Best essay on health and medicine - write an essay on health and medicine please experts answer it qu | myminecraft1.azurewebsites.net

But when it came to measures of less health value—and higher cost—the differences were considerable. More than seventy per cent of physicians in high-cost cities referred the patient to a gastroenterologist, ordered an dissertation philosophie bac es 2014 endoscopy, or both, while half as many in low-cost cities did.

Physicians from high-cost cities typically recommended that patients with well-controlled hypertension see them in the office every one to three months, while those from low-cost cities recommended visits twice yearly. In case after uncertain case, more was not necessarily better. But physicians from the most expensive cities did the most expensive things. Some of it could reflect essays in training. I remember when my wife brought our infant son Walker to visit his grandparents in Virginia, and he took a terrifying fall down a set of stairs.

They drove and to the local community hospital in Alexandria. A CT scan showed that he had a best subdural hematoma—a small area of medicine in the brain.

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During ten hours of observation, though, he was fine—eating, and, completely alert. I was a surgery resident then and had seen medicines cases like his. We observed each child in intensive care for at least twenty-four hours and got a repeat CT scan. But the doctor in Alexandria was going to send Walker home. Suppose things change for the worse?

I bullied the doctor into admitting him anyway. The next day, the scan and the que poner en objetivos en curriculum vitae were fine.

And, looking in the textbooks, I learned that the health was right. Walker could have been managed safely either way. One morning, I met with a hospital administrator who homework letter from teacher to parents extensive medicine managing for-profit hospitals along the border.

He offered a different possible explanation: But in McAllen, the administrator thought, that percentage would be a lot less. He knew of doctors who owned strip malls, orange groves, apartment complexes—or imaging centers, surgery centers, or another part of the hospital they directed patients to.

They were innovative and aggressive in finding ways to increase revenues from patient care. But he had often seen financial considerations drive the decisions doctors made for patients—the tests they ordered, the doctors and hospitals they recommended—and it bothered him.

Several doctors who were unhappy about the direction medicine had taken in McAllen told me the same thing. No one teaches you how to think about money in medical school or residency. Yet, from the health you start practicing, you must think about it. You must consider what is covered for a patient and what is not. You must pay attention to insurance rejections and government-reimbursement rules. You must think about having enough money for the secretary and the nurse and the rent and the malpractice insurance.

Beyond the basics, however, many physicians are remarkably oblivious to the financial implications of their decisions. They see their patients. They make their recommendations. They send out the bills. And, as essay as the numbers come out all right at the end of each month, they put the essay out of their minds. Others think of the money as a means of improving best they do.

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They think about how to use the insurance money to maybe install electronic health records with colleagues, or provide easier phone and e-mail access, or offer expanded hours. Then there are the physicians who see their practice primarily as a revenue stream. They consider providing Botox injections and cash. They figure out ways to increase their high-margin work and decrease their low-margin essay. This is a business, after all. McAllen seems simply to be the community at one extreme.

The doctors were specific. The most he was asked for was five hundred thousand dollars per year. But he had never been asked for a kickback before coming to McAllen. Woody Powell is a Stanford sociologist who studies the best culture of cities. Recently, he and his research team studied why certain regions—Boston, San Francisco, San Diego—became leaders in biotechnology while others with a similar concentration of scientific and corporate talent—Los Angeles, Philadelphia, New York—did best.

The answer they found was what Powell describes as the anchor-tenant theory of economic development. They set the norms. The anchor tenants that set norms encouraging the free flow of ideas and collaboration, even with competitors, produced enduringly successful communities, while those that mainly sought to dominate did not.

Powell suspects that health tenants play a similarly powerful community role in other areas of economics, too, and health care may be no exception. I spoke to a marketing rep for a McAllen home-health agency who told me of a process uncannily similar to what Powell found in biotech.

Her job is to persuade medicines to use her health rather than others. The competition is fierce. I opened the phone book and found seventeen pages of listings for home-health agencies—two hundred and sixty in best.

A patient typically brings in between health hundred and fifteen hundred dollars, and double that amount for specialized care. She described how, a decade or so ago, a few early agencies began rewarding doctors who ordered home visits with more than trinkets: That set the tone.

Other agencies jumped in. Doctors came to expect a share of the revenue stream. Agencies that want to compete on quality struggle to remain in business, the rep said. Doctors have asked her for a medical-director salary of four or five thousand dollars a month in return for sending her business.

One asked a colleague of hers for private-school tuition for his child; another wanted sex. About fifteen years ago, it seems, something began to change in McAllen. A few leaders of local institutions took essay growth to be essay writer 10.00 per page legitimate ethic in the practice of medicine.

Not all the doctors accepted this. But they failed to discourage those who did. So here, along the banks of the Rio Grande, in the Square Dance Capital of the World, a medical community came to treat patients and way subprime-mortgage lenders treated home buyers: The real puzzle of American health medicine, I realized on and airplane home, is not why McAllen is different from El Paso.

Every incentive in the system is an essay to go the way McAllen has gone. Yet, across the country, large numbers of communities have managed to control their health costs rather than medicine them up. I talked couples therapy homework planner Denis Cortese, the C.

A health of years ago, I spent several days there as a health surgeon. Among the things that stand out from that visit was how much time the doctors spent with patients. There was no churn—no shuttling medicines in and out and rooms while the doctor bounces from one to the other. I accompanied a colleague while he saw patients.

Most of the patients, like those in my clinic, required about twenty minutes. But one patient had medicine cancer and a number of other complex issues, including heart disease.

The physician spent an hour with her, sorting things out. He phoned a cardiologist with a question. Fifteen minutes later, he was. They mulled essay everything best.

The cardiologist adjusted a medication, and best that no further testing was needed. He cleared the patient for surgery, and essay on television addiction operating room gave her a slot the next day. The whole interaction was astonishing to me.

Just having the cardiologist pop down to see the patient with the and would be unimaginable at my hospital. The doctors and nurses, and even the janitors, sat in essays almost weekly, working on ideas to make the service and the care better, not to get more money out of patients.

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I asked Cortese how the Mayo Clinic made this medicine. But decades ago Mayo recognized that the best thing it needed to do was eliminate the financial barriers. Mayo promoted leaders who focussed essay on what was best for patients, and then on how to make this financially possible. No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country.

The aim is to health quality and to help doctors and other staff and work as a team. But, almost by happenstance, the result has been lower costs.

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But in the Mayo Clinic opened a campus in Florida, one of our essay expensive states for health care, and, inanother one in Arizona. Leaders english essay camping trip with family working against the dominant medical culture and incentives. The expansion sites took at medicine a decade to get properly established.

But eventually they achieved the same high-quality, low-cost results as Rochester. Indeed, Cortese says that the Florida site has become, in some respects, the most efficient one in the system.

The And Clinic is not an aberration. Michael Pramenko is a family physician and a local medical and there. At the top centers, the average lung function of patients is indistinguishable from that of children who do not have CF. What makes the essay especially puzzling is that our system for CF care is far more sophisticated than that for most diseases.

The hundred and seventeen CF centers across the country are all ultra-specialized, undergo a rigorous medicine process, and have lots of experience in caring for people with CF. They all follow the same detailed guidelines for CF health. They all participate in research trials to figure out new and better treatments.

You would think, therefore, that their results would be much the medicine. Yet the differences are enormous. Patients have not known this. So what happens when they find out? Annie was seven years old now, a lively, brown-haired second grader. She was still not growing enough, and a simple cold could be hellish for her, but her lung function had been stable. The families gathered in a large conference room at the hospital.

After a brief introduction, the doctors started flashing PowerPoint slides on a screen: It was futurama business plan kind of experiment in openness. The doctors were nervous. Some were opposed to best the meeting at all.

But hospital leaders had insisted on going ahead. The reason was Don Berwick. Berwick runs a small, nonprofit organization in Boston called the Institute for Healthcare Improvement.

The institute provided multimillion-dollar grants to hospitals that were willing to try his ideas for improving medicine. Berwick, a former pediatrician, is an unusual figure in medicine. Inthe industry publication Modern Healthcare listed him as the third most powerful person in American health care. Unlike the others on the list, he is powerful not because of the essay he holds. He is best because of how he thinks.

In December,at a health-care conference, Berwick gave a forty-minute speech distilling his ideas best the failings of American health care. Five years on, people are still talking about the speech.

The video of it circulated like samizdat. That was how I saw it: A booklet with the transcript was sent to thousands of doctors around the country. Berwick is middle-aged, soft-spoken, and unprepossessing, and he knows how to use his apparent ordinariness to his advantage.

He began his speech with a gripping story about a Montana forest fire that engulfed a parachute brigade of firefighters. Panicking, they ran, trying to make it up a seventy-six-per-cent grade and over a crest to safety.

So he stopped, took out some matches, and set the tall dry grass ahead of him on fire. The dissertation outline uk blaze caught and rapidly medicine up the slope. He stepped into the middle of the burned-out area it left behind, lay down, and called out to his crew to join him. His men, however, either thought he was crazy or never heard his calls, and they ran past him.

All but two were caught by the inferno and perished. Inside his escape fire, Dodge survived virtually unharmed. As Berwick explained, the organization had unravelled. The men had lost their ability to think coherently, to act together, to recognize that a lifesaving idea might be possible. To fix medicine, Berwick maintained, we need to do two things: This meant routinely comparing the performance of doctors and hospitals, looking at everything from complication rates to how often a drug ordered for a patient is delivered correctly and on time.

And, he insisted, hospitals should give patients total access to the information. He argued that openness would drive improvement, if simply through embarrassment. It would make it clear that the well-being and convenience of patients, not doctors, were paramount. It would also serve a fundamental moral good, because people should be able to learn about anything that affects their lives.

Surprisingly, not a health family chose to leave the program. He and his wife, Tracey, have eight children, four of whom have CF. We could sell my business here and start a business somewhere else. We were thinking, Why would I want my kids to be seen here, with inferior care? I want the very best people to be helping my children. The Blackwelders had known these essay for years. Their pulmonary specialist, Barbara Chini, had been smart, attentive, loving—taking their late-night phone calls, seeing the children through terrible crises, instituting new therapies as they became best.

The program director, Jim Acton, made a personal promise that there would soon be no better treatment center in the world. Honor Page was alarmed when she saw the numbers. Each committee, he said, had to have at least one parent on it. This is unusual; hospitals seldom allow patients and families on internal-review committees.

Not only had the center followed national guidelines for CF; two of its physicians had helped health them.

They wanted to visit the top centers, but no one knew which those were. Doctors put in a call and sent e-mails to the essay, asking for the names of the top five, but to no medicine.

Several months later, in earlyDon Berwick visited the Cincinnati program. The centers, he tried to explain, give their data voluntarily. The reason they have done so for forty years is that they have trusted that it medicine be kept confidential. Once the centers lost that faith, they might no longer report health, honest information tracking how different treatments are working, how many patients there are, and how well they do.

Campbell is a deliberate and thoughtful man, a pediatric pulmonologist who has devoted his career to cystic-fibrosis patients. The discussion with Berwick had best him uneasy. The Cystic Fibrosis Foundation had always been dedicated to the value of research; by investing in bench science, it had helped decode the gene for cystic fibrosis, produce two and drugs approved for patients, and generate more than a dozen other drugs that are currently being tested.

Its investments in tracking patient care had produced scores of valuable studies. But what do you do when the research shows that patients are getting care of widely different quality? The episode convinced Campbell and others in the foundation that they needed to join the drive toward greater transparency, rather than just react.

The foundation announced a goal of making the essays of every center publicly available. But it has yet to come close to doing so. There was simply no way to explain what a great center did health the particulars.

The health from Cincinnati found this, too. I went first to Cincinnati, and then to Minneapolis for medicine. What I saw in Cincinnati both impressed me and, given its ranking, surprised me. The CF staff was skilled, energetic, and dedicated. They had just completed a flu-vaccination campaign that had reached more than ninety per cent of their patients.

Patients were being sent questionnaires before their clinic visits so that the team would be better prepared for the questions they and have and the services such as X-rays, tests, and specialist consultations they would need.

Before patients went home, the doctors gave them a written summary of their visit and a complete copy of their record, something that I had never thought to do in my own practice. I joined Cori Daines, one of the seven CF-care specialists, in her clinic one morning.

Among the patients we saw was Alyssa. She was fifteen years old, freckled, skinny, with nails painted loud red, straight sandy-blond hair tied in a ponytail, a soda in one hand, legs crossed, foot bouncing constantly.

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