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Latest Posts

Can Physician De-Skilling Be Attributed To The Use Of EMRs?

Turns out there is an unintended consequence of many of the current efforts to standardize the way doctor’s practice medicine.  It is called de-skilling.  De-skilling can occur when physicians and other providers try to adapt to standardized, new ways of doing things.  Examples of such standardization include clinical based care guidelines, electronic medical records (EMRs), Pay for Performance (P4P), Patient Centered Medical Home (PCMH) requirements and so on.

Examples of physician de-skilling were revealed in a recent study which consisted of in-depth interviews with 78 primary care physicians regarding EMR use.  EMRs are all about standardization – what data is captured and recorded, how data is reported, how data is used, and so on.

Over the course of the interviews, physicians in the study described significant examples of de-skilling behavior.  Most indicated  that Read more »

*This blog post was originally published at Mind The Gap*

Does Your Doctor Look Up Information Online In Front Of You?

Nearly three-quarters of survey respondents said they look up information online in front of a patient sometimes or often, and another 11% said they do when absolutely needed. Only 13% deliberately avoid it.

ACP Internist polled its readers in relation to its story on computers in medicine, in which it focused on whether doctors should look up information in front of a patient. From this, 362 readers responded in August that: Read more »

*This blog post was originally published at ACP Internist*

Healthcare Engagement: Most Companies Are Not Meeting Employee Expectations

nancyturettEdelman has been a leader in surveying and analyzing consumer health opinion on a global scale. In 2008 they released the results of a Health Engagement Barometer, confirming the public’s strong desire for personal engagement with health experts and peers online and beyond. I clearly remember Edelman’s revelation that medical bloggers (particularly healthcare professional bloggers) are one of the most trusted sources of health information online. That made me feel good.

This time around, Edelman created a new survey (The Health Engagement Pulse) focused on consumer expectations of their employers. The results reflect a further shift away from traditional siloed roles and relationships (where employers have nothing directly to do with healthcare) and a new era of blended responsibility. To understand this shift, I interviewed Nancy Turett, Edelman’s Global President of Health. Please listen to the audio interview or enjoy the synopsis below.

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The Healthcare Agenda For The New President And Congress?

The Kaiser Family Foundation and Harvard School of Public Health teamed up to survey Americans about their healthcare reform priorities (Kaiser has been doing this every year since 1992). A random sample of 1,628 adults participated in the telephone survey between December 4-14th, 2008. The results were presented at a press conference that I attended on January 15th.

Although you might want to view a presentation of the entire webcast here, I’ll summarize the points that I found the most interesting:

Dr. Robert Blendon (Professor of Health Policy at the Harvard School of Public Health) offered some fascinating commentary on the survey results:

1. Americans Are Fickle About Healthcare Reform Issues. Most public opinion polls do not take into account the degree of conviction with which people describe their health reform priorities. In reality, the public is generally quite ambivalent regarding the specifics of how to achieve reforms like improved access to care, and decreased healthcare costs. The Kaiser survey clearly demonstrated the public’s tendency to agree with specific reform ideas, but then change their minds when the potential downsides of such initiatives were described. So for example, most survey respondents liked the idea of an employer insurance mandate (requiring employers to subsidize employee health insurance costs), but when asked if they would favor it if it might cause some employers to lay off workers, then they no longer supported the mandate.

2. Public And Government Priorities Differ. While the public is primarily focused on relief from skyrocketing healthcare costs, the government is focused on healthcare delivery reform.

3. Americans Don’t Want Change To Affect Them. An underlying theme in the survey was that the average respondent didn’t want to pay more for healthcare, and they also did not want to be forced to change their current care and coverage arrangements.

4. It’s All About Money. America is in a near economic depression, and therefore the healthcare reform climate is very different from that of 1992 (when the Clinton reform plan stalled). Middle income Americans in an economic downturn are not willing to pay more taxes. The only way forward in our current economy is to find a revenue stream for reform that does not increase taxes on the average American. Blendon summarizes:

“It isn’t enough that all the groups agree on how to spend money on healthcare. ‘Who is going to pay?’ is the critical issue.”

At this point in time, it looks as if the American public is most supportive of the healthcare reforms listed below (but their opinion is certainly subject to change, depending on how the political discussions unfold, and how the media influences the debate). Blendon also cautions: “This doesn’t mean that this is a sensible health reform plan, it’s just what has public support at the moment.”

Healthcare Reform Initiatives Currently Favored By Americans

Expanding Coverage

1. Health insurance mandate for children

2. Fill the Medicare doughnut hole

3. Tax credits to employers to help them offer coverage to more employees

4. Health insurance for the unemployed

5. Eliminate medical underwriting (“pre-existing condition” carve outs and such)

6. Expand Medicare to cover people ages 55-64 who are without health insurance

7. Require employers to offer health insurance to their workers or pay money into a government fund that will pay to cover those without insurance

8. Increased spending on medical care for veterans

9. Increased spending on SCHIP

Controlling Costs

1. Negotiate for lower drug costs under Medicare

2. Allow Americans to buy prescription drugs imported from Canada

3. More government regulation of healthcare costs

4. More government regulation of prescription drug costs

5. Regulate insurance companies’ administrative spending and profits

Raising Revenue

1. Increase the cigarette tax

2. Increase income taxes for people from families making more than $250,000 a year

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As you can see, the public supports reform that would result in substantial increases in healthcare spending without a clear idea of how to pay for those initiatives. Our government, in partnership with healthcare’s key stakeholders, is going to need to come up with a reform plan that identifies new revenue streams to cover the costs associated with expanding coverage. I find it hard to believe that increasing taxes on cigarettes (and a few very wealthy Americans) is going to be sufficient. If ever there were a time to nurture our American entrepreneurial spirit, it’s now.

Vote In My Poll Or You Will Be Forced To Read About Cats Forever!

Alright, well a little melodrama never hurt anyone did it? I’m trying really hard to listen to my readers and adjust my blogging themes/topics/approach accordingly. I actually have no idea what you like to read – health policy, touching stories, humor, research explained, expert interviews, celebrity health initiatives, health tips… etc. So I’m asking. What would you like me to blog about? Please vote in my poll on the right hand side of this page. (Or if you’re viewing this message in a reader, well please come on over to my blog and vote.)

So far (my poll has a N=11, not a very high statistical power) you readers seem to be saying that you like personal stories about the blogger (I guess that means you want me to tell you about my cat – well there she is, featured in the top left-hand corner. Her name is “Ona” and she has an insatiable appetite for grilled asparagus.)

But I have this sneaking suspicion that you don’t really want to hear about ME, you’d like to hear about healthcare and medicine from a fresh perspective. But maybe I’m wrong. Maybe this should be a cat blog? Please do vote in my poll so you can water down the voices of those crazy people who are asking for more personal blogging. If you don’t… my only choice is to give the people what they want…  and you may be doomed to read about kitties, etc. forever!

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Bizarre event of the day: I was voted as one the top 20 most influential health voices on Twitter. So go ahead and follow me there. My Twitter name is drval.

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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