The Health Care Blog – Page 451 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Being Gawande

Dec 5, 2014• 11

ROBERT WACHTER, MD

“I learned about a lot of things in medical school, but mortality wasn’t one of them.” So begins Being Mortal, Atul Gawande’s fourth and most ambitious book.

All of Gawande’s prior books – Complications, Better, and The Checklist Manifesto – were beautifully crafted, lyrical, and fascinating, and all were bestsellers that helped cement his reputation as the preeminent physician-writer of our time. Each blended Gawande’s personal experience as a practicing surgeon with his prodigious skills as an author and journalist. They took readers behind the curtain of the hospital and the operating room, revealing much about some very important matters, like medical training, quality improvement, patient safety, and health policy.

But they were only partly revealing of Gawande himself. He told us what we needed to know about his thoughts and biases in order to make his points, but no more. Being Mortal is Gawande’s most personal book, and as such it reaches a level of poignancy that surpasses the others. Mind you, it’s not an easy read, it’s a bit dull in the early going before it hits its stride, and it has an attitude: Gawande’s indictment of modern medicine’s approach to aging and dying is pointed and withering. But, even more than his other books, this one matters deeply.

A Doctor is a Doctor is a Doctor, Right?

Dec 5, 2014• 5

HANS DUVEFELT, MD

I am a foreign born, foreign trained doctor, serving many patients from an ethnic minority, whose native language I never mastered.

So, perhaps I am in a position to reflect a little on the modern notion that healthcare is a standardized service, which can be equally well provided by anyone, from anywhere, with any kind of medical degree and postgraduate training.

1) Doctors are People

No matter what outsiders may want to think, medicine is a pretty personal business and the personalities of patients and doctors matter, possibly more in the long term relationships of Primary Care than in orthopedics or brain surgery. Before physicians came to be viewed as interchangeable provider-employees of large corporations, small groups of like-minded physicians used to form medical groups with shared values and treatment styles. The physicians personified the spirit of their voluntary associations. Some group practices I dealt with in those days were busy, informal and low-tech, while others exuded personal restraint, procedural precision and technical sophistication. Patients gravitated toward practices and doctors they resonated with.

PCORI Board to Consider Hepatitis C & PCORnet Funding at Dec. 8 Meeting

Dec 5, 2014

THCBist

The Board of Governors of the Patient-Centered Outcomes Research Institute (PCORI) will consider a plan for funding comparative clinical effectiveness research on hepatitis C virus infection at its day-long meeting on Monday, Dec. 8. In addition, the Board will vote on a plan to fund the second phase of development of PCORnet, PCORI’s initiative to improve the efficiency of health research by harnessing data from electronic health records (EHRs) and other resources.

The meeting will run from 10:15 a.m. to 5:45 p.m. EST Monday, Dec. 8, at the Renaissance Dupont Circle Hotel, 1143 New Hampshire Ave., NW, Washington, DC. The public may attend in person or via teleconference/webinar. Visit the meeting page on PCORI’s website to view the agenda and register to join the teleconference.

Paper EOBs? Please Make Them Stop!

Dec 5, 2014• 5

ACA Database

This one is important. Maggie writes in to ask:

When I had Premera Blue Cross (Washington state), I could opt-out of receiving paper EOBs. I received a email when an EOB was available and I viewed it online. Now I have MA BC/BS, and I do not have that option, and I can’t get anyone to tell me why? The EOB is available online. I dislike paper EOBs – lots of wasted space, and I have to put them thru the shredder before I can recycle them …

I Am Not a Provider.

Dec 4, 2014• 11

JORDAN SHLAIN, MD

This is the fourth in a never ending series of screeds that attempts to crack open words that are misused, misguided misnomers in the healthcare arena.

“Provider” is a substantial, material word that will require a medical sledgehammer to crack open…and what we find inside this 8-letter facade will turn your stomach and give a new sense of appreciation for it’s history.

First, before the healthcare system adopted and mangled this well-meaning word, it was not a healthcare word. It had real meaning rooted in family life; the head of a household provided for their family. It was rooted in substance and survival. There was an aura of pride and dedication in being that family

Sadly, healthcare has an clumsy tendency to mangle and maim its lexicon….and has rendered provider a hollow noun, a shell of its former self.

As physicians and clinicians we provide a service to people who are sick, worried or dying….as we have since the days of shamans, medical men and healers. So, why and how did the word provider rise so rapidly? If you look at any historical literature or descriptions of healthcare, there are sparse references to medical professionals as providers.

Why We’re Getting Patient Engagement Backwards

Dec 4, 2014• 14

JOE SMITH, MD

There’s a mantra in healthcare right now to “drive patient engagement.” The idea is that informed and engaged patients play a crucial role in improving the quality of care our health system delivers. With the right information, these healthcare consumers will be more active participants in their care, select providers based on quality and value metrics, demand appropriate, high-quality, high-value services and choose treatment options wisely after a thorough process of shared decision-making.

This drive for patient engagement often fails to recognize one important truth: Our healthcare system inadvertently, yet potently, discourages engagement. It ignores the fact that the patient is already the most engaged person in healthcare. The patient bears the disease, the pain, the scar – and, ultimately, the bill. In our search for greater engagement, we must realize what the comic strip Pogo said years ago – “we have met the enemy, and he is us.”

53 Is the New 38

Dec 3, 2014• 3

MIKE TURPIN

Middle Age is where your broad mind and your narrow waist begin to change places.” – John Crossman

I never really took a regular medication for a condition before I was in my forties. My mother did not believe in pills. She was one part Christian Scientist and two parts Inuit Darwinist subscribing to the notion that sick children, like old people, should be just set outside the igloo at night and if they were still alive in the morning, they were allowed to rejoin the family. Illness and chronic conditions were things that plagued other people, like old man Norton who lived across the street. At 85, he suffered from heart failure and diabetes and it seemed like every other week they were lopping off one of his appendages as a sort of burnt offering to his disease. It was a preview of a movie I hoped to never see.

As a kid, you averted your eyes from the vagaries of aging, not so much out of denial but out of some misguided sense that old age only happened to other people. Deep down, you knew it would be waiting for you, like that German Shepherd that sometimes chased you on your bike. On sunny afternoons, I occasionally glimpsed Mr. Norton and he would wave to me from his wheel chair – all two arms, one foot and a half leg. It freaked me out and I made a pact that I would never succumb to old age.

Secrets to Choosing the Right Medical School

Dec 3, 2014• 5

RICHARD GUNDERMAN, MD

The competition to get into medical school is fierce. The Association of American Medical Colleges just announced that this year, nearly 50,000 students applied for just over 20,000 positions at the nation’s 141 MD-granting schools – a record. But medical schools do not have a monopoly on selectivity. The average student applies to approximately 15 schools, and many are accepted by more than one. Students attempting to sort out where to apply and which admission offer to accept face a big challenge, and they often look for guidance to medical school rankings.

Among the organizations that rank medical schools, perhaps the best-known is US News and World Report (USNWR). It ranks the nation’s most prestigious schools using the assessments of deans and chairs (20%), assessments by residency program directors (20%), research activity (grant dollars received, 30%), student selectivity (difficulty of gaining admission, 20%), and faculty resources (10%). Based on these methods, the top three schools are Harvard, Stanford, and Johns Hopkins.

Rankings seem important, but do they tell applicants what they really need to know? I recently sat down with a group of a dozen fourth-year medical students who represent a broad range of undergraduate backgrounds and medical specialty interests. I posed this question: How important are medical school rankings, and are there any other factors you wish you had paid more attention to when you chose which school to attend?

Marketplace: Digital Health Maven Growth Salon NYC

Dec 3, 2014• 2

In MARKETPLACE

Have You Ever Attended a Digital Health Event Specially Designed to Meet YOUR Needs? Now You Can

On December 12, attend an intimate New York City event designed to focus on your unique strategic, business, relationship and knowledge needs in digital health.

The event is organized around a unique system that health executives and medical professionals from around the world are using to boost their knowledge, skills and confidence in digital health.

Health Data Outside the Doctor’s Office

Dec 2, 2014• 66

DeSALVO, WHITE and PAINTER

Health primarily happens outside the doctor’s office—playing out in the arenas where we live, learn, work and play. In fact, a minority of our overall health is the result of the health care we receive. If we’re to have an accurate picture of health, we need more than what is currently captured in the electronic health record.

That’s why the U.S. Department of Health and Human Services (HHS) asked the distinguished JASON group to bring its considerable analytical power to bear on this problem: how to create a health information system that focuses on the health of individuals, not just the care they receive. JASON is an independent group of scientists and academics that has been advising the Federal government on matters of science and technology for over 50 years.

Why is it important to pursue this ambitious goal? There has been an explosion of data that could help with all kinds of decisions about health. Right now, though, we do not have the capability to capture and share that data with those who make decisions that impact health—including individuals, health care providers and communities.

The new report, called Data for Individual Health, builds upon the 2013 JASON report, A Robust Health Data Infrastructure. It lays out recommendations for an infrastructure that could not only achieve interoperability among electronic health records (EHRs), but could also integrate data from all walks of life—including data from personal health devices, patient collaborative networks, social media, environmental and demographic data and genomic and other “omics” data.