The secret to happiness in America. A paradoxical realization

When she used to see an elderly woman on the street, hunched over, taking tentative little steps, Ashton Applewhite would say to anyone who'd listen, "put me out my misery if I ever get like that."

Today, that makes Applewhite, 63, cringe.

"I'm ashamed of thinking that now. Why assume she's miserable? My guess is that she's happy to be alive and out and about. Maybe she's going to meet her boyfriend. It's presumptuous to assume her quality of life sucks because her body has changed," said Applewhite, a writer and self-described "apprehensive boomer turned pro-aging radical."

Applewhite, whose book "This Chair Rocks: A Manifesto Against Ageism" was published March 15, is part of a growing national movement to redefine what it means to age in America.

Leaders in this field include Dr. Dilip Jeste, the director of UC San Diego's Center for Healthy Aging, and AARP Chief Executive Jo Ann Jenkins, whose new book "Disrupt Aging" - which challenges people to not only accept their age but embrace it - came out of a 2014 speech she gave to 10,000 AARP members in San Diego.

On Friday, Dr. Bill Thomas, a Harvard Medical School-educated geriatrician, will bring his so-called Age of Disruption Tour to San Diego's Joan B. Kroc Theatre, where he'll put on a presentation that's part concert, part lecture, part call to arms to revolutionize aging.

Age of Disruption Tour

Who: Dr. Bill Thomas, with musical guest Nate Silas Richardson

What: Afternoon workshop, "Disrupt Dementia," a session designed for people living with dementia and their caregivers; evening event, "Aging: Life's Most Dangerous Game," includes musical and theatrical performances

When: Friday, 2:30-4:30 p.m. and 7-8:30 p.m.

Where: Joan B. Kroc Theatre, 6611 University Ave., San Diego; (619) 269-1552

Tickets: $15 per session; drbillthomas.org/local/san-diego-ca/

It's no coincidence that these four aging advocates are members of the baby boom generation, a group that's rewritten the rules in its youth, middle age and now older years.

"The baby boom has changed every life stage they've been a part of," said Thomas, whose tour is making its way to 30 cities across the country.

"As this giant generation faces this life stage, they're going to say, ‘hey no, I don't like that.'"

Thomas divides boomers into three categories:

Those in denial who try to stay young forever with Botox injections, expensive creams and unproven "snake oil" hormones and remedies. "It's the current equivalent to ‘Hell no, we won't go!'"

The resigned, who munch on kale and flax seed while doing Sudoku puzzles. "They tell themselves, ‘It's going to be bad, but if I do these things it won't be so bad."

And the embracers. "I'm in a rare tribe who looks forward to it with enthusiasm. It's possible to look forward to something and know there are parts of the experience you'd like to avoid, that won't be pleasant. That's why I call (my talk) Aging: Life's Most Dangerous Game," he said.

Thomas likened how people approach old age to those who'd rather go on, say, a safe cruise versus climbing Machu Picchu.

"There are some who would say, ‘you know there could be rock slides,' and there's the adventure traveler who says, ‘yeah, but it's Machu Picchu!' They do it because they think the adventure is greater than the risk. Look, I'm not a silly person who says old age is great and nothing will happen. Something will happen. But people who have a great fear of aging are going against their own future self. They become a traitor by robbing themselves of future possibilities."

All of the experts interviewed for this story said society's view of old age - that it's solely a depressing period of physical and mental decline - isn't backed up by data, science and research.

"We internalize a lifetime of messages that the younger self is worth more than the older self," Applewhite said. "The older self is just different."

She began writing her book while in her 50s, when its original focus was on people in the workforce well into their 80s. Her reporting, as well as research on longevity, led her to "This Chair Rocks."

"What surprised me was how everything I thought I knew about aging was wrong," she said by phone from Brooklyn.

Applewhite cited statistics that show a minute portion of the elderly live in nursing homes, with about 95 percent of Americans living independently. And she noted that while memory will moderately falter for most, about 20 percent of older people experience no decline at all in memory.

"Things slow us down, but it doesn't keep the vast, vast majority of us from functioning just fine," she said. "The epidemic isn't dementia, it's the anxiety about dementia."

Applewhite and Thomas both referred to the U-Bend theory, which holds that people are happiest at the beginning of their lives and toward the end.

"Statistically, the happiest decade is the 70s," he said.

National movement seeks to redefine what it means to age in America - The San Diego Union-Tribune

Dissent roils the AMA, the nation's largest doctors group

As usual the media over-reacts to events. Such is the case regarding the AMAs ambivalent attitude toward the Affordable Care Act.  The AMA sees health care through it's own prism. There is no one in the organization, nor non members who do not support universal access to quality health care, but the devil in in the details.

‘Followers rather than leaders’

That kind of caution is characteristic of the AMA, which generally prefers to work behind the scenes and press its agenda at the negotiating table, rather than rally the public.

“They end up being followers rather than leaders because they want to be where the action is,” said Dr. Marcia Angell, a former editor of the New England Journal of Medicine and a senior lecturer in the department of global health and social medicine at Harvard Medical School.

More than 190 medical organizations with various agendas are represented through the AMA’s House of Delegates, forcing the organization to balance often-competing interests. On top of that, there’s growing political polarization among doctors, now split almost evenly between Republicans and Democrats. And clinicians are further divided by type of practice and employer.

Because the AMA’s tent is so large, “they have difficulty articulating strong policy positions,” said Berenson, the Urban Institute scholar.

           The affordable care act has been a giant step toward the goal. However it has many near fatal flaws written into a non-flexible law. Now is the time for all physicians to step up and encourage changes that will make it successful.

           The numbers of how many more people are insured is no measure of success.  The cart has been placed before the horse. Despite the built in bureaucratic mandates it is paper tiger unrelated to real quality care in provider's offices.  In fact it has reduced efficiency, increased cost and in no way has improved quality of care.  The only measure Health Train Express has seen is the reduction in admissions within 30 days of discharge from a hospital.  I am not certain how that equates to an improvement in QOC except it saves CMS (taxpayers) dollars.













Dissent roils the AMA, the nation's largest doctors group

I Just Fired my Primary Care Doctor. Before the Appointment Even Happened.

I sighed and slumped into a chair. The office was straight out of the 90’s: clunky desktop computer, paper forms attached to a clipboard. 15 minutes after my appointment should have started, a cagey Latino gentleman ambled behind the desk and asked for my ID and insurance card. I handed them over and watched as he proceeded to fire up a printer in an attached room, print off the registration and history forms I’d sent through ZocDoc, and make copies of my information.  I craned halfheartedly to count the number of shelves before I stopped caring. I felt uncomfortable all of a sudden. The dinginess of the cramped office seemed to amplify a sense of entropy, an oppressive, disheveled dysfunctionality. The stacked tower of dusty magazines. Two dying plants, leaves dried yellow and curling. A slightly off-center, sun-faded print: Monet. Reams of manilla folders so ancient that they literally had holes in them. Literally. I don’t want this anachronistic nightmare of a place to become the bottleneck to my ability to access my own health information (or is it even really mine?) Especially not if or inevitably when I become medically vulnerable. Consumer Me can protect Patient Me by being impatient.

Patients now expect physicians to be experts in technology and business acumen.  It is o longer acceptable to be  dependent upon fax machines, when electronic health records and secure digital documents are more efficient and cost effective.

The waiting room and shenanigans in this vignette do not breed comfort or a sense of competence for a patient. Perhaps calling a patient a consumer (anathema to we physicians) can be a good thing. It gives the patient consumer power. ie follow the money. Sad as I am losing the old 'cottage medicine flavor' I see the benefits of the decade  of revolution.

Many physicians embraced the changes adapting EHR, some  aspects of health reform, while most resisted and bridled at changing their ways.

Medical Front Office of the 90s

Reception Area of 2016

I walked with my feet  to another doctor's office:

This morning’s experience combined some of the best consumer-grade tools (Shout out to Zocdoc: Crushing it! Quick, accurate search with no log-in/account required → confirmation code sent via SMS → second text to my phone with a secured link that prompted my phone’s camera to pop up, so I could snap a picture of my insurance card, front and back, for ease of all future transactions. Magic! Love it.), with some of the worst (see above.)

I voted with my feet today. I left behind an unseen doctor whose clinical adeptness was rendered useless by his business ineptness,   

I Just Fired my Primary Care Doctor. Before the Appointment Even Happened.

Let My Doctor Practice

I hope you will find time to watch and listen to this video.  It synthesizes the thoughts of most physicians.  While watching the video take some  notes to discuss with your friends, doctors and your representatives.

Here are the time markers of  high  points in the video:

:04

:22

:36

;50

1:20

1:50

2:13

2:30

3:16

3:27  The Story of Esther

4:46  Let my doctor practice (the summit)

5:40  Professional practice in the United States is in progressive decline

www.letmydoctorpractice.org

www.docs4pcfoundation.org

I hope you will share this important information widely.  Please comment.

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Own your health care !

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These are the healthiest and unhealthiest states in the country

Hawaii is the healthiest state in the country for the fifth consecutive year, according to an annual state-by-state health ranking report. 

The 2016 America's Health Rankings highlight some long-term improvements in overall health across the country and some disturbing new trends. 

While smoking among U.S. adults decreased by 41% since the start of the report in 1990, and the percentage of the population that is uninsured decreased by 35% in the past five years, for the first time in the report’s history, cardiovascular deaths increased over the past year. Even more disturbing, over the past two years, the rate of premature death has also increased, according to Reed Tuckson, external clinical advisor United Health Foundation, a not-for-profit foundation, that sponsors the report. 

“We are still living longer, but sicker, and getting sicker sooner,” Reed said. "People are experiencing obesity and related consequences earlier in life which is also a problem.”  Obesity, poor eating habits and the explosion of diabetes related complications offset many improvements in health during the past two decades.

The report also found that drug deaths increased 9% over the past five years. Tuckson said the report highlights that the nation is at a health crossroads, with positive health changes like a decrease in smoking and more insured people as wins, but troubling levels of obesity, diabetes, high blood pressure and sedentary behavior diminishing the positive steps. 

"We have to remember that we have to put the fight for promoting health and prevent disease much higher on the agenda," Tuckson said. "If we don’t, we as a nation will see further slippage and see those fearful trends of premature death, people dying from cardiovascular disease at higher rates than years before." 

According to the report, Hawaii ranked first in overall health, with a low percentage of uninsured people, low rates of obesity and a low prevalence of obesity. But it's not all beachy in paradise, according to the report, which notes Hawaii scores above the national average for excessive drinking.

Mississippi fell from 49th to 50th this year, according to the report, which uses data from the Centers for Disease Control and Prevention, American Medical Association, Census Bureau and even the FBI. It looks at a slew of measures of health, including tobacco and alcohol abuse, exercise, infectious diseases, crime rates, public health funding, access to immunizations, premature birth rates and cancer and heart disease rates.

Mississippi has a high prevalence of smoking, low birthweight and a high percentage of children living in poverty, according to the report. But while Mississippi has the most room for improvement, the state does have a low prevalence of excessive drinking and drug-related deaths. 

Here's a look at the top five healthiest states: 

1. Hawaii

2. Massachusetts

3. Connecticut

4. Minnesota

5. Vermont

States with the most room for improvement: 

50. Mississippi 

49. Louisiana

48. Arkansas

47. Alabama 

46. Oklahoma

45. Kentucky 

Where does your state fall?

These are the healthiest and unhealthiest states in the country

Direct Primary Care Conference - Nuts

Physicians are starting new methods of reimbursement, to decrease operating overhead and eliminate much of the bureaucracy involved with billing health insurance plans.

Two  terms which may not be familiar to patients are 'direct pay'  and 'concierge medicine'.  Both eliminate the insurance plan as an intermediary for payment of patient services.

Health insurance as we know it today is not insurance.  It has evolved into a comprehensive health plan(s) governed my medicare and commercial health plans.  Their goal is to  increase and/or maintain profitability in lieu of patient care.  They are designed to provide reimbursement for soup to nuts. This is very inefficient and increases  cost measurably.

Purchasers of health plans no longer have a choice of tier or to opt-out of unneeded coverage. The 50 year old post menopausal woman pays for pregnancy care, and delivery even though she will never use this coverage.

The DPC and Concierge plans are designed for primary care (family practice and some internal medicine and pediatric practices)



The Direct Primary Care conference, is sponsored by 'Doctors for Patient Care' and independent non-profit organization whose mission is to alter the current health care system.

Our Principles

 

Direct Primary Care (DPC) is an innovative alternative payment model for primary care being embraced by patients, physicians, employers,payers and policymakers across the United States.The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider.

Empowering this relationship is the key to achieving superior health outcomes, lower costs and an enhanced patient experience. DPC fosters this relationship by focusing on five key tenets:

1. Service: The hallmark of DPC is adequate time spent between patient and physician, creating an enduring doctor-patient relationship. Supported by unfettered access to care, DPC enables unhurried interactions and frequent discussions to assess lifestyle choices and treatment decisions aimed at longterm health and wellbeing. DPC practices have extended hours, ready access to urgent care, and patient panel sizes small enough to support this commitment to service.

2. Patient Choice: Patients in DPC choose their own personal physician and are reactive partners in their healthcare. Empowered by accurate information at the point of care, patients are fully involved in making their own medical and financial choices. DPC patients have the right to transparent pricing, access, and availability of all services provided.

3. Elimination of Fee-For-Service: DPC eliminates undesired fee-for-service(FFS) incentives in primary care. These incentives distort healthcare decision-making by rewarding volume over value. This undermines the trust that supports the patient-provider relationship and rewards expensive and inappropriate testing, referral, and treatment. DPC replaces FFS with a simple flat monthly fee that covers comprehensive primary care services. Fees must be adequate to allow for appropriately sized patient panels to support this level of care so that DPC providers can resist the numerous other financial incentives that distort care decisions and endanger the doctor-patient relationship.

4. Advocacy: DPC providers are committed advocates for patients within the healthcare system. They have time to make informed, appropriate referrals and support patient needs when they are outside of primary care. DPC providers accept the responsibility to be available to patients serving as patient guides. No matter where patients are in the system, physicians provide them with information about the quality, cost, and patient experience of care.

5. Stewardship: DPC providers believe that healthcare must provide more value to the patient and the system. Healthcare can, and must, be higher-performing, more patient-responsive, less invasive, and less expensive than it is today. The ultimate goal is health and wellbeing, not simply the treatment of disease.

DPC providers are committed to ensuring that American healthcare delivers on these goals.