new survey 40% of usd adults report experiencing unsafe, wasteful, or poorly coordinated health care!!


this is really not news me, since I see wasteful and inefficient health care daily.

this new report is found at www.cmwf.org and the contact for the story is Mary Mahon, the Public Information Officer.




"Coordination and information are vital to improving our health care system. When care isn't coordinated there is a higher risk for unsafe care and uuplicative or wasteful medical spending, " said Commonwealth Fund President Karen Davis. "This survey shows that patients place high value on having a medical home that coordinates all of a patient's care and provides better access to information and care. Unforthunately, the reality is that too many patients have short-term relationships with their physicians and rarely have easy to their own medical records."

I sincerely believe that the PHR, or personal health record, where the patient has the complete medical record in a transportable, electronic, secure system, is part of the answer to patient centered health care. It is one component that is necessary. In other words, each patient should have a complete copy of ALL data about their health: xrays, laboratory results, hospital records, physician office records, and insurance information, together with a personal and family medical history.


Dr Lloyd A. May

Wednesday, October 18, 2006.

unseasonably hot and humid today.

new rx help people to avoid getting sick reads the headline of USA TODAY for today.

what a radical concept!


when I went to medical school, we did not have a single lecture on Health. or Staying Healthy.

all the lectures were on science, and disease, not wellness.

or wholeness, or spirituality, or what makes us human.

today's article highlights Progress Plaza, in Philadelphia, which is undergoing a facelift under sponsorship from the non-profit The Food Trust, a program that finds innovative ways to bring more healthful foods into urban neighborhoods, public schools, and grocery stores, according to the story. the idea is change the environment, to lead to better lives, and possibly longer, and healthier lives. the idea is catching on.


Lloyd A May MD

Surgery may be among many pushing medical costs higher....


the headline of a USA TODAY article from Tuesday, October 17, 2006 pg d1.

headlining spinal fusion, a back surgery technique....highlighting this as an example of how a "complex set of conditions, which include expensive new technology, varying doctor preferences, financial incentives, patient expectations, and a lack of data on what works best, is helping drive demand for medical care and raising costs."

low back pain is extremely common, and costs the economy $50 Billion dollars a year! but, unfortunately, a consensus on treatment is controversial, and as a result spinal fusion surgery rates vary tremendously by locale, up to 500% variation.

"physicians and hospitals get paid by the piece for what they do, so they have no financial incentive in looking hard at the issue of overuse."

and, as the editorial states on page 17a "health care is an expensive, chaotic mess." "it also appears dead certain to turn into an all-out crisis."

so what should you, the patient, and consumer, or practitioner, do?

I think that patient's should question the therapies and procedures recommended to them; and, conversely, should not solicit a new procedure just because it is new. Also, for each problem, there are a range of solutions and therapies. For example, with back pain, chiropractic therapy should be a mainstay of treatment. Likewise, massage therapy has benefits. As does acupuncture. And yoga. And QiGong. Mind Body techniques, such as mindfulness programs are being used successfully to treat chronic severe back pain.

But all these other therapies must be offered, and possibly the most cost effective ones should be the ones that Medicare and insurance companies should reimburse. Of course, this is not currently the modus operandi of medical practice. But as costs spiral even higher, maybe eventually things will change.


Dr Lloyd A May
www.alternativedr.com

Medical decisions confusing...

so reads the headline from USA TODAY, for Monday, October 16th 2006 on page d1.


deluged with studies, doctors try to sort out, what works, what does not...

this is an understatement.

for starters, studies usually do not get done unless they are sponsored by a drug company.

so most herbal, and alternative, and nonpatentable therapies are not routinely studied, although this is somewhat changing.

most studies are, drug A vs drug B or drug A vs placebo, with a very specific set of qualifiers, with a population that may or may not correspond to private practice.

for a few years now, especially since the onslaught of alternative medicine popularity, doctors have
espoused the "gold standard" randomized control trial as the mantra of modern medicine.

however, most of general medical practice has NOT been subject to these very same criteria, and so to decry a therapy because RCTs are not done is somewhat hypocritical. whether it (RCT) is the best method for determining medical practice is not a foregone conclusion. but, even if it were, it is virtually impossible to keep abreast of all the current trials, and apply them to your medical practice.

as the article mentions, there are over 25,000 medical journals worldwide, and over 80 RCTs are published DAILY.

again, as the article mentions, medical practice has for years involved therapies that are only now being slowly eliminated with education. I clearly remember the hormone controversy. As my attending in residency mentioned over 20 years ago, hormone therapy for women has fallen in and out of favor for 40 years. I remember the studies, and the reports, and the pharma reps pushing hormones for everything from hot flashes to dementia to cardiovascular to....and the 5 year-ago-gold standard of estrogen-progestin is now out of favor. which brings me to an aside: many doctors change little, if at all, from their residency training. the best doctors keep up to date, and change their practice based on the latest consensus data; but unfortunately, their are just as many who do not, and have not changed in years, despite continuing medical education. and again there is the insidious practice of pharma educating the doctors, by presenting only their data, and their drugs, as sales pitches disguised as science.

as the article mentions, what would you think if you took your car to five mechanics, and got five different recommendations on what the problem was, and what the remedy should be? and that's where we are in medicine today. that is even before you get an alternative medicine opinion. and what happens when the current medical practice is found to be incorrect?

the article gives a good example of that with the encainide and flecainide antiarrhthmic drug studies, the results of which were questioned for years before doctors stopped writing out the drugs...

and the article mentioned the blood clot prophylaxis data, and how many lives could be saved each year if doctors only applied information that is common medical knowledge!! I know personally that of the three major hospitals where I admit patients only ONE has in place an almost idiot-proof method to force doctors to consider whether blood clot prophylaxis is appropriate or not, and if so, order it now, not later. and even at this hospital, anecdotal information suggests that doctors still ignore the chart forms....

what is the solution?

at www.cebm.org the centre for evidenced based medicine, are resources for practitioners. and there are handbooks which give best practices using evidence based medicine. and I believe United Healthcare gives this handbook free to its physicians. but it is, I think, equally important that patients become more educated, ask questions, and not just assume that they are receiving the best treatment possible. and this is true not only for Western medicine, but for alternative and complementary medicine as well. and eventually, finally, there needs to be a understanding of the value of the belief system: the belief of the patient in the treatment or therapy AND equally important, their belief or faith in the healer.


Dr Lloyd A May
www.alternativedr.com

universal health care appeals to USA


so reads the headline in USA TODAY for Monday, October 16, 2006 pg 4b.

American do want universal health insurance, by a 56% margin. however, they are divided on how to pay.

but a little reality check is in order; by the number 46,600,000 Americans lack health insurance, a record number;

for those who do not want the government involved in health care: they already are, already footing the bill
for 45% of our 2.2 trillion dollar health care costs...

covering 43 million Americans through Medicare (over 65 and disability)

and Medicaid, coadministered by the states and the federal government, covers 50 million, with the other

approximately 150 million Americans covered by traditional health insurance plans of some sort.

So here is the paradox: we want universal coverage, but we do NOT want limits on doctor usage, or any limits on benefits, OR any increased costs to pay for this coverage; ie no new taxes. this is inherently imposssible, which is the reason that this impasse exists. Solutions for this will not come until all parties are satisfied with an equitable solution. But if you change the debate to focusing on making current health care insurance more affordable to those who pay for it, and also demand better quality health care for your insurance dollars, then more Americans would embrace universal health insurance.


Dr Lloyd A May

Consumer unease with US health care grows


so reads the headline of USA Today this morning, Monday, October 16, 2006.

the article discusses a survey taken in early September by USA TODAY, aBC News and the Kaiser Family Foundation.

the poll found a sense of unease about rising health costs, confusion about the various causes of this increase, but also, unfortunately, a lack of conviction about making difficult personal choices that might improve healthcare.

over 80% of respondents are dissatisfied with the total health care bill, now estimated at 2.2 trillion dollars!!

few people really understand what the major factor driving up costs-demand for new drugs, procedures, and immediate treatment regardless of the costs. also, there is a startling lack of understanding, that personal choices of lifestyle and health maintenance, or lack thereof, is a major driver in the upward spiral.

quality of health care is also an issue; only 44% stated they were satisfied with health care overall quality. some research is being done on cost-benefit analysis of healthcare; and hospital are being forced to address quality, especially since the landmark Institute of Medicine study "To Err is Human," the study of excess deaths related to drug errors in hospitals.

but, as a physician, I have rarely seen quality as an issue among hospitals, insurance companies, or privately practicing physicians. The quality movement is in its infancy. Physicians, in general, see quality in terms of insurance oversight, not as an issue in its own right.

as the article states, major drivers of health care cost include how rapidly Americans embrace the latest drug or technology, even before adequate studies are performed. and physicians and hospitals readily oblige, if only to patients who have health care insurance. and health care insurance is seen as desirable and necessary; too often the sentiment patients have is that I have Blue Cross or Medicare, so I want to get everything I can from my insurance, whether I really need it or not. And even though health care insurance is expensive, once that card is obtained, any concern about costs is relegated to copay cost. and in our current systems, no one really get a complete transparent description of the total cost involved, each step of the way.

although the survey cited excess profits for drug companies, hospitals, and physicians, and malpractice costs as the prime drivers of health care inflation, this is actually only a small part of the overall picture.

one helpful idea I have is to make health care expenditures totally transparent; give the patient a complete financial snapshot, not just of an office visit, but the really expensive items: MRIs, CT scans, PET scans, hospitalizations, drugs. and also give a detailed explanation of what happens to each dollar expended.

unfortunately, 66% of respondents were NOT in favor of assuming more personal responsibility for health care costs. this movement is part of the so-called consumer driven health care movement. although most people favor some sort of universal health coverage, few understand that universal coverage will NOT be necessarily cheaper than the current system. but with a record 46,600,000 persons now without health insurance, our society must address this inequity, or face the consequences.

and, not mentioned in this article, is the Misperception of the supremacy of the US Healthcare system. as mentioned in my blog, the US is almost last in developed countries with regard to health care needs met.

certainly, I see patients everyday who have no health insurance. treating them is not the problem; but obtaining hospital care when needed, or testing when needed, is extremely difficult, even though 3/4 hospital here are "not for profit."

the issues are in the open to discuss. I invite your comments.

echoes from New York


a late night talk by Dr Abdul Alim Muhammad, Director of the Abundant Life Clinic, in Washington DC started with Ramadan Mubarak! or Happy Ramadan!

He spoke of the integral necessity of the spiritual in daily life as the major factor in health...

with health being the perfect attainment of all potential as intended by the Creator...


"...he who saves a life, it is as though he had saved the lives of all men..." Qur'an 5:30

Nation Scores 66 out of 100!


A recent survey, the U S Health System Performance A National Scorecard, issued by Foundation for Health Care, www.cmwf.org, shows the US could save 150,000 lives annually, and save over 100 Billion Dollars if Health Care performed to higher standards!

Although we pride ourselves on our technology and scientific medicine, the US actually lags behind most developed nations, and there is a wide variation in the quality of health care.
Despite these facts, the US leads the world in health care dollars consumed as a percent of GDP and in total amount.

This is an unfortunate fact of modern medicine, as practiced in the United States. As a practicing physician, I personally witness huge variations in physician practices, hospital practices, and insurance practices. There should be the highest level of accountability for all the above, given the important stakes.

I invite your comments about inequities in quality of care you have received, and recommendations you have to improve your health care.


Please go the the website www.cmwf.org to see the original report.


Dr Lloyd A May

one week later


the conference Building Bridges of Integration for TCM, October 5-8, 2006, is over.

for the next few weeks, I will explore some of the topics discussed. attendees included students, physicians, acupuncturists, psychologists, addiction therapists, psychiatrists, doctors of oriental medicine, and numerous other specialties. physicians from China lectured on research on hepatitis b and c, as well as research on traditional medicine. despite the scientific presentations, I felt a distinct spiritual emphasis, and a community of healers met for a brief few days to increase their knowledge and renew their spirit.

The keynote speech is given by Dr Nan Lu. In it, he describes Traditional Chinese Medicine as a complete medical system based on Natural Law. It operates with organizing principles and theories that recognizes the energetic correspondences between all things, and utilizes numerous integrated healing modalities.

The four strands of TCM are the Theory of Qi: the life force or energy essential; Meridian Theory the energy fields more important than the immune system, nervous system or endocrine system; Yin/Yang which describes the law of opposing energy; and Five-Element theory, which describes the web of correspondences within and without the body and the universe.

The treatment modalities in TCM include Acupuncture, Acupressure, Herbal Therapy, Foods for healing or medicated diet, Qigong, and Chinese psychology with emphasis on Five-Elements consciousness.


Dr Lloyd A May

Transformation Spirit in Healing

I am attending a conference called Building Bridges of Integration for Traditional Chinese Medicine, at the Sheraton Meadowlands Hotel and Conference Center.

I attended the preconference workshop by Dr Nan Lu. The title of his talk was TCM Medicine, Miracles, and Modern Health Care.

He talked about Qi, the life force or vital energy; Ying Yang theory, the law of opposite forces, Meridian theory, in TCM more powerful and important than endocrine, nervous, and immune systems; he talked about Five Element Theory, the web of correspondences within and without the body.

The idea of ying yang everything has opposites, not just disease; the 3 dimensions are just a reflection of The TCM physical exam consists of seeing, listening, questioning, and feeling the pulse. The inspection is of the face, tongue, and expressions or spirit; listening to the patient. The various modalities of treatment include acupuncture, herbal therapy, food therapy, psychology, and tuina. He spoke of miracles, which come from the patient, and are facilitated by the practitioner. TCM has benefits for treating cancer, heart disease, pain, menopausal problems, and obesity. "when you discover who you are, you are the master," he answered in response to a question of how to find a master to train under.

Later, after this session, the meeting adjourned to a final session, participatory, called Chill-Out Qigong.

Dr Lu is an OMD, or Oriental Medical Doctor, and is the Founding Director of the Traditional Chinese Medicine World Foundation and its sister organization, the American Taoist Healing Center. He is a classically trained doctor of traditional Chinese medicine, and is licensed in New York state under acupuncture. He holds a doctorate from Hubei College of Traditional Chinese Medicine, Hubei, China, and a Master of Science degree from City University of New York. He has served as an adviser to the Rosenthal Center for Alternative and Complementary Medicine at Columbia University. He is also an executive board member of the Center for Culturally Competent Education and Training SUNY at Stonybrook. He is an international Tai Chi expert. He has authored three books: A Woman's Guide to Healing from Breast Cancer; A Woman's Guide to a Trouble Free Menopause; and A Natural Guide to Weight Loss That Lasts.


Dr Lloyd A. May