Longer looks: The time is now for community health workers; Patients sharing in medical decisions; One doctor's plea for help

Oct 5 2012

Every week Shefali S. Kulkarni selects interesting reading from around the Web.

The Philadelphia Inquirer: Temple Hospital Trains Workers For The New Front Lines Of Health Care
(By) the time Frederick Pegues Jr. was resting in bed at Temple University Hospital, the irony struck him hard. Here, he had just finished a month-long course in being a community health worker, sponsored by Temple University Hospital. He had learned how to help patients navigate a complicated health system. Yet he himself had not been able to get the help he needed. Unwillingly, Pegues, 38, an unemployed and uninsured diabetic from North Philadelphia, had become Exhibit A for why people needed a community health worker. ... In the United States, these health workers have been an idea whose time, over the decades, is always coming but yet to fully arrive (Jane M. Von Bergen, 9/28).

The Atlantic: The Cost Of Assuming Doctors Know Best
Shared decision making is a process designed to ensure that patients are fully informed, and then use that information to get the treatment they want. A common though non-essential part of informing patients is a "patient decision aid." Decision aids can be videos, websites, or pamphlets, and they present the available medical evidence on all reasonable treatment options -- including the option to do nothing -- in a way that patients can understand. ... Here's the icing on the cake in terms of health care spending: Patients also tend to choose less invasive (and therefore less expensive) treatment options (Shannon Brownlee and Joe Colucci, 9/28).

Earlier, related KHN story: Study: Decision Aids Show Promise In Reducing Medical Procedures (Rao, 9/5)

Journal of the American Medical Association: Lack of Data
Right after the birth of our first child and during my final year of fellowship, I was diagnosed with an extremely rare and aggressive cancer. I could write many things about this: the difficulty of going from full-time physician to full-time patient and the loss of professional identity that comes with that. Knowing enough about what's going on medically to be terrified, but not enough to be able to sort through the data on my own. Dealing with insurance companies from the other end. ... I want to focus on an incredibly frustrating thing that the medical community can do something about: the "lack of data" regarding rare diseases, which now defines my life and care (Dr. Julie Maher, 10/3).

Slate: Why Is Romney Campaigning On Medical Quackery?
Let's play doctor. A patient comes to you with joint pain, difficulty concentrating, anxiety, poor attention, and mood swings. You might run a series of tests to rule out a persistent infection or other disorder. ... If you are a doctor who believes that the CDC and NIH have misrepresented carefully vetted clinical trial data about the diagnosis and treatment of Lyme disease, however, you might diagnose your patient with chronic Lyme disease and prescribe an intensive, long-term, side-effect-laden, mega-dose of antibiotics. And who would be the biggest supporter of your and your patient's right to pursue a worth-testing-but-found-wanting treatment? Mitt Romney and Paul Ryan (Laura Helmuth, 9/29).

The Economist: An Incurable Disease
Health care expenditure in America is growing at a disturbing rate: in 1960 it was just over 5% of GDP, in 2011 almost 18%. By 2105 the number could reach 60%, according to William Baumol of New York University's Stern School of Business. Incredible? It is simply the result of extrapolating the impact of a phenomenon Mr Baumol has become famous for identifying: "cost disease". His new book gives a nuanced diagnosis, offerings both a vision of a high-cost future and a large dose of optimism. The cost disease may be incurable, but it is also survivable-;if treated correctly (9/29).