A Day in the Life Scenarios



Best States for Health Care

The most recent edition of Medical Economics Online published the results of two surveys I found interesting. One reflects the state of medical care in different states in the U.S., and the other is a commentary on the social and ethical state of the general population. I have overused the word state in this statement, but the state of affairs in the United States needs a restatement, ie. shaking up!

In the first survey, titled “2019’s Best and Worst States for Health Care,” Wallet Hub, a personal financial website, took data from the Center for Disease Control (CDC), the Centers for Medicare and Medicaid Services (CMS), and the Kaiser Family Foundation and compiled a listing of the best areas of the U.S. to obtain medical care. They evaluated 43 measures of cost, accessibility, and patient outcomes. Cost included insurance premiums, deductibles, and out-of-pocket expenses, the lower the better. Accessibility referred to public access to physicians, hospitals, and other providers and services. Outcomes refers to the quality of care patients received and if their state of health improved.

In reverse order, the Top 10 States for Health Care are as follows:

10. Iowa

9. North Dakota

8. Maine

7. Hawaii

6. New Hampshire

5. Vermont

4. District of Columbia

3. Rhode Island

2. Massachusetts

1. Minnesota

Unfortunately, the article omitted an explanation of each state’s strengths and weaknesses, but several subcategories were listed and rankings within those groups were stated. Minnesota, overall number one, was not first in any of these categories, but it ranked well-enough in each (2nd in cost, 4th in access, 9th in outcomes) to earn the top ranking.

Massachusetts was first in patient outcomes.

District of Columbia was first in cost.

Maine was first in access to medical care.

Lowest infant mortality rate: Massachusetts

Lowest cancer rate: New Mexico

Lowest heart disease rate: Colorado

States in the deep south and Appalachia were near the bottom in several categories. Kentucky had the highest cancer rate, and West Virginia the highest rate of heart disease. The overall worst state was Alaska which had the highest cost of any state, average access, and below average outcomes. My two states, Indiana and Arizona, ranked 34th and 41st, respectively.

Dr. G’s Opinion: I’m not sure what purpose this survey serves other than to give medical economists something to talk about, and I really doubt this will motivate people to move to Minnesota or Massachusetts. People still live where they want to live or where they can find a job that supports their family. Yes, I suppose cost, access, and outcomes are important to Joe Public, but not as much as being happy and gainfully employed.

The second survey is a disturbing commentary on the state of honesty and ethical behavior in the U.S. It deals with patients lying to their physicians. The title “Do Patients Lie to Their Doctors?” is answered by a resounding “YES!” Just turn on the TV and watch interviews of just about anybody. Politicians, celebrities, commentators, etc. all skew the facts or ignore them, then lie to support their biased agenda or slander someone else. Our society has become one in which if you have to lie to get what you want, or hide something, so be it.

In this survey, a company that helps people select and buy life insurance, asked 500 people if they lied to their doctors. Twenty-three percent, or nearly one-fourth, of the people admitted they had lied to their doctor. Various reasons were cited:

46% lied about smoking

43% lied about their exercise habits

33% lied about the amount of alcohol they drank

29% lied about sexual partners they had (33% of women, 21% of men)

I know the smoking issue to be true. Patients deny smoking even when the smell of tobacco smoke wafts from their clothing. Alcohol consumption is always underestimated. Patients don’t deny drinking, but they often say they just drink socially when they really consume much more. It’s not uncommon for a grossly overweight patient to overstate their amount of exercise. If they really did as much exercise as they say, their weight would reflect it.

The survey determined several reasons why patients lie to their doctors.

33% lied to avoid discrimination or embarrassment

22% lie because they don’t want to admit something

1% lie to avoid hearing about their faults

1% lie about sex when their spouse/parent are in the room

Lying to your doctor hurts no one but yourself. He’s going to know you smoke because he can smell it on you. He knows you drink more because your spouse has told him. He knows you don’t exercise because you’ve gained, not lost, weight. And you’re not taking your medicine everyday because your BP, cholesterol, and blood sugar show it.

So if you’re not honest with your doctor, who are you honest with? Anybody? It’s easier to tell the truth because you know the true story. When you lie, you have to remember what you said to be able to give the same lie when asked again. I’m not surprised by this survey because I dealt with patients distorting the truth every day. All doctors do. It’s almost an accepted societal norm. If it is, it’s a darn shame and speaks poorly of our ethics.

Unfortunately, doctors can bend the truth, too. That’s inexcusable. The doctor-patient relationship is based on trust and confidence which cannot be jeopardized by either side not being truthful with the other. Even when it’s embarrassing and hurts to admit, telling the truth is always best. Being truthful to yourself first, then also to others, is the best thing to do. Lying diminishes other people’s opinion of you and confidence in you. Being deceptive to your doctor doesn’t hurt him, but it certainly influences his opinion of you. Telling the truth reveals your ethical values and wisdom and strengthens your relationship with your doctor. That’s a good thing!

References: https://wallethub.com/edu/States-with-best-Health-care


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