Yesterday was good

I DID go to the exercise class and stayed for almost the whole time, doing everything a little less energetically than usual, but doing it! It felt so good. I had a smile on my face the whole time. My friends in the class were happy to see me, and I got lots of smiles and hugs. So healthful.

I have been reading mainly the NYT and The New Yorker; somehow a book seems too much of a commitment at the moment. An insightful and mind-opening article in the June 1st issue (yes, I am way behind) caught my attention. It is "The Cost Conundrum," by Atul Gawande, a doctor and an associate professor at Harvard Medical School and Harvard School of Public Health.

Dr. Gawande travelled all over the country, to the cities that spent the most on health care to those that spent the least. McAllen, Texas, which has beautiful, up-to-date hospitals, somehow manages to spend more than almost any community and yet comes out with some of the worst outcomes. How can that be? Gawande suggests that it is the fact that the costly effects of the fee-for-service setup is exacerbated there because the doctors own the MRI machines and all the other costly equipment--and they use it excessively. In his interviews with doctors there, they had no idea that what they were doing was costing so much and producing less-than-optimal results. They were all working hard, 12 hours a day.

The best results and the cheapest costs were in cities where doctors are on salary, and fee-for-service is not in place.

The article is well worth reading. Dr. Gawande suggested that it's not the insurance companies but the doctors' ownership of expensive equipment that they must then use that ratchets up the cost of medicine.

He made me think of my own internist, who is also a cardiologist (recently honored as one of the top cardiologists in the state in the New York Times. He has an x-ray machine. So I need an x-ray every year. Do I really? When he hears nothing untoward in my chest? I need an EKG every time I visit, even though two years ago the EKG did not reveal that I had blocked arteries. I had a little lump in my leg recently; so I needed a doppler scan (did I?), which he happens also to have available in his office. It turned out to be nothing, of course. So what is a patient to do? I trust my doc, and when he says I need something, I do it. He works as hard as those doctors do in Texas, 12 hours at least a day. But something is wrong with this picture. I don't want to blame the doctors, but perhaps it is the doctors-linked-to-equipment that is the issue?

I am looking forward to being in the City later today, meeting our granddaughter Michelle for dinner, probably at Szechuan Gourmet, my favorite neighborhood restaurant. Next time I write it will be after the BMB at St. Vincent's. I won't know anything for at least two weeks after that.

Love to all,
Bernice