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Q: How many magicians does it take to change a light bulb?
A: Depends on what you want to change it into.

Turns out, weekends are especially hard. On weekdays, I would get up, do chores (mostly dog and chicken related), go to work, then come home. Either Danielle would have supper ready or, increasingly, we would go out because it was too much hassle cooking for two. Then I would settle down to do a little work and Danielle would do her thing until it was time for bed. Our days would overlap mostly at supper. The weekends, though, would be when we did OUR thing.

Danielle: Remember, tonight is Art Walk Friday

Me: Ok, but I’ll be about 6 because I have patients

Danielle: Well don’t be late because we’re meeting folks at the Bike Shop for dinner at 7:30 and I have to see the show at the Skinny Gallery. And then tomorrow we have to go to the symphony, and then…

Even on days like this when I was on call, we would carefully plan our trips and errands around my rounding schedule.

Now I have had to change my weekend routine.  Change, as they say, is inevitable.

Q: How many Marxists does it take to change a light bulb?
A: None. The light bulb contains the seeds of its own revolution.

Ranking things seems to be the new “news.” Almost everyone has put together a list of best and worst based on some criteria or another. My kids tell me these are called listicles. having the list without information in the title, so I understand, encourages folks to “click” ensuring more ad revenue. USA Today’s offering today was “The least healthy cities in America.” As everyone in America clicked to find out how their city fared, we in Mobile were (dis)honored to be #4:

4. Mobile, Ala.
>Premature death rate:
 490.3 per 100,000
> Adult obesity rate: 36.1%
> Pct. adults without health insurance: 12.9%
> Poverty rate: 19.9%

The average Mobile adult feels in poor mental shape for five days a month on average, far longer than the 3.5 days the average American feels in such a state. Poor mental health outcomes in Mobile may be tied to multiple unhealthy behavioral and socioeconomic factors in the area.

Mobile’s 36.1% obesity rate and 29.6% inactivity rate are both far higher than the corresponding national figures. Additionally, nearly one-fifth of area residents live in poverty, and 7.0% of the workforce is unemployed, each some of the highest such figures in the country.

Wow. For those with a memory for these things, in 2013 Business Insider tagged us the 3rd most miserable city in 2013. At the time I pointed out

The results of that survey, Perkins said, made it clear that Mobilians suffer from poor mental and physical health in large part because the city’s built environment is not conducive to being active. Access to healthy foods in poor neighborhoods is also poor, he said.

If Mobile wants to work its way off these lists, it’ll take change (see figure). We’ll need to invest in infrastructure  such as parks and bike lanes so people make healthier choices. Increase the minimum wage so folks have time to use these amenities to get and stay healthy. Expand Medicaid so folks are not one illness away from bankruptcy. Focus our care delivery system on health instead of on making money off of illness. In other words, while change may not be inevitable for Mobilians, it is the only way to get off of these lists.

Or, we could just double down on our football success:

HOW MANY SEC STUDENTS DOES IT TAKE TO CHANGE A LIGHT BULB?

At ALABAMA: It takes five, one to change it, three to reminisce about how The Bear would have done it, and one to throw the old bulb at an NCAA investigator.

8802-figure-1

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I rarely read USA Today except for the headlines when standing in line for coffee or when staying in a hotel and it ends up at my door. This time it is the hotel excuse but I admit I might have actually paid for a copy for this series. When Doctors Make You Sick is a series on people who think they were receiving but it turns out their doctor (as we say in health care) was Dr Iatros (meaning that the treatment caused actual harm, known as iatrogenic illness). The series now has 10 installments and range from hospital acquired infections to today’s article on doctors who perform unnecessary surgery. The article makes some observations that are pretty damning:

Tens of thousands of times each year, patients are wheeled into the nation’s operating rooms for surgery that isn’t necessary, a USA TODAY review of government records and medical databases finds.Public attention has been limited to a few sensational cases, typically involving doctors who put cardiac stents in patients who didn’t need them. In fact, unnecessary surgeries might account for 10% to 20% of all operations in some specialties, including a wide range of cardiac procedures — not only stents, but also angioplasty and pacemaker implants — as well as many spinal surgeries. Knee replacements, hysterectomies, and cesarean sections are among the other surgical procedures performed more often than needed, according to a review of in-depth studies and data generated by both government and academic sources.

And why are these procedures being done? Per USA Today, the answer is MONEY!

Who are these doctors?

“I think there are a very small percent of doctors who are crooked, maybe 1 or 2%,” says John Santa, a physician and former health system administrator who became director of the Consumer Reports Health Ratings Center in 2008.

“I think there’s a higher percentage who are not well trained or not competent” to determine when surgery is necessary, Santa says. “Then you have a big group who are more businessmen than medical professionals — doctors who look at those gray cases and say, ‘Well, I have enough here to justify surgery, so I’m going to do it.'”

The pressures are real. Doctors’ income can hinge largely on the number of surgeries they do — and the revenue those procedures generate. Those numbers also can determine whether doctors get privileges at certain hospitals or membership in top practices.

There’s no way to know what portion of unnecessary surgeries are related to these more subtle pressures, as opposed to poor training or fraud. Researchers simply know they’re happening.

USA Today offers a list of commonly over recommended procedures that is worth looking at. Bottom line, spending more on health care has not been proven to improve our health as a nation and in fact may contribute to our poor health. The series is worth a look.

 

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