September 11th, 2009 by Emergiblog in Better Health Network, Opinion
Tags: Blog, Blogging, Blogosphere, How To Start, Medblog, Medbloggers, Nursing
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I’ve received some emails from nurses who would like to start a blog. Some are a bit nervous about starting, others are not sure how to begin. There are a million sites out there on how to start a blog; in fact, I wrote a post specifically on how to be a “nurse blogtitioner”.
But their emails got me thinking about the blogosphere in general and the most important considerations in starting/maintaining a blog.
1. The blogsosphere can never be saturated.
Think you have nothing to add to the dialog? Think that everything about your topic has been said? Think again. If you aren’t blogging there is still a voice that needs to be heard. What exactly do you bring to the discussion? You! No one has had your experiences or can express your opinions. More importantly, no one else can bring your voice. And unlike a meeting or an email, there are no time limits or physical boundaries to the blogosphere. There is room for everybody, and that means you!
2. The heart of the blogosphere is interactivity.
If you read blogs, you probably leave comments. Comments are the soul of the blogosphere. With them, the blogosphere is a conversation. Without them, the blogosphere is simply a virtual collection of “articles”. By starting a blog, you bring the dialog to your “home turf”, so-to-speak. You are the host/hostess of a virtual “salon”, providing information on your sphere of expertise, initiating the debate and most importantly, learning from those who comment on your posts.
3. The blogosphere is the great equalizer.
There is no hierarchy of blogs. Don’t confuse size with importance. Some blogs may have a million readers a day and some may have ten, but in the blogosphere, no one is “better” than anyone else. Your blog, with that first post, is just as important and just as relevant as anything you see on “Instapundit” or the “Huffington Post”. It’s unique and cannot be replicated, because it is based on your outlook and experiences.
Here are some things to keep in mind as you start your blog:
1. Content is King
Maybe you look at the blogs with the sidebars and the graphics and the ads and the widgets and think, “Man, I don’t know how to do all that!”. You don’t have to do all that! All you have to do is start posting. One post. Later, if you want, you can add a blogroll or a few widgets. But the way to start is to begin writing, and keep writing. People will come for your content. Everything else takes a back seat to that.
2. Promotion, Ur Doin’ it Right
You’ve just put up your first post. A few folks might stumble on your site by accident, but you need to get out the word that you’re on the web. This is where you start promoting your blog. The best way to do this is find a carnival for your niche and submit a post. For those of us in the medblogging community, examples would be Grand Rounds, Change of Shift, Patients for a Moment and The Handover. Make your url part of every email signature and blog comment you send. Write it, and they will come…but they need to know you’re there.
3. Prolific Perfection…Not
Blogging can be addicting, and in a good way. It can be challenging, therapeutic, frustrating, and energizing – all in one post! But…you do not have to be the “perfect” writer. Just find your style and run with it. And while consistent posting makes it easier for readers to find your blog, you control your posting schedule. “Prolific” is what you say it is, be it once a week or once a day. But know this: the more you write, the easier it becomes to write; the more you are interacting with the blogosphere, the more inspiration you will find and the more you will want to write. It’s the blogosphere “circle of life”!
So…if you ask me, should I blog?
I’ll say YES!!!!
Been there, still doing that, and if I can do it, you can do it.
It will clarify your outlook.
It will recharge your batteries.
It will change your life.
Really, the bottom line?
You’ll never know unless you write…
That first post.
*This blog post was originally published at Emergiblog*
September 9th, 2009 by KevinMD in Better Health Network, Health Policy, Opinion
Tags: Death Panels, Government, Healthcare reform, media, Misinformation, Myths, Newsweek
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Blame motivated reasoning.
Newsweek’s Sharon Begley writes about the phenomenon, which goes a long way why the myth about “death panels” continues to persist in the health reform conversation. She cites the work of sociologist Steve Hoffman, who explains: “Rather than search rationally for information that either confirms or disconfirms a particular belief, people actually seek out information that confirms what they already believe.”
And with a growing majority obtaining their news through pundit-tinged lens, such as from FOX News on the right and MSNBC on the left, there’s always fodder to confirm pre-existing beliefs.
Ms. Begley goes on to suggest that cognitive dissonance is also in play:
This theory holds that when people are presented with information that contradicts preexisting beliefs, they try to relieve the cognitive tension one way or another. They process and respond to information defensively, for instance: their belief challenged by fact, they ignore the latter. They also accept and seek out confirming information but ignore, discredit the source of, or argue against contrary information.
This is seen often in those who believe there is a link between vaccine and autism, despite convincing evidence to the contrary.
And with information freely available on the internet and on the 24-hour cable news cycle, there are endless opportunities to confirm, rather than challenge, one’s beliefs.
*This blog post was originally published at KevinMD.com*
September 8th, 2009 by Nancy Brown, Ph.D. in Better Health Network, Opinion
Tags: Diet and Exercise, Epidemic, Obesity, Overweight, Pediatrics, Plus Size, Psychology, teens
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For the first time I am starting to see teen literature including successful and positive plus-size characters, and all I can say is, “it is about time!” Finally, there are large teens who are perceived as heroes and successful people.
While our culture keeps getting larger and childhood obesity and eating disorder rates keep climbing, the fact that there were no large, fat, plump, curvy, plush, whatever term you prefer, main characters with positive self-esteem, was really ridiculous. But all that seems to be changing.
There are now books with titles like “Looks,” Models Don’t Eat Chocolate Cookies,” “Food, Girls, and Other Things I Can’t Have,” “All About Vee,” and “This Book Isn’t Fat It’s Fabulous,” that include large teens in positive roles for large people. There are also blogs our there, like “Diary of a Fat Teenager,” for teens looking for support about being happy with there bodies and not spending their energy trying to be thin!
Some days I think there is hope!
This post, Plus Size Teens, Positive Role Models, And The Media, was originally published on
Healthine.com by Nancy Brown, Ph.D..
September 8th, 2009 by DrRich in Better Health Network, Health Policy, Opinion
Tags: Classical Liberal, Czars, Great American Experiment, Healthcare reform, Liberal, Obama, White House
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Because some of his recent posts seem to have confused many of his readers (why is he so strongly against proposed healthcare reforms when he supports so many of its goals?), DrRich will state once again, for the record, his political philosophy.
DrRich is a classical liberal. This means he deeply values the concepts that guided America’s Founders; individual autonomy, property rights, freedom from restraint, free markets and limited government. He is deeply committed to the Great American Experiment, which is, to determine whether a nation conceived in personal liberty and dedicated to the proposition that all people are created equal can long endure.
He believes that healthcare is very, very important, and indeed, has dedicated his career and most of his life to healthcare. But it is not the most important thing. For our generation to abandon the Great American Experiment for the sake of healthcare, or anything else for that matter, would be a perfidious act against our posterity, and indeed a crime against humanity.
DrRich is in favor of healthcare reform, and is glad that serious efforts to reform healthcare are at last taking place. He even finds much to like in the proposed reforms now percolating through Congress, such as, provisions for health insurance to be made available to most, if not all, of the people who cannot afford it today; the provision for health insurance to be made available to all the people who are blocked from insurance today because of their underlying illnesses; and the provision to prevent insurance companies (if any continue to exist in their present form) from canceling policies of their subscribers who get sick. These are all very good things.
But, as regular readers will know, DrRich has recently strongly criticized these proposed reforms, and hopes they will fail. This has angered and confused some of his readers, who know that he has favored universal healthcare, comparative effectiveness research, and other aspects of the reform plan now before Congress.
DrRich has turned against this reform plan not so much because of what’s in the reform bill itself. As DrRich has pointed out, the actual words of the reform bill are entirely open-ended. This is why proponents of one view or another can find in the bill what they wish to see (death panels vs. no death panels, continued availability of private insurance vs. a poison pill for private insurance, etc.), and it’s why their arguments take on the cast of debates among Biblical scholars over the true meaning of some cryptic Old Testament passage.
Rather, DrRich’s objection to this healthcare reform is based on the context in which it is being advanced. And in recent months he has come to see the context as this: a broad dismantling (whether inadvertent or not) of the Great American Experiment.
This dismantling probably began earlier than the fall of 2008 when DrRich first noticed it. But last fall was when our Congress (the peoples’ representatives) first began the wholesale abandonment of their duties and of the Constitution, with their passage of TARP. TARP took $700 billion and presented it to the Secretary of the Treasury to spend as he saw fit, thus creating, arguably, the second most powerful government official in U.S., and certainly the most powerful unelected one, in a manner never conceived under our Constitution. This was followed by the government’s moves to begin consuming Fannie Mae, Freddy Mac, AIG, numerous banks and investment houses, and the auto manufacturers. And all of this was begun under a Republican administration.
While the Obama administration did not start any of this, they took the ball and ran with it, and to a degree that would have seemed impossible (to DrRich, at least) a year ago. They completed the acquisition of the car companies and other private and quasi-private institutions into the federal portfolio. They added yet another $800 or $900 billion onto the federal debt with the Stimulus Bill, and in the process our flaccid Congresspersons once again acceded to the idea that when the executive branch cries “crisis,” it is perfectly acceptable to pass a 1000+ page law into existence without even making a pretense of discovering what is in it.
Then there is the disturbing gathering of power by the executive branch. This includes commandeering control of the upcoming census by the White House, and just this past weekend, bringing the interrogation of foreign (and presumably domestic) terror suspects under White House control. (Under what circumstances do you suppose a Congressional Intelligence Committee would ever launch an investigation of the White House’s interrogation practices?) Perhaps more disturbingly are the 30+ unelected “czars” the President has named so far, individuals with potentially very big (but undefined) powers that at least threaten to impinge on the functions of Constitutionally legitimate government agencies and branches. These czars are not approved, or even vetted, by Congress (our representatives) – and at least some of them look to DrRich like very scary people, whose avowed political philosophies are collectivist, anti-capitalist, and dismissive of the Constitution.
So when the healthcare reform process began, yet again, with the presentation of a 1000+ page bill and the exhortation to pass it immediately – don’t bother reading it – on account of the dire crisis confronting our healthcare system, DrRich had seen enough. When that “pass-it-quick-it’s-an-emergency” strategy failed for once, and people began reading the monstrosity and reacting to it (as the Constitution provides that they may), and when in response our leaders accused them of being fascists, terrorists, mobsters, and other disturbing things, DrRich had seen enough. When DrRich read big parts of the reform bill himself, and realized that it is an intentionally ambiguous document whose effect will be to turn over the re-shaping of our entire healthcare system to appointed functionaries, czars, and other unelected bureaucrats, DrRich had seen enough.
DrRich has never been a conspiracy buff. He has always believed that sustaining for any length of time a conspiracy any more extensive than, say, cheating at bridge, would be impossible. He has always considered the right-wing nut-jobs who think the opposition secretly wants to convert the United States to a Marxist utopia to be, well, nut-jobs. But if the governmental activities we’ve seen over the past six months are not a concerted effort to end, once and for all, the Great American Experiment, then they are at least an inadvertent effort to do so. DrRich wants this to stop.
Reforming healthcare is important, very important. But reforming healthcare is not worth abandoning the foundational precepts of the most exceptional country the world has ever seen.
We can reform our healthcare system effectively and equitably, in a way that specifically preserves and strengthens those foundational American precepts. (DrRich has described how elsewhere.) At one time DrRich thought current reforms could possibly be turned into a first step in that direction. Now, thanks to the context in which these reform proposals are being advanced, he sees present efforts at healthcare reform as an irreversible step in the opposite direction, and possibly a final step from which we are unlikely to ever recover.
First we must decide what kind of society we are to be – and that’s the real “discussion” we’re having now – and then, and only then, can we decide how we are to reform our healthcare system.
And this is why DrRich will make his paltry efforts to try to stop it.
*This blog post was originally published at The Covert Rationing Blog*
September 1st, 2009 by GruntDoc in Better Health Network, Health Policy, Opinion
Tags: EM Physicians' Blog, Healthcare reform, Richard Bukata, Universal Coverage
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In an effort to get the word out about their new EM Physicians’ blog ( em-blog.com ) Dr Bukata has asked to post here to generate some conversation, and some buzz for their blog.
Dr. Bukata has long been a leading light in EM, and it’s my pleasure to present:
THE SECRET TO UNIVERSAL HEALTH COVERAGE – DOCTOR BEHAVIOR
As the debate goes on regarding the Obama initiatives for healthcare reform, the one recurring theme that is heard is – cost. What is universal access to healthcare going to cost and who is going to pay for it? It really is just about money. The fundamental premise is that, if we spend at current rates, it will cost an ungodly amount of money to cover everyone in this country no matter who pays.
Given that we cannot continue to spend at the current rate, yet we want to insure the 40 million people or so who have no insurance (and all of this is supposed to remain budget neutral over time), the logical answer regarding cost must be reducing per capita spending while increasing the number of people covered.
How do we achieve this goal? There is really only one way. The answer is to narrow practice variation. Practice variation between doctors is absolutely huge. The data are compelling. Even small changes in the degree of practice variation have the potential to save hundreds of billions. I refer readers to an article in the New England Journal of Medicine by Elliott Fisher, et al (360:9, 849, February 26, 2009). The article is entitled Slowing the Growth of Health Care Costs – Lessons from Regional Variation. This short paper gives examples derived from the Dartmouth Atlas on Health (which I have referred to in the past and which is absolutely fascinating reading concerning Medicare practice variation nationally) that make it clear that doctors are major determinants of healthcare costs. We order the tests, we order the drugs, we put people in the hospital and we determine where they go in the hospital and, to the chagrin of hospital administrators, we determine how long they stay.
Using Medicare as an example, at our current rate of spending growth in healthcare it is estimated that Medicare will be in the hole by about $660 billion by 2023. If per capita growth could be decreased from the national average of 3.5% to 2.4% (just a measly 1.1%), Medicare would have a $758 billion surplus. Just a measly 1.1%.
Now for some examples. Per capita inflation-adjusted Medicare spending in Miami over the period 1992 to 2006 grew at a rate of 5% annually. In San Francisco it grew at a rate of 2.4% (2.3% in Salem, Oregon). In Manhattan, the total reimbursement rate for noncapitated Medicare enrollees was $12,114 per patient in 2006. In Minneapolis it was $6,705.
It is noted that three regions of the country (Boston, San Francisco and East Long Island) started out with nearly identical per capita spending but their expenditures grew at markedly different rates – 2.4% in San Francisco, 3% in Boston and 4% in East Long Island. Although these differences appear modest, by 2006 per capita spending in East Long Island was $2,500 more annually than in San Francisco – with East Long Island representing about $1 billion dollars more from this region alone.
Are the patients sicker in East Long Island? Hardly. There is no evidence that health is deteriorating faster in Miami than in Salem. So what’s the difference? People point to “technology” as being one of the biggest sources of costs in American healthcare. But “technology” does not account for these regional differences. Residents of all U.S. regions have access to the same technology and it is implausible that physicians in regions with lower expenditures are consciously denying their patients needed care. In fact, Fisher and colleagues note that the evidence suggests that the quality of care and health outcomes are better in lower spending regions.
So what is the answer? It is physician behavior.
It is how physicians respond to the availability of technology, capital and other resources in the context of the fee-for-service payment system. Physicians in the higher cost areas schedule more visits, order more tests, get more consults and admit more patients to the hospital. Medicine does not fit the supply and demand model of modern day capitalism. Normally when there is lots of competition, prices go down. Not in medicine. In medicine payment remains the same and is not sensitive to supply or demand.
And normally when there are a lot of businesses providing the same service, there are fewer customers per business. Not in medicine. Although doctors may have fewer patients in an area saturated with providers, they don’t necessarily have fewer visits because doctors determine the frequency of revisits and the literature indicates there is huge variability in what they consider the appropriate frequency for revisits when given identical patient scenarios. And do patients shop prices to choose medical providers – no way – it is impossible. Bottom line – medicine is largely immune to the laws of supply and demand and other economic drivers.
So what’s the answer? It is simple, yet hard. Doctors in high cost areas need to learn to practice like doctors in low cost areas. Are doctors in low cost areas beating their chests and bemoaning the inability to care for their patients with the latest technology? Not at all. But doctors in high cost areas are largely clueless to the practice patterns of physicians in low cost areas and are likely to whine if asked to tighten their belts and learn to be more cost-effective. The good thing – mathematically, this will result in only half the doctors in the country complaining as they are prodded to emulate the practices of their more cost-effective cousins.
To accomplish this narrowing in practice variation, doctors will need help (and, particularly, motivation). Payers and policymakers will need to get involved to facilitate and stimulate the information transfer between doctors. Based on research by Foster and colleagues, it’s advised that integrated delivery systems that provide strong support to clinicians and team-based care management offer great promise for improving quality and lowering costs.
Given that most physicians practice within local referral networks around one or more hospitals, it is suggested that they could form local integrated delivery systems with little disruption of their practice. Legal barriers to collaboration would need to be removed by policymakers and incentives to create these systems would drive their formation.
Fundamentally, Medicare would need to move away from a solely volume-based payment system (since doctors are the drivers of their volumes) and other forms of payment would need to be incorporated (such as partial capitation, bundled payments or shared savings). Hospitals and doctors lose money when they improve care in ways that result in fewer admissions, and they lose market share when they don’t keep pace in the local “medical arms race” (does everyone need a 64-slice CT?). In the current system there are no rewards for collaboration, coordination or conservative practice. This must change.
The bottom line – much can be done to save money yet provide patients with high quality, technologically advanced care without rationing (or worse yet having some government “board” telling you what to do). There is so much waste in the current system largely resulting from physician practice variation that the opportunities are huge.
And, should they choose, doctors are in a position to take the lead. The AMA and other physician organizations can initiate (well, that may be asking a lot) and support incentives that will facilitate the needed changes outlined above. Unfortunately, organized medicine (almost an oxymoron) is more often than not reactionary. “What are they (payors) making us do now?” That’s the typical response. What’s needed is for physicians to take the leadership role that their patients expect of them. The status quo is not an option. And if doctors won’t act, the payors will – because ultimately, the payors have the power. That is one rule of economics that does apply even to the practice of medicine.
W. Richard Bukata, MD
I respectfully disagree about markets not working in medicine, but have few arguments with the rest.
What say you?
*This blog post was originally published at GruntDoc*
