August 3rd, 2007 by Dr. Val Jones in News
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An emergency medicine physician friend of mine sent me a link to a fascinating article about why cell phones aren’t good communication devices in major disasters like 9/11. When I was in NYC during 9/11 my cell phone didn’t work (the lines were all busy). Here’s what the article had to say:
“So why do text messages get through when phone calls can’t? For one,
SMS text messages are very short, so they require very little capacity
when they are transferred over the network. The second reason is that
text messaging works by allowing messages to be stored and sent through
the network.
If there is a delay in connecting to the network, the phone will
store the message in its memory and it will continue attempting to send
the message until it gets through. By contrast, voice is a
delay-sensitive application. If a sustained connection can’t be made,
the person on the other end won’t be able to understand what you are
saying. And so the call cannot be completed.
While it’s quite common for cell phone networks to get overloaded
during serious emergencies, there isn’t much that can be done to fix
the problem. The main reason is that it just isn’t economically viable
for carriers to build their networks to handle a tenfold increase in
capacity in every inch of their footprint.
“People have to remember that this is a commercial service,” Golvin
said. “It was never designed to be an emergency network. And it just
doesn’t make business sense for carriers to try to build it that way.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 24th, 2007 by Dr. Val Jones in Announcements
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From July 26-29 I’ll be in Chicago at the annual BlogHer conference. BlogHer is a community of women bloggers determined to make the world a better place. Revolution Health is proud to be a sponsor of BlogHer this year, and I’ve been asked to moderate a break out session contained within the “Earn Our Votes: What Questions Do Women Bloggers Want Candidates to Answer in Election 2008?” session. Revolution Health is non-partisan, and my role as moderator is to facilitate sincere discussion.
The break out session is 25 minutes long, and the goal is to distill all the important healthcare questions into only 3 key questions that women would like to ask presidential hopefuls about healthcare. In order to get the discussion going, I’ll present a list of questions featured recently on YouTube and in the BlogHer blogs. Please feel free to add questions in the comments section of this blog, and we’ll discuss them in Chicago on Saturday. Hope to see you there!
References
The recent CNN/YouTube Democratic Debate featured the following healthcare questions:
- How will your healthcare plan address the needs of the aging population, specifically those with Alzheimer’s, heart disease and diabetes?
- What will your healthcare plan do to address the need for affordable preventive medicine services?
- Does your healthcare plan cover undocumented workers?
- How do you intend to make sure that all Americans have some form of health insurance?
Various posts from the BlogHer conference blog:
Affordability / Universality
- How can we pay for healthcare in US sustainably?
- How can we make sure that anyone in the US not only has access to healthcare, but can afford it?
- How do we weed out those who choose not to have healthcare from those who desperately need it?
- How can we make healthcare a right, not a privilege, for every citizen?
- How can we mandate that all children in the US are insured?
- How do we protect families from insurance companies who deny claims in the face of a health crisis?
Women’s Issues
- How can we ensure increased access to family planning?
- How do we get birth control to be covered universally under health insurance policies?
- How do we achieve “scientific fairness” to women?
- How can we make women’s and children’s health issues a priority?
- How do we improve health education for women and children?
- How can we make childbirth and maternity leave less of a burden for working mothers? Especially as disability insurance is not offered to all nor is it usually enough. Women can afford to take time off after having a child.
- Can a woman’s reproductive rights be protected in US healthcare?
Ethics / Technology
- How can we ensure everyone has the same access to the same tests and treatments?
- How can we protect research, such as stem cell research, that has the possiblity to wipe out diseases?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 12th, 2007 by Dr. Val Jones in News
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The New England Journal of Medicine published a letter to the editor about a man who was struck by lightning while wearing his iPod. He was jogging home in a thunderstorm, listening to some energy-boosting music when -whammo- the poor Canadian man got more than he bargained for on the energy front. A nearby tree was struck by a lightning bolt, and the side flash reached him, and followed the wiring to his ear buds. The electrical shock passed from one ear bud to the other, blowing out his ear drums and causing such a violent contraction of all his facial muscles that his jaw snapped under the tension.
So this begs the question: could this happen to you? Does carrying a cell phone or iPod put people at higher risk for being struck by lightning?
Well, because lightning strikes are exceedingly rare there are very few case reports in the literature about folks who have been struck while talking on their cell phone or carrying an electronic device. And best I can tell, this is the bottom line: carrying a cell phone or iPod does not increase your chance of being struck by lightning (there is not enough metal in those items to act as a lightning rod). The lightning is more likely to strike a nearby tree or tall object than it will a human. However – if you are struck (such as the man described above) any metal objects (even ions found in your sweat) that you are in contact with can influence the direction of the current. Normally, lightning passes over the skin externally, but if you are wet or have metal in your ears, it can direct the electricity internally, where it can do more damage.
So if you’re caught in a lightning storm, I’d consider keeping metal out of direct contact with your skin. But the chance of you being struck by lightning in your lifetime is almost one in a million, so I think there is little cause for general alarm. Or to use a bad pun: we can all lighten up about lightning risks.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 29th, 2007 by Dr. Val Jones in Health Policy, Humor
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Alright, I can’t help it – I just watched the new movie
Sicko, so I have to write about it. Labeled a propagandist
by some, self-contradictory by others, the value of Michael Moore’s
work is in its ability to get the public talking about a critically important
subject. And I must agree with the New York Times reviewer on this point – Sicko was the best
edited and most entertaining of Mr. Moore’s documentaries.
Why
Socialized Medicine Won’t Work in the US (In My Humble Opinion)
Sicko
was interesting for me because it compared the healthcare systems of the US, Canada,
France and Britain. Moore’s whole thrust is that socialized medicine is the
potential cure for America’s
healthcare crisis. I grew up in Canada,
spent summers in France,
trained in medicine in the US,
and my mom’s British – so I have a unique and very deep appreciation for the
cultural differences of these 4 countries. And here’s what I see: the way
a country cares for the sick is a reflection of their shared cultural
values. Each healthcare system has its own personality – like wine made
from grapes grown in the unique soil and climate of a specific region.
Even if you export the same vines to another place, the wine will never taste
the same. Let’s take a look at a few of these cultures (and yes I am
using somewhat stereotypical language to clarify the differences):
Americans
are fiercely individualistic. They are passionate, driven, and believe
that success is proportional to how hard you work. They believe in
survival of the fittest – if you’re not doing well, it’s probably your own
fault. Everything’s a competition, and capitalism spurs on a constant
parade of advertising, marketing, sales and consumerism, all orbiting the
almighty dollar and personal convenience. It’s critical to them that
anyone can attain the American dream – if they work hard enough. Fabulous
riches are within the grasp of any average Joe if he concocts a really good,
money-making business plan. Americans don’t have time for health prevention,
long vacations, taking care of others – no, they’re so busy working that only a
medical emergency will jar them out of their usual pursuits.
What
sort of healthcare system would grow out of this cultural milieu? A
hurried, high stakes, emergency intervention focused, technology driven
grab-all ruled by any stakeholder who can outsmart the competition.
Forget the poor, they’re not productive and don’t deserve equal care
really. But that financially successful “average Joe” will receive mind-blowing
technologically advanced care that costs hundreds of thousands of dollars and
can keep him alive long beyond any reasonable need to do so. Joe has a
shot at immortality, and somehow that makes all the work worthwhile. Yep,
that’s pretty much what the US
healthcare system is like.
Canadians
are good natured and tolerant. They put the needs of others first.
They will pull over in a snow storm to help you change a tire, and then they’ll
have a beer with you and talk about hockey at a local pub after towing your
vehicle out of the ditch. They will also wait patiently and without
complaint for hours on end in a line for tickets or groceries, or whatever the
line is for. There are so few people in Canada (compared to the land mass)
that nothing feels crowded or busy. Their socio-political views lean
strongly toward socialism –almost no one is really rich or very poor in Canada.
Everyone is treated with the same friendly respect, living comfortably, no real
crime or racial tensions. What sort of healthcare system would these
people invent?
A
socialized, government-run system that offers “free medical care” for all, with
insanely high taxes to cover it all. There are long lines, competent
doctors, and moderately satisfied patients.
The
French are argumentative and political. They tend to value
leisure above work, they don’t like rules imposed on themselves, and believe
that their government’s purpose is to serve their needs at all times.
They protest regularly, everything is unionized and everyone is focused
on personal rights and liberties. Employers are at the mercy of
government rules and employee whims. They work very little and expect
extensive social services, smoking cigarettes and drinking coffee, watching the
world walk by from neighborhood cafes. What sort of healthcare system
would these people want?
A
government-run, heavily social service oriented system that caters to a
leisurely lifestyle. Spa treatments, alternative medicines, herbalism all
thrive, but in order to keep people from overburdening the spas, copays for
many basic services run as high as 40% of the total bill.
So
the question is this: how would Americans respond to these other brands of
healthcare? If they were served up the Canadian system, they’d
scream at the tax rates, and become hysterical at the inability to trade up to
a platinum level of care for those who have “earned it.” They would not
accept the long lines for care and would immediately start a scheme for
off-shoring medicine to circumvent the lines.
If
Americans were offered the French system, they’d be immediately annoyed by the
inconvenience of the office hours (months of vacation are taken at a time by
all members of society, including doctors), they’d never use the preventive
health measures (they don’t have time for that stuff), and although they’d be
glad to receive home health aides for no more excuse than – “I just had a
baby and I’d like a government worker to clean my house” – when they saw the
tax rates it would take to make this available to all, they’d find it
unacceptable, especially with such high copays and out of pocket expenses..
So
socialized medicine will never work in the United States – not because it’s a
fundamentally flawed system, but because the American culture will not tolerate
it. Healthcare solutions are not globally applicable – (though I’d say
that from an IT perspective, there is an information sharing system that is
needed equally badly by all countries). Instead, systemic changes should
be personalized to the culture. Looking to other countries for magical
fixes to healthcare woes is like expecting that all cancers will respond to the
same chemotherapy regimen. Medical care is most effective when it is
customized to the individual, and healthcare reform will be most effective when
it takes into account the unique cultural values held by a country’s people.
In my next post, I’ll explain why health insurance companies
and big government health plans (Michael Moore’s solution to US healthcare
woes) share a common flaw.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
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.
