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The Art of Asking: What’s Your Biggest Fear?

By HANS DUVEFELT

When a patient presents with a new symptom, we quickly and almost subconsciously create a hierarchy of diagnostic possibilities. I pride myself in my ability to effectively share my process of working through these types of clinical algorithms.

But sometimes I seem to get nonverbal clues of dissatisfaction or simply no reaction at all to my eloquent reasoning. And only then do I remember to ask the important questions, “do you have any thoughts on what’s causing this” and, most importantly, “what’s your biggest fear that this could be”.

It doesn’t matter how brilliant a diagnostician you are if a patient with less medical knowledge than you has a thought, fear or hunch that diseases and symptoms work in ways that don’t make sense to you.

An uncle may have had a burning sensation in his nose minutes before a stroke, so this symptom may seem like a much more obvious harbinger of disaster to your patient than it does to you. How would you know, if you didn’t ask, what the number one question is that your patient wants the answer to?

We are often so focused on our own thinking process, especially with our time pressures and the bureaucratic requirements of medical encounters these days, that we risk forgetting our patients may not think the way we do.

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Local Doctors Get the “Centers of Excellence” Treatment: Embold Health’s CEO on Data-Driven Quality

By JESSICA DaMASSA, WTF HEALTH

Apparently, self-insured employers hot on better managing their healthcare spend are finding truth (and dollars) in Embold Health’s mantra that “quality is the best, most sustainable way to control costs.” This health tech startup is applying the old “Centers of Excellence” framework to the individual physician level; helping identify high-performing primary care docs and specialists in local markets for employers who not only want to offer their employees better quality care, but also improve the healthcare system in the communities in which they live and work.

Daniel Stein, Embold Health’s co-Founder & CEO, explains the company’s model, which is being perfected with one of the most demanding-yet-coveted “health activist” employers out there: Walmart. In this particular case, Walmart is actually incentivizing its employees to go to the providers ranked highest by Embold’s assessment, which looks at physician performance along three categories: 1) appropriateness of care; 2) outcomes; and 3) cost-effective compared to peers in-market. Backed by the robust national BlueCross BlueShield dataset, the information Embold Health is collecting, analyzing, and doling out to employers can definitely cause some health systems to take pause — and their docs to bristle. So, how does Embold Health diffuse potential blowback? Here’s where the competitive nature of local healthcare, particularly in the world of primary care, becomes clutch. Tune in to hear the details, including some very interesting stats, as well as Embold’s latest endeavors to help docs make better referrals to specialists.

Better Get Your Quantum Computer

By KIM BELLARD

By all rights, I should be writing about the battle between Reddit forum WallStreetBets and Wall Street hedge funds. Depending on one’s point of view, it’s hilarious, frightening, or a searing indictment on stock trading – maybe all three. 

But I’m going to let Elon Musk and Elizabeth Warren handle that one.  Instead, I want to talk about quantum computing – and why healthcare needs to be looking ahead to it.

Let’s start with this: for the low, low price of $5,000, you could have your very own quantum computer.  Spin Q Technology, a Chinese company, has recently introduced its Spin Q, a less expensive, less powerful version of its Spin Q Gemini, which went for $50,000.  Other quantum computers, such as those by Google, IBM, or D-Wave, have a few more zeroes in their price.  Spin Q Technology has a clear goal in offering this version:

We believe that low-cost portable quantum computer products will facilitate hands-on experience for teaching quantum computing at all levels, well-prepare younger generations of students and researchers for the future of quantum technologies.

You may remember that Steve Jobs and Apple had a similar strategy in the 1980’s, establishing a presence in the education market and among a generation of users that has served it well. 

If you’re looking for something more powerful, maybe even use for business purposes, you are also in luck: today Microsoft announced that Azure Quantum “is now open for business.”    Microsoft bills Azure Quantum as “the world’s first full-stack, public cloud ecosystem for quantum solutions.” 

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THCB Gang Live, Episode 41–Thurs 1pm PT – 4pm ET

THCB Gang will be held live on Thurs Feb 4 at 1pm PT -4pm ET.

Joining me, Matthew Holt (@boltyboy), will be consultant/author Rosemarie Day @Rosemarie_Day1), patient advocate/entrepreneur/author Robin Farmanfarmaian (@Robinff3), Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune), health futurist Jeff Goldsmith (@JeffcGoldsmith), Digital health futurist Fard Johnmar (@fardj).

The Biden Administration is now getting into the grist of governing. What happens next?

You can see the video below live and it’ll be on our podcast channel (Apple/Spotify) from Friday

#Healthin2Point00, Episode 182 | Sidecar Health, Folx, TimelyMD & more

On Episode 182 of Health in 2 Point 00, we’ve actually got deals less than $100 million. Starting off with one though, Sidecar Health raises $125 million bringing their total to $163 million. Folx raises $25 million providing telehealth for the LGBTQ+ community and growing fast, TimelyMD raises $60 million providing telehealth for colleges, another MSK company SWORD Health raises $25 million and GetWellNetwork acquires Docent Health for an undisclosed amount of money. —Matthew Holt

David Medvedeff, CEO Aspen RxHealth, talks about his new model for pharmacists

By MATTHEW HOLT

David Medvedeff, CEO Aspen RxHealth, tells me about the new role of pharmacists in managing chronically ill patients. Aspen RxHealth has put together a network of independent pharmacists and a tool that allows them to select patients, call them and consult with them for their pharmacy issues. It’s kinda like the original Teladoc model but for pharmacists, while the clients are health plans keen for their patients to avoid problems with polypharmacy. They’ll be doing 200K+ consults this year and just raised $23m.

#Healthin2Point00, Episode 181 | SPAC-ing rumors & more deals

Today on Health in 2 Point 00, Jess asks me about Lyra Health raising $187 million — this is their third raise in less than a year — and gets my take on the SPAC rumor for 23andMe, which is valued at $2.5 billion and just raised $82.5 million in December, and the rumor about Ro following Hims & Hers in a SPAC. Sharecare IS planning on “SPAC-ing” and recently acquired Doc.ai, and DarioHealth acquires Upright Technologies for $31 million. —Matthew Holt

One-Price, 30-Day Warranty, Payment at Discharge: Carrum Health’s CEO on Changing How We Buy Surgery

By JESSICA DaMASSA, WTF HEALTH

No copays. No coinsurance. No surprise out-of-network anesthesiologist fees or pre-op imaging bills. Just one, single price (that you see in advance) tells you EXACTLY what you’ll be paying for your surgical care on Carrum Health. Backed by the recent close of a $40M Series A funding round, the health tech startup’s CEO Sach Jain talks through all the ways his company is looking to disrupt how we buy surgical care. Standardized bundle pricing is just the beginning. Carrum requires its Centers of Excellence (and each of their docs) to pass a proprietary 50-point inspection before they can join the platform, AND every surgery must be backed by a 30-day Warranty! How have they convinced providers to jump through these kinds of hoops? With a growing client-base of self-insured employers (Sach says they have several Fortune 100 and Fortune 500 clients) and payment-in-full made to providers upon discharge, the case for additional revenue and zero A/R days is pretty compelling to a health system. And what about the other side of the business model? Tune in to find out why Sach believes Carrum Health’s “marketplace” approach will appeal to the growing base of “activist” employers whose HR benefits administrators are becoming more and more adept at building-their-own healthcare networks.

The Art of Prescribing (Or Not)

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By HANS DUVEFELT

I have learned a few things about prescribing medications during my 42 years as a physician. Some are old lessons, and some are more recent. I thought I’d share some random examples.

First: I don’t like to have to use medications, but when they seem necessary, I choose, present and prescribe them with great care.

CHOOSING MEDICATIONS

Medications are like people. They have personalities. With so many choices for any given diagnosis or symptom, I consider their mechanism of action, possible beneficial additional effects and their risk of unwanted side effects when selecting which one to prescribe. To some degree that goes against today’s dogma.

Blood pressure medications, for example, have what I call an A-list and a B-list. The A-list contains drugs with a proven track record of not only reducing blood pressure, but also actual heart attack and stroke risk. Why we choose from the B-list, the drugs that don’t decrease cardiovascular risk or actually increase it, is a little beyond this simple country doctor’s ability to understand.

ACE inhibitors like lisinopril and diuretics like hydrochlorothiazide are the two recommended first choices in this country. But the A-list also contains amlodipine, a calcium channel blocker and, further down, metoprolol, a beta blocker. I make those less favored A-listers my initial choice in two scenarios:

Amlodipine is my choice when I see a hypertensive patient who prefers a set-it-and-forget-it treatment plan. No bloodwork is required after starting it to monitor for kidney or electrolyte problems, so even if the patient doesn’t come back for a year or more, there is no real risk involved.

Metoprolol, which blocks the effect of the stress hormone adrenaline on the cardiovascular system, is what I talked my own doctor into prescribing for me. That was back in the day, when I was a hard working, somewhat Type A personality with high blood pressure. With the passage of time, life experience, weight loss and my transformative relationship with my Arabian horses, my blood pressure normalized and I didn’t need medication anymore.

Years ago, we all selected blood pressure medications according to the “phenotype” (appearance or general impression) of the patient: metoprolol if intense, hydrochlorothiazide if swollen, nifedipine if cold-handed, lisinopril If naturally hypokalemic (low potassium).

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The Art of Explaining: Starting With the Big Idea

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By HANS DUVEFELT

We live in a time of thirty second sound bytes, 280 character tweets and general information overload. Our society seems to have ADHD. There is fierce competition for people’s attention.

As doctors, we have so many messages we want to get across to our patients. How many seconds do we have before we lose their attention in our severely time curtailed and content regulated office visits?

I have found that it generally works better to make a stark, radical statement as an attention grabber and then qualifying it than to carefully describe a context from beginning to end.

Once a person shows interest or responds with a followup statement or question, you have a better chance for a meaningful discussion. Just starting to explain something without knowing if the person wants to hear what you have to say could just be a waste of time.

Here are some of my typical conversation starters – or stoppers, if you will:

“The purpose of a physical is to talk about stuff that could kill you, more than about symptoms that annoy.”

“Nothing makes a cold go away faster.”

“Urology is about plumbing, nephrology is about chemistry.”

“Most headaches are migraines.”

“Sinus headaches don’t exist in Europe.”

“I don’t care what your blood pressure is today if you’re scared or in pain.”

“A healthy lifestyle is at least as effective as taking Lipitor.”

“We now know that eating fat makes you lose weight.”

“Cholesterol only causes damage if there is also inflammation.”

“Fat free means high in sugar.”

“I don’t believe in vitamins.”

“Osteoporosis happens to every woman around 80, so is it really a disease?”

“You have to treat 35 men for prostate cancer to save one life.”

“You know how many cases of testicular cancer I’ve come across in 40 years? Three!”

“It takes 45 minutes of walking to burn 100 calories, but only 10 seconds to drink them.”

My brief experience as a substitute teacher for junior high school students as well as my many years as a scout leader taught me that you can’t assume you have people’s attention just because you’re standing in front of them. They will give it to you if they believe you have something interesting to say. You often have less than thirty seconds to prove that you do.

Is our medical knowledge alive enough in our minds that we can share it in a quick, easy and captivating way with our distracted patients?

Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.

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