Now... you must be wondering why Bush is threatening to veto the bill.  Does he have something against docs? I don't think so.  Hmmmm.   If you look at the bill and where the spending would have come from it becomes all too clear.  Bush is once again siding with his corporate cronies  in part because it would reduce federal payments to private Medicare Advantage plans, offered by insurers like Humana, UnitedHealth and Blue Cross and Blue Shield companies.   So rather than help seniors by ensuring they will be able to see a doctor with Medicare as their sole coverage, or doctors who face rising liability assoc costs and rising office costs ---in the face of diminishing reimbursement----Bush sides with his buddies.  How predictable!!!!

 Now... will docs drop Medicare ?????

This will be a very interesting few weeks.   

[I]t’s simpler to change behavior than attitudes,” Kahn writes. In other words, we won’t get all doctors to respect their patients, but maybe we can get them to act like they do.

 A little bit of etiquette can go a very long way to allay fears and make a hospital stay a tad more "comfortable." Our patients are the ones who are "suffering",---our misery with the state of the healtcare system or our local politics, etc should not affect how we relate to our patients.  They deserve a caring, polite and respectful professional to greet them every day.   

Grounded in research at the Dartmouth Medical School, slow medicine encourages physicians to put on the brakes when considering care that may have high risks and limited rewards for the elderly, and it educates patients and families how to push back against emergency room trips and hospitalizations designed for those with treatable illnesses, not the inevitable erosion of advanced age.

 Nice article in the NY Times today regarding end of life care.... 

I applaud the efforts of the Dartmouth medical community and the folks at the hospice and nursing homes in their catchment area.  Elder care and the money we waste to delay the inevitable consumes an enormous percentage of every health care dollar.  It is obvious now that proper education and a shared decision process can make the entire end of life process more humane.   It also allows the person/patient to maintain their dignity while giving the family and caregivers an active role in the process.   

Cmon.... turn off the computer and go outside !!! 

Now that residents of MA need to carry health insurance there are a multitude of insured patients hitting the pavement with their new insurance cards---only to find that the next available visit for a comprehensive phyiscal could be in 2009.  Why... because nobody thought about the primary care docs, whose numbers have been dwindling, and how many may be necessary to serve the needs of the newly insured. 

“It’s a recipe for disaster,” Dr. Sereno said. “It’s great that people have access to health care, but now we’ve got to find a way to give them access to preventive services. The point of this legislation was not to get people episodic care.”

This is also an interesting video segment ----from a reporter in Boston, I believe. 

 And why he believes his DNA matters

The Dartmouth Atlas of Care   was released today.  According to the report, it is not the overall chronicity of care that costs american the most during their final two years...it is the intensity of care.  The WSJ healthcare blog reports

Nearly as notable as the Atlas’ findings–that Medicare could have saved as much as $50 billion over five years if all U.S. hospitals cared for dying, chronically ill patients the way the most efficient facilities do– are its proposals for change.

Giving patients a “medical home” by putting one primary doctor or practice in charge of coordinating their care makes sense, particularly for the chronically ill, David Goodman, a Dartmouth pediatrician and Atlas coauthor, told Health Blog. But as long as specialists have an incentive to refer patients to one another ad infinitum, we’re still in for trouble. “An island of medical home is still sitting within these very strong currents of reimbursement incentives that reward inpatient care and intensive care and specialty care,” Goodman said

 Furthermore....

“There is a belief, particularly among patients, that more care is better care,” said John Lumpkin, senior vice-president of the Robert Wood Johnson Foundation, which funds the Atlas. “The Dartmouth Atlas shows that is not the case.”

I think that a better educated patient will ultimately be a healthier patient.  Like most information we receive...we need to know the source and any potential motive behind it.   We need to vet the source and decide whether or not we believe following a certain opinion is in our best interest.  That is the basic premise of shared decision making.