Tuesday, March 31, 2009

Medically Complex Patients

There was a great article today in the New York Times, http://tinyurl.com/cttxvp. The article talks about some of the issues involved in treating patients with multiple medical conditions, many of whom are age 65 or older.

One of the basic issues, which I had not really thought of before, is that almost no research has been done on medications. Lots of research is done on, say, diabetes medications, when diabetes is the only medical condition being treated. There is little to know research on diabetes medications when they are taken along with medications for heart disease, Alzheimer's disease, blood pressure, and high cholesterol.

What we know is that the more medications a patient takes, the greater the possibility of serious side effects, and the higher the risk of serious drug interactions. The way our health delivery system is fragmented, there are many patients who have a cardiologist prescribing one set of drugs, an internist prescribing other drugs, and then maybe an endocrinologist or a gastroenterologist also prescribing drugs. This often means that no one doctor is looking at the patient as a whole. This is further complicated by the fact that so few doctors are trained in geriatric issues.

The article suggests that at this point, patients are pretty much on their own, and must take responsibility themselves to stay informed about their medications and be proactive when talking to their doctors.

Monday, March 2, 2009

Little Known Facts About Medical Scans

There was an interesting article in the New York Times http://tinyurl.com/bpl8fz today about medical scans. It seems that radiology centers are not required to be accredited, so there are no standards governing the quality of the scans being done.

According to the article, there is a great deal of discrepancy between good scans and bad scans, but insurers, including Medicare, pay the same price regardless of quality. In an example from the article, a woman had an MRI of her knee that was so bad the radiologist could not read it, but she went ahead and had surgery. The surgeon found no damage, and she still has knee pain. Her insurance company paid for the initial scan, but would not pay for a follow-up scan, and they paid for the unnecessary surgery.

Imaging centers can choose to be accredited by the American College of Radiology, which does requires that technicians be certified and provides standards for physicians. A new Medicare law was passed recently that will only allow Medicare to pay for scans at accredited centers, but this law does not go into effect until 2012.

Until there is more regulation, there is little for a health care consumer to do. The article does suggest however that consumers ask why the scan is needed, ask about the center's accreditation, ask about the technician's credentials, and ask how old the scanner is. Scanners more than 10 years old are much more likely to produce poor quality scans, because the technology has improved so much in the past 10 years.