Category: Uncategorized

We are Asking Our Physicians to Do Too Much. It’s No Wonder They are Burnt Out.

Nov 1, 2021

By GAIL PEACE

We have heard the phrases “physician fatigue” and “burnout” too often in the last year – and for good reason. Covid-19 has placed an incredible burden on our healthcare providers. However, as healthcare professionals, the stats representing physician burnout are not new for us.

We have seen similar trends and stats for years. Covid-19 did not cause the current state of physician burnout, it has just exacerbated it and further exposed critical issues with the expectations placed on physicians in today’s healthcare system. Ludi conducted a survey of physicians across the country confirming that exact theory:

68 percent of physicians feel pessimistic or indifferent about their occupation
48 percent describe the relationship with their hospital partners/employers as combative or transactional at best

We need to ask ourselves: What is actually causing this dissatisfaction and how can hospitals better align with their physician partners?

According to the physicians surveyed, 68 percent agreed they have too much administrative burden placed on them. More often than not, our industry blames EHRs for dominating administrative time, but from the physicians we surveyed, EHRs are just part of the problem. In fact, 54 percent of physicians indicated they spend 1-3 hours per day on administrative work outside of EHR time, with another 35 percent spending more than 4 hours per day on similar tasks.

Let’s put that into perspective. On top of seeing patients, charting in EHRs, and all the other things physicians are expected to do to take care of patients, physicians are also spending at least another 1-3 hours per day on “everything else.” This everything else includes meetings, training, compliance, policy, etc.

We are asking our physicians to do too much. It’s no wonder they are burnt out.

#Healthin2Point00, Episode 239: Hinge, Femtec, Science37, Augmedix

Oct 30, 2021

On a special Saturday edition of Health in 2 Point 00, Jess and I talk about her amazing forecasting and the huge scale of one deal. Yes, the Tiger pounces and Hinge Health takes its total raise to $1 billion. There’s also an complex combo deal for Femtec, raising $38m buying Birchbox and more, and we give a quick mention to the brief history of public companies Science 37 & Augmedix – Matthew Holt

#Healthin2Point00, Episode 238 | Truepill, Stride Health, Bardavon, and Wider Circle

Oct 28, 2021

Today on Health in 2 Point 00, Jess and I talk about the importance of a good company name. Some deals today: Truepill gets 142 million in a Series C bringing their valuation to 1.6 billion with 300 million ARR; Stride Health gets 47 million gets, bringing up their total to 86 million; Bardavon Health Innovations gets 90 million, bringing their total up to 109 million; Wider Circle gets 38 million, invested in by AmeriHealth Caritas. – Matthew Holt

Godwin’s Law and the Rise of Hyperbole on MedTwitter 🙄

Oct 28, 2021

By @roguerad

I first clashed with authority when I was eight. Every Saturday bunch of brown kids, children of Indian immigrants to Britain with an identity crisis who longed for the culture they left behind, attended a class in the temple about “our culture” taught by a joyless scholar of Hinduism – a pundit – whose major shtick was punctuality. When I turned up late, even by a minute, he’d make me stand outside, even if freezing. Some kids called him “Hitler,” or “Hitler uncle,” the qualifier “uncle” indicated that because he was as old as our fathers, he deserved respect.

Then, I believed that Hitler meant authority. I preferred calling the pundit “wanker” or “asshole” but the foul language would have gotten me afoul with my parents, my authority figures. “Hitler” amply conveyed disdain for our pot-bellied teacher who exercised his authority whenever he could, without tarnishing our nubile vocabulary.

Eventually, I understood the significance of Hitler, and of World War 2, the Nazis, and the Holocaust. Though related neither morphologically to the perpetrators nor ethnically to the victims of this ghastly period in human history, I developed a reverence, a sensitivity if you will, to such allusions. The Lord of the Old Testament instructed Moses that his name be not used in vain, lest every blocked sink or traffic jam evoked “oh my God.” I resolved never to use Nazi as an epithet frivolously.

I was surprised how common Nazi name-calling was in American political discourse across the political spectrum, which peaked during the Trump Presidency. Some likened migrant detention facilities to “concentration camps.” Many saw in the rise of white nationalism during Trump’s reign parallels with the Third Reich. The former White House strategist, Steven Bannon, was compared to the Nazi propagandist, Goebbels. Bannon is loathsome, detestable, a wanker. Goebbels is a mass murderer – no adjectives are needed to describe him further.

#Healthin2Point 00, Episode 237 | Horowitz and Tiger Global, Medable, Zerigo Health, and more deals

Oct 27, 2021

Today on Health in 2 Point 00, Jess and I talk about Andreessen Horowtiz’s new ventures and the reemergence of Tiger Global in Health Tech. Some big deals for Episode 237: Medable receives 304 million in Series D bringing their total up to $521 million; Zerigo health gets $43 million, bringing their total up to $67 million; Click Therapeutics receives 52 million, but with side deals their total rises to $100 million; Workit Health gets $112 million, bringing their total to $138 million. Among Horowtiz’s new ventures, Patina gets 57 million despite not having launched yet, and Marley Medical gets $9 million. – Matthew Holt

#Healthin2Point 00, Episode 236 | HLTH 2021, Oak Street, 23andMe, Babylon Health, and Everlywell

Oct 26, 2021

Today on Health in 2 Point 00, Jess and I catch up after HLTH 2021. Some massive deals in Episode 356: Oak Street acquires Rubicon MD for 190 million, 130 in cash; 23andMe acquires Lemonade (a virtual care and drug delivery company) for 400 million – 300 million in stocks and 100 million in cash; Babylon Health’s SPAC deal, 4.2 billion in market cap now; Everlywell acquires Natalist – their third acquisition in 6 months. – Matthew Holt

Medicine May Be an Art, but AI May Be Artists

Oct 26, 2021

By KIM BELLARD

Six hundred years ago, Swiss physician/scientist/philosopher Paracelsus disclaimed: “Medicine is not only a science; it is also an art.” Medicine, most people in healthcare still believe, takes not just intelligence and fact-based decision-making, but also intuition, creativity, and empathy. This duality is often cited as a reason artificial intelligence (A.I.) will never replace human physicians.

Perhaps those skeptics have not heard about Ai-Da.

Now, I have to admit, “she” wasn’t on my radar either until recently, when she was imprisoned/impounded at customs by Egyptian authorities on her way to an art exhibit at the Great Pyramids of Giza, where she was scheduled to show her work. Egyptian authorities first objected to her modem, then to the cameras in her eyes. “I can ditch the modems, but I can’t really gouge her eyes out,” said her creator Aidan Meller. After a 10 day stand-off, she was released late last week.

Let me back up. Named in honor of famed 19^th century mathematician/programmer Ada Lovelace, Ai-Da is “the world’s first ultra-realistic humanoid robot artist.” She was created in 2019, and uses AI algorithms to create art with her cameras/eyes and her bionic arms. She can draw, paint, even sculpt, and had her first major exhibit – Ai-Da: Portrait of the Robot — this summer at London’s Design Museum.

The description of her exhibit says:

As humans increasingly merge with technology, the self-titled robotic artist, Ai-Da, leads us to ask whether artworks produced by machines can indeed be called ‘art’…Ai-Da can both draw and engage in lively discussion…These features, and the movements and gestures that Ai-Da is programmed to perform, raise questions about human identity in a digital age.

Her website elaborates:

…current thinking suggests we are edging away from humanism, into a time where machines and algorithms influence our behaviour to a point where our ‘agency’ isn’t just our own. It is starting to get outsourced to the decisions and suggestions of algorithms, and complete human autonomy starts to look less robust. Ai-Da creates art, because art no longer has to be restrained by the requirement of human agency alone.

State-Based Marketplaces 2.0 Part 2: Engines of Innovation, Competition, and Consumerism

Oct 25, 2021

By ROSEMARIE DAY and DAVID W. JOHNSON

Within the current political reality, how can America implement policies that increase access to health insurance while also reducing premium costs and enhancing responsiveness to consumer priorities and needs?

Large-scale healthcare reform appears off-the-table for the Biden Administration. Yet, given the impact of the COVID pandemic on people who have lost (or have worried about losing) their employer-based insurance coverage and the intensifying pressure to reduce overall healthcare costs, solutions that increase health insurance access and affordability have become more important than ever. A significant answer to this complex puzzle can be found at the state level.

Enabled by the Affordable Care Act (ACA) in 2010, state-based marketplaces (SBMs) currently operate in 14 states and the District of Columbia. Another six states operate as SBMs using the federal government’s HealthCare.gov technology platform. Three states, Kentucky, Maine, and New Mexico, will become full SBMs by 2022.

While federal measures to improve insurance access have stalled or been reversed over the past eight years, SBMs have quietly implemented programming modifications for stabilizing local markets that improve the quality and marketability of health insurance offerings to the benefit of consumers.

In Part 2 of our series on marketplace health plan innovations, we examine how SBMs have operated as experimental policy laboratories. They’ve taken their own paths to expand consumer choice, increase access to vital healthcare services, and lower premiums.

The “Secret Sauce” – A Comparison of TSMC and Pfizer

Oct 22, 2021

By MIKE MAGEE

This week’s Tom Friedman Opinion piece in the New York Times contained a title impossible to ignore: “China’s Bullying Is Becoming a Danger To The World and Itself.” The editorial has much to recommend it. But the item that caught my eye was Friedman’s full-throated endorsement of Taiwan’s “most sophisticated microchip manufacturer in the world,” Taiwan Semiconductor Manufacturing Company (TSMC).

TSMC owns 50% of the world’s microchip manufacturing market, and along with South Korea’s Samsung, is one of only two companies currently producing the ultra-small 5-nanometer chips. Next year, TSMC will take sole ownership of the lead with a 3-nanometer chip. In this field, the smaller the better. (For comparison, most of China’s output is 14 to 28 nanometers.)

U.S. Silicon Valley companies like Apple, Qualcomm, Nvidia, AMD, and recently Intel contract with TSMC rather than produce chips on their own. In addition, the key machines and chemicals necessary to produce the chips are willing supplied to TSMC by U.S. and European manufacturers. TSMC’s secret sauce, according to Friedman, is “trust.” As he writes, “Over the years, TSMC has built an amazing ecosystem of trusted partners that share their intellectual property with TSMC to build their proprietary chips.”

“Trust me” is not a phrase often associated with intellectual property. Consider, for example, Washington Post’s reporting the very same day as Friedman’s under the banner, “In secret vaccine contracts with governments, Pfizer took hard-line in the push for profit, report says.” The article reveals documents in a Public Citizen report that confirms that Pfizer has been maximizing their vaccine profits “behind a veil of strict secrecy, allowing for little public scrutiny… even as demand surges…”

As I describe in my book “Code Blue: Inside the Medical Industrial Complex” (Grove 2020), Pfizer’s focus on intellectual property as a commercial weapon has a history that extends back a half-century.

We Use Too Many Medications: Be Very Afraid of Interactions

Oct 21, 2021

By HANS DUVEFELT

I happened to read about the pharmacodynamics of parenteral versus oral furosemide when I came across a unique interaction between this commonest of diuretics and risperidone: Elderly dementia patients on risperidone have twice their expected mortality if also given furosemide. I knew that all atypical antipsychotics can double mortality in elderly dementia patients, but was unaware of the additional risperidone-furosemide risk. Epocrates only has a nonspecific warning to monitor blood pressure when prescribing both drugs.

This is only today’s example of an interaction I didn’t have at my fingertips. I very often check Epocrates on my iPhone for interactions before prescribing, because – quite frankly – my EMR always gives me an entire screen of fine print idiotic kindergarten warnings nobody ever has time to read in a real clinical situation. (In my case provided by the otherwise decent makers of UpToDate.)

I keep coming back in my thoughts and blogging about drug interactions. And every time I run into one that surprised me or caused harm, I think of the inherent, exponential risks of polypharmacy and the virtues of oligopharmacy.