   He proudly showed me the exam rooms, his medical equipment, and other parts of the facility that related to patient care.  Then, we came to a large room with a bunch of desks piled high with paper.  He explained, bitterly, that this part of his office was for the people he had to keep on the payroll to do nothing but deal with insurers.  This administrative expense was cutting his margins to the bone and did not help him take better care of his patients.  He eventually left practice, to pursue a second career as a physician executive – a job that was, for him, more remunerative and more satisfying.

Continue reading “Paying for Insurers’ “Choice?” A Look at Physician Practice Administrative Costs”

Designing Insurance Benefits to Yield Better Outcomes

Patricia Salber

Posted 12/12/11 on The Doctor Weighs In

Co-pays and co-insurance were introduced into insurance benefit designs to help curb over-utilization that occurs because something is completely free (the “moral hazard” of insurance). The problem is that these cost-sharing vehicles may also reduce the use of beneficial services, such as prescription drugs.

The concept of Value Based Insurance Design (VBID) is the idea that benefits would be designed in a way that promotes the use of services that bring value to the individual(s) consuming them. A commonly used example is eliminating co-payments for diabetes drug used by beneficiaries with diabetes.

Continue reading “Designing Insurance Benefits to Yield Better Outcomes”

FutureMed: Monitors for Your Health

Pat Salber

Posted 11/15/11 on The Doctor Weighs In

I love BodyMedia. They want to give you the info you need to manage your own health, lose weigh, de-stress, sleep better.  Self-mesurement, self-monitoring, self-management…this, I think, is the future of health care.  Hey, it’s your health, you should own it.

Astro Teller Discusses Body Monitors from The Doctor’s Channel on Vimeo.

Cleveland Clinic Announces Top Ten Health Care Innovations for 2012

Patricia Salber

Posted 10/07/11 on The Doctor Weighs In

Every year the Cleveland Clinic announces the top 10 innovations that their experts think will impact healthcare the most in the following year.  Here are the winners for 2012:

#1 Catheter-based renal denervation for resistant high blood pressure

People with hypertension (HTN) are at risk for heart attacks, strokes, and kidney failure.  When high blood pressure cannot be controlled with three or more medications, it is considered resistant.  One-third of Americans have hypertension and 20-30% of these cases are considered resistant.  High blood pressure is the leading risk factor for death worldwide – worse than cigarettes.  Until the development of renal denervation, there was no effective treatment for resistant hypertension.  In a small randomized controlled trial, the Simplicity HTN study, 39% achieved target blood pressures and 50% had some measurable benefit compared to the controls, treated only with high blood pressure mediations that had no change from their baseline blood pressures.  Average decrease in systolic blood pressure was an astonishing 35 mm Hg with a 12 mm drop in diastolic blood pressures.  The procedure takes about 40 minutes and is performed in a hospital’s catheterization lab.  If the results hold up – and if there are no unintended consequences – this could be really BIG (which, of course, is why it won the #1 slot on this list).

Continue reading “Cleveland Clinic Announces Top Ten Health Care Innovations for 2012”

Got a Smartphone? Get a Rhythm.

By Patricia Salber

First posted 10/03/11 on The Doctor Weighs In

There are so many really cool mobile devices and apps out there now.  Here is one I particularly love:  the iPhone ECG.  That’s right folks, click on a cover with embedded sensors and you convert your iPhone 4 into a ECG machine.  There are also business-card sized iCard ECG that you can attach with velcro to the iPhone 3Gs or an iPad. There is also an Android version.

When you hold the phone between two hands or put it on your chest and you detect and automatically upload what the developer, Dr. David Albert, says is a “clinical quality” snapshot of your heart’s rhythm (Lead 1). It is stored on the device and well as being as transmitted and stored on the company, AliveCor‘s servers. It that way it can be made available “instantly” to doctors “anywhere in the world.”

Continue reading “Got a Smartphone? Get a Rhythm.”

Putting the Mouth Back Into the Body

Patricia Salber

First posted 9/29/11 on The Doctor Weighs In

Medicine has been great at creating body silos over the years.  The most obvious example is the disconnect between physical health and mental health.  Physical health providers often find it very difficult to get information about their patients’ mental condition from their patients’ mental health providers and mental health providers rarely connect with physical health providers to really understand the total health picture of the person they are treating.  Vision – mostly treated by optometrists is rarely integrated into general medical care and increasingly our feet are carved out to podiatrists practicing in a one-off fashion.

I could go on and on about body carve-outs, but won’t, as what I want to talk about today is oral health.  Unless you get a mouth cancer of some sort, oral health pretty much belongs to the dentists and the dentists are not really connected (or considered by most doctors to be a part of)  your medical care.

Continue reading “Putting the Mouth Back Into the Body”

50 Years for Medicare Fraud

Pat Salber

First posted 9/19/11 on The Doctor Weighs In

Big dollars attract big fraudsters.  Medicare is no exception.  Medicare fraud is particularly galling, however, because the Medicare trust fund is teetering on the brink of insolvency and many of the proposals to fix the problem seem to focus on cuts and more cuts to the program.  That is why today’s post should make you smile and pound your fist in the air…50 years in jail for Medicare Fraud…way to go!  Here’s the story:

Continue reading “50 Years for Medicare Fraud”

Happy Birthday, Dr. Berwick!

Patricia Salber

First posted 9/14/11 on The Doctor Weighs In

Dr. Don Berwick, head of CMS, just turned 65.  He has already turned in his paperwork to get his Medicare coverage.  This is fantastic.  The head of CMS will now receive benefits from the health insurance program that he oversees.

Of course, he is still working, so he still has his employer-sponsored benefits.  But an article on indicates he may only sign up for Part A (hospital coverage) to supplement his existing health plan.  Because he doesn’t need to sign up for Part B (doctors and other non-hospital services) yet, he won’t have to worry about paying a means-tested monthly premium.

Continue reading “Happy Birthday, Dr. Berwick!”

Who Is The Fattest Of Them All?

Patricia Salber

First posted 7/20/11 on The Doctor Weighs In

What state has the highest rate of obesity in the land?  If you guessed Mississippi, you would be correct.  For the seventh straight year, Mississippi tops the list of the “Fattest States in the Nation.”  When they first took possession of this top ranking of one of the nation’s most infamous lists of unhealthiness, the rate of obesity was just 19.4%.  Now, they are almost unbeatable with a (whopping) rate of 34.4%.  Congratulations, Mississippi.  You are the fattest of them all.

Most people knowledgeable about obesity in the US know that is it going to take a multi-pronged effort to reduce obesity – one of the leading causes of death in this country because it is the fuel for Type 2 diabetes and associated conditions, such as hypertension, heart disease and stroke.

Folks who don’t really understand the complexities of obesity like to blame the fatties – you have heard it:  “they have no will power, they don’t exercise, they don’t this and they don’t that.”  These “personal responsibility advocates” are not willing to put on the table societal contributing factors, such as the following:

  • Ubiquitous presence of fast food restaurants and their seductive advertising ploys
  • Lack of full service grocery stores in some low income neighborhoods – you  can buy alcohol in its various forms, but not fresh fruits and vegetables
  • Lack of health literacy – because this is not a priority in our schools
  • Poverty – a Big Mac may be cheaper than a couple of tomatoes from the farmer’s market
  • Exercise-unfriendly neighborhoods – unsafe streets, no exercise facilities, no support

Continue reading “Who Is The Fattest Of Them All?”