Wintery Knight

…integrating Christian faith and knowledge in the public square

White House review of VA finds “corrosive culture” to blame for poor patient care

The Wall Street Journal reports.

Excerpt:

A White House review of the VA health system points to a culture that has degraded the timely delivery of care and requires a restructuring to improve transparency and accountability.

Acting Secretary of Veterans Affairs Sloan Gibson and Rob Nabors, White House deputy chief of staff, told President Barack Obama on Friday that significant further action was needed to address systemic problems.

Six weeks after the president dispatched Mr. Nabors to assess problems within the VA, the president’s aide outlined a long list of issues affecting access to timely care at VA medical facilities.

Mr. Nabors’s work is the latest in a series of reviews and reports issued in the past two months, including those from the VA’s independent inspector general, the Office of the Special Counsel and the VA itself. The new report found what Mr. Nabors described as a “corrosive culture” that affects employee performance and patient care. He added that the Veterans Health Administration structure has “impeded appropriate management, supervision and oversight.”

The review also found that the VA’s goal for scheduling many medical appointments within 14 days is “arbitrary, ill-defined and misunderstood.” That goal had been set in 2011. The VA recently eliminated that 14-day target.

Mr. Gibson praised the report. “We know that unacceptable, systemic problems and cultural issues within our health system prevent veterans from receiving timely care,” he said in a statement.

The White House has scrambled to respond to evidence of widespread mismanagement within the VA and to fill a growing number of vacancies in top posts. An internal assessment also revealed improper appointment-scheduling procedures and efforts to hide long wait times across the VA health system.

Another interim report from the VA inspector general confirms that:

The VA’s independent inspector general office has said it would likely issue in August its full report on its sweeping review of the department. An interim report, issued just days before Mr. Shinseki’s resignation, showed problems throughout the VA. They included employees tinkering with official patient appointment wait times to make them seem much shorter than the actual times veterans were having to wait.

In case you were wondering why this is all happening in the VA health care system and not in the private health care system, it’s because the VA is 100% pure government-run health care, as health care expert Avik Roy explains in Forbes magazine. The VA is not scandal is not some sort of aberration from government-run health care. Long wait times and patient deaths are essential to government run health care, in practice.

Filed under: News, , , , , , , , , , ,

Two famous near-death experiences: Pam Reynolds and Maria’s tennis shoe

Dr. Mario Beuregard writes about out of body experiences and near death experiences in the leftist Salon.com, of all places.

NDE number one:

Pam was brought into the operating room at 7:15 a.m., she was given general anesthesia, and she quickly lost conscious awareness. At this point, Spetzler and his team of more than 20 physicians, nurses, and technicians went to work. They lubricated Pam’s eyes to prevent drying, and taped them shut. They attached EEG electrodes to monitor the electrical activity of her cerebral cortex. They inserted small, molded speakers into her ears and secured them with gauze and tape. The speakers would emit repeated 100-decibel clicks—approximately the noise produced by a speeding express train—eliminating outside sounds and measuring the activity of her brainstem.

At 8:40 a.m., the tray of surgical instruments was uncovered, and Robert Spetzler began cutting through Pam’s skull with a special surgical saw that produced a noise similar to a dental drill. At this moment, Pam later said, she felt herself “pop” out of her body and hover above it, watching as doctors worked on her body.

Although she no longer had use of her eyes and ears, she described her observations in terms of her senses and perceptions. “I thought the way they had my head shaved was very peculiar,” she said. “I expected them to take all of the hair, but they did not.” She also described the Midas Rex bone saw (“The saw thing that I hated the sound of looked like an electric toothbrush and it had a dent in it … ”) and the dental-drill sound it made with considerable accuracy.

Meanwhile, Spetzler was removing the outermost membrane of Pamela’s brain, cutting it open with scissors. At about the same time, a female cardiac surgeon was attempting to locate the femoral artery in Pam’s right groin. Remarkably, Pam later claimed to remember a female voice saying, “We have a problem. Her arteries are too small.” And then a male voice: “Try the other side.” Medical records confirm this conversation, yet Pam could not have heard them.

I like the second one even better than the first.

NDE number two:

Maria was a migrant worker who had a severe heart attack while visiting friends in Seattle. She was rushed to Harborview Hospital and placed in the coronary care unit. A few days later, she had a cardiac arrest but was rapidly resuscitated. The following day, Clark visited her. Maria told Clark that during her cardiac arrest she was able to look down from the ceiling and watch the medical team at work on her body. At one point in this experience, said Maria, she found herself outside the hospital and spotted a tennis shoe on the ledge of the north side of the third floor of the building. She was able to provide several details regarding its appearance, including the observations that one of its laces was stuck underneath the heel and that the little toe area was worn. Maria wanted to know for sure whether she had “really” seen that shoe, and she begged Clark to try to locate it.

Quite skeptical, Clark went to the location described by Maria—and found the tennis shoe. From the window of her hospital room, the details that Maria had recounted could not be discerned. But upon retrieval of the shoe, Clark confirmed Maria’s observations. “The only way she could have had such a perspective,” said Clark, “was if she had been floating right outside and at very close range to the tennis shoe. I retrieved the shoe and brought it back to Maria; it was very concrete evidence for me.”

This case is particularly impressive given that during cardiac arrest, the flow of blood to the brain is interrupted. When this happens, the brain’s electrical activity (as measured with EEG) disappears after 10 to 20 seconds. In this state, a patient is deeply comatose. Because the brain structures mediating higher mental functions are severely impaired, such patients are expected to have no clear and lucid mental experiences that will be remembered. Nonetheless, studies conducted in the Netherlands, United Kingdom, and United States have revealed that approximately 15 percent of cardiac arrest survivors do report some recollection from the time when they were clinically dead. These studies indicate that consciousness, perceptions, thoughts, and feelings can be experienced during a period when the brain shows no measurable activity.

Here’s the author bio:

Mario Beauregard is associate research professor at the Departments of Psychology and Radiology and the Neuroscience Research Center at the University of Montreal. He is the coauthor of “The Spiritual Brain” and more than one hundred publications in neuroscience, psychology and psychiatry.

It’s a helpful article, and one you might want to share or tweet to get a discussion started.

In previous posts, I have listed six arguments for non-physical minds, and also blogged about peer-reviewed scientific evidence on how consciousness changes brain chemistry through mental effort.

Filed under: Polemics, , , , , , , , , , , , , , , , , , , ,

Doctor shortage: how Obamacare makes it harder to find a doctor

Remember how Obama promised that if you liked your doctor, then you could keep your doctor? It turns out that there is more to making policies than just saying what you’d like to do in a scripted campaign speech. The truth is that some health care policies will make you lose your doctor, regardless of what the President reads off of a teleprompter. Is Obamacare one of these policies? Let’s see.

Avik Roy writes about it in Forbes magazine.

Excerpt:

On Saturday, the Wall Street Journal reported that, due to Obamacare’s cuts to Medicare Advantage, among other factors, UnitedHealth expects its network of physicians “to be 85 percent to 90 percent of its current size by the end of 2014.” The result? Some retirees enrolled in Medicare Advantage will need to find new doctors. And it’s a trend that could accelerate in future years.

[...]Over the next ten years, Obamacare was designed to spend around $1.9 trillion on expanding health coverage to the uninsured. The law pays for this new spending with $1.2 trillion in new taxes, and $716 billion in cuts to Medicare, relative to prior law.

[...]The private insurers who supply Medicare Advantage plans, like UnitedHealth and Humana, have been responding to the cuts by squeezing out inefficiencies in the way they deliver care. One obvious way to do that is to pay doctors and hospitals less—or kick out the providers who refuse to accept lower reimbursement rates. And that’s what United has done, according to the WSJ report from Melinda Beck.

“Doctors in at least 10 states have received termination letters, some citing ‘significant changes and pressures in the health-care environment,’” writes Beck.

Another one of my favorite health care policy experts is the ex-Canadian Sally C. Pipes, who knows all about the horrors of single-payer health care. It killed her mother! Here’s what she had to say about the doctors shortage in a Forbes magazine article from earlier this year.

The first problem is that we have an aging doctor population and since we do such a poor job of educating our children (public school indoctrination centers) we aren’t making any new ones:

Right now, the United States is short some 20,000 doctors, according to the Association of American Medical Colleges. The shortage could quintuple over the next decade, thanks to the aging of the American population — and the aging and consequent retirement of many physicians. Nearly half of the 800,000-plus doctors in the United States are over the age of 50.

The second problem is that adding more regulations and burdensome paperwork makes a lot of people not want to be doctors any more:

Obamacare is further thinning the doctor corps. A Physicians Foundation survey of 13,000 doctors found that 60 percent of doctors would retire today if they could, up from 45 percent before the law passed.

The third problem is that the government isn’t reimbursing doctors as much as private insurance companies do, and it makes them refuse to take government-funded patients:

They’ve long limited the number of Medicaid patients they’ll treat, thanks to the program’s low reimbursement rates. According to a study published in Health Affairs, only 69 percent of doctors accepted new Medicaid patients in 2011. In Florida, just 59 percent do so. And a survey by the Texas Medical Association of doctors in the Lone Star State found that 68 percent either limit or refuse to take new Medicaid patients.

Medicaid pays about 60 percent as much as private insurance. For many doctors, the costs of treating someone on Medicaid are higher than what the government will pay them.

These underpayments have grown worse over time, as cash-strapped states have tried to rein in spending on Medicaid. Ohio hasn’t increased payments to doctors in three years; Kentucky hasn’t raised them in two decades. Colorado, Nebraska, South Carolina, Arizona, Oregon, and Arizona all cut payments in 2011.

By throwing nine million more people into the program without fixing this fatal flaw, Obamacare will make it even harder for Medicaid patients to find doctors.

It’s not just Medicaid that’s the problem, either. It’s the government-controlled exchanges.

Healthcare providers are signaling that they may turn away patients who purchase insurance through the exchanges, too.

In California, for example, folks covered by Blue Shield’s exchange plan will have access to about a third of its physician network. The UCLA Medical Center and its doctors are available to customers of just one plan for sale through the state exchange, Covered California. And the prestigious Cedars-Sinai Medical Center is not taking anyone with exchange insurance.

Now I know what you’re thinking – why not just force doctors to work for lower wages, like a good socialist country might? Well, that actually makes the shortage worse, because people don’t like to learn hard things and then work hard for little pay. And doctors work VERY hard – it’s not an easy profession to get into. That will just make all the doctors leave the country for other countries where they can be paid fairly for the work they do.

And in fact that is exactly what happened in a 100% socialized health care system in Venezuela, according to this report from the left-leaning Associated Press.

Excerpt:

Half the public health system’s doctors quit under Chavez, and half of those moved abroad, Natera said.

Now, support staff is leaving, too, victim of a wage crunch as wages across the economy fail to keep up with inflation.

At the Caracas blood bank, Lopez said 62 nurses have quit so far this year along with half the lab staff. It now can take donations only on weekday mornings.

I recommend reading that entire article for a glimpse of where the Democrats are trying to take us. There is not a dime’s worth of difference on policy between the Democrat party and the socialist party of Venezuela, except that the socialists have been in control in Venezuela for longer, and so they are further along the road to serfdom.

In other news, the Washington D.C. insurance commissioner was fired after raising concerns about the “fix” proposed by Obama in his speech last week. That’s also something that you might expect to see in a country like Venezuela. That’s what happens in authoritarian socialist countries. Whistleblowers and critics just disappear.

Filed under: News, , , , , , , , , , , , , , , , , , , , , , , , ,

New study: NHS patients are 45 percent more likely to die than US health care patients

Wes sent me this article from the UK Telegraph.

Excerpt:

Patients are 45% more likely to die in NHS hospitals than in US ones, according to figures revealing how badly England’s health service compares with those of other countries.

Previously unpublished data collated by Professor Sir Brian Jarman over more than 10 years found NHS mortality rates were among the worst of those in seven developed countries.

A patient in England was five times as likely to die of pneumonia and twice as likely to die of septicaemia compared to similar patients in the US, the leading country in the study, the data suggested.

The elderly were found to be particularly at risk in English hospitals compared with those in the other countries.

The figures showed that the situation had improved since 2004, when the death rate in English hospitals was 58% higher than that in the best performing country.

But NHS institutions still lagged behind in the most recent data, from 2012, despite reforms of the health service and increased funding.

Of the other six countries studied, only the US was named because of the sensitivity of the data.

Prof Sir Brian, who adjusted the data to take account of differences in the countries’ health services, did not initially release his figures because he was so shocked by them he at first assumed there must be a flaw in his methodology.

There was, however, “no means of denying the results,” he said.

“I expected us to do well and was very surprised when we didn’t,” the Imperial College London medic told Channel 4 News.

“If you go to the States, doctors can talk about problems, nurses can raise problems and listen to patient complaints.

“We have a system whereby for written hospital complaints only one in 375 is actually formally investigated. That is absolutely appalling.”

Previously, I had posted a summary of a book by Scott Atlas, a medical doctor at the Hoover Institute at Stanford University. In that article, he laid out the reasons why the U.S. healthcare system was the best in the world.

Related posts

Filed under: News, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Near-death experiences and mental effort: evidence for the soul

I was listening to J. Warner Wallace’s latest podcast on the mind and the brain last night and he mentioned 6 philosophical arguments for the existence of a non-physical mind. But he also said that science didn’t have much to say on this question of mind/brain and body/soul. I think that there is some evidence for the the soul.

In this post, I wanted to link to a previous post the research of Dr. Jeffrey Schwartz. That research on “mental effort” is my first piece of evidence. Below, there is a second piece of evidence from “corroborated near-death experiences”. This should help boost Wallace’s case for the mind. I will do a separate post on Wallace’s podcast later in the week. It was a great podcast.

Near-death experiences

Dr. Mario Beauregard writes about out of body experiences and near death experiences in the leftist Salon.com, of all places.

NDE number one:

Pam was brought into the operating room at 7:15 a.m., she was given general anesthesia, and she quickly lost conscious awareness. At this point, Spetzler and his team of more than 20 physicians, nurses, and technicians went to work. They lubricated Pam’s eyes to prevent drying, and taped them shut. They attached EEG electrodes to monitor the electrical activity of her cerebral cortex. They inserted small, molded speakers into her ears and secured them with gauze and tape. The speakers would emit repeated 100-decibel clicks—approximately the noise produced by a speeding express train—eliminating outside sounds and measuring the activity of her brainstem.

At 8:40 a.m., the tray of surgical instruments was uncovered, and Robert Spetzler began cutting through Pam’s skull with a special surgical saw that produced a noise similar to a dental drill. At this moment, Pam later said, she felt herself “pop” out of her body and hover above it, watching as doctors worked on her body.

Although she no longer had use of her eyes and ears, she described her observations in terms of her senses and perceptions. “I thought the way they had my head shaved was very peculiar,” she said. “I expected them to take all of the hair, but they did not.” She also described the Midas Rex bone saw (“The saw thing that I hated the sound of looked like an electric toothbrush and it had a dent in it … ”) and the dental-drill sound it made with considerable accuracy.

Meanwhile, Spetzler was removing the outermost membrane of Pamela’s brain, cutting it open with scissors. At about the same time, a female cardiac surgeon was attempting to locate the femoral artery in Pam’s right groin. Remarkably, Pam later claimed to remember a female voice saying, “We have a problem. Her arteries are too small.” And then a male voice: “Try the other side.” Medical records confirm this conversation, yet Pam could not have heard them.

I like the second one even better than the first.

NDE number two:

Maria was a migrant worker who had a severe heart attack while visiting friends in Seattle. She was rushed to Harborview Hospital and placed in the coronary care unit. A few days later, she had a cardiac arrest but was rapidly resuscitated. The following day, Clark visited her. Maria told Clark that during her cardiac arrest she was able to look down from the ceiling and watch the medical team at work on her body. At one point in this experience, said Maria, she found herself outside the hospital and spotted a tennis shoe on the ledge of the north side of the third floor of the building. She was able to provide several details regarding its appearance, including the observations that one of its laces was stuck underneath the heel and that the little toe area was worn. Maria wanted to know for sure whether she had “really” seen that shoe, and she begged Clark to try to locate it.

Quite skeptical, Clark went to the location described by Maria—and found the tennis shoe. From the window of her hospital room, the details that Maria had recounted could not be discerned. But upon retrieval of the shoe, Clark confirmed Maria’s observations. “The only way she could have had such a perspective,” said Clark, “was if she had been floating right outside and at very close range to the tennis shoe. I retrieved the shoe and brought it back to Maria; it was very concrete evidence for me.”

This case is particularly impressive given that during cardiac arrest, the flow of blood to the brain is interrupted. When this happens, the brain’s electrical activity (as measured with EEG) disappears after 10 to 20 seconds. In this state, a patient is deeply comatose. Because the brain structures mediating higher mental functions are severely impaired, such patients are expected to have no clear and lucid mental experiences that will be remembered. Nonetheless, studies conducted in the Netherlands, United Kingdom, and United States have revealed that approximately 15 percent of cardiac arrest survivors do report some recollection from the time when they were clinically dead. These studies indicate that consciousness, perceptions, thoughts, and feelings can be experienced during a period when the brain shows no measurable activity.

Here’s the author bio:

Mario Beauregard is associate research professor at the Departments of Psychology and Radiology and the Neuroscience Research Center at the University of Montreal. He is the coauthor of “The Spiritual Brain” and more than one hundred publications in neuroscience, psychology and psychiatry.

It’s a helpful article, and one you might want to share or tweet to get a discussion started.

Filed under: Polemics, , , , , , , , , , , , , , , , , , , ,

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