Health Business Blog

While changing planes at Washington Dulles I picked up a discarded Washington Post and read its particularly good Health section. I found the article Gifted? Autistic? Or Just Quirky? about the labeling of children to be quite thought provoking:

Increasing numbers of children are given increasingly specific labels, ranging from psychiatric and neurological diagnoses such as Asperger’s and attention-deficit disorder to educational descriptors including “gifted” and “learning disabled.” And parents who in the past might have fought ferociously against giving their children labels — particularly for once-stigmatized conditions such as learning disorders — sometimes actually seek such diagnoses for their children to get them extra time on tests, to receive insurance reimbursement for treatment, to qualify for extra educational services or simply to have a name (and treatment) for a problem.

The article then discusses the pros and cons of labeling. My attitude toward labeling is largely negative, but situation-dependent. Here are some problems:

• Diagnoses are often wrong and the conditions themselves frequently ill-defined and overlapping
• Labels tend to stick even after a child grows out of whatever they had
• Labeling authorizes discrimination –positive and negative
• Labeling can provide a handy excuse for lazy parents, teachers and caregivers who don’t bother to understand a labeled child’s individuality
• Labeling ‘medicalizes’ non-medical conditions, such as what we used to call “boyhood”

Sometimes a label is good, though

• When drug or behavioral therapy is appropriate. (Although the definition of “appropriate” needs its own post)
• When it’s helpful for a child to understand him or herself or for a parent to give advice to a teacher on how to work with a kid

Parents can sometimes feel forced by their school into having their kids tested and labeled. In many cases it’s worth the trouble to resist that pressure. I also worry that if enough kids get labeled it puts the unlabeled at a disadvantage: they don’t get extra time on tests, and they get a smaller piece of the fixed pie of educational resources.

Plus, as they say in the Incredibles, ‘If everyone’s special, no one is.’

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The latest Cavalcade of Risk blog carnival is up at Renthusiast.

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There’s a good Cases column in today’s New York Times (A Mystery Ailment, but not for the Right Doctor) about a patient with a mysteriously sore foot. He’d done his research on the web and sought out a tropical medicine expert (the author of the Times article) to test his theory that the problem was caused by a mosquito bite he got in India. To make a long story short, what he really needed was a bone and joint expert. Partly by luck he ended up seeing one and having his condition diagnosed properly.

If you already know your diagnosis –even if it’s for something obscure– it’s not hard to find good information about it on the web. But if you have only a collection of symptoms to go by, you’re in much tougher shape (even if you try your hand at Google diagnosing). It’s hard to even know what symptoms or other findings are relevant and what kind of physician to go to. You could go to one that causes more harm than good or ends up prescribing a medication that masks symptoms another doctor would need to make an accurate diagnosis, as happened in this case.

There is an answer to this problem: consumer-focused decision support tools that help patients figure out what kind of physician to see and what information to present. I predict you’ll be hearing more about this approach within the next year.

Note: the Times site was down so I’ve linked to the same article in another newspaper. 

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Check out Grand Rounds, the best of the week’s medical blogging. It’s hosted this time at Musings of a Dinosaur.

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I noticed my shuttle bus driver seemed to be taking a circuitous route tonight to get from the Sheraton hotel in New Orleans to Mardi Gras World, site of a rockin’ bash sponsored by Motion Computing and Intel in connection with the HIMSS conference.

I asked the bus driver what was going on and he said all the drivers at HIMSS are under orders not to go through areas devastated by Katrina.

That seems ridiculous to me.

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Every store is a liquor store, in whole or in part.

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I’ve written before (here and here) about the profound effect I expect Wal-mart’s $4 generics to have on US health care. In addition to the direct cost savings, it also helps consumers realize that insurance shouldn’t be necessary to pay for routine products and services.

Today I received an email from a friend that put a personal spin on it:

There has been much talk about Wal-mart and the $4 monthly supply for some generics and whether it is a real benefit or just a marketing ploy with a short list of generics covered (something like 500 out of several thousand, although my bet is it’s more like 80/20 on volume).

My wife’s doc phoned in an Rx to the local Walgreen’s (our normal pharmacy) for a generic.  I was a bit shocked to find out they wanted over $150 for 90 tablets/days supply.  I found out the drug was on Wal-mart’s $4 list at twice the dose, so I had my doc’s office call the local Wal-mart with an Rx for the higher dose.  I got 45 tablets/90 days supply for $6.  The pill splitter cost about $4.  I still can’t figure out why I’m shocked by this, given all the cost shifting and the $6 aspirins in hospitals, but I am.

Walgreen’s and others watch out.

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Made it down to New Orleans today for the HIMSS conference, no thanks to United Airlines. I had a 6 am flight through DC, which United canceled at the last minute. The best they could offer was to rebook for Tuesday, the same day I’m returning! Capacity to New Orleans is way down post-Katrina, but tens of thousands were trying to get to HIMSS.

Luckily my travel agent was available at 5 am and we rebooked on US Airways through Charlotte to Jackson, Mississippi. I then drove the three hours to New Orleans from there. Listening to satellite radio I did hear one good doctor joke:

I went to the doctor and all he did was suck my blood. You should never go to Doctor Acula!

A couple weeks back I was traveling in Kentucky and North Carolina with my Southern colleague Mack Amaker (“American by birth, Southern by the grace of God” he tells anyone who’ll listen) and he asked me how I defined the South. I didn’t (and still don’t) have a clean definition, but as a result of my car trip today I have refined my view a bit:

I was hungry as a result of not being fed on the flights, so stopped at Subway for my favorite, the veggie patty. But Subway’s in the South don’t have that. They have pork sandwiches instead. So I stopped in a Burger King, where I was happy to see the BK Veggie on the menu board. When I ordered it I found out that the guy who is in charge or ordering for the restaurant is always told to order some but doesn’t.

I gave up and reluctantly went back to Subway for a Veggie Delite, which they served me with a certain reluctance.

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Last day of vacation and no real time to blog, but two people sent me a link to today’s WSJ article: Faltering Family M.D.s Get Technology Lifeline; Doctors Think Small To Revive Solo Role For Primary Care.

They rightly concluded that I would applaud the efforts by some primary care physicians to offer a high-service model to a regular sized panel of patients by relying on technology and intelligent operations. It’s a much better solution than the concierge model.

[I]n early 2001, Dr. Moore took a risky step. He borrowed about $15,000 to start a solo medical practice in a tiny space with no nurse, receptionist or waiting room. He bought computer software to help him track patients’ appointments, illnesses and medications, and to process insurance claims.

Patients at his “micropractice” can call or email to get appointments the same day. Visits last 30 minutes. Dr. Moore can be reached day or night on his cellphone. To refill a prescription, he walks “zero feet,” he says, and taps a few keys on his laptop. “I was able to build a Norman Rockwell practice with a 21st-century information-technology backbone,” he says.

More later…

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I was struck by the number of obese people I saw today in the Magic Kingdom riding around in electric carts. Of course I didn’t ask people about their individual conditions –I’m sure some were in the carts for reasons other than their weight– but I think it’s safe to say that more obese people are interested in getting out and about. It’s become more socially acceptable.

An Israeli kibbutz has capitalized on this phenomenon, modifying its 2-3 seater electric scooters into single passenger models for the US market. They can carry a person who weighs up to 500 pounds. I didn’t see any of their models today –perhaps they are too large for the park.

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