Stanford neurosurgeon Paul Kalanithi died March 9th at the age of 37. This is his story.
[youtube width=”450″ height=”275″]http://youtu.be/d5u753wQeyM[/youtube]
Above the Fold
Status Epilepticus
The girl seizes. Her body torques and twists and jerks about like a snake trapped on an electric fence. She flops back and forth on the gurney before us, her pale forehead glistening with sweat, her brown hair wetted black from the effort of muscle contractions that threaten to tear apart her tiny frame.
Trauma Room Two is silent save for the gluck-gluck-gluck of her gagging as her jaw and teeth grind and bang together out of control.
This.
Is.
Seizure.
Her body screams with each shimmy and shake.
Her father stands next to me. He strokes her head with trembling fingers, running them through her damp hair, trying to keep the strands out of her grimacing face. His fingers move in time with the rhythmic nod of her skull as the tonic-clonic seizure ratchets and cranks her body. I take a deep breath. I start my chant.
Break seizure break.
Break seizure break.
I say it in my head, I say it in my bones, I say it in every part of me, keeping time to her dance.
Tech Industry, Heal Thyself
“Physician, Heal Thyself – Luke 4:23”
Not knowing the originator of this phrase, I found this description on Wikipedia: “The moral of the proverb is counsel to attend to one’s own defects rather than criticizing defects in others.” It’s common for those of us in the tech industry to lament how appallingly out-of-date healthIT is. Taking the glass-is-half-full approach, one can see opportunity in that – Why It’s Good News HealthIT is So Bad.
There are a number of reasons why this is the case — convoluted decisions processes, for example — and that health systems are spending billions to prepare for the last battle. However, I’m much more interested in how we fundamentally change the equation than why we’re in our current predicament. The same tech companies that have kvetched about healthcare being behind on technology can address that defect by taking some simple actions.
The Guy at the Gym Wants to be Your Healthcare Provider
Almost three years ago, I excoriated the American College of Sports Medicine for partnering with a medical screenings company to push useless screens upon, of all things, their membership. You can read the post here. It was truly embarrassing to a supposedly credible organization. The leadership’s reply, in addition to having their communications director call me and implore me to take the post down, was to claim they had no idea this was happening.
Now, the American Council on Exercise, another fitness industry trade group, beggars itself with an open letter to the U. S. Congress, in which it essentially asks to hop aboard the national healthcare gravy train. You can read the entire plaintive wail here. The essence of it, however is this:
The American Council on Exercise, which educates, certifies, and represents more than 55,000 fitness professionals, health coaches, and other allied health professionals, and advocates for extending the clinic into the community with science-based preventative services delivered by well qualified professionals not necessarily thought of as health providers, welcomes you to Washington.
Let me translate both the highlighted paragraph, and, indeed, the entire letter: hey, Congress, everyone else is making money from healthcare reform, what about us? Where’s our handout? We’re healthcare providers, too, sort of. That ought to be enough to qualify us for reimbursement, even though we have zero evidence that the fitness industry, or any specific category of fitness professional (you could be one by 5:00 pm today), actually can change outcomes. Exercise? Important almost beyond expression. Fitness industry and its entire coterie? Not so much. Over the past three decades, the fitness industry has boomed.Continue reading…
Got an Infection? Good Luck Finding an ID Doctor
BOSTON, Ma. — It was Christmas Day. I was on call at the hospital and was waiting for my wife and 6-week-old son to come so we could eat lunch together. She was bringing kimbap, sweet potatoes, and avocados. But then my pager buzzed.
On the phone was a hospitalist physician.
“Is this ID? We have a new consult for you,” she said. “This man has a history of dementia. For some reason he has a urinary catheter to empty his bladder. We gave him an antibiotic, but now his urine is growing a resistant bacteria.”
I sighed. Yet another catheter associated urinary tract infection.
I walked up the stairs to his hospital room. He was bald, thin, and sitting alone in bed. The peas and fish on his tray were untouched. There were no gifts or tree in his room. I washed my hands, put on gloves and a yellow isolation gown, and introduced myself.
“How are you?”
“Ok, I guess,” he replied.
“Do you know where you are?”
“I’m not sure.”
“You are in the hospital. Do you know what day today is?”
Satisfaction Scores: How I Almost Made a Hotel Manager Lose His Job
BY SAURABH JHA, MD
Recently, I was asked to fill a questionnaire during check-out at a hotel in India. I was very pleased with my stay so I agreed to providing feedback. It is worth pointing out that if I was only mildly satisfied I would not have agreed. If I was disappointed with my stay I would have filled the form more enthusiastically.
When I offer feedback I am in one of two extreme emotions: I either love the service or, more commonly, loathe it. There is no time to talk about the average. And I have given up on Comcast.
The form had about twenty questions asking how satisfied I was with various components of their hospitality. I had to choose between one and ten, the higher number for greater satisfaction. I decided to set a record for the fastest completion of the questionnaire. I quickly chose ‘9’ and ‘10’. To appear objective I gave a ‘7’ to a service, randomly. Seven meant “above average”. Nine and ten meant “outstanding” – that is satisfaction cannot be measurably higher.
In the section which asked “how can we do better?” I said “put some more trees.” I didn’t really think the hotel premise needed more trees, but I was on a roll of objectivity. I had to say something.
What If Restaurant Bills Looked Like Hospital Bills?
You’d get something like this:
HAT TIP: Jeanne Pinder. WHHY Philadelphia. Learn more about Pinder and her project here.
On THCB This Week
“Apple ResearchKit (Not) Ready For Prime Time – Yet. A Medical Researcher’s Perspective”
By Philip Jones, MD
“Apple’s ResearchKit Is Open Source. But Is it Open? “
By Vince Kuraitis
“King v. Burwell: Can the Supreme Court save the Republican Party From Itself?”
By Gary L. Kaplan
“A Checklist For Surviving Academic Medicine”
By Martin Samuels, MD
“Do Value-Based Payments lead to Higher Doctor Satisfaction Scores?”
By Jack Cochran, MD and Charles Kenney
“Value-based Health”
By Cyndy Nayer
“Validic meets Cerner: Drew Shiller speaks”
By Matthew Holt
From Google to New Reimbursement Models: Digital Health Trends for 2015”
By Ryan Beckland
A Checklist For Surviving Academic Medicine
- Decide who you are and don’t kid yourself
- Don’t bluff; the triple (quadruple) threat is an illusion
- Know your subject; teaching is not a trick; you must have something real to transmit
- Don’t replace substance with gimmicks (e.g. fancy powerpoint)
- Simulated patients produce simulated doctors and de-professionalize students
- Respect your teachers but don’t believe in the Days of the Giants; they have feet of clay
- Don’t become “one of them.”
- Develop a reputation beyond the local environment
- Train people, but remember that some will not respect you (remember Bouchard)
- Stand proudly for clinical excellence
- Write briefly, simply and parsimoniously (remember Babinski)
- Be a professional
- Don’t be an asshole
- Don’t bullshit
Abstracted from the “Academic Medicine Survival Guide” Martin Samuels, MD. The Health Care Blog. March 2015.
Academic Medicine Survival Guide
The History of the Problem
The European University (e.g. Italy, Germany, France, England) descended from the Church. The academic hierarchy, reflected in the regalia, has its roots in organized religion.
The American University was a phenocopy of the European University, but the liberal arts college was a unique American contribution, wherein teaching was considered a legitimate academic pursuit. Even the closest analogues in Europe (the colleges of Cambridge and Oxford) are not as purely an educational institution as the American liberal arts college.
The evolution of American medical education (adapted and updated from: Ludmerer KM. Time to Heal, Oxford University Press, Oxford, 1999) may be divided into five eras.
I. The pre-Flexnerian era (1776- 1910) was entirely proprietary in nature. Virtually anyone with the resources could start a medical school. There was no academic affiliations of medical school and no national standards.
II. The inter-war period (1910-1945) was characterized by an uneasy alliance between hospitals and universities. Four major models emerged. In the Johns Hopkins model, led by William Osler, the medical school and the hospital were married and teaching of medicine took place at the bedside. The Harvard model in which the hospitals grew up independently with only a loose alliance with the medical school, represented a hybrid between pre- and post-Flexnerian medical education.Continue reading…
