tag:blogger.com,1999:blog-72557767072983933672024-03-15T18:09:13.887-07:00Saving Money and Surviving the Healthcare CrisisYour Guide to Better Care For LessDavis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.comBlogger267125tag:blogger.com,1999:blog-7255776707298393367.post-26141581960703544222012-11-05T10:41:00.001-08:002012-11-05T10:41:52.481-08:00Moving On to New Website<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbcf6ksIkOrrMArqD0D2B84bq7RyYf7EHVwOnJHE07SQ2f5pCQktDIXWp5ek8EyUogQepl5kjnQRYWzWVXgS1J2Yq-9kJlj8DwHMQirjbKCYW42lz_xgcNRziz6d0cWuuG6MMjZcEZZUg/s1600/Liu+photo+web.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbcf6ksIkOrrMArqD0D2B84bq7RyYf7EHVwOnJHE07SQ2f5pCQktDIXWp5ek8EyUogQepl5kjnQRYWzWVXgS1J2Yq-9kJlj8DwHMQirjbKCYW42lz_xgcNRziz6d0cWuuG6MMjZcEZZUg/s200/Liu+photo+web.jpg" width="138" /></a>Thanks for following my blog which since 2007 has provided a home for my thoughts and musings about the challenges for doctors and patients to get the right care each time. This blog was the starting point for my first book - <a href="http://www.amazon.com/Stay-Healthy-Longer-Spend-Wisely/dp/0979351200/ref=sr_1_1?ie=UTF8&qid=1352140610&sr=8-1&keywords=davis+liu">Stay Healthy, Live Longer, Spend Wisely - Making Intelligent Choices in America's Healthcare System.</a><br />
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I hope you continue to enjoy much of the terrific content here as well as follow me to my new home which features the latest commentary and insight at <a href="http://www.davisliumd.com/">Davis Liu, MD</a> as well as my newest book - <a href="http://www.amazon.com/The-Thrifty-Patient-Insider-Staying/dp/0979351227/ref=sr_1_3?ie=UTF8&qid=1352140688&sr=8-3&keywords=davis+liu">The Thrifty Patient - Vital Insider Tips For Saving Money and Staying Healthy.</a><br />
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Of course you can still follow me on Twitter <a href="https://twitter.com/davisliumd">@davisliumd</a><br />
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Sincerely,<br />
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<br />
Davis Liu, MD<br />
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Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com4tag:blogger.com,1999:blog-7255776707298393367.post-89567870023032084682012-10-16T06:41:00.001-07:002015-06-02T20:11:16.710-07:00NYT Kristof's A Possibly Fatal Mistake Shows Future of Health Care. It Isn't Good.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipy7Y3GWacIdSxr-8ZKTokH0KNToEO4-spqbXMdnOYtsdRkbSKZz4IL1TcpMmyvvxtEDxlZNTIT2YZzDebuURkHW1ljT7obRhpwW1SWMpms7fNc63rXTxyM4ssDBiW59Ck2TMOw_b8uZg/s1600/Kristof_New-articleInline-v2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipy7Y3GWacIdSxr-8ZKTokH0KNToEO4-spqbXMdnOYtsdRkbSKZz4IL1TcpMmyvvxtEDxlZNTIT2YZzDebuURkHW1ljT7obRhpwW1SWMpms7fNc63rXTxyM4ssDBiW59Ck2TMOw_b8uZg/s200/Kristof_New-articleInline-v2.jpg" width="158" /></a></div>
NY Times columnist Nicholas D. Kristof wrote a heartfelt piece <a href="http://www.nytimes.com/2012/10/14/opinion/sunday/kristof-a-possibly-fatal-mistake.html?_r=1&ref=opinion">"A Possibly Fatal Mistake"</a> about his college roommate Scott Androes, who recently was diagnosed with metastatic prostate cancer. His story illustrates the problem with the current health care system. It isn't about the lack of health insurance. It's about the obstacles all patients face in making the right decisions and the right treatment.<br />
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<a href="http://davisliumd.blogspot.com/2011/02/why-consumer-driven-health-care-will.html">Something that will increasingly be harder with consumer driven health care.</a><br />
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Kristof lets his 52 year old friend, who is well-educated (graduate of Harvard, financial and pension consultant) and also was uninsured starting in December 2003, tell the story.<br />
<blockquote class="tr_bq">
<div itemprop="articleBody">
<i>In 2011 I began having greater difficulty peeing. I didn’t go see
the doctor because that would have been several hundred dollars out of
pocket — just enough disincentive to get me to make a bad decision.</i></div>
<div itemprop="articleBody">
<i> </i> </div>
<div itemprop="articleBody">
<i>Early this year, I began seeing blood in my urine, and then I got
scared. I Googled “blood in urine” and turned up several possible
explanations. I remember sitting at my computer and thinking, “Well, I
can afford the cost of an infection, but cancer would probably bust my
bank and take everything in my I.R.A. So I’m just going to bet on this
being an infection.”</i></div>
<div itemprop="articleBody">
<i> </i> </div>
<div itemprop="articleBody">
<i>I was extremely busy at work since it was peak tax season, so I
figured I’d go after April 15. Then I developed a 102-degree fever and
went to one of those urgent care clinics in a strip mall. (I didn’t have
a regular physician and hadn’t been getting annual physicals.)</i></div>
<div itemprop="articleBody">
<i> </i> </div>
<i> The doctor there gave me a diagnosis of prostate infection and prescribed antibiotics. </i></blockquote>
Androes, after being diagnosed with metastatic prostate cancer, like most of us, would reflect on what went wrong.<i> </i><br />
<blockquote class="tr_bq">
<i>I read Nassim Taleb’s book “The Black Swan” and imbibed his idea
that you should keep an eye out for low-probability events that have
potentially big consequences, both positive and negative. You insure
against the potentially negative ones, like pros</i><i>tate cancer.</i><br />
<br />
<i><i>So why didn’t I get physicals? Why didn’t I get P.S.A. tests? Why
didn’t I get examined when I started having trouble urinating? Partly
because of the traditional male delinquency about seeing doctors. I had
no regular family doctor; typical bachelor guy behavior.</i></i><br />
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<i><i><i>I had plenty of warning signs, and that’s why I feel like a damned
fool. I would give anything to have gone to a doctor in, say, October
2011. It fills me with regret. </i></i></i></blockquote>
What can we learn about his experience and the future of our health care system?<br />
<br />
<h2>
Smart educated patients can make bad decisions </h2>
Androes is highly educated. If anyone should understand the cost benefit analysis of money and health, it should be a pension consultant educated at Harvard. He had opportunities to seek care sooner, but chose not to. Understanding this psychology is important as it is the underpinning of consumer driven health care - <a href="http://davisliumd.blogspot.com/2011/02/why-consumer-driven-health-care-will.html">patients will choose more rationally if they have more financial skin in the game. Yet all I continue to see is evidence to the contra</a>ry.<br />
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First, Androes had many obstacles and not all related to lack of health insurance. <a href="http://davisliumd.blogspot.com/2010/07/americans-cut-back-on-doctor-visits.html">He didn't choose to see a doctor when symptoms started in October 2011 because the cost didn't seem worth it. This is where our common sense and experience falls short. </a>We've all had
experiences of an ache, pain, or symptom. Many go away on their own.
Androes like many other patients have this "success" and filed it away.
Plus, work is too busy or important to put on hold (another major
problem with the economic crisis of 2008) and personal health takes a
back seat. The problem is our previous success with other symptoms may
not necessarily apply to the current symptom.<br />
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It isn't clear if at that point he researched his symptoms with the always available Dr. Google. Unfortunately, like many patients he winged it hoping for the best. Had he thought about it some more, he might have realized that he never had urinary complaints prior to this episode. Having urinary problems are quite uncommon in young or middle-aged men.<br />
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So, Androes, like many others, he extrapolated his prior experience to his current situation, which may not have been appropriate.<br />
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<h2>
Who has time to be sick? Don't "bet" on the wrong diagnosis with Dr. Google </h2>
Second, when he did have blood in the urine, Androes did consult Dr. Google. Dutifully, Dr. Google pulled up two possibilities. Infection or prostate cancer. Androes "bet" that it was infection. This is no different than "winging" it. Unlike the first episode of urinary problems, Androes clearly is informed about the possibility of cancer. Problem is he can't afford a catastrophic illness like cancer either from a financial or time point of view.<br />
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Here is the reality. None of us can afford it. There is never a good time to be diagnosed with cancer or any other serious life-altering illness. Yet is behavior is common among many patients I see. Their job or their financial assets are more important than their health. Androes "chose" to go after April 15th, after tax season, when it was most convenient for him. <a href="http://davisliumd.blogspot.com/2011/06/what-dr-oz-learned-from-his-cancer.html">Dr. Oz nearly made a similarly bad decision regarding his colonoscopy and colon cancer screening a few years ago and then again when he failed to follow-up as recommended for colon cancer surveillance.</a> Part of the reason we all fall into this cognitive trap is that for
the most part, our body does a good job in running despite what we eat,
our sedentary lifestyle, and long hours of work.<br />
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The most important financial asset is your health. With good health you can always make more money, with more money you can't buy good health. So certainly, Androes had his less than optimal choices.<br />
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<h2>
Did doctors miss a chance to diagnose prostate cancer earlier? </h2>
What about the health care system and doctors? Did we miss an opportunity?<br />
<br />
Yes. It is possible there were two, though unclear if it would have made a difference in his case.<br />
<br />
When Androes sought care with a doctor in urgent care and a urologist, he noted the former diagnosed him with a prostate infection and the latter did blood work. It isn't clear whether either doctor did a rectal exam to feel the prostate. A patient with metastatic prostate cancer with a PSA of 1,110 (normal range less than 4) should have a very abnormal prostate exam.<br />
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Had a prostate exam been done, either doctor had a very good chance in telling him he had prostate cancer prior to any confirmatory blood work. At that point, however, even with this knowledge it would have been too little and too late to alter the outcome or overall prognosis.<br />
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The second issue is whether the benefits of physical examinations or lab testing, like PSA, would have made a difference. Neither have been demonstrated to save lives. In other words, as a nation we might feel better that everyone gets an annual check-up or lab testing, but there is no scientific evidence that either help. Also, as noted previously, it isn't clear patients will seek preventive care for the reasons above.<br />
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So, how does this one story, which sadly is repeated too often by different writers and involves different protagonists, predict our health care future?<br />
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It does in the following ways:<br />
<br />
<h2>
Common sense does NOT apply to health care- four challenges in making good decisions about health</h2>
<a href="http://davisliumd.blogspot.com/2012/08/update-on-thrifty-patient-vital-insider.html">Common sense does not apply to health care.</a> Patients may have symptoms they have never had before and erroneously assume based on prior experience, that this new problem is nothing to worry about. Denial is a powerful emotion and can cause inaction precisely when action is needed.<br />
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Second, when patients feel fine they don't protect against low probability but high risk problems. Will people buy health insurance? Will they demand for preventive screening tests that save lives? Will they willingly get vaccinated against preventive illnesses? Increasingly we see more parents choosing not to have their children immunized and then nationally see many preventive illness, like pertussis, return again with significant consequences. <br />
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Third, there are many obstacles preventing good decision making. Whether higher deductibles, copays, or simply working too hard to focus on one's health, people ignore their health until they have no choice or have symptoms. If Androes who had the good fortune of being educated at an elite Ivy League school made poor medical decisions, what are the implications for the rest of society? Patients should be more motivated to take charge of their health, yet it is likely the drive to consumer driven health care will make the nation's overall health care worse, not better. A similar experiment was attempted in retirement planning with devastating outcomes for retirees.<br />
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<a href="http://davisliumd.blogspot.com/2012/08/rock-health-enterpreneurs-doctors-and.html">Fourth, people are increasingly devaluing the important of expertise and experience with the increasingly ease and availability of information on the internet.</a> That isn't to say that non-experts cannot make a contribution to furthering progress. The challenge is that the availability of data provides many non-experts a false sense of certainty and absolute truth which is not necessarily true in medicine. We do have genomics, but it is in its infancy. We do have personalized testing, but it isn't clear if knowing the results will be medically important. When dealing with the complexity of the human body, nuance and ambiguity are prevalent.<br />
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More patients are emailing me requesting for CT scans or MRIs because the office visit copay is too expensive. They don't feel that seeing a doctor, taking a detailed history or examination is worth it.<br />
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Yet, to counter the issues above it is doctors who can convince people to act in getting testing, treatments, and interventions when they don't want to emotionally or are uncertain what to do. It is doctors who can encourage patients to get preventive testing and immunizations when faced with the overwhelming amount of information and clutter from the media, the internet, and friends. It is doctors who can tell patients when they must seek care and when they can safely skip. There is medical science and then there is everything else. <br />
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However, this is not where our country is headed. Too many believe that to lower costs and improve health outcomes, patients must make better decisions. Patients will do so if they have more financial responsibility and more cost transparency.<br />
<br />
Show me the evidence because I don't see it.<br />
What I do see, unfortunately, is more cases like Scott Androes.
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</iframe>Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com2tag:blogger.com,1999:blog-7255776707298393367.post-38259481534519874632012-10-10T06:47:00.000-07:002014-09-06T08:15:24.675-07:00Is the Iron Triangle of Health Care a Law or an Observation?A recent commentary in the Journal of the American Medical Association titled, "<a href="http://newsatjama.jama.com/2012/10/03/jama-forum-the-iron-triangle-of-health-care-access-cost-and-quality/">The Iron Triangle of Health Care: Access, Cost, and Quality</a>" reflected that any health care system can only optimize two of the three elements - quality, access, cost. A health care system which provides the finest quality and best access cannot do so without raising costs to unaffordable levels. An inexpensive health care system available to all cannot do so without sacrificing quality. The iron triangle of health care was introduced to me during my medical school training in the 1990s. Like many others, I simply assumed it was a fact. An immutable law. A fixed certainty that could not be altered any more than gravity.<br />
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What if this iron triangle isn't a fundamental truth or law? Why don't other industries have their own iron triangle? Is health care really different than aviation or computing? Asking this simple yet basic question is something medical students and doctors don't ask. Fortunately, this was not the case for <a href="http://www.claytonchristensen.com/">Harvard Business School Professor Clayton Christensen</a>, author of the <a href="http://www.amazon.com/The-Innovators-Prescription-Disruptive-Solution/dp/0071592083">Innovator's Prescription</a>. His
book not only details the theory of distruptive technologies, but also
how companies who do "disrupt" the incumbent companies and the status
quo are the ones that ultimately provide goods and services which are more affordable, more accessible, and of higher quality. Might there be analogies for health care? Professor Christensen highlights aviation and computing as two examples.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEBHzT-Kl7bGKKKvXdEALVMkOq2j66dIRAstZ3aCASejJyxB0d8PZd6lavegCt3sxmBziGNcoLa36Ae6zzELlivx3XYJxlANg6j9n0anF5iFiOv_H5K-BNrYi2UIy4S3oO73MCOz2kS9U/s1600/SouthwestAirlines.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="140" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEBHzT-Kl7bGKKKvXdEALVMkOq2j66dIRAstZ3aCASejJyxB0d8PZd6lavegCt3sxmBziGNcoLa36Ae6zzELlivx3XYJxlANg6j9n0anF5iFiOv_H5K-BNrYi2UIy4S3oO73MCOz2kS9U/s200/SouthwestAirlines.jpg" width="200" /></a>Commercial flight for the masses was not a realistic possibility over a century ago when the Wright Brothers navigated their winged contraption in Kitty Hawk. Even decades later, as epitomized by Pan-Am in the 1960s, air travel was for the affluent and a special event. At that point, air travel was not accessible or affordable for the general public. Yet, in the 1970s, a Texas start-up known as Southwest Airlines provided discounted travel to the general public by offering low fares, no amenities, and a point to point service rather than hub and spoke system.<br />
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And traveling by air was never the same again.<br />
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Now, more people travel by air than anytime in history with unparalleled safety. More accessible. More affordable. Higher quality.<br />
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Computers had a similar beginning evolving from a product where only available to a few due to cost and complexity of the systems to now where computers are affordable, ubiquitous, easy to use and of even better quality than the past. One of the first computers in the 1940s, was Eniac, a huge and expensive mainframe computer which was not reliable, extremely complicated, and accessible only to academics. Years later, the general public typically accessed these mainframe computers at work via technicians. Access was limited. It wasn't until the late 1970s that desktop computers appeared. Hobbyists and others, like Steve Jobs, built computers which were less expensive and underpowered compared to the mainframe computers, but they were more accessible to the general public. It wasn't until many years later that subsequent computers became more affordable, more powerful, and more accessible in the form of laptops, netbooks, and now smartphones and tablets. More people had access to computing because the products were more affordable and of even higher quality.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgp0lvl1bekMKNgdFIgficX4dnQEEHreCc9wCQyH23RjRpQdB8B6iDD9-s-7HHg22eEO_hZ4xJ5owRQ_L_vJuRFi3033ObiyzAiGLKZ1qZstVxfVkypA0GmwSqQQJgCiTIkcSvVnQifogg/s1600/original.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="112" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgp0lvl1bekMKNgdFIgficX4dnQEEHreCc9wCQyH23RjRpQdB8B6iDD9-s-7HHg22eEO_hZ4xJ5owRQ_L_vJuRFi3033ObiyzAiGLKZ1qZstVxfVkypA0GmwSqQQJgCiTIkcSvVnQifogg/s200/original.jpg" width="200" /></a><br />
And computing was never the same again. <br />
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Based on Christensen's model, we can predict that health care will indeed break the iron triangle and demonstrate it is not a law but an observation. The question is who will lead these changes? Insurers? Doctors? Patients? Entrepreneurs?<br />
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Our next generation of doctors must be trained in other disciplines outside of health care. <a href="http://www.davisliumd.blogspot.com/2012/04/why-understanding-teaming-is-critical.html">We must collaborate and accept other ways of looking at the same challenges</a> through the lens of other disciplines including business school. Yet, there is a loathing for this. There is the belief that health care is different. Yes, we can continue to talk about the iron triangle of health care and accept that as a reality.<br />
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We can also say no. The iron triangle is not a law but an observation. We choose a different path.<br />
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The truth is that this is the most exciting time in health care with the intersection of better medical understanding, the availability of technology, and the best and brightest minds working on the issues of better quality, better access, and lower costs. As doctors and educators, it is our job to make sure the next generation is equipped with the right mindset to team with others. <a href="http://www.davisliumd.blogspot.com/2012/08/rock-health-enterpreneurs-doctors-and.html">If not, others will define the future of health care.</a><br />
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This is what worries me the most. <br />
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</iframe>Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com0tag:blogger.com,1999:blog-7255776707298393367.post-24808388721563684242012-09-12T06:33:00.000-07:002014-10-06T22:50:29.712-07:00The Truth About Ovarian Cancer Screening - book excerpt<br />
The New York Times editorial "<a href="http://www.nytimes.com/2012/09/12/opinion/false-promises-on-ovarian-cancer.html">False Promises on Ovarian Cancer</a>" says it all. What is most concerning is that a third of doctors recommend what medical science shows not to be true: screening for ovarian cancer does NOT work.<br />
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Enjoy the excerpt from my book - <a href="http://www.amazon.com/The-Thrifty-Patient-Insider-Staying/dp/0979351227/ref=sr_1_3?ie=UTF8&qid=1347455536&sr=8-3&keywords=thrifty+patient">The Thrifty Patient - Vital Insider Tips to Staying Healthy and Saving Money</a> - and be smarter than 1/3 of doctors! Simple to read and incredibly informative.<br />
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Enjoy!<br />
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<h2>
Ovarian Cancer Screening</h2>
One of the most feared cancers for many women is ovarian cancer, which occurs in one out of sixty-eight women. Unfortunately, like many cancers (lung, pancreatic), there is no screening test that has been helpful to detect the illness early and reliably proven to save lives.<br />
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Until organizations like the American Cancer Society (ACS) recommend certain tests or examinations, everything you may hear on the news or from friends about breakthroughs in screenings is inaccurate.<br />
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In the latest update by the American Cancer Society, women are urged to seek medical care if they have had the following symptoms, which could be early signs of ovarian cancer:<br />
<br />
<ul>
<li>Abdominal swelling or bloating (due to a mass or accumulation of fluid)</li>
<li>Pelvic pressure or abdominal pain</li>
<li>Difficulty eating, or a feeling of being full quickly</li>
<li>Urinary symptoms (having to go urgently or often)</li>
</ul>
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Certainly many benign causes also can cause similar symptoms. If you have these symptoms, they are not typical for you, and you aren’t sure what the cause might be, check with your doctor. The ACS acknowledges that two tests often used to “screen” for ovarian cancer are the blood test CA-125, a tumor marker, and/or a transvaginal ultrasound, an ultrasound probe placed in the vagina to evaluate the ovaries. The update correctly notes that in women at high risk for ovarian cancer and those with no risk, neither test has been shown to save lives.<br />
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Unfortunately, until medical researchers find a better and more precise test, women will need to be observant about their bodies. This is the best medical science has in trying to detect ovarian cancer early.<br />
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Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com0tag:blogger.com,1999:blog-7255776707298393367.post-5361037998670004832012-08-31T06:58:00.006-07:002014-09-06T08:43:53.474-07:00Rock Health, Enterpreneurs, Doctors and Witchcraft?<div style="font-family: Arial,Helvetica,sans-serif;">
<span style="font-size: small;">I recently viewed health care through the lenses of a technology entrepreneur by attending the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I was inspired to hear from Andy Grove, former CEO of Intel, listen to Thomas Goetz, executive editor of Wired magazine, and Dr. Tom Lee, founder of One Medical Group as well as ePocrates.</span></div>
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<span style="font-size: small;"><br /></span></div>
<div style="font-family: Arial,Helvetica,sans-serif;">
<span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirxZ1fxwqysRO0UMvhus0ma4ufcyFewpCTjtZrU8a0DhzNyC6ENGjrwC-MFRCvoSK7qjG66-oADoMUC9iS7sgmkZcLS1uHMpnzcuMQiNzyezeYhAEFqdRNqfU0cpp_mdt5_3tU169SAFc/s1600/191664_451121191598608_96231992_o.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirxZ1fxwqysRO0UMvhus0ma4ufcyFewpCTjtZrU8a0DhzNyC6ENGjrwC-MFRCvoSK7qjG66-oADoMUC9iS7sgmkZcLS1uHMpnzcuMQiNzyezeYhAEFqdRNqfU0cpp_mdt5_3tU169SAFc/s320/191664_451121191598608_96231992_o.jpg" height="212" width="320" /></a>Not surprising, the most fascinating person, was the keynote speaker,
</span></div>
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<span style="font-size: small;">“Health care is like
witchcraft and just based on tradition.”</span><br />
<span style="font-size: small;"><br /></span>
<span style="font-size: small;">Entrepreneurs need to develop technology that would
stop doctors from
practicing like “voodoo doctors” and be more like scientists.</span><style>
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<span style="font-size: small;"><br /></span>
<span style="font-size: small;">Health care
must be more data driven and about wellness, not sick care.</span><br />
<span style="font-size: small;"><br /></span>
<span style="font-size: small;">Eighty percent of doctors could be replaced by machines. </span><br />
<span style="font-size: small;"><br /></span>
<span style="font-size: small;">Khosla assured the audience that being part of the health care system was a burden and disadvantage. </span><span style="color: black; font-size: small;">To disrupt health care, entrepreneurs do not need to be part of
the system or status quo. He cited the example of <a href="http://www.wired.com/business/2012/06/ff_dorsey/all/">CEO Jack Dorsey of Square</a> (a wireless payment
system allowing anyone to accept credit cards rather than setup a more costly corporate account with
Visa / MasterCard) who reflected in a Wired magazine article that the ability to disrupt the electronic payment
system which had stymied others for years was because of the 250 employees
at Square, only 5 ever worked in that industry.</span></div>
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<span style="font-size: small;">Khosla believed that </span><style><!--
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div.W</style><span style="font-size: small;">patients would be better off getting diagnosed by a machine than by doctors. Creating such a system was a simple problem to solve. </span><span style="color: black; font-size: small;">Google’s development of a
driverless smart car was “two orders of magnitude more complex” than providing
the right diagnosis. </span><span style="font-size: small;">A good machine learning system not only would be cheaper, more accurate and objective, but also effectively replace </span><span style="font-size: small;">80 percent of doctors simply by being better than the average doctor. To do so, the level of machine expertise would need to be in the 80th percentile of doctors' expertise. </span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="color: black; font-size: small;">Is it possible technology entrepreneurs can disrupt health care? He challenged any doctor in the room to counter his points.</span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="color: black; font-size: small;">Silence.</span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="color: black; font-size: small;">Was it because everyone agreed? Were the doctors in the room simply stunned? Was there a doctor in the house? And where did he get that 80 percent statistic?</span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="font-size: small;"><br /></span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="color: black; font-size: small;">Was Kholsa serious that technology could make health care better by utilizing large data sets and computational power to clinch better and more precise diagnoses? Was he simply being provocative to hear other points of view to learn even more? Like many others in the conference, he believes that giving consumers more opportunities, access, and choice to information about themselves and their bodies would empower them to do the right thing. He held up an <a href="http://alivecor.com/">EKG attachment to the iPhone</a> which was just one of many consumer directed products in the pipeline his company has invested in.</span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="color: black; font-size: small;"><br /></span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="color: black; font-size: small;">Kholsa is a very smart and successful entrepreneur. Does innovation mean the two guys in a garage who come up with a radical idea or is it possible that innovation is having people with different experiences and point of view looking at the same problem as best selling author Malcolm Gladwell noted in his New Yorker piece <a href="http://www.newyorker.com/reporting/2011/05/16/110516fa_fact_gladwell?currentPage=all">Creation Myth - Xerox PARC, Apple, and the Truth About Innovation</a>? Surely to make health care better, technology entrepreneurs must engage with doctors. All the speakers before and after Kholsa spoke about the incredible value and insight different stakeholders to bring to the table. The most vocal? The doctor entrepreneurs and those who worked with doctors to bring their ideas to market.</span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="font-size: small;"><br /></span>
<span style="color: black; font-size: small;">Kholsa's criticism of the health care system is completely valid. </span><span style="color: black; font-size: small;">Can
we do better in being more reliable,
consistent, and creating a system process and design that is comparable
to highly reliable organizations and industries? Of course. Can we be
more systematic and doing the right things every patient every time on
areas where the science is known to level of the molecule? Yes. Care
must be incredibly simple to access, extremely convenient and intensely
personal.</span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="font-size: small;"><br /></span>
<span style="color: black; font-size: small;">It isn't that we don't have smart people. </span><span style="color: black; font-size: small;">Compared to a century ago more illness are understood, specific
medications and treatment protocols can be designed. But we haven't
solved it all. </span><span style="color: black; font-size: small;">When we thought we knew it all, we were shown how little we truly knew. Thirty years ago, doctors predicted the demise of infectious
diseases as a specialty, another footnote in medical texts as more powerful
antibiotics and vaccines were available. Enter AIDS, the swine flu,
and many super-bugs which have humbled our profession. Ask <a href="http://davisliumd.blogspot.com/2010/10/abraham-verghese-top-gun-of-american.html">accomplished physician and writer Dr. Abraham Verghese about his experiences.</a></span><span style="color: black; font-size: small;"> Dr. Verghese is rightly worried, as many others are, that even doctors are being too focused on the iPatient and not on the real patient as he writes in his New York Times op-ed<a href="http://www.nytimes.com/2011/02/27/opinion/27verghese.html?pagewanted=all"> Treat the Patient, Not the CT Scan</a>. Is this what we want our health care system to look like?</span><br />
<span style="font-size: small;"><br /></span>
<span style="color: black; font-size: small;">Health and medical care is an incredible intersection of technology,
science, emotions, and human imperfections in both providing care and
comfort. As conference speaker Dr. Aenor Sawyer, an orthopedic surgeon from UCSF noted, we need to figure out how to have our different cultures of doctors, gamers, designers, and technologists interact. Fixing health care is more than simply "we know the problem and we know the solution". She reflected that the level of dedication, perseverance, and a willingness to make impact among the different groups demonstrates more similarities than differences.</span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="color: black; font-size: small;"><br /></span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="color: black; font-size: small;">I know health care can't simply be solved by smart people in Silicon Valley alone. </span><span style="font-size: small;"> </span><span style="color: black; font-size: small;">To solve health care we need everyone to collaborate. As <a href="http://davisliumd.blogspot.com/2012/04/why-understanding-teaming-is-critical.html">Harvard Business School professor Amy Edmondson noted in her book Teaming</a> - </span></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
<blockquote class="tr_bq">
<span style="font-size: small;">"For
over a century, we've focused too much on relentless execution and
depended too much on fear to get things done. That era is over...human
and organizational obstacles to teaming and learning can be
overcome...Few of today's most pressing social problems can be solved
within the four walls of any organization, no matter how enlightened or
extraordinary... Generating ideas to solve problems is the currency of
the future; teaming is the way to develop, implement, and improve those
ideas."</span></blockquote>
</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="font-size: small;">Perhaps Kholsa's call to action was simply an entrepreneurial mindset, but simply ignoring those who have chosen a field to improve and safe lives and who meet humanity everyday on the front-lines is problematic and dangerous. There are some things that may never be codified or driven into algorthims. Call it a doctor's experience, intuition, and therapeutic touch and listening. If start-ups can clear the obstacles and restore the timeless doctor-patient relationship and human connection, then perhaps the future of health care is bright after all.</span><br />
<br />
</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<span style="font-size: small;"><br /></span></div>
<iframe style="width:120px;height:240px;" marginwidth="0" marginheight="0" scrolling="no" frameborder="0" src="//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=tf_til&ad_type=product_link&tracking_id=dalimd-20&marketplace=amazon®ion=US&placement=078797093X&asins=078797093X&linkId=IQFVIQ65L52XUCXZ&show_border=true&link_opens_in_new_window=true">
</iframe>
Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com2tag:blogger.com,1999:blog-7255776707298393367.post-55237056048463419632012-08-21T06:26:00.000-07:002014-10-06T22:52:17.670-07:00Five Vital Skills to be The Thrifty Patient<br />
From my upcoming book - The Thrifty Patient - Vital Insider Tips For Saving Money And Staying Healthy<br />
<br />
<iframe frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=tf_til&ad_type=product_link&tracking_id=dalimd-20&marketplace=amazon&region=US&placement=0979351227&asins=0979351227&linkId=X2T45HVD3IGODVXX&show_border=true&link_opens_in_new_window=true" style="height: 240px; width: 120px;">
</iframe>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
Chapter 2 - The Thrifty Patient<br />
<h2>
<br /></h2>
<h2>
Five Vital Skills to Staying Healthy and Saving Money</h2>
<br />
Throughout the book, we’ve covered various important aspects of getting the right care. It boils down to five separate but important areas you should be knowledgeable about: <b>the doctor’s office visit, prescription medications, preventive screening tests and interventions, selecting the right doctors, and using the Internet</b>. Each is also important to help save money. For example, learning how to communicate with doctors clearly about your concerns and needs as well as providing the doctor the information he needs can decrease the likelihood of unnecessary testing and medications. When seeing a doctor, the goal is to solve the problem you are having. It isn’t to get all of the imaging tests, lab work, or prescription medications available. When focused on the right goal, you get the right care and save money.<br />
<br />
Sometimes, paradoxically, this may mean spending money to see the doctor to pick his brain and get his expertise. You may be tempted to ask for blood work or a MRI first and skip the office visit. Talking to a doctor seems so old-fashioned and out of date. Yet, as we will review, lab work and imaging tests are simply tools to help doctors. By themselves, without a good patient history, the test results have little meaning.<br />
<br />
If your doctor recommends prescription medication, then there are ways to ensure that the medications you receive are effective and affordable. Many prescription medications are simply me-too or copycat drugs. Pharmaceutical companies market and promote these medications as aggressively as beer and soda. Don’t be fooled. When a medical condition is common, such as heartburn, seasonal allergies, high cholesterol, high blood pressure, and diabetes, save money by avoiding the latest advertised medication. There are often plenty of excellent and less expensive alternatives.<br />
<br />
<h2>
Focusing on prevention is extremely important. </h2>
<h3>
Getting screened for cancer and requesting vaccinations can keep you healthy. </h3>
It isn’t particularly sexy, trendy, or even fun depending on these tests, but they can save your life. Periodically check out what the latest guidelines are, as the recommendations can change with continued medical research.<br />
<h3>
<br /></h3>
<h3>
Identifying which doctor to go to is also important to getting the right care. </h3>
It is extremely rare that any one doctor is the “best.” Don’t worry about finding the best, but rather focus on finding doctors who provide excellent quality care and who also listen to you. How do you determine if a doctor is good? How do you find one? Who is on your medical team? Should you always have a primary care doctor? If you need a specialist, how do you choose?<br />
<br />
<h3>
We also will review the use of the Internet and social media as a way to keep you informed. </h3>
The ease of accessing information can both be a blessing and a curse. Used correctly, information from the Internet, whether from trusted health care organizations, patient or doctor blogs, or tweets, can improve decision making. It may help you determine if a symptom requires medical attention or can be safely treated and managed at home. Yet the access to this information can be equally as problematic.<br />
<br />
The Internet, much like the lab tests and imaging studies doctors use, is still a tool. Like any tool, it can be helpful or harmful depending on how a person uses it. A simple rule of thumb—if an answer or solution sounds too good to be true, it often is.<br />
<br />
Increasingly, you are being asked to pay more for medical care and be more responsible in making medical decisions. Knowledge is power. It isn’t that hard. Let me show you how.<br />
<br />
Five simple skills can make you a thrifty patient who is staying healthy and saving money.<br />
<br />
Finally, just a brief primer on what you should do outside of where I work regularly, the medical system. For most of us, life is not filled with doctor visits. That’s a good thing. Sometimes you or a loved one does, however, need our help. This is the first step to getting you the skills you need to stay healthy and choose wisely.<br />
<br />
Let’s get started.Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com2tag:blogger.com,1999:blog-7255776707298393367.post-12971612209797418052012-08-09T06:54:00.002-07:002014-09-06T08:26:12.371-07:00Update on The Thrifty Patient - Vital Insider Tips For Saving Money And Staying HealthyNew book is finally taking shape. A revised and streamlined version of my previous work with new content is nearly completed and will be available soon on Amazon and Kindle.<br />
<br />
<br />
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<br />
Here is a sneak peak of the first chapter!<br />
<br />
Enjoy!<br />
<br />
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<br />
<div class="MsoNormal">
Introduction –</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Why This Book Matters To You</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
After you finish this book, you will know what I know when
it comes to medical care. I believe it can be boiled down into these short but
important phrases.</div>
<ul>
<li>Newer isn’t necessarily better.</li>
<li>More isn’t necessarily better.</li>
<li>Common sense may not apply.</li>
<li>Staying healthy and well means sometimes seeking medical
care.</li>
<li>You need to be informed and educated to get the best care.</li>
</ul>
<div class="MsoNormal">
Or I could burden you with statistics from the health care
system</div>
<div class="MsoNormal">
which you probably already know.</div>
<ul>
<li>Twenty-three seconds.</li>
<li>Fifteen minutes.</li>
<li>Forty percent.</li>
<li>Medical costs.</li>
<li>Increasing dissatisfaction.</li>
<li>Worst among industrialized countries.</li>
</ul>
<div class="MsoNormal">
These are the questions to the previous answers.</div>
<div class="MsoNormal">
<br /></div>
<ul>
<li>Twenty-three seconds: How much time do you have before your
doctor interrupts you?</li>
<li>Fifteen minutes: What is the average face-to-face time at a
doctor’s office visit?</li>
<li>Forty percent: What is the misdiagnosis rate based on
autopsy?</li>
<li>Medical costs: What is the leading cause of personal
bankruptcy? Many had health insurance.</li>
<li>Increasing dissatisfaction: How does the public feel about
the American health care system?</li>
<li>Worst among industrialized countries: How does the United
States rank in terms of health care quality for prevention and
treatment?</li>
</ul>
<div class="MsoNormal">
<b>Staying healthy and well means sometimes seeking medical
care. </b></div>
<div class="MsoNormal">
I could tell you that too many Americans die every year unnecessarily and
too soon due to missed opportunities. Healthy patients forget to get screened
for colon cancer or breast cancer. Heart attacks and strokes that could have
been prevented occur. Grandfathers and grandmothers aren’t around to attend
holidays, graduations, or spend time with their grandchildren. Parents leave
their children alone because their cancer was caught too late. No one is the
wiser to this.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Newer isn’t necessarily better. More isn’t necessarily
better.</b></div>
<div class="MsoNormal">
You may have noticed that increasingly doctors rush through
office appointments and don’t listen. Too often blood work is done,
medications prescribed, and x-rays ordered, and despite all of the
additional treatments patients don’t feel healthier. Television, radio, magazines,
and the Internet inundate you with the latest prescription medications or
therapy promising you better health. The news warns you to check with your
doctor about the latest therapy with quick, thirty-second sound bites.
You are fearful that you might be missing something important that could
save your life.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Common sense may not apply.</b></div>
<div class="MsoNormal">
Increasingly more parents are not having their children
immunized against preventable illnesses such as measles and pertussis (whooping
cough). Now news reports note more cases. Some children die. Many
have lost faith and look for alternative and more “natural” therapies. Doctors
who are supposed to help guide you and distinguish truth from fiction are just
too busy, so more people are relying on family, friends, and the Internet for
medical advice.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>You need to be informed and educated to get the best care.</b></div>
<div class="MsoNormal">
To add even more stress, health insurance is becoming too
expensive. Small and large companies are trying to control costs by offering
health insurance with health savings accounts (HSAs). These plans have lower
monthly premiums with high deductibles. Since 2004, these plans have become
more common. Many patients are now asked to choose when to seek care and when
to safely skip care based not only on their health needs but on their ability
to pay, even as research consistently shows that they don’t want the financial
responsibility to do so.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>There is good news.</b></div>
<div class="MsoNormal">
Despite all of these challenges, there is good news. You
aren’t alone. When I took the Hippocratic oath to do no harm and help patients
to the best of my ability, I didn’t realize that pledge included writing a
book. I’ve always wanted to be a doctor. Never a writer. I hated English. I
only took the class because I had to, not because I wanted to. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Despite that, I
am compelled to write because of what I know is occurring with alarming
frequency in our country. Americans are skipping needed and recommended care
that could save their lives and allow them to live to their fullest. Patients
are more distracted, as life is more complicated and busier than ever.
Households have both parents working, sometimes two jobs, just to make ends
meet. They easily would make the right choice if someone would be willing to
explain things in a simple, understandable manner. They would prefer a health
care system that was so incredibly simple to use, convenient, and personalized
that it would anticipate their needs so they could get the right care and get
back to living life.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Instead, our health care system offers patients higher
co-pays, deductibles, and out-of-pocket medical expenses. It shifts the burden
of making the right choices to people who frankly are just getting by. It asks
people to fend for themselves at a time when they need us, doctors, the most.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
How do I know? Two things occurred that changed my life.</div>
Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com0tag:blogger.com,1999:blog-7255776707298393367.post-55553772800847653342012-08-01T23:15:00.001-07:002012-08-01T23:17:21.050-07:00Doctors, Patients, or Insurers - Who Will Shape Health Care?Recently New Yorker staff writers and best-selling authors Malcolm Gladwell and Atul Gawande addressed the question of whether <a href="http://www.advisory.com/Daily-Briefing/2012/06/26/Gawande-v-Gladwell">the problem in health care is that patients are too reliant on doctors and don't have the ability to make decisions.</a>
In reading between the lines, is that the reason health care is not
affordable and care not commoditized or consumer driven like other
industries? <br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix7i9m49jYNBSFE6CXcmXVTn1Nt5c3l964vUatgxo7QhYGz6UKkWA55wBgmREZsi91JXlc35uWhjv1Gxiq0jl09LFM3d3VWydcqMONsbhTVFkB2bq25fr_o3NmA7wxb9sDPTFfUh6cXO8/s1600/mal460x276.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="120" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix7i9m49jYNBSFE6CXcmXVTn1Nt5c3l964vUatgxo7QhYGz6UKkWA55wBgmREZsi91JXlc35uWhjv1Gxiq0jl09LFM3d3VWydcqMONsbhTVFkB2bq25fr_o3NmA7wxb9sDPTFfUh6cXO8/s200/mal460x276.jpg" width="200" /></a>At <a href="http://www.healthleadersmedia.com/print/LED-281614/AHIP-Gawande-Gladwell-on-Healthcares-Chauffeur-Problem">a conference for America's Health Insurance Plans</a>,
Gladwell argued that patients or consumers have been unable to be more
empowered because doctors, as the intermediary, held the power of
knowledge much the same way chauffeurs did for the early days of the
automobile and Xerox technicians did in the early days of photocopying. A
person was needed to guide and assist the individual to get the job
done. At some point, however, the technology became simpler. People
began to drive their own cars and make their own photocopies. The
mystique of the chauffeur and technician was lifted. Now everyone could
drive. Everyone could make photocopies.<br />
<br />
Is it possible
that for health care and the health care system, which for many people
is a system they interact with rarely and in an area (health / illness)
where the uncertainty and stakes many be too "high", that individuals
willingly to defer the responsibility to someone else? Gladwell hints
that might be a possibility:<br />
<blockquote class="tr_bq">
"A key step
in any kind of technological transition is the acceptance of a
temporary deficit in performance at the beginning in exchange for
something else," said Gladwell. That something else can eventually
include increased convenience and lower cost. He offered a number of
examples, including the shift to digital cameras where early pictures
were not as good as film and the advent of the digital compression of
music, which he contends has made the quality of music worse....<br />
<br />
The
changes in film and music were accepted, he said, in exchange for new
opportunities to arrange, manipulate, and personalize our pictures and
music. "In healthcare we don't have the same stomach for that period of
transition. That's striking to me."</blockquote>
The disruptive
innovation that Gladwell is hoping for has yet to affect healthcare. It
is possible that as more Silicon Valley start-ups focus on making
medical care more convenient, worry-free, hassle-free, more
personalized, and more accessible that the majority of individuals won't
adopt them because doctors don't approve. The shift to a "temporary
deficit in performance" may not be as acceptable even if less expensive
and more convenient. As Gladwell notes in the case of dialysis, despite
being around for over seven decades, patients in general still don't
self-administer treatment, which would be less expensive, but rather
continue to go to facilities which are overseen by doctors.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFAGd4grNqT1gRJAqjmEr4iIzovuqV8PN7zFrLz0B4FjiX9zHFtFWA0Kq1rwSB-qqheBUmu_FsOutYP5sLL4ola70vDm3l8GQnbrd4Uk73vwU94T2vV5IL7Kp4MMruGI5mDLIxfyYf5dM/s1600/gawande.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFAGd4grNqT1gRJAqjmEr4iIzovuqV8PN7zFrLz0B4FjiX9zHFtFWA0Kq1rwSB-qqheBUmu_FsOutYP5sLL4ola70vDm3l8GQnbrd4Uk73vwU94T2vV5IL7Kp4MMruGI5mDLIxfyYf5dM/s200/gawande.jpg" width="200" /></a>His
colleague, Dr. Atul Gawande, countered that other industries, like
"teaching, firefighting, and police work" still have intermediaries that
do the work on behalf of the individuals. Gawande believes that the
real issue is that the care we provide as doctors isn't integrated. We
focus on optimizing each part of the health care system without looking
across the entire experience of care. Extending this analogy to building
the best car and using the best manufacturer for each part, Gawande
notes:<br />
<blockquote class="tr_bq">
building a car with Porsche
brakes, a Ferrari engine, a BMW chassis, and a Volvo body. "Put it all
together and what you have is an expensive pile of junk that doesn't go
anywhere because the pieces don't work together,"</blockquote>
No
where was the need for doctors to lead change and think about the entire
experience for the patient more clear than a recent New York times
piece by health reporter Tara Parker-Pope, titled "<a href="http://draft.blogger.com/%20%20%20http://well.blogs.nytimes.com/2012/07/25/too-much-medical-care/?ref=taraparkerpope%20">Too Much Medical Care</a>".
She chronicled her experience as an educated patient and parent of a
daughter who suffered an ankle injury at camp. She started first with:<br />
<blockquote class="tr_bq">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimPAjdA3Xl5wqNGXdQH4yU304e2C9pq3MLvNYAX_Q-dRCF00RNR7bo_mVbErVzp3iNfRBF75ct2QkS2FOVWVPhLuBD6yGrKdFBtBx-IeY6w5ohooLW05RAdBYITJ1Gxkb8Dyxfj6hHhhk/s1600/tpp190.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimPAjdA3Xl5wqNGXdQH4yU304e2C9pq3MLvNYAX_Q-dRCF00RNR7bo_mVbErVzp3iNfRBF75ct2QkS2FOVWVPhLuBD6yGrKdFBtBx-IeY6w5ohooLW05RAdBYITJ1Gxkb8Dyxfj6hHhhk/s200/tpp190.jpg" width="133" /></a></div>
Pediatrician. Initial visit. <br />
One month later, still not better so she takes daughter to Sports Medicine specialist. MRI ordered.<br />
Referral to Pediatric Orthopedic Surgeon. Another MRI. Blood work.<br />
<br />
Slightly abnormal blood work.<br />
Referral to eye specialist. <br />
Referral to pediatric rheumatologist. More blood work. Another (3rd) MRI. Xray of hands. </blockquote>
<blockquote class="tr_bq">
Five months after original injury, daughter notes that her ankle still hurts. </blockquote>
Finally,
Parker-Pope takes back control. She consults with the sports medicine
specialist who reviews the case with the pediatrician. The focus in back
on the patient and pain relief. Soon, the daughter is back to resuming
her activity.<br />
<br />
In retrospect, what is most surprising is
how long the entire process went and still the daughter's problem
hadn't been solved. Three MRIs for an ankle injury. Four specialists.
Three MRIs. Many blood vials drawn. Xray of the hands, though the ankle
was the injured joint. It's not that Parker-Pope is naive or uneducated.
She is a health reporter for the New York Times and has talked to many
doctors and written many stories. The fact that she and her daughter
were caught up in the health care system illustrates the challenges
facing the public.<br />
<br />
Solving the health care crisis will
require both points of view offered by Gladwell and Gawande. We need
both patient engagement as well as a more coordinated integrated health
care system. It is however increasingly clear, particularly based on the
New York Times piece, that empowered patients alone won't be able to
bend the cost curve. Despite the easy availability of information via
the internet and self-diagnosis, there is value to the "expert" in
determining the right course of action. As both Gladwell and Gawande
note in their previous works there is a need for 10,000 hours of
deliberate practice to become expert and that <a href="http://www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande">even the experts need coaching</a> for continuous improvement, respectively.<br />
<br />
The
real problem is whether the "experts" are willing to make the judgement
calls that our training provides? When to refer? When not to refer?
When to get the MRI? When not to get the MRI? When to prescribe
antibiotics? When to hold ground and sympathize when it is a virus? When
to comfort, empathize, and heal when it means stopping chemotherapy
when treatment is futile? When to do surgery? When to hold off? Are we
willing to have others observe us in action so we can be even better? If
not, why not?<br />
<br />
For health care to be better, doctors
must lead the change. No one else can. Insurers and employers have
exhausted strategies to make patients more accountable. Increasing
deductibles and co-pays indefinitely won't work. Despite the
unprecedented access to information, empowered patients and other
patient advocates will never be able to fully close the knowledge gap.
That difference in knowledge, as Gladwell points out in his book, <a href="http://www.gladwell.com/blink/index.html">Blink</a>, is what allows an expert to distinguish between an authentic piece of artwork and a very good looking fake.<br />
<br />
It
is also the difference between stopping a number of unnecessary
referrals and the cascade effect of subsequent imaging, blood work, and
appointments and instead focusing on the patient.<br />
<br />
Who will shape health care? Doctors, Patients, and Insurers and in that order.<br />
<br />
Or entrepreneurs who partner with doctors to solve our challenges so we can go back to focusing on healing patients.Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com2tag:blogger.com,1999:blog-7255776707298393367.post-24921902427182999492012-04-26T21:52:00.000-07:002014-09-06T08:14:14.990-07:00Why Understanding Teaming Is Critical for Health Care Leaders
<iframe style="width:120px;height:240px;" marginwidth="0" marginheight="0" scrolling="no" frameborder="0" src="//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=tf_til&ad_type=product_link&tracking_id=dalimd-20&marketplace=amazon®ion=US&placement=078797093X&asins=078797093X&linkId=6OC2D7LWQZDGEU6T&show_border=true&link_opens_in_new_window=true">
</iframe>
Solving the American health care system crisis is among the most complex and
important challenges facing this generation. Is it possible to provide
high quality care with better access at a more affordable cost? Is this
problem solvable or simply to complicated? Though that answer is not
yet clear, what is increasingly apparent is that a new type leadership
is needed if there is any hope in achieving this goal.<br />
Professor Amy Edmondson of Harvard Business school has crafted a practical
evidenced based book on how leaders and organizations must approach the
increasing complexity of problems they face. Unlike the mindset of
execution, which was successful in the past, Professor Edmondson
demonstrates that in an increasingly competitive global economy a
different approach is needed.<br />
<br />
Organizations must learn by teaming.<br />
<br />
It is a must read for physician leaders or other leaders in health care. <br />
<br />
She provides leaders a clear understanding of how individual and
organizational psychology, the reality of hierarchical status, cultural
differences, and distance can and do separate team members which can
prevent successful teaming. Leaders can close these gaps by
understanding the existence of these obstacles and by adapting their
leadership style to support and facilitate teaming successfully. She
demonstrates the challenges as well as the solutions where teaming has
gone well and not so well (the "impossible" rescue of miners in Chile
and space shuttle Columbia tragedy) with numerous case studies and
insights.<br />
<br />
Professor Edmondson also notes that leaders
must also thoughtfully identify where the challenges they face fit on
the Process Knowledge Spectrum (routine, complex, or innovation).
Routine operations could be a car manufacturing plant where outcomes and
certainty are known. At the other extreme, innovation operations, like
an academic research lab, the outcomes and certainty are quite unknown.
Hospitals are considered complex operations. Although the teaming
framework applies in each of these three cases, the leader's specific
behaviors and actions change. Having excellent outcomes and teaming
necessitates matching the right approach to the correct operation.<br />
<br />
Interestingly
to maximize learning, conflict and failure are necessary for teaming to
be successful. These can only occur if leaders create an environment of
psychological safety. Learning thoughtfully from these failures and
framing them as essential for continuous improvement and innovation is
key for organizations to benefit from teaming.<br />
<br />
Most importantly, the learning never stops. <br />
<br />
<br />
Professor Edmondson provides many examples from health
care as she has "spent an inordinate amount of time studying people in
hospitals." In one example, she notes how two of four cardiovascular
surgical teams studied successfully implemented Minimally Invasive
Cardiac Surgery (MICS) because of how the leader framed the challenge.
It was a shared learning experience. The other two teams failed because
they focused on the individual surgeon rather than on the team. For
doctors, being able to ask others for help is culturally difficult and
yet vitally important given the increasingly complexity of hospitals and
medical knowledge. She notes that the "single most powerful factor
explaining success" among the the four teams was how the leader framed
the challenge. <br />
<br />
She notes that for 23 hospital ICU improvement teams, those most
successful in changing were those "who engaged in the interpersonal
learning behaviors crucial to teaming".<br />
<br />
One of the three
case studies is about leading teaming in a complex operations at
Children's Hospital. The goal of Julie Morath, the chief operating
officer, was to harm no patients and achieve a 100 percent in patient
safety. She engaged her staff to solve the problems. She eliminated the
tendency of the medical culture to view and blame a medical error as the
fault of the individual. Instead via "blameless reporting", observers
merely communicated what they saw and analysis followed. aBy creating a
culture of psychological safety, the hospital learned from their
"accident" and explored ways to improve the their care. As a result, the
hospital became nationally recognized as a leader in patient safety.<br />
<br />
"For
over a century, we've focused too much on relentless execution and
depended too much on fear to get things done. That era is over...human
and organizational obstacles to teaming and learning can be
overcome...Few of today's most pressing social problems can be solved
within the four walls of any organization, no matter how enlightened or
extraordinary... Generating ideas to solve problems is the currency of
the future; teaming is the way to develop, implement, and improve those
ideas."<br />
<br />
Although at times, the conclusions from her
twenty years of research and observation seem counterintuitive, her
findings and stories woven into a actionable framework and structure
makes <a href="http://www.amazon.com/gp/product/078797093X/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=078797093X&linkCode=as2&tag=dalimd-20&linkId=AJ3QWKWDARLAJTQ7">Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy</a><img src="http://ir-na.amazon-adsystem.com/e/ir?t=dalimd-20&l=as2&o=1&a=078797093X" width="1" height="1" border="0" alt="" style="border:none !important; margin:0px !important;" /> compelling. It is destined to be a classic reference
for leaders today and in the foreseeable future as they lead their
colleagues and organizations into confronting and solving increasingly
complex problems and challenges.<br />
<br />
Professor Edmondson hopes
that her book will enable organizations to execute at a higher level
only "when leaders empower, rather than control; when they ask the right
questions, rather than provide the right answers; and when they focus
on flexibility, rather than insistent on adherence... When people know
their ideas are welcome, they will offer innovative ways to lower costs
and improve quality, thus laying a more solid foundation for meaningful
work and organizational success."<br />
<br />
She succeeds at every level.Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com0tag:blogger.com,1999:blog-7255776707298393367.post-74887679033506899392012-04-05T18:20:00.001-07:002012-04-05T18:20:30.635-07:00Will Doctors or Patients Bend the Cost Curve?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiv5QT4dIpeWROg8V28X0m7wOO-9478YjrjvrnxIEzF-lyQPar0Y2p8-pEhPpinZPH2Y9ebswuXOt4-IUiflVntl6I6DRrUUy3yaebAp3qo2P-gYEdjCv9u3EhLRvxdrSD_QxZRqsY-go8/s1600/04well-blog480.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiv5QT4dIpeWROg8V28X0m7wOO-9478YjrjvrnxIEzF-lyQPar0Y2p8-pEhPpinZPH2Y9ebswuXOt4-IUiflVntl6I6DRrUUy3yaebAp3qo2P-gYEdjCv9u3EhLRvxdrSD_QxZRqsY-go8/s200/04well-blog480.jpg" width="200" /></a>The American Board of Internal Medicine (ABIM) and nine other professional medical societies announced that doctors should perform 45 tests and procedures less often than currently done because there is no good medical evidence that they add any value. Specifically, a xray or other imaging for low back pain in an otherwise healthy individual or an EKG as part of a routine physical, just add a lot of unnecessary cost to the health care system as a whole and don't provide doctors or patients any meaningful information that would be helpful in improving health or arriving at the right diagnosis and treatment.<br />
<br />
The ABIM partnered with Consumer Reports to create a new campaign called <a href="http://choosingwisely.org/">Choosing Wisely</a> and are joined also by collaborators like employers (the National Business Group on Health, the Pacific Business Group on Health), hospital safety (the Leapfrog Group), and labor unions (SEIU). The mission is simply to have doctors and patients deliver and receive care that is medically necessary, based on evidence, avoids harm, and minimizes duplication.<br />
<br />
The real question is - will it work? Will doctors follow what their professional societies recommend? <br />
<br />
Though Choosing Wisely is a laudable attempt to make medical care
better quality, the truth is doctors won't likely follow these
guidelines from their medical societies. If it was that easy, we would not have this problem! Even today, it is still a
challenge for the medical profession to have all doctors wash their
hands correctly every patient every time, get immunized routinely against influenza, or even not
to prescribe antibiotics for coughs, colds, and bronchitis
due to viruses! What is more disturbing is that doing these basic interventions did not impact a doctor's
income. Some on the list of Choosing Wisely, however, will.<br />
<br />
Take a look at <a href="http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_AGA.pdf">the recommendations by the American Gastroenterological Association</a> specifically around the need for repeat colonoscopy after a normal one.<br />
<blockquote class="tr_bq">
<br />
Do not repeat colorectal cancer screening (by any method) for 10
years after a high-quality colonoscopy is negative in average-risk
individuals.<br />
</blockquote>
<br />
Yet, if a doctor does fewer colonoscopies, which is the
right thing to do, that also means his income will decrease. In the fee
for service reimbursement system, doing fewer procedures means fewer
things to bill for. As noted in a previous post, <a href="http://davisliumd.blogspot.com/2011/03/save-money-on-medical-costs-get-your.html">a new patient to my practice wanted a repeat colonoscopy 5 years after her prior one</a> because it was recommended by her doctor even though she had no family history and a completely normal test! <br />
<br />
Will patients protest if their doctors offer one of the 45 recommended tests, treatments, or procedures highlighted to be avoided? Are they ready for this new world? Perhaps according to the NY Times piece "<a href="http://well.blogs.nytimes.com/2012/04/04/do-patients-want-more-care-or-less/?ref=health">Do Patients Want More Care or Less"? </a> <br />
<blockquote class="tr_bq">
<br />
“People are more receptive to conversations about medical interventions having both pros and cons” says Dr. [Michael Barry, president of the Informed Medical Decisions Foundation, a nonprofit group that promotes sound medical thinking]. “Traditionally, newer and more aggressive interventions were often assumed to be better.” But there are hints of a shift, he says: “When patients are fully informed, they tend to be more conservative.”... [he] believes patients are ready to hear the message. He cites popular books like <a href="http://davisliumd.blogspot.com/2011/07/required-reading-for-medical-students.html">“Overtreated,”</a> by Shannon Brownlee, and “Overdiagnosed: Making People Sick in the Pursuit of Health,” by H. Gilbert Welch. These are among a slew of books in recent years written by health experts on the dangers of the “more is better” attitude about health care.</blockquote>
Yet, we should also be skeptical about this perspective. <a href="http://davisliumd.blogspot.com/2007/09/routine-annual-physical-not-worth-time.html">Research has consistently shown that there is no value for an annual physical or check-up</a>, yet how many people still have one "just to be safe?" Although there is a small number of patients who are empowered and question their doctors about the treatment plan, the fact is most patients expect their doctors to make the best choices on their behalf. If a doctor recommends an antibiotic for a sinus infection or suggests a MRI for low back pain, will a patient really say no? In general, it takes a doctor more time and energy to educate a patient on why an antibiotic or MRI isn't necessary, how an individual's personal experience is different than those of their friends and family who all got antibiotics and MRIs in the past, and to do so in a caring and compassionate way.<br />
<br />
If we expect doctors or patients to bend the health care cost curve this way with more education, better communications, and encouraging patients to talk to their doctors about the appropriateness of care, we will fail.<br />
<br />
But increasingly there is a trend I am seeing which will bend the cost curve. Patients are increasingly questioning the need for expensive imaging tests not because they want to only get the right care proven by evidence, but because they have high deductibles and copays that require hundreds of dollars.<br />
<br />
This would be good news except now instead of having a conversation and an examination with a doctor to determine if a MRI is needed for back pain, more patients are now simply calling in and asking for a MRI. After all, isn't talking and touching a patient and the healing aspect of a doctor patient relationship simply antiquated in a time with technology? It is now taking more time and energy to educate a patient why an office visit actually is more valuable than imaging!<br />
<br />
If there is hope to make care more affordable and of even higher quality, then it will be because doctors have shouldered this responsibility. Our commitment won't be the result of our professional organizations rolling out an educational component, or the media highlighting the "waste" in our system, but rather it will be questions each of us will need to answer. Is doing no harm also mean avoiding unnecessary testing? Will we do the right thing even when it is hard? If there should be some optimism, then it should be that the current and next generation of doctors will lead this change.<br />
<br />
This spirit and responsibility is best captured by Dr. Bob Wachter, professor and chief of the division of hospital medicine. chief of the medical service at the University of California San Francisco Medical Center, chair-elect for the ABIM and the "father" of the hospitalist movement, in <a href="http://www.the-hospitalist.org/details/article/1755049/Wachter_Highlights_New_Era_for_Hospitalists.html">his keynote address to the Society of Hospital Medicine.</a><br />
<br />
<blockquote class="tr_bq">
“We need to be great team players, but we also need to be great leaders," </blockquote>
<blockquote class="tr_bq">
“We need to embrace useful technology, but we can’t be slaves to it … improve systems of care, but welcome personal and group accountability. Strive for a balanced life but remember medicine is more a calling than a job. And think about the patients’ needs before our own. These are core and enduring values even as we move into this new era.” </blockquote>
<blockquote class="tr_bq">
“We have big targets on us and I think they are appropriate,” said Dr. Wachter. “There are others who should have targets as well, but the main target has to be us. Change is impossible if we don’t embrace change.”</blockquote>
In the end, it will be doctors who can bend the cost curve.<br />
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<br />Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com1tag:blogger.com,1999:blog-7255776707298393367.post-45842067278125455622012-03-08T23:12:00.002-08:002012-03-08T23:12:46.564-08:00Part II - What Doctors and Healthcare Can Learn from the New England PatriotsAlthough my team, the New England Patriots lost Super Bowl XLVI to the New York Giants in one of the most exciting and tense games in recent memory, reviewing both the pre and post game coverage provided even more learning for doctors and healthcare than my <a href="http://www.davisliumd.blogspot.com/2012/01/what-doctors-and-healthcare-can-learn.html">prior post</a>. One can demand excellence and still fall short. When one fails to achieve the intended goals, the learnings can be as important if not more so than when one is successful. In the latter, you assume that you understand the reason for success. In the former, you must investigate to determine problems. It is the approach that matters.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0I707wUx0dgAOU1f18sxbdFMUz7qX_EMBisjqYL155Fhl1mJWJn0wK-ovumFjJrRTSweOlUFgNgrzloHgxmU6hyPEBMkNmdCL8VDMHBbEsdxNxYepVW8oJYvRqx1JIXHo8GBHd0Sy8Q0/s1600/Super-Bowl-2012.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="111" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0I707wUx0dgAOU1f18sxbdFMUz7qX_EMBisjqYL155Fhl1mJWJn0wK-ovumFjJrRTSweOlUFgNgrzloHgxmU6hyPEBMkNmdCL8VDMHBbEsdxNxYepVW8oJYvRqx1JIXHo8GBHd0Sy8Q0/s200/Super-Bowl-2012.jpg" width="200" /></a>CEO of the Patriots, Robert Kraft noted in a post Super Bowl conference that statistically every NFL team has a 6 percent chance of reaching the Super Bowl and consequently a 3 percent chance of winning. Over the past decade, the Patriots have been in half of them. An impressive statistic considering other teams have equally dedicated players and coaches who also are focused on success. So what makes the Patriots so successful?<br />
<br />
One learning is the true meaning of teamwork. Sure football is a team sport, but are the players and coaches truly a tight knit team on the same page for excellence? Prior to the 2002 Super Bowl, players were introduced onto the field individually by name. Hearing your name called out and then running out onto the field to a crowd of screaming fans undoubtedly is a thrill for every player, particularly when it is the Super Bowl. Yet for the Patriots that year, this was not the case. Earlier that season at an away game, a mix-up in the team introductions had the team unprepared. Instead of the usual player introductions, the team instead raced onto the field as a team rather than individually.<br />
<br />
Then 9/11 happened. For the remainder of the season, the Patriots found it fitting to continue dash onto to the field as a team as the nation came to grips of an unspeakable assault on our country.<br />
<br />
Hours before 2002 Super Bowl kick off, head coach Bill Belichick notified his team that the NFL and television network required that the team be introduced as individual players. To come out as a team would be in violation of policy.<br />
<br />
What did the team want to do?<br />
<br />
They ran out as a team. The first time ever that has occurred. As noted on ESPN by former 49er quarterback and football analyst Steve Young, that tradition has continued to present day and shifted the focus back from the individual to the team, the right thing for football.<br />
<br />
And perhaps this is the right thing for doctors and the health care system. How often do hospitals and health care organize themselves around having the "best" doctor? How often do people ask, who is the "best" surgeon, internist, oncologist, cardiologist. Is medical care really about one person or is it about having the right team? Dr. Atul Gawande, author, <i>New Yorker</i> writer, and surgeon, noted in his commencement speech titled, <a href="http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html">Cowboys and Pit Crews</a>, at the Harvard Medical School in 2011 that today.<br />
<br />
<blockquote class="tr_bq">
“[Medicine’s complexity] has exceeded our individual capabilities as doctors… <br />
The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves... But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.”<br />
<br />
“...We don’t have to look far for evidence. Two million patients pick up infections in American hospitals, most because someone didn’t follow basic antiseptic precautions. Forty per cent of coronary-disease patients and sixty per cent of asthma patients receive incomplete or inappropriate care. And half of major surgical complications are avoidable with existing knowledge. It’s like no one’s in charge—because no one is. The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it’s pit crews people need.”</blockquote>
<br />
It really should be about the team and not the individual. This is particularly true when it comes to medical errors. When a wrong site surgery occurs or a medication is administered at a dosage that exceeds safe usage, the question in health care is - "Who is responsible?" As noted safety expert and UCSF professor Dr. Robert Wachter notes in a <a href="http://pub.ucsf.edu/magazine/200408/interview.html">2004 interview</a> when a medical error occurs at a hospital -<br />
<blockquote class="tr_bq">
<br />
"...people
invariably point fingers at that place and person and lose
sight of the systems failures that are really responsible.
Look at it this way -- ask anyone if they've seen a medical
error and they'll immediately tell you a story about one. Could
it possibly be that all doctors and nurses are careless and
stupid? Or, perhaps, does the ubiquity of the problem
indicate that something deeper and far more interesting is
going on?"</blockquote>
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipyhZuengNPbY221sSB2cuRTcEgR1i3QZFds5LHDrgrpc7JVO0HYdPcoiS1gmuA6yjQ7pqruH2XsvtjhbU8Z-llbHEfu9NA6zDxI8HQG25CSrQMGt-aC5rY_TGfJ8X_e0Xy_r-r1QM-o4/s1600/patriots1-articleLarge.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="117" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipyhZuengNPbY221sSB2cuRTcEgR1i3QZFds5LHDrgrpc7JVO0HYdPcoiS1gmuA6yjQ7pqruH2XsvtjhbU8Z-llbHEfu9NA6zDxI8HQG25CSrQMGt-aC5rY_TGfJ8X_e0Xy_r-r1QM-o4/s200/patriots1-articleLarge.jpg" width="200" /></a></div>
So in the true meaning of teamwork, should something happen, the team is accountable not necessarily the individual. The team owns the problem and does not leave the individual alone, unsupported, or in shame. Even after the most recent Super Bowl loss when many people picked up on
individual player errors of dropped passes, <a href="http://www.nytimes.com/2012/02/06/sports/football/welker-drop-and-brady-safety-led-patriots-miscues.html?_r=1">including one from wide receiver Wes Welker</a>, one of the most sure handed receivers in the
NFL, which likely would have resulted in a Super Bowl win, no one from
the team scapegoated him or others. As <a href="http://sportsillustrated.cnn.com/video/nfl/2012/02/06/020611.Tom_Brady_sound.SportsIllustrated/index.html">quarterback Tom Brady put it in the post Super Bowl press conference </a>- <br />
<br />
<blockquote class="tr_bq">
You win as a team and you lose as a team. Certainly it wasn't one play is the reason that we lost today. Everybody feels that we could have done more....<br />
<br />
There was some missed opportunities.</blockquote>
When surveyed on the Boston Globe on <a href="http://www.boston.com/sports/football/patriots/superbowl2012/blame_game/">who should be blamed most for the Super Bowl loss</a>, quarterback Tom Brady, head coach Bill Belichick, the Patriots defense, or the receivers Aaron Hernandez or Wes Walker, the majority of votes distributed the blame evenly across the team. It was not just one person. <br />
<br />
Yet in health care, we do a terrible job in supporting others when errors happen. We often assume the individual was at fault rather than a collective fault or system failure. Health care professionals who have dedicated their lives to saving lives are devastated. <a href="http://www.msnbc.msn.com/id/43529641/ns/health-health_care/t/nurses-suicide-highlights-twin-tragedies-medical-errors/#.T1UQlsx3LLg%20">Some commit suicide after a medical error.</a><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpccMEzUYLzVZT5vR86hHutm4LiOklvIQQkgzzji1aEVYwS_BgEwUvn2xvufrPe_wZFlbRVRnNFs-iCDD_sMIUEDp17nt2Fb1H5sLEFf4nRXl1TLJWvFZd-Gaf4SYTzlVO7KoXvhNWRdI/s1600/228045-bradying.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="183" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpccMEzUYLzVZT5vR86hHutm4LiOklvIQQkgzzji1aEVYwS_BgEwUvn2xvufrPe_wZFlbRVRnNFs-iCDD_sMIUEDp17nt2Fb1H5sLEFf4nRXl1TLJWvFZd-Gaf4SYTzlVO7KoXvhNWRdI/s200/228045-bradying.jpg" width="200" /></a></div>
Finally the last learning is leadership, having a vision, and understanding what really matters. All season long as his young defensive unit was getting dogged in the
press as being among the worst in giving up total yards to other teams,
Belichick calmly noted that it wasn't about that statistic which
mattered, but what was the win - loss column. Hard to argue with that as
this team did make the Super Bowl.<br />
<br />
Belichick is known to resist the status quo. He's a football coach, not a fashion model, yet was mandated by the NFL to wear Reebok sanctioned clothing on the sidelines to look nice. What did he do? <a href="http://sports.yahoo.com/nfl/news?slug=dw-wetzel_bill_belichick_patriots_rebel_coach_020112">He picked up the ugliest piece of clothing he could find, the hoodie.</a><br />
<br />
<blockquote class="tr_bq">
There was no way to opt out of that deal so Belichick considered the fashion options laid out in front of him, and selected the most unstylish outfit, a grey hooded sweatshirt. He began wearing it each week. Only not before having the sleeves cut off to make it even less attractive.<br />
<br />
“It’s comfortable,” Belichick said in explaining his fashion choice. “I carry my stuff in my pouch.”<br />
<br />
What about chopping off the sleeves?<br />
<br />
“I have short arms,” Belichick said.<br />
<br />
The irony is the “BB hooded sweatshirt” became a hot seller. It was so bad, it was cool. It now comes in all sizes and colors, even women’s versions. They sell for about $80</blockquote>
As a coach and leader, he knows what really matters: putting his players in a position to win. This is what leaders do and what players and analysts noted repeatedly up to the game. Belichick does everything possible for them to succeed. Near the end of the game, Belichick understood that the Giant offense had a high probability of scoring a touchdown and he needed to give his future hall of famer quarterback Tom Brady time to score. So he asked his defense to let the go ahead touchdown to go through to allow maximum time on the clock.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTE_kYdSaWSEPThJlqMCMRzIFaGxp1WF7qciXAZSE7zBskE6uGC-QIZwtdN7RhGqYOv0xNZ5Zgn33zduYF058YhHDJMoBT2tk31Va-3-0Vd7yuZ8Q7kH3yxePH_fDoYHPIHhKWAEHQgOM/s1600/belichick3_0201.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTE_kYdSaWSEPThJlqMCMRzIFaGxp1WF7qciXAZSE7zBskE6uGC-QIZwtdN7RhGqYOv0xNZ5Zgn33zduYF058YhHDJMoBT2tk31Va-3-0Vd7yuZ8Q7kH3yxePH_fDoYHPIHhKWAEHQgOM/s200/belichick3_0201.jpg" width="200" /></a><br />
Good move? Well the outcome and the win for the Patriots didn't happen. But, it was the right leadership decision and recognized by Giants quarterback Eli Manning, who "<a href="http://sports.yahoo.com/nfl/news?slug=ro-rogers_ahmad_bradshaw_touchdown_super_bowl_020512">had ordered [Giants running back] Bradshaw to take a knee."</a><br />
<br />
Do we in health care have these leaders who can create environments that allow doctors and other care providers the opportunity to be successful? Do we have leaders who truly have vision and know what really matters?<br />
<br />
Even without a Super Bowl win, we can still learn a lot from the New England Patriots. A true culture of teamwork matters and exists when we can still support each other not when things go smoothly, but when things don't. We need to have leaders who not only have vision, but also the discipline to do the right thing and challenge conventional thinking and the status quo.<br />
<br />
Only then can health care truly transform and be what Americans want and deserve. <br />
<br />
Though I look forward to next year, there obviously is much unpredictability in which team reaches the Super Bowl. I'm certain the Patriots will have another successful year.<br />
<br />
Congratulations to the NY Giants and their team, coaches, and leadership.<br />
<br />
Unlike football, where there is next year and they need to perform for a game at a time, for us we need to get a win with every patient everyday at every moment. Our performance can never lapse.<br />
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<br />Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com0tag:blogger.com,1999:blog-7255776707298393367.post-73635219448835276312012-01-09T10:08:00.001-08:002012-01-09T10:10:20.951-08:00What Doctors and Healthcare Can Learn from Tom Brady, Bill Belichick, and the New England PatriotsAs the new year starts, I'm eager for a fresh start and
working on improving myself both physically and emotionally. I'm also
eager for the NFL playoffs and seeing how my favorite team, the New
England Patriots, fares under the leadership of Coach Bill Belichick and
quarterback Tom Brady. Doctors and health care can learn much from
their examples.<br />
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Over the past decade, <a href="http://www.usatoday.com/sports/football/nfl/2010-02-16-franchise-of-the-decade-patriots_N.htm">the New England Patriots have been dominant</a>
appearing in 40 percent of the Super Bowls played and winning 3 out of
4. Nothing prior to 2000, would have suggested this superior performance
with playoff appearances only six times from 1985 to 2000 and two Super
Bowl appears, both losses. Their new head coach Bill Belichick hired
in 2000 had a losing record in his prior stint at Cleveland. Their
current quarterback Tom Brady was drafted in the second to last round.<br />
<br />
<br />
So what was their secret for success? Nothing
particularly earth-shattering. It was and still is a relentless focus on
continuous improvement by practicing deliberately and explicitly. This
is an important learning for the US healthcare system which consistently
lags that of other industrialized countries when measured on quality
outcomes.<br />
<br />
In general, doctors don't focus on how medical
care is delivered. We don't focus on our own continuous improvement,
which is a far different philosophy than individual athletes in
professional sports. In our profession and in our training, we also
typically don't focus on ensuring that the care we provide is
consistently reliable over a period of time with our diverse medical
team.<br />
<br />
Yet, success in the NFL is based on whether a group
of individuals, which composition may differ annually, can execute the
plan well every time. <br />
<br />
For the team to do well, it first
relies on the individual player to do well. Take the Patriots'
quarterback Tom Brady. He is currently among the best quarterbacks in
the NFL playing today. Some argue he may be the best ever to play the
position. Was he destined for greatness early in his career? <br />
<br />
<br />
No. In fact, Brady doubted his abilities early on
while at Michigan. Change started to occur when he adopted a different
mindset presented by one of his mentors, Michigan associate athletic
director Greg Harden. <a href="http://www.thepostgame.com/features/201101/tom-bradys-guru">It
isn't about just talent that will result in success, but in fact a
focus on improving one's skills which allow the possibility to be the
best.</a> Though he did succeed at Michigan, Brady was drafted in 199th by the Patriots in 2000.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja6RlBewIVAMIZoXy7knKRURtq4lOiY6Rs8mp10cztaMBlL7TSSLfMilJv-_ouBzM6-usGDGBs3Fa5rlZx4duwZ-ujZPvd4po-HsEEPKE7NIEyYWma2gPvFWV6mFw2AKyE3XeF_NblwJw/s1600/tom+brady" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja6RlBewIVAMIZoXy7knKRURtq4lOiY6Rs8mp10cztaMBlL7TSSLfMilJv-_ouBzM6-usGDGBs3Fa5rlZx4duwZ-ujZPvd4po-HsEEPKE7NIEyYWma2gPvFWV6mFw2AKyE3XeF_NblwJw/s200/tom+brady" width="200" /></a>What
did he do? The future hall of famer simply did what he learned at
Michigan - learn the position better than anyone else and be deliberate
about his practice. His NFL rookie year was unremarkable. In the
following year, as a second year quarterback, he started off slowly. He
steadily improved to the point that when the Patriots were in the Super
Bowl, he led the team to a final winning drive. Brady became the
youngest quarterback ever to win a Super Bowl.<br />
<br />
Despite
reaching the pinnacle of a football career in January 2002, he hasn't
stopped improving his skills. When asked recently to<a href="http://www.youtube.com/watch?v=_nzIC4BPCc8"> impart some wisdom to NFL quarterback rookie and Heisman trophy winner Cam Newton</a>, Brady said this –<br />
<blockquote class="tr_bq">
You
always realize that you can always be better. You can always be a
better friend, a better player, a better teammate, and always try to
find ways to improve. I go out there and be the best teammate I can be;
because the goal in life is to win.</blockquote>
Yet how often do
doctors work specifically on themselves and improve what they truly
control, that is their own individual skills and talents? How often do
we each work hard on improving our clinical acumen, communication
skills, surgical techniques, or diagnostic skills? As doctors after we
have finished our advanced training via a residency or fellowship
program, we don't seek opportunities to improve skills we believe we
have mastered. In fact, we bristle at continuous improvement as New
Yorker writer and surgeon Dr. Atul Gawande notes in his article <a href="http://www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande?currentPage=all">Personal Best</a>.<br />
<blockquote class="tr_bq">
Nearly
every élite tennis player in the world [has a coach]. Professional
athletes use coaches to make sure they are as good as they can be.<br />
<br />
But
doctors don’t. I’d paid to have a kid just out of college look at my
serve. So why did I find it inconceivable to pay someone to come into my
operating room and coach me on my surgical technique?</blockquote>
Gawande
tries an experiment and convinces a mentor, who he respects highly, to
observe him in the operating room. Gawade reflected that in the
debriefing with his mentor <br />
<blockquote class="tr_bq">
That one twenty-minute discussion gave me more to consider and work on
than I’d had in the past five years. It had been strange and more than a
little awkward having to explain to the surgical team why Osteen was
spending the morning with us. “He’s here to coach me,” I’d said. Yet the
stranger thing, it occurred to me, was that no senior colleague had
come to observe me in the eight years since I’d established my surgical
practice. Like most work, medical practice is largely unseen by anyone
who might raise one’s sights. I’d had no outside ears and eyes.</blockquote>
Gawande observes that in health care<br />
<blockquote class="tr_bq">
...the
capabilities of doctors matter every bit as much as the technology.
This is true of all professions. What ultimately makes the difference is
how well people use technology. We have devoted disastrously little
attention to fostering those abilities.</blockquote>
So
individually, each doctor can and should focus on improving his
individual abilities and to know his position the best, to be a doctor's
doctor.<br />
<br />
But there is more. Health care isn't just
about one position, one profession, or one doctor. Providing complex
medical care is like leading a football team of 53 players of which only
11 are on the field at any given time to play offense, defense, or
special teams. For success, each individual must do his job consistently
and reliably every time. Anything short of that is incredibly obvious.
Failings unfold weekly to tens of thousands of fans in the stadium and
millions watching via instant replay, the internet, and ESPN. Success
and failure is dictated by a win-loss record until the season ends and
the cycle repeats itself.<br />
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<br />
The
Patriots have been exceptional in the past decade not only because of
having Tom Brady but also for the many other individual players who are
focused not only on making their own skills better but to do so for the
benefit of the team. Previous "troublemakers" and prima donna wide
receivers Randy Moss and Chad Ochocinco, when joining the Patriots have
been quiet, humble, hard-working, and focused on improving and
contributing to the team. This team focus comes directly from the top
with head coach <a href="http://www.youtube.com/watch?v=pUQNHq3SaSg">Bill
Belichick. Profiled recently by NFL films, note how he leads and
prepares his team deliberately to think ahead, anticipate problems, and
execute the plan consistently in practice.</a> Though each player is a
paid professional and should know the game instinctively, Belichick
takes no chances. He says the following to players in practice - <br />
<blockquote class="tr_bq">
I want to call out the situation, pay attention.<br />
I don't care whether you are part of it or not.<br />
First and ten, plus 50, alert for what.<br />
Ok, they have no time outs. The ball is on the one yard line. Tell me what is going to happen here.<br />
We got 40 seconds and need a field goal, two minutes.<br />
<br />
We good on every thing fellas? No questions? We're good? <br />
<br />
(confiding
to his son) - Those situations are just as good for the coaches as they
are for the players. Makes everybody think about what I might want to
call here.<br />
<br />
Like [Tom] Brady he's thinking one thing,
Billy (Patriots' quarterback coach) is thinking something. We want them
both thinking the same thing you know. </blockquote>
The win-loss
record as well as playoff appearances, conference championships, and
Super Bowl wins are consistent with high performance outcomes.
Impressive considering that every other team in the NFL has players and
coaches each driven to excel. What might healthcare learn from the
Patriots head coach?<br />
<br />
Can doctors and staff work together
and regularly drill on scenarios both likely and rare? Can we use
checklists and protocols and modify accordingly much the same way a
coach changes the playbook? In medicine, we assume that that everyone
knows his task when it comes to code blues and emergency surgeries. We
also assume that everyone knows his task when it comes to mundane stuff
like drawing up medications or discontinuing orders in the hospital. We
are then stunned when <a href="http://davisliumd.blogspot.com/2011/12/white-coke-cans-and-importance-of.html">adult heparin is given to babies in the ICU</a> and the <a href="http://webmm.ahrq.gov/case.aspx?caseID=257">blood
thinner coumadin isn't stopped when a resident doctors is interrupted
with a text message with significant consequences to the patient.</a><br />
<br />
We often blame the individual rather than ask can it be about something else that increases likelihood for success? <br />
<br />
<br />
We don't fully appreciate the discipline or the
processes needed to create a highly reliable organization. What we don't
have are physician leaders who can take the care we provide to the next
level. Note the comments from Dr. Thomas Lee, network president of
Partners HealthCare System and professor of medicine at Harvard Medical
School in a <a href="http://blogs.hbr.org/ideacast/2010/04/the-leadership-health-care-needs.html%20">podcast</a> regarding his article in Harvard Business Review - <a href="http://hbr.org/2010/04/turning-doctors-into-leaders/ar/1">Turning Doctors Into Leaders</a>.<br />
<blockquote class="tr_bq">
[Doctors are] taught to rely solely upon themselves. They don't
necessarily work well in teams. They don't think about the bigger
picture, because they've been taught to focus just on the patient in
front of them.<br />
<br />
...to respond to the pressures created by all this [medical
progress which causes rising costs, quality challenges, and chaos that
patients experience] is for providers to get more organized and adopt
systems that will bring order to the chaos. But that takes leadership.
It takes the kind of leadership where you can persuade clinicians to
work together in teams, as in almost every successful business, they
already do.</blockquote>
For the US healthcare system to improve and succeed in providing
highly reliable and safe care to everyone, it will require individual
doctors to be like Tom Brady and ask - is there something I can do even
better? It will require some doctors to be like Bill Belichick and ask -
is there a process and discipline I can provide to allow the team that I
lead succeed?<br />
<br />
Doctors can and must lead the changes that
everyone in the country wants from our health care system. There is no
other group best suited to the task.<br />
<br />
The question is - are doctors ready to step up?<br />
<br />
Go Pats!Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com1tag:blogger.com,1999:blog-7255776707298393367.post-82847410330036449532011-12-02T05:57:00.001-08:002011-12-02T06:49:32.981-08:00White Coke Cans and the Importance of Visual Cues in Reducing Medical ErrorsI read with some amused interest that many consumers were <a href="http://www.dailymail.co.uk/news/article-2068952/Coca-Cola-ditch-festive-snow-white-customers-mistake-Diet-Coke.html?ito=feeds-newsxml">upset that Coca Cola had updated their traditional red regular Coke can for a holiday themed one complete with white packaging.</a> The new holiday design was felt to be too similar to the diet Coke, which is silver. Although Coke has released festive appearing Coke cans in the past, this design was devoid of significant elements of red which make it stand out from the silver Diet Coke packaging. This year Coke felt a bold design would highlight their association with the <a href="http://www.worldwildlife.org/home-full.html">World Wild Fund</a> and saving the polar bear.<br />
<br />
As a result, Diet Coke drinkers not realizing the switch would find themselves gulping the sugary regular Coke, an absolute no-no. Outraged, they took their concerns up on the internet. Coke has decided to take the new white Coke can off the market and replace it with the traditional red Coke can sooner than planned.<br />
<br />
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" width="400" /><br />
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But what does this have to do with medical errors?<br />
<br />
Plenty.<br />
<br />
Doctors and nurses often work in a world devoid of visual cues where the stakes are much higher than sipping the wrong type of cola. Ironically, doctors and nurses when they makes these errors, they blame themselves and not the package design for some of the error. Even the public <br />
<br />
Case in point? <br />
<br />
About four years ago, actor Dennis Quaid's newborn twins nearly died from a drug overdose of the blood thinner heparin while hospitalized at the prestigious Cedars Sinai medical center. The babies were given <a href="http://www.usatoday.com/news/health/2010-04-13-Quaid13_ST_N.htm">the adult dosage of heparin which was 1000 times greater than that for a baby.</a> Their blood essentially was water and coming out of every orifice. <br />
<br />
Part of the reason for the error? The packaging of the vials for adult and pediatric heparin is nearly identical.<br />
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<img alt="" 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" /><br />
<br />
Do they look identical to you? A busy nurse used to routine perhaps gets a heparin dose which by design looks similar but not exactly the same mistakenly draws up the dose because it looks similar but not difference enough to jostle her conscious memory that there is a problem here. This is part of human nature and using mental shortcuts subconsciously. Looking at it now with your full attention it seems obvious.<br />
<a href="http://blogs.wsj.com/health/2008/03/28/dennis-quaid-acts-on-medical-errors/tab/comments/">Even the public and health care personnel often attributed the error to the individual rather than the design packaging when reviewing some of the public comments related to the story.</a><br />
<br />
<blockquote class="tr_bq">
Why is Baxter being sued for the hospital having stupid nurses who can’t read?… Shame on Dennis Quaid and shame on the Cedars Sinai for retaining a moron of a nurse.<br /><br />As a nurse, the reality is that the NURSE DID NOT READ THE LABEL before admninstering the drug. Nurse are taught to take a minute and look over the drug that are about to give. Is it the right route, the right dose, the right drug and is it the right patient. We are taught to not check one but twice or three times. Besides heparin there are many different drugs pachaged the same way. You would have to change every single drug packaging to prevent errors. The reality is the nurse DID NOT perform the 4 checks she was suppose to! That is not the fault of the pharmaceutical company.</blockquote>
But in an intensive care unit where you normally work
everyday and where you never had had an error and you mistakenly draw up
a medication 1000 times too potent because the packaging looked similar
enough that your brain didn't see a problem? You didn't realize that
somehow the high dosed medication made it to your hand.<br />
<br />
Kind
of the same way many diet Coke drinkers didn't realize a higher calorie
content soda reached their hand and in their mouth as they went about their routine daily
lives.<br />
<br />
Unlike doctors and nurses, however, the public rightly didn't blame
themselves. The package design contributed to their error. It is about
time that our health care providers do the same and work on fixing the
system we work in rather that often simply concluding it is the fault of the
individual.<br />
<br />
As for me, I think I'll pick up some white Coke cans for the holidays. They are kind of cute!<br />Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com0tag:blogger.com,1999:blog-7255776707298393367.post-11648399396202002472011-10-11T05:48:00.000-07:002014-09-03T00:35:40.304-07:00Your Medical Mind - Book Review. Best for Patients or Doctors?<iframe style="width:120px;height:240px;" marginwidth="0" marginheight="0" scrolling="no" frameborder="0" src="//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=tf_til&ad_type=product_link&tracking_id=dalimd-20&marketplace=amazon®ion=US&placement=014312224X&asins=014312224X&linkId=QHUFWES2MVJUCSYD&show_border=true&link_opens_in_new_window=true">
</iframe>
I looked forward to reading Dr. Jerome Groopman’s new book, <a href="http://www.amazon.com/gp/product/014312224X/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=014312224X&linkCode=as2&tag=dalimd-20&linkId=5IVM34GOHV7CP6GK">Your Medical Mind: How to Decide What Is Right for You</a><img src="http://ir-na.amazon-adsystem.com/e/ir?t=dalimd-20&l=as2&o=1&a=014312224X" width="1" height="1" border="0" alt="" style="border:none !important; margin:0px !important;" />
, co-authored with Dr. Pamela Hartzband. His previous work, <a href="http://www.amazon.com/gp/product/0547053649/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0547053649&linkCode=as2&tag=dalimd-20&linkId=BHPEW2H6HCG5CVW7">How Doctors Think</a><img src="http://ir-na.amazon-adsystem.com/e/ir?t=dalimd-20&l=as2&o=1&a=0547053649" width="1" height="1" border="0" alt="" style="border:none !important; margin:0px !important;" />
, shaped my thinking as a practicing primary care doctor on the importance of language and the potential pitfalls we make in reaching decisions. <a href="http://davisliumd.blogspot.com/2011/07/required-reading-for-medical-students.html">I always recommend my medical students read that book.</a><br />
<br />
Unfortunately, his latest work fell quite short of my expectations. In it, the authors try to understand and create a framework on how patients reach decisions about their medical care. In the end, this was a book about human psychology wrapped in the doctor patient relationship. Nothing particularly earth shattering here.<br />
<br />
The real question I had is who is responsible for helping patients avoid these cognitive and psychological errors? Patients or doctors?<br />
<br />
They note how the mindset of patients can be divided into the following categories – “believers and doubters; maximalists and minimalists; a naturalism orientation or a technology orientation.” Specifically, some patients want maximal treatment and others believe “less is more”. To avoid cognitive traps, the authors recommend that data be viewed in both positive and negative forms. Telling a patient that a therapy has side effects for 10 percent of patients is very different than saying 90 percent of patients have no side effects.<br />
<br />
Other tips to good decision-making included minimizing emotion before deciding, bringing a friend or family member to an appointment to provide additional eyes and ears, and also getting second opinions. Finding a doctor who provides “shared medical decision making” might also decrease the chance of making a choice only to regret it later. In the book, many patients moved beyond decision paralysis upon hearing a story of another patient with a similar illness and predicament. Specifically, patients realized that instead of focusing on the negative, like the side effects, focusing on the positives and the ability to adapt made all the difference. There is both power and potential pitfall in hearing other patient’s stories, which may be anecdotal.<br />
<br />
Dr. Groopman and Dr. Hartzband noted that patient decision making and autonomy vary depending on circumstance. Sometimes patients want full control. Other times they wish to cede it to physicians, hence the reason many want to find the “best” physician. Surrogates, who act on behalf of patients when incapacitated, are ideally supposed to use “substituted judgment” and choose treatment based on what the patient would have wanted. Like patients, however, surrogates too will change their mind or relinquish or reclaim autonomy depending on the situation. As a result, sometimes doctors use the principles of “beneficence”, the principle that physicians should act in the patient’s best interest, and “nonmaleficence”, to do no harm.<br />
<br />
Physicians can also unwittingly bias a patient’s decision by recommending a “best” treatment and downplaying others, which could be a better match for the patient’s preference. Although there is a movement in health care to provide treatment which is evidence based, the authors conjecture that this focus would result in doctors recommending treatment not in preference of a patient. These seems rather ludicrous as already many current guidelines are not being followed.<br />
<br />
The authors conclude that patients are best served if they find doctors who do not superimpose their preferences while at the same time don’t simply rubberstamp what you want. “A doctor who facilitates but also may challenge your decision process sometimes gives you more.”<br />
<br />
Completely agree. Perhaps this book is best suited for doctors. While the book may be an enlightening read for patients, there isn’t necessarily an easy practical framework which will help them make the right decisions.
Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com1tag:blogger.com,1999:blog-7255776707298393367.post-10753754270976619822011-09-09T00:20:00.000-07:002011-09-09T00:21:28.918-07:00Do Computers Really Come Between Doctors and Patients? Is the Future Here?One of my favorite movies is Back to the Future starring Michael J. Fox. I must admit after reading this New York Times piece, titled "<a href="http://well.blogs.nytimes.com/2011/09/08/when-computers-come-between-doctors-and-patients/?ref=health">When Computers Come Between Doctors and Patients</a>" I have to wonder.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinlSQHBeEVWdmnJoWAd5Q-DJS8a5bELBtdnuYjFeLyenYyomIm5xxXmUmj2M8BzW6TDKd3AJSaaKRrIHKqAirqOrC_TM8NXqp_KuMkx2BFKn3Y0mZ9xlteNxM5cYSNxcrwc8SOy7-7nbY/s1600/back-to-the-future-poster.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="148" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinlSQHBeEVWdmnJoWAd5Q-DJS8a5bELBtdnuYjFeLyenYyomIm5xxXmUmj2M8BzW6TDKd3AJSaaKRrIHKqAirqOrC_TM8NXqp_KuMkx2BFKn3Y0mZ9xlteNxM5cYSNxcrwc8SOy7-7nbY/s200/back-to-the-future-poster.jpg" width="200" /></a></div>
<br />
Am I fortunate to be coming from the future? Because I <a href="http://davisliumd.blogspot.com/2011/08/ny-times-finding-quality-doctor-why.html">completely disagree with Dr. Danielle Ofri, again.</a><br />
<br />
I've had the privilege and opportunity to work in a medical group which has deployed the world's largest civilian electronic medical record and have been using it since the spring of 2006. I don't see the issue quite as much as Dr. Ofri did. It is possible that she examined patients in her office with a desk rather than an examination room.<br />
<br />
If placed and mounted correctly in the exam room, the computer actually is an asset and can improve the doctor patient relationship. It is part of the office visit. The flat screen monitor can be rotated to begin a meaningful dialogue between the patient and I. We review the lab work together as well as the trends. Look at xrays. Who needs anatomy flip charts when I can google any image instantly? Patient friendly information to reinforce our discussion is a click away.<br />
<br />
The computer can certainly enhance the doctor patient visit. Like any skill, unless we deliberately practice in getting better, we will simply find the new method awkward and unnatural.<br />
<br />
And the same goes for emailing patients securely. An October 2010 article in Pediatrics found that for a 127 families <a href="http://casesblog.blogspot.com/2011/07/secure-web-messaging-between-patients_18.html">only 5 emails were generated compared to over 2300 phone calls over an 8 month period.</a> The data doesn't lie.<br />
<br />
The conclusion of the article was that -<br />
<br />
<blockquote>
Although these patients/families expressed strong interest in e-mailing, secure Web messaging was less convenient than using the phone, too technically cumbersome, lacked a personal touch, and was used only by a handful of patients.</blockquote>
<br />
So doctors could conclude that patients really don't want to email their doctor. What a relief because the majority of patients still do not have the option to do so and doctors don't really want to do it. (Though there could be <a href="http://thehealthcareblog.com/blog/2010/08/09/why-i-don%E2%80%99t-accept-e-mail-from-patients/">compelling business reasons not to offer email</a> to patients even if the doctors were technically savvy enough to offer it).<br />
<br />
But yet this earlier press release in July 2010 may cause doctors to pause before returning to paper charts, pens, and phones. This study found that over a two month period, <a href="http://xnet.kp.org/newscenter/pressreleases/nat/2010/070710ehrupsquality.html">35,000 patients generated 556,000 email threads</a>. <br />
<br />
So what does this all mean? As doctors we need to change our mindset and look at these changes as opportunities for the medical field to provide care that is increasingly worry-free, hassle-free, and personalized.<br />
<br />
The future is here. That means embracing the computer.<br />
<br />
None of my patients would ever go back.<br />
<br />
Neither would I.<br />
<br />
Speaking of Back to the Future, I understand a limited supply of Marty McFly's shoes are <a href="http://draft.blogger.com/goog_1714196828">now available for purchase! Bids are at $4000!</a><a href="http://nikemag.ebay.com/"><br /></a><br />
<br />Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com4tag:blogger.com,1999:blog-7255776707298393367.post-24827104803235047322011-09-05T15:15:00.000-07:002014-09-06T08:46:32.280-07:00A Doctor Thanks His Mentor - Steve Jobs<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhANdhD9kYW8MTIGjixMyA5YSz-C4x4w9N3tQjWUwa782apuAUnqQfPJQve9ZOl1qaZC1nKcvHG-09VBoRqEDIpXVru1xEFc0Km2vEmzE1jDH5M6ZIrEi-XciEbD6bnGjoAD9hY4qC-evQ/s1600/steve-jobs.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhANdhD9kYW8MTIGjixMyA5YSz-C4x4w9N3tQjWUwa782apuAUnqQfPJQve9ZOl1qaZC1nKcvHG-09VBoRqEDIpXVru1xEFc0Km2vEmzE1jDH5M6ZIrEi-XciEbD6bnGjoAD9hY4qC-evQ/s200/steve-jobs.jpg" height="200" width="155" /></a>I've been reading <a href="http://www.amazon.com/Game-Plan-Life-Power-Mentoring/dp/1596917016">A Game Plan for Life: The Power of Mentoring</a> written by famed UCLA basketball coach John Wooden. Wooden spends half of his book thanking the people who had a powerful influence on his life, coaching, philosophy, and outlook on life. Important people included his father, coaches, President Abraham Lincoln, and Mother Theresa.<br />
<br />
Yes, President Abraham Lincoln and Mother Theresa.<br />
<br />
Though clearly he could have never met the former and didn't have the opportunity to meet the latter, Wooden correctly points out that as individuals we can be mentored by the writings, words, and thoughts of people we have never and will likely never meet.<br />
<br />
Which seems like the most opportune time to thank one of my mentors, founder and former CEO of Apple, Steve Jobs.<br />
<br />
Now, I have never met nor will I ever meet Steve Jobs. Lest you think I'm a devoted Apple fan, I never bought anything from Apple until the spring of 2010. Their products though beautifully designed were always too expensive. I'm just a little too frugal. I know technology well enough that people mistaken me for actually knowing what to do when a computer freezes or crashes. Yet, the value proposition was never compelling enough until the release of the first generation iPad. Then the iPhone 4. Finally the Macbook Air last Christmas.<br />
<br />
No, thanking Steve Jobs isn't about the amazing magical products that have changed my life as well as millions of others. It's more than that. What he has mentored me on is vision, perspective, persistence, and leadership. Nowhere is this more important than the world I operate in, the world of medicine. Increasingly health care is fragmented, confusing, and frustrating for patients. As <a href="http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html">Dr. Atul Gawande noted in his commencement</a> to Harvard Medical School:<br />
<br />
<blockquote>
Everyone has just a piece of patient care. We’re all specialists now—even primary-care doctors. A structure that prioritizes the independence of all those specialists will have enormous difficulty achieving great care.<br />
<br />
We don’t have to look far for evidence. Two million patients pick up infections in American hospitals, most because someone didn’t follow basic antiseptic precautions. Forty per cent of coronary-disease patients and sixty per cent of asthma patients receive incomplete or inappropriate care. And half of major surgical complications are avoidable with existing knowledge. It’s like no one’s in charge—because no one is. The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people.</blockquote>
<br />
We don't have an actual system of care. A majority of doctors still use paper charts and prescription pads which can be difficult to access or decipher (doctors have poor penmanship?) and communicate with colleagues via letters, faxes, and phone calls. In an industry which is information driven, this seems too antiquated to be true. Hospitals each have their own unique system of care and their is little standardization which means both patients and doctors need to learn new rules with each new hospital. Patients cannot invest in long term relationships with their doctors because they change jobs, their company or their doctors dropped their previous insurance plan.<br />
<br />
What we have is a potpourri of doctors, hospitals, pharmacies, and health insurers cobbled together to form a "health care system". For a patient, the number of combinations is staggering. Each experience varies depending on who they see, what insurance coverage they have, and the type of (or lack of) information technology their doctors have. Many doctors today still bristle at the possibility that they actually need to email their patients and as a result don't offer that as a way of communication or education.<br />
<br />
In the end, what patients and doctors really want sits at the intersection of humanity and technology. Patients want doctors who know them as individuals, use medical technology thoughtfully, and a system that is highly reliable, safe, and focused on them to stay well or get them better. Doctors want patients who are partners in their care, technology that enables them to get the accurate information they need real-time, and a system that is streamlined to allow doctors to be healers.<br />
<br />
In other words, we need a better health care system for both parties.<br />
<br />
As a practicing primary care doctor, his words inspire me to help work towards creating a system which "simply works" for both doctors and patients. Some of the most important quotes that has shaped my thinking include:<br />
<br />
“Innovation has nothing to do with how many R&D dollars you have. When Apple came up with the Mac, IBM was spending at least 100 times more on R&D. It’s not about money. It’s about the people you have, how you’re led, and how much you get it.” — <a href="http://www.wired.com/epicenter/2011/08/money-quotes-steve-jobs-style/">Fortune, Nov. 9, 1998</a><br />
<br />
“It’s really hard to design products by focus groups. A lot of times, people don’t know what they want until you show it to them.” — <a href="http://www.wired.com/epicenter/2011/08/money-quotes-steve-jobs-style/">BusinessWeek, May 25 1998</a><br />
<br />
“It comes from saying no to 1,000 things to make sure we don’t get on the wrong track or try to do too much.” — <a href="http://www.wired.com/epicenter/2011/08/money-quotes-steve-jobs-style/">BusinessWeek Online, Oct. 12, 2004</a><br />
<br />
“Do you want to spend the rest of your life selling sugared water or do you want a chance to change the world?”<br />
<a href="http://www.wired.com/epicenter/2011/08/money-quotes-steve-jobs-style/">— The line he used to lure John Sculley as Apple’s CEO, according to <cite>Odyssey: Pepsi to Apple</cite>, by John Sculley and John Byrne </a><br />
<br />
"So you can't go out and ask people, you know, what the next big [thing.] There's a great quote by Henry Ford, right? He said, 'If I'd have asked my customers what they wanted, they would have told me "A faster horse." ' " <a href="http://money.cnn.com/galleries/2008/fortune/0803/gallery.jobsqna.fortune/2.html">-- CNN / Money</a> <br />
<br />
"My job is to not be easy on people. My job is to make them better. My job is to pull things together from different parts of the company and clear the ways and get the resources for the key projects. And to take these great people we have and to push them and make them even better, coming up with more aggressive visions of how it could be." <a href="http://money.cnn.com/galleries/2008/fortune/0803/gallery.jobsqna.fortune/5.html">-- CNN / Money</a><br />
<br />
"Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma — which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary." <a href="http://news.stanford.edu/news/2005/june15/jobs-061505.html">-- Stanford 2005 commencement address</a><br />
<br />
Many of my blog posts have reflected on whether health care can indeed be better than it currently exists much the same way Jobs has redefined how we as a society communicate, relate, receive, and create content.<br />
<br />
<a href="http://davisliumd.blogspot.com/2011/04/does-america-want-apple-or-android-for.html">Does America Want Apple or Android for Health Care? </a><br />
<br />
<a href="http://davisliumd.blogspot.com/2010/07/what-steve-jobs-and-iphone-4.html">What Steve Jobs and iPhone 4 Antennagate can Teach Doctors and Patients</a><br />
<br />
<a href="http://davisliumd.blogspot.com/2009/09/why-healthcare-needs-to-be-more-like.html">Why Healthcare Needs to be More Like Apple and Less Like Windows / Intel </a><br />
<br />
I as a doctor I'm incredibly sorry that medicine has not yet evolved to the point that a cure exists for the rare type of cancer Jobs. I'm sorry that he is so ill at an incredibly young age, in his mid 50s, when many people begin to contribute even more to society with all of the knowledge and experience they've acquired. The future might be a little less bright without Jobs leading his team at Apple on creating products and experiences none of us truly knew existed until he showed them to us.<br />
<br />
And yet, I wanted to thank him for his mentoring. Clearly though the outpouring of comments and support across the web, Steve Jobs has had a profound influence in many of our lives. In most cases, it wasn't even about the products.<br />
<br />
It was simply a way of living and viewing life.<br />
<br />
I look forward to learning one last time from my mentor this fall with the release of <a href="http://www.amazon.com/Steve-Jobs-Walter-Isaacson/dp/1451648537/ref=sr_1_1?ie=UTF8&qid=1315258180&sr=8-1">his book titled Steve Jobs. </a><br />
<br />
My thoughts are with him, his family, and the people at Apple who continue to innovate and challenge themselves so the rest of us benefit. <br />
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<br />Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com0tag:blogger.com,1999:blog-7255776707298393367.post-29200943956881748282011-08-21T14:32:00.000-07:002011-08-23T22:50:29.351-07:00NY Times - Finding a Quality Doctor - Why the Author and Doctors Are Wrong.<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixLuwVpOPJZTxIvoA7ZAupYZVUXDBZKSG2BD5JoZaIzI4SyZzktEnRcRTRG54zMZ8RX-c24dFf8Gt9RXLwbODvthq24tahA1eX99sJio19Xb4JaQMbCsInWyueKF2_OLbNGRPgKWy1xlU/s1600/Gold-Medal.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixLuwVpOPJZTxIvoA7ZAupYZVUXDBZKSG2BD5JoZaIzI4SyZzktEnRcRTRG54zMZ8RX-c24dFf8Gt9RXLwbODvthq24tahA1eX99sJio19Xb4JaQMbCsInWyueKF2_OLbNGRPgKWy1xlU/s200/Gold-Medal.jpg" width="103" /></a>The New York Times recently published an article titled, <a href="http://well.blogs.nytimes.com/2011/08/18/finding-a-quality-doctor/?ref=health">Finding a Quality Doctor</a>, Dr. Danielle Ofri an internist at NYU, laments how she was unable to perform as well as expected in the areas of patient care as it related to diabetes. From the <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1006298">August 2010 New England Journal of Medicine article</a>, Dr. Ofri notes that her report card showed the following - 33% of patients with
diabetes have glycated hemoglobin levels at goal, 44% have cholesterol
levels at goal, and a measly 26% have blood pressure at goal. She correctly notes that these measurements alone aren't what makes a doctor a good quality one, but rather the areas of interpersonal skills, compassion, and empathy, which most of us would agree constitute a doctor's bedside manner, should count as well. <br />
<br />
Her article was simply to illustrate that "most doctors are genuinely doing their best to help their patients and that these report cards might not be accurate reflections of their care" yet when she offered this perspective, a contrary point of view, many viewed it as "evidence of arrogance."<br />
<br />
She comforted herself by noting that those who criticized her were "mostly [from] doctors who were not involved in direct patient care (medical
administrators, pathologists, radiologists). None were in the trenches
of primary care."<br />
<br />
From the original NEJM article, Dr. Ofri concluded when it related to the care of patients with diabetes and her report card -<br />
<br />
<blockquote>
I
don't even bother checking the results anymore. I just quietly push the
reports under my pile of unread journals, phone messages, insurance
forms, and prior authorizations. It's too disheartening, and it chips
away at whatever is left of my morale. Besides, there are already five
charts in my box — real patients waiting to be seen — and I need my
energy for them. </blockquote>
<br />
As a practicing primary care doctor, I'm afraid that Dr. Ofri and many other doctors are making a fundamental attribution error is assuming that somehow doctors can't do both. She is also wrong in thinking that the real patients waiting to be seen are somehow more important that those whose blood pressure, cholesterol, and blood sugars are poorly controlled and the disease literally eats them up from the inside which could result in end organ damage to the eyes (blindness), kidneys (renal failure resulting in dialysis), extremities (amputation), and heart (coronary artery disease) and possibly premature death. They aren't in the office and yet are suffering.<br />
<br />
Until we as doctors begin to take responsibility for our performance in hard clinical and objective outcomes like glycated hemoglobin levels, cholesterol, and blood pressure, our patients will pay a price. We should not pretend that bedside manner should trump clinical outcomes nor that clinical outcomes should override the humanistic part of medicine.<br />
<br />
It is possible to do both today. It isn't theoretical. I only serve as one example. <br />
<br />
<br />
I'm a front-line primary care doctor who also takes care of
patients. I like Dr. Ofri also get a report card on my performance in caring for
patients with diabetes. <br />
<br />
Based on the medical evidence, my goals are set similarly to hers. For
2010, my performance wasn’t perfect but was 88.6%, 80.8%, and 70% at
goal respectively.
<br />
<br />
I suspect critics will immediately begin to make a lot of assumptions of how these scores were achieved, when Dr. Ofri, another primary care doctor had very different outcomes. Is it that I am not a quality doctor? Perhaps I’m too driven
by data and have no - “soft” attributes like attentiveness, curiosity,
compassion, diligence, connection and communication. Perhaps I "fire" those patients who are not able to achieve good outcomes.<br />
<br />
I can tell you many patients wish to join my practice and rarely do people choose to leave it. The organization I work for also takes the softer side of medicine, a doctor’s bedside
manner, seriously. My employer randomly surveys patients on their experience.
Does your doctor listen and explain? Do they know your medical history?
Do they partner with you in your health? Do you have confidence in
the care they provided you?
<br />
<br />
For 2010, 92.8 percent rated me very good or excellent on these elements.
<br />
<br />
So what does this all mean?
<br />
<br />
We should not automatically assume that doctors with great bedside manner cannot also provide great clinical care.
<br />
<br />
I can achieve the goals, which patients would want, and still be a doctor with great bedside
manner because I work in a functional system like Kaiser Permanente.
Primary care doctors are blessed with <a href="http://davisliumd.blogspot.com/2011/02/why-this-primary-care-doctor-loves-his.html">a comprehensive electronic medical record</a>, are partnered with staff who help patients get the care
they need, and are surrounded by specialty colleagues equally as
focused to keep patients healthy and well.
<br />
<br />
So if there is any area of agreement with Dr. Ofri it is that simply giving doctors report cards and telling them to try harder will simply achieve mediocre outcomes. Until there is a fundamental restructuring on health care is delivered (and simply making appointments longer isn't necessarily going to solve it either), then primary care doctors will continue to leave the specialty in droves. Doctors need to lead change and use tools and skills honed in other industries, whether the Toyota Production model or lean process, which has been utilized by the <a href="http://www.cbsnews.com/stories/2009/06/06/eveningnews/main5068218.shtml">Virginia Mason Hospital</a>, or usage of protocols and checklists based on scientific evidence as demonstrated by <a href="http://www.nytimes.com/2009/11/08/magazine/08Healthcare-t.html?pagewanted=all">Intermountain Healthcare and Dr. Brent James.</a><br />
<br />
Until we as doctors lead, we cannot or should not expect improvement in patient outcomes. We can no longer hide behind the reasons of our Herculean effort or bedside manner as what should really matter and account for something. Patients expect these attributes intuitively.<br />
<br />
With already so many examples of success in the country marrying the art, science, and humanistic part of medicine, the only thing stopping us to re-invent American medicine in the 21st century is simply ourselves. Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com1tag:blogger.com,1999:blog-7255776707298393367.post-23902471660441414842011-08-15T16:20:00.000-07:002011-08-17T07:47:39.740-07:00Newsweek - Just Say No! - One Word Can Save Your Life. Too Simplistic. Doctors Need to Help.<a href="http://www.thedailybeast.com/newsweek/2011/08/14/some-medical-tests-procedures-do-more-harm-than-good.html">Newsweek</a> has a very provocative and yet incredibly too simplistic piece for the public and patients on its cover story - <a href="http://www.thedailybeast.com/newsweek/2011/08/14/some-medical-tests-procedures-do-more-harm-than-good.html"><i>One Word Can Save Your Life: No! - New research shows how some common tests and procedures aren’t just expensive, but can do more harm than good.</i></a><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHcz96K353lD0QOW1bamJGUOY_j5POKUUFTWXZyOZszabNnH4XBYGxwzDqfUpx9nRjG9ltSLxRlPzxZaIhc1-cS9AMjodauWk6qXfGeTpKvGN5DmgrQGoL0Q4Qc6DBI1HDfO6hHI188-U/s1600/1313379907989.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="158" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHcz96K353lD0QOW1bamJGUOY_j5POKUUFTWXZyOZszabNnH4XBYGxwzDqfUpx9nRjG9ltSLxRlPzxZaIhc1-cS9AMjodauWk6qXfGeTpKvGN5DmgrQGoL0Q4Qc6DBI1HDfO6hHI188-U/s200/1313379907989.jpg" width="200" /></a></div>
<br />
The piece is actually well written and highlights facts that have been apparent for some time. More intervention and treatment isn't necessarily better. Having a cardiac catheterization or open heart surgery for patients with stable heart disease and mild chest pain isn't better than diet, exercise, and the prescription medication treatment. PSA, the blood test previously suggested by many professional organizations, <a href="http://davisliumd.blogspot.com/2010/03/truth-about-prostate-cancer-screening.html">isn't helpful to screen for prostate cancer</a>, even though the value of the test was questioned years ago. Antibiotics for sinus infection? Usually not helpful.<br />
<br />
Certainly doctors do bear part of the blame. If patients are getting routine colonoscopies sooner than every 10 years or are getting them despite being quite a bit older (80 and older) and frail, then clearly patients should say no to more care. More isn't better. (Whether a patient has the conviction to do so is another story. When my auto mechanic says it is time to change the brakes or change the oil, who am I to say no?)<br />
<br />
But the overtreatment and overuse of medical technology does not just fall on the doctors. It is also the patients' and the public's perception of what is the right care. Whether this perception was shaped by doctors, the media, movies and television shows, or patients comparing notes is hard to say, but the reality is patients have a certain expectation of what should be done which often is in stark contrast to the right thing to do. For low back pain, many patients simply want a MRI and avoid an examination or visit. After all, isn't the truth in the MRI? Isn't talking to a patient and examining his back, knee and ankle reflexes, evaluating for joint strength and sensation simply from a by-gone era that is antiquated in the 21st century? Do patients know the limitations of our understanding not in the history or physical examination honed by generations of doctors before us, but the shiny new piece of technology rolled out annually by General Electric? As Dr. Michael Lauer, a cardiologist of the National Heart, Lung, and Blood Institute noted in the piece,
“Our imaging and diagnostic tests are so good, we can see things we
couldn’t see before...But our ability to understand what we’re seeing
and to know if we should intervene hasn’t kept up.” <br />
<br />
Doctors who do provide the right care, which often is low tech and common sense, might be viewed as denying care. If a patient has chest pain which is easily treated with a statin (cholesterol lowering) drug and beta-blocker and a cardiologist is not needed for further intervention, do you think the patient or the family will feel more relieved or more anxious? If a stress test isn't offered to an otherwise healthy middle aged man as part of a physical (or at a minimum an EKG) and yet is offered the identical tests as part of an executive physical, do you think the public at large will feel better or worse in not having the tests, which are correctly noted in the article not proven to save lives? (It is ironic that although fantastic experts are quoted in the piece including Dr. Steven Nissen, a cardiologist at Cleveland Clinic, <a href="http://my.clevelandclinic.org/executive-health-program/default.aspx">his organization offers executive physicals</a>, which you guessed it provide many of these tests and interventions to paying clients. Though the results of the majority of the tests are normal it is that remote possibility that something might be wrong and the basis of the testimonials on the website that have the public clamoring for more testing and treatments).<br />
<br />
In today's society where news is disseminated as sound bites or tweets, I am concerned about the unintended implications this Newsweek story will bring: patients will say no to everything. Based on a well written, though not entirely balanced article, <a href="http://davisliumd.blogspot.com/2011/07/are-patients-becoming-day-traders.html">patients will anchor their decisions to default to no based on this small piece of information.</a> It has already occurred with vaccinations. As the National Committee for Quality Assurance noted in its 2010 State of Health Care Quality report, <a href="http://www.ncqa.org/tabid/1259/Default.aspx">childhood immunization rates for those in private insurance has actually fallen compared to those in public insurance (Medicaid) plans</a>.<br />
<br />
<blockquote>
Childhood vaccination rates in 2009 declined by almost four percentage points in commercial plans. A possible cause of this drop is commercial plan parents may refuse vaccines for their children based on the unproven, but increasingly popular, notion that vaccines cause autism. Celebrity activists are outspoken advocates of this view. Interestingly, we see vaccination rates in Medicaid – the program serving the poor – continuing to steadily improve. </blockquote>
<blockquote>
“The drop in childhood vaccinations is disturbing because parents are rejecting valuable treatment based on misinformation,” said NCQA President Margaret E. O’Kane. “All of us in health care need to work together to get better information to the public.”<br />
The State of Health Care Quality Report examined quality data from over 1,000 health plans that collectively cover 118 million Americans.</blockquote>
<br />
Because of the complexity, nuances, and ever changing nature of medicine, patients more than ever need doctors to lead and be firm on what works and what does not. The anecdotal quote by a doctor who opted not to have a mammogram should be taken as one person's opinion and not a recommendation for all women to do the same. Having patients say no or expecting them to make the right decisions for themselves and family is not how the country will get better care. A recent NY Times piece by Dr. Pauline Chen titled <a href="http://well.blogs.nytimes.com/2011/08/11/letting-doctors-make-the-tough-decisions/#more-57305">Letting Doctors Make Tough Decisions</a> could not have been more timely.<br />
<br />
<blockquote>
... a new study reveals that too much physician restraint may not be all that good for the patient — and perhaps may even be unethical. While doctors might equate letting patients make their own decisions with respect, a large number of patients don’t see it that way. In fact, it appears that a majority of patients are being left to make decisions that they never wanted to in the first place….<br />
<br />
The challenges appear to arise not when the medical choices are obvious, but when the best option for a patient is uncertain. In these situations, when doctors pass the burden of decision-making to a patient or family, it can exacerbate an already stressful situation. “If a physician with all of his or her clinical experience is feeling that much uncertainty,” Dr. Curlin said, “imagine what kind of serious anxiety and confusion the patient and family may be feeling.”</blockquote>
<br />
Medical choices are not as obvious. Today the vast amount of information and choices are overwhelming. The easy and natural thing to do is to run away or bury our heads in the sand, or simply say no when decisions are complex. <br />
<br />
<br />
The Newsweek article concludes -<br />
<br />
<blockquote>
<b>Many doctors don’t seem to be getting the message about useless and harmful health care. </b>Medicare pays them more than $100 million a year for screening colonoscopies; some 40 percent are for people in whom they will almost certainly harm more than help. Arthroscopic knee surgery for osteoarthritis is performed about 650,000 times a year; studies show that it, too, is no more effective than placebo treatment, yet taxpayers and private insurers pay for it. And although several large studies, including the Occluded Artery Trial in 2006, have shown that inserting a stent to prop open a blocked artery more than 24 hours after a heart attack does not improve survival rates or reduce the risk of another coronary compared with drugs alone, the practice continues at a rate of 100,000 such procedures a year, estimate researchers led by Dr. Judith Hochman, a cardiologist at New York University. “We’re killing more people than we’re saving with these procedures,” says UT’s Goodwin. “It’s as simple as that.”</blockquote>
<br />
Actually, I think doctors are getting the message as Dr. Atul Gawande noted in the June 2009, New Yorker piece <a href="http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande">Cost Conundrum</a>. Doctors are compensated more to do more. Even medical students get the message. Increasingly more are becoming specialists as reimbursement is far more lucrative in doing procedures than it is to simply talk and counsel patients.<br />
<br />
The Newsweek piece tries to simplify the problem too easily by hinting to patients that saying no is a good thing rather than challenging patients to have an open-minded, important and thoughtful conversation about the advantages and disadvantages of having certain tests or treatments with their primary care doctor. <a href="http://davisliumd.blogspot.com/2010/08/why-solution-to-primary-care-crisis.html">Of course since fewer medical students want to do primary care</a>, my job and those of my colleagues in family medicine and internal medicine just got a lot harder. Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com0tag:blogger.com,1999:blog-7255776707298393367.post-86451605991963726812011-07-27T07:39:00.000-07:002011-08-10T05:53:07.769-07:00Are Patients Becoming Day Traders?<div class="separator" style="clear: both; text-align: center;">
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Let me say first that I am a practicing primary care doctor who is very much focused on patient centered care. Though I cannot go back to being a patient who is unaware about what a doctor does, the terminology she uses, or what the importance of certain test results are, I can empathize with the overwhelming amounts of information, challenges, and stressors patients and families can have in navigating the healthcare system to get the right care. This is the reason I wrote <a href="http://www.lulu.com/product/ebook/stay-healthy-live-longer-spend-wisely/12287402?productTrackingContext=search_results/search_shelf/center/1">my book</a>.<br />
<br />
However, over the past few months I've noticed a particularly disturbing trend. Patients are not consulting doctors for advice, but rather demanding testing for diagnoses which are not even remote possibilities. A little knowledge can be dangerous particularly in the context of little to no clinical experience. Where many patients are today are where medical students are at the end of their second year - lots of book knowledge but little to no real world experience.<br />
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More patients are becoming the day traders of the dot.com boom. Everyone has a hot stock tip, only now it is "be sure to ask your doctor for this test" or "ask for this medication because it is the only one that works". Everyone is an expert with his own suggestion on what should be done. If a medical expert, like a doctor, weighs in and does not agree, <a href="http://www.psychologytoday.com/blog/owning-pink/201107/when-docs-get-annoyed-empowered-patients">then there is a set of patients and doctors who begin to argue that these doctors are out of touch or arrogant. </a><br />
<br />
Hardly.<br />
<br />
I certainly agree that many doctors frown upon their patients doing research online. I disagree with my colleagues. I'm all for patients being partners in their health as long as when they research they also go to reputable websites, like the Mayo Clinic or Kaiser Permanente, and also give equal weight to my medical advice. Ultimately, patients should be more knowledgeable about their health and engage not only with doctors, but with family and friends as health does not begin with doctors, but in households and communities. However, today's world is increasingly polarized due to the ability to gather information and find opinions of like minded people quickly and easily. A patient researching information can unwittingly blind themselves into believing that a medication, a treatment, a test, or a diagnosis is the only one that explains their symptoms. <br />
<br />
Many of the patients who Google their symptoms, do cursory research, and are so convinced that they have a particular problem and need a particular solution are the group I worry about the most. They want to see a specialist for a problem adequately handled in primary care. They want a branded medication when a generic medication works equally as well. They want CT scans and MRIs for migraine headaches or sprained ankles when a generation ago, doctors and patients believed diagnoses based on common sense. They decline vaccinations for preventable illnesses like pertussis, whooping cough, because they are healthy and don't want "chemicals" even though the state they live in had <a href="http://www.kesq.com/news/25306857/detail.html">the worst outbreak of pertussis since 1955.</a><br />
<br />
With more Americans paying for their health insurance through higher
copays for doctor visits, medications, imaging, and treatment, it is
understandable that they want more information and are seeking it. What is particularly troubling, however, is much like the day traders of
years ago, many are bypassing experts for some advice and consultation.
Indeed a decade ago many ridiculed financial guru Warren Buffet for
failing to understanding the new world and being a dinosaur. Principles
of the past no longer applied. (Of course, financials principles remained - you do need to make money to be an ongoing company). As a front line doctor, I'm seeing the
same phenomenon in health care. Doctors still clinch the right diagnoses by talking to and then examining patients. Skipping directly to lab work or imaging often gets the wrong answer. Sometimes there is no test or imaging study that can get the diagnosis. Yet somehow if asked, patients retort I don't have money to see you, I'd rather spend the money on the test or medication, so can you order it?<br />
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Like the day traders of a decade ago, these individuals have the illusion of control or mastery. Only later do they discover when the results are normal and the problem remains that being an expert and having the ability to take in information, process it, and then come up with a plan is harder than it looks. (Dr. Lisa Sanders, whose <a href="http://topics.nytimes.com/topics/news/health/columns/diagnosis/">New York Times series Diagnosis</a> was the inspiration for the television show House, M.D., has excellent patient cases which challenge the public on getting the right diagnosis).<br />
<br />
That is not to say that there are not patients who are indeed experts. The individuals who are leading the empowered patient movement often know a lot about their diagnoses and treatment options and have mutual respect from their doctors. Enlightened doctors realize that they cannot know it all. I would hope and believe that empowered patients also recognize this inherent problem in themselves as they also cannot know it all either. It is the rich discussion and collaboration which occurs when both groups are on relatively equal footing in terms of knowledge that the answers, solutions, and treatment plans are far better than if only one side or the other led the conversation. Those patient experts probably can and have identified their condition when they read it in Dr. Sander's column.<br />
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Who would have guessed that the day traders of the past would now appear as patients? Funny and sad how history repeats itself. The difference is unlike money the stakes are significantly higher when it comes to health.<br />
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Not sure what to do when you have a problem? It's ok to research online, but then have an open mind when talking to your doctor. If your doctor does not want to listen, then find another one. Be sure, however, as you research and listen, that you do not become a day trader. Indeed, if not done correctly <a href="http://davisliumd.blogspot.com/2011/02/why-consumer-driven-health-care-will.html">the consumer driven health care movement has the potential to be equally as problematic as the retirement planning and investing movement a decade ago.</a>Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com0tag:blogger.com,1999:blog-7255776707298393367.post-29585169223320886042011-07-05T06:56:00.000-07:002014-09-03T00:46:10.683-07:00Required Reading for Medical Students, Interns, and Residents.<iframe frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=tf_til&ad_type=product_link&tracking_id=dalimd-20&marketplace=amazon&region=US&placement=1582345791&asins=1582345791&linkId=U2ZNBFSQF76HH3CV&show_border=true&link_opens_in_new_window=true" style="height: 240px; width: 120px;">
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I have had the privilege of working at an organization which is actively improving the lives of its members and also <a href="http://www.time.com/time/politics/article/0,8599,1913363,00.html">was mentioned by the President as a model for the nation</a>. Over the past few years, I have also demonstrated to first year medical students what 21st century primary care should look and feel like - a fully comprehensive medical record, secure email to patients, support from specialists, and assistance from chronic conditions staff.<br />
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But as my students know, there are also some suggested reading assignments. I'm not talking about Harrison's or other more traditional textbooks related to medical education. If the United States is to have a viable and functioning health care system, then it will need every single physician to be engaged and involved. I'm not just helping train the next group of doctors (and hopefully primary care doctors), but the next generation of physician leaders.<br />
<br />
Here are the books listed in order of recommended reading, from easiest to most difficult. Combined these books offer an understanding the complexity of the problem, the importance of language in diagnosing a patient, the mindset that we can do better, and the solution to fixing the health care system.<br />
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Which additional books or articles do you think current and future doctors should know? <br />
<br />
<b><a href="http://www.amazon.com/gp/product/1582345791/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1582345791&linkCode=as2&tag=dalimd-20&linkId=GUYMZEEMWY5Q2MWN">Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer</a><img alt="" border="0" src="http://ir-na.amazon-adsystem.com/e/ir?t=dalimd-20&l=as2&o=1&a=1582345791" height="1" style="border: none !important; margin: 0px !important;" width="1" />
</b><br />
Balanced and thoroughly researched, this book illustrates how the failings of our healthcare system are more complex than simply claiming that insurers are greedy and malpractice insurance premiums are too expensive. <br />
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Patients with the same illness are getting more costly medical care in certain parts of the country but actually do worse. The amount of medical care delivered is driven by the number of specialists, hospitals, and technology available in the community. The more doctors and hospitals add new services and technology the more likely those expensive services are used regardless of whether patients need it but because the providers can get paid for it. When organizations and committees try to set up guidelines or do research to see if current therapies are effective, special interests and politics kill the initiatives. <br />
<br />
Hospitals focus on generating more business in departments which are profitable, like oncology, with newer buildings and the latest medical equipment so that they can afford to run emergency departments which continually lose money. Doctors and patients are enamored with the latest treatments and interventions which often are far more expensive, aren't better than existing therapies, and like the case of bone marrow transplant for metastatic breast cancer patients, are more lethal. <br />
<br />
The pharmaceutical industry is intimately linked to doctor education and invariably influences which prescriptions are prescribed and market prescription medications as easily as consumer companies promote common household products. It is money not science that drives the healthcare system. <br />
<br />
The author believes that solving the dysfunctional healthcare system requires that doctors and hospitals align themselves into integrated healthcare organizations like the Mayo Clinic, Kaiser Permanente, and the Veterans Health Administration. Unfortunately, however, because she makes such a compelling case of how each of the various providers and businesses each have a financial self interest to keep the current system going at the detriment of patient care, it is difficult to see how the transition will occur, if ever. <br />
<br />
<b><a href="http://www.amazon.com/gp/product/0547053649/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0547053649&linkCode=as2&tag=dalimd-20&linkId=NDIVWSRSX43OQ56E">How Doctors Think</a><img alt="" border="0" src="http://ir-na.amazon-adsystem.com/e/ir?t=dalimd-20&l=as2&o=1&a=0547053649" height="1" style="border: none !important; margin: 0px !important;" width="1" />
</b><br />
Fascinating read and written in the same spirit as Malcolm Gladwell's Blink. Dr. Groopman investigates how doctors make misjudgments and misdiagnoses because of their failures to understand and acknowledge cognitive limitations and errors in thought that affect all of us and are unbeknownst to us. He feels that if doctors take a step back, are introspective and insightful about these deficiencies and take appropriate steps to minimize these problems, we can be better clinicians. The doctors he profiles are truly inspirational, remarkable, and masters in their fields, not only because of their medical knowledge, but because of their recognition of what it takes to be superb people and clinicians. <br />
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If there is an area of disagreement, then it is the fact that Dr. Jerome Groopman suggests that the pressures of managed care and inadequate time are the cause of many of these cognitive errors. Yet, he never actually proved this in the book. He never showed that doctors were more likely to make the correct diagnoses in an era with fewer time constraints. In fact, he laments that doctors in training, where he teaches at Harvard, don't know how to think and then realized that he hadn't be trained how to think either over thirty years earlier (and hence the reason for his investigation and this book). He claims that quality of medical care shouldn't be simply defined as whether or not a patient with diabetes has his blood sugar checked routinely, yet Dr. Groopman also doesn't acknowledge that the major reason the United States ranks last in the world in keeping people healthy is because the quality of care delivered never was measured as carefully as it is today. Research shows that 80,000 Americans die prematurely (twice the number of breast cancer deaths) simply because the right preventive care wasn't delivered. Had the nation adopted those health insurance plans, hospitals, and doctors, who performed at the top 10 percent of providing this care, these individuals would be alive today. How do they do so well? It is because of implementation of systems that promote excellence.<br />
<br />
As a practicing primary care doctor I understand the concerns of my colleagues of showing and proving that they are doing what they say. But we all know if you don't measure something and then re-evaluate it, how do you know if you are doing better? If anything, Dr. Groopman seems to suggest that medical care would be better if doctors didn't have to prove that they performed these metrics to the level of what the evidence shows to be effective even though other industries like financial services, manufacturing, and the airline industry do so rigorously to maintain their high levels of reliability, consistency, and safety. <br />
<br />
Although he encourages patients be advocates for themselves, to ask questions, and how to slow a doctor down and think more clearly with certain comments, from his own examples it is clear that it isn't easy to do and frankly somewhat intimidating.<br />
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If there is a lesson to be learned, then it is that as doctors we need to understand that our thought processes can be clouded by emotions and can be limited simply because we too are human. To overcome this problem, which affects all of us, we need to be deliberately thoughtful and systematically introspective when caring for patients. As a practicing primary care doctor, I believe that we, not the patients, bear this responsibility and that I hope doctors in training are being taught this routinely in this country and that others welcome the opportunity to do better. While it should be a required reading assignment for medical students, interns, residents, and practicing physicians, better thinking doctors alone aren't going to improve healthcare quality in the United States. Dr. Groopman's subtle suggestions that they might are simply his error in thinking and his inability to remain open-minded. The world he trained in is far different than the world his trainees are about to enter. <br />
<b><a href="http://draft.blogger.com/goog_1862339922"><br />
</a></b><br />
<b><a href="http://www.amazon.com/gp/product/0312427654/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0312427654&linkCode=as2&tag=dalimd-20&linkId=YOVU6RJWTZFXHAQW">Better: A Surgeon's Notes on Performance</a><img alt="" border="0" src="http://ir-na.amazon-adsystem.com/e/ir?t=dalimd-20&l=as2&o=1&a=0312427654" height="1" style="border: none !important; margin: 0px !important;" width="1" /></b>
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A fascinating and quick read. In each section there are plenty of inspiring stores about doctors making a difference. Dr. Atul Gawande, a general surgeon at Brigham and Women's Hospital and staff writer for the New Yorker has keen observation and insight to make single stories demonstrate not only the failings of our healthcare system but also the solutions to them because of individuals asking questions on how to do better. Ultimately, one of the questions he asks is how can doctors and hospitals be positive deviants? How does one become a positive deviant or an outlier that pushes beyond convention and advances patient care to new levels? <br />
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He gives examples of how over four million children need to be vaccinated in Northern/Southern India in three days to prevent a large polio outbreak. An immunization rate of less than 90 percent would be considered a failure. <br />
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Dr. Gawande talked about the evolution of obstetrics. After a damaging report in 1933, the specialty consequently committed itself to standardizing childbirth ensuring that with the new medical knowledge that it was applied consistently and routinely throughout the country. As a result maternal death in childbirth fell 90 percent from one in 150 in the 1930s to one in 2000 by 1950s. With continued innovations and the commitment to do better, the chance of a woman dying in childbirth is less than one in 10,000 today. <br />
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There are plenty of amazing examples that you don't have to be a doctor to relate on how truly inspirational these individuals are in times when the stakes could not be higher - life or death.<br />
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Until our healthcare system improves to its full potential as Dr. Gawande challenges us to do, unfortunately will always remain benefiting those who are insiders and harming those who are not. The real question is which one are you? This failing is part of the reason for the <a href="http://davisliumd.blogspot.com/2010/09/empowered-patient-is-this-what.html">rise of the empowered patient movement.</a><br />
<b><a href="http://draft.blogger.com/goog_1862339925"><br />
</a></b><br />
<b><a href="http://www.amazon.com/gp/product/0071592083/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0071592083&linkCode=as2&tag=dalimd-20&linkId=TLTYO6FH5ENGQVYL">The Innovator's Prescription: A Disruptive Solution for Health Care</a><img alt="" border="0" src="http://ir-na.amazon-adsystem.com/e/ir?t=dalimd-20&l=as2&o=1&a=0071592083" height="1" style="border: none !important; margin: 0px !important;" width="1" /></b>
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The decade worth of research spent understanding, studying, and ultimately offering solutions to make the health care system more accessible, higher quality, and affordable is clear. Unlike other books, the authors avoid the traps the plague most other solutions by taking a completely different perspective by looking at other industries where products and services offered were "so complicated and expensive that only people with a lot of money can afford them, and only people with a lot of expertise can provide or use them." Yet convincingly through plenty of examples, it shows how telephones, computers, and airline travel moved from only accessible to those with the resources to become available and affordable to all. <br />
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The book tackles every aspect of health care and asks how will those in health care be disrupted and subsequently surpassed by other providers which deliver care that is more convenient, higher quality, and lower cost. <br />
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What will hospitals need to do as increasingly more surgical procedures are performed in high volume specialty hospitals? <br />
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How will doctor practices sustain themselves as new diagnostic tools and research makes the identification and treatment of problems more precise that nurse practitioners with clear protocols can deliver care previously required by physicians? <br />
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What mechanisms exist to streamline and integrate the various players of health care (doctors, hospitals, purchasers, insurers) so that all are focused on the benefit of wellness and outcomes of patient care rather than maximizing each of their own financials? (Hint: large employers will integrate health care and others will only purchase care delivered by integrated healthcare delivery systems). <br />
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What should medical schools do to prepare the next generation of doctors as current training is steeped in tradition, relevant a century ago, but woefully inadequate for the future? <br />
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How should pharmaceutical, medical device manufacturers, and diagnostic equipment makers position themselves for the inevitable changes that will affect them the same way previous leaders in other industries were overtaken by competitors and disruption? <br />
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How must the reimbursement system and regulators adapt to foster the innovation to make these changes occur? <br />
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If there is anything close to a crystal ball on what health care delivery will look like in the United States that will be increasingly affordable, higher quality, and accessible to all, this is it. The authors, respected Harvard Business School (HBS) professor, a doctor who also was the Director of Health Care Delivery Policy Program at Harvard Kennedy School, and another doctor and graduate of the MBA program at HBS have convincingly demonstrated the likely path as well as indicated why a single payer nationalized system will stifle the innovation needed to improve our health care system. Those who wish to succeed in the new world of health care as predicted by this comprehensive and thoughtful analysis would be wise to consider this book.Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com0tag:blogger.com,1999:blog-7255776707298393367.post-87917115927734629142011-06-12T10:48:00.000-07:002011-06-16T06:00:00.323-07:00Physician Autonomy, Professionalism, and Protocols – Mutually Exclusive?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl8YojUxsFlTEBzcf3ShAAy6UnS-ZgRj6Mo_1r-CNAO9OxQr4s-ymoJxq1yjRKLVfzvbLsro8Hhe5zSMSDK5Xfb4iCnILkWTf0DDzDKpNsesWQPYBkxjtyN7J9NgeOtRGK788opumMixQ/s1600/fm1_airpilot.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="162" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl8YojUxsFlTEBzcf3ShAAy6UnS-ZgRj6Mo_1r-CNAO9OxQr4s-ymoJxq1yjRKLVfzvbLsro8Hhe5zSMSDK5Xfb4iCnILkWTf0DDzDKpNsesWQPYBkxjtyN7J9NgeOtRGK788opumMixQ/s200/fm1_airpilot.jpg" width="200" /></a>Doctors are professionals. But are doctors cowboys or pit crews? Recently, physician writer, Dr. Atul Gawande, spoke about the challenges for the next generation of doctors in his commencement speech titled, <a href="http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html">Cowboys and Pit Crews</a>, at Harvard Medical School. Gawande notes that advancement of knowledge in American medicine has resulted in an amazing ability to provide care that was impossible a century ago. Yet, something else also occurred in the process.<br />
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<blockquote>“[Medicine’s complexity] has exceeded our individual capabilities as doctors… <br />
The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves. One needed only an ethic of hard work, a prescription pad, a secretary, and a hospital willing to serve as one’s workshop, loaning a bed and nurses for a patient’s convalescence, maybe an operating room with a few basic tools. We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.”</blockquote><br />
Despite all of the advancements in medicine, the outcomes and consistency in treatment and care are not as good as they could be. Doctors are not doing basic things. The fact that Gawande, author of The Checklist Manifesto, spoke at one of the finest medical schools in the country indicates how much more the profession needs to go. <br />
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<blockquote>“We don’t have to look far for evidence. Two million patients pick up infections in American hospitals, most because someone didn’t follow basic antiseptic precautions. Forty per cent of coronary-disease patients and sixty per cent of asthma patients receive incomplete or inappropriate care. And half of major surgical complications are avoidable with existing knowledge. It’s like no one’s in charge—because no one is. The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it’s pit crews people need.”</blockquote><br />
So what is the issue?<br />
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Doctors usually bristle when facts of failure are mentioned. When solutions are offered, a variety of reasons of why they won’t work often occur. Doctors deal with patients and illness. Medicine is different from other industries like aviation or auto manufacturing in their experience with providing a highly consistent and reliable service or product. In many ways, this is true. Patients are unique in their genetic makeups, personalities, backgrounds, and experiences. Yet, the understanding of many illnesses has evolved to the point that doctors understand how to prevent, screen for, and treat these maladies which often afflict patients in similar ways. When understood at this level of detail, this knowledge can be codified into protocols and workflows. As research studies demonstrate what works and what does not, these can be refined further. Analysis of medical errors borrow the same processes and tools from other organizations dealing with complex systems to determine underlying problems and more importantly solutions to avoid similar outcomes in the future.<br />
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The creation of standardized workflows, checklists, and protocols causes doctors to bristle even more. As Gawande notes, the training of doctors today is essentially unchanged from generations ago which valued physician autonomy. When asked to follow protocols, doctors often feel this freedom to practice medicine is threatened. A natural tension exists between physician autonomy and adherence to protocols. Many will argue that the two are mutually exclusive. Both, in fact, can co-exist only if we look at the problem through a different lens. It is about the difference between what <a href="http://www.forbes.com/global/2011/0314/features-clayton-christensen-health-care-cancer-survivor.html">Professor Clay Christensen, Harvard Business School professor, and author of the Innovator’s Prescription, calls intuitive medicine and precision medicine. </a><br />
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It is also about professionalism. Are doctors professionals or cowboys or pit crews? <br />
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What Professor Christensen refers to as intuitive medicine is essentially how the public and doctors view themselves. As a result of the medical training, history, and tradition, doctors are thinkers. Patients present themselves with a set of symptoms or signs that they want doctors to solve. Because the body only has a certain limited number of ways to manifest an illness (note that for a dermatologic disorder, the skin turns red and can blister due to a burn, drug rash, autoimmune disorder, or contact dermatitis), clinching the right diagnosis required doctors to ask questions, think, use pattern recognition, and experimentation. Until the relatively rapid learnings over the past century, doctors did not understand the specific mechanisms, pathophysiology of diseases, or the appropriate treatments. <br />
<br />
An example of intuitive medicine was an illness that humbled American medicine just three decades ago. It afflicted mainly young gay men. Aside from the observations of a low T cell count and unusual opportunistic diseases affecting these patients, doctors were at a loss of what to do. How did the illness occur? How was it transmitted? How as it treated? The fear among the public was palpable. During that time, doctors tried a variety of treatments that invariably failed though through some experimentation and observation, some patterns began to emerge. The reasons for a few successes became better understood when HIV was discovered and doctors had a better understanding of AIDS. As a result, the course of illness and then the development of therapies, treatment, and prevention programs occurred which now allow individuals with HIV to live productive lives. <br />
<br />
When scientific understanding of maladies becomes so clear that prevention, screening, and specific therapeutic options can be written down into steps, protocols, and workflows, Professor Christensen refers to this type of medicine as precision medicine. Many medical problems, like diabetes, are in this category.<br />
<br />
The pathophysiology of diabetes is known. There are two types of diabetes, insulin dependent and non-insulin dependent diabetes. The degree of blood sugar control can be determined with a simple blood test, HgbA1c. If a patient has insulin dependent diabetes, the treatment must begin with insulin. For non-insulin dependent diabetes, treatment can often start with weight loss, physical activity, and dietary changes. Prescription medications, like metformin, and then later glipizide can be added in a stepwise approach based on a specific protocol should an individual patient’s blood sugar control require it. The fact that the understanding of diabetes and development has occurred over the past few decades has benefited Professor Christensen greatly. He has insulin dependent diabetes. Had he been born a century ago, he would not have lived very long as insulin was not discovered until the early 1920s.<br />
<br />
Yet, there are some areas in diabetes research which continue to evolve. Intensive blood sugar and blood pressure control in patients with insulin dependent diabetes was found to decrease the risk of complications and death. It was assumed and extrapolated that similar treatment would also benefit those with non-insulin dependent diabetes. Recently studies have shown that older patients did not benefit and perhaps were harmed with this level of treatment. As a result, the guidelines have changed.<br />
<br />
Although the protocols and guidelines are good, they are not perfect. They are only as good as the research available at that time. They continue to be refined. They are not static. It is this element that opponents of using precision medicine shout out words like “cookbook medicine” which have significant negative connotation. This simply denigrates the hard work and research that has allowed an illness to move from the realm of intuitive medicine to precision medicine. The fact that these protocols are not perfect, should not be a reason not to use them. <br />
<br />
At the heart of being a professional and consummate physician is the knowledge and wisdom to understand when a patient’s illness or treatment of a condition fits a known workflow or protocol and when it does not. The very best physicians follow procedures meticiously and thoughtfully whether placing a central line using the <a href="http://www.nytimes.com/2010/03/09/science/09conv.html">five critical steps as outlined by McArthur grant recipient and John Hopkins critical care specialist, Dr. Peter Pronovost</a>, to eliminate risk of infection or taking seriously a surgical timeout to avoid wrong site surgeries.<br />
<br />
Too often doctors will argue that blindly following protocols infringes on their autonomy. That is true. Blind adherence is a problem. However, passively going through the motions is equally as disasterous. Life saving treatment isn’t rendered. Screening tests not offered. Preventable medical errors still occur. In November 2010, only six months before Gawande’s commencement speech, a <a href="http://www.npr.org/blogs/health/2010/11/12/131264315/a-surgeon-confesses-to-error-and-hopes-it-s-a-lesson-learned">wrong site surgery case was prominently profiled in the New England Journal of Medicine</a>. It occurred at one of the nation’s most prestigious hospitals, Massachusetts General Hospital.<br />
<br />
In the end, it is the mindset of physicians which matter. We aren’t cowboys. We aren’t pit crews. If analogies must be made, then we are like the pilots in flight crews who are professionals and despite the complexity of their roles provide ultrasafe travel. Doctors are professionals. It is what the public expects. Using protocols, checklists, and standardized workflows are just as important as refining them to be even better. Knowing when not to apply them, is just as vital as ensuring that those situations where they do apply that they are done - every patient every time.<br />
<br />
Our patients deserve better. We can and must do better.Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com3tag:blogger.com,1999:blog-7255776707298393367.post-40849009639395606492011-06-02T15:56:00.000-07:002014-09-06T08:48:55.564-07:00What Dr. Oz Learned From His Cancer Scare - Honest and Unplugged. What Doctors Can Learn.<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSlsJq3AqQnj9xeOkhU2XBJhxG-rM4abkCaBz-lIyS565axbkgsXy4lDZpa8UH7K4lkb8P86fTha2ACUK-NSxNnKEJzu0JpbY6aYRqfUQaYIzEto-kummmrxpm56bkWALVUFCnaIHTvg8/s1600/hoz_0613.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSlsJq3AqQnj9xeOkhU2XBJhxG-rM4abkCaBz-lIyS565axbkgsXy4lDZpa8UH7K4lkb8P86fTha2ACUK-NSxNnKEJzu0JpbY6aYRqfUQaYIzEto-kummmrxpm56bkWALVUFCnaIHTvg8/s200/hoz_0613.jpg" height="200" width="150" /></a>Dr. Mehmet Oz recently had a piece in Time titled "<a href="http://www.time.com/time/specials/packages/article/0,28804,2075133_2075127_2075098,00.html?xid=tweetshare">What I Learned from My Cancer Scare</a>" in which he became the the more humbled Mr. Mehmet Oz. As noted previously here, <a href="http://davisliumd.blogspot.com/2010/09/dr-oz-colon-cancer-screening-colon.html">Dr. Oz last summer had a colonoscopy at age 50 and much to everyone's surprise had a precancerous colon polyp</a>. He was advised to follow-up again for a repeat test in 3 months.<br />
<br />
As the Time magazine piece noted, he didn't return for 9 months despite repeated reminders from his doctor.<br />
<br />
From this experience, he essentially stumbled upon what has been challenging American medicine and primary care. How do we enable patients to do the right thing and get the screening tests done and treatments necessary to avoid premature death and maintain a high quality of life? As a highly trained professional, Dr. Oz knows the risks and benefits of not doing a preventive screening test. As a doctor, he knows all of the secret protocols and codespeak we use when calling patients or asking them to see us in the office for important matters. As a doctor, he also understood the importance of a repeat colonoscopy to ensure no more colon growths.<br />
<br />
Yet he didn't return for 9 months. Why?<br />
<br />
None of us want to deal with our mortality. Having a screening test means there is a possibility that the test may be abnormal and now we must confront it face to face. Skipping the test means to be blissfully ignorant, even if it is the wrong thing to do.<br />
<br />
Also, as Dr. Oz noted, many individuals, particularly those who are otherwise healthy with no family history, feel that many of these tests or interventions don't apply to them. Trust me, I know. As a practicing primary care doctor, do you know how hard it is to convince someone to get screened for colon cancer? Get vaccinated for pertussis, influenza, or pneumonia?<br />
<br />
Dr. Oz, however, did discover what will compel people to do the right thing. It isn't about statistics. It isn't about knowledge. (And though he never discussed it, <a href="http://davisliumd.blogspot.com/2011/02/why-consumer-driven-health-care-will.html">it certainly won't be consumer driven health care where the theory is that forcing people to have more financial "skin in the game" will enable the right behavior</a>). It's about getting to our emotions.<br />
<br />
<blockquote>
Most important, my colonoscopy wasn't entirely about me. It was about my wife and our children. It's about our someday grandchildren. It's about my childhood friends whose lives remain closely intertwined with mine. It's about my colleagues and patients at the hospital who teach me as I learn from them. I need to be there for all these people I know and care about. I need to show up in my own life. And you need to show up in yours. Sometimes that requires courage — the courage to undergo a colonoscopy or Pap smear or mammogram or chest X-ray. It's not easy, but it could save your life. And if it helps even a little, remember that I will be rooting for you.</blockquote>
<br />
Reminding our patients that their inaction isn't just affecting their own livelihood but their network of family and friends. It's the reason why certain topics in the media, like the concerns about vaccine safety and autism, gain far more momentum than the scientifically researched and proven life saving interventions and treatments do. <br />
<br />
They focus on the emotional aspect of us that make us uniquely human.<br />
<br />
Until we, as doctors, employ those same tools, too many Americans will not learn from Dr. Oz's cancer scare or those from a variety of public figures. The same problems will simply repeat themselves, just different people become spokespersons (note Katie Couric from a decade earlier regarding colon cancer screening).<br />
<br />
Though highly unlikely Dr. Oz will ever read this article, one thing he must do is to highlight the need for a robust primary care workforce and inspire a generation of doctors in training to become the front-line of prevention. Despite his work as a public figure, the intimate and personal conversations needed about preventive tests and treatments happen one on one at a primary care doctor's office. <a href="http://davisliumd.blogspot.com/2009/12/why-medical-students-should-chose.html">And we certainly need a lot more of us to get the job done.</a>
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</iframe>Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com0tag:blogger.com,1999:blog-7255776707298393367.post-23157063330448050092011-04-25T10:56:00.000-07:002011-04-25T10:56:26.343-07:00The Disappearing Family Doctor - Is It a Bad Thing?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh1GICk_i3sDtI5FQtG_JuKOv2GriByA3U8PR-EQW1iMHaoCv03nohRoGI8B4M_LZvI-s2_Yc1WT6qU13eaTvlo1XC_bhfnLZT7-XwVfzey4NBXATtASzJvX6QFK8QA81WtRdPFalQjwY/s1600/doctor1.gif" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh1GICk_i3sDtI5FQtG_JuKOv2GriByA3U8PR-EQW1iMHaoCv03nohRoGI8B4M_LZvI-s2_Yc1WT6qU13eaTvlo1XC_bhfnLZT7-XwVfzey4NBXATtASzJvX6QFK8QA81WtRdPFalQjwY/s200/doctor1.gif" width="200" /></a>The New York Times recently published an article titled the <a href="http://www.nytimes.com/2011/04/23/health/23doctor.html?_r=1">Family Can't Give Away Solo Practice </a>wistfully noting that doctors like Dr. Ronald Sroka and "doctors like him are increasingly being replaced by teams of rotating doctors and nurses who do not know their patients nearly as well. A centuries-old intimacy between doctor and patient is being lost, and patients who visit the doctor are often kept guessing about who will appear in the white coat...larger practices tend to be less intimate"<br />
<br />
As a practicing family doctor of Gen X, I applaud Dr. Sroka for his many years of dedication and service. How he can keep 4000 patients completely clear and straight in a paper-based medical system is frankly amazing. Of course, there was a price. His life was focused solely around medicine which was the norm of his generation. Just because the current cohort of doctors wish to define themselves as more than their medical degree does not mean the care they provide is necessarily less personal or intimate or that the larger practices they join need to be as well.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUFlZB2JHYhSPiWy1Fqq-0U9Om8keZMCmOBTDiv_B7qbYfJTSOVaztTXKyBDJNJ5h4uWbRSew_DtC6EOrLwFvbC6krea0rVdGgE8cWDFKIP7aetv48izwuvNG7jO2IrZ7Ws-CYDpUOkq0/s1600/doctor2.gif" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="169" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUFlZB2JHYhSPiWy1Fqq-0U9Om8keZMCmOBTDiv_B7qbYfJTSOVaztTXKyBDJNJ5h4uWbRSew_DtC6EOrLwFvbC6krea0rVdGgE8cWDFKIP7aetv48izwuvNG7jO2IrZ7Ws-CYDpUOkq0/s200/doctor2.gif" width="200" /></a>The New York Times article and many patients typically confuse high quality care with bedside manner. Not surprising. In the <a href="http://www.ebri.org/pdf/EBRI_Notes_11-2005.pdf">November 2005 survey by the Employee Benefits Research Institut</a>e, 85 percent or more of the public felt that the following characteristics were important in judging the quality of care received:<br />
<br />
<br />
<blockquote>The skill, experience, and training of your doctors<br />
Your provider’s communication skills and willingness to listen and explain thoroughly<br />
The degree of control you have in decisions made regarding your health care<br />
The timeliness of getting care and treatments<br />
The ease of getting care and treatments</blockquote><br />
The first three items relate to the ability of a doctor to translate knowledge, training, and expertise into the ability to listen, communicate, and partner with a patient. This is bedside manner. The last two items relate to whether a patient can be seen quickly and easily when care is needed.<br />
<br />
But beyond bedside manner and ease of getting care, both which are very important, does the public care about getting the right care or just assume that it is a given? My suspicion is that they assume all medical care provided by doctors is the same, yet research demonstrates the contrary. One study found that <a href="http://davisliumd.blogspot.com/2010/04/seventy-five-percent-of-primary-care.html">75 percent of primary care doctors provided the wrong type of colon cancer screening. </a>Those most likely to do the wrong test after a positive stool screening test? Those who graduated from medical school before 1978, who were not board-certified, and who were in solo practice. <br />
<br />
Personal relationships between doctors and patients are important, but that should not be the only criteria regarding high quality care. <br />
<br />
I love primary care. I've worked at Kaiser Permanente (KP) in Northern California since 2000, a "larger practice". The number of patients a full-time doctor cares for is about half of the 4000 patients of Dr. Sroka's. Doctors have access to a <a href="http://davisliumd.blogspot.com/2011/02/why-this-primary-care-doctor-loves-his.html">comprehensive electronic medical record</a> that provides real-time information about a patient's lab work, imaging studies, and medications 24/7. Primary care doctors and specialists can collaborate working off a common database and eliminating the uncertainty that exists in a paper based medical system and when doctors work in isolated solo practices. Our primary care doctors are supported with a call center which is open all year round day and night to provide patients advice on symptoms and advice on when problems can be safely cared at home, when a doctor's appointment is needed, or when medical care is more emergent.<br />
<br />
In other words, doctors can be doctors.<br />
<br />
Let's not assume or confuse the rising trend of large group practices or the implementation of more electronic medical records and technology in doctors' offices as automatically dooming doctor-patient relationships to becoming more impersonal. The rise of social media like Twitter and Facebook have increasingly made society more connected than ever.<br />
<br />
If Americans and doctors want solo practices, then they will demand them. Certainly there are successful solo practice models like the <a href="http://www.idealmedicalpractice.com/info.html">Ideal Medical Practice</a>, which also supported by information technology, that can provide patients with a doctor who is a sole proprietor. To say all primary care doctors should join large group practices should be absurd because doctors like patients are individuals and one type of practice does not fit all. <br />
<br />
Yet, the fundamental problem with this New York Times piece is the implication that solo practices provide doctor-patient relationships that are more intimate and where patients have a level of trust and confidence in doctors that perhaps exceeds that of thoughtfully designed larger practices. It offers no evidence if the quality of care delivered is as good. Let's not use a practice model which was prevalent in the 1960s and assume its passing is a bad thing. It may not be up to the challenges of the 21st century.Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com1tag:blogger.com,1999:blog-7255776707298393367.post-12705980421744436842011-04-13T21:53:00.000-07:002015-01-20T23:37:00.869-08:00Does America Want Apple or Android for Health Care?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjko_BIN21K_WTnvbiPgvDDpidY6PSx9_MMd1dJs7ehfcu7WFUi67NKvcTY1vvL_Oxi-pMGIViwl9d2KEkkTtGaaTy5BxSfxDbj2yah2_yn6Orq-YYukj5OUqDD6i_8CfnytXGqLpzjrw/s1600/apple-logo1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjko_BIN21K_WTnvbiPgvDDpidY6PSx9_MMd1dJs7ehfcu7WFUi67NKvcTY1vvL_Oxi-pMGIViwl9d2KEkkTtGaaTy5BxSfxDbj2yah2_yn6Orq-YYukj5OUqDD6i_8CfnytXGqLpzjrw/s200/apple-logo1.jpg" height="200" width="165" /></a></div>
The future direction of American health care is unclear. Certainly the cost trend as it exists is unsustainable with health care costs being a major concern of the private sector, the government, and individuals. How does the nation manage costs while ensuring high quality medical care, access, and service? Proposals include increasing competition among insurers, providers, and hospitals to drive down prices or giving more financial responsibility to patients via higher deductibles and co-pays with the belief that they will demand price transparency, shop around for the best price, and as a result slow health care costs.<br />
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What if both ideas are wrong?<br />
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While it is possible these plans might work, I cannot help but notice the similarities in the challenges for patients in navigating the health care system and consumers figuring out how to purchase and use technology. Walk into your neighborhood electronics store. Individuals are overwhelmed with the number of product choices, manufacturers, differences in technical specifications and features. In the majority of situations, consumers are unsure of what they are purchasing. They want something that just works, whether surfing the internet, making home movies, or being connected with loved ones. The gap in knowledge between an expert and a consumer is great and often unintentional and unapparent.<br />
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<h3>
Two Different World Views - Apple or Android? </h3>
<br />
Within the technology world, there are two groups of thought. The first group offers technology in a closed system, like Apple, where the focus has been on just making things work. There are a limited number of product types and designs. For example, its current smartphone, the iPhone 4 comes in only two types. Aside from the base memory of 16 GB or 32 GB and two different prices, the phones are otherwise identical in features with the same apps, cameras, and ability to record video. Although the specifications are available for anyone to see, the focus is rarely on the technical elements of the products themselves and more on what they can do for you. Walk into any Apple retail store and the products are situated by function. Staff ask not how much computing horsepower, storage space, or CPU speed one needs, but what one plans on using the smartphone or computer for.<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtlCPU_-b2obCXz5TIfWIrC8rxd1di0qahTA3bKWC-icTycNb7c7gG4XaGSvyZWPjT3DpG3_q5rrF8MXVBh4mie5xSRUMLu7lnPO_UDiNwLB4iE_2MTxYAsAsOlthgy9oAKMWZbhoU4uY/s1600/android-logo.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtlCPU_-b2obCXz5TIfWIrC8rxd1di0qahTA3bKWC-icTycNb7c7gG4XaGSvyZWPjT3DpG3_q5rrF8MXVBh4mie5xSRUMLu7lnPO_UDiNwLB4iE_2MTxYAsAsOlthgy9oAKMWZbhoU4uY/s200/android-logo.jpg" height="200" width="181" /></a><br />
In contrast, Google's sponsored Android platform, which runs smartphones from a variety of manufacturers gives consumers maximal choice. Companies like Motorola, Samsung, HTC, and LG offer a variety of combinations of styles, features, and ironically even different software versions at various price points. Verizon and AT&T wireless offer no less than 10 different Android based smartphones. The amount of choice and options could be intimidating. While potentially an Android smartphone could be cheaper than a comparable Apple iPhone, people often fail to account for all of the time and energy spent on researching, thinking, and also potential worry and buyer's remorse that the right choice was made. The time and energy spent does cost, either monetarily or emotionally.<br />
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Which one would you choose? A system which just works, gets the job done, and has been designed to fulfill most of your needs? Or alternatively, a different system which provides more choice, more options, and in many cases, requires more time to research and become an expert to make the best decision?<br />
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<h3>
Choice - Competition - Let the Consumer Do the Integration </h3>
<br />
If you look at proposals and trends in health care, it appears many are advocating for Android. <br />
To manage costs, consumer driven health care, where patients have more financial responsibility via the addition of deductibles and higher co-pays are felt to be the answer. The patient is the party accountable to having the right tests done, finding the right doctors, reviewing and maintaining their medical chart using personal health records, and shopping around for the best price when it comes to imaging and other procedures. After all, who has the most motivation to make the best choice but the individual who's life depends on it?<br />
<br />
Increasingly there is research that shows people are decreasing health care costs. Unfortunately it is not the behavior of avoiding expensive excessive care (opting to see a primary care doctor rather than the emergency room for non-emergent evaluation) but skipping preventive tests, prescription medications, follow-up evaluations to treat chronic conditions at the early stage to prevent future complications. If true, the implications of these small inconsequential choices by patients could be problematic years later.<br />
<br />
Also similar to Android philosophy, others argue for more competition. With the consolidation of insurers and in some case providers and hospitals over the years, understandably <a href="http://www.boston.com/news/local/massachusetts/articles/2009/01/23/partners_insurer_under_scrutiny/">many are concerned that prices are driven higher through monopoly power.</a> Instead, the belief is that having many insurers, providers, and hospital networks will improve health care as they compete for patients on areas of service, quality, and access. The market will reward those who are best in providing all three. With the large number of competitors, groups will be unable to have pricing power and therefore costs will be managed.<br />
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Providing patients plenty of choices is proposed as the key to fixing the health care crisis. Perhaps this is the reason for the creation of insurance exchanges in the recent health care reform legislation. Patients will have the opportunity be to select health insurance plans which are not tied to their place of employment. Let them figure out which insurance plan is the best. Have them figure out which doctors take their insurance and are the best. They can select from their menu of different hospitals and determine the best one for their needs.<br />
<br />
<h3>
Health Care Integrates So Patients Don't Have To </h3>
<br />
Is there another way? Would patients prefer a different system which is integrated and seamless and where patients can focus on simply getting better and not spending time and energy trying to figure out where to go and who to select?<br />
<br />
One example might be where I work, at Kaiser Permanente in Northern California, a vertically integrated organization with health plan, hospitals, and doctors working together to provide care that is convenient, simple, and personal for our members. Dr. Atul Gawande in his June 2009 New Yorker piece, the <a href="http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande">Cost Conundrum</a> noted places like Grand Junction, Colorado, were able to provide high quality care at lower costs when doctors worked together. Other organizations which were physician led and accountable also had similar outcomes. <br />
<blockquote>
Grand Junction’s medical community was not following anyone else’s recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care. </blockquote>
<blockquote>
This approach has been adopted in other places, too: the Geisinger Health System, in Danville, Pennsylvania; the Marshfield Clinic, in Marshfield, Wisconsin; Intermountain Healthcare, in Salt Lake City; Kaiser Permanente, in Northern California. All of them function on similar principles. All are not-for-profit institutions. And all have produced enviably higher quality and lower costs than the average American town enjoys.<br />
<br /></blockquote>
Perhaps this is the reason for the creation of Accountable Care Organizations in the health care reform legislation. Whether the legislation and regulations can foster and replicate similar organizations and outcomes remains to be seen. What I can tell you is that within my organization, doctors, nurses, and support staff are working hard to improve how care is delivered to our members much the same way I suspect software engineers and designers at Apple focus on <a href="http://www.youtube.com/watch?v=tyEpaPEbjzI&feature=player_profilepage">their technology to make it intuitive and so it just works.</a><br />
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<h3>
Why a Patient Choose Kaiser Permanente </h3>
<br />
Perhaps there is no illustration better of the potential of American health care than the <a href="http://thelizarmy.blogspot.com/2009/03/i-heart-kaiser-permanente.html">words from a patient.</a><br />
<blockquote>
<h4>
Here's why I chose Kaiser for my medical needs at age 25:</h4>
1. I liked their Web site.<br />
2. It was easy to set up appointments over the phone and via the Internet.<br />
3. They have a 24-hour Advice Nurse phone line which is helpful if your parent is not "just a phone call away".<br />
4. Through the Web site you can choose a primary care physician and OB/GYN by location, gender, and bio. If you don't like your choice you can always change it later.<br />
5. You can email non-urgent messages to your doctor through the Web site and your doctor has to respond within 48-hours.<br />
6. The Kaiser Web site will send you an email when test results are available online.</blockquote>
<blockquote>
<h4>
At age 29, here's why I know Kaiser was the best decision I ever made:</h4>
1. When I was brought to the Kaiser emergency room after my first seizure the staff was able to retrieve my complete medical history, which aids staff in making decisions about my care ... even when I'm unconscious.<br />
2. After scans revealed I had a tumor in my brain, the head of neurology came down to see me and had me admitted to the hospital that night.<br />
3. My newly acquired neurologist arranged for my transport to the neurosurgery center for the Sacramento region.<br />
4. Once I got there I worked with Kaiser's neurological equivalent to Dr. House, except this doctor was way nicer.<br />
5. My neurologist, neuro-surgeon, oncologist, neuro-oncologist, OB/GYN, primary care practitioner, orthopedic doctor, and physical therapist are all informed about my medical status.<br />
6. I never have to seek, or wait for, a referral. If a new specialist is needed for my care I get to see him/her as soon as I'm able to get a ride.<br />
7. I can get lab work done at any Kaiser facility and the test results are sent electronically to the requesting doctor within minutes/hours (or a few days if it's analysis of brain tissue).<br />
8. Kaiser specialists network with peers from other medical institutions and often seek second and third opinions for you. They'll even tell you who disagreed with them and why. If you want to get the second opinion yourself they are respectful of your decision and make sure you get all required materials to make this happen (e.g., charts, scans).<br />
9. After my most recent brain surgery, my tissue was analyzed by pathologists in Sacramento and Oakland, then sent to Kaiser in Redwood City, who sent it along to UCLA.<br />
10. While my friends and I did a lot of our own research, Kaiser made it easy for us to get treatment. We never had to figure it out all by ourselves and my doctors/nurse practitioners answered every question I had ... even the silly questions.</blockquote>
<h3>
The future of American health care is unclear. Do Americans what Apple or Android for health care?</h3>
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Let's let them decide.Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com1tag:blogger.com,1999:blog-7255776707298393367.post-9491894342745891732011-04-01T23:42:00.000-07:002011-04-01T23:42:02.661-07:00The Rise of Desktop Medicine -- Wrong Terminology, But Right Thing to Do<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2xrfGHbLsvddaqaRJxX7zmUNeRdromrHBo5TsikBWiYkqZa4i6XIrv843nKKujHablhaB_X0nu4dXTg130_A0pMCpbiSuIAHOfLDP0ooe8S2NrGo_kmT0MrVuByzz0v8bFgeMG80Kvh0/s1600/30chen-blog480.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2xrfGHbLsvddaqaRJxX7zmUNeRdromrHBo5TsikBWiYkqZa4i6XIrv843nKKujHablhaB_X0nu4dXTg130_A0pMCpbiSuIAHOfLDP0ooe8S2NrGo_kmT0MrVuByzz0v8bFgeMG80Kvh0/s200/30chen-blog480.jpg" width="200" /></a></div>A recent NY Times article, <a href="http://well.blogs.nytimes.com/2011/03/31/the-rise-of-desktop-medicine/">the Rise of Desktop Medicine</a>, highlighted the use of technology in accessing information (desktop medicine) and how doctors were spending less time with patients (bedside medicine). Many doctors were concerned about the change and longed for the old days. Yet, the reality is that with more medical knowledge, doctors must retrieve information from clinical trials, calculate risk of heart attack or osteoporosis, rather than rely on intuition, particularly when data exists.<br />
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My biggest problem with this article really was with the term desktop medicine. I don't like it. Certainly over the past few decades, our understanding of certain illnesses has become more precise, the interventions and treatments more clear, and therapies more evidence based (precision medicine). Other illnesses, however, still continue to be more challenging and determining the correct course of action less clear (cognitive or intuitive medicine). <br />
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Precision medicine, a term used by <a href="http://davisliumd.blogspot.com/2010/12/best-book-on-healthcare-reform-or.html">Harvard Business School Professor Clayton Christensen</a>, has simply occurred at the same time computers and the ability to rapidly access information developed. Imagine if medical science knowledge had evolved but that there was no infrastructure or technology available to retrieve information like clinical trial outcomes quickly. Doctors would still be treating patients based on intuition rather than science completely oblivious to the latest knowledge. Research has shown it takes 17 years before outcomes from research studies become commonly practiced in the community. <br />
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No desktop medicine isn't the right term to describe the phenomenon in medicine. It implies doctors are simply indentured servants to computers and technology. Nothing could be further from the truth. Generations ago, doctors had few tools and treatments. When people developed pneumonia, we could do nothing but wait and hope because antibiotics were not discovered yet. We simply comforted individuals and families. Many people died.<br />
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Today we have more tools, more treatments, and a better understanding of many, but not all illnesses. To say this additional knowledge and the ability to retrieve this information somehow erodes the doctor patient relationship is incorrect. We can still be caring and use our technology to access information to make the care of the patient in front of us more precise and personalized than ever before.<br />
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No, the terms desktop medicine and bedside medicine are incorrect because they provide the wrong type of connotation. The former term implies cold and impersonal. The latter term suggests humanity and comfort. Better terms with less emotional attachment would be precision medicine and intuitive or cognitive medicine.<br />
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I'm a big fan of the <a href="http://davisliumd.blogspot.com/2010/10/abraham-verghese-top-gun-of-american.html">art of medicine and bedside manner</a>. I also love how <a href="http://davisliumd.blogspot.com/2011/02/why-this-primary-care-doctor-loves-his.html%20">my computer allows me to make care more convenient and more personal. </a><br />
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The next generation of doctors must be experts at both bedside manner and using the vast knowledge of medical science to make care precise in areas we have good understanding. For illnesses where we don't, we still do what we did generations ago, comfort and heal. <br />
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No computer will ever replace that.Davis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.com0