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Sun., June 23, 2013, midnight

Smart Bombs: Talking with patients is cheap, effective

The American Medical Association has voted to consider obesity a disease in the hopes that this will spur more direct communication between doctors and patients. Plus, it might increase the pressure on insurance companies to pay doctors for having these discussions.

It seems some physicians aren’t comfortable telling patients how to live, but if the discussion is about treating a disease, they’ll be more likely to weigh in. I got an email last week from a reader who wondered why doctors aren’t more aggressive in pointing out patients’ poor health habits. I’ve wondered the same, noting that I get more directives from dental hygienists and plumbers than any doctor I’ve ever had.

Most of us can identify our lousy health habits, but knowing the doctor will follow up on our progress – or lack thereof – at the next appointment can be a motivator. However, our health care system doesn’t always encourage this.

A couple of years ago, I made an “appointment” with my children’s pediatrician with no intention of bringing a kid along. I just wanted to talk with him privately about some concerns, but the nurse’s exasperation made it clear that I had breached a protocol. In the end, I was granted the chat, and it was cordial and productive. Whether it was deemed “billable,” I don’t know, but it could explain the frustration.

Doctors should get paid for taking the time to discuss health issues. It’s vital to preventing disease or managing conditions. It’s a key to cutting health care costs. But fee schedules favor tests and procedures. It wasn’t until 2011 that Medicare began paying doctors for broaching end-of-life planning with patients and their families. Before that, long-shot procedures would be covered, but not a discussion that could head off unwanted heroism. But the change had to be ushered in quietly – via presidential directive – to avoid more tantrums about “death panels.”

It’s good to see the grown-ups taking charge in health care.

bridge to Irrelevance. “Connectivity” was the buzzword for proponents of a grand pedestrian and bicycle bridge that would span the railroad tracks from the Riverpoint Campus to Sprague Avenue, just east of Division. It’s a concept Spokane City Councilman Mike Fagan might’ve kept in mind as he explained why he would be the lone holdout on the project.

At last Monday night’s City Council meeting, he noted his general distrust of state and federal government, which is where some funding would come from, the frustrating wait for full funding of the North Spokane Corridor and concerns about snow removal and general maintenance of the bridge. So far, so good. Then he concluded with this:

“I truly don’t think it is the right time, to tell you the truth. We’ve got this ugly piece of legislation that’s going to be starting in January 2014 called Obamacare. And personally I feel that it is going to hurt a lot more Americans than it reportedly is supposed to help. So, again, I remain very, very hesitant to support this.”

So there you have it: Obamacare – it’s why we can’t have nice things.

This episode has inspired me to keep a list of things the Affordable Care Act will get blamed for. Feel free to send me examples as you come across them. Connectivity optional.

Meter Made. “Worrisome.” “Invasion of privacy.” “Very Big Brother-ish, a little bit.”

Reactions to the National Security Agency spying on us? Nope. Cameras in public places? Nope. In fact, most Americans are fine with those types of surveillance, according to recent surveys.

This is about the possibility of high-tech parking meters snooping on cars in downtown Spokane. They know when cars arrive and depart. They know when the time is up. They know how to contact ticket writers when the meter expires.

The comments in Thursday’s Spokesman-Review article were, well, very over the top, a little bit. But it’s something to keep in mind the next time government is bashed for inefficiency. Some people prefer that.

Associate Editor Gary Crooks can be reached at or (509) 459-5026. Follow him on Twitter at @GaryCrooks.

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