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Physician Specialty Silos Can Cause Friendly Fire Casualties

It’s no secret that medicine has become a highly specialized business. While generalists used to be in charge of most patient care 50 years ago, we have now splintered into extraordinarily granular specialties. Each organ system has its own specialty (e.g. gastroenterology, cardiology), and now parts of systems have their own experts (hepatologists, cardiac electrophysiologists)  Even ophthalmologists have subspecialized into groups based on the part of the eye that they treat (retina specialists, neuro-ophthalmologists)!

This all comes as a response to the exponential increase in information and technology, making it impossible to truly master the diagnosis and treatment of all diseases and conditions. A narrowed scope allows for deeper expertise. But unfortunately, some of us forget to pull back from the minutiae to respect and appreciate what our peers are doing.

This became crystal clear to me when I read an interview with a cardiologist on the NPR blog. Dr. Eric Topol was making some enthusiastically sweeping statements about how technology would allow most medical care to take place in patient’s homes. He says,

“The hospital is an edifice we don’t need except for intensive care units and the operating room. [Everything else] can be done more safely, more conveniently, more economically in the patient’s bedroom.”

So with a casual wave of the hand, this physician thought leader has described a world without my specialty (Physical Medicine & Rehabilitation) – and all the good that we do to help patients who are devastated by sudden illness and trauma. I can’t imagine a patient with a high level spinal cord injury being sent from the ER to his bedroom to enjoy all the wonderful smartphone apps “…you can get for $35 now from China.” No, he needs ventilator care and weaning, careful monitoring for life-threatening autonomic dysreflexia, skin breakdown, bowel and bladder management, psychological treatment, and training in the use of all manner of assistive devices, including electronic wheelchairs adapted for movement with a sip and puff drive.

I’m sure that Dr. Topol would blush if he were questioned more closely about his statement regarding the lack of need for hospital-based care outside of the OR, ER and ICU. Surely he didn’t mean to say that inpatient rehab could be accomplished in a patient’s bedroom. That people could simply learn how to walk and talk again after a devastating stroke with the aid of a $35 smartphone?

But the problem is that policy wonks listen to statements like his and adopt the same attitude. It informs their approach to budget cuts and makes it ten times harder for rehab physicians to protect their facilities from financial ruin when the prevailing perception is that they’re a waste of resources because they’re not an ICU. Time and again research has shown that aggressive inpatient rehab programs can reduce hospital readmission rates, decrease the burden of care, improve functional independence and long term quality of life. But that evidence isn’t heeded because perception is nine tenths of reality, and CMS continues to add onerous admissions restrictions and layers of justification documentation for the purpose of decreasing its spend on inpatient rehab, regardless of patient benefit or long term cost savings.

Physician specialists operate in silos. Many are as far removed from the day-to-day work of their peers as are the policy wonks who decide the fate of specialty practices. Physicians who have an influential voice in healthcare must take that honor seriously, and stop causing friendly fire casualties. Because in this day and age of social media where hard news has given way to a cult of personality, an offhanded statement can color the opinion of those who hold the legislative pen. I certainly hope that cuts in hospital budgets will not land me in my bedroom one day, struggling to move and breathe without the hands-on care of hospitalists, nurses, therapists, and physiatrists – but with a very nice, insurance-provided Chinese smartphone.

Cardiologist Discusses Upcoming mHealth Summit

Post image for Dr. Eric Topol discusses this “extraordinary time” in medicine #mHS11

Dr. Eric Topol

It is hard to easily comprehend the depth and breadth of Dr. Topol’s career. He has been a major figure in cardiology, genomics and wireless health while also assuming leadership positions in landmark institutions such as the Cleveland Clinic and the Scripps Institute in La Jolla.

As chairman of cardiology at the Cleveland Clinic, he led the program to become number one for heart care. He was lead investigator on numerous national & worldwide cardiovascular clinical trials and started a medical school at the Clinic. He was also among the first physicians nationwide to call attention to the potential cardiac dangers of Vioxx. His very public criticism of Merck and the FDA brought to light the intimate but not always visible connections between the pharmaceutical industry and academic medicine.

Later he moved to San Diego, where he currently serves as director of the Scripps Translational Science Institute, Chief Academic Officer for Scripps Health and Professor of Translational Genomics. He has been a leading proponent of wireless medicine for more than a decade. He co-founded the West Wireless Health Institute with Gary and Mary West who contributed the initial $45m gift to start the Institute and have since committed an additional $100m to found a not-for-profit venture fund for wireless health companies. He currently serves as Vice Chairman of the Institute which is dedicated to “innovating, validating, and advocating for the use of technologies including wireless medical devices to transform medicine.” Be sure to check out our recent interview of WWHI chief executive Don Casey.

Dr. Topol is delivering the opening keynote for the mHealth Summit on December 5. His new book “The Creative Destruction of Medicine” is also making its debut at the Summit as an e-book, available to meeting attendees. Read below to hear his thoughts on the mHealth Summit and wireless platforms’ potential to improve health & transform the practice of medicine.

Why are you participating in the mHealth Summit? Read more »

*This blog post was originally published at iMedicalApps*

Top Health Quotes of the Week

The combined profits of the Fortune 500 increased by 81% this year, the third largest gain in history. Compare that to the unemployment rate, which fell by just 8% over the past 12 months.” Ezra Klein, while analyzing last week’s jobs report by the Federal Government.

erictopol Top Quotes of the WeekWhy would I listen to ‘lub dub’ when I can see everything?” Eric Topol, a cardiologist in San Diego who carries a portable ultrasound device with him in lieu of a stethoscope. The device lets him and his patient see the heart muscle and valves, and blood flow into and out of the organ.

There probably is not a whole lot that we can do at the pipeline level to dramatically improve the number of students choosing primary care. Where the money is, is where the money is.” Mark Schwartz, an associate professor at the NYU School of Medicine, discussing a study showing that high medical school debt and low compensation are driving people away from General Internal Medicine.

It sounds like a new Apple product.” Bara Vada, describing IPAB, the Independent Payment Advisory Board, a controversial panel tasked by the Affordable Care Act to make binding recommendations to reduce Medicare spending. Read more »

*This blog post was originally published at Pizaazz*

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