Space Coast Progressive Alliance

The Future of the American Experiment is in Your Hands
Tuesday, 22 September 2015 19:37

About Healthcare in the USA

Written by  Dr. Steve Blythe, compiled by Team SCPA

Posted September 22, 2015
Healthcare USA, cont'd.

A family medicine physician who works in 'urgent care' in Oregon recently wrote anonymously and critically about healthcare in the USA, for a sassy online blog. A reader asked SCPA what we thought. We turned to Dr. Stephen Blythe -- a physician and friend of The People, and a member of Space Coast Progressive Alliance -- and asked Dr. Blythe if he would comment. He did, and how! Thank you, Dr. Blythe!
-- SCPA Editor

INDEX
1. Blog Excerpt, Clean Food Dirty Girl: Healthcare in the US …
2. Comments by Dr. Stephen Blythe, D.O.

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1.
Healthcare in the US: I managed to get a Doctor to Spill the Beans…
By Molly Patrick, Clean Food Dirty Girl Blog, Sept. 7, 2015

EXCERPT

"Dr. Mo" works for one of the biggest hospital chains in the country. He practices family medicine and works in urgent care in the Portland (OR) area. 

He is a doctor who understands the important role that food plays on health, and who is willing to impart this knowledge to his patients.  Here is what he has to say about the medical profession. ...

(Dr. Mo writes:)… I went into medicine because I am compassionate by nature, and I love the sciences. I did 5 years of undergrad, 4 years of medical school and 4 years of residency.

I decided to practice family medicine because I wanted to do a whole breadth of care and hopefully intervene early in people’s lives to help make a difference.

Here are a few of the problems that I experience first hand within the medical industry ...

https://cleanfooddirtygirl.com/healthcare-in-us-i-managed-to-get-a-doctor-to-spill-the-beans/#more-23177

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2.
Comments by Dr. Stephen Blythe, D.O.
Board-Certified Family Physician and Nutritionist

While this article (referenced blog above) brings up some serious concerns about the U.S. health care system, Dr. Mo certainly is not “spilling the beans” by saying anything new. In fact, his observations are rather simplistic and skewed by the fact that although he is trained as a family physician, he practices urgent care. If he were really interested in helping keep people healthy and avoiding some of the defensive medicine rat-race, he would practice family medicine as he was trained to do (more work and less pay than working urgent care, though).

His viewpoint is clearly skewed when it comes to lawsuits and defensive medicine. Doctors who work in urgent care and emergency medicine do not establish relationships with their patients. This makes them more likely to be sued if they make a mistake or even if there is simply a poor outcome. They also feel they need to meet patient expectations of “good care,” even though many patients interpret “massive care” as good care. I see this all the time. A patient seen in the ER or at Urgent Care with abdominal pain but without a fever and with a totally normal examination will end up getting a CT scan. I am sure most patients think that this is “good” medical care. A patient with a fairly minor concussion but no signs of an intracranial bleed will get a CT scan. I had a patient in Maine who slipped on the ice and landed on his back. He had diffuse pain and tenderness, not surprisingly. He ended up getting not even x-rays but a CT scan of the neck, upper back, AND his lower back. That’s a whole lot of radiation to evaluate a simple low-velocity injury which resulted in no signs of major trauma. A good primary care provider will take a medical history, examine the patient, develop some assumptions about what is happening, and then develop a treatment plan. There is nothing wrong with a treatment plan that includes “watchful waiting” or scheduled reassessment as long as the patient has a clear understanding of what changes would represent a red flag for reassessing the situation. Back in the days before CT scans if we had a low-to-moderate suspicion of appendicitis we gave the patient or parents detailed instructions of what to watch for and often had the patient stay overnight or return in twelve hours for reevaluation. The same with minor concussions. When my youngest daughter fell and was briefly knocked out she was taken to the ER. She had a normal exam, but the ER doc said: “Maybe we should do a CT scan.” I replied: “Maybe we should wait and simply watch for any indications of an intracranial bleed.” His response was a surprising: “Good. You know with all the radiation involved CT scans are going to be the asbestos of the 21st Century.” He knew the dangers of CT scans and was mostly covering his butt by offering one — he was just as happy not to do it, although I have no doubt that he then adequately covered his butt by documenting that “a CT scan was offered but refused.”

I personally think excessive expensive and invasive testing is the sign of a lazy and unintelligent physician, and/or one who doesn’t want to be bothered to educate the patient. I am willing to spend a lot of your money if needed, but I am happy also to lay out a rational approach to following up the problem.

Undoubtedly the climate of litigation results in increased “defensive medicine.” And while the tort system is a good thing — people who have been damaged by the actions or inactions of another should have justice and compensation — we have gone a little bit off the deep end.

Consider Xarelto. If you watch TV you have seen lawyer ads asking you to call if you took this medication and had any bleeding. Xarelto is a “blood thinner” — an anticoagulant medication designed to reduce the tendency of your blood to clot. OBVIOUSLY the use of this medication may result in increased problems with bleeding. We use this medication to prevent deadly pulmonary emboli and deadly strokes in those at risk. A patient with the heart rhythm irregularity called atrial fibrillation, for example, has about a 5% chance per year of having a major stroke. If we put them on an anticoagulant medication that risk drops to 1-2%. BUT — the risk of bleeding obviously increases. Bleeding, however, is something that we can usually get stopped and “fixed.” Not so much with a stroke or pulmonary embolism. So the only negligence associated with the use of this medication would not be by the manufacturer  — this medication does exactly as promised. The only negligent thing about the use of this medication would be if the prescribing physician failed to thoroughly discuss the risks and benefits of taking this medication. Life is a crapshoot. Taking medication or getting ANY kind of medical treatment (or not) is a crapshoot — it is always a question of weighing the odds and making a well-informed decision.

Yes, we practice “evidence-based medicine,” but no one forces us to practice evidence-based medicine. In fact, one problem is that now with the formation of new entities like ACO’s (Accountable Care Organizations) insurance companies are demanding that we do things that sound good but are NOT based on any evidence. We are supposed to do a fall risk assessment on all older patients and at least yearly develop a “weight management plan” for all patients with a BMI over 30 — this sounds good but those who study these things (the U.S. Preventive Medicine Task Force) say they do not make any beneficial impact. Simply advising a patient to “eat less and move more” has no lasting consequences. Dr. Mo’s assertion that there is never mention of diet is wrong — the problem is that physicians are now being forced to deal with weight concerns even though they are not trained to do so and there are no really good treatments to offer. The Atkin’s Diet and Weight Watchers still are gold standards.

And the problem is not only the food and drug manufacturer’s influence, but the effect of dogma. Changing embedded ideas is like turning a battleship. For some reason many decades ago it was decided that because a high blood level of cholesterol was associated with a higher risk of cardiovascular disease that EATING cholesterol must be a bad thing. This in spite of the lack of evidence that would suggest this. I was almost kicked out of my graduate program in nutrition because I pointed this out to our director, who was receiving lots of federal funding to study the evils of dietary cholesterol. I was not told that anything I said was incorrect (as I pointed out all the studies showing NO relationship between ingested cholesterol and heart disease) — I was told that I had a “bad attitude!” Finally — 35 years later — the powers-that-be have acknowledged this truth and eggs have been invited to sit at the table once again. In fact, the push to force Americans to eat less fat and more carbohydrate-rich foods has been associated with increased obesity and diabetes over the last few decades. The drive against dietary fat was a feel-good effort NOT based on evidence. (Obviously those who are overweight need to reduce caloric intake, which includes reducing consumption of fat-laden foods for sure.)

Evidence IS important! The biggest criticisms of evidence-based medicine often come from those who sell crap or try to convince us that we need to drink kale smoothies with no evidence to back up their claims of benefit. A current example is the company selling Prevagen — “a protein from jellyfish that helps support brain health.” While the protein in question IS found in the brain, ANY protein taken into the stomach is broken down into component amino acids which the body uses to manufacture whatever proteins it needs to make. So an expensive supplement of “prevagen” results in no more impact on your brain than does a few peanuts.

Many people take (or sell) supplements based on indirect “evidence” — but NOT evidence of any benefit from those supplements. Wishful thinking often leads to extrapolation of reality to fantasy. For decades people took Vitamin E because of evidence that people who ate whole grains had less heart disease. But eventually when these supplements were studied they were found to have no effect on heart disease. The same with selenium and prostate cancer, Vitamin D and breast cancer, and Vitamin A and cancers in general. Studies do not support the use of these supplements to prevent those diseases — and yet, men with higher levels of selenium in their blood have lower rates of prostate cancer and for decades the NHANES studies (National Health and Nutrition Evaluation Survey) have shown that smokers who regularly eat broccoli and carrots have 40% lower rates of lung cancer. Women with higher Vitamin D levels have lower rates of breast cancer — and yet taking supplements does not seem to lower the rate of breast cancer. The conclusion: live a healthy life, eat whole foods, and enjoy sunshine in moderation.

Does “evidence” come from industry-funded studies? Yes, sometimes. And that can be good or bad, and must always be taken with a grain of salt. A good example was the major study of Celebrex (an anti-inflammatory medication often used to treat osteoarthritis). This study, conducted by the drug maker, was designed to see if Celebrex reduced the formation of pre-cancerous colon polyps in people who were prone to those. It was this study that helped to demonstrate an increased rate of heart attacks in people taking anti-inflammatories. Those results did not help sales of their product. My problem with this study is that it was comparing Celebrex to a placebo. This is the common sneaky practice of drug companies — they have to show that their product is safe and effective for the problem studied — they do not have to show that it is any better, cheaper, or safer than alternatives already in use. I have no doubt that Celebrex will reduce the formation of colon polyps — studies for decades have shown that people who regularly take anti-inflammatory medication for their aches and pains have significantly reduced rates of colon polyps and even colon cancer. But this study was designed to compare Celebrex to a placebo, and would have resulted in a major push to sell Celebrex for this purpose. What they did NOT study was a comparison of $400-per-month Celebrex versus $2-per-month ibuprofen.

Any physician who does not stay abreast of the literature and look for the evidence behind any claims is a lousy physician. Do I recommend things without evidence? Of course I do, but only after a discussion with the patient about risks, benefits, and realistic expectations. An extreme example would be putting a bar of soap in your bed to prevent night-time leg cramps. Patients have told me that this old-wives’ tale works for them. It doesn’t make physiological sense, but I am happy to pass this suggestion along to patients simply because it is safe and cheap — and if it doesn’t work, well — you still have the soap! Other suggestions, such as trying 5-HTP to treat mild depression, make sense (this is a precursor to serotonin in the brain) even though there are no studies to support it. It is safe and cheap. For a patient with severe depression, though, I would strongly encourage them to take a medication with a well-documented history of effectiveness.

Will your health care provider direct you in leading a healthier life? Only minimally. Will your local nutritionist, naturopath, or chiropractor direct you in leading a healthier life? Only minimally — and more often than not based mostly on what they are selling. People who are frustrated and desperate and who no longer trust the conventional health-care establishment will often believe anything. I know people who ingest iodine or diatomaceous earth because they have been told that it “recognizes the bad bacteria in their gut and will only kill the bad bacteria.” This is utter nonsense, but it sounds great.

The most important healthy-living advice I have heard probably came from my grandmother. She liked to cook, and she enjoyed local foods of all types. But living on a small self-sufficient farm, she also knew the importance of a diet rich in a variety of foods, especially fruits and vegetables. A plate full of color DOES turn out to be healthy, and bacon and eggs for breakfast is NOT a bad thing. In addition to working hard in the garden she walked to the mailbox and back six days a week — almost a mile each way. Of course, they didn’t sit on the couch for hours a day either. The only real problem with their style of eating is that those who do no physical exercise would want to moderate it considerably (perhaps keeping the eggs but substituting low-calorie turkey bacon for the fattier version) — but keeping the whole foods, the fruits, berries, and vegetables.

Dr. Mo has not revealed anything that has not been widely discussed for years. Unfortunately, the bottom line when working with a health care provider OR those who recommend supplements and dietary advice is: “caveat emptor” — let the buyer beware…

SO: the best advice is free and takes only six words: “Eat whole foods and walk daily.” (And don’t smoke, of course!)

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Dr. Stephen Blythe, D.O., is a Board-certified Family Physician and Nutritionist, and is a member of Space Coast Progressive Alliance. Compiled by Team SCPA.

 

Last modified on Tuesday, 22 September 2015 20:02
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