Can Physical Exams Save Healthcare Costs?

Val Jones, MD

By Val Jones. I’ve often heard physicians say that “the history is 90% of the diagnosis.” In other words, they can usually determine the underlying cause of a patient’s problem just by listening to their account of how it evolved. The physical exam is merely to confirm the diagnosis, and is often cursory, limited, or ignored.

I believe that the physical exam is far more important than it seems – and I learned this during my recent oral medical specialty board examination. Although I have been sworn to secrecy regarding the content of the test questions, I will share an epiphany that I had during the exam.

The examiners’ job is to describe a patient and then ask the examinee what else she’d like to know and what she’d do next. With each description, I found myself struggling to visualize the patient – wishing I could see their face and hear their tone of their voice as they described their condition. I hadn’t realized that so much of my clinical judgement was based on laying eyes on a patient – I needed to see if they were in pain, if they were straining to breathe, if their skin was pasty or pale, if they were disconnected and potentially drug-seeking, if they were fidgety, if they were articulate, forgetful, or well-groomed. All of these subtle cues were gone.  I was left staring at the examiner – who himself couldn’t describe the patient more fully because he was to stick to the script, reading verbatim from a prepared list of signs and symptoms.

And then something interesting happened – based on the short description of an imaginary patient’s complaint, I began to go down an inappropriate (and expensive) diagnostic pathway. Since I couldn’t see the patient, and some of the symptoms could have been life-threatening, I suggested some pretty aggressive measures. I would not have ordered any of these tests had I been able to see the patient in-person, because I would have been able to see what was actually wrong quite quickly.

I realized that when two doctors plan for the care of a patient they’ve never met, all manner of inappropriate and expensive testing and treatment can occur. So I wondered to myself: what will happen to our healthcare system if we continue to divorce ourselves from patient contact? When diagnostic algorithms become even more rigid, and patients are pressed into diagnostic code categories with pre-determined courses of action prescribed for them long in advance? It’s going to become easier and easier for people to be locked in to an incorrect diagnosis, and subjected to a battery of expensive, and unnecessary tests and procedures… when all that was needed was a pair of human eyes and a thoughtful exam at the very beginning.

I’m pleased to report that I passed my specialty board exam, and I’m now certified in Physical Medicine and Rehabilitation. However, as I consider my clinical future – I know that to be a good diagnostician, I must spend time with my patients in-person… and I’m looking forward to it.


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A new meaning for “skin in the game” in health care

Jane Sarasohn-Kahn

Health is where we live, play, work and pray — and also where we moisturize.

Eucerin is working to create a Skin Savvy Nation. Welcome, health consumers, to the Eucerin Skin Health Cost Calculator, a tool that quantifies the financial impacts of skincare habits by estimating the life-cycle costs and benefits those skin health habits would have. The Calculator takes the consumer through a battery of questions together which yield a “skin score.” These include personal health habits such as not smoking, using skin-protecting moisturizer on a daily basis, and staying out of the sun.

Eucerin gauges the cost of poor skincare at $400 billion a year in the U.S., about $400 per capita for each American.

This is part of Eucerin’s PR campaign called the “Skin First Movement,” in which the company is trying to persuade consumers to classify personal skincare as part of their overall health care. The campaign offers a site on Skin Wisdom (a blog), and, of course, a Facebook page to ‘like.’

While beauty companies have been involved in marketing the health aspects of SPFs in moisturizers and makeup foundations, this is the first time one of them has offered a health cost estimating tool for consumers.

This development follows the FDA’s announcement earlier this month that the Agency would simplify the labeling of products marketing SPFs for sun protection.

Health Populi’s Hot Points: In the 2008 Edelman Health Barometer, we learned that physical appearance ranks just after physical health and mental/emotional health as part of their personal definition of “health” for 9 in 10 of the most engaged health citizens, as shown in the bar chart.

Eucerin worked with a pharmacoeconomist Rajesh Balkrishnan to develop the Calculator. He is quoted in Eucerin’s press release, saying, “The sooner you put your skin first, the less you’ll have to pay for skin recovery and the higher your quality of life will be.” Paying for skin recovery can reach as much as $100,000 for a patient, based on Balkrishnan’s calculations. (more…)

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“Take the Test, Take Control”: Today is National HIV Testing Day

Every year on June 27th the National Association of People With AIDS (NAPWA) organizes National HIV Testing Day (NHTD), in partnership with other national and local groups. They do this to send the message to both those at risk and those already living with HIV that it is critical to know your HIV status. This year marks the 17th NHTD.

The CDC estimates approximately 21 percent of the 1.3 million Americans living with HIV are unaware that they have it. Voluntary HIV counseling and testing is the important first step in taking control and responsibility over one’s health, their message for NHTD “Take the Test, Take Control” reflects this.

As the HIV epidemic turns thirty it is more important than ever to to heed their message.

For More Information:


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Invitation to National Hispanic Medical Association Regional Discussion: Health Reform Implementation

National Hispanic Medical Association Invites you to

National Hispanic Medical Association Regional Discussion

“Health Care Reform Implementation”

Speaker:

Mayra Alvarez, MPH*

Director, Public Health Policy, Office of Health Care Reform

U.S. Department of Health and Human Services

Thursday, June 30th, 2011

6:00 pm – 9:00 pm

Clyde’s of Gallery Place

707 7th St. NW

Washington, DC

R.S.V.P. to RSVP1@nhmamd.org by June 27th

In partnership with the DC Medical Society, Latino Medical Student Association, and NHMA Council of Residents and sponsored by AMGEN

Founded in Washington, DC in 1994, The National Hispanic Medical Association (NHMA) is a nonprofit association representing Hispanic physicians in the U.S. NHMA’s mission to empower Hispanic physicians to improve the health of Hispanic populations with Hispanic medical societies, resident and medical student organizations and our public and private partners. 

*Invited

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Coke or medicines – which reaches Timbuktu?

Lois Privor-Dumm

By Lois Privor-Dumm. We’ve heard the anecdote that you can find Coke in just about any village in Africa, but not always essential medicines.  Is that really true?  Well, our team at the International Vaccine Access Center (IVAC) at Johns Hopkins set out to find out. 

It’s actually not as easy as you might think to test the hypothesis, as Hopkins PhD candidate Kyla Hayford found out.  We did, however, get enough data to say comfortably that the anecdote is true as you will find in our new IVAC report, Improving Access of Essential Medicines through Public-Private Partnerships.

Photo credit: Tielman Nieuwoudt

First, we found an astonishing lack of available data about stock outs, wastage and other measures that indicate whether essential medicines are available.  Our report compared this to measures of availability of consumer packaged goods – things like candy bars and cola and calling cards – which seem to be stocked in abundance throughout the developing world. 

Why are these indicators important?  The simple truth is that no one dies if there aren’t mobile phone cards at the local kiosk, but the stakes are high if an antibiotic is not available to treat a child with a deadly disease.  Why is it, then, that consumer goods companies have many means to effectively track distribution, while there are very few measures in place to track the availability of essential medicines throughout Africa?

We found that injectable ceftriaxone, for example – a life-saving antibiotic for those with severe infections – was available in Kenyan and Tanzanian hospitals less than half the time, while mobile phone cards were available 90% of the time. 

So what can be done? (more…)

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More Prominent Cigarette Health Warnings

Beginning September 2012, FDA will require larger, more prominent cigarette health warnings on all cigarette packaging and advertisements in the United States.  These warnings mark the first change in cigarette warnings in more than 25 years and are a significant and necessary advancement in communicating the dangers of smoking.

The final set of cigarette health warnings contains nine different text warnings and accompanying color graphics to:

  • increase awareness of the specific health risks associated with smoking, such as death, addiction, lung disease, cancer, stroke and heart disease;
  • encourage smokers to quit; and
  • empower youth to say no to tobacco.

The above is one of the new warnings; to see more of the new warnings of to learn more about them click here.

Watch today’s announcement live from the White House:
When:
  Tuesday, June 21, at 12:30 PM EST
Webcast Link:  http://wh.gov/live10

You can also join Dr. Howard Koh, Assistant Secretary for Health at HHS, and Dr. Lawrence Deyton, Director, Center for Tobacco Products at FDA, in a Twitter Q&A session:
When:  Tuesday, June 21, at 2:30 PM EST
Twitter Account:  @FDATobacco
How: To participate and ask questions, simply follow along at the hashtag #cigwarnings and make sure to tag your Twitter questions with #cigwarnings.  

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Preventing Burnout in Family Caregivers

The following is a guest post by Kathy N. Johnson, PhD, CMC. Dr Johnson is a Certified Geriatric Care Manager, Founder and Chief Executive Officer of Home Care Assistance. She holds a Doctorate in Psychology from the Illinois Institute of Technology.  Kathy co-authored the book, Happy to 102: The Best Kept Secrets to a Long and Happy Life, based on the ground breaking Okinawa Centenarian Study, which spells out precisely what it takes to delay or escape Alzheimer’s and other chronic diseases, as well as how to slow the aging process.

By Dr. Kathy Johnson. Family members who provide care for a chronically ill, disabled, or aging parent make up almost 30% of the U.S. population. The majority are women, ages 40-65, and they spend an average of 20 hours per week in hands-on care giving. Family caregivers are often adult daughters who are also caring for children and juggling job responsibilities, household chores, and the needs of a spouse.

If you are in this “sandwich generation,” the pressure to do it all makes you particularly vulnerable to stress. Research has shown that nearly 75% of caregivers report not going to the doctor as often as they should; 63% have poor eating habits; and 58% indicate that their exercise habits are disrupted by care-giving responsibilities. 

Being a family caregiver is never easy. However, many women feel so overworked and unappreciated that they are unsure about their ability to continue being a caregiver. The daily emotional and physical demands of the care-giving process often lead to feelings of burnout.

The Signs of Burnout

Psychologists define burnout as “a debilitating psychological condition brought about by unrelieved stress.” Burnout isn’t as obvious as getting a sore throat or the flu, and family caregivers often deny or are oblivious to the signs of burnout. Sometimes burnout is noticed first by other family members and friends around you. Pay attention to these warning signs:

  • Feeling pessimistic and dissatisfied
  • Decreased energy or emotional exhaustion
  • Withdrawing from friends or social interactions
  • Loss of interest in work or enjoyable activities
  • Increased use of alcohol or medication to relax
  • Becoming impatient, irritable, or argumentative
  • Lowered resistance to illness (more…)


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June Man of the Month: Dr. Francis Collins

Francis S. Collins, MD, PhD is the Director of the National Institutes of Health and because of  his work and leadership is Disruptive Women in Health Care’s June Man of the Month. Dr. Collins wrote the article below which was originally posted in The Huffington Post on June 15th. This article is a perfect example of why he is our Man of the Month for June.

Broadening Our Global Health Vision

Over the past few decades, global health research has primarily focused on the “big three” diseases: AIDS, TB and malaria. And, thanks in large part to biomedical innovation, we today have better ways to treat these dreaded, infectious diseases and lower the risk of transmission — advances that have saved millions of lives and promise to save countless more.

However, the job of biomedical research is far from over. Given the changing nature of the global health landscape, we must act now to broaden our vision even further. First, we need to apply the power of scientific innovation to more health problems. Secondly, we need to recognize that developed nations are not the only source of such innovation.

While infectious diseases remain a significant problem, low-income nations face many other serious health challenges. In fact, the fastest growing causes of death and disability in the developing world are injuries, such as those caused by traffic accidents, and non-communicable diseases, such as cancer, heart disease and diabetes.

It will be no easy task to identify and implement the right tools to tackle this formidable — and potentially very costly — array of problems in resource-poor countries. To succeed, we will need the brightest minds in all parts of the world, including those from both the public and private sectors, to work together in new and highly creative ways. (more…)

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mHealth grows around the world, but the lack of evidence hinders adoption

Jane Sarasohn-Kahn

By Jane Sarasohn-Kahn. Over 85% of the world’s population is covered by wireless phone signals. The global proliferation of wireless phones provides a technology platform to move health services to people — broadly referred to as ”mobile health” or “mhealth.” mHealth: New Horizons for health through mobile technologies, the World Health Organization’s (WHO’s) second report on mobile health, summarizes a survey of mobile health developments around the world, published in June 2011 based on survey data from 2009 collected in 114 nations.

WHO learned that mHealth is most easily deployed into health applications where voice communication via traditional phone networks has been used. Thus, in important applications like surveillance and decision support, mHealth is less likely to be established because these functions require more advanced capabilities and technology infrastructure.

The survey evaluated mHealth services in 14 categories, as shown in the chart. These include health call centres, emergency toll-free phone services, emergencies and disasters, mobile telemedicine, appointment reminders, community mobilization and health promotion, treatment compliance, mobile patient records, information access, patient monitoring, health surveys and data collection, surveillance, health awareness raising, and decision support.

The most prevalent of these services are toll-free emergency applications, mobile health call centres and emergency services, and mobile telemedicine, all available in over 50% of WHO member states. In addition, mHealth-based appointment reminders are available in a plurality of nations.

The most popularly piloted mHealth programs include patient monitoring, treatment compliance, mobile telemedicine, and patient records.

Health Populi’s Hot Points:  Most of the mHealth deployments around the world tend to be small-scale pilots that deal with single issues. The largest scale mHealth programs are usually supported via public/private partnerships. (more…)

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The Case For Annual Eye Exams: Normal Vision Doesn’t Guarantee Healthy Eyes

Val Jones, MD

By Val Jones.  You probably see your primary care physician once a year, and your dentist twice a year. But how often do you see your eye doctor? Vision is the most valued of the 5 senses, and yet Americans don’t seem to be making regular eye exams a priority. A recent CDC survey suggests that as many as 34.6% of adults over the age of 40 (with moderate to severe visual impairment) believe that they don’t need regular eye exams. About 39.8% of the respondents said that they didn’t get regular exams because they were too costly, or because their health insurance didn’t cover the expense.

Although cost may play a role in peoples’ thinking, a comprehensive eye exam costs as little as $45-50 at retail outlets. I suspect that the real reason why people don’t get regular eye exams is because they incorrectly believe that if their vision is stable, their eyes are healthy.

A comprehensive eye exam is a type of medical check up – it is not just a vision assessment. Eye care professionals can diagnose everything from glaucoma and cataracts to high cholesterol, diabetes, high blood pressure, and even neurologic conditions such as brain tumors and multiple sclerosis. The eyes are more than a “window to the soul” but a window to general physical health. And the good news is that exams are relatively inexpensive and painless – so please consider making them part of your yearly health maintenance routine.

And to my primary care friends – don’t forget to encourage your patients to get annual eye exams. As the CDC notes:

Recommendations from primary-care providers can influence patients to receive eye-care services; persons who had visual screening during routine physical examinations had better eye health because of reminders to visit eye specialists. Public health interventions aimed at heightening awareness among both adults aged ≥65 years and health-care providers might increase utilization rates among persons with age-related eye diseases or chronic diseases that affect vision such as diabetes.

I myself have had an unexpected diagnosis during an eye exam, and feel passionate about the importance of preventive screening. In fact, I’ll be the upcoming host of a new eye health education initiative – a radio show called, “Healthy Vision with Dr. Val Jones” supported by ACUVUE brand contact lenses. The first show will be released here today, and it’s also available at Blog Talk Radio. (more…)

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Yes, Virginia (and 49 other states) There is Healthcare Reform Beyond the Beltway

Mary R. Grealy

By Mary Grealy. It’s easy to get so caught up in the battle over whatever healthcare legislation is before Congress, or the newest set of regulations to come out of the departments and agencies, that one can make the mistake of thinking that all healthcare reform has its genesis within the confines of Washington, D.C.

The truth, though, as spelled out in forceful detail by McKesson Corporation CEO John Hammergren (a Healthcare Leadership Council member) in a Forbes blog post this week, is that genuine, system-changing reform is taking place up and down the healthcare spectrum outside of the Washington Beltway.

His sound advice to his counterparts in the healthcare industry is simple and compelling:  Don’t wait for Washington to enact change.  Make it happen yourselves.

Mr. Hammergren cites hospitals and insurers that have reduced costs and improve the quality of patient care through sound use of information technology, adherence to evidence-based medicine and innovative delivery approaches and management techniques.  As he writes, “Disciplined leadership and visionary planning turn intractable problems into exciting opportunities.”

Actually, the Healthcare Leadership Council is bringing that argument to government policymakers.  Our HLC Value Compendium cites numerous examples, with the metrics to back them up, of private sector healthcare companies and organizations taking steps to improve the value of healthcare and improving patient outcomes.  We believe these success stories can be a springboard for the Center for Medicare and Medicaid Innovation’s efforts to develop successful payment and delivery reform demonstration projects. 

In the meantime, the next time we get caught up in the latest health policy political spat that has everyone inside the Beltway talking, we should remember the message in Mr. Hammergren’s Forbes post.  What’s happening everyday in healthcare venues throughout the country, he writes, “is the kind of reform that no one will want to repeal.”

Originally posted on the Prognosis Blog on June 9th.

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Righting wrongs to reduce medical errors

Anna Gawlinski

The following is a guest post by: Anna Gawlinski, RN, DNSc, FAAN, Director, Research and Evidence-Based Practice and Adjunct Professor at Ronald Reagan UCLA Medical Center and UCLA School of Nursing and Elizabeth Henneman, PhD, RN, Assistant Professor at The School of Nursing at the University of Massachusetts-Amherst.

It’s easy to criticize the current state of our health care system. All over the place, even outside of Washington DC, people are talking left and right (politically, that is) when they should be talking right and wrong (care, that is). But, one important talking point that’s almost always left out of the equation is our role, the role of the nurse. Or more specifically, the critical care nurse whose job it is to save you or your family members’ lives if hospitalized in the intensive care unit (ICU).

With its latest effort to reduce medical errors through the National Patient Safety Initiative, the government is putting dollars behind this effort. Hospital ICUs not only house a hospital’s sickest patients, but they also account for up to 30 percent of a hospital’s costs. As many as 1 in 5 patients die in the ICU and this is partially attributed to the severity of medical conditions and the high rate of health care-associated infections (HAIs). However, we all know that medical errors also play a huge role.

Medical errors occur in the ICU. In the past, many have been of the mindset that they are inevitable. However, our study recently published in the American Journal of Critical Care illustrates that nurses can play a significant role in reducing medical errors. (more…)

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Fragmented Care Requires Clarification Of Roles By Each Member Of The Medical Team

The following is a post by Dr. Jessie Gruman from the Center for Advancing Health. This blog post was originally published at Prepared Patient Forum: What It Takes Blog. It was also posted on Better Health.

By Jessie Gruman.“The most important thing I learned was that different doctors know different things: I need to ask my internist different questions than I do my oncologist.”

This was not some sweet ingénue recounting the early lessons she learned from a recent encounter with health care.  Nope.  It was a 62-year-old woman whose husband has been struggling with multiple myeloma for the last eight years and who herself has chronic back pain, high blood pressure and high cholesterol and was at the time well into treatment for breast cancer.

Part of me says “Ahem.  Have you been paying attention here?” and another part says “Well of course!  How were you supposed to know this?  Have any of your physicians ever described their scope of expertise or practice to you?”

I can see clinicians rolling their eyes at the very thought of having such a discussion with every patient.  And I can imagine some of us on the receiving end thinking that when raised by a clinician, these topics are disclaimers, an avoidance of accountability and liability.

But all of us – particularly those receive care from more than one doctor – need to have a rudimentary idea of what each clinician we consult knows and does. Why is this clinician referring me to someone else? How will she communicate with that clinician going forward? How and about what does she hope I will communicate with her in the future?

Why does our clinician need to address these questions?

Because in the absence of real guidance we will guess.  Some of us will make informed guesses and be mostly right. Others of us will leave our primary care provider in the dust and seek care for routine health matters from our specialist, whom we see more frequently and who seems to know us better. Some of us, like my friend above, will ask for help from whichever physician is handy and will call back, regardless of the problem.  And some of us will throw up our hands in frustration and head for the local emergency department when we find we can’t breathe and don’t know which of our doctors to consult about those damn allergies.

These ad hoc solutions are a waste of our time and surely contribute to a poor use of clinician and institutional resources. (more…)

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Dr. Jack Kevorkian Dies

Early last Friday morning Dr. Jack Kevorkian died at the age of 83. He was a Michigan pathologist who put assisted suicide in the forefront of medical ethics world. Kevorkian was often referred to as ”Dr. Death” as he was a staunch supporter of physician-assisted suicide and “right-to-die” legislation. He was charged with murder numerous times in the 1990s for helping terminally ill patients take their own lives and was convicted of murder in 1999 stemming for the death of a patient who suffered from Lou Gehrig’s disease. He was paroled four years ago in 2007.

Do you believe physician-assisted suicide is murder?

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  • June 6th, 2011 Help Wanted: Artists to Create Miracles
    By Glenna Crooks