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Monday, March 18, 2019

Doctor on Video Screen Told a Man He Was Near Death, Leaving Relatives Aghast

Hmmm...something is amiss with this situation. Terminal lung disease rarely sneaks up on anyone. Terminal lung conditions tend to be chronic and progressive over years. So, either the patient didn't present to medical attention until the very end (unlikely) or we never had a serious illness conversation with the patient and family about the expected progression of the lung disease. Having an initial serious illness conversation during an acute hospitalization is not the ideal circumstance as studies have shown increased patient and family anxiety and PTSD-like symptoms even when a live human-being trained in palliative and hospice care does so face to face. Thus, the response this family had to such news from the tele-ICU doctor is the same type of reaction experienced with an in-person conversation. For serious, progressive health conditions from which one may succumb, the serious illness conversation is best initiated in the outpatient setting. The inpatient conversation should be a continuation of the outpatient conversation (not a newly initiated one). Simple outpatient questions such as: 1) Have you considered your wishes if your disease progresses despite ongoing best medical treatment? 2) What goals and objective do you have for the remainder of your life? 3) How much independence are you willing to give up and how much suffering are you willing to endure in order to meet those objectives? 4) Would you wish to be intubated and kept alive on a mechanical ventilator? 3) Would you desire nutrition via an artificial feeding tube if you are no longer able to feed yourself? 5) How long are you willing to try "heroic" life support measures before determining a different focus and strategy would be appropriate? The answers to these questions aren't really the issue. It's the consideration of the questions which is meaningful. The patient may go home and ruminate on these questions. They may discuss with family members. If and when they are finally hospitalized due to progression or sequelae of their disease, the continued seriously illness conversation will not be psychologically or emotionally shocking.
from Rajesh Harrykissoon, MD

Saturday, March 16, 2019

Food labeling combats obesity in low-income communities - Vital Record

Information isn't sufficient to change behavior. For instance, the mandated inclusion of caloric value and the common labeling of healthier options with a red heart or green leaf icons on menus have not curbed the obesity epidemic. People make choices psychologically by what offers "joy in life." If something offers joy in life now but may harm later, we tend to choose joy now. Eating what you want and what you like now offers a bit of joy in life now. We'll deal with potential downstream consequences later...we'll practice self-restraint with the next meal or go for a jog tomorrow. And, we know how those self-promises tend to work out. Curbing the obesity epidemic will require more than labels and posted calorie counts. It will require acceptance by an entire culture that an alternative lifestyle offers more joy in life than the current.
from Rajesh Harrykissoon, MD

Saturday, March 9, 2019

Panic attacks at night: Causes and how to cope

If you feel you may suffer from nocturnal panic attacks or from night terrors, talk to your doctor about further evaluation.
from Rajesh Harrykissoon, MD

Friday, March 1, 2019

Is asthma genetic? Causes and risk factors

Understand and control your asthma. Diagnostic testing may include spirometry, FENO (exhaled nitric oxide) and/or methacholine challenge testing. The ravages of asthma over years, known as chronic obstructive asthma, which beset prior generations is by and large entirely avoidable with today's medical management. But, we can't offer you that benefit if you and your doctor do not know the diagnosis exists. Not all that wheezes is asthma. Before presuming, get checked out.
from Rajesh Harrykissoon, MD

Wednesday, February 20, 2019

Micro-hospitals Market Set for Rapid Growth and Trend by 2026: Global Key Players Emerus Hospitals, SCL Health, Baylor Scott & White Saint LukeĆ¢€™s Health System, Dignity Health, Baylor Health Care System, and Christus Health - openPR

Micro-hopitals have been gaining markent presence in the last decade. Microhospitals are small footprint hospitals typically of a dozen inpatient beds or less. They are often associated with an attached emergency room or detached but near by elsewhere in the community. They may identify themselves simply as a hospital or as an "emergency hospital." Their market targets those of lower acuity illness which averages 3 day or less of inpatient stay. Those patients of higher acuity or who may require more than 3 days of inpatient care may be transferred/diverted to a larger general hospital. Microhospitals seek to be responsive to the consumer preference of convenience in health care. While they may take federal insurance (such as Medicare) some may opt not to do so as to avoid regulatory burdens which increases their operating costs. However, as the federal beneficiary and HMO (capitated care) payer mix approaches 80% of their market, excluding such payers becomes challenging to unavoidable. Thus, microhospitals tend to pop up in affluent communities with a higher median household income and higer than average education demographics. Some may use added insurance data such as median credit score for a geographic area which they purchase from a credit monitoring company. Knowing such information for zip code 77845, for instance, allows them to assess the likelihood of incurring bad debt (customers unable to pay their bills). Microhospitals have gained chagrin from competing and often pre-existing general hospitals in the communities who contend that microhospitals "cherry-pic" the best patients who are likely to pay and pass everyone else onto the general hospitals; thus, increasing the bad dept risk for the general hospitals. General hospitals further contend that quality of care provided at microhospitals may not be equitable to that at general hospitals especially if the microhospital tries to manage higher acuity patients before untimately transferring that patient to a general hospital whereupon the patient risk and prognosis may we worse, complications higher and outcomes poorer. Some complications and outcomes are reportable to monitoring agencies and directly impact the reinbursement rate of general hospitals and may cause reputational injury with financial jeopary (due to change in customer choices for their healthcare service) when reported to public websites, social media and agencies such as As with a growing trend of corporatization of healthcare, a microhospital may not indeed be a locally owned facility, but may belong to a larger system which owns/operates such facilities statewide or multisate and/or may have institutional equity owners. Contact your insurer to determine whether a microhospital is in-network. As consumer preferences dirives the market, my assumption is that microhospitals will serve a role in communities. Indeed, some of the general hospital systems are erecting microhospitals of their own to directly compete for market share.
from Rajesh Harrykissoon, MD

Sunday, February 17, 2019

How to get help with a surprise bill from a health care provider

Sticker shocked by a surprise medical bill? Perhaps you were transported to an out-of-network facility for a presumed emergency, and you had no control of the destination, but now you're left with a hefty bill. If you were surprised to get a bill from a doctor, hospital, or other health care provider that isn’t part of your health plan’s network, get help through the Texas Department of Insurance (link below).
from Rajesh Harrykissoon, MD

Saturday, February 2, 2019

Docs offer 3 solutions to patients being ‘rehabbed to death’ in nursing homes - News - McKnight's Long Term Care News

What's your strategy to avoid this revolving door of nursing home to hospital to nursing home to hospital, ongoing? Might a performance rating scale such at the one pictured help one select where their hard limits lie to escape from this revolving door?
from Rajesh Harrykissoon, MD