Demystifying Medicine One Month at a Time

Category: books (Page 2 of 6)

RIP: Jake Page (1936-2016)

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Jake Page. Source: Rio Nuevo

I didn’t know Jake Page. Until his death, I wasn’t even aware of him.

But reading his obituary, I see a kindred spirit.

Page was a young editor at Doubleday when he was given responsibility for an imprint called “Natural History Books.” He’d never taken a science course in high school (how is that possible?) or college, and was suddenly in charge of making science books accessible to regular people.

“My job was to edit them so that any idiot could read them,” he told an interviewer. “I was any idiot then for the next seven years.”

He eventually wrote a monthly column for Smithsonian Magazine called “Phenomena, Comment and Notes.”

His style was to report on science by imbuing his writing with humor. “Science, which always seems earnest to the point of stuffiness, is too important to leave only to scientists.”

Amen, I say. The same holds true for medicine.

One other note about Mr. Page: Apparently, he had a good eye. Early in his career, he recommended publishing a series by a British author named J.R.R. Tolkien, only to be rebuffed by his boss.

Recalling his life in publishing, Page recalled, “Most memorably, the editor…shot down my notion that we should publish a fascinating trilogy by an English author, so the whole billion-dollar Hobbit enterprise was taken on by Ballantine.”

Ouch.

Costs of Care

Getty Images

Getty Images

Ever received a bill for a health service that troubles you? Does it seem too much?

Is it hard to understand what you owe from what insurance pays? Does it seem like the share you pay always goes up?

Medical costs are a universe unto themselves. How doctors and medical facilities (hospitals, radiology practices, etc.) come up with their charges seem to lack any rational basis.

Famously, in his article that became a book, author Steven Brill challenged the CEO of a big health insurance company to explain his ‘explanation of benefits’ (the bill-like statement you get that is NOT A BILL), and the CEO couldn’t do it. Here Brill recounts the story in an interview with Minnesota Public Radio. Context — Brill had a big operation for an abdominal aortic aneurysm, so he decides to use himself as a test case:

After I got home, about 2 or 3 days later, I received in the mail 36 different explanations of benefits from my insurance company, in 36 different first class envelopes, which tells you something about how inefficient the system is.

As I started to open them, I thought to myself: I’m the world’s leading expert on hospital bills and insurance bills, this is going to be fun. When I opened the third envelope, it said the following. This is an explanation of benefits from United Healthcare, which is headquartered in Minnesota: Amount billed: $0; amount paid by insurance: $0; amount you owe: $154.20. I looked at it and I looked at it. If nothing was billed, how could I owe $154.20? I turned it over, I tried to decode it, I couldn’t figure it out.

As it happened, before I went into the hospital, I had scheduled an interview with the CEO of United Health out in Minnesota … So as soon as I was able to travel, I went out to Minnesota and I did the interview. … And then at the end, I reached into my pocket and took out that explanation of benefits and handed it to him. I said: “I’m wondering if you could just help me understand this, I’m having trouble figuring out what this means. How could I be billed $154 if nothing was billed?”

He looked at it and he looked at it, he turned it over, he looked at the coding, and finally looked up and said to me: “I could sit here all day and I could not explain that to you. I have no idea what it means. I don’t know why they sent it to you.”

I said, “Aren’t you they?

That explanation of benefits is the single most common form that consumers receive in what is by far the largest industry in the United State: The healthcare industry. Tens of millions of those explanations of benefits go out from United Healthcare every year, and the head of the company can’t even understand what it means, so how are the rest of us supposed to understand what it means?

As an entree to discuss the issue of health costs in the U.S., and people’s disparate reactions to them, I share with you the story of Mrs. Sutton, a patient of mine who had a somewhat atypical reaction to the cost of her colonoscopy — even though she owed nothing out of pocket. I also want to emphasize how poorly doctors do in helping patients anticipate their costs of care. Reliable pricing information is hard for us to come by, too — as some commenters note. But some new companies (apps, of course) are trying to tackle this issue head-on.

Click on the box below to read it. Feel free to add your own story to the mix.

Evidence shows that in spite of mutual doctor-patient desire to discuss drug costs, we docs usually shirk the duty, writes Dr. John Henning Schumann.

Posted by NPR on Saturday, January 16, 2016

Thanks for reading.

People of the Book

51LnzMAiHuL._SY344_BO1,204,203,200_Doctors are a group that prize scientific evidence in plying our trade — whether making recommendations to our patients or arguing with each other about how to interpret and act upon our profession’s ever-growing body of research.

I find it pretty easy to lapse into the rationalization that “the latest evidence” is usually right, and therefore should heavily weight both our actions and our “knowledge base.”

But a new book challenges this rationalizing — pointing out that over the decades, many assumptions about best medical practices later come into question and are thrown out — a process known as “Medical Reversal.”

I blogged about this before, as several articles in this genre stood out to me. Now that line of research has been turned into a book: “Ending Medical Reversal,” by Vinay Prasad and Adam Cifu. I was delighted to be asked to review this book for Johns Hopkins Press, and glad to see that they’ve published it (in fact, they used a statement in my review as a blurb (!) on the book jacket).

If you like to know how medical knowledge gets disseminated, communicated, retracted, and paved over, then this will be an enjoyable read. The NYTimes just reviewed the book, with a recommend, only questioning the rather esoteric title, suggesting instead that the book be called “OOPS!” or “Are You Kidding Me?”

I like those.

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This past week I had the opportunity to meet the great Roz Chast, author of the award-winning graphic memoir “Can’t We Talk About Something More Pleasant?”

She visited the Tulsa City-County Library as part of a series of programs put on in conjunction with Clarehouse, a local not-for-profit hospice. The goal of the series is to increase awareness and dialogue about improving care for people at the end of life.dr john schumann 3

Being Black and a Doctor in America

Imagine you’ve a new medical student. You’re trying to prove yourself among your professors and your peers. You dress the part, you work hard, and early on you start feeling like you can do it.

Then one morning as you enter the lecture hall, the professor says, “Oh — you’re here to fix the lights. What took you so long?”tweedybook

You turn around, thinking he can’t be talking to you. But there’s no one behind you. He has simply assumed that you’ve come to answer his maintenance request, because of the color of your skin.

Now imagine you’re a resident, a doctor-in-training, working in hospitals to diagnose and treat patients at all hours of day and night. You enter a cubicle in the Emergency Department to evaluate your next patient, and he blurts out, “I don’t want no n**ger doctor.” Welcome to the profession.

Such are the experiences of many African-American medical students and doctors in the U.S. Not only must minority medical students excel with the content of medical science, they must develop strategies for coping with people’s pre-conceived notions about them based on their race.

A new memoir by one black doctor, Damon Tweedy, recounts his journey through these travails to become a faculty member in psychiatry at Duke University.

I was fortunate enough to interview Dr. Tweedy recently, and I found him to be just like the self he presents in the book — thoughtful, warm-hearted, and very open and engaging. His memoir is an excellent read, one that I would strongly recommend to anyone thinking about joining the health care field — or anyone who likes memoir, recent U.S. history, or the study of race relations.

His book has generated reviews in major news sources, and while all of them laud his candor and writing, some criticize Dr. Tweedy for not fully addressing the policy questions surrounding the dearth of blacks (particularly black males) in the medical profession. I think this is an unfair criticism, because in telling his story, Tweedy moves the discussion forward and teaches Americans not in the medical profession something that the folks in charge of medical education already know.

Tweedy’s book will move us forward in creating more inclusivity in Medicine. It’s incumbent on all of us in health and education to think through ways of improving this imbalance.

Slow Medicine (Cont’d.)

slow medicineIf you are a regular GlassHospital reader, you may recall a recent post describing the concept of Slow Medicine.

Author and doctor Michael Finkelstein has just re-released his book, now called Slow Medicine: Hope and Healing for Chronic Illness. It was previously published in 2013 under the title 77 Questions for Skillful Living.

Finkelstein has had an interesting journey. He trained in internal medicine at Penn, and eventually became the medical director of a hospital. Increasingly, he felt that he was not living a life that promoted health — either for his patients or himself. He wound up enrolling in Dr. Andrew Weil’s Integrative Medicine fellowship, as a member of the third cohort offered from what is now a well-established and internationally famous center.

Unlike many practitioners of so-called complementary/alternative medicine, Finkelstein in no way rejects “Western”/conventional medicine. He has simply chosen to expand his conventional US medical training by adding elements of other traditions that he has found most effective in helping those with chronic illnesses — the ones that conventional medicine often fails to impact.

Finkelstein lives on a working farm that he has named SunRaven, which is only 50 miles outside of New York City. He gave it that name because the property’s previous owners had used the farm to nurture injured and stray animals, including a raven. In addition, he came across a Native American parable about the SunRaven returning light and healing to the world.

I interviewed him about the release of his newly-titled book for Public Radio Tulsa, and came away feeling that SunRaven is a place I’d like to visit.

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