April 3rd, 2008 by Dr. Val Jones in Medblogger Shout Outs
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Well, I know that blog post title probably got your attention. I’m referring, of course, to the unusual career path of Paul Levy, CEO of Harvard’s Beth Israel Deaconess Medical Center in Boston. Paul has done wonderful things over the past several years as CEO, including using his blog to promote outcomes transparency (by making his hospital’s infection rates public) and being accessible to all his staff via Facebook.
I had the chance to speak with Paul at Dr. Anonymous’ Blog Talk Radio show tonight. You should listen to the podcast to learn more about the world of hospital administration, Paul’s life journey, and what constitutes quality care in medicine. Here are some choice quotes from the call:
“I’m from New York, actually, which is something you don’t say very often when you live in Boston. I have to explain that I really didn’t want to be born in New York but my mother was there and I felt it would be appropriate to be near her during the time of childbirth… And I want to make it absolutely clear that I root for the Red Sox…
Well, personally I have a checkered past. I had no idea I was going to do this [hospital administration.] My background is in the energy field and telecommunications. I used to regulate the utilities in Massachusetts, then the state energy department in Little Rock, Arkansas, and then I ended up running the water and sewer system in the greater Boston area. I guess running a sewer system is good training for running a hospital…
There had been a merger of Beth Israel and Deaconess in the mid 1990s. The merger failed and the place was about to go out of business. I thought it was worth saving, so I persuaded them to hire me. It’s not the usual path. I hope that not too many other hospitals that are failing would want to hire the guy who runs the sewer system.”
So there you have it, folks. Sometimes the best CEOs may be found in unusual places… Kudos to Paul Levy for spearheading a major hospital turn around, and kudos to the Harvard system for recognizing leadership excellence in an unexpected corner of the world. Listen to the podcast to find out more about this fascinating story.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 2nd, 2008 by Dr. Val Jones in Announcements, Medblogger Shout Outs
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For those of you who enjoyed the April Fool’s Grand Rounds (I was participant #2 in an amusing “progressive blog” string of hosts), please join me at the Dr. Anonymous show tomorrow night (9pm EST, April 3) to find out how we pulled it off. In addition to going “behind the scenes” of the April Fool’s edition of Grand Rounds, Paul Levy (CEO of Beth Israel/Deaconess in Boston and author of “Running A Hospital“) will be Dr. Anonymous’ special guest. Paul recently won Medgadget’s coveted “Best Medical Blog of 2007” award.
You can listen to the conversation, join the chat room, call in to the show, or watch Dr. A’s live video feed. This will be a multi-media extravaganza with some of the medical blogosphere’s brightest stars… so don’t miss it! Go to this link a few minutes prior to the show start time.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 2nd, 2008 by Dr. Val Jones in True Stories
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I’m at a medical conference in Houston this week (picking up some CME credits) and between lectures I’ve had some interesting conversations with my peers. Here’s my favorite story:
A patient underwent a total hip replacement surgery, had a normal post-operative course, was transferred for inpatient rehabilitation, progressed well and was discharged home. Several months later the patient decided to sue the hospital, claiming that he was sent home with a dislocated hip. The hospital couldn’t prove that the patient’s hip was not dislocated at the time of discharge because no x-ray was taken on that day. Of course, the only reason an x-ray would have been taken was if there were a strong suspicion of a fracture or dislocation (x-rays are not normally repeated on the day of discharge).
The hospital was found liable and will settle out of court for an undisclosed (but very large) amount.
My guess is that this case will cause:
1. The hospital to take unnecessary x-rays of all total hip patients on the day of discharge from now to eternity.
2. More dishonest patients to file frivolous law suits.
3. The local med/mal attorney population to spread the word about a new source of income.
4. Further cutbacks in the hospital’s charitable care due to funding deficits.
5. Someone with a hip replacement to buy a new Ferrari.
Sigh.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 29th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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Interesting thoughts from The Happy Hospitalist:
How do you define quality care?…
If preventing 90% of in-hospital DVT’s with a medicine that cost $30 a day was quality, so be it.
What if you could prevent 99% of in hospital DVT’s with a medicine that cost $300 a day. Would the 90% be quality or the 99% be quality? What if it cost $3,000 a day to prevent 99.99% of in- hospital DVT’s?
Which effort would be considered quality? Who defines the cut off, and at what price?
Here’s what he has to say about Pay for Performance measures, and why they won’t add up to significant savings:
Unfortunately, the measures being undertaken for quality initiatives are, from my stand point, minuscule in terms of the overall potential cost savings to the system.
And the reason is simply, at least in my part of the medical physician spectrum, a very large chunk of health care expenditures comes in the form of evaluation, and not management…
In the medical profession, there exists a sense of universal freedom to order tests, xrays, labs, and procedures with a sense of unlimited funding. Somebody will pay for it. My patient sitting in front of me is the center of my attention and their needs supersede all other needs from a social/financial point of view of the nation…
Where are the government incentives for quality medicine in the evaluation of disease?
Where is your bonus payment for not ordering the heart cath?
For not ordering the CT Angiogram?
Where is your physician bonus payment for not ruling out a low probability DVT?
Or not ordering an EGD?
For choosing watchful waiting.
Where are your quality bonus payments for evaluation of illness?
They simply don’t exist. Because doing so would overtly ration the public and create a firestorm.
Is the storm coming nonetheless?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 25th, 2008 by Dr. Val Jones in Expert Interviews
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Women in their 40’s are at an advantage when it comes to weight control and fitness. How so? I asked three of my favorite medical experts to explain what it means to be fit and forty, and how you can get there.
Myth-busting With Dr. Dickerson
Dr. Val: I know that many women in their 40’s complain of having gained weight. What causes that weight gain? Is it inevitable?
Dr. Dickerson: Many women don’t gain weight in their 40’s so it’s certainly not inevitable. There are a few common misconceptions about weight gain and aging that I’d like to address.
First, hormone supplements don’t cause weight gain – menopause, in general, with or without hormones, is associated with about a 10 pound gain. This often starts in perimenopause so it could occur as early as the 40’s.
Second, lean muscle mass decreases slowly from mid-30’s probably until menopause when it decreases more steeply. So women in their 40’s don’t experience too large a change in their metabolism.
Third, the weight that women have in their 40’s is often about how many babies they have had. Data show us that women retain about 10 pounds per pregnancy. Weight begins to shift as the perimenopause era begins – more towards the abdomen and the hips and thighs.
And finally, weight gain is not due to hormonal or metabolic changes, but may be more about emotional eating. Women often experience the empty nest syndrome in their late 40’s and change their eating habits to constant “snacking” – they tend not to count these calories when adding things up
Dr. Vivian Dickerson, Past President of the American College of Obstetricians and Gynecologists, Medical Director, women’s health programs and care, Hoag Hospital, Newport Beach, CA.
Increasing physical activity is the key to success
Dr. Val: How can women in their 40’s counteract potential weight gain? What’s the most effective strategy to stay trim and fit?
Dr. Hall: While it is true that body remodeling and loss of muscle mass probably starts in the late 30’s it is almost completely a matter of now much physical activity is taking place. Much of the perceived change in body image, (gravity-dependent “sagging”) is also accentuated with decreased muscle tone in the sedentary woman. Weight gain, on the other hand is quite related to caloric intake. It is greatly modulated by the degree of physical activity as well.
My general feeling is that most diets do not work, and the older you are, the truer that is. After age 40 women cannot consistently lose weight and keep it off without a plan of regular physical activity (aerobic) plus some resistance work (weights, bands) to improve body tone.
Dr. Bill Hall, Past President of the American College of Physicians and Director of the Center for Healthy Aging, Rochester, NY.
The 40’s: no better time to get trim and fit
Dr. Val: Do women in their 40’s have an advantage in losing weight?
Dr. Dansinger: Your 40’s are a great time to take lifestyle changes to new heights. Whether for weight loss, or prevention of diabetes or other related medical problems, many women who struggled in their 20’s and 30’s finally find success in their 40’s. For many women at this age, previously insurmountable logistical barriers such as raising preschool age children, or inflexible work schedules, often improve somewhat. Such expertise in schedule-juggling, when combined with a renewed commitment toward preventing health problems, often gives such ambitious women the strength and experience to finally achieve consistency with an effective exercise and healthy eating routine that produces long-lasting results.
Although the metabolism slows gradually throughout adulthood, the effectiveness of lifestyle changes for health improvements remains strong throughout life, and may actually become most beneficial as we grow older. Gaining muscle and bone strength through weight-lifting type exercise may help a woman in her 40’s reduce the risk of muscle and bone loss that typically affected women of her mother’s generation.
Dr. Michael Dansinger, Lifestyle Medicine Physician/Researcher, Tufts Medical Center, Boston. Nutrition and fitness advisor to NBC’s Biggest Loser.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
