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Ten Good Things About The U.S. Healthcare System

President-elect Obama and Secretary of HHS designate, Tom Daschle, invited concerned Americans to discuss healthcare reform in community groups across the country. My husband and I hosted one such group at our home in DC yesterday. Although we had been instructed to compile a list of compelling stories about system failures – instead we decided to be rebellious and discuss “what’s right with the healthcare system” and compile a list of best practices to submit to the website.

The event was attended by a wide range of healthcare stakeholders, including a government relations expert, FDA manager, US Marine, patient advocate, health IT specialist, transportation lobbyist, real estate lobbyist, health technology innovator, Kaiser-trained family physician, medical blogger, and EMR consultant. Here is what they thought was “right” with the healthcare system:

1.    Customer Service. Market forces drive competition for business, resulting in increased convenience and customized service. Healthcare consumerism has driven patient-centered innovations that improve quality of life. Examples include convenient walk-in clinics, online scheduling, services available in a one-stop location, and seamless transfer of health information (such as within the Kaiser Health system).

Memorable Quote: “We have a tremendous amount of choice in our system. That’s very good for patients and I hope we never lose it.”

2.    Accommodations For People With Disabilities. Kaiser Permanente was cited as an organization that takes special interest in facilitating good patient experiences for vulnerable populations and people with disabilities. For example, extra time is allotted for travel to and from the clinic, and schedules are built with flexibility to accommodate mobility impairments.

Memorable Quote: “Kaiser trains all its staff to be sensitive to people with ethnic, racial, and sexual preference differences. They learn to listen to the patient, and never assume they know what they think or feel.”

3.    Specialty Care. So long as a person has health insurance, access to the very best specialists in the world is available in a very democratic fashion to all patients. Several success stories included surgery and follow up for major multiple trauma, and congenital anomaly repair.

Memorable Quotes: “I’m only here today because of the technical skills of a U.S. surgeon who saved my life…” “I’ve traveled all over the world, and I wouldn’t want to get my medical care in any other country.”

4.    Social Media. Internet-based tools and social media platforms are leveling the communication “playing field” between providers and patients. People are discussing their care and treatment options with others like them online, as well as socializing with physicians and receiving real-time input on health questions.

Memorable Quote: “On Twitter I have I.V. access to physicians. I asked a health question and within 10 minutes I had 6 physicians answer me.”

5.    Access To Allied Health Professionals. Scheduling time with mid-level providers is easy, convenient, and effective. Patients enjoy the ability to access generalist care with nurse practitioners (for example) who provide quality care at a more relaxed pace.

Memorable Quote: “I love my nurse practitioner. She really listens to me and her schedule is much more flexible than physicians I’ve known.”

6.    Drug Development For Rare Diseases. The U.S. government offers grants, extended patents, and exclusivity to drug companies willing to develop drugs for rare diseases. This dramatically improves the quality of life for patients who would otherwise have no treatment options.

Memorable Quote: “The FDA recently approved the first drug for Pompe’s disease. Only a few hundred patients in the U.S. have the disease, and yet this life-saving medication was developed for them thanks to government incentives.”

7.    Patient Autonomy. The healthcare consumerism movement has replaced medical “paternalism” with care partnership. Patients are seen as consumers with choices and options who must take an active role in their health.

Memorable Quote: “Patient accountability is key to better health outcomes. But they need guidance and decision support… General health literacy is at a sixth grade level.”

8.    Health Education. Technology has improved health education dramatically. Patient education about their disease or condition is often facilitated by demonstration of computer-based anatomic models.

Memorable Quote: “I think that doctors are getting much better at communicating with patients in ways they can understand.”

9.    Coordination of Care. Some hospitals like the Mayo Clinic do an excellent job of coordinating care. For example, they provide each patient with photos and names of all the physicians, nurses, and specialists who are on their care team. Nurses update the patient’s schedule daily to reflect the tests and procedures anticipated and provide dignity and sense of orientation to the hospital experience.

Memorable Quote: “The Mayo Clinic has gone Facebook.”

10.    Democratization of Information & Transparency. Patients have the right to view and maintain all their medical records. They have many PHR options, and may be provided with CDs or thumb drives of their personal radiologic information to take with them to their next provider. Many doctors write their notes with the understanding that the patient will be reading them.

Memorable Quote: “One day soon, hospital stays will no longer occur in a black box. Family members and friends will be invited by the patient to view their daily schedule online, while nurses update planned procedures, events, and meetings. Family members won’t miss the opportunity to meet with the patient’s care team, because it will be on the schedule. MyChart (from EPIC) is working on making this hospital experience a reality at the Mayo Clinic soon.”


Thanks so much to all of you who attended. My husband will be preparing a report for the transition team shortly.

Making the Right New Year’s Resolution … And Keeping It

By Steve Simmons, MD

What do New Year’s Resolutions tell us about ourselves?  Will they cast light on our hopes for the coming years or embody regrets best left in the year past?  Resolutions tell us about our hopes, about who we want to be, and if made for the right reasons can lead us to the person we wish to be tomorrow.  A positive approach utilizing the support of family, friends, and caregivers will help us follow through with our resolutions and improve our chances for success.

For the last two years, resolutions to stop smoking, drinking, or overeating, have ranked only ninth on the New Year’s Resolutions list, while getting out of debt, losing weight, or developing a healthy habit are the top three.  If you find this surprising, you are in the company of many physicians. Yet this demonstrates the positive approach preferred by a majority making a New Year’s resolution. For each person making a resolution to stop or decrease a bad behavior, five choose to increase or start a good behavior, instead.  We can learn from this and maintain a positive focus when considering and following through on a resolution.  Keep in mind that only 40% find success on the first try and 17% of us need six tries to ultimately keep a resolution.

Avoid making hasty New Year’s resolutions based on absolute statements, which all too often meet with failure at the outset.  We recommend an approach based on The Stages-of-Change-Model, developed from studying successful ex-smokers.  For 30 years, primary care doctors have used this model to help their patients successfully rid themselves of a variety of bad habits.  The Model’s foundation is the understanding that real change comes from within an individual.

Below, I’ve outlined the five typical stages a person progresses through in changing a behavior, using the example of a smoker:

1.    Stage One/Pre-contemplative: This is before a smoker has thought about stopping.
2.    Stage Two/Contemplative: A smoker considers stopping smoking.
3.    Stage Three/Preparation: The smoker seeks help, buys nicotine gum, etc.
4.    Stage Four/Action: The smoker stops smoking.
5.    Stage Five/Maintenance and Relapse Prevention: Still not smoking, but if our smoker smokes again, keeps trying to stop, learning from mistakes.

The family and friends of a resolution maker are an intrinsic part of success and should avoid a negative approach. Instead, help them move through the stages, advancing when ready at their own pace.  The following exchange is typical of an office visit where a spouse’s frustration spills over, finding release:

“Dr. Simmons, Tell John to stop smoking!” John’s wife demands of me.

“Mr. Smith, you really should stop smoking,” I request of John.

“Well Doc, I don’t want to and that’s not why I’m here,” John says, pushing his Marlboros deeper into his shirt-pocket, clearly agitated with his wife and me.

“I’m sorry Mrs. Smith, John doesn’t want to stop, perhaps I could hit him over his head, knock some sense into him?”

Once negative energy has been interjected between me and my patient, I struggle to find an appropriate response.  Should I use humor to redirect?  I have rarely seen someone stop a bad habit after being berated.  I would prefer a chance to help him think about smoking and how it’s affecting his health.  Does he know that smoking is making his cough worse?  Has he been thinking about stopping lately?  Nagging seems to be more about our own frustration than a desire to help and should be avoided since the effect is usually the opposite intended.

A resolution can show the path to a happier and healthier life.  If you or someone close to you is planning to make a New Year’s resolution, just start slow, stay positive, have a strong support network….and one more thing: Resolve to stay Resolved.

Farewell To The Medscape Journal

On January 31, 2009 The Medscape Journal will be discontinued. One can only assume that the journal’s parent company, WebMD, could no longer justify the cost associated with a free, open-access, peer-reviewed medical journal that receives no income from advertisers or sponsors. The Medscape Journal’s budget has been supported by revenue generated from Medscape (the website), and their robust Continuing Medical Education (CME) business.

In these challenging economic times, American companies are taking a cold, hard look at their P and L spreadsheets and nixing the least profitable parts of their businesses. The inevitable “non-profit” casualties present an ethical dilemma. What will become of the noble pursuits that are based upon “doing the right thing” rather than making a profit?

There is no such thing as completely unbiased publishing (humans all have personal agendas – whether conscious or unconscious), though The Medscape Journal came about as close to it as any medical journal ever has. The journal is free to authors and readers, and provides 24-hour online access to both professional and lay viewers from around the globe. There are no advertisements or outside sponsors, peer reviewers work without compensation or specific recognition, and editors are paid a minimal salary (full disclosure: I know this because I was an editor for The Medscape Journal several years ago). CME credit is offered for articles determined to be of special relevance, but no articles are commissioned specifically for the purpose of CME.

The Medscape Journal is a wonderful experiment in high ethics. It espouses, in my opinion, the gold standard principles of medical publishing. Tragically, market forces (or perhaps the lack of perceived value by its own parent company) killed it. So what does this mean for medical publishing? If there is no economic model for “pure science” then are medical journals doomed to go the way of health media – promoting sensational or biased science for profit?

The answer is no. But we must tread very carefully now. The Medscape Journal is our proverbial canary in a publishing coal mine. Its inability to survive on ethics alone speaks to a growing lack of value placed on purity over profitability. We must soberly consider the facts: 1) The Internet creates the illusion that information is “free” and therefore subscription-based publishing platforms will end as viewers simply refuse to pay. 2) Advertisers are becoming more aggressive in their requirements – dynamic microsites and multi-media advertorials have replaced the old billboard approach, often blurring the lines between content and advertisement. 3) Search engines like Google are changing the way that health messages reach the public and scientists alike. The “impact factor” of research often lies in its marketing campaign. Important negative trials are buried under case reports, anecdotes, and news stories with snappier headlines.

So what are scientists to do? I suggest that those of us committed to science-based medicine join together in a united effort to harness new media tools for the public’s benefit. Let’s use social networking applications (blogs, Twitter, Facebook, online communities, etc.) to educate others about science, research, health claims, and potential biases. Let’s not be afraid of marketing scientific integrity – decades have already shown us how effective marketing can be for snake oil. If we don’t raise our collective voices – how will people get good information on the Internet? How will Google searches return highly ranked, sound information rather than sensational headlines?

Farewell to The Medscape Journal – and thank you for nearly a decade of honorable medical publishing. May the rest of us continue the vision, if only on different platforms.

Bumpy Blogging Ahead

I’m going to be migrating my server and upgrading the website over the next week or so. Comments have been disabled (I have no idea why – and yes I’m quite exasperated). Please stick around… I already have blog separation anxiety. 8-O

The “you may also like these posts” section is rather interesting below. How did it know I’d need stress buster tips?

Hospital CEO Leads By Example

This is a great example of hospital administrator leadership (from Shadowfax):

As I exited the parking garage, I noticed a man in work clothes shoveling off the walkway to the hospital.  I was fiddling with my cell phone (actually texting the wife to let her know I made it OK) so I didn’t pay him any mind.  I was surprised when he greeted me by name, and more surprised when I looked at him more closely and realized it was the CEO of the hospital.

Shoveling snow.

At 5:30 AM.

In the garage.

The CEO.

I was stunned.  I made a little joke about how he’s been reduced to pushing a shovel, and he replied with good cheer, “Well, somebody’s got to do it, and half the staff wasn’t able to make it in, what with the roads and all.  The last thing I want is for an employee or patient to slip on their way in — that’s be all we need!”   We chatted for a minute and parted ways.  As I was finishing my text, I noticed him stop to greet a couple of nurses on their way in, and thank them for coming in to work today.

Now that’s leadership.

I bet Nancy Schlichting would do the same. Bravo, CEOs. Keep up the good work!

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