I saw a patient today and looked back at a previous note, which said the following: “stressed out due to insurance.” It didn’t surprise me, and I didn’t find it funny; I see a lot of this. Too much. This kind of thing could be written on a lot of patients’ charts. I suspect the percentage of patients who are “stressed out due to insurance” is fairly high.
My very next patient started was a gentleman who has fairly good insurance who I had not seen for a long time. He was not taking his medications as directed, and when asked why he had not come in recently he replied, “I can’t afford to see you, doc. You’re expensive.”
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10
March
From: SMITH K.M.
The Stimulated Body and the Arts: The Nervous System and Nervousness in the History of Aesthetics
International Interdisciplinary Conference
17-18 February 2011
Centre for the History of Medicine and Disease Durham University, UK
Venue: Hatfield College, Durham, UK
Deadline for submission of abstracts: 31 July 2010
This conference will discuss the history of the relationship between aesthetics and medical understandings of the body. Today's vogue for neurological accounts of artistic emotions has a long pedigree. Since G.S. Rousseau's pioneering work underlined the importance of models of the nervous system in eighteenth-century aesthetics, the examination of physiological explanations in aesthetics has become a highly productive field of interdisciplinary research. Drawing on this background, the conference aims to illuminate the influence that different medical models of physiology and the nervous system have had on theories of aesthetic experience. How have aesthetic concepts (for instance, imagination or genius) be grounded medically? What effect did the shift from animal spirits to modern neurophysiology have on aesthetics?
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25
February
After a spy plane confirmed the Soviet Union was building launch platforms for first-strike ballistic missiles in Cuba in October, 1962, President John F. Kennedy convened his Joint Chiefs of Staff and cabinet members to help him decide how to respond.
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9
November
It does seem to take a health care bill to remind us all how incredibly screwed up the political process is in these here United States. The Medicare Modernization Act was railroaded through by Tom Delay and friends using all their charm and finesse. And last night the House passed its version of the health reform bill. It includes employer mandates, exchanges, subsidies, public option and taxes on those earning more than $500,000 to close the cost gap. And CBO in its wisdom says that it doesn’t increase the deficit.
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8
November
The following is a guest post from Rushika Fernandopulle, MD, MPP,
Co-Founder of Renaissance Health
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9
April
Over the past few months, I've seen a convergence of emerging ideas that suggest a new path forward for decision support and information therapy. I believe we need Decision Support Service Providers (DSSP), offering remotely hosted, low cost knowledge services to support the increasing need for evidence-based clinical decision making.
Beth Israel Deaconess has traditionally bought and built its applications. Our decision support strategy will also be a combination of building and buying. However, it's important to note that creating and maintaining your own decision support rules requires significant staff resources, governance, accountability, and consistency. Our Pharmacy and Therapeutics Committee recently examined all the issues involved in maintaining our own decision support rules and it's an extensive amount of work. We use First Data Bank as a foundation for medication safety rules. We use Anvita Health to provide radiology ordering guidelines based on American College of Radiology rules. Our internal committees and pharmacy create and maintain guidelines, protocols, dosing limits, and various alerts/reminders. We have 2 full time RNs just to maintain our chemotherapy protocols.
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7
April
Most discussions regarding health care focus on parts that need fixing.Health care has many parts and some are broken and some aren't. But if we want to solve the problem, first we better decide on whether we have the right model. In the model that follows, we strongly emphasize building trust between participants but, as always, trust has to be verified.
Several years ago, we hadthe idea of building a non-adversarialmanaged care system for large employers and their injured workers. We namedit "The Managed Care Alliance." As people familiar with workers' compensation know, it is among the most adversarial medical systems in the world. Employers and payers have little control over medical care and attendant costs. Abusewas rampant and providers, patients, and payers were pitted against each other. Many cases ended up in the courts. Our theory was that by eliminating friction, we could better ensure appropriate care for patients and significantly lower costs. Over a 10 year period during which I was involved, that is exactly what happened.
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12
February
I'm going to go out on a big ol' limb here by saying that 90 percent of our health care problems could be solved by rebuilding and refocusing our primary care delivery system.
It's the issue most discussed issue in reform circles (aside from single-payer) and it makes perfect sense. Toyota has succeeded because it goes to great lengths to find the true source of quality issues. They have recognized that addressing root causes significantly limits efforts needed because you avoid treating secondary level problems that occur further down the line.
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22
November
By Gregory Kellett, a cognitive neuroscience researcher at SFSU and UCSF, and science writer for Lumos Labs.
Ever wonder about the workings of your nervous system? As mentioned in our previous post on cognition, the nervous systemis responsible for integrating and processing information about your surroundings while directing action towards the achievement of goals; whether this be eating a tuna sandwich, serenading a lover or getting out of the way of a speeding bus. Physically, it is made up of your brain, spinal cord and peripheral nerves.
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19
November
By Gregory Kellett, a cognitive neuroscience researcher at SFSU and UCSF, and science writer for Lumos Labs.
Ever wonder about the workings of your nervous system? As mentioned in our previous post on cognition, the nervous systemis responsible for integrating and processing information about your surroundings while directing action towards the achievement of goals; whether this be eating a tuna sandwich, serenading a lover or getting out of the way of a speeding bus. Physically, it is made up of your brain, spinal cord and peripheral nerves.
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19
November