Future of Health CareValue-Based Health CareWomen and Health Care
April 11, 2019

When Women Call Out Medical Gaslighting, Providers Lose the Whole Family

A smart business would not deliberately blame customers for needing their services or accuse them of spinning fictions. A business dependent on customer loyalty and engagement for their success—and what business doesn’t?—would normally pay close attention to customer concerns in social and mainstream media. All the more so in health care, where the needs are generally much more significant, and the consequences of failing the patient are literally a matter of life or death. That’s why providers In Value-Based Health Care should pay close attention to the increasing din of “medical gaslighting” charges by women. These are not idle accusations.…
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Future of Health CareMedical Decision-MakingResearch
April 3, 2019

If Not Now, It’s Too Late: Simple Randomization Can Lead to False Inferences 
About Treatment Decisions

Medical decisions are best made on the basis of clinical science. Accurate research, shared between physician and patient, enables the patient to make an informed choice about risks and outcomes of treatment options. That’s how it should work, in theory. But in practice, even with the best shared medical decision-making, far too much clinical research employs faulty methodologies that limit the relevance of findings. This must change. In a recent blog post, I suggested that clinical science can improve by choosing more representative groups of people for study. Many clinical studies use convenience samples of patients rather than samples chosen…
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Future of Health CareMedical Decision-MakingPopulation HealthValue-Based Health CareWomen and Health Care
March 28, 2019

Women with Autoimmune Diseases Fight Uphill Battle on Every Health Care Front

Our articles on women’s health care issues have focused on areas that must change in order to provide better quality and outcomes, to lower costs, to advance treatment, and to treat women respectfully and equitably as patients and providers. We have demonstrated how women have been sidelined from getting the right health care because of two key systemic obstacles that must be addressed: Cultural bias that prevents accurate clinical assessment of symptoms and diagnosis, adoption or use of protocols relative to women’s biology, and effective health care therapies, and Inadequate basic science and clinical research that will illuminate sex-differentiated biology…
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Future of Health CareResearchWomen and Health Care
March 20, 2019

At the Heart of Gender Disparities in Health Care is Women’s Pain

Pain is a key symptom of injury or disease, and managing acute pain is usually one of the first services provided to patients. But if the patient in pain is a woman, the provider may require more convincing. Providers doubt that women’s pain is real and underestimate the level of pain for women. Substantial evidence shows that providers report higher levels of pain for men than for women. Gender stereotypes are so strong that in a recent pediatric study, participants evaluating a child’s pain reported higher levels when told that the child was a boy and lower if told it…
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ACOsFuture of Health CarePopulation HealthValue-Based Health CareWomen and Health Care
March 13, 2019

Women’s Health Research Needs an Infusion: How Health Systems and ACOs Should Help Correct Gender Disparities

Women receive health care that is below par, and the consequences are unnecessary morbidity and death. It is fact, not fiction—borne out by significant data that reveal disparities across many major conditions—that inattention to women’s unique symptoms, risk factors, disease biology and treatment effects are causing harm to women. Despite the reality, a poor body of research exists to point women’s health in the right direction. Value-Based Health Care (VBHC) assumes that we can measure providers’ delivery of health care against clinical standards. What if we don’t even know how half the population exhibits disease or responds to therapies? At…
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Future of Health CareMedical Decision-MakingResearch
March 6, 2019

If Not Now, It’s Too Late: Clinical Science Is Futile If We Study the Wrong Population

In 1936, the Literary Digest, a respected national magazine, undertook a public opinion poll. Who would win the race between Republican Alfred Landon, governor of Kansas, and Democratic incumbent Franklin D. Roosevelt? Mock ballots were mailed to 10 million Americans. About 2.4 million responded—one of the largest survey samples ever created. Their prediction? Landon would carry the day. They were wrong—by a landslide for FDR. That’s because respondents were biased toward Landon and did not accurately represent the distribution of presidential preferences across all voters. Notably, George Gallop accurately predicted FDR’s victory using a smaller representative sample of about 50,000…
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Consumers & PatientsFuture of Health CareValue-Based Health CareWomen and Health Care
February 27, 2019

How Gender Discrimination Against Women Physicians Handicaps Value and Patient Care

We need to get women’s health care right. This is not a parochial issue, important only to women, and disconnected from Value-Based Health Care. Gender disparity in health care is real, with significant ramifications for outcomes—for the patients, certainly, as well as for providers’ ability to succeed under risk. Just as quality measurement is necessary to improving quality, achieving the triple aim of quality, cost and patient experience must include both measurement and elimination of gender and gender-race impediments. ACOs and providers accept that they must help patients overcome social attributes of health if those patients are to improve. Yet…
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ACOsFuture of Health CareValue-Based Health CareWomen and Health Care
February 20, 2019

Providers, Take Note: Prepare for the Future Health Care of Older Women

Our review of women’s health care has called attention to disparities in risk factors and biological disease differences, treatment variances, and lack of adequate research. Gender and race have obscured perceptions of women’s symptoms, creating delays in diagnoses and treatments and even early death. A serious gap in gender-specific research and gender-analyzed data contributes to this profound lack of understanding of differential biology and treatment options. Even for conditions that are more specific to women, such as breast cancer and maternity, clinical care and research funding is heavy on front-end detection and prevention but fails to focus on women at…
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Consumers & PatientsFuture of Health CareMedical Decision-MakingResearch
February 13, 2019

If Not Now, It’s Too Late: Clinical Science Needs Fixing

In 1967, the year I graduated from high school, my family’s television required “rabbit ear” antennae with perched aluminum foil. Our farming family had little time to watch TV, but when we did, the ritual included a side trip to reset the antennae’s angle to ensure good reception. Today, I watch a clear picture on myriad devices, no antennae needed. In the 1980s, my trips to a library to find medical literature were few. A single trip to the library would take hours and net only a small number of papers. Now, I obtain articles on any topic in a…
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Population HealthRiskValue-Based Health CareWomen and Health Care
February 6, 2019

Higher Risks, Worse Disease, Fewer Choices: Health Care Fails African American Women the Most

No matter how we measure disparity in health care for women in the U.S, African American women stand out. Across the board, they have higher risk factors for disease and poorer outcomes, including much higher mortality for many conditions. African American women contract cardiac disease and cancer at a younger age and, often, in worse forms. Their risk of maternal death after giving birth is three or four times greater. Health care for African American women is complicated by racial and gender prejudices as well as by poverty and inadequate insurance coverage. But even among African American women who are…
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