There was a poll taken among doctors recently that indicated doctors thought there were too many doctors in the United States.

Well, of course doctors think there are too many doctors. It’s like asking real estate salesmen whether they think there are too many real estate salesmen.

I’d like to have a poll taken among patients to see if patients think there are too many doctors.

My position is that until every American has his own personal physician in constant attendance to take care of any hangnail that might occur during the day, there aren’t too many doctors.

We all want the kind of care President Bush gets. If I have a heart attack and start to fall, I want a doctor right there to catch me and start giving me nitroglycerin before I hit the floor.

I don’t have a lot of complaints with doctors. As a matter of fact, I have a high regard for them.

My wife’s father was a doctor. I admired him greatly and learned a lot about the medical profession from him.

I was skiing years ago at Lake Placid and took a bad, head-over-heels fall. I had made friends in the lodge with a doctor and we were skiing together when I went down. I didn’t have any idea what my new friend’s medical specialty was, but I knew I’d done something serious to my shoulder. So, when he came up to where I was lying in the snow, I asked him to see if my collarbone was broken. He looked anguished and said, “Gosh, Andy. I’ve been practicing psychiatry for 18 years. I don’t know one bone from another.”

Most of us think that until we beat the whole ugly business of dying, there are NOT too many doctors. I have no business giving doctors advice but I’m going to anyway.
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They picked the name Carol for its retro ring, like leaning over the back fence to get advice from a neighbor. But Carol.com’s ambitions are entirely futuristic.

Its creators want to do for health care what Travelocity did for airline tickets.

Ankle pain? Click on the matching body part and two options pop up. For $199, doctors at Sports and Orthopaedic Specialists will check out your ankle, review your medical history and recommend treatment. TRIA Orthopaedic Center lists a similar package for $213 — and a reminder that they are the team doctors for the Vikings and Timberwolves. What did patients think? Read user reviews. Will your health plan pay? Tap in your details and find out.

Plymouth-based Carol.com, which debuted this month, is the first attempt in the country to put those pieces together in an online medical marketplace. In doing that, Carol’s creators are riding the leading edge of a wave of change headed toward consumers just as questions about how to cure the nation’s chronic health care crisis are resounding from the corner cafe to the presidential campaign trail.
Some think putting more choices in consumers’ hands will drive down spiraling health care costs. Others fear those choices may be too complex for the average person to make. This occasional series aims to help you prepare for the potential benefits and risks in solutions being considered — and sometimes already launched — by insurers, providers, government and entrepreneurs such as Carol.com.

It’s been two decades since employers began a similarly seismic shift from pensions to 401(k) investment plans. Now, after struggling for years with shouldering medical costs that outstripped inflation, many employers would like a 401(k)-style setup for health care. They would contribute money, but employees would be responsible for spending the dollars and investing in healthy behavior.

That would create a clamor for information on prices, services, doctors and hospitals.

For now, the Carol site remains a work in progress with a limited number of services. But if it takes off, supporters say, Carol and the copycats it inspires could profoundly affect how Americans buy health care. That’s why it’s being watched by Harvard researchers, Washington think tanks and health care reformers across the country.

Its success depends on whether hospitals and clinics embrace the radical notion of bundling and pricing care with consumers in mind, not insurers, and make it all easy to compare. That open competition, proponents say, will drive down costs and raise quality.

“We need to move in this direction,” said Paul Ginsburg, president of the Center for Studying Health System Change in Washington. If Carol succeeds in the Twin Cities, Ginsburg said, “it should work in a lot of other places.”

Some providers are plunging in. Others are dipping a toe. HealthPartners put 100 employees to work describing and pricing more than 60 packages on Carol. Mayo Clinic has posted just one — for pregnancy counseling. The Twin Cities’ two biggest chains, Allina and Fairview, have yet to join.

The biggest buy-in will have to come from consumers themselves. Most Americans with insurance have high expectations for the care they’re entitled to, cost be damned. Are they ready to make the mind-shift to shopping for care and living a healthier lifestyle to reduce costs in the long term? As employers continue to pare benefits, they may not have a choice.

How did we get here?

In the past, most patients cared about just two numbers: monthly premiums and the co-pays they forked out for a doctor visit.

While everyone has felt the sting of rising premiums, with no clue to the actual cost of care, there has been little push to seek cheaper options or get serious about prevention.

Critics say this has helped fuel medical inflation, with medical costs now consuming a whopping 16 percent of the economy — far more than in other developed nations.

The Bush administration wants to moderate costs with health savings accounts, where consumers stash tax-deferred funds for medical expenses. These are paired with high-deductible, low-premium plans. The hope is that patients will take the money saved on premiums, park it in those accounts and make wise spending decisions on the first $2,000 or $5,000.

It’s too early to say whether these newfangled plans lead to better health or lower costs, but many employers aren’t waiting. This year, 9.5 million Americans have health savings accounts and their cousin, health reimbursement accounts, according to the Consumer Driven Market Report in Washington. That’s expected to rise to 13 million next year. (Health savings accounts are portable between employers while health reimbursement accounts are not.)

In addition, many health plans now also come with co-insurance, with members liable for 10 or 20 percent of a certain portion of medical bills.
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An Australian teenager who received a liver transplant has astonished medical experts by taking on her donor’s immune system. Writing in The New England Journal of Medicine, doctors from Sydney’s Westmead Children’s Hospital reported that the teenager’s blood group had changed to the donor’s blood type. Other tests revealed the stem cells from the donor liver had penetrated her bone marrow.

Astonishingly, the doctors involved found the girl’s immune system had almost totally been replaced by that of the donor and she no longer has to take anti-rejection drugs.

“We consulted widely throughout the hospital and then looked at the medical literature and consulted colleagues around the world to see if anyone had seen this kind of thing before,” Westmead’s Dr Michael Stormon told ABC News. “No one had, so we were stunned and amazed.”

Doctors from Westmead Children’s Hospital, the University of Sydney and the Australian National Liver Transplant Unit are researching the phenomenon further.
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Specialists in other states reject qualms about CVS units

The future of medicine in Massachusetts can be found along an unremarkable patch of suburbia south of Hartford, inside a CVS pharmacy where Sheree Albino sat hunched and pale on a recent Sunday morning.

Her sinuses were killing her. She wanted relief. And she didn’t have time to wait.

“So I came here,” Albino, 52, said, her voice rasping like sandpaper. She’d just left the drugstore’s MinuteClinic, a sliver of a medical office next to the photo processing counter and not far from the chew toys for dogs. “It’s quick and easy. They should have done this a long time ago.”

With CVS planning to open dozens of medical clinics in Massachusetts, Mayor Thomas M. Menino of Boston and other critics have warned of inferior care driven by an unquenchable profit motive. He and others predicted that in the name of convenience, patients would sacrifice an ongoing relationship with a doctor.

But interviews with a dozen independent researchers, insurers, and regulators in other states painted a far more positive portrait. Increasing evidence, they said, suggests that when patients are treated for sore throats and other minor illnesses at retail clinics, the care may actually be as good as – if not better than – in more traditional doctor offices. That is testament, in large measure, to an approach akin to a chef faithfully following a cookbook. Nurse-practitioners in the clinics use a computer-generated template that, for example, will not allow them to prescribe an antibiotic unless they first make sure the patient has no allergies to the drug.

“Frankly, from our perspective, there’s a lot of good stuff in the MinuteClinic model,” said Dr. Marcus Thygeson, vice president of HealthPartners, a major Minnesota medical plan whose patients have made 20,000 visits to the retail clinics in the past four years. “We like the convenience and ready access.”

No state has more experience with retail clinics than Minnesota, the birthplace nearly eight years ago of MinuteClinic, which still dominates the field even as competitors crowd in. An independent, nonprofit coalition of doctors, insurers, consumers, and employers called MN Community Measurement annually rates health clinics’ and doctors’ practices statewide.
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Under what circumstances can a patient in an emergency room be forced to submit to a procedure that doctors deem to be medically necessary? That question — and the notion of informed consent — is at the heart of a civil case that is about to go to trial in March in State Supreme Court in Manhattan.

Brian Persaud, a 38-year-old construction worker who lives in Brooklyn, asserts that he was forced to undergo a rectal examination after sustaining a head injury in an on-the-job accident at a Midtown construction site on May 20, 2003. Mr. Persaud was taken to the emergency room at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, where he received eight stitches to his head.

According to a lawsuit he later filed, Mr. Persaud was then told that he needed an immediate rectal examination to determine whether he had a spinal-cord injury. He adamantly objected to the procedure, he said, but was held down as he begged, “Please don’t do that.” As Mr. Persaud resisted, he freed one of his hands and struck a doctor, according to the suit. Then he was sedated, the suit says, with a breathing tube inserted through his mouth.

After Mr. Persaud regained consciousness, he was arrested, then taken — still in his hospital gown — to be booked on a misdemeanor assault charge. Gerrard M. Marrone, who was Mr. Persaud’s lawyer, got the criminal charges dropped, then helped Mr. Persaud file a civil lawsuit against the hospital.
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