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Has Healthcare Reform had a Cardiac Arrest?

Healthcare Reform - Cardiac ArrestThe debate over healthcare has loomed large on the national stage this year. Naturally, few topics draw as much (or zeal) as this one among our generation of . For good reason. No single group of consumers is going to have a greater need or place greater demands on the medical delivery system of the near future than ours will. It is a matter of self-interest: we have an enormous stake in the outcome of this legislative slug-fest.

But make no mistake about it: This is not a debate about health care! It is simply an attempt to reform, to massage, our insurance coverage. What we call medical care in the United States is an outgrowth of a profit and market-driven disease management process. It is based upon paying physicians and hospitals for treating disease and carrying out procedures.

The equation is transparently simple: the more diseases diagnosed, the more frequently these diseases are treated, and the more invasively they are addressed, the higher the reimbursement (and hence the greater the profits). There’s an old saying: “The behaviors you incentivize are the ones you see.” And this is why our healthcare system is a disease care system. It is not concerned with health because it is only incentivized to compete in treating illness.

Think about this: As a physician, if I work with my patients and get them to adopt a healthier diet and exercise regularly, I will receive no compensation for having helped make those patients become healthier nor will the system reimburse me for having contributed to reducing the overall for these patients. There is simply no incentive for—nor value placed upon—prevention.

If on the other hand, I simply go on testing patients’ blood sugars and charting their lipid profiles and prescribing more insulin to lower blood sugar and more statins to restrain cholesterol levels, then the system continues to gurgle with profitable contentment. In fact, if a few of my patients then go on to need cardiac surgery from the sustained, unrelenting impact of these diseases, then the system hits the multiple hundreds of thousands of dollars per capita jackpot!

If I give them gym memberships to get on the treadmill, an opportunity to work with nutritionists, or a regimen supervised by trainers—nada. Nothing. I’ve actually removed lucrative potential customers out of the system. I’ve stolen patients by helping them to prevent disease.

It may seem paradoxical, but a good healthcare system puts medical insurance companies out of business. Period. Ideally, a great healthcare system aims to maximally maintain the health of its citizens. It ensures that the utmost effort and zeal are exerted to prevent disease and intervening early to return the patient to a state of wellness before they even succumb to illness.

In short, the better a healthcare system works, the less disease there is to treat, the less surgery required, the less hospital stays….You get it. The gigantic, global, medical-industrial complex begins to wind down, slowly rumbling to a halt. And if you think such a gigantic set of industries is going to go quietly into that good night, you’re dead wrong. The medical industry—the hospitals, the physicians, the equipment suppliers, the pharmaceutical industries—make the Big 3 auto makers in Detroit look like a little kids’ lemonade stand in terms of size and dollars.

As laudable as President Obama’s and Congress’s intentions may be (and have my doubts about some of them), no one seems ready to assert that the only way we can turn this disease-treatment system into one of prevention is by having a sole-payer, government-run healthcare delivery system that is not based on profit and but is truly motivated to hold down medical costs by focusing on preventing disease.

Only the government could subsidize healthier eating. Only the government could lead a program at developing a healthier food supply. Only the government could insist on a mandate for better nutrition and extensive physical education of our school-aged children. Only the government could use tax rebates to encourage and incentivize citizens to obtain and regularly use gym memberships, to exercise daily. Only the government has the clout to put an end to the economic ruin and devastation that insurance companies have imposed on our country.

We pay nearly twice as much for healthcare as any other developed country. We’re ranked thirty-seventh in the world in terms of the quality of the healthcare of our people-behind Cuba, a country that had made exemplary strides aimed at prevention and spends less than ten percent of what the US does on medical care.

I don’t know where this whole healthcare debacle will end. Unfortunately, my best guess is that it is unlikely to go where it should—towards a truly healthier citizenry. No one seems to want to go there. Like global warming, like ecological conservation, like military imperialism, like nuclear proliferation, like regulating Wall Street and big banks, like immigration reform, like civil rights…we always seem to wait too long, to cling to the status quo for too long.

Originally posted

written by Allan J. Hamilton, MD, FACS on Boomer-Living.com

Why Am I In My Own Way?

Often we undertake bringing about healthful, positive changes in our lives, but we always seem to find ourselves falling short of our expectations. Our resolution just seems to eventually fizzle out. We have the best of intentions. We start off well with lots of enthusiasm and determination. And then, life just starts to get back in our way. We tell ourselves that it’s just a momentary hiatus, nothing more and that we get right back on track; but, we don’t. Instead, we find ourselves on a slippery slope and our determination eventually evaporates.

Every one of us can tell a similar story whether it’s weight loss, exercise, or spending quality time with our kids. As one of my acquaintances put it, “I’ve been losing the same twenty pounds my whole adult life.”

So why do we all find ourselves falling short? The answer: We all exhibit a lack of mindfulness. We deal with our expectations–with what we should bedoing–what the future was supposed to be. Or, we kick ourselves in the rear with frustration or guilt about the past–what we should have done. In both the past and the future, we’ve locked ourselves out of the present (the now–the moment) where the real engine of change and transformation lies.

So let’s say I’ve resolved to finally lose that twenty pounds of extra weight my doctor has told me I need to shed. I get out my healthful dietary plan and recipes. For a few days, I’m all pumped up, psyched. I’m the fervent convert.

The first week goes well.

But then there’s the night when I’m stuck at the office. I get home late. I take some paperwork home to finish that night. I tell myself I can’t afford the extra minutes to cook something so I stop off at McDonald’s. I grab my bag and drive home. Plop my work on the dining room table and start reaching in for a few fries. I turn on CNN to catch up on the news and the stock market.

So where am I in all this? I’m all over the place! I’m bouncing off the walls and my attention is ricocheting like a bullet. I’m not even enjoying the burgers. I’m not giving my attention to the paperwork. And the market dropped a hundred and fifty points, so I’m worried about how my portfolio is going to do tomorrow.

What was I really feeling through out all of this? Resistance. I was not mindful enough to stop, feel it, and recognize when it was happening. I was angry and frustrated that my boss made me stay late. I could have made a healthy meal out of the fridge. It actually would have taken less time and money than the stop at McD’s but, in truth, the burgers were the consolation prize I gave myself for what I perceived as having been treated unfairly and made to stay late against my wishes. So I felt I deserved “a break today”, as the commercials say.

I reacted to my resentment. I did not stop to ask myself what I was really feeling at that moment as I watched the clock ticking away in the office. Nor did I ask myself what I wanted to do about it. I just reacted. And how did I react? Returning to old familiar habits which is what we all do when we react viscerally. As John Shukwit, a behavioral health therapist, put it, “Habit, by definition, is not mindfulness”. Habit is autopilot. We’re not flying the plane. We’re being carried by it. We’re passengers.

After I’m done gulping down the burgers (I ate them so fast while watching the news I was hardly aware of what I ate), I hate myself for it. Oh, I should have just come home and grabbed something. I chide myself that I should be eating healthier. And there are those magic words again–should have (the past)–should be (the future). Guilt in the past. Expectations in the future. Me? Where do I find myself? Nowhere close to being mindful, in the present.

What is the moment? I hate my boss right now. I’m anxious about reading all those files. Right now: I’m bloated; I’m nauseous; I’m taking an Alka Seltzer. Right now: I am feeling better about my diet when I plan out my breakfast because it helps me feel like I’m correcting myself. Right now: Here’s the orange I’m picking for tomorrow’s breakfast. I love the smell. The feel. The organic label makes me feel safe. The whole-wheat toast feels rough and grainy. The egg whites are put in their container and I’m chopping up some neat looking vegetables to add to the omelet. I acknowledge what I’m feeling. Resistance lies in the past and the future. I cannot focus on what I wanted myself to do or what I hope I will do tomorrow if I declare what sensations I have in this instant.

The question that keeps us anchored in the present is: What am I feeling now? And now? And now? There’s no resistance because I’m acknowledging it. There may be anger and frustration over quitting my diet but that’s what I’m feeling and I want to discern that because when I stick to my diet plan I feel healthier.

So asking the right question can keep us returning to the moment. And that’s where our ability to carry out transformational change is to be found. Right now. No regrets. No wishes. Just doing or not doing. Even if it takes a whole lifetime to do it.

originally posted in Boomer-Living.com by Dr. Hamilton

Climatic Change in American Healthcare: Melting Resolve

Climatic Change in American Healthcare: Melting Resolve

President Obama will address the nation on how he proposes to fix healthcare. Unfortunately, neither the President nor Congress have the courage, will, or strength to put forth a proposal that would support a government-backed single payor plan—the one and only long-term solution to the crisis in American healthcare.
That’s because such a plan would mean the end of excessive profiteering by both the health insurance and the pharmaceutical industries. Together, these two industrial sectors represent the most powerful lobbying groups the Congress has ever seen. Their combined revenue last year was in excess of a trillion dollars and that buys the attention and compliance of a lot of members of both the House and the Senate. And those elected officials who do not go along with the agenda of these lobbyists will find their more willing opponents well funded in the next upcoming election.
A single payor universal healthcare plan would mean no private insurance company (what’s referred to as third party payors) could survive if they charged more than the government. That would be equivalent to a congressional mandate requiring that private health insurance not seek reimbursement greater than what is provided by Medicare—a non-profit, government-run healthcare program. An insurance company cannot comply with such a requirement and still skim off thirty percent of its insurance premiums to funnel back to shareholders and top executives (many of whom received bonuses in excess of $4 million last year while millions of Americans lost their jobs and healthcare coverage). Most third party payors currently seek reimbursement rates as high as 115-200% of Medicare reimbursement.
Unfortunately, the situation is even more despairing when it comes to the pharmaceutical companies. The last thing they want to see is a federal single payor system that can basically demand that negotiated prices on drugs carried in the government’s formulary be reasonable, fair, and subject to periodic review. That would be a pity for many of the pharmaceutical companies that see as much as three thousand percent mark-up on the medications they sell. To put this excessive profiteering into perspective, American patients spend as much as eighty percent more for exactly the same medications that their European counterparts are purchasing. Why? Because American healthcare is as ripe for plundering and profiteering as Wall Street found the real estate market to be.

Many critics (and now the ubiquitous “carpet bombing” of television ads produced by the insurance and pharmaceutical companies) claim that a government-run single payor system is tantamount to the s word—socialism.  So what. Such socialistic healthcare systems have worked well in more than twenty countries in Europe. In fact, every nation listed in the top twenty of the World Health Organizations ranking of health care systems provides its citizens with universal health care.  The United States, incidentally, is ranked thirty-seventh, just behind Costa Rica and just in front of Slovenia. Ask how many Americans want to seek their healthcare in Slovenia? Interestingly, Medicare could be fairly described as a socialist institution. No one has objected to the fact that currently more than fifty percent of all American healthcare is funded and overseen by the US government and that it used as the standard by which the private payors measure the coverage in their own healthcare plans (not the cost, just the coverage).

Finally, sooner or later, America must have a single payor system. It is inevitable that something must be done to control the upward spiraling costs of healthcare. We are just beginning to learn that we must tackle global warming or we will all perish with our planet. For healthcare, the end is much closer than for carbon emissions. Medicare funds will be completely depleted by 2015. If Medicare and Social Security costs continue at the current rate of growth then, by 2050, the entire budget of the federal government will be reduced to just these two items. No DOD. No EPA. No Department of Justice, Homeland Security, or Department of the Interior. It will mean the end of government as we now know it. So, like it or not, we have got to control healthcare costs (and, yes, to some extent, probably ration it too). The only solution lies in a universal, single payor, healthcare program for the United States.

But, in the next few months of debate and hearings about healthcare reform, the only mention of a national single payor system will be denouncements by naysayers. Not supporters. It will be discussed as untenable, unnecessary, and un-American—largely by the individuals bullied or paid to say it. As the American people, we have recently been witness to the un-American qualities with which the top executives have been leading this country’s largest, most powerful corporations. And you will see the idea of a national, single payor healthcare conveniently smothered at the hands of hundreds of our elected representatives—again. And we will wait for American healthcare to collapse–as we did for the auto industry, the mortgage funds, and the stock brokerage houses–before we can find the courage to do what’s right and to do what’s needed.

Stick With The Doctor Who Answers Your Questions

Every patient has the right to ask any and all questions. And the questions can be plenty stupid. Usually, the “stupid” ones are the best ones. A disturbing number of patients report they never felt they were given time to ask all their questions of their doctor. I hear the patients say: “Well, he seemed to be in a real hurry. I didn’t want to bother him.” Or “I just felt my questions were silly. I was so anxious about the procedure I couldn’t think straight. I was numb at the time.”

One of my attendings at the Massachusetts General Hospital had a rule: the patient could only ask one question of him. As soon as the patient started to take a breath and get up the courage to ask something, this particular surgeon would hold up his hand and say: “Aah, aah, aah! Before you ask me anything, I just want to remind you that you should really carefully consider what question is the most important to you…because you’ll only get one.” Few patients ever asked a question. Who could ever be sure what would be the most important one? If any doctor ever says something like that, slam the examination room door in his or her face and head for the nearest exit.

So what’s my practical advice? Always listen first to what your doctor has to say. Tell him or her that you want some time to think things over. Make a follow-up appointment in two days (unless it’s a life-threatening emergency and you need to be operated upon immediately, in which case there’s not a whole lot of time to ask questions). If the doctor seems put off by your request to come back, get out of the office, and find another surgeon. If the doctor says something like: “Okay. But I have an opening in my surgery schedule this week and I was going to put you into that slot. I won’t be able to do that if you want to come back another time,” run out of the office and find yourself a new surgeon. If he or she says: “Fine. I’ll see you in a couple of days,” then you can head home and make an appointment to come back.

During the two-day hiatus, pull your family circle together. Brainstorm a list of all the questions you can. Put them down on paper. Number them; it doesn’t matter how many of them you have. The more, the better. Leave a space of three or four lines after each question so someone can jot down the doctor’s answers as you plow through your whole list. It is far better to be asking questions before the procedure than afterwards.

Here Are Some Resources For Improving Communication With Your Doctor:

About.com Patient Empowerment Effective Patient - Doctor Communications - By Trisha Torrey, About.com

“There are more challenges than ever in today’s healthcare environment. …. these challenges and others make effective communications between patients and their practitioners more important than ever.”

Time Health & Science - Better Bedside Manners
By Laura Blue Every patient wants to find a doctor who listens. But wouldn’t it be easier if all doctors were just better listeners?

Having Surgery: 10 Questions Every Patient Should Ask Your Doctor Before Having Surgery or Other Medical Procedures By Deborah Trendel, RN, About.com

Checking a doctor’s bedside manner in a blog?
By the Boston Globe City & Region Desk


Medical Students Learn to Listen with Dr. Hamilton’s Innovative Program
Horses Help Doctors Improve Communication Skills - About.com
Patient’s confidence in their physicians depends on the doctor’s ability to communicate.

“Medical students at the University of Arizona College of Medicine have been getting sensitivity training in an unusual way.  Created and taught by Dr. Allan Hamilton, the class “Medicine & Horsemanship: An Introduction to Human Nonverbal Interaction at the Bedside” teaches them to improve their communication with patients by teaching them to communicate with horses.”more

The Country’s Surgeon General and the General Health of the Country

Dr. Sanjay Gupta

The country still has no clear grasp of what it may see for a national health care system. Rumors are circulating that CNN medical correspondent, Dr. Sanjay Gupta, may be tapped by President Obama for the position of “Top Doc” for the American people. Dr. Gupta is a good choice for Surgeon General. He is a neurosurgical colleague of mine who has served honorably and effectively on the faculty of Emory University.  His duties as medical correspondent for a global news service have called upon him to bear witness to many of the globe’s greatest medical calamities. From the devastation of the tsunami in 2007 off the coast of Indonesia, to the starvation of refugees in Africa. From the threat of avian flu virus to Hurricane Katrina.  He’s had to evaluate these issues, not only with the insight of a practicing physician but also with the impartial eye of a journalist who must report to the public in a fair, balanced, and judicious method—not a bad test run for a Surgeon General.

Dr. Gupta’s considerable abilities in front of the camera may also serve the President well when it comes to translating his national healthcare agenda in front of representatives of Congress and lay audiences. Still, Dr. Gupta cannot translate healthcare policy until it has been fully articulated by the President. Too long has this country waited for national healthcare. On all sides, we hear captains of industry and spokespersons from Congress telling us our healthcare must be less expensive. That’s rubbish. Price is not the primary issue. Quality, trustworthiness, and accessibility are foremost.  Naturally, the matters of financing national healthcare are considerable but taking care of the nation’s health is not the same thing as producing toasters. Cutting production costs may make a product more competitive in the marketplace, but that is not especially pertinent to the issues of health. We cannot shave pennies off of human life and death.

A system of national healthcare must be expansive to be effective. First, it must reach our children. During the early and formative years of our children, we set the foundation for a life’s worth of health. Accessibility is also a vital issue to all of American citizens. It matters little if we have national healthcare coverage if we cannot get into the doctor’s office to get it. And this access must be timely. Waiting periods of 6-12 weeks are common when patients call their primary care physician. This is unacceptable. We must set a target that every patient will be seen within 48 hours of calling for an appointment. If more urgent attention is needed then that will be the province of the emergency room. However, at present, hospital emergency rooms are choked, dealing with throngs of patients whose regular doctors simply refuse to make time in their schedule to see them. Our emergency rooms have become a kind of de facto primary care system for the uninsured and the unattended. A timely visit to the doctor’s office can prevent the nagging cough from becoming pneumonia or the suspicious skin lesion from turning into something more menacing.

High blood pressure, also known as hypertension, is known as a “silent killer”, because people who have the disease often do not experience symptoms. Simple, routine screenings can identify people at risk. photo from the CDC/ James Gathany

Secondly, we need to create national programs that are aimed at prevention. The prevention of obesity. The eradication of heart disease. The elimination of stroke. And, finally, the annihilation of cancer. Such preventive programs must be local with extensive networks that encourage individuals and families to access them rather than leaving them to struggle, to run the gauntlet of medical care.

Thirdly, we must change the culture of our healthcare professional. The field of medicine cannot flourish on motivation resting too heavily on profit. It is an immorally derived equation when we balance financial productivity solely as a function of the diseases treated or surgeries performed. Quality, compassion, and accessibility must also be factored in. A good doctor is worth more than a mediocre one—no matter what they are treating.

We see the behaviors we promote. We must not encourage irresponsible diagnostic evaluations nor unnecessary surgeries. The medical profession must return to its principles of human service. A national system of educational vouchers must be created to help subsidize medical and nursing school students. It must support residency salaries to ensure that an army of physicians becomes available to answer the summons of a new national healthcare initiative. This program of subsidies must be aimed at pouring resources and trained healthcare professionals, from doctors to nurses, from physician’s assistants to laboratory technicians, into those sites around the country where new facilities need to be established to make healthcare more accessible.
American healthcare must learn to shed the exclusive and virtually paranoid attitude that the peer review process must be hidden from the light of day and the scrutiny of the common citizen. Without an open forum to evaluate the morbidity and mortality of medical accidents, there will be little motivation to move ahead and see these errors eliminated once and for all. The American people do not deserve a healthcare system which decimates its patients, whose death toll has risen to the point where five times more people may die from medical adverse events than from riding on the roads and highways of this country. This is where we can save more than a buck.

Prevention must be the centerpiece of a new healthcare initiative. This requires an outright war be waged

To help fight obesity, parents should encourage their children to play outdoors, and should also limit the amount of time their child spends in front of the television, as well as to maintain a healthy diet. Photo CDC/ Jim Gathany

To help fight obesity, parents should encourage their children to play outdoors, and should also limit the amount of time their child spends in front of the television, as well as to maintain a healthy diet. Photo CDC/ Jim Gathany

against obesity. Complacency and laziness need to be undone. Exercise needs to be a national priority. Hiking and bicycle paths have to become cornerstones of rebuilding our national infrastructure. Employers will need to provide significant healthcare premium discounts and financial incentives to ensure workers and their family members enroll in programs aimed at better fitness, nutrition, and wellbeing.

Mental health must, finally, be a priority. The psychological and emotional aspects of our citizens must also be addressed in a new healthcare system. The scope of health has broadened not narrowed. Mental health has been neglected too long. Programs for the emotional support of our veterans, who have served their country so honorably, need to be expanded. Services for disabled children must be enhanced. Prenatal healthcare, so important for all mothers (but especially vulnerable, young unwed mothers) must be assured once and for all. Finally, stable, dependable, trustworthy aftercare must be available to our patients once they’ve been discharged from the hospital. This will reduce postoperative complications. This will reduce inpatient costs dramatically. However, we need to ensure that expert care is provided in the home so that intravenous administration, wound care, bathing, physical therapy and other services are carried out in keeping with the highest standards.

Compassion, motivation, and education create an efficient healthcare system–not budget cuts. As Tom Peters put it: “You cannot shrink into greatness.” America needs and deserves a great healthcare system: one that is revitalized and bent on meeting the needs of our people. Our citizens wait for the courageous and thoughtful action to be taken by President Obama’s administration and this Congress to finally give them the healthcare they have yearned for so long. They will find their nation grateful beyond words.

Further Resources:

2-Min. Bio Surgeon General: Sanjay Gupta on TIME.com

Obama budget foresees national health care – International Herald Tribune

Strong Medicine Required: Prognosis for employer healthcare
Extremely in depth analysis of health coverare from Price Waterhouse Coopers

The Alliance for Health Reform.
Features a source book for journalists, links to dozens of reports, and webcasts of briefings.
Overweight and Obesity – Centers for Disease Control and Prevention – with articles on trends, healath consequences recommendations resources

Childhood Overweight and Obesity – Centers for Disease Control and Prevention

Best Practices for Enhancing Quality
By Skip Freedman, MD article in Patient Saftey & Quality Healthcare
“Most states protect doctors involved in hospital peer review. Still the professional working relationships among doctors make peer review difficult. Doctors do not want to review colleagues for fear of criticizing their friends and possibly being censured in return.” more

Disease Prevention Programs Could Generate Substantial Savings In Health Care Costs, Report Finds – Medical News Today

The Magic Bullet: Exercise

Perhaps, outside of a life-threatening catastrophe, there is no advice about recovery and rehabilitation a doctor can give you that will outweigh the benefits of exercise. If there is a tonic—a fountain of youth (though not eternal)—it is exercise. I know that this is advice that everyone gets almost daily, from the Surgeon General’s Office to the latest infomercial trying to sell you a machine designed to give you abdominal “six-packs of steel.”

Exercise at Any Age

Exercise at Any Age!

The reason I want to reinforce exercise, in particular, is that most patients do not understand how vital, re-invigorating, and restorative exercise can be. In its responses to “stress,” the human body is astounding in its capacity to adjust, accommodate, and improve. I am not referring to stress in the sense of anxiety but rather refer to “stress” in the engineering context of a work-load being placed on the body. The human body will strengthen itself in response to increased demand whether you are eighteen or eighty. Imagine, for a moment, how implausible it would seem if someone claimed to have developed an automobile where the engine became bigger, more powerful, and more fuel efficient the harder and faster you drove it! But that is precisely how our bodies respond.

Imagine that it was announced today that a major pharmaceutical company had discovered a compound that could substantially prolong life, reduce stress, and lose weight. Imagine it was also claimed to help individuals reverse osteoporosis, enhance sexuality, make folks look younger, and, to date, the FDA had discovered no serious side effects or long-term toxicity. It would the “wet dream” of every global pharmacological company. For many of us, the notion that it is not a pill we can just swallow is disappointing. But exercise is not something you ingest, it’s something in which you invest. You have to discipline yourself to daily exercise. It requires participation and commitment.

Exercise has another saving grace: anyone can do it. You can start small and build yourself up. So what if your body needs to adjust to simply walking briskly for two blocks while the next-door neighbor is entering the Ironman® Triathlon. Get over it! Start! Just get going! As the Nike shoe company slogan puts it: “Just Do It!” The miraculous part of exercising is that, within a relatively short interval of consistent, persistent exercise, your body will have grown accustomed to the initial two blocks. Now it’s ready for more. If you can’t walk because you are wheelchair-bound, then don’t give up. Roll the chair! Roll it up hill, like a driveway, until that becomes easy. Then go up and down twice and so on.

Even while you are in the hospital, get up, and get moving. Crawl to the bathroom if you must. If you’re bedridden, then start by contracting your calves by pressing the balls of your feet against the footboard. You get the idea. I will put it bluntly: unless you are in a coma, you can figure out how to exert yourself. Exercise is more important to your recovery than all the drugs in the Pharmacy. I know that this may sound too simple but it’s the truth. Again, God offers us a wonderful solution to our dilemmas. In the final analysis, it is senseless to reject exercise because a sound mind can only work in a sound body. While this mortal machinery of ours must eventually fail, we show our gratitude for the gift of life by maintaining our bodies to the limit of their capabilities.

Read More, The Get Moving!

Mayo Clinic Article: Exercise: Rev Up Your Routine to Reduce Stress
Physical activity– whether it is a relaxing walk, bicycle racing or meditative tai chi–helps relieve stress.

Managing Stress With Regular Exercise on mindtools.com

How Can You Rehab a Broken Heart? article on washingtonpost.com
A substantial body of evidence holds that cardiac rehabilitation programs can benefit people who have had a heart attack or undergone heart surgery, improving their physical fitness and reducing the risk of another cardiac event.

Doctors’ Conscience and Rights

Okay, I’m bracing myself for a torrent of emails. The mere mention of the word “abortion” seems to polarize nearly everyone. It’s as if we are all zapped suddenly with a high voltage charge. So I expect sparks to fly.
Let’s get this clear: As a physician, I would never personally perform an abortion but, as a citizen, I would never restrict any woman’s right to have one. I remember seeing a single abortion in my education as a medical student. I left the room—the only surgical procedure I have walked out on in my entire medical career. But I would help any woman get the best medical attention she needed to obtain an abortion.

Now, in the twilight of his administration, President George W. Bush wants to sign regulations that would reportedly protect the rights of doctors and nurses who refuse to perform abortions on grounds of personal morals. But why has the President limited his final, executive attention span to reproductive issues? Isn’t this more of a political agenda than an ethical or medical one? Since when have physicians or nurses been compelled to deliver healthcare against their personal, moral objections? Aren’t they expected to excuse themselves if and when they feel morally compromised as long as the patient’s life is not in imminent peril? And aren’t they equally responsible to ensure that medical attention is rendered to the patient by someone whose care is not limited, compromised, or impaired by personal or ethical issues? Or are they allowed to restrict patient care because of personal beliefs?

Where do we draw these moral lines? Just abortion and reproductive issues? What if a surgeon decides it is against his or her moral code to help save the life of a convicted serial murderer? Is that a right to be protected? What if a nurse refused to treat a patient because of color or religious faith? Where do the line of personal morality end and the boundary of discrimination begin? Do the rights of doctors need protection, or do those of patients? Why isn’t there a dialogue, instead, about why healthcare cannot be delivered without compromise—irrespective of what reasons stand in the way?

I take the issues of spirituality and morality in Medicine very seriously. But I care enough to know that they extend to every corner of healthcare delivery. It impacts every practitioner and every patient. It’s not an issue to be signed at the midnight hour, but one to be debated in the broad daylight of public interest.

Learn more about the Right of Conscience rule and its implications on your rights:


LA Times - Broader medical refusal rule may go far beyond abortion
“The Bush administration plans a new ‘right of conscience’ rule that would allow more workers to refuse more procedures. Critics say it could apply to artificial insemination and birth control.”

Beliefnet - Bush Abortion Ruling Causes Furor
“A last-minute Bush administration plan to grant sweeping new protections to health care providers who oppose abortion and other procedures on religious or moral grounds has provoked a torrent of objections, including a strenuous protest from the government agency that enforces job-discrimination laws.”

The New York Times Op-Ed Contributor - Blocking Care for Women, By HILLARY RODHAM CLINTON and CECILE RICHARDS Published: September 18, 2008
“LAST month, the Bush administration launched the latest salvo in its eight-year campaign to undermine women’s rights and women’s health by placing ideology ahead of science: a proposed rule from the Department of Health and Human Services that would govern family planning.”

USNews.com - Your Doctor’s Rights Vs. Your Rights by Deborah Kotz

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