Category: Uncategorized

Got an Infection? Good Luck Finding an ID Doctor

Mar 15, 2015• 2

By PHILIP LEDERER, MD

BOSTON, Ma. — It was Christmas Day. I was on call at the hospital and was waiting for my wife and 6-week-old son to come so we could eat lunch together. She was bringing kimbap, sweet potatoes, and avocados. But then my pager buzzed.

On the phone was a hospitalist physician.

“Is this ID? We have a new consult for you,” she said. “This man has a history of dementia. For some reason he has a urinary catheter to empty his bladder. We gave him an antibiotic, but now his urine is growing a resistant bacteria.”

I sighed. Yet another catheter associated urinary tract infection.

I walked up the stairs to his hospital room. He was bald, thin, and sitting alone in bed. The peas and fish on his tray were untouched. There were no gifts or tree in his room. I washed my hands, put on gloves and a yellow isolation gown, and introduced myself.

“How are you?”

“Ok, I guess,” he replied.

“Do you know where you are?”

“I’m not sure.”

“You are in the hospital. Do you know what day today is?”

Satisfaction Scores: How I Almost Made a Hotel Manager Lose His Job

Mar 15, 2015• 10

BY SAURABH JHA, MD

Recently, I was asked to fill a questionnaire during check-out at a hotel in India. I was very pleased with my stay so I agreed to providing feedback. It is worth pointing out that if I was only mildly satisfied I would not have agreed. If I was disappointed with my stay I would have filled the form more enthusiastically.

When I offer feedback I am in one of two extreme emotions: I either love the service or, more commonly, loathe it. There is no time to talk about the average. And I have given up on Comcast.

The form had about twenty questions asking how satisfied I was with various components of their hospitality. I had to choose between one and ten, the higher number for greater satisfaction. I decided to set a record for the fastest completion of the questionnaire. I quickly chose ‘9’ and ‘10’. To appear objective I gave a ‘7’ to a service, randomly. Seven meant “above average”. Nine and ten meant “outstanding” – that is satisfaction cannot be measurably higher.

In the section which asked “how can we do better?” I said “put some more trees.” I didn’t really think the hotel premise needed more trees, but I was on a roll of objectivity. I had to say something.

What If Restaurant Bills Looked Like Hospital Bills?

Mar 15, 2015• 8

By THCB MD

You’d get something like this:

HAT TIP: Jeanne Pinder. WHHY Philadelphia. Learn more about Pinder and her project here.

On THCB This Week

Mar 13, 2015

By THCB STAFF

“Apple ResearchKit (Not) Ready For Prime Time – Yet. A Medical Researcher’s Perspective”
By Philip Jones, MD

“Apple’s ResearchKit Is Open Source. But Is it Open? “
By Vince Kuraitis

“King v. Burwell: Can the Supreme Court save the Republican Party From Itself?”
By Gary L. Kaplan

“A Checklist For Surviving Academic Medicine”
By Martin Samuels, MD

“Do Value-Based Payments lead to Higher Doctor Satisfaction Scores?”
By Jack Cochran, MD and Charles Kenney

“Value-based Health”
By Cyndy Nayer

“Validic meets Cerner: Drew Shiller speaks”
By Matthew Holt

From Google to New Reimbursement Models: Digital Health Trends for 2015”
By Ryan Beckland

A Checklist For Surviving Academic Medicine

Mar 13, 2015

By MARTIN SAMUELS, MD

Decide who you are and don’t kid yourself
Don’t bluff; the triple (quadruple) threat is an illusion
Know your subject; teaching is not a trick; you must have something real to transmit
Don’t replace substance with gimmicks (e.g. fancy powerpoint)
Simulated patients produce simulated doctors and de-professionalize students
Respect your teachers but don’t believe in the Days of the Giants; they have feet of clay
Don’t become “one of them.”
Develop a reputation beyond the local environment
Train people, but remember that some will not respect you (remember Bouchard)
Stand proudly for clinical excellence
Write briefly, simply and parsimoniously (remember Babinski)
Be a professional
Don’t be an asshole
Don’t bullshit

Abstracted from the “Academic Medicine Survival Guide” Martin Samuels, MD. The Health Care Blog. March 2015.

Academic Medicine Survival Guide

Mar 13, 2015• 13

By MARTIN SAMUELS, MD

The History of the Problem

The European University (e.g. Italy, Germany, France, England) descended from the Church. The academic hierarchy, reflected in the regalia, has its roots in organized religion.

The American University was a phenocopy of the European University, but the liberal arts college was a unique American contribution, wherein teaching was considered a legitimate academic pursuit. Even the closest analogues in Europe (the colleges of Cambridge and Oxford) are not as purely an educational institution as the American liberal arts college.

The evolution of American medical education (adapted and updated from: Ludmerer KM. Time to Heal, Oxford University Press, Oxford, 1999) may be divided into five eras.

I. The pre-Flexnerian era (1776- 1910) was entirely proprietary in nature. Virtually anyone with the resources could start a medical school. There was no academic affiliations of medical school and no national standards.

II. The inter-war period (1910-1945) was characterized by an uneasy alliance between hospitals and universities. Four major models emerged. In the Johns Hopkins model, led by William Osler, the medical school and the hospital were married and teaching of medicine took place at the bedside. The Harvard model in which the hospitals grew up independently with only a loose alliance with the medical school, represented a hybrid between pre- and post-Flexnerian medical education.Continue reading…

King v. Burwell: Will the Supreme Court Save the Republican Party from Itself?

Mar 12, 2015• 103

By GARY L. KAPLAN

Last week, the Supreme Court heard arguments in the most recent and pernicious attack on the Affordable Care Act – aka Obamacare. In the absence of a dysfunctional Congress, the case would be beneath the dignity of Court: it addresses no complicated legal issues that might guide future decisions of lower courts. Instead, the Supreme Court has been asked to decide whether a drafting error resulting in one unfortunate phrase in the much maligned 2000 page law –“Exchange established by the States” — means that more than 6.3 million citizens would not be eligible for federalsubsidies allowing them to afford commercial (i.e. – non-governmental) health insurance.

Ordinarily, Congress is expected to fix such drafting problems itself. Each year Congress pass dozens of “Technical Corrections” bills to fix such errors in prior legislation. These bills are akin to software patches that are regularly released by companies to fix unanticipated “bugs” previously release programs. But this is no ordinary legislation. Having spent six years vilifying for President Obama and has supporters for passing legislation that improves American lives it is far too late in the day for the Republican Congress to replace demagoguery with common sense.

So this issue is now in the lap of the Supreme Court, with its well-known partisan divide of four liberals, four arch-conservatives, and Justice Kennedy, who as the “swing vote” effectively decides many of the most divisive cases himself. The Court can decide to gloss over this drafting error, as proposed by the Obama Administration, or apply its language to devastating effect. Prior Supreme Court cases—i.e. “precedent” in the jargon of the law—can be found to support either position. In the end, there have been few cases in which the Court has more judicial freedom – assuming precedent ever really binds the Court – to do whatever it wants in keeping with the Justices own political biases.Continue reading…

Apple’s ResearchKit is Not (Yet) Ready For Primetime – But Soon? A Medical Researcher’s Perspective

Mar 12, 2015• 7

By PHILIP JONES, MD

I am a clinician and a clinical trialist. Medical research in some form or another (performing it, consuming it, reviewing it, editing it, etc.) occupies much of my time. Therefore, you can imagine my excitement while watching Apple’s product announcement yesterday when they introduced a new open source software platform called ResearchKit. Apple states ResearchKit could:

“revolutionize medical studies, potentially transforming medicine forever”

ResearchKit allows clinical researchers to have data about various diseases collected directly from a study participant’s iPhone (and perhaps other devices in the future — see below). The software is introduced as a solution to several important problems with current clinical studies, such as:

limited participation (the software allows everyone to participate; anyone with an iPhone can download a specific app for every study they want to participate in)
frequent data entry (patients can enter data as often as required/desired, rather than only at limited opportunities such as hospital or clinic visits)
data fidelity (currently-used paper patient “diaries” are prone to entering implausible or impossible values — the iPhone can limit the range of data entered)

Specifically, the website states:

ResearchKit simplifies recruiting and makes it easy for people to sign up for a study no matter where they live in the world. The end result? A much larger and more varied study group, which provides a more useful representation of the population.

This is a bold claim. We’ll see below that it doesn’t yet ring true.

Validic meets Cerner–Drew Schiller speaks

Mar 12, 2015• 1

By MATTHEW HOLT

Validic is one of the more interesting companies in what we define as the “data utility layer.” They’ve had a bit of a meteoric rise in the past 2 years, and now have over 45 employees, over 90 customers and are now one of the main names that come up when the conversation turns to “how do we get all that device data into the EHR?” Today they announced a new deal with Cerner (release here). This is the quick interview with CTO Drew Schiller.

[youtube width=”450″ height=”275″]https://youtu.be/yvlXdAQb9lY[/youtube]

Apple Research Kit is Open Source But Is It “Open”?

Mar 12, 2015• 7

By VINCE KURAITIS

For now, the answer is “we don’t know”.

But… the question is very important and worth tracking over the coming months. Let’s not assume that open source will equate to “open”.

What is ResearchKit?

Apple’s press release provided an overview of ResearchKit:

Apple® today announced ResearchKit™, an open source software framework designed for medical and health research, helping doctors and scientists gather data more frequently and more accurately from participants using iPhone® apps. World-class research institutions have already developed apps with ResearchKit for studies on asthma, breast cancer, cardiovascular disease, diabetes and Parkinson’s disease.

…With hundreds of millions of iPhones in use around the world, we saw an opportunity for Apple to have an even greater impact by empowering people to participate in and contribute to medical research,” said Jeff Williams, Apple’s senior vice president of Operations. “ResearchKit gives the scientific community access to a diverse, global population and more ways to collect data than ever before.”

Many members of the research community have had high praise for ResearchKit. For more details and perspectives about ResearchKit, see the list of articles appended at the bottom of this post.