health care reform

John Garvey’s open letter on the Institute of Medicine’s health care proposals. Steve Schneck and Michael Sean Winters on the inadequacy of HHS’s conscience protections. Robert George’s comments to ACOG would also be pertinent to the recent IOM report resulting in HHS’s new rule re mandated coverage. “The key thing to see is that the issues in dispute […]

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“In law school he had committed acts which had formerly seemed to him of great vileness and had inspired a feeling of self-loathing in him at the time he committed them; but subsequently, seeing that such acts were also committed by highly placed people and were not considered bad, he, without really thinking them good, […]

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… The NYT has an article that summarizes hospice use/cost trends. As is often the case, the accompanying comments provide a wonderful window into our community.

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“Health is not a commodity. Risk factors are not disease. Aging is not an illness. To fix a problem is easy, to sit with another suffering is hard. Doing all we can is not the same as doing what we should. Quality is more than metrics. Patients cannot see outside their pain, we cannot see […]

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Gawande identifies core values for today’s physicians … “Which brings us to the third skill that you must have but haven’t been taught—the ability to implement at scale, the ability to get colleagues along the entire chain of care functioning like pit crews for patients. There is resistance, sometimes vehement resistance, to the efforts that […]

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… Charles von Gunten’s comments on the recent JAMA article looking at non-profit & for profit hospice characteristics. “The for-profit agencies whose shares are traded publicly on the stock exchanges and report large profits do, in fact, ‘‘cherry pick’’ less expensive patients who live longer … Now that the data are out—everyone in the United States should […]

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Palliative care focuses on improving a patient’s quality of life by managing pain and other distressing symptoms of a serious illness. Palliative care should be provided along with other medical treatments. Hospice is palliative care for patients in their last year of life. Hospice care can be provided in patients’ homes, hospice centers, hospitals, longterm […]

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… higher costs in LA for the seriously ill related to 35% more hospital beds as well as more traditional hospice delivery model. Quality measures favored San Diego. Related editorial describes this medical torture. Related editorial in today’s NEJM.

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In the Middle Ages, the figure of the sick man identifies the poor, the outcast and the man in need. Disease is the feature of a particular social class and therapy coincides with assistance to the poor, and with the charitable care of poverty. Poverty itself is defined “morborum genitrix (the mother of diseases)” and the sick man is […]

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… Giorgio Israel in “Medicine Between Humanism and Mechanism” in Journal of Medicine and the Person discusses important foundational issues pertinent to the daily practice of medicine. “Radically objectivistic medicine replaces the idea of “cure/treatment” with the idea of “repair”. It stops listening to the patient and renders the role of clinical practice drastically marginal […]

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