Sean Khozin, MD, MPH

The Journal of the American Medical Association (JAMA) recently published a case about a 66 year-old man with heart disease and an enlarging abdominal aortic aneurysm (AAA). Once these aneurysms grow beyond a certain size, they may rupture and place one at the risk of bleeding to death. What I found unique about this case was not the story about the AAA but the patient’s own account of his situation, published in the same article. As the physicians taking care of this patient closely monitored the size of the AAA and aggressively managed his heart disease risk factors, the patient gradually came to accept his disease as a reality of life:

I was first diagnosed with my aneurysm about 4 or 5 years ago. My doctors found it accidentally when they were looking for problems with my esophagus. After the tests, my doctor called me and said, “I need to see you . . . now.” So I went in and she told me about the aneurysm and I went, “Oh,” feeling as if there wasn’t much else to say. I backed up, relaxed a little bit, and tried to grasp what was going on. She referred me to a cardiovascular specialist who follows me. We’ve been following the aneurysm now for about 4 years. I see my cardiovascular surgeon about every 6 months and so far it hasn’t gotten big enough for me to worry about.

I know the aneurysm can break or rupture and have dire consequences. It took about a year to let that information settle. But when it did, I realized that we have winter too, and I don’t like it either.

I came to terms with my aneurysm on an intellectual basis. There’s nothing I or anybody else can do. At some point I’m going to die, so all I can do is enjoy what I’ve got. I can’t spend my life worrying about an inevitability. That’s a waste of my time and a misdirection of my efforts.

Last year I was introduced to Nancy Pando, the producer of a new documentary that is taking a bold look at the frustrations of practicing physicians in the country:

Being a physician today carries a complexity and responsibility, known only to those whom are expected to tend to the ills of society. But when doctors are suffering themselves – who really cares? We are all patients and come the day that we allow for money to supersede humanity, we all become collateral damage. Crash Cart Productions.

The documentary is being pre-screened for one day in NYC::

Sunday, October 25th at 4:10PM

Village East Cinema
181 2nd Avenue at 12th Street Manhattan, New York

I’m looking forward to seeing the documentary. It’s certainly a timely topic. Let’s hope that the hippocratic oath is not really vanishing.

In the past few weeks, CNN has done a great job presenting the real views of physicians about the healthcare system. In fact, today I was on CNN with Heidi Collins speaking about my medical practice and healthcare reform (will post the video when it’s up).

One of the recent commentaries on CNN is an interesting account of Dr. Vance Harris’s frustrations as a primary care physician. I had published an earlier piece by Dr. Harris on my blog last year called “Not in a Million Years.”

After venting out a bit, Dr. Harris ends his commentary with:

Good luck recruiting primary care specialists when we are projected to be short 39,000 by 2020, according to the American Academy of Family Physicians. And nearly half of all doctors surveyed by the Physicians’ Foundation have said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.

I know this is true because I am struggling to find a primary care doctor to take care of my wife and myself. Now that is ironic. Anyone know who is taking new patients in California?

Dr. Harris initially posted his commentary on Sermo and was met with great words of moral support from his colleagues.

Here’s an interesting interactive map from MSNBC and Moody’s measuring the economic health of the United States. It’s not pleasant to see all the states in red, i.e., recession. Move the top cursor on the map a few years back to see how the recession evolved.

I’ll be on a panel at the PSFK conferene tomorrow with my business partner taking about HelloHealth. Stop by if you’re in the area.

The Crisis of Credit Visualized from Jonathan Jarvis on Vimeo.

Not sure if this is our First Lady’s official twitter page, but the picture posted there is kinda cool and a refreshing representation in the dry world of politics.

The wheels for economic recovery have been set into motion, or at least are being lubricated, with the signing of the American Recovery and Reinvestment Act of 2009 by President Barack Obama on February 17, 2009. The plan was put together rather quickly behind closed, or at best ajar, doors.

The bill is designed to stimulate the economy, or as it’s phrased officially “to create jobs, restore economic growth, and strengthen America’s middle class through measures that modernize the nation’s infrastructure, enhance America’s energy independence, expand educational opportunities, preserve and improve affordable health care, provide tax relief, and protect those in greatest need, and for other purposes.”

Try saying that in one breath although I would be more impressed with achieving all the objectives in one lifetime.

There is a lot of money set aside for heathcare reform, with serious emphasis on health information technology. Here are the highlights:

• More than $140 billion in healthcare spending
• Increase in federal payments by $87 billion to States in order to prevent Medicare cuts
• $25 billion to cover 65% of the COBRA premium costs for lower-income workers
• $19 billion in grants and incentives for companies and medical practices to buy health information technology
• $10 billion to increase the research budget of the National Institutes of Health (NIH) on top of the agency’s $29 billion budget
• $1.1 billion dedicated to comparative-effectiveness studies at NIH and other agencies

The government is planning to hand out millions in grants to States and “State-designated entities” to promote the uptake of health information technology. Dozens of committees, even new federal agencies, are being formed to carry out the administration’s new policies. Comparative effectiveness research, where cheaper therapies are weighed against more expensive ones, will be the new buzzword. This will set the stage for the government to exert more influence over the medical decision making process, steering patients towards cheaper therapeutic alternatives that are deemed as good as their more expensive counterparts, or as it’ll most likely evolve, just good enough.

Roy Porter, the late British historian, starts his 1999 book “The Greatest Benefit to Mankind: A Medical History of Humanity” reflecting on the strangeness of our times. He observes the paradox of being healthier than ever but more anxious about our health (remember that life expectancy at the turn of the 20th century in the Western world was in the 40’s). Would the rationing of healthcare resulting from expanding coverage in the face of a shortage of healthcare providers and denying expensive therapies make us even more anxious? Maybe so, but our psychological health, and perhaps even our physical one (if you’re the cancer patient who is denied the “expensive” chemotherapy) are now secondary to the economic health of the country.

So let’s hope that the American Recovery and Reinvestment Act of 2009 accomplishes what it intends to do, i.e. to “create jobs, restore economic growth, and strengthen America’s middle class through measures that modernize the nation’s infrastructure, enhance America’s energy independence, expand educational opportunities, preserve and improve affordable health care, provide tax relief, and protect those in greatest need, …”