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Articles by Jeff KaneColumnist
Dr. Jeff Kane: Variable bang for the healthcare buck
Have you ever seen your name on a theater marquee? I have. Many years ago, four-inch red letters blared “Dr. Kane” in front of a movie theater near Fourteenth and Fruitvale in Oakland. Films were no longer shown there, though. The theater had been divided into sad little offices, one of which was a medical clinic run by a pair of podiatrists. Each day they refreshed the marquee according to which doc was on duty. Young and naive, I knew something about medicine, but little about how the world worked.
Dr. Jeff Kane: Online docs
Telemedicine has been around awhile as a service to inaccessible patients and for some emergencies. Innovators are now unveiling the next logical advance, standard medical care via the internet. GoodRx.com, a drug discounter I mentioned in a previous column, has now brought forth GoodRx Care, which will have a remote doctor consult with you for $49 or, if you’ve purchased Gold membership, $19. Its services include treatments for common ailments, prescription refills, and testing.
Dr. Jeff Kane: The pharmaceutical shell game
I’ll sooner understand quantum theory than how drug prices are determined. Here’s the short answer: “Pharmacy Benefit Managers.” PBMs are firms hired by health insurance companies to handle price negotiations, insurance claims, and distribution of prescription drugs. They also negotiate rebates from drug manufacturers and mail-service pharmacies. In theory, PBMs are designed to take advantage of the collective buying power of patients, enabling lower drug prices. Are you still with me?
Dr. Jeff Kane: Contra-Contraception
A prominent source of numerous public health threats is overpopulation. Too many people has long been an issue of concern. In 1729, Anglo-Irish author Jonathan Swift addressed the issue with a facetious recommendation that the starving poor of Ireland could nourish both belly and purse by eating their too-numerous children.
Dr. Jeff Kane: Denial — A mental health emergency Original
COVID is pandemic, but denial is even more widespread. We’re in denial when we know something to be true but act as though it isn’t. Psychologists call denial a “defense,” since it protects us from what we’re not ready to face. You say I have cancer, Doc? You must have switched my records with someone else’s, so I’ll just stow that news on the back shelf and go back to watching the PGA tournament. Everyone employs denial occasionally. After all, it’s instantly effective.
Dr. Jeff Kane: Please press one
Suffering disturbing symptoms, I dialed Dr. Wamsgann’s number. “Hello. You’ve reached NextHealth, committed to the finest care for our valued patients. If this is an emergency, please hang up and dial 911. If you’re depressed or have experienced self-destructive thoughts, please hang up and dial 988. If you’re a youth in crisis, please hang up and dial 1-800-448-4663. This call may be monitored for training or by third parties.
Dr. Jeff Kane: Notes on aging
Ah, the revelations of aging. For example, we realize we’re not as cute as we used to be. Our spotless skin begins to look like salami. Getting up off the floor now requires planning, like parallel parking. What worked smoothly yesterday needs concentration today. Ease devolves into strain. With its almost daily changes, aging is like the unpredictability of adolescence, isn’t it?
Dr. Jeff Kane: Progress in healthcare
Healthcare has changed enormously during my lifetime. While it’s gotten outrageously expensive and is generally more corporate and impersonal than ever, it’s improved in many ways, too. When I was in training, for example, childhood acute leukemia was uniformly fatal. Today 85% of children with that diagnosis are alive after five years. Survival gains are equally impressive for many adult cancers.
Dr. Jeff Kane: Why aren’t we healthier?
There’s a disturbing gap between American healthcare and its goal, our health. Our system is arguably the best in the world for those who can afford it, but our general health lags behind. One dismal statistic from the World Health Organization finds the U.S. ranking 36th in life expectancy, behind Slovenia, Costa Rica, Canada, Japan, and all the rich countries of Europe. Much of our lag comes from widespread income inequities and uneven healthcare access.
Dr. Jeff Kane: Rx: Humor
A Gary Larson cartoon depicts a group of doctors on rounds, pointing and laughing at a patient. It’s captioned, “Doctors researching whether humor aids healing.” Sick, right? But we still laugh, so why? Maybe because illness is an experience so serious that humor, breaking the tension, suddenly makes us feel a bit better. In other words, humor is medicine. The classic example is Saturday Review editor Norman Cousins’ famous strategy for treating his painful spinal arthritis.
Dr. Jeff Kane: What’s going on
“Tell me about yourself.” This was the way a medical classmate of mine, a psychiatrist, greeted every new patient. It’s a great opener, since that’s what psychiatry’s about, after all. But as a doctor and well-experienced patient myself, I wonder why docs don’t generally do that, since it would benefit all concerned. For docs, perceiving patients in a scope wider than the diagnostic quest makes their work come alive … and, sadly, vice-versa.
Dr. Jeff Kane: The only thing we have to fear…
Six years ago, the American Medical Association adopted a resolution defining gun violence as a public health issue. Said its president, “With 30,000 men, women and children dying each year at the barrel of a gun in schools, movie theaters, workplaces, houses of worship and on live television, the United States faces a public health crisis of gun violence.” Despite all our thoughts and prayers, the shootings continue: last year gun deaths totaled 40,000.
Dr. Jeff Kane: Post-Traumatic Stress Disorder
Your cancer’s cured. It’s gone. You’re safe, so why are you so low now? You should be kicking up your heels, and instead you’re feeling anxious and losing sleep and flying off the handle for no reason. What’s wrong with you? Post-Traumatic Stress Disorder. Psychologists estimate that 7% of Americans are affected. We popularly associate PTSD with combat veterans, and certainly they experience extreme trauma, but it’s relatively common in cancer patients, too.
Dr. Jeff Kane: Dr. Oz rules
Last week we received a mass-mailed postcard touting a healthcare-oriented product. The card’s text and grammar were at fourth-grade level, virtually screaming SPAM, but a photo of Dr. Oz caught my eye. Pushing the product, the card stated, verbatim, “It was the most watched episode of dr oz in history.” In that case, sure, I’ll try it. What can I lose? If you can’t trust Dr. Oz, then these are indeed the end days. Not so long ago, physicians were icons of trust.
Dr. Jeff Kane: Why is America’s health sliding?
By some metrics our national health is doing well. Compared to other industrialized countries, we enjoy a higher survival after age 75, higher rates of cancer screening and survival, better control of blood pressure and cholesterol levels, and lower stroke mortality. In other important areas, though, America’s health comes up shockingly short. According to the National Institutes of Health, we suffer a higher infant mortality rate than any peer nation.
Dr. Jeff Kane: When you don’t know who you’re dealing with
Maybe you’ve seen the video series in which CEOs get themselves hired incognito as bottom-level newbies in their own businesses. Once on the job, they witness things their boardroom suits would never see, like maybe rats in the kitchen, a repulsive bathroom, or a psychopathic manager. They discover pleasing things, too. In this series it’s all there.
Dr. Jeff Kane: Alternative atmosphere
About half of us use “alternative” or “complementary” treatments. That’s a whole lot of acupuncture, homeopathy, herbs, Reiki, and a hundred other disciplines. In fact, it’s a colossal industry: Americans spend upward of $30 billion annually on alternatives. The most common question asked about them is, “Do they work?” That deserves more than a yes or no. Work toward what?
Dr. Jeff Kane: How it was is how it is
Many years ago I was the sole doc in a scruffy forest community that required a rough-and-tumble style of practice. A neighbor called me late one rainy winter night. “You gotta go see Butch the Rapper. I think he’s got pneumonia.” I actually had a little black doctor bag then. I fitted it with a couple of tools and a syringe of penicillin, donned my poncho, and scrabbled up the hill to Butch’s lean-to. Butch was a speed freak who made a paper-thin living hauling firewood.
Dr. Jeff Kane: Healthcare by bullying?
“Please don’t use unkind words with our staff. If you think you can do a better job, we’re accepting applications.” — Sign in a local pharmacy window As the pandemic further divides our culture, we’ve become pretty testy. Angry people, perceiving their rights are violated, bully, threaten, and attack restaurant workers, flight attendants, healthcare practitioners and other handy targets.
Dr. Jeff Kane: The Soviet pharmacy
When I visited Russia a couple of times in the old Soviet Union days, that system’s deliberate insanities amazed me daily. Trucks, for example, had windshield wiper mounts but no wipers. “Because it is not raining,” explained an Intourist guide. In August, Moscow’s largest public swimming pool was waterless “to prevent diseases.” Every consumer transaction was exasperating. Customers for anything from bread to socks had to wait in three separate lines.
Dr. Jeff Kane: ‘Gullible’ has been removed from the dictionary
Have you heard? Last week a whistleblower revealed that the new president of Ireland can’t speak a word of English. If you believe that, friends might consider you either crazy, ridiculously ignorant, or, depending on how they think, in possession of a scandalous truth. Every month I meet on Zoom with four psychiatrists. It’s not that I’m a high-maintenance patient; these are medical school classmates in regular reunion.
Dr. Jeff Kane: The stick
Walter, a retired art teacher with stage four prostate cancer, attended our patient support meetings. He was often in pain. When asked how he was doing, he’d say, smilingly, “Well, I have good days and I have better days.” One afternoon he arrived with a long, narrow package. Inside was a sturdy hardwood branch he’d whittled into a walking stick. He’d sculpted one end into a bald head which looked a lot like his, presumably reflecting a common side effect of chemo treatment.
Dr. Jeff Kane: Treatment vs. care
“A specialist is someone who knows more and more about less and less until he or she knows everything about nothing.” — Sign seen in Mayo Clinic The sign only exaggerates a bittersweet truth. Cardiologists thoroughly know hearts and neurologists know nerves, but although most specialists claim to also address the “whole patient,” their practice tends to narrow their scope to their organ of interest.
Dr. Jeff Kane: The tale and the teller
Shelley first attended our cancer support group just a day after she was diagnosed. When another participant gently asked her if there was anything she’d like to say, she only cried. In the next weekly meeting, she muttered that she was having a hard time and didn’t want to talk more about it. In her third meeting, Shelley said, “Cancer’s completely disrupted my life, and my family’s, too. It’s all I think about. I don’t even know how to think about it.
Dr. Jeff Kane: Tell me about yourself
As a freshman medical student, I took a course called “Introduction to the Doctor-Patient Relationship.” I was placed at the bedside of a randomly chosen patient for a half-hour. I knew no medicine, so we small-talked. Then I joined a group of four other students and two practicing doctors to discuss our experience. One of our instructors was a behavioral psychologist, the other an orthopedist, Dr. Lorin Stephens. The conversation rambled around, as if no one was sure of the curriculum.
Dr. Jeff Kane: Medical curmudgeons speak
I recently hung out — on Zoom, of course — with three med school classmates, Sam, Jean and Connor. We graduated before your parents were born, so, as befits our ages, we met in rocking chairs on our respective porches and reminisced about the “old days.” Our unsurprising consensus was that almost everything was better then: fifty cent coffee, easy parking, free college tuition. And that was before insurance agents, lawyers, drug reps, and bureaucrats contaminated the medical examining room.
Dr. Jeff Kane: Body/mind language
We’re all familiar with “body language,” our innate practice of expressing ourselves wordlessly, however unconsciously. We fold our arms and cross our legs when we feel defensive. We recognize winks, grimaces, and raised eyebrows as statements. Vocal tone communicates feeling as much as words do, and often more reliably. We express emotions in the form of sweat, aromas, pheromones, and who knows what else. Hardly any behavior, no matter how unconscious, is accidental.
Dr. Jeff Kane: Denial
Gina announced to her cancer support group, “I’m so tired of medical appointments and treatments and side effects. At this point I’m going to just live my life as though I don’t have cancer.” Another member said, “Don’t you think that’s being in denial?” “You bet it is,” Gina replied. “Denial is the only thing that works for me now.” She reopened her law practice and enjoyed what she could of her final months. Denial is refusal to acknowledge what’s demonstrably so.
Dr. Jeff Kane: Vaccine purgatory
Where is your place in the COVID immunization line? Vaccine is on the way, but there isn’t enough for everyone yet. Pfizer has said it can’t supply before June any additional doses to the U.S. beyond the 100 million already ordered. Since that immunization requires two doses, that’s enough for only 15% of Americans.
Dr. Jeff Kane: Unrest in the healthcare workplace
Emotions run high in medical settings — and higher in some places and times than others. When I was working in a county hospital decades ago, the sheriff found it necessary to maintain a substation in the ER. The first day I worked there, a martial arts instructor addled by a horse tranquilizer kicked me across the room. During this current pandemic of both virus and misinformation, emotions are especially high.
Dr. Jeff Kane: High-tech and high-touch
A month ago, Dr. John Sievert published a Union column applauding the emergence of telemedicine, also known as telehealth. He described several successful instances of its use in his practice, and recommended it as a valuable practice aid during current social distancing. I can’t help but agree. Ten years ago I observed a breast cancer support group that convened through video links. Participants checked in from widespread, medically underserved rural areas in Northern California.
Dr. Jeff Kane: How much do drugs really cost?
I like to think of myself as reasonably knowledgeable, and my training should equip me to understand things like drug prices. But almost every aspect of that field is as confusing as a back alley shell game. Like me, you were probably unfamiliar with PBMs. Health insurance companies hire “pharmacy benefit managers” to handle price negotiations, claims, and prescription drug distribution. PBMs serve 266 million Americans; the three largest occupy 78% of the market.
Dr. Jeff Kane: Silence as medicine
I was facilitating a support group for physicians one morning. Participants spoke of their professional experiences and joys, and their stresses and dissatisfactions, as well. One, a family practice doc, said, “I don’t know how I can go on. I have this huge office overhead and employees who rely on me, but our payments get cut more every month. I’m working my tail off but losing more money than I make. It’s killing me and wrecking my family.” He began to cry. The room went silent.
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