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Category: Health Policy

A Christmas Message to All Physicians From a Swedish-American Country Doctor in Maine

By HANS DUVEFELT, MD

Growing up in Sweden without a Thanksgiving holiday, Christmas has been a time for me to reflect on where I am and where I have been and New Year’s is when I look forward.

I have written different kinds of Christmas reflections before: sometimes in jest, asking Santa for a better EMR; sometimes filled with compassion for physicians or patients who struggle during the holidays. I have also borrowed original sentences from Osler’s writings to imagine how he would address physicians in the present time.

This year, with the pandemic changing both medicine and so many aspects of life in general, and with a gut wrenching political battle that threatens to erupt in anarchy or civil war within the next few weeks or months, my thoughts run deep toward the soul of medicine, the purpose of being a good doctor, even being a good human being.

We live in ideological silos, protected from dissenting opinions. News is not news if it is unpopular. Fake news and fake science are concepts that seemed marginal before but have now entered the mainstream.

As a physician, I serve whoever comes to see me to the best of my ability. But this year I have had to pay extra attention to the fact that so many people have already made up their minds about the nature and severity of the pandemic we are living with. If they don’t believe the country’s top experts, they are not likely to believe in me. Still, I try to gently state that we are still trying to figure this thing out and until we do, it’s better to be cautious.

I am starting to read about what some are now calling the Fourth Wave of the pandemic, the mental health crisis this winter may see in the wake of the physical illness we are surrounded by.

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Two Surgeons—a Veteran and a Newcomer—Talk Fighting COVID Burnout

By MICHAEL E. LIPKIN and RUSSELL S. TERRY, JR.

Burnout has always been a concern in medicine, and that concern has been amplified by the added stress of COVID-19. Many months into an unpredictable and distressing situation, we have both hung on to our mental health and professional passion by seeking out strategies that work for us. We offer them in two perspectives: veteran and relative newcomer.  

Dr. Lipkin: A Veteran’s Perspective

When lockdown began in March, we slowed down my practice for about 6 to 8 weeks, and then returned to full pre-COVID levels. It feels like the uncertainty has affected me most, since it has not been clear if and when things will get substantially better. Everyone is both experiencing and projecting persistent anxiety, stress and uncertainty. Isolation is a problem as well. I no longer have the time or ability to sit down with colleagues and vent over a beer, which was an outlet I counted on to mitigate burnout. At the same time, on a more concrete level, the pandemic has made everything we do incrementally more difficult, which is grindingly stressful. These tips are helping me cope and avoid burnout.

There are so many changes—just accept them. As COVID affects so many areas of practice, there’s a kind of low-grade stress that fluctuates with events. It seems like everything is a little bit harder. We have to shift some patient visits to telehealth and make sure they get COVID tests before surgery. We’re all looking over our shoulders, wondering who’s going to get us sick. There’s always the specter of more shutdowns and how they might affect our livelihoods. Budgets have been cut back, so hiring is frozen and there’s virtually no incremental spending. Everything will stay this way for now, so the best thing to do is accept that we’re going through a tough period and focus on the big picture, rather than the list of irritations.

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COVID-19 Symptom Data Challenge Showcase Event — WEDNESDAY 4pm ET!

After receiving applications from 115 people (across every continent except Antarctica!) and 50 organizations, including 35 academic institutions, the judges have declared DeepOutbreak, a team with members from Georgia Tech, the University of Iowa, and Virginia Tech as the winner of COVID-19 Symptom Data Challenge.

Second place was awarded to K&A, a Russia-based team working with the World Bank and the Higher School of Economics. $75,000 in prizes will be awarded to the winners.

The winners and the other three finalists will present their prototypes at the COVID-19 Symptom Data Challenge Showcase on Wednesday, December 16th, from 4-5:30pm ET. Register here!

The program’s distinguished speakers include

  • Dr. Tom Frieden, President & CEO of Resolve to Save Lives, an initiative of Vital Strategies & former director of the CDC
  • Dr. Mark McClellan, director of the Duke Margolis Center for Health Policy
  • Dr. Farzad Mostashari, CEO of Aledade & former National Coordinator for Health IT at the Department of Health and Human Services, and
  • Kang-Xing Jin, Facebook’s Head of Health.

Chrissy Farr, Principal and Health-Tech Lead at OMERS Ventures and former technology and health reporter for CNBC.com, will serve as emcee.

Register for the COVID-19 Symptom Data Challenge Showcase on Wednesday, December 16th, from 4-5:30pm ET here

The Year When Everything Changed: Covid, Self Care and High Tech Innovation In Medicine

By HANS DUVEFELT

Life as we knew it and medicine as we had viewed it shapeshifted so dramatically in the past year that it is still hard to believe.

Medicine has started to move from an in-person only profession to one that finally recognizes that clinical assessment and treatment have fewer boundaries than people assumed. A patient of mine with newly diagnosed mastocytosis had a productive first consultation with an immunologist hundreds of miles away right from her own living room.

Efficiency increased when we could handle straightforward clinical issues electronically, even over the telephone, and still get paid. We were liberated from the perverted and miserly view by insurers that services not delivered in person should be free, as if fast food restaurants couldn’t charge for food at the drive through.

We delivered more virtual services to allow patients the safety of staying at home and avoiding lobbies, waiting rooms and exam rooms where airborne particles might linger.

Yet, when a primary care or mental health patient is in crisis or a person with new symptoms needs to be evaluated, a video visit is sometimes not enough. Step by step, we improvised screening protocols, not knowing which would be efficient or relevant as we didn’t know quite how the coronavirus behaved and transmitted.

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The “Right” to Health Care in America

By MIKE MAGEE

I’ve been working on a Spring lecture for President’s College at the University of Hartford titled, “The Constitution and Your ‘Right to Health Care’ in America.” 

My description reads, “This lecture explores the recent political history and legal controversy surrounding attempts to establish universal health coverage in America. “Is health care a right?” viewed within the context of the Bill of Rights and especially the 9th and 10th Amendments?”

Self-described libertarian-conservative John R. Graham, a health policy analyst in the Trump administration’s HHS, writing on the topic in 2010 stated that, “As a non-lawyer, my understanding is very simple: The Ninth Amendment states that ‘the enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.’ So, if you claim a ‘right to health care,’ there’s nothing in the Constitution that denies your claim. Indeed, libertarians and conservatives should be more willing to concede a ‘right to health care,’ because once it’s defined as a right, the entire weight of the Constitution comes down against federal (and perhaps even state) control.”

This bit of semantics crash-lands with common sense, as it did in my own state in 1965 when the Supreme Court in a 7 to 2 decision (Griswold v. Connecticut) dismantled an 1873 Comstock Law that prohibited married couples from buying and using contraceptives. Writing for the Court, Justice William O. Douglas declared that “specific guarantees in the Bill of Rights have penumbras, formed by emanations from those guarantees that help give them life and substance.” Though marital privacy was not mentioned in the Bill of Rights, legal analysts have suggested that Douglas was asserting that logic dictated that marital privacy “is one of the values served and protected by the First Amendment through its protection of associational rights, and by the Third, the Fourth, and the Fifth Amendments as well.”

Justice Goldberg concurred at the time, writing: “The language and history of the Ninth Amendment reveal that the Framers of the Constitution believed that there are additional fundamental rights, protected from governmental infringement, which exist alongside those fundamental rights specifically mentioned in the first eight constitutional amendments. . . . To hold that a right so basic and fundamental and so deep-rooted in our society as the right of privacy in marriage may be infringed because that right is not guaranteed in so many words by the first eight amendments to the Constitution is to ignore the Ninth Amendment and to give it no effect whatsoever.”

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RWJF Emergency Response Challenges Video

On November 19, 2020 Catalyst @ Health 2.0 hosted the finals of the RWJF Emergency Response Challenges, one for tools for the General Public and the other for the Health System. The promise of the tools that have been built as part of these challenges is immense in the battle against this COVID-19 pandemic and the ones yet to come. The finalists for the General Public challenge were:

Binformed Covidata– A clinically-driven comprehensive desktop + mobile infectious disease, epidemic + pandemic management tool targeting suppression and containment of diseases such as COVID-19. The presenter was veteran health IT expert Rick Peters.

CovidSMS– A text message-based platform providing city-specific information and resources to help low-income communities endure COVID-19. In contrast to Rick, CovidSMS’ team were undergraduates at Johns Hopkins led by Serena Wang

Fresh EBT by Propel– A technology tool for SNAP families to address food insecurity & economic vulnerability in times of crisis – highlighted by Michael Lewis on his Against the Rules podcast about coaching earlier this year. Stacey Taylor, head of partnerships for Propel presented their solutions for those in desperate need.

The finalists for the Health System challenge were:

PathCheck– A non profit just spun out of MIT. It has a raft of volunteers and well known advisors like John Brownstein and John Halamka among many others, and is already working with several states and countries. Pathcheck provides privacy first, free, open source solutions for public health to supplement manual contact tracing, visualize hot spots, and interface with citizen-facing privacy first apps. MIT Professor Ramesh Raskar was the presenter.

Qventus– A patient flow automation solution that applies AI / ML and behavioral science to help health systems create effective capacity, and reduce frontline burnout. Qventus is a great data analytics startup story. It’s raised over $45m and has lots of health system clients, and they have built a suite of new tools to help them with pandemic preparedness. Anthony Moorman, who won the best facial hair of the day award, showed the demo.

Tiatros – A mental health and social support platform that combines clinical expertise, peer communities and scalable technology to advance mental wellbeing and to sustain meaningful behavioral change. They’ve done a lot of work with soldiers with PTSD and as you’ll see entered this challenge to get their tools to another group of extremely stressed professionals–frontline health care workers. CEO Kimberlie Cerrone and COO Seth Norman jointly presented.

We also presented the Catalyst @ Health 2.0 Covid19 SourceDB between the two competitions. Please enjoy the video

What, Us Worry

By KIM BELLARD

2020 has been an awful year.  Hurricanes, wildfires, murder hornets, unjustified shootings, a divisive Presidential election, and, of course, a pandemic.  Most of us are spending unprecedented amounts of time sheltering in place, millions have lost their jobs, the economy is sputtering, and over a quarter million of us didn’t survive to Thanksgiving.  If you haven’t been depressed at some point, you haven’t been paying enough attention.

Within the last two weeks, though, there has finally been some cause for hope.  Whether you want to credit Operation Warp Speed or just science doing what it does, we are on the cusp of having vaccines to battle COVID-19.  First Pfizer/BioNTech, then Moderna, and most recently, AstraZenica, announced vaccines that appear to be highly effective. 

We’re having our Paul Revere moment, only this time with good news.  The vaccines are coming!  The vaccines are coming!

It strikes me, though, that our enthusiasm about these vaccines says a lot about why the U.S. has had such a hard time with the pandemic; indeed, it tells us a lot about why our healthcare system is in the state it is. We’re suckers for the quick fix, the medical intervention that will bring us health.

Unless you were alive when Woodrow Wilson was President, COVID-19 has been the worst public health crisis of our lifetime.  It took some time for us to fully realize how bad it was going to be, and, even then, most of us underestimated exactly how bad that would be.  We may still be underestimating how bad these next few months will be.

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Can the Government Mandate a Covid-19 Vaccine? Will It Have To?

By PHILLIP MEYLAN

With the emergence of two vaccines with high levels of effectiveness, there’s a strong prospect of having powerful new tools to combat Covid-19 in the months ahead. But the road between a vaccine and society returning to normal is far from certain. Millions of doses will need to be produced and intelligently distributed, and critically, people must be willing to take them. The last few months have seen already-low confidence in such a vaccine fall even further, with just two-thirds of Americans expressing a willingness to be vaccinated when one becomes available. Similar trends are playing out globally. 

Source: The Economist

Bringing the pandemic under control will likely require successfully vaccinating 60–70% of the population to halt community transmission. Vaccine skepticism puts rapidly reaching that goal in jeopardy. Can the government at the state or federal level mandate vaccination? What is motivating this growing skepticism in Covid vaccination and how might those sentiments shift over time? This week, Phillip looked at 28 articles from 24 sources to explore likely pathways toward vaccination, as well as related vaccine skepticism. 

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Women Leaders Increasingly Visible In The Fight Against Covid-19

By MIKE MAGEE, MD

As we struggle to control a second wave of Covid-19, we are reminded once again of the nurses and doctors who place themselves at risk willingly and consistently.  They are struggling uphill with a deeply segmented health care system that chronically rewards the have’s over the have-not’s, and a President clearly intent on creating as much havoc as is humanly possible on the way out the door.

Filling the leadership void this week, we witnessed the unusual appearance on network television of two national leaders from the professions of Nursing and Medicine, Dr. Susan Bailey (President, AMA) and Debbie Hatmaker (Chief Nursing Officer, ANA) appearing in tandem. 

The united front presented by these two women leaders was reassuring. They didn’t pull punches, but spoke truth to power, describing the nation’s condition as “very grim” and “quite stark.”

In many ways, their joint appearance was a reflection of a changing reality in communities large and small across America. A Medscape survey released this week found that women’s roles in health care are growing in leaps and bounds. For example, in Family Medicine, close to 40% of the physicians are now women, and they work approximately the same number of hours per week as their male counterparts.

These women doctors are increasingly working in team settings. The majority of Family Physicians (71%) now work within a team that includes either a Nurse Practitioner (NP) or Physician’s Assistant (PA).

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Social Workers are the Healthcare Heroes We Need

By ALIZA NORWOOD

I’m a primary care doctor at a clinic providing care to uninsured and under-insured patients in central Texas. As COVID-19 cases rise around the country, one thing has become crystal clear: social workers are more critical to our work than ever, and we don’t have enough of them.  

I’m reminded of this one day with a patient I’ll call David. It’s late September, and he’s back for a 3-month follow-up visit. Behind the pane of a face shield, I look at his phone as he shows me pictures. By now I’m used to the blur as the shield fogs from my mask, but it adds to the disorienting feeling of these moments. 

In the clinic room, his own vision blurs as tears flow freely down his cheeks. We look at FaceTime screenshots from last week: his elderly mother in a hospital bed, her face obscured by tape and tubes; his similarly bedridden cousin with a fully gowned nurse in the background; a man in his twenties smiling and hugging a squirming toddler. He shows me those who are already dead, and those who are left behind. 

I don’t want to dismiss the grief that hangs in the air like an unseen cloud, but the ticking clock forces me to push ahead. “David, I’m concerned about your blood pressure and sugar,” I say. His numbers are worsening. He nods his head wearily, explaining how he lost his health insurance along with his job and can no longer afford his medications. His grief comes in waves and he can’t sleep. He is suffering.  

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