AHRQ has published a list of 20 tips to help you avoid medical errors. These tips include good, practical, common sense ideas like making sure your doctor knows all the medicines you are taking (including prescription medicines, over the counter drugs, and supplements), making sure your prescription is legible, understanding your medical condition and it’s treatment, getting advice from your pharmacist to make sure you take your medicine the right way, and getting written information on potential side effects and how to manage them.

We don’t have to wait for government to make our health system better; we can take responsibility to make sure we get great medical care.

How can this be? We explore the possibilities with Professor Cochrane to see how regulation is at the heart of the problem, and that 1,000’s of pages of more regulations in the Affordable Care Act will likely only make things worse. Introducing more competition—both among insurers and providers of health care—would be a better solution.

But are those coupons a good thing? The may increase the use of expensive drugs and cause drug prices to be higher than they would be if patients had more responsibility for paying the cost of care.

We explore this issue with Wells Wilkinson, Director of Prescription Access Litigation Project and staff attorney at Community Catalyst, a national consumer organization that works for access to quality, affordable care. Wilkinson explains that drug coupons may encourage overuse of costly medications when lower priced generic medications could work equally well. He also expresses concerns about the privacy implications of using these coupons.

Our guest today is Helen Darling from the National Business Group on Health. The National Committee on Quality Assurance recently honored her for her leadership promoting health care quality as an issue of commercial competitiveness. She has helped American businesses become better purchasers of health care and has helped government and industry leaders understand the economic importance of health care quality.

Dramatic increases in health care costs have been major problems for U.S. employers hurting growth and competition. Despite the high costs, the quality of care is uneven. Too often, Americans get care that is either less than optimal or that makes things worse. No one solution may solve this. There are dozens of potential solutions that can help. Large employers can help identify key targets, can provide onsite health support, and can encourage employees to participate in condition management.

The lack of personal responsibility for health care costs is a central problem in the US health care system. Our system literally provides a blank check for health care coverage with little to no incentive for patients or their doctors to consider cost. This results in utilization that is off the chart. The Choosing Wise Initiative identified five overused interventions that don’t add health. People should realize that some preventive tests and procedures may not be helpful and that a healthy lifestyle is.

The public can get access to the list of over 30,000 top doctors through the Castle Connolly website. The information is also available in the America’s Top Doctors book, regional magazines and U.S. News.

Castle Connolly is hosting its 7th annual Physician of the Year awards. These awards celebrate physicians’ dedication, not just for the 5 ward winners but in recognition that no one goes into medicine without dedication. Too often physicians are seen in a less than wonderful light. People should have even broader recognition of doctors’ commitment to patients

Bill’s critical message is that there are good, mediocre, and excellent doctors, that top doctors matter, and that better outcomes can be expected when seeing a top doctor. His final message is that these are confusing times for health care, and that politization gets in the way. We are blessed with being able to access awesome medical care. Be a good consumer!

One key to improving outcomes may be to tie payment to successful treatment, putting more at stake for physicians. This is a contentious and exciting time in medicine!

A basic principle of health care reform efforts should be to maintain innovation. Health care represents a huge segment of the economy. Healthy workers are essential to our economy. Strides need to be made to promote better diet and fitness and reduce the problems of obesity and diabetes.

There is massive documentation on wasteful use of health care resources. Some 30-40% of health care is wasted. The fragmented medical system results in needless repetition of tests. In order to “bend down the curve” of health care spending, there are about half a dozen things crying out for attention, including avoidable hospital readmissions, coordination of care and improved faithfulness to use of medicine. New organization models including medical homes and accountable care organizations may help.

Next week, Tom continues the discussion, speaking on how well (or not well) patients use their medications. Improving adherence to treatment is critical, but there is no one solution. Research shows that patients are non-adherent for lots of reasons. Their total list of medications may not be right, doses may not be right, and review by a physician and/or pharmacist could help. Other barriers include side effects, complicated dosing, and very personal factors, such as costs and beliefs about medication effects. Strategies to improve adherence will need to be customized to patients’ specific needs. Doctors, insurers and drug companies may play a role.

One key to improving outcomes may be to tie payment to successful treatment, putting more at stake for physicians. This is a contentious and exciting time in medicine!

The goals of the League’s adherence initiative are based on focus groups that showed what was needed. The key issue was for patients was understanding medication better. There’s a lack of knowledge about the relationship between poor adherence and poor medical outcomes. Patients should speak to their doctors to make sure that the reason for the medication and the expectations of it are understood. The campaign will work to promote better adherence. It has over 100 public and private partners and will focus initially on 6 regions across the United States. There will be publicity, a website, many tools, and a pledge for better adherence.

Listeners should consider assessing their own adherence and consider using the campaign tools if needed. A great resource is scriptyourfuture.org.

What are exchanges? The health insurance exchanges will be state run insurance plans that pool risk and make care more affordable. The details of these exchanges vary by state, some states having created non-government agencies. The exchanges will cover the poor and the employees of small employers.

By providing information and competition, the exchanges will promote greater cost transparency, lower costs and better quality/value. People don’t like shopping for health insurance—it’s very complex—so having just a few choices and good information is key. The NCQA plays an important role by providing measures of quality that can be reported and compared across plans, for example, how well does the plan do with patients with diabetes, etc.

Something is being done. The Centers for Medicare and Medicaid Services, CMS, has an Innovation Center that is developing and testing new ways of paying for health care, new approaches designed to put incentives into alignment in order to achieve better health care quality at lower cost.

Our guest today is Dr. William Shrank, Director of the CMS Innovation Center’s Rapid Cycle Evaluation Group. Dr. Shrank explains how the Affordable Care Act (so-called “Obamacare”) has put into place a program to develop, test and implement new payment models to reduce cost and improve quality, to bend down the upward curve of medical care spending.

Dr. Shrank explains that the current system pays for higher volume care, not higher quality or more efficient care. The “DRG” system was put in place years ago to pay hospitals for episodes of care, but it didn’t cover other health care costs. More holistic systems and perhaps accountable care organizations will provide a means to take extend the advantages of DRG’s to health care in a more global way.

Dr. Shrank lets us know that the Innovation Center is seeking input and suggestions through its website.

Our guest today is physician and author Cindy Koelker, MD. Her latest book Armageddon Medicine, How to Be Your Own Doctor in 2012 and Beyond explains how to treat hundreds, even thousands of conditions as a family doctor would. The inspiration for this book came when she realized how many people are concerned about the future of this country, from the economy, to terrorism, to natural disaster, not to mention 2012 prophecies. This book is her contribution to being prepared for any contingency.

Could such contingencies be needed. Koelker points out that the our health care system is at least as fragile as the economy, that pharmacies only keep a few days of medicine on hand, that most of our generic drugs come from overseas, and that if communication or transportation is disrupted, you’ll be on your own. During Hurricane Katrina, pharmacies were flooded and shut down, as were doctors’ offices. Serious potential problems can occur, for example if a patient with diabetes ran out of insulin or someone with asthma were out of their inhaler.
Or what if you were asthmatic and were out of your inhaler? Things could have been much worse, as Katrina was a local problem, with the rest of the United Sates available as a back up. If our society was disrupted to the extent that Haiti was, things would be much worse.

Koelker suggests everyone should be prepared to care for themselves for at least 6 months. This means getting an extra supply of essential medications, such as insulin, inhalers, and antibiotics. It means understanding your condition to the point of being able to care for yourself in a crisis. It means gathering more than a medical kit – though that’s a good place to start. Over the counter medications can be used to treat at least dozens of conditions, including vertigo, asthma, allergies, reflux, ulcers, fungal infections, yeast infections, poison ivy, swimmer’s ear, respiratory infections, diarrhea, strains, certain fractures, and much more.

Koelker’s book Armageddon Medicine is only available for sale online. You can find it at ArmageddonMedicine.net.

Dr. Koelker is also author of the book 101 Ways to Save Money on Health Care which we will feature on an upcoming show.

Show host Dr. Steve Feldman talks about the advantages and disadvantages of online doctor ratings. For him, the advantages far outweigh the disadvantages, giving doctors an easy way to get feedback from patients, giving patients information on doctors, and getting a more representative picture about doctors out to the public, a picture much more representative than that which is depicted on the news or in other media.

Feldman is the founder of the DrScore.com physician rating/patient satisfaction website. Thousands of doctors across the country encourage patients to do online ratings at DrScore as an easy, high quality, low cost way for the doctor to collect detailed patient feedback. The site uses a validated survey methodology.

Feldman describes the findings of the recent 2011 DrScore Annual Report Card. Based on over 36,000 ratings, the report found that half of doctor visits have waits of 15 minutes or less and that 2/3rd of the office visits involved the doctor spending more than 10 minutes with the patient. Of the nearly 300 doctors who had 10 or more ratings, the average score was 9.2 on a 0-10 scale (where 10 is the highest possible score).

The main limitation of online rating is the problem of unrepresentative scores. This is a particular problem when doctors have only a few ratings. One proposed solution is to ban online doctor rating. Doing that, according to Feldman, would only make it look like doctors have something to hide. Instead, it would be better to embrace online doctor ratings so that the information is more representative, something that would help both patients and doctors. You can rate your doctors at www.DrScore.com.

While problems with our health care system are generally recognized, the health care system has a lot of strengths, too. Our current health care system gives many, many people great medical care, though quality could be improved and costs could certainly be reduced. While the Patient Protection and Affordable Care Act works to get people insured, Ferrara is correct that it doesn’t directly reduce the cost of care, the major problem with our current system. At some point, someone needs to take responsibility for bringing the costs under control. For better or worse, we are now on a path in which the government regulators will do that. The alternative is for us to have a system in which individuals take greater responsibility for the cost and decision-making in their own healthcare, something that greater use of health savings accounts and catastrophic insurance would do and which would save money. Neither of these approaches are “disasters”; both have their advantages and disadvantages. One gives the government more control over health care decisions, which few want to see happen, but the other requires individuals to take more personal responsibility. Are we ready for that?

Dr. Charon describes how stories are involved in how people know they are sick and in how they communicate that information to others. She also explains how storytelling and listening skills are important for physicians and their patient encounters. Dr. Charon talks about the benefits and risks of having a narrative focus in patient encounters.

Dr. Charon describes how social and behavioral issues are critical in medicine. Many common medical problems are caused by our behaviors. In addition, social issues can be a barrier to successfully treating patients. Doctors and patients often don’t speak the same language, there can be deficits of trust, and sometimes sick people simple lack access to care. Cultural and religious issues play into the difficulties, and the potential solutions.

Part 1 of our discussion with Dr. Orman focused on defining what we mean by stress. The word stress can be used to mean different things. Orman stresses (pardon the pun) that there are both external and internal factors that contribute to what we perceive as stress. He points out that instead of dealing with “stress”—which often means dealing with the symptoms of stress—that we should be dealing more effectively with the root causes, the specific problems in our lives that make us feel stressed.

In today’s show, which is part 2 of our discussion with Dr. Orman, we discuss how hidden internal factors affect how we deal with our problems. He points out that one of the best ways to effectively deal with the stress is to develop greater self-awareness of how we deal with problems internally. He applies this to everything from family at the holidays to visits with physicians.

Dr. Orman offers a lot of free coaching on stress though his Internet website, www.DocOrman.com.

Part 1 of our discussion with Dr. Orman focuses on defining what we mean by stress. The word stress can be used to mean different things. Orman stresses (pardon the pun) that there are both external and internal factors that contribute to what we perceive as stress. He points out that instead of dealing with “stress”—which often means dealing with the symptoms of stress—that we should be dealing more effectively with the root causes, the specific problems in our lives that make us feel stressed.

In part 2 of our discussion with Dr. Orman, we discuss how hidden internal factors affect how we deal with our problems. He points out that one of the best ways to effectively deal with the stress is to develop greater self-awareness of how we deal with problems internally. He applies this to everything from family at the holidays to visits with physicians.

Dr. Orman offers a lot of free coaching on stress though his Internet website, www.DocOrman.com.

Part 1 of the program focuses on what we know about patients’ use of their medicine. Patients beliefs about medication are a major determinant of whether they use their medicine or not, something called “adherence” to treatment. Dr. Rickles describes the major known reason about why patients don’t take medication including their motivation, beliefs, costs, accessibility and even forgetfulness. Dr. Rickles points out that patients are taking a greater role in their health care decisions and need information for making good choices.

In part 2 of this program, Rickles explains what role pharmacists have. It has changed a lot from the time in which there was a mom and pop druggist who knew the patient and had a relationship with the patient, a relationship that came with trust. Community pharmacists can still help patients a great deal, and in one study the relationship with pharmacist was the number 1 predictor of medication use. Dr. Rickles also discusses the relationship between pharmacists and physicians and how they can help each other.

In order to facilitate the behavioral changes that will lead to better health outcomes, Dr. Rickles recommends that health care providers have empathy and stop & listen to learn what is important to their patients. At the same time, there are things patients can do, including sharing their concerns with their doctors.

Part 1 of the program focuses on what we know about patients’ use of their medicine. Patients beliefs about medication are a major determinant of whether they use their medicine or not, something called “adherence” to treatment. Dr. Rickles describes the major known reason about why patients don’t take medication including their motivation, beliefs, costs, accessibility and even forgetfulness. Dr. Rickles points out that patients are taking a greater role in their health care decisions and need information for making good choices.

In part 2 of this program, Rickles explains what role pharmacists have. It has changed a lot from the time in which there was a mom and pop druggist who knew the patient and had a relationship with the patient, a relationship that came with trust. Community pharmacists can still help patients a great deal, and in one study the relationship with pharmacist was the number 1 predictor of medication use. Dr. Rickles also discusses the relationship between pharmacists and physicians and how they can help each other.

In order to facilitate the behavioral changes that will lead to better health outcomes, Dr. Rickles recommends that health care providers have empathy and stop & listen to learn what is important to their patients. At the same time, there are things patients can do, including sharing their concerns with their doctors.

In part 1 of a two-part program, Jackson describes why medical malpractice costs us so much. In order to protect themselves from lawsuits, Jackson describes how doctors order tests that reasonable people would not think are beneficial to patients. This inappropriate testing is estimated to cost $650 billion dollars per year. That money would be better spent helping compensate patients who truly are injured. Such a system could be based on a workman’s compensation system model. The workman’s compensation system has been a win-win, helping workmen who are injured while protecting companies from lawsuits.

In part 2 of this two-part program, Jackson describes in detail how a compensation system would work to replace malpractice litigation. In addition to better compensation for injured patients, the system would encourage health care providers to learn from errors and improve patients’ outcomes. The effort to begin this change is focused now in Florida and Georgia.

Key elements of the malpractice reform proposal include:
• Replacing the current tort system with no fault system patterned after state based workers compensation system
• All malpractice assigned as exclusive jurisdiction to Special Administrative Agencies
• All cases reviewed by Medical Review Board
• All negligent cases awarded compensation by Patients’ Compensation Board
• Quality Improvement Council developing root cause analysis of medical errors and “best practices”
• Providers who practice substandard care will be disciplined by the State Licensing Board
• Entire system is funded by insurance premiums from all providers
• All patient complaints are heard
• More claims paid to more patients
• Faster guaranteed payments (years faster)
• Eliminates unnecessary tests & defensive medicine, saving
o As much as $650 billion per year
o As much as $125 billion in Medicare costs per year
o As much as $96 billion in Medicaid costs per year
• No cost to taxpayer
• Patient compensation, quality of care and physician accountability increase

You can learn more about it at Patientsforfaircompensation.org.

In part 1 of a two-part program, Jackson describes why medical malpractice costs us so much. In order to protect themselves from lawsuits, Jackson describes how doctors order tests that reasonable people would not think are beneficial to patients. This inappropriate testing is estimated to cost $650 billion dollars per year. That money would be better spent helping compensate patients who truly are injured. Such a system could be based on a workman’s compensation system model. The workman’s compensation system has been a win-win, helping workmen who are injured while protecting companies from lawsuits.

In part 2 of this two-part program, Jackson describes in detail how a compensation system would work to replace malpractice litigation. In addition to better compensation for injured patients, the system would encourage health care providers to learn from errors and improve patients’ outcomes. The effort to begin this change is focused now in Florida and Georgia.

Key elements of the malpractice reform proposal include:
• Replacing the current tort system with no fault system patterned after state based workers compensation system
• All malpractice assigned as exclusive jurisdiction to Special Administrative Agencies
• All cases reviewed by Medical Review Board
• All negligent cases awarded compensation by Patients’ Compensation Board
• Quality Improvement Council developing root cause analysis of medical errors and “best practices”
• Providers who practice substandard care will be disciplined by the State Licensing Board
• Entire system is funded by insurance premiums from all providers
• All patient complaints are heard
• More claims paid to more patients
• Faster guaranteed payments (years faster)
• Eliminates unnecessary tests & defensive medicine, saving
o As much as $650 billion per year
o As much as $125 billion in Medicare costs per year
o As much as $96 billion in Medicaid costs per year
• No cost to taxpayer
• Patient compensation, quality of care and physician accountability increase

You can learn more about it at Patientsforfaircompensation.org.

In part 1 of a two-part program, Dr. Beach describes why doctor/patient communication matters. She points out that patients need to be heard. We discuss that doctors not only need to listen but that doctors also need to convey to patients that the doctor is listening and hears the patient. Doctors also need to communicate treatment plans effectively so that patients are able to buy in and use treatment effectively.

Dr. Beach points out that research studies have documented common communication problems between doctors and patients. She suggests that doctors are trained to unload too much information, and don’t often ask patients’ opinions about what patients want to know.

In part 2 of this two-part program, Dr. Beach describes some of the many things doctors can do better regarding patient communication. A key skill is empathic or reflective listening, something that comes in handy at home with a spouse, too. Instead of only focusing on fixing problems, doctors may find it helpful to take time to acknowledge patients’ feelings and emotions.

Another valuable tool is for patients and doctors to set an agenda so that time is used efficiently and all patients’ concerns are addressed. Simply asking “what else” may be all it takes. Patients should feel empowered to ask questions and should recognize that they deserve to have a respectful doctor who listens to their concerns.

In part 1 of a two-part program, Dr. Beach describes why doctor/patient communication matters. She points out that patients need to be heard. We discuss that doctors not only need to listen but that doctors also need to convey to patients that the doctor is listening and hears the patient.
Doctors also need to communicate treatment plans effectively so that patients are able to buy in and use treatment effectively.

Dr. Beach points out that research studies have documented common communication problems between doctors and patients. She suggests that doctors are trained to unload too much information, and don’t often ask patients’ opinions about what patients want to know.

In part 2 of this two-part program, Dr. Beach describes some of the many things doctors can do better regarding patient communication. A key skill is empathic or reflective listening, something that comes in handy at home with a spouse, too. Instead of only focusing on fixing problems, doctors may find it helpful to take time to acknowledge patients’ feelings and emotions.

Another valuable tool is for patients and doctors to set an agenda so that time is used efficiently and all patients’ concerns are addressed. Simply asking “what else” may be all it takes. Patients should feel empowered to ask questions and should recognize that they deserve to have a respectful doctor who listens to their concerns.

The NCQA bases its reports on objective quality indicators reported by over
1,000 health plans across the country. The report found that preferred provider organizations (PPOs) are catching up with health maintenance organizations (HMOs) or measures like childhood immunization and diabetes care. Greater use of electronic health records has contributed to the improvements.

The NCQA data help consumers find health plans that provide better value.
Health care consumers—like you and me—can find more information at NCQA.org or at ConsumerReports.org.

Patients need to be empowered to care for themselves. We spend $2.4 trillion dollars per year on health care, yet very little to educate and empower patients. Patients are being asked to play a greater role in their healthcare decisions, but they often don’t have the information needed to make informed decisions. Sometimes, basic information, like the need for regular monitoring in diabetes, isn’t provided. Medications may not work because patients may not know how to properly use them.

The right information needs to go to the right patient from the right source. Patient don’t need to know all the information given in medical school, and too often, basic, essential facts are lost in the noise of a package insert. Some 80% of physicians report that they provide patients insufficient materials!

There are many potential solutions to this problem including more physician time devoted to patient education, greater use of physician extenders and other handouts. But the big gorilla is the Internet, the wild, wild West of health care information. Vivacare is working to make trustworthy, physician-approved information available through doctors’ websites. Other resources include WebMD, Google and the National Library of Medicine.

The future of patient education is bright, with video, interactive tools, quizzes and information linked to patients’ medical records all very much soon possible. While the Internet may be overwhelming, having a physician partner as a guide will help assure patients get good, high quality, trusted information.

Patient advocates are people who assist patients. Often, patient advocates have a background in nursing, social work, or pharmacy or can even be a retired physician.

Patient advocates accompany patients to medical visits, help patients and their families understand diseases and their treatments, and may act as cheerleaders, encouraging better use of treatments. They may also help find additional resources.

Patients can find patient advocates through the Professional Patient Advocate Institute or locally through advertisements or talks at senior centers. Currently, there are no license or certification requirements, so buyers have to beware. There is no rule of thumb or standard for the cost of a patient advocate’s services (though hourly fees may run from $75-200 per hour).

Patient advocacy is a growing field, and there are opportunities for people to enter the field. Courses are available through the Professional Patient Advocate Institute.

Patient advocates are people who assist patients. Often, patient advocates have a background in nursing, social work, or pharmacy or can even be a retired physician.

Patient advocates accompany patients to medical visits, help patients and their families understand diseases and their treatments, and may act as cheerleaders, encouraging better use of treatments. They may also help find additional resources.

Patients can find patient advocates through the Professional Patient Advocate Institute or locally through advertisements or talks at senior centers. Currently, there are no license or certification requirements, so buyers have to beware. There is no rule of thumb or standard for the cost of a patient advocate’s services (though hourly fees may run from $75-200 per hour).

Patient advocacy is a growing field, and there are opportunities for people to enter the field. Courses are available through the Professional Patient Advocate Institute.

1. Responsibility and accountability for the ongoing care of patients
2. Accessibility to patients on short notice including expanded hours and open scheduling
3. Consultations using email and telephone technology
4. Using up-to-date and and evidence-based medical approaches
5. Using electronic personal health records
6. Systems to assure that patients get regular check-ups and early treatment/prevention measures so that costly emergency procedures and hospitalizations are prevented
7. Encouragement for healthy lifestyle decisions
8. Coordinated care to make sure procedures are relevant, necessary and performed efficiently.

In our discussion, Dr. Grundy describes how health care costs are dragging American industry down and how industry and insurers got together to create more rational, effective, efficient and affordable health care systems. Grundy describes how patient centered medical homes are proliferating and how they have been proven to save money for industries that adopt them for their employees. Grundy also points out that changes toward patient centered medical homes are happening rapidly, in part because they make sense and in part because employers have big incentives to keep their employees healthy and to locate their businesses in regions that provide better (less costly and higher quality) services.

1. Responsibility and accountability for the ongoing care of patients
2. Accessibility to patients on short notice including expanded hours and open scheduling
3. Consultations using email and telephone technology
4. Using up-to-date and and evidence-based medical approaches
5. Using electronic personal health records
6. Systems to assure that patients get regular check-ups and early treatment/prevention measures so that costly emergency procedures and hospitalizations are prevented
7. Encouragement for healthy lifestyle decisions
8. Coordinated care to make sure procedures are relevant, necessary and performed efficiently.

In our discussion, Dr. Grundy describes how health care costs are dragging American industry down and how industry and insurers got together to create more rational, effective, efficient and affordable health care systems. Grundy describes how patient centered medical homes are proliferating and how they have been proven to save money for industries that adopt them for their employees. Grundy also points out that changes toward patient centered medical homes are happening rapidly, in part because they make sense and in part because employers have big incentives to keep their employees healthy and to locate their businesses in regions that provide better (less costly and higher quality) services.

In part two of a two part series, we’re joined again by Dr. Nortin Hadler, author of the books Rethinking Aging: Growing old and living well in an overtreated society and Worried Sick: A prescription for health in an overtreated America. Dr. Hadler is a brilliant physician, board certified in Internal Medicine, Rheumatology, Allergy & Immunology and Geriatrics and is Professor of Medicine and Microbiology/Immunology at the University of North Carolina

In this episode, Dr. Hadler discusses the issues of screening tests. He makes clear that it is hard to take well people and make them healthier. The bottom line is that people not only need to be better educated health care consumers, we also need to rethink what it means to be health and to get past medicalizing everything. We should be celebrating and enjoying our lives.

In part one of a two part series, we’re joined by Dr. Nortin Hadler, author of the books Rethinking Aging: Growing old and living well in an overtreated society and Worried Sick: A prescription for health in an overtreated America. Dr. Hadler is a brilliant physician, board certified in Internal Medicine, Rheumatology, Allergy & Immunology and Geriatrics and is Professor of Medicine and Microbiology/Immunology at the University of North Carolina

In this episode, Dr. Hadler describes some of the difficult issues faced in assessing the quality of health care interventions. He describes in detail the issue of coronary artery bypass grafting. The bottom line is that people need to be better educated health care consumers.

We are joined again by Dr. Robert Whaples, Professor and Chair of Economics at Wake Forest University and director of the EH.net economics history website. Dr. Whaples is also the lecturer in The Teaching Company course, Modern Economic Issues (which I heartily endorse).

In this episode, how changing tax laws, the structure of our insurance system and increasing competition can help address this crisis.

Our guest is Dr. Robert Whaples, Professor and Chair of Economics at Wake Forest University and director of the EH.net economics history website. Dr. Whaples is also the lecturer in The Teaching Company course, Modern Economic Issues (which I heartily endorse).

In this episode, we discuss how insurance affects demand for health and the concept of moral hazard.

Dr. Steve Shama, a national speaker and retired physician who dedicates himself to helping others communicate and connect in these difficult times, joins the program to explain these conflicts and how they can be managed better. He describes how treating people respectfully and speaking authentically from the heart can help quench heated conflicts and bring people closer together.

In this first installment of a 2-part episode, Dr. Greer addresses the real causes of illness and why we need a more global perspective on solving our health care problems.

Dr. Richard Amerling— Director of Outpatient Dialysis at Beth Israel Medical Center in New York City, Associate Professor of Clinical Medicine at Albert Einstein College of Medicine, and a Director of the Association of American Physicians and Surgeons (an organization founded in 1943 to guard against the intrusion of government into the practice of medicine) believes that these arrangements interfere with physicians’ primary responsibility to their patients.

In this final installment of a 3-part series, Dr. Amerling describes the problems with the regulatory burdens and explains why more bureaucracy is part of the problem, not the solution to our health care problems.

Show host Dr. Steve Feldman speaks with Dr. Richard Amerling, Director of Outpatient Dialysis at Beth Israel Medical Center in New York City, Associate Professor of Clinical Medicine at Albert Einstein College of Medicine, and a Director of the Association of American Physicians and Surgeons, an organization founded in 1943 to guard against the intrusion of government into the practice of medicine.

Dr. Amerling describes how the lack of a free market is the major impediment to improving medical quality and reducing cost.

On today’s show, Dr. Steve Feldman continues the discussion with Hal Luft, Ph.D., an economist, Professor Emeritus at the University of California San Francisco, and director of the Palo Alto Medical Foundation. Dr. Luft explains pay-for-performance involves. He describes how it is best suited for primary care practices because in primary care there are good measures that can be used to assess performance.

For more information, Dr. Luft recommends his website, securechoice.info. You can also read his book, Total Cure: The Antidote to the Health Care Crisis.

On today’s show, Dr. Steve Feldman talks with Hal Luft, Ph.D., an economist, Professor Emeritus at the University of California San Francisco, and director of the Palo Alto Medical Foundation. Dr. Luft explains the economic incentives present in our health care system, alternative ways health care economics could be organized, and the potential impact of changing incentives in our health care system. Next week, Dr. Feldman continues the discussion with Dr. Luft, focusing on pay-for-performance systems in medicine.

Poor use of medication is an enormous problem in our health care system, leading to bad outcomes for patients, needless hospitalizations, and high dollar costs. There are many reasons for poor adherence, including risks and costs of medication, patients not knowing what to do, forgetfulness, and the complexity of some treatment regimens. Even patients with severe disease who truly need the medication don’t take the medication. Dr. Piette describes how adherence is measured, including electronic monitors that record when patients open and close their medication containers. He also talks about work being done to help patients use their medications better.

You can find more information on poor adherence and how to do a better job taking medication in Dr. Steve Feldman’s book, Great Medical Care: The Handbook for Making Your Visit to the Doctor Better.

On our show today, Dr. Steve Feldman talks with John Piette, Ph.D., Senior Research Career Scientist at the Veterans Administration and Professor of Internal Medicine, Director of the Program on Quality Improvement for Complex Chronic Conditions at the University of Michigan. In this first of a two-part program, Dr. Piette describes health services research and why health care delivery seems to vary so much, including economic, behavioral and organizational issues. Dr. Piette describes some of the problems with how doctors get their information, in particular physician detailing by drug companies and the impact this has on patients’ care.

On today’s show, Dr. Feldman talks with Dr. T. Keith Vaughan, a private practicing dermatologist in Puyallup, Washington. Dr. Vaughan is a graduate of the Oral Roberts University School of Medicine. We discuss the emotional characteristics that doctors bring to their relationships with patients, and we discuss some of the very practical and important ways in which Dr. Vaughan’s Christian faith informs his practice of medicine and how he cares for people.

Dr. Vaughan recommends Gary Chapman’s book, The Five Love Languages, for its emphasis on quality time, acts of service, gifts, physical touch and words of encouragement, qualities that are important in medicine as well as in other aspects of our lives.