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The Unintelligible Language Of Healthcare

Writing about health care reform, Peggy Noonan complains of the decay of the English language:

A reporter asked a few clear and direct questions: What is President Obama’s health plan, how would it work, what would it look like?  I leaned forward.  Finally I would understand.  [Secretary of Health and Human Services Kathleen] Sebelius began to answer in that dead and deadening governmental language that does not reveal or clarify, but instead wraps legitimate queries in clouds of words and sends them our way.  I think I heard “accessing affordable quality health care,” “single payer plan vis-a-vis private multiparty insurers” and “key component of quality improvement.”  . . . . As she spoke, I attempted a sort of simultaneous translation.  . . . But I gave up.  Then a thought crossed my mind: Maybe we’re supposed to give up!  Maybe we’re supposed to be struck dumb, hypnotized by words and phrases that are aimed not at making things clearer but making them obscure and impenetrable.  Maybe we’re not supposed to understand.

Noonan is on to something, but it’s not what she thinks.  What she’s hearing is real-life language of our health care system from the people in charge of it.   And it’s not just government officials who talk this way — Sebelius’ language is just as common in the private sector.

It reveals the deepening divide between how people talk about health care and what it really means to be sick.  Noonan jokes that if Sebelius’ child were to get a high fever she might say “This unsustainable increase in body temperature requires immediate access to a local quality health-care facility,” instead of just “We have to go to the hospital.”  But I don’t believe that.

When a loved one is sick, all the abstract ideas melt away.  It becomes about trying to get help from a doctor, and a doctor doing his or her best to help.

You might think our health care system would be set up to make that process easier.  But it isn’t.

Patients and doctors report in overwhelming numbers how dissatisfied they are with what they see as the interference of well-meaning insurers, governments and others.

You might also think that the reform conversation happening in Washington would have the doctor-patient relationship at the forefront.  But it doesn’t.

Look at the “eight principles of health care reform,”  proposed by the President and supported by the big players in health care:

(1) protecting families’ financial health, (2) making health coverage affordable, (3) aiming for universality, (4) providing portable coverage, (5) guaranteeing choice, (6) investing in prevention and wellness, (7) improving patient safety and quality, and (8) maintaining long-term fiscal sustainability.

What does all of this stuff mean?  How do you talk about health care and not even use the word “doctor” or talk about “patients”?  Worse, I’m not sure more than one or two of these even qualify as “principles” as that word is normally used.  So what’s going on?

I don’t think anyone is trying to deceive anyone. Like Sebelius’ choice of words, the list is as much of a description of the problem as a solution to it.  We don’t have a consensus of what is really important in health care, so we avoid the problem altogether by using vague language that everyone can support.  What’s worrisome is that vague, abstract talk is almost certain to lead to vague, abstract solutions.

Before we try to reform health care, let’s first talk about it in plain, clear language.

*This blog post was originally published at See First Blog*

The Canadian Health Care System: Just Like Ours

Why paying for health care is so difficult:

a gigantic, complex raft of billing codes which are seemingly designed to haunt you in your sleep. With thousands of codes, and with frequent revisions to the fee schedule, it’s difficult to imagine a bureaucratic system. . . more challenging to decipher.

American health care?  No, Canadian.

Some problems are inherent to health care, regardless of who pays for it.

*This blog post was originally published at See First Blog*

The President is Wrong About Second Opinions

The New York Times interviews President Obama about health care:

I’m a pretty well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor.  But ultimately he is the guy with the medical degree.  So, if he tells me, You know what, you’ve got such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.

It’s shockingly bad advice.

Numerous studies show that patients get the wrong diagnosis as much as 20% of the time, and get the wrong treatment half of the time.  Thirty-five percent of doctors and 42% of patients report errors in their own care or that of a family member.  Studies show that most errors happen because of a failure to analyze the patient’s problem correctly.  Experts, like Dr. Jerome Groopman from Harvard, say that doctors, strapped for time and dealing with complicated problems, easily fall prey to cognitive pitfalls that create poor quality.

Ask questions, be skeptical, disrupt your doctor’s thought process.  Make sure the decisions about your care are right.

Above all, remember it is you, the patient, that are in charge, not the “guy with the medical degree.”

(h/t @epatientDave via twitter)

*This blog post was originally published at See First Blog*

Misdiagnosis Could Have Paralyzed Young Screenwriter

My younger brother is an executive producer of the show “Nip/Tuck” and an executive producer of soon-to-air Fox show “Glee.“  Last year, he almost died.

It started when he woke up one day with numbness on one side of his body.

His doctor ordered an MRI. It found bad news: a tumor in his spinal cord, high up in his neck. He was referred to a neurosurgeon.

The plan was straightforward, but dangerous.  First, radiation.  Then, his spinal cord would be carefully cut open to remove the tumor. He was told he could end up paralyzed, or dead.  Concerned, he called me, and we started a case at Best Doctors.

One of our nurses took a history, and we collected his records.  Two internists spent hours reviewing them.  The records noted our family history of a kind of malformed blood vessel.  Our grandfather had hundreds of them in his brain when he died at 101, and our father has dozens of them in his.  I have one in my brain, too. This was in my brother’s charts, but none of his doctors had mentioned it.

An expert in these malformations told us a special imaging study should be done to rule this out as a cause of the problem.  Best Doctors gave that advice to my brother and his doctors.  They agreed.

The test showed this was precisely what he had.

Quickly, the plan changed. He still needed surgery — if the malformation bled, it could also paralyze or kill him.  But there would be no radiation, which might have caused the very bleeding we feared.  Even if that didn’t happen, the surgeons were prepared to operate on a tumor.  They would have been surprised to find a delicate malformation there instead.

In the end, his surgery went well.  He is having a good recovery and is busy with his new show.  But his case is a constant reminder of how important it is to have the right diagnosis, and how easy it is for things to go wrong.

Even in  Hollywood.

Five Things That Employers Want To Stop Doing

Our survey of employer attitudes about health benefits told us a lot about what employers are doing, and what they want to stop doing.  Here are 5 things employers want to stop doing:

1. Stop paying for bad employee lifestyles. Bad lifestyle choices are big drivers of expense.  Our study shows that employers want to stop being solely responsible for those costs.  More than half (54%) are adopting programs that use incentives — and penalties — to encourage employees to take responsibility for their health.  A study released last week by Watson Wyatt showed similar results.

2. Stop expecting health plans to deliver customized programs. Health plan offerings are popular — there is a nearly 90% adoption rate for core health plan services.  But employers increasingly turn to outside vendors for customized programs to fix bad employee health habits.  Health plans are looked to for value-based insurance designs, with 40% of employers looking to implement VBID or similar programs.

3. Stop paying for programs that don’t work. Fifty-five percent of employers said they were reducing the number of health benefits they offer or focusing on those with a proven ROI.  With 59% saying cost savings are their top priority, it makes sense that they cut costs where they don’t see savings.

4.  Stop confusing employees with too many benefit offerings. Employers have in place 10 or more distinct health benefits, with 60% identifying at least five major programs (EAPs, nurse help lines, health coaching, wellness, etc).  Employers want to implement a single point of contact to navigate their programs, with adoption rates of these services expected to triple in the next 2 years.

5.  Stop thinking bad medical outcomes are because of bad luck. Sixty-five percent of employers said their employees struggle with making the right treatment decisions when sick.  Thirty-five percent said making sure their employees have better quality care was a high priority, with 38% saying they wanted to do more to empower employees to make good health care decisions.

*This blog post was originally published at the See First blog.*

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