Summary of “How Do You Talk to Your Patients About Death?”

Instead of admitting patients from the emergency room and addressing all of their medical problems throughout their hospital stay, I saw patients only when another doctor requested a consultation for a patient, usually to treat certain symptoms and to talk with patients and families about their treatment goals-what patients considered most important and dear to them when living with a serious illness.
I’d gone from assuming that many of my patients would live for years after their hospital stays to knowing that some of my patients would die within the coming weeks or months after returning home.
“No, it’s your first day! So on our team we have two nurses and an attending physician and me. Everyone usually shows up for rounds at 9:30 or so, and we will talk about each of the patients on our list. The attending this month is Dr. Harris, and she’ll assign you a few patients to see. Oh, and you’ll need that,” she said, motioning to a pager on the corner of my cubicle.
Businesslike and efficient as she introduced herself, Dr. Harris told me that her day was packed with meetings, but that she would assign me several patients to see and we would talk about them later in the afternoon.
Almost all of our patients required family meetings, and some also required better control of pain.
The biggest shift was my new relationship to language, my attention newly focused on the words I used with patients and colleagues, and the words I heard them use.
“Take note of how long the oncology fellow talks before allowing the family to speak.” The oncologist, a brown-haired man with a kind face, spoke for twenty-five minutes about the gravity of the patient’s diagnosis, the chemotherapies that theoretically could be used, and all the reasons why the patient was too sick to qualify for them.
A patient with a failing liver asked me how much time I thought he had to live and begged me not to mince my words.

The orginal article.

Summary of “‘It’s Kind of Crazy in a Developed Country’: Inside the Amputation Crisis in the Rio Grande Valley”

A couple of months after the blister appeared, Zamora drove 2 miles to Valley Baptist Medical Center, where doctors quickly diagnosed him: His diabetes, uncontrolled for years, had blocked blood flow to his toe, preventing it from healing.
Perhaps the most visceral indication of the Valley’s diabetes crisis is the shocking number of people living with amputations.
Gregg, who worked on the study, told the Observer that though diabetes care overall has improved, the “Alarming” findings are a “Wake-up call.” He says amputations are important indicators that something went wrong with diabetes management, because they’re generally preventable in patients who can access diabetes education and primary care.
A family physician who’s originally from Brownsville, Oliveira opened the first wound care center in the Rio Grande Valley in the early ’90s. At his Edinburg clinic, tucked into a complex of buildings at Doctors Hospital at Renaissance, most of his patients are diabetic, with stubborn wounds that refuse to heal.
Diabetics had to travel hours to get this kind of care, said Oliveira, who co-founded the Rio Grande Valley Diabetes Association in 2007.
“Everybody’s big on the amputations, but not big on the preventive care part. They’re so busy doing hospital consults on patients that already need an amputation. They don’t have time to do the preventive care.” In the Rio Grande Valley, the numbers are more stark.
Researchers at UTHealth estimate that nearly 30 percent of adults in the Rio Grande Valley are diabetic, and more than one-third of Valley diabetics don’t know they have the disease.
Another community program aims to reach people at risk of diabetes before it gets too bad. At a makeshift clinic in the pulga, or flea market, in Alamo, nestled among booths hawking tropical fruits, used clothing and Mexican candy, health workers offer free diabetes testing and consultation.

The orginal article.

Summary of “The Jail Health-Care Crisis”

The crisis is particularly acute in jails, because large numbers of people booked into custody are in a state of distress or, like Laintz, will suffer withdrawal, which can require close monitoring and specialized treatment that jail wardens are not equipped to provide.
“People really are trying to provide high-quality health care, and jail environments are really tough,” Brent Gibson, a physician who is the chief health officer of the National Commission on Correctional Health Care, said.
The health services at the jail were provided by Correctional Healthcare, the company that was later acquired by Wellpath.
Opioid addiction, too, is an area in which jail health care is increasingly relied on by default.
Nancy Fishman, a criminal-justice policy expert at the Vera Institute, told me that “Every sort of convocation of sheriffs or jail administrators or law enforcement” these days is consumed by the opioid crisis and its impact on jail health care.
The concurrent rise of for-profit health care in jails and prisons has not been accompanied by the kind of public debate, congressional scrutiny, or scholarly research that has informed other fields of health policy.
In some European Union countries, where universal access to health care is fully established, prison and jail health care is often administered by state health services.
Last July, after a woman gave birth in her cell at the York Correctional Institution, in Niantic, Connecticut, where health care was overseen by the University of Connecticut, and where there had been other complaints about care, officials transferred responsibility for prisoner health care statewide back to the state corrections agency.

The orginal article.

Summary of “Medicare-for-all explained: insurance deductibles for work plans rising”

The West Virginia teachers went on strike over rising health care costs, eventually securing a pay bump and a freeze on insurance premiums.
Ending work-based insurance is still a humongous challenge Medicare-for-all has become incredibly popular among the Democratic base, but the primary problem it will face is that many people are fine with the insurance they have today.
The polling bears out this sentiment: 83 percent of people with employer-sponsored insurance said in March 2016 that they thought their health insurance was excellent or good, according to the Kaiser Family Foundation.
The price for insurance in the employer market has always been significantly less than buying insurance in the individual market.
The foundation of our work-based insurance system – that health insurance benefits are tax-free to companies and workers – also makes the problem worse.
Health care spending for job-based insurance increased by 44 percent from 2007 to 2016, according to researchers at the Health Care Cost institute.
Should your employer really determine your health insurance? One of the promises of Obamacare was that it might loosen the ties between work and health coverage.
There is a foundational question here, one often lost in debates about premiums and health care expenditures and uninsured rates or rates of growth: Should your employer be allowed to decide what kind of health insurance you have?

The orginal article.

Summary of “Affordable Daycare and Working Moms: the Quebec Model”

With more than two decades behind it, the Quebec program that spawned an affordable child care model has some lessons for the rest of the world.
With many years behind it, the Quebec program that spawned a global subsidized child-care model has shown marked progress in some areas in its original home province-while still lagging in others.
Since beginning the program more than two decades ago, Quebec has seen the rate of women age 26 to 44 in the workforce reach 85 percent, the highest in the world, according to Fortin.
A few dramatic statistics suggest the influence of the program on women in particular: In addition to a high overall rate of employment in the province, Quebec has seen particular increases in female employment amongst mothers of young children.
Another recent study from Statistics Canada compared Quebec to fellow Canadian province Ontario, which hasn’t adopted an expansive program like Quebec’s, found an even more dramatic increase in workforce participation of almost 20 percent for moms with a child younger than 3 over a similar time period.
The increase in working mothers has achieved one important outcome: revenue to pay for its government child care program.
In a common refrain heard about subsidized child care programs the world over, critics of Quebec’s program often claim the costs of the program don’t justify the expenses, and that the government could allocate the resources needed for these programs elsewhere.
Early estimates anticipated the program would generate 40 percent of its costs via increased income taxes from working parents.

The orginal article.

Summary of “How Cubans Live as Long as Americans at a Tenth of the Cost”

Cuba has long had a nearly identical life expectancy to the United States, despite widespread poverty.
The humanitarian-physician Paul Farmer notes in his book Pathologies of Power that there’s a saying in Cuba: “We live like poor people, but we die like rich people.” Farmer also notes that the rate of infant mortality in Cuba has been lower than in the Boston neighborhood of his own prestigious hospital, Harvard’s Brigham and Women’s.
In Cuba, health care is protected under the constitution as a fundamental human right.
As a poor country, Cuba can’t afford to equivocate and waste money upholding that.
Family doctors work in clinics and care for everyone in the surrounding neighborhood.
Then the doctors put patients into risk categories and determine how often they need to be seen in the future.
Unlike the often fragmented U.S. system where people bounce around between specialists and hospitals, Cuba fosters a holistic approach centered around on a relationship with a primary-care physician.
The system requires around twice as many primary-care doctors per capita as we have in the U.S., made possible because the country also invested in medical education, creating in 1998 what U.N. Secretary General Ban Ki-moon called “The world’s most advanced medical school.” Cuba has become known for training not just domestic doctors, but those from around the world-and sending its doctors to help other, wealthier countries when needed.

The orginal article.

Summary of “The Great American Health Care Panic”

No matter what they say about President Donald Trump, and regardless of what they think of their relatively moderate Republican congressman, Brian Fitzpatrick, the people and particularly the senior citizens and retirees who live in the state’s newly drawn 1st Congressional District are all but in lockstep when it comes to the health care system.
He voted for the Trump tax cut, for example, but he also voted against the health care bill that would have gutted President Barack Obama’s Affordable Care Act.
“I’m paying more for my health care than what we pay for our mortgage.” Rickert was out of work for six months last year because of a rib she fractured on the job and then pneumonia and other ensuing complications-and she lost her health insurance because of it, she said.
“They’re servants of the people. Isn’t that what they say?” The way she sees it what’s their incentive to work together to come up with solutions? “Until they get the same health care we do” She brought up the S.S. United States, the derelict ghost ship, rusting just down the Delaware.
At the Band Box bar, Mike Episcopo, 52, the co-owner along with his father, fretted over the fact that the cost of health care for his family has doubled of late.
The notion of universal health care is little more than a campaign scare tactic.
The most courageous thing he’s done in Congress? “Voting against the health care bill under immense pressure,” he said.
Any increase in health care costs or decrease in availability-especially for people like them with pre-existing conditions-would be a burden almost impossible to handle.

The orginal article.

Summary of “Nobel Prize-winning physicist Leon Loederman sold his medal for $765,000 to pay medical bills”

Leon Lederman won a Nobel Prize in 1988 for his pioneering physics research.
The physicist, who passed away Wednesday, sold his Nobel Prize medal for $765,000 to pay his mounting medical bills.
Leon Lederman, an experimental physicist who studied subatomic particles, has died at 96 after selling his Nobel Prize for $765,000 at an auction to help pay medical bills.
Even an accomplished physicist and university professor isn’t immune from America’s sky-high health care prices.
The cost of receiving care in a nursing home can also present a significant burden.
A private room in a nursing facility costs, on average, $7,698 per month.
Medicare, which covers the vast majority of Americans over 65, generally does not cover long-term nursing care.
Many Americans do end up getting Medicaid to cover nursing home bills – but that often requires selling off significant assets and dwindling down savings in order to fall below the public program’s income requirements.

The orginal article.

Summary of “Paper Trails: Living and Dying With Fragmented Medical Records”

Every year, an untold number of patients undergo duplicate procedures – or fail to get them in the first place – because key pieces of their medical history go missing.
Without an easy way to get a patient’s full medical files, I must ask where their prior doctors were, have the patients sign a release form, fax it to the other hospitals, and receive stacks of papers in return.
Patients may be the biggest advocates for sharing medical information, says Mark Savage, director of health policy at the University of California, San Francisco’s Center for Digital Health Innovation.
A 2014 survey of more than 2,000 patients by Mark Savage, then with the National Partnership for Women & Families, and colleagues showed that 95 percent felt electronic records “Were useful in assuring timely access to relevant information by all of their health care providers.” And more than three-quarters said they already share information with their health care providers all or most of the time.
Over my last few years as a doctor, I can’t think of a time when a patient complained that a doctor knew too much of their medical history.
How much is faulty record sharing to blame? My colleague, Marta Almli, an internal medicine doctor, surveyed the resident physicians at my hospital and others and found widespread dissatisfaction with how we obtain medical records: among 58 physicians surveyed, 81 percent said it was “Somewhat difficult” or “Extremely difficult” to get information about patients who transferred from another health care facility.
One of the most widely used electronic health vendors called Epic has a “Care Everywhere” platform, which helps facilities share electronic patient records quickly and efficiently.
There were some records, but for discharge patients they were stored in a paper binder in a separate storage facility.

The orginal article.

Summary of “The New Old Age”

That’s a small but telling example of why women seem better prepared for old age than men: we are willing to take on new experiences.
The plan does not cover prescription drugs dispensed by pharmacies, dental care, psychotherapy and physiotherapy by non-physicians, or home and community care for those who can no longer manage on their own.
Frequently, the elderly are admitted to hospital not because they are desperately ill but because there aren’t enough medical and social supports to care for them at home or available spots for them in long-term care residences.
Median wait times to move into long-term care in Ontario in 2014/15 was sixty-eight days for hospital patients and ninety-four days for those living at home, according to the Canadian Medical Association.
Calculate the price of keeping somebody in hospital who would be better cared for in the community, either at home or in a long-term residence, and you can see why health care expenditures are soaring.
These care gaps, along with excessive wait times for non-emergency treatment and a clunky arrangement whereby most physicians are independent contractors rather than an integral component of health care delivery, have downgraded our system internationally.
That’s why CARP “Is advocating for greater financial support, particularly for low-income caregivers and recipients, significant investments in respite care, and home care to help alleviate the burden on caregivers,” Wanda Morris says.
The federal government committed in its 2017 budget to spending $11 billion over ten years on home care, palliative care, and mental health care.

The orginal article.