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An Open Letter to Tom Price MD , Secretary of HHS re healthcare

From one AMA member to another. I am embarrassed that you stood there supporting Trump’s plan to replace the ACA with another terrible piece of legislation. I am delighted that it failed.

Like it or not, the ACA provided health care for millions of American who did not have it. Was it great – no, it needed to be fixed and still does. What you tried to do was ram through a terrible bill in 18 days when it originally took a year and a half to formulate and get passed – the ACA- and even then it was imperfect.

If you want to improve healthcare in the US, you need to sit down with all parties involved — ie Democrats and Republicans. Your plan alienated many of those who voted for your boss, Trump.

You know as well as I do, why the 65 yo male has to pay for maternity care, because the 23 yo female pays for his prostate care. The well finance insurance for the sick – if not the government pays for it.

So when you were an orthopedist – a non insured 23 yo male came in with a fracture? Did you send him out because he had no insurance — no the hospital had to eat the bill and you gave care for free. We all need to be insured or no one is safe. Today 60% of individual bankruptcy filings are because of medical bills due to lack of insurance.

On your web site it says that you are” dedicated to advancing the quality of health care in America – both as a physician and policymaker.” Prove it by working across the aisle to improve our system not destroy it. You know as well as I that we need to get rid of for profit insurance companies – all Americans should be able to afford insurance – not make insurance company CEOs get rich. The cost of drugs needs to be brought down too. Why is one drug in Canada or Europe half the price of the same drug here. Also the costs of medical malpractice insurance needs to be reduced with tort reform.

Although I hate to admit it, Medicare does a good job of covering me. The overhead for the insurance is low and it gives me peace of mind that my care will be covered and even though I maintain a catastrophic insurance policy, I know that my doctors and hospitals will receive payment.

In doing your job, you should re look at the Hippocratic Oath — do no harm is a main tenet – you would have harmed over 12 million persons by removing their insurance.

As a doctor, I have learned from my mistakes and have always been inclusive when making important decisions — I hope you can do that too.

William Rosenblatt MD
AMA Delegate from New York State 1983 – 2013

Round or Shaped Breast Implants: How to Decide

I am often asked by my patients contemplating breast augmentation whether should they get anatomically shaped implants rather than round implants, with the thinking being the shaped implants would improve the visual result.  I am not a particular fan of the anatomically shaped implants because I don’t think this type of implant actually improves the result,  and only costs patients more money for no increased benefit.   I believe that the results of mammoplasty, as in most cosmetic plastic surgery procedures,  are directly related to the skill of the surgeon.

Now there is a study that supports my thinking.  Recently, plastic surgeons and nurses were asked to look at both pre- and post-operative photos of patients who had either smooth round implants or anatomically shaped implants. They were asked to decide which type of implant they thought the patient had received.  The result of the study was that they were unable to differentiate between the two.  They had a 50% chance of guessing right or wrong, just like a coin toss. The authors concluded that there was no justification for the systematic use of anatomically shaped implants. You can read the results of the study here: https://www.ncbi.nlm.nih.gov/pubmed/28027228.

So, I am delighted that there is now evidence in the literature supporting my opinion that it is a waste of money to the patient to implant anatomically shaped implants for routine augmentation mammoplasty.

BOTOX® vs. XEOMIN®: Is one better than the other for frown lines?

It used to be that BOTOX® (onabotulinumtoxinA) was the only kid on the block for treating the those deep frown lines between the eyebrows that many of us have from a lifetime of worrying or just genetic bad luck.  Now, doctors have XEOMIN® (incobotulinumtoxinA) as an alternative treatment. XEOMIN was FDA-approved in 2011 for the temporary improvement in the appearance of moderate to severe glabellar (frown) lines in adults, so there is already a lot of experience with it.

A recent head-to-head study of 547 female adults (mean age, 41 years) with moderate to severe frown lines examined  the effect of BOTOX or XEOMIN at 1,2,3, and 4 months.  Both an independent review panel AND the treated patients reported similar satisfaction with the results at all times points.  For both BOTOX and XEOMIN, the median onset of effect was similarly reported to be 3 days.

And there was no difference in “peak effect,” which is medical researcher talk for the time is takes for the full effect to become obvious.

peak-effect

Now that BOTOX has some competition, it’s possible to get the benefits of BOTOX at lower cost.  XEOMIN is less expensive and also has an ‘Xperience” program than can save you even more money.  Check it out here:  http://www.xeominaesthetic.com/xperience-program/  and stop frowning about the cost of BOTOX.

Cosmetic surgery can change what people think of you… and it’s more than your attractiveness

Research from Georgetown University and published in JAMA Facial Plastic Surgery, suggests that facial profiling can change following facial plastic surgery.  The study involved rating personality traits, attractiveness, and femininity using before and after photos of white female patients who underwent facial rejuvenation surgery (face lift, upper or lower blepharoplasty, eyebrow lift, neck lift, and or chin implant).  The traits rated were aggressiveness, extroversion, likability, trustworthiness, risk seeking, social skills, attractiveness, and femininity.

Of the 8 traits evaluated, the following 4 traits had significant ratings improvement: likability, social skills, attractiveness, and femininity.

Plastic surgeons have always felt that cosmetic surgery improves more than one’s appearance.  This study finally confirms that belief. So, don’t expect the world to radically change for you with cosmetic surgery, but with the improvement in your appearance, you may find there will be some benefits beyond what you see in the mirror.

 

Don’t Be Deceived by “Top Doctor” Lists

In her article Top Doctors, Dead or Alive  in the August 12, 2014 edition of the New York Times, Abigail Zuger, MD talks about the “Best Doctor” lists that are published yearly. Many patients read New York Magazine and Castle and Connolly’s lists of Best Doctors, and either check for their physician or look for one to go to based on these lists.  But is that the best way to go about finding a doctor that is right for you? One fallacy of these lists pointed out by Dr. Zuger was a physician who had died 16 years earlier but was still listed as a “Best” doctor.

There are many ways to get onto one of these lists and each source lists how they go about selecting physicians. Often referrals from other physicians help a doctor get onto these lists. Sadly, one of the ways physicians can increase their chances of being selected is by hiring  a publicist to get his/her name circulated in the news media—both television and print.  This form of “advertising” can boost a person’s opinion of a particular doctor. Even another doctor’s opinion.

I have been on Castle and Connolly’s Best Doctors lists for many years, and have once again been chosen as a Top Doc for 2014. New York Magazine has also selected me for their Best Doctors list from time to time. Why I make it one year and not the next is not clear to me.   What I do know is that I don’t have a publicist, and perhaps that is one of the reasons.

How to Really Evaluate a Physician

I believe that when one searches for a physician, these are the things to look for.

1. Board certification in their specialty. Check out the doctor online. In New York State it is easy. Just go to the New York State physician profile site here. You can learn where your doctor went to school, where he or she trained, and their board certification. If the doctor has a bad malpractice record, you will learn that as well. Also, any problems with professional misconduct will be listed. In addition the American Board of Medical Specialties Website here will give you additional information on the board certification of your doctor.

I don’t believe that many of the popular patient Website reviews are valuable to patients. Why? Because the patients who write reviews are usually those who are either very happy or very annoyed. Thus,  reviews are often skewed either low or high. I would worry if all the reviews you read of a particular physician are great, as someone may be falsifying them.  Just as there is no way that everyone loves the same restaurant, it is not possible that everyone loves the same doctor. Remember, there are no perfect physicians, as there are no perfect patients.

 2. The feeling you get when you see your doctor. Does your doctor answer your questions and spend adequate time with you? It is true that today’s health insurance pays so little that it is often hard to get everything in during your 10-minute slot, which is why clear, concise communication is very important by both the physician and the patient. Will the doctor be around on weekends and nights if you have an issue? Does s/he look at you when you are talking or is s/he engrossed in the computer, charting your data in their electronic record. Charts were much more personal, whereas computers are impersonal; this puts a large electronic wedge between the patient and the physician (you’ll hear more from me on this topic at a later date).

3. Is your doctor affiliated with a good hospital network? If so, your doctor’s credentials have been vetted by hospital administration and s/he should be well qualified. This also gives your doctor a large network of specialists to choose from in case you need other specialized care. Also, you don’t always need to see the “Chief.” Often they are chosen more for their administrative skills rather than patient care skills, so don’t be swayed by that credential alone.

So find a doctor you like, who is kind, gives you time, answers your questions. If s/he are on someone’s “Best” list, all the better, but don’t make that your only selection criterion.