Patients With High Medical Costs Less Likely To Trust Their Docs

A paper in the current issue of the Journal of General Internal Medicine reports that the rising cost of medical care threatens a vital aspect of the effective delivery of medical care—patient trust in their physician and continuity of care. This study found that patients with high medical cost burdens were more likely to question whether their physician would put their needs first, would refer them to specialists when needed and would perform unnecessary tests. Patients with high medical cost burdens also had more negative assessments of the thoroughness of care they receive from their physician. The association of high medical cost burdens with patient trust and perceived quality of care was greatest for privately insured people.

Other studies have suggested that patients and their doctors each play a part in creating this situation. For example in his book "How Doctors Think" Dr. Jerome Groopman points out that when working with a patient with multiple conditions doctors often tend to focus on the first one the patient talks about, and minimize the importance, or inter-relationship, of the others. This can cause the patient to doubt that the doctor is looking at their total situation. On the other hand, patients burdened with high medical costs are likely spending more time with doctors than the general population and be more involved in the specfic details of their care than the general population. As a result they may have expectations about the care they receive that healtheir individuals don't have.

What Not To Eat

Men's Health Magazine has published its 2009 list of the 20 worst foods in America. For the full list go here. Here is their pick for the #1 worst food in America:

Baskin Robbins Large Chocolate Oreo Shake
2,600 calories
135 g fat (59 g saturated fat, 2.5 g trans fats)
263 g sugars
1,700 mg sodium

Gag me with a spoon!

Author of "Autism's False Prophet" Gets Death Threats From Anitvaccine Crusaders

Talk about unhealthy behavior. Dr. Paul Offit, a highly respected pediatrician and the chief of infectious diseases at the Children's Hospital of Philadelphia, has received numerous death threats from those who are outraged by his book that claims there is no link between childhood vaccines and autism.

In recent years, the debate over vaccines and autism, which began in fear and confusion, has hardened into anger. As Dr. Offit's book details, numerous studies of thimerosal, measles virus and other alleged autism triggers in vaccines have been conducted, and hundreds of children with diagnoses of autism have undergone what he considers sham treatments and been "cured." Both sides insist that the medical evidence backs them.

Dr. Offit's book has been widely endorsed by pediatricians, autism researchers, vaccine companies and medical journalists who say it sums up, in layman's language, the scientific evidence for vaccines and forcefully argues that vulnerable parents are being manipulated by doctors promoting false cures and lawyers filing class-action suits.

For more on this highly charged topic, read this article by Donald G. McNeil in the NYTimes.