The Health Care Blog – Page 247 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

How to Practice Medicine in a World We Can Never Truly Understand

Nov 1, 2018

By Kent Bottles, MD

Central to the problem of how best to live in a world that we cannot understand is how to regard:

“The Extended Disorder Family (or Cluster): (i) uncertainty, (ii) variability, (iii) imperfect, incomplete knowledge, (iv) chance, (v) chaos, (vi) volatility, (vii) disorder, (viii) entropy, (ix) time, (x) the unknown, (xi) randomness, (xii) turmoil, (xiii) stressor, (xiv) error, (xv) dispersion of outcomes, (xvi) unknowledge.” (Nassim Nicholas Taleb, Antifragile, London: Allen Lane, 2012)

To this impressive list, I would add seventeenth and eighteenth items: failure and death. All of these characteristics scare and frighten most of us, and so we do our best to avoid them.

Despite the popularity of self-help books emphasizing the pursuit of happiness, a vocal minority has advocated embracing all of the above negative items in order to live fully and successfully.

Eric G. Wilson perhaps provides the best overview of this minority report when he observes that

“To desire only happiness in a world undoubtedly tragic is to become inauthentic, to settle for unrealistic abstractions that ignore concrete situations.”

And

“Our passion for felicity hints at an ominous hatred for all that grows and thrives and then dies.” (Eric G. Wilson, Against Happiness, New York: Sarah Crichton Books, 2008)

To be alive and to realize that you are going to die means being insecure and vulnerable. According to Martha Nussbaum one should embrace this uncertainty.

Life-Saving Data That Is Nowhere To Be Found: Hospitals’ C-section Rates

Oct 31, 2018• 10

By DANI BRADLEY MS, MPH

The United States is the only developed nation in the world with a steadily increasing maternal mortality rate — and C-sections are to blame. Nearly 32% of babies are born via C-section in the United States, a rate of double or almost triple what the World Health Organization recommends. While C-sections are an incredibly important life-saving intervention when vaginal delivery is too dangerous, they are not devoid of risks for mom or for baby. Hospitals and doctors alike are aware, as it’s been widely reported that unnecessary C-sections are dangerous — and hospitals and doctors agree that the number one way to reduce this risk is to choose a delivery hospital with low a C-section rate. However, information on hospitals’ C-section rates is incredibly hard to find, which leaves women in the dark as they try to make this important choice.

In an effort to help women make informed decisions about where to deliver their babies, we set out to collect a comprehensive, nationwide database of hospitals’ C-section rates. Knowing that the federal government mandates surveillance and reporting of vital statistics through the National Vital Statistics System, we contacted all 50 states’ (+Washington D.C.) Departments of Public Health (DPH) asking for access to de-identified birth data from all of their hospitals. What we learned might not surprise you — the lack of transparency in the United States healthcare system extends to quality information, and specifically C-section data.
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You Can’t “Elon Musk” Healthcare

Oct 30, 2018

By SOFIA NOORI

On January 26th, Philadelphia discovered that the 22-year-old organizer of its largest COVID-19 vaccination site, Andrei Doroshin, had turned away elderly members of the Philadelphia community from their vaccine appointments. Instead, he pocketed extra vaccine vials to administer to 4 friends and girlfriend. An RN witnessed the event and reported it to authorities.

Local news reporters quickly discovered that this incident was just the tip of the iceberg for Doroshin. A Drexel University graduate student with no experience in healthcare, Doroshin had enlisted his college friends to organize a group that would go on to win one of the biggest vaccination contracts from the city of Philadelphia. He told his friends that “this is a wholly Elon Musk, shoot-for-the-heaven type of thing,” and that “we’re going to be millionaires.” His organization had also amended its privacy policy allowing for patient data to be sold, administered large numbers of vaccines to people ineligible to receive the vaccine yet, and threw Philadelphia’s COVID vaccination program into chaos.

For the people in the back: One can’t simply “Elon Musk” healthcare. We have seen this too many times – a privileged young upstart with little experience believes that s/he can transform healthcare and make millions – or billions – doing so. Examples abound: we only have to look a couple years into the past to remember Elizabeth Holmes, the Stanford dropout who founded Theranos and misrepresented its technology, or to Outcome Health, whose former CEO Rishi Shah defrauded investors by overinflating business metrics. If “move fast and break things” works in other sectors, many reason, why won’t it work in the 4 trillion dollar industry of healthcare?

Healthcare is simply not the kind of business where one can shoot a rocket into the sky and accept the risk that it might explode. Simply put, this is people’s lives we’re dealing with. But a deeper layer involves trust in the medical establishment. U.S. healthcare is already marred by multiple grave issues: a complex bureaucracy, serious health inequities, and astronomical costs that can bankrupt a person in just one hospitalization. The trust that people have in U.S. healthcare has steadily dropped over the years. Further, the politicization of the COVID-19 pandemic and the U.S. government’s bungled response to it has only sowed further distrust, especially among marginalized and minoritized communities.

A Unique Offering for Students, Professors, and Lifelong Learners: “The ‘Right’ to Health Care and the U.S. Constitution.”

Oct 30, 2018

By MIKE MAGEE

“The ‘Right’ to Health Care and the U.S. Constitution.”

(Register For Virtual Zoom Access Here.) https://securelb.imodules.com/s/1878/lg21/form.aspx?sid=1878&gid=2&pgid=1306&cid=3139&srce=WBpcfall2021

Join me, in-person or virtual, on 4 consecutive Thursdays this Fall.

Together we’ll examine 250 years of history and case law, to expose what our U.S. Constitution says (and leaves unsaid) about Americans’ “right” to health care. From the Bill of Rights to the Federalist Papers, from McCulloch v. Maryland to Griswold v. Connecticut, from “Comstockery” to Sanger, and FDR’s “Court Packing,” we’ll cover it all.

You’ll learn about “penumbras” from William O. Douglas, and Due Process within the XIV Amendment; how the AMA chose Reagan as their spokesperson against “socialized medicine”, and how LBJ forced integration of hospital wards on Bible Belt states.

We’ll do a deep dive into Roe v. Wade and learn how Justice Blackmun arrived at his compromise solution for “Jane Doe” and others, and examine why Texas Governor Abbott is trying to torpedo it a half-century later.

We’ll revisit the politicization of the Terri Schiavo “Right to Die” case, and uncover “conflicts of interest” and deficiencies in “informed consent” at the University of Pennsylvania that contributed to the research death of Jesse Gelsinger.

We’ll hear the voices and opinions of students and professors, analyze Justice Roberts’ National Federation of Independent Business v. Sebelius split decision that preserved the Affordable Care Act…address mandated vaccines, and much, much more.

In just four 90-minute packed sessions, you’ll gain a perspective on the current struggle for health care in America. Most of all, you’ll learn and participate in the process. That’s a promise!

Register Today HERE. https://securelb.imodules.com/s/1878/lg21/form.aspx?sid=1878&gid=2&pgid=1306&cid=3139&srce=WBpcfall2021

How do Consumers view Technology’s Role in Healthcare?

Oct 30, 2018

By HARRY GREENSPUN, MD

As technology-enabled home health becomes more pervasive, how will consumers respond? What concerns and reservations will they have? Will they readily adopt new technologies? Deloitte conducted focus group research to better understand consumer expectations and preferences for receiving health care services in the future, focusing on care in the home.

In general, consumers are optimistic: To them, the benefits of technology-enabled home health far outweigh the risks, and they are eager to try it. For the unwell, home health technology can help manage their conditions and slow disease progression. For caregivers, it can offer peace of mind. For the healthy, it can provide the tools and support to maintain healthy behaviors.

Even though interest is high, we heard some concerns. Consumers value the personal nature of health care and the patient-doctor relationship. Many are concerned that increasing reliance on technology will erode the relationships that they feel are already threatened by the fragmented nature of health care, decreasing face time with doctors, and difficulty establishing and maintaining those meaningful relationships. While it may seem obvious that technology should reinforce and facilitate relationships rather than supplant them, consumers’ previous experiences with technology temper their enthusiasm.

Technology-enabled solutions that are perceived to intrude on people’s privacy, such as sensors that monitor an individual’s sleep quality or motion patterns at home, face resistance. Education may be required to effectively convey the benefits of such monitoring; consumers are then able to evaluate the pros and cons, and many are amenable to the tradeoff.

As more care moves to self-care, consumers want to have influence and control over their own care and health information. They expect to learn about new technologies and to be actively involved—as patients or caregivers—in deciding which technologies are used for their care, how they are used, and what data will be disclosed and shared.

Companies—whether newcomers or traditional players—developing the technology for home health are expected to negotiate a number of challenges:

Medicine is Child’s Play: Where’s Waldo, Spot the Difference and Whack-a-Mole

Oct 30, 2018

By HANS DUVEFELT, MD

I started writing a post a few days ago about the challenge of quickly finding what you’re looking for in a medical record. As I came back to my draft this morning, it struck me how much this felt like some of the games my children played when they were young. This got me thinking…

Where’s Waldo: Finding what’s important in the medical record

I did a peer review once of an office note about an elderly man with a low grade fever. The past medical history was all there, several prior laboratory and imaging tests were imported and there was a long narrative section that blended active medical problems and ongoing specialist relationships. There was also a lengthy Review of Systems under its own heading.

In what would probably have printed out over ten pages long, the final diagnosis was “Urinary tract infection” and the man was prescribed antibiotics.

This final diagnosis seemed to come out of left field. I didn’t recall reading anything about urinary symptoms, urinalysis, an abdominal exam or pain on percussion over the back.

During National Kidney Month, Protect Patients by Protecting Their Health Care Choices

Oct 30, 2018

By ALLYSON Y. SCHWARTZ and ELENA RIOS MD, MSPH

The recent coronavirus outbreak has millions of Americans thinking carefully about their health and wellness. For the 37 million of our friends and neighbors battling chronic kidney disease, however, health care risks that the rest of us often take for granted are never far from their mind.

Every year, 124,000 patients with kidney disease see their condition progress to end-stage renal disease (ESRD), also known as kidney failure and will require dialysis at least three times per week to survive.

Hannah, an ESRD patient in Henrico, Virginia, describes dialysis as “the most painful thing, physically and emotionally, I’ve had to endure.”

As a physician who represents medical providers in the Hispanic community – a demographic disproportionately impacted by kidney disease (Rios) – and a former lawmaker who worked to reduce the uninsured rate and improve quality of care (Schwartz), we know that stories like Hannah’s are all too common.

Facts, Conclusions, and More Questions on the Road to Solving Disparities

Oct 30, 2018• 2

By SCOTT COOK PhD

We tested whether new payment mechanisms could be harnessed in health care delivery reform to reduce health and health care disparities. Here’s what we found.

First, there were facts that couldn’t be ignored:

#1: Children in rural Oregon on Medicaid suffered more health-related dental challenges compared to children with private insurance, including the pain, systemic health problems and disruptions to education that come with them. Advantage Dental, the state’s largest provider of Medicaid services, was determined to do something about it.

#2: New mothers on Medicaid in a New York City hospital were less likely to have a postpartum care visit compared to privately insured women. As a result, they missed assessments and screenings for a number of health conditions, some of which can lead to chronic health problems throughout their lives. For many women, the postpartum visit is one of the few chances to engage them in ongoing health care. The providers and care teams at the Icahn School of Medicine and the Mount Sinai Health System wanted to find out what it takes to increase postpartum visit rates.

#3: In Fairfax County, Virginia, multi-racial and multi-ethnic populations being served in three County-funded safety-net clinics were less likely to receive the typical high-quality care provided for hypertension, diabetes, and cervical cancer screening when compared to their Hispanic counterparts. The providers and teams at the Community Health Care Network stepped forward to address the issue.
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Silencing Noisy Health Care?

Oct 30, 2018

By MATTHEW HOLT

As you’ve probably heard (enough!) from me and Indu Subaiya over recent months on video, at Health 2.0 or here on THCB, we are finally arriving at the point where health care tech is “flipping the stack” — where we realize that we can’t practice the old way, and instead need to move the care of the chronically ill to an always on, always monitoring, always measuring, always messaging tech platform.

But we need to figure out a way to both create that platform and the services for the people who need help–without overwhelming them. Too often we are putting too much technology into patients’ and clinicians’ lives and creating too much noise. While I’ve been aping Bob Wachter calling for an air traffic control function in health care, one of the most interesting new companies in health tech/services, Livongo, has been working on a related idea. They’ve been promoting it by looking to #SilenceNoisyHealthCare on Twitter and Linkedin recently

Tuesday 30th at 1 ET – 10 PT I’m hosting a webinar with Livongo’s CEO Glen Tullman & & Chief Medical Officer Jennifer Schneider, M.D. Jessica DaMassa tweeted that Glen and I are in a cage match, and it is an Oxford v Cambridge affair (although Jennifer brings some Stanford & Hopkins class to the proceedings).

But what’s really going on is that Livongo is adopting a new philosophy that they think will silence the noise and fix the patient experience. What do they mean by that? Join me on the webinar to learn more.