By Evan Falchuk

Patient safety is another way to look at health care quality.

Some hospitals are doing meaningful things to improve both patient safety and the quality of care.   Over at the Better Health blog, Dr. Val Jones has put together a terrific three-part video series with Paul Levy, President and CEO of Beth Israel Deaconess Medical Center.

The Harvard-affiliated BI Deaconess is one of the leading hospitals in the country.  And Paul Levy is one of the leading-edge innovators in the use of social media through his blog and active twitter use.  Dr. Val has managed to capture that unique combination in the work done by the BI Deaconess in her videos.

There are three videos.  One is about how BI keeps patients aware of their safety record, and another talks about how patients can keep in touch with friends and family while they are in the hospital.

The one I liked the best is about how patients can have a better hospital experience by keeping themselves informed.  You can watch that below.

The work hospitals are doing to improve question of patient safety is something we should hear more about.  Kudos to Val for helping people see this in action.

By Evan Falchuk

My mother sent me this incredible medical story from the New York Times.  It’s about a young woman, Jessa Perrin, who suddenly faced a life-threatening diagnosis, and the heroic work her doctors and nurses did to save her.

The story spans the globe- from the remarkable medical team at the Hadassah hospital in Israel to the transplant team at New York Presbyterian Hospital.  But perhaps the most moving people in the story are unnamed – the family of a little girl who, on her death, donated her liver to save Jessa.

Most people with transplants have time to prepare, but she had woken up one day in an intensive care unit, thinking she was still in Israel, only to be told that she was in New York — with a new liver. Jessa said only, “It’s crazy.”

In this time of heated debate around health care reform, it is easy to lose sight of the heroic work doctors do every day to save people’s lives.  It doesn’t matter what kind of health care system they work under, they focus every day on making things possible that seem like miracles.

By Evan Falchuk

Attention doctors:

Your patients are talking about you.

They tell their friends, family and co-workers about you.  They talk about you in public places where people they don’t know might overhear them.  Probably every doctor understands this.  But for some reason, once all this talking starts happening on the internet, some doctors do odd things.  Like trying to get patients to sign “gag orders” before agreeing to treat them.

It’s a mistake, and a missed opportunity.

The Washington Post reports on efforts by some doctors to “quell criticism.”  But in the age of the internet, you simply can’t squash criticism.  Indeed, in trying, doctors risk not only undermining the trust that is necessary for a good relationship with their patient, but they also miss out on an opportunity to improve their practices– and our health care system.

Here’s what I mean.

Jeff Jarvis, blogging pioneer and author of the best-selling book What Would Google Do? thinks your angriest customers are doing you a great favor:

Here’s some free advice: Go to Google (GOOG), enter any of your company’s brands followed by the word “sucks,” and you will see the true consumers’ reports. Brace yourself: It won’t be pretty. Wal-Mart’s (WMT) unofficial Google Sucks Index turns up 165,000 results; Disney’s (DIS) 530,000; Google’s 767,000. What’s your number?

Now don’t get mad at these people. Instead, help them get even with you. These angry customers are doing you a great favor. They care enough about your product or service to tell you exactly what went wrong. Other customers may just desert you and head to the competition. But these are telling you what to fix. Listen to them. Help them. Respond to them. Ask their advice—and they’ll give it to you.

It’s about “co-creating” with your customer, figuring out what is important to them and whether what you’re doing serves that need.  It sounds like the practice of medicine, but it’s also about the very personal and subjective nature of the doctor-patient relationship.

What you want from your doctor is pretty simple- you want the doctor to pay attention to you, think about you, answer your questions, and help you understand your condition. Truthful feedback in these areas can be very hard to come by.  No government agency is going to measure it.  But patients are happy to share their views.

So shouldn’t doctors embrace web sites that give patients the chance to say what they think?

Some doctors don’t think so.

One, Dr. Nancy Falk, told the Washington Post that the “people least capable of judging the quality of care are patients”  (she is wrong about this, by the way).  She also said wishes there were a “Web site where I could complain about patients.”

Now, what do internet commenters have to say about Dr. Falk?  The Post says commenters called her “curt and intolerant of questions.”  Falk denied those descriptions, but her quotes make it sound like maybe there is something to them. Still, other commenters had equally strong positive recommendations.

Could she improve the quality of her relationships with her patients if she asked each one if they thought she was “curt and intolerant of questions,” and really wanted to know their honest answer?  If her practice is like any other business that asks its customers what they think, the answer is yes.  In a world where patients are increasingly encouraged to “shop” for medical care, doctors who don’t do this will lose out.

But there’s an even larger point that these doctors are missing.

Modern doctors are some of the best educated and best trained people the world has ever seen.  But our health care system, which forces them to spend too little time with each patient, systematically undervalues all of the things patients really want.

Doctors should embrace any technology, any system that lets the voice of the patient be spoken more loudly.  Doctors should encourage the collection of all of the stories from patients about how they feel their doctor doesn’t have enough time, or was harried, or curt, or distracted by some insurance or government requirement.  They should take this information and show it to insurers, legislators, the media.  And they should make a simple point: we don’t want to work under these conditions, and our patients don’t want us to, either.

Making our health care system work to serve these purposes is what it means to put patients first.

By Evan Falchuk

I belong to a terrific organization that brings together C-level executives, once a month, to discuss issues each of us face.  It’s called Vistage.  One of the subjects we talked about yesterday was health care.  It was like a focus group made up of seasoned, senior executives from many different industries.

The discussion revealed the tremendous divide between what ordinary Americans think about health care and what policy makers in Washington are doing.  It’s a combination that is almost certain to ensure that whatever reform passes may make our problems worse, rather than better.

At the meeting were about 30 executives, representing everything from financial services, commerical real estate, manufacturing, high technology, pharmaceuticals, insurance, retail, non-profits, travel and others.  Although all thought health care costs were in a state of crisis in America, I did not hear anyone say this was the case in their business.  To be sure, some complained that health costs were high, and that there were few alternatives available.  But others described changes they had made to their plan designs that had actually reduced their corporate health expenses.

We talked about the proper role of government, the comparative worth of systems in other countries, the responsibility of people to take care of their own health, end-of-life care, over-treatment, the uninsured, access to care, comparative effectiveness, and our own expectations of what the system should do for all of us.  There was no consensus among this group of 30 business leaders as to these subjects and what we should do about them, other than that they are important topics that we need to address.  I suspect this is true outside of this group, too.  Indeed, the huge collection of issues that fall under the category of health care reform is something I’ve pointed out before.

But the President and leaders in Congress want debate on health care to end.  They want a a bill to pass in the next couple of weeks.

Most of the group members were surprised to hear that Congress had already drafted legislation and was getting ready to vote on it.

It’s a remarkable thing.  We are in the midst of trying to redesign the largest health care system in the world, and we’re barely debating the merits of it.  How many members of Congress will have read the 1,1018-page bill once they vote on it?  How many Americans will understand what implications it has for their health care if it — or something like it — becomes law?

The President often says that the status quo in health care is “not an option.”  The trouble is, the status quo in health care is a rapidly changing thing.  Today, every day, employers and doctors and so many others are busy making real, meaningful changes to our health care system.  Not by waiting for committees of Congress to pass legislation, but by getting together and doing things that improve the quality and cost of care and the lives of patients.  We need to be listening to their stories, and learning from them.  Congress hasn’t done this, and can’t now.

There is an opportunity to build a real consensus around the important issues we talked about yesterday.  We can transform our health care system in ways that make all of us proud.  But it can only happen by working through these hard questions, not by hurrying to pass a bill before the August recess.  Those who say we have a once in a generation chance to reform health care today may be right, but not for the reasons they think.  By passing bills without consensus on this deeply important and emotional issue, they are ensuring that no one will really want to try to reform health care again for a very long time.

Which leaves us very much where we started.  I will continue to do my part to share the important stories of how real people are making real reform.  The political attention to reform may end sometime this year, but the reality of people trying to figure out what to do when sick will continue.

By Evan Falchuk

Many Americans look to Canada, as an example of a government-run health care system that works.

But is that really what it is?

Health care in Canada is funded mostly publicly, but is provided mostly privately.  That is, most care is delivered by privately run hospitals and medical clinics, with fees paid for by the various provincial governments.

Americans often call this system “single payer,” but it’s really not true.  There are many other payers.

For example, if you’re injured on the job, your care is paid by a workers compensation insurance plan funded by employer premiums.  Millions of  Canadians also have supplementary health insurance policies, typically called “extended health care” coverage, which cover things not paid for by the government, like prescription drugs and other medical services.  There is also a growing market for full medical insurance plans, and critical illness plans to provide cash to offset the out of pocket burdens of medical cost.  As much as 30% of Canadian health care expenses are funded through these non-government payers.

However paid for, supply (and funding) for health care has not been able to keep up with increasing demand.  The result has been well-documented: long waits for health care services.  Waiting is a normal part of the Canadian health care experience, with provincial governments publishing  information on wait times and working to fix them.  The Canadian Supreme Court admonished the provincial governments in 2005, saying “access to a wait list is not access to health care.”

And so an interesting dynamic has emerged.

Canadians are justifiably proud of their extraordinary health care system, and care deeply about preserving its core principles.  But they also care deeply about looking after each other, and are as creative and innovative as any people on the planet.  As wait times have grown, so has a burgeoning private market.

Hospitals running diagnostic imaging equipment like MRIs are only paid by the government to run during certain hours of the day.  So creative hospitals decided to run the same machines during the overnight hours, charging patients (rather than the government) a fee for the service, which could be provided on an expedited basis.  While politically controversial, it made it possible to serve more patients without the need for additional government funding.

These types of ideas have grown, extending now to stand-alone diagnostic centers.  A couple of days ago, I visited one, Mayfair Diagnostics, in Calgary.  This center was created by a group of physicians, who, like others I have met, knew they couldn’t change the system, but could improve the part in which they work.  So they bought leading imaging equipment and opened up centers that cater to self-pay patients, as well as those funded through other sources.  They actively promote themselves as a way to get needed medical insight only a couple of days – as opposed to the 6-8 week average wait patients would otherwise face.  Doctors working in this center also work in hospitals serving government-sponsored patients, making the Mayfair center and others like it a supplement to the government system.  And at a price of $650 for an MRI, it’s inexpensive by U.S. standards.

Other kinds of private centers have opened up as well.  Some operate almost as membership-only medical practices, offering much of what might be considered primary care.  Others provide even more comprehensive services, making most aspects of ambulatory care available on a privately-paid basis.  For certain specialties like orthopedics, some even offer complete hospital surgical services.

The Canadian system remains very different from the American one.  Canadians do not want their system transformed into anything that reflects American “rugged individualism.”  And yet the natural human desire to look after oneself and ones family poses dilemmas.  When a loved one is sick, all the abstract ideas melt away, and you think – how can I do everything I can to get help, now.

We’re all entitled to that kind of help — Americans, Canadians, whatever.

The ways Canadians are trying to make sure everyone gets that help are slowly changing the face of Canadian health care.

By Evan Falchuk

The first thing you see when you enter the Toronto General Hospital’s Pathology Department is a prominent sign bearing a quote from Sir William Osler.  “As is your pathology, so goes your clinical practice,” it says.  It’s the first clue that there is something special happening here.

Dr. Silvia Asa is the Chief of the department and has built a remarkable facility in downtown Toronto.  With a team of nearly 40 full-time pathologists in a multi-specialty setting, and dozens of residents and fellows, her department reviews thousands of samples a week.  Walking the halls where the doctors do their work, you might think you were in a law firm, except for the massive microscopes adorning each desk.  The technology and organization were just about the opposite of what I saw in Argentina.

But it wasn’t the technology that was most impressive.  It was the deep passion the doctors clearly feel about the art of pathology, and the prominence it must have in any realistic conversation about quality in health care.  “Pathology has always been in the basement,” Dr. Asa told me, and she means it more than just literally.  Most hospitals have their pathology departments in basements, where the space needed for big lab equipment is at less of a premium.  But it also reflects the importance some place on pathology, almost treating it as an afterthought.

Back row, left to right: Dr. Runjan Chetty Director of Surgical Pathology, me (Evan Falchuk); Front row, left to right: Dianne Charmichael, President of Best Doctors (Canada) and Dr. Silvia Asa, Chief of the Surgical Pathology Department at Toronto's University Health Network

In creating her department, Dr. Asa set out to change all that.  She convinced the hospital to put her department on the 11th floor, instead of spread among various empty basement spots.  Having the department in one place, and close to other physicians, creates easy access and the opportunity to collaborate with specialists in the hospital.  Day by day, she drives an appreciation of how important the art of pathology is to the delivery of high quality medical care.

Dr. Runjan Chetty is Dr. Asa’s Director of Surgical Pathology sees this in action every day.  He worries that as medical education has become increasingly focused on clinical activity, an appreciation of the pathology of disease is being lost.   Busy doctors have a tendency to accept the results of a pathology review as a given.  But as treatments have become increasingly specialized to match specific pathologies, the importance of getting it right is greater than ever.  And so treating doctors need to be more closely involved in understanding how these decisions are made.  They need to engage with the pathologist, question the assumptions on which the diagnositc and treatment decisions are made, and help make sure the patient gets the right care.  Dr. Chetty says that neurosurgeons are especially good at this, and you can sense how rewarding he finds it to have that kind of engagement with a treating doctor.

I hope to be able to write more about Dr. Asa’s extraordinary work in a future post.  But what struck me at the beginning stayed with me at the end.  More than 100 years ago, Dr. Osler instructed us to remember:  “as is your pathology so goes your clinical practice.”  Every day, Dr. Asa puts that lesson into practice, and does her important part in improving the quality of health care.

Disclosure: My company, Best Doctors, from time to time sends pathology to the Toronto General Hospital for review by its expert physicians.  Dr. Asa consults for Best Doctors on related issues.

By Evan Falchuk

Doctors and patients complain all the time about how badly our health care system works.  It shouldn’t be a surprise — neither doctors or patients designed it.  But the internet, and especially blogs, have changed things.  Once the little guy couldn’t possibly have a meaningful seat at the table in making policy, today bloggers are among the most influential political forces in America.

Doctors are the emerging political force on the web.  Their blogs tell the stories of what it’s really like to practice medicine, and often give the most insightful prescriptions on how to make things better.

But the best doctor-bloggers aren’t political.  They simply describe the world as it really is, from inside their offices, to the hallways of their hospitals, to their real-life experiences with patients.  Like the best doctors, they aren’t afraid to just call it like it is, and do it with a sense of humor.

Doctors have a chance to transform health care in a way no other group can — and doctor-bloggers are in the vanguard.