DeathWise.org – 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 DeathWise.org

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.

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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:

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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.

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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.

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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.”

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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.

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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.

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