Doctors And Patients

Daniel Gray's stomach tells a story. The gnarled lines across his abdomen are the mementos of three surgeries on his digestive system. The slashes along each side are reminders of the time the stitches broke and the doctors put him into a drug-induced coma for seven weeks, keeping his abdomen open for repeated washes. The doctors made the slits so that they would have enough skin to stretch over the opening when they sewed him together. Gray, 46, was diagnosed 24 years ago with Crohn's disease, a chronic inflammation of the bowel and intestines that afflicts nearly 1 million people worldwide.

DOCTORS with the state medical society have come up with a way to address consumer angst surrounding health maintenance organizations.Among the bills they are pushing the in General Assembly is one that would penalize medical directors at HMOs -- including medical license revocation -- if a patient is hurt by an HMO's refusal to pay for medical treatment. This is a toned-down version of another bill -- a long shot -- that would allow patients to sue their HMOs.Both address the real worry shared by patients and doctors that some overly cost-conscious HMOs are denying patients needed medical treatment.

Health care mess is hurting both doctors and patientsThe Sun's article "Insurer may try to cut rates" (Aug. 5) noted that CareFirst BlueCross BlueShield hopes to renegotiate hospital rates with Maryland's hospitals. While the Maryland Hospital Association has petitioned the Health Services Cost Review Commission (HSCRC) to stop this, the HSCRC has taken a wait-and-see attitude.Hospitals around the state shudder at the prospect of yet another rate decrease, as they attempt to juggle budgets to remain afloat and offer good care.

Aetna U.S. Healthcare came under fire from the American Medical Association yesterday in the wake of complaints from doctors in six states that the health insurer's contracts are illegal and compromise patient care.If the alleged problems are not corrected, the AMA may file a lawsuit to try to force Aetna to make changes, the association said yesterday.In a letter to Aetna, the doctors' group contends that the contract allows insurance company officials to override patient care decisions without an avenue of appeal.

BOSTON -- By any definition, this one must be called a landmark case. It is described in just these terms of law and topography by everyone involved.On Wednesday, lawyers and doctors, patients and plaintiffs will carry the subject of death and dying over rough ethical and constitutional terrain into the Supreme Court. They will be asking the justices to point out a path across a treacherous landscape.The question arriving at the court from opposite ends of the country is whether a state can ban physician-assisted suicide.

A leader of the right-to-die movement said in Baltimore last night that the medical establishment should help people die if they are near death and ask for assistance.But an expert in medical ethics countered that argument and said such practices could lead to abuses, especially in a climate of high health care costs.Those were the polar views of Derek Humphry, author of "Final Exit," the best-selling book about assisted suicide for the dying, and founder of the Hemlock Society, and Dr. Arthur Caplan, professor of bioethics at the University of Pennsylvania.

It may be at least a year before the Supreme Court says anything definite about the rights of dying patients who want to hasten their deaths, but doctors and patients may not wait for the outcome -- and neither will the deepening ethical, moral and political controversy.Two recent rulings by federal appeals courts -- preludes to a likely test in the Supreme Court next year -- may already be sending a signal to terminally ill patients and their doctors that the "right to die" now has a firmer legal basis.

Trying to impose controversial new rules on health maintenance organizations, a House committee in Annapolis approved legislation yesterday that is intended to ensure patients' freedom to choose doctors.The heavily lobbied bill would require health maintenance organizations to offer patients the opportunity -- for an unspecified added cost -- to see doctors outside of the HMO.Although the House Economic Matters Committee overwhelmingly approved the bill, it faces strong opposition from the HMO industry and from doctors who had sought such legislation but were dismayed by some amendments.

Boston -- In a year when all politics is personal, it's almost a relief to come upon the ballot questions.The mixed assortment of initiatives, propositions, questions and referendums that dot the ballots offers far too many hot levers to pull on crime, taxes, immigration and term limits. But at least they are about something.Oregon's Measure 16 has gone straight to the biggest question of all: death. It's brought ''death with dignity'' or aid-in-dying for terminally ill patients before West Coast voters for the third time in four years.

IT IS with a great deal of pleasure that I register a loud and enthusiastic bravo for something the Clinton administration has done. The Department of Health and Human Services has issued new guidelines on the treatment of pain in cancer patients and has accordingly moved the country one step in the direction of sanity.There has long existed a paradox in this country: Just about anyone who wanted to get his hands on narcotics for illicit purposes could do so, but those who truly needed the drugs -- like cancer patients -- found themselves thwarted in a dozen frustrating and infuriating ways.

It's a name only a policy wonk could love: comparative effectiveness research. But get ready to hear a lot about it; it could save your rights as a patient - and maybe even your life. If opponents have their way, it could be the bogeyman that brings down health care reform. Using false and misleading scare tactics, Conservatives for Patients Rights, a group opposed to comprehensive health care reform, announced last week a $1 million ad attacking comparative effectiveness. However, an emerging consensus of strange bedfellows - from insurance companies to the Institute of Medicine to patients rights advocates - all support making a national investment in research to compare the effectiveness of drugs, devices and diagnostic procedures, and sharing the information that results with physicians and patients.

WASHINGTON - Medical researchers and politicians are tiptoeing into an area of health care that makes some Americans uncomfortable, even angry, and it has nothing to do with such hot-button issues as cloning and stem-cell research. This time, the idea is to press doctors and patients to use particular drugs and treatments in order to save money. On the surface, it seems simple enough: Billions of dollars could be saved if everyone adopted the regimens that research showed were best and most cost-effective - which, experts say, happens far less often than most patients think.

Daniel Gray's stomach tells a story. The gnarled lines across his abdomen are the mementos of three surgeries on his digestive system. The slashes along each side are reminders of the time the stitches broke and the doctors put him into a drug-induced coma for seven weeks, keeping his abdomen open for repeated washes. The doctors made the slits so that they would have enough skin to stretch over the opening when they sewed him together. Gray, 46, was diagnosed 24 years ago with Crohn's disease, a chronic inflammation of the bowel and intestines that afflicts nearly 1 million people worldwide.

When a study published this spring showed that Avandia, a drug that lowers diabetics' blood sugar, also increased their risk of heart complications, Dr. Mary M. Newman, a Lutherville internist, was in a quandary about what to advise her patients taking the medication. "It was easy for patients to feel the drug was proven to be dangerous and everyone was concerned," Newman said. "But the thing is, there were benefits." In the end, she said, the decision on whether to continue the medication varied with each patient.

In Brief Partial eclipse tonight The southern United States will be treated to a solar eclipse tonight at dinnertime, but even with safe viewing equipment and clear skies, Marylanders will see just a fraction of it. The moon's shadow will race across the Pacific Ocean, making landfall in Costa Rica and Panama before crossing the northern end of South America. There, the eclipse will be total, or "annular," with the moon blocking all but the outermost ring of the sun's disk. Between here and there, it will be a partial eclipse.

Physicians tend to do more of the talking during examinations when their patients are African-American, suggesting that race plays a role in how doctors and patients communicate, according to a new study that analyzes recorded conversations inside doctors' offices. The study, published in this month's American Journal of Public Health, listened in on examining rooms for clues to why minorities tend to get lower-quality health care than whites, even when they have equal access to care. Researchers at the Johns Hopkins Bloomberg School of Public Health, who conducted the study, found physicians talked 43 percent more than their black patients and only 24 percent more than their white ones.

Less than 24 hours after federal authorities announced that yet another painkiller was possibly linked to heart attacks, an arthritis sufferer e-mailed her Baltimore doctor yesterday a question that echoed across the country: "So what now?" The patient had shifted from Vioxx to Bextra to Celebrex and finally to naproxen - each time abandoning a drug that worked when news of possible cardiovascular risks emerged. Now, with the surprise announcement that naproxen had come under scrutiny, Dr. Marc C. Hochberg had no choice but to admit his limitations.

Come together to pass reform of tort system A General Assembly special session has been called, and we are overdue for bipartisan action to deal with Maryland's most serious health care and economic crisis in a decade ("Ehrlich calls for special session," Dec. 18). In a carefully researched report, the Governor's Task Force on Medical Malpractice and Health Care Access has offered a realistic, practical set of recommendations to proceed out of an impasse that is, to some degree, the fault of the trial lawyers, who can receive up to 40 percent of a malpractice settlement.

Doctors in Western Maryland kicked off a weeklong push yesterday to focus attention on skyrocketing medical malpractice insurance premiums, which they say are hounding them out of critical practice areas and threatening to lower the quality of health care. Instead of doing elective surgeries and office work, more than 50 doctors - mostly private practitioners in Washington County - plan to use most of the week to try to rally their patients and to lobby politicians in Annapolis, according to organizers of the effort.

A new study of 20,000 women with early breast cancer found that more than half did not receive the recommended schedule of chemotherapy. That deviation may have put them at risk for worsening of the disease or recurrences that could have been avoided. Often, doctors delayed therapy or cut back the dosage out of concern about side effects. "I think the intention here is good, to not make patients sick," said Dr. Gary H. Lyman, an author of the study and an oncologist at the University of Rochester.