Login Form

Op/Ed: A Health Savings Account Could Save Your Life

AddThis Social Bookmark Button

In a lawsuit against Aetna for denial of benefits which the patient alleges "almost killed him," Aetna's medical director admitted under oath that he never looked at patients' medical records when deciding whether to approve or deny care.

Concomitant with the flow chart revolution, patients complain that when barely a nanosecond has passed since the physician's first "hello,” they are handed a DNR (Do Not Resuscitate) form. Reasoning that the State cannot be held responsible for its determination-of-death laws, because doctors have "broad and legitimate discretion" to end patients' life support.

We dread the day when "algo-medicine" devoid of human emotion, intuition, or instinct will say Sell! (to the mortician) when the patient hits 70? Buy! if the baby has no problems discerned on prenatal ultrasound?

Algo-Trading /Algo-Medical Treatment

Some pundits blamed algorithmic trading for the stock market's recent wild ride. "Algo-trading" relies on computers programmed to follow defined instructions for placing trades. For example, the computer buys 50 shares of stock when its 50-day moving average goes above the 200-day moving average. Period. Algo-trading was popularized as a systematic approach that removes human emotion, intuition, or instinct from the transaction.


Beltway Insider: Trump Talks 2020; Mueller Pushes Onward to Jared, Ivanka; Hicks Out; Syria’s Civil War; Nor’Easter


Advanced medical algorithms are becoming the next best thing. Their intended purpose is to improve and standardize decisions made in the delivery of medical care, enabling multiple levels of health care practitioners to use the same "thought" process.

A medical algorithm can be a list of risk factors for various conditions, such as heart disease, or a simple calculation such as BMI (body mass index) utilizing height and weight to determine ideal numbers. Many algorithms are flowcharts with a binary decision tree: if BMI is greater than 25, do this; if not, do that.

Newer algorithms based on machine learning, a form of artificial intelligence that simulates how humans learn, can analyze and diagnose radiology images or pathology slides or predict the actual risk of developing certain conditions.

Some of these advances are extraordinary and will likely add to our medical armamentarium. But they do not exist in a vacuum. Concomitant with the flow chart revolution, patients complain that when barely a nanosecond has passed since the physician's first "hello," they are handed a DNR form.

Are Patients Deemed Viable or Useless Before

Yes, it is a good thing for a physician to know about a patient's desires at what could be the end of his life. But it is unsettling when the 35 year-old "provider" cheerfully encourages a patient to fill out the form, crowing that she signed her DNR form.

The patient is thinking, "you'll feel a lot different about it at 65 than you do now." Unfortunately in today's healthcare delivery factories, when illness strikes "your” doctor may be a previously unknown-to-your hospitalist whose sole knowledge about you, the human being, is lab tests, x-rays, findings on physical exam, and a form you signed 10 years ago. Your family relationships, religious views, and the like are not his purview. When death is actually walking down your street you want to know and trust those in charge of your life.

In a recent case, a toddler was declared brain dead by one hospital, but apparently showed signs of life. His mother sought but failed to stop the removal of her child from life support. After the plug was pulled, she challenged the constitutionality of California's Determination of Death Act which effectively takes away life-and-death decisions from parents.

The Act provides that a person is dead when, in accordance with accepted medical standards, either the body or the brain has irreversible cessation of all function. A federal court dismissed the case, reasoning that the State cannot be held responsible for its determination-of-death laws, because doctors have "broad and legitimate discretion" to end patients' life support.

Less obvious but nonetheless devastating, is the power Medicare, Medicaid, and insurers exercise over life and death through pre-authorizations and denials of claims. In a lawsuit against Aetna for denial of benefits which the patient alleges "almost killed him," Aetna's medical director admitted under oath that he never looked at patients' medical records when deciding whether to approve or deny care.

If physicians have the power over life and death, "if you like your doctor, you can keep your doctor" takes on added significance as more states adopt physician-assisted suicide laws. Even in Belgium where euthanasia is legal, its proponents are increasingly uncomfortable with the speedy approval of psychiatric patients' requests to die. Discomfort turned to outrage when a dementia patient was euthanized when there was no evidence that the patient had asked to die.

As independent physicians we want to use the best advances to help our patients but we do not want medicine to devolve into paint-by-the-numbers. We dread the day when "algo-medicine" devoid of human emotion, intuition, or instinct will say Sell! (to the mortician) when the patient hits 70? Buy! if the baby has no problems discerned on prenatal ultrasound?


Op/Ed: Is it Really Our Job to Save the Addict


If you want to ensure that your doctor has your back, run – don't walk to a direct primary care practice (DPC). Tell your congresspersons to add the 1-page Primary Care Enhancement Act (HR 365 / S 1358) to upcoming "must pass" legislation. This will allow patients to use Health Savings Accounts (HSAs) to pay for DPC. Your life could depend on it.

 

Bio: Dr. Singleton is a board-certified anesthesiologist. She is also a Board-of-Directors member and President-elect of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School.  Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard's Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law.  She interned at the National Health Law Project and practiced insurance and health law.  She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.

 

Haute Tease

  • Bonhams Announces Sale Of The Largest Private Collection Auction Of Andrew Grima Jewellery

    AddThis Social Bookmark Button

    Charismatic Anglo-Italian jeweller Andrew Grima was regarded as one of the 20th century's most daring and imaginative designers.  He was the go-to society jeweller for royals, celebrities, socialites and his earliest clients included HM The Queen, The Princess Margaret, Jackie Kennedy Onassis.

     
  • 30th Film Independent Spirit Award Nominations Announced

    AddThis Social Bookmark Button

    LOS ANGELES (November 25, 2014) – Film Independent, the nonprofit arts organization that produces the Film Independent Spirit Awards, the Los Angeles Film Festival and Film Independent at LACMA, announced nominations for the 2015 Spirit Awards this morning.

     
  • HL Health, Wellness: Feeling Less Than Frisky - Ten Foods to Get You In the Mood

    AddThis Social Bookmark Button

    Valentine's Day is rapidly approaching and instead of making reservations to some over-hyped trendy spot, stay in and prepare a "Lover's Platter" full of indulgent aphrodisiacs guaranteed to heighten our interest in a full dessert menu making it a steamy night to remember.

     
  • Op/Ed: The Courage to Trust Medical Care to Patients and Physicians

    AddThis Social Bookmark Button

    The days of trusting legislators to focus on a constituencies best interests are in the rear view as the main interest is parroting the necessary buzzwords for election and then consumed with banking lobbying money.

     
  • The Cleveland Orchestra Announces 100th Season; Returns to Carnegie Hall; Continues Youth Free Programs

    AddThis Social Bookmark Button

    The Cleveland Orchestra and Music Director Franz Welser-Möst have announced details of the upcoming 2017-18 calendar.  The season will be the ensemble's 100th year of concerts and marks the launch of its Second Century.  It is also the 16th year of the Orchestra's acclaimed partnership with Franz Welser-Möst.  

  • UPDATED: Terrorist Shot Dead in France Supermarket Attack

    AddThis Social Bookmark Button

    Authorities stormed the Super U grocery store in Trebes, France, a small town in the South, where an Islamic State loyalist had been holed up demanding release of one of the collaboraters of the October 2015 attacks, killing him.  

     
  • The Jewish Museum of Florida-FIU Miami Beach Presents the U.S. Premiere Of Stranded In Shanghai

    AddThis Social Bookmark Button

    The Jewish Museum of Florida-FIU presents the U.S. premiere of Stranded in Shanghai: Arthur Rothstein's Photographs of the Hongkew Ghetto, 1946, the timely exhibition featuring a lesson from history about tolerance, compassion for human suffering and solidarity.

Donate Elite

It's the desire at Haute-Lifestyle.com to keep journalism free. Running a business, however, dictates what is now a common dilemma; a paywall, subscription or donation. Thank you for your donation.