In years past, a doctor had the authority and power to decide what treatment and/or modality was appropriate. Each health care provider chose the remedy, relief &/or intervention based upon the following: (1) a specific diagnosis; (2) a tentative diagnosis [provisional]; &/or (3) a differential diagnosis [generally, that which relates to multiple conditions or causes that are based upon probabilities].
As medical insurance, Medicare, Medicaid and now Obamacare (officially entitled the Affordable Care Act) have intervened, their coverage for treatment rendered by a physician has been strictly refined and restricted, as well as subject to interpretation more often than not by lay individuals. These current business and regulatory systems in place seek to justify their role by pointing to, among other things, the nature and amount of waste, and their goal to make our health care better. In doing so, they often perceive medical treatments as increasingly suspect. As such, the scope of coverage of the third party payer system has continued to place limits on physicians, hospitals and other health care providers, along with using monetary incentives to achieve their political and business goals.
Clearly, there are many who support the current scheme and, therefore, contend it is designed to produce an effective health care system, albeit conceding it is far from an ideal one. The opponents assert this system will inevitably lead to the rationing of medical care with a much smaller group of health care providers who choose such a career and, therefore, less available to serve the public, fewer innovations, and eventually far less medical research. In addition, they cite other countries that have socialized medicine and the inherent problems therein, including but not limited to the increasing waiting time before one can obtain an examination or evaluation; the length of time until one can obtain certain procedures and treatment; the inability of the physician to choose the nature and extent of care deemed appropriate; and, the growing trend to depersonalize the health care system as a whole. The debate continues while the ability to produce a better result is limited as each side remains polarized, and at times vilifying the other.
LiveScience published an article today on significant research conducted by the Brain Institute Center for Smell and Taste of the University of Florida. It was noted that the first area of the brain to degenerate in people who have been diagnosed with Alzheimer’s is the front part of the temporal lobe of our brain. This is the region that forms new memories and processes smells. The researchers believe the ability to perform these two skills are among the first to be affected in cognitive impairment.
This Blog is not intended as a substitute for a thorough and complete evaluation by a primary care physician &/or neurologist who commonly perform a painstaking history and physical examination and, when indicated, appropriate tests in order to arrive at a diagnosis. It is noteworthy that in some cases a physician may first come to a differential diagnosis and begin the task of ruling out one or more possible diseases. In terms of cognition and behavior, a neuropsychologist may perform a battery of tests to help a medical team arrive at a definitive diagnosis while physicians often use an MRI to rule out a stroke or a tumor that can cause changes and/or behavioral problems. Because there are other causes such as mental illness, depression, hypoglycemia (low blood sugar), it is critical that a physician be consulted for medical advice and treatment.
In the area of Alzheimer’s disease, physicians have declared there are several stages, beginning with no memory impairment (no symptoms of dementia) to severe or late-stage Alzheimer’s disease. A diagnosis of Mild Cognitive Impairment (MCI) might be made when a person takes longer to think of a word and/or to recall someone’s name, forgets things more often, etc.
The researchers at the University started with the premise that people with Alzheimer’s have been found to have a greater degeneration on the left side of their brain. They devised a very simple test for the smell acuity of patients they believe could aid in the diagnosis of early-stage Alzheimer’s disease. While the test only helps to confirm such a diagnosis, they hope to eventually be able to predict who will get Alzheimer’s. Essentially, patients were asked to close their eyes and pinch their right nostril while being asked when they smelled a cup of peanut butter that was placed near their other nostril. They found that patients who were later diagnosed with Alzheimer’s, which is linked to the left side of the brain, required the peanut butter to be placed closer to their left than their right nostril before it could be smelled. They concluded this test showed a degree of degeneration in the left hemisphere of the brain and could be a new step in the early diagnosis of Alzheimer’s.