29Jul10 Taking Stock

GlassHospital...soon to be listed on the Big Board...invest now!

This week I wanted to tell you how grateful I am that you’ve been a GlassHospital reader.

We’re at the six month mark of our “go live,” and I wanted to share with you some of the successes that you’ve helped make possible.

In six months of “publication,” GlassHospital has been seen by:

  • 9,000 unique visitors from
  • eighty-four (!) different countries that have combined for
  • 53,000 page views.

The most popular posts have been:

  1. “Emergency” (the very first one!), followed by
  2. “A Good Death” and
  3. “Lifestyle Modification“

Feel free to check them out if you haven’t, or take a trip to refresh your memory. I’d like to think that the popularity of posts is predicted by the high-quality writing, but I also believe that it has everything to do with topic selection. People love to bash the ER, so I felt compelled to offer some thoughts on its successes and failures. Dying in America is a hot button issue; if you’re not a subscriber to The New Yorker, do yourself a favor and read Atul Gawande’s long article in this week’s (August 2, 2010) issue called “Letting Go.” As for healthy lifestyles, many people have asked me whether I’ve kept up with the Engine 2 diet. No. Well, not entirely. But I’ve put many of the principles into practice and have developed a modified version, reflecting my non-absolutist tendencies.

Other highlights:

Writing this blog, developing ideas that come to mind about demystifying medicine, has helped clarify my thinking. I’ve realized now that many of my posts are about “patient experience.” This is because I have a passion for making hospitals work better for patients, and in so doing, improving hospital performance. Shooting for the proverbial win-win. It’s helped me enlarge the scope of my job, and given me the confidence to talk with senior management about implementing patient-centered ideas. It’s still a daily struggle.

The emphasis on patient experience led me to the Cleveland Clinic to participate in and cover the first ever Empathy and Innovation/Patient Experience Summit. I’ve set a goal of being invited back next year as a presenter, to offer my thoughts on “Improving Patient Experience: From Zero to Sixty in One Year.” Blogging has helped me think up catchy titles before I even know what I might say or write. There’s still a lot to accomplish to earn that invite.

Lastly, joining the blogosphere has been a wonderful educational and networking experience. Posts from GlassHospital have been picked up by KevinMD, “social medicine’s leading physician voice,” as well as two different blogs from the American College of Physicians, ACPInternist and ACPHospitalist. GlassHospital has also joined the Medpedia network. We regularly contribute to Medical Grand Rounds and even hosted our first one here.

I’ve “met” many other prolific and talented bloggers, and hope to meet many more. I also hope to build a broader audience, so read on, subscribe, tell your friends, and re-post entries liberally when you think they are worthy on Facebook, Twitter, etc. As always, your comments are very welcome, as are your questions, ideas, and health care adventures and misadventures.

Thanks again for stopping by!

-GH

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21Jul10 United Nations of Medicine

Let's make peace happen

Recently, I had the opportunity to decamp from the the friendly confines of GlassHospital and trek a few miles to the north.

GlassHospital has brokered a teaching and patient-sharing agreement with a nearby religiously-affiliated community hospital I’ll call Our Lady of Blessed Proximity.

Our Lady has a residency training program, just like ours, with the major difference being that nearly all of the doctors come from foreign lands.

Something you should know about medicine in America is that there are many more residency training slots (greather than twenty thousand) than there are U.S. medical school graduates each year (fewer than seventeen thousand). International graduates compete to fill those few thousand “extra” spots. These spots typically occur in less prestigious hospitals that are often in locations less desired by U.S. graduates.

I was supervising a team consisting of two residents and two interns (residents in their first year of training after medical school). We even had a couple of “observers” show up late in the month, as they were going to soon be starting their internships and wanted to get the feel of things around the hospital.

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13Jul10 RIP: HP (1939-2010)

Talk about kicking a city when it’s down.

You can take the boy out of Cleveland, but you can probably never squeeze all of the burning Cuyahoga out of me.

After watching the media frenzy surrounding basketballer LeBron James and his utter betrayal/stabbing us in the back exercising his economic options, now this:

Harvey Pekar has died.

Who was Harvey Pekar?

Look up the word curmudgeon. Close your eyes. He’s who you should be picturing.

You can read the real obits to learn about his talents as a raconteur du everyday-ness. He definitely will go down as a pioneer in helping re-invent and propagate the comic book as art form, beyond kids and super heroes.

Yet Pekar’s heroism has other facets: his spent his career working as a file clerk at the Louis Stokes VA in Cleveland (where I did rotations as a med student).

He was an avid jazz fan and collected 78s (whatever those are). He stood up for the little guy against the corporations, going so far as to call David Letterman a “shill” for NBC, back when his show was on Late Night on that network. In other words, back when his show was good. And edgy. And had guests like Pekar.

Those were my high school years. Pekar probably never would have appeared on television if not for the influence of Steve O’Donnell, then Letterman’s head writer who also hailed from off the streets of Cleveland.

The notoriety that Pekar obtained no doubt led to the greenlighting of American Splendor, the 2003 film in which Paul Giamiatti (look in that same dictionary under “dyspeptic”) starred as Pekar.

I once met Pekar at a book signing. He was the same way in person as he was on TV. The same way he was in his comics. And now he’s gone. Another little piece of Cleveland torn asunder.

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11Jul10 Saving Primary Care: Is There Anyone Home?

Dear Readers: This was a pitch for a magazine article, so I apologize if it’s a little too wonk-y. I decided to post it here to see what other ideas you could drum up.

Quick summary: There’s an idea floating around called the Patient-Centered Medical Home–a way to integrate, automate, and improve how primary medical care is delivered in the U.S.

It has the approval of all major medical societies. A ton of money is being spent on a national demonstration project.

It’s never going to work.

*                    *                    *                    *                    *                    *

Patient Centered Medical (?Glass) Home?

The Patient Protection and Affordable Care Act (a.k.a “Health Care Reform”) signed by President Obama in March will revolutionize Primary Care in the United States. By 2014 tens of millions of uninsured people will “enter” the system by being granted insurance, either through expansion of the Medicaid program or through mandated purchasing of insurance via state pools or the private market.

This alone will have a profound impact, straining the capacity of our already frayed system. Therefore, embedded in the law are funds to encourage growth and improvement in Primary Care: Incentives to encourage graduates to enter primary care fields (Family Medicine, Internal Medicine, and Pediatrics) and practice in underserved areas (through scholarships and loan forgiveness), and money to re-format the way that Primary Care is practiced and paid for.

The most prominent example of Primary Care restructuring is something called the Patient Centered Medical Home (PCMH). Currently a national “demonstration” project is underway to show us that the PCMH model is a sustainable way forward. The PCMH promises nothing less than greater access to primary care, delivered with improved quality and safety, better data capture and analysis, all with lower per capita costs. Devotees of the PCMH are surging ahead to tie together the twin strands of incentives for transitioning to electronic medical records and improving on the delivery and payment models of Primary Care.

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6Jul10 A Grand Rounds Celebration!

Hope you had a wonderful holiday weekend.

GlassHospital is proud to host this week’s Grand Rounds, a compendium of medical-related writing and blogging from around the world. This week’s theme, in honor of the holiday, is CELEBRATION. Here at GH we’re pleased to be celebrating the six month anniversary of our debut.

We have 21 pieces to share with you, including one poem and one photo. This week’s submissions, all celebratory-themed, seemed to cluster into five main categories: Aging gracefully, history & literature, medical drama, health care policy, and good ol’ humor. So pull up a chair, maybe a nice iced coffee, and dig in.

Here we go:

Aging Gracefully

Delia O’Hara, a former Chicago Sun-Times reporter, who blogs at Birth Story, wrote a beautiful post celebrating her older daughter’s graduation, and her own good fortune in being there.

Eve Harris, writing at A Healthy Piece of My Mind, wrote in about her family’s “Cancerversary,” a 20th anniversary remembrance of her mother and how the Internet has changed the ways we gather knowledge.

Dr. Elaine Schattner, who hosted last week’s Grand Rounds on her blog Medical Lessons, submitted a wonderful post about the performances of James Taylor and Carole King together both on television (and later after seeing them in concert at Madison Square Garden). Wearing her doctor’s hat, she can’t help but celebrate Taylor’s apparent success in kicking drug addiction. “Life gets better as you get older,” the music made her think. Amen!

Marie Cooper, blogmaster of Nourish: Living, Laughing, Whining sent in a celebration of her resiliency in the face of multiple sclerosis. Fireworks are loaded with meaning for her as she courageously faces her chronic illness.

Finally in the Aging section, we offer Dr. Kimberly Manning, author of Life at Grady, a blog about her doctoring at Atlanta’s most famous public hospital. This post was sent courtesy of the American College of Physicians publication “ACP Hospitalist.” Poor Dr. Manning thought she was the hippest, coolest attending around. Then an outdated reference blew her cred. All of it. Boy, can I relate to this one…

History & Literature

Some of us liberal-artsy types make it here in Medicine. We often celebrate with our writing. Examples:

Look no further than Medical Resident, blogger at A Medical Resident’s Journey. She wrote a lovely poem celebrating her stethoscope.

Michelle Wood, blogger at Occam Practice Management, submitted an interesting history of physician signers of the Declaration of Independence. Very theme appropriate. Know how many signers were docs? Three. [Correction: Four!]

I was lucky enough to be driving last week around the same time as Dr. Charles, and got to hear the StoryCorps piece on NPR from last week about Lillie Love. Dr. Charles sent in a wonderful post about celebrating life inspired by her story, at his blog The Examining Room of Dr. Charles.

Lastly, though not exactly celebratory, Inside Surgery sent in an interesting tidbit that medical buffs and historians will like:  how snake oil earned its reputation–despite purported health benefits!

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