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lauramontini

One Doctor’s View of Personal Science: You Won’t Learn Anything.

Jan 31, 2012• 10

By Seth Roberts

Bryan Castañeda, who lives in Southern California, told me this:

The law firm I work at specializes in toxic torts. We represent people who have been occupationally exposed to chemicals and are now sick, dying, or dead. Most of our clients have been exposed to benzene and developed some kind of leukemia. We sponsor various leukemia charities, walks, and other events. [On January 21, 2012] in Woodland Hills, CA, the Leukemia & Lymphoma Society held its first annual Blood Cancer Conference. Although the speakers were mainly doctors, it was a conference meant for laymen. The chair was an oncologist from UCLA Medical Center.

After introductory remarks and the keynote speaker, there were several breakout sessions. I attended a session on acute lymphoblastic leukemia and acute myeloid leukemia. The speaker was [Dr. Ravi Bhatia,] a doctor specializing in leukemia from City of Hope in Duarte, CA. His talk was almost exclusively about new drugs and clinical trials. Very dry and dull. Things got more interesting during the question period. At one point, [Dr. Bhatia] told an attendee not to experiment on his own because “you won’t learn anything and others won’t learn from it, either.”

I would have liked to ask Dr. Bhatia three questions:

1. What’s the basis for this extreme claim (“you won’t learn anything and others won’t learn from it”)? Ben Williams, a psychology professor at UC San Diego, wrote a whole book (Surviving “Terminal” Cancer, 2002) about taking an active approach when faced with a very serious disease (in his case, brain cancer). Likewise, the website Patients Like Me is devoted to (among other things) learning from the experimentation of its members. Lots of forums related to various illnesses spread what one person learns to others. MedHelp has many forums devoted to sharing knowledge.

Treating Heart Failure on a $100 Budget

Jan 30, 2012• 2

By Molly Kantor

As a third year medical student, I spent one afternoon each week at a health clinic at a community hospital affiliated with my medical school. This health clinic was focused on primary care for patients with HIV, and many of our patients were poor, homeless, immigrants, or uninsured. Many were also living with their diagnosis in secrecy and had to hide their medications and medical bills from family members.

One of my patients, who I will call Clara, was a 65 year old Haitian immigrant who diabetes, heart failure, and depression, along with HIV. Due to her medical conditions, she was unable to work. She had two grown children, but they did not live nearby and did not know about her medical problems, especially her HIV. Her husband, unfortunately, was very ill and lived in a nursing home. Clara somehow managed on her own, but her lack of insurance, poor medical literacy, and limited English proficiency made it difficult for her to stay healthy, and she was constantly coming to clinic for help.

At one visit, Clara seemed unusually tired and revealed that she had been feeling short of breath at home. In my mind, this raised many questions—Could this be a heart attack? Worsening heart failure? A blood clot in her lungs? Pneumonia?

The Entrepreneur’s Dilemma

Jan 28, 2012• 7

By Lisa Suennen

Last week Steve Case wrote an Op-Ed in the Washington Post called Give entrepreneurs room and they will grow the economy. For those not familiar with him, Case was the original founding CEO of AOL and he has been an active healthcare investor, among other things, for the past 7 years. My firm, Psilos Group, is a co-investor with Case’s Revolution Health Fund in a health services company called Extend Health.

Anyway, it was a very good editorial and one of the statistics within it particularly stood out to me in light of my venture capital role: firms less than five years old have produced 40 million American jobs over the past three decades–accounting for all of the net new jobs created in that period. That is a pretty stunning fact and also one that really makes a person scratch their head about current U.S. policy towards start-ups. It is worth watching this Kauffman Foundation 3 minute video which is very instructive about start-ups and job creation.

Nowhere is this issue more relevant than in the healthcare industry, which conveniently happens to be the only thing I know anything about. In a world where there is no way out of the healthcare crisis except through the innovation of new ideas to solve our healthcare problems, young companies are the golden ticket to new employment.

Medical Records Supporting San Francisco’s Universal Care Add Millions to Official Cost

Jan 27, 2012• 3

By Angela Hart

The San Francisco Department of Public Health says it is ahead of the curve in rolling out databases that keep tabs on tens of thousands of patients across a citywide network of clinics and hospitals. The rollout is needed not just to make a local form of “universal health care” work, but also to meet a 2014 deadline under national health reform.

And the city says it spent just $3.4 million on new patient-tracking technology. Not bad for an unprecedented charity care initiative whose total budget has grown to $177 million just this past year.

But while clinics and hospitals across the city are now linked up to a common intake tool that eliminates overbilling and duplicated medical appointments, that is only the first step in making the Healthy San Francisco program successful, directors of local health centers and technology experts say.Continue reading…

What I Learned from Listening to a Patient

Jan 26, 2012• 8

By Peter Pronovost, MD

I was reminded again recently of how important it is to sometimes just sit back and listen to what our patients have to say. Every month, as part of our hospital-wide patient safety efforts, I meet with staff and interview patients, seeking to learn how we can improve the care we provide to them.

A young patient shared two stories with me, one telling me how we get it right and one reminding me how we sometimes get it wrong, even without realizing it. She was nervously awaiting a procedure in Interventional Radiology when a nurse sensed her anxiety and called in a child life specialist. The specialists came and significantly helped relieve the patient’s suffering. She listened to the patient, offered a comforting touch, and provided her age-appropriate reading material and Sudoku puzzles, a brilliant though infrequently used intervention. If anything could take your mind off of your illness, it is Sudoku.

What was amazing was that after all the patient had been through―weeks in the hospital, countless procedures, scores of clinicians―what she remembered was the nurse’s act of kindness by caring enough to call the specialist. The patient reminded me that though we can cure disease sometimes, we can relieve suffering always, often with nothing more than a kind word, a gentle touch or a warm smile.

As I listened, the patient, along with her mother, went on to tell me more. They told me how the patient has complex allergies and that her mom knew her disease better than any clinician. They had lived with the disease for a decade. Yet at times, neither the patient’s mother nor the patient felt they were being heard by the doctors. The mom expressed frustration that clinicians often dismissed her concerns and discredited her knowledge.

Listen to What Innovators Don’t Talk About

Jan 26, 2012• 6

By Michael Schrage

While working away on my laptop at a hotel breakfast, I couldn’t help but overhear the four gentlemen poring over an iPad two tables way. Their intense discussion revolved around rolling out their high-tech prototypes in a medical care complex. Since I’ve written about prototypes and prototyping, I couldn’t help but eavesdrop.

Forgive me.

The foursome represented a mix of medical care complex personnel and what was clearly an entrepreneurial innovator with a potentially high-impact idea. I’ll skip the technical details, but this was clearly a sophisticated group who were both smart and ambitious. The prototypes were their gateways to success. Their debates included whether it made more sense to field one or two more “finished” prototypes or whether they could get more information more quickly by fielding “roughs.” Were “staggered roll-outs” more cost-effective than “staggered builds”? They talked about the need to be able to “patch” quickly and whether their prototypes should optimize particular subsystems or overall system performance. They argued timelines and sequencing for test.

These questions are classic and it’s always fascinating to hear how — and what — decides them. Getting great value and insight from prototypes and pilots is more an art and craft than a science. Successful tech prototyping in health care contexts is particularly demanding.

That’s why the more passionately they spoke, the more nervous I got. Something was missing. Whenever innovators gather, I always listen for what’s not discussed. In almost 50 minutes of detailed discussion (yes, I am that kind of eavesdropper), I heard not a single mention, reference or allusion to the challenge of training the people onsite on how best to use or learn from the prototype. Details of prototype design and roll out were discussed as if the medical care personnel were irrelevant to the process. It reeked of “over the wall” technology transfer. OMG.

Our Cancer Journey – Week 6

Jan 26, 2012• 2

By John Halamka, MD

We’re halfway through the most challenging cycles of chemotherapy, Kathy has lost her hair, and her fatigue is getting worse but her mood is still very positive.

On Friday January 20th, Kathy received Cyclophosphamide (Cytoxan) 1200 mg, Doxorubicin (Adriamycin) 120 mg and her pre-chemotherapy supportive medications Fosaprepitant 150 mg, Dexamethasone 12 mg and Ondansetron 8 mg.

She tolerated it well.

Her Complete Blood Count shows that her Granulocyte Count has dropped from 6690 to 3610 since the chemotherapy affects her fast multiplying white cells as a side effect of targeting the cancer. Her hematocrit has fallen from 42 to 32. She tires more easily but her appetite is good. Small frequent meals enable her to overcome any GI symptoms.

We’ve been told that the Adriamycin/Cytoxan is the most difficult chemotherapy. Only two more cycles to go.

The photograph above shows Kathy and me at age 21 in our Stanford graduation photo. She’s always had long, luxuriant hair, even a waist length braid at one point.

On January 21st, her hair began falling out in clumps. It was not exactly painful, but felt very odd, as if her hair had not been washed in months and just did not lie on her scalp properly. In consultation with her cancer survivor friends, she decided to shave it off. Her hairdresser gave her a “GI Jane” cut realizing that the small hairs left will fall out soon, but in a more manageable and comfortable way. I seriously considered shaving my head in solidarity, but she asked me not to.

DSM-5: You’re Still Autistic. You’re Just Weird. You We’re Not Sure About. Call Us Tomorrow.

Jan 26, 2012• 95

By Anne Dachel

Reports of autism cases per 1,000 children grew dramatically in the US from 1996 to 2007. Source: Wikipedia.

It’s hard to imagine more chaos in the world of autism than what we see happening right now. Autism is more and more in the public spotlight. The numbers are huge and no one can explain them. Since 2009 we’ve been told that one percent of children have autism. Among boys alone, it’s almost two percent. Mainstream medicine can’t explain the stunning increase in a once rare disorder. For years health officials gave doctors credit for all the autism everywhere. They said it was the result of “greater awareness” and “better diagnosing.” Children who were mislabeled as something else were now correctly called autistic. The criteria for diagnosing autism was laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and a child with symptoms would be placed somewhere on the autism spectrum, as it came to be known. This included very high functioning autism and Asperger’s syndrome all the way over to the other end of the spectrum to those with severe intellectual impairment and all the signs of classic autism.Continue reading…

Care Innovations Summit Live Blog

Jan 26, 2012• 2

By Connie Chen and Laura Montini

Wrapping up the CI Summit with a Health Affairs Chat

By Laura Montini

The Care Innovations Summit wrapped up with a fireside chat, and moderator Susan Dentzer observed that there hadn’t been much discussion about the Medicaid population throughout the day, even though the summit was co-hosted by the Centers for Medicare and Medicaid Services. Dentzer asked Deputy Administrator Director of CMS Cindy Mann how innovation could play into the care of the Medicaid population.

Mann mentioned three major ways: experimentation (with payment rules and service delivery), peer to peer learning and data. Though she mentioned data last, she emphasized it the most.

“We need to be much more intentional about getting the data that we need to see what’s working, what’s not working,” Mann said.

The Rise of the Programmable Self

Jan 24, 2012

By Fred Trotter

Programmable self is a riff on the Quantified Self (QS). It is a simple concept:

Quantify what you want to change about yourself + motivational hacks = personal change success.

There are several potential “motivation hacks” that people regularly employ. The simplest of these is peer pressure. You could tell all of your co-workers every morning whether you kept your diet last night, for instance. Lots of research has shown that sort of thing is an effective motivator for change. Of course, you can make peer pressure digital by doing the same thing on Facebook/Twitter/Google+/whatever. Peer pressure has two components: shame and praise. It’s motivating to avoid shame and to get praise. Do it because of a tweet and viola, you have digital peer pressure motivation.

Several books have recently popularized using money, in one form or another, as a motivational tool. There is some evidence, for instance, that people feel worse about losing $10 than they feel good about earning $10. This is called loss aversion, and it can easily be turned into a motivational hack. Having trouble finishing that book? Give 10 envelopes with $100 each to your best friend. Instruct them to mail the envelopes to your favorite (or most hated) charity for each month that you do not finish a chapter. Essentially, you’ve made your friend a “referee” of your motivational hack.