March 21st, 2011 by DavedeBronkart in Health Policy, Health Tips
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It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.
Sherlock Holmes, in Scandal in Bohemia
I’ve been reading Jack Wennberg’s new book Tracking Medicine, which is about his lifetime of work in understanding the reality of how medicine is practiced, as a route to helping us achieve the best care possible for each of us. My first post about this was three months ago, en route to a seminar on SDM (shared decision making); my first post after the seminar was shortly after. The whole subject has bent my thinking about healthcare so severely that it’s taken me this long to decide what to say next.
Key findings:
- Your doctors, with the best of intentions and the best of training, may unwittingly be prescribing treatments that aren’t necessary for you, or not prescribing things that are. (“You” includes anyone you’re caring for.)
- This realization was developed not through people’s opinions but by looking at cold hard numbers. After controlling for all variables, the odds of a given patient getting a given treatment vary by hundreds of percent from region to region. Read more »
*This blog post was originally published at e-Patients.net*
December 31st, 2010 by DavedeBronkart in Better Health Network, Health Tips, Research
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This is the first of the follow-up posts I hope to write from participating in the Salzburg Global Seminar titled “The Greatest Untapped Resource in Healthcare? Informing and Involving Patients in Decisions about Their Medical Care.”
One of our purposes on this site is to help people develop e-patient skills, so they can be more effectively engaged in their care. One aspect is shared decision making, which we wrote about in September. A related topic, from August, is understanding the challenges of pathology and diagnosis. Both posts teach about being better informed partners for our healthcare professionals.
I’ve recently learned of an another topic, which I’m sure many of you know: Practice variation. This is a big subject, and I’ll have several posts about it. It’s complex, the evidence about it is overwhelming, and its cost is truly enormous. Read more »
*This blog post was originally published at e-Patients.net*
January 18th, 2010 by EvanFalchukJD in Better Health Network, Health Policy, Opinion
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“We can no longer afford an overall health care system in which the thought is more is always better, because it’s not.” – Peter Orszag
Could anyone disagree? Not really. Which ought to be the first clue that it’s a meaningless truism. I mean, of course more isn’t always better.
But this hasn’t stopped this truism from becoming one of the most popular refrains in health care reform. Most of the time this is directed at one area: end-of-life care. Read more »
*This blog post was originally published at See First Blog*
November 8th, 2009 by Richard Cooper, M.D. in Better Health Network, Opinion
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Is poverty the major factor underlying geographic variation in health care? It assuredly is. There is abundant evidence that poverty is strongly associated with poor health status, greater per capita health care spending, more hospital readmissions and poorer outcomes. It is the single strongest factor in variation in health care and the single greatest contributor to “excess” health care spending. It should be the focus of health care reform but, sadly, many provisions in the current bills will worsen the problem.
Much of this is discussed elsewhere on this blog and in our recent “Report to The President and The Congress.” In this posting, I would simply like to tap into your common sense. We all know that poverty is geographic. There are wealthy neighborhoods and impoverished ones, rich states and poor ones, developed countries and developing ones. Sometimes poverty is regional, as in Mississippi, but sometimes it’s confined to “poverty ghettos,” as in the South Bronx. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
