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.
By Evan Falchuk
At the Well blog, Tara Parker Pope links to a provocative piece by Dr. Pauline Chen on what happens when a diagnosis is missed.
Dr. Chen writes about a patient that had found a small mass on her breast. Ignoring her doctor’s advice to start the process of properly diagnosing and treating it, she decided to try alternative therapies. It wasn’t until the tumor had become “the size of a young child’s head” that the patient became worried enough to visit Dr. Chen and have surgery to remove it.
In her piece, Dr. Chen wonders about issues in our care delivery system that lead people to miss out on getting the right care. But I think cases like Dr. Chen’s patient are of an entirely different kind. They’re suffering not just from the effects of disease, but also another, more common problem, denial.
I remember my father, who is an internist, telling me stories like the one Dr. Chen tells. These were 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.
It seems like it’s very hard for doctors, too.
Dr. Chen is right to point to ways in which our system can do better at reminding people of the importance of following up on their doctor’s recommendations. But the problem she is talking about is much deeper and fundamental to the human psyche than any change in the process of delivering care may be able to ever address.
By Evan Falchuk
At Slate, Professors Barry Schwartz and Kenneth Sharpe write about why trying to incentivize good medical practice is a mistake:
Almost all doctors want to practice good medicine—at least before they get socialized by the grind of medical school, residency, student debt, malpractice premiums, and the like.Yes, of course, they want to make a good living, but many—perhaps most—doctors would happily trade high compensation for a chance to practice medicine as it should be practiced. So the most important thing to do about incentives is this: Cease and desist. Stop thinking about incentives as the way out of the health care cost explosion.
Think instead about how medical training and practice can nurture and sustain the fragile desire to do the right thing that most students bring with them into medical training.
Our focus on incentives has happened because we have, for decades, mistakenly seen the practice of medicine as a simple economic transaction. We’ve prioritized money over medicine. And by focusing on ever more clever ways to design economic incentives, we have systematically undervalued everything that makes for high quality medicine. Things like time with your patient, thinking about his or her problems, consulting with colleagues, and coming up with sound advice.
The professors have it right – read the whole thing.
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.
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.
by Evan Falchuk
Friday, I went to the National Press Club in DC for the Putting Patients First event. It was organized by Dr. Val Jones of the Better Health blog, and was meant to raise the profile of patient issues in our discussion of health care reform.
Val deserves congratulations, as the issue has gotten wide attention in the medical blogosphere and beyond.
Here’s a round-up of reactions.
By Evan Falchuk
In my role as President of Best Doctors, I have the great opportunity to meet and work with some of the world’s leading health innovators.
And by innovators I mean people who don’t just talk about improving health care, they actually do it. My first Q&A is with Delia Vetter, Senior Director of Benefits for EMC Corporation.
Look for it here tomorrow morning.
Next, on Friday I’m attending what promises to be a terrific discussion at the National Press Club in Washington, D.C.
Dr. Val Jones of the Better Health blog is hosting an event called “Putting Patients First.” It will feature Rep. Paul Ryan (R-WI), and the finest collection of doctor-bloggers you may ever see. I’ll be live-tweeting the event and follow-up with some insights afterwards.
By Evan Falchuk
Ezra Klein recently wrote that doctors were at the root of our health care problems, citing Atul Gawande’s discussion of McAllen as his inspiration, as well as Steve Pearlstein’s work. I’ve already noted how both Klein and Pearlstein misunderstand Gawande’s work.
Now, Klein has scored an interview with Gawande.
By Evan Falchuk
Steven Pearlstein actually wrote that in the Washington Post on Wednesday, right after (another) long rant against physicians. At the end, he offers doctors an olive branch. Or maybe its an offer he thinks doctors can’t refuse:
The choice for doctors now is quite clear: They can agree to give up a modest amount of autonomy and income, embrace more collaboration in the way they practice medicine and take their rightful place at the center of a reform effort that will allow them to focus more on patient care. Or they can continue to blame everyone else and remain — stubbornly — a part of the problem.
After reading Pearlstein’s columns, I’m still sure not why he has such a problem with doctors. I am beginning to think it’s because he just misunderstands them.
By Evan Falchuk
Everyone is reading Atul Gawande’s article in the New Yorker about health care costs. But I think most people misunderstand Gawande’s major point.
Everyone's At It
