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The demands for robotic surgery

Many months ago,
I wrote about the da Vinci Robot Surgical System and expressed doubts
about whether there was evidence to support the clinical efficacy of
this equipment, as opposed to the marketing efficacy of the company
selling it. Well, the time has come to graciously say, “Uncle!”

Without
making any representations about the relative clinical value of this
robotic system versus manual laparoscopic surgery, I am writing to let
you know we have decided to buy one for our hospital.

Why? Well, in
simple terms, because virtually all the academic medical centers and
many community hospitals in the Boston area have bought one. Patients
who are otherwise loyal to our hospital and our doctors are
transferring their surgical treatments to other places.

Prospective
residents who are trying to decide where to have their surgical
training look upon our lack of the robot as a deficit in our education
program. Prospective physician recruits feel likewise. And, these
factors are now spreading beyond urology into the field of
gynecological surgery. So as a matter of good business planning,
concern for the quality of our training program, and to continue to
attract and retain the best possible doctors, the decision was made for
us.

So there you have it. This is an illustrative story of the health care system in which we operate

Paul Levy is the President and CEO of Beth Israel Deconess Medical
Center in Boston. He blogs about his
experiences at, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.

Consumer-Generated Clinical Trials? Research Minus Science = Gossip

ValjonesMy readers know how passionate I am about
protecting the public from misleading health information. I
have
witnessed first-hand
many well-meaning attempts to “empower consumers” with Web 2.0 tools.
Unfortunately, they were designed without a clear understanding of the
scientific method, basic statistics, or in some cases, common sense.

Let me first say that I desperately want my patients to be
knowledgeable about their disease or condition. The quality of their
self-care depends on that, and I regularly point each of my patients to
trusted sources of health information so that they can be fully
informed about all aspects of their health. Informed decisions are
founded upon good information. But when the foundation is corrupt –
consumer empowerment collapses like a house of cards.

In a recent lecture on Health 2.0, it was suggested that websites
that enable patients to “conduct their own clinical trials” are the
bold new frontier of research. This assertion betrays a lack of
understanding of basic scientific principles. In healthcare we often
say, “the plural of anecdote is not data” and I would translate that to
“research minus science equals gossip.” Let me give you some examples
of Health 2.0 gone wild:

Continue reading…

Medical informatics needs a rock star

Medical informatics needs a rock star. Not a David Brailer-esque figure
who could excite people in the technology sphere, but perhaps a Don
Berwick type who can reach every level and constituency of health care,
and even capture the imagination of the general public.

I had this thought yesterday during a highly engaging session at the American Medical Informatics Association‘s
annual symposium in Washington, a session with the mouthful of a title,
“Harnessing Mass Collaboration to Synthesize and Disseminate Successful
CDS Implementation Practices.” In English, that means panelists were
discussing the forthcoming “Improving Outcomes with Clinical Decision Support: An Implementer’s Guide” and related feedback mechanisms, including a wiki.

Continue reading…

A patient’s perspective: Do doctors read?

After monitoring e-patients.net and The Health Care Blog, I have to ask: Do doctors read? And if so, what?

I know four things from my own experience (and watching “Grey’s Anatomy”).

First, physicians are busy often exhausted individuals who deal with life-and-death matters.  For some, a robust sense of importance, if not their institutional setting, makes them deaf to patient input. The work-to-the-max ethic and lifestyle is inculcated since before medical school.

Second, physicians in my daughter’s chain of medical events were highly resistant if not resentful of patient input regarding new sources of information, from medical to newspaper to Internet articles. Regardless of how tactfully the material was presented.

Third, as is clear from my own posts, the ones I encountered don’t read The New York Times.

Fourth, the doctors I know, when they do have leisure time, spend it at the health club, on the ski slopes, at the theater or flying jets. They don’t read for leisure and thus are unlikely to familiarize themselves with the irony, say, of Robert B. Parker’s Spenser novels. Irony is useful here in that it, and the humor in Spenser, arises from the skepticism of a Single Joe dealing with large, but not efficient, corporate and government entities.

So I raise the question: Do doctors read? And if so, what?

Whatever they are reading, or not reading, seems to contribute to the ossification of attitude implicit in David Kibbe’s recent post on The Health Care Blog about his quest to urge physicians to adopt up-to-date Information Technology.  Of all the entities involved in transformation of the health care system, the physician community seems least able to adapt to changing times.

Christine Gray is a patient who blogs at e-patients.net, where this post first appeared.

Baseball and Health Care: Only One Is a Spectator Sport

It’s fascinating when two of my passions collide in the opinion pages of the New York Times like they did over the last week. On Friday, October 24, some seriously strange bedfellows came together to write about, “How to Take American Health Care from Worst to First.” Strange enough that Newt Gingrich and John Kerry joined together, but
the lead author was Billy Beane, often thought to be the pioneer in the
trend toward data-driven major league baseball general managers.

I’ve been studying the health care system for nearly two decades,
but I’ve been studying sabermetrics (complex baseball statistics) since
a decade before that. So you’d think that their argument would resonate
with me and, to some extent, it does.

Their thesis is rational in many ways. Much of what is done in
health care has no evidence basis, and we end up spending a lot of
money on things that are unnecessary or even detrimental (or, at the
least, things for which we just don’t know). By developing a better
evidence base and encouraging more use of it, we could improve quality
and lower cost.

Continue reading…

Safeway uses incentives and transparency to improve employee health

In this interview on “The Business Case for Health 2.0,” Ken Shachmut,
Senior VP Strategic Initiatives, Health Initiatives, and Health
Re-engineering at Safeway, shares is thoughts on some of the highly
impressive results that the company has obtained by introducing market-based
health plans.

SS: Ken, thanks for making time today. Tell me a little about your background?

KS: I have been active as an executive and
management consultant for over 30 years. I graduated from Princeton in
Engineering and later obtained my MBA from Stanford. In consulting, I
worked first with McKinsey & Company,
later at Booz Allen Hamilton, and for awhile independently.  I had done
some consulting for Safeway. I later joined Safeway and have been there
the last 15 years in various capacities.

Due to my consulting background and analytical focus, I am
frequently asked to look at new challenges and opportunities for the
organization. As health care costs continued to rise, we started
looking at ways that we could engage our employees or work with the
unions to control costs. The process has been highly successful, and we
now have broad participation in “market-based health care” (MBHC) plans
– starting with our non-union population and evolving into our union
plans currently. In consequence, our employees are now much more
actively involved in their health care and are making better choices
that improve their health. As a result of our learning and success, we
have helped to create the Coalition to Advance Health Care Reform
(CAHR) which is led by our CEO Steve Burd. CAHR now has over 60
companies as members.

Continue reading…

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