Posts Tagged ‘Health Care Blogging’

Weekend Round-up

Monday, February 8th, 2010

By Evan Falchuk

Some things you might have missed these last few days, what with the snow and the Superbowl:

1.  The always interesting Hank Stern at Insureblog talked about the first of my three posts on Japan (the other 2 are here and here).

2.  KevinMD used my post about how your doctor’s moods affect the quality of your care to talk about the problem of burn-out among physicians.  He’s written about it before, and it’s important.

3.  I tried to explain why U.S. employers aren’t crazy.  At least they’re not crazy to want to pay for health care themselves, thank you.

4.  Good news at the Wall Street Journal’s Health blog: government-designed, privately-sold, cheap health insurance.  Too good to be true?  Yes, as I point out in a comment there and in more detail here.

5.  This research makes me think oh my God.  Please hurry up and build the technology seen in either Avatar or the Matrix.

More Good Reading

Monday, December 14th, 2009

By Evan Falchuk

A round-up of interesting things found on the web:

1. Joe Lieberman wants you dead.

Well, maybe not you, in particular.  But Ezra Klein can’t figure out why Senator Joe Lieberman opposes the current version of the Senate health care reform bill.  So, he has reflected on the point concluded that it is because he

seems primarily motivated by torturing liberals. That is to say, he seems willing to cause the deaths of hundreds of thousands of people in order to settle an old electoral score.

Well, ok, then.  Health care seems to make people say some crazy things.

2.  Jonathan Bush doesn’t like Congress.

Babies are enjoying a renaissance.  First, they day trade.  Now, they seem to have access to Israeli-manufactured submachine guns:

I still have to keep going to Washington and sucking up. . . . Because the problem is when you have a baby with an Uzi, right, they might accidentally mow you down. But here’s the thing . . . they’re brilliant people. It’s just that the idea of a market in health care never occurred to them.

But the CEO of Athena Health makes some interesting points.  He doesn’t think the reform proposals in Washington are a good idea, but says that companies like his stand to make a lot of money implementing whatever it is that is passed.  It’s a colorful interview that is worth reading.

3.  Massachusetts businesses are worried that federal reform will undermine the Massachusetts reforms of 2006

For all the talk about how bad the Massachusetts health care reforms are, a coalition of the most important business groups are worried federal law might undermine them.  So they wrote a letter to  Senator Kennedy’s (temporary) replacement Senator Paul Kirk asking him to make sure this doesn’t happen:

Our hope was that national health reform efforts would compliment, rather than undermine, our state efforts. In recent weeks, we have grown increasingly concerned that many provisions contained in the health reform bills before Congress could actually undo the success of Massachusetts health reform by making coverage more expensive. . . . .Employers cannot absorb this increased cost, particularly when our health care costs are already among the highest in the nation.

The business groups are especially concerned with taxes on health insurers and so-called “Cadillac” plans, but also raise a number of other issues.  Their biggest concern is cost-containment and they are worried that the Senate bill isn’t going to address that problem.

4.  The UK’s Health Insurance and Protection Magazine featured an interesting story on Best Doctors

As I noted after my recent visit to our European headquarters, different countries may have different health care systems, but the experience of being sick or treating patients is very similar:

The fact that medical treatment varies locally and internationally is well-established.  In the UK, mastectomy rates for breast cancer patients range from 36% to 53% between regions, and between surgeons from 19% to 92%. . . . [T]hese examples serve as useful reminders that doctors operate within a complex context. While national guidelines exist, there remain difficult choices to be made.

Bottom line: everyone wants more control over their health care.

5.  Tinker!

At Healthcare etc., Marya Zilberberg says good things happen when we question authority and try things for ourselves:

People, we are no better informed than our ancestors banging their drums to ward off solar eclipse. . . . If we want true innovation, we need to get back to our tinkering roots. Learn to darn your socks, help your child to read and teach her to tinker, so that she can stay curious. Question “experts”: most of the time the mountains of complexity behind their concepts are useless or unnecessary, or created for the purpose of exclusion by obfuscation. Throw open these black boxes and shine a light in them. Play with stuff. Play with ideas. Tinker!

I’m all in favor of her advice.  Except the the part about sock darning.

UPDATE 12/15/09: This was cool and came out late yesterday:  My brother and his co-creators of the show Glee received 2 nominations for awards from the Writer’s Guild of America.

UPDATE #2: And they got four Golden Globe nominations.  Not a bad day.

Weekend Roundup

Monday, November 30th, 2009

By Evan Falchuk

Some reading from the weekend:

1.  The state of Hawaii wants to opt-out of the federal health care reform.

2.  Health care and politics: a bad mix.  Eighty-one percent of those surveyed disagree with new scientific mammogram recommendations.  You think politicians will make sure the science doesn’t become public policy?

3.  A Massachusetts health plan and a hospital system try an alternative to fee-for-service medicine.  Will it work?

4.  A depiction of an especially grisly medical mistake.

5.  Speaking of grisly: Turbaconducken.

The Hardest Word

Wednesday, November 25th, 2009

By Evan Falchuk

Dr. Toni Brayer asks – is it dangerous for doctors to say “sorry?”

In the past, physicians were advised to never admit to a problem or to apologize for clinical errors with the thought that it would lead to more lawsuits. Saying “I’m sorry” might be taken by a lawyer as an admission of guilt and malpractice. Attorneys advised, “Say nothing” but that left patients with unanswered questions and often the feeling that the doctor just didn’t care.

She points out that some 35 states have passed laws that prevent a doctor’s apology from being used against him or her in proving a malpractice claim.

I understand why these kinds of laws may be needed.  If you say you’re sorry for something, you are implicitly taking some degree of responsibility for whatever has happened.  Plaintiff’s lawyers will use a doctor’s apology to the maximum extent possible to show the doctor knew what they did was wrong.

“Sorry” is, as wise people have observed, the hardest word in the English language.  But why is this?

I think people like to think of themselves not as infallible in their actions but as infallible in their intentions. By this I mean, whatever I do, it will be with the right intentions.  Even if something goes wrong, it will not be so much my fault so much as a bad twist of fate.  Apologizing is, in this sense, a very un-natural thing to do.  You haven’t done anything wrong.

But think of it from the perspective of the person who has been harmed by your actions.  If you’ve hurt me in some way, I may conclude that the reason it happened wasn’t dumb luck but rather that you were careless, or at the least not concerned enough with my well-being.  Your failure to apologize will look to me like my conclusions are right.  You can’t even say you’re sorry?  You must not care much about me at all.

It’s enough to make someone very angry.  And it’s awfully easy for an angry person to find a lawyer who will listen to them.  At that point, it’s too late for sorry.

Saying you’re sorry is so hard because it takes so much humility.  We have to be willing to accept that not only are we imperfect in our actions, but we can also be imperfect in our intentions.  Or at least that others may believe we are imperfect in our intentions.  You have to be able to admit that, yes, it’s true, I wasn’t as attentive as I could have been.  Or you know, you’re right, I can see why you would think I was being careless, I’m sorry for what I did.

So long as your apology is genuine, timely, and based on a true understanding of the problem you have caused, you will defuse the problem.  But your work isn’t done.  Apologizing doesn’t fix everything, it just gives you the opportunity to repair your relationship.  So, saying sorry is not a cure for problems of medical malpractice, but it might prevent more cases than you think.

Still, there is something very wrong with the notion that we need to pass laws to make it so that an apology isn’t a legally dangerous thing to do.  We should not look upon a doctor’s apology as something to be used against him, but rather as a sign of his humility and his caring for his fellow man.

If he has committed malpractice, there will be plenty of facts that can demonstrate it.  Whether he acted as a good and caring person in dealing with the aftermath of a bad event ought not be one of them.

Good Reading

Monday, November 16th, 2009

By Evan Falchuk

Here’s a round-up of some recent posts worth reading from around the web:

1.  Market failure -> New entrants?

Paul Levy is the CEO of Boston’s Beth Israel Deaconess Medical Center, and he blogs regularly about how he sees health care from that perspective.  He is always insightful and candid in his observations about health care.  In this post, you can read how the uncompetitive market for private insurance looks from the perspective of the CEO of a major, Harvard-affiliated teaching hospital.  By the way, although he never mentions who the “dominant provider,” he means Partners.  And although he never says who dominates the Massachusetts insurance market, he means Blue Cross Blue Shield of Massachusetts.

One quibble I would have with Levy is this.  He’s right, the BI Deaconess is at a disadvantage compared to Partners in terms of its negotiating leverage with Blue Cross, but the BI Deaconess is still one of the best hospitals with some of the best doctors in the world.  Perhaps it’s more of a statement of the high quality of academic medicine in Massachusetts that a hospital like his can be considered second to anyone.  I’ve posted previously on some of Levy’s good work on health care quality here.

2.  Duty Hours, the ACGME and the Surgeons.

At Medrants, Dr. Robert Centor talks about how well-intentioned duty-hour limits on surgical residents are leading to a poorer quality educational experience for surgical residence.  It puts the quality of care these doctors will deliver at risk.  Money quote from Dr. Centor:

I want a physician who trains in a tough, demanding residency.  You cannot learn medicine without appropriate volume. No one makes you become a physician.  If you want a less stressful residency, then you can choose one.

He thinks residents should be able to choose, rather than being placed in a one-size fits all kind of a program.  He still thinks we may be surprised at what kind of training most would prefer.

3.  Reality Check: Doctors Can’t Fix Everything.

On the Commonhealth blog, Dr. Annie Brewster writes a heartfelt and meaningful post about how sometimes there are no easy choices – or good answers – in medicine.  She says she is writing the post as much to convince herself of her point as she is her readers, which I think is always a sign you are about to read something very thoughtful.  Go there and read the whole thing.

4.  Why Errors Happen.

A new study takes strides in creating a taxonomy of diagnostic error in medicine.  This was interesting.  A study was performed that asked doctors to recall instances in which they had made diagnostic errors, and to classify what the cause of the errors were.  Three quarters of all errors were either because the clinician neglected to properly order a follow-up, or because the clinician failed to properly assess data.

5.  Should the character in “Glee” that uses a wheelchair actually be played by an actor who uses a wheelchair?

I have no idea.  But I feel obligated to link to any story about my brother’s show that is published in the “Health” section of a major national newspaper.  By the way, the character, named Artie, is played by an actor named Kevin McHale.  No, not that one.

6.  Did you know?

Did you know that outside of Washington, DC, on September 1, 1926, a baseball team made up of Ku Klux Klansmen played a game against a team of local Jewish all-stars?

You do now.  The Klan won, 4-0, but the game was called by rain in the 7th inning.

Top 5 Most-Read Posts for October

Monday, November 9th, 2009

By Evan Falchuk

Here are the top 5 most-widely read posts from See First for the month of October.

1.  What Really Matters

2.  Why Is Health Insurance So Expensive?

3.  If You Had to Fix Just One Thing

4.  Doctors: Beware of Politics

5.  Don’t Get Sick

The Dark Side of Hope

Wednesday, November 4th, 2009

By Evan Falchuk

In today’s Booster Shots, Shari Rowan says sometimes patients “shouldn’t hold on to hope.”

She describes research that suggests that patients that have a realistic view of their medical situation do better than those who don’t.  One of the authors of the study said that hope “is an important part of happiness. But there’s a dark side to hope.”

I think she’s talking about just another form of denial.   These are patients – and, often their families – who suffer not only from a disease, but also of the psychology of how they deal with it.  As I wrote at the time:

I remember my father, who is an internist, telling me stories [of] . . .people with obvious, visible effects of a disease, but who weren’t getting any care.  It wasn’t that they had no one paying attention to them – often they had family and friends almost begging them to go and get help.  They just refused to go.

It is a reaction that I think is common to anyone who has suffered from a serious illness.  You don’t want the bad thing to be happening, it’s much easier to deny its existence.  The thinking is: I don’t want to be sick.  If I need medical treatment, then that means I’m sick.  So I will not seek medical treatment.

It’s much worse if the family of the patient is in on it, too, enabling the denial.  And I’m sure it’s devastating to those family members who want to see their loved one get help, but can’t get them to listen.

Misplaced hope is really the same.  Of course, realizing this is not the hard part.  Figuring out when your hope is misplaced is the hard part.  Is it really true that the condition is irreversible?  Sometimes it’s easy to say “yes,” or “no,” but very often the answer is “we don’t know.”

What then?

The struggle – the journey – for a patient or the family of a sick patient is trying to figure this out.  Are you doing more harm than good by fighting to get a better outcome, when you’d be better off just accepting reality?  Or are you doing yourself or your loved one a disservice by giving up when there are things you could do to make their situation better?  And as a family member of a patient, is it all really dependent on you?

— Whatcha got ain’t nothin new. This country’s hard on people, you can’t stop what’s coming, it ain’t all waiting on you. That’s vanity.

No One Should Die or Go Broke

Friday, September 4th, 2009

By Evan Falchuk

It’s been all over Facebook and Twitter the last couple of days. People updating their status with this message:

No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree, please post this as your status for the rest of the day.

It strikes me as odd. I mean, who can disagree with these statements? And for what policy proposal are they meant to encourage support?

How about just changing it to “no one should die, and no one should go broke”? I’d be in favor of that, too.

(more…)

New “Patients for a Moment” is Up

Wednesday, August 12th, 2009

By Evan Falchuk

The 5th edition of the health blogosphere’s most interesting new carnival, Patients for a Moment, is up at Adventures of a Funky Heart.

If you don’t know, Patients for a Moment is the brain child of blogger Duncan Cross, and is the blog carnival “for, by and about” patients.

This week’s edition has a slew of great posts, go on over and check them out.

My Reaction to “Putting Patients First”

Tuesday, July 21st, 2009

By Evan Falchuk

A blogger at the event put it simply: As bad as it is being sick, there are many things in our system that make it worse.

All of the clinicians who spoke at the event understood this, and talked about ways to improve the doctor-patient relationship.

But the problem is worse than the clinicians may think, and it’s not something health care reformers are talking about.

Let me share some data with you so you can see what I mean.

(more…)

  • "Medicine is learned by the bedside and not in the class room. Let not your conception of manifestations of disease come from work heard in the lecture room or read from the book: see and then research, compare and control. But see first."
    - Sir William Osler, MD
    The Father of Modern Medicine
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