April 26th, 2009 by Dr. Val Jones in Humor, Medblogger Shout Outs
2 Comments »
This post is republished from Paul Levy’s blog. Please feel free to repost and distribute to raise awareness of those who do not enjoy free speech:
Thanks to T at Notes of an Anesthesioboist for getting this going, a group of bloggers is holding a blog rally in support of Roxana Saberi, who is spending her birthday on a hunger strike in Tehran’s Evin Prison, where she has been incarcerated for espionage. According to NPR, “The Iranian Political Prisoners Association lists hundreds of people whose names you would be even less likely to recognize: students, bloggers, dissidents, and others who, in a society that lacks a free press, dare to practice free expression.”
Hearing reports like these has prompted us to do a ribbon campaign. Blue for blogging.
Please consider placing a blue ribbon on your blog or website this week in honor of the journalists, bloggers, students, and writers who are imprisoned in Evin Prison, nicknamed “Evin University,” and other prisons around the world, for speaking and writing down their thoughts. Also, please ask others to join our blog rally
November 30th, 2008 by Dr. Val Jones in True Stories
4 Comments »
The successful “Engage with Grace” campaign resulted in ~95 bloggers promoting end-of-life care discussions with family members over Thanksgiving. Paul Levy called it the first “medical blog rally on the Internet.” I wonder how many readers took the challenge?
I spent Thanksgiving with my sister (mom of 3) and brother-in-law in Michigan. After our dinner (with the kids tucked in for the night) we enjoyed a glass of wine and a game of Cranium (if you haven’t tried this game yet, you might want to pick one up in time for the next group of holidays – it’s like Pictionary, Charades, Trivial Pursuit, and American Idol wrapped into one). I looked for an opportunity to “pop the question” on end-of-life issues.
During a brief lull between rock song humming I casually inquired about whether or not my sister and brother-in-law had a living will. They said they hadn’t thought of it but agreed that it would be important to have one. We discussed various scenarios related to organ donation, end-of-life care, and cremation vs. burial preferences. Things degenerated a bit as I asked what their individual preferences might be for resuscitation under special circumstances (it was almost like a scene from Monty Python – “So, if you had no arms and no legs and you had a 10% chance of normal brain function recovery, would you like to be tube fed? How about if you had one leg and half an arm and a 5% chance of mental recovery? What about if you had 1/2 a liver, no spleen, and only one eye worked, but you COULD do math questions?”) We all had a good laugh at the black humor, but recognized that something important underlay the jesting. There is no doubt that we each had a 100% chance of dying at some point during our lives.
And then something unexpected happened – my brother-in-law looked me in the eye and said, “If anything happened to us, we’d really love it if you took our children and raised them as your own.”
I was very touched and happily agreed to do so. I replied with a wagging finger, “Now this doesn’t mean that you should take up helmet-free motorcycling…”
We all had a good chuckle and returned to Cranium, each feeling a little richer for the experience – we knew how we’d like to be cared for in case of critical illness, and I’d become the proud new godmother of 3.
November 8th, 2008 by Dr. Val Jones in Celebrity Interviews, Expert Interviews
8 Comments »
 |
|
Dr. Gawande
|
Kaiser Permanente sponsored a special event in DC today – Charlie Rose interviewed Dr. Atul Gawande about patient safety in front of an audience of physicians. Dr. Gawande is a young surgeon at Harvard’s Dana Farber Cancer Institute, has written two books about performance improvement, and is a regular contributor to the New Yorker magazine. I had heard many positive things about Atul, but had never met him in person. I was pleasantly impressed.
Atul strikes me as a genuinely humble person. He shifted uncomfortably in his chair as Charlie Rose cited a long list of his impressive accomplishments, including writing for the New Yorker. Atul responded:
I’m not sure how my writing became so popular. I took one fiction-writing class in college because I liked a girl who was taking the class. I got a “C” in the class but married the girl.
He went on to explain that because his son was born with a heart defect (absent aortic arch) he knew what it felt like to be on the patient side of the surgical conversation. He told the audience that at times he felt uncomfortable knowing which surgeons would be operating on his son, because he had trained with them as a resident, and remembered their peer antics.
Atul explained that patient safety is becoming a more and more complicated proposition as science continues to uncover additional treatment options.
If you had a heart attack in the 1950’s, you’d be given some morphine and put on bed rest. If you survived 6 weeks it was a miracle. Today not only do we have 10 different ways to prevent heart attacks, but we have many different treatment options, including stents, clot busters, heart surgery, and medical management. The degree of challenge in applying the ultimate best treatment option for any particular patient is becoming difficult. This puts us at risk for “failures” that didn’t exist in the past.
In an environment of increasing healthcare complexity, how do physicians make sure that care is as safe as possible? Atul suggests that we need to go back to basics. Simple checklists have demonstrated incredible value in reducing central line infections and surgical error rates. He cited a checklist initiative started by Dr. Peter Pronovost that resulted in reduction of central line infections of 33%. This did not require investment in advanced antibacterial technology, and it cost almost nothing to implement.
Atul argued that death rates from roadside bombs decreased from 25% (in the Gulf War) to 10% (in the Iraq war) primarily because of the implementation of check lists. Military personnel were not regularly wearing their Kevlar vests until it was mandated and enforced. This one change in process has saved countless lives, with little increase in cost and no new technology.
I asked Atul if he believed that (beyond check lists) pay for performance (P4P) measures would be useful in improving quality of care. He responded that he had not been terribly impressed with the improvements in outcomes from P4P initiatives in the area of congestive heart failure. He said that because there are over 13,000 different diseases and conditions, it would be incredibly difficult to apply P4P to each of those. He said that most providers would find a way to meet the targets – and that overall P4P just lowers the bar for care.
Non-punitive measures such as check lists and applying what we already know will go a lot farther than P4P in improving patient safety and quality of care.
Atul also touted the importance of transparency in improving patient safety and quality (I could imagine my friend Paul Levy cheering in the background). In the most touching moment of the interview, Atul reflected:
As a surgeon I have a 3% error rate. In other words, every year my work harms about 10-12 patients more than it helps. In about half of those cases I know that I could have done something differently. I remember the names of every patient I killed or permanently disabled. It drives me to try harder to reduce errors and strive for perfection.
Atul argued that hospitals’ resistance to transparency is not primarily driven by a fear of lawsuits, but by a fear of the implications of transparency. If errors are found and publicized, then that means you have to change processes to make sure they don’t happen again. Therein lies the real challenge: knowing what to do and how to act on safety violations is not always easy.
 |
|
Charlie Rose
|
Charlie Rose asked Atul the million dollar question at the end of the interview, “How do we fix healthcare?” His response was well-reasoned:
First we must accept that any attempt to fix healthcare will fail. That’s why I believe that we should try implementing Obama’s plan in a narrow segment of the population, say for children under 18, or for laid off autoworkers, or for veterans returning from Iraq. We must apply universal coverage to this subgroup and then watch how it fails. We can then learn from the mistakes and improve the system before applying it to America as a whole. There is no perfect, 2000 page healthcare solution for America. I learned that when I was working with Hillary Clinton in 1992. Instead of trying to fix our system all at once, we should start small and start now. That’s the best way to learn from our mistakes.
October 27th, 2008 by Dr. Val Jones in Medblogger Shout Outs, Opinion
2 Comments »
There is nothing concealed that will not be disclosed, or hidden that will not be made known.
– Mat 10:26
The Internet may be fueling the fulfillment of an ancient prophecy – that there will come a day when nothing can be kept hidden or secret. Of course, early adopters of full transparency are regarded as reckless by some (potentially those who have something to hide?) and laudable by others (though they may be afraid to follow suit). In today’s Boston Globe there is an article about my friend and fellow blogger, Paul Levy. Paul is the CEO of Beth Israel/Deaconess, leading the charge to make hospital errors a matter of public record.
Paul writes about the errors made at his hospital (and many other subjects) in his popular medical blog, Running A Hospital. The blog won the “Best Medical Blog of 2007” award, and he is the first (and perhaps only) hospital CEO that has adopted such a high view of transparency. And for that, I commend him.
In my experience, hospital errors are alarmingly common. Read more »
