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When Cardiologists Sue The Government

It’s sad that cardiologists have had to sue as their last resort to save their practices:

“Heart specialists on Monday filed suit against Secretary of Health and Human Services Kathleen Sebelius in an effort to stave off steep Medicare fee cuts for routine office-based procedures such as nuclear stress tests and echocardiograms.

The lawsuit, filed in U.S. District Court for the Southern District of Florida, charges that the government’s planned cutbacks will deal a major blow to medical care in the USA, forcing thousands of cardiologists to shutter their offices, sell diagnostic equipment and work for hospitals, which charge more for the same procedures.

Perhaps other professional organizations will be forthcoming with similar suits as private doctors and their patients pay dearly for the reform efforts underway. Read more »

*This blog post was originally published at Dr. Wes*

H1N1 Blogger Briefing With Anne Schuchat & Friends

valtraceyThe Department of Health and Human Services held a blogger-targeted webcast about the H1N1 flu today in Washington, DC. Although Secretary Kathleen Sebelius had planned to co-lead the event, she was called to the White House for some healthcare reform deliberations – which might take a while? (She promises to try again to speak to us bloggers at a later date, though, so I’ll be sure to let you know when that happens). Dr. Anne Schuchat, Director of the National Center for Immunization and Respiratory Diseases, carried the event with ease, and Jenny Backus (Acting Assistant Secretary for Public Affairs – pictured with me) moderated the incoming blogger and Twitter questions.

This was a particularly entertaining webcast for me because I was invited “behind the scenes” to witness the event at the HHS studio as well as submit questions for Dr. Schuchat’s consideration. The webcast is available for viewing on the HHS YouTube channel.

What you may not get from the webcast, however, is how much work goes into HHS’s efforts to communicate accurate information to the public. I was very impressed with the studio space (it has a National Press Club feel) and the staff are technically skilled and affable. So friendly were they that I “memorialized” our meeting with a few candid shots (below). Read more »

How Do Doctors & Patients Find Out About Food & Drug Alerts?

I recently created a focus group survey of physician bloggers to determine how they (and their patients) typically receive food and drug alerts. Twenty people responded. The results to 5 key questions are displayed below.

My most interesting take home messages:

1. Most physicians surveyed first receive drug alerts via eNewsletters from companies like MedPage Today and Medscape. (This is consistent with the large number of page views achieved by these sites/month).
2. Most patients find out about recalls via mainstream media – TV and newspapers.
3. EMRs, ePrescribing tools, coaching programs, and social media networks (like Twitter) are perceived to be the most valuable means of disseminating targeted recall information to the right person at the right time.

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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*

Dr. George Lundberg: A Fine Choice For Surgeon General

Rumor has it that Sanjay Gupta is no longer in the running for the office of Surgeon General. Many people had voiced their concerns about his potential nomination (including Paul Krugman, Maggie Mahar, Gary Schwitzer, Dr. David Gorski, and myself) and it looks as if his lack of experience or training in matters of public health, along with a history of industry ties has put the kabosh on his nomination.

So who will be our next Surgeon General? It’s hard to say, but a petition is circulating on behalf of Dr. George Lundberg – a fine nominee for the position in my opinion. Let me explain why.

A review of Dr. Lundberg’s curriculum vitae easily establishes his professional qualifications for the position. Not only has he been one of the longest standing Editors-In-Chief of all the American Medical Association journals (including JAMA), and the founder of the world’s first open-access, peer reviewed online medical journal (Medscape Journal of Medicine) but has served in an advisory capacity to everyone from the World Health Organization, to AHRQ, the Joint Commission, Harvard’s School of Public Health, the Department of Health and Human Services, Food and Drug Administration and the Surgeon General of the US Navy. He is also a prolific and influential writer, having authored 149 peer-reviewed articles, 204 editorials, and 39 books or book chapters. Dr. Lundberg has a large and devoted national and international audience and is highly esteemed by all who know him.

Dr. Lundberg has provided editorial leadership since the mid 1980s in American healthcare reform, campaign against tobacco, prevention of nuclear war, prevention and treatment of alcoholism and other drug dependencies, prevention of violence, changing physician behavior, patient safety, racial
disparities in medical care, health literacy, and the ethics of medical publishing and continuing medical education.

However, what may not be obvious from Dr. Lundberg’s list of extraordinary accomplishments, is his extraordinary character and wisdom. I had the privilege of working with George at the Medscape Journal of Medicine and reported directly to him. From this vantage point I was able to to observe his impartiality, his commitment to honesty and integrity, and his ability to walk the line between inclusivity of opinion and exclusivity of falsehoods. George is a defender of science, a welcomer of ideas, and an impartial judge of content. He can capture an audience, nurture imagination, and see through deception. George is exactly the kind of person we need as Surgeon General – he can be relied upon to discern truth, and maintain his faithfulness to it under political or industry pressure.

But best of all, George understands the central role of trust in healthcare. In his recent book, Severed Trust, George analyzes the policy decisions that have shaped our current healthcare system, and laments their inadvertent collateral damage: the injury to the sacred trust between physicians and patients.

If we want to come together as a nation to restore hope and trust in America – and we want to create an equitable healthcare system that leaves none behind, restores science to its rightful place, and heals the wounds endured by both providers and patients, then we need a Surgeon General like George Lundberg to help us.

I can only hope that his candidacy will be given the full consideration it deserves.

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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