Healthcare Archive

Getting a living will, health care proxy, or other advance directive now will give you more power over your treatment later.

Talking to you loved ones about your wishes for future medical care is key to ensuring you choices are respected.
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You've probably heard of a living will, a legal document that allows you to specify the kind of medical care you'd like at the end of life. But who'll make sure those wishes are carried out? And what if you need someone to make your health care decisions long before life's end?

In January the Department of Health and Human Services released new guidelines outlining patients' rights to their own medical records.

Ask the doctors

Q: I went for my usual check-up, and in addition to taking my blood pressure, the medical assistant handed me a form to fill out with nine questions related to my mental health. I've never had this happen before. Is this new?

A: Yes, it is new for most people. The U.S. Preventive Services Task Force (USPSTF) has just released an important depression screening recommendation. The USPSTF recommends regular depression screening for all adults, which is a modification from advice originally given in 2009, in which screening was recommended only for clinics or doctors who had adequate support systems to provide mental health care for those who were identified with depression. Since that time, multiple studies have found that mental health care from primary care clinicians works very well, and probably just as well as specialist care from psychiatrists. That isn't to say we don't need care from psychiatrists, but rather that not everyone needs a psychiatrist, especially those with mild to moderate depression.

Your primary care provider should help you control risks for heart disease and refer you to a cardiologist if needed.

Any primary care provider you see—a doctor, nurse practitioner, or physician's assistant—should offer detailed advice on how to lessen your odds of cardiovascular disease, which is responsible for one in three deaths in the United States. However, some people need more specialized care for their hearts.

"I see or hear from a lot of people who have very common problems, like high cholesterol and high blood pressure, who think they need to see a cardiologist," says Dr. Patrick O'Gara, a cardiologist at Harvard-affiliated Brigham and Women's Hospital. For many people, a primary care physician can effectively manage those problems. But if you have specific concerns, talk to your doctor about whether more specialized care might be beneficial, says Dr. O'Gara.

They're convenient and affordable, but they don't replace a relationship with a primary care physician.

Walk into a drugstore, supermarket, or "big box" store these days, and you'll find more than prescriptions, food, and household goods. Many now feature health clinics. They're part of the big trend of making health care more convenient. "Twenty years ago you had to go to an emergency department if you got sick and needed immediate care. Now we have an explosion of options, such as retail health clinics," says Dr. Ateev Mehrotra, a researcher on the topic and an associate professor of health care policy at Harvard Medical School.

The clinics

Retail health clinics began showing up about 15 years ago. Today, there are about 2,000 clinics across the United States, mostly in large retail chain settings. A typical clinic is open from 7 a.m. to 7 p.m., seven days a week, and is staffed by a nurse practitioner or a physician assistant. Clinics offer all kinds of health services—everything from treating minor illness like a cold, pinkeye, or a urinary tract infection to providing physicals, health screenings, lab work, smoking cessation help, and vaccinations.

Music therapy can calm anxiety, ease pain, and provide a pleasant diversion during chemotherapy or a hospital stay.

It's almost impossible to find someone who doesn't feel a strong connection to music. Even if you can't carry a tune or play an instrument, you can probably reel off a list of songs that evoke happy memories and raise your spirits. Surgeons have long played their favorite music to relieve stress in the operating room, and extending music to patients has been linked to improved surgical outcomes. In the past few decades, music therapy has played an increasing role in all facets of healing.

What is music therapy?

Music therapy is a burgeoning field. People who become certified music therapists are usually accomplished musicians who have deep knowledge of how music can evoke emotional responses to relax or stimulate people or help them heal. They combine this knowledge with their familiarity with a wide variety of musical styles to find the specific kind that can get you through a challenging physical rehab session or guide you into meditation. And they can find that music in your favorite genre, be it electropop or grand opera.

Medicare Advantage plans are offering home visits to healthy people who have their own doctors. Their purpose isn't clear.

For many of the 17 million people insured by a Medicare Advantage plan, the offer of a home visit may come as a surprise. (Medicare Advantage plans, which cover about a third of Medicare recipients, are offered by private companies approved by Medicare, and Medicare reimburses those companies for part of the care they pay for.) According to the Centers for Medicare & Medicaid Services, home visits are on the increase among people with these plans, and not just among the sick or housebound. Patients who are healthy and mobile are also being offered home visits, and millions have undergone them.

What are home visits?

The home visit—which typically lasts 45 minutes to one hour and includes a physical exam, health history, and lab tests—is conducted by a nurse practitioner or physician under contract to the insurance plan. The results are forwarded to the person's primary care provider for follow-up. The insurers stress that the home visits are not a substitute for an annual physical or recommended screening tests.

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Ask the doctor

Q. I would like to take generic drugs instead of brand-name drugs whenever possible, because they're cheaper. But are they really as effective?

A. First of all, generic drugs contain the exact same active ingredients as the brand-name versions. Second, in the United States, before approving a generic drug, the FDA must test it to be sure that the manufacturer has produced the same molecule, and that it achieves the same levels in the blood as the brand-name drug. Third, there have been many careful studies comparing generic drugs (once they have been approved) to their brand-name equivalents.

News Briefs

New guidelines from the American College of Physicians (ACP) urge doctors to prescribe generic medications whenever possible, rather than more expensive brand-name medications. The guidelines were published online Nov. 24, 2015, in Annals of Internal Medicine. An ACP committee, led by Harvard Medical School's Dr. Niteesh Choudhry, analyzed more than 2,500 studies and found that brand-name prescription medications are more likely to be prescribed, but not filled. The committee also observed that people do a better job of sticking to a medication regimen if they take generics, since the drugs are cheaper and people are more likely to get prescriptions filled. (If you're more likely to take a medication, you're more likely to get better.) Do generics work just as well? The committee found that the vast majority of the evidence showed generic drugs are as effective as brand-name medications when it comes to health outcomes. If your doctor prescribes a brand-name medication, ask if there's a generic that will do the same job and save you money.