MD’s advice about getting “successful medical care” in and out of the hospital

This article in yesterday’s Washington Post is about an MD whose wife ended up in the hospital.  He learned some lessons “about surviving the American health-care system.”

He makes four points in this article:

* Speak up.
* Don’t be afraid to ask for a specialist.
* Don’t feel bad about asking to speak with a patient advocate.
* Share your health challenges with others and don’t stop searching for help.

Here’s a link to the article:

As a doctor, I thought I knew how to treat my patients. Then my wife ended up in the hospital.
Here’s what her illness taught me about successful medical care.
The Washington Post
By Joseph Ladapo
January 25, 2016



Article about Oncologist Using Oregon’s Dying with Dignity Legislation

Yesterday, I received this email from long-time local support group member Denise Dagan.  She’s referring to an article in “The Week,” which is an excerpt from a longer article in the January 2016 issue of “Harper’s Magazine.”  The articles are about a medical oncologist’s use of the Dying with Dignity law in Oregon.  Then the oncologist is diagnosed with cancer.  Denise says that despite a couple of errors, the excerpt is “a well written reminder that we should all think about what is important to us when it comes to end of life care and/or treatment.”

In her email, Denise also discusses for-profit hospice and non-profit hospice, plus Dr. Gawande’s book “Being Mortal.”

Thanks to Denise for sharing!



From Denise Dagan:

The Week magazine has a nice excerpt from a Harper’s Magazine article about an oncologist using Oregon’s dying with dignity legislation.  It doesn’t mention palliative care; and it should.  [Perhaps the full length article does.]  It also implies, in the second paragraph, that you can’t die at home if you are enrolled in hospice care, which is patently false.  Otherwise, it’s a well written reminder that we should all think about what is important to us when it comes to end of life care and/or treatment.

A more fully explored text on this topic is Being Mortal: Medicine and What Matters in the End, by Atul Gawande.  The first half of the book mostly explores the evolution of housing and assisted living options for seniors and the disabled.  The second half follows the author’s father’s end of life experience.  The upshot is the author’s personal growth as a physician in helping patients understand the medical options available to them and navigate their own end-of-life path.  He is a huge proponent of palliative and hospice care, and has some remarkable statistics from the insurance companies which support palliative and hospice care universal availability.  He believes every physician should be better educated in explaining the benefits of these services to their patients.

Personally, I think many people don’t realize some of the hospice services are for-profit businesses.  Articles like this one from CBS Money Watch discusses the pros & cons of for-profit and non-profit services.

Principally, for-profits market themselves toward long-term care patients, like those with dementia, so they can bill MediCare longer.  Since their focus is money, they may provide more limited visits and actual services with staff who have less training than Non-profits, which don’t do much marketing, take all patients, and tend to provide longer visits with more qualified staff.  Actual studies have not shown significant difference between profit and non-profit hospice care, as found in this abstract from the NIH:

Here’s a link to the full article in Harper’s Magazine from January, 2016:

Here is the link to excerpt in The Week:


Managing Orthostatic Hypotension (article for physicians)

This post may be of interest to those who would like some ideas on dealing with orthostatic hypotension.

An article was published in late October 2015 in a managed care journal for MDs on how to treat neurogenic orthostatic hypotension that occurs in MSA, LBD, and Parkinson’s.  It’s a short article, and is available at no charge online.

In particular, I like the list of non-pharmacologic physical “counter-maneuvers” that can be employed for orthostatic hypotension (OH).

Two websites are mentioned with video instructions and tutorials — and

On the last page, you can find a link for the PDF of the full article.  Looking at the PDF seems to be the only way to view the tables.  There are two good tables — a list of drugs that cause OH (copied below), and details on three medications for OH (droxidopa, midodrine, and fludrocortisone).


Table 2. Drugs That Cause Orthostatic Hypotension

Alpha1-adrenergic antagonists
doxazosin, prazosin, terazosin

Antipsychotic drugs
clozapine, quetiapine, iloperiodone, chlorpromazine, thioridazine

furosemide, hydrochlorothiazide

amitriptyline, clomipramine, imipramine, doxepin >6mg/day, trimipramine, trazodone

Calcium channel blockers
diltiazem, verapamil

Anti-Parkinson drugs
amantadine, levodopa, pramipexole, ropinirole, selegiline

Monoamine oxidase type A inhibitors
phenelzine, tranylcypromine

isosorbide dinitrate, nitroglycerin


“What you can do to keep the doctor-patient relationship healthy”

Here’s an article written by Consumer Reports, published in a recent Washington Post, about “fixing” concerns you may have with your MD.

The concerns include a failure to communicate; the MD discouraging second opinions; disorganized MD’s office; not feeling respected by the MD; and the MD holding back important info.


Health & Science
What you can do to keep the doctor-patient relationship healthy
Washington Post
By Consumer Reports
January 18, 2016



Short excerpt from “Being Mortal”

Over the last six months or so, I’ve heard from many of you via email or at support group meetings about Atul Gawande’s book “Being Mortal.”  I have seen the wonderful documentary, based on the book.

Here’s an email I received yesterday from long-time local support group member Helen Medsger:

I’ve just completed “Being Mortal,” a powerful and very personal non-fiction by Atul Gawande, a general surgeon at Brigham Women’s and Children’s. He chronicles his own journey with his father, patients and friends as they face end-of-life decisions and how the process that our modern, technology-driven medical system has created should change to provide more compassionate care.  I’d recommend it for families that are in the process of making end-of-life decisions and who can truly be open to the tough questions.  A sample is below.


Excerpts from “Being Mortal” by Atul Gawande that resonated with Helen:

“We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?

The field of palliative care emerged over recent decades to bring this kind of thinking to the care of dying patients. And the specialty is advancing, bringing the same approach to other seriously ill patients, whether dying or not. This is cause for encouragement. But it is not cause for celebration. That will be warranted only when all clinicians apply such thinking to every person they touch. No separate specialty required.

If to be human is to be limited, then the role of caring professions and institutions – from surgeons to nursing homes – ought to be aiding people in their struggle with those limits. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.”