Month: August 2010

“If There’s a Doctor on Board, Please Ring Your Call Button”

Aug 25, 2010• 1

By BOB WACHTER, MD

Well, it happened again. Last Thursday evening, I was somewhere over Saskatchewan, returning from a lovely Mediterranean cruise, in that uncomfortable semi-conscious state that passes for sleep when you’re flying coach, when the airplane’s PA system rang out:

“If there’s a doctor on board, please ring your call button!”

If you’re old enough to remember the show “To Tell the Truth,” you know what happened next. In the show, four B-list celebrity judges guess which of three contestants holds a certain unusual job. Once the judges have made their guesses (guided by contestants’ answers to a series of questions), the real skunk breeder, or tea taster, or cemetery lot saleswoman is asked to stand. One contestant begins to rise, then checks herself and sits down. Then another. Finally the correct contestant stands. The audience lets out a collective “oooh.”

I’m guessing that the average packed Boeing 777 has at least a handful of doctor-passengers. When the call comes for a physician, I’m sure a few mutter, “no f-ing way” and go back to their Sudoku. But most, I think, respond like I do: we reach tentatively for our call button then, thinking better of it, stop, look around, start again, then finally push the damn thing. Even as we nobly hit the button, in our heart of hearts we hope that we’re number two – our guilt assuaged but our services unneeded.Continue reading…

To Med Students Considering Primary Care

Aug 24, 2010• 13

By ROB LAMBERTS, MD

Dear Student:

Thank you for your consideration of my profession for your career. I am a primary care physician and have practiced for the past 16 years in a privately-owned practice. (At some point I intend to stop practicing and start doing the real thing. It amazes me at how many patients let me practice on them.)

Anyhow, I thought I’d give you some advice as you go through what is perhaps your biggest decision regarding your career. Like me, you probably once thought that choosing to become a doctor was the biggest decision, but within medicine there are many options, giving a very wide range of career choices. It is the final choice that is, well, final. What are you going to do with your life? ”Being a doctor” covers so much range, that it really has little meaning. Dr. Oz is a doctor, and he has a very different life from mine (for one, he’s not the target of Oprah’s contempt like I am – but that’s a whole other story).

Here are the things to consider when thinking about primary care:

1. Do you like talking to people who are not like you?

Primary care doctors spend time with humans – normal humans. This is both good and bad, as you see all sides of people, the good, bad , crazy, annoying, funny, and vulnerable sides. If you see mental challenge as the main reason to do something, and would simply put up with the human interaction in primary care, don’t do it. The single most important thing I have with my patients that most non-pcp’s don’t have is relationship. I see people over their lifetime, and that gives me a unique perspective.

Health 2.0 Europe Conference Videos

Aug 23, 2010• 1

By Matthew Holt

On April 6-7, 2010, Health 2.0, in collaboration with Basil Strategies,
held the Health 2.0 Europe Conference in Paris, France. At long last Health 2.0 has posted the videos from this conference (translating geek speak about digital video formats was harder than we
thought). If you
go to Health 2.0 TV you can find all of the best on stage moments,
including the hosts’ opening introduction to Health 2.0, the keynote
speakers, the panels, and the demonstrations. We want to start you off
with the panel that has been called the best panel ever at Health 2.0,
Patients and Online Communities. This panel discussion is about the
impact that cultures, languages and context have on care delivery in
different countries.

Make sure that you stop by the Health
2.0 website and check out the Europe 2010 Conference videos.

Cliquez pour la vidéo en français

Op-Ed: The Government EHR

Aug 23, 2010• 19

By MARGALIT GUR-ARIE

No, you didn’t miss anything, there is no Government EHR. But should there be one? And if so, what should it look like?

The argument in favor of a Government EHR goes something like this: If we have 19 Billion dollars to spend on EHR adoption, why not spend a small fraction of that money and buy or build an EHR and make it freely available to all physicians and hospitals? Not a bad idea. I would add that, if we must, we could spend the rest of those billions on training and supporting physicians in their efforts to computerize their records. So how would a Government go about accomplishing such monumental task?Continue reading…

It’s My Life, It’s Now or Never

Aug 22, 2010• 16

By LISA SUENNEN

You can walk into a pharmacy any day and buy a test kit to find out if you are ovulating so that you can undertake family planning activities. You can buy home testing kits to screen for high cholesterol, presence of the HIV virus, even illicit drug use. You can also pony up $500 and buy yourself a genetic test kit from 23andMe, a retail DNA testing service, to find out what might be in your genetic blueprint. Hey, you can even visit a fortune teller if you feel that is how you want to make pre-emptive healthcare decisions.

While some might look askew at how you get information to make choices about your life, it is rare that someone steps in and tries to stop you from doing so. In general, the American way is to say, “Hey, you’re an adult and it’s your life. If you want to engage in self-actualization, whether or not it has a scientific basis, that’s your beeswax.”

As medicine has evolved to a point where over-the-counter testing has become more and more accessible, many consumers have responded to the perceived advantages of privacy, convenience and the heightened ability to make health decisions early. In fact, these are part of the key principles espoused by those who believe that consumers have a right to their own healthcare information. The idea is that the information is about you, the healthcare consumer, and thus should be both readily available to you and yours to do with what you wish. And yet, that is not always the case. Often it’s not even close. Continue reading…

Trust Me I’m a Doctor vs. Physician Quality Report Cards

Aug 21, 2010• 84

By KENT BOTTLES, MD

In Quality Measures and the Individual Physician, Danielle Ofri, MD, PhD, questions the usefulness of feedback report cards for individual providers. She states, “Only 33% of my patients with diabetes have glycated hemoglobin levels that are at goal. Only 44% have cholesterol levels at goal. A measly 26% have blood pressure at goal. All my grades are well below my institution’s targets.” (http://danielleofri.com/?p=1169)

It would be better for Dr. Ofri’s patients if these numbers were higher. I think even Dr. Ofri would agree with that assessment. And yet Dr. Ofri’s response to these low scores is that “the overwhelming majority of health care workers are in the profession to help patients and doing a decent job.” And more upsetting is Dr. Ofri’s conclusion where “I don’t even bother checking the results anymore. I just quietly push the reports under my pile of unread journals, phone messages, insurance forms, and prior authorizations.” (http://danielleofri.com/?p=1169)

Three Wishes

Aug 19, 2010• 33

By ROB LAMBERTS, MD

So I was walking down the hallway in my office, mildly distracted,
when I kicked something. It was a USB “thumb drive.” I picked it up
and inspected it, trying to figure out who had dropped it. The side of
the drive had a picture that I couldn’t make out, as it was all smudged
with something. I pulled out a tissue and rubbed it, thinking it may be
a clue as to whose drive it was.

There was a sudden rushing sound and a strong wind. Out of the thumb drive emerged a large blue figure wearing a turban.

“Are you a genie?” I asked

“No, I am David Blumenthal, the health IT ‘czar.’” he responded.

I hung my head down, “I guess this is about the fact that I write the word healthcare instead of health care. I was wondering how long it would be before the feds came down on me for that.

“No, that’s not my realm. That would be the job of the Department of
Language Security, and they’ll be appearing in some creative way next
week to get on your case about the whole healthcare thing. It has Matthew Holt and Maggie Mahar in a big tiff.”

Announcement: eHealth Initiative Posts New Positions Experienced Applicants Encouraged to Apply

Aug 19, 2010

The eHealth Initiative (eHI) is growing! We encourage you to take a look at our new job openings and spread the news amongst your colleagues and friends. eHI is a Washington, D.C.-based independent, non-profit organization dedicated to improving the quality, safety and efficiency of healthcare through information technology.

Director of New Business Development
Senior Level Director of Programs
Manager Public Policy

As with all positions at the eHealth Initiative, applicants must have the ability to work in a fast-paced, entrepreneurial environment. The eHealth Initiative offers an excellent employer paid benefits package (health care, 401K, generous vacation time, flex time) and is an equal opportunity employer.

To view job descriptions or find out more go to http://www.ehealthinitiative.org/careers.html

Don Casey, CEO, West Wireless Health Institute on the Health 2.0 Developer Challenge

Aug 19, 2010• 2

We spoke with Don Casey, CEO, West Wireless Health Institute about the institute's commitment to cost effective solutions in health using wireless technology. But it's about more than just new sensors and devices. Don discusses the importance of mechanisms that will connect data from devices to social networking platforms so that the wireless revolution can be truly accelerated and applications built on top of social networking platforms can offer richer experiences. Listen as he describes their rationale for the Accelerating Wireless Health Adoption through a Standardized Social Network Platform and what's in it for the winner.

Interview with Don Casey, West Wireless Health Institute

Short answer, it's the Health 2.0 Developer Challenge's biggest prize to date, 10K! And a chance to showcase the solution at the Health 2.0 Conference this Fall.

If Reform Fails

Aug 19, 2010• 35

By MAGGIE MAHAR

If conservatives manage to kill health care reform legislation, what will happen next?

I really don’t want to go there.

First, I’m convinced that conservatives won’t be able to repeal the Affordable Care Act (ACA). Democrats will hold onto the Senate, and President Obama still has a veto. If necessary, he will use it to protect the bill. Meanwhile, the majority of the public either favors the legislation or want to “wait and see” how well it works. Most voters would be utterly disgusted if Congress returns to the health care debate this fall. It was ugly the first time around; virtually no one wants to watch re-runs on C-Span. In the months ahead, Americans hope that their elected representatives will do just three things: create jobs, create jobs, and create jobs.

Secondly, if conservatives somehow succeed in crippling the reform bill, we will find ourselves back in a world of laissez-faire health care where medical spending continues to spiral by 4.5% to 9% a year (just as it has for the past ten years), thanks to a combination of climbing prices and rising utilization.

Here, I’m not talking about how much insurance premiums rose: reimbursements that private insurers, Medicare and Medicaid paid out to hospitals, doctors and patients over the past ten years have been climbing by 4.5% to over 9% annually.

In some years, Medicare reimbursements were growing faster; in other years, payouts by private insurers levitated. Over the same span, Kaiser reports that premiums for a family plan rose by an average of 13.1% a year.