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Big data in health care: Are we measuring the wrong things?

Health Policy

July 23, 2014

We believe in data. We are scientists after all. And yet in this new era of big data is it possible we are measuring the wrong things?

Most measures of physician performance are process or intermediate outcome measures aimed at a production line model of care. Was an A1c done, did the physician use a computer to send an order to the laboratory, were antibiotics given within two hours of presentation.

Yet …

Excessive turnover in inpatient care can wreak havoc

Val Jones, MD

Physician

July 23, 2014

If you (or a loved one) have been admitted to a hospital recently, you were probably surprised by the number of times you were asked the same questions. At first you might assume that the staff are being diligent in double-checking your information, but after the fifth healthcare provider asks you to explain why you’re there, you start to feel as if interacting with “the system” is like talking to …

Practicing convenience medicine in the ER

Michael Perraut, MD

Physician

July 23, 2014

It’s easy to get frustrated in the ER. First, you’re at work. Second, most of your patients don’t want to be there. Third, many (if not most) of your patients don’t need to be there. Finally, by the time you see them, most of your patients are tired of being there.

It’s easy to become jaded when you trudge through this never-ending mire of patient after patient, and indeed ER docs …

Here’s why you can’t resist eating that dessert

Peter Ubel, MD

Conditions and Diseases

July 23, 2014

It all comes down to willpower, right? Strength of purpose. Muster the resolve to skip dessert, and you have a shot at losing that spare tire hanging off your belly. Succumb to your temptations, however, and you are simply being weak.

But is it just weakness that causes us to overeat?

A study in Psychological Science suggests that our inability to resist that mouthwatering looking chocolate cake doesn’t arise simply because our …

The VA scandal exposes the folly of metrics

Jennifer Gunter, MD

Physician

July 23, 2014

The Veteran’s Administration is under fire for covering up deaths. Men and women who were eligible for care languished on impossibly long waiting lists and even worse when some died waiting for care their deaths were covered up. This is horrific and everyone wants to know how this tragedy could have happened?

Veteran’s hospitals have long waits in my experience because they are underfunded, many (if not all) patients with complex …

Patient education: Simple solutions are the best solutions

Shirie Leng, MD

Physician

July 22, 2014

In another entry for the communication category, here’s a little play I wrote:

Scene: Pre-op area. Patient arrives for surgery exactly at the scheduled start time, that is, 90-minutes late.

Anesthesiologist (me): Good morning Mrs. Jones. I’m Dr. so-and-so. How are you this morning?

Patient: Oh, doctor, I have the most terrible headache. They told me my surgery was at 11 so here I am at 11, and now they tell me I’m late.

Me: …

8 ways to better support someone dealing with cancer

Elana Miller, MD

Physician

July 22, 2014

As many of you picked up from the tone of my last article, I am feeling much, much better. As more time has passed from the disasters of six weeks ago when I lost my relationship and home (making me feel more physically ill than I had felt this entire time), my body has finally had a chance to recover. I also have benefitted from a …

A case that illustrates the way medicine is meant to be

Ira M. Pinnelas, MD

Conditions and Diseases

July 22, 2014

As most everyone knows, medicine is not an exact science. Every patient and every family must be treated individually. We all recognize that many things have the possibility of not going perfectly, especially when an ill child presents to the hospital. I am lucky enough to be a part of many families’ experiences at the hospital that go so well that you want to tell people about them.

Goodness knows, there …

Do surgical checklists work? A closer look at the data.

Skeptical Scalpel, MD

Physician

July 22, 2014

The other day Atul Gawande tweeted the following:

Some still oppose WHO Safe Surgery Checklist because no RCT was done. Well, new RCT finds it cut complications 42% http://t.co/qWacE54NIW

— Atul Gawande (@Atul_Gawande) June 18, 2014

I am not against checklists. When I was a surgical chairman, I implemented and used one in both the operating room and the ICU. They do not add costs and …

Doctors are not the only ones who can keep a painful secret

James C. Salwitz, MD

Physician

July 22, 2014

I have written many columns urging doctors to be honest with their patients, especially about difficult news. Too often patients are lead on false hope therapy rides, rather than empowered with honest information so that they can cope with their disease and future. Doctors are not the only ones who can keep a painful secret.

I admitted Sarah to the hospital late on Saturday night. For over two years, she had …

Digging deeper into the Commonwealth Fund health rankings

Margalit Gur-Arie

Health Policy

July 22, 2014

The Commonwealth Fund just published its fourth Mirror, Mirror on the Wall study comparing the U.S. health care system with other countries, and as in all previous studies, we ranked as the absolutely worst health care system in the developed world, bar none.

Yikes.

The Commonwealth Fund studied many health care domains, and we didn’t rank in first place for anything. The best we managed to do is place a lackluster third …

Bad medical care: Is it better than none at all?

WhiteCoat, MD

Physician

July 21, 2014

In my past few shifts in the emergency department, I have seen the following patients who were seeking further care after being treated by other providers.

One was a child who had been seen twice at an urgent care clinic. He had a fever of 103 degrees and wasn’t eating. The first time he went to the urgent care center, he was diagnosed with an ear infection. He was started on …

The difficulty of moving the needle on patient safety

Ashish Jha, MD, MPH

Health Policy

July 21, 2014

Adverse events — when bad things happen to patients because of what we as medical professionals do — are a leading cause of suffering and death in the U.S. and globally. Indeed, as I have written before, patient safety is a major issue in American health care, and one that has gotten far too little attention. Tens of thousands of Americans die needlessly because of preventable infections, medication errors, surgical …

Fitbit in health care: Is more data better?

Kevin R. Campbell, MD

Health Technology

July 21, 2014

For scientists and researchers who are developing new treatments for disease, Data is power. For patients, Data can mean empowerment. Devices that track health indicators are readily available. These devices can track heart rate, blood pressure, blood sugar and even respiratory rate and body temperature.

In the Wall Street Journal, the medical applications of the Fitbit device are explored. The Fitbit is a basic pedometer that tracks movement, steps taken, calories consumed …

The future of doctors? Airline pilots provide a clue.

Suneel Dhand, MD

Physician

July 21, 2014

When I was a boy, my dream was to become an airline pilot. The job seemed glamorous and exciting, and appeared to be held in high regard by all the people around me. I actually used to have a bit of an obsession with airplanes, and living so close to Heathrow Airport, had plenty of opportunities to see planes and visit the airport: both as a passenger and whenever we …

The suspect quality improvements of the medical home

Ira Nash, MD

Health Policy

July 21, 2014

There is an old gag about an intensely optimistic child whose bright outlook on life is so irrepressible that when he is presented with a room full of manure for Christmas, he screams with delight, convinced that there “must be pony in there someplace.”

I was reminded of that when I read the recent research report and the accompanying …

Paying the doctor directly is better for all concerned

Stephen C. Schimpff, MD

Physician

July 21, 2014

Next in a series.

The fundamental problem in health care delivery today is a highly dysfunctional payment system that leads to higher costs, lesser quality and reduced satisfaction. It also means less time between doctor and patient with the loss of “relationship medicine.” The core problem? Price controls and regulations that reduce the trust and core interactions between doctor and patient. The patient is no one’s customer and visit …

We need to make eating real food a whole lot easier

Brad Stulberg

Conditions and Diseases

July 20, 2014

I want to commend Mark Bittman on the underlying message in his recent editorial in the New York Times, “What Causes Weight Gain.” Bittman suggests that as much as we need research to “determine precisely what causes diet related chronic illnesses,” we also need a program that will get this “single, simple message across: eat real food.” While we have yet to isolate what in our diet is …

Personal health data: 5 key lessons for better health

Patricia Flatley Brennan, PhD, RN and Steve Downs

Health Technology

July 20, 2014

Like many, we followed Apple’s recent announcement about its Health app and HealthKit development platform with interest. In many ways, it echoed a vision — of an ecosystem where personal health data formed a platform upon which many could develop apps that help people live healthy lives — that we have supported for many years through the Robert Wood Johnson Foundation’s Project HealthDesign. We were particularly interested to …

Throwing the Hippocratic Oath in the trash

Andrew Morton, MD

Physician

July 20, 2014

An excerpt from The Demise of Medicine.

The Dalai Lama has once been quoted as saying, “Our prime purpose in this life is to help others. And if you can’t help them, at least don’t hurt them.” In a nutshell, the Hippocratic Oath can be summarized in this one phrase: “Primum non nocere — above all, do no harm.” Amongst my many tattoos is that exact phrase and assuming I …

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