Author Archives

John Irvine

All the President’s E-mail

Aug 25, 2015• 2

By HANS DUVEFELT, MD

Perhaps doctors should be more like the President.

After all, we also carry the ultimate responsibility for our constituents, even though we, too, have team members who do part of that work.

The way I understand things to work at the White House, those other team members collect, review and prioritize the information the President needs in order to manage his, and all our, business.

That is how things used to work in medicine, too, before computerization revolutionized our workflows: Nurses, medical assistants or secretaries would open the mail, gather the faxes, look over the lab and X-ray reports and put them on physicians’ desks in a certain order. Highly abnormal or time-sensitive information would be prioritized over routine “signature-needed” forms, and in my case, essentially normal reports on patients already scheduled to be seen within a few days wouldn’t even reach my eyes until the patient appointment.

Computers changed all that.

Now, most of the information goes straight to the doctors’ inboxes, unseen by other human eyes in the office. This is said to be faster. It is, to a degree, in the sense that the information leaves the laboratory or the X-ray department faster via their Internet connected computers. But in the typical medical office, we have now turned decision making doctors into frontline mail sorters and de facto bottlenecks of routine information.

How Stanford Med Got “Work-Life Balance” Wrong

Aug 24, 2015• 4

By KAREN SIBERT, MD

Did it ever occur to some of today’s physicians that many people work awfully hard and complain a lot less than they do about “burnout” and “work-life balance”?

Did it ever occur to them that “work-life balance” is the very definition of a first-world problem, unique to a very privileged class of highly educated people, most of whom are white?

Every day, I go to work and see the example of the nurses and technicians who work right alongside me in tough thoracic surgery cases. Zanetta, for instance, is the single mother of five children. She leaves her 12-hour shift at 7 p.m. and then faces a 60-mile commute to get home. She never complains, and unfailingly takes the extra moment to get a warm blanket for a patient or cheerfully help out a colleague

For Patient Safety: A Reversal. What Can Healthcare Teach the Aviation Industry?

Aug 23, 2015

By RHONDA WYSKIEL

There are more than 50 in-flight medical emergencies a day on commercial airlines — or one for every 604 flights, according to a study published in 2013.

What are the odds that two emergencies would occur on the exact same flight, above the Atlantic Ocean and hours from the nearest airport?

My colleague Mark, a critical care physician with whom I’d worked as an ICU nurse, and I were traveling to the Middle East for a patient safety conference. We were comfortably tucked into our seats, as he snored next to me.

It must have been about 3 a.m. when I was awakened by an overhead announcement asking for a medical doctor. I nudged Mark, asking him to press his call light.

As the flight attendant approached, I told her that Mark was a doctor.

“And she’s an ICU nurse, and we work together,” he said, gesturing toward me.Continue reading…

Will Private Exchanges Move Us Closer to Socialized Medicine?

Aug 21, 2015• 7

By BLAKE ASHBY

Private exchanges have become the next big thing in healthcare, the newest approach to controlling employers’ healthcare costs and maybe even a way of moving healthcare from a defined benefit to a defined contribution. But they are unlikely to control healthcare costs and the only thing they will move us towards is socialized medicine.

An increasing number of employers are having employees use online “private exchanges” to make their annual healthcare plan selections. According to an Accenture study, one in four employers is considering a private exchange and an estimated 30 million employees will select their employer-provided healthcare plan through a private exchange by 2017.

On the surface private exchanges are attractive. Instead of the employer choosing a healthcare plan for its employees, the employer gives each employee a set amount of money to spend on a healthcare plan of the employee’s choosing. The employees then use the online exchange to select plan parameters that best meet their needs. Employees are able to maximize the value they receive from their healthcare allotment. The employer is removed from the healthcare decision process, no longer providing a defined benefit, healthcare, instead just providing a defined financial contribution for the employees to spend as they see best.

Save the Hipsters

Aug 21, 2015• 1

By THCBist

Evil health plan marketing or genius? Such a fine line.

Except to see more spots like this one from Rocky Mountain Health Plans as the online marketplace for health insurance created by the Affordable Care Act continues to mature.

Filed under: Affordable Care Act, Unintended consequences. Hipster marketing schemes. Stuff our Editors Like.

Why Prisons Should Try Readmissions Penalties

Aug 19, 2015• 4

By STUART M. BUTLER

By the end of 2013 there were approximately 1.5 million people in state or federal prisons, and the U.S. incarceration rate is the highest in the world. And while there is debate about the relationship between this level of imprisonment and crime rates, there is considerable research to show that a spell of incarceration exacerbates economic and social conditions for families as well as former inmates, especially in low-income neighborhoods. That has led the Obama Administration and some interesting strange-bedfellow groups to call for alternatives to prison for some infractions.

The other side of the prison coin is recidivism. Prisons are often called “correctional facilities” but that is a cruel joke – they do a dismal job in turning lives around. According to the U.S. Department of Justice, about two-thirds of released state prisoners were re-arrested within three years and three-quarters within five. Prison is a revolving door.Continue reading…

Bringing Clinicians, Patients, and Financial Administrators into a Common Conversation About Affordable Care

Aug 17, 2015• 1

By NEEL SHAH, MD and DAN MICHELSON

It all started a few years ago with an out-of-the-blue e-mail:

“Neel – I saw the work you are doing via the article in the journal ‘Leadership’. Congratulations as this is a great area of focus to pursue – the need to take down the complexity as it relates to cost/charge/reimbursement is a tough and an important issue. There may be some interesting ways we can collaborate. Best, Dan”

That e-mail would lead to a major initiative, a National Story Contest called The Best Care, The Lowest Cost: One Idea at a Time that we are launching this week. More on that below, but first a little more background.

At the time, Neel was finishing his clinical training as a physician and about to join the faculty at Harvard Medical School. Despite all that training, there was something that no one taught him: how his decisions were impacting what patients had to pay. Dan, who was leading Strata which is a company that helps hundreds of healthcare delivery systems with financial analytics, realized that most of these organizations didn’t have any access to cost data – they were flying blind.

Moving From Spaced Repetition to Spaced Learning

Aug 17, 2015• 1

By RITESH PATEL

Medical education is dynamic and constantly adapting to the needs of society. With new technological advances, scientific discoveries, and healthcare policies arising each day, the amount of information medical students are required to learn increases exponentially. Many describe the early years of medical education as a vicious cycle of cramming and forgetting with block exams, shelf exams, and board exams. Long-term retention is rarely rewarded and the integration across topics is limited. On the contrary, medicine IS a life-long learning process that is heavily dependent on the ability to attain, integrate, and apply data.

Unfortunately, time is limited, and as a result, cramming often prevails as the method of choice for many students. As medical students, we constantly find ourselves re-learning large amounts of information time and time again, always preparing for the next exam or hurdle, rather than thinking years down the line when we will be taking care of patients. This is very inefficient.

In June, Duke medical students wrote an article entitled “Want to enhance medical education? Use Spaced Repetition”. This article proposed a strategy that revolves around the cognitive technique known as spaced repetition. Spaced repetition takes advantage of time and reinforces one’s knowledge the moment before one forgets it. This technique involves reviewing material according to a schedule determined by a temporal relationship known as the “spacing effect”.

Protecting Americans from Preventable Infections: Working Together Will Save Lives

Aug 17, 2015• 4

By TOM FRIEDEN, MD

“Alone we can do so little; together we can do so much.” Those words spoken by Helen Keller nearly a century ago remain powerful and relevant today.

A new report from the Centers for Disease Control and Prevention (CDC) projects that thousands of lives could be saved every year if health care facilities and public health departments work together to track and stop antibiotic resistance – and if they communicate with each other about these infections to prevent spread from one facility to another.

Even if one health care facility follows all recommended infection control practices, antibiotic-resistant organisms can spread when patients are transferred among facilities. Even the best health care facilities can’t go it alone when it comes to antibiotic-resistant infections and C. difficile.

We need to protect our whole community; advance warning of possible antibiotic-resistant infections at one facility allows actions to be taken to prevent spread at the receiving facility.

New modeling data from CDC project that a community-wide approach – in which hospitals, long-term acute care facilities, nursing homes and health departments across an area work together – could reduce the number of patients infected with carbapenem-resistant Enterobacteriaceae (better known as CRE) by up to 70% over five years. CRE is a nightmare bacteria because it does not respond to most antibiotics and is extremely deadly should it enter the bloodstream – especially if a patient is already sick. A significant drop in these infections would be a life-saving scenario for patients.

Health care facility administrators are key to making this coordinated approach a success. Hospitals, long-term acute care facilities and nursing homes all need better systems to alert one another when transferring patients carrying drug-resistant bacteria and C. difficile. Strict infection control practices must be implemented in every health care setting, and clinical staff need access to prompt and accurate laboratory testing to identify antibiotic-resistant bacteria.

Did the Wellness Industry Just Admit Fraud?

Aug 14, 2015• 4

By AL LEWIS and VIK KHANNA

Hopefully at least a few of you have lamented –we’ll settle for “noticed” — our absence from The Health Care Blog for the last six months. There are two reasons for that. First, in the immortal words of the great philosopher Gerald Ford, “When a man is asked to make a speech, the first thing he has to do is decide what to say.” Likewise, we need something compelling to say, and at this point yet-another-vendor-making-up-outcomes is old news, and in any event there is now an entire website devoted to exposing lies in wellness. We, uh, take appellations and kick posteriors.

Also, our exposés were backfiring, having exactly the opposite of the intended effect. For example, our THCB essay pointed out that Health Fitness Corporation’s Nebraska program should have its C. Everett Koop Award revoked because HFC admitted lying about saving the lives of Nebraskan cancer victims who it turns out never had cancer in the first place. Instead of revoking the award, the chair of the awards committee, Ron Goetzel, has subsequently twice called the Nebraska program a “best practice.”Continue reading…