I recently watched Dr. Atul Gawande on video describe how what American healthcare needs is pit crews and not cowboys. This sentiment is also memorialized in his thought-provoking writings for the New Yorker.
Interestingly, Dr. Gawande is not the first person I have heard to suggest such a thing. A colleague named Dr. Ken Catchpole actually studied Formula 1 pit crews and used the information to guide improvements in …
Health care needs the Lollipop man
The biggest problem with health care delivery in the US is cost, which seems to have taken a back seat to other issues meant to be addressed by health care reform. We spend about $2.5 trillion dollars a year on health care—that’s over eight thousand dollars a year for every man, woman, and child. What’s that getting you?
According to the government, about 30% goes to hospitals; 20% goes …
Where do our wasted health dollars go to?
In the current climate of health care reform, it is important to understand doctors and the work they do. I have found 3 common misconceptions, held even by doctors themselves, concerning the job of being a doctor.
The first is the idea that doctors are conservative, resistant to change. Facts show that doctors deal with change all the time. They are familiar with the concept of change for change’s sake and …
3 common misconceptions about doctors
Three out of four dentists recommend this tooth brightening toothpaste — make your smile sparkle like never before! Six out of seven plumbers recommend this drain opening de-clogger — make your bathtub drain like never before! Nine out of ten doctors recommend improving the medical system in the United States — make your health care system heal like never before!
But how do we do that?
Do doctors think the Affordable Care Act is the soothing balm …
While doctors disagree, every physician wants to fix health care
A group of nine medical specialty societies recently announced the “Choose Wisely” campaign, targeting 45 commonly performed medical procedures and tests that offer little or no value in improving health. These interventions waste precious health care resources, lead to erroneous conclusions and/or false security, spur unwarranted additional interventions, and cause patient harm. Among the appropriately indicted procedures was cardiac stress testing of asymptomatic, low-risk patients. There is an old …
Why academic medical centers need a stress test
Only a generation ago, medical students thought about what specialty to choose simply in terms of what interested them most. All doctors made a comfortable income; money wasn’t a primary motivator. There was a sense that cardiac surgeons or neurosurgeons could make more than most other physicians, but in fairness their training was much harder and longer. Internal medicine was held up to us as the most prestigious and intellectually …
Why the physician shortage is worse than you think
An excerpt from Potent Medicine The Collaborative Cure for Healthcare.
It was mid-summer 2010 when the full scope of everything that Nancy D’Agostino did not know hit home. Still raw from surgery and missing parts of her body, she thought that all the hard choices were behind her. Then here was a new face, a radiation oncologist, outlining side effects of treatment and asking her to choose. And then a medical …
Lack of health care coordination benefits physicians
There will be some very disruptive and some transformational changes in the way health care is delivered, not as a result of reform, but as a result of the drivers of change described in a previous post on KevinMD.com. They included an aging population, an obese society, shortages of doctors, and emerging consumerism, among others.
I interviewed in depth about 150 medical leaders from across the United States to collect …
The coming changes in health care delivery
Patients have been arriving at the doors of emergency departments in increasing numbers over the past decade, and this trend will only grow in the future. I believe there are five key factors that suggest every ED should brace itself for a never-ending rush hour.
As the CEO of a physician group that provides medical care to over 4 million patients per year, I have the opportunity to study in great …
5 key trends to look for in the emergency department
In our world of 24/7 media, where we seem to hear about the next big cure, important dietary change or very dangerous drug virtually every day, it is hard to believe that the news people, tweeters and bloggers could miss anything that is going on in health care today. However, it appears most everyone missed a big one. This might be one of the most important stories in health care today, that no one …
Making more drugs non-prescription is bad for patients
Based upon the past and the current state of affairs in healthcare, healthcare reimbursement will change dramatically in the future. I believe that reimbursement based upon fee-for-service will gradually disappear and be replaced by models based upon the ability to better manage patient diseases and conditions. That is, reimbursement will be based upon the quality of service delivered by the provider. For insurers, whether private or governmental, I believe that …
Healthcare reimbursement will change dramatically in the future
Amid all the political rancor and media hoopla currently surrounding the American healthcare system and the clamor for reform from all sides, one question has gone unasked; what exactly is this thing we call healthcare? Is it the local hospital with its giant façade and ambulances coming and going all hours of the day and night? Is it the clinic where you sit and wait to have your blood pressure …
What exactly is this thing we call healthcare?
The fundamental challenge in any high-risk industry is balancing “productivity” versus “safety.” The term “protection” is frequently used within the scientific literature to express the role of safety departments within an organization. Described this way, it might sound as if the safety experts are framing the debate to suggest “the evil factory bosses are continually speeding up the assembly line, while the righteous safety-folks are yelling ‘slow down!’” This essential …
The problem of mixing productivity with patient safety
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When I moved from the news business, writing about crime and investigating corrupt politicians and police officers, to the healthcare industry in the mid-1970s, we measured only the basic hospital performance indicators — including census, staffing, inventory, days in accounts receivable and average length of stay. The data was not in real time by any stretch of the imagination. By the time the information was produced and distributed to managers, …
A simple innovation to improve hospital quality and safety
One advantage of being a surgeon and an MBA is the opportunity to observe different ways of approaching and responding to challenges. My surgical training and 25 years of practice in academic and community hospitals have helped me become more comfortable with making major decisions despite the lack of perfect information. Although I find that it takes longer to bounce back from nights on call, I relish the excitement of …
Why we need physician champions to reform health
The U.S. spends far more on cancer care than 10 European countries, but according to a new study, it may be “worth it” as “the value of the survival gains greatly outweighed the costs.”
The study, published this week in Health Affairs, found that U.S. spending on cancer care, in 2010 dollars, increased by 49% from 1983 through 1999, from $47,000 per cancer case to $70,000 per case. Meanwhile, in …
Is our high cost of cancer care worth it?
Who better knows how to fix a leak than a plumber?
Who better knows how to repair a cracked doorway than a carpenter?
Who better knows how to solve the conundrum of our leaking cracked health care system than a doctor?
Doctors are an important part of public discussions about health care reform. Our prescriptions drive healthcare costs. We are the crucial middlemen between the biomedical industry and patient health. Sharing our first hand experiences in health care …
Why doctors should drive health reform
I’ve just come back from my semi-annual renewal in my belief that family medicine is the foundational solution to make healthcare more affordable in America: the interim session of the Texas Academy of Family Physicians. The most important activity at these meetings is the networking: the chance to bounce ideas and experiences off colleagues from around the state.
The issue of cost came up and two colleagues in private practice told …
The unintended cost consequences of patient centered care
Fed up with our health care delivery system? Maybe even angry? What should a person do? What can a person do?
I recently wrote a post on drivers of change in health care delivery such as the aging population, adverse lifestyle behaviors, shortages of physicians and developing consumer expectations. I planned to follow up today with what those drivers will produce as change in the delivery system. But a commentator responded …
Take charge of your healthcare quality and costs
Imagine you’re a physician, and you have a full schedule of patients to see the day after the Supreme Court has thrown out the entire Affordable Care Act. Imagine you never liked “Obamacare” in the first place, so you are feeling pretty good about the Supreme Court decision.
Your first patient, an elderly retiree named Mrs. Jones, comes in for her annual Medicare wellness visit—one of the new Medicare preventive benefits …
Chaos for doctors if the Affordable Care Act is struck down
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