In three weeks at the Mayo Clinic, as their invited Visiting Professor in Internal Medicine, I’ll be delivering the most fascinating talk of my career. I’ll be formally starting the process of examining whether we must all agree that there’s a hole in the dominant paradigm of how medicine works, and whether we must solve this together by creating a new, scientific approach to patient engagement.
To start, please watch the four minute video below. For convenience, and to make it more searchable, at bottom of this post is a transcript.
To do this I’ll be using the 1962 book that brought the word “paradigm” into popular use: The Structure of Scientific Revolutions, by Thomas Kuhn. His definition of paradigm was much more strict and rigorous than the trendy loose word we throw around today; he studied numerous scientific revolutions (Newton, Copernicus, etc) and identified a regular, repeated structure to the process by which a scientific field takes form and then, sometimes, realizes a revolution is needed.
The process is both scientific and sociological – a fact that annoyed the crap out of scientists who believed that they are solely logical. From Wikipedia: Continue reading →
Open data, sort of: In a post on the Health Affairs blog, some big brains from Brookings talk about how open data can help end over-treatment and high-cost treatment when science doesn’t support either one. In my opinion (which I shared in a comment on the post) they left somebody out in the data-share: patients. “How Open Data Can Reveal and Correct the Faults in Our Health System”
That which does not kill you … might still kill you: Dr. Aaron Carroll takes up the question of what are called the social determinants of health on his Healthcare Triage YouTube channel. Here’s a link to a post on The Incidental Economist with that video, and some other perspective on the topic. “How Long Are You Going to Live?”
Overwhelmed by over-treatment: One of our friends, Shannon Brownlee, is a globally known thought leader on ending medical overtreatment and shared decision making. From her view on the leadership team of the Lown Institute, she’s seen all the science on why overtreatment is still a pernicious issue in US healthcare. Her op-ed on the subject from DrKevinMD: “Fixing overtreatment: Lone rangers need not apply”
“Let Patients Help” – hospital board edition: In a piece on the NY Times Upshot blog, Austin Frakt says that hospital boards need to have more clinical expertise on them, so that treatment guidelines in the facility don’t wander off the evidence-based/quality-outcome reservation. We think he left out an important consideration: *patients* on hospital boards. “In Hospitals, Board Rooms Are as Important as Operating Rooms”
Less is more, health IT edition: On the HL7 Standards blog, Michelle Ronan Noteboom looks at the idea that too much is way too much when it comes to several things, including portals and medical treatment. “When Less Is More in Health IT”
You can get it at Lowe’s: Not hardware, although they do certainly have plenty of that. In this piece on the Health Affairs blog, Bob Ihrie and Alan Spiro take a look at how Lowe’s retooled their employee health insurance coverage with an eye on behavioral economics, trust, and relationship dynamics. “Engaging Health Care Consumers: the Lowe’s Experience”
Tattoo you: I (Casey) have been making the health IT event rounds lately as a patient voice on panels about health tech and patient engagement. Since I took a very out-there step related to my own health data, my appearance in the room can start some interesting conversations. An example, by Jim Tate in the HITECH Answers blog: “Patient Engagement: I Tattoo, Therefore I Am”
Lab coats – yes or no? A meta-analysis of the study data available on patient satisfaction scores and physician attire shows that patients are likely to rate a doctor who’s dressed professionally higher than one who isn’t. What’s your thinking there – would you prefer a tie (which can be an infection vector), or are scrubs OK with you? From Lena Weiner in HealthLeaders Media: “Physicians’ Attire Linked to Patient Satisfaction Rates”
From the This Will Never Get Old desk: A film director and his wife took to YouTube back in 2010 to illustrate the user experience when you’re a patient booking healthcare, setting that illustration in the context of air travel booking. The results were, and are, hilarious. The New Altons on YouTube: “If air travel worked like healthcare“
On JibJab.com, from my sister, the jazz singer Suede, to augment my 65th birthday post this morning: One of my all-time favorite party songs, “Celebrate,” customized with faces of my family peeps. From left to right below: (Email subscribers, click here)
My granddaughter, y’all!! Zoe
Some guy who just turned 65 TODAY.
My daughter Lindsey
My wife Ginny (bustin’ moves like she used to do, before her bone problems)
Sugar high: Dr. Abigail James, a neuroscientist and educator who’s known globally for her thinking on the science of learning, points out the results of a Yale study on energy drinks and school children, and shares some tips for parents on weaning their kids off the sugar/caffeine rush. “Sugar high: It’s REAL”
Data geek hacky sack: Our longtime friend Brian Ahier is a health IT geek extraordinaire. Here’s a profile of his upcoming booth-babe appearance at HIMSS15, which includes his belief that health IT is an evergreen bipartisan issue. And a call to develop a wearable that counts hacky sack kicks. From Healthcare IT News: “Brian Ahier: HIE-vangelist, hacky sack extraordinaire”
Healthcare hackathon for CEOs: This showed up in my Facebook news feed today, and I was fascinated. In Denver, a dedicated man named Tom Higley – a real Renaissance man: attorney, musician, tech entrepreneur – has a very interesting event underway this week, where 10 CEOs will listen to 10 “wicked” healthcare ideas, and then incubate a solution to one of them in 10 days. From the Denver Post: “Sold-out production gives 10 CEOs 10 days to build viable health startup“
“Birthday candles”. Licensed under CC BY-SA 3.0 via Wikimedia Commons
Updated – see modified population graphic
Some people moan about adding years. I love ‘em. Today I’m 65, and I want lots more! I wanna get old!
We the old and many
are coming for you!
Did you know more than half the humans who’ve ever been 65 are alive today? That’s partly because medicine keeps saving people like me, who tried to die in middle age. Thanks, medicine; now get ready for lots of us getting older, happily, with chronic conditions. (I myself have slightly elevated blood pressure, and I’m just emerging from “obese.”)
Like my classmate Jay Pollack, who posted on Facebook that he’s getting a pacemaker because medicine saved him twice in ten years.
Have you thought about my question last September about taking care of all the old people? Or how about Pew Research’s new book Next America, which depicts among other things how America’s classic “age pyramid” is becoming rectangular? Each band in the graphic is a five year age group. We used to have very few 80+, and now it’s commonplace: (Graphic modified 10pm ET)
This 51 second animation accompanies my article last week in the BMJ, “From Patient Centred to People Powered: Autonomy on the Rise.” The video expresses, concisely, a slide that for years I’ve presented in 3-5 minutes. It’s an idea first published back in 2010 by Lucien Engelen, during the same time period when he was preparing for the TEDx Maastricht event in April 2011 where I spoke. It shows how the flow of valuable information has changed, which makes new things possible, as in all other parts of life.
Short story, long impact: A haunting, thought-provoking piece of “what if” fiction on The Health Care Blog drives home the point that healthcare comes from human hands, but not necessarily human hands on a keyboard. “Please Choose One”
Privacy for sale: On The Doctor Weighs In, Paul Levy tackles the thorny topic of employer-sponsored health insurance plans offering incentives for “wellness” activities. Are we selling our (privacy) birthrights for what amounts to a mess of pottage? “Selling your right to privacy at $5 a pop”
Mea culpa from on high: From the Hospital Leader blog, the President of the Society of Hospital Medicine, hospitalist Dr. Burke Kealey, takes a look at the American Board of Internal Medicine (ABIM)’s recent rethinking of its Maintenance of Certification (MOC) rules. It may sound like inside-baseball, but Kealey’s post is very readable, and shows that large professional organizations – like, say, ABIM – who ignore their members’ input do so at their own peril. “We got it wrong. We are sorry.”
Too much of a good thing? If you’ve gone “krazy for kale” you might want to read this, and adjust your intake accordingly. Moderation is a virtue, even when it comes to virtue. From WBUR in Boston: “The Dark Side Of Kale (And How To Eat Around It)”
Caterpillar races: In a thread on the SPM email listserv, one of our members shared a link to this article with the subject line “the caterpillar is coming,” meaning that the slow roll that is medical practice change might be shifting. In a 2012 research paper re-published this month in Wiley Online Library, a group of researchers share the findings of a study about how a feeling of powerlessness can kill patient engagement before it arrives. “Patients’ engagement in primary care: powerlessness and compounding jeopardy. A qualitative study”
Tongue in cheek: We found a new (to us) site/blog, Life in the Fast Lane, that has a great sense of the absurd in medicine, along with some great content on emergency and critical care. Here’s some satire from their archives: “Reducing the budgetary burden of disease“
Narrow networks, narrower choices: Affordable insurance plans are no guarantee that you’ll find a provider that takes your plan, and is near your home. As the health insurance industry adds millions of new customers via ACA Marketplace plans, it’s turning out to be a contentious relationship for some folks. The NY Times’ Elisabeth Rosenthal breaks down the issue: “Insured, but Not Covered”
Why Anthem hack is potential horror: A very cautionary piece on NPR about the black market for personal data shows that health IDs, particularly Medicare information, is worth a bundle to the bad guys. The real horror here is the lack of cyber-security sophistication on othe part of healthcare industry IT overlords. “The Black Market for Stolen Health Care Data”
John Oliver on “Last Week Tonight” takes on pharma [WARNING: use headphones if you’re at work!]: The weekly HBO news-comedy host takes on pharma marketing in a very funny, but very NSFW (Not Safe For Work), examination of the marketing juggernaut that is the pharmaceutical industry. “Marketing to Doctors”
Geography is health: Geo-mapping expert Bill Davenhall said that in a TEDMED talk. An interesting neighborhood development in Austin has built in open spaces in a new-urbanism model to foster community health and social interaction. NPR has the story: “Urban Utopia”
Worm in that Austin geo-health apple? The new-urbanism that Austin was aiming at in the above story had a flip-side that revealed underlying racial tensions. Recognizing that, and talking about it, has been eye-opening. Social determinants are a big part of public health. Part 2 of the NPR series on the Mueller neighborhood in Austin: “Utopia Tackles Racial Tensions Under the Surface”
UnitedHealth’s $43 billion bet: “Fee for service” is often blamed for the high cost of US healthcare. Health insurer UnitedHealth has taken a big step away from fee for service, and toward value-based payment to medical providers. From the Wall Street Journal: “UnitedHealth’s $43 Billion Exit from Fee for Service Medicine”
Anthem data hack: A piece in FierceHealthIT says that the FBI is on the case in tracking down the folks behind the Anthem hack, which compromised the personal data of 80 million Anthem customers. There are some hints that it might have been a Chinese hacker group, but no solid leads yet. “Details emerge in Anthem hack”