Patients, please listen. I have some things to say to you, per an article today in the Washington Post. The story details the ways in which patients can go online and rate their physicians, at websites such as RateMDs.com and Angie’s List. Patients typically write about such horrible woes as waiting for forty five minutes, having to wait an hour in the waiting room, and other seemingly unbearable complaints. Physicians are now doing the best that they can to enact some form of legislation that would disallow the public commentary about specific doctors and their practices. Why? Because although it may make a patient feel better for a few minutes to completely rant on a doctor for their bad experience and warn the rest of the world never to attend the practice, it can literally crush the entire career of a physician or surgeon. We all have to admit that we have been extremely peeved multiple times due to a doctor’s visit. Our appointment was at 1, we waited until 3, or we sat unclothed in one of those paper robes sitting on the table in the nearly refrigerated room for forty five minutes. In the end, though, did you really consider that a reason to end your doctor’s career or do enough damage where he can’t put enough food on his own table?
This may sound exaggerated, but I warn you it is not. People ask for far more than physicians as individuals can do for them. To become a doctor, you must have a genuine interest in relieving the suffering of another human being, and you must maintain that desire through many trials and tribulations, lasting years. Physicians and surgeons would most likely do every small thing you ask for, if they could. Insurance companies only reimburse physicians and surgeons for the dollar amount that they see fit, which is typically much less than it actually costs. So before you go posting how terrible your experience was, keep in mind that your physician paid for about half of your visit out of his own pocket. Also, if you want physicians to really listen to you and talk to you, answering all your questions, then be respectful if he runs late because that means he was doing just that with his previous patients. He will do the same with you, and the next patient, until he is at work for an extra eight hours than planned. Please do this for me: think of all of your issues with the doctor from his perspective, and it may actually be better than you thought. Extra waiting time means that he will spend extra time with patients, regardless of his schedule (good thing!). Posting good reviews is fine, because it helps other people receive good medical care, and it helps your physician as well, instead of ruining one and warning another. Use your best judgment.
The baby boomers are arriving, and they are arriving into the ‘senior’ category. All around the world, the number of seniors is expanding off the charts. The US Census Bureau released data this week showing that the number of seniors will be greater than the number of children under the age of 5, which is a very rare situation. A study based on the census report titled “An Aging World: 2008″ published the following findings:
- The world’s oldest country is…Japan! 21% of Japan’s population is over the age of 65, compared to 13% in the U.S. The study points out, however, that because of the good ‘ol baby boomers, the U.S. will probably win this category relatively soon.
- In the year 2006, zero biological children were born to women between the ages of 40 and 44.
- Europe is the oldest continent, because it holds 23 of the 35 countries found to be the “oldest.”
- A set of people over the age of 80 are called the “oldest old,” and the number of the oldest old is growing faster than any other population category in most countries.
- Developed countries have more seniors.
Some of these findings come as no surprise, such as the first one. We have all been waiting with our breaths held while the baby boomers age and our society shifts to accommodate. I will assume that no one is surprised that China would win a category when it comes to any number of people (although if we have learned anything, it is that the whole age thing is relatively sketchy when it comes to China).
The second finding is just odd. I’m not exactly sure what would make the researchers pull this statistic, but they claim that this may be a problem in the future when that set of women do not have children to take care of them. I’m sure that the children they had prior to forty will be sufficient; or the children born to them in 2005 or 2007. Don’t worry too much about these ladies, they’ll be fine.
The most important part of this study is not the specifics, however, it is the effect that this data will have on each nation’s society. I can’t speak for other countries, but as far as the United States goes, the aging population will most likely have the most profound effect on the health care system (and probably something to do with retirement benefits, banks, etc, but I don’t understand any of that). The aging population, and I truly do not mean any disrespect, will be using greater than 70% of the nation’s health care funds. This is because the elderly are already using 70% as of 2008, so with the number of seniors increasing exponentially, we can expect this to increase.
In addition to funds being funneled into this newly aging population, there remains the question of who will be administering health care. Will there be enough physicians to take on the new load? As we all know, the elderly are generally the sickest, and in almost all cases have compounding medical problems rather than one. Nearly all seniors suffer from one to three chronic conditions, and cancer is prevalent. The health care reform that may take place not far from now should certainly take into account that the physicians will be the saviors of this era. Money will not solve this impending situation.
I know you are probably sick of hearing about hypertension, blood pressure, and cardiovascular disease by now, but here’s the deal: there are easy ways you can avoid not only hearing about those conditions on the news, but also hearing about them from your doctor (and your insurance company). The steps you can take to control your high blood pressure or risk of high blood pressure were outlined in a study published this week in the Journal of the American Medical Association. Following their guidelines for a more heart-healthy lifestyle “could lower women’s risk of high blood pressure by as much as 80%.” Here’s what they offer:
• do some sort of exercise every day
• go easy on the sodium
• eat a lot of water-based foods like fruits and vegetables
• low-fat dairy is always a good choice
• supplement your diet with folic acid (especially pregnant women!)
• “maintain a normal weight”
That last one seems a bit vague, and I’m sure that if you follow the other steps you’ll have a better chance at maintaining your weight. My advice to you is this: when monitoring your weight, do not, I repeat, do not, rely on your visual system. You know how you look at a picture of yourself and you think you look awful? Chances are, you don’t, but you are convinced that you do. When you hear your voice on a voice recorded the normal response is to go “ewww! My voice sounds so weird, that’s not what I sound like, is it?” There are neurological explanations for this, but I’ll give you the simple version; your brain is bad at processing visual and vocal information about itself. When you eat healthy for a day, you’ll convince yourself that you look better in a mirror, and when you eat poorly for a day, you’ll convince yourself that you have added at least 10 pounds that day. Monitor your weight by how your clothes fit (not jeans, because they shrink and expand with washing and wear). Try on those khakis to get a sense for how things are going.
Exercising every day can come in many forms, too. You may be thinking that with your work schedule there is no way you could adhere to exercising every single day. That is probably true, but it is good to know that exercise is cumulative. Walking ten minutes in the morning, ten minutes in the afternoon, and ten in the evening is thirty minutes of walking a day. You won’t improve your 10k performance that way, but you are exercising. You can park farther away, take the stairs, walk the long way, etc.
This study is again one of those obvious papers that you probably could have written yourself, and a problem I have is that these papers don’t provide real world solutions to the problems. They give you a bullet point list of the “easy” ways to maintain heart health. Hopefully you can see a pattern in my simple solutions to these sometimes inconvenient health habits, and think of these three things: move more, eat every kind of food but in moderation, and reduce as much stress in your life as you can.
Obama stated not long ago that medicine has become more of a “business than a calling.” I could not disagree more with that statement. Medicine has remained a calling for many, but with the salary cuts and lack of regulation of insurance companies, physicians and surgeons have been forced to run a business. Obama has misinterpreted the situation. If you have read my previous posts, you understand that attending medical school at this time is close to a half a million dollar investment, followed by three to six years of a salary under $45,000, followed by one to five years of a salary under $60,000. If physicians have to spend $4,000 per month paying back loans for 10 to 25 years, and insurance companies will only pay 50% of what their procedures actually cost, one can imagine that pretty soon, the physician’s private practice has to operate as a business.
This is a small digression. My purpose in mentioning Obama’s statement is that in order to make up for the extreme debt and very low net salary of private practice physicians, private practices have participated in incentives given by pharmaceutical companies. These companies provide gifts, money, and various other incentives to physicians in order to ensure that their product is used. Often the drug companies will give significant monetary benefits for physicians to push the use of their product, and to push the drug over other, cheaper drugs that are essentially the same.
A law passed this summer in Vermont has set out to ban that practice. It is certainly for the benefit of the patients and their wallets to do so (and the physicians can only hope that reform comes soon so that they can stop taking all the hits when it comes to health care reform). The law, which was signed on June 8th, “bans gifts to physicians from manufacturers of prescription drugs, medical devices, and biologic products, with few exceptions.” These exceptions “include the provision of drug samples for free distribution to patients, the short-term loan of medical devices to permit their evaluation, and the distribution of journal articles and other items ‘that serve a genuine educational function.’”
What all of this really means is that Vermont has taken the first real step forward in an effort to reform the health care system. Perhaps Obama can learn from this, in that we do not necessarily have to change the entire health care system in one giant leap; we can chip away at it by ridding of the small but numerous abuses of the system.
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Oh dear. A study was presented at the Alzheimer’s Association International Conference of 2009 this week, claiming that strenuous exercise may cause cognitive defects in postmenopausal women. The study was done on a set of 90 women between the ages of 50 to 63, all having recently begun menopause. They recorded how often and for how long they have engaged in strenuous exercise since high school. The “results” showed that the women who had been engaging in strenuous exercise for decades performed the worst on tests of learning and memory, as well as attention.
I find this hard to believe, and I warn that you don’t take this article to heart. First of all, every person is different with regards to the muscle fibers they possess. For some, distance running is not strenuous at all; in fact, many distance runners find that their heart rate will go back down to a rate similar to a rate caused by simply walking. For others, running one mile is enough to make them nearly vomit. This study defined strenuous activity as “swimming laps, aerobics, calisthenics, running, jogging, basketball, cycling on hills, and racquetball,” and defined moderate exercise as “brisk walking, golf, volleyball, cycling on level streets, recreational tennis, and softball.” This is far from an adequately controlled experiment. It is hard to believe that volleyball can be strictly defined as moderate exercise. If you play it moderately, then it is moderate, but if you play it strenuously, it is strenuous. Same goes with tennis. These parameters do not allow for accurate analysis or experimental controls. The researchers did not include any controls, such as people who claimed to barely exercise at all. It is nearly impossible to make a conclusion by comparing these women to each other. Instead, the cognitive functions of these women should be compared to those in the same woman when she was in high school. A conclusion like this would take years and years to do correctly.
The researchers claim that their controls involved taking into account “age, education, smoking, and other risk factors for cognitive impairment,” but they also warn that “it could be the strenuous activity itself or some other lifestyle factor shared by these women that is responsible for the negative effect.” Ya think? But don’t worry, the researchers let you know that “the findings don’t prove that vigorous exercise causes mental decline.” For those of us who have done research in the past, or are currently doing so, we are ripping out our hair wondering why we spend year after year trying to publish a real scientific paper, while hundreds of others not only publish, but speak at an international conference about results like this. I would put a wager on this statement: exercise is good for you and will lead to no cognitive deficits in later life as long as you aren’t passing out afterwards or doing an ultra marathon four times a month.
