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Simon Nath

The High Cost of High Cost

“You don’t charge enough.”

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I’ve heard this from a lot of folks. I’ve heard it from my accountant (of course), other doctors, consultants, and even some of my patients.  I’ve had some patients who are especially complex offer to pay me more because of the difficulty of their care.  I think they feel guilty and worry I’m upset that they are being “too demanding” for what they are paying.  I don’t ever take extra money.

When I recently told an elderly patient’s family that I was willing to do house calls if/when the woman needed it, their question was: “how much extra does it cost?”  No extra charge, actually.  They were delighted at how “old fashioned” I am.  Yep, Dr. Smartphone is certainly old fashioned.

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How Proposed New Rules Could Change the Anesthesia Care Team

Karen Sullivan Sibert

I admit, I was taken aback at the headline in the Houston Press:

Going Under: What Can Happen if your anesthesiologist leaves the room during an operation.”

The curious reader is bound to wonder why the anesthesiologist would leave the operating room in the first place.

Of course, reporter Dianna Wray explains that in many hospitals, one physician anesthesiologist often supervises multiple cases staffed by nurse anesthetists. This model of care is called the “anesthesia care team“, and has a very long record of safe practice in nearly all major hospitals in the United States. Typically, the anesthesiologist makes rounds from one operating room to the next, checking on each case frequently, just as an internal medicine physician would round on patients in the hospital who are being monitored by their nurses.

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Medical Errors, Or Not

Nortin HadlerIn a recent post, the renowned neurologist, Martin Samuels, paid homage to the degree to which uncertainties create more than just anxious clinicians, they can lead to clinical errors. That post was followed by another  by Paul Levy, a former CEO of a Boston hospital, arguing that the errors can be diminished and the anxieties assuaged if institutions adhered to an efficient, salutary systems approach. Both Dr. Samuels and Mr. Levy anchor their perspective in the 1999 report of Institute of Medicine Report, “To Err is Human”, which purported to expose an alarming frequency of fatal iatrogenic errors. However, Dr. Samuels reads the Report as a documentation of the price we pay for imperfect knowledge; Mr. Levy as the price we pay for an imperfect organization of health care delivery. These two posts engendered numerous comments and several subsequent posts unfurling one banner or the other.

I crossed paths with Dr Samuels a long time ago when we were both speakers at a CME course held by the American Geriatrics Society and the American College of Physicians. I still remember his talk for its content and for its clinical perspective. His post on THCB is similarly worthy for championing the role of the physician in confronting the challenge of doing well by one patient at a time. Mr. Levy and his fellow travelers are convinced they can create settings and algorithms that compensate for the idiosyncrasies of clinical care. I will argue that there is nobility in Dr. Samuels’ quest for clinical excellence. I will further argue that Mr Levy is misled by systems theories that are more appropriate for rendering manufacturing industries profitable than for rendering patient care effective.

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Key for Health IT Entrepreneurs: Don’t Disrupt the Wrong Thing

millenson-headshotAmong the 200 demos, 60 exhibitors and more than 100 speakers at the annual Health 2.0 conference on digital health, a critical insight for succeeding in this burgeoning market might have gotten lost in the noise.

The crucial advice came on separate days from two of the savviest digerati doctors in Silicon Valley. Not coincidentally, both Dr. Robert Wachter and Dr. Michael Blumpractice at the University of California, San Francisco (UCSF) Medical Center.

Wachter, an internist, was an early and eloquent advocate of the potential of electronic health records (EHRs) to improve the safety and quality of care. Actual EHR implementation, however, brought not nirvana, but a jarring number of “side effects.” Not least was the way the technology often distracts, confuses and complicates the lives of clinicians, endangering patients in the process.

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An October Surprise For Co-Ops

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Leonard Kish sits down with Julia Hutchins, CEO of the Colorado HealthOP, to talk about the recent surprise when Co-ops were informed the federal government would pay just 12.6 percent of the money they’d requested …

LK: Julia, tell me a little about the history of CO-OPs in general and the Colorado Health-OP in particular. When were they formed? Why were they formed?

JH: The CO-OP program was an important part of healthcare reform. The CO-OPs were part of a bipartisan compromise to ensure that there was competition in the individual and small group insurance markets and to ensure that there was competition on behalf of consumers. CO-Ops have enabled lower costs and more responsiveness to consumers as the market moves from one that was previously medically underwritten to one where anybody can buy health insurance regardless of their health status.

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An Interview with InterSystems Clinical Advisor Nelson Le

Screen Shot 2015-10-15 at 12.18.57 PMAn interview with Nelson Le, clinical advisor and senior product advisor for InterSystems

 Michelle Noteboom: Give me an overview of InterSystems and clarify your role in the company.

Nelson Le: InterSystems is a global healthcare IT company and we have different products that we offer the market. We say that technology is the pathway to making an impact in healthcare. The team that I work on is focused on interoperability and our position is that in order to achieve clinical outcomes and to perform well as a healthcare system, you need to be able to be interoperable and connect all your different systems, your different stakeholders, and all the data that you have regarding your patients and your performance.

My role on the team is clinical adviser. What that means is that I look at our products and solutions, I look at our positioning, and I look at our customer base and figure out how we can use technology to drive strong clinical outcomes.Continue reading…

What Cardiologists Can Teach Economists

I had the great fortune and pleasure of studying under the late Kanu Chatterjee during my cardiology fellowship at the University of California San Francisco.

In the early 1970’s, Dr. Chatterjee was among the first to understand the benefits of “afterload reduction” for the treatment of congestive heart failure:

Chatterjee-Circulation

Prior to that time, giving medications that could lower the blood pressure was often seen as heretical.  In fact, during the 1950’s and 1960’s, the treatment of heart failure sometimes consisted in applying measures to raise the blood pressure and increase the work of the heart.

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The “90 Day Contract”

flying cadeuciiAt age 77, having been through all of the fun and games of dealing with the New Hampshire Board of Medicine, a predatory local Hospital CEO, and other adversaries, nothing should surprise me anymore. But, I am surprised that intelligent, well-educated physicians would sign a “welcome aboard” new employee contract, a contract that allows their employer hospital to fire them without stated cause and throw them, literally, out the door using the security guards to do so, and without even time to clean up their offices.

Most doctors, however, are now hospital employees, and have knowingly or unknowingly, signed exactly such a contract.Continue reading…

An Interview with PatientSafe CEO Joseph Condurso

An interview with Joseph Condurso, president and CEO of PatientSafe Solutions

Michelle Noteboom: Give me a short overview of PatientSafe and your role in the company.

Joseph Condurso: I’m the president and chief executive officer of PatientSafe Solutions. I joined PatientSafe in 2011 with the focus of taking its skills and its core competencies as a mobile applications provider from the bedside to the enterprise to the home, which is my vision and goal for the company.

We provide a platform for creating and delivering an intelligent interactive workflow solution. We express those workflows through bedside applications that can be executed at the point of care by the frontline care team. We have also been building out an expression of those workflows to enable the patient to engage the care team as they discharge from the hospital and go into their home and into their daily life.Continue reading…

Trauma Room Two

Screen-Shot-2012-12-14-at-11.05.59-AMSometimes when I am bored, when it is all sore throats and dental pains, when I feel more like I am a social worker and a hand-holder than an emergency medicine physician, I play a game.

I do not look at the chart before I go into a room. I walk in cold. I enter with no idea who is going to be in there or why. In that very first second, before anyone speaks, I try to guess what the story is, who the people in the room are, and why they are in my emergency room.

Here-maybe it would make more sense if I showed you.

I draw back the curtain and step into Trauma Room Two. My eyes scan quickly about, gathering as much information as they can.

There are three people in the room.

For a brief second, I intentionally do not look at the patient lying on the hospital bed, not yet. Two people accompany the patient, a man and a woman. The man sits on a hard plastic chair pushed back against the room’s wall, staring quietly ahead. I start with him. I know if I can just look closely enough, the story is there.

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