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• Getting Better Health Care – 20 Tips To Help Prevent Medical Errors

  The U.S. Agency for Healthcare Research and Quality (AHRQ) notes that one in seven hospitalized Medicare patients experience a medical error. That’s too many, despite the efforts of doctors and other health care provider to improve patient safety. If you are sick or hospitalized, there are many things you can do to avoid medical errors.

  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.

  
• Getting Better Health Care – Better ways to reform our health care system

  University of Chicago Booth School of Business professor John Cochrane says, there is a “coherent free-market, deregulated alternative” to our current health care system, and that the “Affordable Care Act” isn’t the way to get there. Cochrane believes there are ways to assure that people with pre-existing conditions can get health care without the need for individual mandates.

  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.

  
• Getting Better Health Care – Are drug coupon cards a good thing?

  The prices of some drugs are extraordinarily high. Patients may need those drugs but may find the high price, even just the copayment after insurance, to be unaffordable. What to do!? Drug company sponsored coupons that help cover the copayment can help rescue the situation.

  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.

  
• Getting Better Health Care – Does corporate America have solutions for our health care insurance problems?

  In contrast to much of the rest of the U.S. economy, our health care system is a cobbled, poorly coordinated system. Health insurance is provided largely by government and by employers. Do employers, who have lots of experience with well working markets, have market-based solutions for health care problems?

  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.

  
• Getting Better Health Care – Finding a top doctor

  There are a lot of doctors out there. How do you find a great one? Do you rely on word of mouth? This week, we talk with William Liss-Levinson, Ph.D. about top doctors. Bill is Vice President and Chief Strategy & Operations Officer for Castle Connolly Medical Ltd. Castle Connolly helps people find and access great medical care. It researches doctors’ credentials and surveys doctors to find “America’s Top Doctors.”

  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!

  
• Getting Better Health Care – Practical ways to reform our health care system

  On last week’s program, Tom Hubbard, Senior Program Director at NEHI, a national health policy institute and think tank, based in Cambridge, Massachusetts, spoke about some of the practical ways to reform our health care system. This week, we continue the discussion, focusing on how poorly some patients use their medications and what can be done to improve medication use. Improving adherence to treatment is critical because it would improve outcomes and lower costs 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, beliefs about medication effects, and cultural factors. Strategies to improve adherence will need to be customized to patients’ specific needs. Doctors, insurers and drug companies may all 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!

  
• Getting Better Health Care – Practical ways to reform our health care system

  On today’s program, Tom Hubbard, Senior Program Director at NEHI, a national health policy institute and think tank, based in Cambridge, Massachusetts, joins us. NEHI has a diverse membership of 80 member organizations, including patient groups, doctors, health insurers and drug companies. These organizations have a shared interest in better patient outcomes and a shared interest in greater use of evidenced based 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!

  
• Getting Better Health Care – The campaign to promote better adherence to treatment

  Poor use of medication, also called poor adherence, is responsible for medications not working nearly as well as they could. Patients don’t take their medications for a variety of reason, including forgetfulness, fears, side effects, costs, complexity (especially for older folks) and non-belief in efficacy. Our guest today is Rebecca Burkholder, Vice President of Health Policy for the National Consumers League; the National Consumers League is a nonprofit organization that has represented consumers and workers since 1899. The organization is preparing a national campaign to promote better adherence

  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.

  
• Getting Better Health Care – Can state health insurance exchanges help solve health care woes?

  The National Committee for Quality Assurance (NCQA) recently published a report on how state health insurance exchanges can help promote health care quality and reduce health care costs. Our guest this week, NCQA president Margaret O’Kane, describes what these exchanges can do.

  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.

  
• Getting Better Health Care – Medicare is Innovative!

  Medicare provides health insurance coverage to an enormous number of Americans. It is efficient, but very costly. If only something could be done to make it more innovative….

  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.

  
• Getting Better Health Care – Armageddon Medicine, How to Be Your Own Doctor

  The medical care system functions very well on a day-to-day basis. Sure, it has its warts, but far more often than not, if you have a medical problem, you can get great medical care for it. But what if there were a major catastrophe in the United States? What if our medical system weren’t functioning? Would you be prepared to manage simple or complicated health issues?

  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.

  
• Getting Better Health Care – Online doctor rating

  Controversy about online doctor ratings abounds. Some doctors fear that disgruntled patients will make doctors look bad with no recourse for the doctor to respond (because of patient confidentiality reasons). Should online doctor rating be banned?

  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.

  
• Getting Better Health Care – Is Obamacare a disaster?

  Our guest today, Peter Ferrara, is Senior Fellow, Entitlement and Budget Policy at the Heartland Institute and author “The Obamacare Disaster.” On today’s program, Ferrara discusses the fundamental problem in our health care system today that makes the system so terribly costly: a third party payment system in which the consumer of care, the patient, does not have concern for the cost of care. Ferrara further discusses his view of the problems with the legislation that was supposed to address our health care system woes, the Patient Protection and Affordable Care Act, what he calls “Obamacare.” And he talks about the constitutionality of the Act and efforts to reverse it in the Supreme Court.

  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?

  
• Getting Better Health Care – Storytelling

  Narrative—storytelling—plays a crucial role in how people interact, including interactions between patients and physicians. We discuss the narrative medicine with Dr. Rita Charon, Professor of Clinical Medicine and Executive Directior of the Program in Narrative Medicine at Columbia University.

  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.

  
• Getting Better Health Care – Social and behavioral sciences in medicine

  The Association of American Medical College (AAMC), the organization that certifies American medical schools, published a report on the behavioral and social science foundations of medical training. We discuss the AAMC report with Dr. Rita Charon, Professor of Clinical Medicine and Executive Directior of the Program in Narrative Medicine at Columbia University.

  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.

  
• Getting Better Health Care – Stress, stress myths, and how to control stress (Part 2)

  Stress contributes to poor health and poor quality of life. What is stress? According to physician and stress coach Dr. Mort Orman, stress is just a word, not a distinct entity.

  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.

  
• Getting Better Health Care – Stress, stress myths, and how to control stress (Part 1)

  Stress contributes to poor health and poor quality of life. What is stress? According to physician and stress coach Dr. Mort Orman, stress is just a word, not a distinct entity.

  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.

  
• Getting Better Health Care – Patients may not be taking their medication (Part 2)

  Modern medications are light years ahead of the treatments doctors had to offer years ago, but many patients don’t get the full benefit. Studies have shown that many patients aren’t taking their medication. We’re joined today by Dr. Nathaniel M. Rickles, Assistant Professor of Pharmacy Practice and Administration
at
Northeastern University
and author of Social and Behavioral Aspects of Pharmaceutical Care. In this two-part episode, Dr. Rickles describes why patients don’t take their medication and some strategies to help patients do better.

  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.

  
• Getting Better Health Care – Patients may not be taking their medication (Part 1)

  Modern medications are light years ahead of the treatments doctors had to offer years ago, but many patients don’t get the full benefit. Studies have shown that many patients aren’t taking their medication. We’re joined today by Dr. Nathaniel M. Rickles, Assistant Professor of Pharmacy Practice and Administration
at
Northeastern University
and author of Social and Behavioral Aspects of Pharmaceutical Care. In this two-part episode, Dr. Rickles describes why patients don’t take their medication and some strategies to help patients do better.

  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.

  
• Getting Better Health Care – Our broken malpractice system, and how to fix it (Part 2)

  The medical malpractice litigation system is a mess, resulting in hundreds of billions of dollars in defensive medicine practices. Richard Jackson, President & CEO of Jackson Healthcare (an organization that provides health care staffing, including clinical specialists to clinics and hospitals) describes the problem and a practical solution for it.

  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.

  
• Getting Better Health Care – Our broken malpractice system, and how to fix it (Part 1)

  The medical malpractice litigation system is a mess, resulting in hundreds of billions of dollars in defensive medicine practices. Richard Jackson, President & CEO of Jackson Healthcare (an organization that provides health care staffing, including clinical specialists to clinics and hospitals) describes the problem and a practical solution for it.

  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.

  
• Getting Better Health Care – The People’s Pharmacy for Drug and Other Health Information (part 2)

  This week, we speak with Joe and Terry Graedon, whose radio program The People’s Pharmacy, provides patients a wealth of up to date, cutting edge health information, information patients might find difficult getting anywhere else, even from their doctors. Joe Graedon has a Masters in Pharmacology, and Terry Graedon, has a PhD in Medical Anthropology. Last week, in part 1 of this two-part program, we discussed their radio show and what doctors think about patients getting information from their show; this week, we discuss their newest book, Top Screwups Doctors Make and How to Avoid Them.
  The People’s Pharmacy is more than just radio program. The Graedon’s have published about 15 books, starting with The People’s Pharmacy in 1976. Other books include: The People’s Pharmacy Quick and Handy Home Remedies: Q&As for Your Common Ailments, Best Choices From the People’s Pharmacy, The People’s Pharmacy Guide to Home and Herbal Remedies, Dangerous Drug Interactions, and The People’s Pharmacy, Completely New and Revised. Patients can also get information from the Graedon’s many podcasts, newspaper articles, and videos, as well as from a series of inexpensive guides available through The Peoples Pharmacy website. The Graedons get inspiration for shows, books, and newspaper columns from letters they get from their listeners. Listening to others, they point out, is critical.
  There’s so much money around, in the health system, and the Graedons have developed a successful formula to keep from getting corrupted. Their principles include respect for people’s ability to make informed decisions about their health, honesty and integrity in communication and actions, and care, compassion and fairness as the guiding principles for all institutions serving people. They don’t take a penny of drug company money, so they can be viewed as objective umpires and referees.
  Terry Graedon describes her concerned about direct to consumer advertising, particularly when it is related to serious health conditions. Driven by money, this advertising affects health care costs. The financial incentives in the health system can have a negative impact on health care, particularly the short visits with doctors. In contrast, on their program which airs on public radio stations, they have a full hour for intelligent conversation in which they can explore issues in depth, not overly broken up by commercials. Moreover, after the show, their listeners can go to the Internet and dig down for additional information on health topics.
  Joe and Terry have a mixed, Love/hate relationship with doctors. On the one hand, Joe and Terry are always telling people to see their doctor for specific medical advice. Doctors express love for the guests and the information they share. But there are other doctors who listen get angry, who get defensive, and who ask that Joe and Terry avoid talking about “unscientific stuff” and to stick to experts. We discuss how selection bias may impact what they hear from their listeners, how the happy listeners may be unlikely to write in to express themselves while the—hopefully very few— fuming angry folks may be highly likely to write.
  Joe and Terry’s new book Top Screw Ups has critical information for patients, with specifics on what can go wrong in medicine and how to avoid those pitfalls. Doctors are trying to do their best, but Joe and Terry think that doctors not listening to patients is a fairly common problem. Studies show that doctors interrupt to early when patients are describing their conditions. Joe and Terry look to the successful communication strategies employed by pilots and air traffic controllers as a model for better doctor-patient communication. A key component of this is verification or “teach back.” This can be as simple as asking “Am I correct that you said…?” or “Could you tell me what you heard me say so that I know I got the facts across?”
  Misdiagnosis is too common in medicine and may come from lack of time. Doctors may get “anchored” to a provisional diagnosis too quickly and may not pay sufficient attention to facts that are in conflict with the provisional diagnosis. The Graedons recommended Dr. Jerome Groopman’s book “How Doctors Think” for more information on this. To avoid this problem, patients can ask questions, asking their doctors how confident they are of the diagnosis, what other tests might be helpful, and what else could it be?
  Joe and Terry’s book Top Screw Ups provide a host of lists with tips for avoiding problems. Patients need be sure they receive their lab test results and information on proper medication use and the potential for drug interactions. Patients need to make sure their story is heard. While patients may feel intimidated and should try not to come on too strong, they need to be assertive in getting the information they need.
  Patients should also communicate with their pharmacist. Pharmacists have important information to share about medications, in particular drug interactions. Patients should also get information in writing. They can bring a patient advocate or recording device to visits to make sure they capture the information they might otherwise forget. Relying on package inserts isn’t a great way to know about medications because those inserts have too much info.
  Patients need to anticipate that mistakes will be made in the hospital. They need to take advocate, someone who can be on the lookout for mistakes, and they should verify that everything is being done properly. Patients should be assertive in communication, getting clarification of anything they don’t fully understand. Only then can patients fully participate in the partnership of ideal medical care.

  
• Getting Better Health Care – The People’s Pharmacy for Drug and Other Health Information (part 1)

  This week, we speak with Joe and Terry Graedon, whose radio program The People’s Pharmacy, provides patients a wealth of up to date, cutting edge health information, information patients might find difficult getting anywhere else, even from their doctors. Joe Graedon has a Masters in Pharmacology, and Terry Graedon, has a PhD in Medical Anthropology. In this two-part program, we discuss their radio show and what doctors think about patients getting information from their show; next week, we discuss their newest book, Top Screwups Doctors Make and How to Avoid Them.
  The People’s Pharmacy is more than just radio program. The Graedon’s have published about 15 books, starting with The People’s Pharmacy in 1976. Other books include: The People’s Pharmacy Quick and Handy Home Remedies: Q&As for Your Common Ailments, Best Choices From the People’s Pharmacy, The People’s Pharmacy Guide to Home and Herbal Remedies, Dangerous Drug Interactions, and The People’s Pharmacy, Completely New and Revised. Patients can also get information from the Graedon’s many podcasts, newspaper articles, and videos, as well as from a series of inexpensive guides available through The Peoples Pharmacy website. The Graedons get inspiration for shows, books, and newspaper columns from letters they get from their listeners. Listening to others, they point out, is critical.
  There’s so much money around, in the health system, and the Graedons have developed a successful formula to keep from getting corrupted. Their principles include respect for people’s ability to make informed decisions about their health, honesty and integrity in communication and actions, and care, compassion and fairness as the guiding principles for all institutions serving people. They don’t take a penny of drug company money, so they can be viewed as objective umpires and referees.
  Terry Graedon describes her concerned about direct to consumer advertising, particularly when it is related to serious health conditions. Driven by money, this advertising affects health care costs. The financial incentives in the health system can have a negative impact on health care, particularly the short visits with doctors. In contrast, on their program which airs on public radio stations, they have a full hour for intelligent conversation in which they can explore issues in depth, not overly broken up by commercials. Moreover, after the show, their listeners can go to the Internet and dig down for additional information on health topics.
  Joe and Terry have a mixed, Love/hate relationship with doctors. On the one hand, Joe and Terry are always telling people to see their doctor for specific medical advice. Doctors express love for the guests and the information they share. But there are other doctors who listen get angry, who get defensive, and who ask that Joe and Terry avoid talking about “unscientific stuff” and to stick to experts. We discuss how selection bias may impact what they hear from their listeners, how the happy listeners may be unlikely to write in to express themselves while the—hopefully very few— fuming angry folks may be highly likely to write.
  Joe and Terry’s new book Top Screw Ups has critical information for patients, with specifics on what can go wrong in medicine and how to avoid those pitfalls. Doctors are trying to do their best, but Joe and Terry think that doctors not listening to patients is a fairly common problem. Studies show that doctors interrupt to early when patients are describing their conditions. Joe and Terry look to the successful communication strategies employed by pilots and air traffic controllers as a model for better doctor-patient communication. A key component of this is verification or “teach back.” This can be as simple as asking “Am I correct that you said…?” or “Could you tell me what you heard me say so that I know I got the facts across?”
  Misdiagnosis is too common in medicine and may come from lack of time. Doctors may get “anchored” to a provisional diagnosis too quickly and may not pay sufficient attention to facts that are in conflict with the provisional diagnosis. The Graedons recommended Dr. Jerome Groopman’s book “How Doctors Think” for more information on this. To avoid this problem, patients can ask questions, asking their doctors how confident they are of the diagnosis, what other tests might be helpful, and what else could it be?
  Joe and Terry’s book Top Screw Ups provide a host of lists with tips for avoiding problems. Patients need be sure they receive their lab test results and information on proper medication use and the potential for drug interactions. Patients need to make sure their story is heard. While patients may feel intimidated and should try not to come on too strong, they need to be assertive in getting the information they need.
  Patients should also communicate with their pharmacist. Pharmacists have important information to share about medications, in particular drug interactions. Patients should also get information in writing. They can bring a patient advocate or recording device to visits to make sure they capture the information they might otherwise forget. Relying on package inserts isn’t a great way to know about medications because those inserts have too much info.
  Patients need to anticipate that mistakes will be made in the hospital. They need to take advocate, someone who can be on the lookout for mistakes, and they should verify that everything is being done properly. Patients should be assertive in communication, getting clarification of anything they don’t fully understand. Only then can patients fully participate in the partnership of ideal medical care.

  
• Getting Better Health Care – The fundamentals of doctor-patient communication (Part 2)

  Dr. Mary Catherine Beach describes fundamental problems and solutions in doctor-patient communication. Dr. Beach is Associate Professor in the Division of General Internal Medicine and Core Faculty, Berman Institute of Bioethics and Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins University. Her research interests include physician-patient relationships and communication, respect, bioethics, health care quality for vulnerable populations, HIV, and sickle-cell disease.

  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.

  
• Getting Better Health Care – The fundamentals of doctor-patient communication (Part 1)

  Dr. Mary Catherine Beach describes fundamental problems and solutions in doctor-patient communication. Dr. Beach is Associate Professor in the Division of General Internal Medicine and Core Faculty, Berman Institute of Bioethics and Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins University. Her research interests include physician-patient relationships and communication, respect, bioethics, health care quality for vulnerable populations, HIV, and sickle-cell disease.

  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.

  
• Getting Better Health Care – Health care quality in America is improving

  The National Committee for Quality Assurance (NCQA) has published its 2011 State of Health Care Quality Report examining quality data from health plans that cover 118 million Americans. NCQA President Margaret O’Kane joins us to report on the findings.

  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.

  
• Getting Better Health Care – Electronic ways to improve patient education

  Patient education is critical to successful medical outcomes. Mark Becker, pediatrician and founder of Vivacare, a company that makes patient education material available through doctors’ websites, describes how the Internet can be used to better educate patients about their condition and treatment.

  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.

  
• Getting Better Health Care – Working with a patient advocate (part 2)

  A trusted patient advocate can help people manage the complexities of our health care system. Anne Llewellyn, Editor in Chief of Dorland Healthcare, describes what patient advocates are and how they help people navigate a complex and fragmented health care system.

  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.

  
• Getting Better Health Care – Working with a patient advocate (part 1)

  A trusted patient advocate can help people manage the complexities of our health care system. Anne Llewellyn, Editor in Chief of Dorland Healthcare, describes what patient advocates are and how they help people navigate a complex and fragmented health care system.

  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.

  
• Getting Better Health Care – Patient Centered Medical Homes can help solve our health care problems (Part 2)

  Patient Centered Medical Homes are a proven way to reduce the cost of health care while improving health care quality. Dr. Paul Grundy, Global Director, IBM Healthcare Transformation and the current President of the Patient-Centered Primary Care Collaborative, describes how patient centered medical homes provides comprehensive primary care to people of all ages, broadening access to primary care and improving the coordination of care. Key components of a patient centered medical home include:

  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.

  
• Getting Better Health Care – Patient Centered Medical Homes can help solve our health care problems (Part 1)

  Patient Centered Medical Homes are a proven way to reduce the cost of health care while improving health care quality. Dr. Paul Grundy, Global Director, IBM Healthcare Transformation and the current President of the Patient-Centered Primary Care Collaborative, describes how patient centered medical homes provides comprehensive primary care to people of all ages, broadening access to primary care and improving the coordination of care. Key components of a patient centered medical home include:

  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.

  
• Getting Better Health Care – Being wary of treatments that just don’t help

  Our medical care system can accomplish miraculous things. Surgeons can operate on the vessels of the heart, clearing blockages and installing appliances to keep the vessels open. We have new medicines and new treatments designed to catch disease early or prevent it altogether. But do these miracle treatments do anything of value? Do people live longer or better? Are we getting our money’s worth?

  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.

  
• Getting Better Health Care – Paying for unnecessary care

  Our medical care system can accomplish miraculous things. Surgeons can operate on the vessels of the heart, clearing blockages and installing appliances to keep the vessels open. But do these miracle treatments do anything of value? Do people live longer or better? Are we getting our money’s worth?

  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.

  
• Getting Better Health Care – How basic economics informs solutions for the health care crisis

  The basic principles of economics explain why our health care system is in distress. Insurance, tax laws, and lack of competition contribute to the problem. In this second part of a 2-part series, we discuss solutions to our health care crisis based on an understanding of the underlying economic principles.

  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.

  
• Getting Better Health Care – Basic economics of health care

  The basic principles of economics apply to all sorts of systems and decisions, including those of our health care system. In this first part of a 2-part series, we discuss basic economic principles and how those principles apply to the U.S. health care system.

  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.

  
• Getting Better Health Care – Dealing with difficult physician-patient relationships

  Patients don’t go to doctors to be abused by mean-spirited physicians. Physicians didn’t go into medicine because they don’t care about patients. Yet too often patients may have a contentious relationship with a doctor, and vice-versa.

  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.

  
• Getting Better Health Care – Is there a better way to improve the health of all Americans?

  There’s near universal agreement that our health care system is in crisis, that it costs too much, and that the quality is not what it could be. Our guest today offers a different perspective on the problem, writing, “From a policy perspective, the wrong question was asked: ‘How do we make healthcare cheaper?’ The question should have been ‘How do we make those living in our great nation healthier?’” Our guest today is one of the most honored physicians in America, Dr. Pedro “Joe” Greer, practicing gastroenterologist and Assistant Dean for Academic Affairs at the Florida International University School of Medicine. He founded the Camillus Health Concern that services over 10,000 homeless patients annually. Dr. Greer has been honored with three Papal medals, a MacArthur Genius Grant and the Presidential Medal of Freedom. He is author of the book Waking up in America.

  
• Getting Better Health Care – Have we been asking the wrong question?

  There’s near universal agreement that our health care system is in crisis, that it costs too much, and that the quality is not what it could be. Our guest today offers a different perspective on the problem, writing, “From a policy perspective, the wrong question was asked: ‘How do we make healthcare cheaper?’ The question should have been ‘How do we make those living in our great nation healthier?’” Our guest today is one of the most honored physicians in America, Dr. Pedro “Joe” Greer, practicing gastroenterologist and Assistant Dean for Academic Affairs at the Florida International University School of Medicine. He founded the Camillus Health Concern that services over 10,000 homeless patients annually. Dr. Greer has been honored with three Papal medals, a MacArthur Genius Grant and recognition from three Presidents. He is author of the book Waking up in America.

  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.

  
• Getting Better Health Care – The Physicians’ Declaration of Independence

  The U.S. medical system is characterized by a host of financial arrangements—Medicare, Medicaid, HMO’s and various other forms of insurance—that interlope into the physician-patient relationship.

  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.

  
• Getting Better Health Care – Socialized medicine may not be the best solution

  Can top-down solutions—like the Patient Protection and Affordable Care Act (PPACA)— solve the problems in the U.S. medical care system? Dr. Steve Feldman continues the conversation with Dr. Richard Amerling, Director of the Association of American Physicians and Surgeons. Dr. Amerling points out, with plenty of personal experience to back it up, that socialized medical systems don’t adequately incentivize physicians to do the hard work of giving patients great medical care. Amerling points out that private practice, with patients directly paying for and receiving care from a physician, is the best way to provide medical care.

  
• Getting Better Health Care – The Heart of the U.S. Medical Care Problem

  Medical care quality is not good enough. Medical care costs are too high. What’s wrong with the system? On this week’s show, we talk with a physician who believes the heart of the problem in the U.S. medical care system is a deteriorating physician-patient relationship.

  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.

  
• Getting Better Health Care – Understanding pay-for-performance systems

  Last week, we discussed how economic forces play a central role in how health care is delivered. We don’t want to pay doctors and hospitals for giving more care; we certainly don’t want to pay them for giving less care, either. Ideally, we need a payment model that pays doctors and hospitals for giving better care.

  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.

  
• Getting Better Health Care – The economics of health care

  Economic forces drive behavior in the general economy. These same forces affect how health care is delivered, except in health care, there’s a third party (the insurer) paying for the care. What happens in health care is largely driven by these economic forces. Understanding those forces is critical to figuring out how to make our health care system better.

  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.

  
• Getting Better Health Care – Patients only take half their prescribed medication!

  Last week, we began a discussion of health services research with John Piette, Ph.D., Professor of Internal Medicine at the University of Michigan and Senior Research Associate at the Ann Arbor VA Center for Practice Management and Outcomes Research. On today’s show, Dr. Piette describes the problem of “poor adherence,” how patients don’t take their medication.

  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.

  
• Getting Better Health Care – The study of how health care is delivered

  Researchers are investigating how health care is delivered in order to come up with better ways for patients to be treated. The field, called health services research, began with the finding that in different locations, patients would be treated very differently, with resulting differences in costs and outcomes. People realized that this variation probably means that there wasn’t uniformly ideal medical care across the country.

  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.

  
• Getting Better Health Care – Doctors are human beings

  The interaction of a doctor and a patient involves two human beings. Doctors are people who have feelings, biases, and varying beliefs. Doctors bring these characteristics to the patient-doctor relationship.

  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.

  
• Getting Better Health Care – Vermont’s single payer plan, a way to solve our health care problems?

  Health care systems vary in who pays for the care and who delivers the care. Right now, the U.S. health care system consists of a patchwork of providers, with bandaids in place to try to fix the resulting problems. Dr. William Hsiao, Professor of Economics at the Harvard School of Public Health, has studied health care systems around the globe. Last week, in the first of a two-part episode, he explained the global architecture of a health care system. This week, in part two, he explains the Vermont plan for a single payer health care system and how that system is the best way to meet the goals of high quality medical care for everyone at a reasonable price.

  
• Getting Better Health Care – The patchwork U.S. health care system

  Health care systems vary in who pays for the care and who delivers the care. Right now, the U.S. health care system consists of a patchwork of providers, with bandaids in place to try to fix the resulting problems. Dr. William Hsiao, Professor of Economics at the Harvard School of Public Health, has studied health care systems around the globe. This week, in the first of a two-part episode, he explains the global architecture of a health care system. Next week, in part two, he explains the Vermont plan for a single payer health care system and how that system is the best way to meet the goals of high quality medical care for everyone at a reasonable price.

  
• Getting Better Health Care – The private practice physician’s perspective on quality health care

  This week, we continue our discussion with Dr. Jane Orient, practicing internist and member of the Association of American Physicians and Surgeons (AAPS). Dr. Orient explains the benefits of our fee-for-service, private practice medical system and the potential downside to “Obamacare” and salaried medical systems. She offers practical advice from the practicing physician perspective on how to strengthen our health care system by strengthening the physician-patient relationship. Bottom line: doctors should work directly for their patients, not for 3rd party insurance or government systems.

  
• Getting Better Health Care – The private practice physician’s perspective on quality health care

  Dr. Jane Orient, practicing internist and member of the Association of American Physicians and Surgeons (AAPS), describes her experiences in different medical practice settings. She explains the benefits of our fee-for-service, private practice medical system and the potential downside to “Obamacare” and salaried medical systems.

  
• Getting Better Health Care – Physician communication and the evolution of physician licensure

  In this second part of our two part interview with Dr. Scott Kirby, Medical Director of the North Carolina Medical Board, we discuss the critical importance of physician communication in an age in which electronic records are taking over. Dr. Kirby discusses how electronic records pose a challenge to assuring adequate communication and great medical care. He also describes how he sees the future of medical licensure evolving.

  
• Getting Better Health Care – State medical boards’ role in assuring good medical care

  Medicine is regulated by states, and state medical boards are charged with licensing and regulating physicians. What’s involved? Learn about how doctors get a medical license and how medical boards respond to patient complaints. We speak with Dr. Scott Kirby, Medical Director of the North Carolina Medical Board.

  
• Getting Better Health Care – How insurers can help achieve higher quality, more affordable health care

  What can insurers do to improve quality while making care more affordable? We continue our conversation with Dr. Anthony Nguyen, Senior Vice President for Care Management at Wellpoint, Inc, one of the Nation’s largest commercial insurers. In this second of a two part episode, Dr. Nguyen describes how Wellpoint is working to better coordinate patients’ care and describes some of the exciting, new technologies being implemented to provide higher quality, more affordable care.

  
• Getting Better Health Care – How insurers can help achieve higher quality, more affordable health care

  Our health care system is great in many ways, but it is expensive and could be even better. Insurers pay for the care, but can they help improve quality while making care more affordable? In this two part episode, we talk with Dr. Anthony Nguyen, Senior Vice President for Care Management at Wellpoint, Inc, one of the Nation’s largest commercial insurers.

  
• Getting Better Health Care – The employers’ role in health care change

  For better or worse, much of our health care system is based on employer-provided coverage. Whether this is a good system or not, employers have a central place in the effort to improve health care quality and lower cost. Can they put their usual business practices to work to make health care better and more affordable? We talk with Caryol Hendricks, Executive Director of the Employers’ Health Coalition.

  
• Getting Better Health Care – Law and medicine: Doctor ratings

  Legal issues are common aspects of medicine. To start our exploration of the law and medicine, we discuss legal aspects of Internet rating of doctors on websites like DrScore.com. If you leave a negative rating, are you at risk? Are websites liable for what they post? We talk with our legal expert, Dr. Noah Scheinfeld, J.D., M.D., to learn more.

  
• Getting Better Health Care – Where can we find reliable health information?

  When it comes to getting reliable information on consumer goods, Consumer Reports has been the gold standard. There are a number of reliable resources for healthcare information on the web like Medlineplus, but it is great to know that Consumer Reports is also devoting resources to make health care quality ratings available to consumers. We talk with Dr. John Santa, Director of Consumer Reports’ Health Ratings Center.

  
• Getting Better Health Care – Is hospital safety improving?

  A 1999 Institute of Medicine report found big risks in American hospitals resulting in dedicated efforts to reduce those risks. Are things getting better? A recent New England Journal of Medicine article says no. We speak with the author of that study, Dr. Christopher Landrigan, about his findings.

  
• Getting Better Health Care – Can we make health insurance more rational?

  Our system for financing health care is all screwed up, paying lots for things that add little to no value. Can we change this system so that we get value for our money? It’s already happening. Dr. Mark Fendrick, Co-Director of the University of Michigan Center for Value-Based Insurance Design, tells us about value-based insurance and how we can incentivize patients to seek out better health care at lower cost.

  
• Getting Better Health Care – Pharmacists can help us get better medical care

  Pharmacists have expert knowledge about medications. They serve in local drug stores and in many other roles. Research is discovering new ways pharmacists can work with physicians to help patients get better medical care. Dr. Barry Carter, Professor of Pharmacy Science and Practice in the College of Pharmacy at the University of Iowa, tells us how. You can learn more about pharmacists at the American College of Clinical Pharmacy or the American Pharmacists Association.

  
• Getting Better Health Care – America’s small town hospitals

  Large academic medical centers may make the news, but much of American medical care is delivered in small, local hospitals. What are they like? Can they deliver good care or are they just stepping-stones to the nearest academic medical center? Bill James, CEO of Northern Hospital of Surry County, located in Mt Airy, North Carolina, boyhood home of Andy Griffith and the town on

  
• Getting Better Health Care – Are U.S. military health care costs degrading military effectiveness?

  Auto companies spend more on health care than on steel. Is the same thing happening to the U.S. military? The military’s over $50 billion health care bill threatens to crowd out the spending needed for military readiness. We’ll learn where those costs are coming from and why it is so hard to get them under control from expert Todd Harrison, Senior Fellow for Defense Budget Studies at the Center for Strategic and Budgetary Assessments.

  
• Getting Better Health Care – Reforming the U.S. health system (part 2)

  What’s right and what’s wrong with the U.S. health system? Does it need a major overhaul or a few tweaks? In part 2 of this 2 part episode, we discuss the cost of the U.S. health care system with Dr. Robert Berenson, a health care policy expert who has served as a practicing physician, the manager of a large health plan and in senior government positions, including being in charge of Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Services. Dr. Berenson describes how incentives need to change to get control of our medical costs.

  
• Getting Better Health Care – Reforming the U.S. health system (part 1)

  What’s right and what’s wrong with the U.S. health system? Does it need a major overhaul or a few tweaks? In part 1 of this 2 part episode, we discuss the make up of the system with Dr. Robert Berenson, a health care policy expert who has served as a practicing physician, the manager of a large health plan and in senior government positions, including being in charge of Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Services.

  
• Getting Better Health Care – It’s hard to make well people better, but it’s not hard to make them worse

  Screening for illness promises to help identify disease at a curable stage and to keep us healthy. But is it worth the cost and risks? We discuss the very real downside of health screening and preventive care with Dr. Gilbert Welch, author of Overdiagnosed: Making People Sick in the Pursuit of Health, from the Dartmouth Institute for Health Policy and Clinical Practice.

  
• Getting Better Health Care - Improving health care by changing payment structures

  Individual health care experiences may all be outstanding, but overall health care may still not be good because of poor coordination of care. Do we really want to live with a system that pays doctors to provide more care instead of better care? We discuss how to change the structure of the system and the ways medical care is paid for with Harold Miller, Executive Director of the Center for Health Care Quality and Payment Reform.

  
• Getting Better Health Care – Small town family practice

  TV shows give us a picture of big city hospitals and high intensity care. But what is medical practice like in the trenches of small town America? What kind of medical quality is practiced there? We speak with Dr. John Dykers, who recently retired after nearly 50 years of family practice in Siler City, North Carolina.

  
• Getting Better Health Care – The Academic Medical Center

  Academic medical centers are charged with training new doctors, expanding health knowledge through research, and providing cutting edge clinical care. To get a better understanding of the academic medical center, we speak with Dr. Steven Block, Senior Associate Dean of the Wake Forest University School of Medicine.

  
• Getting Better Health Care – Clinical trial myths

  Do new drugs really cost a billion dollars to develop? We speak with Dr. Lawrence Friedhoff, author of the book New Drugs: An Insider’s Guide to the FDA’s New Drug Approval Process for Scientists, Investors, and Patients.

  
• Getting Better Health Care – How are new drugs tested (part 2)?

  We are blessed with wonder drugs that would have been considered either magical or miraculous in earlier times. How are drugs tested to assure efficacy and safety? Clinical researcher Bea Abrams, PhD, with over 30 years experience in pharmaceutical development, explains the nitty-gritty of clinical trials done to bring a new drug to market.

  
• Getting Better Health Care – How are new drugs tested?

  We are blessed with wonder drugs that would have been considered either magical or miraculous in earlier times. How are drugs tested to assure efficacy and safety? Clinical researcher Bea Abrams, PhD, with over 30 years experience in pharmaceutical development, explains the steps involved in clinical trials to bring a new drug to market.

  
• Getting Better Health Care – Certifying electronic health record systems

  The government is pouring money into encouraging doctors and hospitals to switch to electronic health record systems. A bevy of companies are taking advantage of it. But will these systems work? Will the be secure? Will they be able to communicate with each other? We speak with Dr. Karen Bell, Chair of the Certification Commission for Health Information Technology (CCHIT®).

  
• Getting Better Health Care – How you can help your doctor give you great care.

  Your medical condition may be complicated. You can make sure you give your doctor the information the doctor needs to give you great care. Dr. Alan Ettinger, neurologist and author of The Essential Patient Handbook, explains how doctors think so that you can be a better partner with your physician.

  
• Getting Better Health Care – What your doctor won't tell you

  Doctors strive to give their
  patients great medical care, but Dr. Evan Levine, author of the book, What Your Doctor Won’t (or Can’t) Tell You, and of the blog, Healthcare – A behind the scenes look, believes there’s another side to the story, of doctors engaging in unethical practices and taking advantage of patients to make money. Learn what to watch out for.

  
• Getting Better Health Care – Alternative medicine

  Given the limitations of traditional medical care, people have turned to complementary and alternative medical treatment (CAM) to meet their needs. What is complementary medicine and are these treatments safe? Are they effective? We talk with physician Dr. Sarah Taylor.

  
• Getting Better Health Care – A day in the life of a medical student

  Doctors are the heart and sole of the health care system. Where do they come from? What is their training like and what role do they play in giving patients care? We talk with Wake Forest University School of Medicine student Craig Yarbrough.

  
• Getting Better Health Care – Patient privacy in the electronic era

  The ability to share information makes electronic health records a fabulous way to improve patients’ care, but that same ability makes it easier to access and abuse patients’ privacy. We discuss medical record privacy rules with Alicia Gilleskie, partner-elect with the law firm of Smith
  Anderson in Raleigh, North Carolina. We also discuss the privacy concerns of doctor rating websites.

  
• Getting Better Health Care – Protecting patients’ health information

  With the growing use of electronic technologies, there is a growing need to protect patients’ health records from abuse. A key law that provides such protections is HIPAA, the Health Insurance Portability and Accessibility Act. We discuss the privacy rule and myths about it with Trisha Torrey, Every Patients Advocate, the Patient Empowerment Guide on About.com and author of You Bet Your Life! The Ten Mistakes Every Patient Makes.

  
• Getting Better Health Care – Controlling health care costs

  Dramatic changes are needed if we are going to bring health care costs under control. The Council for Affordable Health Insurance (CAHI) is working toward development of a health care system that enables all citizens to have affordable, quality health care . CAHI Executive Director J. P. Wieske tells us how we can insure patients, give patients choices in health care, and control costs.

  
• Getting Better Health Care – The nuts and bolts of improving health care quality

  Modern medical centers can provide glitzy, miraculous services, but quality comes down to doing the little things well every time. Dr. Russell Howerton, Vice Chief Medical Officer of the Wake Forest University Baptist Medical Center tells us how it is done.

  
• Getting Better Health Care – The state of health care quality.

  The National Committee for Quality Assurance (NCQA) has been measuring health care quality in the United States for the past 20 years. NCQA president, Margaret O’Kane brings us up to date on the strengths and weaknesses of health care quality and its measurement.

  
• Getting Better Health Care – Health care reform beyond the hype.

  We’re inundated with partisan bickering over health care reform. What does the legislation really do? Dr. Jack Resnick followed health care reform for the AMA and the American Academy of Dermatology, has read the whole bill, and tells us the real story without the bias.

  
• Getting Better Health Care – Improving patients’ satisfaction

  Doctors are trained to make the right diagnosis and prescribe the right treatment; satisfying patients sometimes gets lost in the process. Susan Keane Baker, author of “Managing Patient Expectations,” tells us what physicians and patients should be doing to improve patients’ satisfaction.

  
• Getting Better Health Care – Winnable disease prevention battles

  The Centers for Disease Control and Prevention is a Federal agency dedicated to protecting health and reducing death and disability. The CDC is focusing resources on winnable battles. Learn what those battles are and how they will be fought from CDC Director of Program Dr. Janet Collins.

  
• Getting Better Health Care – A trustworthy source of medical information

  The Internet makes all kinds of information available, but what can we trust? The National Library of Medicine is a source for reliable healthcare information and much, much more. NLM Deputy Director Betsy Humphreys tells us about it.

  
• Getting Better Health Care – Saving money on hospitalization

  Hospitalization is one of the biggest expenses in health care. Is there any way to reduce the cost of a hospitalization? Our guest this week, Dr. Cynthia Koelker, author of 101 Ways to Save Money on Healthcare, explains how.

  
• Getting Better Health Care – What do doctors think?

  Our health care system is broken, and legislation to fix it has been passed. What do doctors think? We talk with Dr. Cecil Wilson, President of the American Medical Association, the pre-eminent national association of physicians in the United States.

  
• Getting Better Health Care – Can we reduce medical errors?

  Serious, preventable medical errors are too common. What is being done about it? What can you do to make sure you don’t become a victim? Find out from Dr. David Nash, Dean of the School of Population Health at the Thomas Jefferson University.

  
• Getting Better Health Care – Is medical school research tainted by industry?

  Academic medical centers and physicians partner with drug companies for research and education. Does this create conflicts of interest that harm the public health? Find out from Dr. Guy Chisolm, Director of the Innovation Management and Conflict of Interest program at the Cleveland Clinic.

  
• Getting Better Health Care – How will social media change medical care?

  Social media like Facebook and Twitter are rapidly changing the way people in our society interact. Can they be harnessed to improve the care we get? Dr. Jeff Benabio, a pioneer in the use of social media in his practice, explains social media, describes how social media can be used, and lets us in on some pitfalls to watch out for.

  
• Getting Better Health Care – Using technology to improve healthcare

  The buzz is about improving the health care quality; it isn’t going to happen using the medical record keeping systems of the past. Ann Lefebvre, Director of the Improving Performance in Practice Program for the state of North Carolina, explains benefits of electronic record systems.

  
• Getting Better Health Care – Can mobile clinics reach people with the greatest health care needs?

  There are thousands of mobile health clinics across America. Dr. Nancy Oriol, founder of the award winning Family Van program in Boston, tells us about the barriers to accessing our health care system and how reaching out to the community can help reduce those barriers.

  
• Getting Better Health Care – What’s the best way to save money on health care?

  Don’t get sick, of course. Preventive health care is a great way to reduce health care costs. Our guest this week, Dr. Cynthia Koelker, author of 101 Ways to Save Money on Healthcare, tells us how we can save money on preventive care, including information on which screening tests we need and which we don’t.

  
• Getting Better Health Care – Can we fix our health care system?

  Our health care system is isn’t a coordinated system. Can meaningful reform legislation pass? We speak with Wake Forest University political economist David Coates about the basic problem with U.S. health care, what change is needed and whether we can make that change happen.

  
• Getting Better Health Care – Are medications safe?

  Modern drugs can work miracles, but drug safety is a controversial topic that makes the news regularly. The FDA is responsible for making sure that marketed drug products are effective and safe. How do they do it? We speak with Dr. Sandra Kweder, Deputy Director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research.

  
• Getting Better Health Care – How can we better manage complex conditions?

  Complex conditions, like diabetes, require patients to be educated and involved in their disease management. Diabetes educator and researcher Dr. Julienne Kirk, Professor of Family & Community Medicine at Wake Forest University, describes the team of people who are there to help.

  
• Getting Better Health Care – Pharmaceutical companies: Good or bad?

  Pharmaceutical companies are responsible for the modern day medications that let doctors work miracles. Is there a downside? We talk with Lori Reilly, Vice President for Policy and Research at the Pharmaceutical Research and Manufacturers of America (PHRMA).

  
• Getting Better Health Care – Will the electronic medical record revolutionize health care?

  Electronic medical records (EMR) are touted as promising better healthcare, less error, and lower cost. Is there no downside? Dr. Dan Siegel, a pioneer in the use of electronic medical records, explains both the ups and the downs of EMR and what we can do today to reap the benefits.

  
• Getting Better Health Care – How can we possibly control the costs of medical care?

  The politicians tell us the system needs to change in order to lower health care costs. But maybe there’s a bottom-up approach. Dr. Cynthia Koelker, author of 101 Ways to Save Money on Healthcare, empowers each of us to lower our healthcare costs.

  
• Getting Better Health Care – Does board certification mean I’m seeing a good doctor?

  One of the central elements used to assure the quality of our physicians is board certification. What is Board Certification? How do doctors get it? Is it always for real? We discuss board certification with Dr. Kevin Weiss, President and CEO of the American Board of Medical Specialties.

  
• Getting Better Health Care – Where’s the leadership for changing our health system?

  For all its good, there’s general agreement the health care system needs to change, but leadership for effective change seems lacking. We explore what can and should be done with Jim Frogue, Vice President of the Center for Healthcare Transformation.

  
• Getting Better Health Care – A government agency devoted to improving healthcare quality?

  The most controversial aspect of healthcare reform is the possibility of rationing. The Federal government’s Agency for Healthcare Research and Quality (AHRQ) is already supporting guidelines and studying efficiencies. Is that code for developing ways to ration our healthcare? Dr. Carolyn Clancy, Director of AHRQ tells us what the Agency is really doing.

  
• Getting Better Health Care – How do doctors keep up with new developments?

  Doctors have to be devoted to staying abreast of new medical developments. They must document hours and hours of education every year. How does that education work? How is it kept free of inappropriate drug company influences? Dr. Michael Lischke, Executive Director of Continuing Medical Education at Wake Forest University School of Medicine explains.

  
• Getting Better Health Care – What does it take to be a better patient?

  As good as our health care system is, it isn’t perfect. Doctors are only human. You can get better health care by taking a leadership role. Margo Corbett, creator of The Savvy Patient’s Toolkit, tells us how to become more engaged, eliminate medical errors, and reduce needless testing.

  
• Getting Better Health Care – Who’s watching over doctors?

  State medical boards across the country are responsible for licensing and disciplining over 700,000 doctors. Dr. Humayun Chaudhry, President & CEO of the Federation of State Medical Boards, explains how doctors are trained and licensed and how the public can access state medical board information on doctors’ training and disciplinary history.

  
• Getting Better Health Care – Who’s watching over hospitals and other health care organizations?

  When we’re in need of serious medical care, we often don’t have a lot of time to study whether a hospital is up to standards or not. Jerod Loeb, PhD, Executive Vice President of the Joint Commission, explains how hospitals are accredited and how over 100,000 other healthcare organizations aren’t.

  
• Getting Better Health Care – Are insurers part of the problem or part of the solution?

  Some people deride insurers as a deadweight loss in our health care system. How do insurers’ perceive their role? Barbara Morales, Vice President of Health Policy at BCBS, explains how insurers are patient advocates and describes the strengths and limitations of recent health reform legislation.

  
• Getting Better Health Care – What does the health care reform legislation do?

  Did Congress just take over the health care system? Will the health care reform legislation end and destroy our health care system? Legal scholar Mark Hall cuts through the partisan hype to tell us what we can really expect from the “monumental” health care reform legislation.

  
• Getting Better Health Care – Be prepared to save a life.

  Major disasters grab the news, but minor, potentially life-threatening disasters are all too common. Dr. Richard Bradley, Chief of Emergency Medical Services at the University of Texas Medical School at Houston and long time American Red Cross volunteer, tells us how to be ready.

  
• Getting Better Health Care – The limits of our perceptions.

  Some say the new health care reform law is a step forward while others claim it is a government take over that will destroy our medical system. Which is it? It depends on your perception. We speak with psychologist Dr. Alan Gilchrist about how our perceptions can be deceiving.

  
• Getting Better Health Care – Dying well.

  Our medical system at times offers miraculous treatments, but those treatments may not always be desirable. Neurosurgeon Dr. Richard Rapport, a humanist physician, describes both the medical miracles and the times when it is best to say enough is enough.

  
• Getting Better Health Care – The American Red Cross: A disaster safety net

  Our medical system does miraculous things on a daily basis, but it also has to be flexible to address urgent needs in times of disasters. Throughout the United States, the Red Cross helps people and the medical system prepare for and meet emergency needs. Learn how.

  
• Getting Better Health Care – Complementary and integrative medicine.

  American medicine gives patients many effective treatments, but is that enough? Patients want safe, natural, holistic care, and there are a growing number of doctors who are trying to meet those needs. We talk with Dr. Kathi Kemper, internationally recognized expert on integrative medicine.

  
• Getting Better Health Care – An obscene takeover of US healthcare?

  Peter Ferrara, director of entitlement and budget policy for the Institute for Policy Innovation and general counsel of the American Civil Rights Union, is disgusted with current healthcare legislation, fearing the effects of a government takeover. Should we be worried?

  
• Getting Better Health Care – Healing a sick healthcare system.

  Award-winning health economist Professor Victor Fuchs of Stanford University describes the numerous problems with our healthcare system and what we will need to do to fix this system. His prescription? A major overhaul.

  
• Getting Better Health Care – Angels of Mercy.

  Doctors do so much for their patients. For many doctors, that’s just not enough. Some volunteer in their communities. Others answer bigger needs. Listen to Dr. Joel Schlesinger tell his inspiring story of medical volunteerism and making a difference in people’s lives in earthquake-ravaged Haiti.
  http://www.huffingtonpost.com/2010/01/12/haiti-earthquake-relief-h_n_421014.html
  http://www.cnn.com/2010/LIVING/01/13/haiti.earthquake.how.to.help/index.html

  
• Getting Better Health Care – Who is this physician assistant?

  Doctors can only do so much for their patients. Other health care professionals are now helping doctors do more. When you go to see the doctor, you may end up seeing a Physician Assistant. Who are Physician Assistants and what do they do? Physician Assistant Wayne VonSeggen clues us in.

  
• Getting Better Health Care – Protecting doctors and patients from medical malpractice.

  Dr. Jeff Segal’s business, Medical Justice, protects doctors from frivolous lawsuits. He says this is good for patients, too. Learn how contracts are being used to help make malpractice law fairer, helping to reduce the costs and risks of defensive medicine.

  
• Getting Better Health Care – Medical malpractice: The plaintiff’s perspective.

  Defensive medicine is cited as a major cause for the high cost of health care. Medical malpractice plaintiff’s attorney Tom Comerford tells us that defensive medicine isn’t the problem people say it is and shares his insights on how to make sure you are getting great medical care.

  
• Getting Better Health Care – The physician’s perspective on health care reform.

  Patients still trust their physicians. Patients want to know what physicians think health care reform will do to the quality of our health care system. Dr. Joel Schlessinger joins us to talk about his impressions of health care reform legislation and the problems with behind-closed-doors politics.

  
• Getting Better Health Care – A comprehensive plan for universal health care.

  William Roth believes health care is a fundamental right. He’s researched health plans around the world to develop a plan that would give all Americans the care they deserve. Has he solved our health care problem? Listen and find out.

  
• Getting Better Health Care - Irrational medical decisions.

  Economists tell us we are rational, but behavioral economist Dan Ariely says we are far from it. Regularly we make decisions more like Homer Simpson than like Commander Spock. Learn how we can harness our irrationality to get better health care.

  
• Getting Better Health Care - What are doctors really like?

  Our doctors are our most important medical partners. What are they like? Are they caring professionals or greedy jerks? Medical anthropologist Dr. John-Henry Pfifferling, Director of the Center for Professional Well Being tells us about hardworking, caring doctors and the dark side they can fall into.

  
• Getting Better Health Care - Physician-patient relationships

  Physician-patient relationships are the heart and soul of medicine. Clinical psychologist and dermatologist Dr. Richard Fried discusses the impact of disease on patients’ lives, the complexity of doctor-patient relationships, and how patients can have a more fulfilling interaction with their doctor.

  
• Getting Better Health Care - Clearing the fog around breast cancer screening.

  Breast cancer is a leading cause of cancer deaths in women. The United States Preventive Services Task Force cut back their recommendations on screening for this killer. Surgical oncologist Dr. John Stewart tells us a simple message: screening saves lives.

  
• Getting Better Health Care - The weak against the strong.

  How can individual patients possibly go up against behemoths like hospitals, insurers or drug companies? Sheila Rittenberg, Senior Director at the National Psoriasis Foundation tells us how patients can band together to get better health care.

  
• Getting Better Health Care - Insurance coverage for medications.

  Are you confused about how insurers decide what drugs are covered? Barry Ginnetti of the GMR Group describes drug benefits in insurance plans. Learn how insurers decide what drugs to put on their formulary and what to do if an insurer denies coverage of a drug that you need.

  
• Getting Better Health Care - New but expensive drugs.

  David Beier, Senior Vice President at Amgen and former Chief Policy Officer to the Vice President of the United States tells us about new drug development, health care reform, and how uninsured patients can get access to expensive medications.

  
• Getting Better Health Care - Managing lupus.

  Lupus is a chronic autoimmune disease that devastates the lives of young women and other sufferers. Dawn Isherwood, RN, Nurse Educator with the Lupus Foundation of America tells us what lupus is, how to manage it, and how to use patient advocacy groups in order to get better health care.

  
• Getting Better Health Care - Import the Canadian health system?

  People point to Canada as a possible model for U.S. health system reform. Dr. Kevin Smith, a Canadian physician practicing across the border in Niagara Falls tells us where he would go for medical care if he was ill and why.

  
• Getting Better Health Care - Are patients satisfied with their care?

  Medical care in the United States is expensive. Are we getting our money’s worth? Dr. Roger Anderson, Professor of Public Health at Penn State University and a founder of an online doctor rating website, DrScore.com, tells us things you can do to have a more satisfying medical care experience.

  
• Getting Better Health Care - Taking medication for chronic illness

  Chronic illness is a growing problem in the United States. Our guest, Dr. Rajesh Balkrishnan, Professor of Pharmacy at the University of Michigan, describes how many patients don’t regularly take their medications. He provides specific advice for healthier living and for how to remember to take medication properly.
  
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