June 22nd, 2007 by Dr. Val Jones in Medblogger Shout Outs
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Dr. Richard Reece wrote a wonderful personal reflection on the value of hospital ratings. As you may know, there has been much recent debate about their usefulness. With all the different rating systems, a single hospital can be ranked #1 in the country by one source and middle of the pack by another. It’s true that there are many variables to be considered, and that measuring quality is a tricky business. But one would hope that if we were getting close to observing something real about a hospital, most different scoring systems would lead to the same general conclusion.
The fact that this isn’t the case yet says to me that there is a lot of work to be done in standardizing scoring, developing transparency in the system, and removing hospital marketing efforts from objective data.
I am glad that we’re beginning to shine the light on institutional quality, but there is an elephant in the room. When it comes to good medicine, the most important factor is the individual healthcare provider.
I have personally witnessed outstanding medical care in the midst of hospitals with poor reputations, and I have observed horrific outcomes at top ranked hospitals as well. What made the difference? The provider taking care of the patient.
My insider perspective is that consumers are on the right track with physician ratings – worrying more about getting into the hands of a good doctor, than into the hands of the right hospital. But physician ratings can be dangerous – if left open to the public without any form of moderation or intelligent analysis, one patient with borderline personality disorder and a grievance could hijack the rating system and destroy a physician’s public reputation. Safeguards against that sort of behavior can and should be put in place.
The most helpful physician rating system will offer data from multiple sources (patient ratings, peer ratings, health plan ratings) and include sophisticated anti-sabotage algorithms. It’s also important for the ratings to be protected from self-interests (so that the physician herself doesn’t game the system and use it as a marketing tactic).
Rating quality care is complex, and there will always be a subjective element to it. Hospitals are run by flawed humans, healthcare providers make mistakes, and yet everyone wants the same thing: consistently excellent medical care.
And that will never happen – so long as humans are imperfect.
As Dr. Reece says,
Unfortunately, variable costs, variable quality, and variable outcomes
are a function of humanity, regional cultures and their constituencies.
Independent variables are part of the human condition. Some of these
variations may be beyond managerial control…
It’s going to take a while to establish criteria to judge and sort out
the good, the bad, and the ugly. Public disclosure of outcome data and
performance data on the processes of care may help, but they are only
part of a complicated human equation.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 15th, 2007 by Dr. Val Jones in Announcements, Expert Interviews
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I was recently interviewed about my blog (and this week’s edition of Grand Rounds) by Dr. Nick Genes at Medscape. For the curious among you – here is the full Medscape interview with Nick Genes (prior to editing). It gives you a little more information about Revolution Health…
1. You’ve
been involved in writing since medical school, for various audiences. Who are
you trying to reach with your new blog, and how have you found blogging to be
different than the other media you’ve worked in?
The best part about
blogging is that it’s a dialogue rather than a monologue. I find the interactive discussions and
heartfelt responses to be touching and engaging. My previous writing was more academic because
of the medium (medical journals) but now I’ve found that blogging is where I
can really be myself – there is no team of reviewers to scrub my words. So what you read is what you get!
2. I’m
very curious about Revolution Health, your role as Senior Medical Director, and
where you think this is all going. But all revolutions have their origins
somewhere, and yours seems to start… on a yogurt farm. Please share a little
of what that was like, and maybe what early influences have given you such an
interesting background. From small towns to New York City, from theology to medicine, it
seems like you’re living a very rich life.
Yes, I guess you could
say that my origins as a revolutionary are firmly rooted in dairy farming. Although it may not be immediately apparent
how the two are related, Internet startups and cattle herding have their similarities. First, you have to wear many hats – there is
no job too small or too large. If the
cows need milking, and the electric machines are broken, you do it by hand. If a cow breaks through the fence and wanders
off into town, you lure her back with short feed. If a large batch of yogurt curdles, you’ve
got yourself a gourmet meal for your pigs… you get the drift. In a large start up, all manner of unexpected
events happen – but the trick is to handle them quickly and efficiently, and
make sure the outcome is a win-win.
As far as my other
life detours… I guess you can say that I’ve been a victim of my own
curiosity. There are so many interesting
things going on, I just can’t help but want to try them out. In the past I’ve held jobs in the following
capacities:
A protestant minister,
NYC bartender, bank spy, food critic, doctor, cartoonist, computer sales
associate, yogurt mogul, nanny, motivational speaker, biophysics researcher,
graphic designer and revolutionary medical director.
So my life has
certainly been an adventure!
3. How did you get involved with this company? Did Steve
Case find you, or know you from before — or was there an application process?
Is the mingling of medical and computer technology folks going smoothly? Is it a
mix of hospital culture vs. laid-back internet start-up culture? (Foosball and
mountain bikes, or suits and meetings?) Can you make comparisons to your time
with MedGenMed?
A friend of mine had
interviewed at Revolution Health for an executive position and thought that the
company would be a great fit for me.
When I heard who was involved (including Colin Powell, Steve Case, Carly
Fiorina) and that the goal was to create a website to help patients navigate the health care
system, I thought – gee, this sounds serious, challenging and worthwhile. So I sent in my resume, got offered an
interview, put on a bright red suit and announced that I’d heard that there was
a revolution afoot and wondered where I could sign up. They hired me that same day (May 8, 2006) and
it’s been the most exciting job I’ve had to date!
About the “mingling”-
a very interesting question. There is a
hint of Foosball/mountain bike in the mix, but I think we’re a little more hard
driving than that. Since Revolution
Health is in its start up phase, there is simply too much work to do for people
to be playing Foosball. When I started,
there were 30 employees, now there are closer to 300. We are all working long hours on cutting edge
projects that I believe will make a big difference in supporting the
physician-patient relationship, streamlining the process of healthcare delivery
and improving accessibility to the uninsured and underinsured. Revolution has attracted some of the
brightest minds in the tech industry – and they are building products I could
never have dreamed of on my own. Since I have such an unusual background,
I’m bilingual in both techie speak and
physician speak, and this helps a great deal.
Because I understand what physicians and patients need, and can translate
that for the “creatives” we can build some really meaningful tools and products
together.
My time at MedGenMed
was wonderful, primarily because Dr. George Lundberg is a dear friend and
mentor. He has done fantastic work
creating a pure platform (no pharma influence or fees for readers or authors)
for open-access publishing. He taught me
to speak my mind, follow my gut and never compromise my ethics. His book, “Severed Trust” galvanized me into
action – to do my part to improve the damaged physician-patient relationship
that is at the core of our broken system (caused by middle men, volume
pressures and decreased time with patients).
After reading his book, I wanted to do something big – so I joined a
revolution.
3. Revolution
Health has some bold ideas about improving care for its members — getting
appointments with specialists, patient advocacy in dealing with insurance, and
of course, sharing information. What’s your job entail, as medical
director? Do you think you’ll find yourself making policy decisions that
could affect, directly or indirectly, chunks of the population? Could
you find yourself in a position where some specialists are not recommended
based on their insurance? Will Revolution Health have a formulary, will it
be evidence-based — or could could care be rationed ?
My job is incredibly
challenging and fun, and I rely on both halves of my brain for much of what I
do. We have 146 medical experts most of
whom I’ve personally recruited, I’m responsible for coordinating the medical
review of all the content on our portal (so that it conforms with
evidence-based standards), I facilitate relationships with major hospital
systems (such as Columbia University Medical Center), spearhead new product
initiatives (such as Health Pages for physicians), monitor and promote our 30+
expert bloggers, participate in writing press releases, creating podcasts, radio interviews,
identifying new partnership opportunities and much more.
I do think that
Revolution Health will greatly influence vast “chunks” of the population. And this is what’s particularly exciting
about working here. We really are
building a brand new navigational system for healthcare – and this will empower
patients to take control of their health and provide them with better
information and guidance in living their best.
I believe that Revolution Health will become the new virtual medical
home for physicians and patients, just the way that AOL grew to be America’s
Internet home. You log on first to AOL
to get your email, check your news, and get plugged in before surfing the
net. You’ll log in to Revolution Health
to track your health, connect with your lifestyle coach or physician guide, get
involved with a community of others like you, or track your loved ones’ health
issues through Care Pages. This is a 20
year project, so all of our plans and programming may not be apparent yet, but
the trajectory is amazing and I wouldn’t want to be anywhere else as a
physician today.
5. What are some of your favorite posts — something that
struck a nerve with readers, or captured something you wanted to express?
Please provide links!
My absolute favorite
post is the story of how my mom, a strong patient advocate, saved my life as a
baby. She refused to accept the
misdiagnosis I was given, and continued to nag the medical team until they
realized what was wrong and took me to the O.R.
If it hadn’t been for her persistence (or the incredible skill of the
surgeon who ultimately took care of me), I wouldn’t be here today. And maybe that’s why I’m passionate about
both good medical care AND patient empowerment!
Other posts that have
been well received are true stories from my medical training days. Some are controversial (like this one about
end of life issues and my first day as a doctor),
and others are warmer reflections. But ultimately, I just share what’s on my
heart and let the audience take away what they can from it.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 11th, 2007 by Dr. Val Jones in Medblogger Shout Outs
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…continued from Grand Rounds 3.38…
GRAND ROUNDS XR
(asterisk = honorable mention for great writing)
Happy Posts
*Kerri from Six Until Me tells the heart-warming story of a
Starbucks Barista who understood her diabetic needs and treated her with
special care.
Traveling Doc from Borneo Breezes Blog, submits a post about
the bush pilots of the Canadian north.
Even though it’s summer time you’ll shudder at this arctic tale of a
native woman whose life was saved by a bush pilot and an Australian surgeon.
Tony Chen of Hospital Impact submits a post by Nick Jacobs, the CEO of Winder Medical Center.
In it Christopher apologizes for being ill tempered and snapping at a
woman who posted a paper sign on the wall.
Dr. Jolie Bookspan of the Fitness Fixer Blog offers a
fascinating look at the physical healing power of prayer. Jolie reports that the movements involved in
Muslim prayer (including standing, bowing, kneeling, and sitting) can promote
flexibility, increase quad strength, and burn up to 80 calories/day. She explains that similar prayer posturing
(found in Russian Orthodox prayer and some forms of yoga meditation) may be
equally useful.
Rita Schwab at MSSP Nexus Blog writes a really funny post
about disaster preparedness. She muses
about how she had been taught to hide under her school desk in case of a
bombing, and even then (at the tender age of 8) wondered how the desk vs. bomb
equation would really pan out for her.
But the real amusement comes when you click on her link to the CDC’s
recommended communication releases on such plagues as tularemia. Yes, the bacterium found in rabbits and
rodents (that perhaps 125 hunters succumb to each year in this country) is not
contagious from human to human and causes flu-like symptoms. I’d give this a fear factor of 1 out of 10. [Cartoon]
Dr. Bruce Campbell of Reflections Blog describes the medical
school graduation ceremony – the first time “doctor” is officially tied to the
graduate’s name. [Cartoon]
Mother Jones, RN from Nurse Ratched’s Place, confesses to
being a trekkie. She did find a good
role model in nurse Chapel, though. Now
here’s my confession: I’ve been known to utter a few “Damn it, Jim-s!” when
asked to do non-medical related work at my current job.
Roy
at Shrink Rap pulls a “Jerky Boys” style practical joke on Dinah. He uses prerecorded audio clips of Dr. Phil
McGraw to simulate a live Skype conversation with her, and gets Dr. Phil to ask
Dinah outrageous questions and give her bizarre advice such as, “I want you to
live as a gay woman.” Poor Dinah falls
for it for a short time… and it’s rather funny, especially if you enjoyed the
Jerky Boys prank call to Hooters with Arnold Schwarzennegger clips. [Cartoon]
Laurie at a Chronic Dose tells a hilarious story of 3 chronically ill family members who experience a comedy of errors during a vacation in Cape Cod. Somewhere between the brain aneurysm, flood, sunburn turned staph cellulitis, and cell phone lost in the ocean, there’s humor in the midst of tragedy.
Susan Palwick from Rickety Contrivances of Doing Good describes the evolution of hand washing requirements for all staff (including chaplans) at her hospital.
Sad Posts
ERnursey from ERnursey: Stories from an Emergency Room Nurse
gives us an eye-rolling perspective on exactly how emergency departments are
abused by drug-seekers and non-emergent cases of ridiculousness. Triage ain’t easy. [Cartoon]
*Type B Pre-med from the blog by the same name, offers a
tear jerking slice of life from the ED.
A woman with breast cancer finds out that it has metastasized to her
brain while a 9 year old sexual assault victim waits for the doctor to see him
next.
Christian Bachmann from Med Journal Watch reminds us that
tranquilizing medications are associated with shorter lifespans in the demented
elderly population. [Cartoon]
Matthew at Path Lab tells the sad story of a bariatric patient’s woes in the hospital, and what daily life is like for nurse assistants.
Hot Buttons
Dr. Tara Smith at Aetiology, discusses the tragedy of
infanticide, and the events that led up to the recent murder of a newborn in Iowa. She asks whether designated “safe havens”
(where mothers can drop off unwanted babies, no questions asked) are not
promoted enough by the media or if the state of mind of a woman who has just
given birth to an unwanted baby wouldn’t be receptive to that messaging.
Dr. Hsien-Hsien Lei interviews the CIO of Suracell Personal
Genetic Health to try to get to the bottom of whether or not nutrigenomic
testing is a form of hucksterism. This
quote followed an objection about nutrigenomic supplements costing more
than similar products in health food stores: “Well, our clients like paying
more for what they believe is something better than the cheaper versions.” Orac should take a look at this.
David Williams of Health Business Blog submits a
thought-provoking podcast of a recent interview he conducted with the founder
(founded in 2002) and creator of Planet
Hospital, Rudy
Rupak. Rudy starts the podcast
explaining that his company arranges surgical treatment for travelers who need
emergent care in foreign countries, but later on explains that the primary
income stream for Planet
Hospital involves
healthcare outsourcing for American women who are “too wealthy for Medicaid and
too young for Medicare” and want cosmetic procedures or IVF done at a lower
price. Rudy then explains that he has a
program called “the best of both worlds” where plastic surgeons travel overseas
to perform their procedures for cash – outside of malpractice laws and with
lower overhead. [Cartoon]
Henry Stern, at InsureBlog comments on the recent loss of
Flea and other medical bloggers. He says
that “There’s a creeping reticence in the blogosphere… and maybe that’s a good
thing.”
Amanda from It’s All About the Walls marries her frustration
with her own health issues with some frustration at the apparent censorship of
certain bloggers.
N=1 from Universal Health offers this challenge – doctors
should try to get outside of their egocentric shells and get to know (and learn
from) all of the knowledgeable, competent allied
health professionals around them, especially nurses. [Cartoon]
Kim at Emergiblog expresses deep inner conflict about going to see Michael Moore’s new movie, Sicko. If she goes, she donates $10 to his cause, if she doesn’t go she’ll be left out of a hot topic of conversation. This is a tough call, fair sister.
Helpful Tips
Dr. Auerbach from Healthline describes how to handle
encounters with bears. I didn’t realize
that humans should respond differently, depending on the kind of bear. Check out what to do if you run into a
Grizzly versus a Black Bear.
Bertalan Meskó from Science Roll lists some “Web 2.0”
activities for patients and physicians alike.
But Bertalan forgot about Revolution Health!
Sarah (a bubbly Aggie from Texas A&M) has some
practical tips on how to get into medical school.
Dr. Joshua Schwimmer from Healthline explains that
Gadolinium used to be the contrast agent of choice for patients with kidney
disease (since the regular iodine-based agents can cause “contrast
neuropathy”) but now new cases of a scleroderma-like condition (called
“nephrogentic systemic sclerosis”) have been associated with Gadolinium. Bottom line: if you have kidney disease, any
sort of contrast dye is risky!
Dr. Lisa Marcucci from Inside Surgery offers up the
technical how-to’s for an open pyloromyotomy to repair baby stomachs. Some little ones are born with a narrow,
thickened area in the junction between the stomach and the intestine so food
can’t pass through. But thank goodness
for surgeons like Lisa who can fix them in a jiff! [Cartoon]
Chronic Babe describes her impulsive eating habits and what
she’s going to do to try to avoid chocolatey, salty days in the future. [Cartoon]
Case Reports
Dr. Ves Dimov of Clinical Cases and Images – Blog –
discusses the New England Journal’s recent case report of Acute Wiiitis
(contracted as an overuse injury from the Nintendo video game Wii remote
control). He rightly points out that as
far as medical nomenclature is concerned, “itis” is more appropriately appended
to the name of the affected body part (e.g. tendon-itis). As far as we know, a Wii remote is not part
of the human body – though one can see how the NEJM editors couldn’t resist
accepting the resident physician’s title selection.
Dr. Iñarrito-Castro from Unbounded Medicine presents a
fascinating case report of an exceedingly rare pancreatic tumor. Beautiful imaging and photos.
Uncategorized
Dr. Keith Robison of Omics! Omics! Blog describes his
thought process of what it might take to determine the underlying genetic cause
for one little girl’s unknown syndrome.
In the end he suggests that it might cost $1 million (to map her entire
genome) and result in no clinically useful benefit. In this cost-benefit analysis, it looks as if
mom got it right – love the child as she is, and spend your money on mobility
enhancing equipment.
Dr. Joe Wright submits his commencement speech (for
Harvard’s graduating class of MDs and DDSs) for your consideration.
Girlvet from Madness: Tales of an Emergency Room Nurse
describes some promising research in Alzheimer’s Disease and how her own mom died in a nursing home from complications of the disease. [Cartoon]
Nurse JC Jones from Healthline, highlights the recent
Wellcome Trust announcement of significant advances in the genetic
underpinnings of several major diseases. She includes a recent photograph of
James Watson (of Watson and Crick fame), who is now 79 years old.
Rachel from Tales of My Thirties highly recommends a book
about Type 2 Diabetes.
SPECIAL BONUS POSTS
Now, because Dr. Val has a keen eye and is very meticulous, she has rounded up some savory morsels that she found on her own – these posts were not formally submitted to Grand Rounds 3.38, but will be included because she’s sure their authors wouldn’t object:
Dr. Richard Reece from MedInnovationBlog summarizes Regina Herzlinger’s arguments for consumer driven healthcare.
PandaBearMD explains why he believes that Chiropractors are quacks – and other controversial issues.
Kevin, MD points out that while websites designed to allow patients to rate doctors are gaining acceptance, websites that allow clients to rate lawyers are causing a legal meltdown.
Dr. Stanley Feld (former President of the American Association of Clinical Endocrinologists) takes a very well argued swipe at Dr. Steve Nissen’s recent article about Avandia in the New England Journal of Medicine.
Dr. Charles exposes the quackery of Dr. Heimlich (of the Heimlich maneuver).
Dr. Au from the Underwear Drawer accidentally summarizes the difference between men and women in a conversation with her husband about whether or not to save an old medical school name tag.
Dr. Rob from Musings of a Distractible Mind offers some hilarious genetic explanations for male/female differences.
Hallway Four captures a fascinating disconnect between what a patient thinks a doctor is doing and what a doctor is actually doing.
Dr. Hildreth at the Cheerful Oncologist gives us 8 ways to cope with a malpractice lawsuit.
Dr. Scalpel presents a case of a scratch (plus toenail fungus) sufferer presenting for a work excuse.
#1 Dinosaur argues that obese doctors are more empathic counselors for obese patients who wish to lose weight.
TBTAM recounts a sexual history dialogue in which a patient had condoms delivered at 5am from a local deli.
Ian from ImpactEDnurse continues the condom refrain with an interesting analogy: how practicing “safe nursing” is like practicing safe sex.
FLASHBACK: And for the all time coolest classic blog post… let’s go back to GruntDoc circa 2004 for a look at the scariest menace in the ED: “Some Dude.”
Thanks for reading! Hope you’ll tune in for our regular Wednesday feature of Revolution Rounds – the best of the 27+ person Revolution Medical Blogger team posts, organized and served up friendly by yours truly.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
