13May12 Social Docs

What is “social medicine”?

For some, it becomes a discussion of doctors and other health professionals who have jumped into the social media fray. Whether it’s blogging, Twitter, Facebook or the like.

Which raises a question:

Does it matter to you if your doctor has a social media “presence?” Do you care if your doctor has a Twitter feed or blog?

The blogosphere is full of doctors and patients who care deeply about social media. It’s generational. Twenty-somethings simply expect to be able to find information–both about medical topics and about their doctors on the web. But it’s not just the young ones. The fear is that not establishing a presence will cause “brick and mortar” doctors to lose business if they aren’t social media-savvy.

What do you think? Do you email your doctor? Is your doctor willing to email you?

Research shows that less than 10% of doctors communicate with patients via e-mail. Reasons for this include

  • another source of traffic to tend to
  • no compensation for the time and energy
  • perceived lack of security regarding personal health information.

Patients that do have email communication with their doctors are enthusiastic about it. It saves time. It saves visits. Therefore it saves money. Satisfaction is high.

With the adoption of electronic health records (EHRs), practices often buy systems that include patient portals. These are clunky but secure channels that allow patients to see some of their health records and get some questions electronically answered. Too often the portals simply are tools to generate more visits to the office.

Entrepreneurs are furiously trying to develop applications to address the present need for patents to better communicate with their doctors.

One such company is Twistle (disclaimer: I am one of their physician advisors), a Seattle-based startup that is beta-testing a delightful, secure communication tool for doctors to talk to each other, our staffs, and our patients.

Whether Twistle is successful largely depends on its ability to meet the expectations of the marketplace and garner market share and attention for its application. Whether you’re a doctor or a patient, I encourage you to try it and see what you think. Your feedback is welcome.

“Social medicine” also brings to mind the social purpose, or social utility of the profession. This week thought leaders are coming from around the nation to Tulsa, Oklahoma, to discuss the question, “What is the social mission of medical education in the 21st century?”

It’s all part of an effort known as Beyond Flexner 2012, a Kellogg foundation-funded study that looks at innovative ways of educating doctors to care not just for patients but also for entire communities.

Look for a Twitter feed about the conference under the hashtag #Flexner2012. You’ll also see news posted right here at GlassHospital.

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6May12 LabOregon

The Wall Street Journal ran a story about a new plan in Oregon to provide health care for less money.

Also starts with O

Paradoxically, the federal government is giving the state $1.9 billion over five years to make it happen. According to the state’s health authority director (and quoted from the article), “The state expects to net a full return on the federal investment within five years.”

The plan invests in the state’s Medicaid program.

Most Oregonians on Medicaid are already enrolled in managed care plans–the type that force people with that type insurance to get care at specified places with specified doctors using a restricted list of state-approved medications.

Nothing really novel in that approach. There simply has to be some way to rein in costs.

In this 21st century version of managed care, the state will organize doctors into groups, and pay them a set monthly fee based on the number of Medicaid patients that they care for.

When health care is paid for like this, people get excited:

–On the plus side, the medical establishment is incentivized to find cost-effective ways to treat people and prevent expensive things like hospital admissions. This is an overall good, in that it usually drives innovation and greater attention to a process known as case management. More attention is paid to those with chronic conditions like heart failure, diabetes, or emphysema.

–On the minus side (and we had experience with this in the 20th century), incentives to lower costs can lead to skimping as the main means of controlling costs. For every insured patient that doesn’t use health services, more of the pot of money stays around.

One thing I find interesting about the Oregon experiment is that instead of using the already-cliched term accountable care organization, the term here is coordinated care organization.

Is this just a tweak in jargon or a meaningful change in lexicon?

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29Apr12 The Gift that Kept Giving

Old guy, generous young guy and his even more generous sister. (Photo: AP)

In case you missed it, there was a heartwarming story in the news about two kidney transplant recipients.

One, a young man with an autoimmune disease that destroyed his kidneys, was lucky enough to receive the gift of a kidney from his sister.

When the new kidney started to fail from the same disease process, he was offered the chance to have it removed so that another, older patient (who did not suffer from the same disease process ) could try to benefit from it.

Charitably, both he and his sister (the original donor) accepted this plan.

It worked!

The older gentleman (who happens to be a retired surgeon) is now in good condition, off of dialysis, and feeling better than he has in years.

According to news reports, this is the first documented U.S. case of ‘kidney recycling.’

For you medical buffs, the disease in question is focal segmental glomerulosclerosis (“FSGS“). And it’s not unusual that it would harm the donated kidney-the disease process occurs independent of the origin of the kidney (i.e. even if the donated kidney had come from an unrelated donor, his FSGS would have started going to town on that one as well). According to the literature, this happens ~40% of the time.

Yet when removed from the FSGS environment, the kidney recovered function and now works well in a new recipient.

Weird science!

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22Apr12 Local Flavors

stuff of legends

Moving is never easy–especially leaving behind family, friends, and patients that you care about, and a workplace that provided opportunities to grow.

One of the more interesting aspects, though, is comparing and contrasting the old and new places.

People often stop me on the street and ask, “Hey, Glass–how do you like Oklahoma?”

  • “Don’t you miss Chicago?”
  • “Are there any differences between the two?”
  • “What about the health care?”

Politics aside, three things are starkly different about life in Oklahoma vs. life in Chicago.

For me, the big three are

  1. Oil
  2. Native Americans
  3. Meth

These three cultural/social/economic touchstones are woven through the fabric of everyday life here, “where the Midwest, South, and Southwest collide.”

I knew (and still know, though my learning curve is steep) nothing about oil beyond liberal pieties on fossil fuels, OPEC, and global warming. Oklahoma (and much of the continental U.S.) is felt to be newly awash in petroleum reserves due to the technological advances in drilling and extraction. Horizontal drilling and fracking have changed the game. Fracking is in play as a political issue (I imagine, in large part due to works like Jonathan Franzen’s “Freedom,” and controversy over whether or not it can pollute ground water and/or cause earthquakes…), and until I learn more, I will steer clear of editorial comment. For now.

Oklahoma has only been a state since 1907. Before that, it was known as Oklahoma Territory. The Trail of Tears gave multiple Native American tribes new homelands here, which are still present. Oklahoma is home to more Native Americans than any other state (Alaska has more per capita, 13% of its population). As such, they have important impact on the state’s culture, politics and economy.

Unfortunately, Oklahoma is also a leader in both production and use of methamphetamine. Stories about meth in local media tend to come in spurts, usually related to crimes or busts committed over the stuff. That and becoming addicted to the series “Breaking Bad” have raised this issue into my consciousness as a severe public health problem.

Regarding health care, know that the major reason we moved here was the challenge of working to improve the health of one of the least healthy states in the U.S. This topic is fodder for future posts, but I’ll leave you with one cultural difference:

Whereas in Chicago people in need of chronic pain medication would favor the opioid Vicodin, here people flatly refuse the stuff and instead demand Lortab.

I consider it strange since medicinally speaking, they’re exactly the same thing.

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15Apr12 Churchin’ Up

"You get wise! You go to church!"

You may have seen advertisements in your local paper (do you still get one of those?) or in your [junk] mail offering you health screening tests at discount prices.

  • No doctor’s order necessary!
  • Submit to all five tests  and get discount pricing!

You can take the handy-dandy results issued from these purveyors and head right over to your local doc’s office to discuss any findings. These companies want to help you (and your doctor), after all.

In their promotional materials and on their websites, these for-profit outfits offer testimonials from happy customers that screening tests “saved their lives.”

What you won’t hear from the companies is that the best medical evidence that we have would caution patients AGAINST having these tests–because the science says they don’t save lives and aren’t indicated for people in the general population. In aggregate, tests like these cause MORE HARM than GOOD.

The companies also won’t tell you that if you have one of these tests and it’s not totally normal that you’ll now be subject to repeat testing (presumably by your real doctor inside the medical system) ad nauseum and untold anxiety that you’re slightly less than perfect. That’s an example of HARM.

What I find particularly galling about these companies is that they target lambs er, people where they are most vulnerable: at their places of worship.

Who, after all, would question the well-intentioned offering of preventive health screenings (albeit for profit-making fees) at church?

Seems like a win-win: Your clergy person thinks s/he is doing a mitzvah offering a resource to the community. The doctors in the congregation, loathe to upset the apple cart, would never want to dissuade their brethren from taking health seriously. [That, and they may have some financial interest in such an arrangement.] The congregants get “health” without having to go their doctor.

Convenience. For a price.

You can read a more scholarly discussion of this phenomenon here [local paper! I still get one!]. Then the ripple rolls out a little further.

Please comment or email here if you’ve had screenings from one of these companies or worked for one. I’d love to know about your experiences.

-GlassHospital

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