In January, Ezekiel Emanuel – one of the country’s foremost health experts – threw a presumptive grenade into the national discourse: the annual physical is worthless. As we watched the initial burst of reactionary fervor following hisNew York Times opinion piece, we weren’t quite sure what to think.
Then we realized why: in our training and burgeoning careers in primary care, neither of us has ever scheduled an “annual physical” for a patient. To us, the notion of such a visit – for scheduled, non-urgent care, and one not specifically for chronic disease management – is already dated. Given current trends in American health care delivery and professional training, we argue it is one that may well soon be obsolete.
But does that obsolescence change the value of that time – whether 15 minutes or 60 – with a patient, on a regular interval? Our perspective from medicine’s emerging front line offers a resounding no.
The most obvious argument for regular primary care visits is preventive care. Dr. Emanuel bases much of his argument on the validity (or lack thereof) of annual physicals. Drawing off that same evidence base, the U.S. Preventive Services Task Force sets recommendations for evidence-based screening in various populations. Even the young and healthy benefit from cervical cancer screening, initiated at 21 years of age and continued every three years provided negative results until the age of 30 (when the recommendations change slightly). Patients with higher risk earn further screenings, based on whether they smoke, their weight, their age and their family history.
Contrary to what you may think, most doctors do want to make eye contact. They aren’t antisocial. They want to engage. But they can’t. They’re too distracted by one of the worst computer games ever invented—the electronic medical record (EMR).
You may be surprised to see the EMR compared to a computer game, but there are many similarities. Both offer a series of clicks with an often-maddening array of tasks to solve. There are templates to follow, boxes to fill in & scoring. However, unlike most electronic games, the points accrued in the EMR often translate into payment—real dollars for either your doctor or the hospital.
Although these clicks and boxes may be necessary to document your visit, it’s distracting. And your doctor begins to feel more like a librarian cataloging information rather than, say, a historian capturing your story.Continue reading…
When providers and their staff don’t have the time or tools to effectively communicate with patients, a slew of issues can result: from physicians missing important cues and misdiagnosing patients to preventable hospital readmissions and poor outcomes because patients didn’t understand or follow care guidelines.
The problem has become endemic. According to one study, 80% of what doctors tell patients is forgotten as soon as they leave the office. Beyond that, 50% of what the patient did recall is incorrect. In addition to impact communication and follow up have on care and outcomes, patients are expecting a different experience than they once had. Nearly two thirds of patients now say they would consider switching to a physician who offers access to medical information through a secure Internet connection.Continue reading…
In 1994, I recorded a fictitious interview with the person whom I imagined to be the last well person on earth. (1) I mistakenly thought well people were disappearing and I wanted to call attention to their disappearance. I missed the big picture and now want to correct my misconceptions. Well people are not disappearing; instead, a new species of man is emerging: homo clinicus.
An evolution of the symbiotic relationship between man and medicine has been going on for some time. Lewis Thomas deserves the credit for an early spotting of the new species, first observed in America. He called our attention to this phenomenon in the 1970s.
Nothing has changed so much in the health-care system over the past 25 years as the public’s perception of its own health. The change amounts to a loss of confidence in the human form. The general belief these days seems to be that the body is fundamentally flawed, subject to disintegration at any moment, always on the verge of mortal disease, always in need of continual monitoring and support by health-care professionals. This is a new phenomenon in our society.
Stanford neurosurgeon Paul Kalanithi died March 9th at the age of 37. This is his story.
[youtube width=”450″ height=”275″]http://youtu.be/d5u753wQeyM[/youtube]
The girl seizes. Her body torques and twists and jerks about like a snake trapped on an electric fence. She flops back and forth on the gurney before us, her pale forehead glistening with sweat, her brown hair wetted black from the effort of muscle contractions that threaten to tear apart her tiny frame.
Trauma Room Two is silent save for the gluck-gluck-gluck of her gagging as her jaw and teeth grind and bang together out of control.
Her body screams with each shimmy and shake.
Her father stands next to me. He strokes her head with trembling fingers, running them through her damp hair, trying to keep the strands out of her grimacing face. His fingers move in time with the rhythmic nod of her skull as the tonic-clonic seizure ratchets and cranks her body. I take a deep breath. I start my chant.
Break seizure break.
Break seizure break.
I say it in my head, I say it in my bones, I say it in every part of me, keeping time to her dance.
“Physician, Heal Thyself – Luke 4:23”
Not knowing the originator of this phrase, I found this description on Wikipedia: “The moral of the proverb is counsel to attend to one’s own defects rather than criticizing defects in others.” It’s common for those of us in the tech industry to lament how appallingly out-of-date healthIT is. Taking the glass-is-half-full approach, one can see opportunity in that – Why It’s Good News HealthIT is So Bad.
There are a number of reasons why this is the case — convoluted decisions processes, for example — and that health systems are spending billions to prepare for the last battle. However, I’m much more interested in how we fundamentally change the equation than why we’re in our current predicament. The same tech companies that have kvetched about healthcare being behind on technology can address that defect by taking some simple actions.
Almost three years ago, I excoriated the American College of Sports Medicine for partnering with a medical screenings company to push useless screens upon, of all things, their membership. You can read the post here. It was truly embarrassing to a supposedly credible organization. The leadership’s reply, in addition to having their communications director call me and implore me to take the post down, was to claim they had no idea this was happening.
Now, the American Council on Exercise, another fitness industry trade group, beggars itself with an open letter to the U. S. Congress, in which it essentially asks to hop aboard the national healthcare gravy train. You can read the entire plaintive wail here. The essence of it, however is this:
The American Council on Exercise, which educates, certifies, and represents more than 55,000 fitness professionals, health coaches, and other allied health professionals, and advocates for extending the clinic into the community with science-based preventative services delivered by well qualified professionals not necessarily thought of as health providers, welcomes you to Washington.
Let me translate both the highlighted paragraph, and, indeed, the entire letter: hey, Congress, everyone else is making money from healthcare reform, what about us? Where’s our handout? We’re healthcare providers, too, sort of. That ought to be enough to qualify us for reimbursement, even though we have zero evidence that the fitness industry, or any specific category of fitness professional (you could be one by 5:00 pm today), actually can change outcomes. Exercise? Important almost beyond expression. Fitness industry and its entire coterie? Not so much. Over the past three decades, the fitness industry has boomed.Continue reading…