JustCare

Tag: Doctors

  • Want to live longer? See a doctor who’s female

    Want to live longer? See a doctor who’s female

    A new study finds that women live longer when they see female doctors. This study adds to a body of research that finds women and minorities who see female doctors have better health than their counterparts, reports Liz Szabo of NBC News.

    The study published in the Annals of Internal Medicine found that women who are hospitalized are more likely not to face a hospital readmission and not to die within 30 days of hospital discharge if they are being treated by a female doctor.

    The study looked at almost 800,000 hospitalized people with Medicare who were over 65. A statistically significant higher percentage of them died within 30 days if they were treated by a male doctor than if they were treated by a female doctor, 8.38 percent v. 8.15 percent. That difference amounts to 5,000 lives that could be saved.

    Of note, the gender of the doctor did not affect the lives of men who were hospitalized or their readmission to the hospital. Women and minorities have been found to get worse medical care than white men from male physicians.

    It’s not clear why women fare better when they are treated by female doctors. But, it could be that women are better able to communicate with female doctors. There is less likelihood of misunderstanding and bias and of having pain and other symptoms overlooked.

    Another study found that women and people of color who see male doctors have between a 20 percent and 30 percent greater likelihood of misdiagnosis than white men.

    This Just Care post reports on several studies showing that people who see female doctors appear to have better health outcomes. The research suggests that female doctors might be better listeners and hew more closely to clinical guidelines. A 2016 Harvard study looked at 1.5 million Medicare patients who were in hospital. They found that the male and female patients who had female doctors had a reduced risk of death as well as a reduced likelihood of being rehospitalized after discharge than patients treated by male doctors.

    Here’s more from Just Care:

  • Can AI help with medical advice?

    Can AI help with medical advice?

    A post by the Lown Institute asks whether AI (artificial intelligence) could replace your doctors and provide you with as good or better medical advice? It picks up on a  JAMA Internal Medicine article reporting that AI chatbox answered patient questions better than many doctors, with regard to content and empathy.

    The JAMA article actually found that AI chatbox offered as much as ten times more empathy than your typical doctor. And, empathy is actually a critical component of treatment, though our health care system tends not to value it.

    The researchers studied AI responses to 195 random patient questions found on social media. Then, the AI answers were compared with those of doctors. Licensed health care professionals preferred the AI answers to those of the doctors.

    But, can AI really build trust with patients? It can’t replace the personal connection people have with their doctors. How could it?

    At the same time, doctors are generally pressed for time. It’s hard for them to be compassionate when they are typically in a rush. They often cannot offer quality time to their patients; they might feel bad about their conduct, while possibly harming patient well-being.

    The question becomes whether AI could offer a good support for patients in tandem with their doctors. It could supplement the care that doctors provide, even if it could never take the place of doctors.

    AI could help to deliver care that is empathic. AI also can help doctors with administrative tasks so that doctors have more time with patients. And, AI can answer some medical questions.

    Here’s more from Just Care:

  • Roundup: Your doctors and your health

    Roundup: Your doctors and your health

    Some doctors are a lot better than other doctors. As you get older, it’s especially important that you and your loved ones have doctors who listen to you, who do not undertreat or overtreat you, and who work with you to think through your health care wishes and your treatment options. These days, many doctors are looking at their computers and their watches during the patient’s visit, and those doctors should be avoided at all costs. Here’s a bunch of things to think about as a caregiver and as a patient:

    Take care of your health:

    Choose your doctors carefully:

    Make the most of your doctor’s visit:

    Speeding your recovery:

  • How to prepare for your doctor’s visit

    How to prepare for your doctor’s visit

    Whether you’re in good health or poor health, in a separate post I explained why it’s important to have a good primary care doctor. And, I’ve provided four questions to help you know whether your primary care doctor is meeting your needs. Here, I want to help you prepare for your doctor’s visit, so that you make the most of it.

    1. Confirm that your doctor accepts your insurance. If you have traditional Medicare, ask if the doctor accepts assignment, which means that the doctor accepts Medicare’s rate as payment in full. If you have a private insurer such as Aetna or Cigna, to save money, make sure the doctor is in-network. Always find out how much more you may have to pay out-of-pocket.
    2. Ask a family member or person you trust to join you. No matter what your age, it’s always good to have a health care buddy, a second pair of ears to listen to the doctor’s advice and, ideally, to take notes. You may also want your buddy to ask questions. The doctor’s visit can be stressful. You can decide to have your buddy be present for some or all of the visit – you are in charge!
    3. Make sure you bring a list of your medications with you, both prescription drugs and over the counter. And, ask your doctor whether you should be taking all these drugs.  It may be that you don’t need to be on a drug or that one drug you’re taking interacts poorly with another one. As you collect the bottles, think of any concerns, side effects or questions you have about your treatments.
    4. Make a list of all the questions you have for your doctor and other information you want to share, including any symptoms and concerns you have about your health. [Editor’s note: If you go alone to the visit, be sure to bring a pen and paper to take notes and repeat the doctor’s advice in order to confirm that you understand it.]
    5. If it’s your first appointment, you want to be sure to let your doctor know about any chronic conditions and any other health problems you have, as well as diseases that run in your family. If possible bring past medical records, test results, and your immunization records. You can ask the last doctor you saw to provide this information to your doctor, or you can sign a release form to have your new doctor’s office request your prior records.  If you are already an established patient of the doctor, be ready to provide your doctor with any major family health updates—for example, if your brother has been recently diagnosed with high blood pressure, or a parent was diagnosed with cancer.
    6. Check with the office if you are expected to come on an empty stomach to your appointment. There are only a few tests that need to be done in the “fasting state” (meaning, no food or drinks other than water for 12 hours). If you are expected to be fasting, tell the office if you are taking medications that require food, or if you think this will be difficult for you for any reason. Remember that most routine tests are not affected by drinking water, but being dehydrated could lead to slightly abnormal results.
    7. If your doctor is suggesting a test or treatment, to avoid overtreatment, be sure to understand why you need it. What are your options? How will it help? Are there side effects?
    8. Be sure that when you leave the office you understand your diagnosis and what you need to do, as well as when and how to contact the doctor and when to make another appointment. If you need a new prescription, make sure you know when to take it and what to do if you experience any side effects.

    [Editor’s note: This post was originally published on June 29, 2016.]

    Here’s more from Just Care:

  • Coronavirus: Doctors and nurses reconsider their professions

    Coronavirus: Doctors and nurses reconsider their professions

    The novel coronavirus has taken a huge toll on the lives of millions of Americans, particularly health care workers and other essential workers. Kaiser Health News reports on how some doctors and nurses are responding to this pandemic. The news is not pretty; it’s easy to imagine a future with robots as healthcare providers.

    Many nurses are fighting back against low-wage jobs that put them at risk. Their small hospital salaries are not enough to make the risk of catching COVID-19 worth it. They are leaving these steady hospital jobs for far higher paying jobs that guarantee them the personal protection they need.

    And, they are taking jobs that pay thousands of dollars a week to provide care to people in their homes. Working as private pay nurses, they can earn more than $6,000 a week. In some cases, they can earn $10,000 a week. By the hour, their base rate is $95. But, their jobs are not secure and do not come with health insurance.

    These traveling nurses will go wherever they are needed. And, their ranks are rising rapidly, now at 50,000. Just two years ago, there were 31,000.

    The result is a hospital crisis. And, greater health inequities. The hospitals in poor areas generally can’t afford to attract the nurses they need. Rural hospitals and public hospitals in urban areas are finding themselves understaffed. They don’t have the health care workers they need to provide care to COVID-19 patients.

    And, because COVID-19 is surging throughout the country, there are few areas with an extra supply of nurses.

    The good news is that finally nurses are commanding fair wages. The bad news is that some of them now command wages that most hospitals and individuals cannot afford.

    At the same time, thousands of doctors’ offices have been forced to close. With COVID-19, many primary care doctors saw a sharp drop in their patient volume. With that, came a major loss of revenue. As it is these doctors tend to earn a lot less than specialists, averaging less than $200,000 a year.

    Consequently, there are too few primary care doctors. This new wave of closures is only making it more difficult for people to get needed care.  It puts many of them with chronic conditions at increased health risk.

    Pre-novel coronavirus, we had a shortage of some 15,000 primary care doctors. According to the Health Services Research Administration, about one in four Americans live in an area where there is a a shortage of health care workers.

    One survey found that about one in twelve doctors’ offices have closed as a result of the novel coronavirus. That’s about 16,000 offices. The doctors say they do not have the financial means to remain open.

    Here’s more from Just Care:

  • Coronavirus: President Trump’s immigration policy leaves many hospitals short-staffed

    Coronavirus: President Trump’s immigration policy leaves many hospitals short-staffed

    President Donald Trump’s recent change to US immigration policy is leaving many hospitals short-staffed, reports Dara Lind for ProPublica. Trump’s proclamation of June 22 bars most immigrants from entering the US on work visas. Many US hospitals, however, have been counting on foreign doctors to get these work visas and serve as medical residents.

    Literally hundreds of young doctors from abroad will not be able to begin their hospital residencies as planned. Highly skilled workers planning to enter the US on H1-B visas, including practicing doctors, have not been able to enter the country. Other doctors planning to enter the US on other visas cannot get their visa applications approved because the US consulates in their countries are closed.

    Trump did exempt doctors caring for hospitalized COVID-19 patients from his immigration ban. The Department of State and Homeland Security are charged with providing guidance on how to implement this exemption. To date, the exemption has been inconsistently applied.

    Only now after ProPublica questioned the State Department about the implementation of the exemption, have a number of consulates begun to approve doctors’ visas. Still, some have yet to do so. This is causing staffing crises at many hospitals.

    A few foreign doctors who had planned to serve as medical residents in the US treating COVID-19 patients have told ProPublica that they are still waiting approval from the federal government. The Department of Homeland Security arranged emergency consulate appointments for them. But, at their in-person meetings, they learned that the US would not approve their visas.

    Recently, the State Department told ProPublica that it was still working with the Department of Homeland Security on how to implement the visa ban and exemption. Shortly thereafter, several foreign doctors whose visa applications had been rejected received approvals. But, in many countries, consulates are not approving visa applications as of yet. They apparently are still awaiting State Department guidance.

    As a rule, doctors care for thousands of patients a year. So, thousands of patients are at risk for each doctor that has not succeeded at getting his or her visa approved. Hospitals serving poorer populations and in rural areas are more likely to feel the effects of President Trump’s immigration policy. These hospitals rely more heavily on foreign doctors than urban hospitals and other hospitals serving patients who are better off.

    At one New York City hospital serving people with less means, foreign doctors represent a huge number of its first-year medical residents. Right now, almost half of these new residents are not able to enter the US. The same is true for a big Midwestern hospital.

    Many foreign physician specialists are also currently unable to enter the US.

    When there aren’t enough incoming residents to replace departing third-year residents, staffing crunches result. Short-staffing at hospitals means longer hours and less sleep for new medical residents. It also means greater stress and exhaustion. Some hospitals are relying on fourth-year medical students to take the place of foreign medical residents.

    Hospitals also are in need of residents to treat a surge in patients who need non-COVID care. Non-COVID-19 patients with serious chronic conditions are scheduling much needed care that they had put off because of the pandemic.

    President Trump’s ban on foreign immigrants does not apply to people who already hold visas. So, in many cases, it is foreign medical residents already in the US who are doing the heavy lifting at the hospitals. But, they might not be able to come back to the US if they leave. And, they must leave the US in order to get visa approval if they change jobs.

    The majority of foreign medical residents have J-1 visas, and Trump’s proclamation did not bar them from entering the US. But, they still need consular approval. Because of the pandemic, it can be challenging to get appointments. Many of them have visa applications that remain in “administrative processing,” who knows for how long.

    Whether doctors come on a J-1 or H1-B visa, they do exactly the same work. Their visa type is irrelevant. Medical residents with H1-B visas, however, have met more qualifying criteria, having completed all three phases of the US Medical Licensing exam. They also have practiced medicine in their native countries.

    Here’s more from Just Care:

  • How to ensure you get the care you want and need

    How to ensure you get the care you want and need

    Judith Garber reports for the Lown Institute on why you should not believe every new medical study you learn about. There’s a lot of medical misinformation. Be prepared to question your doctor about a recommended treatment and share in the decision-making to avoid getting care that you do not want or need.

    As a result of poorly conducted medical research, a large swath of study findings that you and your doctors might hear about are problematic at best. They are unreliable and do not help patients. In many cases, for example, researchers are paid by industry to generate findings of benefit to industry.

    Of course, you know that you shouldn’t believe everything you read. Just because a reputable journal publishes study findings does not mean that they are to be believed. Yet, like all of us, health care professionals at times believe them. Even they don’t always have the ability to independently evaluate the reliability of new research findings. The best source for independent analysis of studies on the benefits of a particular medical treatment is Cochrane.org.

    It goes without saying that people don’t have the tools to independently assess the reliability of evidence. And, most of us do not have the desire to do so. Rather, we tend to appreciate the benefits that a study might highlight and minimize risks.

    Shared decison-making between you and your doctors helps to ensure you do appreciate the risks of a treatment, along with its benefits. It engages you in conversation with your doctors about your health preferences, priorities and goals. And, you get a good idea of your treatment options. And, it likely will bring you greater satisfaction.

    Because not all physicians will engage you in a conversation about your priorities, be prepared to ask them about the treatment they are proposing. Find out how well they understand the treatment, How frequently have they recommended it to their patients. Have them tell you about the harms patients might face from a particular treatment, as well as the likelihood of benefit. Ask them whether other physicians typically recommend the treatment and, if not, what treatment is typically recommended for someone like you.

    Here’s more from Just Care:

  • Half of health care spending goes to doctors and hospitals

    Half of health care spending goes to doctors and hospitals

    A recent Peterson-KFF health tracking report shows that spending on hospitals and doctors has been increasing faster than inflation. Today, half of health care spending goes to doctors and hospitals.

    In 2018, about one-third of overall health care spending went to hospitals. Another 20 percent of spending went to physicians and health clinics. And, another nine percent of spending went for prescription drugs. The rate of increase in health care spending for doctors, hospitals and prescription drugs has slowed down some recently.

    Over the last nearly 50 years, spending on health care has grown significantly. In 1970, we spent $74.6 billion (6.9 percent of GDP) on health care. Thirty years later, total health spending was $1.4 trillion. In 2018, health care spending more than doubled to $3.6 trillion (17.7 percent of GDP.)

    Per person spending on health care in the US was 31 times higher in 2018 than in 1970. It grew from $355 a person to $11,172. In 2018 dollars, per person spending grew six times from $1,832 in 1970 to $11,172.

    Not surprisingly, out-of-pocket health care costs also have grown considerably since 1970. They totaled an average of $119 in 1970 ($613 in 2018 dollars) and $1,150 in 2018. These costs do not include premium costs.

    Public and private health insurance premiums have also grown. One-third of all health care spending is for private health insurance. In 1970, 21 percent of total health spending went towards private insurance. Public insurance represents 41 percent of total spending, up from 22 percent in 1970. When you include spending on public health and research, the government is responsible for almost half (45 percent) of total spending.

    Notably, private insurers have not been able to rein in health care spending as well as Medicare and Medicaid. In addition to having high administrative costs, private health insurers have not been able to rein in provider rates. Private insurer per person spending grew 52.6 percent in the ten years between 2008 and 2018. In stark contrast, Medicare per person spending grew 21.5 percent, and Medicaid per person spending grew 12.5 percent.

    Administrative costs grew quicker in 2018 than in the previous ten years. They represented 7.9 percent of overall spending (excluding provider administrative costs). That’s up from 2.8 percent in 1970.

    Here’s more from Just Care:

  • Five questions to ask your doctor to avoid overtreatment

    Five questions to ask your doctor to avoid overtreatment

    When your doctor suggests a particular test or treatment, it’s OK to have questions. (Overtreatment can be a problem.) These five questions, adapted from the book Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer, are intended to help you start a conversation and get the right care. If your doctor feels like there isn’t time to answer all of these questions in one appointment, it’s OK to ask for another.

    1. What are my options? For many conditions and illnesses, there can be more than one treatment. Sometimes changing your lifestyle, such as your eating or exercise habits, can reduce your symptoms or risk of a bad outcome enough to make additional treatment unnecessary. Sometimes, not getting treated at all is a reasonable choice. Ask your doctor what your options are, and to explain each one carefully.
    2. How exactly might the treatment help me? Sometimes patients have one idea about what a treatment can do, and the doctor has another idea.You need to know exactly what you stand to gain. A hip replacement, for example, might allow you to walk again with greater ease, but it won’t cure your arthritis, and you might need another replacement in 10 to 20 years. A drug might be able to relieve some symptoms and not others. Ask your doctor how the proposed drug or procedure is supposed to help you.
    3. What side effects can I expect, and what bad outcomes might happen? Every test, drug, surgery, and medical procedure has side effects, and some can be very serious. Simply being in the hospital exposes you to the possibility of bad reactions, medical errors, and hospital-acquired infections. You need to know the risks so you can decide if the danger or discomfort of your condition is more worrisome to you than the risks of the proposed treatment.
    4. How good is the evidence that I’ll benefit from the treatment? Many of the treatments and tests that doctors prescribe have never been adequately tested to find out if they work, or if they work in patients like you. You need to know if the treatment your doctor is recommending is a proven therapy. If not, your doctor should explain why he or she thinks it’s a good idea.
    5. If it’s a test, what do you expect to learn from it, and how might it change my treatment? If the test won’t change the treatment, ask your doctor if you really need the test.

    When you or someone you care about is in the hospital for a serious condition, such as heart failure, cancer, kidney failure, emphysema or any other advanced chronic condition, all of these questions are relevant. In addition, there is one more question and request you should make.

    • Do you have a palliative specialist in this hospital? If so, ask for a “palliative care consult.” Palliative care specialists are nurses, doctors ad other health professionals who are expert in controlling pain. They also help patients and their families with important decisions, such as whether or not to have surgery. For patients who are in the terminal stage of their disease, palliative care can explain various options patients have around end-of-life care, and help them and their families decide what kind of care they want and need. You should not have to pay out of pocket for a palliative care consult.

    _______________________________________

    This post was originally published on December 2, 2015

    Here’s more from Just Care:

  • John Oliver: Racism and sexism in medicine

    John Oliver: Racism and sexism in medicine

    Most Americans respect doctors. Still, racism and sexism in medicine is not uncommon. John Oliver explores this topic in Last Week Tonight.

    Biases in medicine, as in every profession, abound. In medicine, however, biases, can have a tremendous impact on health outcomes. Oliver reports that women and people of color often have a very different relationship to our health care system than white men. “People have biases, and doctors are people. And they may have come up in a system that intentionally, or not, has often discounted the experiences of a major portion of the population.”

    Sexism in medicine is real. Women have challenges getting needed health care. One study shows that if you are a woman, you are less likely to get a referral for a knee replacement. Another study shows that women over 50 who are critically ill are less likely to receive life-saving interventions than men. Still another shows that women who go to the ER with terrible stomach pain are less likely to receive pain medicine than men. A woman’s pain may be dismissed as emotional imbalance.

    Some doctors do not appreciate that women may experience different symptoms from men for a particular condition. For example, women’s heart attack symptoms are different from men’s. Because some doctors are unaware, women who come to the hospital with heart attack symptoms are far more likely to be misdiagnosed than men. One study found they were seven times more likely to be misdiagnosed than men.

    At the systemic level, doctors literally may know less about women’s bodies than they do about men’s bodies. Women’s bodies have not been studied as extensively as men’s; for decades women could not participate in research trials. Instead, researchers simply assumed that women’s bodies were fundamentally the same as men’s bodies, notwithstanding hormonal differences.

    Racism in medicine is also severe. Just look at life expectancy differences between black men and white men. By one estimate, because of racial disparities in health care, there are 83,570 unnecessary deaths of black men each year.

    There is tremendous misinformation about African Americans when it comes to health care. Oliver reports that studies show that some doctors believe there are biological differences between African Americans and white Americans, including with regard to skin, blood, and nerve endings. One in four doctor residents think black people have thicker skin than white people.

    Many studies show that black Americans have less chance of getting the care they need than white Americans for hip fractures, prostate cancer and pneumonia, among other conditions. One study showed that blacks were 34 percent less likely to be prescribed opioids for pain than whites.

    Racism and sexism in medicine contribute to poor health outcomes. Also, poor treatment of women and people of color can lead women and people of color to forsake needed treatment.

    Oliver recommends that doctors and medical students should get bias training. We also need more diversity in the medical field. Patients need to advocate for themselves. How? Wanda Sykes, a guest on Oliver’s show, suggests that you bring a white man to the hospital or doctor’s office with you. And, ask the white man to repeat everything you say. That just might get your voice heard!

    Here’s more from Just Care: