I had a recent conversation with an old friend about her elderly father that encapsulates a lot of what is both great and terribly wrong with healthcare in America today.
Here are the basic facts: the man is in his mid-80s, retired from teaching school, and is active and vigorous, living in the community; he is cognitively intact. He has a history of coronary disease and had an intracoronary stent placed some years back. He is asymptomatic on a typical “cocktail” of meds including aspirin, a statin, and an ACE inhibitor. Over the summer, he had a routine follow-up visit with his cardiologist, who detected a carotid bruit. After a duplex sonogram and a CT angio, a high-grade unilateral internal carotid stenosis was identified, and carotid endarterectomy surgery was recommended. My friend called me to see if I could recommend a surgeon in the city where she and her father both live.
Continue reading The Good, the Bad and the Ugly
There is a growing awareness of the importance of health literacy – the extent to which patients and their families are able to understand words we speak and the written materials we provide. This is a good thing, since there is very good evidence that patients who have a better understanding of their condition and recommended treatment feel better, adhere better to recommendations, enjoy better health outcomes and rate the experience of their care higher. Oh, and they also sue for malpractice less frequently. The problem for providers is that it is not easy to get this right. Continue reading Health Numeracy
As I have noted previously I have a “love-hate” relationship with practice guidelines. Love because it is often helpful to refer to a set of evidence-based recommendations as part of clinical decision-making; hate because of all of the shortcomings of the guidelines themselves, as well as the evidence upon which they are based. Continue reading Practice Guidelines and Quality Care
I have been thinking a lot about cancer screening tests. It seems that there has been a constant stream of articles about screening in both the lay press and professional journals — as well as the inevitable stories in the lay press about the reports in professional journals — but this is more personal. I have had two recent experiences that I can’t get out of my mind. Continue reading Cancer Screening