Physician Patient

Archive for the ‘Message from the President’ Category

What are we thinking about Gender Dysphoria and Why?

Monday, June 24th, 2019

Katherine Kersten’s (June 21) Opinion article raises this important question: How can consumers (patients and families), taxpayers, and third party payers (employers, health plans, and government) evaluate the (growing) business of gender assignment, reassignment, and medical (hormonal) or surgical treatment for gender dysphoria? At Minneapolis Children’s Hospital a new program is doing this:https://www.kare11.com/article/news/childrens-hospital-minnesota-launches-new-gender-health-program/89-7e796ebb-00d9-432a-99b1-23bfdecea6bc

The motivation for professional gender dysphoria diagnosis and treatment may be altruistic, economic or other. But how scientific and clinically sound is this new business?

As a retired adult and addiction psychiatrist with no clinical experience treating gender dysphoric children (although I’ve heard concerns from a few of their parents), my chief concern is how the gender dysphoria diagnosis is conceptualized as a medical or mental disorder and the consequences to patients, the medical profession and society when our US health care system embraces “standards of care” such as http://www.teni.ie/attachments/92d213ab-8474-4f34-a931-ab95489b2afe.PDF
Society and politicians need to be informed about the ethical and economic underpinnings of the rationale by our major health care institutions such as Minneapolis and Boston Children’s Hospitals which now sponsor and promote insurance and government supported programs for hormone and surgical interventions geared to help gender dysphoric children (and adults). To my knowledge, these diagnostic assessments and treatments are based on psychological assessments of gender identity often in flux, as described by professor Eli Coleman at the University of Minnesota https://www.health.umn.edu/people/experts/eli-coleman-phd-lp
Moreover, we need to know much more about the consequences of implementing these hormonal and surgical interventions on suicide and medical morbidity, and we we need to consider advice to the public (and professions) about “best practices” for psychotherapy. Beware of government edicts.
On what assumptions and evidence are crucial psychological assessments of gender dysphoria based? We should ask psychiatrists and psychologists in the academic and practicing communities  familiar with these questions to offer their recommendations.
We also need to ask the patients and their families about their experiences. Hopefully they will receive more and more social acceptance, more economic skin in the game, and more and better health care choices in the future.

Empowered Employees: Employers are key to true Consumer-directed Health Care Reform

Friday, May 31st, 2019

https://www.wsj.com/articles/some-middlemen-reduce-health-care-costs-11559241151

https://www.wsj.com/articles/cut-out-the-medical-middlemen-11558294424?mod=article_inline

https://www.activatehealthcare.com/about-us/news/paladina-health-acquires-activate-healthcare-to-amplify-impact-of-primary-care-nationwide

Can employees benefit directly financially from employer-funded health care programs? If so, let’s discuss the evidence.

Companies like Activate (above) sell Direct Primary Care products to their employer clients. These are claimed to be cost-effective to the employer’s bottom line.

However, we must do better. Health care funding products should incentivize patients (consumers) to make cost-effective health care choices when evaluating and shopping for their health care. Are there “insurance” products available to employers which reward employees immediately and directly when they make (prudent) health care choices? What, in addition to funding patient controlled HSAs and HRAs, are employers willing to do to reward their employees (patients) when they seek out cost-effective medical care?
If employers see employee empowerment as being in their business interest (and we think it clearly is), this will be a boon to independent medical practices who (by definition) in providing personalized care seek to reduce health care costs by helping their patients to know and compare (whenever practical or feasible) real time health care prices for their medical care services and products (including medications).