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Demystifying Medicine One Week at a Time

Category: narrative (page 5 of 15)

HealthCare Prediction CheckUp

doc-office-aca_wide-403577f90f9f2aa9fdfb92060c1f512825900d1f-s6-c30A while back I made a list of predictions about the world of health care as we entered the Obamacare era.

Let’s see where we stand:

1. “Obamacare will move forward” — in spite of staunch opposition. — Check.

2. Big Data #1 — you’ll be nudged by your doctor or medical home with reminders for preventive care items like flu shots or colonoscopies. — Check minus. This was already happening (e.g. letters reminding women of annual mammogram screenings), but not yet to the extent I foresee.

3. Big data #2 — targeted medical marketing along the lines of Netflix or Amazon, using your prior purchases/preferences. — Nope. I still see this coming. We are at the precipice of a slippery slope.

4. “Patients will be a step closer to becoming true consumers.” What I meant here is that we will see increasing efforts launched to provide price transparency and comparability for health care services, so that patients will actually be able to value shop. — Big proto-check. Big because of a few key efforts — see Elisabeth Rosenthal’s amazing series called “Paying Till it Hurts” in the NY Times, which inspired its own Facebook group and grassroots effort to rein in health costs and bring greater transparency to the ‘market,’ and Steve Brill’s TIME magazine wholly devoted to the mysteries of the ‘chargemaster’ — we are moving quickly in this direction. But only a proto-check because we are nowhere near where we need to be.

5. “More people will get insurance. The 47 million uninsured will be cut in half within four years…” — Check. We are well on the way. See #6.

6. “By 2020, all states will have expanded their Medicaid pools, providing more coverage to the poorest of the poor.” — Nope. But 27 states and the District of Columbia potentially have us near a tipping point. I gave myself some leeway here, and I’m confident we’ll get there.

7. “The number of nurse practitioners and physician assistants will grow dramatically. Nurse practitioners will continue to gain more independence in practice. A new category of health worker will flourish: the community health worker, a lay combination of social worker and medical provider. In particular, community health workers will help with the 5 percent of people who account for half the health care spending in the U.S.” — You betcha.

8. “We will see the rise of the first nationwide health plans. Archaic rules that keep health care local will be modified to eventually allow for consolidation. Like hotel chains, you’ll be able to get health care at the same organization in different cities. The sponsors may be hospitals, say the Cleveland Clinic, or big health insurers, like Aetna. As with hotels and airlines, you’ll have frequent visitor programs, and you’ll be able to amass points toward discounts and perks.” — Not yet. Just you wait. Industry consolidation (i.e. mergers and acquisitions) will continue and drive this.

9. “The traditional doctor-patient relationship in which a single doctor gets to know you over years will become a luxury.” — Check. Just take a look here. Or here.

Generously scoring, that’s six out of nine right so far. Sixty-seven percent is no Nate Silver, but there’s plenty of time still on the clock for the long range bets.

Stories of Hope and Miracles

christmasgiftartHolidays can make us…sentimental.

Sometimes in spite of a worldview that prioritizes scientific rationality above all us, we see things that aren’t easily explained.

Its important to be open to wonder. Even for docs.

Post by NPR.

Holidays

Last year I wrote a reflection piece for NPR about working in the hospital on Christmas during my intern year, in 1997.

kstreetersnoglobeI remember lamenting my first December having to work straight through. A wise mentor helped me reframe my self-pity. “It’s a privilege to work on Christmas,” he told me. “Our patients count on us. You may not want to be in the hospital, but think of what they’re going through.” He smiled, as if he were welcoming me to a special club, one that I wasn’t wholeheartedly ready to join. “Your mere presence helps reduce each patient’s sense of loss.”

I had the privilege of working again this year, in much less harrowing circumstances. Several of the hospital staff gave me warm nods, acknowledging we were all part of the club — either choosing to work the holiday or ‘taking our turn.’

As an attending physician, it’s one of my jobs to pass on the tradition of medicine as a calling to the next generations of doctors. Using the essay as fodder, I asked my interns how they were coping with working their first Christmas.

One intern replied meaningfully that since he doesn’t celebrate the holiday, he’s glad to be working in place of others so that they can spend time with their families.

I was moved. I do get sentimental this time of year.

Radio as Public Health

micMany of you know of GlassHospital’s passion for radio. Recently, I blogged about a radio-doctor colleague named Anne Hallward, a psychiatrist from Maine whom I was fortunate to interview.

Hallward is the creator and host of “Safe Space Radio,” now in it’s seventh year, a show that’s a back-to-back winner of the Maine Association of Broadcasters’ Public Affairs Award.

She recently gave a TED talk at an event in Maine. It’s compelling viewing, deeply personal, and gives a window into how one caring and empathic doctor has taken her skills to a broader, community-wide, public health level.

It’s well worth a listen.

Tortoises and Hares

slowmedimageI’ve become increasingly aware of a movement, a philosophy, an attitude called Slow Medicine.

The concept is an outgrowth (and homage) of the Slow Food movement.

I’d heard about Slow Medicine from the book “God’s Hotel” by Victoria Sweet, who practiced for two decades at Laguna Honda Hospital outside of San Francisco. Let’s just say that Laguna Honda is not your typical American hospital.

A concept that Sweet shared really stuck with me: viewing the human body as a garden to be tended (a medieval view) instead of the modern attitude of the human body as a machine to be fixed.

Think about that.

More recently, I was fortunate to be included as a recipient of “Updates in Slow Medicine” from two doctors, Pieter Cohen and Michael Hochman, who both trained at the Cambridge Health Alliance, in Massachusetts. That’s where I also trained as a resident.

Their work really resonated, so I was lucky to be able to write about it for NPR:

Post by NPR.
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