If Americans are out of shape due to poor exercise, too much sugar, too much salt, etc., can the outcomes be expected to be stellar? To what degree can we hold the physicians, surgeons and hospitals responsible for reported longer length of hospital stays and poor outcomes?

During the fiscal year of 2010, self-referrals amounted to over $109 million dollars in extra payments from Medicare, which equates to approximately 400,000 diagnostic imaging examinations for seemingly arbitrary purposes.

Self-referral leads to more images, more treatment, more surgeries, etc., and contributes to the escalation in the unsustainable rising health-care costs. It is a vicious cycle. So why not just eliminate self-referral?

As parents, we tell our children not to drink coffee since it might "stunt your growth," but we do not tell them not to drink these caffeine-loaded energy drinks since it might kill them. The risks and severity of the dangers of these drinks are not being recognized.

Recent research shows that poor self-perception about weight actually contributes to obesity -- especially in teens.

Tell your referring physician and your radiologist -- and any other health care provider you see -- about pre-existing conditions and your symptoms. The more you reveal from the get-go, the better off you will be.

CT examinations, like all medical tests, should be performed only when medically required. The results of the proposed CT or any imaging examinations should answer a clinical question and either confirm or exclude a suspected condition.

Health care today is in a state of transition. Ultimately, good outcomes must prevail and delivery of services must be based on access to affordable quality care, not on discount shopping.

If nothing else, such a ban forces the consumer to stand up to get a refill, which may allow time for the individual to exercise some self-control as well as actually get a moment or two of physical exercise.

To help assure quality care for all, federal mandates have been issued requiring capture of information on race, ethnicity and language data as self-reported by patients or their caregivers. New regulations require hospitals to identify/address these health care disparities.

Patients should participate in the process of questioning as to what medical exams are to be performed and why. Active patient involvement will have the strongest impact on helping to curtail unnecessary testing, which is contributing to the health care crisis.

Bullying can happen in various forums and to individuals of all ages. Those without a voice, children, teenagers, the physically and mentally challenged, and the shy and timid are all vulnerable and in need of protection.

While the power of technology will and should continue to evolve and drive health care forward, technology like avatars, diagnostic supercomputers and automated service must not be considered a replacement for human interaction.

Free medical school tuition would certainly decrease the financial burden, but I believe that it is unlikely to be sufficient to steer medical students to enter primary care practices.