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Holiday Airline Troubles Are Reminiscent Of Health Care Experiences

One of the hot phrases in health care these days is “patient-centered,” as in “patient-centered hospitals,” “patient-centered practices,” and “patient-centered medicine.” For all of you out there working on creating such “patient-centered” systems, let me provide a bit of advice based on a recent experience my family and I had with Delta Airlines. For if you substitute the word “customer” for “patient,” you get what every business, whether in health care or not, should be focused on — the person receiving, nay, purchasing, their services. The ones you hope will return, again and again.

I’m actually writing this as I sit in the lobby of a hotel in Park City, Utah. It is a gorgeous day outside, crisp and cold, just perfect for the skiing my family had in mind when we booked this trip; it’s a short trip– just 3 days on the slopes before we head home — so every minute counts. Unfortunately, despite plenty of time sitting in airports yesterday (i.e., no tight connection), only 2 out of our 6 pieces of luggage made it here. Fortunately, one of those was the suitcase filled with skiing togs. Unfortunately, one of the missing pieces was my son’s new snowboard, also filled with all of his ski togs. So while my boys are out on the slopes (the snowboard kid wearing my ski clothes), I’m sitting in the lodge awaiting our luggage. It is nearly noon — half of the day gone, one-sixth, possibly one-third, of our vacation gone–and I have not yet set foot on the slopes. Sure, I could head over and buy all-new ski stuff. . . . but that isn’t the point.

The point is how this was handled. Read more »

*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*

Broaching The End Of Life Topic With Loved Ones: Join The Campaign

This is my 3rd year participating in The Engage with Grace Blog Rally.  Engage With Grace is a movement designed to help advance the conversation about the end-of-life experience.  It began with a simple idea:  Create a tool to get people talking.  Their tool is a slide with five questions designed to initiate dialog about our end-of-life preferences.  I originally heard about Engage with Grace from Paul Levy and he’s at it again this year.

This campaign has forced me to Read more »

*This blog post was originally published at 33 Charts*

Are MDs More Effective At Running Hospitals Than MBAs?

It’s been more than five years since Henry Mintzberg released the enlightening book ‘Managers, not MBAs’, a well-reasoned criticism of prevailing management education that basically revolves around Master in Business Administration (MBA) programs. Financial crisis was not even in sight but Mintzberg, a professor at McGill University in Montreal and one of the most important guiding lights in the questionable field of management, already pointed out that it was a serious danger for modern organizations to rely on professionals that had just finished their MBAs as the prime source for senior managerial positions.

Mintzberg focused his criticism on two essential aspects. First, most programs are aimed at people with no previous experience or knowledge about organizations and how they look like from the inside… and these same people then storm into companies believing that the real world works exactly as business school taught them it does. The second point is that many of these business schools spread a perverted set of values, such as the hunt for short-term profit, the belief that a good aim justifies any means and the urge to translate all human behaviors into accountable figures (the ‘countophrenia’ depicted by Vincent de Gaulejac in his must-read ‘La Société Malade de la Gestion’).

Then the crisis rose, and many CEOs of the biggest organizations had their share of responsibility for it, as they were enjoying multi-million dollar bonuses while taking their companies to the edge of bankrupcy. Most of them came from the most famous business schools in the world. I have outlined in the past the outrageous conflict of interests of many of these institutions, starting with Harvard, as Charles Ferguson perfectly displayed in his brilliant documentary ‘Inside Job’.

‘Social Science and Medicine’ published in its August issue a very interesting work by Amanda Godall, professor at the IZA Institute for the Study of Labor in Bonn, Germany. Godall’s is the first empirical research on the correlation between hospital results and having MDs in their top managerial positions. Read more »

*This blog post was originally published at Diario Medico*

Experience In Medicine Has Its Downsides

You have probably read that experience makes for better doctors.

And of course this would be true–in the obvious ways, like with the hand-eye coordination required to do complex procedures, or more importantly, with the judgment of when to do them.

There’s no news here: everyone knows you want a doctor that’s been out of training awhile, but not so long that they have become weary, close-minded or physically diminished. Just the right amount of experience please.

But there’s also potential downsides and struggles that come with experience. Tonight I would like to dwell on three ways in which experience is causing me angst.

But first, as background…

It was the very esteemed physician-turned-authors, Dr. Groopman and his wife, Dr. Hartzland, who wrote this thought-provoking WSJ essay–on how hidden influences may sway our medical decisions–that got me thinking about how I have evolved as a doctor. They were writing from the perspective of the patient. But in the exam room, there are two parties: patient and doctor.

# 1) The sobering view that experience brings: Read more »

*This blog post was originally published at Dr John M*

Solving The Health Care Crisis By Understanding The Uncertainty And Variability Of Health Care

Every day in the U.S. countless experts discuss plans and policies to contain the cost of health care using words and concepts that run counter to our (the public’s) experiences with finding and using care. Most of us ignore the steady stream of proposals until one political party or the other crafts an inflammatory meme that resonates with our fears of not getting what we need. At which point, we leap into action online, in town meetings and in the voting booth. As Uwe Reinhardt noted in his Kimball Lecture at the recent 2011 ABIM Foundation Forum, researchers and policy makers “cannot even discuss the cost-effectiveness of health care without being called Nazi(s).”

Our discomfort with the array of private and public sector proposals to improve health care quality while holding down costs should not be surprising. Most of us hold long-standing, well-documented beliefs about health care that powerfully influence our responses to such plans. For example, many of us believe that:

… if the doctor ordered it or wants to do it, we must need it.

… talking about less expensive treatments makes us feel that others are trying to bargain-shop our care and that scares us.

… clinical care does not vary much among our own doctors and hospitals.

… when we talk about the “quality” of health care we are referring to Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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